2015 Annual Report by UMMS

2015 Annual Report

BE A PART OF SOMETHING GREATER.

“It is amazing what you can accomplish if you do not care who gets the credit.”

HARRY S. TRUMAN

What a remarkable year it has been for the Cancer Institute at UM SJMC. Just as we had hoped and planned, our hard work and compassionate care is offering rewarding results. In 2015, the Institute experienced a noticeable increase in patient volume, programmatic growth, clinical research and quality outcomes. While the annual report details many of our activities, I would like to highlight some of our most noteworthy achievements and future goals: •

$150,000 from the Beverly K. and Jerome M. Fine Foundation for Serpick Infusion Center renovations

Cancer management is a highly interdisciplinary area of medicine that requires a team of physicians with diverse areas of medical expertise. The exceptional compassionate care provided by our multi—disciplinary clinical teams (Breast, Thoracic, GI, GU and General Oncology) is reflected in the healthy growth we have seen in the past year and the recent recognition of 13 Cancer Institute physicians as Top Docs in the November issue of Baltimore magazine, accounting for more than 50% of our cancer institute physicians.

•

$100,000 from the Emmert Hobbs Foundation toward three private Serpick Infusion Center bays

1,294 cancer cases were treated – 84% (1,084) of which were analytical cases. The five most frequent cancer sites treated at UM SJMC are breast, prostate, lung, colorectal and melanoma.

•

$100,000 from the Emmert Hobbs Foundation to fund the Caring Touch medical garments boutique

Philanthropic contributions totaling $650,000 in FY 2015, a 200% increase over FY 2014, have taken the Cancer Institute to an unprecedented level of excellence.

•

Neuro-oncology and orthopedic oncology clinics were added to our cancer patient service lines.

•

Gynecologic oncology and cutaneous oncology are being developed as formal multi-disciplinary programs.

•

The 9th Annual Cancer Symposium, held on November 12, 2015 featured presentations focused on “Prevention, Screening and Early Detection of Cancer.” Attracting 116 attendees, the symposium was a huge success receiving very positive feedback and high remarks for subject matter expert speakers. We are looking forward to the 10th Annual Cancer Symposium planned for November 10, 2016.

•

Collaboration between our medical oncology team and pharmacy resulted in cost savings of over $1 million in calendar year 2015.

•

Expansion of our palliative care program is underway, and we are in the process of developing a palliative care score card that will translate into better patient care and additional cost savings.

Nader N. Hanna, MD, FACS Medical Director, Cancer Institute Professor of Surgery, University of Maryland School of Medicine

2015 GIFTS TO THE CANCER INSTITUTE •

•

$263,000 from grateful patients and friends of the Breast Center to support the Geraldine G. Schultz Endowment

•

$32,000 from two individual donors to purchase eight new infusion therapy chair

•

$15,000 from the Foundation for Spirituality and Medicine to fund the education and training of nurses in Healing Therapies and Integrative Medicine therapies

•

$1,000 from the Mildred Mindell Cancer Foundation to support the Lagniappe art therapy program

A Letter from Our Cancer

Our Vision

Dear Colleagues, On behalf of the physician speakers and staff at the Cancer Institu attending the 9th Annual Cancer Symposium.

We are grateful to have had the insights and perspectives provided

To be a preeminent, creative and visionary cancer institute in providing the highest quality of cancer prevention, Bradford W. Hesse, Ph.D screening, diagnosis, treatment and survivorship to patients in our community. As a formal affiliate of the nationallyChief, Health renowned University of Maryland Marlene and Stewart Greenebaum Cancer Center, the UM St. Communication Joseph Cancer and Informatic Behavioral Research ProgramDivision Institute exists to enhance quality and extend lives of our cancer patients in a faith-based environment honoring ourof Cancer Con National Cancer Institute healing ministry. •

•

Clinical research trials have expanded, and our partnership with the UM Marlene and Stewart Greenebaum Cancer Center continues to yield significant successes. In calendar year 2015, we enrolled 90 patients in various clinical trials, accounting for 8% of our cancer cases, exceeding the commendation requirement of 6%. We currently have 11 active clinical trials for various cancer sites, including, breast, pancreas and lymphoma. Our application to become a member of the Alliance group was approved in 2015, which will enable the Cancer Institute to expand its clinical research portfolio and offer our cancer patients access to national trials close to their community. Our five cancer quality metrics reported to the Commission on Cancer exceeded the national average.

His presentation on “Cancer prevention in (an) era of social med informative and enlightening.

•

Community outreach activities continue to serve an unmet need are in our service area. to our own University of Maryla Special thanks also extended

for sharing their informative presentations. Their collective know

From my personal perspective, it was a great year, and advancements in the field of oncology. I Itwant to take this to opportunity to educate officially medical recognizeprofessionals on t is our mission continue to my colleagues, the Cancer Institute volunteers, providing valuable resources andstaff, seminars designed to enlighten a supporters, referring physicians and most importantly, our patients who our are the reason for our success. I am can be used fo Please note newmain patient referral number, which honored to be part of(7462) the University of Maryland St. Joseph 1-800-441-SJMC Medical Center Cancer Institute family and to be serving Onthe behalf everyone associatedand with this Symposium, as leaderoffor such a committed talented group of thank you th to seeing you next year at the 10 Annual Cancer Symposium on individuals. Sincerely, Sincerely,

Nader Hanna

Nader Hanna, MD, FACS Nader Hanna, MD, FACS Director of Cancer Institute University of Maryland St. Joseph Medical Center 3

Clinical Research

The success in improving cancer survival can be attributed to an increased understanding of which treatments are more beneficial than others. This is a direct result of knowledge gained from clinical trials in which cancer patients participate. Since the UM St. Joseph Cancer Instituteâ&#x20AC;&#x2122;s formal affiliation with the University of Maryland Greenebaum Cancer Center, we continue expanding our portfolio of available clinical trials. Current open studies are listed below. A011202: EVALUATING THE ROLE OF ALND IN BREAST PATIENTS (T13N1) WITH + SLND AFTER NEO-ADJUVANT CHEMOTHERAPY PHASE III Patients in this study have breast cancer that has spread to the lymph nodes under the arm (axilla) and have been treated with chemotherapy before having surgery to remove any remaining breast cancer. The purpose of this study is to examine whether removing some of the lymph nodes from the axilla, followed by radiation therapy (experimental) will be as effective as having the majority of the lymph nodes removed from the axilla followed by radiation (standard of care). HEALING TOUCH PILOT STUDY Healing Touch is an energy therapy in which practitioners use their hands in a heart-centered and intentional way to support and facilitate physical, emotional, mental and spiritual health. These non-invasive techniques employ the hands to clear, energize and balance the human energy field. This is a randomized research study designed to evaluate the effects of healing touch therapy on fatigue, stress and health-related quality of life for patients with breast cancer who are undergoing radiation therapy. This therapy is complementary to planned treatment. It will not substitute or replace any prescribed medical treatment, medical intervention or psychotherapy ordered. MOMENTA: MOM-M402-103 MOMENTA: A PHASE I/II, TWO-PART, MULTICENTER STUDY TO EVALUATE THE SAFETY AND EFFICACY OF M402 IN COMBINATION WITH NAB-PACLITAXEL AND GEMCITABINE IN PATIENTS WITH METASTATIC PANCREATIC CANCER Patients in this study have been diagnosed with metastatic pancreatic cancer that has been histologically or cytologically confirmed. This study is testing a new drug to be given in combination with the standard therapy that is currently used for pancreatic cancer. Subjects who received gemcitabine in combination with nab-paclitaxel lived longer than subjects who received only gemcitabine. In this study, necuparanib is being tested in combination with this new regimen (nab-paclitaxel and gemcitabine).

MECHANISMS OF WEIGHT GAIN DURING BREAST CANCER CHEMOTHERAPY: UMMS This study, in collaboration with the University of Maryland School of Nursing, is designed to describe associations between weight gain, body composition, nutrient intake, physical activity, sleep habits and resting metabolic rate in women receiving adjuvant breast cancer chemotherapy. UMMS HP-00056148 (RASH STUDY): GENETIC, CLINICAL, AND BIOMARKER CORRELATES OF EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) INHIBITOR-RELATED RASH. The purpose of this study is to test if circulating soluble EGFR levels are associated with development and severity of EGFR inhibitor-related rash. Participants in the study are greater than 21 years of age and have histologically confirmed cancer that is treated with an epidermal growth factor receptor inhibitor (any type/stage). NALA: A STUDY OF NERATINIB PLUS CAPECITABINE VS. LAPATINIB PLUS CAPECITABINE IN PATIENTS WITH HER2+ METASTATIC BREAST CANCER (MBC) WHO HAVE RECEIVED TWO OR PRIOR HER2-DIRECTED REGIMENS IN THE METASTATIC SETTING This is a clinical research study in breast cancer patients looking at progression-free survival (PFS) following treatment with neratinib plus capecitabine vs. lapatinib plus capecitabine in patients with HER2-positive MBC. It is comparing independently adjudicated PFS following treatment with neratinib plus capecitabine versus lapatinib plus capecitabine in patients with HER2+ MBC who have received two or more prior HER2-directed regimens in the metastatic setting.

Research nurses Patricia Johnson (seated) and Alana Temple work closely with our patients and their healthcare team to identify patients that are eligible to participate in clinical trials. They provide education about the details of the study and the potential risks and benefits to the patient.

ROBUST: PHASE 3 RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED, MULTICENTER STUDY TO COMPARE THE EFFICACY AND SAFETY OF LENALIDOMIDE (CC-5013) PLUS R-CHOP CHEMOTHERAPY (R2-CHOP) VERSUS PLACEBO PLUS R-CHOP CHEMOTHERAPY IN SUBJECTS WITH PREVIOUSLY UNTREATED ACTIVATED B-CELL TYPE DIFFUSE LARGE B-CELL LYMPHOMA This study will test the standard R-CHOP21 against R-CHOP21 plus lenalidomide. The purpose is to see whether adding lenalidomide works better and is as safe as R-CHOP by itself. This study is only for patients with ABC type DLBCL who have not yet been treated. Lenalidomide is not approved for use in DLBCL. Its use in this disease is experimental. In this study, the experimental treatment is lenalidomide + R-CHOP21 x 6.

Cancer Liaison Report

ASSESSMENTS OF CANCER CARE MEASURES For the past several years, University of Maryland St. Joseph Medical Centerâ&#x20AC;&#x2122;s (UM SJMC) Cancer Institute has taken part in the Commission on Cancer (CoC) Rapid Quality Reporting System (RQRS). This system uses data compiled by our certified tumor registrars (CTRs) to generate real-time assessments of five measures of cancer care across three of five the most commonly diagnosed malignancies. UM SJMC was one of the pilot programs participating in RQRS. This program has helped enhance the quality of care delivered to all of our patients. RQRS is no longer a pilot program and will be required for all centers to gain and maintain accreditation from the CoC.

Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.

Stephen Ronson, MD Cancer Liaison Physician

Combination chemotherapy is condsidered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0 or stage IB - III hormone receptor negative breast cancer.

Tamoxifin or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB - III hormone receptor positive breast cancer.

At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.

SAFETY NET PROGRAM MONITORS CONCORDANCE LEVELS WITH RQRS STANDARDS UM SJMC Cancer Institute also piloted a safety net program during the last three years that is designed to maintain the highest cancer care as measured by CoC reporting standards. As part of this program, our CTRs report directly to the responsible physician if a patient is within 60 days of becoming non-concordant with one of the RQRS standards. If a patient is within 30 days of becoming non-concordant, I am personally notified. If necessary, I personally contact the treating physicians and their staff to discuss CoC RQRS standards and the timeframe in which treatment should take place. As a result of this safety net, we have seen our concordance level with RQRS standards rise to their highest level since being introduced. To assess our performance, we regularly compare our concordance rates with those of other hospitals in the state, region and across the entire country. While all data continues to show the care delivered at the UM SJMC Cancer Institute is of the highest quality, we are committed to looking for more ways to improve.

Cancer

The University of Maryland St. Joseph Medical Centerâ&#x20AC;&#x2122;s (UM SJMC) Cancer Institute began collecting cancer data for its American College of Surgeons Commission on Cancer (ACoS-CoC) approved cancer registry, starting with patients diagnosed in January 1997. The cancer registry now serves as a cancer data repository for more than 16,500 cancer cases. Under the direction of UM SJMC Cancer Institute leadership, certified cancer registrars are data management experts who report cancer statistics for various healthcare facilities.

Registry

The cancer registry is an information system designed for the collection, management and analysis of data on persons with the diagnosis of cancer. Cancer information collected includes patient demographics, primary site, tumor histology, cancer stage at diagnosis and treatment provided (surgery, radiation therapy, chemotherapy, hormonal therapy and immunotherapy). Cancer registrars work closely with physicians, nurse practitioners, genetic counselors, leadership and researchers to provide support for program development and ensure compliance of reporting standards. They serve as a valuable resource for cancer information with the ultimate goal of preventing and controlling cancer. Each of our cancer registrars is involved in managing and analyzing clinical cancer information for the purpose of education, research and outcome measurement. The cancer registry is also responsible for maintaining lifetime annual follow-up, including treatment and recurrence data to assess survival and disease status. Lifetime follow-up is an important aspect of the

2014 NATIONAL COMPARISON OF SELECTED CANCER SITES 2014 Five Most Frequent Cancer Sites Diagnosed at UM St. Joseph Compared to Maryland & National Statistics

Breast

Prostate

Lung

Colorectal

Melanoma

UM SJMC*

358 159 84 81 66

Percentage

33% 14.6% 7.7% 7.5% 6%

MARYLAND+

4,570 5,000 3,990 2,500 1,400

Percentage

14.9% 16.3% 13.0% 8.1% 4.6%

NATIONAL+

235,030 233,000 224,210 136,830 76,100

Percentage

14.1% 14.0% 13.5% 8.2% 4.6%

* Source: UM St. Joseph Cancer Institute Registry Analytic Cases + Source: American Cancer Society Facts & Figures 2014

PRIMARY CANCER SITES BY ANALYTIC CASE TYPES & GENDER Primary Cancer Site

Total Analytic* Non-Analytic** Male Female 2014 Cases Cases Cases 122

473 480

Primary Cancer Site

Analytic* Non-Analytic** Male Female Total Cases Cases 2014 Cases

Breast

358

Anus

Prostate

159

167 0

167

Small Intestine

Lung

42 46

Tongue

4 0 4

Colorectal

50 56 106

Brain/Other CNS

Melanoma

47 26

Ureter

Pancreas

22 35

Gall Bladder

Kidney/Renal Pelvis

Other Digestive Organs

Thyroid Gland

Tonsil

2 1 3

Bladder

33 2

Peritoneum, Omentum, Mesentery

Lymphoma

15 16

Soft Tissue

Leukemia

8 18 26

Mesothelioma

1 2 3

Uterus

0 20 20

Skin - Non Melanoma

Liver – Intrahepatic Bile Duct

Cervix

0 3

Esophagus

7 4 11

Gum & Mouth

Stomach

8 4 12

Retroperitoneum

0 1

Ovary

0 9

Vulva

0 2

Miscellaneous

Myeloma

4 4

Biliary Tract - Other

TOTALS

24 1,084

5 210

1 6 7 4

11 18 29 485 809 1,294

* Analytic Cases: Patients either diagnosed or diagnosed and/or received a portion of first course treatment at UM St. Joseph’s Cancer Institute. ** Non-Analytic Cases: Patient received first course of treatment elsewhere and presented to UM St. Joseph’s Cancer Institute disease recurrence or progression.

cancer registry. Current follow-up serves as a reminder to physicians and patients to schedule regular clinical examinations and provides accurate survival information. Registry data is collected and analyzed in accordance with the standardized cancer data collection rules set forth by the ACoS-CoC and the Maryland Cancer Registry (MCR). UM SJMC clinicians and physicians use cancer registry data to assess clinical outcomes, measure the institution’s cancer prevalence and survival. We also employ cancer registry data as source documentation for research and to identify our clinical performance and opportunities for quality improvement. The Cancer Institute has also elected to collect data for patients being treated at the facility for a recurrence or progression of a cancer that was previously diagnosed and who received initial treatment elsewhere. In strict compliance with the Federal Health Insurance Portability and Accountability Act, UM SJMC cancer registry data is reported to a variety of external organizations, including the ACoS-CoC’s National Cancer Data Base (NCDB), the Maryland Cancer Registry (MCR), the North American Association of Central Cancer Registries (MAACCR) and

the Centers for Disease Control National Program of Cancer Registries (CDC-NPCR). These statistics are used to measure cancer incidence and are ultimately used to assist public health professionals in designing early screening, analyzing referral patterns, evaluating patient outcomes, quality of life and satisfaction issues, and implementing procedures for cancer prevention and improvement programs. The ability to retrieve timely, reliable cancer registry data is an important objective of the UM SJMC cancer program. The medical staff routinely reviews cancer registry data to ensure its quality and validity. Cancer registrars are required to participate in continuing education activities including national, local and on-line educational seminars. At present, we have three full-time cancer registrars, all of whom are certified. The registry is abstracting cases within three to four months from the patient’s date of first contact. For the 2014 data year, the UM SJMC cancer registry has an annual total case load of 1,084 analytic cases and 210 nonanalytic cases.

Serpick Infusion Center Renovation New Patient Bays Ensure Privacy

In response to the needs of our patients, the Serpick Infusion Center expanded this year. Renovations were made possible through generous philanthropic donations. Three new private infusion bays have been added. Each bay holds a hospital bed to accommodate patients who are unable to sit in a chair or who are more comfortable in a bed. The increased privacy allows those who may be physically ill to feel more comfortable during their stay and provides an environment for more confidential and discreet discussions between patients and their nurses, social workers and providers as needed. In addition to acknowledging the comfort and privacy needs of our patients, we are responding to stricter isolation guidelines that have been required by the Centers for Disease Control and Prevention (CDC) in recent years. Patients now carrying resistant bacterial infections must be isolated for their lifetimes during hospital stays. The previous guidelines required isolation for only one year. Therefore, at the Cancer Institute, we needed to create an increased number of private bays to ensure compliance with the CDC guidelines. The providers, nurses, techs and other staff in the Serpick Infusion Center are excited to be able to offer these new private rooms to our patients who need them.

IN SICKNESS AND IN HEALTH – Love Blossoms at the Serpick Infusion Center Family and physicians gathered during the happy event honoring Matt and Amanda. L-R: Jason Citron, MD, Bob Sumpter, Amanda Sumpter, Rima Couzi, MD, Nancy Sumpter, Matthew Bayne, Michael Schultz, MD, and Amy Grimes.

Nothing quite matches the unique cancer journeys of Amy Grimes and Nancy Sumpter, whose paths crossed in a most unusual way. Both employees of the UM St. Joseph Medical Center, the two quickly turned to the healthcare organization they admire and trust for treatment of their breast cancer diagnoses.

Amanda Sumpter and Matt Bayne at their engagement party held November 4th at the Cancer Institute’s Serpick Infusion Center.

Now in remission, Grimes and Sumpter credit their expert care and positive outcomes with their physicians — radiation oncologist Jason Citron, MD, oncologist Rima Couzi, MD, and Breast Center director Michael Schultz, MD, as well as their team of supporting specialists and caregivers at the Cancer Institute. But there is one outcome they never expected — and that was the engagement of their children to one another. The idea to have their children meet began when Grimes and Sumpter became good friends through hours spent chatting while receiving chemotherapy at the Cancer Institute’s Serpick Infusion Center. Grimes is a supply chain manager of surgical services at UM SJMC, and Sumpter is a nurse practitioner in the neonatal intensive care unit. After learning their children were close in age, liked to fish, and, most importantly, were single, the matchmaking began, first through Facebook, then through fishing dates, and the romance continued. One year later — a wedding proposal. To celebrate the engagement, the Cancer Institute threw a party in their honor, demonstrating that something positive can bloom out of challenging circumstances. And where better to have the celebration than the place the matchmaking began — the infusion therapy center. Truly a love story, UM St. Joseph Medical Center style. 11

Community Outreach

The University of Maryland St. Joseph Medical Center (UM SJMC) Cancer Institute outreach program involves a collaborative effort with the UM SJMC Community Health program, the Maryland State Cancer Collaborative and community-based partners in the Baltimore metro area. Coalition building and advocacy are vital to a strong outreach program. The Cancer Institute outreach manager serves on the Patient Navigation Network Leadership and Steering Committees of the Maryland Cancer Collaborative, which was established in 2011 as a statewide coalition to implement the Maryland Comprehensive Cancer Control Plan. A revised cancer plan will be released in the first quarter of 2016. The goals of the collaborative are to work with individuals and organizations throughout the state to implement the Maryland Comprehensive Control Plan cancer plan and bring together existing groups and new partners from across the state to collaborate on a common goal: to reduce the burden of cancer in Maryland.

Donna Costa, MA, MHS Oncology Community Outreach Manager

UM SJMC Cancer Institute staff participated in various professional educational programs throughout the year, including the 3rd Annual Patient Navigation Network Conference (PNN) held September 16, 2015, at Sheppard Pratt Conference Center. This conference was attended by more than 110 oncology health professionals and offered two PNN webinars: Understanding the Landscape: Integrative Oncology and Integrative Navigation and Recruiting Considerations for Clinical Trials. Cancer prevention and early detection continue to be the primary focus for outreach at the Cancer Institute, which sponsored or participated in numerous educational programs for the community throughout the year. Highlights included participation in the WJZ-TV Ask the Expert community call-in event (which received more than 500 calls), a breast cancer risk assessment program at the Towson Y with our board-certified genetic counselor, the Archdiocese of Baltimore Health and Wellness Fair, McCormick’s Annual Health and Safety Day and the Susan G. Komen Race for the Cure. Additionally, in collaboration with the Baltimore County Cancer Prevention program, we hosted a free six-week smoking cessation program at UM SJMC. Multidisciplinary events included the 4th Annual Women’s Health Conference sponsored by and held at UM SJMC in May. More than 100 community members participated. Our Cancer Institute breast surgeon and nurse navigator gave a presentation called “Breast Cancer: Knowing Your Risk.” In October, numerous departments participated in the UM SJMC Employee Wellness Fair. At this event, the Cancer Institute specifically raised awareness about high-risk breast and colorectal cancer screenings, and provided educational materials and resources.

2015 Cancer Screenings Summary Table by Race, Ethnicity and Insurance Status Screenings

Date

Hispanic

African White

/NH

Amer.

Asian

Unknown

Uninsured

Total Screened

Ethnicity

Cervical

3/7

23/8

Prostate

9/16

0/26

Breast

10/10

1/20

12 Monthly

Jan. -

59/5

Breast CA

Oct.

105

142

Screenings TOTALS

Totals include 3 yearly screenings and 12 monthly screenings.

Cancer screenings remain a priority and focus of community outreach activities. In accordance with the Commission on Cancer (CoC) requirements, all prevention and screening programs were based on a community needs assessment and were consistent with evidencebased national guidelines. Persons with positive findings are referred to resources within the community and/ or to UM SJMC for follow-up care under our charity care program. Three community cancer screenings, as well as 12 monthly breast cancer screenings for the uninsured were provided in 2015, serving a total of 142 community members. Even though the Affordable Care Act is now in effect, 69% of those screened by our program were uninsured, thus we served an unmet need in our community. Screenings are a joint effort between Community Health, the Cancer Institute, the Breast Center, Advanced Radiology and numerous health care providers who donate their time and expertise. Achieving program sustainability requires commitment. The 100 Free Screenings Mammogram Program, which began February 14, 2012, evolved from a competitive 18-month grant award called One Voice, which we received from the American Cancer Society and continues today. The purpose of the program is to reduce barriers to

breast health literacy and increase routine screenings among uninsured, underserved women in the Baltimore metropolitan area. Monthly opportunities are offered for uninsured women in Baltimore City and Baltimore County to receive a clinical breast exam and screening mammogram in collaboration with Advanced Radiology, the Breast Center and Nueva Vida, a comprehensive breast cancer support program for Latinas. For the 4th year, Advanced Radiology generously renewed UM SJMC Cancer Instituteâ&#x20AC;&#x2122;s contract for the 100 Free Screenings Mammogram Program through April 2016, bringing the total number of mammograms provided to 400 mammograms. Due to an increase in screening requests and follow-up diagnostics, Advanced Radiology provided additional mammograms to meet our needs. As a quality improvement measure, the follow-up diagnostic mammograms are also covered under this program. This quality process, which includes patient navigation, facilitates better continuity of care for our uninsured participants. During the period of January through October 2015, 64 women were screened; approximately 33% of these women received a mammogram for the first time. Follow-up diagnostics were provided for 18 women, including one who received a biopsy. The program includes 13 13

The Cancer Institute | 2014 Annual Report

Community Outreach Continued

in-kind staffing, resources, program materials and administrative costs. Additionally, there is now a seamless referral process to Baltimore County’s Cancer Program for uninsured women who are eligible for free cervical and/or colorectal screening. Recent patient letters reflect the feedback we often receive from women who participate in this screening program: •

“As a mom without health insurance and with no money to pay for it, I would love to express my gratitude to the Cancer Institute and Nueva Vida for making this program possible and bringing it to us free of charge. Being there was a very warm experience. The staff answered all my questions. They guided me in all the procedures. I did not wait long to have my mammogram and, last but not least, for the first time I did not feel ashamed of my immigration status. I applaud initiatives like this that save lives and do (not) discriminate. I pray that there is always someone who takes care of the needy. God bless you!” These patient messages are a testimony to our Cancer Institute’s commitment to UM SJMC’s mission to “serve the poor and marginalized and partner with others to improve the quality of life in our community.”

Collaborative efforts coordinated by UM SJMC community outreach and their community partners offer free mammogram screenings to the uninsured and disadvantaged. Team members include: (L-R) Teresa Orellana, Maria Romero, Rocio Canno, Ada Espejo, Xiomara Ruiz, Sandra Villa DeLeon, Ethan Rogers, MD, Julia Flukinger, MD, Randy Tabb, MD and Donna Costa.

In 2016, the Cancer Institute, in collaboration with American Cancer Society and the Employee Health program at UM SJMC, will participate in the national Colorectal Cancer Roundtable Initiative -“80% by 2018” - to increase the number of people screened for colon cancer and eliminate disparities in access to care.

Philanthropy

Above: (L-R) The late Larry Becker, MD, Mohan Suntha, MD, MBA, Michael Schultz, MD, and Nader Hanna, MD at an event to acquaint philanthropists with the Geraldine G. Schultz Breast Center Endowment.

The torrential rains from Hurricane Joaquin didn’t stop more than 100 people from attending an afternoon gathering at Sherri and Andy Cohen’s home on October 4, 2015. Co-hosted with the late Dr. Larry Becker and his wife, Alma, the event was held to acquaint their guests with the Geraldine G. Schultz Breast Center Endowment. Created in 2014 by Michael Schultz, MD, director of the Breast Center at University of Maryland St. Joseph Medical Center’s (UM SJMC) Cancer Institute, and his wife Joan, the endowment honors his late mother, who was a 40-year breast cancer survivor. Dr. Schultz spoke movingly to the guests about Geraldine Schultz’s kindness, grace and passionate commitment to helping others.

Above: (L-R) Alma Becker, the late Larry Becker, MD, Sherri Cohen, LCPC, Gail Cohen, Grant Cohen and Andy Cohen

When fully funded, the endowment will sustain supportive care programs that educate breast cancer patients and their families about prevention, screening, treatment and survivorship issues. In addition, proceeds from the fund will provide coping tools and information as patients and their families enter the wellness phase of breast cancer survivorship. Sherri Cohen, LCPC, a psychotherapist and community advocate, explained that the fund will also help provide complementary and integrative therapies designed to assist in alleviating pain and anxiety in the clinical setting. Some of these include Healing Touch, aromatherapy, visual imagery and mindfulness. Several guests immediately pledged gifts to support the endowment, raising more than $60,000. Following the gathering, gifts have continued. To make a gift, please contact UM SJMC’s Foundation, 410-337-1397 or visit stjosephtowson.com/giving. 15

Philanthropy

NEW MEDICAL GARMENTS BOUTIQUE MEETS PATIENT NEEDS A diagnosis of cancer is frightening, often made more so by the contemplation of what a course of treatment entails, especially to a woman’s appearance. Fear of the loss of her self-image and femininity can even eclipse her fear of the disease itself. With this in mind, the Cancer Institute, with a gift from the Emmert Hobbs Foundation, is adding to our mission of treating patients, not diseases. Opened in November 2015, the Caring Touch Boutique, located next to the Breast Center in the Cancer Institute, addresses fears about a changing appearance with both love and compassion. Under the guidance of Caring Touch owner Debi Drybala, the boutique works exclusively with cancer and lymphedema patients. Designed as a retail store, Caring Touch offers products to ensure that cancer patients maintain a sense of style while undergoing treatment. Wigs, special bras for mastectomy patients and Topricin cream for the side effects of chemotherapy and radiation on the skin are available. The boutique also offers jewelry, stylish clutch purses, colorful scarves and many items that simply make one feel good to own. It is important to our mission that Caring Touch is not exclusively perceived as a cancer store, but instead a healing space that also carries items a cancer patient may need. Nader Hanna, MD, director of the Cancer Institute comments, “Philanthropy is a critical component in the ability of the Cancer Institute to fund special projects like the boutique. We are grateful to the trustees of the Emmert Hobbs Foundation for recognizing the vital importance of maintaining a positive self-image during cancer treatment. I believe the Caring Touch boutique is a beautiful demonstration of holistic medicine at its best.”

ELECTRONIC MEDICAL RECORDS/ EPIC PORTFOLIO On Sunday, October 5, 2014, UM SJMC went live with a new electronic medical records (EMR) system called Epic Portfolio. An EMR is an electronic version of a patient’s medical record that contains the same information as paper records, including test results, medications, doctors’ notes, telephone messages and other important and personal information about the patient’s medical history. EMR MEDICAL PROVIDER ADVANTAGES Epic Portfolio will position UM SJMC and the University of Maryland Medical System (UMMS) for success in the managed population health environment, allowing us to study trends in our patient outcomes and make improvements across the system that result in better management of chronic disease. Additionally, it allows us to cultivate the use of common workflows across UMMS that will improve patient safety by increasing the use of best practices and reducing variation in care. The implementation of Epic Portfolio also helps improve patient safety outcomes and enhances clinical decision making and collaboration. This is accomplished by providing clinicians with timely, comprehensive medical information that is secure, standardized and easily shared among providers. Interoperability is a major part of any EMR, and we are happy to announce that through the use of Epic Portfolio, UM SJMC patient information has been shared appropriately to providers and facilities in almost every state as well as several other countries. The number of shared records across the world coming from and into the UMMS EMR has expanded exponentially in the past year thanks to this 17

ELECTRONIC MEDICAL RECORDS/ EPIC PORTFOLIO Continued

implementation. That number will grow as other UMMS facilities go live. EMR PATIENT ADVANTAGES Epic Portfolio offers many advantages for our patients, as well. Patient health information is up-to-date avoiding the delay created when handwritten notes wait to be transcribed. Test results and all medical history are recorded directly into the patient’s EMR. Utilizing an EMR that is shared or well integrated across the system eliminates the need for patients to register multiple times. It also allows the patient to be the keeper of his or her overall health record from encounters at different entities within the University of Maryland Medical System. Patients will also be able to view their medical records from home. Approximately one year since going live at UM SJMC, Epic Portfolio has expanded to five other UMMS facilities. On November 8, 2015, UMMC Midtown campus and UM Rehabilitation Network went live on the Epic Portfolio. PATIENT AND PROVIDER PORTALS NOW AVAILABLE In addition to the continued roll out of Epic Portfolio, UMMS has implemented both a patient and a provider portal. Patients of the Cancer Institute may now view their laboratory work, view scheduled appointments and send queries to their physician. Further improvements to this portal are forthcoming. At UM SJMC, patient care is — and always will be — our first priority. We are proud to report that our team continues to work together to ensure patient care which is never compromised.

PATIENT/PROVIDER PORTAL HIGHLIGHTS •

Providers are now able to view their patients’ records using Internet capabilities from any computer.

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PortfolioMD is the brand name of the UMMS physician portal which provides simple, safe access to any part of the EMR record as if the provider was at UM SJMC viewing the record.

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As support of the Epic Portfolio suite of applications has transitioned from go-live support to stabilization, we are now in the long-term optimization phase in which improvements to the overall EMR build continue to occur through planned monthly updates.

Quality & Safety Committee Update

2015 ACCOMPLISHMENTS Ensuring that cancer patients receive high-quality care and the correct treatment at the right time, is regularly reviewed by the Cancer Quality and Safety Committee. A variety of performance measures to assess patient safety and quality of care are tracked. Standards of practice are set and nationally-accepted quality measures are utilized as benchmarks. We also measure ourselves against national averages.

THE QUALITY ONCOLOGY PRACTICE INITIATIVE UM SJMC’s Cancer Institute continues to participate in an American Society of Clinical Oncology (ASCO) project called Quality Oncology Practice Initiative (QOPI). This initiative provides a standard methodology, a robust library of quality metrics and a collection tool to: •

Reliably and routinely assess care

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Inform quality improvement activities, and

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Demonstrate quality to patients and external stakeholders.

The Cancer Institute participates in this initiative by collecting patient data on breast cancer, lung cancer, end-of-life care and symptom management care. One of the projects completed in 2015 to improve quality and safety outcomes was identified as a result of our QOPI data. The objective of the project was to examine how the Cancer Institute could better support patients who take oral chemotherapy medication at home. Since medical literature indicates issues exist with patient understanding and compliance with oral chemotherapy, our medical oncology multi-disciplinary team felt the need to review the process of patient and family education and support. The current electronic medical record (EMR) was modified to allow accurate identification of all patients taking oral chemotherapy and to track follow-up phone calls to assure compliance. A tool was created in the EMR system to determine if Cancer Institute patients had any problems with oral therapy administration and if they were taking it correctly. The tool also allows us to track progress in supporting our oral chemotherapy patients.

Quality & Safety Committee Update Continued

Our process of education and support will be enhanced according to resulting discoveries from EMR reports. The Quality and Safety Committee also began tracking how long it took patients to receive oral chemotherapy from a specialty pharmacy. To expedite orders more efficiently, the UMMS specialty pharmacy obtains authorizations for patients and either sends the medication directly to the patient or works with the patient’s insurance company’s preferred pharmacy to advance the order. As a result, patients are receiving their medications within seven days as opposed to two to three weeks. Other enhancements recommended by UM St. Joseph Medical Center include: •

Updating patient education support materials

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Standardizing follow-up communication between the nurse navigator and oral chemotherapy patients to ensure that each patient knows exactly when and how to take their medications and manage any side effects.

SURGICAL ONCOLOGY METRICS Chief of Urology and Director, Urologic Oncology Center, Dr. Marc Siegelbaum, reviewed patients who received a prostatectomy during the last quarter of 2014 for the following metrics: 1.

Estimated Blood Loss (EBL)

2. Length of Stay (LOS) 3. Surgical Margins Results reflect an EBL at 2.6%, which was lower than the past average of 8.6%. Further examination of cases found no issues related to standard of care. The average LOS was 2.0 days, which was slightly higher than our past average of 1.3 days, but considered acceptable. The analysis of surgical margins included margin type (proximal, distal, inked soft tissue) and rate of positive vs. negative by surgeon. The positive margin rate of 7.9% was lower than the past average of 10.5%. Analysis demonstrated continued rates were consistent with national benchmarks. All cases with positive margins were reviewed, and subsequent care was found to be consistent with the standard of care.

Average Length of Patient Visits (in Minutes) at UM SJMC Infusion Center

350 300

323 239

Avg mins*

250

154

200

251

238 209

190

205 136

112

MD to Door Port to MD Door to Port

150 100 50 0

34 25

Wk 3-4 Apr

Wk 1-2 May

January 2013 (baseline)

Wk 1-2 Apr

39 30 Wk 3-4 May

PATIENT EXPERIENCE IMPROVEMENTS For the past two years, a multidisciplinary team has been working on ways to improve our patientsâ&#x20AC;&#x2122; experience when coming to see their provider before receiving chemotherapy on the same day. This combined visit represents about 75% of total daily visits. As time is very precious to a cancer patient, the reduction in wait times during their visits would help support an improved quality of life during treatment. Initial audits confirmed infusion patients spend an average of five hours per visit in the Cancer Institute. Visits are comprised of seeing a physician or nurse practitioner and receiving a 90-minute infusion. To evaluate how we could lower time spent at the Cancer Institute, a structured problem solving and continuous improvement approach called A3 was employed. Initially a lot of time was spent working through the process in an effort to identify the barriers and activities that did not provide value to the patient. After mapping out the current process, our target process was identified, with a goal of reducing patient waiting time by 50%. Our data categories were organized according to patient flow isolating activities from the time they entered the building to the time they left. It was discovered that the greatest opportunity for time reduction was in the last part of a patientâ&#x20AC;&#x2122;s visit, from the time the patient saw the provider to the time they left. Key strategies to reduce patient visit time included staffing model changes, the addition of nurse practitioners and an increased focus on having chemotherapy orders available before the patient arrives. A 26% reduction rate was achieved and length of visits were decreased from an average of 323 total minutes to an average of 239 total minutes.

Quality & Safety Committee Update Continued

Cancer Institute Operations Director, Monica Fulton (L) and Performance Improvement Specialist, Robin Schaffer (R) stand with their Lean management chart, which summarizes the process of streamlining patient wait time.

PALLIATIVE CARE QUALITY SCORECARD The Cancer Institute’s palliative care program, led by Dr. Helen Gordon, continues to grow and serve more patients. This is in line with the new ASCO guidelines which recommend doctors, patients and caregivers talk about palliative care soon after diagnosis for any patient with metastatic cancer and for patients with many or severe symptoms. The committee has worked together to develop a palliative care quality scorecard. PALLIATIVE CARE SCORECARD METRICS

Helen Gordon, MD, FACP Director of Palliative Care

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Number of palliative outpatient visits

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Number of palliative inpatient visits

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Number of patients who received chemotherapy within last 14 days of life

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% of patients who received chemotherapy within last 14 days of life

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Number of patients hospitalized within last 30 days of life

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% of patients hospitalized within last 30 days of life

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Average hospice length of stay

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Number of patients admitted to hospice

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% of patients admitted to hospice

A GUIDE TO IMPORTANT CANCER SCREENINGS Note: These are the most recent guidelines as published by the American Cancer Society. They are for average-risk individuals. We recommend that you discuss your individual risks and these guidelines with your primary care physician to determine the best screening plan for you. SITE/TYPE OF TEST

POPULATION

PATIENT RECOMMENDATIONS

Women 40–44 years

Should have the choice for annual mammograms

Women 45–54 years

Yearly

Women 55+

Continue yearly or switch to every 2 years

Women 21–29 years

Every 3 years plus, HPV testing if there’s an abnormal Pap result

Women 30–65

Every 5 years plus an HPV test, or a Pap test alone every 3 years

Women 65+

No screening if they have had normal results for the past 10 years. Women with a history of serious cervical pre-cancer in the last 20 years should continue screening.

BREAST Mammogram

CERVIX Pelvic exam and Pap test

COLON (tests that find polyps and cancer) Flexible sigmoidoscopy

Men and women starting at age 50

Every 5 years*

Colonoscopy

Every 10 years*

Double-contrast barium enema

Every 5 years*

COLON (tests that mostly find cancer) Fecal occult blood test (gFOBT)* or fecal immunochemical test (FIT)* or stool DNA test (sDNA)

Men and women, starting at age 50

Yearly

Women 18+

Report any unexpected vaginal bleeding or spotting.

Women at menopause

Discuss risks and symptoms of endometrial cancer with a physician.

Men and women ages 55–74 with a 30-pack year smoking history who either still smoke or have quit within the last 15 years. (A pack-year is the number of packs smoked daily multiplied by years a person has smoked.)

Annually

Men starting at age 50

Talk to your doctor to decide if testing is the right.

Men starting at age 45 who are African American or have a father or brother who had prostate cancer before age 65.

Talk to your doctor.

Men and women ages 20+

Regular check-ups should include exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes and ovaries.

Every 3 years

ENDOMETRIAL Uterine

LUNG CANCER Low-dose CT scan of the chest

PROSTATE Digital rectal exam and PSA

CANCER-RELATED CHECKUPS

*Should be discussed with a physician.

Services Support Services Cancer Institute • Nurse Navigators • Oncology-Certified Nurses • Clinical Research • Ostomy Care • Nutrition Counseling • Psychosocial Support for Patients and Families • Surgery, Chemotherapy & Radiation Classes • Genetic Counseling • Tumor Registry • Pain Management • Lymphedema Services • Financial Counseling • Red Devils, Support for Breast Cancer • SOS (Survivors Offering Support) • Financial Support for Eligible Patients • Ostomy Support Group • Palliative Care Program • High-Risk Breast Cancer Screening Program Medical Oncology & Hematology • Serpick Infusion Center • Inpatient Unit • Biotherapy • Management of Red Cell, White Cell, Leukocyte and Platelet Disorders • Chemotherapy • Targeted Therapy • Leukemias, Lymphomas–Hodgkin’s and Non-Hodgkin’s Lymphoma, Multiple Myeloma and Myelodysplastic Syndrome Surgical Oncology • Comprehensive management of breast cancer with oncoplastic reconstruction • Complex surgical procedures for gastrointestinal malignancies and retroperitoneal cancers • Tumor debulking (cytoreductive) surgery with Hyperthermic Intraperitoneal Chemotherapy for abdominal carcinomatosis (from appendix, colorectal, ovarian, primary peritoneal malignancies; and peritoneal mesothelomia) • Minimally invasive Laparoscopic and Robotic surgery for resection of colon, rectal, gastric, pancreatic, liver, kidney, lung, prostate and adrenal tumors • Advanced endoscopic and interventional radiology techniques for esophageal, rectal, pancreatic, hepatobiliary, and lung cancers

Important Contacts Radiation Oncology • Electron Therapy • Stereotactic Radiosurgery (SRS) • Varian Trilogy System • CT Simulator • Prostate Brachytherapy • High Dose Rate (HDR) Brachytherapy • Breast HDR Brachytherapy • IMRT • IGRT • Respiratory Gating • Stereotactic Ablative Radiotherapy (SABR) • Varian TrueBeam Linear Accelerator • Rapid Arc

New Patient Referrals 1-800-441-7562

Spiritual Care • Spiritual Counseling • Advance Directives Counseling • Caregivers Support Group

Breast Center - 410-427-5510

Community Participation • Susan G. Komen Race for the Cure® • Hopewell Run • Relay for Life: American Cancer Society • Cancer Coalition: Baltimore County/ Baltimore City Health Departments • Look Good, Feel Better© • Pancreatic Cancer Action Network: Purple Stride • Maryland Half Marathon and 5K • Nueva Vida • St. Clare Medical Outreach • Maryland Cancer Collaborative Patient Navigation Network Community Outreach • Screenings for Cervical, Prostate, and Breast Cancers • Community Cancer Education • Maryland Cancer Control Plan Steering Committee • Patient Navigation for Monthly Community Breast Screening Programs • Medical Garments Specialty Boutique (Caring Touch)

Cancer Institute Main Line 410-427-5585 Hospital Information/Main Line - 410-337-1000 Advanced Directives Counseling - 410-337-1109 Advanced Radiology •

Ultrasound and X-ray - 410-580-2200

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Breast Imaging/Mammography - 410-580-6000

Billing Questions – 410-337-1020

Cancer Institute Business Director – 410-427-2558 Cancer Institute Nurse Manager – 410-427-5268 Caring Touch Boutique – 410-337-1081 Community Outreach – 410-427-2548 Financial Counselor – 410-427-5575 Foundation Office – 410-337-1397 Genetics Counselor – 410-337-1697 Nuclear Medicine – 410-337-1465 Oncology Clinical Research – 410-427-4569 or 410-427-2571 Palliative Care – 410-427-5352 PET/CT at the Cancer Institute – 410-580-6020 Physical and Occupational Therapy – 410-337-1330 Radiation Oncology Center – 410-427-2525 Radiation Oncology Clinical Manager – 410-427-2562 Serpick Infusion Center – 410-427-5585 Social Work – Outpatient Oncology – 410-427-5388 Speech and Language Therapy – 410-337-1331 Spiritual Counseling – 410-337-1109 TDD Access – 410-337-1671 Walgreens Pharmacy at UM SJMC – 410–337–0557 Wound and Ostomy Center – 410-427-2345