2013 ephrata cancer program annual report ephrata cancer program annual report with statistical data...

2013 Ephrata Cancer Program Annual Reportwith Statistical Data from 2012

Ephrata Community Hospital

STRIVING TO MEET EVERY NEED -ALL THE TIME.

Compassion

Empathy

Caring

Quality

Efficiency

State-of-the-Art

In picture: Terry (patient) and Sue Steffy with Traci Wilcox, RN, OCN and Karen Comerford, RN, OCN.

In picture: Tracey Selvaggio, B.A., RT(R)(T), Chief RadiationTherapist.

Cancer Committee Members 2

The Year in Review 3

Cancer Program Overview 4

Cancer Program Accreditations/Affiliations 5

Ephrata Cancer Center Physician Staff 7

Medical Oncology Services 8

Radiation Oncology Services 10

Clinical Trials/Genetic Testing 12

General Surgery/Radiology 13

Pathology and Laboratory/Pharmacy 14

Tumor Board Conferences 16

Comprehensive Breast Health Program 16

Center for Wound Healing & Hyperbaric Services 17

Health Programs: Wellness Center 17

Patient Financial Services 17

Community Outreach 18

Cancer Registry Report 21

Site Analysis: Lung Cancer 25

Table of Contents

Giridhar Adiga, M.D.Medical Oncology

Cancer Registry Quality Coordinator

Sue Auxier, B.S.N, R.N.Coordinator, Center for Women’s Health

Comprehensive Breast Care Program

Pamela Boland, RNVice President


Heather Brown, RN, OCN, CRNIClinical Nurse Manager

Karen Comerford, RN, OCNNurse Navigator

Community Outreach Coordinator

Huyen Cao, M.D.Radiology

Kelly Edwards, B.S.American Cancer Society

Lisa Forcellini, R.D. L.D.N.Registered Dietitian

Cheryl L. Gardner, D.O., F.A.C.O.I.Medical OncologyLiaison Physician

Vincent Glielmi, D.O.Senior Vice President of Medical Affairs

Medical Director

Joy GoodCancer Registry

Diane Gordon, R.N., C.P.H.Q. Quality Improvement

Jessica Hildebrandt, M.S., R.D.Registered Dietitian

Helen Lawson, M.S.W., L.S.W. Social Services

Wilfred A. Layne, M.D.Medical Oncology

Joanne Martin, R.T. (R)(T), B.H.S.A.Administrative Director

Quality Improvement Coordinator

Deb Musser, R.N., O.C.N.Radiation Oncology Nursing

Diane Noll, R.N.Clinical Trials & Clinical Research Coordinator

Rachiel Oakley, M.D., F.C.A.P. Pathology & Cancer Conference Coordinator

William Piepgrass, M.D., F.A.C.S.General Surgery

So Hyang Park, M.D.Medical Oncology

Mary Phillips, R.H.I.T., C.T.R. Cancer Registry Consultant

Steve Powell, R.Ph. Pharmacy

Kim Rock, R.T. (T)Chief Radiation Therapist

James Stephenson, M.D.Family Practice

Theresa Walls, D.O., M.B.E. Behavioral Health

Psychosocial Services Coordinator

Patricia Windham, B.S.N., R.N.Director, Inpatient Nursing Services


2012 Cancer Committee Members

Michael J. Lambo, M.D.Radiation Oncology

Chairperson

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2012: A Year in ReviewThroughout the years, the Ephrata CancerProgram has concentrated on expanding serviceswhile remaining focused on quality. In 2000, theEphrata Cancer Center began providing cancerservices with Medical Oncology and RadiationOncology and has grown to include Hematology,Clinical Trials and Genetic Services. A number ofpurposes led to the inclusion of these services inour program.

To make it easier and more convenient for localphysicians to refer patients for HematologicalServices, the Cancer Center sought to centralizethose services at the Center. To bring the bestcutting edge treatment to the community, theorganization chose to affiliate with ThomasJefferson University Hospital Clinical Trials andGenetics Program. This affords our patients theopportunity to enroll in beneficial clinicalresearch treatments they would not otherwisehave access to. The Genetics Program allows specific patients and families the ability to meetwith a specially trained Genetic Counselor whowill review the patient’s family history and otherfactors and counsel them as they consider theirdecision on whether genetic testing is right forthem. In addition to these services, the organiza-tion consistently strives to improve our technolo-gy to better meet the needs of our patients andstaff.

This year, the Cancer Program focused on a number of important goals. Utilizing the 2012Community Needs Assessment Survey, the CancerProgram began an outreach effort toward educat-ing the community on the guidelines for coloncancer screening and the importance of theguidelines in detecting colon cancer early. Thisoutreach was based on Lancaster County surveyoutcomes being below the acceptable benchmark.Educational seminars were scheduled concentrat-ing on maximizing community attendance.

Another important endeavor of the programincluded adding a Nurse Navigator to the staffcompliment. This Nurse Navigator acts as the link and conduit for care management. Buildingthis additional relationship assists in smoothingout the patient experience throughout their care.

Additionally, comprehensive patient binders were created to help patients understand and becomemore involved in their care. The binders coversite specific cancer information as well as generalinformation to educate them on services of theEphrata Community Hospital and the surround-ing community.

We invite you to read about our statistics and ourservices that set us apart form other organizations.

Michael J. Lambo, M.D.Ephrata Community Hospital

Cancer Committee Chair

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Cancer Program OverviewThe Ephrata Cancer Programprovides outpatient cancer carethrough the Ephrata CancerCenter. The Cancer Centerincludes Medical Oncology andRadiation Oncology. Throughour teritiary clinical affiliationwith Thomas Jefferson Univer-sity Hospital, the EphrataCancer Center offers ClinicalTrials and Genetic Counselingand Testing. Dedication to quality can be observed in all services across the organiza-tion’s network. By linkingEphrata Cancer Center’s services with the existing

Ephrata Community Hospital’s(ECH) Surgical Program, HomeHealth, Diagnostic, Pathologyand Laboratory services, the organization further gave thesurrounding area complete care options.

A non-profit health servicesorganization, Ephrata Comm-unity Hospital strives toadminister the best quality careclose to home. This is accom-plished through a network ofECH facilities that provide the community with preventiveservices, primary care, diagnos-

tic services, acute care, andrehabilitation services. TheECH network of outpatient centers includes the BrossmanCenter for Health, CocalicoCenter for Health, CommunityMedical & Diagnostic Center,Cornerstone Center, CrossroadsCenter for Health, Center forHealth at Garden Spot Village,Center for Health at GraniteRun, Georgetown Center,Meadowbrook Center forHealth, Rothsville MedicalCenter, and the EphrataDiagnostic Center.

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Why is it important to be aCommission on Cancerapproved program? Only onein four hospitals that treat cancer receive this specialapproval. It recognizes thequality of comprehensive cancer care available and offersa commitment that patientswill have access to all of thevarious medical specialists whoare involved in the diagnosisand treatment of cancer.

Receiving care at the EphrataCancer Center ensures thatpatients will receive:• Quality care close to home.• Comprehensive care offeringa range of state-of-the-art services and equipment.

• A multi-specialty team approach to coordinate thebest treatment options available to cancer patients.

• Access to cancer-related information, education, and support.

• A cancer registry that collectsdata on type and stage of cancers and treatment results, and offers lifelong patient follow-up.

• Ongoing monitoring and improvement of care.

• Information about ongoing clinical trials and new treatment options.

As a patient begins to thinkabout treatment and ongoingcare there is not a need to trav-el great distances from homebecause the care needed isright here in the Ephrata area.

Of course, no one can guaran-tee the outcome of any type of treatment, but a patient’schoice of an approved cancer

treatment program means thatthey will receive the best diag-nosis and treatment of cancerand that full consultative serv-ices will be available from allmedical disciplines involved indiagnosing and treating cancer.

Patients can also be sure thattheir conditions will bewatched carefully through alifelong program of follow-upcare.

Cancer Program Accreditations/Affiliations

COMMISSION ON CANCER

JEFFERSON KIMMEL CANCER CENTER NETWORKEphrata CommunityHospital is affiliatedwith Thomas Jefferson UniversityHospital and theJefferson CancerNetwork inPhiladelphia. Thisaffiliation providesour patients withaccess to genetictesting and clinical

trials as well as thelatest developmentsin cancer research,technology, andtreatment.Physicians in thenetwork consultwith each other andpatients have agreater opportunityto benefit frominnovative treatment

options closer tohome. This affilia-tion also provideslocal access to edu-cation opportunitiesfor the physiciansand nursing staff atEphrata CommunityHospital.

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The American College ofRadiation Oncology (ACRO)Practice Accreditation Programbegan in 1995 and consists ofstandards of practice forRadiation Oncology. Accred-itation is voluntary and is most often chosen because of a program’s commitment toquality. An audit of the prac-tice is conducted to assure thatACRO standards of safe andeffective radiation oncologypractice are being followed.These standards are continuallyevaluated and updated toreflect present standards ofpractice.

Practice auditing includes: • Evaluating equipment in relationship to disease sites treated, appropriate quantity of equipment for patient load,and function of equipment.

• Type of staff and quality of staff in terms of certificationand educational commitment.

• Peer review against current accepted standards of practiceaccording to the patient diagnosis.

• Site visit following online casesubmissions. Surveyors verifysubmitted data and clarifystaff knowledge on any clinical issues involving reviewed cases.

Full accreditation is for a period of three years anddemonstrates a program’s commitment to quality inRadiation Oncology.

Cancer Program Accreditations/Affiliations

AMERICAN COLLEGE OF RADIATION ONCOLOGY

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Michael Lambo, M.D.Radiation OncologistBoard certified by the AmericanBoard of Radiology

Suman Tiwari, M.D.Radiation OncologistBoard Certified by the AmericanBoard of Radiology

Wilfred A. Layne, M.D.Medical Director/Medical OncologistBoard certified in internal medicine,hematology and medical oncology

Cheryl L. Gardner, D.O.Medical OncologistBoard certified in internal medicine,hematology and medical oncology

So Hyang Park, M.D.Medical OncologistBoard certified in internal medicine,hematology and medical oncology

Giridhar Adiga, M.DMedical OncologistBoard certified in internal medicine,hematology and medical oncology

2012 Ephrata Cancer Center Physician Staff

Medical Oncology services areavailable on both an inpatientand outpatient basis. Outpatientmedical oncology care is pro-vided at the Ephrata CancerCenter by physicians who areboard certified in medicaloncology, hematology, andinternal medicine, as well as byoncology trained and certifiednurses. In calendar year 2012,there were 5,379 physicianoffice visits and 8,476 infusiontreatments at the center.

Being sensitive to patient privacy, the Ephrata CancerCenter offers private rooms forphysicians to complete patientexaminations. In addition to thephysical exam, the physiciansbegin to educate each patientabout the disease, treatmentoptions, and appropriate follow-up. The Ephrata CancerCenter nurses reinforce thiseducation and the treatmentplans.

Treatments are administered ina large, bright infusion area inthe comfort of one of 17 reclin-ers equipped with privacy cur-tains. The curtain allows family,

friends, and loved ones privacyif they choose. There is also theoption of two private treatmentrooms. In addition to medicalcare, the nurses are also skilledat providing assessments, edu-cation and ongoing emotionalsupport to patients and theirfamilies.

The physicians and nurses consult with ancillary supportservices, as necessary. Theseinclude, but are not limited to,nutrition, social, pastoral, reha-bilitation, psychiatry, home careand hospice services. Referralsare also made to communityagencies for additional supportservices. This ensures a compre-hensive plan of care with ourcommitment to compassionand excellence in clinical care.

The Ephrata Cancer Centerstrives to provide the best inpatient care with the personaltouch our patients and familiesappreciate.

Heather Brown, R.N., O.C.N.,C.R.N.I.Clinical Nurse Manager

Medical Oncology & Radiation Oncology Services

MEDICAL ONCOLOGY SERVICES

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“The entire staff at the Ephrata Cancer Center goes above and beyond to give us thebest care.”

Trisha ShafferPatient of Dr. Wilfred Layne, M.D.

In 2012, Radiation Oncologyprovided 175 Consultations, 375Treatment Simulations, and4,225 Treatments.

Radiation Oncology continuesto improve our services by constantly evaluating areaswhere we can meet the needs of our community and exceedour customers’ expectations.Our current compliment ofservices include IntensityModulated Radiation Therapy(IMRT), Image Guided RadiationTherapy (IGRT), 3-D TreatmentPlanning, and Prostate SeedBrachytherapy.

We understand that a cancerdiagnosis is life changing andwe are here to guide youthrough every step of the way.Our specialty team consists ofboard certified radiation oncologists, an oncology board

certified nurse, a board certifiedmedical dosimetrist, and boardcertified radiation therapists.

During the initial consultation,the radiation oncologist willwork with you and your familyin developing an individualizedcare plan. Next, the medicaldosimetrist works behind thescenes, using the most advancedtechnology to develop a uniquetreatment plan that minimizesthe effects of radiation. Once the radiation therapy treatmentplan is complete, radiation therapists precisely deliver yourdaily treatment. In addition,they ease any concerns or questions you and your familymay have. Lastly, during weeklyvisits, our nurse will be yourfoundation for symptom management and patient education regarding your specific regimen.

Additionally, patients receivedaily quality care as they interact on-site with our highlyskilled nutritionist, social workers, and support staffmembers. The Ephrata CancerCenter is proud to offer thecommunity the best state-of-the-art treatment, close tohome.

Kim Rock, R.T.T.Chief Radiation Therapist

Medical Oncology & Radiation Oncology Services

RADIATION ONCOLOGY SERVICES

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Using a multi-disciplinary approach, Radiation Therapy treatments are planned underthe primary direction of the Radiation Oncologist with expertise from a Dosimetrist,Physicist, and Radiation Therapist.

In picture: Michael J. Lambo, M.D. with Heidi Fronheiser, Dosimetrist.

Research is the vital componentin finding answers to many ofthe diseases that confront us.The goal is not only to lengthenlife expectancy but also toimprove the quality of that life.The information gathered inclinical trials is important to the development of new andup-to-date treatments for cancer, thus research is beingconducted at a furious pace.The clinical trials program ispart of Ephrata CommunityHospital's affiliation withThomas Jefferson UniversityHospital.

A clinical trial follows a logicalprocess which includes threephases. Phase I seeks to answerquestions of safety such as thecorrect dose and side effects.Phase II looks at how the drugworks and what cancers thedrug is effective against. PhaseIII compares the new drug tothe current standard treatmentand requires a large number of

participants. The cancerresearch program at Ephrataaffords patients the opportunityto participate in Phase II and IIIclinical trials without having totravel, while assisting sponsorsin reaching accrual goals at afaster rate. For a complete list ofavailable clinical trials, visitwww.ephratahospital.org/cancercare. Use the drop-downmenu to learn more aboutclinical trials.

Genetic testing is an importantcomponent of cancer care, andis offered here at the EphrataCancer Center in cooperationwith Thomas JeffersonUniversity. Oncologists at theEphrata Cancer Center evaluatepatients for any genetic coun-seling needs. Those who wouldbenefit from genetic counselingare referred to the geneticcounselor from ThomasJefferson University for anappointment. For patientconvenience, patients will

receive genetic counseling atthe Ephrata Cancer Center. Thegenetic counselor will reviewthe patient history as well asfamily history for cancer. Ifappropriate, genetic testing willbe discussed. If genetic testingis performed, the genetic coun-selor will contact the patientdirectly with the results of thetest. (It will take 4-6 weeks forthe results to be available).Future monitoring recommen-dations for the patient andfamily will be discussedaccording to the patient andfamily history and genetic testing, if performed.

This is just another example ofhow the Ephrata Cancer Centerbrings quality care close tohome.

Diane Noll, R.N.Clinical Research Nurse

Clinical Trials/Genetic Testing

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Ephrata Community Hospitaloffers a large spectrum of surgical options for cancerpatients. Patients and their primary care physicians canselect the surgeon who has theknowledge and expertise fortheir specific disease.

The Hospital offers both inpatient and outpatient surgery settings for patient treatment. The majority of surgical procedures performedat Ephrata Community Hospitalare done on an outpatient basis.That means that most patients

have their surgery, recover, andgo home on the same day.

The Day Surgery Center atEphrata Community Hospital ismaking outpatient surgery easi-er for patients and their fami-lies. The Center has operatingrooms equipped to handle awide range of procedures, fromtonsillectomies to laparoscopicand arthroscopic surgery tolaser procedures on the eye.Physicians from every surgicalspecialty use the Day SurgeryCenter for care of patients of allages.

The surgeons on staff workclosely with the medical andradiation oncologists to ensureproper adjuvant treatmentplanning subsequent to cancersurgery. They attend TumorBoard Conferences on a regularbasis to provide coordinatedtreatment recommendations forcancer patients.

Linda Coulombe, B.H.A., R.N.,H.R.C., C.N.O.R., C.R.C.S.T.Director of Surgical Services

General Surgery & Radiology

GENERAL SURGERY

RADIOLOGYThe Radiology Department ofEphrata Community Hospitaloffers a full range of servicesand is involved in the diagno-sis, staging and management ofpatients with various cancers.The Department offers all diag-nostic procedures including CT,MRI, Ultrasound, NuclearMedicine, PET Imaging andDigital Mammography, which

aid in the detection and follow-up evaluation of cancers andtheir treatment as well as assist-ing biopsy guidance. In 2009,radiology upgraded their MRIoptions to include a high fieldstrength open MRI. Thisupgrade provided the freedomof an open MRI with anincrease in diagnostic qualityimages.

Other Ephrata CommunityHospital specialized servicesavailable include Stereotacticand Ultrasound-Guided BreastBiopsies as well as SentinelLymph Node Mapping, BreastMRI and MR-Guided BreastBiopsy.

Buddy Tomko, R.T.Director of Imaging Services

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A key role of our pathology andlaboratory services is to screenfor new malignancy, accuratelydiagnose and stage cancer andto provide information used inguiding treatment and follow-up.

The Ephrata CommunityHospital (ECH) Laboratorymaintains clinical excellence ina number of different ways.Certified by the College ofAmerican Pathologists, the labfollows set guidelines of operation to ensure quality

control and spur continualquality improvement. Evalua-tion of most lymph node andbone marrow biopsies includesstandard microscopic examina-tion and flow cytometry withfrequent use of molecular andcytogenetic studies all of whichare coordinated here by staffpathologists for maximumaccuracy.

Frequent Tumor BoardConferences foster close work-ing relationships betweenpathologists, oncologists and

other caregivers to optimizepatient care. To expand the clinical laboratory servicesavailable, the hospital utilizesCentral Pennsylvania AllianceLaboratory (ECH clinical affiliatelaboratory) and other highquality reference laboratories toperform esoteric, moleculardiagnostic, and cytogeneticstests.

Peter C. Côté, M.D.Medical Director of Pathologyand Laboratory Services

Pathology/Lab Services & Pharmacy Services

PATHOLOGY& LAB SERVICES

PHARMACY SERVICESAt the Ephrata Cancer Center,there is a pharmacist on sitewho is responsible for theacquisition, storage, prepara-tion, distribution and control of drugs and drug-relatedproducts. The pharmacist alsoplays a key role in the interdis-ciplinary approach to care bymeeting the staff informationalneeds related to drugs and drugtherapy.

Most recently, the pharmacyarea was renovated to meet all

USP 797 guidelines for thepreparation of sterile products.These guidelines ensure envi-ronment compliance with thehighest standards for manufac-ture of IV and sterile products.This involves certification of theLaminar flow hoods used toprepare sterile products andalso certification of the roomthey are prepared in. The goalof acquiring this certification isto provide the safest and high-est quality products for ourpatients.

In addition, with a recentlyadded retail license, the phar-macy has the ability to dis-pense oral chemotherapy drugsprescribed in place of or con-current with traditional IV regi-mens.

Stephen J. Powell, R.Ph.Pharmacy ManagerEphrata Cancer Center

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Laboratory Services are performed on-site by Certified Medical Laboratory Techniciansusing specialized equipment for consistency and quality.

In picture: Marjatta Virkkunen, M.L.T. amd Connie Noel, M.T.

Ephrata Community Hospitaloffers two Tumor Board confer-ences monthly. The TumorBoard is a multi-disciplinarycancer conference open to allstaff. Physicians are encour-aged to request their patients,particularly problematic cases,

be discussed during these con-ferences. The managing physi-cians discuss the patient’s careutilizing a team approach. Thebest course of treatment for thepatient is mapped out accord-ing to NCCN guidelines andprofessional recommendations

from experts in each discipline.Required representationincludes Radiology, Pathology,Surgery, Medical Oncology, andRadiation Oncology.

Joy GoodCancer Registry Coordinator

TUMOR BOARD CONFERENCES

COMPREHENSIVE BREAST CARE PROGRAMThe Comprehensive Breast Careprogram of Ephrata CommunityHospital is here for women tobe proactive in their breasthealth. Mammograms are stillthe best screening tool to helpdetect breast cancer at the earli-est stages and are recommendedby the American Cancer Societyto begin at age 40. The benefitof regular mammograms is theability to detect breast changesfrom one year to the next.Digital mammography, breastultrasound and breast MRI areall available at ECH to providecomprehensive breast imaging.We offer breast cancer riskassessments in the Center forWomen’s Health to provideanother tool to enhance personal knowledge.

If a breast study reveals anabnormality, our RegisteredNurse Breast Care Coordinators(BCC) are here to help thepatient. They give informationabout the biopsy process andcan schedule an appointment.

Minimally invasive breast nee-dle biopsies (many utilizing vac-uum-assisted equipment) areperformed by the radiologist orsurgeon under local anesthesiawith stereotactic, ultrasound orMRI guidance.

If a cancer is discovered, theBCC will continue to help thepatient navigate throughout thesystem with care and confi-dence. Members of our multi-disciplinary breast care teaminclude a surgeon, plastic sur-geon, radiologist, medical oncol-ogist, radiation oncologist,pathologist, OB/GYN, nursesand technologists. We balancemedical expertise with anunderstanding of the individ-ual’s personal needs. Breastsurgeries, lumpectomy andmastectomy are offered includ-ing options for breast recon-struction. Sentinel lymph nodemapping is performed by ourskilled surgeons. Educationalsupport continues post surgery,as well as before, during, and

after treatment. A referral maybe recommended to a medicaloncologist and/or a radiationoncologist.

After the treatment plan isdeveloped, the Ephrata CancerCenter nurse navigator worksclosely with the breast team tocontinue the personal touch asthe patient moves forward intreatment. The ECH systemprovides specialty supplies suchas bras and mastectomy sup-plies. Should lymphedema carebe needed, our certified lym-phedema therapist will managethis specialized aspect of thepatient’s care. Breast cancerpatients are invited to attendthe monthly breast cancer sup-port group where they may beon the ‘giving support’ or‘receiving support’ portion oftheir individualized breast cancer journey.

Sue Auxier, B.S.N., R.N.Coordinator, Center for Women’s Health

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The Wellness Center offerscommunity education programs about a variety ofhealth topics that affect ourpatient population. Healthtopics include nutrition,weight management, diabetes,and smoking cessation.

Other services include community health fairs andscreenings, fitness and healthrisk assessments, CPR & firstaid and senior programs. TheWellness Center provides the community with access tomany services and educational

programs that might not otherwise be available locally.

Steve Batchelor, M.S.Director of Wellness Services

HEALTH PROGRAMS: WELLNESS CENTER

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CENTER FOR WOUND HEALING & HYPERBARIC SERVICES

Chronic wounds cause pain,discomfort, and limitations inactivities of daily living forapproximately three to five mil-lion Americans. The Center forWound Healing and HyperbaricServices at Ephrata CommunityHospital applies proven woundcare practices and advancedclinical approaches, includingHyperbaric Oxygen Therapy, tohelp heal patients who sufferfrom such chronic wounds.

Hyperbaric Oxygen Therapy isa painless treatment that isused in conjunction with otherprocedures to speed the healingof patients with lower extremityand other unresolved woundissues. Hyperbaric oxygentherapy is also an approvedtreatment for other diagnosessuch as bleeding from pastradiation soft tissue injuries.

The program provides expertisein prevention, evaluation, andmanagement of woundsincluding surgical wounds,pressure ulcers, traumaticwounds, diabetic ulcers, andlower extremity wounds.Ostomy care is also available.

Dawn Fortna, M.S.Ed., R.N.,C.D.E., C.W.O.C.N.Manager of Wound Care/Hyperbaric Services

PATIENT FINANCIAL SERVICESWe are not just caring for themedical needs of our patients,but also ensuring that we haveexhausted all efforts at obtain-ing financial assistance to helpease that burden as well.

Patient Financial Advocates atThe Ephrata Cancer Center help patients navigate theirtreatment-related financial con-cerns. For patients with financialneed who are concerned about

large out-of-pocket expenses,our staff can provide access to avariety of resources.

Medical Assistance enrollmentcan be expedited through avendor representative availablein-house. The ECH CaresProgram is another option,offering discounts on out-of-pocket expenses based onhousehold income. PatientFinancial Advocates also work

with the in-house pharmacistand outside pharmaceuticalcompanies to identify potentialfree or replacement cancerdrugs (some drugs are veryexpensive or have significantlyhigh patient co-pays).

Deborah Moyer, C.H.A.M.,C.P.A.T.Patient Access Manager

JANUARY 2012Look Good, Feel BetterThe American Cancer Societyoffered six sessions at theEphrata Cancer Center.

FEBRUARY 2012Oncology on CanvasLilly’s Oncology on Canvas artwork was displayed at theCancer Center and at the Centerfor Women’s Health for oneweek. The 50 pieces of art werecreated by cancer patients orcaregivers.

MARCH 2012American Cancer Society -Relay for Life of NorlancoMeetingDiane Noll, R.N., Clinical TrialsNurse, spoke about clinical trialoptions currently available.

APRIL 2012Oral, Head and Neck CancerScreeningSteven N. Dorf, D.O. and JosephS. Annese, D.O. (OtolaryngologyPhysicians of Lancaster) conduct-ed the screening. Eighteen people were screened, nine were recommended to follow-up, and one patient was recom-mended to follow-up with adermatologist.

MAY 2012Nutritional Cooking Demo at Lititz Public LibraryApproximately 20 people attended this demo presented by Jessica Hildebrandt, M..SR.D.,Dietitian.

Skin Cancer ScreeningGeorge E. Groleau, M.D., derma-tologist, conducted the skin cancer screening. Twenty-threepeople were screened. Sixpatients were referred to see adermatologist and five patientswere referred to see a dermatol-ogist and have a biopsy done.

Garden Spot VillageEmployee Health FairKaren Comerford, R.N., O.C.N. &Dipti Patel, R.T. (T) spoke toapproximately 150 employees asthey came through the exhibitarea. In addition, seventy-fiveSkin Cancer Prevention quizzeswere distributed.

American Cancer SocietyRelay for Life FundraisingEvent – Patient Bingo Partyfor Team “A Cure for Carol”Karen Comerford, R.N., O.C.N. and Sue Auxier, R.N. staffed aneducation table that offeredBreast Cancer Prevention,Diagnosis and Treatment information. Approximately 85 people attended this event.

JUNE 2012Patient Celebration at theStevens Fire HallPatients, their families, and thecancer center staff celebratedwith food, music, crafts, andbingo.

Day in the ParkThe Ephrata Cancer Center participates in the hospital’sAnnual Day in the Park event.Unfortunately, this year’s eventwas cancelled due to flooding at the park. Activities gearedtoward educating the publicunder the age of 18 about prevention of cancer wereplanned, but were used at laterevents.

American Cancer SocietyRelay for Life – NorlancoKaren Comerford, R.N., O.C.N.provided an education table onFriday evening and handed outapproximately 25 ColoringBooks made by the CancerCenter that educate young people on how to prevent cancer later in life.

Community Outreach

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SEPTEMBER 2012Prostate Cancer ScreeningPaul J. Sisbarro, D.O. fromSisbarro Urological Specialists,Ltd. and Chris G. Theodoran, D.O.from Lancaster Urology perform-ed this screening. Forty-one menwere screened. Of those screened,four men had abnormal PSAsand 14 men had abnormalexams (13 BPH and one abnor-mal exam). No one had both an abnormal exam and anabnormal PSA.

OCTOBER 2012Breast Care Awareness Event – “Living Well ThroughMindfulness”This event was co-sponsored bythe Center for Women’s Healthand the Ephrata Cancer Center.It featured free clinical breastexams, sessions on yoga, massage, and guided imagery,and table displays from variousdepartments and communityorganizations. It also featuredtwo speakers – JessicaHildebrandt, M.S., R.D. andAnthony J. Bazzan, M.D.Approximately 25-30 womenfrom the community attendedthe event

Karen Comerford, R.N., O.C.N.Nurse NavigatorFacilitator, Outreach Program

Community Outreach

2012 CANCER SUPPORT GROUP TOPICS

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JANUARYOpen Discussion

FEBRUARYClinical Trials Diane Noll, R.N.

Clinical Trials NurseEphrata Cancer Center

MARCH Nutrition Basics During

Cancer Treatment & BeyondJessica Hildebrand, M.S., R.D. &

Lisa Forcellini, R.D., L.D.N.Registered Dietitians

Ephrata Cancer Center

APRIL Open Discussion

MAYNo Matter Who You Are,

We Can HelpKelly Edwards

Health Initiatives RepresentativeAmerican Cancer Society

JULYOpen Discussion

AUGUSTSkin and Oral Care

for the Cancer PatientErika Hehnly, R.N., O.C.N. Traci Wilcox, R.N., O.C.N.

Medical Oncology NursesEphrata Cancer Center

SEPTEMBEROpen Discussion

OCTOBER Tips for Caregivers

Helen Lawson, M.S.W., L.S.W.Wendy Mast, B.S.W.

Social WorkersEphrata Community Hospital

NOVEMBER Open Discussion

DECEMBERHoliday Celebration

Patients and their families are grateful for the support and assistance our socialworker provides when making decisions about their care and accessing outside services in the community.

In picture: Mary with Helen Lawson, M.S.W., L.S.W.

A Cancer Registry is an infor-mation system designed for thecollection, management andanalysis of oncology data. Thehospital maintains data on allpatients diagnosed and/ortreated for cancer at EphrataCommunity Hospital andreports statistics to thePennsylvania Cancer Registryand the National Cancer DataBase. The American College ofSurgeons Commission onCancer requires an establishedCancer Registry for ACoS CoCapproved cancer programs andstate laws make cancer, includ-ing all central nervous systemtumors, reportable diagnoses.Confidentiality of patient infor-mation is strictly maintained.

Standards for the Evaluation ofCancer Clinics and Registrieswas first published in 1930 bythe ACoS Committee on theTreatment of MalignantDisease. The first surveys ofcancer clinics were conductedin 1931. Since that time, thestandards for cancer programshave been revised and expand-ed to reflect both the compre-hensive scope of cancer pro-grams and the continuouschanges in the health careenvironment.

Today, approximately 1,500healthcare facilities in theUnited States provide cancerprograms certified by the ACoS

Commission on Cancer. Thisnumber represents 30% of thegeneral medical-surgical hospitals in the United Statesand Puerto Rico and providescare to more than 70% ofpatients who are newly diag-nosed with cancer each year.In May of 2005, the EphrataCommunity Hospital cancerprogram received accreditationby the ACoS CoC with designa-tion as a Community HospitalCancer Program and wasawarded the OutstandingAchievement Award. In addi-tion, ECH received the NationalAccreditation Program forBreast Centers (NAPBC) accredi-tation award in May 2013. TheNAPBC recently hit a nationalmilestone - 500 NAPBC-accredited breast centers.

Ephrata Community Hospital is an affiliate of the JeffersonKimmel Cancer Center Network – working together toprovide advanced medicineand superior care, educationand research. Established in1993, as the Jefferson CancerNetwork, JKCCN continues toprovide its member hospitalsaccess to the latest develop-ments in cancer research, technology and treatment tooffer patients at member hospi-tals the opportunity to partici-pate in clinical trials utilizingstate-of-the-science approachesto preventing, diagnosing and

treating cancer. Physicianshave the advantage of eachother’s consultative knowledgeand patients have a greateropportunity to benefit frominnovative treatment optionsclose to home.

To facilitate a thorough andaccurate evaluation of theEphrata Community HospitalCancer Program, a SurveyApplication Record (SAR) isupdated annually and an on-site survey is performed everythree years by a physician sur-veyor trained by the ACoS CoC.A portion of the data collectedin the SAR describing the facili-ty’s resources and services isautomatically shared with theAmerican Cancer Society. Thisinformation is made availableto cancer patients, caregiversand the general publicenabling them to make moreinformed decisions aboutoptions for cancer prevention,diagnosis, treatment modalitiesand subsequent follow-upcare.

In the year 2012, 412 new cases were accessioned into theECH Cancer Registry database.These cases include 376 analyt-ic, cases diagnosed and/ortreated at ECH, and 36 non-analytic, cases diagnosed andtreated elsewhere with a

Cancer Registry Statistical Review 2012

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Cancer Registry Statistical Review 2012

recurrence and/or subsequenttreatment at ECH.

To date, over 7000 cases areregistered in the ECH cancerregistry database. Thirteencomplete years of statisticaldata are available as a valuableresource for patient care evalu-ation studies, outcomes analy-ses as well as survival data, toimprove and enhance patientcare, to complete qualityimprovement audits and toparticipate in research andcomparison studies with theNational Cancer Data Base, thePennsylvania Cancer Registryand the American CancerSociety.

ECH Top Sites 2012: Breast20.7%; Colorectal 12.7%; Lung10.2%; Prostate 7.3%; NHL 5.8%;Bladder 5.4% and Endometrial4.6%

ECH Top Systems 2012:Digestive 21.9%; Breast 20.7%;Respiratory 10.7%; Male Genital8.0%; Female Genital 6.8%;Lymphoma 6.3% and Urinary5.8%.

Lifetime follow-up is an important aspect of the CancerRegistry. Current patient follow-up serves as a reminderto physicians and patients toschedule regular clinical exami-nations and provides accuratesurvival information. In

compliance with the ACoS CoC,accurate surveillance informa-tion is documented annuallyregarding recurrence, subse-quent treatment and patientstatus. The ECH CancerRegistry exceeds the minimumrequirements established bythe Commission on Cancer forpatient follow-up.

A Certified Cancer Registrarstaffs the Cancer Registry. Theregistrar attends annual confer-ences in order to maintain cer-tification and participates as amember of the National CancerRegistrars Association, thePennsylvania Association ofCancer Registrars, the Pennsyl-vania Society of Oncology andHematology, and the AmericanHealth Information Manage-ment Association.

The registrar ensures that time-ly, accurate and complete dataare incorporated and main-tained on all types of report-able cancers diagnosed and/ortreated at Ephrata CommunityHospital and participates inmanaging and analyzing clini-cal cancer information for thepurpose of education, researchand outcomes analyses for site-specific studies, administra-tive reports, program enhance-ments and quality improve-ments. The registrar assistswith Cancer Conferences andCancer Committee meetings

and collaborates with the Cancer Committee in complet-ing the Annual Report, theSurvey Application Record andthe National Cancer DatabaseCall for Data.

A multidisciplinary staff ofphysicians, nurses and ancillarypersonnel attend the monthlyTumor Board conferences. In2012, 33% (123 analytic cases)were presented: total casesincluded 60 (72%) female breastcancer cases diagnosed and/ortreated at Ephrata CommunityHospital/Ephrata Cancer Center.All case presentation wereprospective. ContinuingMedical Education (CME’s),Category I, credits are offeredfor attendance at conferences.

The Annual Report utilizes datafrom 2012, specifically examinesthe diagnosis and treatment ofLung Cancer, and providescomparative data from thePennsylvania Cancer Registry,the American Cancer Societyand the National Cancer DataBase. In addition, the AnnualReport summarizes the goals,objectives and accomplish-ments of the hospital’s cancerprogram for 2012.

Respectfully submitted,

Mary H. Phillips, A.R.T., R.H.I.T.,C.T.R.Cancer Program/CancerRegistry Consultant

Lung cancer refers to malignancies that originatein the airways or pulmonary parenchyma. Lungcancer is the second most common cancer inboth men and women excluding skin cancerand is the leading cause of cancer deaths. Morepeople die of lung cancer than of colon, breast,and prostate cancers combined. In 2013, therewill be approximately 228,190 new cases of lungcancer diagnosed and 159,480 lung cancer deathspredicted in the United States. From 2005 to2009, lung cancer incidence rates decreased by1.9% per year in men and by 0.3% per year inwomen. Lung cancer is projected to remain theleading cause of cancer deaths for many decadesdespite decreasing incidence and death rate inthe United States.

The one year relative lung cancer survival hasincreased from 37% in 1975-1979 to 44% in 2005-2008. Only about 15% of lung cancers arediagnosed at an early stage, for which the fiveyear survival rate is 53.5%. However, the five yearsurvival rate for all stages combined continues tobe dismal at about 16.6%. The five year survivalfor small cell lung cancer is lower than that fornon small cell lung cancer.

RISK FACTORS

The primary risk factor for the development of lung cancer is cigarette smoking, which is estimated to account for approximately 90 percent of all lung cancers. Factors that increasethe risk of developing lung cancer in smokersinclude the extent of smoking and exposure toother carcinogenic factors, such as asbestos. Riskincreases with both quantity and duration ofsmoking. Cigar and pipe smoking also increaserisk. Environmental Radon gas exposure is esti-mated to be the second leading cause of lungcancer.

Other risk factors include exposure to second-hand smoke, asbestos, certain metals (chromium,cadmium, arsenic), some organic chemicals, radiation, air pollution, diesel exhaust, and paint. Occupational exposures such as rubbermanufacturing, paving, roofing, and chimneysweeping may increase lung cancer risk. Medicalhistory of tuberculosis may be associated withincreased risks. Genetic factors may affect boththe risk for and prognosis from lung cancer.

PREVENTION AND SCREENING

Majority of patients with lung cancer are diagnosed at an advanced stage that is notamenable to cure. Smoking is the single mostimportant preventable cause of lung cancer. Even though percentage of smokers has de-creased since 1983, about 43.8 million adultswere current smokers in 2011. There has been no major change in the smoking rate amonghigh school males (20%) and females (16%)between 2003 and 2011. Smoking rate remainshigh necessitating aggressive smoking cessationmeasures. The best way to prevent lung cancer is never to start smoking and promote smokingcessation.

Clinical outcome for non-small cell lung canceris directly related to stage at the time of diagno-sis, ranging from over 60% five year survival for stage I disease, to less than 5% for stage IVdisease. The purpose of screening is to identifythe presence of cancer in an early asymptomaticstage which may increase the overall cure rateand allow more limited surgical resection toachieve cure.


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Screening with annual chest x-ray has notbeen shown to reduce lung cancer mortality.While screening for lung cancer has the poten-tial benefits, it may also be associated withpotential harms. Benign abnormalities may bedetected that require further evaluationincluding invasive procedures with associatedcomplications and anxiety. Radiation exposurefrom serial imaging and overdiagnosis areother concerns. The National Lung ScreeningTrial (a randomized trial) demonstratedreduced lung cancer mortality in a high riskpopulation who were screened with low dosecomputed tomography (LDCT). This has led toguidelines and recommendations from multi-ple professional organizations.

The U.S. Preventive Services Task Force in itsdraft statement recommends annual screeningfor lung cancer with LDCT in persons at highrisk for lung cancer based on age and smokinghistory. American Cancer Society guideline recommends that clinicians with access tohigh-volume, high-quality lung cancer screen-ing and treatment centers should initiate a discussion about screening with apparentlyhealthy patients aged 55 years to 74 years whohave at least a 30-pack-year smoking historyand who currently smoke or have quit withinthe past 15 years, and who are in relativelygood health. American Society for ClinicalOncology, American College of ChestPhysicians, National Comprehensive CancerNetwork, and American Lung Association havesimilar recommendations. The AmericanAssociation for Thoracic Surgery recommendsscreening for individuals up to 79 years of agewith a 30 pack-year history of smoking.

HISTOLOGIC TYPES

Lung cancer results from sequential accumula-tion of genetic and epigenetic changes. Mult-iple mechanisms involving cellular pathwaysof activation and inhibition are involved in the pathogenesis of lung cancer.

Lung cancers are classified as either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC) based on the histologicfeatures and response to conventional thera-pies. NSCLC, which includes 3 cell types (adenocarcinoma, squamous cell and large cell carcinoma) accounts for most (~80%) ofthe lung cancers.. Adenocarcinoma is the mostcommon type of NSCLC in the United States.Lung cancer is further divided into varioussubtypes and variants based on molecular and tumor genetic profiling. Specific mutationsmay cause a lung tumor to respond differen-tially to targeted therapeutic agents; for example, the presence of an epidermal growth factor receptor (EGFR) mutation willindicate the response to therapy with EGFRtyrosine kinase inhibitors (TKIs). Lung cancer is now considered a heterogeneous group ofdiseases and mutational profiling is becominga routine practice.

CLINICAL FEATURES, DIAGNOSIS ANDSTAGING

Lung cancer may not cause any symptoms in itsearliest stages. This makes prevention and earlydetection (cancer screening) important. Signs andsymptoms of lung cancer typically occur whenthe disease is advanced. Common symptoms



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include persistent new cough or changes in achronic cough, coughing blood, shortness ofbreath, chest pain, hoarseness and unexplainedweight loss. Symptoms due to metastasisdepends on the site and extent of metastaticlesions.

A number of diagnostic tests are used to identifyand assess extent of the disease. A definitivediagnosis requires pathologic examination.Various methods of pathologic examinationinclude sputum cytology, pleural fluid cytology,bronchoalveolar lavage and tissue sampling.Biopsy is generally required to establish accuratediagnosis and to test for tumor genetics.

Once the diagnosis is established, it is importantto assess extent of disease (Staging). Various testsand procedures used for staging includes mediastinoscopy, thoracentesis, computedtomography (CT), Magnetic resonance imaging(MRI) and positron emission tomography (PET)scans. TNM (tumor node and metastasis) stagingsystem is used which categorizes lung cancerinto 4 stages depending on the extent of spread.Stage I represents cancer limited to the lung andless than 5 cm in size. Stages II or III depends onsize and lymph node involvement. Stage IV rep-resents cancer spread to the pleura, other lung oroutside of lungs. Small cell lung cancer is some-times staged as being limited (to one lung area)or extensive stage, which helps in assessing thebenefit of radiation therapy. Information frompathology, tumor genetic testing and staging areessential to assess prognosis, plan appropriatetreatment and response to treatment.

MANAGEMENT

Management of lung cancer requires a multidisciplinary approach. Various specifictreatment modalities include surgery, radiationtherapy, chemotherapy and targeted therapies.Supportive services including palliative care isutilized depending on clinical needs.

For localized non-small cell lung cancers, surgery is usually the treatment of choice.Adjuvant chemotherapy is given after surgery in select patients to improve survival. Radiationtherapy and chemotherapy are commonly usedfor locally advanced stage disease sometimeswith surgery.

Metastatic lung cancer is usually treated withchemotherapy or targeted therapy. Severalchemotherapy agents either alone or in combi-nation offer multiple therapeutic choices forpatients with advanced NSCLC. Targeted therapyrefers to medications used to selectively targetmolecular pathways responsible for or substan-tially contribute for malignant behavior of cells.Currently approved targeted agents includeEGFR inhibitors (erlotinib, gefitinib, afatinibcetuximab), vascular endothelial growth factorinhibitors (bevacizuman) and inhibitor of EML4-ALK (crizotinib).

Chemotherapy alone or combined with radiation is the usual treatment of choice forsmall cell lung cancer depending on the stageof disease.



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RECENT DEVELOPMENTS

Science is advancing in all aspects of lung cancerfrom diagnosis to treatment. Research on ways tohelp people quit smoking as well genetics ofsmoking behavior are ongoing. Various regulato-ry measures to discourage smoking are beingadopted. Newer diagnostic modalities such asVirtual bronchoscopy and Fluorescence bron-choscopy may offer advantages in some clinicalsituations. New molecular diagnostics are beingdeveloped. Lung cancer screening using LDCTscan is increasingly being adopted for high riskindividuals.

Newer surgical techniques include minimallyinvasive video assisted thoracoscopic surgery androbotic-assisted surgery. Discovery of EGFR andother driver mutations has resulted in develop-ment of treatments against specific molecularpathways. New genetic and molecular tests toidentify best treatment options and predictresponse of treatment are being developed.

Rapidly expanding knowledge on genetic andmolecular biology of cancer have revealed multi-ple molecular subsets of cancer and new potentialtherapeutic targets. This has also resulted in shiftin the design of oncology treatment trials. In"basket studies", effect of a drug is tested on asingle driver mutation in a variety of cancertypes. Umbrella studies are designed to test theeffect of different drugs on different mutations ina single type of cancer. Research is also underwayin other fronts including developing new targetedtherapies, new combinations as well as vaccineand immune based treatments.

LUNG CANCER STATISTICS AT EPHRATA CANCER CENTER

In the time period of 2008 to 2012, there were atotal of 214 new cases of lung cancer representing11 % of all cases. In 2012, there were 40 new casesof lung cancer representing 10.6% of all new casesin 2012. In 2012, majority of lung cancers werediagnosed in advanced stages IIIb or stage IVtogether accounting for 67% of cases. This is simi-lar to 5 year data from 2008 to 2012 where collec-tively Stages IIIb and IV accounted for 61.47% ofall lung cancer cases.

In 2012, adenocarcinoma continued to be thepredominant histology accounting for 35% ofcases. Small cell carcinoma accounted for 20%and squamous cell carcinoma accounting for17.5%. Histologic distribution in 2012 was similarto the five year average from 2008 to 2012.Overall, lung cancer statistics are similar toregional and national trends.

Ephrata Community Hospital Cancer Programoffers a comprehensive array of services for lung cancer. This includes state-of-the-art endo-bronchial ultrasound, PET scan, video assistedthoracoscopic surgery, a range of genetic andmolecular testing, modern chemotherapy, targetedtherapy based on genetic mutation testing, intensity modulated radiation therapy, geneticcounseling, financial, psychosocial and smokingcessation counseling.

Nurse navigator service is available to help fromdiagnosis through treatment. Low dose CT scanfor lung cancer screening is available at Wellspancancer program. Eligible patients may participatein any of the several research clinical trials avail-able.



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References:SEER Cancer Statistics Factsheets: Lung andBronchus Cancer. National Cancer Institute.Bethesda, MD,http://seer.cancer.gov/statfacts/html/lungb.html

American Cancer Society,http://www.cancer.org/index

American College of Chest Physicians,http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/More-Guidelines

UpToDate, http://www.uptodate.com

Giridahar Adiga, M.D.


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To support our patients, community volunteers and organizations provide hand-knitted scarves, hats, shawls and other items free of charge. The CancerProgram is grateful for all the support!

2013 ephrata cancer program annual report ephrata cancer program annual report with statistical data...

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