2015 annual report lafortune cancer center st. john health ... · st . john’s palliative care...

2015 ANNUAL REPORT

LaFortune Cancer CenterSt. John Health System

S T . J O H N L A F O R T U N E C A N C E R C E N T E R | 2 0 1 5 A N N U A L R E P O R T

TABLE OF CONTENTS

Mission, Vision and Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Report from the Cancer Committee Chairman . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Cancer Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Cancer Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Primary Site Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Cancer Census Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Prevention and Screening Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Studies of Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Annual Community Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12


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MISSION, VISION AND VALUES

MissionRooted in the loving ministry of Jesus as healer, we commit ourselves to serving all people, with special attention to those who are poor and vulnerable . Our Catholic health ministry is dedicated to spiritually centered, holistic care that sustains and improves the health of individuals and communities . We are advocates for a compassionate and just society through our actions and words .

VisionWe envision a strong and vibrant Catholic health ministry in the U .S ., which will lead to the transformation of health care . We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle . We will expand the role of the laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future .

ValuesWe are called to:• Service of the poor: generosity of spirit, especially for those most in need• Reverence: respect and compassion for the dignity and diversity of life• Integrity: inspiration of trust through personal leadership• Wisdom: integration of excellence and stewardship• Creativity: courageous innovation• Dedication: affirmation of the hope and joy of our ministry


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CANCER COMMITTEE CHAIRMANIt is my privilege to review the activities and events of the cancer program at St . John Medical Center for 2015 . The year 2015 continued to witness the progressive growth of cancer care and its related activities . Also quite noteworthy were the beginnings of a massive restructuring of the cancer care delivery models at St . John . The relationship between St . John and MD Anderson Cancer Center, as a member of MD Anderson Cancer Network®, a program of MD Anderson Cancer Center, continued to evolve and expand .

All surgical oncology caseloads continued to grow in 2015 . This included breast, colon, rectal, prostate and gynecologic surgery . With the addition of a fellowship-trained brain tumor surgeon, surgery for that disease grew at a rapid pace . Our dedicated oncology floor, 14 West, continued its focus as the nexus for inpatient cancer care at St . John Medical Center . Our 28-bed unit provides cancer care to not only cancer patients, but also general medical patients as oncology treatment continues to evolve, and our multidisciplinary team follows OCN standards . Radiation oncology continued with strong volumes in all areas, including the expanded the use of the CyberKnife Center for the post-operative adjunctive treatment of brain tumors . An additional trend has been the increase in total number of transfers to St . John, with a proportion of those cases consisting of oncology diagnoses .

The 2015 cancer symposium focused on the management of brain tumors and featured internationally known faculty and esteemed local experts . It was well-attended and continued to expand the reputation of both the LaFortune Cancer Center and St . John Neuroscience Institute .

As mentioned previously, the relationship between St . John Medical Center and MD Anderson as an affiliate site expanded greatly during 2015. This included ongoing treatment concordance studies that served as templates for performance improvement . Every Tuesday morning, an interactive tumor conference connects MD Anderson with its certified members, which allows for direct dialogue with MD Anderson experts and network medical, radiologic and surgical oncologists . Discussions were initiated to construct data interchange pathways to stream line quality assessment and performance improvement activities .

St . John’s palliative care program showed growth in 2015 in both the interdisciplinary team and patient contacts. Staffing increased from one board-certified palliative medicine physician and one nurse to two board-certified physicians, one advanced practice nurse, two nurses and a social worker, all dedicated to full-time palliative care services . We also expanded our multidisciplinary team, which included the previously mentioned positions as well as nutrition, pharmacy, hospice and pastoral care . We also expanded to include a physical therapist from the STAR (Survivorship Training and Rehabilitation) Program . We worked closely with the oncology rehab program at St. John to identify patients who would benefit from this important service. We moved our offices adjacent to the oncology unit and have been working closely with the oncology nurses in education regarding basic palliative measures for oncology patients and helping the team identify appropriate patients .

For the first time at St. John, we now offer outpatient palliative care by embedding in specialty clinics to provide supportive care for patients who are actively seeking curative measures, and we now offer home visits with the addition of our nurse practitioner . We have been able to be more actively involved with our patients who are imminently dying in the hospital, providing an

John Forrest, MD, FACS


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additional layer of support for patients and their families as well as nursing staff and physicians . Our palliative care physicians have continued to serve as medical directors for St . John Hospice to continue a continuum of care for our patients who are no longer seeking or no longer eligible for curative therapies . All team members have been focused on staff education and promoting awareness that palliative care is not just about end of life but actually about improved quality of life to work synergistically with the other treating physicians .

Regarding oncology clinical research, the St . John Health System Institutional Review Board (IRB) meets twice a month to review clinical research trials . The IRB incorporates active and passionate members comprised of facility members, physicians, nurses and community members . Dr . Coty Ho and Dr . Robert Gilbert serve on the IRB to support expert evaluation of medical and radiation oncology studies submitted for IRB review . The foundation of the IRB is guided by the core values of service, presence, human dignity and wisdom, with commitment to the mission of service and day-to-day interactions with those who serve and are served .

St . John has centralized research resources and coordinates and conducts clinical trials by providing investigators with an efficient infrastructure, committed research staff and operational expertise . The St . John Clinical Research Center has full-time nurse coordinators and research nurses with 100 percent of their time dedicated to clinical trials. The clinical staff is specifically trained to perform research procedures and collect data as mandated by study protocol and federal, state and local regulations and guidelines . The Clinical Research Center and LaFortune Cancer Center have a designated oncology pharmacist, Matt Taliaferro, PharmD . Mr . Taliaferro has completed human subject protection and CITI training and is registered through the Cancer Trials Support Unit as the designated investigational pharmacist for the LaFortune Cancer Center . John Morelli, MD, is CITI-trained and registered through the Cancer Trials Support Unit as the lead diagnostic radiologist for LaFortune Cancer Center . Dr . Morelli is a resource for measuring RECIST criteria for tumor response to protocol treatment . Clinical researchers, physicians, nurse coordinators and nurses are registered through CTSU and complete human subject protection training annually .

The LaFortune Cancer Center participates in clinical research trials by the National Institutes of Health’s National Cancer Institute through CTSU affiliation. The LaFortune Cancer Center is a main member of the Alliance Cooperative Group . In addition, the LaFortune Cancer Center is an affiliate member in partnership to MD Anderson for the NRG Oncology Group. Active and long-term follow-up clinical trials at the LaFortune Cancer Center include ones with the Eastern Cooperative Oncology Group, National Surgical Adjuvant Breast & Bowel Project and Radiation Therapy Oncology Group, affording access via the Main Cooperative Groups through the CTSU affiliation. In addition to cooperative group clinical trials, the LaFortune Cancer Center is engaged with industry clinical trials partnering with leading pharmaceutical companies to conduct clinical trials . The LaFortune Cancer Center also provides active referrals for participants to clinical trials through the MD Anderson Clinical Research Network, Mayo Clinic and Baylor Medical Center .

St . John Health System and the LaFortune Cancer Center afford multiple institutional resources to conduct high-quality, multidisciplinary cancer control, prevention and treatment trials throughout our comprehensive oncology program for our patients . The LaFortune Cancer Center’s robust network allows our oncology patients to stay home and maintain active lifestyles supported by their family, friends and community . Engagement in clinical trials provides our oncology patients with access to potential advanced treatment options . The Alliance Cooperative Group network provides an immeasurable multidisciplinary clinical trial support system to our oncology patients .


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At the end of November 2015, a letter of intent was signed by St . John Medical Center and Tulsa Cancer Institute to enter into a joint venture that would combine the cancer expertise, providers and volumes of cancer care into a new entity that would be the vehicle for the provision of cancer care to St . John Health System and the State of Oklahoma . Next year’s report will highlight those changes .

Sincerely,

John Forrest, MD, FACS 2015 Cancer Committee Chairman Chief Medical Officer St . John Medical Center


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CANCER COMMITTEEThe St . John Cancer Committee is composed of representatives from a variety of medical disciplines and support services involved with the care of cancer patients . The committee met 10 times in 2015 under the leadership of the chairman, John Forrest, MD, chief medical officer at St. John Medical Center .

The committee is concerned with the entire spectrum of care for cancer patients seen at St . John Medical Center . Committee responsibilities include:

• Developing and evaluating annual goals and objectives for the clinical, educational and programmatic activities related to cancer .

• Promoting a coordinated, multidisciplinary approach to patient management .

• Ensuring educational and consultative cancer conferences cover all major sites and related issues .

• Ensuring an active supportive care system is in place for patients, families and staff .

• Monitoring quality management and improvement through completion of quality management studies that focus on access to care and outcomes .

• Promoting clinical research .

• Supervising the Cancer Registry and ensuring accurate and timely abstracting, staging and follow-up reporting .

• Performing quality control of registry data .

• Encouraging data usage and regular reporting by planning and conducting a minimum of two patient care evaluation studies annually, one to include survival and comparison data, if available .

• Ensuring content of the annual report meets requirements .

• Upholding medical ethical standards .

COMMITTEE MEMBERSJohn Forrest, MD, FACS . . . . . . . . . Surgical Oncology/Cancer

Committee Chairman

Phil Ames . . . . . . . . . . . . . . . . . . . . . . Administration, LaFortune Cancer Center

Amy Arnold, RN . . . . . . . . . . . . . . . . Inpatient Oncology Nursing

Kanwaljit Aulakh, MD . . . . . . . . . . . Pathology/Cancer Liaison Physician

Candida Barlow, RN . . . . . . . . . . . . . Clinical Research

Kelly Berry, MPT . . . . . . . . . . . . . . . . Outpatient Rehabilitation

Dedee Boss, CPMSM . . . . . . . . . . . . . Medical Staff Services

Brenda Frank, RN . . . . . . . . . . . . . . . Hospice

Joyce George, RN . . . . . . . . . . . . . . . . Medical Records and Admissions

Coty Ho, MD . . . . . . . . . . . . . . . . . . . Hematology/Oncology/Cancer Liaison Physician

Jodi Hudson . . . . . . . . . . . . . . . . . . . . American Cancer Society

Julie Kinzie, LCSW . . . . . . . . . . . . . . Social Services

Carol Lane, CTR . . . . . . . . . . . . . . . . Cancer Registry

Donna Longfield, RN . . . . . . . . . . . . . Radiology Nursing

Jack Mocnik Jr ., MD . . . . . . . . . . . . . Radiology

Denise Rable, MD/Cole Davis, MD . Surgery

JoAnn Rushenberg, RN . . . . . . . . . . Quality Assurance

Natalie Sanders, MS, RD, LD . . . . . Healthy Lifestyles

Douglas Schram, MD/ John Hendrix, MD . . . . . . . . . . . . . . . Palliative Care

Kathy Smarinsky . . . . . . . . . . . . . . . . Administration, St. John Medical Center

Matt Taliaferro, PharmD . . . . . . . . . Pharmacy

Kimberly Will . . . . . . . . . . . . . . . . . . . Community Relations

Frederick Willison, MD . . . . . . . . . . . Radiation Oncology/Cancer Conference Coordinator


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14

17

8

9

3

61

35

55

13

138

83

17

30

2

2

2

2

36

1090

20

54

50

21

25

3

2

1

1

137

6

1

11

106

3

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CANCER REGISTRYThe St . John Cancer Registry maintains a complete database of all cancer cases diagnosed and/or treated through St . John Health System . More than 28,898 cases have been accessioned since the registry’s reference date of 2000. In addition, 14,226 non-analytic cases have been registered . Three full-time cancer registrars and one follow-up secretary are responsible for collecting and maintaining complete and accurate data, including annual follow-up information for all cancer patients diagnosed and/or treated at St . John .

During 2015, the cancer registrars:• Abstracted 2,028 cases into the database .

• Abstracted the required 90 percent within a six-month time frame .

• Registered 1,380 non-reportable cases .

• Completed follow-up on 90 percent of the 14,488 cases under review.

• Reviewed and re-abstracted 10 percent of 2015’s accessioned cases .

• Prepared for the weekly Cancer Conference presentation .

• Prepared for the Cancer Committee .

• Prepared the annual report .

• Responded to 10 requests for studies or information from various departments, physicians and administrators .

ANALYTIC CASES BY COUNTYThere were 2,028 analytic cases diagnosed at St . John in 2015 . Of them, 1,981 were from Oklahoma, and 47 were from other states. The case totals for Oklahoma counties are shown below:

OTHER STATES

Kansas . . . . . . . . . . . .20Arkansas . . . . . . . . . .13Missouri . . . . . . . . . .10Florida . . . . . . . . . . . . .2Arizona . . . . . . . . . . . . .1Texas . . . . . . . . . . . . . . .1

Total . . . . . . . . . . . . . .47


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PRIMARY SITE TABLE Code Frequency Percent Cumulative Freq. Percent

TONGUE 1 9 0.4 9 0.4

TONGUE OTH 7 0.3 16 0.8PALATE 5 1 0.0 17 0.8MOUTH 6 3 0.1 20 1.0PAROTID GL 7 8 0.4 28 1.4TONSIL 9 6 0.3 34 1.7OROPHARYNX 10 4 0.2 38 1.9NASOPHARYNX 11 2 0.1 40 2.0ESOPHAGUS 15 15 0.7 55 2.7STOMACH 16 24 1.2 79 3.9SM INTESTINE 17 12 0.6 91 4.5COLON 18 92 4.5 183 9.0RECTOSIGMOID 19 22 1.1 205 10.1RECTUM 20 45 2.2 250 12.3ANUS 21 9 0.4 259 12.8LIVER 22 21 1.0 280 13.8GALLBLADDER 23 4 0.2 284 14.0BILIARY TR. 24 3 0.1 287 14.2PANCREAS 25 39 1.9 326 16.1DIGESTIVE 26 3 0.1 329 16.2NASAL CAVITY 30 1 0.0 330 16.3SINUS 31 1 0.0 331 16.3LARYNX 32 10 0.5 341 16.8LUNG 34 276 13.6 617 30.4THYMUS 37 1 0.0 618 30.5PLEURA-MED 38 3 0.0 621 30.6BONE 41 5 0.2 626 30.9BLOOD SYS 42 61 3.0 687 33.9SKIN 44 123 6.1 810 39.9PERITONEUM 48 5 0.2 815 40.2CONNECTIVE 49 9 0.4 824 40.6BREAST 50 413 20.4 1237 61.0VULVA 51 17 0.8 1254 61.8CERV UTERIUS 53 30 1.5 1284 63.3CORP UTERIS 54 83 4.1 1367 67.4UTERUS 55 13 0.6 1380 68.0OVARY 56 41 2.0 1421 70.1FEM GENIT 57 4 0.2 1425 70.3PROSTATE 61 92 4.5 1517 47.8TESTIS 62 14 0.7 1531 75.5KIDNEY 64 118 5.8 1649 81.3


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Mean = 47.77Standard error of mean = 0.39Frequency mode = 413Code = 50Standard deviation = 18.02

Code Frequency Percent Cumulative Freq. Percent

REN PELVIS 65 7 0.3 1656 81.7URETER 66 5 0.2 1661 81.9BLADDER 67 88 4.3 1749 86.2URINARY 68 2 0.1 1751 86.3EYE 69 2 0.1 1753 86.4MENINGES 70 34 1.7 1787 88.1BRAIN 71 41 2.0 1828 90.1CENT NERVE 72 27 1.3 1855 91.5THYROID 73 66 3.3 1921 94.7ADRENAL GL 74 1 0.0 1922 94.8ENDOCRINE 75 7 0.3 1929 95.1OTHER 76 1 0.0 1930 95.2LYMPH NODE 77 50 2.5 1980 97.6UNKNOWN 80 48 2.4 2028 100.0TOTAL 2028 100 2028 100


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CANCER CENSUS REPORTDuring 2015 St . John Medical Center was busy with the growth of the oncology program . The LaFortune Cancer Center continued to treat a wide variety of cancer diagnoses . The bulk of the cases were comprised of five major types of cancer: lung, breast, colorectal, skin and kidney. Newly diagnosed in 2015 were 276 cases of lung cancer, 413 cases of breast cancer, 159 cases of colorectal cancer, 123 cases of skin cancer, and 118 cases of kidney cancer .

Newly diagnosed cancers in Oklahoma continue to increase every year . In 2015, the state had 19,830 new cases .

.

Primary Sites for 2015

MaleLung . . . . . 143Colorectal . . 90Skin . . . . . . 76Kidney . . . . . 71Breast . . . . . . 2

Total . . . . . 382

CombinedColon . . . . . . 92Rectosigm . . 22Rectum . . . . 45Lung . . . . . 276 Skin . . . . . 123Breast . . . . 413Kidney . . . . 118

Total . . . 1,089

FemaleBreast . . . . 411Lung . . . . . 133Colorectal . . 69Kidney . . . . . 47Skin . . . . . . 47

Total . . . . . 707


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PREVENTION AND SCREENING PROGRAMSPrevention Programs

Cancer prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the change of developing cancer . In 2015, colorectal cancer brochures were distributed to around 100 participants at the St . John health fairs in Broken Arrow and Owasso . Skin cancer prevention information was distributed to about 25 participants at the St . John health fair in Broken Arrow . The information in the brochures discussed education and cancer risk awareness using the American Cancer Society’s evidence-based guidelines .

In 2015, at the St . John health fair in Owasso, smoking cessation materials were distributed to about 25 participants . This information was related to smoking/chewing tobacco cessation using the American Cancer Society’s evidence-based guidelines .

Screening Programs

Cancer screening programs apply screening guidelines to detect cancers at an early stage, which improves the likelihood of increased survival and decreased morbidity . In 2015, St . John Medical Center provided low-dose CT lung cancer screenings . Brochures were handed out to increase lung screening awareness . At the start of the screenings, a co-pay was not

charged . About 70 screenings were completed, and a number of lesions were identified. Patients were referred to appropriate physicians for any lesions found .

STUDIES OF QUALITY

The annual evaluation of cancer patient care provides a baseline to measure quality and an opportunity to correct or enhance care and quality outcomes . Quality improvement is a multidisciplinary effort and must include support and representation from all clinical, administrative and patient perspectives .

In 2015, St . John Medical Center reviewed the National Accreditation Program for Breast Centers (NAPBC) Standard 2 .19, which states “the evaluation and management of benign breast disease should follow nationally recognized guidelines, specifically the NCCN.” While benign breast disease is generally defined as “breast findings found on clinical breast examination deemed nonsuspicious by the examiner and/or a BIRADS category 1 or 2 on breast imaging,” this study/quality improvement was specific to clinically benign disease without atypia s/p biopsy on BIRADS category 4 or 5 — patients who now fall under the care of the St . John Breast Center nurse navigator .

In May 2015, 66 patients falling into the above category were evaluated . In June and July 2015, 151 patients in the above category received a handout and follow-up recommendations from a radiologist (i .e ., six-month US, six-month MRI, etc .) .


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ANNUAL COMMUNITY ACTIVITIESCelebrating the Art of Healing

The annual community event, sponsored by St . John Medical Center, the Leukemia & Lymphoma Society, Grace Hospice and Saint Francis Hospice, features professional speakers and breakout sessions to provide local cancer survivors with a day of learning, healing and fun . Celebrating the Art of Healing had 218 participants .

St. John Mini Relay for Life

The Mini Relay for Life is co-sponsored by the American Cancer Society (ACS) and St . John Medical Center . A reception took place in honor of survivors, allowing each to share his or her story with others . The event raised more than $5,500 for ACS and honored the LaFortune Cancer Center’s survivors . Seventy-seven survivors and caregivers participated in this annual event .

Komen Tulsa Race for the Cure

Every year St . John sponsors a breast cancer survivor team, paying for every survivor’s registration and supporting the yearly fundraiser for Susan G . Komen Tulsa . In 2015, 196 participated on the St . John Survivor Team along with 13 volunteers .

Cancer Symposium

St . John Medical Center annually hosts a free cancer symposium for health care professionals . The 2015 symposium, titled “Comprehensive Management of Brain Tumors,” had 90 attendees (a drastic increase from 58 the previous year) and featured special guest speakers from The University of Texas MD Anderson Cancer Center .

Cancer Policy Forum

St . John Health System hosted and helped plan the American Cancer Society Cancer Action Network’s first cancer policy forum in

Oklahoma . Free and open to the public, the forum featured remarks from legislative and health care leaders and allowed for discussions on initiatives for colorectal cancer screenings, preventing and reducing tobacco use, the risks of tanning and more . About 35 people attended this inaugural event .

Holiday Heart & Hope

A yearly celebration for patients, families and caregivers, Holiday Heart & Hope is a day of fun, hope and therapeutic connections . Participants receive free chair massages, manicures, pictures with Santa Claus and lunch . The activities afford survivors the opportunity to celebrate and make important therapeutic connections with other survivors . In 2015, Holiday Heart & Hope had around 170 participants .

Additional services

Many St . John Medical Center patients receive additional services through the American Cancer Society . The number of patients served during the first six months of 2015 was 175, with 138 of those newly diagnosed . Services provided included:

• Look Good Feel Better workshops

• Guestroom

• Personal health manager

• Wigs and other head coverings

1923 S. Utica Ave.Tulsa, OK 74104

2015 annual report lafortune cancer center st. john health ... · st . john’s palliative care...

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