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2017 CANCER CONTROL ANNUAL REPORT

Academic Comprehensive Cancer ProgramAccredited by the American College of Surgeons Commission on Cancer

The American College of Surgeons has designated University Medical Center of Southern Nevada as an Academic Comprehensive Cancer Program and is currently the only program of its kind in the state of Nevada. This designation indicates that the hospital program has met very stringent requirements for the care of cancer patients. UMC Medical Staff Cancer Control Committee supervises the program.

The UMC Academic Comprehensive Cancer Program offers a full range of diagnostic and treatment capabilities for the patients who have been found to have one of the many forms of cancer.The staff of the Academic Comprehensive Cancer Program includes physicians with special interest, training, and abilities in the care of the cancer patient. Members of the UMC medical staff with special interests in oncology include internal medicine, obstetrics/gynecology, thoracic and cardiovascular surgery, general surgery, colorectal surgery, genitourinary surgery, neurosurgery, pediatrics, plastic surgery, radiology, and pathology.

The specially trained and experienced nursing staff is of vital importance in the management of the patient. The separate oncology nursing unit assures continuity of care for our patients to include rehabilitation, home health care, palliative and hospice care. An Oncology Nurse Navigator provides specialized assistance for the community, patients, families, and caregivers to assist in overcoming barriers to receiving care and facilitating timely access to clinical services and resources.

Treatment may require surgical care, radiation and/or chemotherapy/biotherapy administration for adults and pediatric patients. Radiation treatment is provided by an affiliation with the 21st Century Oncology Radiation Center. Radioactive Iodine therapy is provided for thyroid cancer patients needing inpatient services related to this type of cancer-directed therapy. The Nevada Cancer Research Foundation is one of 34 designated sites for the NCI Community Oncology Research Program (NCORP) which provides cancer patients with participation in clinical trials and supports the physicians in their care of the patient.

The Pharmacy Department plays an active role in the preparation of chemotherapy/biotherapy, pain control and assistance with research protocols. With their expertise, the pharmaceutical services ensure safe and accurate distribution of medications. Pharmacists are responsible for compliance with the American Society of Hospital Pharmacists and OSHA guidelines for chemotherapy/biotherapy preparation, handling, and dispensing of chemotherapeutic and biological agents.

Rehabilitation of patients is done with the assistance of the UMC Rehabilitation Center, the HOPE Chaplains and counseling programs at UMC and the American Cancer Society. The American Cancer Society (ACS) provides the Look Good Feel Better (LGFB) Program in the community. The LGFB program is free and teaches beauty techniques to women in active treatment to help them with appearance-related side effects of cancer treatment. A general Cancer Survivor Support Group is facilitated onsite at the Healthy Living Institute at UMC. A full-time Social Worker is available to oncology patients related to psychosocial needs.An enterostomal therapist is available to provide specialized care and treatment for patients with ostomies, skin problems, decubitus ulcers and draining wounds. Patients receive pre-and-post operative counseling, treatment and education.

Registered Dieticians are available to provide adequate nutritional support to patients receiving supplements, such as TPN or tube feedings, and to assist with planning special menus.The Cancer Control Committee supervises the Academic Comprehensive Cancer Program. Professional educational programs include CME activity and the UMC Tumor Board, which reviews cases and furnishes an annual review of cancer diagnosis and therapy. The committee is responsible for supervision of the cancer registry, participation in studies of the American College of Surgeons and the publishing of the Cancer Control Annual Report.

UMC | University Medical Center 3

Academic Comprehensive Cancer ProgramUMC Treatment and Diagnostic Programs

JOHN ELLERTON, M.D., C.M. MEDICAL ONCOLOGY/HEMATOLOGY CHAIRPERSONQUALITY IMPROVEMENT COORDINATORWYDELL WILLILAMS, M.D.SURGERYCANCER LIAISON PHYSICIANSURGICAL ONCOLOGISTONO, JILL, M.D., PATHOLOGIST CANCER CONFERENCE COORDINATORRONALD KNOBLOCK, M.D., PATHOLOGIST CANCER CONFERENCE COORDINATOR- ALTDIANE MAZZU, M.D., DIAGNOSTIC RADIOLOGISTASHOCK GUPTA, M.D., DIAGNOSTIC RADIOLOGISTIAN HAYCOCK, M.D. DIAGNOSTIC RADIOLOGIST – ALTPAUL TREADWELL, M.D.RADIATION ONCOLOGIST SCOTT LEADERPHARMD, HEMATOLOGY/ONCOLOGYJARED SPLINTERPHARMD, PHARMACIST – ALTDEBRA FOX, RNCHIEF NURSING OFFICERCANCER PROGRAM ADMINISTRATORMARGARET COVELLI, RNACNO CANCER PROGRAM ADMINISTRATOR ALT

2017 Cancer Control Committee Members

DORIS COWELL, RN, BSN, OCNONCOLOGY PROGRAM COORDINATORCOMMUNITY OUTREACH COORDINATORONCOLOGY CERTIFIED NURSESHANNON YULE, CCRPNEVADA CANCER RESEARCH FOUNDATION PROGRAM ADMINISTRATORCLINICAL RESEARCH REPRESENTATIVEDIANE SEGAFREDONEVADA CANCER RESEARCH FOUNDATIONCLINICAL RESEARCH REPRESENTATIVE - ALTROBYN SIMON, CTRCANCER REGISTRARCANCER REGISTRY QUALITY COORDINATORSALLY SABAN, RDDIRECTOR OF CLINICAL NUTRITIONBRUCE MACKIE, OTREHABILITATION SERVICES REPRESENTATIVEMARIA ZENQUIS, LSW ONCOLOGY SOCIAL WORKER PSYCHOSOCIAL SERVICES COORDINATORPAM NORCIA, LCSWDIRECTOR OF SOCIAL SERVICESERIKA GURNEEAMERICAN CANCER SOCIETY REPRESENTATIVEEMYLIA TERRYAMERICAN CANCER SOCIETY REPRESENTATIVE- ALT

UMC | University Medical Center4

MEDICALCME Program was held on May 12, 2017:A CME (1.0 AMA PRA Category 1 Credit) was provided for physicians, nurses, and other health care providers entitled CD-30 in Lymphoma: Increasingly Important Role in Testing and Targeting.Speaker: Christiane Querfeld, M.D. PhDDirector of Cutaneous Lymphoma ProgramAssistant Professor, Departments of Pathology, Hematology and DermatologyCity of Hope National Medical Center, Duarte, CA

EDUCATIONAL OBJECTIVES:At the conclusion of this activity, participants should be able to demonstrate the ability to:► Review the role of CD30 testing in the diagnosis of each of the subtypes of CD30-positive lymphomas.► Describe the role of the pathologist in diagnosing CD30-positive lymphomas and the tests used in CD30

determination.► Explain the utility of CD30-targeted antibody drug conjugates in treating CD30-positive lymphomas

based on the mechanism of action, efficacy, toxicities, and late-phase clinical trial results.

TARGET AUDIENCE: This activity is intended for community oncologists, pathologists, oncology nurses, and other health care professionals involved in the care of patients with lymphomas.

CREDIT DESIGNATION: The Potomac Center for Medical Education designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME program entitled Targeting the Immune System to Improve Patient Outcomes in Advanced NSCLC was held on June 30, 2017Presented by Taofeek K. Owonikoko, MD, PhD, MSCR Associate ProfessorGRA Distinguished Cancer ScientistCo-chair, Clinical and Translational Research CommitteeAssociate Director, Hematology/OncologyFellowship Training ProgramEmory University Winship Cancer Institute

EDUCATIONAL OBJECTIVES:At the conclusion of this activity, participants should be able to demonstrate the ability to:► Evaluate mechanisms of actions in immunotherapies in advanced NSCLC.► Assess emerging data for immune checkpoint inhibitors in advanced NSCLC.► Discuss the role of biomarkers for patient selection for immunotherapies.► Educate patients with NSCLC about promising immunotherapeutic agents and clinical trial

opportunities.

TARGET AUDIENCE This activity is intended for oncologists, pathologists, thoracic surgeons, pulmonologists, intervention radiologists, nurses, and other health care professionals involved in the care of patients with NSCLC.

CREDIT DESIGNATION The Potomac Center for Medical Education designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


2017 Program Activities - Professional Medical Education

NURSING:ONCOLOGY NURSING SYMPOSIUM – APRIL 22, 2017Greater Las Vegas Chapter Oncology Nursing Society 15th Annual Oncology Nursing Symposium Amy E. Pierre, BS, MSN, APN-BC presented Managing Relapsed/Refractory Myeloma in the Era of New Agents for TreatmentDebra L. Winkeljohn, MSN, RN, CNS, AOCN presented Incorporating CDK 4/6 Inhibitors in the Treatment of Estrogen Receptor-Positive Breast CancerBeth Faiman, PhD, MSN, APRN-BC, AOCN Multiple MyelomaMichelle McGrorey, BSN, RN, OCN, HTCP, CAChill Out!! Holistic Care For You and Your Patients4.0 CNE contact hours were awarded through this program.

Annual Nursing Chemotherapy/Biotherapy Certification Competency – June 2017

CNE Home Studies to include the following: Labs & Tests Pertinent to Cancer Patients; Oncology Nursing Overview; Oncologic Emergencies; Pain Management in the Cancer Patient; Oral Medications in the Treatment of Cancer and Non-Oncology Diagnoses

Acronym GlossaryACS American Cancer SocietyAJCC American Joint Commission on CancerNCORP NCI Community Oncology Research ProgramCME Continuing Medical EducationCNE Continuing Nursing EducationONS Oncology Nursing SocietyOSHA Occupational Safety and Health AssociationUMC University Medical Center

2017 Program Activities - Professional Medical Education


CoC Standard 4.6 Monitoring Compliance with Evidence-Based Guidelines The Use of Antiemetic Therapy for Oncology Patients Receiving Moderately to Highly Emetogenic-Related Cancer TherapyJohn Ellerton, M.D. Medical Oncologist

Nausea and vomiting are two common side effects of chemotherapy. Whether it be anticipatory, acute at the time of administration or delayed; the adequate control of nausea and vomiting benefits the patients in many ways and helps ensure the successful completion of therapeutic regimens.

Vomiting is a natural protective mechanism to rid the body of toxic substances. Nausea and vomiting are the most feared toxicity of chemotherapy and thus are of major concern.

Vomiting is a brainstem based reflex arc. The emetic center in the brainstem is the quarterback, organizing all the components of the vomiting response. Input is from many sources including the chemoreceptor zone, the vagus nerve and nerve endings in the GI tract are just a few. Interruption in the message, at the level of neurotransmitter receptors has been the major strategy to deal with the problem. To that end ASCO set out to categorize chemotherapy agents into high, intermediate and low emetogenic potential. For each category a recommended preventative strategy has been developed, leading to ASCO and NCCN guidelines for the prevention of nausea and vomiting. The treatment includes specific drugs plus adjunctive drugs such as Ativan (lorazepam).

UMC’s Cancer program undertook an analysis of patients receiving chemotherapy in 2017, to ensure that recognized and effective national guidelines were being followed. Patients were divided by the emetogenic potential of their therapy and the drugs used to control the nausea and vomiting were analyzed.

A majority of patients were in the high risk group. 80% of the antiemetic regimens met the national standard. 20% did not. The breakdown of patients by diagnosis were studied and illustrated in the graph provided in this study.

Of the 19 patients in the high-risk group whose therapy did not follow the national guideline, 8 did not get NK-1 receptor agonists. These drugs are important in preventing acute nausea and vomiting but are essential in preventing delayed nausea and vomiting — a particular problem with several drugs including cis-platinum. 11 did not receive corticosteroids, an important adjunctive drug in these patients.

The cancer program is still analyzing the difference in outcomes for the two groups of high-risk patients. This data is harder to come by, but we know that prevention works and is essential and that prevention effort should be maximized.

The next step is to remind physicians writing chemotherapy orders of the standards and to reinforce these standards with the oncology nursing staff. As well, the cancer program will review all the frequently used high-risk protocols in the electronic chemotherapy ordering system to ensure those protocols are current with the recommended standards. This effort will be part of the ongoing effort of the cancer program to provide the best patient care.

References:ASCO guidelines 2017NCCN Guidelines 2017


n = 31

n = 17

n = 9

n = 8

n = 8

n = 2

n = 6

n = 5

n = 4

n = 2

n = 2

n = 1

n = 1

n = 1

0 5 10 15 20 25 30 35

Lymphoma

Bone Marrow

Head & Neck

Gastrointestinal

Lung - NSCLC

Lung - SCLC

Breast

Testicular

Kaposi's

Primary Unknown

Bladder

Pancreas

Cervix

Soft Tissue Sarcoma

UMC 2016 Oncology Patients Given Chemotherapyby

Site/Histology

YES80%

NO20%

UMC 2016 ONCOLOGY PATIENTSby

APPROPRIATE ANTI-EMETIC GIVEN

n= 8 n= 9

n= 26

n= 54

Minimal Low Moderate High

UMC 2016 ONCOLOGY PATIENTSby

EMETOGENICITY RELATED TO CHEMO REGIMEN


The Cancer Registry at UMC is just one of the important parts of an American College of Surgeons approved Academic Cancer Program Hospital Cancer Program. The registry collects, manages, and analyzes data on patients who are diagnosed and/or treated with a malignancy or CNS Tumor at UMC. The Cancer Registry at UMC was established in 1979 and its reference year is 1995. There are approximately 15,345 cases in its database with 845 new cases accessioned into the registry in 2016 and approximately 6,600 patients followed annually. The registry’s primary goal is to assist the hospital in providing optimal care to the cancer patients. To ensure a credible database, the registry performs ongoing quality control checks through IOP (Improving Organizational Performance) improvement procedures on case finding for both pathology and Disease Index List sources of cases. The registry also maintains the quality of registry data with a review of 10% of analytical cases by Cancer Control Committee Member and also assists with review of a random 10% of the Pathology Reports eligible for CAP (College of American Pathologists) protocols. These findings are reported to the Cancer Control Committee on a quarterly basis. The Registry also participates in Special Studies required by the Commission on Cancer. They work closely with the Cancer Committee Chair, Cancer Liaison Physician and the Cancer Program Coordinator to assure the hospital maintains its approval with the American College of Surgeons. The Registrar annually attends the yearly Education Conference sponsored by the National Cancer Registrars Association (NCRA) and keeps all members of the Cancer Control Committee advised of changes to the CoC Standards that will impact the facility.

UMC CANCER REGISTRY Robyn Simon, CTR

5% 5%

10%

22%

31%

20%

6%

1%

0%

5%

10%

15%

20%

25%

30%

35%

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

UMC 2016 Analytic Malignanciesby

Age Range

1%

2%

4%

4%

4%

4%

5%

5%

6%

7%

8%

9%

14%

27%

Bones, Joints and Soft Tissue

Leukemia

Brain & Nervous System

Endocrine System

Other

Lymphoma

Male Genitalia

Oral Cavity & Pharynx

Urinary System

Breast

Female Genitalia

Skin

Respiratory System

Digestive System

UMC 2016 Analytic Malignanciesby Body System

63%

14%11%

8%

4%

White Hispanic Black Asian Other

UMC 2016 Analytic Malignanciesby Ethnicity

Male54%

Female46%

UMC 2016 Analytical Malignanciesby Gender


Not Insured7%

Insured, NOS15%

Private Insurance42%

Medicaid8%

Medicare28%

UMC 2016 Analytical Malignanciesby

Primary Pay Source

0%

20%

40%

60%

80%

100%

120%

1 Year 2 Years 3 Years 4 Years 5 Years

Percentageof

Patients

UMC 2012 Analytic Breast MalignanciesSurvival by AJCC Stage

Stage 0

Stage I

Stage II

Stage III

Stage IV

Stage 0 Stage I Stage II Stage III Stage IV UnknownUMC 9% 15% 26% 17% 28% 4%NCDB 21% 43% 24% 7% 4% 1%

0%

5%

10%

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AJCC Stage

2015 Analytic Breast Malignanciesby AJCC StageUMC vs NCDB

UMC NCDB


COMMUNITY NEEDS ASSESSMENT 2017 CoC Standard 1.8 Community Outreach Doris Cowell, BSN, RN, OCN Clinical Supervisor Oncology Program

INTRODUCTIONIn an effort to provide a cancer prevention and screening program at UMCSN (University Medical Center of Southern Nevada), a community needs assessment had been completed for 2017. The Nevada Cancer Coalition, American Cancer Society and UMCSN Tumor Registry department were the main resources for gathering data related to the needs of the community. The Nevada Cancer Coalition is a non-profit collaboration of state and local government, health, medical, and business leaders, researchers, cancer survivors, caregivers, and advocates in Nevada. The Coalition works in partnership with the State of Nevada Comprehensive Cancer Control Program to develop, implement and manage the plan. Thus, the Nevada State Cancer Plan had been developed for the years 2016-2020.

NEVADA DEMOGRAPHICSWith Nevada being the 7th largest state geographically, it is among the fastest growing state in the United States. The population has increased by 12.96 percent between 2006 and 2015 for a total of 2.8 million residents in 2015. There are 17 counties with only 3 of them (Clark, Washoe, and the state capital, Carson City) as urban. The other 14 counties are rural or frontier that equates to pronounced geographic disparities. The average distance between acute care facilities in rural Nevada is 115 miles.

The United States Census Bureau (2013) identifies the greatest percentage of Nevadans as white (52.2%), followed by Hispanic (27.5%), Black (9.0%), Asian (8.1%), and Pacific Islander (0.7%).

CANCER BURDEN IN NEVADAAccording to the American Cancer Society, Cancer Facts & Figures 2017, the number of estimated new cancer cases in the United States for all sites and in both sexes is 1,688,780 and an estimated 609,920 cases of cancer death will occur. When looking at the estimated incidence and deaths associated with cancer in the United States, lung and colon cancers show a higher mortality rate than breast cancer for both sexes. New cases of lung cancer are estimated at 222,500 for both sexes and 155,870 cancer deaths are estimated for 2017. Men show a slightly higher incidence of cancer death (n = 84,590) than women (n = 71,280) for lung cancer. With colon cancer, the estimated number of new cases is 95,520 for both sexes and slightly higher incidence for women (n= 47,820) than men (n = 47,700). The estimated number of cancer deaths from colon cancer is 50,260. However, there is a higher estimated number of colon cancer deaths for men (n = 27,150) than women (n = 23,110).

In the state of Nevada, the estimated number of cancer cases is 13,840 for all sites. Lung cancer is the second highest estimated rate of cancer (n = 1,680) and estimated to be the highest incidence of cancer death (n = 1,400). Next to breast cancer, colorectal cancer is estimated at 1,160 cases and estimated at 500 cases for colorectal cancer deaths.

CANCER PROFILESLung cancer is the leading cause of cancer death among men and women in Nevada and is the top site at University Medical Center of Southern Nevada. According to the Nevada Comprehensive Cancer Report, January 2015, smoking causes 90% of lung cancer cases, either through smoking directly or through second-hand smoke. This makes lung cancer preventable in many cases. In Nevada, 19.4% of adults have been identified as smokers, compared to 19% nationwide.

In Nevada more cases of colorectal cancer are diagnosed as late-stage, 59.6 percent, versus early stage, 40.4 percent. Whereas, national statistics show a rate of 39.5 percent for early stage colon cancers and 56 percent as a late stage disease at diagnosis (Nevada Comprehensive Cancer Control Program, 2016-2020).


COMMUNITY NEEDS ASSESSMENT 2017 CoC Standard 1.8 Community Outreach

Doris Cowell, BSN, RN, OCN Clinical Supervisor Oncology Program

COMMUNITY OUTREACH PREVENTION AND SCREENING PROGRAMSWith breast cancer being one of the top 5 sites at UMCSN and according to the American Cancer Society, an estimated 2,010 new cases of breast cancer are expected with 380 cancer deaths related to breast cancer in 2017, cancer committee had decided to provide education related to the current ACS breast cancer screening guidelines. A pre and post test will serve as a measurement of success for this prevention program (CoC Standard 4.1).

Since colon cancer has been estimated to cause more cancer deaths in both men and women and considered the second-leading cause of cancer deaths (Nevada State Cancer Plan 2016-2020) and in response to a colon cancer screening initiative identified through the National Colorectal Cancer Roundtable initiative to put forth a national effort to screen 80% of adults age 50 and older regularly for colon cancer by 2018, cancer committee at UMCSN had decided to include colon cancer screening as a goal for CoC Standard 4.2. Colon cancer screening will be provided through FIT Testing and/or colonoscopy.

Because lung cancer accounts for more deaths than any other cancer in men and women, and presents with advanced stage disease at UMCSN (64% of lung cancer cases in 2016), cancer committee decided to set a prevention goal (CoC Standard 4.1) related to smoking cessation and a screening goal (CoC Standard 4.2) to provide LD-CT scans for high-risk groups according the US Preventive Services Task Force guidelines. In 2015, the S.P.O.T.S. (Screening Pulmonary Oncologic Tumor Services) Program was developed and implemented. It is a lung cancer screening program established by University Medical Center of Southern Nevada (UMC) and University of Nevada School of Medicine (UNSOM). The program offers Low Dose CT Scans to patients at high risk for lung cancer. Patients who undergo screening are followed by a multi-disciplinary team of physicians with the benefit of expedited referrals, decreased time to therapy and coordinated treatment.

Once a patient is referred to the S.P.O.T.S. program, he or she may be scheduled for a Low Dose CT Scan at UMCSN’s Radiology Department. The goal is to look for any lung nodules or abnormalities that may suggest the presence of cancer. If the screening is positive, the patient will be evaluated in clinic by a pulmonologist and the patient may be sent for further testing. If the screening is negative, the patient will be scheduled to undergo annual Low Dose CT Scan. Patients are followed by a nurse navigator who coordinates screening/diagnostics in collaboration with UNSOM clinic staff. All appropriate patients in the S.P.O.T.S. program are also referred to a smoking cessation program.

REFERENCES:Data Source: Preliminary data, Nevada Comprehensive Cancer Report, January 2015, Office of Public Health Informat-ics and Epidemiology.

State of Nevada Comprehensive Cancer Control Plan 2016-2020 and is funded by the Division of Public Behavioral Health through grant number CDC DP12-1205 from the Centers for Disease Control and Prevention.

American Cancer Society, Cancer Facts & Figures 2017.


The Nevada Cancer Research Foundation – NCI Community Oncology Research Program (NCRF NCORP) is a non-profit, clinical trials oncology program that has been funded since 1983 by various grants from the Division of Cancer Prevention, National Cancer Institute (NCI). The mission of the NCI-supported NCORP Network is to develop and conduct state-of-the-art cancer prevention, control, and treatment clinical trials with significant involvement of community oncologists and populations they serve. The NCORP Network mission includes: (1) accelerating development of interventions to prevent and treat cancer and its symptoms by increasing accrual to trials; (2) fostering quality care in the community through adoption of results from clinical trials; and (3) increasing the involvement of minority and underserved patient/participant populations in cancer clinical trails.

The NCRF NCORP is fortunate that University Medical Center of Southern Nevada (UMC) has been affiliated with the NCRF since 1983. To assist the NCRF, UMC provides a regulatory umbrella for studies that are conducted at UMC. In addition, the UMC Institutional Review Board reviews Non - NCI CIRB approved studies so that these studies are available for patients being treated in local oncologists’ and radiation oncologists’ offices.

These clinical trials are available to the patients because UMC is a member of NCI Clinical Trials Networks through its affiliation with the NCRF NCORP. These networks serve as “research bases” for the NCRF NCORP and provide a portfolio of clinical trials from which the NCRF NCORP and UMC are able to choose studies that best fit the patient population. The national Networks which UMC is affiliated with via the NCRF NCORP include: Alliance, COG, ECOG-ACRIN, NRG, SWOG, the University of Rochester Cancer Center and Wake Forest. There are approximately 40 studies that are active currently and many more studies that are closed to new patient enrollment but the NCRF NCORP and UMC continue to collect data on these patients. This collaboration will continue for many years as each study has a unique period of time where the patient is followed after active treatment. This may range from a few months to the lifetime of the patient.

In 2008, UMC became a member of the Children’s Oncology Group (COG). The UMC now has 4 pediatric oncology studies available for children with leukemia which include correlative science and quality of life studies.

UMC has been instrumental in the success of the NCRF NCORP program due to the support and commitment of the UMC administration, as well as the medical and nursing staff of the Pediatric and Oncology Units.

For more information on the Nevada Cancer Research Foundation NCI Community Oncology Research Program, telephone (702) 384-0013.


The Nevada Cancer Research Foundation NCICommunity Oncology Research Program Shannon Yule, CRA NCORP Program Administrator

REVIEW OF CANCER PROFILESAccording to the American Cancer Society and the Nevada Cancer Coalition, lung cancer is the leading cause of cancer death among men and women in Nevada and is the top site at University Medical Center of Southern Nevada (UMCSN). Colon cancer is the second leading cause of cancer death among men and the third leading cause of cancer death in women. Along these lines, the estimated number of breast cancer cases in Nevada = 2,010, making it the number one top site in the state. According to the Nevada Comprehensive Cancer Report, January 2015, smoking causes 90% of lung cancer cases, either through smoking directly or through second-hand smoke. This makes lung cancer preventable in many cases. In Nevada, 19.4% of adults have been identified as smokers, compared to 19% nationwide.

With lung cancer accounting for more deaths than any other cancer in men and women, cancer committee at UMCSN decided to set a prevention goal (CoC Standard 4.1) related to smoking cessation and a screening goal (CoC Standard 4.2) to provide LD-CT scans for high-risk lung cancer groups according the US Preventive Services Task Force guidelines.

DATA RELATED TO CANCER PREVENTION (COC STANDARD 4.1) AND SCREENING PROGRAMS (COC STANDARD 4.2)PREVENTION PROGRAMSAs previously mentioned in the Community Outreach Needs Assessment for 2017, cancer prevention goals (CoC Standard 4.1) included education related to ACS breast cancer screening guidelines and continued smoking cessation efforts for patients through the S.P.O.T.S. program.During Breast Cancer Awareness month, UMCSN held educational sessions for 200 female participants who were asked questions regarding the American Cancer Society breast cancer screening guidelines. 99% of women did not know the age of which to begin screening and how often to get screened with mammography based upon age and risk factors for breast cancer. 100% of women did not know about the BRCA gene mutation and tools to assess lifetime risks for breast cancer. After presenting ACS information related breast cancer screening guidelines, 95% of women were able to verbalize the guidelines. 85% of eligible women stated they were receiving annual mammograms and yearly checkups. 10% of eligible women stated they were overdue for their annual mammogram and would follow up with appointments.

When looking at the number of patients through the lung cancer screening program who were smokers in 2016, a small percentage (25%) of patients stated they would be interested in quitting. Most people who try to quit are not successful. This led to a prevention goal for smoking cessation in 2017 in an effort to help smokers be successful in quitting.

The UMCSN Healthy Living Institute had started to provide smoking cessation programs according to the American Lung Association. However, a minimum number of people (four) were required to sign up for the classes. The first class was scheduled in August 2017. There was not enough interest in the first smoking cessation class, so a subsequent class was scheduled in 2017. Oncology in-patients that were current smokers were given a flyer and highly encouraged to quit smoking after educating the patient on the benefits of smoking cessation. Patients coming through the S.P.O.T.S. program who were current smokers, were counseled on smoking cessation by the pulmonologist and directed to the UMCSN smoking cessation program for those interested in quitting. The smoking cessation classes had to be cancelled due to lack of interest in signing up for the program. The next class will be scheduled in early 2018. Advertisement for the UMCSN smoking cessation program has been increased throughout the hospital and on the UMCSN website and Intranet towards the end of the 4th quarter of 2017.

COMMUNITY OUTREACH SUMMARY 2017 CoC Standard 1.8 Community Outreach Doris Cowell, BSN, RN, OCN Clinical Supervisor Oncology Program


SMOKING CESSATION THROUGH THE S.P.O.T.S. PROGRAM:Number of patients seen in the S.P.O.T.S. program = 57Number of current smokers = 10 Number of current smokers who received smoking cessation counseling = 10Number of current smokers who quit smoking = 2

SCREENING PROGRAMSSince colon cancer had been estimated to cause more cancer deaths in both men and women and considered the second-leading cause of cancer deaths (Nevada State Cancer Plan 2016-2020), cancer committee at UMCSN had decided to include colon cancer screening as a goal for CoC Standard 4.2. The Community Outreach Cancer Screening Committee had identified challenges in obtaining FIT Kits as a method for providing early detection of colon cancer. However, screening colonoscopies were performed through UMCSN as a method of early detection of colon cancer. A total of 105 screening colonoscopies were performed through the prevention program in 2017.

Number/percentage of adenomatous polyps = 59 (56%)Number/percentage of hyperplastic polyps = 25 (24%) Number/percentage of carcinomas = 2 (2%) age 89 Male and age 57 FemaleAge ranges of patients with adenomatous polyps = ages 50-59 (24%), ages 60-69 (22%), ages 70-79 (9%) ages 80+ (2%)Age ranges of patients with hyperplastic polys = ages 40-49 (1%), ages 50-59 (8%), ages 60-69 (11%), ages 70-79 (5%), Ages ranges of negative colonoscopies = ages 40-49 (1%), ages 50-59 (6%), ages 60-69 (4%), ages 70-79 (3%), ages 80+ (2%)Insurance types = Medicare (22%), Medicaid (11%), HMO/PPO (26%), VA (24%), and Private (17%)Gender: Male (64%) Female (36%)The S.P.O.T.S. lung cancer screening program had been developed in collaboration with the University of Nevada School of Medicine (UNSOM). However, in the summer of 2017, the University of Nevada Las Vegas School of Medicine had assumed the S.P.O.T.S. program in collaboration with UMCSN. The same program offers Low Dose CT Scans to patients at high risk for lung cancer. Patients who undergo screening are followed by a multi-disciplinary team of physicians with the benefit of expedited referrals, decreased time to therapy and coordinated treatment.Analysis of the numbers and types of cancer diagnoses through the lung cancer screening program are as follows:Number of LD-CT scans for high risk pts = 23Number of patients referred from Primary Care Facilities = 19Number of patient referred from the Emergency Dept. with incidental nodules = 176Number of patients that were considered high risk according to the US Preventive Services Taskforce guidelines = 57Number of patients seen in lung cancer screening clinic = 185Number of cancer diagnoses (total 42):NSCLC = 36SCLC= 6Stage IV = 54% of lung cancer casesAll patients had follow up care with the oncologist and radiation oncologist through the lung cancer screening program. Palliative care services were provided as needed.



CHALLENGES: Since the smoking cessation program at UMCSN is associated with the American Lung Association, there is a minimum number of people (four) required to sign up for the class in order to conduct it. This has been seen as a barrier to having a couple of interested people who could benefit from the program. In addition, the program is an 8-week process and has been shown to be a challenge for some people to commit to the amount of time it takes to complete the program. An additional challenge was related to FIT testing with coordination of obtaining FIT kits in a timely manner to provide colon cancer screening through this method in 2017.

EFFECTIVENESS OF PREVENTION AND SCREENING PROGRAMS:PREVENTION:As stated previously, under the above section Data Related to Cancer Prevention, education related to ACS breast cancer screening guidelines was successful in women identifying when to begin screening and what risk factors would exist for considering earlier screening for breast cancer in women at higher risk for breast cancer. When analyzing the effectiveness of the smoking cessation program for current smokers, the number of people who have been counseled on smoking cessation and quit smoking is a low percentage (20%). However, there was an increase from 12% in 2016 to 20% increase in 2017 in the percentage of people who were successful in smoking cessation.

SCREENING:In analyzing the effectiveness of the colon cancer screening program, the FIT Kits posed a challenge to the overall efforts to screening for colon cancer through an early detection method. However, the program was successful in providing 105 screening colonoscopies as one of the most effective methods of prevention and early detection of colon cancer. Results of the screening colonoscopies revealed two positive cancer diagnoses and fifty-nine (59) cases of adenomatous polyps with all patients receiving follow up care. When considering most colon cancers develop from an adenoma, it behooves people at general risk for colon cancer to be screened. For people who may not consider colonoscopy as a method of screening for colon cancer, limitations to the program did not provide another method of testing for early detection of colon cancer as seen in FIT testing.

When analyzing the effectiveness of the lung cancer screening program, we have found more patients with late stage disease in 2017. When comparing the percentage of lung cancer diagnoses as a primary site in 2016 (74%), there were more primary lung cancer diagnoses in 2017 (100%). Of those patients diagnosed with lung cancer in 2017, 7% were considered to have an earlier Stage of disease (Stage I).

RECOMMENDATIONS FROM CANCER COMMITTEE:

► The Community Outreach Coordinator will work with the community outreach team at UMC to obtain the FIT kits and coordinate the testing and follow up care as an extension of the colon cancer screening program.

► Community Outreach Coordinator to follow up with the UMCSN Healthy Living Institute regarding the status of providing smoking cessation through the American Lung Association Smoking Cessation program.

► Community Outreach Coordinator to continue meeting with the UMC Community Outreach Cancer Prevention and Screening Committee in developing prevention and screening programs based on the needs of the community for 2018.



ACTIONS:Under the direction of cancer committee, the Community Outreach Coordinator will follow up with recommendations from cancer committee and coordinate subcommittee meetings related to cancer prevention and screening in an effort to provide community outreach programs that are multidisciplinary and outreaching in the community for 2018.

REFERENCES:Data Source: Preliminary data, Nevada Comprehensive Cancer Report, January 2015, Office of Public Health Informatics and Epidemiology.

State of Nevada Comprehensive Cancer Control Plan 2016-2020 and is funded by the Division of Public Behavioral Health through grant number CDC DP12-1205 from the Centers for Disease Control and Prevention.

American Cancer Society, Cancer Facts & Figures 2017.

UMCSN Cancer Registry Data, 2017.


UMC Cancer Survivor Celebration 2017

Celebrating National Cancer Survivor Day

Tuesday, May 2 5:30 p.m. - 7:30 p.m.

Jeanette Tellefsen, Cancer Survivor and Life GuidePresenting: Cancer Survivorship

Music by: String Valley (Sans Quartet)Refreshments will be served

Healthy Living Institute at UMC901 Rancho Lane Suite 180Las Vegas, Nevada 89106

(Across the street from CVS Pharmacy)Please RSVP by April 29 to

Doris Cowell,RN at 702-383-2713

Light refreshments and door prizes.RSVP with Doris Cowell at 702-383-2713

no later than December 1, 2016

CANCER SURVIVORHOLIDAY PARTYCANCER SURVIVORS, FAMILIES AND

FRIENDS WELCOMED

Tuesday, Dec. 5Registration and Holiday

Entertainment begin at 5:30 p.m.

Activities will include: Presentation on Patient Navigation and Survivorship

By Barbara Brummel, RN, OCN

Healthy Living Institute at UMC901 Rancho Lane Suite 180, Las Vegas, NV 89106

Enter on the Tonopah Rd side of the building – to the right of the entrance

Nevada’s ONLY Level I Trauma Center, Nevada’s ONLY Designated Pediatric Trauma Center, Nevada’s ONLY Burn Care Center and Nevada’s ONLY Center for Transplantation

Nevada’s Highest Level of Care

Thank you to our entire health care community for coming together

and providing hope during our city’s greatest time of need.

UMCSN.com

2017 cancer control annual report - umcsn.com › medical-services-at-umcsn › ...an enterostomal...

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