cancer program reporting of outcomes 2017 statistical ... · statistical data for 2016 11...

Cancer Program Reporting of Outcomes 2017*statistical data for 2016

*statistical data for 2016 3

Overview of Cancer Program Services

Complete Services Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Cancer Committee Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2017 Cancer Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Responding to Community Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Multidisciplinary Care Conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Patient Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Quality Improvements – ERAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Accountability and Quality Improvements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Guidance Before, During and After Genetic Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Advancing Care Through Clinical Trials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Cancer Screening Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Programmatic and Clinical Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Cancer Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

4 Cancer Program Reporting of Outcomes 2017


Who We Are

Our Mission

The mission of CHI Memorial and Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities.

Reverence | Integrity | Compassion | Excellence

Cancer CareCHI Memorial has proudly served the Chattanooga, north Georgia and surrounding communities since 1952. The cancer program has consistently maintained accreditation with commendations from the American College of Surgeons, Commission on Cancer: program designation, “Comprehensive Community Cancer Program.”

Leading Cancer Care The Rees Skillern Cancer Institute at CHI Memorial is the leading provider of adult cancer services in the Chattanooga area. Our comprehensive program includes seven centers of excellence, each dedicated to a specifi c type of cancer and supported by interdisciplinary tumor boards, clinical trials and advanced technologies.

Seven Centers of Excellence Breast Center of Excellence – The MaryEllen Locher Breast Center GI/GU Colorectal Center of Excellence Gynecological Oncology Center of Excellence Head & Neck Center of Excellence Prostate Center of Excellence Radiation Center of Excellence – H. Clay Evans Radiation Oncology Thoracic Center of Excellence – Buz Standefer Lung Center

Rees Skillern Cancer Institute Medical Directors – Ted Arrowsmith, M.D., Medical Oncology; Sanford Sharp, M.D., High Risk Genetics; Betsy Washburn, M.D., Breast Cancer; Taylor Rowlett, M.D., Radiology; Mark Brzezienski, M.D.,

Plastic and Reconstructive Surgery; Jeff rey Mullins, M.D., Urologic Cancer. Not pictured – Taylor Whaley, M.D., Radiation Oncology; Peter Hunt, M.D., Head, Neck and Melanoma; Lanette Varnell, M.D., Breast Imaging



Complete Service ListingCHI Memorial offers a comprehensive range of services to meet all of your cancer care needs and concerns.

GI Colorectal Center of Excellence3T MRI technologycapsule endoscopy endorectal ultrasoundERCPoptical and virtual colonoscopiesrobotic-assisted surgery

Gynecological Oncology Services

cervical screening outreach programrobotic-assisted surgery

Head and Neck Center of Excellence robotic-assisted surgery

MaryEllen Locher Breast Center bone density tests cancer risk counselingcommunity outreachdiagnostic 2D & 3D tomosynthesisdedicated breast MRImammography screeningmobile mammography services in 11 counties in

north Georgia and 25 counties in Tennesseestereotactic ultrasound guided breast biopsiessecond opinion clinicultrasound AWBUS diagnostics

Prostate Center of Excellencepartial nephrectomyrobotic-assisted prostatectomytargeted MRI/ultrasound biopsy

Radiation Center of Excellence image-guided radiation therapy (IGRT)intensity-modulated radiation therapy (IMRT)MammoSite treatmentsNovalis TxTrueBeam STx

Thoracic Center of Excellence cone beam CT endo-bronchial ultrasoundfluoronavigational bronchoscopylung biopsieslung cancer screening programPET scanspulmonary rehabrespiratory testingrobotic-assisted surgery

Holistic Support Services chaplain servicesgenetic testing and counselingmassage and healing touchoncology dietitiansoncology licensed clinical social workersRN navigation support groupssurvivorship care plansspiritual counseling

Additional ServicesThe Joe and Virginia Schmissrauter Center

for Cancer SupportCancer Risk, Genetics and Survivorship Center Elizabeth R . Smith Melanoma ProgramPelvic Health Centermobile coaches for breast and lung cancer detectionpalliative caretumor registry

In healthcare, the word accreditation can become commonplace. So much so that it’s easy to discount the smart, thorough and forward-thinking work that’s happening behind the scenes that impacts people diagnosed with serious diseases and helps them lead healthier lives.

CHI Memorial’s Rees Skillern Cancer Institute has always made accreditation a top priority in our work to provide patients, their families, and physicians in our community with a fully integrated, state-of-the-art, multidisciplinary approach to the prevention, early intervention, diagnosis and treatment of malignancies. We are accredited by the American College of Surgeons, Commission on Cancer, as a Community Hospital Comprehensive Care Program. To earn this voluntary accreditation, the program must meet or exceed 34 quality standards and be evaluated every three years through an extensive survey process. It must also maintain specific levels of excellence in how patient-centered care is delivered. CHI Memorial has maintained this certification for the last 20 years.

Accreditation is important because it provides patients the peace of mind that they are receiving treatment recommendations based on national guidelines rather than surgeon or provider idiosyncrasies. It’s a check and balance system that demonstrates CHI Memorial offers a highly qualified cancer-fighting program, and not every hospital is approved. In fact, we are one of only 1,500 approved programs nationwide.

Rees Skillern Cancer Institute uses a multidisciplinary approach to cancer treatment that requires consultation among surgeons,

medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialties. That’s why CHI Memorial offers 11 regularly scheduled cancer conferences. We maintain a cancer registry and contribute data to the National Cancer Data Base (NCDB), the largest clinical disease registry in the world. Data on all types of cancer are tracked and analyzed through NCDB and used to explore trends in care. Physicians can see what’s happening here and across the country at other accredited centers, supporting quality improvement efforts that impact outcomes and patients’ lives.

Finally, accreditation provides the framework to improve patient care – through various cancer-related programs including prevention, early diagnosis, cancer staging, optimal treatment, rehabilitation, and life-long follow up for recurrent disease and end-of-life care. This structure – supported by our dedicated staff and robust medical and surgical capabilities – emphasizes the highest quality of care and support services that help people live well during treatment and into survivorship. It’s one more reason people can feel confident in choosing CHI Memorial for cancer care.

2017 Message from the Cancer Committee: Accreditation Matters

Bertrand Anz, M.D.Cancer Liaison Physician

Sanford Sharp, M.D.Cancer Committee

Chairman



2017 Cancer Committee Members

Sanford Sharp, M.D., Cancer Committee Chair, Pathology, Cancer Registry Quality Coordinator

Bertrand Anz, M.D., Cancer Liaison Physician, Medical Oncologist

John Boxell, M.D., ret., Cancer Program Advisor

Eric Ellis, M.D., Radiation Oncologist

Peter Hunt, M.D., Head & Neck

Lee Jackson, M.D., Urology

Hunter Jennings, M.D., Colorectal

Charles Piez, M.D., Diagnostic Radiologist

Maurice Rawlings, M.D., Breast

Taylor Rowlett, M.D., Diagnostic Radiologist

Eric Schubert, M.D., Cancer Conference Coordinator

Betsy Washburn, M.D., Breast

Penny Andrews, BSN, RN, FCN, OCN, Clinical Research Coordinator

Sherry Baierl, RN, Quality Improvement Coordinator

Kathy Dittmar, Director, Cancer Services, Cancer Program Administrator

Christine Dominguez, RN, Palliative Care Professional

Rhonda Edwards, MSSW, ACSW, Psychosocial Services Coordinator, Mental Health Professional

Amy Fields, American Cancer Society Representative

Debrah Hagen, RN, Social Worker / Case Manager

Mary Ellen Herring, CTR, Tumor Registrar

Sharon Hopper, RD, Dietitian

Jessica Howell, RN, Nurse Navigator GYN, Urology, Prostate

Alline Ingle, RN, Melanoma Outreach

Betsy Kammerdiener, M.Div, Pastoral Care

Marty Laird, D.Ph, Pharmacist

Nick Lockhart, PharmD, BCPS, Pharmacy

Catherine Marcum, APN, AGACNP-BC, DNP, AGN-BC, Genetics Professional

Deb Moore, VP Oncology Services, Cancer Program Administrator

Amy Parker, Rehabilitation Services

Cynthia Perry, CTR, Tumor Registrar

Deborah Phinizy, RT (R)(M), RDMS, MEL Breast Center Manager

Angela Posey, Community Outreach Coordinator

Betsy Quinn, RN, Nurse Navigator, Lung

Kim Shank, BSN, RN, OCN, Oncology Nurse, Colorectal Nurse Navigator

Julie Schreiber, RN, Nurse Navigator, Breast

Gerre Schwert, RN, Social Worker / Case Manager

Jennifer Scollard, RN, Rehabilitation Services

Terri Shults, BSN, RN, BC, Nurse Navigator, H&N, Melanoma

Elvie Smith, RN, Outpatient Infusion

Sentha Srinivasan, Lead Medical Physicist

Casey Waddle, NP, Survivorship Clinic Representative

Hannah Walker, BSN, RN, OCN, Oncology Nursing Unit Director

Responding to Community Needs

Every three years, CHI Memorial participates in a community needs assessment (CNA) that brings together a number of organizations in our primary and secondary service areas to discuss how we can leverage our resources to improve the health of people in our community. The CNA looked at diff erent areas including healthy lifestyle and nutrition; substance abuse and prevention; health disparities and senior care – and identifi ed where CHI Memorial should be focusing its attention.

Rees Skillern Cancer Institute was tasked with addressing these areas related to cancer screening and access to care for the insured and un-insured population in our area, including:

• Improving access and outcomes for low income women living in Dade, Walker and Catoosa counties by providing mobile mammography and cervical screening

services. In addition to our relationship with the Tennessee Department of Health, CHI Memorial became a provider with the Georgia Breast Cervical Screening Program to provide high quality screenings, mammography and a diagnostic workup when an abnormality is found.

• Increasing lung cancer screening and education to stage shift diagnosis from stage III and IV to stage I and II. With a greater

Kathy Dittmar, Market Director, Oncology

Operations

Debra Moore, VP, Oncology Services



emphasis on physician education and increasing awareness around free screening for those at high risk for lung cancer, the number of low-dose lung CTs increased from 478 in 2015 to 711 in 2016.

In 2016, we also prioritized understanding the impact that a cancer diagnosis has on patients and their families. We developed a patient and family advisory council with volunteer representatives who have been personally touched by cancer or who have a close family member with cancer. They are providing invaluable information on the issues that impact cancer care, from screening, to diagnosis, to facing the treatment journey and the ways survivorship looks diff erent to every individual. Our goal is to provide greater collaboration and partnerships from a patient’s point of view.

One result has been the development of a new program called BRIDGES – Building Relationships Integrating Departments Giving Encouragement

and Support. This reenergized program introduces people with new cancer diagnoses to the Center for Cancer Support earlier with the goal of increasing utilization of our support services. Auxiliary volunteers, who are all cancer survivors themselves, are trained to greet and escort individuals who come in for their fi rst course of treatment.

Every time we step back, assess our performance and develop coordinated strategies to improve outcomes, our patients benefi t. When we are listening, we are learning. Our primary goal at the Rees Skillern Cancer Institute is to reduce the number of advanced stage diagnoses and to provide the highest level of cancer care available anywhere. Innovative technologies and the latest treatments to kill cancer will always be a priority. But more than that, we are here to help individuals and families navigate an increasingly complex health care system and to provide the kind of guidance and compassionate care that nurtures their mind, body and spirit.

What We Do

Multidisciplinary Cancer ConferencesEach week CHI Memorial holds several multidisciplinary cancer conferences to discuss individual cancer cases. A team comprised of many diff erent specialties all come together in one place to give their expertise and share their experiences in order to provide the best treatment plan possible for every patient. In this way each patient presented at conference will have their own circumstances and unique set of challenges discussed in addition to adhering to National Comprehensive Cancer Network treatment guidelines. Physicians and staff at all of our locations are invited to attend and participate.

The multidisciplinary cancer care team includes:

Surgeons

Radiation Oncologists

Radiologist

Oncology Nurses

Nurse Navigators

Genetic Counselors

Advanced Practice Nurses

Social Workers

Primary Care Physicians

Pathologists

Medical Oncologists

Dietitians

The following conferences are available to physicians and sta� at CHI Memorial as well as physicians in the community:

Breast conference

GI Pathology conference

Hematopoietic / Lymphatic conference

Molecular conference

Gastrointestinal conference

Gynecological conference

Thoracic conference

Head & Neck conference

Interstitial Lung Disease conference

Genitourinary conference

Melanoma conference



Patient Navigation – Support for Every Need

Nurse Navigators — Left to Right: Marci Bradley, RN, CMSRN, OCN, Breast Navigator; Kim Shank, BSN, RN, OCN, Oncology Clinical Services Director, GI-Colorectal Navigator;

Betsy Quinn, MSN, RN, MA, OCN, Lung/Heme Navigator; Clarissa Boyer, BSN, RN, CBCN, Breast Navigator; Deborah Drake, BSN, RN, Breast Navigator; Terri Henderson, BSN, RN, OCN, Head and Neck/Melanoma Navigator

At CHI Memorial, people diagnosed with cancer can choose to be paired with a nurse who can help them ‘navigate’ the sometimes-complicated process of eff ective cancer treatment. Nurse navigators provide education; answer questions and act as a liaison between patient and doctor when needed, off er resources for fi nancial support; and provide comfort and assistance into recovery.

Navigators are in contact with the patient from the beginning to coordinate appointments, ensure adequate case presentation, facilitate communication at treatment conferences and establish a personal relationship. More than scheduling appointments and treatments, nurse navigators connect patients to supportive care resources, provide emotional support, explain the disease process, help manage side eff ects, and more. Whatever the need, the nurse navigator’s primary role is helping patients through their journey.

One component that sets the Rees Skillern Cancer Institute nurse navigator program apart is that the services are open to the community – no matter where a patient seeks treatment. As a community-based system, all services are complimentary. This removes the cost barrier that sometimes exists for patients who are fi nancially strained with a cancer diagnosis and who can now seek help without worrying about the fi nancial implications.

The nurse navigators at the Center for Cancer Support work together as a team – that also includes dieticians, licensed clinical social workers and support staff – who use their areas of expertise to meet patients’ needs, overcome barriers and off er guidance, encouragement and a listening ear. Whether the concerns are around diagnosis, treatment planning, fi nancial burdens or emotional stressors, this multidisciplinary approach off ers compassionate care for the mind, body and spirit.

To reach a nurse navigator call the Center for Cancer Support at (423) 495-7778.



Quality Improvements

Enhanced Recovery After Surgery (ERAS) Program Expands

The Enhanced Recovery After Surgery (ERAS) program has resulted in a shortened average length of stay and reduced overall complication rate for non-emergent inpatient abdominal surgeries since its implementation at CHI Memorial in early 2016. The ERAS program was piloted with colorectal surgeries through a collaborative team of administrators, surgeons, anesthesiologists, nurses, and care providers from pre-testing through patient discharge. In October 2016, both GYN and urology abdominal surgeries were added to the program, such as prostatectomies, cystectomies and nephrectomies. In May 2017, the program expanded once again to include all non-emergent inpatient open, laparoscopic, and robotic abdominal and bariatric surgeries.

The ERAS program includes the following components designed to improve patient recovery:

• meeting with a pretesting nurse educator to explain the components of the program

• drinking a carbohydrate drink like Gatorade the evening prior to and the morning of surgery

• using an incentive spirometer and documenting practice until the day of surgery

• use of a warming blanket starting in pre-op while receiving 80 percent humidifi ed oxygen to keep oxygen levels high

• taking Acetaminophen and Gabapentin for pain control before and after surgery

• receiving a transverse abdominis plane (TAP) nerve block in pre-op to minimize narcotics usage after surgery and to help with postoperative pain control ERAS Committee Leadership — Jeanie Smith, VP, Surgical Services, Eric Nelson, M.D.,

Shauna Lorenzo-Rivero, M.D., Sandi Brown, Director of Surgical/Ambulatory Planning and Business Development

As patients recover after surgery, the use of active warming and oxygen continues to aid the body’s natural healing process. The team works quickly to get patients out of bed. Patients begin drinking clear liquids the day of surgery and advancing the diet as tolerated. They are given sugar-free chewing gum to help with nausea and improve recovery of bowel function.

A shorter length of stay has been one of the main successes of the program. Data from 2017 shows that patients on the ERAS protocol had a length of stay of 3.55 days. Those not on the protocol had a longer length of stay at 4.26 days. Patients are more satisfi ed because they have better pain control, begin eating more quickly, are able to get up and move around faster, and experience fewer post-operative complications. The changes have been made through a team eff ort and require everyone to work together to consistently improve our care.

Defi ning ERAS

Enhanced recovery after surgery (ERAS) or “fast track” programs focus on perioperative management of patients after abdominal surgery and are also useful for other surgical specialty areas. The goal is to modify the physiological and psychological response to major surgery that leads to reduction in complications and hospital stays, improvement in cardiopulmonary function, and return of bowel function allowing patients to return to their normal activities more quickly.



Accountability & Quality Improvement: CP3R MeasuresThe following CP3R measures, as outlined by the American College of Surgeons (ACoS) Commission on Cancer (COC), are designed to ensure our program is following national guidelines and meeting national benchmarks. CHI Memorial is proud to have met or exceeded the required rates or defi ned confi dence interval for all measures. We are below the standard required rate on only two measures.

For BCSRT, 103 cases eligible for this criterion and out of those, 13 were non-concordant. Of the 13, the majority were due to patient refusals. Going forward, we will continue to educate our patients on the importance of post-op radiation therapy, however the patient ultimately has the fi nal say in their treatment.

The G15RLN measure was also below the required percentage. For this measure, fi ve cases were eligible. Of those fi ve, only two cases were non-concordant. In each case, lymph nodes were removed; however, not enough to meet the standard measure. This has been brought to the attention of the cancer committee, which includes surgeons and pathologists, and all are now aware.

We appreciate every opportunity to discover areas of improvement and work continuously to exceed expectations and standards of care for our patients.

Measure Name

Required Rate

CHI Memorial

Description of ACoS Committion on Cancer Performance Measures

Accountability Measures

BCSRT 90 (or CI 81-93.8 )

87.4 Radiation is administered within 1 year of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer.

HT 90 90.6 Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage II or stage III hormone receptor positive breast cancer.

MASTRT 90 90 Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >= 4 positive regional lymph nodes.

Quality Improvement Measures

nBx 80 91.3 Image or palpation-guided needle biopsy (core or FNA) is performed to establish diagnosis of breast cancer.

12RLN 85 91.4 At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

G15RLN 80 (or CI 17.1-100)

60 At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer.

LCT 85 100 Systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is considered for surgically resected cases with pathologic, lymph node-positive (pN1) and (pN2) NSCLC.

LNoSurg 85 88.2 Surgery is not the fi rst course of treatment for cN2, M0 lung cases

RECTRCT 85 100 Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer.



How We Aff ect Our Community

More than Just Genes

Guidance Before, During and After Genetic Testing Everyone is at some risk of developing cancer in his or her lifetime. The precise risk of any one individual depends on many factors including age, family history and lifestyle. A small percentage of people, however, are at far greater risk for developing cancer because of their genetic makeup. CHI Memorial’s Cancer Risk and Survivorship Center off ers cancer risk counseling to help people better understand how their family history of cancer might aff ect their individual risk.

CHI Memorial is focused on more than just the medical impact of a person’s genetic testing results. We off er a complete, personalized risk evaluation in a comfortable, confi dential setting. We also help patients make sense of information that’s diffi cult to understand. There are several aspects of our program that set us apart.

Research CHI Memorial’s Rees Skillern Cancer Institute is actively involved in genetics research. We are one of 42 sites participating in the world’s largest molecular genetics registry, the backbone of the fi eld that will help determine the course of cancer treatment for countless individuals seeking treatment for cancer. Within the “Molecular Genetics Studies of Cancer Patients and Their Relatives” study that’s funded by the National Institutes of Health, we are actively participating to learn more about susceptibility to cancer, possible gene alteration occurrence, and outcomes after genetic cancer risk interventions.

CHI Memorial has accrued more than 100 patients, with nearly 22,000 families with cancer participating in the registry worldwide. This data is vital to understanding the biologic, genetic and environmental factors that contribute to cancer and determine outcomes. Pre- and Post-Distress Screening

CHI Memorial also conducts pre- and post-distress screening for patients who come through the Cancer Risk and Survivorship Center. There is an associated distress with the fi eld of cancer genetics, and we are implementing the National Comprehensive Cancer Network’s stress screening to identify aff ected patients. Within the genetics population, we recognize the potential for a great deal of family and personal stress directly related to genetic testing.

Genetics testing often results in a new medical identify for a person and their family. A parent might have guilt for passing a gene to an off spring or when they don’t have a genetic mutation that their off spring carries. CHI Memorial’s Cancer Risk and Survivorship Center specifi cally addresses the psychosocial needs of

patients and is what sets us apart. Because we are in tune with these psychosocial needs, we can off er support groups that directly speak to the fears, anxieties and unanswered questions they have related to their diagnosis.

Holistic Cancer Care The entire experience for oncology genetic testing is designed to improve a person’s understanding of their family history, adjust the appropriate surveillance based on their risk and determine what further actions patients and physicians feel would be benefi cial. The focus on education, research and advancing the fi eld of genetics is one of our priorities at Rees Skillern Cancer Institute, and it’s making a measurable impact on this community.

CHI Memorial’s Genetics Team — Lisa Ong, Genetics Assistant; Sanford Sharp, M.D., Pathologist; and Catherine Marcum, APN, AGACNP-BC, DNP, AGN-BC, Board Certifi ed Advanced Genetics Nurse



The Commission on Cancer (CoC) requires Comprehensive Community Cancer Programs (CCCP) to have at minimum four percent of their patients on clinical trials each year. To achieve a special commendation by the CoC, they require six percent of patients on clinical trials. In 2016, CHI Memorial off ered 163 clinical trials, with seven percent of patients enrolled. Several areas within our program are active in clinical trials including medical oncology, radiation oncology, breast surgery and genetics. CHI Memorial has gone above and beyond what is required to off er our patients the most advanced and up-to-date care possible.

Off ering clinical trials brings many potential benefi ts for patients. The fi rst benefi t is access. Participation in clinical trials off ers patients the opportunity to benefi t from the very latest

treatment options. The teams conducting clinical trials are comprised of physicians at the forefront of their respective fi elds, working together to change cancer outcomes and help people live better after treatment has ended. Certain trials may also cover part of all treatment costs, which is another attractive option for people with fi nancial considerations.

Physicians who practice at the Rees Skillern Cancer Institute and who off er clinical trials for their patients are working diligently to make fi ghting cancer easier on patients, more eff ective and with fewer side eff ects than ever before.

Advancing Cancer Care Through Clinical Trials

Clinical Trials – Mark Brzezienski, M.D., Reconstructive and Plastic Surgeon; Catherine Marcum, DNP, APN, Board Certifi ed Advanced Genetics Nurse; and Ted Arrowsmith, M.D.,

Medical Oncologist are part of the medical professionals who off er clinical trial participation to their patients.

2016163 clinical trials

7% enrolled

Cancer Screening Programs The committee continues to push for more outreach to the community and to the underserved population. Our goal is stage shift for better outcomes.

94

406

104

21

4,160

Breast Cancer Outreach

Mobile Mammography

opportunities

total site visits

served very low-income and marginalized communities

counties visited

educational handouts

approximately

57

programs canceled or rescheduled due to low participation, machine breakdowns or partner issues

762

164

4,320

14

1 at Stg 0

5 at Stg 1A

7 at Stg 2A

1 at Stg 2B

mammograms for uninsured women

abnormal exams reported

mobile mammograms

patients diagnosed with breast cancer to date

MaryEllen Locher Breast Center

240 public programs at medical facilities, community centers and events (59%)

166 private / commercial industries commercial industries visited (41%)

166

240



9

Development of mole patrol on mobile for partnerships

2

39

Mobile Cervical, Pap and CBE Exams

programs

HPV diagnoses

uninsured women

53

exams conducted

Special Projects for Outreach

Skin Disease Outreach

14 1,445

educational encounters handouts

Elizabeth R. Smith Melanoma Program

2 3

Mole Patrol

events found malignancies, including 1 melanoma

85

participants

Oral, Head and Neck

1

event

Collaborative community participation to increase awareness of head, neck and oral cancer for the general public.

The head and neck multidisciplinary team continues to educate the dentist community on the need for thorough oral exams and immediate referrals for questionable findings.

120

participants

Hosted and facilitated Cancer Survivorship Day, 78 in attendance

Special Projects for Outreach

Nutrition and Wellness

Nutrition in relation to cancer prevention, treatment and survivorship:

7 1

116

educational encounters published recipe

participants plus 6 media appearances

Oral, Head and Neck Outreach

Stress Reduction Techniques

4

classes 41

participants



33

people completed Freedom from Smoking classes

Smoking Cessation

Lung Screening Postcards and Information

8 711

educational encounters Lung screenings

750

1

handouts distributed

published article

9 (5) Stage I

(2) Stage II

(1) Stage III

(1) Stage IV

cancers diagnosed

Getting an Edge on Lung Cancer

Lung Disease Outreach and Smoking Cessation

Lung cancer is unrelenting – especially for people who smoke. It’s by far the leading cause of cancer death among both men and women, and according to the American Cancer Society each year more people die of lung cancer than breast, colon and prostate cancer combined. But identifying patients who are at highest risk remains a challenge in the current healthcare environment.

Rees Skillern Cancer Institute has made stage shifting for lung cancer a priority through low

dose CT screenings for high-risk individuals. In 2015, we completed 478 screenings and that number increased to 711 in 2016. As more people at high risk for lung cancer take advantage of screening, an increasing number will be diagnosed at these earlier stages, positively affecting outcomes and quality of life. With any cancer, treatment options increase and outcomes improve when someone is diagnosed with stage 1 or stage 2 disease. For lung cancer, that means the possibility of surgery, and for non-surgery candidates stereotactic radiotherapy is available.

Lung Screenings

2015 2016 2017 Total (3yrs)

January 33 56 59

February 23 47 49

March 41 45 53

April 20 54 74

May 39 61 74

June 45 92 55

July 52 68 63

August 41 68 88

September 35 51 78

October 47 62 94

November 36 50 90

December 66 57 99

Total 478 711 876 2,065

Cancer Findings 2015 2016 2017 Stage I Stage II Stage III Stage IV

January 0 0 1 1

February 0 1 3 1 + 3

March 0 0 1 1

April 0 0 0

May 0 0 0

June 3 1 1 2+1+1 1

July 1 1 1 1+1 1

August 1 0 0 1

September 0 2 1 2 1

October 0 1 0 1

November 0 3 3

December 3 1 2 1 + 1

Total 8 10 8 16 4 5 1

GREEN = year 2015 | PINK = year 2016 | Blue = year 2017 | GRAY = total of ALL 3 years



2016 Programmatic and Clinical Goals

Melanoma Service Line Leadership — Terri Henderson, BSN, RN, OCN, Nurse Navigator and Head and Neck/Melanoma Program Coordinator; Alvaro Valle, M.D., and Peter Hunt, M.D., Melanoma Program Medical Director

Each year, Rees Skillern Cancer Institute sets programmatic and clinical goals to establish criteria and standards by which you can determine performance and progress. Two of the goals established for 2016 were the establishment of a melanoma services line (program goal) and Decrease Stage III and IV Lung cancers by increasing CT lung screening using approved CMS orders and processes by June 2017 (clinical goal).

Establish Melanoma Service Line Rees Skillern Cancer Institute expanded its services to include a melanoma service line in June 2016. Peter Hunt, M.D. was appointed as medical director, and Terri Henderson

assumed the role of nurse navigator to improve community education, program enhancement and physician involvement. Twenty-two multidisciplinary conferences, four melanoma committee meetings and 10 physician meetings were conducted. Branded educational material has been developed in two languages with the help of physician advisors. Screening criteria and tracking in the TAV Health system used by nurse navigators has also been established.

In 2016, more than 2,500 people attended 24 melanoma awareness/education events and two mole patrol events. Seventy-one individuals with melanoma were navigated with some still being followed.

Decrease Stage III and IV Lung Cancers by Increasing CT Lung ScreeningOne clinical goal in 2016 was to decrease stage III and IV lung cancers by increasing CT lung screening using approved CMS orders and processes. Low-dose CT lung cancer scan has shown to improve survival by 20 percent according to The National Lung Screening Trial (NLST) by the National Cancer Institute (NCI).

Behind the scenes work was completed to increase the likelihood of physicians ordering a low dose CT for high risk patients. That included physician education around which patients were considered high risk and therefore qualifi ed for the screening at no cost. Our team also provided physician offi ces the ability to order the screening with one click. A new order form for low dose CT screenings was developed that includes physician attestation of Shared Decision Making (SDC).

In addition, a dedicated employee has been assigned to monitor each of the scheduled lung screening patients to ensure capture of the remaining 23 reimbursement requirements. When patients do not fall within the defi nition of high risk for lung cancer, they are notifi ed before screening is completed.

Team-Based Treatment

Lung cancer is multifaceted and requires a large team working

together to change outcomes for people diagnosed with this deadly

disease. If cancer is found, CHI Memorial and the Rees Skillern Cancer

Institute are ready to provide the latest diagnostic and therapeutic

techniques, advanced technologies and the guidance patients and

families need to navigate a potentially complicated medical journey.



Tumor Site Origins

Primary Site Total PercentLung 383 16.3

Breast 378 16.1

Prostate 342 14.6

Colon/Rectum 177 7.6

Melanoma 154 6.6

Urinary Bladder 133 5.7

Lymphoma 93 4.0

Oral Cavity/Pharynx/Tonsil 88 3.7

Kidney & Renal Pelvis 76 3.4

Thyroid 59 2.5

Corpus Uteri 58 2.5

Pancreas 53 2.3

Leukemia 49 2.1

Esophagus 25 1.1

Stomach 24 1

Ovary 22 1.0

Larynx 20 0.9

Myeloma 11 0.5

All Other 203 8.1

Total 2348 100.0

Residence by County at Time of Diagnosis

County Total PercentHamilton County, TN 1,212 51.6

Walker County, GA 239 10.0

Bradley County, TN 160 6.8

Catoosa County, GA 139 5.9

Rhea County, TN 105 4.5

Marion County, TN 73 3.1

Dade County, GA 70 3.0

Whitfield County, GA 64 2.6

Jackson County, AL 39 1.5

Grundy County, TN 31 1.3

Murray County, GA 29 1.2

Polk County, TN 27 1.2

Sequatchie County, TN 27 1.2

DeKalb County, AL 18 0.7

Meigs County, TN 14 0.6

McMinn County, TN 13 0.6

Bledsoe County, TN 13 0.5

Chattooga County, GA 12 0.4

Henderson 8 0.3

Others 55 3.1

Patient Volumes - 2016

Lung

Breast

Prostate

Urinary

Colorectal

Melanoma

Head & Back

GYN

Lymphoma

Other

other12%

Lung17%

Breast16%

Prostate15%Urinary

9%

Colorectal8%

Melanoma7%

Lymphoma4%

Head & Back7%

GYN5%

CHI Memorial Top Cancer Sites in 2016

CountyPostal Code at Diagnosis

Patients Diagnosed

Hamilton (TN) 37343 181




Catoosa (GA) 30736 110

Walker (GA) 30741 89







Rhea (TN) 37321 54




Bradley (TN) 37311 48

Dade (GA) 30752 47




Sequatchie (TN) 37327 35

Marion (TN) 37397 31


Rhea (TN) 37381 27

Murray (GA) 30705 25

Whitfield (GA) 30721 23

Meigs (TN) 37322 23



CountyPostal Code at Diagnosis

Patients Diagnosed

Catoosa (GA) 30742 20







Jackson (AL) 35958 15

Rhea (TN) 37338 15



Meigs (TN) 37336 13

Dade (GA) 30738 12

Bledsoe (TN) 37367 12



Dade (GA) 30750 10





Dade (GA) 30757 8

Grundy (TN) 37387 8


Rhea (TN) 37332 7

Grundy (TN) 37339 7


Marion (TN) 37310 6


All others n/a 173

**we see patients in 152 different zip codes within 47 different counties.

Residence by Zip Code at Time of Diagnosis in 2016


Site 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Breast 367 372 465 382 388 453 439 435 445 378

Lung 292 330 373 425 382 347 384 418 412 383

Prostate 372 367 477 348 413 400 349 307 367 342

Skin (Melanoma) 235 217 319 231 268 282 313 216 218 154

Colorectal 223 202 274 256 238 234 241 196 191 177

Head & Neck 168 194 252 275 185 220 220 235 223 202

Lymphoma 148 103 174 128 177 152 123 103 92 93

Bladder 102 98 132 107 98 93 123 108 102 133

Pancreas 42 47 58 45 57 67 56 75 69 53

Corpus Uteri 32 52 67 35 29 49 63 61 61 58

Cancer at CHI Memorial Rees Skillern Cancer Institute

Distribution by Age at Time of Diagnosis in 2016

900

800

700

600

500

400

300

200

100

0

Can

cer

Age

51

141

418

761

651

275

3515

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

The Rees Skillern Cancer Institute team is pushing to be better and to give better cancer care. This is our life’s work to fi nd cancer earlier and treat it with the most advanced methods

available today, all while keeping our patients at the center of everything we do.

CHIMemorial.org | (423) 495-2525 | Follow us on Twitter @CHI_Memorial

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cancer program reporting of outcomes 2017 *statistical ... · *statistical data for 2016 11...

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cancer program reporting of outcomes 2017 statistical ... · statistical data for 2016 11...