2010 cancer program annual report - cleveland clinic · 2015. 5. 14. · 2010 i cancer program...

2010 I CANCER PROGRAM ANNuAl REPORt I 1

2010 Cancer Program Annual Report


Message from the Medical DirectorPatients First – Always and In All Ways. Caring for our patients is the most important, reinforcing aspect of being an oncology physician. We keep our focus on patients first when we use evidence based guidelines as the platform for our treatment plans and when we craft our partnership with patients and their families with compassion, honesty, and mutual respect.

Our annual report highlights prostate cancer clinical services and care. Prostate cancer remains one of the top five cancer sites diagnosed at Marymount Hospital. How we approach treatment is influenced by age, co-existing medical problems,

disease state and patient preferences. I believe it is important for a cancer program to evaluate clinical care provided at Marymount Hospital. By doing so, we remain focused on improving outcomes, decreasing morbidity and reducing the cost of care.

In 2010, Marymount Hospital provided three prostate cancer screening reaching 121 men. We also moved towards providing a stronger educational component to our prostate cancer screening program. We focused our efforts in informing participants about the screening guidelines and encouraged a dialogue about the risks and benefits of prostate cancer screening. We began to focus our efforts in promoting access to our prostate cancer screening program to minority groups in our service area. Our work will continue in 2011.

In addition to the focus we placed on prostate cancer, we had patient care improvements that examined cancer patient’s perception of satisfaction in pain management, established our connection with our oncology patients’ community resources such as the Gathering Place and American Cancer Society and streamlined the process in caring for neutropenic oncology patients entering our emergency department.

lastly. our annual report pays tribute to our oncology nurses. We toast an exceptional group of nurses who remind us to keep our focus on patients and their families. It is clear that our patients value their presence.

We are proud that this annual report provides us a chance to share how progress is being made in our cancer program and our work focused on patients first: always and in all ways.

Bachar Dergham, MD Chairperson, Cancer Committee 2010

Bachar Dergham, MD


Physician leadership: Prostate Cancer Care at Marymount HospitalPhysician Leadership Focus: Dr. Leonard Bernstein

Dr. Bernstein believes men must be fully informed of all the options available, including “watchful waiting”, in which surgery or treatment is delayed and men undergo frequent PSA testing and occasional biopsy to determine when and if treatment is needed.

Dr. Bernstein is passionate about finding ways to help prostate cancer patients become informed. He provides information to allay fears and maintain patients’ sense of control. He believes the mastery of information helps his patients move through their diagnosis and treatment with a keen eye on survivorship.

Dr. Bernstein is the urology department chair at Marymount. His colleagues, Dr. J. lapeyrolerie, and Dr. G. Kondray all work together to provide community education and promote prostate cancer screening.


Quality Focus: Prostate Cancer treatment at Marymount Hospital2010 Outcome Study on Prostate Cancer: Amended Report

Leonard Bernstein, M.D Kenneth Weiss, M.D.

Study assistants: laura Suladie, RHIt, CtR tracy Funk, RHIA, CtR Heather Fisher, CtR Rosemary B. Field, MS, RN, AOCNS

Objectives•Determinedemographicchangesforcurrentyearand2005MarymountHospital

(MMH) patient population diagnosed with prostate cancer.•Comparetreatmentselectionforthemostprevalentstageofprostatecancer

patients diagnosed at Marymount Hospital with appropriate NCDB populations.•TocompareMarymountHospital&NCDBsurvivaldataforpatientsdiagnosed

with prostate cancer.

Methodthe populations chosen for this comparison of diagnosis and treatment are:•Patientsdiagnosedand/orhadinitialtreatmentforStageIIprostatecancerat

MMH in 2008-2009 (106 cases)•NCDBbenchmarkdataoncasesreportedtotheNCDBby478CommunityHospitalCancerProgramsin2008(134,774cases)

the populations for comparison of observed survival is prostate cancer cases diagnosed in:•1998-2002for477NCDBCommunityHospitalCancerProgramsAllstates(64,378cases)•1998-2002forMarymounthospital(307cases)-alargeenoughpopulationto

allow for stage separation

DemographicsProstate cancer remains one of the top five cancer sites diagnosed at Marymount Hospital.Thenumberofprostatecancercases/yearrangefrom47cases/yearto106cases/year.MMHsawthehighestvolumeofprostatecancercasesin2005(106newcases)andlowestvolumein2009(47newcases).Despitethelowervolumein 2009, prostate cancer remained the 4th most frequently diagnosed cancer at Marymount Hospital.


the demographic profile of cases changed slightly when we compare 2009 to 2005 MMH cases. In 2009, the racial mix shifted slightly and the number of patients in the70andolderagegroupincreasedslightly.

Table 1. Comparison of Marymount Hospital demographics at diagnosis

2005 2009RACE White 78% 70% African American 22% 26% Other 0 4%AGE 50-59 23% 17% 60-69 38% 38%70-79 27% 36% 80-89 11% 9% 90-99 1% 0TOTAL CASES 101 47

Stage at Diagnosis. Despite differences in patient volume, Marymount Hospital has seen a consistent distribution of prostate cancer stage at diagnosis when 2005 data (106cases)iscomparedwith2009(47cases)[Figure1].Currentdataforstageatdiagnosis of prostate cancer at Marymount Hospital is similar to community cancer programsincludedinNCDBdatabase[Figure2].

Figure 1

100%

80%

60%

40%

20%

0%

Marymount Hospital ProstateStage at Diagnosis 2005 vs 2009

I II III IV UNK

Percent of Cases

Marymount 2009Marymount 2005

1% 0%

78%

Stage at Diagnosis

89%

11% 9% 6% 2% 4% 0%


Figure 2

*2008NCDB(134,774cases)

**2008-2009 Marymount Data (106 cases)

Treatment at DiagnosisDecision making regarding initial treatment choice is often shared between clinician and patient, taking into consideration adverse effect profiles of treatment and other factors. life expectancy should be the foremost component of the discussion.

through 2009, at Marymount Hospital, most cases fall into Stage II by staging definitions.StageIincludedonlyGradeIcancersincidentallyfoundinlessthan5%of tissue removed at a tuRP for benign disease. For Stage III, proof of extension beyond the prostate is required, usually found by prostatectomy, so fewer cases are staged this way. Figure 3 compares the treatment patterns for the prostate cancer cases at Marymount Hospital with NCDB data for the Stage II cancer patient.

the NCDB data base and MMH patients diagnosed with stage II cancer were predominantlybetweentheagesof60-79yearsold.MarymountHospitalhadagreater number of stage II cancer patients between 80-89 years old when compared to NCDB data. the age difference coupled with a various acceptable treatment approaches, active surveillance and patient preferences may explain the difference in treatment selection at diagnosis for the MMH prostate cancer patient compared toNCDBdata.[Table2]Acloserevaluationoffindingsiscompletedinthe2010patient care evaluation study for prostate cancer.

I II III IV UNK


Age atDiagnosis

Stage I Stage II Stage III Stage IV NA/UNK TotalsMarymount NCDB Marymount NCDB Marymount NCDB Marymount NCDB Marymount NCDB Marymount NCDB

20-29 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%30-39 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%40-49 0.0% 0.0% 3.4% 2.4% 14.3% 3.7% 0.0% 2.9% 0.0% 1.7% 3.8% 2.4%50-59 100.0% 11.8% 19.5% 19.2% 14.3% 25.2% 12.5% 14.7% 0.0% 16.4% 18.9% 19.1%60-69 0.0% 31.4% 35.6% 38.5% 71.4% 46.7% 37.5% 27.7% 100.0% 34.7% 39.6% 38.0%70-79 0.0% 39.1% 25.3% 31.7% 0.0% 19.2% 25.0% 26.5% 0.0% 30.4% 22.6% 30.6%80-89 0.0% 15.5% 14.9% 7.7% 0.0% 4.6% 12.5% 22.8% 0.0% 14.0% 13.2% 9.0%90+ 0.0% 2.3% 1.1% 0.4% 0.0% 0.5% 12.5% 5.2% 0.0% 2.7% 1.9% 1.0%Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Table 2. Comparison of Marymount vs. NCDB Data Age by Prostate Cancer Stage

*2008NCDB(134,774cases)

**2008-2009 Marymount Data (106 cases)

Figure 3

*2008 NCDB Data

**2008-2009 Marymount Data


Figure 4

Observed SurvivalObserved survival (Figure 4) is not adjusted for age or other causes of death. We compared the rates for Stages II and III (where we had the most cases) and for all stages. We did not have enough cases in other stage categories for accurate comparison. Overall, the rates for Marymount Hospital are comparable to those for the National Cancer Data Base group of Community Hospital Cancer Programs.


Patient Care Focus: Oncology Nurses’ Work from the Patient’s Point of View

Rosemary Field, RN, AOCNS Oncology Clinical Nurse Specialist

It is late Wednesday afternoon. I just spent the last part of my workday with lee, who had just been told the lump on her neck was lymphoma. As I walk her to the in-patient cancer unit, she had all sorts of questions…she was full of fear. She wanted to know what would happen to her. She asked me, “What would being treated for cancer be like… how would it make me feel? What about pain, feeling tired, losing my hair and fighting infection?” She was worried about what it would be like for her family…for her son. As we approached her room, she asked, ‘Who is going to be with me?”

I think of Kina, Amber, Cheryl, Edna, Jennifer, Alina, Simona, Krissy…these names represent a fraction of the oncology nurses who have passed through my life. they are the invisible warriors who help patients and their families make sense of their cancer experience. they guide them through the process of reclaiming their lives. they coach them to reach the best life possible. these nurses will be with lee.

Nurses are at the heart of cancer care. Shirley, a patient with pancreatic cancer, described for me gifts her nurses gave her. “they are a vital set of eyes and ears that watch over me. they tell the doctors what they need to tune in to when they do


Cancer nurses

are required to

maintain a balance

of high touch in

a highly technical

environment.

rounds in the morning. they call the doctor just before I start turning bad. they never fail to rescue me from the “bad stuff” that I feel because of the cancer and the chemo. they have arms that can be oh so tender and yet so strong. their arms cradle me and pull me through. My nurses teach me and my family about my cancer, its treatment and its effect on my body. they stand with me as I learn about what I need to do between now and the time I die. I have learned from every one of them so it is not so frightening to go home. I can feel confident in taking care of myself…I feel safe. I know I have touched their lives as much as they have affected mine. But do you know what I cherish the most about my nurses? they stay with me. they are the partners in my recovery. they will be partners in my death.”

Cancer nurses are required to maintain a balance of high touch in a highly technical environment. the tapestry of care they weave is shaped by the science of their nursing specialty. they take the best of what we know in cancer care to manage common physical problems like pain, fatigue, nausea and mouth sores. they understand the experience of uncertainty and suffering and provide care to address the emotional, spiritual and cultural context of cancer and its impact on the human spirit. the joy in their work comes from engaging in a partnership with their patients and their families to preserve functioning, optimize life quality and maintain the richness of life in spite of a cancer diagnosis. they make sure that patients and families find their voice and that their voice is heard as treatment decisions are made. As integrators of care, cancer nurses work the health system to bring resources to make sure that patients and their families get the best care possible in the hospital, clinic and at home. they are there as the patient moves through their treatment. they are there when they die. they are guides, coaches, cheerleaders, diplomats, and negotiators. At Marymount Hospital, they are the bedrock of cancer care.


tending the Spirit: Marymount’s Pastoral Care ProgramBaskets of Hope and Healing

Christmas came early for Brenda. She received a prayer shawl in her favorite colors and a basket filled with her favorite things, “I love it…it’s such a nice thing to have. I am a tea person, so I know I will enjoy everything in this basket. It is such a thoughtful gift.” Brenda had struggled with breast cancer since 2000. She was one of the many recipients of baskets of hope from Mute Swan ministry. Our pastoral care program makes a difference in our patient’s hospital stays by providing little surprises such as these baskets that represent best wishes and intentions by community organizations such as the Mute Swan ministry.


Marymount Cancer Program Facts and Figures Summary Cancer Cases in Marymount Hospital diagnosed in 2009


Program Growth

Community Outreach Program, 2010

Name of Event Date

Prostrate Cancer Screening Feb. 21

Prostrate Cancer Screening Jun. 20

Prostrate Cancer Screening Sept. 19

leadership: 2010 Cancer Committee members

B. Dergham, MD Medical Oncology, Chair

L. Rabinowitz, MD Pathology, Co-Chair

K. Weiss, MD Cancer liaison Physician

B. Coffman, MD Outreach Coordinator

J. Masten, MD Radiology

P. Catanzaro, MD Radiation Oncology

W. O’Brien, MD General Surgery

D. Waite, MD thoracic Surgery

L. Bernstein, MD urology

P. Conroe, MHMS, RHIA Director/MedicalRecords Quality Cancer Registry Data Coordinator

L. Suladie, RHIT CTR/CancerRegistrar

V. Edick Director/AccreditationQualityImprovement Coordinator

R. Field, AOCNS Oncology Nurse Specialist

Stephanie Conard-Scott, RN Interim Clinical Nurse Manager

A. Blaha Case Management

B. Zinner Adminstrative Director Cancer Program Administrator

S. Preston, RPh Pharmacy

M. Douglas Rehab Services

A. Croft American Cancer Society

M. Prizada laboratory Services

V. Parker, RN Nursing

A. Almasy Nutrition Care Services

B. Gulick Pastoral Care Services

R. Bednar Marketing

12300 McCracken Road Garfield Heights, OH 44125

www.marymount.org

2010 cancer program annual report - cleveland clinic · 2015. 5. 14. · 2010 i cancer program...

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