2016 Annual Report

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Daniel D. Lydiatt, DDS, MDMedical DirectorMethodist Estabrook Cancer Center

Josie Abboud, RN, BSN, MBAExecutive Vice President and Chief Operating OfficerMethodist Hospital

Patty Bauer, MSHA, RN, RRTService Executive Oncology Services

This is our cancer program’s 60th continuous year of accreditation, a hallmark of the excellence of our people and services.

Following this year’s survey by the Commission on Cancer of the American College of Surgeons (CoC), Methodist Estabrook Cancer Center (MECC) was granted a three-year re-accreditation with commendation.

Methodist was first in our state and metropolitan area to earn CoC accreditation back in 1956, and the commitment to delivering the highest quality cancer care with a patient-centered, multidisciplinary team approach has only deepened over the past six decades.

We will continue to offer cutting-edge clinical trials, opportunities for meaningful research, educational opportunities for a variety of healthcare professionals and increased efficiencies in delivering outstanding patient-centered care with improved outcomes.

Together, our work to fight cancer and enhance care continues, and we thank you for your interest and support.

In this, Methodist’s 125th anniversary year, we celebrate another milestone. 2016 Achievement Highlights

Effective July 1, MECC became home to the Midwest’s largest specialty practice for the treatment of head and neck cancers. Our Head & Neck program is complemented by comprehensive onsite program offerings, including Speech Language Pathology, Counseling, Oncology Social Work, Oncology Nutrition, and Rehabilitation Services.

Outpatient Palliative Care services have been integrated into Lung Cancer Clinic Care plans.

Radiation Oncology achieved re-accreditation through the American College of Radiology.

MECC partnered with the Methodist Jennie Edmundson Cancer Center to offer lung cancer screening and genetic counseling services at Methodist Jennie Edmundson in Council Bluffs.

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A lump in the thyroid gland is called a nodule. Thyroid nodules represent a wide range of benign and malignant (cancerous) tumors. Most nodules within the gland are benign. Some, about 5 percent, are cancerous, the vast majority of which are called papillary or follicular thyroid cancer.

These cancers have a very good prognosis and represent over 95 percent of all cancers of the thyroid. The more rare cancers, medullary, anaplastic and lymphoma represent less than 5 percent.

Thyroid Cancer UpdateWilliam Lydiatt, MD

Cancers of the thyroid are 2 to 3 times more common in women and occur most frequently around age 50. Since 1978, the number of cancers of the thyroid has increased almost 8 times. The majority of this increase is due to diagnosis of smaller cancers, many of which may not ever have become a problem for the individual.

Risk factors for the development of thyroid cancer include hormones and obesity. There is an increased risk of thyroid cancer for every 5 kg over ideal body weight. Radiation exposure is a clear risk. We know this because of the increase in thyroid cancer that followed the nuclear explosions in Japan that ended World War II, the atomic bomb testing in the Pacific Islands in the 1950s and 60s and most recently due to the disaster in the Soviet Union with the Chernobyl nuclear power plant meltdown.

The Chernobyl disaster occurred in April 1986 and demonstrated how radioactive iodine is released from the fires that burned in the nuclear reactor following the meltdown and

0

10

20

30

40

50

60

HISTOLOGY

PE

RC

EN

T

Follicular Varient Papillary

Carcinoma

Papillary Carcinoma,

NOS

Papillary Microcarcinoma

Anaplastic Carcinoma,

NOS

Follicular Adenocarcinoma,

NOS

Medullary Carcinoma,

NOS

Histology of Thyroid Cancer 2014All Diagnosis Types

Nebraska Methodist Hospital

Papillary Adenocarcinoma,

NOS

52%

33%

6% 4% 2% 1% 2%

0

5

10

15

20

25

30

AGE

PE

RC

EN

T

30-29 40-49 60-69 70-79 80-8950-59

Age Group of Thyroid Cancer 2014All Diagnosis Types

Nebraska Methodist Hospital

20-29

8% 10%

23%27%

21%

10%

1%

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fact, these studies demonstrate that the likelihood of a woman having a thyroid nodule by ultrasound is approximately equal to her age.

The evaluation of someone with a thyroid nodule is first a careful history and physical examination, followed by appropriate laboratory testing to see if the person has a

normal thyroid level. If warranted, an ultrasound examination will follow. Depending on the findings of the ultrasound, a fine needle aspiration (FNA) biopsy may also be recommended and performed. The findings on history that are worrisome for cancer are age less than 14 or greater than 55, a history of neck irradiation, a family history of thyroid

Thyroid Cancer Update continued

were then carried on the prevailing winds to infiltrate the food supply. This caused a significant increase in thyroid cancer. Rates of thyroid cancer were 15 to 20 times higher in children and increased to 50 times higher especially in children who were less than five years of age at the time of the exposure.

Thyroid cancer tends to present as a lump in the lower central neck. The lump can be found by either routine clinical examination, as a result of investigation for either hyper or hypothyroidism, as part of the investigation for symptoms of difficulty swallowing or difficulty breathing, or as an incidental finding as part of other tests for unrelated problems. It is estimated that 1 to 2 percent of males and 6-7 percent of females will have a nodule that can be felt in the neck. Autopsy studies show that half or more of all people have thyroid nodules and many also have thyroid cancer at the time of their death. Some studies show that age, especially in women, is a predictor of whether someone will have a thyroid nodule. In

Cancers of the thyroid are 2 to 3 times more common in women and occur most frequently around age 50.

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In this situation, careful discussion between the patient and their physician needs to occur to determine if surgery or observation is the best course of action. Most of the time, surgery is preferred in this situation. In these circumstances, genetic testing on the FNA biopsy may be recommended, although as a general rule, it is only marginally useful in helping to determine whether to do an operation or not.

If thyroid cancer is found on biopsy, the treatment is surgery. Typically, either half (thyroid lobectomy) or all (total thyroidectomy) will be recommended. Lymph node dissection or removal of lymph nodes is typically done only when positive lymph nodes are seen on ultrasound or at the time of surgery.

The survival after treatment for thyroid cancer is generally excellent and is determined by the extent of cancer at the time of the operation, the age of the patient, specific pathologic findings at the time of surgery, and whether the cancer has spread elsewhere in the body.

Thyroid Cancer Update continued

cancer especially medullary carcinoma, male gender or a rapid but not sudden growth of the nodule. Worrisome physical findings include a nodule that is hard, fixed, large or irregular on examination or associated with either enlarged and rounded lymph nodes or vocal cord paralysis. If the person has hyperthyroidism, iodine scans may be done to determine if the nodule is hyperfunctioning.

Ultrasound is by far the most sensitive evaluation of the nodule and provides a great way to assess for likelihood of malignancy; is painless and safe and provides an excellent

opportunity to determine whether a biopsy is needed. In addition, ultrasound can also assess whether lymph nodes, either in the region around the trachea or windpipe or in the lateral neck, are abnormal. Ultrasound also provides an excellent way to follow patients after diagnosis.

If worrisome factors are present, additional testing may be performed with the most common being ultrasound-guided FNA biopsy. FNA biopsy can be done in the office or ultrasound suite under local anesthetic and gives the patient and clinician additional information that will be helpful in determining the next course of action. The most common results of the biopsy are that the nodule is benign. Biopsy may show that the nodule is cancerous, in which case surgery is indicated. About 20 percent of the time an intermediate finding may be rendered called follicular neoplasm.

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Each calendar year, the cancer committee organizes and offers at least one cancer prevention program designed to reduce the incidence of a specific cancer type and targeted to meet the prevention needs of the community.

Each prevention program is consistent with evidence-based national guidelines for cancer prevention. (Standard 4.1 from Cancer Program Standards.)

As a cancer program, we are asked to identify risk factors within our community and patient population, and then use strategies to modify attitudes and behaviors to reduce

Cancer Prevention Programs and MECC’s No Tobacco Challenge

2015 No Tobacco Challenge Winning Drawing 1st prize: St. James Seton, Teacher: Julie Cunningham

Following surgery, additional therapy might be recommended and typically involves radioactive iodine treatment. In addition, thyroid hormone will be given to replace the missing thyroid hormone. External radiation is rarely given.

After treatment is completed, all patients are followed by a physician that specializes in the care of thyroid cancer. This consists of physical examination, periodic neck ultrasounds,

and may include blood test measurements called thyroglobulin or chest imaging from time to time. In the rare situations that the thyroid cancer has spread elsewhere, radioactive iodine or new drugs called Kinase inhibitors or BRAF V600E mutation inhibitor therapy may be initiated.

Surgeons at Methodist Estabrook Cancer Center specialize in the care of patients with thyroid cancer. Working with our

colleagues in Endocrinology, Nuclear Medicine, Medical Oncology and Radiation Oncology, we discuss all patients at a multidisciplinary cancer conference to determine the best recommendations for treatment for our patients.

The survival after treatment for thyroid cancer is generally excellent.

Thyroid Cancer Update continued

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Challenge project is a community-based, collaborative, project with the main objectives of preventing initiation of tobacco products among youth. It is known that the rate of teen smoking and use of e-cigarettes is rising. It is also known that the younger people are when they start using tobacco; the more likely they are to become strongly addicted to nicotine.

The designed activity provides prevention education as well as instruction about the short and long-term consequences of tobacco use. This one-hour classroom discussion includes materials for presentation to students on the dangers associated with tobacco use. Elementary school students are “challenged” to make the commitment to “no tobacco” and sign a contract that makes the pledge. Participating classrooms are entered into a drawing, with five classrooms winning Barnes and Noble gift certificates for classroom supplies and a pizza party.

Cancer Prevention Programs and MECC’s No Tobacco Challenge continued

2015 No Tobacco Challenge Winning Drawing 2nd Prize: Our Lady of Lourdes, Teacher: Mrs. Kreikemeier

the chance of developing cancer. Some examples of cancer prevention programs include: nutrition, physical activity and weight loss programs related to cancer prevention; radon education and testing related to lung cancer prevention; smoking/chewing tobacco cessation; skin cancer prevention programs; and smoking prevention in adolescents.

Every three years a Community Needs Assessment is done for the metropolitan Omaha community. In the most recent

Assessment (completed in the summer of 2015), it was found that lung cancer was third most common cancer in the metro area with an incidence rate of 73.8/100,000 individuals (prostate cancer is 134/100,000 and female breast cancer is 131.8/100,000). However, when looking at age-adjusted death rates for cancer types, lung cancer causes 51.4 deaths/100,000 every year, more than

double that of prostate (22.3 deaths/100,000) and breast cancer (21.9 deaths/100,000).

According to the Centers for Disease Control and Prevention for the year 2015, cigarette smoking has declined among U.S. youth in recent years. The use of some of the other tobacco products, such as electronic cigarettes, has increased. In 2015, the CDC reported that about 7 of every 100 middle school students (7.4%) and about 25 of every 100 high school students (25.3%) used some type of tobacco product.

In an effort to continue to have the smoking rate decrease for our community’s adolescents, the Lung Cancer Program organizes an annual No Tobacco Challenge for metro area third graders. We partner with the Douglas, Sarpy and Cass County school districts, Metro Omaha Tobacco Action Coalition, and Tobacco Free Sarpy and Cass County. Our funding is graciously provided by Methodist Hospital Foundation. The No Tobacco

In 2015, 1,739 students pledged to be “tobacco free” representing 154 3rd grade classrooms.

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Primary Sites Total Analytic Non-Analytic

LIP 5 5 0

TONGUE 27 24 3

GUM 6 6 0

FLOOR OF MOUTH 2 2 0

PALATE 7 5 2

MOUTH 8 8 0

PAROTID GLAND 6 6 0

SALIVARY GLAND 3 3 0

TONSIL 17 16 1

OROPHARYNX 3 3 0

NASOPHARYNX 5 4 1

PYRIFORM SINUS 3 3 0

HYPOPHARYNX 3 1 2

ORAL CAVITY 1 1 0

ESOPHAGUS 24 21 3

STOMACH 24 21 3

SMALL INTESTINE 13 11 2

COLORECTAL 166 160 6

ANUS 3 3 0

LIVER 5 5 0

GALLBLADDER 5 5 0

BILIARY TRACK 9 9 0

PANCREAS 64 58 6

NASAL CAVITY 5 3 2

SINUS 2 2 0

LARYNX 22 22 0

TRACHEA 0 0 0

LUNG 197 178 19

THYMUS 0 0 0

HEART-PLEURA-MEDIASTINUM 1 1 0

BONES-JOINTS-CARTILAGE 4 4 0

BLOOD SYSTEM 50 40 10

CLL 12 6 6

ALL 4 4 0

Primary Sites Total Analytic Non-Analytic

SKIN 163 157 6

MELANOMA 155 151 4

AUTONOMIC NERVOUS SYSTEM 0 0 0

PERITONEUM 5 4 1

CONNECTIVE TISSUE 12 11 1

BREAST 325 320 15

VULVA 43 25 18

VAGINA 3 3 0

CERVIX UTERI 53 48 5

CORPUS UTERI 220 216 4

UTERUS 1 1 0

OVARY 82 79 3

FEMALE GENITAL 17 17 0

PLACENTA 0 0 0

PENIS 0 0 0

PROSTATE 236 200 36

TESTIS 16 15 1

MALE GENITAL 0 0 0

KIDNEY 94 85 9

RENAL PELVIS 5 5 0

URETER 7 7 0

BLADDER 98 85 13

URINARY ORGANS 0 0 0

EYE 4 4 0

MENINGES 10 7 3

BRAIN 17 12 5

CENTRAL NERVOUS SYSTEM 5 4 1

THYROID 56 53 3

ADRENAL GLAND 1 1 0

ENDOCRINE 9 8 1

LYMPH NODES 44 37 7

UNKNOWN 20 18 2

OTHER 2 2 0

TOTALS 2248 2054 194

2015 Cancer Cases

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Male 723 39%

PROSTATE 200 27%

HEAD/NECK 100 14%

COLORECTAL 87 12%

MELANOMA,SKIN 75 11%

LUNG & BRONCHUS 69 9%

BLADDER 65 9%

KIDNEY & RENAL PELVIS 60 8%

PANCREAS 27 4%

LYMPH NODES 20 3%

BLOOD SYSTEM 20 3%

Female 1,028 61%

BREAST 314 31%

CORPUS UTERI 216 21%

LUNG & BRONCHUS 100 10%

OVARY 79 8%

COLORECTAL 73 7%

MELANOMA,SKIN 70 7%

HEAD/NECK 67 7%

CERVIX 48 5%

PANCREAS 31 3%

KIDNEY & RENAL PELVIS 30 3%

AJCC Stage at Diagnosis

INSITU 133 6%

I 731 36%

II 388 19%

III 359 18%

IV 321 15%

NA 102 5%

UNKNOWN 20 1%

Age at Diagnosis Male Female

10-19 0 0% 0 0%

20-29 8 1% 29 2%

30-39 26 4% 39 3%

40-49 44 5% 133 11%

50-59 181 22% 277 23%

60-69 294 35% 355 29%

70-79 185 22% 245 21%

80-89 79 9% 132 10%

90+ 18 2% 9 1%

Totals 835 1219

2015 Top Ten Cancer Sites AJCC Stage & Age at Diagnosis

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n Achieved NAPBC re-accreditation of the Breast Care Center

n Hosted a Lung Cancer Symposium

n Hosted and participated in community cancer screening events with particular attention to the underserved and diverse populations

n Achieved 16 percent patient enrollment in clinical research trials of the total number of patients screened

n Collaborated with Methodist Jennie Edmundson to establish a half day monthly Cancer Prevention & Hereditary Cancer Risk clinic

n Maintained NCCN guideline compliance for the various tumor sites treated at MECC

n Continued evolvement of the Cancer Patient and Family Advisory Council

n Increased visibility of Harper’s Hope services within the Greater Omaha community

n Partnered with the Methodist Foundation to maximize all grant and donor opportunities

n Offered lung cancer screenings in compliance with the US Preventative Task Force recommendations and the CMS Coverage Decision

n Implemented Cerner scheduling for Oncology Nutrition services

n Coordinated Omaha Fashion Week’s Cancer Survivor’s Style Show

n Submitted stem cell program data to CIBMTR (Center for International Blood & Marrow Transplant Research)

n Documented psychosocial distress screenings and patient navigation services in Cerner

n Participatedinafieldtestwith Professional Research Consultants (PRC) to administer the CAHPS for Cancer Care survey, a standardized oncology patient satisfaction tool in finaldevelopment

n Created and distributed survivorship careplans and treatment summaries in compliance with the CoC’s implementation time frame and scope

n Initiated the planning process for refurbishment of the Infusion Center

n Provided a post-surgical bra free of charge to all breast cancer patients undergoing a lumpectomy or mastectomy in collaboration with Project Pink’d

n Explored complementary interventions on the Inpatient Oncology Unit to include Aromatherapy

n Enrolled in the national Radiation Oncology Incident Learning System (RO-ILS).

n Increased access for GYN Oncology patients by solidifying the satellite officehoursandofferingdedicated PA clinics for established, stable patients.

n Increased new Behavioral Health Outpatient visits by 24 percent

n Achieved American College of Radiology Lung Cancer Screening Center Designation

n Increased the Oncology Social Work coverage to meet the growing demands for these services.

n Developed and implemented Financial Navigation classes for MECC patients and families to enhance their understanding of healthinsurancebenefitsandavailablefinancialresources

n Expanded Oncology Nutrition services to WDMP

n Transitioned documentation for the Behavioral Health Program to Cerner

n IncreasedCertifiedGeneticCounselor services by 8 hours per week to meet the growing demand

2015 Accomplishments

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n Create a database for tracking and monitoring of adherence to NCCN guidelines for pancreatic cancer

n Increase effectiveness of clinic to hospital coordination for Surgical Oncology clinic patients

n Track and monitor adherence to NCCN guidelines for invasive breast cancer

n Collaborate with Charles Drew to offer mastectomy fittingservicestothelowincome and uninsured population they serve

n Continue development and implementation of CPOE chemotherapy protocols for GYN Oncology

n Provide ongoing education to MECC clinics and departments regarding Behavioral Health services

n Implement FEES (Fiberoptic Endoscopic Evaluation of Swallowing) Procedure in the Head and Neck Surgical Oncology Clinic

n Partner with the American Lung Association to create and facilitate a Lung Cancer Support Group

n Offer an educational workshop for laryngectomy patients and their families

n Partner with Leap-for-a-Cure to host a Neuro-Oncology Conference for patients/families and healthcare professionals

n Design and implement a cancer rehab program specifictoheadandneckcancers

n Collaborate with Children’s Hospital to implement a Children’s Thyroid Clinic at Children’s Hospital

n Implement evidenced-based protocols for enhanced surgical recovery of GYN Oncology patients

n Achieve Commission on Cancer re-accreditation with commendation

n Achieve Radiation Oncology re-accreditation

n Design and launch a newwebsitespecifictooncology services

n Achieve the 90th percentile in oncology patient satisfaction results

n Achieve 12 percent patient enrollment in clinical research trials of the total number of patients screened. Achieve 5 percent enrollment specifictotreatmenttrials.

n Collaborate with Methodist Jennie Edmundson to establish a lung cancer screening program at Methodist Jennie Edmundson

n Implement the electronic health record in the Hereditary Cancer Risk Program

n Incorporate Palliative Care into the Lung Cancer Clinic

n Create an Inner Beauty satellite location on the Inpatient Oncology Unit

n Complete refurbishment of the Infusion Center

n Provide system-wide staff education regarding the safe handling of hazardous drugs and potential by-products

n Implement Aromatherapy on the Inpatient Oncology Unit

n Purchase and install a replacement CT scanner equipped with 4-dimensional capabilities in Radiation Oncology

n Utilize the Infusion Center to centralize infusion and transfusion scheduling for Methodist Hospital

n Explore the possibility and feasibility of a high-risk cancer clinic

n Increase Oncology Dietitian coverage at MECC to better support growing demand for services

n Centralize patient transportation services

n Implement education and training on Cardizem protocol application for patients on the Inpatient Oncology Unit having heart rate control issues to allow treatment on the unit versus transferring to a higher level of care

2016 MECC Goals

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Mark Omar, MD

Geetha Palaniappan, MD

Irina Popa, MD

Diane RandolphHome Health and Hospice*

James Reilly, MDCancer Liaison Physician*

Lauren RobinsOncology Rehab*

Sharlon Rodgers Radiation Oncology

Todd Sauer, MD

M. Shashidharan, MD

William Shiffermiller, MD Medical Staff Administration

Kathryn Simone Breast Care Center

Greg Smith, MDPathologist*

Russell Smith, MD

Yungpo Su, MD

Stefano Tarantolo, MD

Jane Theobald, MD

Jackie ThielenPalliative Care*

Teri TiptonNursing Administration

Kimberly TomeiSurgical Oncology Clinic

* Designates individuals or positions that are required by the American College of Surgeons Cancer accreditation program.

Robert Langdon, MDCo-Chairman*

Daniel Lydiatt, DDS, MDCo-Chairman* Medical Director, Cancer Center

Josie AbboudMethodist Hospital Administration

Amy Bamburg Tumor Registry*

Kathryn Bartz Oncology Research*

Patty Bauer Cancer Center Administration*

Margaret Block, MD

Cheryl BohacekInpatient Oncology

Kathy ChristiansenCancer Prevention & Hereditary Risk*

Paul Christy, MD

David Crotzer, MD

George Dittrick, MDSurgical Oncologist*

Randy Duckert, MDRadiation Oncologist*

John Edney, MD

Steve Goeser Methodist Hospital Administration

David Hilger, MD

Stephen Hosman, MD

Tien-Shew Huang, MD

Timothy Huyck, MD

Peggy JarrellOncology Social Worker*

Brett Jepson, MD

Bev JohnsonClinical Effectiveness*

Richard Kutilek, MDRadiologist*

Stephen Lemon, MD

Fred MassoomiPharm.D.

Deb MeyersLung/Thoracic Oncology Clinic*

Mary MeysenburgData Management

Alireza Mirmiran, MD

Peter Morris, MD

2015 Cancer Committee Members

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© 2016 Methodist Estabrook Cancer Center