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2013 ANNUAL REPORTBUILDING On STRENGTH
MULTIDISCIPLINARY CLINICAL TEAMS + PATIENT NAVIGATION
+ GENETIC COUNSELING + CLINICAL RESEARCH + CLINICAL
EDUCATION + INTEGRATIVE MEDICINE + PATIENT SUPPORT
AND EDUCATION + INNOVATIVE CLINICAL TRIALS CENTER
+ SURVIVOR CELEBRATIONS + COMMUNITY OUTREACH
1 Letter from Leadership
2 Cancer Committee Members
3 Baylor Charles A. Sammons Cancer Center at Irving
4 Programs of Focus
Faxitron
Low Dose CT Lung Screenings
Nursing Oncology Forum
NICHE
Magnet
9 Patient Support
Community Events/Outreach
Patient Spotlight
American Cancer Society
15 Continuum of Care
Genetics Counseling Program
Breast Imaging Services
17 Palliative Care
25 Achievements
27 Cancer Registry
2013 Screenings
Summary of 2012 Cancer Registry Data
35 Education
Cancer Conferences
29 Campus and Area Maps
37 Contact Information
Cancer research studies on the campus of Baylor Medical Center at Ir-ving are conducted through Baylor Research Institute, Texas Oncology, and US Oncology. Each reviews, approves, and conducts clinical trials independently. Their clinical trials are listed together, in this publication, for the convenience of patients and physicians.
Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor Medical Center at Irving or Baylor Health Care System. © 2014 Baylor Health Care System. All rights reserved. Photographs may include models or actors and may not represent actual patients. SAMMONS_444_2014 SC
1901 N. MacArthur Blvd.Irving, TX 75061972.579.8100BaylorHealth.com/IrvingCancer
CONTENTS
BUILDING On STRENGTH
1 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
LETTER FROM LEADERSHIP
At Baylor Medical Center at Irving our cancer program continues to thrive under the new name, Baylor Charles A. Sammons
Cancer Center at Irving. Becoming a part of the Baylor Charles A. Sammons Cancer Center network in 2012 has championed our
cancer program as a premier choice for cancer care in Irving, Las Colinas and the surrounding communities.
This past year, the designation has brought the full array of Baylor Health Care System’s cancer diagnostic and treatment
resources to our community. In 2013 and moving forward, the Baylor Charles A. Sammons Cancer Center network provides our
cancer patients with highly specialized medical expertise and access to advanced clinical trials.
The cancer program remains committed to improving the lives of the patients we serve currently and to improving the opportunities
for those we will serve in the future. One such area of opportunity is with lung cancer. We have expanded our screening
capabilities for patients at high risk for developing lung cancer. Our cancer program now includes lung cancer screening using
low-dose computed tomography (CT) technology. The addition of this screening to our arsenal of cancer diagnostic tools is
exciting and demonstrates our continued commitment to advance the oncology services available to residents in our service area.
Baylor Irving’s Cancer Committee served as a guiding force to continue the hospital’s vision of excellence in cancer care by
maintaining our accreditations and community outreach efforts. Through collaboration with the American Cancer Society and the
Irving Healthcare Foundation in 2013, we were able to achieve our goal of providing quality care for our cancer patients with
access to grants used for cancer care and education, support groups, numerous community events and cancer care initiatives.
As we look forward to 2014, we are optimistic about the future and growth of Baylor Charles A. Sammons Cancer Center at Irving
and what this means for the cancer patients we serve and will serve in the future.
Sincerely,
Cindy K. Schamp Edward Clifford, MD
President Medical Director
Baylor Medical Center at Irving Baylor Charles A. Sammons Cancer Center at Irving
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 2
Edward Clifford, MDMedical Director
Cindy K. Schamp, President
CANCER COMMITTEE MEMBERS
Physician members:
Edward Clifford, MD, Surgery, Chairperson
Amy Balis, MD, Radiology
Peter Heidbrink, MD, Pulmonology and Quality
Jeffrey Embrey, MD, Pathology, Chief Medical Officer
Robyn Olney, MD, Pathology
Tim Schroeder, MD, Palliative Care
Granger R. Scruggs, MD, Radiation Oncology
Sridevi Juwadi, MD, Medical Oncology
Hospital administrative members:
Brenda Blain, Chief Nursing Officer, Chief Executive Officer
Penny Thesing, Oncology Director
Susan Shipp, Healthcare Improvement Director
Jame Restau, ACNP, Palliative Care
Amanda Smith, Manager, Inpatient Oncology and Rehab Unit
Pam Beers, Community Outreach
Outreach members:
Phyllis Burton, Women’s Imaging Manager
Katherine Clark, Women’s Imaging Director
Gary Green, Pharmacy
Elizabeth Broyles, Research Nurse
Natasha Angel, Dietician
Kathleen Loinette, Nurse Navigator
Community member:
Jocelyn Heisser, American Cancer Society
3 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
BAYLOR CHARLES A. SAMMONS CANCER CENTER AT IRVING
Baylor Irving is a proud member of the Baylor Charles A.
Sammons Cancer Center network. Through this affiliation, the
hospital’s cancer program continued to grow in 2013 as a result of
the accreditation process by the American College of
Surgeons’ Commission on Cancer (CoC). Network membership
has heighted Baylor Irving’s commitment to compassionate
cancer care, cancer research and cancer education. The
hospital’s cancer patients benefit from the expertise of highly
trained physicians, nurses and other health care professionals
who are focused on one goal, to provide current recommended
care based on proven clinical research for newly diagnosed oncol-
ogy patients in Irving and surrounding communities. The Baylor
Charles A. Sammons Cancer Center network assures cancer
patients in North Texas they will receive the same standard of care
while being able to remain close to home. In 2012, the number
of newly diagnosed cancer patients reached 1,238,910 while the
five-year survival rate climbed to 67 percent. This improvement
is due, in part, to efforts such as the Baylor Charles A. Sammons
Cancer network to provide long-term care for cancer survivors
through survivorship programs and services. Baylor Irving’s
community outreach programs provided information about healthy
lifestyles, prevention and early detection to the patients in the
community in 2013.
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 4
5 Baylor Medical Center at Irving | BUILDING On STRENGTH
PROGRAMS OF FOCUS
Faxitron and Comfort Top Table
The Baylor Irving Women’s Imaging Center continued to focus
on providing patient-centered care. In 2013, the Center installed
a Comfort Top Table to make a patient’s time during a diagnostic
procedure as comfortable as possible. The table also improved
the physician’s capability to complete the procedure. In addition,
Faxitron® technology was added to the Center’s procedure suite.
The self-contained system produces a high-resolution digital
image in a matter of seconds. The image can be saved in the
hospital’s digital imaging archives for immediate and simultaneous
review by the radiologist. This technology significant reduced the
amount of time a patient was under anesthesia and ensured the
physician that all calcifications were in the tissue being removed.
Low Dose CT Screening for Lung Cancer
In 2013, Baylor Charles A. Sammons Cancer Center at Irving
began offering a lung cancer screening program to those at high
risk for the disease. The program used a simple, low-dose
computed tomography (CT) scan of the lungs to screen and
diagnose lung cancer before symptoms developed. Candidates
for the screening program included:
• High-risk population of current and former smokers over the age
of 55 with greater than or equal to 30-pack-per-year history of
smoking and have quit smoking greater than 10 years
FAXITRON | LOW DOSE CT SCREENING FOR LUNG CANCER
• People over 50 years of age that have
smoked the equivalent of one pack per
day for 20 years and have one
additional risk factor other than
second-hand smoke – occupational
exposure to other carcinogenic agents,
including asbestos and diesel fumes
– COPD – personal history of cancer –
family history of lung cancer.
Baylor Irving’s oncology program began
offering this lung cancer screening to
high-risk individuals because, according
to the American Cancer Society, lung
cancer is the leading cause of cancer
death. A study conducted by the
National Cancer Institute proved that
screening people at high risk of
developing lung cancer with low-dose
CT scans reduced mortality from the
disease by 20%. The study estimated
that early detection and treatment of
lung cancer could save more than
70,000 lives a year.
7 Baylor Medical Center at Irving | BUILDING On STRENGTH
PROGRAMS OF FOCUS
Nursing Oncology Forum
In 2013, Baylor Irving participated in the Baylor Health Care
System oncology nursing forum. The forum was created to
provide oncology clinicians throughout Baylor Health Care System
with a way to discuss shared concerns/issues that affect the
safety and outcomes of their oncology patient population.
NICHE
In 2013, Baylor Irving became a NICHE (Nurses Improving Care
for Healthsystem Elders) facility. NICHE is a national program
designed to improve care for older hospitalized adults. It was
created in recognition of the aging of hospital patients, the
ongoing national shortage of nurses trained in gerontology, and
the need for hospitals to contain costs while improving patients’
health care experience. By joining NICHE, Baylor Irving expects
to significantly advance its understanding of the needs of older
patients, train nurses to meet those needs, and launch several
NURSING ONCOLOGY FORUM | NICHE | MAGNET® STATUS
new protocols to prevent health care
problems that are common in this
population. Through this program, Baylor
Irving will undertake a number of steps
to recognize and prevent or treat these
health problems. In the first phase of the
program, Baylor Irving will begin
providing additional training to a core
group of geriatric resource nurses, who
will become leaders and role models
to their peers on the inpatient units
throughout the hospital.
Magnet® Status
In 2013, Baylor Irving received Magnet®
designation from The American Nurses
Credentialing Center (ANCC).
Magnet® status is one of the high-
est levels of recognition a hospital can
achieve and is awarded after the hospital
has demonstrated excellence in provid-
ing patient care in more than 35 areas.
The Magnet® Recognition Program is
the benchmark for patients to measure
the quality of care they should expect to
receive while a patient in a hospital. The
Magnet® designation signifies a
hospital’s ability to attract and retain
professional nurses.
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 10BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 59 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Grapevine 6
COMMUNITY EVENTS/OUTREACH
PATIENT SUPPORT +
Thousands of residents of Irving and surrounding communities
received cancer information and screenings thanks to a variety
of activities in 2013. Education was provided on a variety of
cancer topics including breast cancer, women’s health,
colorectal cancer, lung cancer, prostate cancer, skin cancer,
men’s health, ovarian cancer and gynecological cancer. The
education and screenings were provided in a number of venues
throughout the Baylor Irving service area including:
• Health fairs for the cities of Grapevine and Keller
• Hospital-sponsored CME courses for physicians and
clinicians
• For Women, For Life™ women’s health event
• Look Good, Feel Better™
• Tobacco kNOw (presented to middle schools in the
service area)
• American Cancer Society Relay for Life teams
• I Can Cope™
• It’s A Guy Thing™ men’s health event
• Smoking cessation classes
In October 2013, Baylor Irving held its
29th annual fundraising event benefitting
the Irving Healthcare Foundation in
support of cancer services at Baylor
Charles A. Sammons Cancer Center.
The event was held at the Four Seasons
Resort and Club in Las Colinas. Featuring
fun for the entire family, the event
included activities such as a chili cook-
off, pumpkin decorating contest, kids’
crafts, health information displays,
obstacle course, miniature golf course
and rock climbing wall. Thanks to the
generosity of participants, the Foundation
was able to provide funding to acquire
the Flexitron® technology and the
Comfort Top Table for the Women’s
Imaging Center.
11 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
PATIENT SUPPORT +
For Leslie Williams, a typical night of talking on the phone and
watching television turned into a life-changing event when she
found a lump in her left breast. That was 2009, six years after her
baseline mammogram and a year before she was due to have her
second annual screening mammogram.
“My baseline mammogram was normal, as was my first annual
screening,” says Williams. “So, I was surprised to discover the
lump in my breast. I immediately scheduled an appointment at the
Baylor Irving Women’s Imaging Center. After additional diagnos-
tic tests including ultra sound, stereotactic biopsy, CT/PET scan
and oncotype DX, I was diagnosed with stage 1 infiltrating ductal
carcinoma triple negative breast cancer. Thankfully, the testing
showed that I was negative for the BRCA gene.”
Williams says there was no history of cancer in her family. Working
closely with her medical oncologist she successfully completed
her treatment plan of a lumpectomy and chemotherapy and
radiation.
The diagnosis of triple negative breast cancer launched her quest
to learn more about this particular type of breast disease. She
discovered that to find out what type of breast cancer she had,
her physicians were searching for the presence or absence of
three receptors, proteins that live inside or on the surface of a cell
and bind to something in the body to
cause the cell to react. The three recep-
tors include estrogen receptor-positive
breast cancer, progesterone receptor-
positive breast cancer and HER2-positive
breast cancer. If one or more are present,
treatment generally involves medicines
that prevent, slow or stop cancer growth
by targeting the receptors. Triple nega-
tive breast cancer means that none of
the receptors are present and a different
type of treatment is needed, generally
chemotherapy that has proven to be most
effective.
Williams was especially interested to
learn that, according to the Triple Nega-
tive Breast Cancer Foundation, several
studies suggest that being premeno-
pausal, African-American or Caribbean
increases a woman’s risk of developing
basal-like or triple negative breast cancer.
The studies also indicate that among
African-American women who develop
breast cancer, there is an estimated 20 to
40 percent chance of the breast cancer
being triple negative.
“I am blessed to be 46 years old, living
in Arlington, and working as a quality
engineer in the information technology
field,” says Williams. “Fortunately, when I
was diagnosed, I had good insurance with
great benefits. I had lots of paid time off
and sick days accumulated and a good
FMLA program. My job also allowed me
to telecommute, so I was able to work
from home while undergoing treatment.
My family and friends embraced my
cancer journey, to tackle the unknown
together. I had a 10-person entourage
with me for my lumpectomy. My dad and
brother cut off my hair and oiled my scalp
two weeks after my first round of chemo.
My friends and family took different shifts
for all of my treatments. My support base
got stronger and to this day it continues
to grow larger.”
Williams says her experience with Baylor
PATIENT SPOTLIGHT: LESLIE WILLIAMS
Irving was warm and welcoming. “I
developed a personal connection with my
oncologist,” explains Williams. “I was her
student/friend and she was my mentor
and cheerleader. The nursing staff and
technicians made it a point to remember
my name and follow up on past conver-
sations. My breast cancer nurse naviga-
tor guided me through the process. All
of them were, and always will be, my
extended support family. I recommend
Baylor Irving to others I meet, especially
my newly diagnosed ‘breast friends.’”
Williams has been featured in a patient
testimonial advertising campaign for
Baylor Health Care System and she says
that is one of her most memorable events
from her cancer experience. “I believe,
because of the powerful relationship I
established with my extended Baylor
family, they asked me to smile for the
camera. It was an honor and a blessing
doing the advertisements and public
service announcements to let people
know the confidence I have in Baylor
Irving. I also enjoy the effort they put into
celebrating breast cancer survivors with
an annual luncheon or pink pajama party.”
Believing that there was a reason for her
experience with breast cancer, especially
triple negative breast cancer, Williams
started Survivors On Purpose, a social
network group, in April 2013. “We meet
every fourth Thursday at Baylor Irving in
the Sammons Cancer Center,” says
Williams. “We have monthly activities
with a variety of topics and guests from
lymphedema specialists to beauty make-
overs and much more. I also belong to the
Junior League of Arlington, an educational
and charitable organization of women
committed to promoting voluntarism,
developing the potential of women and
improving the community.
“As I grow my social network group, I
would like to do more joint community
service activities to gain momentum for
both Survivors On Purpose and Baylor
Irving. It would be a great collaboration.”
“I RECOMMEND
BAYLOR IRVING
TO OTHERS I
MEET, ESPECIALLY
MY NEWLY
DIAGNOSED
‘BREAST
FRIENDS.’”
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 12
13 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
TOGETHER,
WE ARE A
RELENTLESS
FORCE
FIGHTING
CANCER.
AMERICAN CANCER SOCIETY
PATIENT SUPPORT +
The American Cancer Society has been an incredible partner to
Baylor Sammons Cancer Centers, including Baylor Irving, deliver-
ing lifesaving results. American Cancer Society representatives
collaborated with oncology staff to deliver support, and served on
the cancer committee to help provide resources to fulfill the
Commission on Cancer standards for cancer care.
In 2013, the American Cancer Society engaged with 33 patients
providing 94 services at Baylor Irving. All newly diagnosed
patients received a Personal Health Manager kit from the Society
which provided personalized information on the patient’s specific
cancer type, resource information, and tools that helped patients
and caregivers keep appointments, monitor test results and keep
prescriptions organized throughout treatment. American Cancer
Society patient navigators provided free and confidential
support and guidance to all patients and their caregivers during
their cancer journey. Patients received support from the Society’s
wig program as well as transportation services. Newly diagnosed
breast cancer patients received assistance through the Reach To
Recovery® program where Society-trained breast cancer
survivors provided valuable information and encouragement
to patients in their journey. Additionally, female patients were
introduced to the Look Good Feel Better® program, dedicated to
improving appearance-related side effects, and building personal
confidence while undergoing treatment.
As the official sponsor of birthdays, the
American Cancer Society knows how
important each and every birthday can
be. In May of 2013, the Society
celebrated its 100th birthday – 100 years
of saving lives and 20 years of partnering
with Baylor hospitals. The Society saves
lives by helping individuals stay well
through prevention and early detection,
helping them get well by being there
during and after a diagnosis, finding cures
through groundbreaking discovery, and
fighting back through public policy. In the
last two decades the Society has
contributed to a 20% decline in cancer
death rates in the US. Last year, the
Society and Baylor hospitals reached
over 2,100 patients with more than 6,000
programs and services. That’s one in four
cancer patients treated at Baylor
hospitals.
The Women’s Imaging Center at Irving continued to serve
thousands of area patients in 2013. A total of 10,733 screening
mammograms were performed and 2,589 diagnostic
mammograms were completed at sites in Irving and Coppell.
The Women’s Imaging Center maintained its designation as an
American College of Radiology Center of Excellence as well
as its designation from the National Accreditation Program for
Breast Centers of the American College of Surgeons. A total of
12,810 patients were served by the Women’s Imaging Center
in 2013.
BREAST IMAGING SERVICES
CONTINUUM OF CARE +
15 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
Patients at high risk of developing cancer
as a result of genetic pre-disposition, were
evaluated by a physician and, if appropri-
ate, referred to a certified genetic counselor
at the Charles A. Sammons Cancer Center
at Baylor University Medical Center.
GENETICS COUNSELING
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 16
Disclosure Statement: Jame Restau nor Pamela Green have
any disclosures to claim.
Synopsis/Abstract: One in five patients will receive terminal
care in the intensive care setting. The majority of these
patients will die after withdrawing or limiting the life-sustaining
measures provided in the intensive care setting. The burden of
these decisions are shared by the medical staff providing care
for the patient and family. The integration of palliative care into
the intensive care unit provides care, comfort and planning
for patients, families and the medical staff to help decrease
the emotional, spiritual and psychological stress of a patient’s
death. The quality measures for palliative care in the ICU is
discussed along with case studies to demonstrate how this
integration can be beneficial for a patient and family. Integrating
palliative care into the ICU is also examined in regards to the
complex adaptive system.
Key Words: palliative care, intensive care, quality, patient and
family centered care, complex adaptive system.
Key Points:
• High quality care for intensive care patients and their families
should include palliative care.
• Nearly half of all patients who die in the hospital will receive
intensive care services during their terminal admission.
IN THE INTENSIVE CARE UNIT
Jame Restau, MSN, RN, ACNS-BC, ACHPN, OCN, Baylor Medical Center at Irving, Jame.Restau@baylorhealth.eduPam Green, MSN, RN, FNP-BC, Baylor Regional Medical Center at Carrollton, Pamela.Green@baylorhealth.edu
PALLIATIVE CARE +
17 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
• One of the key goals of health care
is to limit costs while simultaneously
improving or maintain the quality of
care that patients and families receive.
• Quality measures for palliative care in
the ICU are being developed at a
national level and can be implemented
in diverse ICU units across the nation.
Palliative Care in the Intensive
Care Unit
Restorative care and comfort care
are often seen as mutually exclusive.
Promulgating this misconception are
insurance mandates that patients forgo
curative treatment when seeking
comfort and symptom management in
the face of terminal illness. This
dichotomy of care has created barriers
to early access of palliative services
for the patient and their family. Provid-
ing quality of care to patients with life
limiting illness is the challenge facing the
staff in the intensive care unit.
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 18
Importance of the Problem
Although the Bible reminds us “there is
a time to be born and a time to die,”
we have paid strikingly little attention to
the “time to die” until recently. In
ancient times, death was quick and
often sudden. Now death most often
occurs during the course of prolonged
chronic illness that may last years.
Patients may experience serious physi-
cal, emotional, social, and spiritual
suffering. In addition, such patients, their
families, the physicians, nurses and
others involved in the delivery of care
face ethical and financial challenges.1
Curative and palliative care should be
provided congruently to meet the needs
of all partners in a patient’s care. The
symptom burden of disease, commu-
nication of goals of care, alignment of
treatment and therapy to goals, values
and preferences, and appropriate, timely
transition of care should not be limited
by prognosis.2
Review of the Literature
The United States has seen a decline in the number of
hospitals since early 1986; however, some areas report as
high as a 26% increase in the number of intensive care beds.
Occupancy rates and average length of stay in the intensive
care units are increasing.3 One in five patients will receive
terminal care in the intensive care setting.4 Approximately 90%
of deaths in the intensive care unit occur after discontinuing
or limiting treatment.5 Of all hospital deaths, 47% will receive
intensive care services during the terminal admission6 with
less than 20% of these patients having completed an advance
directive.7 Do not attempt resuscitation orders are often
written within days of death. Due to the fact these conversa-
tions occurring late in the disease trajectory, patients and
families perceive this dialogue as a sign of impending doom
rather than a result of advance care planning.8
Family members making decisions for their loved ones often
continue treatment despite prior conversations with the patient
to the contrary.9 These decisions create emotional distress
and financial burden on the family.10 Poor understanding of
diagnosis, prognosis, and treatment options has been identified
in 54% of family members with loved ones suffering serious
illness. Families have the perception that healthcare providers
experience stress when discussing end of life in the
IN THE INTENSIVE CARE UNIT
PALLIATIVE CARE +
19 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
intensive care unit which can often lead
to families second-guessing themselves
in regards to the care decisions they
have made.
It is well documented that the last
chapter of life is characterized by three
major deficiencies: unnecessary
suffering11, unacceptable variation in
treatment with striking excesses in
non-beneficial treatment12, and unsus-
tainable costs. Approximately 30% of
the Centers of Medicare and Medicaid
Services (CMS) dollars have been
attributed to end of life care.13 Forty
percent of CMS costs occur in the last
30 days of life.14 The number of
Americans age 65 and older will double
by 2030.3 Too many patients get too
much medical intervention, too little
advance care planning, and too little care
in the last chapter of life.
In response to these deficits, the
National Consensus Project for Quality
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 20
Palliative Care and the National
Quality Forms established standards for
high-quality palliative care. The Institute
of Medicine (IOM), the major societies
representing critical care health care
professionals, government and industry
healthcare payers along with large-scale
healthcare systems across the nation
agree that palliative care in the ICU
should be a quality improvement prior-
ity.10 The Center to Advance Palliative
Care (CAPC) developed an ICU focused
initiative (IPAL-ICU) in 2010 where
healthcare systems could assess
resources, guidelines and expertise.
These recommendations have been
used to guide the development of ICU
palliative care programs and establish-
ing standards for tracking and bench-
marking for quality. A consensus of
expert professional opinion developed
domains for quality palliative care (Table
1). Integrating these features into the
ICU can be difficult as each has its own
culture created by history, structures of
care, policies and procedures, and by
the attitudes and professional interaction
between the different disciplines working
in the critical care setting.15
Poor quality end of life care creates
stress for the patient, family and health-
care providers. Lack and/or limited
access to palliative care can result in
higher costs and more aggressive care
at the end of life. Family members
suffer post-traumatic stress disorder and
extended grieving with prolongation of
the death process in their loved ones.
Nelson et al stress the importance
family members place on early attempts
to elicit the patient’s values and treat-
ment preferences, as this decreases the
burden and guilt family members feel
when making treatment decisions for
their loved one.17 Healthcare providers
witness patient and family suffering, high
mortality, inappropriate care and poor
resource stewardship, which lead to
intensive care staff burnout.18
As part of a large healthcare system in
Northeast Texas commitment to patient
centered care, Supportive and Palliative
Care programs have been established in
half of the acute care facilities through-
out the healthcare system. As part of
this initiative, significant gains have been
realized in the quality of care delivered in
the intensive care units. Interdisciplinary
critical care teams help to identify those
patients who would likely benefit from
Supportive and Palliative Care services.
Screening criteria has been implemented
across the health care system. This
screening process has been
implemented in the intensive care
units, as well as on admission in some
facilities. Palliative Care consultation is
included on ventilator order sets with
a prompt for Palliative Care screen on
ventilator day four. The emergency
departments are also initiating a screen-
ing tool to identify patients appropri-
ate for palliative care services earlier
in an effort to decrease the number of
readmissions. A standardized order set
has been developed for withdrawal of
mechanical ventilation. By establishing
standardized protocols, clinicians are
provided practice recommendations to
ensure patient comfort during the
withdrawal process.
For the first quarter of fiscal year 2014,
the percentage of palliative care consults
are graphed below. Included are
percentages from three of the hospi-
tals who have palliative care programs.
BUMC is the largest hospital in the
healthcare system and also the site of
first palliative care program within the
system. Irving is a community hospital
where the first palliative care APRN
was hired in 2008. Carrollton is a new
program that began in 2010. The final
percentage represents the percentage of
consults as a whole from all
palliative care programs within the
healthcare system. Palliative Care was
consulted in 4.8% of the patients
admitted to medical and surgical
services. On average, 26.5% of all
Palliative Care Consultations originated
in the Intensive Care Unit. Patients seen
by Palliative Care made different
decisions regarding resuscitation status
with 49% choosing Do Not Attempt
Resuscitation (DNAR) status.
Professionals’ Definition of Domains of ICU Palliative Care Qualityfrom the Robert Wood Johnson
Foundation Critical Care End-of-Life Peer Workgroup
Symptoms Management and Comfort Care
Communication within team and with patients/families
Patient-and-Family Centered Decision Making
Emotional and Practical support for patients and families
Spiritual support for patients and families
Continuity of Care
Emotional and organizational support for ICU clinicians
Data from Clarke EB, Curtis JR, Luce JM, et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med. 2003; 31; 2255-2262.16
Palliative Care Consultsas Percentage of Admissions
FY14 YTDJuly 1, 2013 to October 31, 2013
BUMC
4.2%3.6%
5% 5%
Irving Carrollton BHCS
Palliative Care ConsultsOriginating in ICU
FY14 YTDJuly 1, 2013 to October 31, 2013
BUMC
41.7%
29%
45%
26.5%
Irving Carrollton BHCS
Case Studies
Two case studies are provided to demonstrate the benefit of
Supportive and Palliative Care services in providing patient/
family centered care. Nursing and medical staff benefit in time
saved and emotional support is also realized. These case
studies highlight opportunity for improvement.
Case #1: AG presented to his primary care provider with
increasing cough, dyspnea and associated elevated tempera-
ture worsening over the previous 48 hours. He had a history of
chronic obstructive pulmonary disease, having smoked
cigarettes for 50 years. He quit smoking 15 years ago. He
also had a history of osteoarthritis and hearing loss “since the
military”. He lived alone in a single story house. He had been
widowed for 10 years, his wife dying of cancer. He volunteered
at his church and assisted other members with transportation
needs and errands.
AG had not completed an advanced directive despite
conversations with his primary care provider and his family
members. AG felt his his children would “do the right thing if
something happened”.
AG was admitted to the hospital with community acquired
pneumonia complicated by chronic obstructive pulmonary
IN THE INTENSIVE CARE UNIT
PALLIATIVE CARE +
21 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
disease. Intravenous antibiotics,
steroids, nebulizer treatments and
oxygen therapy were initiated. Despite
treatment, his condition deteriorated
requiring intensive care. Due to loss of
decision making capacity, AG’s children
were approached to make decisions
regarding their father’s treatment. The
children express their concern that their
father would never want to be “kept alive
by machines”. The intensivist felt the
patient had a good change for recovery;
however, sensed hesitancy from the
family to proceed with ventilator support.
The intensivist consulted the Supportive
and Palliative Care team for goal setting
and treatment options.
The Palliative Care Advanced Practice
Registered Nurse and physician meet
with the family. Prognosis and likelihood
for meaningful recovery were discussed.
The family was educated on the
disease trajectory of chronic obstructive
pulmonary disease. Through reflection
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 22
and storytelling, the family was able to
come to a definition for quality of life that
would be acceptable for their father. The
children made a decision for a limited
trial of ventilator support to afford their
father an opportunity to improve.
Despite maximum treatment and
ventilator support, AG’s condition
continued to decline. The family was
able to make a decision for withdrawal
of treatment, allowing their father to pass
peacefully. Though difficult, the decision
to withdraw treatment was made with
the knowledge that every opportunity for
recovery had been afforded the patient.
The family was confident they had
represented their father’s wishes.
Case #2: DD is a 22 year old male
diagnosed with acute lymphoblastic
leukemia at age five. The patient had
been in complete remission following
a bone marrow transplant at age nine.
Since that time, he has been active,
graduated from high school and was
currently in his senior year of college.
DD presented to the hospital with
intense right lower extremity pain, onset
one week prior to arrival. The pain was
attributed to possible injury when helping
a friend move. An x-ray was performed
by his primary care provider and found
to be abnormal. The patient was admit-
ted to the hospital for further diagnostic
evaluation.
Diagnostic testing revealed an elevated
white count and decreased platelets.
MRI showed increased uptake in the
right femur, pelvis and perihilar lymph
nodes. Bone biopsy revealed leukemia.
Treatment was initiated within 48 hours
of diagnosis. The patient tolerated the
initial cycle of chemotherapy well;
however, he developed neutropenia. He
later became septic and was placed on
appropriate antibiotic therapy. His
condition deteriorated requiring transfer
to the intensive care unit, where he was
placed on vasopressors. The patient
and family chose to continue aggressive
treatment in spite of the deterioration
in overall condition, the presence of
elevated temperature and the need for
continuous renal replacement therapy
(CRRT).
The patient’s condition deteriorated
requiring endotracheal intubation and
ventilation. The health care team met
with the family to discuss overall
prognosis and reasonable expectations
for a meaningful recovery. The family
felt “the physicians weren’t trying hard
enough”. The meeting ended with the
family insisting “everything continue to
be done”. The health care team felt
frustrated and confused about the
family’s expectations.
After several more days of continued
aggressive treatment with no improve-
ment in overall condition, the family
asked to have the patient transferred to
another facility. The patient’s family
had retained legal counsel and the
health care providers felt pressure to
comply with the family request, despite
their belief the patient was not stable
for transfer. Amid objection from various
members of the health care team, an
accepting physician and receiving facility
were secured and emergency medical
transport was arranged to provide trans-
fer. The patient suffered a cardiac arrest
en route to the accepting facility. Resus-
citative measures were unsuccessful.
The family was angry, blaming the health
care team for not providing adequate
care. The health care team felt they had
failed the patient by facilitating the
transfer.
Relation to the Complex
Adaptive System
The study of complex adaptive science
or systems developed from the roots of
biology, physics, and mathematics and
has expanded to organizations such as
health care systems.19 Health care
systems are a prime example of a com-
plex adaptive system due to the diversity
of systems and the complexity of inter-
actions and interdependence. There are
four common features of complex adap-
tive systems: dynamic states, massive
entanglement, emergent and robust.19
Health care systems are influenced
by connections and forces to make
changes. Connections are internal and
external to the practice environment. The
ICU is constantly undergoing changes
due to such factors as staffing, practice
guidelines and advances in technology.
Evidence-based practice (EBP) has been
one of the strongest external forces for
change in health care. EBP supports the
integration of palliative care into the ICU
to improve quality of care for patients
and families approaching end-of-life. The
relationships within an ICU can make
integration of palliative care difficult.
Physicians and other health care provid-
ers may be hesitant to utilize palliative
care services due to lack of exposure
or education about the services that
palliative care can provide for patients,
families and staff. Physicians and nurses
have a complex and interdependent
relationship in ICU. One cannot func-
tion without the support, engagement
and skill of the other. They adapt to
each other’s behaviors in regards to the
intensity and focus of patient care. This
interdependence can be both positive
and negative factors for palliative care.
If either factor has negative feelings or
prior experience with palliative care, it
can block the ability for palliative care
to provide patient/family-centered care.
Yet, these same forces can be used to
create change in the ICU one patient
experience at a time.
Small changes to the care and communication at the bedside,
can lead to large changes in the ICU. These small changes
can spread quickly throughout a exact path that it follows in
the future. The same relationship within families can change
the care in an ICU. The relationship between and among family
members can lead to tension and stress for the physicians and
nurses. These relationship can further complicate the care of
the patient as differences in opinion can lead to prolonged
suffering for the patient, family and staff at the bedside. The
robustness or fitness of the ICU is altered based upon
feedback; the type of feedback received from physicians,
patients, and families. Feedback can come in the form of
surveys, letters, and face-to-face communication between
physicians, families and staff. This communication can help
validate the role of palliative care into ICU.
Implication for Practice
Major stakeholders are calling for changes in healthcare with
regard to focus and intensity of care at the end-of-life. One of
the key goals of health care is to limit costs while simultane-
ously improving or maintaining the quality of care that patients
and families receive. One of the key ways to achieve this goal
is through integration of palliative care in the ICU for patients
suffering from terminal and/or life-limiting illness, providing
comfort, care and planning to achieve their personal goals.
IN THE INTENSIVE CARE UNIT
PALLIATIVE CARE +
23 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
The ICU environment can be overwhelm-
ing, scary and confusing for patients and
families. One of the major stressors of
an intensive care is the uncertainty that
often accompanies the patient with a
terminal and/or chronic condition. Pallia-
tive care offers a service to patients and
families that can help to alleviate some
of the stress and uncertainty during an
ICU admission. This support, commu-
nication and coordination improve the
quality of care received by the patient
and family while assisting the medical
staff by decreasing the burden of care.
References
1. Nelson JE, Cortez TB, Curtis JR, et
al. Integrating Palliative Care in the ICU.
J Hosp Palliat Nurse. 2011; 13: 89-94.
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2. Nelson JE, Campbell ML, Curtis JR,
et al. (2010). Defining standards for ICU
palliative care: a brief review from the
IPAL-ICU project. Center to Advance
Palliative Care. http://ipal.capc.org/
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 24
downloads/ipal-icu-defining-standards-
for-icu-palliative-care.pdf. Published July
2010. Accessed September 22, 2013.
3. Aslakson RA, Bridges JFP. Assess
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6. Grossman, S. Development of the pal-
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Accessed September 9, 2013.
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NA, et al. A controlled trial to improve
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JAMA. 1995; 274: 1591-1598.
12. Resnick B. Ethics and medical futil-
ity: the healthcare professional’s role.
National Conference of Gerontological
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nual Meeting; September 27-October 1,
2006: Ponte Vedra Beach, FL.
13. Raphael, C., Ahrens, J., & Fowler,
N. (2001). Financing end of life care in
the USA. Journal of the Royal Society of
Medicine, 94, 458-461. Retrieved from
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ticles/PMC1282187/pdf/0940458.pdf
14. Lubitz JD, Riley GF. Trends in
Medicare payments in the last year
of life. NEJM. 1993: 328: 1092-1096.
doi:10.1056/NEJM199304153281506.
15. Mosenthal AC, Weissman, DE,
Curtis, JR, et al. Integrating palliative
care in the surgical and trauma intensive
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Palliative Care in the Intensive Care Unit
(IPAL-ICU) Project Advisory Board and
the Center to Advance Palliative Care.
Crit Care Med. 2012; 40: 1199-1206.
doi:10.1097/CCm.0b013e31823bc8e7.
16. Clarke EB, Curtis JR, Luce JM, et al.
Quality indicators for end-of-life care in
the intensive care unit. Crit Care Med.
2003: 31; 2255-2262.
17. Nelson JE, Puntillo KA, Pronovost,
PJ, et al. In their own words: Patients
and families define high-quality palliative
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CCm.0b013e3181c5887c.
18. Strand JJ, Billings JA. Integrating palliative care in the inten-
sive care unit. J Support Oncol. 2012; 10(5):180-187.
19. Begun JW, Zimmerman B, Dooley K. Healthcare organiza-
tions as complex adaptive systems. In: Mick Se, Wyttenchach
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Francisco, CA: Jossey-Bass; 2008, 253-288.
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Grapevine 14
The Baylor Irving oncology program maintained several
prestigious recognitions in 2013:
• Accredited by the American College of Surgeons Commission
on Cancer (CoC).
• Women’s Imaging Centers recognized as National
Accreditation Program for Breast Centers (NAPBC) by the
American College of Surgeons.
BAYLOR IRVING RECOGNITIONS
ACHIEVEMENTS +
25 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 26
27 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 28
CANCER REGISTRY +SUMMARY OF 2013 SCREENINGS
SCREENING JANUARY - JUNE
MAMMOGRAMS January February March April May June
1019
125
5
36
16
1
2
1
0
989
117
0
36
24
2
2
2
1
Screeners
Recalls
Positive Biopsies
COLONOSCOPIES
Screeners
Abnormals
Positive Biopsies
CT LUNG SCREENINGS
Screeners
Abnormals
Positive Biopsies
881
111
2
44
15
0
3
2
0
1012
113
2
44
25
2
8
4
0
1033
136
12
47
19
0
2
1
0
919
135
1
62
30
1
2
0
0
SCREENING JULY - DECEMBERMAMMOGRAMS January February
MAMMOGRAMS July August September October November December TYD
963
124
2
54
29
3
3
2
0
998
118
4
50
24
0
1
0
0
Screeners
Recalls
Positive Biopsies
COLONOSCOPIES
Screeners
Abnormals
Positive Biopsies
CT LUNG SCREENINGS
Screeners
Abnormals
Positive Biopsies
889
96
2
40
26
1
4
3
0
998
119
2
64
27
1
1
1
0
845
68
1
64
27
1
4
2
0
899
97
1
62
19
0
0
0
0
11445
1359
34
603
281
12
32
18
1
29 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 30
CANCER REGISTRY +SUMMARY OF 2012 CANCER REGISTRY DATA
Estimated Number* of New Cancer Cases by Sex, US, 2013/State of Texas, 2013 versus Actual Number** of Analytic Cancer Cases by Sex, Baylor Health Care System, 2012
TOP TEN CANCER SITES
SITE MEN
Estimated NewCancer Cases
Nationally,2013
238,590
118,080
73,680
54,610
45,060
40,430
37,600
29,620
27,880
22,740
854,790
28%
14%
9%
6%
5%
5%
4%
3%
3%
3%
100%
Prostate
Lung & Bronchus
Colon & Rectum
Urinary Bladder
Melanoma of the Skin
Kidney & Renal Pelvis
Non-Hodgkin Lymphoma
Oral Cavity & Pharynx
Leukemia
Pancreas
All Sites
Estimated NewCancer Cases in the State of Texas, 2013
17,579
9,034
6,058
3,081
2,989
2,794
2,540
1,943
1,870
1,449
62,740
28%
14%
10%
5%
5%
4%
4%
3%
3%
2%
100%
Actual CancerCases,
Baylor Irving, 2012
0
29
37
3
0
0
7
3
6
2
127
0%
23%
29%
2%
0%
0%
6%
2%
5%
2%
100%
TOP TEN CANCER SITES
SITE WOMEN
Estimated NewCancer Cases
Nationally,2013
232,340
110,110
69,140
49,560
45,310
32,140
31,630
24,720
22,480
22,240
805,500
29%
14%
9%
6%
6%
4%
4%
3%
3%
3%
100%
Breast
Lung & Bronchus
Colon & Rectum
Uterine Corpus
Thyroid
Non-Hodgkin Lymphoma
Melanoma of the Skin
Kidney & Renal Pelvis
Pancreas
Ovary
All Sites
Estimated NewCancer Cases in the State of Texas, 2013
17,002
6,570
4,975
2,663
2,076
2,111
1,978
1,775
1,325
1,628
54,632
31%
12%
9%
5%
4%
4%
4%
3%
2%
3%
100%
Actual CancerCases,
Baylor Irving, 2012
91
25
25
0
12
5
1
3
2
4
198
46%
13%
13%
0%
6%
3%
1%
2%
1%
2%
100%
Source: *2013, American Cancer Society, Inc., Surveillance Research Source: *Cancer Epidemiology and Surveillance Branch, Texas Department of Stat Health Services, April 2013 ** Baylor Health Care System Cancer Registry, Electronic Registry System
Source: *2013, American Cancer Society, Inc., Surveillance Research Source: *Cancer Epidemiology and Surveillance Branch, Texas Department of Stat Health Services, April 2013 ** Baylor Health Care System Cancer Registry, Electronic Registry System
Estimated Number* of New Cancer Cases by Sex, US, 2013/State of Texas, 2013 versus Actual Number** of Analytic Cancer Cases by Sex, Baylor Health Care System, 2012
31 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 32
BAYLOR MEDICAL CENTER AT IRVING: ANALYTIC/NON-ANALYTIC CASES DIAGNOSED 2012
All Sites Oral CavityLip TongueOropharynxHypopharynxOther Digestive SystemEsophagusStomachColonRectumAnus/Anal CanalLiverPancreasOther Respiratory SystemNasal/SinusLarynxLung/BronchusOther Blood & Bone MarrowLeukemiaMultiple MyelomaOther
Bone
Connect/Soft Tissue
SkinMelanomaOther
566
1608008
1172
1250273
1265
8114
715
4730143
1
6
761
Primary Site Total Ananalytic Non-analytic Male Female In Situ Local Regional Distant NA/Unknown
244
1205007
3318
1140522
2514
191
322192
0
4
651
239
1208004
702
1026202721
4102
372
271971
1
2
541
327
400004
4702
2471544
4012
343
201172
0
4
220
24
000000
400301000
00000
0000
0
0
000
154
200002
3903
1611
2412
1000
100
0000
1
2
220
88
606000
2500
1490101
1901
180
0000
0
0
000
129
000000
2717
1130041
3300
321
432713
3
0
1
110
171
802006
2212640711
1913
114
4310
0
3
431
322
403001
8414
39233743
5600
524
15951
1
2
110
Breast Female GenitalCervix UteriCorpus UteriOvaryVulvaOther Male GenitalProstateTestisOther Urinary SystemBladderKidney/RenalOther Brain & CNSBrain (Benign)Brain (Malignant)Other EndocrineThyroidOther Lymphatic SystemHodgkin’s DiseaseNon-Hodgkin’s Unknown Primary Other/Ill-Defined
136
1653800
2220
20
1910
90
1712
14
3731
6
335
28
7
4
Primary Site Total Analytic Non-analytic Male Female In Situ Local Regional Distant NA/Unknown
45
923400
2020
00
13760
4013
1715
2
182
16
3
3
1
000000
2220
20
14950
1000
10
1183
152
13
4
4
135
1653800
0000
5140
7124
2623
3
183
15
3
0
18
000000
0000
2200
0000
000
000
0
0
64
220000
6420
4220
2011
770
133
10
0
0
24
110000
1100
0000
0000
990
303
0
0
6
601500
4400
3120
0000
000
505
0
0
24
722300
1111
00
10550
1510
13
2115
6
122
10
7
4
91
730400
2020
6330
1311
11
2016
4
153
12
4
1
Data Source: Electronic Registry System, Baylor Health Care System Cancer Registry
This report INCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases phoma/myeloma category.
33 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 34
2010 & Prior 2012 Forward Diagnosis Year 2011 (CoC) *2009 *2010 *2011 *2012 Breast Cancer
Post Breast Conserving Surgery Irradiation: Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 and receiving breast conserving surgery for breast cancer (Accountability Measure)
Adjuvant Chemotherapy: Combinationchemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cNoMo, or Stage II or III hormone receptor negative breast cancer (Accountability Measure)
Adjuvant Hormonal Therapy: Tamoxifen or third generation aromatase inhibitor is consid-ered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cNoMo, or Stage II or III hormone receptor positive breast cancer (Accountability Measure) Colorectal Cancer
Adjuvant Chemotherapy: Adjuvant chemo-therapy is considered or administered within 4 months (120 days) of diagnosis to patientsunder age 80 with AJCC III (lymph node posi-tive) colon cancer (Accountability Measure)
Surgical Resection Includes at Least 12 Lymph Nodes: At least 12 regional lymph nodes are removed and pathologically exam-ined for resected colon cancer (Surveillance Measure)
Rectal Cancer
Radiation Therapy for Rectal Cancer: Radiation therapy is considered or adminis-tered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathological AJCC T4NoMo or Stage III receiv-ing surgical resection of rectal cancer (Surveil-lance Measure)
ONCOLOGY QUALITY METRICS 2012NCDB Target
NCDB, CoC, NQF, NAPBC
NCDB, CoC, NQF, NAPBC
NCDB, CoC, NQF, NAPBC
NCDB, CoC, NQF
NCDB, CoC, NQF
NCDB, CoC, NQF
90%
90%
90%
90%
80%
90%
CoC Stateof Texas
PerformanceRate
90%
90%
90%
90%
80%
90%
86.8%
90%
86.1%
88.5%
90.5%
91.6%
88.8%
90.5%
87.1%
89.4%
89%
90.6%
91.8%
92.5%
90.3%
90.6%
87.8%
91.8%
CoC Census Region (West)Performance
Rate
All CoCPrograms
PerformanceRate
Baylor Medical Center at IrvingPerformance Rate
100%
94.1%
97.7%
90%
96.4%
100%
97.6%
100%
100%
100%
95.5%
100%
100%
100%
100%
100%
94.4%
100%
100%
100%
100%
100%
100%
100%
*Source: Baylor Health Care System Cancer Registry/Baylor Irving
All Sites Oral CavityLip TongueOropharynxHypopharynxOther Digestive SystemEsophagusStomachColonRectumAnus/Anal CanalLiverPancreasOther Respiratory SystemNasal/SinusLarynxLung/BronchusOther Blood & Bone MarrowLeukemiaMultiple MyelomaOther
Bone
Connect/Soft Tissue
SkinMelanomaOther
566
1608008
1172
125027
312
65
8114
715
473014
3
1
6
761
Primary Site Total Ananalytic Non-analytic Male Female In Situ Local Regional Distant NA/Unknown
244
1205007
3318
1140522
2514
191
3221
92
0
4
651
239
1208004
702
102620
2721
4102
372
2719
71
1
2
541
327
400004
4702
2471544
4012
343
2011
72
0
4
220
24
000000
400301000
00000
0000
0
0
000
154
200002
3903
1611
2412
1000
100
0000
1
2
220
88
606000
2500
1490101
1901
180
0000
0
0
000
129
000000
2717
1130041
3300
321
432713
3
0
1
110
171
802006
2212640711
1913
114
4310
0
3
431
322
403001
8414
3923
3743
5600
524
15951
1
2
110
ONCOLOGY QUALITY METRICS 2012
35 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH
CANCER CONFERENCES
EDUCATION +
Cancer conferences are an essential forum to provide multi-
disciplinary, consultative services for oncology patients, as well as
to offer education to physicians and allied health professionals. To
provide a consultative service patients and physicians, 80 percent
of the cases presented must be discussed prospectively, that is,
address patient management issues. Prospective cases are
presented by physicians to the multidisciplinary team.
Prospective cases include, but are not limited to the following:
• Cases requiring an adjustment or change in the original
treatment plan
• Cases requiring consideration of adjuvant treatment or
palliative care
• Cases with treatment complications or disruptions
• Cases with recurrent cancer requiring/needing further
treatment consideration
At Baylor Irving, the general cancer conference met monthly with
the following multidisciplinary composition – medical oncology,
radiation oncology, surgery, pathology and diagnostic radiology.
Site conference case presentations include, but are not limited to:
• Case summary with prospective and interdisciplinary discussion
• Image projections with radiologic findings
• Pathology slides, pathologic findings
including special stains
• Molecular studies/prognostic indicators
• Clinical and pathologic staging (AJCC or
other specific staging)
• Treatment planning
• Citation of national treatment guidelines
(e.g., NCCN)
• Citing of clinical trials availability
• Discussion of need to refer for genetic
testing
• Discussion for referral to palliative care
services
In 2013, Baylor Medical Center at Irving
sponsored three cancer conferences. The
general cancer conference met monthly, the
breast cancer conference met twice a month
and the thoracic conference met twice a
month. A combined total of 000 cases were
presented to the conferences, all prospec-
tively. The top five cancer sites reported to
the conferences included: breast, lung, colon,
lymphoma, urinary/bladder, thyroid.
INSIGHT
CASE-SOLVING
EDUCATION
CAMARADERIE
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 36
CAMPUS MAP
37 Baylor Charles A. Sammons Cancer Center at Irving | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Irving 38
Hwy. 183/Airport Fwy.
Wes
t Par
k La
ne
Mor
ris P
arris
h Bl
vd.
N. M
acAr
thur
Blv
d.
Lane Street
ParkingPublic Only
Medical Office Building II
Medical Office Building I
Hospital
ParkingPublic/Staff
ParkingStaff Parking
EmergencyParking
Sammons Cancer Center
Sky Bridge
ParkingPhysicians
CopperTree Medical Office Bldg.
Free Valet Parking
Emergency Entrance
ParkingPublic Only
OutpatientLobby
Main Entrance
O’Co
nnor
Blv
d.
Irving Blvd.
Baylor MedicalCenter at Irving
West Airport Fwy.
Belt
Line
Roa
d
Mac
Arth
ur B
lvd.
Stor
y Ro
ad
Rock Island Road
Hwy. 16
1
Loop
12
Hwy. 114
Shady Grove Road
Hwy. 183
Hwy.
161
Hwy. 183/Airport Fwy.
Wes
t Par
k La
ne
Mor
ris P
arris
h Bl
vd.
N. M
acAr
thur
Blv
d.
Lane Street
ParkingPublic Only
Medical Office Building II
Medical Office Building I
Hospital
ParkingPublic/Staff
ParkingStaff Parking
EmergencyParking
Sammons Cancer Center
Sky Bridge
ParkingPhysicians
CopperTree Medical Office Bldg.
Free Valet Parking
Emergency Entrance
ParkingPublic Only
OutpatientLobby
Main Entrance
O’Co
nnor
Blv
d.
Irving Blvd.
Baylor MedicalCenter at Irving
West Airport Fwy.
Belt
Line
Roa
d
Mac
Arth
ur B
lvd.
Stor
y Ro
ad
Rock Island Road
Hwy. 16
1
Loop
12
Hwy. 114
Shady Grove Road
Hwy. 183
Hwy.
161
AREA MAP
BEATING CANCER
BaylorHealth.com/IrvingCancer1901 N. MacArthur Blvd.Irving, TX 750611.800.4BAYLOR972.579.8100
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