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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


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.


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.


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.’”



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 +


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


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, [email protected] Green, MSN, RN, FNP-BC, Baylor Regional Medical Center at Carrollton, [email protected]

PALLIATIVE CARE +


• 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.


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


PALLIATIVE CARE +


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


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


PALLIATIVE CARE +


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


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.


PALLIATIVE CARE +


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.

doi:10.1097/NJH.0b013e318203d9ff.

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/


downloads/ipal-icu-defining-standards-

for-icu-palliative-care.pdf. Published July

2010. Accessed September 22, 2013.

3. Aslakson RA, Bridges JFP. Assess

the impact of palliative care in the

intensive care unit through the leans of

patient-centered outcomes research.

Curr Opin Crit Care. 2013; 19: 504-510.

doi:10.1097/MCC.0b013e328364d50f.

4. Ferrell BR, Dablin C., Campbell ML,

Paice JA, Virani R. End-of-Life Nurs-

ing Education Consortium (ELNEC)

Training Program: improving palliative

care in critical care. Crit Care Nurs Q.

2007; 30:206-212. doi:10.1097/01.

CNQ.0000278920.37068.e9.

5. Levin TT, Moreno B., Silvester W,

Kissane, DW. End of life communica-

tion in the intensive care unit. Gen Hosp

Psych. 2010; 32, 433-442. doi:10.1016/j.

genhosppsych.2010.04.007.

6. Grossman, S. Development of the pal-

liative care of dying critically ill patients

algorithm. J Hosp and Palliat Nurse.,

15:355-359.

7. Camhi SL, Mercado AF, Morrison SR,

et al. Deciding in the dark: advanced

directives and continuation of treat-

ment in chronic critical illness. Crit Care

Med. 2009; 37: 919-925. doi:10.1097/

CCM.06013e31819613cc.

8. Loertscher L, Reed DA, Bannon

MP, Mueller PS. Cardiopulmonary

resuscitation and do not resuscitate

orders: a guide for clinicians. Am J

Med. 2010;123: 4-9. doi:10.1016/j.am-

jmed.2009.05.029.

9. Kass-Bartelems BL, Hughes R.

Advanced care planning, preferences

for care at the end of life: Research in

Action. Agency for Healthcare Research

and Quality. http://www.ahrq.gov/re-

search/findings/factsheets/aging/endlife-

ria/index.html. Published March 2003.

Accessed September 9, 2013.

10. Penrod JD, Deb P, Dellenbaugh C, et

al. Hospital based palliative care consul-

tation: effects on hospital cost. J Palliat

Med. 2010; 13: 973-979. doi:10.1089/

jpm.2010.0038.

11. Connors AF, Dawson NV, Desbien

NA, et al. A controlled trial to improve

care for seriously ill hospitalized patients.

JAMA. 1995; 274: 1591-1598.

12. Resnick B. Ethics and medical futil-

ity: the healthcare professional’s role.

National Conference of Gerontological

Nurse Practitioners (NCGNP) 25th An-

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

http://www.ncbi.nlm.nih.gov/pmc/ar-

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

care unit: A report from the Improving

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

care in the intensive care unit. Crit Care

Med.2010; 38: 808-818. doi: 10.1097/

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

M (eds). Advances in Health Care Organization Theory. San

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


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


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


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.


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

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


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


CAMPUS MAP


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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