cancer care program 2015 annual report - einstein

Cancer Care Program 2015 Annual ReportWith Statistical Data From 2014

EINSTEIN.EDU 1.800.EINSTEIN

EINSTEIN MEDICAL CENTER MONTGOMERY CANCER CARE PROGRAM1


A Message from the Einstein Medical Center Montgomery Cancer Committee Chair

As chair of the Cancer Committee, I have the absolute privilege of working with the entire committee membership, which represents a wide variety of clinical and ancillary services responsible for providing care for our patients. I want to take this opportunity to thank the committee for another year of exceptional work, as each member is instrumental in our continual efforts to provide multidisciplinary patient-centered care at the highest level.

The committee meets bi-monthly and participates in a variety of different activities, such as setting annual clinical and programmatic cancer goals, reviewing screening and educational outreach activities, and providing oversight of data managed by the oncology tumor registry team.

In 2014, the oncology program at Einstein Medical Center Montgomery continued to move forward with positive momentum, as evidenced by the program earning a three-year national accreditation from the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). In addition, EMCM’s Breast Health Program earned accreditation from the National Accreditation Program for Breast Centers (NAPBC), also a program of the ACoS, for its commitment to providing patients with the best possible care, and the Department of Radiation Oncology was awarded full three-year accreditation from the American College of Radiology (ACR) in 2015.

These recognitions – along with numerous physicians being named Top Docs by Philadelphia magazine – are a testament to the time, effort and energy that the committee has provided throughout this past year, as well as in years past. We continue to incorporate best practices into the treatment planning of our patients by utilizing national cancer care guidelines, and identify available clinical trials that are the most beneficial for the patients seen at Einstein Medical Center Montgomery.

We are also very proud of the resources we provide to assist patients dealing with cancer. Our team of nurse navigators provides support and guidance to patients throughout the care continuum. Einstein Medical Center Montgomery’s partnerships with community organizations continues to flourish and provides additional resources to patients, as evidenced by collaborations with the American Cancer Society, Unite for Her and the Young Survival Coalition Program.

The above is simply a brief highlight of some of the great work being accomplished to support our mission and help our patients, as we continue the fight against cancer. On behalf of the Cancer Committee and Oncology Program, I am proud to present the Einstein Medical Center Montgomery Cancer Care Program’s 2015 Annual Report.

William Biermann, MD, MBACancer Committee ChairmanMedical Director of Medical OncologyEinstein Medical Center Montgomery



Community Outreach, Education and PreventionThe oncology program at Einstein Medical Center Montgomery participates in a variety of outreach, education and prevention programs for patients, families, caregivers and the general public.

OUTREACH, EDUCATION AND PREVENTION EVENTSProgram & Description ParticipantsBreast Cancer Education 40 Provided instruction on Breast Self-Exam and distributed American Cancer Society (ACS) pamphlets highlighting screening recommendations.

Breast Cancer Screenings 34 Provided multiple mammography screening events to members of the Keystone Mercy Health Plan.

Breast Cancer Support Group 45 Open-ended, mutual self-help/support group for all breast cancer survivors.

Colorectal Education 25 Distributed self-administered stool for occult blood testing kits, along with ACS pamphlets: “They know how to prevent colon cancer and you can, too.”

General Cancer Support Group 80 Open-ended mutual self-help/support group for patients and/or family members experiencing cancer.

Health and Wellness Expo at Montgomery County Community College 200 Health and wellness fair presented by the Health Sciences students at Montgomery Community College and Einstein Medical Center Montgomery, highlighting areas of prevention and screening for cancer, as well as other common health issues.

Look Good… Feel Better 23 Makeup and wig program for women undergoing chemotherapy sponsored by American Cancer Society, Cosmetics Toiletries and Fragrance Association, and the Cosmetology Association, providing interactive instruction in applying makeup and ways to use wigs and scarves.

Lung Cancer Screening Information 53 Distributed and discussed new guidelines for lung cancer screening, including Low Dose CT screening program being offered at Einstein Medical Center Montgomery. Prostate Cancer Education 20 Distributed ACS materials about prostate cancer and screening guidelines.

“Freedom From Smoking” Smoking Cessation 41 Smoking cessation program sponsored by Einstein Medical Center Montgomery and the American Lung Association Program, “Freedom From Smoking” features a step-by-step program for quitting smoking.

Unite For Her Wellness Day 31 A day of complementary therapies for women undergoing breast cancer treatment to learn ways to manage side effects and symptoms, and become fully restored.



Einstein Medical Center Montgomery’s Cancer Committee is comprised of a wide variety of clinical and ancillary services responsible for providing care for our patients, including:

Outpatient Medical Oncology and HematologyThe board-certified physicians, nurse practitioners and nurses that staff Outpatient Medical Oncology and Hematology provide services five days a week and see approximately 525 patient visits per month.

Through the accessibility of novel biological agents, we have expanded our armamentarium of treatments, which have improved response rates of chemotherapy without adding any more toxicity or negatively impacting quality of life. The Outpatient Medical Oncology and Hematology service continues to provide state-of-the-art therapy in a friendly setting at Einstein Medical Center Montgomery, while having the ability to provide more innovative experimental therapy via collaboration with Einstein Medical Center Philadelphia.

Inpatient Medical Oncology – 3 West3 West is a 24-bed unit specializing in the care of stable ventilator patients, as well as oncology, chemo-therapy and hospice patients. Ninety-eight percent of the RNs on 3 West have their Bachelor’s degrees in nursing, while the remaining two percent are in the process of receiving their degrees.

Since opening in September 2012, the staff on 3 West has partnered with the Hospice and Palliative Care Team for in-depth training and daily rounding on shared patients. This enables the patients on 3 West to receive collaborative care that encompasses all aspects of their needs and enhances their experience. Additionally, 3 West has partnered with our outpatient oncology group, as both a resource for education and a continuation of care for our patients who have been seen in the outpatient setting, but require hospitalization. The Oncology Nurse Navigators are available to both patients and staff, as they assist in bridging care from the outpatient to inpatient setting.

Through these multidisciplinary partnerships, 3 West is able to provide the best care possible for our patients throughout all phases of their illness.

Radiation OncologyAccredited by the American College of Radiology (ACR), the Radiation Oncology Department provides personalized services for the treatment of cancer and benign diseases. Leading-edge technologies, such as 3D conformal external beam therapy; IMRT (Intensity Modulated Radiation Therapy) for areas such as prostate, head and neck cancers, and brain tumors; and stereotactic body radiation therapy are utilized to deliver optimal patient care.

Our radiation oncologists use advanced radiation treatment planning techniques to tailor the radiation treatment program to the individual patient. These treatment and planning techniques are customized for each patient to maximize the chance for controlling the tumor while minimizing the risk of side effects. In addition, our radiation oncologists are actively involved in clinical trials that give patients access to the newest and most advanced breast cancer treatments available.

In preparation for these cancer treatments, the Radiation Oncology CT scanner with 4D capabilities is utilized to monitor respiratory motion and to minimize dose to normal surrounding tissue. Additional treatment options available through the Einstein Healthcare Network include: High Dose Rate (HDR) radiotherapy for gynecological malignancies and Stereotactic Radiosurgery (SRS) for brain tumors.

Breast HealthThe Breast Health Program at Einstein Medical Center Montgomery is home to one of the most highly-regarded breast health teams in the region, featuring distinguished breast surgery specialists and the region’s top radiologists. The program is recognized by the National Accreditation Program of Breast

Cancer Committee: A Multidisciplinary Team



Centers (NAPBC) for delivering a high level of care and life-saving treatment options through individualized services and advanced technologies. It is the program’s emphasis on personal relationships and the latest techniques/technologies, including digital mammography and minimally invasive biopsies, which make EMCM’s Women’s Center a destination for breast health care.

Breast ImagingDesignated as a Breast Imaging Center of Excellence (BICOE) by the American College of Radiology (ACR) and accredited by the ACR, according to the Mammography Quality Standards Act, Einstein Medical Center Montgomery offers advanced breast imaging technologies, including: digital mammography (digital breast tomosynthesis), ultrasound, magnetic resonance imaging (MRI) and all interventional breast procedures.

Digital breast tomosynthesis, the new 3D imaging technology, takes multiple low-dose images at different angles and displays them in thin multiple layers allowing our radiologists to look at smaller areas and see “through” breast tissue better than a 2D mammogram. Tomosynthesis reduces the number of false-positive results and the need to come back for further testing. The radiology breast team participates in research trials that are designed to enhance their diagnostic skills at finding and diagnosing breast abnormalities.

Interventional RadiologyOur Interventional Radiology team utilizes the most advanced technology available to perform image-guided procedures to treat a wide variety of diseases throughout the body, including cancer. Interventional Radiology treatments minimize risk, require little to no incisions, are generally performed with sedation rather than general anesthesia, and more importantly, have less pain and recovery time than conventional surgery.

Hospice Einstein Medical Center Montgomery’s Hospice Program is a community-centered healthcare program for individuals who are in the last phases of terminal illness and who elect not to pursue curative treatments. The hospice staff provides outpatient service to patients in their home, assisted living facilities and nursing homes. The focus of care is on pain and symptom management, psychosocial support for the patient and family, counseling for caregivers and spiritual support.

Under the direction of the patient’s physician, and in conjunction with our hospice medical directors, our hospice team – which consists of the medical director, hospice manager, hospice RNs, home health aides, social workers, chaplain and volunteers – works together to follow a personalized plan of physical, emotional and spiritual care, designed to meet the changing needs of both the patient and their family.

For patients whose pain or symptoms are unable to be controlled in the home setting, short-term inpatient hospice may be an option. Our inpatient hospice service is designed to meet the needs of the terminally ill patient and their family. Hospice care is not limited to oncology, but approximately 30% of hospice patients are cancer patients.

Palliative CareOur Palliative Care program is designed to meet the needs of patients who have complex pain or symptoms, but are not on hospice care. A team of professionals consult on medically complex patients to achieve symptom management, discuss advance directives and provide a holistic approach to the patient experience.

Einstein Medical Center Montgomery’s Home Health, Hospice and Palliative Care Program is the only agency in the region to have each Medical Director nationally certified in hospice and palliative medicine. Additionally, 30% of the nursing staff has achieved advanced certification in hospice and palliative care nursing. This high level of expertise contributes to the overall exceptional patient satisfaction ratings for the program.

Cancer Committee: A Multidisciplinary Team continued



Cancer Registry Summary Cancer registry is an integral part of the Einstein Medical Center Montgomery Cancer Care Program. The registry is an information system that monitors each type of cancer diagnosed and/or treated at our facility. The primary function is to provide continuum data management services under the support and leadership of the Cancer Committee.

The cancer registrar collects and documents demographic information, pathological and diagnostic testing results, treatment information and follow-up data. This is done in accordance with the requirements of the following regulatory agencies: The Department of Public Health, Pennsylvania Cancer Registry, The SEER Program of the National Cancer Institute (NCI), and the Commission on Cancer (CoC) of the American College of Surgeons (ACoS). The reference date for the Einstein Montgomery Medical Center cancer data base is January 1, 2003. • A total of 567 cases were entered into the data base in 2014. 526 of these cases were analytic and

41 were non-analytic cases. There have been 6,732 cases accessioned in the registry since the reference date in 2003. Active follow-up is maintained on approximately 2,697 patients with a target follow-up rate of 80%. Each case is followed annually to monitor diagnostic and treatment outcomes and to provide accurate data to calculate survival rates.

• The cancer registry data are reviewed for accuracy, timeliness and quality by a physician member of the cancer committee. Availability of the cancer data to the Cancer Committee, Hospital Administration and physicians facilitates evaluation of outcomes of treatment and assists in the assessment of the needs of the community. Additionally, physician review of Treatment Planning, Collaborative staging, American Joint Committee on Cancer (AJCC) TNM staging, College of American Pathologists (CAP) Protocols for pathology report and National Comprehensive Cancer Network (NCCN) guidelines is completed quarterly.

• The cancer registrars participated in state and nationwide cancer registry educational activities throughout 2014.

• As required, the Einstein Medical Center Montgomery cancer registry submits data to the Pennsylvania State Cancer Registry. The state registry is a population-based registry and is a member of the Surveillance, Epidemiology and End Results Program of the National Cancer Institute.

• The CoC recognizes recognizes Einstein Medical Center Montgomery as an approved Community Hospital Cancer Program. National Cancer Data Base’s (NCDB) Annual Call for Data was submitted this year, error free.

• The American Society for Clinical Oncology (ASCO) and NCCN Quality Measures & Guidelines continue to be reviewed for Breast and Colorectal Cancers, which allows opportunity for practice improvements. Participation in NCDB Rapid Quality Reporting System (RQRS) provides information on compliance with NCCN guidelines for Breast and Colon cases, and enables registrars to add new treatment information.

• The registry utilizes METRIQ, the cancer data software contracted through Elekta. The METRIQ cancer registry system meets regulatory reporting requirements and provides ready access to the data required to effectively review, analyze and ultimately improve clinical outcomes.

A TOTAL OF567 CASES

were entered into the data base in 2014


TOP Sites for Einstein Medical Center Montgomery 2014Analytical and Non-Analytical

13% 8%

23%

7% 8%

41%

2014 Top-Five Sites For Cancer

KEY Colorectal Lung Breast Skin/Melanoma Bladder All Other



2014 Top-Five Sites with Stage at Diagnosis

0

10

20

30

40

50

60

70

Stage 0 Stage I Stage II Stage III Stage IV Unk N/AStage 0 Stage I Stage II Stage III Stage IV Unk

19

65

25

85

1 0

2014 Analytical Breast Cases

0

5

10

15

20

25

30

35

Stage 0 Stage I Stage II Stage III Stage IV Unk N/AStage I Stage II Stage III Stage IV

0

17

5

15

31

0 0

2014 Analytical Lung Cases


2014 Top-Five Sites with Stage at Diagnosis continued

0

2

4

6

8

10

12

Stage 0 Stage I Stage II Stage III Stage IV Unk N/AStage 0 Stage I Stage II Stage III Stage IV Unk

4 4

1210

8

5

0

2014 Analytical Colorectal Cases

0

4

8

12

16

20

Stage 0 Stage I Stage II Stage III Stage IV Unk N/AStage 0 Stage I Stage II Stage IV

6

11

1 0

2014 Analytical Bladder Cases21

Stage III

1

Unk

1

0

5

10

15

20

Stage 0 Stage I Stage II Stage III Stage IV Unk N/AStage I Stage II Stage III Unk

8

20

52

03

0

2014 Analytical Skin/Melanoma Cases

Stage 0

88

Einstein Cancer Care Reports Five Quality Indicators

How We Compare to the National Cancer DatabaseIn 1998, a Presidential Commission recommended the creation of a national forum in which health care’s many stakeholders could, together, find ways to improve the quality and safety of America’s health care. This recommendation led to the creation of NQF, a private, not-for-profit, public benefit corporation established in 1999 to standardize healthcare quality measurement and reporting.

Established as a public-private partnership, the NQF has broad participation from all parts of the healthcare system, including national, state, regional and local groups representing consumers, public and private purchasers, employers, healthcare professionals, provider organizations, health plans, and others involved in healthcare research or quality improvement. Together, the organizational members of the NQF work to promote a common approach to measuring healthcare quality and fostering system-wide capacity for quality improvement.

The Commission on Cancer (CoC), through the Cancer Program Practice Reports (CP3R), promotes five quality indicators utilizing the data submitted to the National Cancer Database. The data are from 2013.



80.0%

85.0%

90.0%

95.0%

100.0%

BCSRT MAC HT ACT 12RLN BCSRT

2013 CP3R Measures

MAC 12RLNBC M HT H ACTACT N12RLNTCSRTTCSRT MACMAC HTHT ACT N2RLN

EMCM

PA

All COCPrograms

Einstein Medical Center Montgomery’s CP3R Performance

Einstein Cancer Care Reports Five Quality Indicators

85%

90%

95%

100%

EMCM PA All COC Programs

94.6%91.9%

100%

PA

94.6%94.6%

All COC

91.9%

EMCM

100%

Chemotherapy in Hormone ReceptorNegative Breast Cancer Patients (MAC)

(NQF #0559) Combination chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0 or Stage IB - III hormone receptor negative breast cancer. Einstein Medical Center Montgomery’s compliance with this standard is very favorable at 100%, compared to all CoC approved programs’ norm of 91.9%.

(NQF #0220) Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0 or Stage IB - III hormone receptor positive breast cancer. Einstein Medical Center Montgomery’s compliance with this standard is very favorable at 97.1%, compared to all CoC approved programs’ norm of 90.7%.

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0% 97.1%

95.1%

90.7%


Tamoxifen or Third Generation Aromatase Inhibitor in Hormone Receptor Positive

Breast Cancer Patients (HT)


(NQF #219) Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Einstein Medical Center Montgomery’s compliance with this stand-ard is very favorable at 96.9%, compared to all CoC approved programs’ norm of 90.9%.

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

EMCM PA All COC Programs EMCM PA All COC

93.1%

90.9%

Breast Conserving Surgeryand Radiation Therapy (BCSRT)

96.9%98.0%

CP3R and EMCM’s Performance for Breast Cancer

86.0%

87.0%

88.0%

89.0%

90.0%88.9%

88.0%

90.1%


88.9%

EMCM

88.0%

PA

90.1%

All COC

91.0%

Regional Lymph Nodes in SurgicallyResected Patients (12RLN)


80.0%

85.0%

90.0%

95.0%

100.0%100.0%

92.6%88.7%


Adjuvant Chemotherapy for Stage III Colon Cancers (ACT)

CP3R and EMCM’s Performance for Colon Cancer

(NQF #0223) Adjuvant chemotherapy is recommended or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. Einstein Medical Center Montgomery’s compliance with this standard is very favorable at 100%, compared to all CoC approved programs’ norm of 88.7%.

(NQF #0225) At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Einstein Medical Center Montgomery’s compliance with this standard is below all CoC approved programs’ norm of 90.1%, but at 88.9%, is slightly better than the state average.

2014 Primary Site Table

Primary Site Total (%) Analytic Non-analyticORAL CAVITY & PHARYNX 9 (1.6%) 9 0Lip 1(0.2%) 1 0Tongue 1 (0.2%) 1 0Salivary Glands 4 (0.7%) 4 0Gum & Other Mouth 1 (0.2%) 1 0Tonsil 1 (0.2%) 1 0Nasopharynx 1 (0.2%) 1 0DIGESTIVE SYSTEM 104 (18.3%) 98 6Esophagus 5 (0.9%) 5 0Stomach 8 (1.4%) 8 0Small Intestine 2 (0.4%) 2 0Colon Excluding Rectum 35 (6.2%) 35 0Cecum 7 (1.24 %) 7 0Appendix 4 (0.71%) 4 0Ascending Colon 6 (1.06%) 6 0Hepatic Flexure 1 (0.18%) 1 0Transverse Colon 4 (0.71%) 4 0Splenic Flexure 1 (0.18%) 1 0Descending Colon 2 (0.35%) 2 0Sigmoid Colon 8 (1.41%) 8 0Large Intestine, NOS 2 (0.35%) 2 0Rectum & Rectosigmoid 12 (2.1%) 11 1Rectosigmoid Junction 3 (0.77%) 2 1Rectum 9 (1.33%) 9 0Liver & Bile Duct 15 (2.7%) 13 2Liver 13 (2.3%) 11 2Intrahepatic Bile Duct 2 (0.4%) 2 0Gallbladder 2 (0.4%) 2 0Other Biliary 4 (0.7%) 3 1Pancreas 21 (3.8%) 19 2RESPIRATORY SYSTEM 77 (13.6%) 72 5Larynx 4 (0.7%) 4 0Lung & Bronchus 73 (12.9%) 68 5BONES & JOINTS 2 (0.4%) 1 1Bones & Joints 2 (0.4%) 1 1SOFT TISSUE 2 (0.4%) 1 1Soft Tissue (including Heart) 2 (0.4%) 1 1SKIN EXCLUDING BASAL & SQUAMOUS 39 (6.9%) 38 1Melanoma – Skin 39 (6.9%) 38 1BREAST 131 (23.1%) 123 8FEMALE GENITAL SYSTEM 29 (5.1%) 27 2Corpus & Uterus, NOS 19 (3.2%) 18 1Ovary 6 (1.1%) 5 1Other Female Genital Organs 4 (0.7%) 4 0MALE GENITAL SYSTEM 33 (5.8%) 29 4Prostate 28 (4.9%) 25 3Testis 4 (0.7%) 4 0Penis 1 (0.2%) 0 1URINARY SYSTEM 56 (9.9%) 50 6Urinary Bladder 46 (8.1%) 41 5Kidney & Renal Pelvis 9 (1.6%) 8 1Ureter 1 (0.2%) 1 0BRAIN & OTHER NERVOUS SYSTEM 15 (2.7%) 14 1Brain 9 (1.6%) 8 1Cranial Nerves Other Nervous System 6 (1.1%) 6 0ENDOCRINE SYSTEM 12 (2.1%) 11 1Thyroid 7 (1.2%) 6 1Other Endocrine including Thymus 5 (0.9%) 5 0LYMPHOMA 23 (4.1%) 21 2Hodgkin Lymphoma 2 (0.4%) 2 0Non-Hodgkin Lymphoma 21 (3.8%) 19 2 NHL - Nodal 19 (3.4%) 17 2 NHL - Extranodal 2 (0.4%) 2 0MYELOMA 4 (0.7%) 4 0LEUKEMIA 6 (1.1%) 4 2Lymphocytic Leukemia 4 (0.7%) 2 2Myeloid/Monocytic 1 (0.2%) 1 0Other Leukemia 1(0.2%) 1 0MESOTHELIOMA 3 (0.5%) 2 1MISCELLANEOUS 22 (3.9%) 22 0Total 567 526 41




William Biermann, MD, MBA, FACP Medical Director, Medical Oncology Cancer Committee Chairman

Shavon Boxman, MA CCC-SLP Speech Pathologist, Rehabilitation

Kristy Burkart, RN, BSN Coordinator, Quality Improvement

Linda Case, RHIT, CTR Certified Tumor Registrar Cancer Registry Quality Coordinator

Joanne Cipollini, MSN, RN Oncology Nurse Navigator Community Outreach Coordinator

Mary Galetti, BS, RN, OCN Clinical Trials Supervisor Clinical Research Coordinator

Julie Gubernick, MD, FACR Chief, Radiology

Barb Heinzmann, RN, CBCN, BSN Nurse Navigator, Breast Health Program

Doraid Jarrar, MD, FACS, FCCP Thoracic Surgeon, Surgery Co-Director, Lung Cancer Screening Program

Ahashta Johnson, MD Palliative Care Physician, Home Health, Hospice and Palliative Care

Kate Kortum Representative, American Cancer Society

Jaclyn Ladden, PT, DPT, CLT-LANA Physical Therapist, Rehabilitation

Briana Magill, RD, LDN Clinical Dietician, Nutrition Services

Pat Modafferi, MHA Vice President, Health Care Services Cancer Conference Coordinator

Mary Molnar, MBA Senior Director, Physician Liaison Services

Monica Nash, RN, BSN Nurse Manager, 3 West

Carol Palmer, LPN, CTR Certified Tumor Registrar

Patricia Perosio, MD, FASCP, FCAP Pathologist, Department of Pathology

Elton Richardson, LSW Social Worker, Care Management, Psychosocial Services Coordinator

Robin Ryan, RN, MHA Director, Quality Management Quality Improvement Coordinator

Marc Schaller, PT, DPT, MBA Cancer Service Line Administrator - EMCM Cancer Program Administrator

Robert Schiowitz, MD, FACS General Surgeon, Surgery

Leah Sheppard, MS Senior Director, Corporate Marketing and Communications

Jennifer Simmons, MD, FACS Director, Breast Surgery Director, Breast Health Program

Lawrence Solin, MD, FACR, FASTRO Chair, Radiation Oncology

2015 Cancer Committee Membership

559 West Germantown Pike, East Norriton, PA 19403484-622-1000 | Einstein.edu

cancer care program 2015 annual report - einstein

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