Cancer Program

Annual Report

2016–2017

Cancer Program and Cancer Registry

Prepared by the Cancer Care Committee

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TABLE OF CONTENTS

Cancer Care Committee Chairman’s Report 2016 ............................................................................................2

Cancer Care Committee .....................................................................................................................................3

Cancer Registry Report ......................................................................................................................................4

Figure 1. Analytic Cancer Cases, 2016: Comparison of Age at Diagnosis by Site ...................................5

Figure 2. Analytic Cancer Cases, 2016: Comparison of Stage at Diagnosis by Site .................................5

Table 1. Analytic Cancer Cases, 2016: Comparison of Initial Treatment by Site .....................................6

Table 2. Newly Diagnosed Cancer Cases by Site, 2016 .............................................................................7

Cancer Liaison Physician Report 2016 ..............................................................................................................9

Community Health Annual Report 2016 .........................................................................................................10

Psychosocial Care Report 2016 .......................................................................................................................17

Special Report: A Review of Prostate Cancer Diagnosis and Treatment at St. Elizabeth’s Medical Center,

2006-2016 ........................................................................................................................................................19

Figure 3. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Age at Diagnosis,

NCDB vs. SEMC .....................................................................................................................................20

Figure 4. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Stage at Diagnosis,

NCDB vs. SEMC .....................................................................................................................................20

Table 3. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Initial Treatment,

NCDB vs. SEMC .....................................................................................................................................20

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CANCER CARE COMMITTEE

CHAIRMAN’S REPORT

2016

St. Elizabeth’s Medical Center (SEMC) is one of eleven hospitals in the Steward Health Care System in

Massachusetts, and has become a tertiary referral center for the other Steward hospitals. St. Elizabeth’s

maintains its commitment to academic endeavors and teaching as well as its commitment to excellence in

patient care. There is specialty expertise in the following surgical subspecialties: David Boruta, MD, Gynecologic Oncology

Peter Catalano, MD, Head and Neck Surgery

Alan Hackford, MD, Colorectal Surgery

Scott Johnson, MD, Hepatobiliary Surgery

Jan Rothschild, MD, Breast Surgery

Jana Simonds, MD, Colorectal Surgery

John Wain, MD, Thoracic Surgery

Rohan Wijewickrama, MD, Head and Neck Surgery

Medical Oncology and Hematology patients are seen in the Dana Farber Cancer Institute (DFCI) satellite

located on the fifth floor of the Cardinal Cushing Pavilion at SEMC. This unit includes an infusion center

and has been a DFCI-licensed facility on the SEMC campus since June 2014. The division remains

committed to the accrual of patients to clinical trials under the direction of Wendy Loeser, RN, OCN. 83

patients were enrolled in clinical trials in 2016.

The Cancer Care Committee met quarterly in 2016 and remains involved in every aspect of cancer care at

St. Elizabeth’s. The following members of the committee resigned this year: Sarah Blanchard, RN, Performance Improvement

Stephanie Cook, RD, Hematology/Oncology Nutrition Services

Elizabeth Harrahy, RPT, Rehabilitation Services

Katherine Johnson, RN, Nursing

Adah Lau, RPh, Pharmacy

Andrew LeRoy, Administrative Director, DFCI@SEMC

Katherine Magni, RN, Nurse Educator

Gordon Novak, MD, Pain Clinic

Scott Sequeira, MD, Radiology

Ingolf Tuerk, MD, Urology

Ray Wilburn, Director of Radiology

The Committee welcomes the following new members to the committee for 2017: Marina Androssova, MD, Palliative Care

Margaret Huber, MA/CCC-SLP, Rehabilitation Services

Tessa Niven, Operations Director, DFCI@SEMC

Katie Stone, RN, Hospice Nurse, Good Shepherd Community Hospice

John Wain, MD, Thoracic Surgery

We took over as Co-Chairs of the Committee in November 2016. We would like to thank Dr. Leslie Martin,

who served as Chair since 2007, for her excellent stewardship and commitment to quality cancer care. We

also thank the members of the Committee for their dedication to ensuring excellent multidisciplinary care

for our patients. Finally, our personal thanks to Daria James and Laurie MacDougall for their hard work

and dedication to the cancer program.

Respectfully submitted,

Jan Rothschild, MD, and Christopher Lathan, MD, MPH, Co-Chairs

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CANCER CARE COMMITTEE

The Cancer Care Committee at St. Elizabeth’s Medical Center (SEMC) is composed of specialists in all

areas dealing with cancer. The committee, which includes both physician and non-physician members,

meets quarterly. Its agenda includes reviewing all cancer-related activities at SEMC, as well as overseeing

the multidisciplinary care of cancer patients in the institution. As required by the American College of

Surgeons/Commission on Cancer, the committee provides leadership and is responsible for various

activities that are aimed at the improvement of the delivery of cancer patient care. Some of these activities

include patient care evaluation studies, performance improvement projects, cancer conferences, and the

ongoing use of the cancer registry data. The Cancer Care Committee is considered the cornerstone and most

important component of an Approved Hospital Cancer Program.

The following were members of the Cancer Care Committee in 2016:

Co-Chairpersons: Jan Rothschild, MD, Breast Surgery

Christopher Lathan, MD, MPH, Medical Oncology

Former Chairperson: Leslie A. Martin, MD, Medical Oncology

Daria James, CTR, Cancer Coordinator

Michael Bakerman, MD, Chief Medical Officer

Sarah Blanchard, RN, Performance Improvement

Bruce Bornstein, MD, Radiation Oncology

Stephanie Cook, RD, Hematology/Oncology

Nutrition Services

Kathleen Dionne, MS, FNP-BC, Center for Breast

Care

Paul Fallon, MD, Primary Care

Elizabeth Harrahy, RPT, Rehabilitation Services

Beth Herrick, MD, Radiation Oncology

Katherine Johnson, RN, Nursing

Lauren Kohler Darcy, RPT, Rehabilitation Services

Sandeep Krishnan, MD, Gastroenterology/EUS

Adah Lau, RPh, Pharmacy

Fran Leonard, RN, MSN, AOCN, Oncology

Andrew LeRoy, Administrative Director,

DFCI@SEMC

Lori Liston, RN, Steward Home Care and Hospice

Wendy Loeser, RN, OCN, Medical Oncology

Katherine Magni, RN, Nurse Educator

Robert Maheu, Administration

Nicole Mulkern, Director of Mission and

Community Partnerships

Sara Nemitz, LICSW, Hematology/Oncology

Social Services

Gordon Novak, MD, Pain Clinic

Tetyana Novikova, RN, MS, NP-C, Palliative

Care/Good Shepherd Community Hospice

Kevin O’Donnell, MD, Surgery

Phoebe Olhava, MD, Radiology

David Ricklan, MD, Pathology

Jan Rothschild, MD, Breast Surgery

Nicole Sanders O’Toole, American Cancer Society

Scott Sequeira, MD, Radiology

Ingolf Tuerk, MD, Urology

Ray Wilburn, Director of Radiology

Karen Wright, Steward Home Care and Hospice

The Cancer Care Committee met four times in 2016:

February 17, May 18, August 17, and November 16.

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CANCER REGISTRY REPORT

St. Elizabeth’s Medical Center Cancer Registry is a data system designed for the collection, management,

and analysis of data on persons with a diagnosis of a malignant disease. Data are also maintained on several

benign brain and central nervous system tumors as well as other diagnoses that are on a list of “Reportable

Diagnoses” as recommended by the Cancer Care Committee and the Massachusetts Cancer Registry. The

Cancer Registry assists the Cancer Care Committee in setting the goals of education, lifetime follow-up of

the cancer patient, and research. The ultimate goal of the Cancer Registry is to provide the medical staff at

St. Elizabeth’s Medical Center with the data that will enable them to assess the results of their diagnostic

and therapeutic efforts, therefore providing quality care of the cancer patient.

In 2016, the Cancer Registry at St. Elizabeth’s Medical Center abstracted 1,009 new cases of cancer, of

which 916 (91%)were analytic and 93 (9%) were non-analytic. The analytic cases provide us with the most

accurate data and they are the cases used when we complete studies for the American College of Surgeons/

Commission on Cancer (ACoS/CoC). The non-analytic cases are cases that were originally diagnosed and

received all first course of treatment elsewhere and were seen here at the time of persistent, recurrent, or

metastatic disease.

The major sites at St. Elizabeth’s Medical Center for 2016 were prostate, lung, endometrial, breast, and

kidney cancers. Most of these cases come from surrounding areas, with the majority coming from the

Allston/Brighton area.

This year the Cancer Committee elected to review prostate cancers for the period 2006-2016 for our long-

term comparison study for 2016. In addition, the Cancer Registry received many requests from physicians,

residents, and outside organizations such as the Massachusetts Cancer Registry, the Commission on Cancer,

and the Boston University School of Public Health. Many of these requests resulted in published papers or

lectures using the Registry data. As in any department, quality management plays an important role. Quality

management is upheld with monthly physician chart review by members of the Cancer Care Committee and

built-in software edits used by the Massachusetts Cancer Registry and the National Cancer Data Base at the

Commission on Cancer. In addition, the registry voluntarily participates in the Rapid Quality Reporting

System (RQRS) through the National Cancer Data Base. RQRS is a reporting and quality improvement tool

that provides real-time clinical assessment of hospital adherence to National Quarterly Forum-endorsed

quality of cancer care measures for breast, and colorectal cancers. These data are monitored on a monthly

basis.

As always, the focus of the Cancer Registry is to keep current with case abstracting and follow-up while

continuously complying with CoC Standards. The registry continues to stage cancers with SEER Summary

and AJCC staging. In the coming year the registry looks forward to the changes in cancer registry data

collection with the advent of Eighth Edition AJCC staging.

Respectfully submitted,

Daria M. James, CTR

Cancer Coordinator

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Figure 1. Analytic Cancer Cases, 2016: Comparison of Age at Diagnosis by Site

Figure 2. Analytic Cancer Cases, 2016: Comparison of Stage at Diagnosis by Site

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Breast Prostate Kidney Lung Endometrium

PER

CEN

TAGE

SITE

0-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Breast Prostate Kidney Lung Endometrium

PER

CEN

TAGE

SITE

0 (in situ)

I

II

III

IV

Unknown

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Table 1. Analytic Cancer Cases, 2016: Comparison of Initial Treatment by Site

Breast Prostate Kidney Lung Endometrium

Treatment (n=82) (n=222) (n=66) (n=118) (n=84)

SRG only 13.4% 77.9% 89.4% 45.8% 73.8%

RAD only 0.0% 0.9% 0.0% 7.6% 0.0%

SYSTEMIC only 2.4% 1.4% 1.5% 6.9% 2.4%

SRG RAD 13.4% 0.5% 0.0% 1.7% 10.7%

SRG SYSTEMIC 28.1% 14.4% 1.5% 1.7% 9.5%

SRG RAD SYSTEMIC 37.8% 0.9% 1.5% 0.8% 2.4%

RAD SYSTEMIC 0.0% 2.7% 1.5% 26.3% 0.0%

NO TX/BX ONLY 4.9% 1.4% 4.6% 9.3% 1.2%

SRG = Surgery RAD = Radiation SYSTEMIC = Chemotherapy and/or Hormone Therapy and/or Immunotherapy

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Table 2. Newly Diagnosed Cancer Cases by Site, 2016 Primary Site # %

ORAL CAVITY & PHARYNX 8 0.8%

Tongue 4 0.4%

Salivary Glands 1 0.1%

Gum & Other Mouth 1 0.1%

Nasopharynx 1 0.1

Tonsil 1 0.1%

DIGESTIVE SYSTEM 137 13.6%

Esophagus 7 0.7%

Stomach 14 1.4%

Small Intestine 6 0.6%

Colon (excluding Rectum) 36 3.6%

Cecum 5 Appendix 2 Ascending Colon 9 Hepatic Flexure 1 Transverse Colon 4 Splenic Flexure 1 Sigmoid Colon 13 Large Intestine, NOS 1 Rectum & Rectosigmoid 15 1.5%

Rectosigmoid Junction 3 Rectum 12 Anus, Anal Canal, & Anorectum 5 0.5%

Liver & Intrahepatic Bile Duct 9 0.9%

Gallbladder 5 0.5%

Other Biliary 8 0.8%

Pancreas 31 3.1%

Peritoneum, Omentum, & Mesentery 1 0.1%

RESPIRATORY SYSTEM 156 15.5%

Nose, Nasal Cavity & Middle Ear 1 0.1%

Larynx 2 0.2%

Lung & Bronchus 152 15.1%

Trachea, Mediastinum & Other Respiratory 1 0.1%

BONES & JOINTS 1 0.1%

Bones & Joints 1 0.1%

SOFT TISSUE 4 0.5%

Soft Tissue (including Heart) 4 0.5%

SKIN EXCLUDING BASAL & SQUAMOUS 5 0.5%

Melanoma – Skin 4 0.4%

Other Non-Epithelial Skin 1 0.1%

BASAL & SQUAMOUS SKIN 2 0.2%

Basal/Squamous Cell Carcinomas of the Skin 2 0.2%

BREAST 88 8.7%

Breast 88 8.7%

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Table 2. Newly Diagnosed Cancer Cases by Site, 2016 (continued) Primary Site # %

FEMALE GENITAL SYSTEM 130 12.9%

Cervix Uteri 18 1.8%

Corpus & Uterus, NOS 88 8.7%

Corpus Uteri 85

Uterus, NOS 3

Ovary 10 1.0%

Vagina 1 0.1%

Vulva 9 0.9%

Other Female Genital Organs 4 0.4%

MALE GENITAL SYSTEM 249 24.7%

Prostate 243 24.1%

Testis 3 0.3%

Penis 3 1.3%

URINARY SYSTEM 131 13.0%

Urinary Bladder 54 5.4%

Kidney & Renal Pelvis 71 7.0%

Ureter 6 0.6%

BRAIN & OTHER NERVOUS SYSTEM 10 1.0%

Brain 4 0.4%

Cranial Nerves & Other Nervous System 6 0.6%

ENDOCRINE SYSTEM 27 2.7%

Thyroid 27 2.7%

LYMPHOMA 32 3.2%

Hodgkin Lymphoma 2 0.2%

Non-Hodgkin Lymphoma 30 3.3%

NHL – Nodal 16 NHL – Extranodal 14

MYELOMA 8 0.8%

Myeloma 8 0.8%

LEUKEMIA 8 0.8%

Lymphocytic Leukemia 2 0.2%

Myeloid & Monocytic Leukemia 6 0.6%

Acute Myeloid Leukemia 3 Acute Monocytic Leukemia 1

Chronic Myeloid Leukemia 2

MESOTHELIOMA 2 0.2%

Mesothelioma 2 0.2%

MISCELLANEOUS 11 1.1%

Miscellaneous 11 1.1%

TOTAL 1009

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Cancer Liaison Physician Report 2016 Kevin O’Donnell, MD, Cancer Liaison Physician

Topic of Study: Annual review of accountability and quality improvement measures

performance rates.

Purpose: Standards 4.4 and 4.5 require at least an annual review of the performance rates to

make certain they meet the set rate. For those that do not meet the set rate, then an action plan

must be established to correct the low rate.

Data: 2013

Table of the CP3R Performance Rates:

Measure Set Rate Expected

Performance

Rate (EPR)

95% Confidence

Interval Limit

Compliant

BCSRT 90% 100% Yes

HT 90% 91.7% Yes

MASTRX 90% 100% Yes

NEEDLE BX 80% 100% Yes

12RLN 85% 90.5% Yes

ACT N/A 83.3% [53.5%-100%] Yes

RECRTCT 85% 100% Yes

Analysis:

There are seven accountability and quality improvement measures for which data are collected.

All of them met the expected EPR. “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 (Accountability)” is currently at 83.3%; however, the CoC

Standard % is N/A at this time.

Recommendations:

Our numbers in this measure are very low but the committee will continue to monitor to make

sure patients are being evaluated appropriately for adjuvant chemotherapy. The committee will

work with the multidisciplinary team to make sure that appropriate patients are being referred for

treatment evaluation.

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Community Health Annual Report 2016

Nikkie Mulkern, Director of Community Health

Standards 1.8, 4.1 & 4.2 – Monitoring Community Outreach

I. Overview:

4.2: Requirement – 1 screening

o Skin Screening (5/2016)

o Breast Cancer Awareness Event – Mammography (10/2016)

4.1: Requirement – 1 Prevention Program

o Colon Cancer Awareness Event (2/2016)

o Senior Supper – Health Trivia (6/2016)

o Senior Supper – Women’s Health (9/2016)

o Men’s Health Awareness Day (11/2016)

o Lung Cancer Awareness Day (11/2016)

o Great American Smokeout (11/2016)

1.8: Follow-up is an area that is being addressed. Currently no employee is assigned this

role.

o Skin Cancer Screening – letters were sent out to patients requiring follow-up

appointments and/or biopsies.

o The committee is concerned about privacy issues related to further outcomes.

II. Identification of Community Needs:

The Community Health Sub-committee of the Cancer Care Committee reviewed Massachusetts

Cancer Registry data for the catchment area for St. Elizabeth’s Medical Center (Boston,

Brookline, and Newton). Data for 2008-2012 (the most recent available) showed the following

areas of concern:

Melanoma of the skin: statistically significantly elevated incidence rate in Newton

females

Breast cancer: statistically significantly elevated incidence rate in Newton females

Colorectal cancer: statistically significantly elevated incidence rate in Boston males

Lung cancer: statistically significantly elevated incidence rate in Boston males

Prostate cancer: statistically significantly elevated incidence rate in Boston males

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III. Information Provided at Community Health Fairs and Events:

The Director of Community Health, Nikkie Mulkern, attended the following community health

fairs and events during 2016. At each event, educational materials were available on colon

cancer screening, lung cancer screening and smoking cessation, breast cancer screening, and skin

cancer prevention and screening. These cancers were highlighted because there are effective

screening and prevention measures available. Profile cards were also available for primary care

providers as well as relevant specialty physicians.

Healthy Kids Day – YMCA 4/30/16 Sun safety and skin cancer prevention

Oak Square Farmer’s Market 6/1/16 Lung cancer screening and smoking cessation

Senior Supper - Health Trivia 6/9/16 Colon cancer screening

Oak Square Farmer’s Market 7/20/16 Lung cancer screening and smoking cessation

Brazilian Independence Day Fair 9/11/16 Breast cancer screening

Brazilian Magazine Health Festival 10/16/16 Breast cancer screening

Boston College Faculty and Staff Fall Health Fair 10/25/16 Breast cancer screening

IV. Screening Events:

1. Skin Cancer Screening – Monday, May 23, 2016

Early on in the year the committee reviewed data from the 2015 skin screening event to evaluate

the need to hold an event in 2016. The committee determined that based on the number of

attendees and the percentage of those that required a follow-up appointment, the skin screening

was important to repeat. One of the trends from 2015 was that patients would not have had their

skin checked without the screening.

The Skin Screening was held on a Monday night for 2.5 hours. There were four dermatologists

participating, Drs. Mark Amster, Robert Brown, Stephen Kovacs, and Andrew Wang. Two

nurses were also on hand to answer questions as well as provide educational materials. The

event was advertised in both English and Russian (one of the top languages spoken by St.

Elizabeth’s patients), as the St. Elizabeth’s 2016 needs assessment highlighted the need to offer

materials and events in additional languages other than English. The Director of Community

Health collaborated with Dr. Eugene Vaninov, who leads the Russian American Institute of

Medicine. Dr. Eugene Vaninov advertised to his Russian-speaking patients, and the Director of

Community Health went to nine different Russian housing complexes and community

organizations. There was also a Russian interpreter available during the event to translate.

The skin screening event was full one week prior to the event. Fifty-one people attended, of

whom six spoke Russian. After the event, the skin screening forms were reviewed and letters

were sent to those that required a follow-up visit or a biopsy (21/51 or 40%). The letter sent to

patients included contact information for the Director of Community Health as well as the

number to make an appointment with the dermatologist that they saw. The Director of

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Community Health did not receive any phone calls. Because of HIPAA, we were not able

confirm if patients visited the dermatologist.

After the event, the Community Health Sub-committee met and discussed the effectiveness and

success of the event. Based on a survey administered, the number of patients that attended, and

patient feedback at registration, the event was very successful. Patients said that they look

forward to this event every year and that they would not have seen a dermatologist without this

event. Next year we will consider extending the length of the screening and/or adding another

doctor to accommodate the demand.

Data from the event (n=51):

Gender:

Male 22

Female 29

Ethnicity:

White 45

Black 1

Hispanic 0

Asian 3

Mixed race 1

Other 1

Primary language spoken:

English 45

Russian 6

Would not have gotten skin

checked w/o screening.

22

Mole changes 10

Family history of cancer 14

Personal history of skin cancer 8

Hx of Basal Cell Carcinoma 5

Hx of Squamous Cell Carcinoma 1

Biopsy recommended 14

Referred for follow-up visit 20

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2. Breast Cancer Awareness Event and Screening – October 2016

To celebrate Breast Cancer Awareness month in October 2016, St. Elizabeth hosted four

evenings for mammogram appointments (“Chocolate and Roses”), two meet and greets, and free

breast exams. Mammograms were offered from 5:15-8:00 pm on October 12, 17, 19, and 24.

All patients that came for a mammogram were given chocolate, a rose, and a goodie bag.

Twenty-five patients received mammograms during the Chocolate and Roses events, and the

average age of attendees was 51.

Breast Surgeon Jan Rothschild, MD, hosted a meet and greet on October 19 from 5:30-6:30 pm.

Dr. Rothschild introduced herself to patients and answered any questions that they had.

Radiation Oncologist Beth Herrick, MD, and Center for Breast Care Nurse Practitioner Kathleen

Dionne, MS, BSN, FNP-BC, held a meet and greet on October 24 from 6:15-7:15 pm. They also

introduced themselves to patients and answered questions. Free breast exams were offered on

October 24 from 5:15-6:15 pm, but we unfortunately did not have anyone sign up.

This was the first time breast exams were offered, in response to feedback at the breast health-

focused Senior Supper that women wished there was someone that could perform a breast exam

and walk them through how to perform this at home. Unfortunately, we do not feel the timing of

breast exams was optimal. The timing of the mammograms was geared to women in the work

force, who may be less likely to get mammograms because they are working during normal

operating hours. Our attendees had an average age of 51, suggesting that we were meeting the

needs of our target population. Breast exams were also offered during evening hours, which was

not optimal for the elderly.

A survey was administered at the end of the event to gauge the success. All patients said that the

time and day were very convenient. All patients have had a mammogram before, and 80% had

had a mammogram within the last year.

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V. Prevention Events

3. Colon Cancer Awareness Event – Friday, March 4, 2016

Dress in Blue Day/Colon Cancer Awareness Day was held during lunch for three hours in the

cafeteria, where employees, patients, and visitors eat. There were three tables: one for

promotional items, one for central scheduling to book appointments, and one for the photo booth.

Prior to the event e-mails were sent to employees to encourage them to wear blue to raise

awareness of colon cancer and the importance of screenings. The event was also advertised on

the TV screens around the hospital. At the promotional table, we had brochures outlining who

should get screened, information on colon cancer, Dress in Blue Day cards with pins attached,

blue leis, profile cards for SEMC gastroenterologists, American Cancer Society colon cancer

booklets, and colon cancer awareness bracelets.

Highlights:

Distributed 85 colon cancer awareness cards with pins and 50 blue leis.

Scheduled two colonoscopies.

Many people said they have appointments coming up with their PCPs and will discuss

with their doctor if they need a colonoscopy.

Cancer survivors stopped by the table and shared their stories with other attendees. They

also stressed the importance of preventative screenings.

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4. Senior Supper – Health Trivia – Thursday, June 9, 2016

The entertainment for the quarterly Senior Supper was health trivia. Doctors provided questions

based on their specific areas of expertise; among the 40 trivia questions were many on cancer

prevention and screenings. The 35 guests answered each question and then a brief discussion

occurred regarding which answer was correct and why. Physician profile cards and cancer

screening cards were available at the conclusion of the event. Attendees enjoyed the trivia and

were stumped by many of the questions prior to hearing the answer.

5. Senior Supper – Breast Health Over the Age of 65 – Thursday, September 8, 2016

Due to the aging of the population and the high number of elderly in the SEMC catchment area,

the Community Health Sub-committee discussed the need for targeting woman over the age of

65. Kathleen Dionne, MS, BSN, FNP-BC of the Center for Breast Cancer led a discussion on

breast health at the September 8, 2016, Senior Supper. Approximately 42 guests attended,

including a handful of men. Kathleen asked questions about breast health and participants

answered. This led to an interactive and open evening. Pre- and post-tests were administered to

see if their knowledge around women’s health increased after the discussion. 60% of attendees

showed an increase in the number of correct responses from the pre-test to the post-test.

Mammography information cards and profile cards for the staff in the Women’s Health Pavilion

were available for attendees to take. Attendees enjoyed the event and asked many questions on

breast health.

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6. Support Men’s Health Awareness -- Thursday, November 17, 2016

St. Elizabeth’s collaborated with our sister hospitals and parent company Steward Health Care to

raise awareness for men’s health during the month of November 2016. “Movember” is an

annual event involving the growing of moustaches during the month of November to raise

awareness of men's health issues, such as prostate cancer, testicular cancer, and men's suicide.

Movember aims to increase early cancer detection, diagnosis and effective treatments, and

ultimately reduce the number of preventable deaths. On November 17, SEMC hosted a photo

booth with an assortment of moustaches, fingerstache tattoos and mustache stickers. Employees

added mustache stickers to their badges to spark conversation about men’s health. We also used

this opportunity to raise awareness of lung cancer and smoking cessation (the Great American

Smokeout).

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Psychosocial Care Report 2016

Sara Nemitz, LICSW, Psychosocial Distress Coordinator

DFCI/St. Elizabeth’s satellite social worker, Sara Nemitz, LICSW, continues to provide

psychosocial support to patients and families throughout the medical oncology continuum. She

collaborates closely with nurses, physicians and support staff to identify patients in need of

psychosocial support. Psychosocial screening is conducted via initial nursing assessment with

acute signs of distress being responded to within 24 hours of social work notification. Routine

psychosocial needs are identified during daily interdisciplinary huddles as well as

formal/informal social work consultation. Ms. Nemitz has assisted in triaging psychosocial

concerns emerging in other SEMC oncology practices including the Center for Breast Care and

Radiation Oncology, as staffing in these settings does not include psychosocial support. In light

of NCCN guidelines it is increasingly important that each oncology practice within SEMC

design or articulate processes ensuring that all oncology patients are screened for psychosocial

distress.

Clinical services:

psychoeducation around the importance of advanced directives, including healthcare

proxy designation

adjustment counseling for patients and families coping with new diagnosis, disease

progression, and disease surveillance

psychoeducation around family concerns including communication strategies, parenting

techniques, elder care needs, etc.

end-of-life counseling for patients and families facing anticipatory grief, preparing for

death

collaboration with external collaterals to encourage continuity of psychosocial care,

including community mental health providers, home health care providers, elder service

providers, skilled nursing facility and rehab providers

community referrals to bolster overall support available to patients and families including

psychiatry, counseling/psychotherapy, wig services, meal delivery programs, Mass

Health PCA program, elder services, SHINE program, YMCA Livestrong program,

support groups

Group Program

o Patient support group: 6 total patients attended over the course of 7 meetings in 2016.

o Caregiver support group: 4 caregivers attended over the course of 3 meetings in 2016.

o Look Good Feel Better: 21 women registered and 15 attended over the course of 4

meetings in 2016.

o Patient and Caregiver monthly groups being reformatted and streamlined in 2017 into

quarterly topic-based forums in an effort to increase utilization. Potential topics

include “What is Wellness?,” “Money Matters,” “Communicating Concerns,” and

“Happy Hectic Holidays.”

Concrete services:

financial: assessment of illness-related income changes and basic household expenses,

screening for DFCI Patient Assistance Funds ($250/year for groceries, gas, or the RIDE);

collaboration with Program RN to address high medication co-pays; collaboration with

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Financial Coordinator to advocate for limited English speaking patients with insurance

and billing concerns; referrals to SEMC Financial Counselors for Mass Health

applications, referrals to community based utility assistance programs

transportation: referral to Resource Specialist for Mass Health PT-1, The RIDE (MBTA)

or equivalent regional program, ACS Road to Recovery

housing: rental assistance program referrals, advocacy letters to support housing

applications, assisted living referrals

food: referrals to DTA (SNAP/EAEDC benefits), Community Servings (meal delivery

service for patients with chronic illness), grocery store giftcard provision through DFCI

Patient Assistance Funds, community food pantries

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A Review of Prostate Cancer Diagnosis and Treatment

at St. Elizabeth’s Medical Center, 2006-2016

The Cancer Care Committee chose prostate cancer as the site for in-depth review for this report

because it was the most common cancer diagnosed and/or treated at St. Elizabeth’s Medical

Center (SEMC) in 2016. For the period 2006-2016, there were a total of 2,533 cases abstracted.

The National Cancer Data Base (NCDB), to which SEMC data are compared, reported 1,237,718

prostate cancer cases submitted during this time period.

According to the American Cancer Society1, prostate cancer is the most common malignancy

diagnosed in the United States. The ACS estimates that about 161,360 new cases of prostate

cancer will be diagnosed in 2017, and about 26,730 men will die of the disease. Leading risk

factors for prostate cancer include increasing age, African-American race, and family history.2

In Massachusetts, prostate cancer was the most commonly diagnosed cancer, representing 25.4%

of all cancers diagnosed in men for the period 2009-2013.3 It was the second most common

cause of cancer deaths in men during this time period, representing 9.4% of cancer deaths in

men. Incidence rates increase with age, rising from 163.6 cases per 100,000 men aged 50-54 to

728.7 cases per 100 men aged 70-74 and older; the median age of diagnosis was 65.

Figure 3 shows the distribution of age at diagnosis at SEMC vs. data from the NCDB for 2006-

2016. Over 93% of SEMC cases were diagnosed in men aged 50 and older, vs. 96.6% of NCDB

cases. In both groups, the most common age group for diagnosis was 60-69.

Figure 3. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Age at Diagnosis, NCDB vs. SEMC

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

NCDB

SEMC

20

Figure 4 shows the distribution of stage at diagnosis at SEMC vs. NCDB. The majority of cases

were diagnosed at stage II (61.3% of SEMC cases, vs. 69.0% of NCDB cases). Unknown stage

represented fewer than 1% of SEMC cases, vs. 5.8% of NCDB cases.

Figure 4. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Stage at Diagnosis, NCDB vs. SEMC

Table 3 shows the distribution of first course of treatment at SEMC vs. NCDB. More cases at

SEMC were treated with surgery alone (73.0%, vs. 48.3% of NCDB cases), reflecting the

success of the robotic surgery program. Fewer cases at SEMC were treated with radiation only

(5.9% vs. 19.2% of NCDB cases) or radiation and hormone therapy (7.7%, vs. 13.7% of NCDB

cases).

Table 3. Analytic Prostate Cancer Cases, 2006-2016: Comparison of Initial Treatment, NCDB vs. SEMC

TREATMENT NCDB SEMC

SRG only 48.3% 73.0%

RAD only 19.2% 5.9%

SYSTEMIC only 3.7% 1.3%

SRG RAD 1.8% 0.9%

SRG SYSTEMIC 2.4% 3.1%

SRG RAD SYSTEMIC 1.2% 1.6%

RAD SYSTEMIC 13.7% 7.7%

NO TX/BX ONLY 6.9% 6.1%

OTHER/UNKNOWN 2.3% 0.3%

1 Cancer Facts and Figures 2017. American Cancer Society, 2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/estimated-number-of-new-cancer-cases-and-deaths-by-sex-us-2017.pdf.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

0 (in situ) I II III IV Unknown

NCDB

SEMC

21

2 Prostate Cancer Risk Factors. American Cancer Society, 2017. https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html. 3 Cancer Incidence and Mortality in Massachusetts, 2009-2013. Massachusetts Cancer Registry, 2016. http://www.mass.gov/eohhs/docs/dph/cancer/state/registry-statewide-report-09-13.pdf. 4 Relative Survival. https://seer.cancer.gov/seerstat/WebHelp/Relative_Survival.htm.