1

Cancer Program Annual Report

2019

2

3

Contents

Cancer Committee 2018 6

2019 Cancer Program Highlights 8

Performance Improvement Initiatives established in 2019 12

Cancer Registry 13

Acknowledgments 19

References 19

Directory of Services 20

Glossary Of Terms 21

4

5

6

The PIH Health Whittier Hospital Cancer Committee is a multi-disciplinary team composed of medical staff members from diagnostic and therapeutic specialties, administrative staff and allied health professionals involved in the care of cancer patients. The committee members work together to provide the highest quality of care to cancer patients and play a key role in the success of PIH Health.

Physician Members

Anthony Britto MDPlastic Surgeon

Armen Gregorian MDColorectal Surgeon

Brent Gray MDAssistant Vice President of Medical Affairs (VPMA)/OB/Gyn

Dustin E. Stevenson DOHematologist/Medical Oncologist/Chair, Cancer Committee

Edwin Lin MDHematologist/Medical Oncologist

Jack Freimann MDHematologist/Medical Oncologist

Jeffrey Yuen MDRadiation Oncologist

Kennith Thompson MDCo-Medical Director Breast Health Center/Cancer Liaison Physician/General Surgeon

Kimberly Bickell MDCo-Medical Director Breast Health Center, Diagnostic Radiologist

Lily Wang MDDiagnostic Radiologist/Co-Medical Director, Breast Health Center

Lisa S. Wang MDHematologist/Medical Oncologist

Mark Odou MDSurgeon

Merrill Shum MDHematologist/Medical Oncologist

Nadeem Chishti MDPulmonologist

Nathan Honda MDCancer Program Medical Director/Cancer Liaison Physician/Pathologist

Robert Kleinman MDDiagnostic Radiologist

William Kurohara MDQuality Control Coordinator of Registry Data/Radiation Oncologist

William MacDonald MDPathologist

Cancer Committee 2018

7

Non-Physician Members

Andrea Allsup MSWSocial Worker/Psychosocial Activity Coordinator

April Fowler CTRCancer Data Specialist/Conference Activity Coordinator

Breaz DeRousseMarketing Communications Consultant

Cathy Zappia RN BSN PHNSystem Manager, American Cancer Society

Carla Guess RN CBCN CB BNOncology Nurse Navigator, Breast Health Center

Claire McClafferty LCSWPalliative Care

Chantel K. Tanuvasa-Strotman MSWSocial Worker/Psychosocial Activity Coordinator

Dan Ogletree MSWPalliative Care

Daniel Patino-RuizCancer Data Specialist/Conference Activity Coordinator

Debbie McKnight RN MSNAdministrative Director, Med-Surgical Services/Administrator

Gayle Madden-Mathes RN OCNLung Screening Program Nurse Navigator

Genevieve Taguinod RN MSN NPManager, Infusion Center

Graciela Montes RNDirector of Group Operations, Administration

Ivonne Munoz RN BSNDirector, Breast Health Center

Kathy Seymour RN BSN OCNOncology Nurse Navigator, Cancer Program

Kristine Cooper CTRCancer Data Specialist/ Conference Activity Coordinator

Kelly Sanchez RN MSNAssistant Clinical Director, Oncology Unit

Liz Gorski RN BSNSurvivorship Navigator

Lorraine DeGiacomo RN BSN OCNManager, Radiation Oncology

Lucinda Place RN MSNAdministrator, Quality Management

Lynze Ruvalcaba RN BSN OCNClinical Director, Oncology Unit/Infusion Center

Maribel Ordorica RNPractice Manager, PIH Health Physicians Oncology Group

Marie Cruz GarciaCancer Registry

Miriam Turcios RN BSN Radiation Oncology

Ramona Pratt RN MSN MSHCAVice President Oncology Services

Raquel Varella PT/CLTPhysical Therapist, Lymphedema Program

Regina Christ RN MSN NPPalliative Care

Rosie Drulias RN BSN PHN CCRPClinical Trials/Clinical Research Activity Coordinator

Sarah Merkle RN MSN AOCNSClinical Director, Cancer Program / PI Coordinator

Shelly Hart PTA-CLTPhysical Therapist Lymphedema Program

Sovirny PrestonAdministrator QM & Performance Excellence

Sue Jervik RN BSNPain Management Educator

Tammy Neu RNClinical Director, Hospice

Thia Le RDManager, Clinical Nutrition

Vanessa IvieDirector, Community Benefit and Community Health

Vicky WenPhysical Therapist Lymphedema Program

8

The PIH Health Whittier Hospital Comprehensive Community Cancer Center provided a number of services to cancer patients in our community and beyond.

4 Tower oncology nurses participated in the 2019 American Cancer Society Relay for Life.

PIH Health partnered with Vogue Wigs to factilate a wig event for cancer patients and survivors who have experienced hair loss or thinning from cancer treatment. Over 100 wigs were provided on March 30, 2019 at no cost to the patient.

The National Comprehensive Cancer Network (NCCN) distress tool was given to all appropriate patients at PIH Health undergoing cancer treatment in the infusion center and radiation oncology.

Survivorship Care Plan delivery continued to be a priority throughout 2019. The Survivorship Care Plan summarizes the patient’s diagnosis, treatment plan and provided follow-up information and is essential for the continued journey into survivorship for cancer patients.

The PIH Health Whittier Hospital Radiation Oncology center was re-accredited by the American College of Radiology.

Cancer Survivors were invited to learn about nutrition through treatment and beyond at a survivorship workshop held on September 28, 2019.

On June 3, 2019, PIH Health honored all cancer survivors by celebrating National Cancer Survivors day. Gifts and information targeted for survivors were distributed throughout the day.

On November 21, 2019, PIH Health raised awearness about the dangers of smoking by participating in the Great American Smokeout.

2019 Cancer Program Highlights

Olivia Romo, Kodi Miura, Leslee Briggs, Jasmin Martin, Allison Bruton, Lindsay Santos,

Karen Castillo and Melissa Kugelman

Annette Atwood, Constance Evans and Olivia Perez

9

Complimentary Therapy

The Mind Body & Spirit Workshop Series was offered during the course of the year to support cancer patients throughout their journey. Studies have shown patients who manifest a strong spiritual connection or practice tend to be more positive and have better coping strategies. The workshop helps connect patients with their spirituality to move through life’s challenges with greater peace and awareness.

Yoga classes continue to be provided to our cancer survivors. These classes help patients reconnect with their bodies through gentle yoga designed for those facing or recovering from the challenges of cancer or other illness.

Daniel Patino-Ruiz, Marie Cruz-Garcia and Sharice Johnson

Gabrial Rodriguez, Kimberly Palacios and Christopher Smith

Lorraine DeGiacomo, Sharron Cloud, Miriam Turcios, Kelly Sanchez and Liz Gorski

10

Clinical Trials

In 2019, clinical trials continued to be an area of growth for PIH Health Whittier Hospital. Offering clinical trials allows us to provide new approaches to treating and managing cancer.

PIH Health is affiliated with SWOG (formerly Southwest Oncology Group), a global cancer research community that designs and conducts publicly funded clinical trials. Through this affiliation we have 14 clinical trials actively accruing for various stages of breast, lung, kidney, colon and rectal cancers. PIH Health has recently started a collaboration with Translational Research in Oncology-US (TRIO-US). Through TRIO-US, PIH Health will be able to offer further innovative clinical trial treatments to our community by collaborating with scientists, researchers, clinicians and industry partners.

Mariposa Boutique

The Mariposa is a unique wellness boutique that helps patients return to a full and active life after surgery by introducing them to a wide range of products and services. Staff members include Certified Mastectomy Fitters who provide consultations on special breast prostheses and bras, and specialize in fitting lymphedema sleeves and compression medical wear. Women may obtain information on lymphedema, hospital and local support groups, and internet-based resources. Other items available for purchase include scarves, hats, wigs and jewelry. The services at Mariposa enable breast cancer patients and survivors to feel confident and beautiful.

Cancer Screening and Early Detection

PIH Health is focused on wellness and illness prevention. Cancer screenings are designed to detect cancer early and decrease the number of late stage disease. The Cancer Program offered screening programs for breast, colon, and lung cancer. All screening programs are consistent with evidenced based guidelines.

• Breast Cancer Screening

» Performed with mammography » 20, 939 screening mammographies performed

• Colon Cancer Screening

» Performed via colonoscopy » 2,241 screening colonoscopies performed

• Lung Cancer Screening

» Performed with low-dose computed tomography (CT)

» 458 screening CTs performed

Community Outreach and Education on Cancer Prevention

The Cancer Committee worked with multiple internal departments and outside organizations to provide quality cancer care within our organization and throughout the community. PIH Health offered numerous community outreach and educational activities during 2019, including:

• Breast Cancer Awareness

• Colon Cancer Awareness

• Lung Cancer Awareness

• Male Cancer Awareness

• Smoking Cessation Workshop

11

PIH Health and American Cancer Society (ACS) offered numerous support groups including:

• Women’s Cancer Support Group

• Journey Through Cancer Support Group

• Life After Cancer

• Grief Recovery

• Healing After Loss

• I Count Too

• I Can Cope

Oncology Resource Center

The Oncology Resource Center and Wig Bank are available for patients and their family members to access educational material and resources. Wigs and head coverings gifted to these women provide dignity and compassion during their journey. In 2019, 115 wigs and head coverings were provided to women going through cancer treatment. The resources of the wig bank are made possible by the generosity and support of donors in our community.

Sarah Merkle, Annette Atwood, Amy Fitzgerald and Patricia Dudley with PPT Physical Therapy staff making a donation to the PIH Health Wig Bank

12

Decreasing Time from Simulation to First Treatment for Stereotactic Radiation Therapy

The National Oncology Roundtable benchmark for wait time from simulation to first treatment is < 10 business days. The PIH Health Radiation Oncology department had an average of 11.5 business days.The PIH Health Radiation Oncology department was able to optimize workflows and increase staffing ultimately decreasing their wait time to nine days in October 2019.

Decrease Time from Diagnosis to Surgery in Stage 1A-2B Non-small Cell Lung Cancer Patients

In 2018, the average time from diagnosis to Surgery was 100 days for Stage 1A-2B non-small cell lung cancer patients. Many of these delays were related to the required supportive diagnostic imaging required before surgery. Throughout the year, processes were established to ensure timely pre-operative imaging, an effcient workflow for authorization and streamlined care guided by the Lung Cancer Nurse Navigator and Lung Cancer Tumor Board. By October 2019, the time from diagnoss to surgery had decreaed from 100 days to 57 days.

Performance Improvement Initiatives established in 2019

13

Figure 12019 Geographic Distribution of Caseload

Cancer Registry

Established in 1987, the Cancer Registry is an essential component of the PIH Health Whittier Hospital Comprehensive Community Cancer Program. Our cancer database management system is designed to monitor all types of cancers diagnosed and/or treated at PIH Health and is a critical element in the evaluation of cancer care. Demographic information, cancer type, treatment and follow-up data are collected on each cancer patient by the registry staff, who are specially trained in the field of oncology data management. In 2019, the Cancer Registry database included data on 38,796 cases.

Cancer Statistics

In 2019, 1,301 patients were diagnosed or received cancer care at PIH Health. These cases were diagnosed through the PIH Health service area. (Figure 1)

The most commonly diagnosed cancers detected and treated at PIH Health were compared to California cancer incidence and ranked according to frequency. Cancer incidence by gender at PIH Health was 434 males and 669 females. The incidence of breast cancer is higher at PIH Health compared to California rates. (Table 1)

Table 12019 Cancer Incidence by Gender at PIH Health

434 males and 669 Females – Totaling 1,103

MALE FEMALE

Cancer Site #pts PIH Health #pts US Cancer Site #pts PIH Health #pts US

Prostate 97 22% 174,650 20% Breast 269 40% 268,600 30%

Lung/Bronchus 77 18% 116,440 13% Lung/Bronchus 61 9% 111,710 13%

Colon & Rectum 48 11% 78,500 9% Colon & Rectum 45 6% 67,100 7%

Kidney & Renal Pelvis 52 12% 44,120 5% Uterus 68 10% 61,880 7%

Lymphoma 22 5% 41,090 5% Lymphoma 17 3% 33,100 4%

14

CLASS OF CASE SEX* STAGE AT DIAGNOSIS*PRIMARY SITE Cases A N/A M F 0 I II III IV UNK NA

ALL SITES 1301 1103 197 533 768 74 390 136 126 189 65 123

HEAD & NECK 22 17 5 14 8 0 3 2 1 4 4 3

Tongue 3 2 1 2 1 0 0 0 0 0 1 1

Salivary Gland 4 2 2 1 3 0 0 0 0 1 1 0

Floor of Mouth/Gum/Other 3 3 0 1 2 0 2 0 0 1 0 0

Nasopharynx 6 4 2 5 1 0 0 1 1 1 1 0

Tonsil 2 2 0 1 1 0 0 1 0 0 1 0

Hypopharynx/Oropharynx 4 4 0 4 0 0 1 0 0 1 0 2

DIGESTIVE SYSTEM 265 223 42 116 115 2 39 43 43 57 20 10

Appendix 5 3 2 1 4 0 1 2 0 0 0 0

Esophagus 16 15 1 13 3 0 1 2 5 2 2 3

Stomach 17 16 1 12 5 0 5 1 3 6 1 0

Small Intestine/Lg Intestine 21 9 12 11 10 0 2 2 0 4 1 0

Colon/Rectum/Recto sigmoid/Hepatic Flexure/Cecum 91 83 8 46 45 2 21 26 17 9 8 1

Anus/Anal Canal/Anorectum 8 7 1 6 2 0 1 3 1 1 0 1

Liver 37 32 5 21 16 0 7 3 10 5 5 2

Gallbladder/Bile Ducts/other 12 9 3 6 6 0 1 0 3 4 0 1

Pancreas 55 46 9 32 23 0 9 4 4 26 3 0

Other Digestive 3 3 0 2 1 0 0 0 0 0 0 3

RESPIRATORY/ INTRATHORACIC 149 125 24 86 63 8 37 7 12 51 8 2

Nose/Nasal Cavity/ Sinus/Mid Ear 1 1 0 1 0 0 0 0 0 1 0 0

Larynx/Trachea/Mediastinum/ Pleura other Respiratory 5 5 0 4 1 0 2 0 0 2 1 0

Mesothelioma 5 4 1 4 1 0 1 0 0 2 1 0

Lung/Bronchus 138 115 23 77 61 8 34 7 12 46 6 2

BLOOD & BONE MARROW** 113 91 22 58 55 0 6 5 10 29 7 34

Leukemia 31 23 8 14 17 0 0 0 0 5 1 17

Multiple Myeloma 21 13 8 13 8 0 0 0 0 0 0 13

Non-Hodgkin Lymphoma 53 47 6 27 26 0 5 4 7 21 6 4

Hodgkin Lymphoma 8 8 0 4 4 0 1 1 3 3 0 0

SOFT TISSUE/HEART/BONE 7 7 0 2 5 0 2 1 1 0 1 2

SKIN 25 20 5 12 13 4 5 4 2 4 0 1

Melanoma of Skin 20 17 3 11 9 4 5 4 2 4 0 1

Other Skin/Kaposi Sarcoma 5 3 2 1 4 0 0 0 1 1 0 1

BREAST 271 242 29 2 269 45 142 23 12 10 9 1

FEMALE GENITAL 119 109 10 0 119 0 63 14 15 10 7 0

Cervix Uteri/Cervix Insitu 14 12 2 0 14 0 7 2 0 2 1 0

Corpus Uteri/Uterus NOS 68 65 3 0 68 0 46 8 6 2 3 0

Ovary 21 18 3 0 21 0 3 1 9 3 2 0

Vulva/Vagina/Other 16 14 2 0 16 0 7 3 0 3 1 0

MALE GENITAL 103 75 28 103 0 0 15 29 12 14 5 0

Prostate 97 69 28 97 0 0 10 29 11 14 5 0

Testis/Penis/ Other 6 6 0 6 0 0 5 0 1 0 0 0

URINARY 113 100 13 76 37 15 52 2 18 10 2 1

Bladder 31 29 2 24 7 15 6 1 5 2 0 0

Kidney and Renal Pelvis 82 71 11 52 30 0 46 1 13 8 2 1

BRAIN & OTHER CNS 22 18 4 8 14 0 0 0 0 0 0 18

THYROID & ENDOCRINE 37 32 5 7 30 0 16 7 1 1 2 5

OTHER 62 49 12 21 41 0 1 0 0 1 1 46

The Primary Site Distribution Table details PIH Health Whittier Hospital’s 2019 cancer experiences by site, age, gender and stage of disease at diagnosis. (Table 2)

*Stage reflects analytic cases **AJCC Stage not applicable NA = Non-applicable UNK = Unknown StageTable 2

15

Number of New Cancer Cases

Figure 2 depicts the number of newly diagnosed cancer cases added to the Oncology Registry from 2009 to 2019. These cases are categorized into three groups: new cancer cases for the year 2019; cases diagnosed and treatment given; and those diagnosed elsewhere, but received initial treatment at PIH Health.

Stage at Diagnosis for New Cases in 2019

The stage of disease at the time of diagnosis plays a vital role in the prognosis and treatment of a cancer patient. In 2019, 42.1% of all newly diagnosed patients were in early stage at diagnosis (in-situ or Stage I), 12.3% were Stage II, 11.4% were Stage III, 17.1% were Stage IV, 11.2% were not applicable for staging (NA) and 5.9% were classified as unknown stage at time of diagnosis. (Figure 3)

Figure 2

Figure 3Stage at Diagnosis1,019 Analytic Cases

16

Age Distribution at Diagnosis in 2019

Seventy percent of patients were between the ages of 60 and 89 at diagnosis. The median age was 70 years. (Figure 4)

Figure 4

17

Physicians Who Presented and Participated in Case Presentations at Cancer Conferences in 2019

Daniel Akhavan MDAshwin Ashok MDKimberly Bickell MDJohn Britto MDLeo Buxbaum MDAlfred Castellanos MDNadeem Chishti MDRegina Christ NP Dhand Sabeen MD Jacques Dorce MDJoel Garris MDArmen Gregorian MDJack Freimann MDNathan Honda MDC. Rodger Hughes MDNassr Hussein MDSamuel Im MDMaureen Jensen MDRobert Kleinman MDNanette Kovash DOJames Kuo MDWilliam Kurohara MDJason Lai MDEdwin Lin MDShao-Pow Lin MDWilliam MacDonald MDRosemary Melesko NPPaul O’Connor MDMark Odou MD

Christie Pang MDJoseph Park MD Yong Park MDRenee Palta DOAmish Patel MDAnuj Rajput MDMillicent Rovello MDDaniel Saket MD Kiumars Saketkhoo MDRavi Sankar MDDennis Sargent MDMukesh Shah MD Neal Shindel MDMerrill Shum MDJoomee Shim MDDustin Stevenson DOEddie Thara DOKennith Thompson MDEduardo Tovar MDMiguel Velez MDLilly Wang MDLisa S. Wang MDYunfei Wei MDGerald Yoon MDBrian Yue MDJeffrey Yuen MDScott Yun MDMaryam Zamanian MD

18

2019 Breast, Lung & Multidisciplinary Cancer Conferences and Lecture Summary

Cancer conferences provide a multidisciplinary, patient specific, treatment-planning, consultative service for patients and their managing physicians. The conferences offer a forum for discussing various treatments options and assist in determining the most appropriate patient management plan.

CANCER SITE PRESENTEDNUMBER

OF CASES PRESENTED

Breast 238

Lung 101

Colorectal/Anus/Cecum 47

Stomach 7

Skin/Melanoma 8

Pancreas 4

Ovary/Fallopian Tube 9

Corpus Uteri/Vulva/Endometrium 6

Lymphoma 8

Unknown Primary 11

Bladder 1

Head & Neck/Scalp 3

Soft Tissue 2

Thyroid 3

Leukemia/Myeloma 4

Liver 2

Kidney 6

Brain/CNS 2

Esophagus 2

Prostate 3

Cervical Spine 1

Small Intestine/Ileum 2

Testis 2

Nasopharyngeal 1

Retroperitoneum 4

Appendix 3

Additionally, three CME lectures were offered:

• March 26, 2019 Expanded Selection Criteria for Surgical Treatment of Colorectal Liver Metastases Ronald Frank Wolf, MD, FACS Zeljka, Jutric, MD University of Irvine

• May 14, 2019 Biomarker Testing & Immunotherapy Julie Steele, MD Division Head of Anatomic Pathology and Medical Director of Surgical Pathology for Scripps Clinic

• September 17, 2019 Emerging Strategies in the Management of Breast Cancer Sara A. Hurvitz, MD University of California, Los Angeles

19

Acknowledgments

For more information about the PIH Health Comprehensive Community Cancer Program, call 562.698.0811 Ext. 12456 or visit PIHHealth.org/CancerCare.

The 2019 PIH Health Comprehensive Community Cancer Program Annual Report was prepared by Nathan Honda MD; Sarah Merkle RN MSN AOCNS; and Daniel Patino-Ruiz CTR under the purview of the Cancer Committee.

Thank you for preparing the special report.

References

• Cancer Program Manual, 2020, American College of Surgeons Commission on Cancer, Chicago

• Manual for Staging of Cancer, 8th Edition, American Joint Committee on Cancer, Springer, New York, NY2016

• Cancer Facts & Figures, 2018, American Cancer Society Inc., New York, New York

• California Facts & Figures, 2019, American Cancer Society, California Division, Inc., Oakland, California

• PIH Health Cancer Registry Statistical Database

20

Main Hospital Number 562.698.0811

Breast Oncology Nurse Navigator 562.907.0667 Ext. 15326

Cancer Program Education/Support Groups 562.698.0811 Ext. 12570

Cancer Information Hotline 562.945.8326

Cancer Registry 562.698.0811 Ext. 12896

Clinical Trials Department 526.698.0811 Ext. 12930

Colorectal Oncology Nurse Navigator 562.698.0811 Ext. 12580

Hospice 562.947.3668

Home Health 562.902.7763

Infusion Services 562.698.0811 Ext. 12641

Lung Cancer Screening Program 562.967.2892

Lung Nurse Navigator 562.698.0811 Ext. 11271

Lymphedema Program 562.698.0811 Ext. 12594

Nutrition Services 562.698.0811 Ext. 11320

Oncology Resource Center 562.698.0811 Ext. 12820

Patricia L. Scheifly Breast Health Center 562.907.0667

PIH Health Hematology/Oncology Clinic 562.789.5480

Radiation Oncology 562.696.5964

Website Address PIHHealth.org

Directory of Services

21

A = Analytic

Cases that are first diagnosed and/or received all or part of their first course of treatment at PIH Health Whittier Hospital.

N/A = Non-AnalyticCases that are first diagnosed and treated elsewhere, then later admitted to PIH Health with disease.

NA

Not Applicable. Some types of cancer do not have staging schemes.

Life Table Method

The life table method involves dividing the total period over which a group is observed into fixed intervals, usually months or years.

Relative Survival

The ratio of the observed survival rate to the expected rate for a group of people in the general population similar to the patient group with respect to race, sex and age. The relative survival rate represents the likelihood that a patient will not die from causes associated specifically with his/her cancer at some specified time after diagnosis.

Stage at Diagnosis

The extent of disease based on all diagnostic and therapeutic evidence available by the end of the first course of therapy or within four months after beginning treatment.

TNM Staging System

The TNM system is an expression of the anatomic extent of disease and is based on the assessment of three components:• T The extent of the primary tumor

• N The absence or presence and extent of regional lymph node metastasis

• M The absence or presence of distant metastasis

TNM Stage Groupings

After the T, N and M has been assigned, they are grouped into stages. The grouping ensures, as far as possible, that each stage group is relatively homogeneous with respect to survival and that the survival rates of these stage groupings for each cancer site are distinct. Carcinoma in situ is categorized Stage 0; for most sites, a case with distant metastasis is categorized Stage IV. Stages I, II, and III indicate relatively greater anatomic extent of cancer within the range from Stage 0 to Stage IV.

Survival Rate

A statistical index that summarizes the probable frequency of specific outcomes for a group of patients at a particular point in time.

UKN

Unknown.

Glossary Of Terms

221/21-MALV-IH-TBD|523-0

PIHHealth.org