COMMUNITY CANCER PROGRAM

ACCREDITATION WITH COMMENDATION BY THE COMMISION ON CANCER

CANCER COMMITTEE

Lowndes Harrison, MD, Radiation Oncology, Cancer Committee Chairman, Cancer Conference Coordinator

Alberto Echeverri, MD, General Surgery, Cancer Liaison Physician

Elquis Castillo, MD, Medical Oncology

John B. Priest, MD, Pathology

Calvin Herring, MD, Diagnostic Radiology

Ramie Anderson BSRT, (R) (T) Director of Imaging and Radiation Oncology, Community Outreach Coordinator

Lora Ramsey, RHIA, Director of Health Information Management, Quality Improvement Coordinator

Paula Wyatt, CTR, Cancer Registry Coordinator

Kelly Evers, CTR, Quality of Cancer Registry Data Coordinator

Sherri Bryant, RN, Clinical Trials Coordinator

Doris Davis, RN, Quality Management

Taylor Krueger, Administrative Specialist

Kelly Bullock, RN, BSN Director of Oncology Floor

Amy Burns, RN, Case Management

Megan Cox, Dietary

Alison Shirley, American Cancer Society

Norris Hilton, Pastoral Care

Table of Contents

Chairman’s Report............................................................................................................ .................3

Cancer Liaison Report........................................................................................................ ................3

Cancer Registry Data......................................................................................................... ................4-9

Site Specific Analysis-PANCREAS.......................................................................................................10-11

Community Outreach........................................................................................................... .............12

National Cancer Survivor’s Dinner............................................................................................ .........13

Chairman’s Report

The American College of Surgeons Commission on Cancer

provides a useful organization mode for local cancer programs.

Currently only 1,500 hospitals nationwide are approved cancer

programs. Gadsden Regional Medical Center belongs to the

Community Cancer Program Category and is surveyed every three

years for continuation of approval. As a result of the 2014 survey, the

program’s continues to be an accredited facility with commendation

in six areas: Clinical Trial Accrual, Cancer Registrar Education, Public

Reporting of Outcomes, College of American Pathologist Protocols, Nursing Care, Data

submissions and Accuracy of Data.

The approval status are the results of the efforts of numerous individuals-the

administrators, cancer committee members and health care professionals who take care of cancer

patients are all to be commended! Through their efforts and knowledge, cancer patients in this

region are able to rely on comprehensive and compassionate care close to home.

Lowndes Harrison, MD Radiation Oncologist Cancer Conference Coordinator

Cancer Liaison’s Report

At Gadsden Regional Medical Center we strive to emphasize

comprehensive cancer care to our community. We will continue to

provide it in an ever-expanding role for cancer patients and their

families. The Gadsden Regional Medical Center’s cancer program

provides support groups and information for cancer patients and

families. A number of community outreach programs, such as physician

lectures and special events for cancer awareness were offered at Gadsden

Regional Medical Center.

There are currently 436 Community Cancer Programs across the United States. At the Gadsden

Regional Cancer, we offer quality cancer care. Our vision is to provide the best cancer care in a

personalized, comfortable, close to home setting.

Alberto Echeverri, MD General Surgeon

Cancer Registry

The Cancer Registry is an essential component of the Gadsden Regional Medical Center’s Cancer

Program. The registry’s primary duty is collecting and reporting information to the Alabama Statewide

Cancer Registry (ADPH) and National Cancer Data Base (NCDB). Long term follow up of patient outcomes

is sought on ALL cases reported. Other duties include organizing Cancer Committee meetings and Cancer

Conferences and documenting compliance with the CoC standards to maintain the cancer programs

accreditation from the American College of Surgeons Commission on Cancer.

The registry has responsibilities including the accurate and timely collection of information on

cancer diagnosed and/or treated at GRMC and it’s Cancer Center, as well as management and analysis of

this data. The information collected such as demographics, anatomic site, test, treatment and extent of

disease, has multiple uses, which include outcome reporting, patient care reviews, physician education

and clinical trials. The Cancer Registry has two fulltime employees and a part-time abstractor, all are

certified tumor registrars (CTR), which ensures quality and accurate data.

Cancer Registry Staff (left to right)

Barbara Robert, CTR Paula Wyatt, CTR, Cancer Registry Coordinator Kelly Evers, CTR, Medical Secretary

The data collected by the Cancer Registry is electronically submitted to the ADPH and NCDB for

further comparative analysis with other hospitals and databases. Data analysis for specific sites can be

done to compare site, demographics, histology, stage of disease, treatment modalities and survival to

other published state, regional or nation data. This information can be used to benchmark opportunities

on patterns of patient care and survival.

The registry staff participated in ongoing cancer-related education at the local, state and national

levels to maintain abstracting skills and to maintain credentials in their field. The registry staff also

participate in community outreach programs and provides support group information.

Physicians and other healthcare professionals are encouraged to utilize data collected. The Cancer

Registry staff can be reached at (256) 494-4466 (Paula Wyatt) or 256-494-4962 (Kelly Evers).

Cancer Committee

The Cancer Committee meet quarterly throughout the year and is responsible for the cancer

programs operations and establishes specific goals early in the year. The cancer committee monitors

the goals and objectives for endeavors relating to the cancer care in clinical areas, community outreach,

programmatic endeavors and quality improvement. Four coordinators are assigned to specified areas

within the committee to help monitor key elements, Lowndes Harrison MD, Cancer Committee Chair-

man and Cancer Conference Coordinator, Ramie Anderson, as Community Outreach Coordinator, Lora

Ramsey, RHIA, as Quality Improvement coordinator and Kelly Evers, CTR as Quality of Cancer Registry

Data Coordinator.

Cancer Conferences

Cancer Conferences are integral to improving the care of cancer patients by encouraging

multidisciplinary discussions of cancer diagnosis and treatment planning. All members of the medical

staff at Gadsden Regional Medical Center are welcome to attend the cancer conferences. During 2013,

25 cancer conferences were conducted on Wednesday after-

noons. A total of 98 cases were presented, of which 100

percent were prospective cases. The 98 cases presented at

cancer conference represent approximately 19 percent of all

newly diagnosed cancer cases seen in 2013. Several educa-

tion activities were held throughout the year. The purpose

of these activities is to provide the cancer care providers

with current information about cancer prevents, early detec-

tion, diagnosis, stage (extent) of disease, treatment guide-

lines, prognostic indicators, treatment and follow up care.

Cancer specific educational topics and speakers in 2013 in-

cluded:

“Lung Cancer Treatment Options” by Drs. Arianne Bennett-Venner, Christopher Clark and

Elquis Castillo

“Malignant Mesothelioma” by Dr. Alejandro Garcia-Hernandez

Oncology Unit

The oncology unit at Gadsden Regional Medical Center is located on the 7th floor and has 51

rooms available for use. The unit is staffed with a combination of oncology trained nurses and oncology

certified nurses. All experienced nurses who care for patient on the oncology unit, complete annual

competency evaluations. Chemotherapy policies are reviewed and updated regularly to reflect current

evidence based practices. Services provided on the inpatient oncology unit include, but are not limited

to: antineoplastic chemotherapy administration, blood product transfusions, brachytherapy, I131

administration and bone marrow biopsy.

Male61%

Female39%

During 2013, the Cancer Registry accessioned 511 analytic cases for the year. Analytic cases are

patients that were diagnosed and/or received part or all of first course therapy at Gadsden Regional

Medical Center and/or Cancer Center. Top five sites for 2013 are (1) Prostate (2) Lung (3) Breast (4)

Colon/Rectum and (5) Bladder. Sixty one percent of the analytic cases accessioned were male and

thirty nine percent were female (Graph 1). Over half of the analytic patients diagnosed in 2013 were

over the age of 60 (Graph 2) and the overall median age range was 60-69 years old.

2013 Statistical Summary of Registry Data

Graph 1 GRMC Sex Distribution

31

83

166

152

54

25

0

20

40

60

80

100

120

140

160

180

40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 Other

Graph 2– GRMC Age at Diagnosis Analytic 2013 Cases

Age Group

303

67 53 38 50

0

50

100

150

200

250

300

350

Etowah Calhoun De Kalb Cherokee Other

Graph 3-County at Diagnosis

White86%

Black13%

Other1%

Graph 4-Race

73

59

83

34 32

9

16 17

15

2 0 1 0 00

10

20

30

40

50

60

70

80

90

Lung Breast Prostate Gland Bladder Colon/Rectum

White Black Other

Graph 5-Race vs. Top 5 Sites

Graph 3 Shows the county in which patients

lived in at the time of diagnosis. GRMC provides

care not only to Etowah county, but the

surrounding counties as well.

Graph 4 Shows distribution of patient race

Graph 5 Shows the distribution of GRMC’s

top five sites vs. race

Table 1-2013 New Male Cancer Case Comparisons Table 2-2013 New Female Cancer Case Comparisons

Oral Cavity and Pharynx

15

Lung & Bronchus

46

Pancreas

Kidney & Renal Pelvis

3

9

Urinary Bladder 26

Colon/Rectum

Prostate

26

101

Melanoma of Skin

Leukemia

Other Sites

5

7

61

Total 200

5

Thyroid

73

38

Breast

Lung & Bronchus

4 Kidney & Renal Pelvis

2

12

11

Ovary

Uterine Corpus

Colon & Rectum

3

Lymphoma

2

3

Melanoma of Skin

Leukemia

46 Other Sites

Total 311

Tables 1 and 2 below reflects the distribution of Gadsden Regional Medical Center’s 2013 analytic cancer

cases based on gender.

2013 Statistical Summary of Registry Data continued

GRMC 2013

Primary Site

Distribution

Oral Cavity &

Pharynx Male Female

Lip 1 2

Tongue 4 0

Oropharnx 1 0

Hypopharynx 1 0

Other 8 3

Digestive System Male Female

Esophagus 6 0

Stomach 3 3

Colon Excluding Rectum

14 8

Rectum & Rectosigmoid

12 3

Liver 1 2

Pancreas 3 3

Other 4 4

43 23

Respiratory System Male Female

Larynx 6 3

Lung 46 38

Soft Tissue including Heart

Male Female

2 1

Skin- including Melanoma

Male Female

12 3

Breast Male Female

2 73

Female Genital

System Male Female

0 17

Male Genital System Male Female

Prostate 101 0

Testis 4 0

Penis 1 0

Urinary System Male Female

Bladder 26 9

Kidney/Pelvis 9 4

other 2 1

Brain & Other

Nervous System Male Female

Brain 4 4

Endocrine System Male Female

Thyroid 1 5

Other 0 1

Lymphoma Male Female

Hodgkin 1 1

Non-Hodgkin 12 3

Myeloma Male Female

6 2

Leukemia Male Female

7 3

Mesothelioma Male Female

1 0

Miscellaneous Male Female

10 4

Site Analysis-Pancreas

Each year, the cancer program analyzes a specific site. This analysis is used to assess whether

patients within the program are evaluated and treated according to evidence based national

treatment guidelines. This allows for any possible performance improvements within the facility.

National Comprehensive Cancer Network guidelines state diagnostic imaging evaluation, blood

testing and tissue sampling are all necessary for treatment planning. Diagnostic imaging consist of

either CT, MRI, PET, Endoscopic ultrasound or by laparoscopy, followed by blood tests; specifically,

CA19-9. High levels of CA19-9 can be caused by pancreatic cancer but does not confirm pancreatic

cancer.

Pancreatic can be divided into four main groups: resectable, borderline resectable, locally

advanced unresectable and metastatic.

Resectable-Cancer has not spread outside of the pancreas and appears to be easily treated

with surgery.

Borderline Resectable-Cancer that is confined to the pancreas, but the tumor approaches

nearby structures and may not be resectable with clear margins (tumor gets left behind).

Locally advanced unresectable-Cancer has spread beyond the pancreas to nearby

structures (blood vessels or other tissue)

Metastatic-Cancer has spread to other organs and tissues outside of the pancreas

There are more than one treatment available for pancreatic cancer. Most patients with pancreatic

cancer will receive more than one type of treatment.

Neo-adjuvant

Treatment given

to shrink the

tumor BEFORE

surgery.

Adjuvant

Treatment given

after primary

treatment to kill

any remaining

cancer cells.

Primary

Main treatment

given to rid the

body of cancer

First line

treatment

The first set of

treatments

given.

Second line

treatment

The next set of

treatments

given after the

first or

previous

treatments

have failed.

Not every person with pancreatic

cancer will receive every treatment listed.

Cancer treatment for pancreatic cancer can

consist of the following:

-Surgery

-Radiation therapy

-Chemotherapy

-Targeted therapy

-Clinical Trials

In 2013, six new pancreatic cancer cases were diagnosed and/or treated at

Gadsden Regional Medical Center. These six cases were analyzed following the NCCN

guidelines ensuring our patients were evaluated and treated accordingly.

Our analysis showed the following:

-All six cases received appropriate diagnostic testing 100%

-All six cases had CA19-9 blood testing performed 100%

-Five cases had tissue sample testing (biopsy) performed prior to surgery, chemotherapy

and/or radiation therapy 83%

-All six cases received appropriate 1st course treatment recommended 100%

(Chemotherapy was the primary treatment administered or recommended in all six

cases)

In 2013, GRMC treated a small number of pancreatic cancer

cases, this evaluation proves that GRMC is providing the best

comprehensive care to our patients in a community setting. Our

multi-disciplinary team are committed to the care and well being

of their patients.

** Radiation only patient-Chemo was recommended as primary treatment but patient refused, radiation

treatment to metastatic site for palliative care

Gadsden Regional Medical Center and Gadsden Regional Cancer

Center have presented and/or participated in several screening ,

prevention and education activities in Etowah County. Some of

these events include:

Community

Outreach

Look Good Feel Better sessions for female cancer patients (bi-monthly)

Relay for Life of Etowah County

National Cancer Survivor’s Day-Dinner Celebration

2nd Annual GRMC mammogram-athon during the month

of October

Free skin cancer screening by Dr. Wren

Assisted several patients with medication and trips to and from treatment

T.O.U.C.H. Today Our Understanding of Cancer is

Hope.-Monthly meeting

Attend Health Fairs and provide prevention pamphlets

to the community

2013 National Cancer Survivors Day Dinner

Celebration

Gadsden Regional Medical Center

Best in Bama

Resource Directory

Gadsden Regional Medical Center (256) 494-4000

Axillary and Volunteers (256) 494-4399

Cancer Registry (256) 494-4466 or (256) 494-4962

Pastoral Care (256) 494-4081

Health Information Management (Medical Records) (256) 494-4246

Cancer Center (Dr. Lowndes Harrison) (256) 494-4965

Hematology and Oncology Associates of Alabama-

(Drs. Castillo and Garcia-Hernandez) (256) 492-0375

Surgical Associates of Gadsden (256) 492-0020