2014 Annual Cancer Program Report SHSSR - Sutter … Chellappah, M.D. Sutter Roseville Medical Center . Mendl Kebria, M.D. ... 2014 Annual Cancer Program Report Robert Lanlisi, M.D

2014 Annual Cancer Report Sutter Cancer Centers Sacramento Sierra Region

Table of Contents

2 A Note from the Regional Medical Director

4 Cancer Committee Membership By Affiliate

8 Clinical and Patient Support Services

10 2014 Annual Report for the Comprehensive Cancer Centers of the Sutter Health Sacramento Sierra Region

20 References

2014 Annual Cancer Program Report 1

Sutter Health Sacramento Sierra Region Cancer Services

A Note from the Regional Medical Director and Regional Director Infusion Centers and Interim Executive for the Oncology Service Line

To Our Community, Colleagues and Friends,

Gregory Graves, M.D., Medical Director

Belinda Fry, Regional Director Infusion Centers and Interim Executive for the Oncology Service Line

As programs that have been approved by the American College of

Surgeons, (ACoS), we are pleased to present our 2014 Annual Report

to you our community, colleagues, and friends. This report features a

statistical overview of the data from our 2013 Mammography Screening

event held at our four accredited cancer programs: Sutter Auburn Faith

Hospital, Sutter Medical Center Sacramento, Sutter Roseville Medical

Center and Sutter Solano Cancer Center.

The Cancer Committees and Oncology Providers of Sutter Auburn Faith

Hospital, Sutter Medical Center, Sacramento, Sutter Roseville Medical

Center and Sutter Solano Medical Center, respectively, each recommend

that providers follow the American Cancer Society recommendations

for Breast Cancer Screening, which is annual screening mammography

for women age 40 and older. When screening mammography has been

completed, the results are reported to the patient. When any patient has

a result other than BI-RADS 1 (normal findings, no abnormality to report),

they are referred to the nurse navigator for support and assistance with

next steps in the diagnostic process. Included in this annual report, we

are pleased to highlight our nurse navigator program. This highlights the

important work done by the navigators each day for our patients.

2

2014 Annual Cancer Program Report

A few of our accomplishments We are proud of the continued efforts of our cancer center teams to provide comprehensive cancer care. Some of our accomplishments in 2014 include:

Sutter Medical Center, Sacramento was awarded with re-accreditation by the American College of Surgeons Commission on Cancer

Lung Nodule Clinic/Conference Expansion in Roseville

NAPBC Accreditation in Roseville Roseville Infusion Center expanded

to 41 chairs Developed a Nurse Navigator

Program in Auburn and hired Ellen Carlson as the Nurse Navigator

Solano developed a Breast Program Leadership team in preparation for NAPBC application for accreditation

Developed a virtual tour of the Solano Cancer Center for patients to access on the Solano website

Regional participation in the ACCC benchmarking study focusing on Infusion Centers

Participated in community events such as American Cancer Society Relay for Life, and the Coolest 24 Hour Mountain Bike Race

Joining the Sutter team in 2014 were Kristin Arreola, M.D. Medical Oncologist Sutter Auburn Faith Hospital

Rajeswari Chellappah, M.D. Medical Oncology Sutter Roseville Medical Center

Mendl Kebria, M.D. Gynecological Oncologist Sutter Medical Center Sacramento

Radiation Oncologists throughout the Sacramento Sierra Region:

Garrick Chang, M.D.

Sharon Dutton, M.D.

Roger Gilbert, M.D.

Brian Goldsmith, M.D.

Christopher Jones, M.D.

Susan Lee, M.D.

Mark Leibenhaut, M.D.

David Linstadt, M.D.

Mark Logsdon, M.D.

Anthony Pu, M.D.

Seth Rosenthal, M.D.

Janice Ryu, M.D.

Jeffrey Suplica, M.D.

Harvey Wolkov, M.D.

On behalf of our cancer

committees we extend our thanks

to our outstanding communities,

medical staff, employees,

administration and volunteers

for the continued support of

our cancer programs.

We hope you enjoy and learn from

our presentation of the 2014 Sutter

Health Sacramento Sierra Region

Oncology Annual Report on 2013

Mammography Screening event.

For more information,

please visit our website at

www.suttercancer.org

3

http://www.suttercancer.org


Cancer Committee Membership by Affiliate

11815 Education St. Auburn, CA 95602

(530) 888-4500

Sutter Auburn Faith Hospital (SAFH)

Barton Bradshaw, M.D. Surgeon, Chair

David Linstadt, M.D. Radiation Oncologist, Cancer Liaison Physician

Michael Antonini, M.D. Surgeon

Jeffery Jenkins, M.D. Surgeon

Mary Keohane, M.D. Pathologist, Quality Improvement Coordinator

Brian Kim, M.D. Medical Oncologist, Quality of Registry Coordinator

James McGregor, M.D. Palliative Care and Pain Management

Michael Hecimovich, M.D. Diagnostic Radiologist

Dennis Sindelar Director of Ancillary Services

Stephanie Perry, P.T. Rehabilitation Services

Lynnette Messex, R.N. Infusion Center

Sara Stratton Community Outreach Coordinator

Julie Adcock, R.D. Nutritionist

Dayna Lawrence Regional Accreditation and Quality Management Coordinator

Maryann Sacks, CTR Cancer Registry, Cancer Conference Coordinator

Linda Marks Medical Research Director, Clinical Research Coordinator

Terry Wright, LCSW Psychosocial Services Coordinator

Kathleen Zoller American Cancer Society Representative

Nita Robinson, R.N. Nursing Administration

Amy Bazzaroni Quality Improvement

Ellen Carlson, R.N., OCN Nurse Navigator

4


Sutter Medical Center, Sacramento (SMCS)

Harvey Wolkov, M.D. Radiation Oncology, Chair

Gregory Graves, M.D. Regional Medical Director

Dayna Lawrence Regional Accreditation & Quality Coordinator

Dawn Lenakakis, CTR Cancer Registry, Quality of Cancer Registry Coordinator

Ayse Turkseven, MA, CTR Cancer Registry, Quality of Cancer Registry Coordinator

Nitin Rohatgi, M.D. Medical Oncology, Cancer Conference Coordinator

Deepti Behl, M.D. Medical Oncology, Cancer Liaison Physician

Carolyn Cotta Palliative Care

Stacy D Andrea, M.D. Gynecological Oncology

Abbie Gonik, M.D. Gynecological Surgery, Quality Improvement Coordinator

Lisa Guirguis, M.D. Surgery, Quality Improvement Coordinator

Zair Karanjawala M.D. Pathology

Dylan Witt, M.D. Diagnostic Radiology

Jonathan Eandi, M.D. Urology

Yung Yim, M.D. Pediatric Oncology

Abbie Steinaway, R.N. Oncology/BMT Nursing Director

Maude Blundell, MS, CGC Genetic Counselor

Linda Marks Medical Research Director, Clinical Research Coordinator

Sharyl Kooyer Hospice Manager

Erin Knight, LCSW Psychosocial Services Coordinator

Aurelia (Rhea) Berry, R.N. Case Management

Barbara Schikore, R.N. Regional Infusion Manager

Linda Lambert, R.N. BMT Program Manager

Mary Pare, R.N., CBCN Breast Cancer Navigator

Lisa Chai, DO Hospitalist, Palliative Care Medical Director, SMCS

Colleen Root American Cancer Society

Patricia Corona Cancer Center Program Manager

2800 L St. Sacramento, CA 95816 (916) 454-6500

5


Cancer Committee Membership by Affiliate

One Medical Plaza Roseville, CA 95661

(916) 781-1617

Sutter Roseville Medical Center (SRMC)

Uma Gowda, M.D. Medical Oncology, Cancer Committee Chair

Yona Barash, M.D. Surgery, Cancer Liaison Physician

Kristie Bobolis, M.D. Medical Oncology and Breast Program Leadership Chair

Seth Rosenthal, M.D. Radiation Oncology

Fred Weiland, M.D. Nuclear Medicine

Hannah Wong, M.D. Pathology

Barbara White, M.D. Diagnostic Radiology

Elizabeth Kim, M.D. Surgical Oncology

Sivakumar Reddy, M.D. Medical Oncology

Rajeswari Chellappah, M.D. Medical Oncology

Christopher Jones, M.D. Radiation Oncology

Penny Vandestreek, D.O. Nuclear Medicine

Ron Rowberry, M.D. Pathology

Charles McDonnell, M.D. Diagnostic Radiology

Stephen Maxwell, M.D. Surgical Oncology

Kirsten Babski B.S., CCRP Clinical Research Coordinator

Amy Beazizo, R.N., M.S., OCN, CBPN-IC Clinical Manager, Comprehensive Cancer Clinic and Vascular Access Team, Community Outreach Coordinator

Jessica Brest Cancer Services Supervisor & Patient Satisfaction Program Administrator

Susan Cresswell, MHA, CPHQ, CHEM Quality Management Director

Deborah Dix M.S., R.N. Cancer Services Director, Quality Improvement Coordinator

C.J. Doran, LCSW Social Worker, Psychosocial Services Coordinator

Jennifer Holman, R.N. Clinical Manager, Oncology

Olivia Gaffney Palliative Care

Rosangel Klein Infusion Center

Kimberly VanYsseldyk, M.N., FNP-C Cancer Genetics Nurse Practitioner

Michelle Troja, CTR Cancer Registry, Quality of Cancer Registry Coordinator

Laura Tobin Clinical Nurse Specialist

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Sutter Solano Medical Center (SSMC)

Robert Lanflisi, M.D. Surgeon, Chair, Cancer Liaison Physician, Community Outreach Coordinator

Patricia Seid, M.D. Radiation Oncologist, Medical Director, Cancer Liaison Physician, Cancer Conference Coordinator

Kim Etcheberry, R.N., BSN, OCN Cancer Program Administrator, Quality Improvement Coordinator

Walailuk Chaiyarat, M.D. Medical Oncologist

Gurpreet Dhugga, M.D. Palliative Care

James Krasno, M.D. Pathologist

Yelena Krijanovski, M.D. Medical Oncologist

Beverly McLeod, M.D. Medical Oncologist, Cancer Registry Quality Coordinator

Jessica Contreras Quality Management

Marissa Salvatin, RHIT, CTR Cancer Registry, Cancer Registry Quality Coordinator

Richard Siefke, MSW Psychosocial Services Coordinator

Karen Stilwell, R.N., MSN, AOCN Oncology Nurse Navigator, Oncology Nurse

Eric Tao, M.D. Diagnostic Radiologist

Petrick Green-Miller, R.N. Nursing

Maude Blundell, MS, CGC Genetic Counselor

Lalaine Durand, CCRP Clinical Research Coordinator

100 Hospital Drive Vallejo, CA 94589 (707) 554-4444

7


These tables display the broad range of services available at the Sutter Health Sacramento Sierra Region (SHSSR) American College of Surgeons (ACoS) Cancer Programs. Although these tables are reflective of actual physical location of the service, all single site resources are available for referrals for patients within our region.

8

Outpatient Services SAFH SMCS SRMC SSMC

Valet Parking

Comprehensive Breast Center

Cancer Treatment Center

Chemotherapy Treatment

Home Care & Hospice

Nutrition Services

Palliative Care

Pain Management

Dance Movement

Music Therapy

Pet Therapy

Clinical and Patient Support Services

Services SAFH SMCS SRMC SSMC

ACoS Accredited Cancer Center

Blood and Marrow Transplants

Brachytherapy

Cancer Surgery

Cancer Clinical Trials &

Prevention Trials

Cancer Education Programs

Cancer Support Groups

Community Screenings

for Cancer

Indoor Pool for Patient/

Rehabilitation

Core Needle Biopsy Ultrasound

Core Needle Biopsy

Stereotactic

Stereotactic Radiosurgery &

Radiotherapy on Site

Ablation Surgery

Gamma Knife on Site

Genetic Counseling

Infusion Therapy

Interventional Radiology

Mammography

Minimally Invasive Surgery

Nurse Navigator

Oncology Social Worker

Pediatric Cancer and Surgery

PET Positron Emission

Tomography on Site

Image-Guided Prostate Radiation

Therapy

Radiation Oncology Service

Thermo Ablation on Site

IMRT

SPECT

Tumor Board

Tumor Registry (In-House)


Cancer services in the Sutter Health Sacramento Sierra Region are provided in eight counties. These services are provided at hospitals, infusion centers, radiation oncology centers and physicians offices as shown on the regional map.

Sonoma Napa

Yolo

Sutter

Yuba

Nevada

Placer

El Dorado

Amador Sacramento

San Joaquin

Contra Costa

Marin

Solano H

I

I

I

I R

R

R

R

H

H

H

H

H

Yuba City Hospital

Physician

I R

Infusion

RadOnc

Roseville

Auburn

Jackson

Folsom

Orangevale

Sacramento

Elk Grove

Davis

Napa

Brentwood

Concord

Vallejo

Fairfield

IH

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2014 Annual Report for the Comprehensive Cancer Centers of the Sutter Health Sacramento Sierra Region

The Sutter Health Sacramento Sierra Region (SHSSR)

is home to four Comprehensive Cancer Centers

accredited by the American College of Surgeons,

Commission on Cancer. These centers include

Sutter Auburn Faith Hospital, Sutter Medical Center,

Sacramento, Sutter Roseville Medical Center and Sutter

Solano Medical Center. By following American College

of Surgeons Accredited Cancer Center standards, we

provide the patients we serve with high quality cancer

care. These facilities offer the full continuum of cancer

care, from prevention through hospice and end of life

care, in addition to survivorship services. (Surgeons,

2014). The American College of Surgeons, Commission

on Cancer Accreditation is only granted to those

facilities that have voluntarily committed to provide the

best in cancer diagnosis and treatment and are able to

comply with the set standards.

Program Standard 4.1, Prevention Programs, directs

those overseeing cancer care delivery in the ACoS

Centers, to provide prevention programs targeted

to meet the needs of the community and should

be designed to reduce the incidence of a specific

cancer type. The prevention program is consistent

with evidence based national guidelines for cancer

prevention. (Cancer Program Standards, 2012).

In 2013, the SHSSR completed its second annual

Mammography Screening event, offering free

mammography exams to uninsured individuals in

our community. Identifying access to preventative

care as one of the challenges for women in our

community is in alignment with our 2013 Community

Needs Assessment. The 2014 Annual Cancer

Report features the outcomes of this 2013 event.

Sutter Health Sacramento Sierra Region Cancer Services 10


One of the most common and well known procedures in the toolbox of cancer prevention is the screening mammogram. A screening mammogram is recommended annually as part of a comprehensive wellness program for many women. A screening mammogram is performed to detect abnormalities in the breast. These may include benign or high risk lesions, some of which can require surgical intervention. Acting upon these high risk lesions can help prevent a breast cancer from developing. The screening mammogram may find breast cancers early when treatment options are more effective in managing the disease. Each year, in the United States, approximately forty-eight million mammograms are performed. In 2013, of the forty-eight million mammograms performed, 232,340 women were diagnosed with an invasive breast cancer and 64,640 were diagnosed with Ductal Cancer In Situ (DCIS), a form of cancer limited to the milk ducts of the breast (The American Cancer Society, 2013). Early detection of breast cancer may lead to additional treatment options and better long term management of the disease

Mammography breast cancer screening has been available to women in the U.S. since the 1950s. In 1987, approximately 29% of women forty years and older in the U.S. underwent mammography screening. By 2000, 70% of U.S. women 40 and older participated in annual screening mammography. In 2010, data showed sixty-seven percent of women over age 40 continued to receive annual screening mammograms (The American Cancer Society, 2013).

Since 1991, the rate of death from breast cancer has decreased 34%. This decrease is attributable to increased numbers of women being screened, improved screening techniques and the addition of other diagnostic and treatment options for the management of breast cancer (The American Cancer Society, 2013).

Access to health care and insurance are big drivers in the ability of women to receive a screening mammogram. While 71% of women with health insurance receive a mammogram annually, only 32% of women without insurance do the same. A recently completed Triennial Community Needs Assessment, completed by Sutter Health, identified access to preventative care as a major challenge for key constituents in our health care community. The leadership of the four ACoS accredited Cancer Center Hospitals, in conjunction with the Sutter Medical Foundation and Diagnostic Imaging Services, have each identified Access to Preventative Care as a key component of their community service outreach goals.

Sutter Health is committed to providing state of the art comprehensive screening and diagnostic equipment to facilitate

the screening and diagnosis of Breast Cancer in our communities. The Comprehensive Cancer Centers and their Womens Imaging Center partners, offer both digital 2D screening mammography and digital 3D breast tomosynthesis. Digital Breast Tomosynthesis or 3D mammography is a revolutionary new tool designed for early detection of breast cancer. Tomosynthesis captures 3D high-resolution images of the breast using low-dose x-rays similar to the radiation dose of standard digital mammograms. Our Womens Imaging Centers also offer a full range of Breast diagnostic procedures, including diagnostic mammography, ultrasound, ultrasound guided biopsy, stereotactic biopsy and MRI of the breast and MRI guided breast biopsy.

The Cancer Committees and Oncology Providers of Sutter Auburn Faith Hospital, Sutter Medical Center, Sacramento, Sutter Roseville Medical Center and Sutter Solano Medical Center, respectively, each recommend that providers follow the American Cancer Society recommendations for Breast Cancer Screening, which is annual screening mammography for women age 40 and older (The American Cancer Society, 2013).

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TABLE 1 BI-RADS Categories

CATEGORY RESULTS DESCRIPTION

0 Additional imaging evaluation This category means that the exam is incomplete. Additional information and/or comparison to prior is needed in order to make a definitive diagnosis. Additional tests may be mammograms is needed required including spot compression images, magnified views, special

mammogram views and/or breast ultrasound.

This category can also imply that the current mammogram should be compared with the older ones to see if there have been changes.

1 Negative Nothing abnormal to report.

2 Benign (non-cancerous) finding This is also a negative category, meaning no abnormalities to report. However the radiologist did identify a benign finding. This may include: benign calcifications, lymph nodes in the breast, or fibroadenomas.

3 Probably benign finding An abnormality has been identified in the breast, however it has a very Follow-up in a short time high chance of being benign (not cancer). The findings are not expected to frame is suggested change over time. But since it is not proved benign (as with a biopsy), its

helpful to see if the area in question changes in a short time interval.

Follow-up with repeat imaging is usually recommended in 6 months.

4 Suspicious abnormality An abnormality is identified in the breast. This finding may be cancer. Biopsy should be considered The radiologist is concerned enough to recommend a biopsy.

The findings in this category can have a wide range of suspicious levels. These include: 4A: finding with a low suspicion of being cancer 4B: finding with an intermediate suspicion of being cancer 4C: finding of moderate concern of being cancer, but not as high as Category 5

5 Highly suggestive of malignancy The abnormality is highly suspicious, up to 95 percent chance of being cancer Appropriate action should be taken Invalid source specified.

Biopsy is very strongly recommended by the radiologist

6 Known-biopsy proved This category is used for findings on a mammogram that have already been malignancy Appropriate identified as a cancer by a previous biopsy. action should be taken

What Is Screening Mammography? Screening mammography is a preventative procedure, part of a comprehensive wellness program for women. The breast is compressed and flattened for a few seconds and a digital image is taken of the breast tissue. This procedure involves firm pressure to the breasts. Some women do report that this is uncomfortable for a few seconds but it is necessary to produce a good-quality mammogram image.

Mammography Reporting Standards The Mammography Quality Standards Act (MQSA) require physicians performing and interpreting mammography to inform women of their mammography results. This law states that women are to receive a separate, easy-to-understand summary of their mammogram results within 30 days or as quickly as possible if the results suggest cancer is present (Radiology, 2013).

Understanding Your Mammography Report BI-RADS Categories The American College of Radiology (ACR) created a standard way to report mammographic findings and results. The system is called the Breast Imaging Reporting and Data System (BI-RADS). In this system, results are sorted into categories and numbered 0 through 6.

Table 1 provides a brief description of the BI-RADS reporting system.

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TABLE 2 Breast Density Reporting System

CATEGORY RESULTS DESCRIPTION

1 The breasts are The breast contains little fibrous and almost entirely fatty glandular tissue. The breast is more

comprised of fatty tissue.

2 There are scattered There are some areas of fibrous and areas of fibroglandular glandular tissue in the breast. density

3 The breasts are The breast has more areas of fibrous and heterogeneously glandular tissue than fatty tissue. This denser dense, which may tissue can make it difficult to identify small obscure small masses masses or abnormalities in the breast.

4 The breasts are The breast has a large amount of fibrous and extremely dense, glandular tissue. This can make it very difficult which lowers to identify abnormalities in the breast. It can the sensitivity of look like a white cloud on mammography. mammography

Understanding Your Mammography Report Breast Density A mammogram report also include a description of the density of the breast. Breast density refers to the amount of fat and tissue in the breast as seen on a mammogram. A dense breast has more than 50 percent fibroglandular tissue relative to fat.

In April 2013, California passed Senate Bill No. 1538. This bill states that a health facility at which a mammography exam is performed shall, if a patient is categorized by the facility as having heterogeneously dense breasts or extremely dense breasts, include in the summary of the written report the following notice (1538, 2012):

Your mammogram shows that your breast tissue is dense. Dense breast tissue is common and is not abnormal. However, dense breast tissue can make it harder to evaluate the results of your mammogram and may also be associated with an increased risk of breast cancer.

This information about the results of your mammogram is given to you to raise your awareness and to inform your conversations with your doctor. Together, you can decide which screening options are right for you. Table 2 provides a brief description of the Breast Density reporting system.

When a screening mammogram has been completed and the results have been reported, patients who have received any results other than BI-RADS 1 (normal findings, no abnormality to report), should review the results with their physician. These patients may be referred by their physician to a nurse navigator for support and assistance with next steps in the diagnostic process.

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Karen Stilwell MSN, R.N., AOCNS

The Breast Nurse Navigator Role

The Sutter Health Sacramento Sierra Region four nationally accredited cancer centers each have a Cancer Nurse Navigator program. The programs were developed from a growing need in our communities. The shared purpose is to remove barriers and provide quality cancer care to patients across the region. The Cancer Nurse Navigator Program is a support program available to all patients, women and men, who have received a diagnosis of breast cancer. The Cancer Nurse Navigator Program is a community resource that is available to all members of the community who are seeking information on breast health and breast cancer related matters.

Few diseases carry the physical or emotional impact that accompanies a diagnosis of cancer. This programs primary purpose is to meet the needs of women and men facing the uncertainty and complexity of diagnosis, treatment and recovery from breast cancer. As the initial shock

of receiving a breast cancer diagnosis abates, the need for information about breast cancer and how to proceed becomes paramount. The program provides women and men the support of a registered nurse navigator experienced in cancer patient care. This navigator is knowledgeable in community resources, and skilled in addressing the concerns of individuals challenged with adjusting to the diagnosis of breast cancer and the treatment plan.

Navigation occurs throughout the continuum of care, with touch points at critical times during the course of cancer treatment. The Cancer Nurse Navigator meets with each patient newly diagnosed with breast cancer. This is a time of high anxiety and a need for information. At this meeting the navigator provides education regarding breast cancer and reviews the treatment plan of care. The navigator provides an opportunity for the patient to share any concerns regarding breast cancer and to begin

to explore how the diagnosis and planned treatment may impact his or her life. Family caregivers and financial concerns are explored and resources are provided when needed as well.

Each patient is given an educational binder, My Personal Journey, A Womans Guide to Breast Care Services, often referred to as the breast cancer binder. The binder, provided free of charge, courtesy of our respective philanthropic foundations, contains information on medical management, surgery, reconstructive surgery, chemotherapy, hormonal therapy and radiation therapy as well as clinical trials. Additional information is given about local community support programs and services. The Healthy Living section provides information on how to live a healthier life after treatment and survivorship information. Healthcare Finances includes information on health insurance, government programs, state disability, legal resources and information on other assistance

14

Mary Pare R.N., CBCN


Ellen Carlson R.N., OCN Amy Beazizo MS, R.N., OCN, CBPN-IC

programs.The Cancer Nurse navigator introduces the contents and goes over sections most relevant to the patient. The navigator is responsible for the development, compilation, distribution and revision of the breast cancer binder. The 3rd

edition of My Personal Journey was developed, published and distributed beginning in 2014.

The navigator may meet with the patient on the day of surgery. Concerns regarding surgery and recovery are reviewed with the patients and instructions for care at home are reviewed. Navigators provide each patient with postoperative supplies, drain care supplies, postmastectomy camisoles, Necessities Bag and small pillows to provide comfort as the patient recovers. The navigator maintains contact with each patient as needed. This can include psychosocial support through their chemotherapy and radiation treatment.

The Cancer Nurse Navigator role has become more specialized over the

last few years. They are now a key part of the multi-disciplinary cancer care team. The navigator can assist in the referral process to the multiple specialists that are involved in the care of the patient. The navigator helps guide the patient through this complicated maze of providers and ease the transition from one treatment to the next. This allows for an ongoing relationship with the patient.

Ongoing community outreach and education is another key responsibility of the Cancer Nurse Navigator. This may include self-breast examination instruction and breast cancer awareness discussions at local health fairs, high schools or church groups.

An important goal of the Cancer Nurse Navigator Program is to reduce delays in accessing care. Each of the four accredited Cancer Centers participates in the American College of Surgeons (ACoS) Rapid Quality Reporting System. Data regarding breast cancer treatment is submitted continuously to the ACoS through

the cancer registry. On a monthly basis the ACoS provides the Cancer Centers with information regarding the completeness and timeliness of medical treatment. The data is reviewed regularly with the Cancer Committees in an effort to improve the quality of care provided.

The Cancer Nurse Navigator serves as a guide and partner for the patient throughout their treatment journey. The goal is to lessen the fear of the unknown and be a source of hope and information in an otherwise unpredictable world of cancer care.

The Cancer Nurse Navigators in the Sacramento Sierra Region include:

Ellen Carlson R.N., OCN Sutter Auburn Faith Hospital

Mary Pare R.N., CBCN Sutter Medical Center, Sacramento

Amy Beazizo MS, R.N., OCN, CBPN-IC Sutter Roseville Medical Center

Karen Stilwell MSN, R.N., AOCNS Sutter Solano Medical Center

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2013 Free Mammography Screening Cancer Prevention Program: Focal Study of Outcomes Sutter Health Sacramento Sierra Region (SHSSR) held its second annual Free Mammography Screening in October, 2013. The Prevention Program was held at the Sutter Womens Imaging Centers, in coordination with the SHSSR Comprehensive Cancer Centers, Sutter Medical Foundation and Sutter Medical Group Radiology. All participants were female and all participants were uninsured. The Imaging Centers saw a total 384 patients for free screening, 258 of which were screened at our four ACoS Comprehensive Cancer Centers. The remaining 126 patients were seen at the following Sutter Health facilities in Amador (29), Elk Grove (50) and Davis (47). This report will focus exclusively on the results from Sutter Auburn Faith Hospital (SAFH), Sutter Medical Center, Sacramento, (SMCS), Sutter Roseville Medical Center (SRMC) and Sutter Solano Medical Center (SSMC), the four ACoS accredited Cancer Centers in the SacSierra Region of Sutter Heath.

The American Cancer Society recommends annual mammography screening beginning at age 40 for women with normal risk factors. The women screened at this event demonstrated an age distribution from 36 to 78. The average age of patients seen was 53 years. The median age was 52.

Twenty-six patients were screened at SAFH, 74 patients at SMCS, 106 from SRMC and 52 from SSMC. Sixty-seven percent of all screenings done in the 2013 event were completed at an ACoS Center.

100

120

80

60

40

20

0 SAFH SMCS SRMC SSMC

GRAPH 1

Patients Seen for Prevention Screening Free Mammography 2013 SHSSR ACoS Centers

26

74

106

52

50

40

30

20

10

0 /= 70

GRAPH 2

Age Distribution of Patients Receiving Screening Mammography Patients seen for mammography screening by age range by facility.

16


Clinical Outcomes of Screenings All patients seen for mammography screening at this prevention event had their mammograms interpreted by Board Certified Radiologists who have met federal MQSA requirements to read screening mammograms. Results were reported using the BIRADS (Breast Imaging Reporting and Data System). Below are the outcomes of the screening mammography by site and by BI-RADS category.

Of the 258 patients screened, patients were initially categorized as BI-RADS 0, 1 or 2. BI-RADS 1 category is interpreted as negative. Ninety-eight patients screened had BI-RADS 1 outcomes. This was 38 percent of the total women screened.

BI-RADS 2 is a normal finding, but includes benign, non-cancerous findings. One hundred-eighteen patients were interpreted to be BI-RADS 2 on initial screening. This was 46 percent of the total women screened.

Forty-two patients were reported as BI-RADS 0. BI-RADS 0 patients, those requiring additional imaging evaluation and/or comparison to prior mammograms, were identified and managed per guidelines. This was 16 percent of the total women screened. These results are summarized below in Graph 3.

GRAPH 3

Total Patients Screened

100

80

60

40

20

0 SAFH SMCS SRMC SSMC TOTAL

BI-RADS 1 Negative

50

40

30

20

10


BI-RADS 0 Additional imaging evaluation and/or comparison to prior

150

100

50


BI-RADS 2 Benign (non-cancerous) finding

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Resolution of BI-RADS 0 Screening Mammograms

The Breast Imaging Reporting and Data System (BI-RADS) category BIRADS 0 indicates additional imaging evaluation and/or comparison to prior mammograms is needed. The category means that the exam is incomplete. Additional information is needed in order to make a definitive diagnosis. Additional tests may be required including spot compression images, magnified views, special mammogram views and/or breast ultrasound. This category can also imply that the current mammogram should be compared with the previous mammograms to see if there have been changes. Of the 258 patients screened during the 2013 Sutter Health Sacramento Sierra Region Free Screening Mammography event, 42 patients resulted as BIRADS 0. Those patients all received outreach from the screening facilities to pursue additional imaging and evaluation per the guidelines. Further evaluation routinely consists of one of three interventions. Using diagnostic mammography and/or ultrasound or using prior films, patients were converted from BI-RADS 0 to either BI-RADS 2, 3, 4, or 5.

Patients who responded to call backs from the Imaging Centers included ten (24%) patients that were converted to BI-RADS 2. BI-RADS 2 indicates benign (non-cancerous) findings that require no further work-up. This may include: benign calcifications or lymph nodes.

Five patients (12%) were converted to BI-RADS 3 category. BI-RADS 3 indicates a probably benign finding. Follow-up in a short time frame is suggested. An abnormality has been identified in the breast, however it has a very high chance of being benign (not cancer). The findings are

not expected to change over time. But since it is not proved benign (as with a biopsy), its helpful to see if the finding in question changes in a short time interval. A follow-up with repeat imaging is usually recommended in six months.

Five patients (12%) were in BI-RADS 4 category. BI-RADS 4 indicates a suspicious abnormality for which cancer cannot be excluded. The radiologist recommends biopsy in this setting.

One patient (2%) was determined through additional evaluation and testing to be BI-RADS 5. BI-RADS 5 category patients have findings highly suggestive of malignancy. Appropriate action should be taken. The abnormality is highly suspicious, up to 95 percent chance of being cancer. Biopsy is very strongly recommended by the Radiologist.

Six of the 42 patients (14%) pursued care at another facility following the Free Screening Mammography Event. Patients were guided at the event toward insurance opportunities and the six women who received care elsewhere were able to obtain insurance for those alternate facilities.

Fifteen patients (36%) were called multiple times and did not return any phone calls or letter outreach for follow-up care. While this is unfortunate, it was not unexpected that some of the clients would not respond to further diagnostic procedures for which they were unfamiliar or not part of an organized health care provider team. There were no patients that were unable to receive care following mammography findings based on insurance status. Two of the fifteen had relocated to another state and country (Nevada and Peru), at the time of requests for follow up images

were made to them. To the right is the summary of the BI-RADS Follow up. (Table 3)

In summary, twenty-one of forty-two patients (50%) who were BIRADS 0 responded to call backs and were treated at a Sutter Cancer Center. These patients received a combination of diagnostic mammography, ultrasound and/ or prior film comparisons. Eleven of the 21 patients (52%) received Diagnostic mammography, ten patients (48%) received ultrasound and two patients (10%) received a comparison from prior films. The patients who had prior film comparisons were converted to BIRADS 3. The remaining 19 patients were distributed over BI-RADS 2, 3, 4 and 5. This is reviewed in Table 4.

At the completion of the 2013 Free Mammography Screening Event, five of the original 42 BI-RADS 0 patients (12%) were BI-RADS 4 and one patient (2%) was BI-RADS 5. SAFH had two patients with category BI-RADS 4. Both patients underwent stereotactic biopsy and wire localization with subsequent excisional biopsy. SRMC also had two patients with BI-RADS 4, who underwent the same treatment plan; stereotactic biopsy with subsequent wire localization and excisional biopsy. SMCS had a single BI-RADS 4 patient who underwent ultrasound and ductogram. SSMC did not have any patients with category BI-RADS 4.

A single patient in the entire screening, one of forty-two (2%) was BI-RADS 5 after diagnostic mammography and ultrasound. This patient underwent stereotactic biopsy, and wire localization with excisional biopsy. Table 5 reviews the interventions and outcomes of all BI-RADS 4 & 5 patients.



TABLE 3 BI-RADS 0 Follow-Up

Total Received Multiple Outreach Conversion from 0 to: Patients with Care at Calls with NO

BI-RADS 0 Another response from FACILITY at Screening BI-RAD 0 BI-RAD 2 BI-RAD 3 BI-RAD 4 BI-RAD 5 Facility patient screened

SAFH 7 0 3 1 2 0 1 0

SMCS 15 0 5 1 1 1 0 7

SRMC 15 0 2 2 2 0 5 4

SSMC 5 0 0 1 0 0 0 4

SHSSR 42 0 10 5 5 1 6 15

TABLE 4 Diagnostic Interventions for BI-RADS 0 Patients

FACILITY

Total Patients with BI-RADS 0 at Screening who responded

to call backs and were

treated at a Sutter facility

Patients with initial BI-RADS 0 who received

diagnostic Mammography

(#)


diagnostic Mammography

(%)


Ultrasound

(#)


Ultrasound

(%)

Prior Films Comparison

(#)

Prior Films Comparison

(%)

SAFH 6 5 83% 2 33% 1 16%

SMCS 8 2 25% 6 75% 0 0%

SRMC 6 4 67% 2 33% 0 0%

SSMC 1 0 0% 0 0% 1 100%

SHSSR 21 11 52% 10 48% 2 10%

TABLE 5 Follow-Up Care of BI-RADS 4 & 5 Patients

FACILITY BI-RADS 4 BI-RADS 5 Cancers Found

SAFH 1. Patient underwent stereotactic biopsy & wire localization with excisional biopsy

Zero patients with BI-RADS 5 No Cancers Found

2. Patient underwent stereotactic biopsy & wire localization with excisional biopsy

SMCS 1. Patient underwent ultrasound and ductogram 1. Patient underwent stereotactic biopsy & wire localization with excisional biopsy

No Cancers Found

SRMC 1. Patient underwent stereotactic biopsy & wire localization with excisional biopsy

Zero patients with BI-RADS 5 No Cancers Found

2. Patient underwent stereotactic biopsy & wire localization with excisional biopsy

SSMC Zero patients with BI-RADS 4 Zero patients with BI-RADS 5 No Cancers Found

19

Summary

Two hundred fifty-eight women received screening at one of our four American College of Surgeon Cancer Centers during the 2013 Annual Free Mammography Screening. One hundred percent of the patients seen during the 2013 Free Mammography Screening, who responded to requests by Sutter Health to return for additional imaging, received care that was evidenced based and established guidelines were followed. Forty two required further intervention. Twenty-one chose to receive care. Five women required surgery.

No patients were identified to have cancer, but abnormalities identified were addressed and women received state of the art care. This event is in keeping with one goal from our community needs assessment to increase access to preventative care.

The Cancer Centers of the Sutter Health Sacramento Sierra Region continue to provide care in our communities as part of our mission statement: We enhance the health and well-being of people in the communities we serve, through a not-for-profit commitment to compassion and excellence in health care services.

Works Cited 1538, C. S. (2012, September 22). California Legislative Informaton. Retrieved 12 8, 2014, from Bill Text SB 1538 Health Care: mammograms: http://leginfo.legislature.ca.gov

Institute, N. C. (2014, 03 25). Mammograms Fact Sheet. Retrieved 12 16, 2014, from www.cancer.gov/cancertopics/factsheet/detection/ mammograms

Radiology, A. C. (2013). Americal College of Radiology. BI-RADS ATLAS Mammography Reporting System. Retrieved 12 8, 2014, from www.acr.org.

Surgeons, A. C. (2014, 01 21). Cancer Program Standards 2012. Retrieved 12 16, 2014, from American College of Surgeons Quality Programs Commission on Cancer: www.facs.org

The American Cancer Society, I. (2013, 6). Mammography Statistics. Retrieved 12 9, 2014, from American Cancer Society Infographics: www.cancer.org/research/inforgraphicgallery/mammography-statistics


www.cancer.org/research/inforgraphicgallery/mammography-statisticshttp:www.facs.orghttp:www.acr.orgwww.cancer.gov/cancertopics/factsheet/detectionhttp:http://leginfo.legislature.ca.gov

suttercancer.org

926714 4/14

http:suttercancer.org

2014 Annual Cancer ReportTable of ContentsA Note from the DirectorsStructureTable of Contents 2 2 2 A Note from the Regional Medical Directo

4 4 Cancer Committee Membership By Affiliate

8 8 Clinical and Patient Support Services

10 10 2014 Annual Report for the Comprehensive

TRof the Sutter Health Sacramento Sierra R

20 20 References

2014 Annual Cancer Program Report A Note from the Regional Medical DirectoTo Our Community, Colleagues and FriendsTo Our Community, Colleagues and FriendsSectFigureGregory Graves, M.D., Medical Director Gregory Graves, M.D., Medical Director

FigureBelinda Fry, Regional Director InfusioBelinda Fry, Regional Director Infusio

As programs that have been approved by tThe Cancer Committees and Oncology ProviA few of our accomplishments A few of our accomplishments A few of our accomplishments We are proud of the continued efforts of Sutter Medical Center, Sacramento was aw

Lung Nodule Clinic/Conference Expansion

NAPBC Accreditation in Roseville

Roseville Infusion Center expanded to 41

Developed a Nurse Navigator Program in A

Solano developed a Breast Program Leader

Developed a virtual tour of the Solano C

Regional participation in the ACCC bench

Participated in community events such as

Joining the Sutter team in 2014 were Joining the Sutter team in 2014 were Kristin Arreola, M.D. Kristin Arreola, M.D. Medical Oncologist Sutter Auburn Faith H

Rajeswari Chellappah, M.D. Rajeswari Chellappah, M.D. Medical Oncology Sutter Roseville Medica

Mendl Kebria, M.D. Mendl Kebria, M.D. Gynecological Oncologist Sutter Medical Radiation Oncologists throughout the SaGarrick Chang, M.D.. .Sharon Dutton, M.DOn behalf of our cancer committees we exWe hope you enjoy and learn from our preFor more information, please visit our www.suttercancer.org

Cancer Committee Membership by AffiliateFigure11815 Education St. Auburn, CA 95602 11815 Education St. Auburn, CA 95602 (530) 888-4500

Sutter Auburn Faith Hospital (SAFH). Sutter Auburn Faith Hospital (SAFH). Barton Bradshaw, M.D. Surgeon, Chair David Linstadt, M.D. Radiation Oncologist, Cancer Liaison PhyMichael Antonini, M.D. Surgeon Jeffery Jenkins, M.D. Surgeon Mary Keohane, M.D. Pathologist, Quality Improvement CoordinBrian Kim, M.D. Medical Oncologist, Quality of RegistryJames McGregor, M.D. Palliative Care and Pain Management Michael Hecimovich, M.D. Diagnostic Radiologist Dennis Sindelar Director of Ancillary Services Stephanie Perry, P.T. Rehabilitation Services Lynnette Messex, R.N. Infusion Center Sara Stratton Community Outreach Coordinator Julie Adcock, R.D. Nutritionist Dayna Lawrence Regional Accreditation and Quality ManaMaryann Sacks, CTR Cancer Registry, Cancer Conference CoordLinda Marks Medical Research Director, Clinical ResTerry Wright, LCSW Psychosocial Services Coordinator Kathleen Zoller American Cancer Society Representative Nita Robinson, R.N. Nursing Administration Amy Bazzaroni Quality Improvement Ellen Carlson, R.N., OCN Nurse Navigator

Sutter Medical Center, Sacramento (SMCS)Sutter Medical Center, Sacramento (SMCS)Harvey Wolkov, M.D. Harvey Wolkov, M.D. Radiation Oncology, Chair Gregory Graves, M.D. Regional Medical Director Dayna Lawrence Regional Accreditation & Quality CoordinDawn Lenakakis, CTR Cancer Registry, Quality of Cancer RegisAyse Turkseven, MA, CTR Cancer Registry, Quality of Cancer RegisNitin Rohatgi, M.D. Medical Oncology, Cancer Conference CoorDeepti Behl, M.D. Medical Oncology, Cancer Liaison PhysiciCarolyn Cotta Palliative Care Stacy D Andrea, M.D. Gynecological Oncology Abbie Gonik, M.D. Gynecological Surgery, Quality ImprovemeLisa Guirguis, M.D. Surgery, Quality Improvement CoordinatorZair Karanjawala M.D. Pathology Dylan Witt, M.D. Diagnostic Radiology

Jonathan Eandi, M.D. Urology Yung Yim, M.D. Pediatric Oncology Abbie Steinaway, R.N. Oncology/BMT Nursing Director Maude Blundell, MS, CGC Genetic Counselor Linda Marks Medical Research Director, Clinical ReseSharyl Kooyer Hospice Manager Erin Knight, LCSW Psychosocial Services Coordinator Aurelia (Rhea) Berry, R.N. Case Management Barbara Schikore, R.N. Regional Infusion Manager Linda Lambert, R.N. BMT Program Manager Mary Pare, R.N., CBCN Breast Cancer Navigator Lisa Chai, DO Hospitalist, Palliative Care Medical DirColleen Root American Cancer Society Patricia Corona Cancer Center Program Manager Figure2800 L St. Sacramento, CA 95816 2800 L St. Sacramento, CA 95816 (916) 454-6500

Cancer Committee Membership by AffiliateFigureOne Medical Plaza . Roseville, CA 95661.One Medical Plaza . Roseville, CA 95661.(916) 781-1617

Sutter Roseville Medical Center (SRMC).Sutter Roseville Medical Center (SRMC).Uma Gowda, M.D. Medical Oncology, Cancer Committee ChairYona Barash, M.D. Surgery, Cancer Liaison Physician Kristie Bobolis, M.D. Medical Oncology and Breast Program LeadSeth Rosenthal, M.D. Radiation Oncology Fred Weiland, M.D. Nuclear Medicine Hannah Wong, M.D. Pathology Barbara White, M.D. Diagnostic Radiology Elizabeth Kim, M.D. Surgical Oncology Sivakumar Reddy, M.D. Medical Oncology Rajeswari Chellappah, M.D. Medical Oncology Christopher Jones, M.D. Radiation Oncology Penny Vandestreek, D.O. Nuclear Medicine Ron Rowberry, M.D. Pathology Charles McDonnell, M.D. Diagnostic Radiology Stephen Maxwell, M.D. Surgical Oncology Kirsten Babski B.S., CCRP Clinical Research Coordinator Amy Beazizo, R.N., M.S., OCN, CBPN-IC Clinical Manager, Comprehensive Cancer CJessica Brest Cancer Services Supervisor & Patient SatSusan Cresswell, MHA, CPHQ, CHEM Quality Management Director Deborah Dix M.S., R.N. Cancer Services Director, Quality ImprovC.J. Doran, LCSW Social Worker, Psychosocial Services CooJennifer Holman, R.N. Clinical Manager, Oncology Olivia Gaffney Palliative Care Rosangel Klein Infusion Center Kimberly VanYsseldyk, M.N., FNP-C Cancer Genetics Nurse Practitioner Michelle Troja, CTR Cancer Registry, Quality of Cancer RegisLaura Tobin Clinical Nurse Specialist

Sutter Solano Medical Center (SSMC)..Sutter Solano Medical Center (SSMC)..Robert Lanflisi, M.D. Robert Lanflisi, M.D. Surgeon, Chair, Cancer Liaison PhysicianPatricia Seid, M.D. Radiation Oncologist, Medical Director, Kim Etcheberry, R.N., BSN, OCN Cancer Program Administrator, Quality ImWalailuk Chaiyarat, M.D. Medical Oncologist Gurpreet Dhugga, M.D. Palliative Care James Krasno, M.D. Pathologist Yelena Krijanovski, M.D. Medical Oncologist Beverly McLeod, M.D. Medical Oncologist, Cancer Registry Qual

Jessica Contreras Quality Management Marissa Salvatin, RHIT, CTR Cancer Registry, Cancer Registry QualityRichard Siefke, MSW Psychosocial Services Coordinator Karen Stilwell, R.N., MSN, AOCN Oncology Nurse Navigator, Oncology NursEric Tao, M.D. Diagnostic Radiologist Petrick Green-Miller, R.N. Nursing Maude Blundell, MS, CGC Genetic Counselor Lalaine Durand, CCRP Clinical Research Coordinator Clinical Research Coordinator These tables display the broad range of

Figure100 Hospital Drive Vallejo, CA 94589 100 Hospital Drive Vallejo, CA 94589 (707) 554-4444

Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services Outpatient Services SAFH SMCS SRMC SSMC

Valet Parking Valet Parking TDFigure

Comprehensive Breast Center Comprehensive Breast Center TDFigure

TDFigure

Cancer Treatment Center Cancer Treatment Center TDFigure

Chemotherapy Treatment Chemotherapy Treatment

Home Care & Hospice Home Care & Hospice

Nutrition Services Nutrition Services

Palliative Care Palliative Care

Pain Management Pain Management

Dance Movement Dance Movement TDFigure

TDFigure

TDFigure

Music Therapy Music Therapy TDFigure

Pet Therapy Pet Therapy TDFigure

TDFigure

Services Services Services Services Services Services Services Services Services Services Services Services SAFH SMCS SRMC SSMC

ACoS Accredited Cancer Center ACoS Accredited Cancer Center

Blood and Marrow Transplants Blood and Marrow Transplants TDFigure

TDFigure

TDFigure

Brachytherapy Brachytherapy

Cancer Surgery Cancer Surgery

Cancer Clinical Trials & Prevention TriaCancer Clinical Trials & Prevention Tria

Cancer Education Programs Cancer Education Programs

Cancer Support Groups Cancer Support Groups

Community Screenings for Cancer Community Screenings for Cancer

Indoor Pool for Patient/ Rehabilitation Indoor Pool for Patient/ Rehabilitation TDFigure

TDFigure

TDFigure

Core Needle Biopsy Ultrasound Core Needle Biopsy Ultrasound

Core Needle Biopsy Stereotactic Core Needle Biopsy Stereotactic

Stereotactic Radiosurgery & RadiotherapyStereotactic Radiosurgery & RadiotherapyTDFigure

Ablation Surgery Ablation Surgery TDFigure

Gamma Knife on Site Gamma Knife on Site TDFigure

TDFigure

TDFigure

Genetic Counseling Genetic Counseling

Infusion Therapy Infusion Therapy

Interventional Radiology Interventional Radiology

Mammography Mammography

Minimally Invasive Surgery Minimally Invasive Surgery

Nurse Navigator Nurse Navigator

Oncology Social Worker Oncology Social Worker

Pediatric Cancer and Surgery Pediatric Cancer and Surgery TDFigure

TDFigure

PET Positron Emission Tomography on SiPET Positron Emission Tomography on Si

Image-Guided Prostate Radiation Therapy Image-Guided Prostate Radiation Therapy

Radiation Oncology Service Radiation Oncology Service

Thermo Ablation on Site Thermo Ablation on Site TDFigure

TDFigure

TDFigure

IMRT IMRT

SPECT SPECT TDFigure

Tumor Board Tumor Board

Tumor Registry (In-House) Tumor Registry (In-House)

Documents

2014 Annual Cancer Program Report SHSSR - Sutter … Chellappah, M.D. Sutter Roseville Medical Center . Mendl Kebria, M.D. ... 2014 Annual Cancer Program Report Robert Lanlisi, M.D