2015 CHI Memorial Cancer Report

Cancer Program Annual Report 2015Statistical Data for 2014

2 2015 CHI Memorial Cancer Report

Our Mission

Cancer Care

The mission of CHI Memorial and Catholic Health Initiatives is to nurture

the healing ministry of the Church, supported by education and

research. Fidelity to the Gospel urges us to emphasize human dignity

and social justice as we create healthier communities.

Reverence | Integrity | Compassion | Excellence

CHI Memorial has proudly served the Chattanooga, north Georgia and surrounding communities since 1952. The cancer program has consistently maintained accreditation with commendations from the American College of Surgeons, Commission on Cancer: program designation, “Comprehensive Community Cancer Program.”

2015 CHI Memorial Cancer Report 3

Table of Contents Cancer Committee Chairman’s Message – Dr. Sanford Sharp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Patient Navigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

The Joe and Virginia Schmissrauter Center for Cancer Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

2015 Cancer Committee Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Multidisciplinary Cancer Conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Patient Volumes (Tumor Site Origins and Residence at Diagnosis) . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2014 Cancer Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Cancer Incidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Cancer at CHI Memorial Cancer Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

National Accreditation Program for Breast Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-14

Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15

Colorectal Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Complete Service Listing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17


On behalf of the cancer program at CHI Memorial and the Rees Skillern Cancer Institute, the cancer committee is pleased to present the 2015 cancer program annual report. The CHI Memorial cancer program is accredited by the American College of Surgeons’ Commission on Cancer as a Community Hospital Comprehensive Care Program. Our program continues to provide patients, their families, and physicians in our community with a fully integrated, state-of-the-art, multidisciplinary approach to the prevention, early intervention, diagnosis and treatment of

malignancies.

This report highlights the events and services that have contributed to the success of the cancer program and summarizes the statistics from our cancer registry during 2014-2015. During the past year, the cancer committee provided professional guidance in a number of cancer related activities:

• enhancement and implementation of the cancer services strategic plan

• maintenance and improvement of the cancer registry data system

• continued promotion of physician use of the AJCC/TNM staging system

• continued participation in expanded oncology and UAB clinical trials and studies

• continued physician education through many weekly cancer conferences

• continued participation of the continuing medical education program through the Medical Association of Georgia

• continued support of the cancer risk counseling program

• expansion of the navigation and survivorship programs

• continued public education through outreach sites and multiple community education and screening programs

• continued promotion of the hospice program and comprehensive pain management program

• continued support and expansion of the cancer resource center and cancer resource team of specialists

• expansion of services in the infusion therapy program

• expansion of services in the radiation oncology program

• provision of data for special research study and grant proposals

• participation in community outreach events including:

• sponsor for the Susan G. Komen Race for the Cure

• participation in the ACS Relay for Life

• sponsor for the 24th We Care Weekend

• Greater Chattanooga Colon Cancer Foundation’s Rump Run

The cancer committee continues to oversee the overall cancer program at CHI Memorial through coordination and facilitation of all programs and services. The committee sets annual goals to improve services and the care of our patients. It focuses on identifying patient needs and developing strategies to meet those needs. Patients have the assurance of access to hospital-associated resources, community resources for treatment, rehabilitation, support and education on their disease.

2015 Message from the Cancer Committee Chairman

Sanford Sharp, M.D.


Upon diagnosis, patients may choose to be paired with a nurse in our nurse navigator program. This nurse will navigate the patient through treatment; provide education; act as a liaison between patient and doctor when questions arise; offer resources for economic support; and provide comfort and assistance all the way through the discharge and recovery phase.

Navigators are available for the patient from the beginning to coordinate appointments, ensure adequate case presentation, facilitate communication at treatment conferences, and establish a personal

relationship with the patient.

Nurse navigators ensure that each person moves through the care process and is kept well informed. In addition to scheduling appointments and treatments, nurse navigators introduce the patient to our supportive care resources and information, such as social workers, nutritionists, massage therapists, or tai chi. No cancer patient needs to feel alone.

To reach a nurse navigator, call the center for cancer support at (423) 495-7778.

Patient Navigation – Guidance for Patients

Our healing environment philosophy is about taking care of all of the needs of our patients and families.

The Joe and Virginia Schmissrauter Center for Cancer Support – This center offers assistance for every step of a patient’s journey to living well with cancer. Our services are available to anyone in the greater Chattanooga area at no charge. The center offers a team-based, holistic approach to cancer care in these comfortable and convenient locations:

• CHI Memorial Hospital – Chattanooga, Plaza Building, suite 307

• CHI Memorial Hospital – Hixson, Professional Building

Cancer professionals and trained volunteers are available in the centers for cancer support to help patients and their families. The team is comprised of a receptionist, four oncology nurse navigators, two registered dieticians, chaplains, and three masters-level prepared and licensed clinical social workers. Other professionals are added to complement the team on a contract basis.

Cancer Center for Support Services


Cancer Education/Prevention – Education empowers patients in their fight against cancer. In addition to books and other printed materials, a variety of professionals and partners with other organizations are brought in to present educational programs throughout the year.

Cancer Risk and Screening Program – Early identification and information on prevention and monitoring are essential for a person at high risk for cancer. The center for cancer support offers genetic counseling and screening for breast and colon cancer patients with support from the Myriad Laboratory and other laboratories.

Support Groups – Led by registered nurses, chaplains, social workers and/or family therapists, support groups provide a private, supportive environment where cancer patients and their families can find emotional support and learn about treatment modalities and symptom management. Several groups are available to meet different needs, including groups for:

• general cancer concerns

• prostate cancer

• multiple myeloma

• gynecological cancers

• breast cancer

• lung cancer

• leukemia/lymphoma

• pancreatic cancer

• caregivers

• loss, grief and bereavement

• mind-body skills

• smoking cessation classes

• survivorship

Cancer Survivors Network – This network offers a comprehensive selection of stories and discussions among survivors and caregivers on a variety of topics. The cancer survivors network can be accessed via touch-tone or rotary telephone at 1 (877) 333-4673. The link to the network is located on the American Cancer Society website at Cancer.org.

Cancer Center for Support Services (continued)


Sanford Sharp, M.D., pathology, cancer committee chair, registry advisor

Bertrand Anz, M.D., medical oncology, cancer liaison physician

Krishneudu Bhadra, M.D., lung services

John Boxell, M.D., ret., cancer program consultant

Eric Ellis, M.D., radiation oncology

Bob Goldman, M.D., palliative services

Peter Hunt, M.D., head and neck

Lee Jackson, M.D., urology

Kevin Lewis, M.D., chief medical officer

Charles Piez, M.D., diagnostic radiology

Maurice Rawlings, M.D., surgical oncology, director, breast services

Eric Schubert, M.D., pathology, coordinator, multi-disciplinary conferences

J. Lanett Varnell, M.D., radiology breast services

Betsy Washburn, M.D., surgical oncology

Kathy Dittmar, administrator, cancer services

Beena Anchanattu, RN, outpatient infusion

Penny Andrews, RN, clinical research coordinator

Sherry Baierl, RN, quality performance

Jessica Brown, NP, survivorship program

Christine Dominguez, RN, palliative care

Rhonda Edwards, MSSW, ACSW, social worker

Renee Epps, director, radiation oncology

Amy Fields, American Cancer Society

Barbara Guider, director, MaryEllen Locher Breast Center

Debrah Hagen, MSSW, ACSW, social worker

Sharon Hopper, R.D., dietician, cancer support

Leanna Jones, CPA, finance

Betsy Kammerdiener, M.Div, pastoral services

Marty Laird, D. Ph., pharmacy

Catherine Marcum, DNP, APN, cancer sisk counseling

Amy Parker, director, rehab/neurodiagnostics

Cynthia Perry, CTR, oncology data manager

Angela Posey, outreach coordinator

Betsy Quinn, RN, lung nurse navigator

Gere Schwert, MSSW, LCSW, social worker

Kim Shank, RN, navigation, colorectal risk counseling

Terri Shultz, RN, head and neck navigator

Hannah Walker, RN, director, oncology, nursing unit

2015 Cancer Committee


During the conferences, each newly diagnosed case is presented and discussed among all involved physician disciplines as well as ancillary staff. The care team determines the best treatment options, which are tailored to each patient’s case and circumstances.

The multidisciplinary care team includes surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, oncology nurses, nurse navigators, dieticians, social workers and genetic counselors. This team meets three to four times per week for conferences. Physicians and staff at CHI Memorial Hospital – Hixson are also included in the conferences.

The following conferences are available to physicians and staff at CHI Memorial as well as physicians in the community:

• breast conference

• didactic conference

• gastrointestinal conference

• genitourinary conference

• general conference

• GI pathology conference

• gynecologic conference

• hem/lymph conference

• head and neck conference

• thoracic conference

Multidisciplinary Cancer Conferences and Team


Tumor Site Origins Residence by County at time of Diagnosis

Primary Site Total Percent County Total Percent

breast 435 16.6 Hamilton County, TN 1310 50.13

lung 418 16 Walker County, GA 253 9.68

prostate 307 11.7 Bradley County, TN 199 7.6

melanoma 216 8.3 Catoosa County, GA 173 6.6

colon/rectum 196 7.5 Whitfield County, GA 106 4.05

urinary bladder 108 4.1 Marion County, TN 96 3.67

lymphoma 103 3.9 Rhea County, TN 87 3.3

kidney & renal pelvis 86 3.3 Dade County, GA 51 1.95

pancreas 75 2.9 Jackson County, AL 36 1.37

thyroid 72 2.8 Sequatchie County, TN 32 1.22

oral cavity/pharynx 71 2.7 Murray County, GA 30 1.14

corpus uteri 61 2.3 Polk County, TN 26 0.99

leukemia 59 2.3 Meigs County, TN 26 0.99

esophagus 36 1.4 Chattooga County, GA 20 0.78

ovary 35 1.3 McMinn County, TN 16 0.63

myeloma 32 1.2 Grundy County, TN 14 0.55

larynx 28 1.1 DeKalb County, AL 13 0.53

brain/CNS 28 1.1 Bledsoe County, TN 13 0.53

other 247 9.5 other 112 4.29

CHI Memorial Cancer Program Patient Volumes 2014


2014 Cancer Experience

breast

lung

prostate

colorectal

head & neck

melanoma

GYN

bladder

lymphoma

other

18% 17%

16%

12%

8%8%

8%

5%

4%

4%


By understanding our patient population, the Rees Skillern Cancer Institute is able to offer community education, screening programs, clinical trials, state-of-the-art technology and enhanced support programs. More than half of the patients (50.13%) diagnosed

and treated at CHI Memorial reside in Hamilton County, Tennessee. The remaining patients (49.87%) came from other counties in Tennessee, north Georgia, Alabama and other areas.

Cancer Incidence

900

800

700

600

500

400

300

200

100

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

Distribution by Age at Diagnosis 2014 Analytic Cases


2005 -2014 Top Ten Cancer Sites at CHI Memorial

Site 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

breast 354 339 367 372 465 382 388 453 439 435

lung 260 308 292 330 373 425 382 347 384 418

prostate 257 299 372 367 477 348 413 400 349 307

skin (melanoma) 196 236 235 217 319 231 268 282 313 216

colorectal 174 183 223 202 274 256 238 234 241 196

head & neck 126 162 168 194 252 275 185 220 220 235

lymphoma 121 75 148 103 174 128 177 152 123 103

bladder 79 92 102 98 132 107 98 93 123 108

pancreas 35 35 42 47 58 45 57 67 56 75

corpus uteri 32 49 32 52 67 35 29 49 63 61

Cancer at CHI Memorial Cancer Institute


An estimated 231,840 new cases of invasive breast cancer are expected to be diagnosed among women in the United States during 2015, and approximately 2,350 new cases are expected in men. Excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women.

The most common symptom of breast cancer is a lump or a mass in the breast, which is often painless. Less common symptoms include persistent changes to the breast, such as thickening, swelling, distortion, tenderness, skin irritation, redness, or nipple abnormalities, such as ulceration, retraction, or spontaneous discharge. Breast pain is more likely to be caused by benign conditions and is not a common symptom of breast cancer.

Modifiable risk factors associated with breast cancer include weight gain after the age of 18 and/or being overweight, the use of combined estrogen and progestin, physical inactivity, and alcohol consumption. In addition, recent research indicates the long-term heavy smoking may also increase breast cancer risk, particularly among women who start smoking before their first pregnancy.

Non-modifiable factors associated with increased breast cancer risk include high breast tissue density, high bone mineral density, type 2 diabetes, certain benign breast conditions, high-dose radiation to the

chest for cancer treatment at a young age also increases risk. Risk is also increased by certain reproductive factors, family history of breast cancer and inherited mutations.

The MaryEllen Locher Breast Center at CHI Memorial Hospital – Chattanooga is an NAPBC-accredited center. Accreditation is granted to centers that are voluntarily committed to providing the best possible care to patients with diseases of the breast. Each center must undergo a rigorous evaluation and review of its performance and compliance with NAPBC standards. To maintain accreditation, centers must monitor compliance with NAPBC standards to ensure quality of care and undergo an on-site review every three years. Because of this certification, the breast center is able to offer a full range of services for breast care, from screening and diagnosis to advanced care. Our board-certified physicians and support staff provide women with the most-up-to-date options for treatment.

Patients who visit MaryEllen Locher Breast Cancer or one of the mobile coaches have access to comprehensive coordinated services - from screening to diagnostic workup of abnormalities to treatment and support into survivorship.

National Accreditation Program for Breast Centers


After an abnormal mammogram, they meet with doctors to learn about treatment, possible lumpectomies, mastectomies, radiation therapy, chemotherapy and hormone therapy.

The wait time from diagnosis to treatment is kept to a minimum and the MaryEllen Locher Breast Center staff strives to alleviate as much of the patient anxiousness and stress as possible.

The breast center has nurse navigators who assist patients with their options through resources for information, education and support. Clinical trials and research are available giving patients access to new medications and collecting data to determine therapy for current and future patients.

National Accreditation Program for Breast Centers (continued)

Colorectal cancer is the third most common cancer. In 2014, the United States expects 93,090 new cases of colon cancer and 39,610 cases of rectal cancer. Of these cases, 49,700 individuals may not survive.

The incidence of colorectal cancer has been declining in the past two decades, as has the death rate. The decline has been attributed to an increase in screenings that aid in the early detection of colorectal polyps, awareness of risk factors and improvements in treatment options.

Individuals at a higher risk for colon cancer include people age 50 and older, as well as those with

obesity, poor exercise habits, inflammatory bowel disease, type 2 diabetes, diets rich in red meat, high alcohol consumption and, possibly those with diets poor in fruits and vegetables. Genetic conditions such as familial adenomatous polyposis, hereditary non-polyposis colorectal cancer or a family history of colorectal cancer can also lead to increased risk.

Preventive screening for colorectal cancer is imperative primarily because the disease presents no symptoms in its early stages. Therefore the use of screening methods such as sigmoidoscopy, colonoscopy and radiological studies that allow for early detection of polyps is vital.

Colorectal Cancer


Screening recommendations for people age 50 or older include the following:

• stool DNA tests at varying intervals

• fecal occult blood test every year

• fecal immunocytochemistry test every year

• flexible sigmoidoscopy to be conducted every five years

• barium enema every five years

• CTR colonoscopy every five years

• colonoscopy to be conducted every 10 years

As colorectal cancer progresses, it may produce blood in the stools, change of bowel habits, abdominal cramping and weight loss. Anemia may be a result of continuous blood loss and can cause fatigue and weakness. At this point, early detection becomes the priority.

If colorectal cancer is detected, treatment may involve surgery, radiation therapy and chemotherapy.

Frequently, one or more modalities are used depending on the location (colon vs rectum) and how advanced the disease is at diagnosis. Patients with cancer in the colorectal area will likely see different medical specialists who work together in the diagnosis and treatment of the disease.

Overall Survival

The 5- and 10-year relative survival rates for people with colorectal cancer are 65% and 58%, respectively. When colorectal cancer is detected at a localized stage, the 5-year survival is 90%; however, only 40% of colorectal cancers are diagnosed at this early stage, in part due to the underuse of screening. If the cancer has spread regionally, to involve nearby organs or lymph nodes by the time of diagnosis, the 5-year survival drops to 71%. If the disease has spread to distant organs, the 5-year survival is 13%.

Colorectal Cancer (continued)


16

14

12

10

8

6

4

2

0 stage 0 stage I stage II stage III stage IV unk

Colorectal Treatment by Modality

other 0.15

surgery, chemo and radiation 0.08

excisional biopsy 0.09

surgery and chemo 0.15

surgery 0.2

biopsy and surgery 0.33

Age at Diagnosis by AJCC Stage

40-49

50-59

60-69

70-79

80-89

Other


CHI Memorial offers a comprehensive range of services to meet all of your cancer care needs and concerns.

GI Colorectal Center of Excellence

3T MRI technology

capsule endoscopy

endorectal ultrasound

ERCP

optical and virtual colonoscopies

robotic-assisted surgery

Gynecological Oncology Services

Head and Neck Center of Excellence

MaryEllen Locher Breast Center

bone density tests

cancer risk counseling

community outreach

dedicated breast MRI

diagnostic 2D & 3D tomosynthesis

mammography screening

mobile mammography services in north Georgia and 25 counties in Tennessee

stereotactic ultrasound guided breast biopsies

ultrasound AWBUS diagnostics

Prostate Center of Excellence

partial nephrectomy

robotic-assisted prostatectomy

Radiation Center of Excellence

high dose rate brachytherapy

intensity-modulated radiation therapy (IMRT)

MammoSite treatments

Novalis Tx

TrueBeam STx

Thoracic Center of Excellence

CT and PET scans

endo-bronchial ultrasound

lung biopsies

lung cancer screening program

pulmonary rehab

respiratory testing

Holistic Support Services

chaplain services

genetic testing

oncology dietitians

oncology licensed clinical social workers

RN navigation

spiritual counseling

support groups

Complete Service Listing

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Documents

2015 CHI Memorial Cancer Report