HOLZER CENTER FOR CANCER CARE - Holzer Health System · 2017-12-28 · This success is possible through the Holzer Cancer Committee, a diverse group of highly trained physicians and

HOLZER

CENTER

FOR

CANCER

CARE

TABLE

OF

CONTENTS

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6

Cancer Liaison

Physician

Report

Cancer

Registry

Report

Holzer

Center for

Cancer

Care

Physicians

Community

Activity

Outreach

Report

Site of

Focus:

Lung

Cancer

Low-Dose

CT Screening

for Lung

Cancer

Palliative

Care

Cases

Diagnosed

in 2016

2016 Lung

Cases for

Holzer

2016 Clinical and Programmatic Goals

Financial Assistance Provided at HCCC

NurseNavigation

Cancer Program Practice Profile (CP3R)

2016 Quality of Care Studies and Improvements

HCCC Staff/ Cancer Committee

At Holzer Health System, thanks to prevention awareness, earlier detection,

advanced treatment, and supportive care, more patients in our Tri-State area are

surviving cancer than ever before. Unlike most rural cancer centers, Holzer Center

for Cancer Care (HCCC) is located in the center of our Tri-State area, allowing

patients to receive cutting-edge treatment closer to home.

One of our greatest successes in 2016 was the renewal of our 3-year

accreditation with the Commission on Cancer (CoC), a consortium of professional

organizations dedicated to improving survival and quality of life for cancer

patients. The CoC is responsible for establishing standards to ensure high

quality, multi-disciplinary, and comprehensive cancer care delivery in hospitals

throughout the United States, granting accreditation to only those facilities that

are committed to providing the best in cancer diagnosis and treatment.

Holzer takes great pride in this achievement and has received CoC accreditation

every three-year survey cycle since 1937. This success is possible through the

Holzer Cancer Committee, a diverse group of highly trained physicians and staff

dedicated to continually improving our cancer program.

Throughout 2016, the physicians, nurses and other team members of the cancer

center have made significant contributions to improving the health and well-

being of hundreds of area residents facing cancer. Our achievements include:

• Improving care and refining processes to improve our patients’ experiences.

• Creating innovative programs, like our survivor support groups, that focus on enhancing the long-term health and well-being of survivors and their families.

• Providing palliative care to all patients receiving treatment at HCCC.

• Increasing our clinical research and genetics activities.

• Providing our community with cancer screening services, like the Lung Low-Dose CT program and cancer prevention education.

• Educating the next generation of physicians, including our residents and medical students from Ohio University.

As we reflect on the outstanding accomplishments of the past year, it is exciting

to see the progress we have made, in our 80th year of achieving our mission:

Friendly Visits, Excellent Care; Every Patient, Every Time.

A YEAR OF

CANCER LIAISON PHYSICIAN REPORT

THANKS TO

PREVENTION

AWARENESS,

EARLIER

DETECTION,

ADVANCED

TREATMENT, AND

SUPPORTIVE

CARE, MORE

PATIENTS IN OUR

TRI-STATE AREA

ARE SURVIVING

CANCER THAN

EVER BEFORE

ALICE DACHOWSKI MD, FACS

Achievement & Advancement 3

As determined

each year by the

cancer committee

and under the

guidance of

Michelle Rankin,

RN and CC QI

Coordinator,

specific

clinical and

programmatic

goals were

established

in January 2016

to improve

our programs.

2016 PROGRAMMATIC GOAL:

To develop enhancements to the medical patient records and overall patient care that

increases accuracy and efficiency.

Procedures are as follows:The consults will be for any chemo patients with potential/active malnutrition. The protocol for nurses will be:

The changes include:A.

Chemo nurse will discuss concerns/options for nutrition consult with patient The physician

will put in order

Nurse discusses

scheduling preferences

Nutrition responds with an answer

Nurse will send task to

nutrition team and have front desk schedule

consult

Nutrition checks on insurance coverage

Created a template for psychosocial screenings

Designed new protocol of sending a task to nurse navigator and scheduling appointment when treatment completed

Developed more complete clinic notes to consolidate treatment information

Addition of Common Terminology Criteria for Adverse Events Assessment (CTCAE) to electronic chemo documentation

Updated chemo and infusion order set policy to state only provider to fill out order set as per ASCO/ONS chemo admin safety standards

Updated infusion order sets according to NCCN guidelines

Standardization of bar scanning meds and wristbands

Added 3 computers in infusion for increased accessibility

2016 CLINICAL GOAL:

Establish a dietary protocol to allow chemotherapy patients the option of receiving

the essential dietary guidance needed during treatment to extend care.

4 5

Nurse discusses results with patient

Patient sees nutritionist

2016 QUALITY

OF CARE

STUDIES AND

IMPROVEMENTS

A recent report created by the American Cancer Society and the

National Colorectal Cancer Round table states, “Community health

centers can do better with colorectal cancer screening rates. About

1 in 3 adults 50 to 75 years of age (23 million people) has never been

screened for colorectal cancer. ln community health centers (CHC),

which largely serve these populations, the national screening rate for

colorectal cancer in 2012 was 30.2%. CHCs have tremendous potential

to improve colorectal cancer screening rates and reduce colorectal

cancer morbidity and mortality in racially and ethnically diverse,

socioeconomically challenged communities across the country. Since

2012, the Federal Health Resources and Services Administration (HRSA)

has required CHCs to report colorectal cancer screening rates as a

standard performance measure as part of the Uniform Data System.”

Michelle Rankin researched Holzer’s current Adenoma Detection Rate

(ADR). There were a total of 152 colonoscopy procedures in the study.

The results were that adenomas were detected in 57% of the patients

who had a polyp removed. According to ASGE, ADR is reported at

10-40%. A higher ADR rate is associated with lower “postcolonoscopy”

colorectal cancer rate.

Again under the guidance of Michelle Rankin, the cancer center /cancer

committee established methods to consistently collect the withdrawal

time of the colonoscopies. Holzer wants to ensure, once the patient

commits to the expenses and prep for colorectal screening, that we are

providing the utmost quality and care.

The American Society for Gastrointestinal Endoscopy states, “Meticulous

inspection and longer withdrawal times are associated with higher

adenoma detection rates (ADR). A high ADR is essential to rendering

recommended intervals between screening and surveillance examinations

safe. Optimal technique is needed to ensure a high probability of

detecting dysplasia when present in inflammatory bowel disease. Finally,

technical expertise and experience will help prevent adverse events that

might offset the benefits of removing neoplastic lesions.”

Michelle researched Holzer’s current scope withdrawal times. She found

that the average withdrawal time was 10 minutes, with a range of 6 to 28

minutes. As stated earlier, the best practice time is 6 minutes or greater.

Overall, in 2014 our colorectal cancer screening rate was 60% for Medicare

patients, but we currently do not have an accurate way to measure

colorectal cancer screening rates for our overall population.

STUDY #1: Improving Baseline Colonoscopy Rates

STUDY #2: Quality of Colonoscopies

1. Require physician documentation to reflect best practices.

2. Monitor “mucosa/debris” collection rates. These patients should be rescheduled for a colonoscopy.

3. Establish a method to report colorectal cancer screening rates system-wide

4. Monitor rates to ensure the highest level of screenings are achieved.

All of the above suggestions are now in place and working well.

Recommendations for both studies include:

6 7

Our Oncologists treat all major adult

cancers and all adult hematological

disorders. The Medical Oncologists are

proficient in the delivery of routine IV

chemotherapy and oral chemotherapies,

as well as having extensive knowledge in

immunotherapy, targeted therapies, and

combined chemotherapy and radiation

therapies. Our Radiation Oncologist is

competent in the delivery of external

radiation therapy and stereotactic

radiation surgery. Working closely with

the Human Geneticists at The Ohio

State University Comprehensive Cancer

Center - James Cancer Hospital and

Solove Research Institute, they provide

the latest medical knowledge in human

oncology genetics. All oncologists also

refer qualifying patients for clinical trials

to optimize care and treatments.

HOLZER

CENTER

FOR

CANCER

CARE

PHYSICIANS

MEDICAL EDUCATIONBrody School of Medicine at

East Carolina University

Greenville, North Carolina

INTERNSHIPInternal Medicine

Pitt County Memorial Hospital -

Greenville, North Carolina

RESIDENCYRadiation Oncology

University of California - Irvine,

California

BOARD CERTIFICATION•American Board of

Radiology - Radiation

Oncology Certified

KHAWAJA K. HAMID, MD Hematology/Oncology

GHADA KUNTER, MD Hematology/Oncology

MELVA PINN-BINGHAM, MD Radiation Oncology

MEDICAL EDUCATIONSind Medical College

Karachi, Pakistan

RESIDENCY•St. Vincent’s Medical Center

Bridgeport, Connecticut

•St. Elizabeth’s Hospital

Utica, New York

FELLOWSHIPMedical Oncology

Providence Medical Center

Southfield, Michigan

BOARD CERTIFICATION•American Board of Internal

Medicine

•American Board of Medical

Oncology

•American Board of Medical

Specialists

RESIDENCYInternal Medicine

University of Kansas School of

Medicine, Wichita Center for

Graduate Medical Education

Wichita, Kansas

FELLOWSHIPS•Department of Adult

Hematology/Oncology

Winship Cancer Institute

Emory University School of

Medicine - Atlanta, Georgia

•Department of Blood and

Marrow Transplantation

Moffitt Cancer Center,

University of South Florida

Tampa, Florida

•Pediatric Hematology/

Oncology

Children’s Hospital in St. Louis

Washington University School

of Medicine

St. Louis, Missouri

BOARD CERTIFICATION•American Board of Internal

Medicine

•American Board of Pediatrics

•American Board of Pediatric

Hematology/Oncology

•American Board of Adult

Medical Oncology8 9

NURSE

NAVIGATION

Patient Navigators are trained,

culturally sensitive health care workers

who provide support and guidance

throughout the cancer care continuum.

They help people “navigate” through

the maze of doctors’ offices, clinics,

hospitals, outpatient centers, insurance

and payment systems, patient-support

organizations, and other components

of the health care system. Services are

designed to support timely delivery of

quality standard cancer care and ensure

that patients, survivors, and families are

satisfied with their encounters with the

cancer care system.

I. REFERRALS

II. COLLABORATION

III. TRACKING & DOCUMENTATION

IV. EDUCATION

Provides Access to Resources and Assesses Patients’ Current and Future Needs, and Financial Referrals

Develops Physician/Cancer Care

Team Relationships

Tracks Metrics, Quality Indicators; Documents Patient Interactions, Progression

Provides Patient Education, Provides Symptom Management Support

A.

A.

A.

A.

• Makes referrals for services based on patient/family needs – education, finances, psychosocial, survivorship, transportation, child care, lodging.

• Assesses for and assists with patient/family resources.

• Facilitates access to physicians and services.

• Assists with education, including disease state and treatment.

• Assesses for and mitigates barriers to care. Assists patients with access concerns (for screening, diagnosis, or treatment) and assists with paperwork and addressing access barriers as indicated.

• Facilitates appropriate medical record availability at scheduled appointments as needed.

• Facilitates transportation, lodging, and/or child/elder care and addresses any other practical needs.

• Facilitates linkages to follow-up services.

• Facilitates access to clinical trials.

• Creates and reviews Survivorship Care Plan with patients.

• Communicates and collaborates with involved physicians and staff members to facilitate individualized, holistic patient care plan.

• Facilitates communication between cancer care disciplines.

• Maintains communication with patients, survivors, families, and the health care providers to monitor patient satisfaction with the cancer care experience.

• Ensures that navigator functions are meeting physician expectations and that navigator activities remain within scope of defined role.

• Ensure timely documentation of all patient interactions into navigation tracking and documentation system(s).

• Assists with tracking, documentation and outcome reporting for navigation services.

• Assists with ongoing navigation program assessment and identification of process improvement opportunities.

• Assists with annual CoC Standard 3.1 activities related to community needs assessment and resulting program modifications related to needs; assists with program reporting to the Cancer Committee.

• Assists with coordinating appointments.

• Meets with patient by phone or in person prior to, during, and after treatment.

• Facilitates timely coordination of services between diagnosis and treatment.

• Provides telephone triage services (e.g., symptom management, emotional support, education, resource referral) for patients/families.

• Coordinates appointments for diagnostic testing, services, and with providers to ensure timely delivery of diagnostic and treatment services, providing clarification and literacy-level-appropriate education related to the visit.

10 11

Community Outreach

Coordination of Patient Care (coordinating/facilitating appointments, accompanying patients to appointments as needed) B.

B.

• Discusses physician visits with patients and families and answer questions.

• Provides and reinforces education re: treatment, care plan, symptom management and survivorship concerns.

• Empowers patients with education and knowledge to help improve patient outcomes and satisfaction.

• Conducts health promotion and awareness programs in community as appropriate.

• Provides community education presentations as appropriate.

• Coordinates patient care from diagnosis through survivorship or palliative care/hospice.

The Commission on Cancer (CoC)

tracks each case submitted by our

hospital. Those cases that meet the

criteria for the described measures are

reviewed to ensure quality treatment

is met. With the new Rapid Quality

Reporting System, cases are sent

to the CoC on a monthly basis, with

results of the measures given each

month. This proactive system confirms

that the most valuable treatment is

being given on a timely basis.

Image or palpation-guided needle (core or FNA) of the primary site is performed to establish diagnosis of breast cancer

Tamoxifen or third generation aromotase inhibitor is considered or administered within 1 year of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer

Radiation therapy is considered or administered following any mastectomy within 1 year of diagnosis of breast cancer for women with >= 4 positive regional lymph nodes

Radiation is administered within 1 year of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer

Combination chemotherapy is considered or administered within 4 months of diagnosis for women under 70 with AJCC T1cN0, or stage IB - III hormone receptor negative breast cancer

Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for patients under the age of 80 with AJCC stage III colon cancer

Endoscopic, laparoscopic, or robotic surgeries performed for all Endometrial cancer for all stages except stage IV

Use of brachytherapy in patients treated with primary radiation with curative intent in any stage of cervical cancer.

Surgery is not the first course of treatment for stage cN2 M0 lung cases

Systemic chemotherapy is administered within 4 months preoperatively to 6 months postoperatively or it is considered for surgically resected cases with pathologic positive lymph nodes for Non-Squamous Cell Lung Cancer

80%

90%

90%

90%

90%

90%

Not applicable

Not applicable

Not applicable

Not applicable

92.3%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Quality Measures

for Breast, Colon,

Endometrium, and

Lung Cancers

CANCER

PROGRAM

PROFILE

REPORTS

(CP3R)

CoC MeasureStandard to Meet

HCCC Rate

12 13

WHAT IS THE CANCER REGISTRY?

Cancer is a reportable disease in every state in the United States. For every patient

diagnosed with this disease, all physicians, dentists, laboratories, and other health

care providers must collect, process, and report each malignant case through a

certified tumor registrar (CTR). The Holzer Center for Cancer Care CTR, Robin Lyles,

operates under the direction and guidance of Holzer’s Cancer Committee.

Holzer Center for Cancer Care’s (HCCC) Cancer Committee is a diverse group of

individuals within the System, designated to provide leadership in the planning,

initiation, stimulation, and assessment of Holzer’s cancer care services and activities,

in accordance with the American College of Surgeons’ Commission on Cancer (CoC)

requirements. The Committee includes representatives from Surgery, Radiology,

Medical Oncology, Radiation Oncology, Pathology, Administration, Nursing,

Navigation, Palliative Care, Community Wellness, Pharmacy, Social Work, Nutrition,

Rehabilitation, Marketing, Pastoral Care, and Genetics, as well as an American

Cancer Society representative.

WHAT IS THE CANCER REGISTRY USED FOR?

Cancer Registry data is used by the Department of Health, county and local health

departments, patient and public interest groups, researchers, and the public for

health planning and evaluation, as well as for research, incidence patterns, and

trends for southeast Ohio.

The Cancer Registry plays an important role in research to identify the causes of

cancer. Researchers often use the data collected by the registry to identify higher

incidences of cancer with specific exposures and/or particular geographical areas.

HOW DOES THE REGISTRY PROTECT PRIVACY?

All information reported to the Ohio Department of Health and the National Cancer

Data Base is confidential and strict procedures are enforced to protect patient

privacy. For all records sent to the state and national organizations, all patient

indicators have been removed.

WHAT IS A CANCER

CONFERENCE?

HCCC offers a cancer conference each month at

Holzer Health System, allowing multidisciplinary

physicians to determine the most effective care

for the most challenging cancer cases, as well

as providing education for all in attendance. It is

monitored by one of our clinical pathologists and

Cancer Conference Coordinator, Dr. Raul Gagucas,

to ensure these conferences meet the CoC goals.

All in attendance receive 1 CME for each conference.

WHAT INFORMATION IS

COLLECTED ABOUT PATIENTS

WITH CANCER?

The cancer registry collects data on the

demographics, anatomic sites and sizes of tumors,

the stages of diagnosis, the cell types of cancer,

treatment information, and annual follow up. All

malignant cancers are reported except Squamous

and Basal Cell Carcinomas and in situ malignant

tumors from the cervix, prostate, vulva, vagina, and

anus. All brain and nervous system tumors are also

collected, even those that are benign.

HOW LONG HAS HOLZER’S

CANCER REGISTRY BEEN

COLLECTING AND REPORTING

CANCER DATA?

Holzer Center for Cancer Care has been accredited

with the CoC every three-year survey cycle since

1937 and the registry has 12,600 cases on file.

Holzer Medical Center established the cancer

registry in 1977 and has been collecting all required

data since that time.

The commission on Cancer requires that registrars follow all cancer patients in their registry that have received first-course treatment for their lifetime. This information assists physicians when accessing patients who may return for check-ups, aids in early identification of recurrences, and helps to determine treatment. The overall successful followup rate since 2001 at Holzer Center for Cancer Care for 2016 was 90.68% (required minimum is 80%). The successful followup rate for the last 5 years was 94.14% (required minimum is 90%).

Since 2001

4,021

1,646

1,499

293

At least 80%

90.68%

Total new patients in the registry

Less deceased

Number living

Patients lost to follow up

Percentage of Successful Follow Up Rate

HCCC Rate as of December 31, 2015

The last 5 years

1,438

392

752

67

At least 90%

94.14%

CANCER

REGISTRY

REPORT

ONCOLOGY QUALITY/DATA SPECIALIST

Robin Lyles, CTR, MEd

As Cancer Registrar, Robin’s responsibilities are as follows:

Other aspects of Robin’s position includes duties as the Quality/Data Specialist, such as:

• Identifies all patients having the diagnosis and/or treatment of cancer within Holzer Health System and enters each case into the cancer software system.

• Assigns codes for cancer diagnoses utilizing ICD-9, ICD-10, and ICD-O coding and enters diagnostic, demographic, and registry data into the cancer registry software program.

• Prepares the agenda and records minutes for the monthly Tumor Board conferences and quarterly Cancer Committee meetings.

• Performs TNM staging classifications.

• Compiles registry reports utilizing the hospital’s database and national and state statistics.

• Provides patient care evaluation studies each year and presents to the Committee.

• Assists oncology leadership in the development, measurement, and reporting of quality cancer data.

• Participates in educational events annually to maintain certification status, including attendance to regional and national conferences.

• Follows cancer patients treated at HCCC for their lifetime.

• Coordination and management of the Cancer Committee meetings, including review of the 34 CoC standards for accreditation.

• Working closely with all 6 CoC coordinators to originate and implement services and write annual summaries.

• Submission and maintenance of all documentation for the CoC and upload of completed information.

• Performing research studies, workload statistics, and projects, including solution proposals and actions for resolution.

• Identifying methods of utilizing registry data through patient care evaluation audits and special research studies.

• Assistance in the development

of the annual reports.

• Responsible for all aspects of maintaining the system’s oncology program in compliance with the CoC.

• Participating in marketing initiatives, including cancer prevention programs, screenings, and wellness fairs.

• Advising Cancer Committee on changes in cancer patient population, referral patterns, trends in treatment modalities, evaluation of patient care, and other topics of interest to the Committee.

• Robin is also a member of the National Cancer Registrar’s Association, Ohio Cancer Registrars Association, and Cancer Registry Association of Central Ohio.

FOLLOW UP RATES FOR 2016

14 15

FINANCIAL

ASSISTANCE

PROVIDED

AT HCCC

In addition to facing the physical

suffering of cancer treatment, these

procedures can also present serious

financial difficulties for patients and

their families, even for those with health

insurance. With the costs of cancer care

clearly increasing and cancer patients

now living longer than ever before,

many insurance companies transfer

more and more of the costs to the

patients. These additional burdens can

have negative effects on healing, both

mentally and physically.

Today there are many support services

available for patients with cancer.

However, the majority of patients and

even the healthcare providers are

unaware of these services. To help

patients pay for their cancer care,

many drug companies, as well as non-

profit organizations and foundations,

have developed financial assistance

programs to offset the high cost of

cancer care for patients. These financial

assistance programs are designed

specifically to help patients pay for

medications, medical bills, and other

expenses related to cancer care, such

as travel to a cancer facility and hotel

stays during treatment.

HCCC’s Revenue Cycle

Specialist, Ashley

Foster, is certified

through the Association

of Community of

Cancer Care (ACCC).

She assists each patient

in finding alternate

funding to ease this

financial burden prior

to a patient starting their cancer

treatment. Ashley verifies insurance

benefits and determines an estimated

out-of-pocket cost for the planned

cancer treatment. Based on the

diagnosis and medications ordered,

Ashley finds available assistance

programs, grants, or foundations

that the patient would qualify for

and assists them in the application

process. Once approved, she will

continue to work with the programs

to ensure payment is received for

each treatment, taking a huge

financial burden off of our patients.

16 17

18 19

CANCER COMMITTEE

Our strongest asset at Holzer Center for Cancer Care is our staff. Our specialists blend their expertise together to provide a unified approach to optimal treatment and provide the very best comprehensive cancer care available anywhere.

NAME MEMBER STATUS DEPARTMENT NAME MEMBER STATUS DEPARTMENT

Alice Dachowski, MD Appointee SURGERY/COMMITTEE CHAIR/CLP

Amy Bokal, MD Appointee DX RADIOLOGY

Ghada Kunter, MD Appointee MEDICAL ONCOLOGY

Khawaja Hamid, MD Alternate MEDICAL ONCOLOGY

Subhash Khosla, MD Appointee RADIATION ONCOLOGY

Raul Gagucas, MD Appointee PATHOLOGY/CANCER CONFERENCE COORD

Sarah Harrigan, RN, MSN, OCN Appointee CANCER PROGRAM ADMINISTRATOR

Robin Lyles, CTR, MEd Appointee CERTIFIED TUMOR REGISTRAR & CANCER REGISTRY QUALITY COORD

Amity Wamsley, LPN Appointee CLINICAL RESEARCH COORD

MarJean Kennedy, MBA, PCM Appointee COMMUNITY WELLNESS

Melissa Burris, RN Appointee NURSING

Michelle Rankin, RN, MSN Appointee QUALITY IMPROVEMENT/ MANAGEMENT COORD

Teresa Stewart, RN, CHPN Appointee PSYCHOLOGICAL SERVICES COORD

Ryan Ramsburg, RT Additional Member DOSIMETRIST

Stella Barrett, OTR/L Additional Member REHABILITATION

Hilary Nichols Additional Member AMERICAN CANCER SOCIETY

Fred Williams, PhD Additional Member PASTORAL CARE

Jared Vernon, RPh Additional Member PHARMACY

Sarah Ramsburg, LD, RD Additional Member NUTRITION SERVICES

Amity Wamsley, LPN Additional Member LPN/GENETICS ASSISTANT

COMMUNITY

OUTREACH

ACTIVITY

REPORT

2016 DIETARY COMMUNITY OUTREACH ACTIVITIES provided by Holzer Nutritional Services/Registered Dieticians

and Health and Wellness

As a Commission on Cancer

accredited facility, the Holzer Center

for Cancer Care is committed to

community outreach and support

services for cancer care. Community

outreach services increase the

public awareness of prevention

activities, promote the benefits

of early detection and encourage

participation in screening programs.

Holzer Health System, a not-

for-profit entity, conducts a

comprehensive Community

Health Needs Assessment

(CHNA) and Implementation

Strategy in cooperation with

local health departments and

regional health partners every

three years. Holzer completed

its most recent assessment on

June 30, 2016, and subsequent

implementation strategy on

November 15, 2016.

Assessment results of the seven-

county area studied indicate

that obesity, poor nutrition,

and lack of physical activity

remains one of the region’s

most important health issues

leading to chronic disease states

including increased incidence

of cancer. Holzer continued

nutrition efforts to reduce

obesity and increase healthy

eating in 2016 and opened

a new Wellness Center on

November 3, 2016 to encourage

and support healthy lifestyle

behaviors.

DATE EVENT TIME

01/05/16 Diabetes Class - Gallipolis 3 hours

01/29/16 Assessments for Homestead 20 hours


02/10/16 Go Red Luncheon 1 hour

02/27/16 Cardiac Symposium 4 hours

03/03/16 Kids Cooking Class 3 hours

03/08/16 Senior Citizen Center presentation 1 hour

03/08/16 Athens Nutrition Month presentation 1 hour


03/15/16 Jackson Diabetes Class 1 hour




04/05/16 Diabetes Class 3 hours

04/13/16 Woodlands presentation 1.5 hours

04/22/16 Rio Grande University Health Fair 5 hours

04/25/16 TOPS presentation - low sodium 3 hours

04/10/16 MNT assessments for Victory House/Homestead 10 hours

05/06/16 GAMS - Middle School Health Fair 2 hours


05/10/16 Truancy Class 1 hour

05/12/16 Homestead Menus 6 hours

05/18/16 Breastfeeding Coalition 2 hours

05/24/16 Diabetes Class – Jackson 3 hours

06/16/16 Homestead assessments 8 hours

06/21/16 Cooking Demo Jackosn Library 1 hour

06/24/16 Rocky Boots Health Fair 5 hours

07/07/16 DM Support Group 1 hour

07/12/16 DM class - Gallipolis 3 hours

07/12/16 Children’s Library program - Gallipolis 3 hours

07/14/16 Teen’s Library Program - Gallipolis 3 hours

07/26/16 DM class - Jackson 3 hours

08/09/16 DM Class – Gallipolis 3 hours

08/13/16 Buckeye Rural Health Fair 4 hours

09/08/16 Homestead Assessments 8 hours


09/14/16 Gallia High School Career Day 2.5 hours

10/03/16 Diabetes class - Jackson 3 hours

10/06/16 Healthy Men Cooking Demo - with James Center 4 hours

10/11/16 Diabetes Class - Jackson 3 hours

10/11/16 OU Hockey team presentation 1 hour

10/12/16 OVB Health Fair 6 hours

10/17/16 Diabetes class at Woodlands 2 hours20 21

22 23

BREAST AND COLORECTAL CANCER

As part of its Healthy People 2020

initiative, the U.S. Department of Health

and Human Services identified breast

and colorectal cancer screening as

leading health indicators setting a

target of increasing screening rates to

81.1 and 70.5 percent respectively by

the year 2020. These indicators are

relevant because engaging in preventive

behaviors allows for early detection

and treatment of health problems.

This indicator can also highlight a lack

of access to preventive care, a lack of

health knowledge, insufficient provider

outreach, and social barriers preventing

utilization of services. The system’s

CHNA revealed that screening rates

within each of the counties served fall

below HHS targets. Holzer increased its

educational efforts surrounding these

topics, conducted preventative awareness

events in the community and initiated

targeted screening reminder programs

through both face-to-face provider

communication and in-home messaging.

A Colorectal Prevention and Awareness

Event was held on March 29, 2016, in

the Bossard Library Riverside Room in

Gallipolis, OH. Medical Oncologist Dr.

Ghada Kunter provided a presentation

on preventative measures, risk factors,

the importance of screenings, as well

as treatment options after diagnosis.

Holzer chef, Tommy Fallon provided a

healthy eating cooking demonstration

and all in attendance were given a variety

of sample appetizers to enjoy. Sarah

Ramsburg, staff nutritionist, discussed the

importance of healthy eating as a primary

prevention measure. Dr. Kunter asked for

a show of hands to see if the presentation

increased their knowledge about colon

cancer and prevention of the disease. All

acknowledged that their knowledge had

increased as a result of the presentation.

Additionally, two in attendance stated

they had recent colonoscopies, while

five others agreed they would ask their

physicians about scheduling a screening

colonoscopy. Social media activities

surrounding the event resulted in an

additional reach of 809 individuals with

24 actively engaged with the educational

materials.

Holzer staff, in collaboration with the OSU

James Cancer Center, participated in the

annual Komen Race for the Cure event

held in Athens, Ohio on October 23, 2016.

Holzer targeted awareness surrounding

the event resulted in a reach of 1721

individuals with 187 actively engaged in

the educational materials. Additionally,

a targeted breast cancer awareness

article with attached quiz reached 763

individuals with 14 actively engaged

and three taking the quiz to test their

personal knowledge.

LUNG CANCER

Additional primary areas of concern

identified in the CHNA are access to care

and substance abuse including tobacco.

Holzer continues to provide financial

assistance programs as well as low dose

lung CT screenings for high-risk patients.

Holzer completed 100 low-dose lung

CT screenings in 2016 resulting in the

following results:

• HIGHLY SUSPICIOUS: 7 -

Recommendation PET Scan & CT

Guided Biopsy

• SUSPICIOUS: 4 – 1 or more Nodule –

Return in 3 Months

• 1 OR MORE SMALL NODULE: 16 –

Return in 6 Months

• NODULES BUT NOT CONSIDERED

SUSPICIOUS: 34 – Return in 1 Year

• NORMAL: 39 -

25 of screenings were Grant-Funded for

individuals with an inability to pay.

Holzer’s lung cancer coordinator

conducted a feature interview on the

local NBC news, WSAZ Channel 3, on

October 19, 2016, providing awareness,

prevention, and screening information

reaching 68,000 viewers. Social media

awareness during October and November

reached an additional 1905 with 93

actively engaged with the educational

materials. Additionally, a Shine the Light

event to increase awareness of the

dangers of cigarette smoking was held

at the Holzer Center for Cancer Care on

October 12, 2016, with 30 individuals in

attendance.

SKIN CANCER

The Cancer Committee chose skin as the

screening site focus for 2016 as a result

of an increase in Melanoma in the region

and community interest gained from

the CHNA process. Awareness activities

and a skin screening event was held on

November 3, 2016, as part of the grand

opening ceremony of the system’s new

Wellness Center.

19 studies were performed resulting in the

following:

• 4 with at least one seborrheic

keratosis.

• 3 with at least one actinic keratosis.

• 6 with at least one dysplastic nevus.

• 8 biopsies recommended.

• 10 skin cancer pre-tests taken. All

answered the six questions correctly.

Nursing staff conducted followed-up

on the eight recommended biopsies.

Targeted social media awareness in

conjunction with this event reached an

additional 242 individuals with 14 of those

engaged with the related educational

materials.

HOLZER COMMUNITY HEALTH & WELLNESS SCREENING EVENTS

EVENT DATE

Drug Prevention and Resources Monthly Meeting 01/11/16

Wellston High School Health Fair 01/13/16

Vein Screening Event 01/19/16


Holzer Family Pharmacy Wellness Events (all locations) 02/03/16



Red Dress Event - Gallipolis 02/11/16

Cardiac Symposium 02/27/16





Spring Showcase - Jackson 03/18/16

Colorectal Cancer Event 03/29/16

Meigs Agricultural Society 04/08/16


URG Health Fair 04/22/16


Gallia Academy Middle School Health Fair 05/06/16




Athens Health Fair 06/17/16

Rocky Boots Health Fair 06/24/16



Jackson County Fair 07/18-22/16


Gallia County Junior Fair 08/1-5/16

Mason County Fair 08/8-12/16

Buckeye Rural Annual Meeting Health Fair 08/13/16

Meigs County Fair 08/15-19/16



Emancipation Celebration 09/18-19/16


Apple Festival 09/20-24/16

Athens Kid and Safety Fair 10/01/16

OVB Health Fair 10/12/16


Skin Cancer Screening - Wellness Center Opening 11/03/16



PALLIATIVE

CARE

Palliative Care focuses on relieving and

preventing the suffering of patients.

Palliative care specializes in the relief

of the pain, symptoms and stress of

serious illness.

Palliative care is given to improve the

quality of life of patients who have a

serious or life-threatening disease, such

as cancer. The goal of palliative care is

to prevent or treat, as early as possible,

the symptoms and side effects of the

disease and its treatment, in addition

to the related psychological, social,

and spiritual problems. The goal is not

to cure. Palliative care is also called

comfort care, supportive care, and

symptom management.

Palliative medicine

is appropriate for

patients in all disease

stages, including

those undergoing

treatment for curable

illnesses and those

living with chronic

diseases, as well as

patients nearing the end of life.

This can include treating nausea related to

chemotherapy, morphine to treat the pain

of broken leg, or ibuprofen to treat aching

related to an influenza (flu) infection.

Palliative medicine at Holzer utilizes a

multidisciplinary approach to patient

care, relying on input throughout our

healthcare system, including physicians,

pharmacists, nurses, chaplains, social

workers, and Hospice to create a plan of

care to relieve suffering in all areas of life.

This multidisciplinary approach allows the

palliative care team to address physical,

emotional, spiritual and social concerns

that arise with advanced illness.

The Palliative Care Team plans to provide

both effective inpatient and outpatient

management of patients with serious,

potentially life threatening illness

independent of curative or life-prolonging

care. The primary focus is placed on

pain and symptom control, psychosocial

distress, spiritual issues and practical

needs. Additionally, our desire is to be

very informative so that patients and their

families can fully understand the illness,

prognosis and treatment options and then

work from that knowledge in establishing

goals of care. Knowledge, understanding

and compassion are key foundational

concepts for the success of Palliative Care.

HOW DO I KNOW IF PALLIATIVE CARE IS RIGHT FOR ME?

Palliative care may be right for you if

you suffer from pain or other symptoms

due to a serious illness. Serious illnesses

include but are not limited to:

• Cancer

• Cardiac disease

• Respiratory disease

• Kidney failure

• Alzheimer’s

• AIDS

• Amyotrophic Lateral Sclerosis

(ALS)

• Multiple Sclerosis

Palliative care can be utilized at any stage

of illness and alongside curative treatment.

WHAT CAN I EXPECT FROM PALLIATIVE CARE?

When you receive palliative care you can

expect relief from distressing symptoms

such as pain, shortness of breath, fatigue,

constipation, nausea, loss of appetite

and difficulty sleeping. Palliative care

improves your ability to carry on with

your daily life. It improves your ability to

tolerate medical treatments and helps

you to better understand your condition

and your choices for medical care. In

short, you can expect the best possible

quality of life.

COMMON INDICATIONS FOR PALLIATIVE CARE

Some of the more common indications

for palliative care consultation include:

• Intractable symptom (pain,

nausea, depression, etc.)

management associated with

end stage or serious illness,

• Discussing goals of treatment/care

and prognosis, and assistance with

coordination of care,

• Patients who have frequent

readmissions to the acute care

setting can often benefit from

palliative care consultation

especially when a progressing

illness such as COPD, CHF or

advanced renal disease are the

culprit. Complex family system

dynamics often create situations

in which palliative care can be

beneficial as well.

PALLIATIVE CARE & CANCER

Palliative care is given throughout a

patient’s experience with cancer. Our

palliative care nurse, Teresa Stewart,

RN, CHPN, meets with each patient at

diagnosis and continues through treatment,

follow-up care, and the end of life.

Palliative care is provided in addition

to cancer treatment. However, when

a patient reaches a point at which

treatment to destroy the cancer is no

longer warranted, palliative care becomes

the total focus of care. Palliative care will

be continued to alleviate the symptoms

and emotional issues of cancer. Palliative

care providers can help ease the

transition to end-of-life care.

PALLIATIVE CARE & CANCERFAMILY CARE

It’s common for family members to

become overwhelmed by the extra

responsibilities placed upon them.

Palliative care can help families and

friends cope with these issues and

provide the support needed.

24 25

26 27

CASES DIAGNOSED IN 2016: Description of top sites compared to Ohio & National

HCCC PERCENTAGE OHIO PERCENTAGE NATIONAL PERCENTAGE

Lung/Bronchus 62 20.8% 10,550 16.0% 224,390 13.5%

Breast 45 15.1% 9,390 14.2% 246,660 14.8%

Colorectal 31 10.8% 5,430 8.2% 134,490 8.1%

Prostate 22 7.4% 6,760 10.2% 180,890 10.9%

Uterine Corpus 21 7.0% 2,640 4.0% 60,050 3.6%

Leukemia 18 6.0% 2,140 3.3% 60,140 3.6%

Lymphoma 13 4.3% 2,820 4.2% 72,580 4.4%

Bladder 11 3.6% 3,180 4.8% 76,960 4.7%

Melanoma of Skin 10 3.3% 2,880 4.4% 76,380 4.6%

Uterine Cervix 5 1.7% 470 0.7% 12,990 0.8%

All Others 60 20.0% 19,760 30.0% 512,680 31.0%

TOTALS: 300 100.0% 66,020 100.0% 1,658,210 100.0%

An estimated 1,658,210 new cancer cases have occurred nationally in 2016. The state of Ohio is estimated at 66,020. Holzer

Center for Cancer Care (HCCC) had 300 cases for the year. The incidence rate continues to decline for men and is about the

same among women after a long period of increase. Holzer was 7.3% above the national level for lung, our top site, and about

the same as national for breast, our second-highest site. The other selected sites were relatively comparable to the state and

national averages. Prostate was 3% below the national average, Leukemia was 2.4% above the national average, Uterine was

3.4% above the national average, and colorectal was 2.7% above the national average.

HCCC SITE DISTRIBUTION DATA ILLUSTRATION FOR DIAGNOSIS: YEAR 2016

Other Head & Neck: 5.4%

Brain: 1.0% Brain: 0%

Lung & Bronchus: 25.2%

Breast: 2.2%

Digestive System: 23.6%

Urinary System: 6.1%

Reproductive System: 19.1%

Lymph Nodes: 3.8%

Melanoma of the Skin: 3.8%

Blood/Bone Marrow: 7.6%

All Other Sites: 2.2%

TOTAL: 131 Cases

Lung & Bronchus: 19.2%

Breast: 25.1%

Digestive System: 13.8%

Urinary System: 5.9%

Reproductive System: 18.0%

Lymph Nodes: 4.8%

Melanoma of the Skin: 3.0%

Blood/Bone Marrow: 4.8%

All Other Sites: 1.2%

TOTAL: 169 Cases

Other Head & Neck: 3.6%

2016 NATIONAL

COMPARISON

OF ESTIMATED

TOP CANCER

SITES

PRIMARY SITE CASES PERCENT

Bronchus & Lung 30 35.7%

Prostate 22 26.2%

Colorectal 15 17.9%

Blood / Bone Marrow

10 11.9%

Esophagus 7 8.3%

Total 84 100%

PRIMARY SITE CASES PERCENT

Breast 42 30.9%

Bronchus & Lung 32 23.5%

Reproductive Sites 30 22.1%

Colorectal 16 11.7%

Blood/BM 8 5.9%

Lymph Nodes 8 5.9%

Total 120 100%

TOP SITES FOR MEN TOP SITES FOR WOMEN

28 29

Lung cancer was the leading cause

of cancer death in Ohio in 2013,

representing 29.1 % of all cancer

deaths, followed by colorectal

(9.0%), breast cancer (7.2%) and

pancreatic cancer (6.2%). The good

news is that the lung and bronchus

cancer incidence rate for Ohio males

declined 19% and mortality rates

declined 21% from 2004 to 2013. The

lung and bronchus cancer incidence

rate among Ohio females declined 5%

from 2004 to 2013 In Ohio, between

2008 and 2014, 95% of individuals

who developed lung and bronchus

cancer were age 50 and over.

African American men are about

20% more likely to develop and die

from lung cancer than white men,

even though their overall exposure to

cigarette smoke, the primary risk factor

for lung cancer, is lower. About 50% of

Ohio lung and bronchus cancer cases

were diagnosed at a distant stage

in Ohio in 2013, where the five-year

relative survival probability is only 4%.

It is estimated that approximately $10.3

billion per year is spent in the United

States on lung cancer treatment with

an estimated number of lung cancer

deaths at 160,000 for 2014.

One reason malignant tumors are

dangerous is because they grow

uncontrollably. When the cancer cells

grow too fast, they prevent organs

of the body from working well. For

example, if cancer affects the lungs,

the tumor may grow so large it blocks

a major airway so that part of the lung

can’t breathe.

Another reason a cancerous tumor

is dangerous is because it can

spread to different parts of the body.

Sometimes a cancerous tumor sheds

cells. These cells can be carried to

other parts of the body through the

blood or the natural fluid around the

lung tissue called lymph. The cells

can begin to grow uncontrollably in

the new location and cause problems

that keep that part of the body from

working properly.

There are two main types of lung

cancer: small cell lung cancer (SCLC)

and non-small cell lung cancer

(NSCLC). Non-small cell lung cancer

is more common. It makes up about

80% of lung cancer cases. This type of

cancer usually grows and spreads to

other parts of the body more slowly

than small cell lung cancer does. There

are three different types of non-small

cell lung cancer: adenocarcinoma,

squamous cell carcinoma and large cell

carcinoma. Each type is different, but

they are grouped together because

they are treated similarly. Small cell

lung cancer is almost always associated

with cigarette smoking. It is important

to know the type of lung cancer you

have because it helps determine what

treatment options are available.

The five-year survival rate for lung

cancer is 53.5% for cases detected

when the disease is still localized

(within the lungs). However, only 15% of

lung cancer cases are diagnosed at an

early stage. For distant tumors (spread

to other organs) the five-year survival

rate is only 3.9%.

TREATMENT OVERVIEW FOR NON-SMALL CELL LUNG CANCER (NSCLC)

In cancer care, different types of

doctors often work together to

create a patient’s overall treatment

plan that combines different types

of treatments. Cancer care teams

include a variety of other health

care professionals, such as physician

assistants, oncology nurses, social

workers, pharmacists, counselors,

dietitians, and others.

There are 5 basic ways to treat NSCLC:• Surgery• Radiation therapy• Chemotherapy• Targeted therapy• lmmunotherapy

Treatment options and

recommendations depend on several

factors, including the type and stage

of cancer, possible side effects, and the

patient’s preferences and overall health.

SURGERY

A thoracic surgeon is specially trained

to perform lung cancer surgery. The

goal of surgery is to completely remove

the lung tumor and the nearby lymph

nodes in the chest. The tumor must be

removed with a surrounding border or

margin of healthy lung tissue.

The following types of surgery may be

used for NSCLC:• LOBECTOMY. The lungs have 5

lobes, 3 in the right lung and 2

in the left lung. The removal of

an entire lobe of the lung in a

procedure called a lobectomy is

currently thought to be the most

effective type of surgery, even when

the lung tumor is very small.

SITE OF

FOCUS

Lung Cancer

Currently, a man living in the U.S. has a

1 in 15 lifetime risk of developing invasive

lung and bronchus cancer, and a woman

has a 1 in 18 lifetime risk of developing

invasive lung and bronchus cancer

(ACS’ Cancer in Ohio 2016). Lung and

bronchus cancer was the leading cause

of cancer incidence in Ohio in 2016,

representing 15.2% of all new invasive

cancer cases, followed by breast cancer

(14.7%), prostate cancer (11.0%), and

colon and rectum cancer (9.0%).

30 31

intravenous (IV) tube placed into a vein

using a needle or in a pill or capsule

that is swallowed (orally). Most types of

chemotherapy used for lung cancer are

given by IV injection.

A chemotherapy regimen , or schedule,

usually consists of a specific number of

cycles given over a set period of time.

The type of lung cancer you have, such

as adenocarcinoma or squamous cell

carcinoma, affects which drugs are

used for chemotherapy.

Chemotherapy may also damage

healthy cells in the body, including

blood cells, skin cells, and nerve cells.

The side effects of chemotherapy

depend on the individual and the dose

used, but they can include fatigue,

low numbers of blood cells, risk of

infection, mouth sores, nausea and

vomiting, loss of appetite, diarrhea,

numbness and tingling in the hands

and feet, and hair loss. Your medical

oncologist can often prescribe drugs

to help relieve many of these side

effects. Hormone injections are

used to prevent white and red blood

cell counts from becoming too low.

Nausea and vomiting are also often

avoidable. These side effects usually

go away after treatment is finished.

TARGETED THERAPY

Targeted therapy is a treatment that

targets the cancer’s specific genes,

proteins, or the tissue environment

that contributes to cancer growth and

survival. This type of treatment blocks

the growth and spread of cancer cells

while limiting damage to healthy cells.

Recent studies show that not all tumors

have the same targets. For some lung

cancers, abnormal proteins are found

in unusually large amounts in the

cancer cells. This helps doctors better

match each patient with the most

effective treatment whenever possible.

In addition, many research studies

are taking place now to find out more

about specific molecular targets and

new treatments directed at them.

For NSCLC, the following types

of targeted therapy may be used,

particularly in clinical trials. Talk with

your doctor about possible side effects

for a specific medication and how they

can be managed.

• ANTI-ANGIOGENESIS THERAPY.

Anti-angiogenesis therapy is

focused on stopping angiogenesis,

which is the process of making new

blood vessels. Because a tumor

needs the nutrients delivered by

blood vessels to grow and spread,

the goal of anti-angiogenesis

therapies is to “starve” the tumor.

• EPIDERMAL GROWTH FACTOR

RECEPTOR (EGFR) INHIBITORS.

Researchers have found that drugs

that block EGFR may be effective

for stopping or slowing the growth

of lung cancer.

• DRUGS THAT TARGET OTHER

GENETIC CHANGES. Researchers

have found that targeting other

genetic changes in lung tumors

may help stop or slow the growth

of NSCLC. An example is anaplastic

lymphoma kinase (ALK) inhibitors.

Mutations in the ALK gene are

found in about 5% of patients with

NSCLC. Another example are drugs

that target changes in a gene called

ROS1.

IMMUNOTHERAPY

lmmunotherapy is designed to boost

the body’s natural defenses to fight the

cancer. It uses materials made either by

the body or in a laboratory to improve,

target, or restore immune system

function.

GETTING CARE FOR SYMPTOMS AND SIDE EFFECTS

Cancer and its treatment often

cause side effects. In addition to

treatments intended to slow, stop, or

eliminate the cancer, an important

part of cancer care is relieving a

person’s symptoms and side effects.

This approach is called palliative

or supportive care, and it includes

supporting the patient with his or her

physical, emotional, and social needs.

Palliative care is any treatment that

focuses on reducing symptoms,

improving quality of life, and

supporting patients and their families.

Any person, regardless of age or type

and stage of cancer, may receive

palliative care. It works best when

palliative care is started as early

as needed in the cancer treatment

process. People often receive

treatment for the cancer at the same

time that they receive treatment to

ease side effects. In fact, patients who

receive both at the same time often

have less severe symptoms, better

quality of life, and report they are

more satisfied with treatment.

• A WEDGE RESECTION. If the

surgeon cannot remove an entire

lobe of the lung, the surgeon can

remove the tumor, surrounded by a

margin of healthy lung.

• SEGMENTECTOMY. This is another

way to remove the cancer when an

entire lobe of the lung cannot be

removed. In a segmentectomy, the

surgeon removes the portion of the

lung where the cancer developed.

• PNEUMONECTOMY. If the tumor is

close to the center of the chest, the

surgeon may have to remove the

entire lung.

ADJUVANT THERAPY

“Adjuvant therapy” is treatment that

is given after surgery to lower the risk

of the lung cancer returning. Adjuvant

therapy may include radiation therapy,

chemotherapy, targeted therapy,

or immunotherapy. Each therapy is

described below. It is intended to get

rid of any lung cancer cells that may

still be in the body after surgery. It

also helps lower the risk of recurrence,

though there is always some risk that

the cancer will come back.

RADIATION THERAPY

Radiation therapy is the use of high

energy x-rays or other particles to

destroy cancer cells. If you need

radiation therapy, you will be asked

to see a specialist called a radiation

oncologist. A radiation oncologist is

the doctor who specializes in giving

radiation therapy to treat cancer.

The most common type of radiation

treatment is called external-beam

radiation therapy, which is radiation

given from a machine outside the

body. A radiation therapy regimen, or

schedule, usually consists of a specific

number of treatments given over a

set period of time. This can vary from

just a few days of treatment to several

weeks.

Like surgery, radiation therapy cannot

be used to treat widespread cancer.

Radiation therapy only destroys

cancer cells directly in the path of

the radiation beam. It also damages

the healthy cells in its path. For this

reason, it cannot be used to treat

large areas of the body.

SIDE EFFECTS OF RADIATION THERAPY

Patients with lung cancer who receive

radiation therapy often experience

fatigue and loss of appetite. If radiation

therapy is given to the neck or center of

the chest, patients may develop a sore

throat and have difficulty swallowing.

Patients may notice skin irritation,

similar to sunburn, where the radiation

therapy was directed. Most side effects

go away soon after treatment is

finished.

If the radiation therapy irritates or

inflames the lung, patients may develop

a cough, fever, or shortness of breath

months and sometimes years after

the radiation therapy ends. About 15%

of patients develop this condition,

called radiation pneumonitis. If it is

mild, radiation pneumonitis does not

need treatment and goes away on its

own. If it is severe, a patient may need

treatment for radiation pneumonitis

with steroid medications.

CHEMOTHERAPY

Chemotherapy is the use of drugs to

destroy cancer cells, usually by ending

the cancer cells’ ability to grow and

divide. It has been shown to improve

both the length and quality of life for

people with lung cancer of all stages.

Chemotherapy is given by a medical

oncologist, a doctor who specializes in

treating cancer with medication.

Systemic chemotherapy gets into the

bloodstream to reach cancer cells

throughout the body. Common ways

to give chemotherapy include an

33

LOW-DOSE CT

SCREENING

FOR

LUNG CANCER

While cigarette smoking rates in the

United States have steadily decreased

over the past 50 years, lung cancer still

remains the leading cause of cancer

deaths in both men and women,

especially in our tristate area. Every

year we lose more people to lung

cancer than breast, colon and prostate

cancers combined. BUT, we at Holzer are

changing all of that!

REQUIREMENTS FOR

THE LOW-DOSE CT

LUNG CANCER

SCREENING:

Individuals must be

55-77 years old

Individuals must be a

current smoker with a

history of smoking 2

packs per day for 15

years or one pack per

day for 30 years

or

Individuals must be

an ex-smoker who has

quit smoking within

the past 15 years

Holzer Health System now offers a service called Low-Dose CT Screening

for Lung Cancer. Low-Dose CT Screening is basically a CAT Scan using

a lower dosage of radiation to look for nodules in the lungs. It’s a test to

check for disease in someone who does not have any symptoms. According

to the National Cancer Institute, scientists have found a 20% reduction in

deaths from lung cancer among current or former heavy smokers when

screened with Low-Dose CT versus those screened by chest x-ray. CT

Scanning provides detailed, cross-sectional pictures of the lungs that let us

see very small nodules very closely.

The criteria to be eligible for screening are: Patients between the ages of 55-77;

have a 30 pack-year of smoking; or have quit within the last 15 years.

In the year 2016 we completed Low-Dose CTs on 116 patients with a percentage

rate of 30% of these patients having an abnormal outcome. The goal of

screening is to find cancer early when it is more treatable and even curable.

The screening itself is quick and painless; the scan is done while the patient

holds his breath for 5 to 10 seconds and its noninvasive, no contrast dye is

administered and no IV is required. The radiation dose is extremely low, less

than one-fifth of a routine chest CT Scan. The cost of the screening is $100. We

currently have funding provided by a Grant from Whedon Cancer Institute to

off-set this cost if the patient qualifies. We provide this service at our Gallipolis

and Athens locations.

We had a community awareness event called Shine A Light on Tuesday,

November 1, 2016 at the Holzer Center for Cancer Care. The goal of the Shine A

Light Event was to create more awareness and education on lung cancer in our

community. Our featured speaker, David Clagg, is walking proof that the Holzer

Low-Dose CT Program works.

34 35

PATIENT STORY

Holzer Staff, Community Shine Awareness on Lung Cancer

Holzer offered the Shine a Light

on Lung Cancer event on Tuesday,

November 1, at the Holzer Center for

Cancer Care. Shine a Light is the largest

coordinated awareness event for lung

cancer in the United States.

“Cancer changes how you spend

your time. It changes what tomorrow

means. But there is hope,” stated Sandy

Thomas, Program Coordinator, Low-Dose

CT Scan, Holzer Health System. “We are

not promised tomorrow, but with the

technology and advances of healthcare

through the utilization of our program,

we are able to offer hope to individuals

when it is needed most. The goal of the

Shine A Light event is to create even

more awareness and education on lung

cancer in our communities.”

The event featured guest speaker

Ghada Kunter, MD, Radiation Oncology,

Holzer Center for Cancer Care, and Candy

Bowers, who shared the story of her

father, David Clagg, a former patient of

the Holzer Low-Dose CT Scan Program.

“As a physician, I hope to cure every

patient,” stated Dr. Kunter. “It is crucial

to increase awareness in our area. I see

many patients who have smoked from a

very young age. Through events like this,

we are able to shine a light for those who

have passed and those who are currently

fighting cancer.”

“My dad was a smoker from his teens,

and actually quit 10 years ago,” shared

Bowers. “He was the walking definition

of high-risk for lung cancer, but has

always been relatively healthy. He had

no symptoms and through the years, his

numbers always came back in the good

category. We spoke to his Family Practice

Physician about the screening, and since he

fit the qualifications, he agreed to have it.”

In October 2015, Clagg had a Low-Dose

CT Scan at Holzer in Gallipolis. The scan

results warranted a referral to The James

Cancer Center in Columbus, Ohio. “I had

the scan just to appease everyone,” said

Clagg. “I didn’t feel bad, my appetite was

good, I had no symptoms of lung cancer

yet. However, early detection is the key.”

“They removed a tumor from Dad’s

lung. It took three months to reach full

recovery. In October of 2016, he received

an all clear for the year,” commented

Bowers. “Dad is still here because of this

screening tool. Lung cancer does not

have to be a death sentence. My family

and I firmly believe that God had his

hands in this from the beginning. We

are here to share his story to make a

difference in someone’s life.”

According to the Lung Cancer Alliance,

lung cancer causes more deaths each

year than breast, prostate, colon and

pancreatic cancers combined. Nearly 80

percent of those diagnosed are former or

non-smokers. Unfortunately, lung cancer

receives the least amount of research

dollars of all major cancers.

For more information, call 740-441-

3905 or visit www.holzer.org.

Sandy Thomas, Program Coordinator, Low-Dose CT Scan, Holzer Health System

“CANCER CHANGES HOW YOU

SPEND YOUR TIME. IT CHANGES

WHAT TOMORROW MEANS. BUT

THERE IS HOPE. WE ARE NOT

PROMISED TOMORROW, BUT WITH

THE TECHNOLOGY AND ADVANCES

OF HEALTH CARE THROUGH THE

UTILIZATION OF OUR PROGRAM,

WE ARE ABLE TO OFFER HOPE TO

INDIVIDUALS WHEN IT IS NEEDED

MOST. THE GOAL OF THE SHINE

A LIGHT EVENT IS TO CREATE

EVEN MORE AWARENESS AND

EDUCATION ON LUNG CANCER IN

OUR COMMUNITIES.”

Shown pictured is David Clagg, center, Holzer Low-Dose CT Scan former patient, and his family during the recent Shine A Light on Lung Cancer Awareness Event. Clagg and his daughter, Candy Bowers, second from right, who is also a Holzer employee, shared their story as part of the evening’s program.

INSET Photo: Ghada Kunter, MD, Hematology, Oncology, Holzer Center for Cancer Care, speaks during the Shine a Light on Lung Cancer event.

36 37

38 39

Treatment options are determined by the type (Small Cell & Non-Small Cell)

and stage of the cancer. Treatments include: surgery, radiation therapy,

chemotherapy, and targeted biologic therapies such as Avastin, Tarceva, and

Xalkori. For localized cancers, surgery is usually the treatment of choice and

is improved by chemotherapy following surgery for non-small cell tumors.

Because the disease has usually spread by the time it is discovered, radiation

therapy and chemotherapy are often used, sometimes in combination with

surgery. Advanced-stage non-small cell lung cancers are usually treated

with chemotherapy, targeted drugs, or some combination of the two.

Chemotherapy alone or combined with radiation is the usual treatment of

choice for Small Cell Lung Cancer; on this regimen, a large percentage of

patients experience remission, although, the cancer often returns.

HISTOLOGY NBR_CASES

Small Cell Carcinoma

15

Non-Small Cell Carcinoma

47

TOTAL CASES 62

HISTOLOGY Distribution2016 Lung Cases by Histology

As previously stated, the two types of lung cancer are Small Cell (SCLC) and Non-Small Cell (NSCLC). Non-small

cell lung cancer usually grows and spreads to other parts of the body more slowly than small cell lung cancer.

There are three different types of Non-Small Cell Lung Cancer: Adenocarcinoma, Squamous Cell Carcinoma and

Large Cell Carcinoma. Each type is different, but they are grouped together because they are treated similarly.

Small cell lung cancer is almost always associated with cigarette smoking. It is important to know the type of lung

cancer you have because it helps determine what treatment options are available.

Rx TYPE # of CASES

No Treatment 23

Chemo/Rad 11

Chemo only 9

Radiation only 7

Surgery/Chemo 5

Surgery only 3

Surgery/Chemo/Rad 2

Surgery/Rad 2

TOTAL CASES 62

Treatment Combination2016 Lung Cases by Treatment

2016 LUNG

CASES

FOR

HOLZER

TREATMENT

No Treatment

Chemo/Rad

Chemo only

Radiation only

In Ohio, between 2006 and 2010, 95% of individuals who developed lung and bronchus cancer were age 50 and older. In 2016, HCCC

shows a rate of 99.9%.

There are more women diagnosed with stage 1 lung cancer. Lung and Bronchus cancer is more common in men than women. For

Holzer patients in 2016, 46% were women and 54% were men.

AGE RANGE MALE FEMALE

40-49 1 1

50-59 3 4

60-69 11 11

70-79 9 12

80-89 6 4

TOTALS 30 32

Lung Cases by Age & Sex

STAGE MALE FEMALE

I 3 6

II 5 0

III 8 11

IV 14 14

UNK 0 1

TOTALS 30 32

AJCC Stage by Sex2016 Lung Cases by Sex by Stage

HCCC covers a broad geographical area. Counties represented

in 2016 were Gallia, Meigs, Jackson, Vinton, Ohio, and Mason

County, West Virginia.

Diagnosis County Distribution2016 Lung Cases by County

DIAGNOSIS COUNTY CASES

Gallia 28

Meigs 12

Jackson 9

Mason County, WV 9

Athens 2

Vinton 2

TOTALS 62

COUNTIES

Mason County

West Virginia

40 41

12

5

34

1. Gallia2. Jackson3. Meigs4. Athens5. Lawrence

170JacksonPike•Gallipolis,Ohio1.855.4HOLZER (1.855.446.5937)

www.holzer.org

On behalf of Holzer and its Cancer Committee, we want to thank our awesome community

members for your generous and steadfast support for the past 80 years. Together we will

continue to grow and develop expertise in broader and more sophisticated treatments and

support our patients and their families in the fight against cancer.

Dr. Alice Dachowski, Cancer Liaison Physician