Park Ridge Health 2013 - 2014 Annual Report - Cancer Services

Taking Cancer Care to Heart2013 - 2014 ANNUAL REPORT

B R E A S T C E N T E R

Park Ridge Health’s oncology program has been recognized by the American College

of Surgeons’ Commission on Cancer as offering the very best in cancer care.

Providing the best in cancer care in an atmosphere of Christian compassion and healing.

Table of Contents

1


Park Ridge Health Cancer Services

2 Introduction3 Cancer Liaison Physician4 Park Ridge Health Breast Center5 Cancer Registry 20136 Summary of Cancer Registry Data7 Geographic Distribution7 Age at Diagnosis8 Top 10 Cancer Sites9 Analysis: Community Needs Assessment10 Leading New Cancer Cases11 Cancer Profiles12 Patient Access13 Identified Disparities in Henderson County14 Identified Barriers from Data Analysis15 Resources & Tools Utlized in Assessment16 Community Outreach17 Locations18 Park Ridge Health Cancer Program Leadership Team20 References20 Acknowledgements

2 32013-2014 Annual Report Park Ridge Health Cancer Services

IntroductionAt Park Ridge Health we work hard to ensure we offer our patients the absolute best in health care. Accredited by the Commission on Cancer as a Community Cancer Program and the National Accreditation Program of Breast Centers, we seek to meet and exceed the current standards of cancer care, and during 2014 we implemented several quality improvements to further that goal.

To better serve the community, we expanded our outpatient oncology services to include the addition of an outpatient infusion center in Weaverville, NC. In addition, data is analyzed regularly with the Cancer Committee at PRH. As a result, within this report is our community needs assessment addressing identified key disparities and barriers to cancer care in our communities.

Our vision continues to be to deliver oncology health care to meet the needs of our community as part of Christ’s healing ministry and to incorporate Christian values at every level. We are committed to providing and improving upon screening and wellness programs to promote early detection. We continue to offer our patients high quality treatment and care in the comfort of their hometown with the support of their families.

The Cancer Liaison Physician program was established by the Commission on Cancer to allow physicians to manage clinically related cancer activities in their hospitals and communities. In this role, the Cancer Liaison Physician (CLP) is a liaison between the cancer program, the Commission on Cancer and the American Cancer Society. The Cancer Liaison Physician is responsible for reporting on the program’s performance using the National Cancer Data Base (NCDB) data four times per year. The NCDB data includes the Cancer Program Practice Profile Reports (CP3R), Hospital Comparison Benchmark reports and Survival reports. This data is used to evaluate and improve the quality of care at our institution. Dr. Michelle LeBlanc has been serving as the Cancer Liaison Physician for the cancer program at Park Ridge Health since 2011.

Cancer Liaison Physician

Michelle LeBlanc, M.D.

54 Park Ridge Health Cancer Services2013-2014 Annual Report


National Consortium of Breast Centers

The Park Ridge Health Breast Center is designed with women’s breast health in mind. It is a member of the National Consortium of Breast Centers, recognized as a Certified Participant in the NQMBC program through the NCBC and designated as a Breast Center of Excellence through the American College of Radiology (ACR).

The Breast Center is a multidisciplinary “clinic without walls” and offers breast surgery, medical oncology, radiation oncology, plastic surgery, an interdisciplinary breast cancer conference, genetic counseling, pathology, psychological counseling through a licensed oncology social worker, a certified lymphedema therapist, patient navigator, clinical trial nurse and many other services either directly or by referral. Patients are seen not only for malignant disease, but also for a variety of breast concerns.

The Center also offers in-office diagnostic ultrasound as well as ultrasound-guided procedures, such as vacuum-assisted core-needle biopsy and stereotactic breast biopsy. Other services include mammography and breast MRI (accredited through the American College of Radiology (ACR). Surgical procedures are all performed on the Park Ridge Health campus. A mammogram call-back is provided within 24 hours of the procedure for all patients.

The center is staffed with Oncology Certified Nurses and a Breast Health Navigator who coordinates individualized care for each of our patients at the clinic, as well as preoperative and postoperative education to all patients undergoing breast surgery. Our specialized team contacts all mammography patients and facilitates the Breast Cancer Survivor and Friends support group, referrals and follow-up visits. Our Breast Health Navigator also coordinates the American Cancer Society WNC Patient Resource Center, which is located at the Breast Center, as well as the Look Good Feel Better video classes and Reach for Recovery referrals. Additionally, our care team also consists of an ONS Certified Breast Care Nurse and Breast Self-Examination Instructor through the NCBC.

Our Medical Director, Don V. Jackson, Jr., M.D., is board-certified in Oncology. Our surgeon, Michelle LeBlanc, M.D., is board-certified in Obstetrics and Gynecology, and is an Associate of the American Society of Breast Surgeons and the Mastery of Breast Surgery Certification Program. Dr. David C. Price is board-certified in General Surgery, is a Fellow of the American College of Surgeons and is an associate of the American Society of Breast Surgeons and the Mastery of Breast Surgery Certification Program.

The Cancer Registry uses a data system designed for the collection, management, analysis and reporting of information on patients with cancer who have been diagnosed and/or treated through Park Ridge Health. As required by law, each diagnosis of cancer or benign brain or central nervous system tumors in any person who is screened, diagnosed or treated by the facility, is reported to the North Carolina Central Cancer Registry, a unit of the North Carolina State Center of Health Statistics within the Division of Public Health, Department of Health & Human Services.

The Cancer Program at Park Ridge Health is accredited by the American College of Surgeons, Commission on Cancer as a Community Hospital Cancer Program. Since 2005, the Cancer Registry at Park Ridge Health has accessioned nearly 3000 cases into its database. Annually, Cancer Registry data is reported to the Commission on Cancer, National Cancer Data Base for use in national comparative studies; part of a nationwide effort to compile data on the diagnosis and treatment of all types of cancer.

The Cancer Registry coordinates the multidisciplinary Cancer Conferences. These conferences provide consultative services for patients and focus on pre-treatment evaluation, staging, treatment strategy and rehabilitation. The conferences offer education to physicians and allied health professionals in attendance. During 2014 there were 97 cases reviewed during cancer conference involving various cancer topics.

The Cancer Registry conducts annual follow-up on all patients treated for cancer at Park Ridge Health. This follow-up serves as a reminder to both physicians and patients to schedule regular physical examinations. The Cancer Registry at PRH continues to maintain a successful follow-up rate in accordance with Commission on Cancer standards.

Cancer Registry

6 7Park Ridge Health Cancer Services2013-2014 Annual Report

During 2013, there were 737 new cancer cases accessioned into PRH’s Cancer Registry. Of these, 65% were analytic cases (initially diagnosed and/or treated at PRH). The remaining 35% were non-analytic cases (diagnosed and/or treated elsewhere receiving subsequent treatment at PRH).

The Primary Site Table (to the right) reveals anatomical sites for all cancer that were either diagnosed and/or treated at PRH during 2013.

Summary of Cancer Registry Data for 2013:

Distribution of Cancer by Site - 2013 CasesAll Sites Total Cases Analytic Non-Analytic Male Female 737 474 263 277 460

Oral Cavity 22 18 4 17 5Digestive System 95 62 33 52 43 Esophagus 7 6 1 7 0 Stomach 4 3 1 2 2 Colon 34 21 13 16 18 Rectum 14 9 5 9 5 Liver 12 6 6 11 1 Pancreas 15 12 3 5 10 Other 7 4 3 2 5Respiratory System 78 56 22 34 44 Nasal/Sinus 1 0 1 0 1 Larynx 4 3 1 2 2 Lung/Bronchus 73 53 20 32 41Blood & Bone Marrow 95 38 57 48 47 Leukemia 43 14 29 24 19 Multiple Myeloma 16 9 7 6 10 Other 36 15 21 18 18Soft Tissue 5 2 3 1 4Skin 22 17 5 13 9 Melanoma 22 17 5 13 9Breast 205 152 53 1 204Female Genital System 48 33 15 0 48 Cervix Uteri 3 1 2 0 3 Corpus Uteri 22 21 1 0 22 Ovary 11 5 6 0 11 Other 12 6 6 0 12Male Genital System 44 19 25 44 0 Prostate 41 18 23 41 0 Other 3 1 2 3 0Urinary System 40 30 10 27 13 Bladder 26 21 5 22 4 Kidney/Renal 13 8 5 5 8 Other 1 1 0 0 1Brain & Cns 7 3 4 3 4Endocrine 7 6 1 3 4 Thyroid 7 6 1 3 4Lymphatic System 55 32 23 29 26 Hodgkin’s Disease 4 3 2 2 2 Non-Hodgkin’s 51 29 22 27 24Unknown Primary 11 4 7 4 7Other/Ill-Defined 3 2 1 1 2

Burke2.3%Buncombe

26.3%McDowell

4.0%Graham.6%

Haywood18.5%

Madison1.5%

Transylvania2.7%

Jackson.8%

Henderson31.2%

Polk3.2%

Rutherford2.3%

Yancey1.3%

Mitchell.4%

Overall Total Nbr/Percentage 100%

Caldwell.4%

Cherokee.2%

Macon.8%

Swain1.3%

Avery.2%

Not Shown - Duplin .2%

Gaston.2%

Out of State 1.3%

A large majority of the patients diagnosed and/or treated during 2013 were residents of Henderson County.

Geographic Distribution: 2013 Analytic Cases

Age at DiagnosisThe gender distribution of all cancer patients at PRH during 2013 (analytic cases) was 36% male and 64% female. The largest age distribution of patients was between the ages of 60 and 69 years (31%), followed by the 70 to 79 age group (25%).

0

20

40

60

80

0-9 10-19 20-29 30-39 40-49 60-6950-59 70-79

AGE BY GENDER 2013

Male

Female

100Age By Gender 2013

Overall TotalPercentage 100%


Ten Most Prevalent Cancer Sites 2013TEN MOST PREVALENT CANCER SITES 2012

Corpus Uteri

Nh Lymphoma

Bladder

Colorectal

Prostate

Lung

Breast

Cervix

Leukemia

Melanoma

0% 5% 10% 15% 20% 25% 30% 35%

Park Ridge Health 2013Acs Projected Figures North Carolina 2013

Acs Projected Figures National 2013

Top 10 Cancer Sites at PRH Compared ACS NC/National

As shown above, cancer prevalence represents the most common cancers diagnosed and/or treated at PRH in 2013 compared to those estimated across North Carolina and the United States according to the American Cancer Society, Cancer Facts & Figures 2013. Incidence rates of breast cancer and melanoma were slightly higher than national and state figures. Incident rates for lung, prostate and colorectal cancer were slightly lower than state and national figures.

These estimated numbers of new cases as published from The American Cancer Society Cancer Facts & Figures 2013. PRH figures were obtained from the total number of analytic cases accessioned during 2013.

Respectfully Submitted, Park Ridge Health Cancer Registry.

The Commission on Cancer Accreditation Standard 3.1 requires a Community Needs Assessment every three years. The goal of the Community Needs Assessment is to understand and address the disparities and barriers to cancer care in our

communities. Park Ridge Health Cancer Services performed the community needs assessment in 2014. Results of our findings

and efforts to address these concerns are provided in this report.

Cancer Services Community Needs Assessment Overview


Percent ofTotal Cases

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Other

Urinary Bladder

Prostate

Non-Hodgkin Lymphoma

Melanoma (skin)

Lung & Bronchus

Colon & Rectum

Breast Female

PRH 2013North Carolina Henderson Co.National

641,410

109,020

233,000

70,800

76,100

224,210

78,330

232,670

18,490

2,170

7,580

2,110

2,540

7,850

4,230

7,580

391

-

129

-

-

140

75

137

155

21

18

28

16

54

30

153

Cancer Services Survey Results - Access to CareDuring the week of September 22 – 26, 2014, Park Ridge Health Cancer Services surveyed its cancer patient population. Three of our four locations (Hendersonville, Asheville and Clyde) participated in the survey and 154 surveys were collected. The results are shown below:

Population SurveyedGender: 51% Male 49% Female Race: 88% Caucasian 8% Other 4% African American Age: 62% 65 and Older 23% 55-64 12% 45-54Payor: 67% MCR & MCR HMO 11% HMO, PPO 11% Medicaid & Private PayLocation: 48% Asheville 26% Hendersonville 26% Clyde

Disease InformationPrimary Cancer: 49% Other 20% Breast 14% Lung 18% Colon 5% Prostate

51% Had a Secondary Chronic Disease: 31% High Blood Pressure 14% Diabetes & Weight Problems

Lifestyle16% Smoker with 38% having access to Smoking Cessation Classes68% Access to 5-9 servings of fruits and vegetables a day42% Apply sunscreen before outdoor activities

Cancer Profiles – Park Ridge Health

Leading New Cancer Cases 2014 Estimated

The following statistics show the comparison of the leading new cancer cases and deaths on a national level compared to North Carolina, Henderson County and Park Ridge Health. The total cases are shown in the chart below with their percentages graphed for comparison purposes.

Data Collection Analysis

At the national level, the top two new cancer cases estimated for 2014 are Prostate and Breast (female) cancers, with new Lung cases a close second. In North Carolina, new Prostate and Breast cancer cases are equal to what we are seeing nationally, however, they are second to Lung at 15%.

For Henderson County, Breast and Lung are the leading cancer diagnosis with Prostate close behind. 2013 Park Ridge Health abstractions show Breast continues to lead, followed by Lung. Colon/Rectum and Non-Hodgkin Lymphoma tied, showing as the third leading diagnosis for the first time.


Patient Access

0%

20%

40%

60%

80%

Fam

ily P

ract

ice

ACCESS TO PHYSICIANS IN THE COMMUNITY

100%

Inte

rnal

Med

icin

eO

phth

alm

olog

yO

rthop

edic

s

ENT

Neuro

logi

st

Gen

eral

Sur

geon

Onc

olog

ist

Urol

ogist

Psyc

hiat

rist

Car

diol

ogist

81%

39%49%

30% 34% 29%38%

64%

38% 38%30%

0%

10%

20%

30%

40%

Clin

ical

Bre

ast

ACCESS TO SCREENINGS

50%

Col

onos

copy

Mam

mog

ram

Pap

Smea

rPr

osta

te P

SASk

in C

A Ec

am

60%

70%

45%

64%

48%

42% 42%

50%

Access To Screenings

Identified Disparities in Henderson CountyAccess to Other

Park Ridge Health Services

0%10%20%30%40%

Soci

al W

orke

r

ACCESS TO OTHERPARK RIDGE HEALTH SERVICES

50%

Nurse

Nav

igat

or

Finan

cial

Cou

nsel

or

Rese

arch

Stu

dies

Supp

ort G

roup

sCA

Info

rmat

ion

60%70%

41% 42% 45%

34%40%

77%80%90%

Access To Physicians in the Community What Are Health Disparities?National Cancer Institute defines health disparities as gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level. These disparities may stem from many factors, including accessibility of health care, increased risk of disease from occupational exposure, and increased risk of disease from underlying genetic, ethnic or familial factors.

1. Ethnic Factors – Increased Breast Cancer Risks American white women have the highest incidence rate for breast cancer. Henderson

county is 84% white with the population of 52% female. Projected incident rates for Breast Cancer are slightly higher in North Carolina than the national average. Park Ridge Health is significantly higher.

2. Lifestyle Factors – Increased Lung Cancer Risks Unhealthy lifestyles increase risk factors for cancer including: tobacco smoking, physical

inactivity, obesity, excessive alcohol intake, work environmental toxins and eating unhealthy. The results of a larger Needs Assessment Survey showed the increased risks for the Community. For example, the WNC Healthy Impact Partnership selected health priorities for Henderson county for 2011-2015 as: obesity, substance abuse/prescription drug abuse and access to mental health care.

3. Economic Factors – Increased Colon & Prostate Risks People with low income, lack of health insurance, medically underserved (limited

access to effective health care) and screening recommendations not being followed, create higher risks for cancer. There are often transportation issues and the inability to take time off from work, which leads to not obtaining health care. The financial burden of a prevention screening is not a priority. In Henderson county, 13.5% of all the households are below the national poverty level.

Access to Cancer Information:

• 87% Physicians & Clinical Staff• 70% Internet• 58% Books & Magazines

• 53% Family Members• 47% Pharmacy• 13% Other

The following resources and tools were utilized to assist in the data collection:

a. Review and summarize NC data from the 2012 Cancer Quality Improvement Program (CQIP) Report.

b. Analyze 2012 Park Ridge Health data, including diagnosis, referring physician, payor and zip code information.

c. Drill down the top 7 diagnosis. Combine remaining diagnosis.

d. Analyze patient payor status to determine financial barriers. Define current financial assistance programs provided to patients and Park Ridge Health support. Evaluate additional options available for patients.

e. Analyze zip code and define market. Define options available in the community and how to access.

f. Incorporate NCCN distress tool findings.

g. Evaluate our current WOW van outreach activities.

h. 2014 September Cancer Services Community Needs Assessment Survey.

i. Cancer Facts and Figures 2014 ACS, Inc., Surveillance Research.

j. Cancer Statistics 2014 A Presentation from the ACS, Inc.

k. 2013 -14 Henderson County Annual Report to the Citizens.

l. 2013 June Cancer Profiles Henderson County Central Cancer Registry.

m. North Carolina Central Cancer Registry Data & Statistics.

n. Center of Disease Control and Prevention: Cancer Prevention & Control.

o. National Cancer Institute FactSheet Cancer Health Disparities & Surveillance data.

p. Evaluate our current navigational process for Breast and define options available to incorporate additional modalities.

q. Evaluate additional administrative support available to assist.

r. Evaluate other navigational services available at Park Ridge Health.

s. Reports of the Surgeon General website.

t. Behavioral Risk Factor Surveillance System.

u. United States Census Bureau County QuickFacts.


Six barriers to cancer care in our community were identified from the analysis. The Cancer Committee concurred that there were similarities that created overlapping. In summary, the barriers can be grouped as follows:

• Insurance changes in our community, such as Self-Pay and Medicaid are increasing, leading patients to not seek care until late stages of cancer diagnosis.

• There is a need for more awareness and access to cancer screenings to identify early stage cancers.

• Expanding the Park Ridge Health current patient navigation process to include more than breast navigation, will encourage patients to stay within the Park Ridge Health network to receive timely and appropriate

cancer care.

Next Steps Define Goals for Focus & Outcome Measures

This Community Needs Assessment Report will guide us in supporting our community, specifically by improving access to cancer care. Each year, the Cancer Committee will review what goals were achieved and set goals for the following year. Statistics will be updated on an as needed basis. A new Community Needs Assessment will be completed in 2017. To overcome the barriers identified, our focus in 2015 will be on completing the following tasks:

• Create Public Awareness, including: updating the Park Ridge Health Cancer Services website to include screening tools for breast and lung cancer, creating awareness for our employees for cancer screenings,

provide articles in Vital Signs, Citizen Times, Mountain Times, WCMS, PRMA Newsletter and increase participation within Park Ridge Health in the American Cancer Society’s Relay for Life Event in Hendersonville.

• Provide additional Education at the PCP Level, including: providing American Cancer Society guidelines and tools for cancer screenings, recruiting a PRMA PCP physician to join the Cancer Committee, adding a national Lung Screening Tool in Next Gen EMR, educate PRMA PCPs how to utilize the Lung Screening tool and refer to the Cancer Services Navigator.

• Provide additional financial assistance to our cancer patients, including: researching for funding/grants for cancer screenings - including diagnostic screenings, evaluate Low Contrast CT Scans for patients as an alternative for patients and develop or purchase a navigation software to help us navigate patient referrals through the Park Ridge Health network.

Identified Barriers from Data Analysis Resources & Tools Utilized in Assessment


Asheville Hematology & Oncology – Hendersonvillea service of Park Ridge Health 50 Hospital Drive, Suite 4B, Hendersonville, NC 28792828.681.2917

Asheville Hematology & Oncology – Ashevillea service of Park Ridge Health20 Medical Park Drive, Suite B, Asheville, NC 28803828.254.8232AshevilleHemOnc.com Asheville Hematology & Oncology – Weavervillea service of Park Ridge Health179 North Buncombe School Rd., Suite 102, Weaverville, NC 28787828.645.3100AshevilleHemOnc.com

Haywood Infusion Centera service of Park Ridge Health600 Hospital Drive, Clyde, NC 28721828.456.5214

Park Ridge Health Breast Health Center828.650.2790

Cancer Services Blog: prhjourney.com

If you would like more information about any of our Park Ridge Health physicians or to make an appointment, call 855.PRH.LIFE (855.744.5433). Find us online at parkridgehealth.org/cancer-services.

Park Ridge Health Cancer Services Locations

Many Park Ridge Health team members, family and friends, came out to the annual 2014 Henderson County Relay for Life event to volunteer, cheer and show their support for cancer survivors and hope for a cure. In addition, several fundraising events took place to help benefit this worthy cause. Since 2011, Park Ridge Health has raised $11,668 for the Henderson

County American Cancer Society’s Relay for Life.

2014 Cancer-Related Community Outreach ActivitiesDuring 2014 a total of 518 individuals participated in 9 various cancer-related education, prevention and 17 screening activities to include: breast, prostate, cervical, skin and oral cavity.

Kenmure Fights CancerCharitable giving touches the lives and hearts of countless people who battle cancer at Park Ridge Health. For the past several years, the residents of Kenmure, in nearby Flat Rock, have dedicated their annual fundraising efforts toward fighting cancer in our community. Park Ridge Health is deeply grateful to be a beneficiary of Kenmure Fights Cancer and for its 2014 gift totaling $15,311.57 towards the PRH Cancer Program. Thanks to this caring community, Park Ridge Health purchased much needed

equipment for our Infusion Centers to include Infusion Smart Pumps, utilized in our patients’ cancer treatment.

Park Ridge Health Team Relay for Life


Park Ridge Health Cancer Program Leadership

Physician Members

Raymond Thertulien, MD, PhD, Hematology/Oncology, ChairDaniel Baseman, MD, Radiation OncologyQuinten Black, MD, Radiation OncologyGreg Candell, MD, Hospice and Palliative Care Rory Dalton, MD, PathologyAnita Deshpande, MD, Hematology/OncologyCarlton Jenkins, MD, RadiologyMichelle LeBlanc, MD, OB/GYN, Breast Surgeon, Cancer Liaison PhysicianCarlos Mainardi, MD, Chief Medical StaffTram Pham, MD, PathologyDavid C. Price, MD, General Surgery Ralph Ricco, MD, Diagnostic Radiologist

Additional Professional Members

Hilary Alexander, RD, Nutritional ServicesSherri Beane, RN, BSN, Clinical Nurse Manager Cancer Services, Asheville & WeavervilleSarah Bishop, American Cancer Society RepresentativeDenise Burns, Administrative Director Cancer Services, Community Outreach CoordinatorDaniel Figueroa, RN, BSN, Clinical Research CoordinatorDebbie Gentry, MSN, RN, OCN, CBCN, Clinical Director Cancer ServicesDonna Hewitt, RN, BSN, OCN Patient NavigatorLindsay Hyder, RN, Clinical Research Nurse, Coordinator Clinical ResearchRenae Johnson, RN, Director Quality Improvement, Coordinator QIKatherine Kostmayer, SLP, Rehab ServicesSharon Labbate, CTR, Manager Cancer Registry, QC CoordinatorCraig Lindsey, RN, VP, CNO Clinical ServicesMichael Lombardo, Chaplain, Director Pastoral CareBarbara McFarland, MBA, Operations Director Cancer ServicesHarvey Nix, PA, Hospice and Palliative CareTeresa Payne, RN, Clinical Nurse Manager Cancer Services, Haywood & Park RidgeBeth Powell, PharmD, Pharmacy Cancer ServicesPatricia Scholtz, RD, Nutritional ServicesPaula Stegall, PharmD, Pharmacy Cancer ServicesLauren Woodard, MSW, LCSW, OSW-C, Coordinator Psychosocial ServicesDeborah Wooten, RN, Case Management

2014 Cancer Committee Members

21Park Ridge Health Cancer Services20 2013-2014 Annual Report

ReferencesCancer Facts and Figures, American Cancer Society

National Cancer Data Base, Hospital Comparison Benchmark Reports & Survival Reports

Park Ridge Health Cancer Registry

AcknowledgmentsThis has been an outstanding year for our cancer program

and would not be possible without the great team of dedicated professionals working together to meet this goal.

This report can be accessed via the Park Ridge Health website: parkridgehealth.org/cancer-services


Documents

Park Ridge Health 2013 - 2014 Annual Report - Cancer Services