2018 Annual Cancer

Program Report

Table of Contents Chairman’s Comments……………………………………………………..1

Cancer Registry Report…………………………………………………….2

Tumor Conferences………………………………………………………...3

Gender Distribution Compared to State/National Figures…………………4

County of Residence at Diagnosis…………………………………………5

Top Ten Sites by Gender…………………………………………………..6

A Summary of Cancer Screenings………………………………………7-11

On behalf of the Cancer Committee of Baptist Health Floyd, we present to you the annual report that covers

data through 2018. Our cancer program offers patients a full range of advanced diagnostic and treatment

services along with support services via our rehabilitation department, home health services, nutritional

support provided by a dedicated dietician, palliative care, pastoral care, psychosocial care provided by a

dedicated oncology social worker, support groups, survivorship care program, and patient navigators. We

hope you view this program as a resource for education and patient care.

Our patients came from 28 surrounding counties in the states of Indiana and Kentucky, as well as Florida and

Illinois in 2018. Lung cancer has been our most commonly diagnosed malignancy, and given our location, we

have seen relatively more lung cancer cases in males and females, as compared to the state and national

averages. We have also seen a higher volume of breast cancers than the rest of Indiana and the U.S.

Our cancer program is accredited by the Commission on Cancer and our breast program is accredited by the

National Accreditation Program for Breast Centers. Both accrediting organizations are part of the American

College of Surgeons. Our Breast Imaging Center has a Center of Excellence designation by the American

College of Radiology.

Respectfully submitted,

David Stapp, M.D.

Chairman, Cancer Committee

1

Cancer Registry The Cancer Registry is a computerized center responsible for the collection, management, and analysis of

data on patients diagnosed with, or treated for, a malignant disease. The registrars collect demographic

information including age, gender, race, date of birth, residence, and smoking history. Also collected are:

medical history, diagnostic findings including method of diagnosis, primary site, cell type, extent of disease,

therapy and follow-up information.

The information that is collected is reported, according to federal law and with confidentiality, to the state

registry at the Indiana State Department of Health and to the National Cancer Data Base. Data is utilized by

local, state, and national cancer agencies in making important health decisions to maximize public health

funds for screening and education programs. The information collected is also a valuable tool used by

physicians and researchers in the area of etiology, diagnosis, and treatment. The follow-up information

collected serves as a reminder to patients and physicians to schedule regular checkups, and provides survival

and disease-free intervals.

In addition to providing information required by law, the registry also maintains the documentation

necessary for cancer program accreditation by the American College of Surgeons’ Commission on Cancer and

accreditation by the American College of Surgeons’ National Accreditation Program for Breast Centers.

The registrars also coordinate Cancer Committee meetings quarterly, conduct site-related quality studies,

collaborate with physicians for quality control of registry data, and plan/staff Tumor Conferences.

In 2018, there were a total of 737 cases entered into the registry. These included 690 newly diagnosed

cases and 47 cases of recurrent/progressive disease. A total of 10,931 newly diagnosed cases have been

accessioned since our reference date, January 1, 1997. The total percentage of current follow-up since our

reference date is 89.58%, exceeding our target of 80%, and current follow-up for the most recent five years is

94.46%, exceeding our goal of 90%.

It is the goal of the certified registrars to attend a national or regional meeting at least once every three

years. In 2018, the staff assisted in planning the second Regional Cancer Registrars’ Meeting, which was a

cooperative effort between the Kentucky Cancer Registry, the Indiana Cancer Consortium, and the Southern

Ohio Cancer Registrars’ Association.

Finally, the Cancer Registry staff is interested in community service and cancer prevention. Staff served

on the Floyd County Relay for Life Committee. They provide data for grants to support programs for the

underserved/underinsured in our community.

The Cancer Registry is located in the Lower Level of the Cancer Center of Indiana and is staffed by Jill

Aemmer, C.T.R.; Shirley Edlin, C.T.R.; and Michele Hoskins, B.A., C.T.R. For more information or to

request data, please call 812-981-6605 or 812-949-5541.

2

Tumor conferences are designed to improve the care of patients with cancer by providing multidisciplinary

treatment planning. Twice monthly, a group of physicians including surgeons, medical oncologists, radiation

oncologists, radiologists, pathologists, primary care, palliative care or other sub-specialties gather with other

health care professionals to discuss the cancer cases seen at Baptist Health Floyd.

We offer two types of tumor conferences, a facility-wide multidisciplinary Tumor Board where all types of

cancer are discussed, and, a site-specific Breast Conference. These conferences adhere to specific guidelines

set by the American College of Surgeons’ Commission on Cancer and the National Accreditation Program for

Breast Centers. The goal is to present at least 15% of the analytic cases, or those cases diagnosed and/or

receiving all or part of their care at Baptist Health Floyd.

The patient’s medical history is given, and radiological studies are reviewed along with pathology slides.

There is an opportunity in these conferences for the patient care team to discuss the treatment plan face-to-face

while reviewing the nationally accepted treatment guidelines.

The following primary cancer sites were discussed at conferences in 2018:

Anal canal GE junction Penis

Anus Intrahepatic bile duct Rectosigmoid

Bladder Kidney Rectum

Bone Liver Skin

Bone marrow Lymph node Small intestine

Brain Lung Soft tissue

Breast Mediastinum Stomach

Colon Ovary Testis

Esophagus Pancreas Thymus

Unknown primary

Physicians participating in the 2018 program:

What is a Tumor Conference?

Dr. Daniel Altman

Dr. Deepak Azad

Dr. Laura Barkley

Dr. Brett Batchelor

Dr. Michael Bousamra

Dr. Jordan Brown

Dr. Naveed Chowhan

Dr. John Clayton

Dr. Kelly Colomb

Dr. John Cox

Dr. Yasoda Devabhaktuni

Dr. Michael Doyle

Dr. Azmi Draw

Dr. William Garner

Dr. Kendall Goldschmidt

Dr. Lanny Gore

Dr. Matthew Hennig

Dr. Craig Kamen

Dr. Ajay Kandra

Dr. Ilana Kogan

Dr. Michael Mays

Dr. Paddy McCormick

Dr. Hans Mouser

Dr. Matthew Nett

Dr. Roseline Okeke

Dr. David Rankin

Dr. Edsel Reed

Dr. James Rizzo

Dr. David Rodriguez

Dr. Kevin Serey

Dr. Parag Sevak

Dr. Todd Shanks

Dr. David Stapp

Dr. Scott Stevens

Dr. Andrea Walker

Dr. Brian Worm

2018 Cancers in Females Baptist Health Floyd* Indiana** National***

Breast 35% 27% 30%

Lung 24% 15% 13%

Colorectal 8% 9% 8%

Brain/CNS 5% 4% 1%

Non-Hodgkin’s 4% 3% 4%

Lymphoma

2018 Cancers in Males Baptist Health Floyd* Indiana** National***

Lung 33% 19% 13%

Colorectal 11% 9% 9%

Non-Hodgkin’s 6% 4% 5%

Lymphoma

Urinary bladder 5% 7% 7%

Leukemia 4% 3% 4%

Of interest, our incidence of male lung cancers has risen 3% over 2017 numbers. Incidence of male lung

cancer in Indiana has risen 2% since 2017 but has dropped 1%, nationally. Our incidence of female lung

cancers has also risen 3% over 2017. Both of our male and female lung cancer rates are still much higher

when compared to state and national figures. The increase could be related to our aggressive screening

program and coordination of care by our Lung Navigator. Our breast cancer incidence is slightly lower than

2017, but continues to be much higher than the state and national average, which has remained relatively

stable. This is perhaps related to the efforts of our Breast Nurse Navigator and NAPBC-accredited program.

The incidence of both male and female colon cancer has risen at the local, state, and national levels and may

be related to the “80 by 18” screening initiative. Both male and female non-Hodgkin’s lymphomas and

leukemia are in line with national data and are ahead of state data, likely due to our active oncology group.

*Baptist Health Floyd data based on 2018 figures.

**State data courtesy of Indiana State Department of Health and is based on 2016 data.

***National data courtesy of CA-A Journal for Clinicians, 2019.

4

5 A total of 96.16% of our patients who have cancer are from Indiana counties (over 75% of our patients

live in Clark, Floyd, and Harrison counties). A total of 3.56% of our patients resided in Kentucky counties. There was a total of 0.14% of patients from Illinois and 0.14% from Florida.

36.09%

17.50%

23.07%

11.13%

3.66%

1.36%

1.09%

2018 County of Residence at Diagnosis

1.36%

0.14%

0.14%

0.14%

0.27%

0.14%

0.14%

6

Community Outreach in Cancer

2018 Individual Event Report Summary

Date: January 1, 2018 – December 31, 2018

Event Name: Colon Cancer Screening Program

Screening Type: Occult Blood Screening Kits

Location: Kits provided at various locations in our region

Target Population: Adults, at-risk individuals Number Screened YTD: 19

How was the need determined for this outreach activity?

Floyd County, Indiana, has a high risk of deaths related to colon cancer. Information for this can be found at the

Floyd County Health Needs Assessment, floydfoundation.org

List the nationally accepted, evidence-based guidelines that directed this activity.

The CDC recommends annual FOBT (fecal occult blood testing) for adults over the age of 50.

http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm

http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm

Discuss the mechanism in place to ensure follow-up of all positive findings identified through the activity.

All participants are mailed their results along with a letter recommending follow up with their primary care

physician. They are given a number to call if they do not have a primary physician. All positive results receive a

follow up phone call with a registered nurse to discuss next steps in their care and answer any questions they

may have.

Evaluate the effectiveness of access and referral processes.

Occult blood screening kits are available at many of Baptist Health Floyd’s community events. In addition, they

can be picked up for free at the front desk of our Cancer Center. Over 200 kits were distributed at 16 sites.

What is the overall summary of this event?

Year to date, 19 people have participated in this free screening. There were 16 negative results and 3 with a

positive result (RN followed up with patients who were to see their primary care provider).

7

Community Outreach in Cancer

2018 Individual Report Summary

Dates: January 1, 2018 – December 31, 2018

Event Name: Lung Cancer CT Cancer Screenings

Screening Type: Cat Scan of lungs for those who qualify

Location: Baptist Health Floyd Cancer Center

Target Population: Smokers or ex-smokers who have quit within the last 15 years, age 55-77 (private

insurance or self- pay age 55-80), have a 30 pack year history of smoking, and have no signs or symptoms of

lung problems or lung cancer

Number Screened: 153

How was the need determined for this outreach activity?

Floyd County has high number of deaths related to lung cancer according to the community health needs

assessment (found at floydfoundation.org). This screening is intended to catch early stage lung disease among

those who are at a high risk for developing lung cancer.

List the nationally accepted, evidence-based guidelines that directed this activity.

The National Cancer Institute promotes lung cancer screenings. Studies have shown a 20% reduction in lung

cancer deaths among those who received early screenings.

See http://www.cancer.gov/cancertopics/screening/lung

Discuss the mechanism in place to ensure follow-up of all positive findings identified through the activity.

Participants are responsible for their own follow-up. Results are forwarded to their family physician or

physician of preference. All results are discussed with patient same day of service. A Radiologist will discuss

directly with any patient with positive results. All patients are given a copy of report for their records same day

service.

Evaluate the effectiveness of access and referral processes.

Participants learn of this screening through a multitude of media methods, including the community

newsletter, which reaches over 100,000 households.

Medical records are kept as are any normal medical procedures. The patients’ physician has access to these.

8

In 2018, the lung cancer screening program has been overseen by Mindi Burch, the Lung Health Navigator for

Baptist Health Floyd. We expect to see an increase in the numbers of those screened as well as a more

comprehensive follow up process in place for the patients.

Number of Category 1 (normal) results: 83

Number of Category 2 (benign) results: 48

Number of Category 3 (6 month follow up recommended): 12

Number of Category 4 (suspicious for malignancy) results: 10

Number of Patients with confirmed malignant diagnosis: 2

9

Community Outreach in Cancer

2018 Individual Event Report Summary

Date: January 1, 2018 – December 31, 2018

Event Name: Community Skin Cancer Screenings

Screening Type: Skin Cancer Screenings provided by certified Dermatologists

Location: Floyd County YMCA

Target Population: adults Number Screened: 76

How was the need determined for this outreach activity?

According to the National Cancer Institute, non-melanoma skin cancer is the most common cancer in the

United States. These screenings were provided to help detect early cancer as well as heighten awareness and

education regarding skin cancer prevention.

List the nationally accepted, evidence-based guidelines that directed this activity.

The National Cancer Institute as well as the American Academy of Dermatology both recommend skin cancer

screenings provided by certified dermatologists.

Discuss the mechanism in place to ensure follow-up of all positive findings identified through the activity.

When a dermatologist documents that a screening patient should receive a biopsy or further evaluation or

treatment, the patient must sign the following statement, “I understand that I have a possible cancerous or

precancerous condition that requires a follow-up examination. I also understand that it is my responsibility to

arrange for a follow-up examination with a dermatologist of my choice, and that any follow-up examination or

treatment that I may receive is not sponsored, endorsed, or guaranteed by the American Academy of

Dermatology.” We have a 100% completion rate for patient’s signing this statement when required.

10

Evaluate the effectiveness of access and referral processes.

All patients, regardless of screening outcome, are given a list of contact information for all area certified

dermatologists. All participants that have a “biopsy recommended” and/or a “recommended referral” receive

a follow up phone call from a registered nurse. The purpose of this follow up RN call is to discuss any questions

they may have, provide education, and discuss the next steps to receive the care which is recommended.

What is the overall summary of this event?

Results from the two 2018 skin cancer screenings indicate how effective this event is for the region.

Total Screened 76

Possible Basal Cell Carcinoma 3

Possible Squamous Cell Carcinoma 2

Possible Melanoma 2

Biopsy Recommended 13

11