5 CANCER PROGRAM ANNUAL REPORT Hollings Cancer Center · the Leksell Gamma Knife Perfexion and the...

Changing What’s Possible

Hollings Cancer Center��5 CANCER PROGRAM ANNUAL REPORT

A Nat iona l Cancer Ins t i tu te-Des ignated Cancer Center

� | HOLLINGS CANCER CENTER

From the LeadershipAt MUSC Hollings Cancer Center, we positively impact the care of cancer patients throughout the Lowcountry and the state of South Carolina, not just with the highest quality oncology services, but also through innovative collaborative research efforts, outstanding professional education programs and many statewide cancer prevention programs. While striving to achieve this mission, we are pleased to present to you the 2015 Annual Cancer Program Report recognizing the hard work and many achievements of the Cancer Program Committee at Hollings Cancer Center.

As one of the leading cancer treatment centers in the Southeast, Hollings Cancer Center combines the full range of cancer specialties – including medical oncology, radiation oncology, surgical oncology, and reconstructive surgery – to deliver the highest level of care to our patients. The center employs twelve nurse navigators who guide patients through the process of diagnosis and treatment. Hollings Cancer Center is home to more than 120 scientists from numerous disciplines conducting research and collaborating on better ways to prevent, detect, diagnose and treat this complex disease.

Additionally, Hollings Cancer Center is the only National Cancer Institute (NCI)-designated center in South Carolina. Choosing Hollings Cancer Center gives patients access to nationally renowned teams of physicians and scientists equipped with the resources to fight cancer, with cutting-edge technology and new medications not available at other centers. As one of the elite NCI-designated cancer centers in the nation, we have received the highest level of recognition from the federal government’s principal agency for cancer research for the work we do.

Receiving a cancer diagnosis is a difficult time in anyone’s life. At Hollings Cancer Center, our compassion extends beyond the scope of medical services to resources that help our patients and their families sustain hope. Along with state-of-the-art treatments, Hollings assists patients in dealing with the financial, physical and emotional aspects of having cancer.

Some of the additional patient resources Hollings Cancer Center provides include:

• Financial Counseling• Genetic Counseling• Interfaith Oncology Chaplain• Hollings Cafe• Nutrition Services• Patient/Family Resource Center• Psychological Support Services• Social Work• Support Groups• Smoking Cessation Clinic

The past year was filled with outstanding accomplishments, and we are proud of the continual efforts shown by everyone associated with Hollings Cancer Center to serve our patients well, at every phase of the management of their cancer. As we expand our services and outreach in the upcoming year, we will continue to work to reduce the burden of cancer on the citizens of the great state of South Carolina.

David T. Marshall, M.D., MS, Cancer Program Committee Chair

James Brook, MBA, Administrator, Oncology Service Line

2015 CANCER PROGRAM ANNUAL REPORT | 3

Contents

From the Leadership 02 HCC Cancer Program Committee 04

Accreditations, Awards and Recognitions 05

Community Outreach 06

Adherence to National Guidelines 08

Cancer Data Management 12

Cancer Registry Data 14

Additional Resources 22

Our Commitment to Quality Care Includes:

• Hollings Cancer Center offers patients state-of-the-art therapies, treatments and technologies, including Tomotherapy, TrueBeam STx, the Leksell Gamma Knife Perfexion and the da Vinci Robotic Surgical System

• MUSC is one of a small number of health care centers in the nation offering orthopaedic/sarcoma oncology care

• We offer South Carolina’s first, largest and most comprehensive adult blood and bone marrow transplant program and the only pediatric blood and marrow transplant program

• MUSC Health is a Blue Distinction Center+ for bone marrow transplants (BMTs), one of only five centers nationwide with the Center+ distinction and the only center awarded this distinction for both Adult and Pediatric BMTs. According to BlueCross BlueShield, Blue Distinction Centers+ are hospitals recognized for their expertise and efficiency in delivering specialty care.

• MUSC is one of only a few centers in the Southeast using the video-assisted thoracic surgery (VATS) technique in a large percentage of cases

• Our Advanced Breast Reconstruction Program uses the revolutionary DIEP (Deep Inferior Epigastric Perforation) technique

• We are the only center in South Carolina performing surgery for prostate cancer in four different ways: robotic, perineal, retropubic and laparoscopic

• Hollings Cancer Center has one of the world’s most renowned Endoscopic Ultrasound (EUS) facilities

• MUSC offers the most comprehensive program for advanced melanoma care in South Carolina

• In collaboration with MUSC’s Children’s Hospital, we treat a large percentage of all South Carolina children battling cancer

Dr. Carolyn Britten with a patient.

4 | HOLLINGS CANCER CENTER

Cancer Program Committee Chair, Radiation Oncology David Marshall, M.D.Cancer Liaison Physician, Urology Sandip Prasad, M.D.Palliative Care Representative Frank Brescia, M.D., MASC State Cancer Liaison Chair, Surgery E. Ramsay Camp, M.D., MSCRSurgery Eric Kimchi, M.D.Diagnostic Radiology Madelene Lewis, M.D.Medical Oncology Paul O’Brien, M.D.Urologic Surgery Stephen Savage, M.D.Pathology M. Timothy Smith, M.D.Director, Surgical Oncology Kevin Staveley-O’Carroll, M.D.Administrator, HCC Oncology Service Line James Brook, MBAQuality of Cancer Registry Data Program Coordinator Linda Cope, CTRCommunity Outreach Coordinator Diane Aghapour, MAGenetic Counselor Karen Baker, MSSocial Work Renea Bligen, LISWOncology Pharmacy Services Carolyn Bondarenka, PharmD, MBA, BCPSRegistered Nurse Elizabeth Cooke, RNOncology and Medical–Surgical Services Business Manager Alan Edwards, MHAPsychosocial Representative Jennifer Correll, Ph.D.Rehab/Physical Therapy Renee B. Garrison, PT, MHS, MTCCancer Conference Activity Coordinator Helen Gosnell, CTRQuality Improvement Coordinator,PI/QM Professional Jennifer Hooks, MBAAmerican Cancer Society Representative Kitty Karr, BAManager, Coding, and Incomplete Records Christine Lewis, RHIA, CCSClinical Research Data Manager Terri Matson, CCRPNurse Manager, HCC Clinics Tess Morris, RNChaplain Rev. Nancy PelligriniNurse Manager, HCC Infusion Mollie Goode, RN, BSNOncology Dietitian Michael Stafford, RD, CSO, LD

H C C C A N C E R P R O G R A M C O M M I T T E E



Hollings Cancer Center is one of fewer than 70 cancer centers in the nation - and the only one in South Carolina - to receive a designation from the National Cancer Institute (NCI)

2013: Hollings was awarded a Three-Year Accreditation with Commendation by the Commission on Cancer (CoC) of the American College of Surgeons (Continuously Accredited since 1936).

2014 – 2015: Recognized by U.S. News & World Report as being among the top 25% in cancer care in the U.S.

Our Comprehensive Breast Care Program is accredited by the National Accreditation Program for Breast Centers (NAPBC)

Our breast imaging staff was awarded a Breast Imaging Center of Excellence designation by the American College of Radiology (ACR).

2011: The Jenny Sullivan Sanford Melanoma & Skin Cancer Program was named a Melanoma Center of Excellence (MCE) by the Melanoma Hope Network

The Blood and Bone Marrow Transplant adult and pediatric programs have been accredited by The Foundation for the Accreditation of Cellular Therapy since 2003.

Accreditations, Awards and Recognitions



Community Outreach

The Virtual Thoracic Tumor BoardThe Thoracic Tumor Board at MUSC’s Hollings Cancer Center is comprised of pulmonologists, thoracic surgeons, oncologists, radiologists, pathologists, social workers and clinical trials representatives. This group evaluates complex cases of patients with lung cancer and creates specialized treatment plans. Access to such tumor boards is one of the hallmarks of a leading cancer center. The Hollings Thoracic Tumor Board is expanding this special role in patient care to take advantage of new communication technologies.

With a grant from the Duke Endowment, Gerard A. Silvestri, M.D., MS, an MUSC pulmonologist who directs the Thoracic Tumor Board, created a virtual thoracic tumor board called Remote Expert Assessment of Lung Cancer, or REAL Cancer. The virtual tumor board allows physicians statewide to consult with the multidisciplinary team that meets weekly at Hollings Cancer Center to discuss complex thoracic cancer cases.

In this way, the expertise at Hollings Cancer Center can be available to more patients, even those at a distance. By expanding access to a multidisciplinary team of experts who specialize in the care of lung cancer patients, REAL Cancer helps ensure that patients receive the right testing and the best treatment at every step. Access to a team of specialists through the Virtual Thoracic Tumor Board reassures local providers that they are devising the most appropriate treatment plan for their patients.

The equipment and software necessary to participate in REAL Cancer is simple and user-friendly; Dr. Silvestri understands that “for telemedicine to work anywhere, in any subspecialty, we’ve got to make it convenient for the end user. If it’s not simple, if it’s not quick, if they’re not getting the data that they need and they are not getting value for the time they have put in, it won’t work.”

Once their sites have been activated by Dr. Silvestri’s team, physicians from partner sites can submit cases (complete with positron emission tomographic and computed tomographic scans, patient history and clinical findings) via a secure internet connection for consideration by the Thoracic Tumor Board at REAL Cancer’s website (hcc.musc.edu/research/real).

When submitting a case, physicians can choose whether to virtually attend the tumor board where the case is discussed, interacting with all of the assembled specialists via teleconference, or to simply receive a summary of the discussion and the tumor board’s recommendation. For less complicated cases, they can request a simple consult.

According to Dr. Silvestri, patients derive a great deal of comfort from knowing that their case has been thoroughly discussed by a team of the appropriate specialists who care about their outcome. Easy access to the combined expertise of the tumor board also minimizes the psychologically distressing time between diagnosis and management. Dr. Silvestri hopes that the success of this program will lead to virtual access to tumor boards for other solid tumors, such as breast, colon, head and neck and melanoma.

Dr. Gerard A. Silvestri


For more information on how to enroll your institution in REAL Cancer, contact Katherine Taylor, the program’s coordinator, at [email protected].

What are the Roles of the Key Members of the Thoracic Tumor Board?

PulmonologistPulmonologists ensure that cases discussed at the tumor board have been diagnosed and staged correctly. They also provide guidance as to a patient’s ability to tolerate a given procedure or treatment based on lung function tests. They frequently offer important suggestions about how to best handle lung complications arising from the disease itself or from the chemotherapy or radiation used to treat it.

Medical OncologistOncologists bring to the tumor board a detailed molecular knowledge of the biomarkers and mutations relevant to lung cancer, allowing the patient’s treatment to be personalized to his or her genetic profile.

T H O R A C I C T U M O R B O A R D

The virtual tumor board allows physicians statewide to consult with the multidisciplinary team that meets weekly at Hollings Cancer Center to discuss complex thoracic cancer cases.

Virtual ThoracicTumor Board

Thoracic SurgeonThoracic surgeons determine whether a tumor is resectable and assess whether higher-risk patients (such as those with poor lung function, common in lung cancer patients with a history of smoking) can withstand surgery. They also may devise back-up plans should a patient refuse or prove unsuitable for invasive surgery (i.e., smaller wedge resections, stereotactic radiotherapy).

Radiation OncologistThe radiation oncologist can determine whether a patient is a candidate for radiotherapy and devise a plan for radiation that maximizes the dose to the tumor while minimizing the effect on healthy adjacent tissues.


Evaluation of Adherence to NCCN Guidelines for Use of Chemotherapy in Colon Cancer Treatment

Each year the MUSC Cancer Program Committee assigns a study to evaluate the cancer program’s adherence to a set of national guidelines for cancer care. In 2015, the Cancer Program Committee chose to look at the National Comprehensive Cancer Network’s (NCCN) guidelines for the use of chemotherapy in the treatment of colon cancer.

The guidelines establish a clear relationship between the stage of disease at diagnosis and the use of chemotherapy.

• Stage I patients should receive NO chemotherapy

• Stage II patients SOMETIMES require chemotherapy, depending on risk factor assessment

• Stage III patients should ALWAYS receive chemotherapy

• Stage IV patients are managed according to spread of disease and SOMETIMES chemotherapy is appropriate

There should therefore be a clear difference in treatment patterns between Stage I and Stage III patients, with 0% chemotherapy usage for Stage I and 100% usage for Stage III.

The Hollings Cancer Center Cancer Registry database was used to determine compliance with these guidelines for colon cancer patients who presented during the 2013/2014 fiscal years.

Adherence to National Guidelines

98.5%The compliance rate of MUSC Hollings Cancer Center during the study timeframe

Results summary: The MUSC Hollings Cancer Center compliance rate was 98.5% during the study timeframe (see pie chart to the right). Of the 68 patients eligible for the study, all but one could be shown to have received treatment which was carefully matched to their stage at diagnosis and which considered their individual circumstance.

Compliant: Treatment given according to NCCN guidelines.

Compliant by exemption: Treatment not given according to NCCN guidelines because of patient refusal or other health conditions (comorbidities). For example, a Stage I colon cancer patient may receive chemotherapy because the patient presents with multiple cancers and a more threatening tumor determines treatment decisions. A Stage III colon cancer patient may be unable to tolerate chemotherapy due to comorbid conditions.

Non-compliant: One Stage III patient was lost to follow up and the database lacks information to classify treatment as compliant.

NCCN offers patient-oriented treatment guidelines for several types of cancers. The web address to access these guidelines iswww.nccn.org/patients/guidelines.


98.5% Colon Cancers by Stage (Analytic)

Adherence to NCCN Treatment Guidelines for Patients with Colon Cancer

24%

17%

26%

33%

Stage 1Stage 2Stage 3Stage 4

86.8%

11.8%

1.5%

CompliantCompliant by exemptionNon-compliant

�� | HOLLINGS CANCER CENTER

Hollings Cancer Center outperforms the average for all Commission on Cancer facilities for all measures, and outperforms the South Carolina state average on all but one measure.

facilities evaluate the timeliness of cancer treatment given at their facilities. Participation in RQRS is voluntary. MUSC chooses to participate in RQRS because of our commitment to quality patient care.

CP3R reports give a summary of treatment and are used by facilities to monitor the use of evidence-based guidelines. MUSC has a higher rate of eligible patients receiving recommended treatments than national benchmarks (rate for all CoC accredited facilities).

The chart on the following page contains the most recent CP3R data for patients treated at MUSC in calendar year 2012 (data as of 12/12/14). Hollings Cancer Center outperforms the average for all Commission on Cancer facilities for all of the measures and outperforms the South Carolina state average on all but one measure.

Quality of CareThe ACoS Commission on Cancer provides tools to accredited facilities to help facilities improve the quality of their patient care. Two of those tools are the Rapid Quality Reporting System (RQRS) and Cancer Program Practice Profile Reports (CP3R). RQRS provides real-time tracking of treatments recommended by evidence-based standards. RQRS helps

Dr. David T. Marshall with a patient.


2015 CANCER PROGRAM ANNUAL REPORT | ��

Measure DescriptionBreast BCSRT Breast radiation treatment is given after breast conserving surgery

Breast HT Hormone therapy prescribed for women with hormone receptor positive breast cancer that is stage 1-3

Breast MAC Chemotherapy is given to women with hormone receptor negative breast cancer that is stage 1-3

Breast MASRT Radiation treatment is given following mastectomy for women with 4 or more positive regional lymph nodes

Breast nBx Imaging or palpation guided biopsy is performed to establish the diagnosis of breast cancer

Colon 12RL At least 12 lymph nodes are removed and examined for colon cancer treated with surgery

Colon ACT Chemotherapy is given after surgery to patients with stage 3 colon cancer

Gastric G15RLN At least 15 lymph nodes are removed and examined for gastric cancer treated with surgery

Lung LCT Chemotherapy is given to patients treated with surgery for non-small cell lung cancer with positive lymph nodes

2012 CP3R Measures Comparison

0%

20%

40%

60%

80%

100%

120%

Hollings Cancer CenterSouth CarolinaAll CoC accredited facilities


Cancer Data ManagementThe Hollings Cancer Center Data RegistryThe Cancer Registry is the data collection component of the Cancer Program. Cancer registries across the country share a core mission, performed by data specialists trained as Certified Tumor Registrars (CTRs). CTRs do the work of translating the medical narratives of cancer patients into a searchable database. The purpose for collecting information about cancer is to identify better ways to prevent and treat cancer.

Every cancer patient has a story that can contribute to the national effort to understand and fight this disease. These stories begin with a diagnosis. The diagnosis determines what the next chapters will hold for each patient because the type of cancer will dictate the treatment plan. Treatments may include chemotherapy, radiation, surgery, or a combination of these.

CTRs document the type of cancer and treatments in addition to outcomes for our patients. By combining information from so many patients, we can begin to see trends. Collecting this type of information about treatment types and patient outcomes helps physicians develop more effective treatment plans and improve cancer patient care.

Other data items which are recorded relate to patient lifestyle (such as smoking history) or relate to nature of the cancer (such as molecular markers). Documenting these types of characteristics assists public health officials in identifying risk factors for cancer.

The Cancer Registry is a depository of confidential patient information and adheres to strict rules to ensure patient confidentiality while still providing vital information. Cancer Registry data goes through electronic edits as well a quality review process conducted by HCC physicians. In today’s healthcare environment decisions are data-driven and the use of cancer registry data serves our doctors and administrators.

The MUSC cancer registry most often provides data in summary form, such as the example shown below. Summary data do not include any data field that could result in the identification of a given patient. This type of de-identified data is used for cancer program development, cancer research and quality improvement studies.

The Cancer Registry team of seven CTRs and a follow-up coordinator is highly motivated to make their daily work be of real service to the community of cancer patients, clinicians and researchers.

Cancer Data Management ActivityMUSC 2014 Statistical Year

Total Cases 4726Analytic Cases 2954Follow-up Rate-5 Year (Target 90%) 92%Follow-up Rate-Reference Year 2000 (Target 80%) 88%Clinical Trials Accrual 14.2%Complete Database-Reference Year 2000 48,640

2015 CANCER PROGRAM ANNUAL REPORT | �3

Cancer Data Management ActivityMUSC 2014 Statistical Year

Total Cases 4726Analytic Cases 2954Follow-up Rate-5 Year (Target 90%) 92%Follow-up Rate-Reference Year 2000 (Target 80%) 88%Clinical Trials Accrual 14.2%Complete Database-Reference Year 2000 48,640

Lung cancer patient, John Sanders.


�4 | HOLLINGS CANCER CENTER

Hollings Cancer Center plays many different roles in cancer patient care. Hollings Cancer Center physicians may be involved in the diagnosis and/or treatment of the patient during the initial diagnosis of cancer. These patients’ cases are described as analytic because they are used for analysis of treatment effectiveness. Our physicians may also see patients during the initial diagnosis of cancer for second opinions or specialized diagnostic tests. Patients who are initially diagnosed and treated elsewhere may come to MUSC for management of recurrent or persistent disease. These cases are described as non-analytic.

In the following chart:Consult Only — patient was initially diagnosed at MUSC or came to MUSC for a second opinion, but received their treatment elsewhere.

All Other — patients are followed at MUSC for a history of cancer only (no active disease) or patients followed at MUSC as required by the South Carolina Central Cancer Registry.

Hollings Cancer Center’s Role in Patient Care

Cancer Registry Data (July 1, 2013-June 30, 2014)

774

2836

710407

Consult Only (16%)

Treated at MUSC for initialdiagnosis of cancer (60%)

Treated at MUSC forrecurrent or persistentdisease (15%)All other (9%)

Total cases: 4727


Demographic Distribution (Analytic)County of Residence at Diagnosis

>500 patients 300-499 patients 100-299 patients 50-99 patients <50 patients

Ethnologic Distribution (Analytic)Race (Analytic)

73.5%

24.9%

0.7% 0.8%White

African American

Asian Indian, Other Asian

Other (Pacific Islander,Other)

Charleston

Beaufort

Colleton

Dorchester Berkeley

Georgetown

Horry

Jasper

Hampton

Williamsburg

Orangeburg

Allendale

BarnwellBamberg

Aiken

LexingtonRichland

Calhoun Clarendon

SumterFlorence

Marion

DillonDarlington

Lee

KershawFairfieldNewberry

Saluda

Edgefield

McCormick

GreenwoodAbbeville

LaurensAnderson

Oconee

Pickens

Green- ville Spartanburg

CherokeeYork

Union Chester Lancaster Chesterfield Marlboro


Most Common Types of Cancer Seen at MUSC July 1, 2013-June 30, 2014 (Analytic)

Invasive In Situ TotalLung 328 1 329Breast 229 56 285Oral Cavity/Pharynx 192 6 198Melanoma of Skin 190 187 377Pancreas 163 1 164Thyroid 149 0 149Prostate 138 0 138Colon and Rectum 130 1 131Lymphoma N/A N/A 110Leukemia N/A N/A 109

Top 5 Primary Sites (Analytic)

13%

11%10%

7%6%

Lung

Breast

Oral Cavaity and Pharynx

Melanoma of Skin (InvasiveOnly)

Pancreas


*Includes invasive and in situ

Top 5 Cancer Sites for Males (Analytic)

Top 5 Cancer Sites for Females (Analytic)

16%

13%9%

9%

5%Melanoma of Skin*LungProstateOral Cavity and PharynxPancreas

20%

9%

9%

7%

7%BreastMelanoma of Skin*LungThyroidCorpus Uteri


Stage of Disease at Diagnosis (Analytic)

Lung Cancer Stage at Diagnosis

Breast Cancer Stage at Diagnosis

0.30%

31%

10%

16%

41%

1% 0.30%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 NotApplicable

Unknown

20%

39%

27%

10%

3% 1%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%



Oral Cavity and Pharynx Cancer Stage at Diagnosis

Melanoma Stage at Diagnosis

3%

19%

9%13%

51%

5%1%

0%

10%

20%

30%

40%

50%

60%


Unknown

50%

33%

10%5% 3%

0.3%0%

10%

20%

30%

40%

50%

60%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown


Pancreas Cancer Stage at Diagnosis


1%

15%

52%

12%

20%

1%0%

10%

20%

30%

40%

50%

60%

Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown


Content CoordinationHelen Gosnell, CTR

Linda Cope, CTR

Data Analysis and Content ContributionShai White-Gilbertson, Ph.D., MSCR, CTR

Helen Gosnell, CTR

Allison Leggett, Hollings Cancer Center Strategic Communications Director



FOR INFORMATION ABOUT CANCER AND SURVIVORSHIP PROGRAMS: The American Cancer Societywww.cancer.org

CANCERcarewww.cancercare.org

The Livestrong Foundationwww.livestrong.org

FOR INFORMATION ABOUT CANCER DIAGNOSIS AND TREATMENT OR QUALITY OF CARE, VISIT:

American College of Radiologywww.acr.org/quality-safety/accreditation

American College of Surgeons Commission on Cancerwww.facs.org/cancer

American Society of Clinical Oncologywww.asco.org

Breast Imaging Center of Excellencewww.acr.org/quality-safety/accreditation/bicoe

Centers for Medicare and Medicaid Serviceswww.cms.gov

National Accreditation Program for Breast Centerswww.accreditedbreastcenters.org

Additional Resources

National Cancer Institutewww.cancer.gov

National Comprehensive Cancer Networkwww.nccn.org

National Quality Forum (NQF)www.qualityforum.org

Oncology Nursing Societywww.ons.org

South Carolina Cancer Alliancewww.sccanceralliance.org

SC DHEC Central Cancer Registrywww.scdhec.gov/Health/DiseasesandConditions/Cancer

8.3.15


C O N T A C T H O L L I N G S C A N C E R C E N T E R

MUSC Hollings Cancer Center86 Jonathan Lucas StreetCharleston, SC 29425843-792-0700hollingscancercenter.org

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The Pearlstine Healing Garden at Hollings Cancer Center.

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Changing What’s Possible

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