Renown Institute for Cancer 2016 ANNUAL REPORTBreast Cancer, Gastrointestinal Cancers (such as...

Renown Institute for Cancer 2016 ANNUAL REPORT

SCREENING CENTER OF

EXCELLENCE

Responsible Screening & Care

Lung Cancer Alliance

1

Renown Institute for CANCER MISSION

Renown Health and the Institute for Cancer make a genuine difference for the families in our communities who have been or may be touched by cancer.

VISION

Renown Health and the Institute for Cancer, with our collaborating partners, provides coordinated, innovative, and personalized care for our communities.

KEY INITIATIVES

1. Integration and coordination – Strengthen and build upon coordinated, multidisciplinary care.

2. Key Relationships – Strengthen and build relationships with providers and communities.

3. Grow Scope and Scale of Program – Build innovative, comprehensive cancer and supportive care services.

2

Table of CONTENTS

Message From Renown Institute For Cancer Leadership____________________________ 3

Cancer Committee Report ______________________________________________________ 4

Multidisciplinary Care __________________________________________________________ 5

Summary of Treatment _________________________________________________________ 6

Radiation Therapy _____________________________________________________________ 7

Oncology ______________________________________________________________________ 8 Surgical Oncology Medical Oncology

Infusion Services _______________________________________________________________ 9

Inpatient Care _________________________________________________________________ 9

Cancer Clinical Trials and Research ______________________________________________ 10

Cancer Genetics Program ______________________________________________________ 10

Support Services ______________________________________________________________ 11

Nurse Navigators and Survivorship ______________________________________________ 12

Emotional Support ____________________________________________________________ 13

Lung Screening Program _______________________________________________________ 14

Quality Improvement Study for Lung Cancer ____________________________________ 15

Quality Standards Programs: National Metrics Comparison________________________ 16

Cancer Registry Report ________________________________________________________ 17

Primary Site Table __________________________________________________________ 18-21

Age at Diagnosis by Gender ____________________________________________________ 22

Five Year Trend _______________________________________________________________ 23

Community Outreach_______________________________________________________ 24-26

Outreach and Telehealth ______________________________________________________ 27

Institute for Cancer 2016 Cancer Committee Roster ______________________________ 28

2

3

MESSAGE from Renown Institute for Cancer Leadership A YEAR OF ACTIVE CHANGE

This year, 2016, has been a year of implementation. The new leadership structure that came in 2015 led to many new programs in 2016, including:

• $8.5M expansion of the Radiation Treatment center, including an improved patient-friendly environment and two new state-of-the-art linear accelerators to provide the most advanced radiation therapy in the region

• Collaborative agreement with community medical oncologists to increase clinical integration and patient coordination.

• Expansion of medical oncology, in preparation for future multidisciplinary centers.

• Expansion of nurse navigation and supportive care programs to enhance the coordination of care.

• Implementation of the first in the region Centers for Medicare & Medicaid Services (CMS) approved Lung Cancer Screening Program, assuring access to high risk patients including an on-site shared decision making clinic.

• Enhancement of the Lung Nodule Clinic with Medical Director, Christina Szot, MD.

• New lung diagnostics, including SuperD, advanced technology that allows the physician to reach distant sites in the lung for biopsies.

• Host for northern Nevada’s participation in Vice President Joseph Biden’s Cancer Moonshot project.

• Expansion of medical oncology outreach, including additional telemedicine sites and outreach clinics.

• Opening of the Cardio-Oncology Program with Christopher Wilson, MD, cardiologist.

This Annual Report provides details of some of these enhancements to our program, and more. The Cancer Registry data also provides information about the cancers we diagnose and treat, along with our Quality Report to include a detailed summary of lung cancer at Renown Institute for Cancer.

Respectfully,

Christos Galanopoulos, MD, MBA, MS, FACS Renown Health VP and Chief Clinical Officer,

Renown Institute for Cancer

Jo Duszkiewicz, MSA Renown Health VP and Administrator,

Renown Institute for Cancer

4

Cancer Committee REPORT Accreditation by a nationally recognized organization demonstrates a commitment to excellence in quality, service and patient care. Renown Institute for Cancer has been accredited by the nationally recognized Commission on Cancer (CoC) since 1999. Our doctors and staff provide standards of care for cancer that are constantly improving to provide the best evidence-based cancer care to northern Nevada and western California.

Implementing the American College of Surgeons’ CoC standards lies with our Cancer Committee. I have a long working relationship with the CoC and currently serve as a national surveyor for the organization. Compliance with the standards is a major undertaking and cancer programs are constantly challenged to improve the care they provide.

As part of a response to the Institute of Medicine report in 1999, the CoC changed standards from “Ensuring Quality Cancer Care” to “Patient Centered.” These changes included:

1. Navigating patients through the medical system and identifying barriers.

2. Identifying psychosocial problems that could prevent a patient from completing their cancer therapy.

3. Providing patients with a “survivorship care-plan” so that they have a better understanding of the care they have received and what they should expect in their post treatment or “survivorship years.”

Renown Cancer Committee reviews the compliance with the CoC standards throughout each year. If problems or barriers are identified, the committee comes up with novel ways to address them. Allied health professionals, supportive care staff and nurse navigators joined the cancer team not only to provide direct care, but also to assist with implementation, monitoring and improvement of these important standards.

This cancer committee meets six times each year to help provide guidance to the overall care of the cancer patient and to the cancer program. This is just another example of the commitment by the physicians, nurses, allied health and administrative personnel for the patients in our region.

With Warm Regards,

James B. Harris, MD, FACS Cancer Committee Chair

Medical Director of Commission on

Cancer Accreditation and Quality

5

Multidisciplinary CARE “Multidisciplinary” is a term used in healthcare when referencing a team of providers that come from many backgrounds or disciplines such as doctors, advanced practice nurses, registered nurses, therapists, dietitians, social workers and more depending on your diagnosis.

In cancer care, your multidisciplinary team consists of multispecialty doctors and staff who have specialized in the care of your cancer.

The term “multispecialty” refers to doctors from different healthcare specialties, such as Surgical Oncologists, Medical Oncologists, Radiation Oncologists, Pathologists (lab), Radiologists (X-ray) and more. These specialists meet regularly at Cancer Conferences (sometimes referred to as Tumor Boards) to discuss and set forth your plan of care. They work together to assure your care is coordinated according to evidence-based practices.

Renown Institute for Cancer also supports three “Center of Excellence” (COE) programs. COE is a team who share the same goals and provide leadership around best practices, research and training for a focused area. In cancer care, COEs are centered on where the cancer starts in your body. At Renown, the three COE programs include

Breast Cancer, Gastrointestinal Cancers (such as colon, rectum, liver, pancreas and stomach) and Thoracic Cancers (including lung and esophagus). Each team meets regularly to develop and update clinical guidelines, to identify quality initiatives, collaborate on clinical trials and to evaluate new technology and processes. In addition, this team actively participates in the multidisciplinary cancer conferences.

The multidisciplinary cancer conference is a place where the many cancer specialists, joined by genetic specialists, Nurse Navigators, nurses, social workers, dietitians, physical therapy specialists and other ancillary providers discuss newly diagnosed cancer cases in order to develop the best treatment plan for you. Having this multidisciplinary approach provides a more comprehensive plan for you early in your diagnosis. It also allows for the team to discuss changes in your treatment plan to ensure you are receiving the best care from the multitude of experts available.

5

6

Summary of TREATMENT To better understand the level of care, we have provided a summary of services you can expect when welcomed into Renown Institute for Cancer. Our team consists of doctors, advanced practice nurses, Nurse Navigators, registered nurses and other clinicians that offers coordinated, innovative and personalized care to ensure you get the very best treatment close to home.

6

7

RADIATION Therapy

Renown Institute for Cancer Radiation Therapy completed renovation in August 2016. This redesign allowed for improved care by:

• Adding two new, state-of-the-art linear accelerators that are the most technically progressive treatment machines on the market today, bringing our number of external beam treatment machines to three.

• Doubling the number of exam rooms from four to eight.

• Relocating the nursing staff closer to the waiting rooms and treatment areas for efficiency and patient care.

• Addition of two inpatient waiting rooms, providing a comfortable and quiet space.

Renown Health Foundation was instrumental in helping to raise $1 million toward this project with donations from community philanthropy.

In 2011, Radiation Therapy was the first in the region to be accredited by the American College of Radiologists in Radiation Oncology (ACR-RO). We have maintained that accreditation by continually striving to be northern Nevada’s center of excellence in Radiation Oncology.

Our team offers several different types of treatments, including:

• Intensity Modulated Radiation Therapy (IMRT) and RapidArc Therapy – delivering radiation that is customized to the size, shape, and location of the tumor in a precise and timely manner.

• Image Guided Radiation Therapy (IGRT) – each treatment machine has the ability to perform a CT just prior to each treatment. During delivery, we can use fluoroscopy (live movie) or snap shot imaging to track tumor movement during treatment, giving doctors the opportunity to make adjustments that ensure accuracy.

• Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) – this radiation delivery is so accurate, it’s used to treat small tumors of the brain and body, while preserving the surrounding healthy tissue. This is “surgery” without undergoing anesthesia or any incisions, but rather by delivering radiation in 1-5 treatments.

• High Dose Rate Brachytherapy (HDR) – temporary insertion of a “live” radioactive source within a catheter for treatment inside your body for breast, lung, gynecologic and other cancers.

• Low Dose Rate Brachytherapy (LDR) – where live radioactive seeds are permanently deployed into the prostate for treatment.

Daisha Puccinelli Radiation Therapist

8

SURGICAL Oncology A vast array of surgical expertise from many specialties is available through the Renown Institute for Cancer including general surgery, thoracic surgery, neuro-surgery, urologic surgery, gynecologic oncology, hepatobiliary and pancreatic surgery, and head and neck surgery. The surgeons work very closely with a team of medical oncologists, radiation oncologists, and other specialists to assure coordination of treatment, planning, and care from diagnosis to post-surgery.

Renown Surgical Services features state-of-the-art technology and sophisticated equipment to support even the most advanced or complicated types of surgery. In addition to extensive experience with traditional open procedures, surgeons have expertise in minimally invasive techniques such as robotic surgery which utilizes the da Vinci Robotic Surgery System for prostatectomy, gynecologic cancers, and colorectal surgery. Radiofrequency ablation is available for less invasive removal of liver and kidney tumors, and brachytherapy is available to provide internal radiation therapy for many types of cancers.

MEDICAL Oncology Renown, in affiliation with community medical oncologists, provides hematology and oncology cancer care for northern Nevadans and northeastern Californians. We provide services at our main location in Reno, a satellite office at Carson Valley Medical Center, and through TeleHealth at Banner Health in Fallon.

Medical oncology provides you and your loved ones an opportunity to discuss treatment options to personalize your care. We work in coordination with all providers who are essential to your treatment and offer all services in one convenient location. This includes laboratory, radiology and infusion services. We also collaborate with highly skilled surgeons and radiation oncologists here at Renown. We provide personalized care while making a genuine difference for those who have been, or may be touched by cancer.

Peter C. Lim, MD Gynecologic Oncologist

Medical Director,

Institute for Robotic Surgery

Deepa Mocherla, MD Medical Oncologist

9

INFUSION Services Renown Infusion Services provides outpatient treatment to adults 16 years of age and older. We are open 365 days a year, with 25 patient treatment areas including 3 private rooms and 21 interactive treatment bays with Wi-Fi access and a personal television. Our on-site pharmacy and laboratory is staffed with pharmacists and a lab technician, who work alongside the oncology certified nurses enabling us to provide comprehensive care to you.

In winter 2016, construction will begin in the Institute for Cancer to expand our Infusion Services, adding four additional treatment bays to meet the needs of our growing community.

We treat a variety of diagnoses including, but not limited to, cancer, multiple sclerosis, anemia, osteoporosis, osteomyelitis, rheumatoid arthritis and genetic disorders. We offer precision treatments such as clinical trials, and the latest immunotherapy and chemotherapy drugs. Our nurses work in collaboration with your healthcare team to ensure quality care. They perform therapeutic phlebotomies, administer IV medications, give injections and administer blood and platelet transfusions. The nurses also perform lab draws, central line care and provide education about specific treatments.

INPATIENT Care Inpatient Cancer Care has 27 private rooms specializing in the care of all types of cancer. All of our nursing staff earn competency to administer chemotherapy and biotherapy via national certificate (Oncology Nursing Society/Oncology Nursing Certification Corporation) or internally via Renown’s Chemotherapy and Biotherapy Certificate Course. Instruction in these courses is rigorous, and provides training in the administration of Chemotherapy and Biotherapy agents along with symptom management, safe handling, and psychosocial dimensions of care.

One of the most serious side effects from chemotherapy is known as Febrile Neutropenia, a condition of having an unusually low number of cells called neutropils and a fever of 100.4 degrees Fahrenheit or greater. Renown developed a febrile Neutropenia Protocol in 2016 which allows clinicians to identify cancer patients at risk for this life threatening side effect quickly. Once identified, these patients are

immediately moved into a prescribed antibiotic therapy protocol. By following this protocol, we have improved positive response outcomes and our patient’s experience. Our high risk patients with Neutropenia are provided alert cards. Patients can present these cards to any ER employee and receive the expedited care of the Neutropenia protocol.

Brandi Griggs, RN, BSN, OCN Manager, Infusion Services

1010

Cancer CLINICAL TRIALS AND RESEARCH Renown Institute for Cancer, in collaboration with the National Cancer Institute and the Nevada Cancer Research Foundation, offers over 40 clinical trials for a variety of cancers. Participating in clinical trials and research allows you to receive the most effective therapy available. These treatments investigate promising new drugs, drug combinations, advances in personalized care and new approaches to surgery or radiation therapy that are otherwise unavailable in traditional treatment.

If you are considering a clinical trial, talk to a member of your cancer care team and consult with your doctor. We are here to provide education and guidance in making decisions about your care and treatment. Our specially trained research nurses will help you understand the process and explain what to expect with each visit. We are committed to bringing the highest quality of cancer care to you and your loved ones.

Cancer GENETICS PROGRAM The Genetic Risk Assessment program works with patients whose personal medical and family history indicates a possible hereditary cancer syndrome. In hereditary cancer, gene mutations can be passed on from generation to generation.

This program has seen more than 2,400 patients since its inception. The majority of patients undergo genetic studies based on comprehensive personal and family history analysis. All results are then reviewed with you and your provider for management decisions. By making genetic testing choices available based on pertinent clinical history, our program can achieve meaningful results and reduce the cost of healthcare.

The program has implemented cancer genetic clinical research protocols, establishing a presence on the regional Institutional Review Board (IRB).

Community outreach includes presentations at local tumor boards and lecture series for clinicians, students and administration. Standardizing genetic information into electronic medical records is also underway. Regional implementation of current National Comprehensive Cancer Network (NCCN) guidelines is the goal.

R. Nathan Slotnick, MD, PhD Medical Director

of Genetics

1111

• Healing touch

• Massage therapy

• Financial counselors

SUPPORT Services

Renown offers programs and services to help you and your loved ones understand cancer, manage through treatment and recovery, and find the emotional support needed. Our dedicated Nurse Navigators, social worker and cancer concierge assess your needs throughout treatment. Some of our support services include:

• Nutrition support

• Guided imagery

• Support groups

• Lodging recommendations

We also help guide you to community and national support programs.

Cynthia Thomas, BS, MA Cancer Concierge

12

Nurse NAVIGATORS Renown Institute for Cancer offers Nurse Navigators to help guide you through the complexities of cancer treatment.

Your Nurse Navigator is here to provide:

• An understanding of your provider’s plan of care.

• Supportive care services.

• Connection to community resources, licensed counselors and financial advocates.

These are just some of the key components to helping you and your family cope through the stressful time.

SURVIVORSHIP We strive to help you maintain your overall health and well-being as a cancer survivor.

Our Nurse Navigators offer survivorship planning as you complete treatment and transition to a life after cancer. You will receive personalized information based on your diagnosis and treatment to promote healthy habits and a strong support system.

• Education to you and your family.

• Coordination of tests, procedures and appointments in a timely manner.

Charmian Lykins, RN, MPH, OCN Survivorship Nurse Navigator

Pictured above (left to right):

Denise Wiley, RN, BSN, OCN Lisa Gardner, RN, BSN, OCN Michelle Nadalin, RN, BSN, OCN Beth Ahart-Valk, RN, OCN Georganna Reynolds, RN, BSN, OCN Charmian Lykins, RN, MPH, OCN Kat Woods, RN, BSN, OCN Nurse Navigators

13

Emotional SUPPORT

All cancer patients will experience distress at some point in their treatment – whether that be emotional, financial or physical suffering. Research has shown that distress in patients with cancer leads to decreased quality of life and can even negatively impact survival.

According to the National Comprehensive Cancer Network (NCCN) guidelines: All patients should be evaluated for distress during their initial visit, at appropriate intervals, and as clinically indicated, especially with changes in disease status (i.e. remission, recurrence, progression, treatment-related complications).

At Renown Institute for Cancer, patients receive distress evaluations at pivotal points during their cancer care.

Regularly administered psychosocial distress screenings are provided during:

• The first visit with their medical oncologist at Renown Medical Group – Oncology.

• The first visit for chemotherapy treatment at Infusion Services.

• Immediately following the simulation procedure appointment or following the first radiation treatment received at Renown Radiation Therapy.

• Transitions from different treatment modalities, such as upon remission, recurrence, progression, during treatment related complications, survivorship or at any time when the medical team deems necessary.

Early intervention for identified reasons for distress leads to improved medical management.

Therefore, if patients have scores of six or higher on the distress evaluation scale of 10, our staff members must obtain additional information from the patient. Some distress is normal with cancer but there are certain signs that manifest when patient distress lever is too high and needs additional interventions. At that point, the patient is referred to a cancer outpatient social worker for further assessment. The social worker then conducts an assessment and provides appropriate resources and referrals pertaining to the type of distress the patient is experiencing.

While new patients tend to have higher scores of distress than established patients, our team is able to provide resources and referrals to those who may be in distress due to their cancer diagnosis.

Renown administered a total of 400 distress screenings for 2016. Of the distress screenings administered to date in 2016, the top three distress problems identified by patients include insurance or financial stress, emotional and physical problems.

Jocelyn Mata, LSW, NSW Oncology Outpatient Social Worker

1414

LUNG SCREENING ACTIVITY Program

Renown Regional Medical Center was named a Screening Center of Excellence by The Lung Cancer Alliance (LCA) in early 2016 for its ongoing commitment to best practice lung cancer screening. The program required a provider referral to the lung screening clinic. All of the referred patients are prescreened for the program using evidenced-based criteria from the National Lung Screening trials and outlined by the Centers of Medicare and Medicaid Services. Criteria guidelines include individuals who are aged 55 to 80 years and have: 1) no symptoms of lung cancer, 2) a 30 pack-a-year smoking history, and 3) currently smoke or have quit within the past 15 years. Each patient that meets these screening guidelines will then meet with an Advanced Practice Nurse for a “shared decision making visit.” Once the patient consents to the screening, they are scheduled for a Low-Dose Computed Tomography (LDCT), which has been proven to find lung cancer at its earliest stages. It is the first and only cost-effective test shown to reduce lung cancer deaths.

Since March 1, 2016 the Institute for Cancer has screened over 200 individuals, referred from primary and specialty care providers. Of those participants who completed their LDCT, two early stage (stage 1) cancers have been diagnosed. Why is this important? Because lung cancer is the number one cancer killer in America, taking more American lives than colon, breast and prostate cancer combined. This early lung cancer detection can and will increase the five-year survival rate to nearly 90 percent. Renown Institute for Cancer, as the healthcare leader in the region, strives for the highest patient care standards from cancer prevention and screening through treatment and survivorship. This program is one example of our commitment to the health of the communities we serve.

15

Quality Improvement Study for LUNG CANCER

Renown Health has provided Low-Dose Computer Tomography or Low-Dose CT (LDCT) as an option for community members for several years. The program was a provider-referral, self-pay program that a Nurse Navigator facilitates through identifying the appropriateness of the referral and worked with patients and providers to assure appropriate follow-up.

When best practice guideline recommendations were released by the US Preventive Service Task Force (USPSTF), Renown Institute for Cancer began planning the implementation of a comprehensive Lung Cancer Screening Program (LCSP). The new program was implemented March of 2016 following a process improvement project supported by a multidisciplinary team. The team’s main objective was to increase the number of early stage lung cancer diagnoses (stage 0, 1, 2) and decrease the number of late stage lung cancers (stage 3, 4) in our program. This goal would be accomplished through early detection screening using the newly published evidenced-based guidelines which use LDCT. This quality improvement project will drive toward increasing the chance of five-year survival to 90 percent for our patients diagnosed with lung cancer. Implementation of the program throughout the Renown organization required a number of initiatives including: • Enhancement of our Electronic Medical Record (EHR) to automate reminders to our providers by adding a Best Practice Alert (BPA) reminder.

• Development of a referral process for patients to first meet with an Advanced Practice Nurse for education and a “Shared Decision Making” visit prior to the screening LDCT.

• Development of a standardized reporting system to assure appropriate follow-up which may include schedule for future screenings, referral to the Lung Nodule Clinic or referral for cancer treatment.

• Development of a process to submit all results to a new lung screening registry, American College of Radiology (ACR) Lung Cancer Screening Registry, for national tracking and reporting.

The program continues to grow, with an expected 450 percent increase in patients referred and a 250 percent in patient screened from prior years. All patients with suspicious lung nodules have been referred to the Renown Lung Nodule Clinic and all cancer diagnosed have been early stage and referred for the appropriate treatment. The long-term goal of reducing the late stage cancers and increasing the early stage cancers diagnosed has just begun. The program will be monitored and reported on annually.

Talk to your doctor to see if you meet the criteria for lung cancer screening.

Patients Referred

Patients Meeting All Criteria

Patients Screened

Patients Biopsied

Cancers Diagnosed (Stage)

211 127 105 8 2 (1)

Results for the first six months of the new program:

Avg Referred/Screened Patients/Year Cancers Diagnosed

100 1

Results prior to improvement project:

16

Quality Standards Programs: NATIONAL METRICS COMPARISON Renown Institute for Cancer is excited to participate in the Commission on Cancer’s (CoC) program to evaluate key outcomes measures in cancer care. As we move towards quality measures as a technique to promote cancer care, participation in a national program allows us to compare ourselves to national benchmarks and compare ourselves to other similar accredited CoC programs.

The CoC’s Cancer Program Practice Profile Reports (CP3R) evaluates 23 quality measures covering 10 primary cancer sites. The following table demonstrates Renown’s performance on breast and colon measures for the years 2011 to 2014. The 2016 Cancer Committee evaluated these measures which demonstrated excellent compliance with the quality standards set by the commission.

CP3R REPORT

Over the past several years, the CoC received many requests for “real time” data that the CP3R could provide in order to closely monitor each measure. In order to satisfy these requests, the CoC developed the Rapid Quality Reporting System (RQRS). By evaluating and assessing current data, Renown Cancer Committee and institute leadership have developed more realistic goals and objectives to make a greater impact on cancer care in northern Nevada. This is one of the ways that Renown Institute for Cancer remains committed to providing outstanding, state-of-the-art cancer care.

17

Cancer Registry REPORT

A cancer registry is a system designed to collect information about the occurrence of cancer, the types of cancers that occur and their locations within the body, the extent of cancer at the time of diagnosis, and the kinds of treatments that patients receive.

We are a hospital-based cancer registry responsible for ensuring that our doctors, nurses and researchers have the best quality data to work with when evaluating patient care and response to treatment. This data is also used to identify community and nationwide trends as well as opportunities for continued quality improvements in caring for our cancer patients at Renown Health.

Cancer is a reportable disease and the hospital registrars known as Certified Tumor Registrars (CTR) are charged with keeping the hospital compliant with federally and state mandated reporting requirements. Their role also includes monitoring strict adherence to patient confidentiality laws and tracking the progress of our cancer programs. Renown Cancer Registry currently has two full-time CTRs and one follow-up clerk.

During 2015, Renown Cancer Registry recorded 2,139 reportable cancer cases and of that number, 1,757 patients (82 percent) were analytical cases that were initially diagnosed and/or received their first treatment at Renown Institute for Cancer.

TOP TEN SITES BY GENDER

Males

Prostate Gland – 166 (17%)

Bronchus & Lung – 116 (12%)

Colon & Rectum – 81 (9%)

Urinary Bladder – 76 (8%)

Kidney & Renal Pelvis – 43 (5%)

Melanoma of the Skin – 43 (5%)

Non-Hodgkin Lymphoma – 42 (4%)

Leukemia – 39 (4%)

Oral Cavity & Pharynx – 37 (4%)

Pancreas – 29 (3%)

All Other Sites – 279 (30%)

Female

Breast – 378 (32%)



Uterine Corpus – 63 (5%)

Thyroid – 49 (4%)



Ovary – 35 (3%)

Cervix Uteri – 32 (3%)



Males

Prostate Gland – 166 (17%)



Urinary Bladder – 76 (8%)

Kidney & Renal Pelvis – 43 (5%)

Melanoma of the Skin – 43 (5%)



Oral Cavity & Pharynx – 37 (4%)



Female

Breast – 378 (32%)



Uterine Corpus – 63 (5%)

Thyroid – 49 (4%)



Ovary – 35 (3%)

Cervix Uteri – 32 (3%)



Genitourinary cancers, prostate, bladder and kidney, were all in the men’s top five newly diagnosed cancer cases at Renown. Lung and colon/rectal cancers make up the other top five cancers.

Nearly 68 percent of the people diagnosed in 2015 at Renown were women. Breast cancer was not only the top newly diagnosed cancer for women, but also the number one cancer diagnosis – 32 percent, at Renown Health in 2015. Combined, gynecologic cancers (uterine, ovarian and cervix) were the second leading diagnosis for women at Renown. Lung, colon/rectal and uterine cancers make up the other top five cancers.

18

PRIMARY Site Table – 2015

Renown Institute for Cancer | 2016 Annual Report

Cancer Registry: Frequency by Primary Site and Gender Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report

Primary Site Total (%) Sex Class of Case Status Stage

M F Analytic NA Alive Exp Stg 0

Stg I

Stg II

Stg III

Stg IV

No Stg

ORAL CAVITY & PHARYNX 60 (2.8%) 37 23 48 12 50 10 0 9 6 6 20 7

Lip 6 (0.3%) 4 2 3 3 5 1 0 3 0 0 0 0

Tongue 23 (1.1%) 14 9 21 2 21 2 0 4 2 4 8 3

Salivary Glands 7 (0.3%) 4 3 5 2 3 4 0 0 0 0 4 1

Floor of Mouth 3 (0.1%) 2 1 3 0 3 0 0 1 1 0 1 0

Gum & Other Mouth 6 (0.3%) 2 4 5 1 4 2 0 0 1 2 2 0

Nasopharynx 3 (0.1%) 3 0 1 2 3 0 0 0 0 0 1 0

Tonsil 8 (0.4%) 7 1 6 2 8 0 0 1 2 0 3 0

Oropharynx 1 (0.0%) 0 1 1 0 1 0 0 0 0 0 0 1

Hypopharynx 2 (0.1%) 1 1 2 0 1 1 0 0 0 0 1 1

Other Oral Cavity & Pharynx 1 (0.0%) 0 1 1 0 1 0 0 0 0 0 0 1

DIGESTIVE SYSTEM 357 (16.7%) 189 168 298 59 260 97 4 46 81 66 72 29

Esophagus 27 (1.3%) 21 6 17 10 18 9 0 4 2 7 3 1

Stomach 34 (1.6%) 22 12 30 4 22 12 2 3 9 4 8 4

Small Intestine 12 (0.6%) 7 5 9 3 9 3 0 3 0 3 2 1

Colon Excluding Rectum 99 (4.6%) 49 50 80 19 79 20 2 12 26 18 16 6

Cecum 30 16 14 24 6 25 5 1 2 8 7 4 2

Appendix 4 1 3 4 0 4 0 0 2 1 0 1 0

Ascending Colon 13 4 9 11 2 9 4 0 1 5 1 2 2

Hepatic Flexure 5 3 2 5 0 3 2 1 0 3 1 0 0

Transverse Colon 8 5 3 8 0 8 0 0 3 4 1 0 0

Splenic Flexure 1 0 1 1 0 1 0 0 0 0 1 0 0

Sigmoid Colon 19 12 7 17 2 15 4 0 4 4 5 3 1

Large Intestine, NOS 19 8 11 10 9 14 5 0 0 1 2 6 1

Rectum & Rectosigmoid 51 (2.4%) 32 19 41 10 47 4 0 4 15 12 8 2

Rectosigmoid Junction 6 4 2 5 1 5 1 0 0 1 2 2 0

Rectum 45 28 17 36 9 42 3 0 4 14 10 6 2

19



Continued Cancer Registry: Frequency by Primary Site and Gender Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report



Stg I

Stg II

Stg III

Stg IV

No Stg

Anus, Anal Canal & Anorectum 11 (0.5%) 4 7 10 1 9 2 0 1 5 2 1 1

Liver & Intrahepatic Bile Duct 32 (1.5%) 17 15 27 5 20 12 0 4 1 2 7 13

Liver 31 17 14 26 5 19 12 0 4 1 2 6 13

Intrahepatic Bile Duct 1 0 1 1 0 1 0 0 0 0 0 1 0

Gallbladder 5 (0.2%) 1 4 5 0 3 2 0 2 0 0 3 0

Other Biliary 7 (0.3%) 3 4 6 1 6 1 0 2 2 1 1 0

Pancreas 70 (3.3%) 29 41 64 6 40 30 0 10 21 11 21 1

Retroperitoneum 4 (0.2%) 4 0 4 0 4 0 0 1 0 3 0 0 Peritoneum, Omentum & Mesentery 5 (0.2%) 0 5 5 0 3 2 0 0 0 3 2 0

RESPIRATORY SYSTEM 241 (11.3%) 126 115 218 23 149 92 7 55 15 39 98 4 Nose, Nasal Cavity & Middle Ear 3 (0.1%) 2 1 2 1 2 1 0 1 0 0 0 1

Larynx 8 (0.4%) 7 1 7 1 8 0 1 4 0 1 1 0

Lung & Bronchus 229 (10.7%) 116 113 208 21 139 90 6 50 15 38 97 2 Trachea, Mediastinum & Other Respiratory Organs 1 (0.0%) 1 0 1 0 0 1 0 0 0 0 0 1

BONES & JOINTS 5 (0.2%) 3 2 3 2 5 0 0 1 2 0 0 0

Bones & Joints 5 (0.2%) 3 2 3 2 5 0 0 1 2 0 0 0

SOFT TISSUE 11 (0.5%) 6 5 9 2 8 3 0 2 3 2 0 2

Soft Tissue (including Heart) 11 (0.5%) 6 5 9 2 8 3 0 2 3 2 0 2 SKIN EXCLUDING BASAL & SQUAMOUS 78 (3.6%) 45 33 65 13 65 13 9 20 11 6 9 10

Melanoma -- Skin 73 (3.4%) 43 30 62 11 61 12 9 20 11 6 9 7

Other Non-Epithelial Skin 5 (0.2%) 2 3 3 2 4 1 0 0 0 0 0 3 BASAL & SQUAMOUS SKIN 1 (0.0%) 1 0 0 1 1 0 0 0 0 0 0 0

Basal/Squamous cell carcinomas of Skin 1 (0.0%) 1 0 0 1 1 0 0 0 0 0 0 0

BREAST 383 (17.9%) 5 378 341 42 367 16 59 142 95 29 15 1

Breast 383 (17.9%) 5 378 341 42 367 16 59 142 95 29 15 1

20



Continued Cancer Registry: Frequency by Primary Site and Gender Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report



Stg I

Stg II

Stg III

Stg IV

No Stg

FEMALE GENITAL SYSTEM 146 (6.8%) 0 146 113 33 130 16 1 68 11 17 9 7

Cervix Uteri 32 (1.5%) 0 32 15 17 31 1 0 7 2 4 1 1

Corpus & Uterus, NOS 63 (2.9%) 0 63 60 3 58 5 0 48 4 2 3 3

Corpus Uteri 60 0 60 57 3 56 4 0 47 3 2 2 3

Uterus, NOS 3 0 3 3 0 2 1 0 1 1 0 1 0

Ovary 35 (1.6%) 0 35 29 6 28 7 0 10 2 9 5 3

Vagina 3 (0.1%) 0 3 3 0 3 0 0 1 2 0 0 0

Vulva 12 (0.6%) 0 12 6 6 9 3 1 2 1 2 0 0 Other Female Genital Organs 1 (0.0%) 0 1 0 1 1 0 0 0 0 0 0 0

MALE GENITAL SYSTEM 178 (8.3%) 178 0 122 56 168 10 0 23 68 14 15 2

Prostate 166 (7.8%) 166 0 112 54 157 9 0 15 67 13 15 2

Testis 9 (0.4%) 9 0 8 1 9 0 0 7 0 1 0 0

Penis 2 (0.1%) 2 0 1 1 1 1 0 1 0 0 0 0

Other Male Genital Organs 1 (0.0%) 1 0 1 0 1 0 0 0 1 0 0 0

URINARY SYSTEM 184 (8.6%) 123 61 168 16 161 23 59 58 14 9 20 8

Urinary Bladder 103 (4.8%) 76 27 93 10 85 18 53 13 11 2 12 2

Kidney & Renal Pelvis 73 (3.4%) 43 30 67 6 70 3 3 44 3 6 5 6

Ureter 7 (0.3%) 3 4 7 0 6 1 2 1 0 1 3 0

Other Urinary Organs 1 (0.0%) 1 0 1 0 0 1 1 0 0 0 0 0

EYE & ORBIT 9 (0.4%) 5 4 1 8 8 1 0 0 0 0 0 1

Eye & Orbit 9 (0.4%) 5 4 1 8 8 1 0 0 0 0 0 1 BRAIN & OTHER NERVOUS SYSTEM 107 (5.0%) 44 63 94 13 90 17 0 0 0 0 0 94

Brain 48 (2.2%) 26 22 43 5 32 16 0 0 0 0 0 43 Cranial Nerves Other Nervous System 59 (2.8%) 18 41 51 8 58 1 0 0 0 0 0 51

ENDOCRINE SYSTEM 90 (4.2%) 28 62 80 10 90 0 0 48 1 9 5 17

Thyroid 65 (3.0%) 16 49 65 0 65 0 0 48 1 9 5 2

21



Continued Cancer Registry: Frequency by Primary Site and Gender

Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report



Stg I

Stg II

Stg III

Stg IV

No Stg

Other Endocrine including Thymus 25 (1.2%) 12 13 15 10 25 0 0 0 0 0 0 15

LYMPHOMA 91 (4.3%) 48 43 69 22 79 12 0 14 12 5 26 12

Hodgkin Lymphoma 10 (0.5%) 6 4 9 1 10 0 0 1 4 0 2 2

Non-Hodgkin Lymphoma 81 (3.8%) 42 39 60 21 69 12 0 13 8 5 24 10

NHL - Nodal 49 26 23 37 12 40 9 0 8 6 4 16 3

NHL - Extranodal 32 16 16 23 9 29 3 0 5 2 1 8 7

MYELOMA 29 (1.4%) 20 9 16 13 24 5 0 0 0 0 0 16

Myeloma 29 (1.4%) 20 9 16 13 24 5 0 0 0 0 0 16

LEUKEMIA 70 (3.3%) 39 31 47 23 58 12 0 0 0 0 0 47

Lymphocytic Leukemia 36 (1.7%) 23 13 18 18 36 0 0 0 0 0 0 18 Acute Lymphocytic Leukemia 6 5 1 6 0 6 0 0 0 0 0 0 6

Chronic Lymphocytic Leukemia 29 17 12 11 18 29 0 0 0 0 0 0 11

Other Lymphocytic Leukemia 1 1 0 1 0 1 0 0 0 0 0 0 1

Myeloid & Monocytic Leukemia 31 (1.4%) 14 17 26 5 20 11 0 0 0 0 0 26

Acute Myeloid Leukemia 17 9 8 14 3 9 8 0 0 0 0 0 14

Acute Monocytic Leukemia 1 0 1 1 0 0 1 0 0 0 0 0 1

Chronic Myeloid Leukemia 13 5 8 11 2 11 2 0 0 0 0 0 11

Other Leukemia 3 (0.1%) 2 1 3 0 2 1 0 0 0 0 0 3

MESOTHELIOMA 1 (0.0%) 1 0 1 0 1 0 0 1 0 0 0 0

Mesothelioma 1 (0.0%) 1 0 1 0 1 0 0 1 0 0 0 0

KAPOSI SARCOMA 1 (0.0%) 1 0 0 1 1 0 0 0 0 0 0 0

Kaposi Sarcoma 1 (0.0%) 1 0 0 1 1 0 0 0 0 0 0 0

MISCELLANEOUS 97 (4.5%) 52 45 64 33 60 37 0 0 0 0 0 64

Miscellaneous 97 (4.5%) 52 45 64 33 60 37 0 0 0 0 0 64

Total 2,139 951 1,188 1,757 382 1,775 364 139 487 319 202 289 321 Exclusions: Not Male and Not Female 0

22


0

50

100

150

200

250

300

350

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

28 22

54

159

335

239

93

8 1333

51

102

263

336

279

103

10 11

Num

ber o

f Can

cer C

ases

Age at Diagnosis

Cancer Registry: Patient Age at Diagnosis by GenderMale Female

Age at Diagnosis by GENDER

The majority of cancer cases diagnosed at Renown in 2015 were between the ages of 60 and 69 for both men and women.

23

Five Year TREND


Five-Year Trend of Renown ANALYTICAL CANCER CASES

1308 1396 14381669 1757

148181

277

320382

2011 2012 2013 2014 2015

Analytic Cancer Cases

Non-Analytic Cancer Cases

Renown has a strong commitment to cancer care and cancer care coordination. This commitment is one of the reasons for significant growth in newly diagnosed cancers managed at the Renown Institute for Cancer.

24

COMMUNITY Outreach Cancer is a complex disease that affects communities in different ways. Prevention is the best way to fight cancer. We believe it is important to take part in outreach and education. Throughout the year Renown partners with other groups and community organizations to insure people get the information they need for better health. Some of the events we participated in for 2016 include:

MOMS ON THE RUN

This non-profit organization helps cover everyday living expenses of northern Nevada families enduring hardships caused by a catastrophic circumstance, with a primary focus on assisting individuals with breast and gynecological cancers. One hundred percent of proceeds stay local. Renown Institute for Cancer sponsored the 16th annual 5k event and provided education information for almost 5,000 participants.

AMERICAN CANCER SOCIETY (ACS) RELAY FOR LIFE

The Relay for Life celebration of cancer survivors and their supporters was held in 2016. Renown Institute for Cancer partnered with ACS as the preventative sponsor and provided educational materials on lung cancer screening to 100 attendees. Funds raised for this event help to support the important research for finding a cure.

NATIONAL CANCER SURVIVOR CELEBRATION

For the first time, Renown Institute for Cancer hosted a Survivor Celebration at Reno Aces baseball game in June 2016. Renown invited over 200 patients and their loved ones for a night to remember and way to celebrate their survivorship. This event attracted more than 5,000 attendees celebrating survivorship and recognizing their loved ones who have been affected by cancer.

24

25

CANCER MOONSHOT EVENT

On June 29, 2016, Renown Institute for Cancer had the privilege to be the lead site presenting the State of Nevada in an unprecedented national call to action to eliminate cancer as we know it, the “Cancer Moonshot.” During his 2016 Sate of the Union Address, President Obama called on Vice President Joe Biden to lead this initiative.

The Cancer Moonshot is the coming together of science, technology, advocacy, social science and big data to solve cancer’s greatest challenges. Cancer is a complex disease that must be attacked on many fronts—through accelerating the best science and by breaking down administrative and financial barriers, increasing data sharing across all research sectors and enhancing collaboration between the public and private sectors. Since its launch, the Cancer Moonshot has brought diverse communities together to contribute their ideas and expertise for fast tracking progress against cancer.

Nearly all 50 States submitted ideas and responses to this national conversation which were then vetted by a presidentially appointed Blue Ribbon Panel. From those responses this Panel developed their top 10 recommendations:

1. Establish a network for direct patient involvement in cancer research

2. Create a translational science network devoted exclusively to Immunotherapy

3. Develop ways to overcome resistance to therapy

4. Build a national cancer data ecosystem

5. Intensify research on the major drivers of childhood cancers

6. Minimize cancer treatment’s debilitating side effects

7. Expand use of proven prevention and early detection strategies

8. Mine past patient data to predict future patient outcomes

9. Develop a 3D cancer atlas

10. Develop new cancer technologies

Renown Institute for Cancer is proud to have been a vital part of this initiative for all Nevadans and Americans alike.

“This is our moonshot. I know that we can help solidify a genuine global commitment to end cancer as we know it today—and inspire a new generation of scientists to pursue new discoveries and the bounds of human endeavor.” Vice President Joe Biden

26

SENIOR FEST

Renown Health and the Institute for Cancer sponsored this event and provided lung cancer screening information to 300 local senior citizens.

PINK PUMPKIN FESTIVAL

We sponsored an information booth presenting breast health information in celebration of Breast Cancer Awareness Month. This event also benefited the Breast Cancer Patient Assistance Fund for the Institute for Cancer.

SUSAN G. KOMEN RACE FOR THE CURE

Renown Institute for Cancer sponsored the Race for the Cure annual event as a strategic partner which included a private breakfast with Melinda Telli, MD, Komen Scholar from Stanford Medicine. There were over 4,800 participants who received information on breast health screening guidelines. Seventy five percent of the funds raised from the Reno race stay in Nevada and are used for patient support services.

GREAT AMERICAN SMOKEOUT

In partnership with the American Cancer Society, American Lung Association and Renown Institute for Cancer, the Great American Smokeout event provided education to employees and community members on programs for smoking cessation, tobacco and e-cigarettes. Over 200 people stopped by, collected materials and got their questions answered.

PEPPERMILL HOTEL & CASINO, EMPLOYEE BENEFITS FAIR

Renown’s Breast Cancer Nurse Navigator attended this health fair and scheduled 30 mammograms on-site. Breast cancer screening guidelines were given out by our Nurse Navigator and a bi-lingual licensed social worker in English and Spanish.

GRAPEVINE EVENT

Renown Foundation invited the public to tour the Institute for Cancer to see the latest state-of-the-art technology, new renovations and discuss the programs and services. Nathan Slotnick, MD, PhD, Medical Geneticist presented to 45 invite-only guests from the community on “Genetics and Cancer.”

SHINE A LIGHT ON LUNG CANCER

Renown Institute for Cancer hosted an inspiring evening to learn about early lung cancer detection, meet survivors and shine a light in honor of loved ones. Free radon kits were provided by University of Nevada Cooperative Extension.

2727

OUTREACH AND TELEHEALTH

Renown Institute for Cancer provides outreach services to our communities in Fallon and Gardnerville. For patients in need of medical oncology appointments or infusion treatment, care is available without traveling outside the community. Thanks to our partnership with Banner Churchill Community Hospital and Carson Valley Medical Center, we are collaborating to improve the health and convenience of cancer care for patients in those communities. Patients can receive infusion services at both hospitals and may be evaluated and managed by Renown Medical Group – Oncology either at our satellite offices, or by TeleHealth. Renown TeleHealth utilizes videoconferencing technology to give you access to top-level care and better outcomes with less stress and fewer travel costs. These services allow our cancer providers to consult on evaluation, diagnosis and treatment of patients in the comfort of their community.

28

ACKNOWLEDGMENTS

The data analyses included in the 2016 Renown Institute for Cancer Annual Report are based on data from the following:

• Renown Regional Medical Center – Cancer Registry

• American College of Surgeons Commission on Cancer (ACoS – CoC)

• American Cancer Society

• Cancer Program Practice Profile Report of the National Cancer Database (CP3R)

RENOWN REGIONAL MEDICAL CENTER Institute for Cancer 2016 Cancer Committee Roster

James B Harris, MD CANCER COMMITTEE CHAIR

Christos Gananopoulos, MD CANCER COMMITTEE CO-CHAIR

Jo Duszkiewicz, MSA VP AND RENOWN INSTITUTE FOR

CANCER ADMINISTRATOR

Susan Allen, PT

Thelma Baker, RN, MSN, OCN

Aaron Bowman, MD

Greg Boyer, MHA

Kelle Brogan, MD

Michelle Chu, MD

Jim Cohen, MD

Susan Cox, RT(T)

Tori DellaRocca

Christie Elliott, MD

John Ganser, MD

Kristina Gipson

Brandi Griggs, RN

Blaine Guinn, PharmD

June Hunter, MPH

Brian Juell, MD

Holly Kulhawick, CTR

Julie Locken, MD

Peter Lim, MD

Karen Martines, MBA, BSN, CPHQ

Jocelyn Mata, LSW, MSW

Erik Olson, MHA

Abhinand Peddada, MD

Rebecca Pitts, RD

Craig Sande, MD

Nathan Slotnick, MD

Jen Stevens, RN, MSN, OCN

Christina Szot, MD

Cynthia Thomas, BS, MA

Jenn Walker, RN, BSN

Shannon White, RN

Kelly Worley, RN, BSN, OCN

renown.org/cancer

RENOWN HEALTH INSTITUTE FOR CANCER

1155 MILL STREET • RENO, NV 89502

775-982-4000

http://renown.org/cancer

Renown Institute for Cancer 2016 ANNUAL REPORTBreast Cancer, Gastrointestinal Cancers (such as...

Documents

Transcript of Renown Institute for Cancer 2016 ANNUAL REPORTBreast Cancer, Gastrointestinal Cancers (such as...