St. Anthony’s Cancer Care Center

Cancer Care Annual Report

St. Anthony’s 2016 Cancer Committee Report

Statement from the Chairman, Mary Graham, MD

This year, more than 1,100 patients were treated for cancer at St. Anthony’s. The most common cancer sites were lung, melanoma, breast , colon, and rectal and prostate (Figure 1). The most common cancer diagnosed was lung cancer. Nearly one-half of patients diagnosed with lung cancer had stage IV disease (Figure 2). This means they had cancer spread outside of their lungs and chest to distant sites of metastasis. Such patients have previously never been thought to be curable, but recent developments in the treatment of metastatic lung cancer are providing new hope. Therapy to prolong life is available, and improving. The majority of patients diagnosed with lung cancer are between the ages of 60-80, though some may be both younger and older. Lung cancer before age 50 is rare (Figure 3).

(Figure 1)

Top 5 cancer sites 2015

 

(Figure 2)

 Lung Cancer Stages at Diagnosis 2015

 

(Figure 3)

Lung Cancer Age at Diagnosis 2015

Lung Cancer Screening

Because lung cancer is the most frequently diagnosed and treated cancer at St. Anthony’s, this year we launched a Lung Cancer screening program. Pamela Lynn, Advanced Nurse Practitioner, is the Cancer Program Lung Navigator. Patients who are eligible for screening are men and women between the ages of 55-74 , are current smokers or past smokers who quit within the past 15 years, have a smoking history equivalent to 30 pack/years (one pack per day for 30 years, or two packs per day for 15 years), and show no symptoms or signs of lung cancer. Patients who are eligible for screening meet with Pamela to discuss the potential risks and benefits of having screening. Patients are screened with a low dose chest CT scan (LDCT). These results are communicated to their primary physicians as well as the patient. If there are suspicious findings these are reviewed in a multidisciplinary group for appropriate observation, further testing or treatment. In 2016, to date, we have screened 269 people. Five people were diagnosed with lung cancer (1.8 percent incidence). For appropriate candidates, the low dose CT should be done annually. For further information regarding lung cancer screening contact Pamela Lynn, Lung Navigator, at 314-525-6095.

Immunotherapy 

Immunotherapy is one of the most significant advances in the fight against cancer and was used against a variety of tumor types at St. Anthony’s this year. This form of systemic therapy stimulates the body’s own immune system to recognize and destroy cancer cells. Immunotherapy is given by medical oncologists and can be used in combination with chemotherapy, surgery or radiation therapy. Specific molecular testing is often necessary to see if an individual patient’s cancer will be sensitive to these agents. The number of patients treated with this type of therapy at St. Anthony’s increased by 14 percent in 2016 . The total number of immunotherapy treatments increased by 70 percent. Some common agents in this category include: ipilimumab (Yervoy), pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), osimertinib and crizotinib. Immunotherapy is most commonly used in the treatment of metastatic non-small cell lung cancer and melanoma, but has also been approved for the treatment of head and neck cancer, Hodgkin lymphoma, bladder cancer and kidney cancer. New indications for immunotherapy are being identified at a fast pace.

Vaccines  

Vaccines can be used to prevent and treat specific cancers. Examples of common vaccines include HPV quadrivalent (Gardasil) and HPV-9-valent (Gardasil-9), HPV bivalent (Cervarix) and Sipuleucil-T (Provenge) and Bacillus Calmette-Guerin (BCG). The HPV vaccines are used to prevent cervical and HPV related head and neck cancers and the BCG vaccine is used for bladder cancer.

Stereotactic Radiation Therapy 

Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) are the specialized focused delivery of high doses of radiation therapy in a single or few treatments (typically less than five). At St. Anthony’s, we delivered 178 SRS or SBRT treatments in 2016. The most common sites of treatment for these modalities are brain and lung tumors. Traditional intracranial (brain) SRS treatments have involved fixing large metal frames to the patient’s head which is time consuming and difficult for patients. At St. Anthony’s, we are using the AlignRT SRS module. This technology and process allow smooth, efficient and accurate treatment of our patients without metal fixation to the patient’s skull. The align RT tracks the patient’s skin surface, not a box or physical marker. No additional radiation is delivered to the patient. Accurate monitoring of the patient during treatment is also achieved to within millimeter precision and assures correct radiation treatment, as the machine can be gaited to stop treatment if movement is out of threshold levels (typically less than 1-2 mm).

Molecular testing

There has been an explosion of bio-marker driven (molecular testing) to diagnose and treat cancer this year. Bio-marker testing provides specific information about a patient’s tumor that can be used in the diagnosis, development of a treatment plan and following the patient’s progress. Biomarkers can be tested on tumor pathology specimens and /or blood testing. Key issues that have been addressed for our cancer patients include reviewing new patient cases in multidisciplinary conferences and QA reviews of adequacy of biopsy samples for molecular testing and assuring that appropriate molecular tests are ordered and obtained for eligible patients.

Quality studies and Quality Improvements

This year two specific studies of quality were performed by the cancer committee. The first study evaluated the diagnostic efficacy of biopsies for lung cancer. Dr. Lodato and her team of pathologists evaluated the efficacy of image guided percutaneous needle biopsies versus bronchoscopic guided procedures, including biopsy, brushings, endobronchial washings and EBUS-guided fine needle aspirations. The results of this study showed a higher diagnostic yield from CT-guided biopsies. It is recognized that a direct comparison of the two diagnostic approaches is like comparing “apples and oranges”, because different patient clinical scenarios warrant different approaches to obtaining a diagnosis. Diagnostic yield and sufficiency for molecular testing increased during this study and additional recommendations for improvement are being implemented.

The second study of quality was an evaluation and comparison of the complication rates after insertion for Port-a-Catheters by interventional radiology and the surgical insertion in the operating room. Port-a-Catheters are placed into the veins in a patient’s chest for long-term use and delivery of chemotherapy. This study, which was performed over a 6 month period of time, found an observed complication rate of 0.07 percent, which is well below the published benchmarks of 2-5 percent. This study confirmed the safe and effective placement of central lines at St. Anthony’s for administration of chemotherapy and related intravenous uses.

A quality improvement this year was in the department of radiation Oncology conducted by Dr. James Monroe, PhD, DABR, Senior Medial Physicist. The complexity and accuracy of modern radiation therapy treatments is greater than ever. Assuring that these highly complex radiation treatments are calculated correctly and administered accurately is imperative. This study used a new Quality Assurance System called Mobius FX. This system showed improved quality assessment of our most complex plans of stereotactic and IMRT treatment plans. These assessments identified ways to prevent patient treatment delays and assured accurate complex radiation therapy treatments such as stereotactic treatment and intensity modulated treatments (IMRT).

Survivorship

More people diagnosed with cancer are surviving than ever before. As the number of cancer survivors living years beyond their cancer diagnosis has grown, so has the recognition that patients and their medical care providers need long-term recognition and intervention for their late risks of physical, psychosocial and practical (sometimes financial) impacts of their cancer and its treatment. It is essential that they have comprehensive follow-up care after treatment ends. St. Anthony’s Cancer Committee has been working very hard to achieve this goal. Heather Girard, MSN, AGNP – BC, was hired as Survivorship Nurse Coordinator. To date, 2017 survivorship care plans were created and given to cancer survivors at St. Anthony’s. The Commission on Cancer’s goal for this year was that 25 percent of eligible patients receive care plans. St. Anthony’s 217 patients represent 27 percent of our eligible patients. Next year’s goal will be that 50 percent of patients receive this counseling and care plans. The goals of the care plans are to

  • Educate patients, primary care and oncology care providers about the clinical follow up needs of cancer survivors
  • Provide tools for primary care and oncology care providers to help implement and improve care for our cancer survivors
  • Equip patients with tools to help them discuss their long-term health with providers
  • Highlight continuing resources and education for improving patient's survivorship.

For further survivorship information, Heather Girard, Survivorship Coordinator, can be reached at 314-525-6091.

Cancer Care Committee Members: 2016

Cancer Committee Members

Dr. Mary Graham
Cancer Committee Chair
Dr. Paul Oberle
Radiologist 
Dr. Kirke Bieneman
Radiologist
Dr. Kiran Chunduri
Interventional Radiologist
Dr. Ronna Lodato
Pathologist
Dr. Emily Popovic
Pathologist
Dr. Steven E. West
Surgeon, ENT specialist
Dr. Sarah Snell
Surgeon, Breast specialist 
Dr. Craig Hildreth
Medical Oncologist
Dr. Stephen Allen
Medical Oncologist
Dr. Mary Graham
Radiation Oncologist
Dr. Shana Coplowitz
Radiation Oncologist
Dr. Michael Gu
Cancer Liaison Physician
Dr. William Morris
Medical Oncologist
Calvin Robinson
Cancer Program Administrator
Bill Hoefer
Chief Operating Officer
Elaine Sharamitaro, RN, ONC
Oncology Nurse
Marie Graham, RN, ONC
Oncology Nurse
Sybil Gist
Social Worker or Case Manager
Kathleen Dooling
Social Worker
Carrie Allison, CTR
Certified Tumor Registrar
Dr. Edward Burns
Palliative Care team member, when these services are provided on-site 
Shari Mareschal
Director, Palliative Care Services
Carrie Allison, CTR
Cancer Conference Coordinator
 
Patti Storey, MHA, RHIA
Quality Improvement Coordinator
Liz Schelp
Stroke Program Manager
Sabina Lall, CTR
Cancer Registry Quality Coordinator
 
Laura Bub, MPH
Community Benefit Manager
Katie Rayfield
Coordinator, Community Outreach
Janet Lesko, RN
Clinical Research Coordinator
Sara Gibson, PharmD
Pharmacy Operations Manager
Grace Marting, MSW
Psychosocial Services Coordinator
Tina Baldridge
Social Worker

 

Additional Participants 

Elizabeth Caspari, MS, Radiation Oncology
Brandy Dirks, RT Oncology Data Services/Radiation Oncology
Mary “Cathy” Feldmeier, RD, LD, Registered Dietician 
 Heather Girard, Survivorship Nurse Coordinator
Al Hibbett, Director, Radiology
Dennis Holter, Hospital Administration, Business Development
Pamela Lynn, ANP, Lung Care Navigator
Dr. James Monroe, Radiology
Jamie Nobbe, Rehabilitation Representative
Chuck Rosso, BCC, Pastoral Care Representative
Lisa Salvati, RN, MSN, Breast Care Navigator
Diane Schreiber, RD, LD, Registered Dietician
Ruth Southards, BSN, RN, CHPN, Director of Hospice Program
Andrea Turner, Manager, Radiology Specialty
Kadi Montez – Vice-President, Information Systems
Damon Broyles – Medical Director, Information Systems
Joann Valentine, RN – Radiation Oncology
Lauren Ruma, RN – Radiation Oncology