St. Anthony’s Cancer Care Center

Cancer Care Annual Report - 2016

St. Anthony’s Medical Center is accredited by the American College of Surgeons’ Commission on Cancer (CoC). The hallmark of our program is rapid access to premier cancer care. Because we know that the word "cancer" can cause significant stress, we pledge to schedule patients with the right specialist(s) in a timely manner and to start appropriate treatment as soon as possible. The majority of new cancer patients will see a doctor within 72 hours and have a coordinated clinical care plan developed within one week.

We provide comprehensive screening, diagnoses, treatment and survivorship planning for the most common types of cancer we see in our community – including lung, breast, colorectal and prostate cancers. Each year more than 1,300 patients are treated for cancer at St. Anthony’s Medical Center. The top five common cancer sites are lung, breast, melanoma, colon and prostate. The most common cancer diagnosed was lung cancer. Nearly one half of patients diagnosed with lung cancer had stage IV disease. 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 ages of 60-80, though some may be both younger and older. Lung cancer before age 50 is rare.

The Cancer Registry at St. Anthony's was established to monitor trends and outcomes of cancer incidence in our community. The Cancer Registry is made up of professionals responsible for the collection and management of accurate and timely cancer patient information. The registry provides members of St. Anthony's staff with data which enables them to evaluate diagnostic and treatment approaches, analyze quality care, study survival rates, and ultimately improve the overall care provided by St. Anthony's. The cancer registry maintains a wide range of demographic and medical information. Demographic information includes age, gender, race/ethnicity, birthplace and residence. Medical history includes physical findings, screening information, occupation, and any history of previous cancer. Diagnostic findings include tests, dates, and results of procedures used to diagnose cancer. Cancer information includes primary site, cell type, and extent of disease. Cancer treatment includes surgery, radiation therapy, chemotherapy, hormone, or immunotherapy. Cancer registry follows up annual information about treatment, recurrence, and patient status. Cancer registry information is both submitted and utilized by state and national cancer registries to enable cancer programs to accurately determine cancer patient populations, formulate plans for improvement and measure outcomes of treatment and survival.

The Cancer Registry is responsible for diagnosis and/or treatment of patients at SAMC. We have three certified cancer registrars and we abstract over 1,300 cases each year across our multiple sites. The Cancer Registry is also responsible for coordinating the multidisciplinary cancer conferences and providing reports on cancer activity.

In 2015, top five sites diagnosed and/or treated at SAMC were Lung (17.76%), Breast (14.38%), Melanoma of Skin (13.60%), Colon (7.75%) and Prostate (7.61%).
 

Top 5 sites diagnosed or treated at SAMC in 2015

Top Five (5) sites diagnosed and/or treated at SAMC in 2015

 

2015 Breast Cancer Stages at Diagnosis

2015 Breast Cancer – Age at Diagnosis

2015 Breast Cancer – Age at Diagnosis

 

 

Performance Measures

The Commission on Cancer (CoC) requires accredited cancer programs to treat cancer patients according to nationally accepted quality improvement measures indicated by the CoC quality reporting tool, Cancer Program Practice Profile Reports (CP3R). The function of the quality improvement measure is to monitor the need for quality improvement or remediation of treatment provided. Accountability measures promote improvements in care delivery. The quality improvement measure function is to monitor the need for quality improvement. Surveillance measures generate information for decision making and/or monitor patterns and treads of care.

Cancer Program Practice Profile Reports (CP3R)

Review of Analytic Rectum, Colon, and Breast Cases Diagnosed

 Title Measure Definition  CoC 
Std%
2013 2014 2015
 RECRT

  RECRTCT - Preoperative chemo and
  radiation are administered for clinical 
  AJCC T3N0, T4N0, or Stage III; or
  Postoperative chemo and radiation are
  administered within 180 days of 
  diagnosis for clinical AJCC T1-2N0
  with pathologic AJCC T3N0, T4N0, or
  Stage III; or treatment is recommended;
  for patients under the age of 80
  receiving resection for rectal cancer
 (Quality Improvement)

 4.5 / 85%  92.3%

 71.4%

(2 patients
started chemo
after surgery;
After measure
deadline)

87.5%
 12RLN   12RLN - At least 12 regional lymph
  nodes are removed and pathologically
  examined for resected colon cancer
  (Quality Improvement) 

 4.5 / 85%  94.7%   93.4%  95.7% 
 ACT

  Adjuvant chemotherapy is 
  recommended or administered within 4
  months (120 days) or diagnosis for
  patients under the age of 80 with AJCC
  stage III (lymph node positive) colon
  cancer (Accountability)

 4.4 / 90%   100%  92.9%  81.3%
 BCSRT   BCSRT - Radiation is administered
  within 1 year (365 days) of diagnosis
  for women under the age of 70 receiving
  breast conservation surgery for breast
  cancer (Accountability)
 4.4 / 90%  100%  100%  94.6%
 HT

  HT - Tamoxifen or third generation 
  aromatase inhibitor is recommended or
  administered within 1 year (365 days) of 
  diagnosis for women with AJCC T1c or
  stage 1B-III hormone receptor positive 
  breast cancer (Accountability)

 4.4 / 90%  98.7%  96.8%  98.2%
 MASTRT 

  MASTRT - Radiation therapy is 
  recommended or administered following
  any mastectomy within 1 year (365
  days) of diagnosis of breast cancer for 
  women with >= 4 positive regional
  lymph nodes (Accountability)

 4.4 / 90% 100%  100% 100%
 MAC   MAC - Combination chemotherapy is
  recommended or administered within 4
  months (120 days) of diagnosis for
  women under 70 with AJCC T1cN0, or
  stage 1B - III hormone receptor negative
  breast cancer (Accountability) 
 NA  100%  100%  100%
 BCS   BCS - Breast conservation surgery rate
  for women with AJCC clinical stage 0, I
  or II breast cancer (Surveillance)
 NA  52.6%  63.8%  57.9%
nBx   nBx - Image or palaption-guided needle
  biopsy to the primary site is performed
  to establish diagnosis of breast cancer
  (Quality Improvement)
 4.5 / 80%  93.2%  94.9%  93.9%


Cancer Conferences at St. Anthony's

Cancer conferences improve the care of patients with cancer by providing multidisciplinary treatment planning and contributing to physician and allied medical staff education. Cases are presented at a point when patient care management can be directly influenced by the discussion. Each discussion includes the patients’ medical history; physical exam; diagnostic; pathologic and operative findings; staging; and treatment options. Discussions also include evidence-based guidelines, protocol updates, literature reviews and presentation of cancer registry data.

Cancer Conferences held in 2015

Meetings   Attendance  Cases
Quarters # Cancer
Conferences
each Quarter

Medical
Oncology
Average %
Attendance
each Quarter

Radiation
Oncology
Average %
Attendance
each Quarter

Surgery
Average %
Attendance
each Quarter

Pathology
Average %
Attendance
each Quarter

Diagnostic
Radiology
Average %
Attendance
each Quarter

# Cases
Presented
each
Quarter 
# Prospective
Cases each
Quarter
% Cases
Presented 
Prospectively
each Quarter 

# Stagable
Cases
each
Quarter

# Cases
with Stage
Given each
Quarter

% of
Cases
Staged
each 
Quarter 

Q1 16 100% 100% 94% 100% 100% 77 76 99% 71 69 97%
Q2 17 94% 100% 88% 100% 100% 82 81 99% 74 71 96%
Q3 17 100% 88% 100% 100% 100% 78 78 100% 72 70 97%
Q4 17 94% 94% 94% 100% 100% 79 79 100% 69 69 100%
     
  Total #
Cancer
Conferences
Med Onc
Average %
Attendance 
Rad Onc 
Average %
Attendance
Surgeon
Average %
Attendance
Pathologist
Average %
Attendance
Diag Rad
Average %
Attendance 
Total # of 
Cases
Presented
Total # of
Prospective 
Cases
% Cases
Presented
Prospectively
Total # of 
Stagable
Cases
Total # of 
Cases 
Staged

% of
Cases 
Staged

Annual
Totals
67 97% 96% 94% 100% 100% 316 314 99% 286 279 98%
 

Cancer Care Committee Members: 2016

Cancer Committee Members

Dr. Mary Graham
Radiation Oncologist
Cancer Committee Chair

Dr. Paul Oberle
Diagnostic Radiologist 

Dr. Kirke Bieneman
Interventional Radiologist

Dr. Kiran Chunduri
Interventional Radiologist

Dr. Ronna Lodato
Pathologist

Dr. Emily Popovic
Pathologist

Dr. Steven E. West
Surgeon, ENT Specialist
Surgery

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
Medical Oncologist
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
Cancer Conference Coordinator

Dr. Edward Burns
Palliative Care 

Shari Mareschal
Director, Palliative Care Services

Carrie Allison, CTR
Cancer Conference Coordinator

 

Patti Storey
Quality Improvement Coordinator

Liz Schelp
Stroke Program Manager

Sabina Lall, CTR
Cancer Registry Quality Coordinator

 

Laura Bub, MPH
Community Benefit Manager
Community Outreach Coordinator

Kayla Seda
Community Outreach Coordinator

Janet Lesko, RN
Clinical Research Coordinator

Sara Gibson, PharmD
Pharmacy Operations Manager

Grace Marting, MSW
Psychosocial Services Coordinator

Tina Baldridge
Social Worker

 

Prevention and Screening:

Screening Program - “Colorectal Cancer Awareness” - Colorectal cancer is the third most diagnosed cancer and the third leading cause of cancer death. Only 34 percent of all colorectal cancer is diagnosed in the early stage in St. Louis County*. Cancers of the colon is the 3rd most diagnosed and treated type of cancer at St. Anthony’s Medical Center. More information is needed in the community on the importance of getting a colorectal screening.

Prevention Program – “Paint the Mall Pink”. St. Anthony’s Medical Center “painted” the mall pink for the month of October. This month long awareness campaign kicked off with a booth staffed by our Breast Care Navigator that focused on providing breast care prevention information to shoppers. St. Anthony's employees were on-hand at all mall entrances to hand out prevention information.

Prevention Program – “Pink Night at the Movies”. To celebrate Breast Cancer Awareness month in October, St. Anthony’s provided an educational event at the movies to learn about how early detection of breast cancer can save lives. Women were educated throughout the event on early detection through self-breast exams and mammograms.

Skin Cancer Screening - Melanoma is on the rise nationally, as well as in the St. Louis region. Skin cancer rates (excluding basal and squamous) in the St. Louis region for men rose from 163 per 100,000 people in 1996 to 347 in the year 2010 and from 275 for women in 1996 to 589 in 2010*. St. Anthony’s has also experienced a rise in melanoma cases. Melanoma was ranked 5th and represented 8 percent of analytic cases seen at St. Anthony’s in 2012. St. Anthony’s had 100 people take part in our annual skin cancer screening. All participants were given education on skin cancer prevention including: information in skin protection, a parent’s guide to skin protection, education on melanoma and early detection, and a packet of sunscreen. A total of 14 members of our community were identified as possibly having some sort of skin cancer, including one possible melanoma and were referred for follow-up.

Monitoring Compliance with Evidence-Based Guidelines, Standard 4.6

In 2015, Dr. Lodato, Pathologist, performed evidence-based study for the treatment of melanoma recommends that as primary treatment for Stage IB melanomas >0.75 mm, and Stage II melanomas, patients should be offered sentinel node biopsy.

Data collection: Melanoma excisions performed at St. Anthony's between January 1 and December 31, 2014, were retrieved from both the tumor registry and Pathology department files, and records for those with tumors T1b >0.75 mm, and T2a-T4b, were reviewed.

Results:

  • 67 patients with T1b-T4b melanomas had surgery at St. Anthony's in the time period. These were operated on by three surgeons (most by a single surgeon).
  • All 63 patients with T1b tumors >0.75 mm, or T2a-T4b tumors, had sentinel lymph node biopsies performed. Of these 10 had positive sentinel nodes, ranging from T2a to T4b. Of these, four had more positive nodes on completion node dissection.
  • Of the four patients with “thin” T1b tumors (<0.76 mm): one patient (0.6 mm) had sentinel node biopsy, and three did not.
  • Nine patients with T1a tumors also had sentinel node biopsies, mostly thick T1a. One was positive (a thin T1a, 0.17 mm, with additional positive nodes in a later dissection).

This shows 100 percent compliance with the NCCN guidelines on management (first course/ primary treatment) of Stage IB and Stage II melanomas.

Quality studies, Standard 4.7 The annual evaluation of the care of cancer patients provides a baseline to measure quality and an opportunity to correct or enhance care and quality outcomes. Quality improvement efforts focus on evaluating areas of cancer care and must include multidisciplinary representation from clinical, administrative, and patient prospective.

In 2015, the following studies were completed and evaluated by cancer committee:

  • Turnaround time from referral to consult in Radiation Oncology
  • Mobius - verification of calculations of physics QA within Radiation Therapy.

Quality Improvements, Standard 4.8Quality or performance improvements are the actions taken, process implemented, or services created to improve cancer care. Implementation of improvements demonstrates a programs continuous commitment to providing high-quality patient care. The results of a cancer-related quality study provide a baseline to measure and improve quality.

In 2015, the following improvements were completed and evaluated by cancer committee:

  • Acquire Vision RT
  • Purchase of Mobius in Radiation Department

Clinical Research Accrual: Clinical research advances science and provides patients with the highest possible level of quality care. Research trials are an integral part of care at the St. Anthony’s Medical Cancer Center. We are dedicated to providing a variety of treatment opportunities to patients that are interested in participating in research studies.

St. Anthony’s Oncology Research Department provides clinical and administrative support for clinical trials sponsored by the Nation Cancer Institute, Alliance for Clinical Trials in Oncology as an affiliate site to Washington University, St. Louis Missouri. Dr. Michael (Minxiang) Gu is our Principal Investigator supported by six NCI Investigators.

  • 16 National Cancer Institute (NCI) sponsored cooperative group clinical trials
  • Six research studies open to new patient registration
  • N-CORP sponsored studies including Phase III and IV trials in quality of care, treatment, and supportive care
  • Multi-site research trials: three breast, one head/neck, one neuro/glioblastoma, and one multi-site (any type solid tumor or lymphoma).
  • NCI Match Trial Phase II clinical trial targeting certain genetic changes and matches patients to more than 20 treatment sub-studies.

St. Anthony’s Medical Center 2016 Cancer Committee is a multi-specialty committee that includes board certified doctors, members of administration, nursing, social services, radiology, quality assurance, cancer registry, and other related specialty staff. The chair for 2016 was Mary Graham, MD radiation oncology and NCI Investigator joined by Michael (Minxiang) Gu, MD, oncologist, PI-Principal Investigator, and CLP-Cancer Liaison Physician. Our cancer research program has been recognized with commendation for exceeding the expectations of clinical trials accruals as a Community Hospital Comprehensive Cancer Program.

Cancer-related trial information is available throughout the Medical Center, Medical Plaza, Cancer Center, Outpatient Infusion, Breast Center, and in the offices of our medical oncologists. Clinical trial information is available via the internet on the St. Anthony’s Medical Center webpage under "More about the Cancer Center” 2) Cancer Patient Services 3) Cancer Trials & Research with a direct link to the Open Research Trials. Trial information is posted on the CAN Cancer Agencies Network of Greater St. Louis website. The American Cancer Society also provides patient referrals to a 1-800 number for national clinical trial information which includes St. Anthony’s list of oncology trial availability.

Survivorship Care Plan

Survivorship can mean different things to different people, but often it describes the process of living with, through and beyond cancer. Transitioning from active treatment into post-treatment care is critical to optimal long-term health. Completing treatment is just the beginning for cancer survivors. They may experience side effects caused by their surgery, chemotherapy and radiation treatments. To help our cancer survivors a survivorship program was launched with supports patient and their families along the continuum of care making them aware of follow up care and health loving beyond caner.

Upon completion of treatment, the information reviewed with the survivorship nurse practitioner or with a member of the multidisciplinary cancer care team. The survivorship care plan with include a treatment summary and serve as a resource for the patient to help him or her monitor and develop a healthy lifestyle. Explanation of the survivorship care plan will include discussion of possible early and late treatment side effect and reviewing health maintenance recommendation by the National Comprehensive Cancer Network (NCCN).

During the survivorship care plan visit patients are provided with recommendations for follow up test, nutrition tips, management of physical changes, emotional health, and cancer support groups. A copy of the Survivorship Care Plan and Treatment Summary will be provided to the patient and sent to the primary care provider, referring providers and those providers requested by the patient. The program goal is to return patient to their pre-treatment lives and activities.

Support Services, Programs & Community Partners for cancer care patients:

A patient navigation process, is driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Patients’ navigators provide personalized guidance, support and assistance to patients and their families. Patient navigator role helps in connecting patients and families to resources and supportive care staff and services. We provide the following support services at St. Anthony's and are community partners with for cancer care patients:

Nurse Navigators

  • Breast Care Navigator
  • Lung Navigator
  • Survivorship Coordinator

Oncology Social Work

Oncology Dietitians

Charitable Foundation Grants

  • Transportation Assistance Grant
  • Individual Support Program
  • Art Therapy Grant

Support Groups

  • Breast Cancer Support Group
  • Prostate Cancer Support Group
  • All Cancer Support Group

American Cancer Society

  • Look Good Feel Better
  • Road to Recovery
  • Reach to Recovery
  • Personal Health Managers
  • Free Wigs
  • Making Strides Against Breast Cancer Walk

Cancer Support Community

  • Frankly Speaking about Coping with the Cost of Care
  • Frankly Speaking about Cancer Treatment and Side Effects

Colon Cancer Alliance Undy Run

Free to Breathe Lung Cancer Walk

Radiation Oncology

St. Anthony’s Cancer Center offers a full range of radiation therapy options, including stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT). SRS refers to treatments within the brain, while SBRT indicates treatments given to sites in the body outside of the brain (lung, liver, spine, pancreas, adrenal gland, bone and pelvis).

Both treatments do not involve invasive surgery, but rather describe the precise, high doses of radiation that are delivered. Treatment is highly accurate and painless. Treatment is given on an outpatient basis on a specialized linear accelerator, and takes only one to five treatment sessions as compared to several weeks for traditional radiation therapy. As there is no surgical incision, patients are able to go home the same day and return to their usual activities within 24 hours. SRS/SBRT procedures are administered by a team, including a radiation oncologist, neurosurgeon, medical physicist, and radiation therapists.

SBRT also includes the use of advanced technology for accurate and precise tumor targeting. For example, in some patients with tumors that move with breathing, an optical surface monitoring system can be used to track tumor motion. Multiple beams are used, allowing the shape and dose of the radiation to precisely treat the target and spare surrounding healthy tissue. The SRS/SBRT system localizes the tumor utilizing internal and external imaging for accurate targeting.

The ideal tumor for SRS/SBRT is relatively small with well-circumscribed boarders that can be accurately imaged by MRI or CT. SRS/SBRT is also ideal for specific tumor types, including melanoma, renal cell carcinoma and soft tissue sarcoma.

OP Infusion

The Outpatient infusion Center at St. Anthony’s Medical Center provides a comfortable, relaxed setting for patients to receive infusion services such as chemotherapy. Treatments are scheduled in cycles — typically over several days or weeks — and can last from 15 minutes to several hours each time, depending upon each patient’s customized treatment plan.

Open chairs as well as private spaces are available for infusion services. Televisions, Internet access, and tablets help patients pass the time while in the Infusion Center. Warm blankets and pillows also are provided, as are lunch and snacks throughout the day.