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Cancer Center Annual Report Annual Report

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					     08
The Cancer Program of The Chester County Hospital
Annual Report 2008
With statistical data from 2007
2008 Cancer Program Review

The Cancer Program of The Chester County Hospital (CCH) diagnoses and treats many
types of cancer each year. In 2007 there were 934 new cancer patients (including both
analytic and non-analytic) seen at The Chester County Hospital with 62.5% of those
patients having a primary cancer site of bladder, breast, colorectal, lung and prostate.

This percentage is similar to the rate of 55.3% for Pennsylvania, as well as to the U.S. rate of 57.5%. The incidence rates can
vary from region to region across the country, and are dependent on a variety of factors, including demographics, screening
patterns, socio-economic conditions and medical coverage. Early diagnosis and treatment play a crucial role in the care of
cancer patients. Through a variety of initiatives, education and screening was provided to more than 2600 Chester County
residents.


As of January 2004, the National Cancer Institute estimates that there were 10.8 million cancer
survivors in the U.S., representing approximately 3.7% of the population. Approximately 14% of these
estimated survivors were diagnosed more than 20 years ago. Three out of every four American families will have at least one
family member diagnosed with cancer. Today, 65 percent of adults diagnosed with cancer will be alive in five years.


The Chester County Hospital has provided cancer care and treatment to its community since 1959. Cancer is a major illness, but
not everyone who gets cancer will die from it. Millions of Americans alive today have a history of cancer and have had successful
treatment. For many of our patients, cancer has become an on-going health problem, like high blood pressure or diabetes.


Our patients have the benefit of treatment by an experienced team of cancer experts close to home.
The Chester County Hospital is a Member of The University of Pennsylvania Cancer Network, representing a select group of
community-based hospitals throughout Pennsylvania, Delaware and New Jersey collaborating with the Abramson Cancer Center
to provide excellence in patient care throughout our region. The Abramson Cancer Center is one of a few cancer centers in the
country designated as a Comprehensive Cancer Center by the National Cancer Institute. Penn’s Cancer Network hospitals are
recognized for their commitment to patient care and to improving the health and well-being of their communities. The close
relationship between The Chester County Hospital physicians and Penn physicians provides an ideal complement to assure that
each patient receives the best care that uniquely focuses on the individual.




                                                                         The Cancer Program of The Chester County Hospital Annual Report 2008   1
In 2007-2008 there were several initiatives undertaken to improve The Cancer Program of The Chester
County Hospital.
• Re-certification with ECOG. We are a research affiliate of the Eastern Cooperative Oncology Group (ECOG) through our
relationship with the Abramson Cancer Center of the University of Pennsylvania. This relationship provides us with access to
National Cancer Institute funded high priority cancer treatment trials.
• Enhancing our complementary programs. Patients now enjoy supportive care programs, such as nutritional counseling, yoga,
specialized fitness programs, art therapy, horse therapy and massage.
• Improved awareness and utilization of our Inpatient Hospice Unit. There is greater community awareness and the patient
census has increased. Physicians, families and our patients have provided us with many public accolades regarding provision
of care in the Inpatient Hospice Unit.



Community Outreach and Education plays an integral part in The Cancer Program of CCH. Community
Cancer Screenings were offered for the following sites: breast, oral and prostate.
We are pleased to be able to provide this free service to the community. During these screenings we frequently find a small number
of individuals who need further evaluation. With early detection and with effective treatment, long term survival is greatly increased.



  In 2007, approximately 2600 individuals participated in FREE Community Education Programs.
  These programs were presented by various members of the Cancer Care team of The Chester County Hospital and covered a wide
  range of topics which included:

 Physician Presentations:                                        Health Promotion Programs:
 • Cancer Prevention                                             • Smoking Cessation
 • Women’s Health Expo                                           • Weight Management : Healthy Steps : for Adults

 Support Groups:                                                 Tobacco Settlement Programs:
 • Art Therapy for Survivors        • Caregivers Series          • Teens Against Tobacco Use (TATU)
 • Bereavement                      • Prostate Cancer              Peer Educators’ Training & Workshop Sessions
 • Breast Cancer                    • Yoga for Survivors           West Chester Area School District : Grades 6 to 8
                                                                 • TATU Peer Education Presentations
 Special Events:                                                   Starkweather Elementary School Students
 • Cancer Survivor Day                                             West Chester Area School District : Grades 4 & 5
 • Relay for Life – Healthy Living Tent                          • Assembly Presentation : Voice to Remember
 • Renew, Refresh & Revitalize – Retreat for                       Tobacco prevention & motivational presentation
   Women Living with Cancer                                        Stetson Middle School Students
                                                                   West Chester Area School District : Grade 6
 Symptom Management:                                             • Student Wellness Days
 • Individual Counseling (Social Work)                             West Chester Area School District &
 • Look Good Feel Better                                           Community based program




                                                                            The Cancer Program of The Chester County Hospital Annual Report 2008   2
The Cancer Program of The Chester County Hospital
2007 Breast Cancer Review
Pamela P. Scott, M.D.
Breast Surgeon
The Chester County Hospital




In 2007, there were 226 women diagnosed with breast cancer at The Chester County
Hospital. Breast cancer is the most common cancer in women, if skin cancers are
excluded. Data from the American Cancer Society shows that one in every four new
cancers diagnosed are breast cancer. The rate in men is much lower.

The incidence of breast cancer increases with age and with long term use of hormone replacement therapy (greater than ten
years). Other risk factors include a family history of breast cancer in a mother, sister, or daughter, a family history of ovarian
cancer, a family history of inherited genetic mutation, early menarche (younger than 12 years), late menopause (after 55 years),
and post menopausal obesity. The lifetime risk of women living in the United States is 12.3% or a one in eight chance of
developing breast cancer.


At The Chester County Hospital, in 2007, breast cancer diagnoses represented 25.4% of all new cancers diagnosed, which is
comparable to what should be expected according to the American Cancer Society. Among the cancers we diagnose, breast
cancer is a higher proportion than is found in other counties and the State of Pennsylvania and in the United States, which report
that among the cancers diagnosed, breast represents 13% of the cancers. This high percentage is not to be misconstrued that
women who live in Chester County are experiencing a high rate of breast cancer, as this is not the case. We attribute this higher
proportion to our reputation in the community and the efforts of a multidisciplinary team who works together to diagnose and
initiate treatment in a timely manner. The Chester County Hospital also offers extensive community screening and outreach
programs which leads to earlier detection.


                                                      Our rates of detecting early stage breast cancer are higher than the
    The components of the                             average rate in the United States – 63.74% of our patients are detected at
    multidisciplinary team include:                   an early stage as compared to 56.39% for the United States. The women
    • Breast Surgeons                                 in our community have a greater awareness of the need for early detection
                                                      and are getting their screening mammograms regularly. Our primary care
    • Care Coordinator
                                                      physicians, gynecologists and physician extenders include regular
    • Medical Oncologists                             mammograms as part of their patient’s health maintenance. The Chester
    • Pathologists                                    County Hospital Radiology Department sends yearly reminders as do many
                                                      of the insurance companies.
    • Plastic Surgeons
    • Radiation Oncologists
    • Radiologists
    • Social Worker




                                                                          The Cancer Program of The Chester County Hospital Annual Report 2008   3
2007 Breast Cancer Review
The Chester County Hospital


Reviewing the National Cancer Data Base (NCDB) five year survival statistics for breast cancer patients diagnosed between 1998
and 2000 shows that patients of The Chester County Hospital with Stage 0 and Stage 1 disease (Early Stage) had a higher survival
rate. History has shown that longer term survival is stage dependent, with the best survival being in patients diagnosed with
early stage disease.

Treatment decisions are made by the patient and her physician after consideration of:
    • the best treatment available for the stage and cell type of her cancer
    • the risks and benefits associated with each treatment choice
    • the patient’s age and preferences

Most women will have some type of surgery, which is combined with treatments, such as: radiation therapy, chemotherapy, and
hormone therapy. Treatment guidelines from the National Comprehensive Cancer Network (NCCN) are a good reference when
designing a patient’s treatment plan. The Chester County Hospital’s treatment plan also offers reconstructive surgery.

The National Quality Forum (NQF) brought public and                                                                                         NCDB Comparison Breast Cancer Treatment for 2005
private payers together with consumers, researchers,                              30.0

and clinicians to broaden consensus on performance                                                                                                                                                                                                       CCH
                                                                                                                                                                                                                                                         Other
measures for breast cancer. The recommended
                                                                                  22.5
measures give CCH the ability to examine program-
specific breast cancer care practices. Against the
                                                                        Percent




measures recommended by NQF, we are pleased to                                    15.0
report that we achieved 100% compliance.

An NCDB1 report for breast cancer patients diagnosed in                            7.5

2005 revealed that patients from The Chester County
Hospital received combined modality treatment more
                                                                                     0
frequently than those breast cancer patients treated in
                                                                                                                   Surg, Rad, Chemo, Horm




                                                                                                                                                                                                                                                                 No Treatment
                                                                                         Surg, Rad, Horm




                                                                                                                                                                                                                                   Surg, Chemo
                                                                                                                                                                                                                    Surg, Rad
                                                                                                                                                Surg, Rad, Chemo




                                                                                                                                                                                                                                                 Other
                                                                                                                                                                                                    Surg Only
                                                                                                                                                                   Surg, Chemo, Horm


                                                                                                                                                                                       Surg, Horm




other Community Cancer Centers across the United
States. The standard of care is that the combined
modality treatment for breast cancer is the most effective
treatment and CCH is adhering to these guidelines.
                                                                                                           C O M B I N E D T R E AT M E N T                                                                     T R E AT M E N T



Conclusion:
The Chester County Hospital and its physicians are committed to the best care and treatment for
women. Breast care includes early detection, prevention, diagnosis and treatment. We are finding
breast cancer earlier than others nationally – we attribute this to a multi-disciplinary approach and
timely intervention. Our survivor rate is higher, largely due to early diagnosis and effective treatment.
1
 The National Cancer Data Base (NCDB), a joint program of the Commission on Cancer (CoC) and the American Cancer Society (ACS), is a nationwide oncology
outcomes database for more than 1,400 Commission-approved cancer programs in the United States and Puerto Rico. Some 75% of all newly diagnosed
cases of cancer in the United States are captured at the institutional level and reported to the NCDB. The NCDB, begun in 1989, now contains approximately
20 million records from hospital cancer registries across the United States. These data are used to explore trends in cancer care, create regional and state
benchmarks for participating hospitals, and to serve as the basis for quality improvement.




                                                                                                               The Cancer Program of The Chester County Hospital Annual Report 2008                                                                      4
Cancer Data Center Review



T
                he Cancer Data Center is the component of the Cancer Program that is designed to
                coordinate the collection, management, analysis and dissemination of the cancer
                information at The Chester County Hospital. The data center is the hub for the
                Commission on Cancer (CoC) approved Cancer Program and plays an integral role for
                providing a multitude of services and support.

All cancer patients diagnosed and/or treated at CCH are entered into the cancer database. The data collected includes patient
demographics, medical history, diagnostic findings, cancer treatment, and lifetime follow-up. The data are handled with the
utmost care and patient confidentiality is required.

Data is submitted to the National Cancer Database (NCDB) and the Pennsylvania Cancer Registry (PCR), thus allowing
comparative analysis with other hospitals across the nation and state. The Cancer Data Center database is a vital tool used for
programmatic and administrative planning, as well as the monitoring of patient outcomes. Statistical reports are generated to
analyze referral patterns, patient survival rates and for educational conferences, journal articles, incidence occurrence, quality
audits and process improvement studies. The Cancer Data Center responded to 25 information requests in 2007.


The reference date for the cancer database at CCH is January 1, 1979. There are 17,220 total patients in our database. In
2007, 934 new cases were accessioned, 874 analytic and 60 non-analytic. Annual lifetime follow-up of the patients is
conducted, according to the Commission on Cancer guidelines. Currently, the data center is following 6,516 patients, with a
follow-up rate of 99.3 percent for our living patients since our reference year of 1979. For the five year reference date we are
following 3,848 living patients, with a follow-up rate of 99.3 percent. Both percentages of follow-up are above the required
rate for the CoC approved cancer program standards.


To assure the continued collection and release of high quality data, the Cancer Program Coordinator conducts monthly and
quarterly quality reviews; the physician members of the Cancer Committee perform a minimum of ten-percent quality control
case audits annually; and the Cancer Data Center software has built in edits for data entry.


The Cancer Program of The Chester County Hospital provides accessible care in a patient friendly
environment. Our care consists of prevention, diagnosis and treatment including medical and
radiation oncology and surgical treatment. Wellness, survivorship, home care, palliative care and
hospice care round out the many other support services we offer. The result is improved quality
of care, strong clinical outcomes, and high patient satisfaction.




                                                                          The Cancer Program of The Chester County Hospital Annual Report 2008   5
All New Cancer Cases at The Chester County Hospital : 2007
This table illustrates the New Analytic Cancer Cases at The Chester County Hospital for 2007*
The statistics are broken down by primary site and gender.

 Site                                   Count        Male      Female       Site                                        Count        Male       Female

 Anus, Anal Canal, Anorectal              2           2              0      Other Biliary                                 1            0           1

 Bladder                                 42          29          13         Other Digestive Organs                        2            1           1

 Brain                                    5           3              2      Other endocrine                               1            1           0

 Breast                                  226          2         224         Other Male Genital                            1            1           0

 Cervix                                   2           0              2      Other non-epithelial skin                     4            2           2

 Colon                                   67          31          36         Other Sites                                  18            8          10

 Cranial Nerves & CNS                     3           1              2      Ovary                                        11            0          11

 Esophagus                                9           7              2      Pancreas                                     17           12           5

 Gallbladder                              6           4              2      Penis                                         1            1           0

 Hodgkin (nodal)                          4           4              0      Prostate                                     92           92           0

 Hodgkin (extranodal)                     1           1              0      Rectum & Rectosigmoid                        24           14          10

 Hypopharynx                              1           1              0      Retroperitoneum                               2            0           2

 Kaposi Sarcoma                           2           1              1      Salivary Gland                                2            2           0

 Kidney & Renal Pelvis                   30          23              7      Small Intestine                               6            2           4

 Larynx                                   8           4              4      Soft Tissue- including Heart                  3            1           2

 Leukemia                                18          11              7      Stomach                                      14           10           4

 Liver                                    7           6              1      Testis                                        6            6           0

 Lung & Bronchus                         93          40          53         Thyroid                                      35            5          30

 Melanoma- skin                          17           9              8      Tongue                                        8            4           4

 Mesothelioma                             1           1              0      Tonsil                                        1            0           1

 Myeloma                                  9           4              5      Ureter                                        1            0           1

 Non-Hodgkin (extranodal)                15          11              4      Uterus                                       27            0          27

 Non-Hodgkin (nodal)                     23           7          16         Vulva                                         3            0           3

 Nose, Nasal Cavity                       2           2              0      Total Analytic Cases                        874          367         507
                                                                            Total Non Analytic Cases                     60           32          28
 Oropharynx                               1           1              0
                                                                            Total Cases Treated at CCH                  934          399         535


Analytic patients are patients that are diagnosed and receive all or part of their initial treatment at CCH or they are patients who have been
diagnosed elsewhere and come to CCH for all or part of their initial therapy. Non analytic cases are patients who received their initial cancer




                                                                                                                                                          6
treatments at another facility and are now receiving their continuing care at CCH.

*Top Sites for The Chester County Hospital in 2007 are highlighted

                                                                                   The Cancer Program of The Chester County Hospital Annual Report 2008
The Cancer Committee 2008
Dennis Berman, M.D., Chairman              Medical Oncology
Michael McGuire, M.D.                      Family Medicine
David Bobman, M.D.                         Gastroenterology
Dianne Hotmer, M.D.                        Gynecology
Richard Donze, D.O.                        Medical Affairs/Hospital Administration
Calvin Lu, M.D.                            Medical Oncology
Michael Picariello, M.D.                   Otolaryngology
Michael Ward, M.D.                         Otolaryngology
Scott Saul, M.D.                           Pathology
Michael Stefan, M.D.                       Plastic and Reconstructive Surgery
William Levin, M.D.                        Radiation Oncology
Richard Yelovich, M.D.                     Radiation Oncology
William Barry, M.D.                        Radiology
Pamela Scott, M.D.                         Surgery and Commission on Cancer Liaison
Kenneth Collins, M.D.                      Urology
Jeanne M. Rogers, RN, Med                  Abramson Cancer Center of the University of Pennsylvania Network
Marianne Casale, RN, MSN, CS, AOCN         Cancer Clinical Specialist & Nurse Education
Angela Matthews                            Cancer Data Center
Cindy Jacobs, RHIT, CTR                    Cancer Data Center
Maria D. Lain, MBA                         Cancer Program Administration
Cynthia Brown, RN, BSN, OCN                Cancer Program Breast Care Coordination
Kim Killgore, CTR                          Cancer Program Compliance
Lisa Rider, MA, RD, LDN                    Cancer Program Nutrition Services
Marge Lang, LCSW, OSW-C                    Cancer Program Oncology Social Work
Blanche Reiner, RN, OCN                    Clinical Research
Cindy Brockway, RN, MSN, CCRP              Clinical Research
Julie Funk, MS, RD, CDE                    Community Outreach and Wellness
Susan Pizzi, MS, RN, CHES                  Community Outreach and Wellness
Heidi Owen, RN                             Hospice/Home Care
Colleen Leonard Leyden                     Marketing and Public Relations
Nona Blauvelt, RN, MSN, AOCN               Medical Oncology Practice Administration
Regina Cohen, PA                           Pathology
Karen Novielli, BSC, MBA                   Pharmacy
Mary Lou Lafreniere, RHIA, CPHQ, MBA       Quality Management
Amber, Bailey, R.T.T.                      Radiation Oncology


The Chester County Hospital is approved by the Commission on Cancer of the American
College of Surgeons and is a member of the University of Pennsylvania Cancer Network.




 Cancer Program
  The Chester County Hospital
                MEMBER
University of Pennsylvania
CANCE                    NETWORK
University of Pennsylvania Health System




CANCE
          A member of the
University of Pennsylvania
BEYOND GOOD CARETM
                         NETWORK
University of Pennsylvania Health System
                                                                                        The Cancer Program of The Chester County Hospital Annual Report 2008   7

				
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