UNC REX CANCER CARE
ANNUAL REPORT 2015 ANNUAL REPORT 2015
A COMPREHENSIVE COMMUNITY CANCER PROGRAM Accredited by the American College of Surgeons Commission on Cancer National Accreditation Program for Breast Centers
Cary Garner Raleigh Main Raleigh Blue Ridge Wakefield
On the cover: UNC REX Cancer Care-Cary 150 Parkway Office Court Parkway Professional Park, Suite 200 Cary, NC 27518
UNC REX Cancer Care locations Cary ~ Garner ~ Raleigh Main ~ Raleigh Blue Ridge ~Wakefield
For more information or to schedule an appointment with UNC REX Cancer Care Call 919-784-3105 www.REXhealth.com/rh/care-treatment/cancer/unc-REX-cancer-care-locations/
ANNUAL REPORT | 3 UNC REX Cancer Care Mission and Core Values
Mission
The mission of UNC REX Cancer Care is to provide our patients with exceptional cancer care and to ensure
timely and convenient access to the most effective strategies that prevent, treat, and ultimately cure cancer
in the future. UNC REX Cancer Care provides expert, compassionate care to patients with cancer through
close collaboration among providers across all disciplines of oncology.
Core Values
Impact
We strive to provide timely access to care in a caring and compassionate setting close to patients’ homes
and to relieve the burden of disease now and for the future through our research, clinical care, education,
outreach and advocacy.
Excellence
We pursue excellence relentlessly and with integrity in all that we do, adhering always to the highest
standards of conduct.
Compassion and Respect
We strive to exceed expectations for compassion and respect for those in our care and for one another.
ANNUAL REPORT | 4
UNC REX Cancer Care Annual Report 2015
Table of Contents Page
. Mission & Core Values 3
. Introduction 5
. Accreditations and Requirements 6
. Annual Study of Quality 2015 7
. Tumor Registry & Site Distribution 11
. Quality Accountability Measures 13
. Publications and Presentations 2015 14
. Community Outreach and Education 15
. Comprehensive Community Cancer Care 16
. Cancer Care Services and Locations 17
ANNUAL REPORT | 5 Introduction The REX Cancer Care Committee is the designated multidisciplinary body for program leadership and administrative oversight, development, and review of oncology services and care at UNC REX Cancer Care. The Cancer Care Committee is an official UNC REX Hospital Medical Staff committee responsible for the overall direction of the oncology program including coordination with Hospital and UNC Health System leadership. Its composition, as required by the Commission on Cancer, includes board-certified physicians from Surgery, Medical Oncology, Radiation Oncology, Diagnostic Radiology, and Pathology, along with the Cancer Liaison Physician, Clinical Research Manager, Palliative Care Specialist, and representatives from Hospital Administration, Nursing, Pharmacy, Psycho-social services, Cancer registry, and Quality. Annually, as required by the Commission on Cancer, the UNC REX Cancer Care Committee identifies a designated topic of relevance and interest for comprehensive study and evaluation. For 2015, the Committee chose Cancer Genetics for its annual study. The results of that study are detailed in the following pages of this Annual Report. These findings are published through the UNC REX Cancer Annual Report and made publicly available to the organization and the community. Cancer Care Committee Membership 2015 . Jeff Crane, MD Chairman . Yale Podnos, MD ACoS Cancer Liaison Physician/ Surgical Oncology . Susan Moore, MD Medical Director, REX Cancer Center . David B. Eddleman, MD Surgeon / Breast Care Committee Chair . Tom Grates, MBA Cancer Center Executive Director . Chad Lefteris, MHA VP / UNC REX Hospital Administration . Alden Parsons, MD Cancer Conference Coordinator/ Thoracic Surgery . Charles Eisenbeis, MD Hematology Oncology . Nathan Sheets, MD Radiation Oncology . Keith Volmar, MD Pathology . Jay Alley, MD Radiology . Kathleen Foote, CTR Cancer Registry Coordinator / Manager . Nancy Burns, RN, OCN Cancer Research Coordinator / Manager . Cynthia Jones, BS, CPHQ Quality Coordinator . Kimberly Fradel, MSW,LCSW Social Work /Psychosocial Services Coordinator . Toni Miller, NP Palliative Care . Mendy Moody, MSN, OCN Oncology Nurse Manager/ Clinical Leadership . Catherine Fine, MS, CGC / Ofri Leitner, MS, CGC Genetic Counseling . Emmeline Madsen, MPH Community Outreach Coordinator / Manager
Additional Supporting General Membership 2015 Matthew Strouch, MD ~ Surgery Douglas Hammer, MD ~ Family Practice Meena Mohan, MD ~ Hospitalist Robert Wehbie, MD ~ Medical Oncology Jon Gerber, PharmD ~ OP Pharmacy Becky Jones, PharmD ~ IP Pharmacy Jennifer Headen, MHA~ RHOA Adm Christopher Wood, RT, MBA~ Radiation Oncology Adm Nancy Reifsteck, OTR ~Rehab Gwyn Hardin, RD, LDN Claudia Hepburn, RN, OCN ~Mgr (OP) Deb Andersson, RN ~Mgr (IP) Kelly McLaughlin, MSN, OCN ~Mgr (OP) Heather Sasser, RN, OCN ~Mgr (OP) Vicky Burton, Staff /Committee Assistant Robbie Tilley, American Cancer Society
ANNUAL REPORT | 6 UNC REX Cancer Care Accreditations
UNC REX Cancer Care is voluntarily accredited by the American College of Surgeons Commission (ACoS) per the Commission on Cancer (CoC) Standards as a Comprehensive Community Cancer Program (CCCP). The pro- gram assesses more than 500 newly diagnosed cancer cases each year, provides a full range of diagnostic and comprehensive treatment services as noted below, either on-site or by referral, as well as participates in cancer- related clinical research and cancer-related clinical trials, per CoC Standards.
UNC REX Cancer Care in addition, is also voluntarily accredited by the National Accreditation Program for Breast Centers (NAPBC). The NAPBC holds organizations to the highest standards of care for patients with dis- eases of the breast. UNC REX Cancer Care is also accredited by the Joint Commission
UNC REX Cancer Care meets and /or exceeds the Commission on Cancer 12 Eligibility Requirements:
Eligibility Requirements Specifications
Cancer Committee Responsibilities Annual monitoring, assessing, and identifying changes that are needed in each of the eligibility requirements.
Facility Accreditation The facility is accredited by a recognized federal, state, or local authority.
Cancer Committee Authority Bylaws or policy and procedure define the cancer committee’s authority and responsibility for the program.
Cancer Conference Policy Program policy addresses the frequency, format, multidisciplinary attendance, attendance rate, prospective case presentations and total case presentations, discussion of stage and treatment planning, clinical trial options, and methods to address opportunities.
Oncology Nurse Leadership An oncology nurse provides leadership within the program.
Cancer Registry Policy & Procedure Policy and procedure addresses the use of Commission on Cancer data & all other cancer registry activities.
Diagnostic Imaging Services are provided. *
Radiation Oncology Services Radiation treatment service locations are currently accredited by a recognized authority or, if not accredited, follow standard quality assurance practices. *
Systemic Services Policies or procedures are in place to guide the safe administration of systemic therapy.*
Clinical Trial Information A policy or procedure is used to inform patients about clinical trials.
Psychosocial Services A policy or procedure is in place to ensure patient access to psychosocial ser- vices.*
Rehabilitation Services Rehabilitative services are provided. *
Nutrition Services Nutrition services are provided.*
Source: CoC,Ad 2014 pat * Servicespublinvente are available either eludem on-site, at locations o that are facility owned, or by referral.
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ANNUAL REPORT | 7
Annual Study 2015: Cancer Genetics
Maha A. Elkordy, MD, MPH; Catherine Fine, MS, CGC; Ofri Leitner, MS, CGC; Cynthia Jones, BS, CPHQ
INTRODUCTION
The field of medical oncology is continuously evolving, and one of the most rapidly growing areas is that of cancer genetics. While the majority of cancers are not due to a hereditary cause, it is estimated that 5-10% of each type of cancer may be due to an inherited predisposition. Compared to the general population, individuals with a known ge- netic predisposition have a higher risk of developing certain cancers in their lifetime, which may develop at a younger age than what is typical. Having a genetic predisposition to cancer directly impacts an individual’s cancer screening recommendations, allows individuals to take advantage of cancer risk-reduction interventions, and provides valuable information for an individual’s family members.
CANCER GENES All cancer has a genetic basis and genetic testing can be performed to look for changes (mutations) in genes related to a specific cancer type. There are two categories of such testing, and each provides different information to patients and their providers: germline genetic testing and somatic genetic testing. Germline genetic testing is typically performed using an individual’s blood or saliva sample, in order to identify muta- tions that were inherited from a parent. If such a mutation is found in an individual, it is present in every cell of the body and can pass from generation to generation. Somatic genetic testing is typically done on tumor tissue to identify acquired mutations that are only present in that tissue and are not inherited. These acquired mutations typically occur due to factors such as aging and environmental exposures such as tobacco, ultraviolet radiation, and viruses. Acquired mutations are the most common cause of cancer, and knowing they exist may help clinicians determine which thera- pies to use in their patients. Gene mutations which contribute to the development of cancer, whether germline or acquired, can be broadly catego- rized as mutations in tumor suppressor genes, mismatch repair genes, or proto-oncogenes. Tumor suppressor genes are protective genes which limit cell growth, and regulate cell repair and cell death. When a tumor suppressor gene is mutated, an abnormal cell may continue to divide to form a tumor. Examples of tumor suppressor genes include the BRCA1 and BRCA2 genes. Germline mutations in the BRCA1 or BRCA2 genes are associated with Hereditary Breast Ovarian Cancer (HBOC) syndrome. Mismatch repair genes are involved in correcting mistakes as DNA replicates or copies itself in the cells. When such a gene is mutated, mistakes cannot be corrected, leading to the development of a tumor. Examples of mismatch repair genes include MLH1, MSH2, MSH6, PMS2, and EPCAM. Germline mutations in these genes are associated with a hereditary cancer syndrome known as Lynch syndrome. Proto-oncogenes help regulate cell growth and differentiation. Mutations in proto-oncogenes cause over-activation of this gene’s activity, leading to the development of a tumor. One example of such a gene is the RET gene. A germline mutation in this gene is associated with a hereditary cancer syndrome known as Multiple Endocrine Neoplasia, type 2.
ANNUAL REPORT | 8
GENETIC COUNSELING AND GENETIC TESTING
Having a hereditary predisposition to cancer is associated with an increased risk of developing cancer in a person’s lifetime, but does not mean an individual will definitely develop cancer. A comprehensive cancer genetic risk as- sessment is critical to identify individuals at increased risk. One way in which individuals can obtain a thorough risk assessment is by meeting with a cancer genetic counselor. Many individuals are not aware of cancer genetic counsel- ing as an option and, thus, primary care providers can play a vital role in identifying individuals appropriate for ge- netic counseling, as well as helping to alleviate potential barriers in seeking this service.
In the initial meeting with a cancer genetic counselor a thorough review of the patient’s medical and family histories is conducted, which provides a better understanding of the potential link between multiple cancers within a family. The following are suggestive of a hereditary cancer predisposition and are hallmark features genetic counselors look for: . Early age of cancer diagnosis (age 50 or younger) . Multiple primary cancers in the same individual (example: colon and uterine cancer) . Bilateral cancers (example: breast cancer in both breasts) . Multiple family members on the same side of the family with cancer . Unusual or rare cancers (example: male breast cancer, medullary thyroid cancer) . From a population with increased risk of having a mutation (example: Eastern European (Ashkenazi) Jews) . A known germline mutation in a cancer susceptibility gene in a family member
In addition to a tailored risk assessment, there are many other benefits to cancer genetic counseling. Based on the information gathered in a genetic counseling session, genetic testing may be indicated in an individual and/or their family member. Genetic counselors discuss the benefits and limitations of genetic testing, potential test results and their implications, and address questions regarding costs and confidentiality.
Lastly, if an individual decides to pursue genetic testing, a genetic counselor reviews the result and subsequent rec- ommendations warranted by these results, discusses the potential impact on family members, including which family members may also need genetic testing and can help refer these family members appropriately. The genetic counse- lor also remains a liaison to the individual and their family over time.
GENETIC INFORMATION NONDISCRIMINATION ACT (GINA)
Genetic discrimination refers to people being treated differently because they have a gene mutation that is associated with a genetic condition. While some people may have concerns about genetic discrimination, this has not been shown to occur with hereditary cancer testing.
In 2008, Congress passed the Genetic Information Nondiscrimination Act (GINA). In general, this is a two part legis- lation which provides a baseline level of protection against genetic discrimination in both health insurance (Title I) and in employment (Title II).
GINA ensures that it is against the law for a health insurer to use a genetic test result or family health history to deny coverage, or decide on the cost of health insurance. Additionally, GINA makes it against the law for health insurers to consider family history or a genetic test result a pre-existing condition, to ask or require that an individual have a genetic test, or use any genetic information they do have to discriminate against an individual, even if they did not mean to collect it.
ANNUAL REPORT | 9 GINA is also intended to ensure that it is against the law for an employer to use family health history and genetic test results in making decisions about employment. Additionally, GINA makes it against the law for an employer to re- quest, require, or purchase the genetic information of a potential or current employee, or his or her family members. There are a few exceptions to when an employer can legally have genetic information. It is important to note that GINA and other laws do not provide protections in obtaining other forms of insurance, such as life, disability, or long-term and short-term care insurance.
TWO COMMON HEREDITARY CANCER SYNDROMES
Hereditary Breast Ovarian Cancer Syndrome: Inheritance of a germline mutation in the BRCA1 or BRCA2 gene results in a significant increased risk of developing breast and /or ovarian cancer in women, as well as breast and prostate cancer in men. A germline mutation in one of these genes may also confer an increased risk of pancreatic cancer and melanoma in both men and women. In addition, other genes that have been recently identified also in- crease the risk of both breast and ovarian cancer. Although testing for these other genes is relatively new, data is emerging on the cancer risks associated with them. The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for the management of patients with a BRCA1 or BRCA2 mutation. These guidelines are available at www.nccn.org. Identification of indi- viduals with these mutations provides an important opportunity for intervention through early screening and risk- reduction strategies. Studies have shown that women with a BRCA1 or BRCA2 mutation dramatically reduced their risk of ovarian cancer by undergoing removal of their ovaries and fallopian tubes (bilateral salpingo-oophorectomy). These women also have a lower risk of cancer incidence and cancer specific mortality. Although surgery is not the only option, women who have both breasts surgically removed (bilateral mastectomies) also dramatically reduce their lifetime risk of breast cancer. Lynch Syndrome: Lynch syndrome is a condition in which there is an inherited mutation in any one of a number of genes (MLH1, MSH2, MSH6, PMS2 and EPCAM) which can lead to disruption in DNA mismatch repair, resulting in an increased risk of certain cancers. The most common cancers associated with Lynch syndrome are colorectal, uter- ine or endometrial, ovarian and stomach. Although rare, Lynch syndrome also increases risk for cancers of the upper urinary tract, central nervous system (glioblastoma), and pancreatic cancers. The risks of Lynch syndrome-associated cancers can be reduced with appropriate screening and risk-reduction strategies. For example, patients with Lynch syndrome are recommended to undergo a colonoscopy annually, which is more frequent than what is recommended in the general population. This and other evidence-based guidelines are outlined by the NCCN. Like other hereditary cancer syndromes, the management of patients with Hereditary Breast Ovarian Cancer syn- drome and Lynch syndrome provides an ideal opportunity for collaboration and multidisciplinary coordination of care that may include a genetic counselor, gastroenterologist, gynecologist or gynecologic oncologist, medical on- cologist, surgeon or surgical oncologist, urologist, and/or dermatologist.
ANNUAL REPORT | 10 STUDY POPULATION During the period January-August 2015, 174 patients were seen at the UNC REX Cancer Genetics Program. The ma- jority of individuals were women referred from Wake County that had an existing cancer diagnosis. Of the cancer diagnoses, breast and gynecologic malignancies were most common. Characteristics of the study patient population: . Demographics: Median age: 54 years Gender: Females n=156 (90%) . Existing cancer diagnosis: n=135 (78%) Breast 68%, GYN 21%, GI 9% No cancer hx: n=39 (22%) . Patient location: Wake County (78%), Johnston County (7.5%), Harnett (2.9%) The majority of patients were referred from UNC REX affiliated providers (77%), while 7% were self-referred. The referring providers were predominantly from cancer specialties (57%) including Medical Oncology, Surgical Oncol- ogy or GYN Oncology. Outside of oncology specialties, referrals were largely from family practitioners, internists, and gastroenterologists. Of the 174 patients seen for genetic counseling, 128 underwent testing. Of those tested, the majority (73%) had nega- tive (normal) results. Fifteen patients (12%) tested were positive for a pathogenic mutation known to increase cancer risk. A Variant of Unknown Significance (VUS) was found in the remaining 19 (15%) patients. Mutations were mostly found in the cohort with breast cancer as compared to those unaffected by cancer. Germline mutations in the BRCA1 gene were most common, followed by germline mutations in the CHEK2 gene, which is associated with an increased risk of breast cancer. Within the group of 10 patients with a gynecologic malignancy, two germline mutations were found; one in the RAD50 gene (associated with an increased risk of female breast cancer and ovarian cancer) and one in the MSH2 gene. In the 22 patients with a GI malignancy who underwent testing, only one had a mutation which was found in the SMAD4 gene (associated w/ juvenile polyposis, and hereditary hemorrhagic telangiectasia-HHT). A total of 46 patients (26%) did not undergo genetic testing because it was not clinically indicated (28 patients), testing a family member first was recommended (6 patients), or because patients declined the recommended testing (11 patients). CONCLUSION The Cancer Care Committee elected to study the cancer genetics population based on preliminary findings from a previous study. The study confirmed that although many cancer patients undergo appropriate genetic testing and fol- low-up through their managing providers, others are referred specifically to the Cancer Genetics service for a more detailed comprehensive cancer risk assessment and to pursue genetic testing. With the expansion of UNC REX Cancer Care to seven multi-site cancer centers, in combination with many of the national cancer center accrediting bodies requiring cancer genetic services, the demands for cancer genetic counsel- ing are growing. This study was an opportunity to evaluate not only the impact of the growing demand for genetic testing but also to better understand the patient demographics, referral patterns and the array of mutations identified. It is important to recognize the strong presence of self-referring patients in a high growth and educated region. These elements are important guides for our clinical services and programmatic leaders in meeting the needs of can- cer patients, and those in our population who have an increased genetic risk and who can benefit from early detec- tion, prevention, and guidance.
Maha Elkordy, MD, MPH Catherine Fine, MS, CGC Ofri Leitner, MS, CGC
ANNUAL REPORT | 11 UNC REX Cancer Tumor Registry The Cancer Registry at REX was first established in 1988. The registry has added over 50,000 cases into the database since the reference date. Analytic cases (A) are defined as patients diagnosed and/or treated at the reporting facility. The CoC requires that analytic cases be abstracted by accredited programs. Non-analytic cases (NA) are defined as patients diagnosed and/or treated elsewhere and seen at the reporting facility for diagnostic workup, in-transit care, disease recurrence or persistence. Although the CoC does not require abstraction of non-analytic cases, these are required by the NC Cen- tral Cancer Registry. . In 2014, the registry added 3195 cases, with 2524 as analytic cases with initial diagnosis and/or first course of treatment at REX Healthcare. The additional 671 cases are non-analytic cases representing patients with recur- rent disease, initially diagnosed and/or treated elsewhere. The primary function of the Cancer Registry is to collect and manage statistical data and clinical elements on REX’s cancer population. Information collected includes patient demographics, medical history, anatomical site and histolo- gy of the primary cancer, extent of disease and treatment. Patient follow-up is an important part of cancer care and maintaining the registry. Each patient in the registry is fol- lowed annually to update information on disease recurrence, subsequent treatment, length of survival and overall well-being. This information is utilized by the cancer program for studies and research by the American Cancer Soci- ety and North Carolina Central Cancer Registry. Follow up information is obtained through communication to physi- cians and patients. . The Registry’s excellent follow-up rate is 95% (90% or greater as required by the CoC Standard. 5.3)
The UNC REX Cancer Tumor Registry Team are Certified Tumor Registrars and Members of the Association of North Carolina Cancer Registrars
Top Ten Cancer Sites by Group UNC REX Cancer Registry CY 2014
PRIMARY SITE TOTAL CLASS SEX AJCC STAGE (% of Total) A NA M F 0 I II III IV Unk N/A ALL SITES 3195 2524 671 1373 1822 283 764 520 405 507 299 417 BREAST 756 (25%) 709 47 7 749 145 290 193 71 16 41 0
DIGESTIVE 586 (18%) 444 142 303 283 12 84 99 127 158 100 6
RESPIRATORY 393 (12%) 297 96 193 200 3 78 28 75 174 34 1
BLOOD & BM 281 (9%) 127 154 137 144 0 1 1 4 1 2 272
MALE GENITAL 244 (8%) 187 57 244 NA 0 59 117 30 20 18 0
URINARY 225 (7%) 206 19 174 51 95 56 20 9 17 27 1
LYMPHATIC 144 (5%) 124 20 82 62 0 32 29 32 42 8 1
SKIN 134 (4%) 111 23 77 57 19 55 15 5 10 28 2
ENDOCRINE 110 (3%) 96 14 35 75 0 55 5 15 5 8 22
GYNECOLOGIC 104 (3%) 75 29 NA 104 7 31 4 22 22 17 1
ANNUAL REPORT | 12 UNC REX Cancer Registry Site Distribution Detail CY 2014
PRIMARY SITE TOTAL CLASS SEX AJCC STAGE
A NA M F 0 I II III IV Unk N/A ALL SITES 3195 2524 671 1373 1822 283 764 520 405 507 299 417 BREAST 756 709 47 7 749 145 290 193 71 16 41 0
DIGESTIVE 586 444 142 303 283 12 84 99 127 158 100 6 ESOPHAGUS 19 16 3 17 2 0 2 2 6 6 3 0 STOMACH 57 47 10 39 18 0 9 4 9 19 16 0 COLON 180 143 37 92 88 1 34 39 53 44 9 0 RECTUM 101 79 22 55 46 1 21 15 25 16 23 0 ANUS/ANAL 55 19 36 25 30 7 2 8 6 2 30 0 LIVER 30 17 13 15 15 0 4 2 3 10 9 2 PANCREAS 88 74 14 43 45 2 4 20 12 47 3 0 OTHER 56 49 7 17 39 1 8 9 13 14 7 4 RESPIRATORY 393 297 96 193 200 3 78 28 75 174 34 1 NASAL/SINUS 1 1 0 1 0 0 0 0 1 0 0 0 LARYNX 14 13 1 10 4 0 4 1 0 8 1 0 LUNG/BRONCH 375 280 95 179 196 3 74 27 74 164 32 1 OTHER 3 3 0 3 0 0 0 0 0 2 1 0 BLOOD & BM 281 127 154 137 144 0 1 1 4 1 2 272 LEUKEMIA 87 47 40 43 44 0 1 1 4 1 2 78 M. MYELOMA 29 20 9 17 12 0 0 0 0 0 0 29 OTHER 165 60 105 77 88 0 0 0 0 0 0 165 MALE GENITAL 244 187 57 244 NA 0 59 117 30 20 18 0 PROSTATE 227 170 57 227 0 48 115 30 20 14 0 TESTIS 14 14 0 14 0 10 0 0 0 4 0 OTHER 3 3 0 3 0 1 2 0 0 0 0 URINARY 225 206 19 174 51 95 56 20 9 17 27 1 BLADDER 160 151 9 125 35 93 36 16 3 7 5 0 KIDNEY/RENAL 59 49 10 44 15 1 19 3 5 10 21 0 OTHER 6 6 0 5 1 1 1 1 1 0 1 1 LYMPHATIC 144 124 20 82 62 0 32 29 32 42 8 1 HODGKIN'S 20 18 2 12 8 0 4 8 3 5 0 0 NON-HODGKIN'S 124 106 18 70 54 0 28 21 29 37 8 1 SKIN 134 111 23 77 57 19 55 15 5 10 28 2 MELANOMA 129 107 22 75 54 18 53 15 5 9 28 1 OTHER 5 4 1 2 3 1 2 0 0 1 0 1 ENDOCRINE 110 96 14 35 75 0 55 5 15 5 8 22 THYROID 88 88 0 26 62 0 55 5 15 5 8 0 OTHER 22 8 14 9 13 0 0 0 0 0 0 22 GYNECOLOGIC 104 75 29 NA 104 7 31 4 22 22 17 1 CERVIX UTERI 11 10 1 11 0 5 1 3 2 0 0 CORPUS UTERI 46 37 9 46 0 21 2 11 7 5 0 OVARY 27 21 6 27 0 3 0 7 11 6 0 VULVA 13 4 9 13 4 2 0 1 0 6 0 OTHER 7 3 4 7 3 0 1 0 2 0 1 ORAL 77 47 30 55 22 2 12 7 12 35 8 1 LIP 0 0 0 0 0 0 0 0 0 0 0 0 TONGUE 38 23 15 29 9 0 7 4 5 19 3 0 OROPHARYNX 6 3 3 6 0 0 0 1 1 4 0 0 HYPOPHARYNX 0 0 0 0 0 0 0 0 0 0 0 0 OTHER 33 21 12 20 13 2 5 2 6 12 5 1 BRAIN & CNS 68 47 21 33 35 68 BRAIN (Benign) 5 3 2 3 2 Brain & CNS Tumors 5 BRAIN (Malignant) 25 18 7 16 9 World Health Organization (WHO) 25 OTHER 38 26 12 14 24 grading system 38 CONT TISSUE 21 16 5 5 16 0 10 2 2 2 5 0 BONE 3 1 2 3 0 0 1 0 0 1 1 0 UNK PRIMARY 32 26 6 19 13 0 0 0 0 0 0 32 OTHER 17 11 6 6 11 0 0 0 1 4 2 10
ANNUAL REPORT | 13 Quality Accountability Measures 2015
Quality Cancer Care The UNC REX Cancer Care Committee ensures that patients with cancer are treated according to nationally accepted guidelines. Services are measured in compliance with retrospective and real-time CoC quality reporting tools, such as the Rapid Quality Reporting System (RQRS) and Cancer Program Practice Profile Reports (CP3R). These programs utilize quality measures endorsed by the National Quality Forum (NQF), National Comprehensive Cancer Network (NCCN), and American Society for Clinical Oncology (ASCO). Four of the measures noted below are endorsed by the NQF as Accountability Measures, meaning that these measures can be used for purposes such as public reporting, payment incentive programs, and the selection of providers by con- sumers, health plans, or purchasers. Additionally, the program reports to and utilizes the nationally recognized National Cancer Data Base (NCDB)— jointly sponsored by the American College of Surgeons and the American Cancer Society with over 1,500 CoC accred- ited facilities. The NCDB reporting tools provide quality related performance measures in comparison to aggregated CoC accredited programs, at state, region and national levels, including quality improvement, quality assurance, and surveillance measures. Through comparison and evaluation, we proactively improve delivery and quality of care for patients in our cancer program. UNC REX Cancer Care is in excellent standing with current performance rates at or above CoC goal.
American College of Surgeons –Commission on Cancer CoC Rapid Quality Reporting System (RQRS) Goal
Radiation therapy is administered within 1 year of dx for women under age 70 receiving 90%
breast conserving surgery for breast cancer
Combination chemotherapy is considered or administered within 4 months of diagnosis for women under age 70 w/ AJCC T1cN0M0, or Stage IB-III hormone receptor negative breast 85%
cancer BREAST
Tamoxifen or 3rd generation Aromatase inhibitor is considered or administered within 1 year of diagnosis for women w/ AJCC T1cN0M0, or Stage IB-III hormone receptive positive 95% breast cancer
Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for pa- 90% tients under 80 w/ AJCC Stage III (LN+) colon cancer At least 12 regional lymph nodes are removed and pathologically examined for resected colon 95% COLON cancer
ANNUAL REPORT | 14 Excellence in Publications and Presentations 2015
UNC REX Cancer Care Team advancing oncology concepts and care through professional publications and presentations
Publications Clinical History and Clinical Correlation. In: Nakhleh RE, ed. Error Reduction and Prevention in Surgical Pathology. New York: Springer; 2015. Volmar KE. Geriatric Assessment-identified Deficits in Older Cancer Patients with Normal Performance Status. Oncologist. 2015 Apr; Jolly TA, Deal AM, Nyrop KA, Williams GR, Pergolotti M, Wood WA, Alston SM, Gordon BB, Dixon SA, Moore SG, Taylor WC, Messino M, Muss HB. In Vivo Assessment of the Metabolic Activity of CYP2D6 Diplotypes and Alleles. Br J Clin Pharmacology. 2015 Nov; Hertz DL, Snavely AC, McLeod HL, Walko CM, Ibrahim JG, Anderson S, Weck KE, Magrinat G, Olajide O, Moore S, Raab R, Carrizosa DR, Corso S, Schwartz G, Peppercorn JM, Evans JP, Jones DR, Desta Z, Flockhart DA, Carey LA, Irvin WJ Jr. Interventions to Treat Malignant Pleural Effusions: Supportive Care. Clinical Journal of Oncology Nursing 2015; 19(5). April Lenker, RN, MSN, AGNP-BC, Deborah K. Mayer, PhD, RN, AOCN®, FAAN, and Stephen A. Bernard, MD, FACP Molecular Testing in Anatomic Pathology and Adherence to Guidelines. A College of American Pathologists Q-Probes study of 2230 testing events reported by 26 institutions. Archives of Pathology & Laboratory Medicine 2015;139(9). Volmar KE, Idowu MO, Souers RJ, Nakhleh RE Phase 2 Trial of De-intensified Chemo-radiation Therapy for Favorable-Risk Human Papillomavirus-Associated Oro- pharyngeal Squamous Cell Carcinoma. International Journal of Radiation Oncology • Biology • Physics 2015 Dec. Chera BS, Amdur RJ, Tepper J, Qaqish B, Green R, Aumer SL, Hayes N, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Funkhouser W, Sheets N, Weissler M, Mendenhall W. Racial Differences in Diffusion of Intensity-Modulated Radiation Therapy for Localized Prostate Cancer. The Ameri- can Journal of Men's Health (2015 Feb 5). Cobran EK, Chen RC, Overman R, Meyer AM, Kuo TM, O'Brien J, Sturmer T, Sheets N, Goldin GH, Penn DC, Godley PA, Carpenter WR. Turnaround Time for Large or Complex Specimens in Surgical Pathology: Volmar KE, Idowu MO, Souers RJ, Karcher DS, Nakhleh RE. A College of American Pathologists Q-Probes study of 56 institutions. Archives of Pathology & Laboratory Medicine 2015;139(2)
Presentations Advances in Surgery. Wake Area Health Education Conference. 2015 Nov; Raleigh, NC. Advances in Breast Surgery: Barbara Dull, MD - David Eddleman, MD, MA, Rachel Goble Jendro, DO, Sentinel Node Biopsy for Melano- ma, Yale Podnos, MD, MPH, FACS The Feasibility of a Telemedicine Platform to Monitor Adherence and Adverse Effects of ABL Kinase Inhibitors. American Society of Hematology 57th Annual Meeting. 2015 Dec; Anureet Copeland, MD, Robert Wehbie, MD, PhD, Monique Clayton, Anderson Black, RN, Barbara Rapchak and Matthew C Foster, MD Molecular Testing in Anatomic Pathology and Adherence to Guidelines. United States and Canadian Academy of Pa- thology Annual Meeting, 2015. College of American Pathologists Q-Probes study of 2230 testing events reported by 26 institutions. Volmar KE, Idowu MO, Souers RJ, Nakhleh RE North Carolina Cancer Registrars ANCCR Fall Conference: September 23-25, 2015; Raleigh, NC. Breast Cancer Potpourri: David B. Eddleman, MD, FACS Cancer Registrars and Genetic Counselors: Together improving patient care: Catherine Fine, MS, CGC Getting the Quality Mission out of Registry Data: Cynthia Jones, BS, CPHQ Healing Touch and Mindfulness: Rachel R. Smith Patient Navigation Along the Cancer Continuum: A REX Perspective: Jessie Weiss, RN Updates in Radiation Oncology: Courtney M. Bui, MD
UNC REX Grand Rounds-Breast Cancer Overview: Screening, Diagnosis and Treatment: October 2015, Raleigh, NC. Breast Cancer Awareness Feature Education. REX Healthcare Clinical Development. Barbara Dull, MD
8th Annual Weber Lymphoma Lecture: UNC REX Healthcare Oncology Grand Rounds Series: November 19, 2015. Raleigh, NC. Featuring Craig Moskowitz, MD, Clinical Director, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center
*UNC REX contributors highlighted in bold
ANNUAL REPORT | 15 Excellence in Community Education and Outreach 2015
UNC REX Cancer Center supporting education and providing outreach across the community throughout the year
Brothers and Sisters of REX: Throughout the year, this specially trained volunteer group, many of whom are can- cer survivors, provides the community with information and education about prevention and early detection of breast, prostate and colorectal cancers through workshops, health fairs, businesses, churches, community service groups and other events.
Save Our Sisters of REX: Throughout the year, specially trained volunteers, many of whom are breast cancer sur- vivors, provide the community with breast health information and promote age-appropriate mammogram screenings through workshops, health fairs, businesses, churches, community service groups and other events.
26th Annual Cancer Survivors’ Day-National Day of Recognition: June 7, 2015. UNC REX Cancer Center, Raleigh, NC
Blood Cancer Conference with Leukemia and Lymphoma Society: April 28, 2015. Peter Voorhees, MD; Dian- na Howard, MD; Katarzyna Jamieson, MD; Joshua Zeidner, MD; Steven Park, MD
Living With and Beyond Breast Cancer: February 21, 2015. David Eddleman, MD; Nirav Dhruva, MD; Justin Wu, MD; Glen Lyle, MD; Julia Taber, MD; Catherine Fine, MS, CGC
Living With and Beyond Gastrointestinal Cancer: March 21, 2015. Matthew Strouch, MD; Brendan McNulty, MD; Nathan Sheets, MD; Naveen Narahari, MD; Jason Harris, MD; Catherine Fine, MS, CGC
Living With and Beyond Lung Cancer: November 19, 2015. Rohit Ahuja, MD; Alden Parsons, MD; Achilles Fa- kiris, MD; Mark Yoffe, MD
Living With and Beyond Lymphoma: Updates in Lymphoma Management. November 20, 2015. Craig Mos- kowitz, MD, Memorial Sloan Kettering
Living With and Beyond Prostate Cancer: September 19, 2015. Jeffrey Crane, MD; Leroy Darkes, MD; Mark Jalkut, MD; Nathan Sheets, MD; James Smith, MD
REX On Call: Breast Cancer Specialists: WRAL-TV & WRAL.com Program featuring the latest in medical technology, treatments, and health trends. October 19, 2015. Lola Olajide, MD; Julia Taber, MD
Time of Remembrance Memorial Service: A time of remembrance for families, friends, staff. January 25, 2015
ANNUAL REPORT | 16
Comprehensive Community Cancer Care
UNC REX Cancer Care provides patients of Wake County and surrounding communities with exceptional cancer care, including access to innovative treatments and support services. As the first nationally recognized Comprehen- sive Community Cancer Center in North Carolina, we provide expert care, close to home, in several convenient loca- tions. In collaboration with UNC Lineberger Comprehensive Cancer Center, our physicians also access the latest in clinical trials. Our physicians are at the helm of ongoing cancer research. Multidisciplinary care is the heart of our program. Our board-certified physicians meet regularly and work together as a team to develop a comprehensive treatment plan tailored to our patients’ needs.
UNC REX Cancer Care includes: . REX Hematology Oncology Associates o Blue Ridge, Cary, Garner, Raleigh, Wakefield . REX-UNC Radiation Oncology o Raleigh, Clayton, Smithfield, Wakefield . REX Surgical Oncology o REX Breast Care Specialists o REX Surgical Specialists . Raleigh, Knightdale, Garner, Knightdale o REX Thoracic Surgical Specialists o REX Neurosurgery and Spine Specialists . Raleigh, Cary . UNC Gynecologic Oncology at REX . REX Comprehensive Breast Care Program . REX Gastrointestinal Cancer Multidisciplinary Care Program . REX Thoracic Cancer Multidisciplinary Care Program . REX Cancer Genetics Program
We also provide patients and their families with access to support services, including:
. Patient Navigation . Financial Counseling
. Clinical Trials . Educational Programs
. Cancer Rehabilitation . Support Groups
. High Risk Nutritional Management . Survivorship Support
. Social Work and Psychosocial Support . Wellness Services
ANNUAL REPORT | 17
UNC REX Cancer Care Locations
REX HEMATOLOGY AND ONCOLOGY ASSOCIATES
RALEIGH BLUE RIDGE CARY 4420 Lake Boone Trail 2605 Blue Ridge Road Parkway Professional Park Suite 200 Suite 190 150 Parkway Court, Suite 200 Raleigh, NC 27607 Raleigh, NC 27607 Cary, NC 27518 T: 919-784-6818 T: 919-784-6060 T: 984-974-2150 F: 919-784-6826 F: 919-784-6061 F: 984-974-2151
WAKEFIELD GARNER 11200 Governor Manly Way 300 Health Park Drive Suite 102 Suite 220 Raleigh, NC 27614 Garner, NC 27529 T: 919-570-7550 T: 919-250-5955 F: 919-570-7551 F: 919-250-5954
REX UNC RADIATION ONCOLOGY RALEIGH WAKEFIELD 4420 Lake Boone Trail 11200 Governor Manly Way Suite 100 Suite 102 Raleigh, NC 27607 Raleigh, NC 27614 T: 919-784-3018 T: 919-570-7550 F: 919-784-1473 F: 919-570-7551
CLAYTON RADIATION ONCOLOGY SMITHFIELD RADIATION ONCOLOGY Johnston Professional Plaza Johnston Medical Mall 2076 Highway 42 West Suite 1200 Suite 120 514 N. Bright Leaf Boulevard Clayton, NC 27520 Smithfield, NC 27577 T: 919-585-8550 T: 919-209-3555 F: 919-585-5882 F: 919-938-7400
REX BREAST CARE REX BREAST CARE CENTER REX BREAST CARE SPECIALISTS (Diagnostic Imaging) (Breast Surgery) 3100 Duraleigh Road, Suite 204 3100 Duraleigh Road, Suite 205 Raleigh, NC 27607 Raleigh, NC 27607 T: 919-784-6186 T: 919-784-4160 F: 919-784-2708
REX COMPREHENSIVE BREAST CARE PROGRAM 4420 Lake Boone Trail Raleigh, NC 27607 T: 919-784-6878 F: 919-784-6899
ANNUAL REPORT | 18 UNC REX Cancer Care Locations
REX NEUROSURGERY AND SPINE SPECIALISTS
T: 919-784-1410 F: 919-784-1409 RALEIGH CARY 4207 Lake Boone Trail, Suite 220 1505 SW Cary Parkway, Suite 302 Raleigh, NC 27607 Cary, NC 27511
REX SURGICAL SPECIALISTS
T: 919-784-7874 F: 919-784-2708 RALEIGH GARNER Medical Office Building 300 Health Park Drive 2800 Blue Ridge Road, Suite 300 Suite 110 Raleigh, NC 27607 Garner, NC 27529
KNIGHTDALE WAKEFIELD 6602 Knightdale Blvd, Suite 201 11200 Governor Manly Way, Suite 208 Knightdale, NC 27545 Raleigh, NC 27614
REX THORACIC SURGICAL SPECIALISTS
RALEIGH T: 919-784-5650 F: 919-784-5651 2800 Blue Ridge Road, Suite 201 Raleigh, NC 27607
UNC GYNECOLOGIC ONCOLOGY AT REX 4420 Lake Boone Trail Raleigh, NC 27607 T: 919-784-6875 F: 919-784-6890
REX GASTROINTESTINAL CANCER MULTIDISCIPLINARY CARE PROGRAM 4420 Lake Boone Trail Raleigh, NC 27607 T: 919-784-6878 F: 919-784-6899
REX THORACIC CANCER MULTIDISCIPLINARY CARE PROGRAM 4420 Lake Boone Trail Raleigh, NC 27607 T: 919-784-6878 F: 919-784-6899
UNC REX Cancer Care locations
Cary ~ Garner ~ Raleigh Main ~ Raleigh Blue Ridge ~Wakefield
For more information or to schedule an appointment with UNC REX Cancer Care Call 919-784-3105 www.REXhealth.com/rh/care-treatment/cancer/unc-REX-cancer-care-locations/
UNC REX Cancer Center 4420 Lake Boone Trail Raleigh, NC 27607 919-784-3105 www.REXhealth.com/rh/care-treatment/cancer