2017 Cancer Services
Annual Report
2 |22017 Report | 2014Cancer CancerServices ServicesAnnual Annual Report
Table of Contents Tntroduction page 5
Standard 4.6 Monitoring Compliance with Evidence-Based Guidelines page 6
Cancer Committee Membership page 7
Language Access Coordinator page 8
Primary Site Table page 10
Regional West and the University of Colorado Cancer Center Partnership page 11
Oncology Social Worker page 12
Cancer Services Support Programs and Activities page 14
For Additional Information page 15
Regional West| |rwhs.org rwhs.org Regional West Medical Center | 3| 3
4 |42017 Report | 2014Cancer CancerServices ServicesAnnual Annual Report
Introduction I’m pleased to share Regional West’s 2017 Cancer Services annual report.
Vincent Bjorling, MD Chairman Cancer Committee
In 2017, Regional West saw 418 newly-diagnosed cancer patients. Providing personalized, individualized care for every cancer patient is a team effort, and in this year’s annual report we spotlight two integral members of our cancer care team: Regional West’s Language Access Coordinator Martin Vargas, and Regional West Oncology Social Worker Jennifer Hiltgen. We also are proud to present and highlight the recent partnership between Regional West and the University of Colorado Cancer Center. The ongoing commitment of Regional West’s Cancer Committee, providers, nurses, and support staff to deliver excellent, compassionate, individualized treatment across the entire continuum of cancer care is a challenge we do not take lightly. We continue to offer our patients new options for cancer prevention, support, and treatment. Our goal is to tailor our services to meet the unique needs of every patient and their family – from diagnosis to treatment to survivorship. For more information about cancer services, support programs, and activities for cancer survivors and their loved ones, I invite you to call Regional West Physicians Clinic-Oncology at 308.630.2101, the Cancer Treatment Center-Scottsbluff at 308.630.1348, or the Dorwart Cancer Care Center-Sidney at 308.254.9192. Vince Bjorling, MD Chairman, Cancer Committee
Regional West Medical Center | rwhs.org | 5
Regional West | rwhs.org | 5
Monitoring Compliance with Evidence-Based Guidelines Tumor Marker Testing Standard 4.6
Regional West Medical Center Cancer Services Standard 4.6 Review for 2017 Completed and reviewed by: Vince Bjorling, MD, Chairman, Cancer Committee and Cindy Keller, CTR, Cancer Registry Coordinator Vincent Bjorling, MD Chairman Cancer Committee
A review of tumor marker testing for Stage IV adenocarcinoma, large cell, squamous cell carcinoma, and other rare subtypes of lung cancer was conducted for the period of October 2015 through October 2016. The reviewed testing included EGFR, ALK, PD-L1, and ROS-1 as referenced in the National Comprehensive Cancer Network (NCCN) guidelines. The review included 22 patients who met the stage and diagnosis criteria listed above. Seventeen of the patients were of adenocarcinoma type and the other five were of squamous cell type. For those of adenocarcinoma type, 16 of the 17 cases reviewed did have tumor marker testing. The lone outlier was a patient who went into hospice four days after diagnosis and did not wish to pursue any treatment. Starting in January 2016, tumor marker testing for lung cancers of squamous cell type was added to the NCCN guidelines. Of the five squamous cell cases reviewed, two were diagnosed in 2015, and were excluded for the purposes of this review.
Cindy Keller, CTR Cancer Registry Coordinator
6 | 2017 Cancer Services Annual Report 6 | 2014 Cancer Services Annual Report
The three cases for 2016 were reviewed and tumor marker testing was ordered in all three cases. There were 20 cases that were eligible for testing and 17 out of 20, or 85 percent, of those received the appropriate testing.
2017 Cancer Committee Membership Standard 1.2 Required Physician Members
(Designated alternate members are italicized)
Cancer Committee Chair/CoChair • Vincent Bjorling, MD • Mark Hartman, MD
Quality Management • Margo Ferguson, MT (ASCP) • Jeannie Miller, BSN, RN
Cancer Liaison Physician • Gitesh Chheda, MD • Jason Walsh, MD, FACS, CWS
Oncology Nursing • Sue Schoeneman, MSN, ACNP-BC, AOCNP • Kim Croft, BSN, RN
Medical Oncology • Vincent Bjorling, MD • Regine Leconte, MD
Community Outreach Coordinator • Paulette Schnell, MSN, RN • Deborah Keener, BSN, RN
Radiation Oncology • Mark Hartman, MD • John Horns, MD
Clinical Research Coordinator • Michele Lambert, OCN, BSN • Barbara Jensen, RN
Pathology • Peter Schilke, MD, FCAP • Randall Williams, MD, FASCP
Ad Hoc Program Members
Diagnostic Radiology • Gitesh Chheda, MD • Stephen Johnson, MD, PhD Surgery • Jason Walsh, MD, FACS, CWS • Jason LaTowsky, MD Palliative Care Services • Connie Beehler, MD, FAAHPM • Deborah Moore, GNP-BC
Required Non-Physician Members Cancer Program Administrator • Jeff Kriewald, MBA, B.S. RT(R)(T) Certified Tumor Registrar • Cindy, Keller, CTR • JoAnn Cervantes, CTR Social Worker • Jennifer Hiltgen, BSW • Jodi Willats, MSW
• John Mentgen, FACHE President/CEO Regional West Health Services • Tadd Greenfield, Executive Vice President & Chief Operating Officer • John Reike, Chief Operating Officer • Lisa Scheppers, MD, FACP, CPE Chief Medical Officer • Connie Rupp, MSN, RN Vice President Patient Care Services & Chief Nursing Officer • Kathy Campbell, MSN, MPA Chief Nursing Officer • John Kabalin, MD, Urology • Kelsey Kriewald, Pharm.D, RPH Director, Pharmacy • Deborah Jelinek, OTR/L, Rehab Services • Sylvia Dolberg, MBA, RT(R)(CV)(CT) Interim Imaging Services Director • Wendy Stirnkorb, CRA, RT (R) (MR) MRSO (MRSC) Imaging Services Director (2017) • Karen Johnson, RD, CSO, LMNT Food & Nutrition Services • Jill Koch/Clare Shanahan, American Cancer Society representatives • Tobie Copp/Alecia Gonzales, Medical Staff Office Regional West| |rwhs.org rwhs.org Regional West Medical Center | 7| 7
Celebrating Patient Diversity: Medic The importance of communication that they can effectively communicate with their health care providers in a dignified, respectful manner, Martin Vargas serves as Regional West’s full-time language access coordinator.
Martin has been Regional West’s language access coordinator since 2014. In addition to providing medical Reinforcing the need for interpretation services in interpretation services at Spanish and translating Regional West, according to a documents like consent forms Nebraska Department of Health and discharge instructions for and Human Services 2015 Regional West patients, he also finding, 37 percent of Nebraska’s manages Cyracom – Regional Hispanic population does not West’s medical interpretation speak English at home or telephone and video remote English is not spoken very well. interpreting system. Cyracom provides qualified interpreters in To address our patients’ more than 250 languages, inindividual needs and ensure cluding American Sign
“
Language, for patients, their family members, and other legally authorized persons. It is available 24/7 either personto-person, or by video remote or telephone. Available for all patient services, patients can access the service by contacting Regional West’s switchboard operator directly at 308-635-3711, or by asking their nurse, the unit director, or Martin for more information. Confidentiality plays a huge role in Martin’s job. Through Regional West, he teaches a medical interpretation course called “Bridging the Gap,” which prepares bilingual individuals to interpret in a medical setting once he has assessed their language aptitude. Section 1557 of the Affordable Care Act states that anyone interpreting in a medical setting shall be tested and trained before providing patient and family services. “We always let our patients know that anything they tell us will be kept strictly confidential,” he explained.
“
The U.S. Census Bureau estimates that a record 61.8 million U.S. residents now speak a language other than English at home – that’s one in five Americans. The largest increase over the most recently recorded three-year period (2010 through 2013) was for Spanish speakers, which increased by 1.4 million people.
I feel that more than an interpreter, I am an advocate for patients who need to learn how to navigate the health care system. Martin Vargas
8 |82017 Report | 2014Cancer CancerServices ServicesAnnual Annual Report
Quality Improvement
cal Interpretive Services “It’s difficult enough understanding insurance co-pays, being in or out of network, and the many complexities with pharmacies for those of us who speak English. Once you add a language barrier, it’s almost impossible to navigate the system without a little help. “I help them get the best possible care and take advantage of the resources available to them and their families during a difficult time. In medical interpretation, we all want the same thing – for the patient to get well,” said Martin. Not only is providing these patient services the right thing to do, it’s the law. Patients have the right to be fully informed of their health status in a language they can understand. Title IV of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, or national origin. The Americans with Disabilities Act of 1973 ensures effective communication with patients who are deaf or hard of hearing, while Section 1557 of the Affordable Care Act (ACA) deals with nondiscrimination and builds on the precedent set by Title IV.
In addition to providing the highest level of customer service, Regional West’s translation and interpretation services benefit our patients with improved communication and understanding, fewer misunderstandings, and an increased adherence to treatment protocol. “The most rewarding part of my job is being the bridge of communication between the patient and their providers,” said Martin. “It’s rewarding to be a key part in our patients’ medical care and help them understand what is going on in their bodies. You really build a bond with someone during a challenging time like this.”
Martin Vargas Regional West Language Access Coordinator
For more information about Regional West’s language access services, contact Martin Vargas at 308.630.2533 or email him at Jorge.Vargas@rwhs.org. Find more information on our website at rwhs.org/patients/ guest-relations.
References: 1. Https://cis.org/One-Five-US-Residents-Speaks-Foreign-Language-Home- Record-618-million 2. Http://dhhs.ne.gov/publichealth/Documents/Nebraska%20Hispanic%20 Socioeconomic%20Profile.pdf
RegionalCenter West || rwhs.org Regional West Medical rwhs.org | |9 9
2017 Cancer Incidence by Primary Site Cancer Treatment Center and Dorwart Cancer Care Center Primary Site Buccal Cavity/Pharynx Lip Major salivary gland Gum and other mouth Nasopharynx Tonsil Hypopharynx Digestive System Esophagus Stomach Colon, excluding rectum Rectum and rectosigmoid Anus/anal canal Liver Pancreas Peritoneum Other digestive organs Gallbadder Respiratory System Larynx Lung, bronchus Trachea pleura and other Soft Tissue Skin (Melanoma) Breast Female Genital System Corpus uteri Ovary Vulva Other female genital organs Male Genital Prostate Testis Urinary System Urinary bladder Kidney and renal pelvis Ureter/other urinary organs Eye Brain/Other Nervous System Endocrine System Thyroid gland Other endocrine Lymphatic System Hodgkin’s disease Non-Hodgkin’s disease Multiple Myeloma Blood/Leukemia Other, Ill-Defined and Unknown
All Sites Combined
ALL Cases (includes non-analytic) 12 1 3 3 1 3 1 70 8 8 24 11 2 4 8 1 3 1 45 2 42 1 3 24 77 23 17 4 1 1 56 54 2 42 28 12 2 1 18 13 8 5 14 1 13 4 8 8
418
Analytic Cases
M
F
Stage 0
Stage I
Stage II
Stage III
Stage IV
Not Staged
11 0 3 3 1 3 1 66 8 7 24 10 2 4 7 1 3 0 40 2 37 1 3 22 73 22 16 4 1 1 49 47 2 40 27 11 2 0 5 7 7 0 14 1 13 4 7 7
6 0 1 2 0 3 0 38 6 6 11 8 0 3 3 0 1 0 23 2 20 1 2 15 1 0 0 0 0 0 49 47 2 33 24 7 2 0 4 1 1 0 7 1 6 3 4 4
5 0 2 1 1 0 1 28 2 1 13 2 2 1 4 1 2 0 17 0 17 0 1 7 72 22 16 4 1 1 0 0 0 7 3 4 0 0 1 6 6 0 7 0 7 1 3 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 4 0 0 0 0 0 0 0 0 18 17 0 1 0 N/A 0 0 0 0 0 0 N/A N/A 0
0 0 0 0 0 0 0 6 0 0 4 2 0 0 0 0 0 0 5 1 4 0 1 8 32 8 7 0 1 0 12 11 1 8 2 6 0 0 N/A 4 4 0 3 0 3 N/A N/A 0
1 0 0 1 0 0 0 16 2 3 5 2 1 2 1 0 0 0 2 0 2 0 1 3 24 1 0 1 0 0 25 25 0 8 7 1 0 0 N/A 0 0 0 5 1 4 N/A N/A 0
5 0 2 0 1 2 0 17 5 1 6 3 0 1 1 0 0 0 11 0 11 0 1 3 8 2 2 0 0 0 3 2 1 2 0 2 0 0 N/A 0 0 0 0 0 0 N/A N/A 0
5 0 1 2 0 1 1 23 1 3 9 3 0 1 4 1 1 0 21 1 20 0 0 2 4 6 3 3 0 0 7 7 0 1 0 1 0 0 N/A 3 3 0 4 0 4 N/A N/A 0
0 0 0 0 0 0 0 4 0 0 0 0 1 0 1 0 2 0 1 0 0 1 0 1 1 5 4 0 0 1 2 2 0 3 1 1 1 0 5 0 0 0 2 0 2 4 7 7
370
Sex
190
Best AJCC Stage
180
27
87
86
52
76
42
*Analytic – Initially diagnosed at Regional West Medical Center, and all or part of first course of therapy at Regional West or case diagnosed elsewhere and all or part of first course of therapy, at Regional West. **Non-analytic case – Initially diagnosed and treated elsewhere, referred to Regional West for recurrence or subsequent therapy and physician office cases. AJCC Stage Grouping T, N, and M categories describe the anatomic extent of disease. Stage groupings gather cases into homogeneous categories to facilitate analysis.
10|10 |2016 2017 Cancer Services Annual Report 8 Cancer Services Annual Report | 2014 Cancer Services Annual Report
CT Simulator
Partnering for Improved Access to the Region’s Most Advanced Cancer Care Regional West and the University of Colorado Cancer Center Quality Improvement
UCHealth is a nine-hospital system with 21,000 employees, based in Aurora, Colo. They have partnered with Regional West since 2007 when Medical Center of the Rockies (MCR) in Loveland, Colo., opened. As the only comprehensive cancer center in the state of Colorado, as designated by the National Cancer Institute CU Cancer Center, CU Cancer Center research has improved the standards of care for cancer patients across the country. Clinical trials of advanced treatments, testing the order of targeted therapy, chemotherapy or radiation, and lifestyle interventions can mean cancer patients live longer with improved quality of life.
“Collaboration with the CU Cancer Center complements and enhances the services Regional West’s cancer program offers. Providing the highest quality of care close to home is very important to our patients and their families,” said Vincent Bjorling, MD, Regional West Cancer Services Medical Director.
“
“
Thanks to a recent partnership between Regional West and the University of Colorado (CU) Cancer Center, in collaboration with UCHealth University of Colorado Hospital (UCH), cancer patients in western Nebraska now have improved access to the region’s most advanced cancer care.
This partnership is very important and reaffirms our commitment to providing exceptional health care services to our community and throughout the region.
John Mentgen, President and CEO Regional West Health Services
The patient’s care team may confer with specialty providers at the CU Cancer Center and UCH to discuss a patient’s diagnosis and collaborate to determine a comprehensive treatment plan. These providers include radiologists, pathologists, surgeons, radiation oncologists, genetic counselors, and social workers.
Regional West continues to offer high-quality, patient-centered cancer care at the Cancer Treatment Center in Scottsbluff, including radiation therapy, chemotherapy, and surgery, as well as radiation therapy at the Dorwart Cancer Care Center in Sidney. Outreach clinics for cancer patients are also held at Alliance, Chadron, and Kimball. “The beauty of this network is that patients receive exceptional care that starts at home,” said Will Cook, UCH president and CEO. “With this new agreement, if patients require advanced cancer treatment, they have the option to be seen by specialists at University of Colorado Hospital with a seamless transition of care. And, through this expanded partnership with UCHealth and the CU Cancer Center that honors our already long-standing relationship, Regional West will be able to offer patients access to advanced medicine and clinical trials not offered anywhere else in western Nebraska.”
Regional West | rwhs.org Regional West Medical Center | rwhs.org | 11| 11
Quality Improvement
Regional West’s Onco
Supporting patients through their canc Cancer diagnosis and treatment is inherently stressful for patients and their loved ones. Regional West’s oncology social worker, Jennifer Hiltgen, BSW, is available as a source of support for patients and their families throughout their entire cancer journey.
Jennifer Hiltgen, BSW Regional West Oncology Social Worker
Jennifer joined Regional West’s Cancer Services team as an oncology social worker in May 2016. She has worked in the field of health care social work for over 18 years. This is her first position in an oncology setting. “I feel like it chose me,” she said. “My family was moving to the area and this position became available the day I decided to apply for a job. I felt like it was where God wanted me to be, having lost my mother, grandfather, and dear friend to cancer. He gave me the opportunity to give back by being able to help others going through their journey.” Jennifer’s oncology social work role is varied and multi-faceted. Following diagnosis, patients are asked to fill out a ‘distress screening’ prior to the start of treatment at Regional West. The self-reported screenings ask patients to rate their overall distress level during the past week, in addition to specific questions related to practical, family, emotional, spiritual, and physical problems. Upon completion of the assessment, Jennifer meets individually with
1212 | 2016 | 2014Cancer CancerServices ServicesAnnual AnnualReport Report
each patient to review the screening and help determine what stressors can be reduced or eliminated during the duration of treatment. She also visits with patients at their chemotherapy education session, at their radiation oncology consultation, or as referred by their oncologists and other medical professionals. Patients and their families are also free to reach out to Jennifer directly. She says that meeting with patients is a good opportunity to discuss where they’re at both physically and emotionally, and that, for many, external concerns related to family caregiving duties, finances, and job concerns leave them overwhelmed and unable to focus on their cancer diagnosis. “The most rewarding part of my job is being able to help patients and their families go through the cancer journey with as little stress as possible,” she said. “This is a time when people are vulnerable and need all the positive support possible – I’m someone with whom they can converse when they need to release frustration, concerns, and joys.” As a social worker, Jennifer is a patient advocate and works to connect patients with available resources within the medical community and beyond. This includes referrals to the proper agencies in the community and at Regional West, such as:
Hispanic Cancer
ology Social Worker
Support Group The popular Hispanic Cancer Support Group grew out of a patient request. Martin Vargas, Regional West’s language access coordinator, works closely with the local Hispanic community, and several people shared with him a desire to form a support group. Jennifer meets with the group monthly, as members share where they’re at in their journey. Some members are currently in treatment, some have completed treatment, while others are dealing with the emotional and physical impact of a cancer recurrence. The group provides support and education on topics relating to cancer, wellness, and other issues that they identify.
cer journey • Regional West’s financial “I’ve never met anyone who has navigator, who assists asked for or planned for his or patients with finding her cancer diagnosis – when the medication reimbursement diagnosis comes, it seems like for chemotherapy. it becomes a new full-time job,” • Applying for disability, she concluded. “But day-to-day Medicaid, and Regional West’s normal life also continues on and financial assistance program. my role allows me to assist our • Support groups. patients through all of this. We • Survivor activities, smile, laugh, and cry together. I’m including the Festival of Hope, able to be wherever the patient the Survivors’ picnic, Camp and family is at, and that makes Hope, Survivors’ Day, my job so gratifying.” and more. Typically, formal oncology social work services end at the completion of treatment when patients are ready to return to their ‘new normal’ in life. Jennifer says she does look forward to visits from former patients.
Jennifer said that she’s often asked, “How do you do it? Your job has to be so difficult and depressing.” She replies that it’s not always easy, but being able to be with patients and their families during a difficult time in their lives is a true honor.
Festival of Hope The Festival of Hope is a nonprofit organization whose mission is to help cancer patients who live in western Nebraska and eastern Wyoming with non-medical expenses during the treatment process. The annual grass roots fundraising event is organized by volunteers, some of whom work at Regional West.
“ Having a front row seat to patients battling this terrible disease, supporting them all the way, and celebrating their accomplishments is both a blessing and an honor, no matter how difficult the journey.
“
“Patients often come back and visit when they’re at Regional West for a follow-up appointment or for other reasons,” she said. “Sometimes they need assistance or support and they feel safe in sharing their concerns, knowing I’m here for support and guidance.”
The
Jennifer Hiltgen, BSW
“This unique program is a true blessing for our cancer patients, their families, and the community,” said Jennifer. “Being able to offer this assistance, along with the full scope of cancer services offered at Regional West, is a huge benefit close to home.” For more information about the Festival of Hope, go to festivalofhope.net. Contact Jennifer Hiltgen at 308.630.1348 or email her at Jennifer.Hiltgen@rwhs.org.
Regional West| |rwhs.org rwhs.org | 13 Regional West Medical Center | 13
Support Programs and Activities Regional West’s Cancer Treatment Center and The Dorwart Cancer Care Center Cancer Support Groups
Held on a monthly basis. Call Oncology Social Worker Jennifer Hiltgen at 308.630.1348 or the Dorwart Cancer Care Center at 308.254.9192 for more information.
Cancer Survivors’ Picnic
An annual summer event celebrating cancer survivors while acknowledging the vital role that families, friends, and other caregivers play in the lives of cancer survivors.
Camp Hope
An annual three-day, two-night camp for cancer survivors and their support persons held at Trails West YMCA Camp in Scottsbluff.
Cancer Survivors’ Day
This annual event allows cancer survivors, physicians, staff, family members, and friends to gather to celebrate cancer survivors and their personal victories. The day involves food, fellowship, entertainment, and fun. For more information, contact Cancer Patient Navigator Kim Croft at 308.630.1691.
Festival of Hope
A nonprofit organization whose mission is to help cancer patients who live in western Nebraska and eastern Wyoming with non-medical expenses related to their cancer care and treatment.
Emma’s Closet
The Cancer Treatment Center offers wigs, hats, and breast prostheses at no cost to cancer patients.
1414 | 2017 Report | 2014Cancer CancerServices ServicesAnnual Annual Report
Look Good, Feel Better
Co-sponsored by the American Cancer Society, this program helps women cope with cancer treatment side effects. Look Good Feel Better offers free workshops, literature, and practical information on skin care, makeup, hair loss, and nail care. For more information, contact Cancer Patient Navigator Kim Croft at 308.630.1691.
A Time To Heal
A free 12-week holistic survivorship program designed to help women regain their physical, emotional, and spiritual health following breast cancer treatment. The group meets for approximately two to three hours every week for 12 weeks. Weekly instruction includes topics such as building resilience, focus on healing, nutrition, facing our fears, regaining and maintaining strength, and how to survive after treatment. For more information or to enroll in “A Time to Heal,” contact Cancer Patient Navigator Kim Croft at 308.630.1691, or the Dorwart Cancer Care Center at 308.254.9192. Unless indicated, call the Cancer Treatment Center at 308.630.1348 for more information on any of these activities or programs.
For Additional Information Call:
308.630.2421
Write: Regional West Medical Center
Cancer Treatment Center 3911 Avenue B, Suite G100 Scottsbluff, NE 69361 Attention: Cindy Keller, CTR Cancer Registry Coordinator
Email: Cindy.Keller@rwhs.org Web:
Access the report at rwhs.org
2017 annual report published October 2018 Teresa Clark, Editor
Regional West| |rwhs.org rwhs.org | 15 Regional West Medical Center | 15
1616 | 2017 | 2014Cancer CancerServices ServicesAnnual AnnualReport Report