Annual Report CANCER PROGRAM 2016
Stratton VA MedicalCenter2016CANCER PROGRAMAnnual Report1
TABLE OF CONTENTSCancer Committee Membership.1Cancer Committee's Chair Report.3Tumor Registry Report.4Tumor Board Report.4Primary Site Table.55 Most Frequently Occurring Sites.6Cancer Care & Support Services.10Quality Studies.25Association of VA Hematology/Oncology (AVAHO) poster presentations. 34Site Review – Liver .i35
COMPREHENSIVE CANCER COMMITTEEThe Cancer Committee includes representatives of professional specialists as recommended by theAmerican College of Surgeons Commission on Cancer with areas of responsibilities including:coordinating educational activities for nursing staff, students and professionals; coordinating multidisciplinary treatment groups such as Oncology, Radiation Oncology and Hematology related clinics andTumor Board; and overseeing the functioning of the Tumor Registry.The Cancer Committee is responsible for discussing the diagnosis and treatment of patients withmalignancy within the facility as well as reviewing the medical records of cancer patients.2016 MEMBERSHIPREQUIRED:E. Ball, CCRPS. Bhatia, MDR. I. Beretvas, MDK. France, RNT. Ferrario, MDL. Hoffman-Hogg, MS RN CNS AOCN T. JardineE. Kim, MDR. LaTourrette, MS,RD,CDN,CSO,CNSCM. Le, MDR. O’Malley, MDB. McCandless, MD/P. Hegener, MDL. McCarthy, MDS. Mehdi, MD, FACPL. Mock, RN/M. Herrington, RNI. Uppal, MDD. Pasquale, MDV. Thalody, MDT. Thierbecker, LCSW, OSW-CB. Williams, CTRRepresentative Clinical Research CoordinatorRepresentative Radiation OncologyRepresentative General Surgery/Co-Chair/QM Coord.Oncology/Hematology Nurse CoordinatorRepresentative General Surgery & ACoS LiaisonCancer Program DirectorCancer Program AdministratorRepresentative HematologyCommunity Outreach Coordinator/Rep NutritionACoS Liaison/General SurgeryACoS Liaison/General SurgeryRepresentative Diagnostic Imaging-Nuclear MedRepresentative Pathology/LaboratoryCancer Conference Coordinator/ChairQuality Improvement LiaisonsRepresentative Pain Control/Palliative CareCancer Registry Quality Coordinator/Rep HemRepresentative Hematology/OncologyRepresentative Social WorkTumor Registry CTRAD HOC:R. Dyer, OTC. Reyes-Lopez/H. Park, MDD. Kupiak, R.PhA. Lupinetti, MDS. Mehdi, MDP. Minkler, RNA. Payne, MDJ. Richter, SWM. Roth, MD/R. Grimm, MDRepresentative Rehabilitation MedicineRepresentative DentalRepresentative PharmacyRepresentative OtolaryngologyRepresentative EthicsRepresentative Oncology/Hematology NurseRepresentative PsychosocialRepresentative American Cancer SocietyRepresentative Primary Care1
STRATTON VA COMPREHENSIVE CANCER COMMITTEEMISSION STATEMENTThe Comprehensive Cancer Committee supervises activities related to cancer treatment, control, educationand reporting within the Medical Center. The committee maintains and expands activities within ourcommunity of Veterans to insure the broadest spectrum of quality care for patients.The departmental reports data dates are January 1, 2016 thru December 31, 2016.2
COMPREHENSIVE CANCER COMMITTEE CHAIRMAN’S REPORTAccording to American Cancer Society, cancer will affect 1 in 2 American adult men and 1 in 3 adultwomen over the course of their lives. Our fight will continue until there is a cure.2016 has been a very exciting time in diagnosing and treating cancer. Precision Medicine has evolved anddifferent patients with same malignancy are now treated differently with significant improvement insurvival.Our cancer program has been accredited by the Commission on Cancer for over 55 years. The cancercommittee is responsible for evaluating quality of care, quality improvements, cancer registry, research &outreach activities and continued educational activities by active participation in the multidiscipline cancerconferences, (Tumor Boards).Our cancer program is comprised of a dedicated multi-specialty team which includes: Certified TumorRegistrar, Chaplin services, Medical Oncology, Hematology, Radiation Oncology, InterventionalRadiology, Surgical Oncology, Dental services, Speech Therapy, Palliative Care, Psychiatry, Nutrition,Quality Improvement, and Primary care.Each year the members of the cancer committee set up goals / studies to improve the care of cancerpatients. We brainstorm ideas in the beginning of the year, and then meet quarterly to follow up. In thesemeetings we discuss the progress of various goals and studies, their timeliness of completion, and trends insurvival. At the end of the year, we share our annual report with the entire medical center and community atlarge.Some of the goals, quality improvements, and individual department achievements are well outlined in thisannual report and I do not want to steal the thunder by mentioning them here.My report would be incomplete if I do not mention Lori Hoffman-Hogg NCP who had been our cancerprogram director over 15 years. She left our VA and is now the National Program Manager, PreventionPolicy, VHA. She was an incredible leader & member of the committee; her working attitude & vision wascontagious and the vacancy created by her departure has been impossible to fill. We wish her the best in herfuture endeavors. In 2016, Cheryl Brennan, one of our most seasoned oncology nurses retired. She hadbeen extensively involved with ACOS standards and been a member of our cancer committee. We all missher and wish her the best.Although all members of cancer committee are extremely dedicated and devoted, the tireless efforts of ourlone CTR Bernice Williams needs to recognized. Her passion for detail, documentation, and hard workethic has enabled us to be compliant with ACOS standards in 2016.In the end, I would like to thank all the members of the cancer committee for their tireless, sincere andcontinued commitments to the fight against cancer. I am positive that with the current pace of scientificadvancements and dedicated individuals like our cancer committee, most cancers will become like chronicdiseases, if not cured. The future is very hopeful.Syed MehdiSyed Mehdi, MD FACPChair Cancer Committee3
2016 TUMOR REGISTRY REPORTBernice Williams, CTRThe Tumor Registry at the VA Medical Center has a reference date of January 1955 (25,998 alive/deadpatients) and currently utilizes a computerized/manual system. In addition to registering and followingpatients with a diagnosis of malignancy, the Registry provides data for research and education to staff. Ourdata is captured and submitted in accordance with the guidelines and procedures are set forth by theAmerican College of Surgeons Commission on Cancer, the State of New York, the SEER (Surveillance,Epidemiology and End Results) of the National Cancer Institute (NCI), National Cancer Database (NCDB)and the VA Central Cancer Registry (VACCR). Interfacing with all of the components that make up theCancer Program, the data collected by the Registry helps promote quality patient care as well for present aswell as future cancer patients. The registry is currently staffed by Bernice Williams, CTR.The Stratton VAMC Cancer program is accredited by the Commission on Cancer (CoC) as a Veteran’sAdministration Cancer Program (VACP). Our program’s compliance with the CoC standards is committedto providing the best in cancer diagnosis and treatment.Lifetime follow-up of patients included in the database supports clinical follow-up & surveillance ofadditional primaries. Follow-up data includes neoplasm status (free or residual/progressive disease),recurrences, subsequent treatment, and vital status. The Tumor Registry maintains a follow up rate forpatients diagnosed from registry date 1955 as of 12/31/16 99%. *Non-analytical, basal and squamouscell cancers of the skin and in-situ of the cervix are excluded from the calculations of follow-up percentage.The abstracting timeliness was 89% of the 2016 cases abstracted within 6 months of the date of first contactwith the facility, 90% is the requirement by American College of Surgeons. The top five most frequentlyoccurring primary site trends include Prostate, Lung, Bladder, Head and Neck and Liver.We strive to provide the highest quality database. We endeavor to achieve this through uniformity of datacollection, annually physician chart review of 10% of our new cases, software edit checks, and accurate andtimely follow-up information on our patients. Our ultimate goal is to contribute to the prevention and cureof cancer.The Cancer Program continues to support the registry’s educational activities which assist us to meet theStandard 1.10; Cancer Registrar Education which includes participating in cancer-related educationalactivities other than cancer conferences.2016 TUMOR BOARD REPORTBernice Williams, CTROur weekly Tumor Board is a conference which includes both case presentation and a didactic program.Following each presentation, there is discussion of the case and review of the recommended staging andtreatment modalities available. This ensures a multi-disciplinary and multi-specialty approach to thetreatment of disease as well as providing education to the house staff, students, and allied healthprofessionals in attendance. Continuing Medical Education credits are given to the physician staff forTumor Board.During 2016, there were 159 presentations (151/95% prospective and 8/5% retrospective) of new primaries,recurrences or follow-ups. Sites presented included: Bladder, brain, breast, colorectal, esophagus, kidney,liver, larynx, leukemia, lung, lymphoma, melanoma, nasal cavity, neuroendocrine, oral cavity, pancreas,prostate, tongue and unknown origin.The Stratton VA Medical Center has several oncology related specialty clinics that oversee the ongoingmulti-specialty care and treatment for Veterans with cancer.4
PRIMARY SITE 2016/TOP 5TOT#ANALNONWMWFBMBFOMO-F0IIIIIIIVUNAINCALL SITES 00002010000TONGUE, BASE1010090100000127000TONGUE, THER/NOS MOUTH IFORM OMACH76160100021120010SMALL INTESTINE22020000000001010System: C00 Lip/Oral Cavity/PharynxSystem: C15 Digestive 000ANUS/ANAL CANAL44031000010210000LIVER/INTRAHEPATIC BIL3329426070000866490011101110000013304000NASAL CAVITY/MID ONCHUS58517504400001761517300System: c40 000000022019163180010055612000PANCREASSystem: C30 RespiratorySystem/Intrathoracic OrgansSystem: C42 : C44 SkinSystem: C49 Connective/Subcutaneous/Other Soft 5010022200000CERVIX TE 000KIDNEY98180100002114100RENAL PELVIS11010000001000000System: C50 BreastSystem: C51 Female Genital OrgansSystem: C60 Male/Genital OrgansSystem: C64 Urinary 603300System: C69 BRAIN21120000000000020System: C73 Thyroid/Other Endocrine76150100104010200System: C77 Lymph Nodes97281000001224000System: C80 Unknown Primary981900000000000905
2016 Stratton VAMC Top 5 Primary LungBladderLiverHead/Neck2016 Stratton VA Top 5 Primary Sitesby Race and ngBladderLiver6Head/Neck
CANCER CARE & SUPPORT SERVICESCANCER SURVIVOR'S CELEBRATIONTess Thierbecker, LCSW, OSW-CThe Twenty Fifth Annual Cancer Survivors Celebration was held on Friday June 2, 2017. Approximately200 cancer survivors, their guests and staff members attended the celebration of life that was held on thegrounds of the Fisher House. The positive energy of the day was highlighted by the beautiful springweather.We are extremely grateful for the support of Voluntary Service and Committee members. The dedicationand generosity of our volunteers has been an invaluable contribution to this annual celebration.The guest welcome was delivered by our hospital director, D. Scott Guermonprez, FACHE. We areextremely thankful to Jennifer Watson, our key note speaker, cancer survivor, and caregiver who shared herexperience and appreciation to VA staff for excellent treatment and support.Entertainment was provided by both Bob Marcello a gregarious performer drawing the crowd into a singalong and also our very own Veteran cancer survivor, William Faye, singer/musician for the fourth year ina row. The colors were presented by the Lansingburgh Uniform Color Guard.Our partners at the American Cancer Society were in attendance. Many beautiful items were also donatedby staff, and volunteers that were used as door prizes.Dr. Syed Mehdi our Chief Medical Oncologist delivered the closing remarks and highlighted theaccomplishments and improvements in the Cancer program throughout the past year. Our Master ofCeremony was John McDonnell, “Mac”, who happens to be the retired Chief of Police at Albany VAMC.The VA Chaplain Service presided over the invocation and benediction. Pastries and coffee were providedby Voluntary Service. Volunteers helped with registration and distribution of T-shirts, pens and waterbottles. A cook out was provided by Wal-Mart Distribution Center 6096, Johnstown, NY; we are extremelyappreciative for their generosity for the sixth year in a row. The Johnstown DC 6096 staff has come toknow our veterans and provided conversation, laughter and assistance with getting food to the table forveterans to enjoy.This event was successful because of the collaborative effort, support and involvement of many dedicatedemployees and volunteers. The planning committee is comprised of retired employees/veterans andpersonnel from various disciplines within the medical center. Their unselfish involvement is proof of theirdedication to our Veteran patients.This year's celebration was again, a huge success. The planning committee is already looking forward toand beginning to plan for next year’s event.WOMEN VETERANS REPORTSuzanne Deane, LCSW WVPMThe Women Veterans Program Manager (WVPM) along with our Women’s Health Medical Director, Dr.Grimm continue to support and advocate for women’s health care and services at the Albany facility andour 11 Community Based Outpatient clinics (CBOC’s). The Women Veterans Health Committee, chairedby the WVPM, meets at least bi-monthly to address issues with our Women Veterans Program.7
Dr. Rachel Grimm, our designated Women’s Health Primary Care Provider continues to have new femaleVeteran enrollees assigned to her patient panel so they can receive “comprehensive primary care” whichincludes their basic gender specific care. Women Veterans who were already assigned to other providerswho cannot provide this comprehensive primary care are given the opportunity to switch to Dr. Grimm’spanel.The “Wellness Woman’s Clinic” takes place every day for GYN except Wednesday which is a surgery dayfor our GYN provider. Women’s primary care is open Monday, Tuesday, Wednesday, Thursday, andFriday (1/2 days). Patients are seen either in the Women’s Wellness Center to ensure that every woman canreceive her basic gender specific care in a separate space designated just for women and from an interestedand proficient primary care provider.Our GYN Provider Dr. Mesidor is full time with surgery time on Wednesdays. This gives our womenVeterans a consistent provider face for primary care and GYN care in our Wellness Center. GYN Clinic isheld every day except for Wednesday (OR day). There is also a GYN Surgical Care Coordinator whomanages preoperative care for GYN surgical patients.Availability for off tour and weekend patient access until 6:30pm on Mondays and every 3 months theclinic is open on some Saturdays. The current wait times for new and returning appointments in the GYNclinic is below 30 days. As our number of female enrollee’s increases, clinic time will be expanded tomaintain access of less than 30 days. Women can access the VA Choice program for mammography if theVAMC cannot provide the service and/or the Veteran lives 50 or more miles from the facility. Same daynursing visits and urgent care scheduling is available.The Albany VAMC GYN clinic offers a check in and waiting area. In the “Women’s Wellness Center”, theWomen’s Health Primary Care Provider and the Gynecologist work collaboratively in this unit to providewomen’s comprehensive primary care and GYN specialty care. Behavioral Health is available within theWomen’s Wellness Clinic area to provide same day access to behavioral health services. The Women’sWellness Clinic providers have begun a pilot program for screening all women Veterans who are seen forcare for interpersonal violence (IPV) and can provide a warm handoff to the VA IPV Coordinator.Thin Prep Pap tests with HPV testing are performed for cervical cancer screening. The GYN provider notesany pap tests that are positive and does follow up as needed. The GYN RN receives a monthly PAP reportwhich is reviewed to ensure appropriate follow up was made.Mammograms are ordered by Primary Care providers or the GYN providers for breast cancer screening.Between January 2016 and December 2016 there were 417 mammograms performed. Mammogram resultsare tracked by the lead Mammographer, in addition to being reported to the ordering provider.Patient education involves all staff in the GYN Clinic as well as the Primary care Women’s Health Clinics.Staff has use of the Veterans Health Library, which offers a wealth of medical information to share with allVeterans.The VA continues to offer women veterans Long Acting Reversible Contraception devices (LARC). Theyare all easily placed and removed at any time the Veteran chooses. These LARCs are available, in additionto the other hormonal, non-hormonal and surgical options that we have.The 3 Intra-Uterine devices/contraceptives or “IUD’s” are available (in the US) and through the VA are:Para guard IUD (No hormones, Copper device for 10 yrs. or less)Mirena IUD (Progesterone IUD for 5 yrs. or less)Skyla IUD (Progesterone IUD for 3 yrs. or less)8
We also now have access to the Nexplanon subdermal implantable device, which is small, and the size of amatchstick. (Progesterone implant under the skin for 3 yrs. or less)Providers can send the Veteran the Women’s Wellness Clinic in Albany, or have an e-consult set up for atelephone consult and our GYN provider will call and speak with the Veteran about the best choices forthat Veteran. The clinicians are planning to begin to expand services offered through telehealth.QUALITY MANAGEMENTMarlene Herrington, BSNThe medical center’s mission is to care for our Veterans with compassion and excellence. Our vision is tobe the health care provider of choice, achieving the highest quality in health care delivery, education, andresearch. We are committed to adding value to our mission by modeling ourI- CARE Values: Integrity Commitment, Advocacy, Respect, and Excellence.Quality and appropriateness of care rendered to oncology patients is reviewed using the foll
V. Thalody, MD Representative Hematology/Oncology T. Thierbecker, LCSW, OSW-C Representative Social Work B. Williams, CTR Tumor Registry CTR AD HOC: R. Dyer, OT Representative Rehabilitation
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