Athens Regional FirstCare Occupational and Industrial Medicine
Comprehensive Wound Center
Home Health
Program
Loran Smith Center
for Cancer Support
Maternal Child Services
Open-Access MRI
Radiology
Regional Lab Outeach (RLO)
Regional Rehabilitation &
Regional SportsCare
The Mind Body Institute
The Physicians Imaging Center
The Spine Institute
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2000 Oncology Annual Report
Overview
Chairman's Report
Medical Services
Oncology Inpatient Unit
Radiation Oncology
Medical Oncology
Wound, Ostomy and Continence Therapy
Cancer Patient Support Services
Loran Smith Center for Cancer Support
Social Work Services
Nutritional Counseling
Chaplain Services
Tumor Registry
Background
Data
Overview
Athens Regional Medical Center is a 315 bed non-profit hospital, and is the cornerstone of its parent company, Athens Regional Health Services, Inc., With a medical staff of approximately 275 physicians and over 2300 employees. Athens Regional Medical Center offers a full range of medical specialties including Oncology, Obstetrics, Gynecology, Neonatal Care, Cardiology, Pediatrics, Orthopedics, Neurosciences, Anesthesiology, Surgery, Radiology, Internal Medicine, Behavioral Health, Nephrology, Urology, and Pulmonary.
Services are provided through:
Outpatient Surgery Center
Physician's Imaging Center
Outreach Laboratory
24 hour Emergency Department
Endoscopy Center
Specialty Intensive Care Units
Ambulatory Treatment Center
Diabetes Education Center
Regional First Care Occupational Health Services
Regional Rehab Services
Radiation Oncology
Home Health Care
Off-Site Urgent Care
Mission Statement
While striving to be an outstanding health care system, the mission of Athens Regional Medical Center is to provide to its patients, their sponsors, its medical staff and the community quality patient care and a scope of services that are of a superior value, delivered in a caring and safe atmosphere with dignity and compassion by competent professionals.
The credibility and reputation of Athens Regional Medical Center are of the utmost important to those served by the institution and its supporters.
Based on the continuous assessment of community needs by management, the medical staff, and the governing body, Athens Regional Medical Center shall diversity and provide selected health care programs within the defined region.
Athens Regional Medical Center strives for excellence, patient satisfaction and a sound financial position.
Values
Excellence
Honesty and Integrity
Continuous Improvement
Efficiency and Effectiveness
Team Spirit
| Sven Swanson, MD, Chairman | Pathology |
| John Barton, MD | Radiology |
| Mark Ellison, MD | Urology |
| Cecil Hudson, MD | Chief of Staff |
| Shiv Khandelwal, MD | Radiation Oncology |
| Kenneth Lipshy, MD | General Surgery |
| Neal Marrano, MD | Medical Oncology |
| Thomas Oliver, MD | Urology |
| John Simpson, M.D. | ENT |
| Steven Scott, MD | Thoracic Surgery |
| Narendra Shah, MD | Radiation Oncology |
| Michael Smith, MD | OBGYN |
| Ronald Terry, MD | Radiation Oncology |
| Jeffrey Thomas, MD | Medical Oncology |
| Mark Vrana, MD | Medical Oncology |
| R. Glen Wiggans, MD | Medical Oncology |
| Martin Sparks, RN, VP, Patient Care Services | Administration |
| Nancy Duval, RN | Oncology Unit Director |
| Mona Mercardante, LCSW | Program Manager, Loran Smith Center for Cancer Support |
| Karen Szwast | Tumor Registrar |
The second full year of the Cancer Program at Athens Regional Medical Center was busy
and exciting. In 2000, all facets of the program were further developed and refined to help improve
the health of our community, the care of our cancer patients at Athens Regional Medical Center and to bring us closer to having an American College of Surgeons (ACOS) Approved Cancer Program.
The quality of data abstracted by the tumor registry has improved. This was due to a
number of factors. Further experience and education of the physicians filling out tumor staging forms and the tumor registrar's continuing education and experience were key to improving case finding, staging, abstracting and follow-up of the cancers. An audit of previously staged forms identified trouble areas and prospective review of abstracts was instituted to increase the accuracy of staging and abstraction. In 2000, the follow-up phase of data collection was started. Collecting follow-up data has been very successful as a significantly greater rate than the required 90 percent has been achieved.
Oncology Case Conference (Tumor Board) has continued to be a great success. It is extremely well attended by physicians and non-physicians, representing all disciplines necessary for successful cancer diagnosis and treatment. This definitely increases the quality of cancer care in our community by providing a forum for collaboration. The requisit number and types of cases were presented and they engendered thoughtful discussions regarding cancer diagnosis and treatment. Greater emphasis was placed on discussion of cancer staging during case conference. There are plans to upgrade the audiovisual facilities used for presenting these cancer cases at Oncology Case Conference.
Construction of the Loran Smith Center for Cancer Support was completed and on August 31, 2000, the center was dedicated. Although rain had been forecast for the dedication, it held off. Hamilton Jordan, cancer survivor and former Chief of Staff to President Carter, gave an emotional keynote speech. The Center provides cancer education and information, support groups, individual and family counseling, quality of life seminars, grief support and complementary therapies to support which enhances the lives of the cancer patients, and their friends and families in our community. The Center's referral form has been improved to make it easier for physicians to refer patients to the Center. The services are provided at no charge to the participants as the Center receives funding from the Athens Regional Foundation.
The oncology inpatient unit now has 40% oncology certified nurses. Other improvements of the nursing component to the program include quarterly educational chemotherapy review, chronic fatigue assessment, music therapy to relieve stress and anxiety, and interaction with local cosmetologists to help chemotherapy patients deal with hair and skin problems that result as a consequence of their therapy. The nursing staff will continue to certify nurses as oncology nurses. The chemotherapy educational component of the oncology nursing unit is not trivial. In the latter part of this year 50 new chemotherapy agents have been introduced for use in treating our patients.
Hospital employees and physicians contribute in other ways to cancer care in our community. The Pink Ribbon Team are volunteers who are breast cancer survivors, and are a component of the breast cancer patient support program. These volunteers visit inpatients that have had a mastectomy and provide support to these patients. There has been participation in prostate cancer screening and in early detection and awareness programs for breast cancer and lung cancer. ARMC is a major sponsor for the annual American Cancer Society Relay for Life, and many physicians and hospital employees participate in this event. Support is also given to the Leukemia/Lymphoma Society Light the Night Walk.
An Oncology Committee goal is to have ARMC qualify as an American College of Surgeons ApprovedCancer Program. The organization and the interaction of the above components will help us meet that goal. In the last year a "Survey Preparedness Self Assessment Tool" has been utilized to help prepare for certification. Also, a consultant to help us assess our preparedness for certification will be visiting in January of 2001. A medical staff physician has been selected as physician liaison to the American College of Surgeons, one of the requirements for approval.
Also in 2000, some medical processes have been updated to enhance our ability to diagnose and treat cancer. For instance, in radiology several enhancements in imaging studies have been employed to better identify tumors. As an example, Neotect is being utilized to detect cancers in the lung and chest cavity. In the laboratory, a pathologist who specializes in the diagnosis of lymphoma and leukemia (an hematopathologist) has been hired and will start in July 2001. The sophistication level of PSA testing used to screen men for prostate cancer and follow-up those with prostate cancer has increased.
Avenues for broadening cancer diagnosis and treatment in Athens and the surrounding area for 2001 include continued investigation into the possibility of performing clinical trials, and possibly interacting with St. Mary's Hospital to be able to truly provide a community wide cancer program.
ARMC has moved significantly closer to the goal of becoming an ACOS Approved Cancer Program while improving cancer care for her patients. Our primary goal for the year 2001, is to become a fully approved cancer program. With the continued tireless efforts of so many dedicated individuals, this goal should be met. Clearly we are on track to improve cancer awareness and education, prevention, diagnosis and treatment for the population we serve.
The inpatient oncology unit is a 12 bed unit. Forty-percent of the nursing staff are nationally certified oncology nurses. The nursing unit director is diligent in keeping the staff educated in current practices through an annual competency day that offers education and review, and assessment of knowledge and performance competency.
The inpatient unit also administers outpatient chemotherapy, in collaboration with the medical oncology physicians practice . A private family room on the unit is utilized for outpatient treatment and is otherwise available to families for relaxation and consultation without having to leave the unit area.
This year the staff continued the previous performance improvement initiative related to assessment and treatment of fatigue in their patient population. The oncology unit members maintain a community connection through participation in the American Cancer Society Relay for Life. Staff members address the emotional and spiritual issues of patients as well as provide excellent nursing care. A designated staff nurse coordinates a grief follow-up program for families that allows them to contact families on a periodic basis after the death of a loved one.
Hematology and Oncology of Northeast Georgia is located a few blocks from Athens Regional Medical Center. There are four medical oncologists in the practice and all are on staff at Athens Regional Medical Center. They are active on the cancer committee and contribute to bi-weekly cancer case conferences. State-of-the art cancer treatment is provided in a caring and supportive environment. The physicians travel to eight different offices in outlying counties to increase access to care for cancer patients, as well as, maintain an active office in Athens. Oncology certified nurses provide expert clinical services.
The social, emotional, and spiritual needs of patients are addressed by an on-site oncology social worker and appropriate referrals are made to support services in the community.
The year 2000 was an extremely busy year for radiation oncology. There are three radiation oncologists on staff at Athens Regional Medical Center. One radiation oncologist practices in the Athens Radiation Oncology Center at ARMC and two practice in a free standing private facility.
At ARMC, an excellent QA program was put in place by the physics staff. The staff also implemented many changes in the treatment planning computer system that allows the department to be more versatile and provide optimal treatment care. The majority of patients are CT simulated providing true "conformal" treatment that assures safe, accurate, and precise delivery of treatments. The department looks forward to moving into a new building with new equipment in 2001. This will allow further expansion of services.
The radiation oncology support staff includes an oncology certified nurse who is able to provide specialty services such as IV medications. She also provides on-going nursing assessment of all patients to alleviate and minimize side effects of treatment. Other staff include a physicist, a docimetrist, radiation therapists and clerical staff. The department coordinates closely with social work services, dietary and the Center for Cancer Support to assure that all patient and family needs are assessed, identified and met.
Two enterstomal therapy nurses provide care to both inpatients and outpatients. They see many cancer patients who have an ostomy as a result of oncology surgery. Patient counseling and pre-operative consults are an essential part of this service. This department also treats skin breakdown, radiation reactions, pressure ulcers, and chronic wounds. The services of this specialty make an important contribution to the quality of life of many oncology patients. The ET nurses facilitate a very successful ostomy support group.
The Loran Smith Center for Cancer Support offers educational, emotional, and spiritual support to cancer patients and families in the community. The Center serves as a resource for patients during and after cancer treatment by providing support groups, individual and family counseling, and an educational resource library. The Center is endowed by Athens Regional Foundation and all services are offered at no charge.
The Support Center is staffed by a licensed clinical social worker, oncology nurse, and office manager. Over 30 volunteers assist staff members in program implementation. Educational workshops, seminars, and individual classes are offered that address physical side effects, psychosocial issues, spiritual concerns, complementary therapies, and grief issues related to the death of a loved one. The social worker and nurse also visit ARMC cancer inpatients and coordinate the Pink Ribbon Team, a group of breast cancer survivors, who visit breast cancer inpatients following their surgery.
The center offers a Breast Cancer Awareness program in October and participates in prostate cancer screenings with the local urologists in September. The staff collaborate closely with the American Cancer Society and the hospital health promotion department in other community prevention, early detection, and support programs.
The dietary department offers a specially trained dietician to provide consultative services to both cancer inpatients and outpatients. Lack of appetite, nausea, and vomiting are problems the cancer patients can experience. A nutritional consult provides information designed to minimize these symptoms and increase one's nutritional status during treatment.
An oncology social worker provides psychosocial support and resources planning for cancer inpatients and outpatients. In coordination with the nursing unit care coordinator, effective discharge planning assures continuity of care for patients. The social worker facilitates application for financial resources when needed and serves as an advocate for the patient from diagnosis through treatment. The hospital social worker coordinates with the physician office social workers to provide support and information through the continuum of treatment.
Prayer and pastoral support is often an important part of the healing experience. Chaplains at ARMC are available twenty-four hours a day should patients desire assistance with faith or spiritual issues, grief support, ethical dilemmas in patient care and /or family support. You may request a hospital chaplain or arrange to have your own minister, priest or rabbi contacted. An interfaith chapel is open 24 hours a day.
Background
The Tumor Registry completed its second year as the database of all cancer patients diagnosed and/or treated at Athens Regional Medical Center. In 2000, 690 analytical cases were added to the Registry, and increase of 184 from 1999. Analytical cases are those patients diagnosed and/or receiving all or part of their first course of treatment at ARMC.
Follow up
This year completes the first year of follow-up which will continue over the lifetime of each patient in the Registry. The follow-up rate for 2000 is 98.7%. This high rate of success is due to the participation of our physicians and good response from patients and families contacted. The Registry also participated with hospitals nationwide in locating patients for follow-up.
Case Conference
There were 23 Oncology Case Conferences held in 2000, proving an excellent opportunity for specific case discussion as well as for presentations from other institutions such as the University of Georgia. Oncology Case Conference is very well attended by medical staff and allied health employees of Athens Regional Medical Center.
Quality Assurance
Quality of information in the Tumor Registry is assured by ongoing audits conducted by the medical staff with results presented to the Cancer Committee.
Goals
During year 2000 the Registry was able to provide reports and statistics to hospital staff on such topics as incidence of cancer by county (Graph 4) and treatment received for particular cancers. As the database increases, the Registry's goal is to be able to provide a more complete picture of the incidence and type of cancer in this area, thus providing our medical community with the information they need to diagnose and treat cancer at an early stage.
Table #1 Top Ten Sites by Gender, 200
|
Site
of Cancer
|
Total
|
Total
%
|
Male
|
Female
|
|
Lung
|
135
|
20
|
85
|
50
|
|
Breast
|
126
|
18
|
0
|
126
|
|
Prostate
|
99
|
14
|
99
|
0
|
|
Colorectal
|
88
|
13
|
46
|
42
|
|
Urinary
Bladder
|
32
|
5
|
25
|
6
|
|
Pancreas
|
20
|
3
|
6
|
14
|
|
Non-Hodgkins
Lymphoma
|
19
|
3
|
9
|
10
|
|
Kidney
|
17
|
2
|
10
|
7
|
|
Thyroid
Gland
|
15
|
2
|
3
|
12
|
|
Stomach
|
13
|
1
|
0
|
11
|
The top ten sites account for 562 (81%) of the total 690 analytical cases in the tumor registry in year 2000.
Back to Top
Table # 2
Comparison of ARMC 2000 Top Ten Sites with ARMC 1999 Top Ten Sites and the National Oncology Data Base Year 2000
ARMC 1999 ARMC 2000
|
Breast
|
103
|
20%
|
Lung
|
135
|
20%
|
|
Lung
|
92
|
18%
|
Breast
|
126
|
18%
|
|
Prostate
|
72
|
15%
|
Prostate
|
99
|
14%
|
|
Colon
|
51
|
10%
|
Colorectal
|
88
|
13%
|
|
Urinary
Bladder
|
42
|
8%
|
Urinary
Bladder
|
32
|
5%
|
|
Non-Hodgkins
Lymphoma
|
17
|
4%
|
Pancreas
|
20
|
3%
|
|
Thyroid
Gland
|
12
|
2%
|
Non-Hodgkins
Lymphoma
|
19
|
3%
|
|
Kidney
|
10
|
2%
|
Kidney
|
17
|
2%
|
|
Stomach
|
10
|
2%
|
Thyroid
|
15
|
2%
|
|
Esophagus
|
10
|
2%
|
Stomach
|
13
|
1%
|
|
All
Other Sites
|
87
|
17%
|
All
Other Sites
|
128
|
22%
|
|
TOTAL
|
506
|
100%
|
TOTAL
|
690
|
100%
|
NATIONAL ONCOLOGY DATA BASE 2000
|
Breast
|
15728
|
19%
|
|
Lung
|
12053
|
14%
|
|
Prostate
|
11680
|
14%
|
|
Colon
|
6846
|
8%
|
|
Urinary Bladder
|
3646
|
4%
|
|
Non-Hodgkins Lymphoma
|
2954
|
3%
|
|
Malignant Melanoma
|
2290
|
3%
|
|
Corpus Uteri
|
2191
|
2%
|
|
Rectum
|
2001
|
2%
|
|
Kidney
|
1780
|
2%
|
|
All Other Sites
|
25025
|
29%
|
|
TOTAL
|
87194
|
100%
|
Since 1999 was the first year of the Tumor Registry at Athens Regional Medical Center (ARMC), there are only two years of data to compare. In order to assess incidence of the top ten ARMC sites against other data, the date from the National Oncology Data Base (NODB) was utilized.
Table #3 Distribution of Case by County
Athens Regional Medical Center servers a large 16 county geographic area of Northeast Georgia as evidenced by the distribution of cases by county.
|
|
2000 |
1999
|
|
|
2000
|
1999
|
|
Banks
|
7
|
10
|
|
Jackson
|
58
|
43
|
|
Barrow
|
50
|
31
|
|
Jasper
|
|
1
|
|
Butts
|
|
1
|
|
Madison
|
63
|
55
|
|
Cherokee
|
2
|
|
|
Morgan
|
20
|
18
|
|
Clarke
|
204
|
159
|
|
Newton
|
|
2
|
|
Clayton
|
1
|
|
|
Oconee
|
53
|
28
|
|
Cobb
|
1
|
|
|
Oglethorpe
|
37
|
28
|
|
Coweta
|
1
|
|
|
Putnam
|
7
|
4
|
|
Dekalb
|
|
1
|
|
Rabun
|
|
4
|
|
Effingham
|
|
1
|
|
Spalding
|
1
|
|
|
Elbert
|
40
|
33
|
|
Stephens
|
20
|
5
|
|
Franklin
|
36
|
24
|
|
Stewart
|
2
|
|
|
Fulton
|
1
|
|
|
Taliaferro
|
|
3
|
|
Greene
|
23
|
14
|
|
Walton
|
25
|
10
|
|
Gwinnett
|
2
|
|
|
White
|
2
|
|
|
Habersham
|
3
|
2
|
|
|
|
|
|
Hart
|
24
|
20
|
|
|
|
|
Breast Cancer Site Specific Study
126 analytic cases, 2000
As can be seen by the above graph, the upper outer quadrant represented the most common site of origin within the breast for breast cancer. This is to be expected as this quadrant typically contains more breast tissue than the other quadrants. This was followed closely by the overlapping lesion category. The other quadrants show an expected distribution of sub-sites.
Breast Cancer Stage at Diagnosis
As was the case in 1999, this graph confirms the trend of earlier diagnosis for breast cancer through excellent screening programs. Overall, stages 0-II represent 83% of the cases.
Kenneth A. Lipshy, MD
General Surgeon
Prostate Cancer - Site Specific Study
Age Distribution
| 0-39 |
40-49 |
50-59 |
60-69 |
70-79 |
80-89 |
90-100 |
Unknown |
| 0 |
2 |
31 |
38 |
24 |
4 |
0 |
0 |
The majority of the prostate cancers are still being diagnosed at age 69 or below. However, compared to last year's data, one-third of the cases occurred in men 59 or younger. This tendency toward earlier diagnosis is consistent with the national trend and may due to the increase of early detection techniques with digital rectal exam (DRE) and prostatic specific antigen (PSA).
Prostate Cancer Stage at Diagnosis
*Unknown means Tx, Nx, or Mx at the time case was abstracted
The majority of our cases are still in Stage II, which indicates the disease is localized to the prostate gland. Once again, with the use of early detection techniques of digital rectal examination (DRE) and prostatic specific antigen (PSA), we are seeing earlier stages at diagnosis and very rarely Stage 4 disease at diagnosis.
Prostate Cancer - First Course of Treatment
The majority of the patients are either having radical prostatectomy or primary external beam radiation therapy as their first course of treatment. This information again indicates that prostate cancer is being diagnosed sooner and thus, is amendable to definitive therapy. We are beginning to see more combination treatments, particularly with hormone therapy in conjunction with radiation therapy and surgery. Although chemotherapy is rarely used as a first course of treatment, there are new agents available that are being used for Stage disease after failure of hormone therapy.
*Unknown means that there is some indication that hormone therapy could be used but it was not clearly indicated when case was abstracted.
Summary: The prostate cancer data from 2000 demonstrates an tendency toward an earlier age of diagnosis that 1999 and continues to show early stage at detection. Cancers continue to be caught at an early enough stage for the majority of them to be treated with definitive therapy with radical prostatectomy or radiation therapy. We are beginning to see a tendency toward multi-modality therapies with combination of hormone therapy with surgery and radiation therapy. In the future, we may see more multi-modality treatments including possibly the use of more chemotherapy.
Mark Ellison, M.D.
Urology/Surgery
Lung Cancer Site Specific Study
In the United States, carcinoma of the lung is the leading cause of cancer death in both men and women. Lung cancer, commonly divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLS) due to differences in biological behavior, was the most common pathologically diagnosed cancer at Athens Regional Medical Center (ARMC) in 2000.
Lung Cancer Best Stage
Lung Cancer Stage at Diagnosis
TNM staging has proven useful in planning treatment and determining prognosis for patients with NSCLC, but it is not as useful in SCLC. Traditionally, most patients with SCLC present at stages III (locally advanced disease) and IV (metastatic disease) and are not treated surgically. The data from ARMC shows that 82% of patients with SCLC presented with this advanced disease. Unfortunately, in NSCLC, 63% of patients had stage III or state IV disease at ARMC, consistent with national trends. ARMC had a slightly higher than expected percentage of stage I patients, 25% compared to the expected 10%. This may reflect the significant number of northeast Georgia patients with lung nodules who are referred for surgical diagnosis and treatment.
County of Residence Distribution
Lung Cancer County of Residence Distribution
As expected, more of the lung cancer patients diagnosed at ARMC resided in Clarke County than any other single county, specifically 23 patients out of the 135 (17%). The percentage was somewhat lower than expected, however, when compared to the percentage of all types of cancer patients at ARMC who were from Clarke in 1999 (31%). The availability in Athens of specialty care in pulmonology and thoracic surgery likely accounts for this.
Lung Cancer - Site Specific Study
Primary Site Study - Total Patients =135
Lung Cancer Anatomic site of Origin
Carcinoma of the lung occurs more frequently in the right lung than in the left lung, with a ratio of approximately 6 to 4. The upper lobe is the most common site of origin, and the middle lobe, because of its size, is the least common site. Over 50% of both small cell and non-small cell lung cancer diagnosed at ARMC were found in the upper lobes.
Summary: Lung cancer continues to be a significant public health problem, due to the large number of patients diagnosed annually and the failure to diagnose patients at an early stage. Widespread cessation of smoking is the main hope for decreasing the incidence of this disease, but earlier diagnosis may be achieved in the future with the development of cost effective screening techniques. Unlike many other cancers, no such screening is currently available and effective for lung cancer. Patient demographics at ARMC reflect its status as a specialty care facility, with a relatively wide geographic distribution of patients and a higher percentage of early stage (surgically treated) tumors.
Steven S. Scott, MD
Thoracic Surgeon
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