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SMHC Cancer Care - Outcomes

napbc mhccn logosSMHC is a proud partner of the MaineHealth Cancer Care Network. ­ The network is designed to reduce the need for travel whenever possible, by connecting local cancer experts with cancer patients. ­ This powerful collaboration brings together nearly 300 of the most talented cancer care providers in northern New England, with the support of the Harold Alfond® Foundation. ­ The foundation is providing a generous five-year grant that supports the staff and technology that connect us.

This is report of outcomes that summarizes some of the activities and results that have been completed or achieved at SMHC in 2019.  This report of outcomes is required by the Commission of Cancer standard 1.12.  It includes information about screening programs, clinical measures, and quality improvement and shows how we compare to national standards.  It is developed to provide useful and helpful information to the communities that we serve.   

Early Detection Saves Lives

Breast and colorectal cancer are among the top four cancers in Maine, which has the highest rate of cancer deaths in the nation. Th e good news is mammography and colonoscopy procedures are excellent screening tools that can catch cancer early, when it’s easier to treat. Early detection can result in a shorter course of treatment for the patient and improves outcomes.

Mammography Screening

Colon cancer typically grows slowly, and colonoscopy is the most common screening test used to detect it. For people at average risk for developing colorectal cancer, the recommended age to begin screening is 50. In 2018 SMHC exceeded the average national colonoscopy rate for patients 50 and older, by screening 75% of patients.

Colonoscopy Screening

Colon cancer typically grows slowly, and colonoscopy is the most common screening test used to detect it. For people at average risk for developing colorectal cancer, the recommended age to begin screening is 50. In 2018 SMHC exceeded the average national colonoscopy rate for patients 50 and older, by screening 75% of patients.

Colonoscopy Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

Oncology Metric
Number of SMHC Cases Submitted
CoC Required Performance Rate
SMHC Performance Rate
At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. (Quality Improvement)

 11  85%  100%
Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III, or postoperative chemo and  radiation are administered within 180 days of diagnosis for clinical AJCC stage III (node positive) colon cancer. (Surveillance)  2  85%  100%

 



Breast Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

Oncology Metric
Number of SMHC Cases Submitted
CoC Required Performance Rate
SMHC Performance Rate
Radiation is administered within 1 year (365 days) of diagnosis for women under age  of 70 receiving breast conserving surgery for breast cancer. (Accountability)

 18  80%  100%
Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III, or postoperative chemo and  radiation are administered within 180 days of diagnosis for clinical AJCC stage III (node positive) colon cancer. (Surveillance)

 35  90%  97.1%
Radiation therapy is considered or administered following any mastectomy within 1 year (365 days)
of diagnosis of breast cancer for women with > = 4  1 positive regional lymph nodes. (Accountability)

 1  90%  100%
Image or palpitation-guided needle biopsy (core or FNA) of the primary site is performed to establish diagnosis of breast cancer. (Quality Improvement) 78  80%  98.7%

 



Lung Cancer Screening Criteria

You must meet all of the following to benefit from a low-dose CAT scan:

  • Age 55-77
  • 30 pack-year history
  • Still smoking or quit within the past 15 years
  • No major health problems preventing you from receiving lung cancer surgery

Lung Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

Oncology Metric
Number of SMHC Cases Submitted
CoC Required Performance Rate
SMHC Performance Rate
Radiation is administered within 1 year (365 days) of diagnosis for women under age  of 70 receiving breast conserving surgery for breast cancer. (Accountability)

 1  85%  100%

 

 

The Maine Health Cancer Care Network has been awarded a six year $5.1 Million award from the National Cancer Institute (NCI) which will expand cancer research in the state of Maine. The NCI Community Oncology Research Program (NCORP) is a national network of investigators, cancer care providers and institutions that bring clinical trials and cancer research to the local community. The goal of NCORP is to bring clinical trials that focus on cancer prevention, screening, treatment and imaging. There is a specialized focus on cancer care delivery to individuals in their own community which contributes to improved patient outcomes and has shown a reduction in cancer disparities. Cancer treatment and delivery will be expanded to underserved populations with a goal of reducing mortality and improving the quality of life for survivors. Patients will have more options and be able to stay closer to home while participating in a clinical trial.

Maine Health Cancer Care also collaborates with pharmaceutical companies to offer clinical trials that investigate new medications or devices that are safe and effective for patients. “Many of these trials are targeting specific subsets of cancers characterized by biomarkers. In many cases we are getting access to novel agents years before they become commercially available”, said Maine Health Cancer Care Medical Oncologist Peter Rubin, MD. Clinical trials are necessary to determine the success of new treatments. The Food and Drug Administration (FDA) provides strict oversite and is provided with the scientific information needed to determine the risk vs. benefit of new treatments.

Maine Health continues to collaborate with The Jackson laboratory to provide genomic tumor testing here in Maine. Genomic tumor tests can identify gene alterations in tumor tissue which in turn can offer targeted therapies to treat specific types of cancer. During the first 2 years, 935 patients have been enrolled all over Maine resulting in 616 successful reports with at least one identifiable mutation. In addition, 492 reports listed one or more FDA approved therapies resulting in 45 patients starting targeted therapy. The future of genomic testing is to provide more treatment options for patients by providing successful testing, interpretation and treatment availability.

What does this mean for you?  At one time clinical trials were only done at major medical centers. This often meant that patients had to travel great distances if they wanted to participate in a clinical trial. Sometimes, this still may be the case with phase 1 and some phase II studies, however today patients have more options available. Keep in mind, each trial has requirements that a patient must meet in order to participate. You always have the right to choose whether you want to participate in a clinical trial. If you meet the criteria, the level of care you receive will not be affected by your decision. If you are considering a clinical trial, you may find it helpful to include family and friends in the decision making process.  If you are interested in clinical trial participation, reach out to your provider or nurse navigator who will put you in touch with a research coordinator to review eligibility. Research coordinators are the link between study patients and their providers. Your oncologist and research coordinator should be able to answer your questions regarding clinical trial participation and helping you find a trial that is right for you.

 

Jennifer Dalton MHA, BSN, RN
Oncology Research Nurse Coordinator
Maine Health Cancer Care


Community Report – Helene Langley, SMHC Breast Care Center

In 2018, SMHC was the first hospital in Maine to introduce a new procedure called magnetic seed localization, or Magseed, for breast cancer patients. This dramatically improved the patient experience while maintaining surgical accuracy and quality outcomes.

SMHC Center for Breast Care continues to find ways to improve patient outcomes. One of those newer ways is called “Axillary Reverse Mapping (ARM)”:

At the time of surgery Breast Cancer patients will often need lymph nodes removed to see if the cancer has spread. This surgery means the patient is at risk for arm swelling (“Lymphedema”). Though the risk is small, some patients develop lymphedema. Now, patients who medically qualify are offered “Axillary Reverse Mapping (ARM),” which is a way to lower lymphedema risk. Some particles are injected into the breast to find the nodes to remove, and  a blue dye is injected into the arm to tell us which nodes drain the arm and we try to leave those alone.

We are also working to bring “Magtrace” to Maine, which we can do because we started Magseed in 2018. Magtrace is a way to lower lymphedema risk to zero in certain mastectomy patients. Currently, patients who have Stage 0 breast cancer who choose mastectomy need to have lymph nodes removed (Sentinel Node Biopsy), just in case the final pathology shows Stage 1 cancer. Magtrace allows us 2 weeks to return to surgery and remove nodes only in patients who end up with Stage 1 cancer. This means that patients who remain a Stage 0 cancer after surgery have no nodes removed and therefore their  lymphedema risk is essentially zero.

Both “ARM” and Magtrace are exciting ways we are working to lower lymphedema rates for our SMHC breast cancer patients. SMHC Center for Breast Care continues to improve patient experience and outcomes.

Furthermore, in 2019 we were re-accredited by NAPBC (National Accreditation Program for Breast Centers). We passed with no deficiencies and flying colors, so much so the surveyor was so impressed with our documentation that she requested a template from Dr Chao as an example for them to use.

We are very proud of our center and hope to continually improve care for our patients. 

Cutting Edge Becomes Standard of Care, Closer to Home:

Improving Access to Genetic Counseling in Oncology at SMHC

Katherine A. Lafferty, MS, CGC
Cancer Genetic Counselor

Cancer Risk and Prevention Program

Genetic testing has become an integral part of cancer care. Over the last few years, Southern Maine Health Care and Maine Medical Center has made it a priority to create access to genetic services in the same clinics where they are receiving their cancer care. With a limited number of genetic counselors in the state of Maine, some patients have to travel long distances to receive in-person genetic counseling and wait times for appointments can be several months. At SMHC, a genetic counseling is available in Biddeford and Sanford locations and patients can have access to this service at a location convenient to them. Wait times are also reduced by having a genetic counselor dedicated to SMHC patients only at two days a week with available slots for urgent appointments are available to meet the patient’s needs.

A genetic counselor is a health care provider with advanced training in human genetics and counseling. When working with patients, they gather detailed personal and family history, provide risk assessment and education to the patients, explain genetic testing options and possible impact of genetic testing results, and provide support to patients and their families for the emotional and psychological impact of genetic information. Within oncology at SMHC, patients are screened for red flags for hereditary risk for cancer. Partnering closely with the Nurse Navigators, a patient’s personal and family history is assessed and a referral for genetic counseling is initiated when indicated. This partnership in screening patients and facilitating referrals is critical in increasing access to genetic services and improving patient care. From January through August of 2019 almost 200 patients were screened by the Nurse Navigators for indications for genetics. A genetic counselor also attends SMHC Oncology and Breast Cancer tumor conferences as another opportunity to screen patients for referral and to share in the multi-disciplinary discussion regarding the management of oncology patients. Referral indications for genetic counselling and genetic testing have established by many professional organizations including the National Comprehensive Cancer Network (NCCN). In addition, the Cancer Risk and Prevention Program provides referral guidelines supported by the MaineHealth Cancer Care Network which are available on the Clinical Guidelines website (https://mainehealth.org/cancer/health-care-professionals/clinical-guidelines).

In the last year, accessed from October of 2018 through September of 2019, 104 patients were seen by the genetic counselor at Southern Maine Health Care with 55% of those patients seen in Biddeford and 45% in Sanford. After a comprehensive genetic counseling appointment, patients are able to make an informed decision about pursing genetic testing. Of the patients seen at SMHC, 76% decided to undergo genetic testing. Integration of genetics screening and collaboration with Nurse Navigator, Helene Langley RN, BS, CBCN, CN-BN, ONN-CG, has been very successful with SMHC Center for Breast Care over the last few years. Of the patients seen by a genetic counselor, 65% of those patients were referred from the breast cancer team, making this the highest volume of patients seen for genetic counseling.

A recent update in recommendation form the American Society of Breast Surgeons (Consensus Guideline on Genetic Testing for Hereditary Breast Cancer; approved Feb 10, 2019) states that “Genetic testing should be made available to all patients with a personal history of breast cancer.” This has been a shift from pervious, criteria-based approaches to referral and indication for genetic testing. This opens the door to exploring a new way of discussion about genetic testing options with patients with breast cancer and gives an opportunity for providers to engage their patients in shared decision making about whether or not to pursuing genetic risk assessment. Based on hospital analytics for new breast cancers diagnosed at SMHC in 2018, it can be extrapolated that approximately 62% of all breast cancer patients were referred for genetic counseling. In our practice, of those patient’s referred from the SMHC Breast Center 78% decided to undergo genetic testing after their genetic counseling visit.

The impact of genetic testing results on a patient’s care plan can be seen in many ways. For mutations in high-risk breast cancer genes, such as the BRCA1 and BRCA2 genes, there is an increased risk for a second primary breast cancer leading to discussion of management options of remaining healthy breast tissue including high risk surveillance after surgery or a prophylactic surgery to remove the at risk tissue. The BRCA1 and BRCA2 genes also carry risk for ovarian, fallopian tube, and primary peritoneal cancers leading to a recommendation for a risk-reducing salpingo-oophorectomy (RRSO). Often thought to be a management recommendation separate from breast treatment, this could become relevant if a patient’s systemic therapy for breast cancer would involve ovarian suppression and discussion of suppression versus RRSO could be considered. Other genes may increase a patient’s sensitivity to ionizing radiation, in which case consideration of management options and possible avoidance of therapeutic radiation could be explored. Numerous clinical trials have been opened for systemic therapy based on germline mutations in many of the genes included on genetic testing panels for cancer risk and a patient’s genetic testing may inform their eligibility for such trials.  Beyond the patient, genetic testing impact their family members who very often make up part of the community we serve at SMHC. When a mutation for hereditary cancer risk is identified, at-risk family members can undergo genetic testing to determine their status and better understand their risk. Those who share the same hereditary risk for cancer can be followed with high risk management considerations with the goal of early detection and possibly risk-reduction. This cascade approach to testing hopes to reduce cancer rates and save the lives of those facing a higher risk for certain cancers.

The integration with genetic risk assessment and testing within the patient’s with breast cancer at SMHC has set a strong example of how other cancer sites can be served by genetic counseling. Future goals are to continue to bring this expert care to patients at SMHC and increase access to this care across the Oncology teams. This increase in access means more patients are getting the most cutting edge information about their cancer risk and management, more patients are being assessed for new advancements in personalized medicine and therapies, and we can help reduce additional cancer risks for our patients and their families, all while keeping that care close to home.