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20 Pages·2016·1.89 MB·English

T H E C A N C E R C E N T E R
STATISTICAL REPORT
WELCOME
We are pleased to present Lehigh Valley Health OUR MISSION
Network (LVHN) cancer program’s 2016 annual
report, featuring LVHN’s 2015 cancer data as well We ease our community’s
as information about our cancer care services.
cancer burden by preventing
Cancer care programs offered by LVHN include
prevention, detection, diagnosis, genetics, patient
cancer, by finding cancer
navigation, nutritional services, social and psychological
support, rehabilitation, clinical trials, multidisciplinary early, by providing
and coordinated care, surgery, radiation, chemotherapy,
comprehensive diagnostic,
hemophilia care and survivorship.
consultative, treatment,
MEMORIAL SLOAN KETTERING ALLIANCE
support and survivorship
Starting in early 2016, LVHN began working closely with
Memorial Sloan Kettering (MSK), the world’s oldest and
services, and by educating
largest private cancer center, as an active member of the
Memorial Sloan Kettering Cancer Alliance. Through this health care professionals
membership, LVHN’s cancer program began offering our
and residents of the
patients access to a variety of cancer studies in 2016. Patients
enrolled in a clinical trial receive evidence-based, standard-of- communities we serve about
care treatment in addition to trial treatment.
advances in cancer care.
Two additional MSK enhancements in 2016 –
 To better align the LVHN cancer program with that of
MSK, our program initiated disease management teams
(DMTs) in 2016. Each DMT is comprised of clinicians CANCER PROGRAM TRANSITIONS TO EPIC
who specialize in a particular type of cancer care. As part of LVHN’s commitment to high-quality care, the
On a weekly basis, DMTs meet to review and discuss cancer program now uses the Epic electronic medical record
new findings within their areas of expertise and interpret the system. This marks the third phase of Epic integration at
data, helping determine what should change standard-of- LVHN and now means that each cancer patients’ diagnosis,
care practice and what shouldn’t. DMTs emulate the MSK treatment and care information is in one medical record
structure, helping bring world-class cancer care to people in that can be seen and updated by their specialty or primary
and around the Lehigh Valley. care provider, as well as in the hospital should they need
 Our clinical providers work closely with their MSK to be admitted. Having one integrated record across the
counterparts, including on individual patient cases. Those system also means patients can access their own information
that pose unique challenges are discussed by experts at through the MyLVHN (mylvhn.org) patient portal.
MSK and LVHN via videoconferencing. The patient’s case With MyLVHN, patients can securely send a message to
can be reviewed by physicians on both teams to develop their provider (or the provider’s team), review after-visit
comprehensive strategies that may benefit the patient. summaries and see test results.
2 LEHIGH VALLEY HEALTH NETWORK
LVHN CANCER CASE INFORMATION
The LVHN cancer program offers a range of cancer services in convenient, patient-focused locations, including
the John and Dorothy Morgan Cancer Center at Lehigh Valley Hospital (LVH)–Cedar Crest, the Cancer Center at
LVH–Muhlenberg, the Health Center at Bangor and the Health & Wellness Center at Hazleton. Patient care also is
provided through Lehigh Valley Physician Group practice offices in Allentown, Bethlehem, Hazleton, Bangor and Lehigh-
ton. Breast Health Services is offered in eight locations throughout the region.
The faculty of the cancer program is composed of physicians who are cancer care specialists and board-certified in their
fields. In calendar year 2015, the cancer program saw more than 3,300 new cancer patients. In fiscal year 2016 outpatient
infusion volumes comprised 5,185 patients for procedures with 45,062 appointments, and radiation oncology comprised
3,652 patients for procedures with 67,836 appointments.
TOP FIVE
MOST
2,000
PREVALENT
SITES OF
CANCERS
484
TREATED AT 508
1,500 505
LVHN 409
Breast 433 418
394
1,000 418
Lung
Colon/Rectal
270 307
285
Prostate 279
500
Blood and Bone Marrow
240 264 274
205
Bladder
Corpus Uteri 180 165 203 202
0
Skin CY 2012 CY 2013 CY 2014 CY 2015
3,337 67,836 45,062
New cancer patient Radiation visits Infusion visits
analytic cases
VISIT LVHN.ORG/CANCER CALL 610-402-CARE 3
CANCER STAGING TOTAL ANNUAL
ANALYTIC CASES
AND INCIDENCE
9
6 7
TERMINOLOGY 3,500 6 65 81 139 3,252 3,4 3,33
9 6 9 9 3,
3,000 75 ,8 2, 2,
2
,
Cancer diagnosis, staging, incidence and 2
treatment have a language of their own. Here are
2,500
some commonly used terms and resources for
more information:
2,000
American Joint Committee on Cancer (AJCC)
staging: A classification system used for describing 1,500
the extent of disease progression based on the
evaluation of the tumor size/invasion (T), nodal
1,000
status (N) and metastasis (M) at the time of
diagnosis. AJCC staging is important in determining
500 8
treatment plans.
8
1
Analytic cancer case: Cases for which the facility
provided the initial diagnosis of cancer and/or for 0
wcohuircshe tohfe t rfeaactilmityen cto.ntributed to all or part of the first CY 2008CY 2009CY 2010CY 2011CY 2012CY 2013CY 2014CY 2015CYH a2z0le1t5on
National Cancer Database (NCDB): The NCDB
is a joint project of the American Cancer Society and
the Commission on Cancer. This database collects
information on cancer cases diagnosed and/or treated
at hospitals throughout the country. This non-patient-
identified information is used to present scientifically 3 1
4
reviewed descriptions of patient diagnosis, treatment Bradford Susquehanna
Tioga 11
and outcomes. The most recent data from NCDB is
Wayne
on cases newly diagnosed in 2013. 2
Wyoming 29
Rapid Quality Reporting System (RQRS): The
6 Lackawanna 8
RQRS is a web-based data collection and reporting
Lycoming Pike
system that uses information gathered through the 153
Luzerne
National Cancer Database (NCDB), a nationwide 156
oncology case repository specifically focused on breast 2 1 Monroe
Montour
Union 190
and colon-rectal cancer patients and their quality
Carbon
of care. LVHN participates in the NCDB data 1 652
collection and reporting program. The resulting data Snyder 161 Northampton
Schuylkill 1,549
contributes to a body of evidenced-based cancer care Lehigh
1
knowledge. Based on the evidence, the RQRS alerts Blair 1 2 245 43
users each month to “anticipated care” for breast and Huntingdon Lebanon Berks Bucks
colon-rectal cancer patients. The value in these alerts 68
is to avoid having patients miss out on adjuvant, Montgomery
evidence-based care or therapy that they could receive 2
4
Chester
in addition to their main treatment. Philadelphia
4 LEHIGH VALLEY HEALTH NETWORK
INCIDENCE BY
COUNTY OF RESIDENCE 2013 2014 2015
COUNTY OF ADAMS 4 0 0
BEAVER 1 0 0
RESIDENCE
BERKS 221 249 245
BLAIR 1 0 1
BRADFORD 1 0 3
Lehigh Valley Health Network provides
BUCKS 52 50 43
cancer care for patients in our
CAMERON 0 1 0
community and serves as a tertiary
referral center. In 2015 alone, we CARBON 189 200 190
provided diagnostic care, second opinion CENTRE 0 0 0
recommendations and treatment to CHESTER 2 2 2
3,337 patients from 25 Pennsylvania
COLUMBIA 1 2 0
counties. In addition, 42 patients came
CUMBERLAND 1 0 0
to our cancer program from communities
DAUPHIN 1 5 0
across the United States.
DELAWARE 1 0 0
ELK 0 1 0
HUNTINGDON 0 0 1
LACKAWANNA 33 23 29
LANCASTER 1 0 0
LEBANON 2 0 2
LEHIGH 1,551 1,694 1,549
LUZERNE 98 118 153
LYCOMING 2 6 6
MONROE 126 142 156
4 3 1 MONTGOMERY 86 90 68
Bradford Susquehanna
Tioga 11 MONTOUR 0 0 1
Wayne
2 NORTHAMPTON 668 666 652
Wyoming 29
NORTHUMBERLAND 1 3 0
6 Lackawanna 8
Lycoming Pike PHILADELPHIA 5 3 4
153 PIKE 5 6 8
Luzerne
156
2 1 Monroe SCHUYLKILL 123 130 161
Montour
Union 190 SNYDER 0 0 1
Carbon
1 652 SUSQUEHANNA 2 4 1
Snyder 161 Northampton TIOGA 1 0 4
Schuylkill 1,549
Lehigh UNION 0 0 2
1
Blair 1 2 245 43 WAYNE 4 8 11
Berks
Huntingdon Lebanon Bucks WESTMORELAND 0 1 0
68
Montgomery WYOMING 1 2 2
YORK 1 0 0
2
4
Chester Philadelphia OUT OF STATE 68 63 42
TOTAL 3,252 3,469 3,337
VISIT LVHN.ORG/CANCER CALL 610-402-CARE 5
2015 ANALYTIC CASES BY
PRIMARY BODY SITE
CHART NOTES THE PRIMARY BODY SITE INVOLVED IN EACH PATIENT’S CANCER DIAGNOSIS.
LEHIGH VALLEY HOSPITAL–CEDAR CREST AND LEHIGH VALLEY HOSPITAL–MUHLENBERG CASES
PRIMARY SITE TOTAL PRIMARY SITE TOTAL
HEAD AND NECK 64 UTERUS (NOT OTHERWISE SPECIFIED-NOS) 1
DIGESTIVE ORGANS 550 OVARY 79
ESOPHAGUS 35 OTHER FEMALE GENITAL ORGANS 8
STOMACH 46 MALE GENITAL ORGANS 321
SMALL INTESTINE 24 PENIS 6
COLON 169 PROSTATE GLAND 298
RECTOSIGMOID JUNCTION 14 TESTIS 17
RECTUM 62 URINARY TRACT ORGANS 318
ANUS AND ANAL CANAL 11 KIDNEY 126
LIVER AND BILE DUCTS 42 KIDNEY, RENAL PELVIS 16
GALLBLADDER 5 URETER 9
OTHER BILIARY TRACT 12 URINARY BLADDER 165
PANCREAS 126 OTHER AND UNSPECIFIED URINARY ORGANS 2
OTHER DIGESTIVE ORGANS 4 CENTRAL NERVOUS SYSTEM 170
RESPIRATORY ORGANS 416 MENINGES 94
BRONCHUS AND LUNG 404 BRAIN 65
THYMUS 6 OTHER NERVOUS SYSTEM 11
HEART MEDIASTINUM PLEURA 6 ENDOCRINE GLANDS 144
MUSCULOSKELETAL SITES 27 THYROID GLAND 116
BLOOD AND BONE MARROW 188 ADRENAL GLAND 3
SKIN 176 OTHER ENDOCRINE GLANDS 25
BREAST 474 OTHER 19
FEMALE GENITAL ORGANS 283 RETROPERITONEUM AND PERITONEUM 14
VULVA 19 OTHER ILL-DEFINED SITES 3
VAGINA 5 ORBIT, OCULAR 2
CERVIX UTERI 30 LYMPH NODES 147
CORPUS UTERI 141 UNKNOWN PRIMARY 53
TOTAL ANALYTIC CASES 3,337
*LEHIGH VALLEY HOSPITAL–HAZLETON CASES
PRIMARY SITE TOTAL PRIMARY SITE TOTAL
HEAD AND NECK 7 FEMALE GENITAL ORGANS 7
DIGESTIVE ORGANS 48 MALE GENITAL ORGANS 11
BRONCHUS AND LUNG 14 URINARY TRACT ORGANS 19
CONNECTIVE AND SUBCUTANEOUS CENTRAL NERVOUS SYSTEM 4
1
AND SOFT TISSUE
ENDOCRINE GLANDS 5
BLOOD AND BONE MARROW 14
LYMPH NODES 5
SKIN 11
UNKNOWN PRIMARY 8
BREAST 34
TOTAL ANALYTIC CASES 188
*This reflects patients who received services solely at LVH-Hazleton. Patients who received a portion of services at LVH–Cedar Crest and/or LVH-Muhlenberg in
addition to LVH-Hazleton are counted in both LVH-Cedar Crest and LVH-Muhlenberg numbers for purposes of this report.
6 LEHIGH VALLEY HEALTH NETWORK
PRIMARY BODY SITES: FIVE MOST FREQUENTLY TREATED AT LVHN
1 BREAST CANCER
INCIDENCE OF BREAST CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 10-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 1 17 76 121 125 102 28 4 474
BREAST CANCER TREATMENT BY STAGE AT DIAGNOSIS
FIRST COURSE Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage UNK TOTAL %
SURGERY ONLY 47 28 8 2 0 0 85 17.9
SURGERY AND RADIATION 17 13 4 0 0 0 34 7.2
SURGERY AND CHEMOTHERAPY 0 3 20 4 0 0 27 5.7
SURGERY, RADIATION AND CHEMOTHERAPY 0 13 12 9 1 0 35 7.4
SURGERY, RADATION AND HORMONE THERAPY 21 80 21 5 0 0 127 26.8
SURGERY AND HORMONE THERAPY 5 19 6 3 0 0 33 7.0
SURGERY, RADIATION, CHEMOTHERAPY AND 0 6 17 11 0 0 34 7.2
SURGERY, CHEMOTHERAPY AND 0 4 3 3 0 0 10 2.1
SURGERY, CHEMOTHERAPY AND 0 6 10 4 1 0 21 4.4
OTHER SPECIFIED THERAPY 0 13 21 3 18 1 56 11.8
NO FIRST-COURSE TREATMENT 2 6 1 0 3 0 12 2.5
TOTAL 92 191 123 44 23 1 474 100%
2 LUNG CANCER
INCIDENCE OF LUNG CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 0 1 11 62 118 124 79 9 404
LUNG CANCER TREATMENT BY STAGE AT DIAGNOSIS
FIRST COURSE Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage UNK TOTAL %
SURGERY ONLY 1 49 11 1 0 0 62 15.3
RADIATION ONLY 1 32 2 5 29 0 69 17.1
SURGERY AND CHEMOTHERAPY 0 2 4 6 0 0 13 3.0
RADIATION AND CHEMOTHERAPY 0 2 5 44 51 1 103 25.5
CHEMOTHERAPY ONLY 0 0 0 3 48 0 51 12.6
SURGERY, RADIATION AND CHEMOTHERAPY 0 0 2 2 1 0 5 1.2
OTHER SPECIFIED THERAPY 0 0 1 0 4 0 5 1.2
NO FIRST-COURSE RX 0 13 2 16 65 1 97 24.0
TOTAL 2 98 27 77 198 2 404 100%
VISIT LVHN.ORG/CANCER CALL 610-402-CARE 7
3 PROSTATE CANCER
INCIDENCE OF PROSTATE CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 0 0 3 70 124 82 17 2 298
PROSTATE CANCER TREATMENT BY STAGE AT DIAGNOSIS
FIRST COURSE Stage 1 Stage 2 Stage 3 Stage 4 Stage UNK TOTAL %
SURGERY ONLY 13 92 18 1 2 126 42.3
RADIATION ONLY 7 15 0 2 0 24 8.1
SURGERY AND HORMONE THERAPY 0 1 2 1 0 4 1.3
SURGERY, RADIATION AND HORMONE THERAPY 0 2 2 3 0 7 2.3
RADIATION AND HORMONE THERAPY 1 60 3 9 0 73 24.5
SURGERY AND RADIATION 0 1 0 0 0 1 0.3
HORMONE THERAPY ONLY 0 3 0 12 0 15 5.0
OTHER SPECIFIED THERAPY 0 0 0 8 0 8 2.7
NO FIRST-COURSE TREATMENT 31 4 0 4 1 40 13.4
TOTAL 52 178 25 40 3 298 100%
4 COLON AND RECTAL CANCER
INCIDENCE OF COLON CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 2 3 14 33 48 32 44 7 183
COLON CANCER TREATMENT BY STAGE AT DIAGNOSIS
FIRST COURSE Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage UNK TOTAL %
SURGERY ONLY 2 31 41 11 6 2 93 50.8
SURGERY AND CHEMOTHERAPY 1 0 8 30 18 0 57 31.1
CHEMOTHERAPY ONLY 0 0 0 0 13 0 13 7.1
SURGERY, RADIATION AND CHEMOTHERAPY 0 0 1 0 0 0 1 0.5
OTHER SPECIFIED THERAPY 0 0 0 0 2 0 2 1.1
NO FIRST-COURSE TREATMENT 0 0 1 1 11 4 17 9.3
TOTAL 3 31 51 42 50 6 183 100%
INCIDENCE OF RECTAL CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 3 5 16 16 16 6 0 62
RECTAL CANCER TREATMENT BY STAGE AT DIAGNOSIS
FIRST COURSE Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage UNK TOTAL %
SURGERY ONLY 3 0 1 4 1 0 6 9.7
SURGERY AND CHEMOTHERAPY 0 0 0 0 6 0 6 9.7
SURGERY AND RADIATION THERAPY 0 2 0 2 3 2 9 14.5
RADIATION AND CHEMOTHERAPY 0 0 0 0 1 0 1 1.6
CHEMOTHERAPY ONLY 0 0 0 3 0 0 3 4.8
SURGERY, RADIATION AND CHEMOTHERAPY 0 1 5 12 1 1 20 32.3
RADIATION THERAPY ONLY 0 1 0 1 0 0 2 3.2
NO FIRST-COURSE TREATMENT 2 8 1 1 1 2 15 24.2
TOTAL 2 12 7 23 13 5 62 100%
8 LEHIGH VALLEY HEALTH NETWORK
5 BLOOD AND BONE MARROW CANCER
INCIDENCE OF BLOOD AND BONE MARROW CANCER BY AGE AT DIAGNOSIS LVHN 2015
AGE AT DIAGNOSIS 0-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 TOTAL
(N) 8 4 2 7 26 42 52 37 10 188
BLOOD AND BONE MARROW CANCER TREATMENT DIAGNOSIS
FIRST COURSE TOTAL %
CHEMOTHERAPY ONLY 67 33.2
CHEMOTHERAPY AND HORMONE THERAPY 13 6.4
CHEMOTHERAPY, HORMONE THERAPY AND IMMUNOTHERAPY 2 1.0
CHEMOTHERAPY, HORMONE THERAPY AND TRANSPLANT 2 1.0
CHEMOTHERAPY AND TRANSPLANT 3 1.5
CHEMOTHERAPY AND OTHER 8 4.0
RADIATION THERAPY ONLY 3 1.5
IMMUNOTHERAPY ONLY 4 2.0
CHEMOTHERAPY AND IMMUNOTHERAPY 2 1.0
OTHER SPECIFIED THERAPY 10 5.4
NO FIRST COURSE TREATMENT 82 43.1
TOTAL 188 100%
VISIT LVHN.ORG/CANCER CALL 610-402-CARE 9
INNOVATIONS AND IMPACT
Each year, the cancer program at Lehigh Valley Health Network (LVHN) continues to grow. Not only have we
experienced steady growth in the number of patients for whom we provide care, we also have become a leader in our area
offering specialized procedures and treatments. Our areas of specializations include clinical trials, robotic surgery, liver
and pancreatic surgeries, thyroid surgery and stereotactic radiosurgery among others.
SEQUENCE OF IMMUNOTHERAPY compared to the reverse order of administration (20 percent).
IMPROVES OUTCOMES Disease progression at 13 and 26 weeks was significantly
In the last few years, LVHN has been at the forefront of improved with nivolumab followed by ipilimumab (38 percent
immunotherapy treatment study. LVHN was the only vs. 61 percent, 38 percent vs. 60 percent), as was 12-month
academic community hospital among eight major medical overall survival (76 percent vs. 54 percent). Nivolumab and
institutions selected to take part in five early-phase clinical ipilimumab are anti-PD-1 and anti-CTLA-4 drugs that
trials using immunotherapy drugs ipilimumab (Yervoy®) enhance the immune system’s response to tumor cells. The
and nivolumab (Opdivo®) for patients diagnosed with results were published in The Lancet Oncology, July 2016.1
stage 4 melanoma. “This trial was a major breakthrough,” says hematologist
Those trials provided evidence that each drug contributed oncologist Suresh Nair, MD, with LVPG Hematology
to improved outcome for patients. We have furthered our Oncology–1240 Cedar Crest, Medical Director of LVHN
understanding of these immunotherapy agents, known as Cancer Institute and an author of the Lancet Oncology article.
immune checkpoint inhibitors, by studying the order in The checkpoint inhibitor trial is one of dozens of clinical
which those treatments are used. In partnership with other trials conducted at LVHN, and that number will continue to
academic medical institutions, LVHN participated in a increase with LVHN Cancer Institute’s membership in the
randomized study with stage 3 and 4 melanoma patients to Memorial Sloan Kettering (MSK) Cancer Alliance. In addition
determine if the sequence the drugs were given to patients to providing access to key MSK clinical trials, the alliance
made a difference in patient outcome. includes adoption of MSK standards for oncology care and
What the researchers learned was that the sequence (the clinical collaboration among oncologists at both institutions.
order) did make a big difference in results. The study found LVHN and MSK also share educational resources by collecting
that twice as many patients (41 percent) responded to the and tracking data on quality of care, outcomes and patient
administration of nivolumab followed by ipilimumab as satisfaction.
2016 ACTIVE CLINICAL TRIALS
PHASE 1 6
1 Symptoms management/blood trials 1-Biology
1 Expanded-access trials 1-Surgical
2 Registry 4-Treatment
1 2 Registry/biology Memorial Sloan Kettering
2 Cancer control Cancer Center Trials
50
PHASE 2
503
3 Pediatric trials
1 5 Adult trials
Total active clinical trials
PHASE 3 11 Pediatric trials
1 0 Pediatric trials 39 Adult trials Clinical trial participants in 2015
2 4 Adult trials
1. “Sequential administration of nivolumab and ipilimumab with a planned switch in patients with advanced melanoma (CheckMate 064): an open-label,
randomised, phase 2 trial,” J. Weber et al. The Lancet Oncology 2016; 17(7): 943-55
10 LEHIGH VALLEY HEALTH NETWORK