2013 ANNUAL PATIENTOUTCOMES REPORT

The Cancer Centerat Roger Williams Medical Center

An affiliate of CharterCARE Health Partners

Table of Contents

p. 3 Cancer Committee Membership

p. 4 From the Cancer Committee Chairperson

p. 5 From the Hospital President and Cancer Center Director

p. 6, 7 Geriatric Oncology Program

p. 8 Patient Satisfaction/Outpatient and Inpatient Oncology

p. 9 Quality Oncology Practice Initiative (QOPI) Data

p. 10 Survivorship and Support

p. 11 CP3R Quality Measure: Breast and Colorectal Cancer

p. 12-13 Cancer Registry & Statistics

p. 14 Primary Cancer Site and Stage (2012 Cases)

3.

2013 Cancer Committee MembershipPhysician MembersDr. Bharti Rathore, Medical Oncology, Chairman

Dr. James Koness, Surgical Oncology, Cancer Liaison Physician

Dr. Marshall Kadin, Dermatology

Dr. Charles Kanaly, Neurosurgery

Dr. Mohit Kasibhatla, Radiation Oncology

Dr. Ritesh Rathore, Medical Oncology

Dr. Maria Aileen Soriano-Pisaturo, Palliative Care

Dr. Brian Stainken, Interventional Radiology

Dr. Li Wang, Pathology

Non-Physician MembersCancer Center Director: Kathy Perry, RN, MBA, Cancer Program Administrator

Cancer Center Manager: Annemarie Mullaney, RN, OCN

Inpatient Oncology Unit Manager: Jennifer Parker, RN

Radiation Oncology Nurse: Patricia Cafaro, RN

Case Management: Mary Beaudette, RN

Geriatric Oncology: Natasha Reis, BSN, RN

BMT Unit: Cynthia Jodoin, RN, BSN, MHA, OCN

Cancer Registrar: Cheryl Raffel, RHIA, CTR

Performance Improvement: Nancy Fogarty, Quality Improvement Coordinator

Quality Improvement: Benjamin Isaiah

Dietary/Nutrition: Donna Castricone, RD

Cancer Center Pharmacist: Thomas Habershaw, RPh

Pastoral Care: James Willsey

American Cancer Society: Lisa Stors, LSW

Tumor Board Conference Coordinator: Billie Baker

Clinical Research Coordinator: Frances Dallesandro, CCRP

Rehabilitation/Speech Pathology: Mary Anne Forgione

Psychiatry: Elinor Collins, RN, MS, CS, PPNS

Public Relations: Brett Davey, Community Outreach Coordinator

Palliative Care/Hospice: Tasha Marietti

Oncology Social Worker: Elizabeth Angell, LSW

4.

From the Cancer Committee Chairperson

Bharti Rathore, M.D.Chair, Cancer Committee

I am pleased to share the 2013 Cancer Program report from Roger WilliamsMedical Center. This report is designed to provide statistics and data so medicalproviders and other members of our community know what cancers we mostoften treat and how we measure up from a quality perspective.

The delivery of multi-disciplinary care is one of our hallmarks. Our physicians,caregivers and support staff have numerous opportunities to collaborate on apatient’s care. We host regular tumor boards, grand rounds and specialtyconferences where our medical professionals can discuss a patient’s case andcollaborate to improve care.

In this report, you can learn more about the quality care delivered at the RogerWilliams’ Cancer Center and about innovations like the first Geriatric OncologyProgram in Rhode Island. It is that focus on quality and innovation that makesour program special from a delivery of care perspective. It is the teamwork andcompassion of our team that brings what we do to the next level. Patients feelmore confident in their treatment when they know caregivers are working togetherin a multi-disciplinary setting.

On behalf of all the team members who contribute to the care of our patients, Iwant to thank you for taking the time to read this report.

5.

Kimberly O’Connell, Esq. Dr. N. Joseph EspatSenior Vice President Director, Roger Williams’ Cancer Center

Chairman, Department of Surgery

From Hospital Administration and the Cancer Center

When you are focused on progress -- whether it is in the treatment of an individualpatient or in the growth of a program -- it is important to have indicators thatmeasure your success. In this report, we are proud to share a number of qualityand treatment metrics that reflect the quality care we are delivering to cancerpatients around our region.

Of course, the statistics are only one part of our story. At the Roger WilliamsCancer Center, we take pride in delivering world class care with a personaltouch. We strive to be recognized as innovators in cancer diagnosis, treatmentand research, so we can deliver better care to each patient and help advancethe collective mission of every institution dedicated to fighting this disease.

In 2013, our cancer program achieved a number of milestones. We were grantedthree year accreditation with commendation by the Commission on Cancer ofthe American College of Surgeons. New leadership was recruited to our Bloodand Marrow transplant unit -- the only one in Rhode Island -- with the arrival ofdirector Todd Roberts, MD, and associate director Mohsin Malik, MD. Our BreastHealth Program was accredited by the National Accreditation Program for BreastCenters. Our physicians, researchers, and staff advanced the science behindcancer with numerous publications and presentations at conference nationallyand abroad. And we were once again host of the New England OncologySymposium, which attracted hundreds of medical professionals intent on learningabout the latest developments in cancer care.

We know that our multi-disciplinary approach to treating cancer is benefitingthose who come to us for care. While we are delivering that care as a team, wealways focus on each patient as an individual. Simply put, that is our recipe forbetter cancer care.

6.

Geriatric Oncology: World class care for seniors with cancerWhen Dr. Ponnandai Somasundar joined Roger Williams MedicalCenter, he quickly noted the average age of patients treated at theCancer Center. Their relatively advanced age was no surprise; RhodeIsland has the sixth highest percentage (14.5) of residents who are65 years or older. What Dr. Somasundar quickly came to understandis that older patients required a different kind of care.

“Older patients may also have multiple problems not specificallyrelated to their cancer,” said Dr. Somasundar, Associate Chief ofSurgical Oncology. “There are so many needs to consider: nutrition,pharmacy, family support. Patients can also be impacted cognitivelyor struggle with depression. Our philosophy is that if we take care ofall these issues, patient outcomes will be better.”

In 2012, Dr. Somasundar was appointed Director of Geriatric Oncology and set out to build the firstprogram of its kind in Rhode Island. The good news? Elder care was already — along with oncology —a primary area of focus at Roger Williams.

The hospital features both specially-designed units for older patients and innovative elder care trainingfor staff. Elmhurst Extended Care, the hospital’s nursing home affiliate, is nationally recognized for itsdelivery of the Eden Alternative philosophy of elder care. CharterCARE’s Home Health service is perfectlysituated to follow up with patients once they leave the hospital.

“A geriatric oncology program made a world of sense given our focus on both cancer and elder care,”said Richard Gamache, Vice President, Extended Care, CharterCARE Health Partners.

In building a geriatric oncology program, Dr. Somasundar pulled together a team of colleagues from awide variety of disciplines including nutrition, pharmacy, geriatrics, nursing, psychiatry, palliative care,and rehabilitation. “These interventions, when needed, are there for patients and can improve theirstandard of living,” he said. “It has also led to significantly improved outcomes.”Dr. Somasundar also had to grapple with an existing mindset that cancer treatment past a certain agewas a waste of time or resources. “This is not about the chronological age,” said Dr. Somasundar. “Thisconcept of ‘The patient has reached 70 years of age and is not a candidate’ has completely gone out ofplace. It is much more about their physical state and the opportunity for successful treatment than it isabout their actual age.”

One major benefit of the Cancer Center at Roger Williams is the fact that most services are locatedunder one roof. Still, the uncertainty that comes with cancer treatment can add unexpected stress,especially in older patients. To help older patients and their families better manage care and treatment,a new position of Geriatric Nurse Navigator was added. This caregiver assesses nutrition, functionalstatus, mood, current medications, and other medical conditions. This information — used to design apersonalized treatment care plan — is also shared with the patient’s primary care physician.

Another innovation is what Dr. Somasundar refers to as “pre-habilitation.” This is a process that ensuresa patient’s physical and mental challenges are addressed before surgery, radiation or chemotherapy toimprove the odds of success.

All of these steps have been taken to ensure older cancer patients get personalized care throughouttreatment. “My favorite saying is, ‘Roger Williams is the best kept secret for taking care of older cancerpatients,’” said Dr. Somasundar. “Our goal is to be a one-stop shop so patients can comfortably see asmany members of the team as possible on each visit.”

Dr. Ponnandai Somasundar con-sults with his colleague medicaloncologist Dr. Vincent Armenio.

7.

87.2

90.392.4

89.7

95.8

83

92.4

80

92.8

88.890.3

96.2

89.987.9

91.389

94.6

88.9

96.4

92.4

97.9

9597.5

95.994.7

93.494.7

99.6

93.4

70

75

80

85

90

95

100Geriatric Oncology 

Before Overall Mean Score Before Avg

After Overall Mean Score After Avg

86

91.6

92.1

92.8

93

93.6

93.3

97.1

96.2

95.9

96.5

96

86.8

88.6

91.4

87.8

89.5

90.3

90.3

94.7

92.5

94.3

93.7

94.4

80 85 90 95 100

Living with Cancer Issues

Scheduling your visit

Symptom Management

Registration

Facility

Personal Issues

Overall

Radiation Therapy

Chemotherapy

Overall Assessment

Nurses

Oncologist

Geriatric Oncology by Section

Before After

To better understand the importanceof caregivers in improving the care ofGeriatric Oncology Patients, atelephone survey was conducted of 37caregivers. In this qualitative study,caregivers of patients enrolled in theGeriatric Oncology program wereasked to rate the effectiveness of theprogram by responding to 12statements and two open-endedquestions.

Results identified six areas of thegeriatric oncology program that wereof significant benefit to thecaregivers:

Pain control for patients (100%)

Delivery of decision-makinginformation (97.3%)

Establishing goals of care (94.6%)

Resources available to caregiversand patients (88.8%)

Well-being and quality of lifeimproved (83.8%)

Time management of caregivers(82.8%)

During the same time period, patientswere surveyed for their satisfactionwith the geriatric oncology program.The surveys showed significantimprovement in satisfaction (seegraphs to the right) for patientscomparing the period before theprogram was in place to the time afterit was established.

Satisfaction Percentage Score

(Patient satisfaction scores before and after start of program)

(Patient satisfaction scores before and after start of program)

75

80

85

90

95

100

Jan Feb Mar Apr May Jun Jul

91 89

92 91 91 93

94

Outpatient Oncology

Patient Satisfaction Jan - Jul 2013

0

20

40

60

80

100

Jan Feb Mar Apr May Jun Jul

80.4 84.8 81.5 83.2

90 89.8 88.1

Inpatient Oncology

Patient Satisfaction Jun - Jul 2013

8.

The Cancer program uses the Press Ganey Company to monitor patient satisfaction. Patients receive

surveys after their visits and comment on the care received by their nursing staff and physician staff, as

well as personal issues from how easy it is to schedule their visits, to how they were treated in the

for our patients and their families needs.

PATIENT SATISFACTION RESULTS

The Quality Oncology Practice Initiative (QOPI) is a voluntary program through theAmerican Society of Clinical Oncology (ASCO). This initiative helps medical oncologypractices improve the quality of care for the patients they serve. This includes areview of staff competencies, documentation, chemotherapy infusion, patientmonitoring and education. Patients can be reassured that the care they are providedis of the highest quality because of the efforts of the Cancer Center here at RogerWilliams Medical Center to be involved with this initiative.

The Cancer Center has been certified since 2010 and completed an on-site reviewin October 2013 with full accreditation for another three years, recognizing ourcommitment to excellent cancer care.

9.

020406080

100

Spring2010

Fall2010

Spring2011

Fall2011

Spring2012

Fall2012

Spring2013

Fall2013

72.2481.39 79.75 81.72 89.01 84.02

94.05 96.26

Quality Oncology Practice Initiative (QOPI)

RWMC Overall Score QOPI Required Score

QUALITY ONCOLOGY PRACTICE INITIATIVE DATA

10.

Survivorship and Support

Survivorship ProgramMoving on to live a healthy, productive life after cancer begins at the time ofdiagnosis! All patients diagnosed with cancer at the Roger Williams Cancer Centerreceive a Survivorship Care Plan. The care plan reviews the treatments you havealready had, summarizing them, and helps you understand what needs you may havein the future. Your plan is individualized and may include follow up imaging, regularvisits and exams with your providers, screening and prevention of conditions that canaffect post-cancer patients more than the general population, nutrition counseling orrehabilitation exercises.

Support GroupsHelping our patients and their caregivers cope with the disease process and treatmentis our goal. Please join us for our informal talks. All groups take place in the waitingarea of the Cancer Center at 50 Maude Street, Providence, RI 02908. Please call401-456-2000 ext. 8409 for an updated schedule of support groups and check backhere for regular updates.

Breast Health and BMT Survivorship ProgramsBoth the Bone Marrow Transplant and Breast Health Programs have survivorshipprograms and plans in place that are specific to these two types of cancer in order tobest meet the needs of these special patient populations. To learn more, call 401-456-2005.

Oncology Trained DieticianOur Nutrition Program is proud to have an Oncology-specific Nutritionist to help meetyour needs throughout the treatment process and after. To learn more, call 401-456-6513.

Oncology Massage ProgramWe are host to massage students and their preceptors who practice Oncology-Specific Massage therapy for our patients at no-cost. They are at the Cancer Centerand the Main Hospital Inpatient Units on Wednesdays. To learn of availability, pleasecall 401-456-5310.

11.

CoC Cancer Program Practice Profile Reports (CP3R) Quality Measures Breast and Colorectal Cancer

The Commission on Cancer (CoC) has defined several quality measures for hospitals with accreditation status. Tracking these

measures provides an opportunity for continuous practice improvement to achieve high quality care for our patients. There is

em.

Quality Measure

RWMC

2009

RWMC

2010

RWMC

2011

CoC / NCDB

Required

Performance

Rate

Breast Cancer

Radiation therapy is administered within 1 year (365 days) of

diagnosis for women under age 70 receiving breast-conserving

surgery for breast cancer.

100% 100% 100% >= 90%

Combination chemotherapy is considered or administered within

4 months (120 days) of diagnosis for women under 70 with

AJCC T1c N0 M0 or Stage II or III ERA & PRA negative breast cancer.

100% 100% 100% >= 90%

Tamoxifen or other third generation aromatase inhibitor is

considered or administered within 1 year (365 days) of diagnosis

for women with AJCC T1c N0 M0, or Stage II or III ERA and/or

PRA positive breast cancer.

100% 91.7% 88.9% >= 90%

Colorectal Cancer

Adjuvant chemotherapy is considered or administered within

4 months (120 days) of diagnosis for patients under the age of

80 with AJCC Stage III (lymph node positive) colon cancer.

100%

100%

100%

>= 90%

At least 12 regional lymph nodes are removed and pathologically

examined for resected colon cancer.

82.6% 80% 100% >= 80%

Radiation therapy is considered or administered within 6 months

(180 days) of diagnosis for patients under the age of 80 of with

clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical

resection for rectal cancer.

No

Applicable

Cases

No

Applicable

Cases

100% Not Yet

Established

All RWMC measures meet or exceed the defined Confidence Interval set by the NCDB (National Cancer Data Base) for 2011, the

most recent year available. Several new measures will be introduced for 2012 cases and reported as they become available.

ROGER WILLIAMS MEDICAL CENTER - AGE AT DIAGNOSIS 2012 681 Total Cases 557 Analytic, 124 Non-Analytic

0

20

40

60

80

100

120

140

160

180

200

0-2930-39

40-4950-59

60-6970-79

80-89

90 and Older

7

25

42

137

95

97

143

123

12

AGE GROUPINGS

Under 65

65 and Older

THE CANCER REGISTRY AT ROGER WILLIAMS MEDICAL CENTER

The Cancer Registry at Roger Williams Medical Center is responsible for capturing acomplete summary of a cancer patient’s disease; from diagnosis through the lifetime ofthe patient. This summary or abstract provides an on-going account of the cancer patient’shistory, diagnosis, stage of disease at diagnosis, treatment, and current status. In additionto data analysis, the Cancer Registry also monitors quality of care and clinical practiceguidelines, provides benchmarking services, and provides information relating to patternsof care and referrals.

2012 CASES AT ROGER WILLIAMS MEDICAL CENTER

The 2013 Cancer Registry report utilizes complete data from the calendar year 2012. Atotal of 681 new cases were added to the Cancer Registry database in 2012, including557 analytic (newly diagnosed) cases and 124 non-analytic cases (those diagnosed andtreated elsewhere in the past, and new to RWMC in 2012). The Cancer Registry maintainsa 90% or greater follow-up rate on patients diagnosed and treated at Roger WilliamsMedical Center and is currently following nearly 3,000 active patients.

12.

13.

66

63

37

46

28

24

53

62

36 37

19

26

49

45

48

38

21 21

43

60

31

40

32

25

59

90

41

54

39

25

0

10

20

30

40

50

60

70

80

90

100

BREAST LUNG COLON MELANOMA LYMPHOMA PANCREAS

2008 - 460 cases 2009 - 432 cases 2010 - 416 cases

2011 - 448 cases 2012 - 553 cases

339

36

173

8

1

Primary Insurance at Diagnosis 2012 Analytic Cancer Cases - 557 Total

Medicare - 61%

Medicaid - 6.4%

Private Insurance - 31%

Not Insured - 1.4%

Insurance, NOS - 0.2%

ROGER WILLIAMS MEDICAL CENTER NEWLY DIAGNOSED CANCER CASES (2008-2012)

Primary Cancer Site and Stage (2012 Cases)

14.

www.weknowcancer.org