2017 Annual Report

2 3

Daniel D. Lydiatt, DDS, MDMedical DirectorMethodist Estabrook Cancer Center

Josie Abboud, RN, BSN, MBAExecutive Vice President and Chief Operating OfficerMethodist Hospital

Patty Bauer, MSHA, RN, RRTService Executive, Oncology Services Methodist Estabrook Cancer Center

Methodist Estabrook Cancer Center is one of only 22 cancer care providers in the nation — and the only one in the area — to earn the 2016 Outstanding Achievement Award from the Commission on Cancer (CoC) of the American College of Surgeons. Announcement of the award followed CoC cancer program surveys performed July 1 through December 31, 2016.

This is our second consecutive CoC Outstanding

Achievement Award and further confirmation of Methodist’s

success in delivering outstanding patient-centered, evidence-

based multidisciplinary cancer care.

Our great strengths are not weakened by the passage of

time or by growth within our competitive marketplace.

Methodist maintains a unique culture and vision. We possess

an unwavering commitment to quality and to those we serve.

We place the highest priority on the total patient experience

throughout Methodist, including all oncology services.

For us, The Meaning of Care is a way of life. It is the special

way our people care for patients and families, and it is our

total environment of care. Our expert, experienced and

compassionate caregivers and support staff create positive

experiences throughout the continuum of care for the best

possible outcomes, including a faster return to health

and function.

The strength of Methodist’s patient experience is also

validated by patient satisfaction survey results from

Professional Research Consultants, Inc. (PRC). This year,

Methodist achieved 21 PRC Awards for Excellence in

healthcare, including numerous 5-Star Awards for our

inpatient and outpatient oncology services.

Our work to fight cancer and enhance care continues, and we thank you for your interest and support.

Methodist’s leadership in cancer care continues.

4 5

Multiple myeloma is a blood cancer of the plasma cells. Normal plasma cells are important for immune function and to regulate antibody (or immunoglobulin) production. Plasma cells are located in the bone marrow and when one becomes cancerous, it reproduces or proliferates. The malignant plasma cells will then make the same type of abnormal immunoglobulin called M protein. This M protein can be detected in the blood and/or urine. The symptoms and signs of myeloma occur due to both the proliferation of the cells in the bone marrow as well as to the damage the M protein causes when it deposits in organs.

Multiple myeloma represents 1 percent of all cancers and

13 percent of hematologic or blood cancers. It is generally

diagnosed later in life with the average age of newly

diagnosed patients being 70 years. Only a third of patients

are diagnosed prior to age 65. It is estimated that 30,280

Americans will be diagnosed with myeloma in 2017

(17,490 male and 12,780 female) and 12,590 deaths are

expected (6,600 male and 5,930 female). The average life

expectancy after a diagnosis of myeloma is approximately

five years although newer treatments have shown to

improve overall survival.

Multiple Myeloma UpdateStefano Tarantolo, MD Symptoms

Approximately 73 percent of patients will present with

anemia due to either poorly functioning kidneys (due to

damage from the M protein) and/or marrow replacement

by plasma cells. Eighty percent of patients will have

bone lesions with about two thirds having some pain in

those areas. Other symptoms include recurrent infections,

peripheral neuropathy and symptoms from kidney damage

(fluid retention).

Laboratory DataPatients suspected of having myeloma undergo the following

diagnostic studies: complete blood count, complete blood

chemistry, 24-hour urine collection of protein electrophoresis

with immunofixation, serum

protein electrophoresis

with immunofixation, B-2-

microglobulin, serum light chains,

a bone marrow biopsy with

flow cytometry and FISH panel.

Additional studies include a fat

pad biopsy to evaluate for a condition called amyloid and

x-rays (PET scan, MRI of bones or complete radiographs of the

entire skeleton). In the near future, gene expression profiling

will be available to aid in risk stratification and selection of

the most active agents for patients upfront.

StagingMyeloma is staged utilizing the International Staging System

(ISS). This staging system is exclusively based on albumin

level and Beta 2 microglobulin. Patients are staged as Stage

I, II or III. The stages correspond to survival prediction: Stage

I, 62 months; Stage II, 44 months; and Stage III, 29 months.

The revised International Staging System (R-ISS) added

serum LDH and high-risk chromosomes by fluorescent in situ

hybridization (FISH).

In 2017, it is estimated that

30,280 Americans will be

diagnosed with myeloma

6 7

2005, more than 100 patients have undergone Autologous

stem cell transplants at Methodist Hospital with improved

results. A recent study published in the April 2017 issue of the

New England Journal of Medicine on 700 adult patients with

multiple myeloma showed an improvement in survival in

patients who were consolidated with an Autologous stem

cell transplant.

New Therapies: Monoclonal AntibodyRecently, two new monoclonal antibodies have been FDA

approved for the treatment of myeloma. Daratumumab is

a human IgG kappa monoclonal antibody that targets the

CD38 receptor on the cell surface and kills plasma cells via

Multiple Myeloma Update continued

TreatmentThe treatment of myeloma has changed dramatically in the

last decade from traditional chemotherapy drugs to now

include “targeted therapies” (drugs that act more specifically

on the cancer cells). This has transformed the prognosis

for patients with myeloma with a median survival of 29

months in 2000 to a median survival of five years in 2016.

For more than 50 years, the mainstay of therapy was oral

melphalan and prednisone. Multiple poly-chemotherapy

agents when compared to melphalan and prednisone showed

similar outcomes resulting in a median survival of 29

months regardless of the therapy utilized. However, recent

research has shown that immunomodulatory agents such as

thalidomide, lenalidomide , pomalidomide and proteasome

inhibitors such as Velcade, Kyprolilis and Ninlaro are

impacting survival.

High-dose therapy with Autologous stem cell rescue has

become the standard of care for selected fit patients. Since

Survival Stage I Stage II Stage III

5-year Overall Survival

82% 62% 40%

Median Overall Survival

N/A 83 months 43 months

High RiskFISH t(4:14), del 17 p13, chromomome 1, hypodiploid elevated Beta-2-microglobulin and elevated LDH

Standard RiskHyperdiploid, t(11;14) normal Beta-2-microglobulin and normal albumin

8 9

ConclusionAs can be noted, the rapid advances in our understanding

of myeloma biology have resulted in unprecedented

development of new treatments that have improved survival

and quality of life for patients. Perhaps more exciting is a

research pipeline that bodes for even a more hopeful future.

Although a cure for myeloma may still be some time away,

the possibility of converting myeloma into a chronic illness

(similar to hypertension or diabetes) is rapidly becoming

a reality.

Attal, M., Lauwers-Cances, V., Hulin, C., Leleu, X., Caillot,

D., Escoffre, M. & Avet-Loiseau, H. (2017). Lenalidomide,

Bortezomib, and Dexamethasone with Transplantation for

Myeloma. NEJM, 376(14), 1311-1320.

Multiple Myeloma Update continued

multiple immune-mediated mechanisms. Daratumumab

demonstrated a favorable safety profile and encouraging

efficacy in heavily pretreated patients. Daratumumab is FDA

approved for second line therapy. There are several ongoing

trials that incorporate Daratumumab in the first line setting,

prior to stem cell transplantation.

The second antibody is Elotuzumab which is also a human

IgG1 monoclonal antibody that targets single lymphocyte

activation of C7 or SLAM-7 or CS-1 (cell surface glycoprotein

CD2) on natural killer

cells. More than 95

percent of marrow

plasma cells express

SLAM-7. Elotuzumab

is administered in

combination with

lenalidomide. Methodist

Hospital is currently

participating in a

research study of

Elotuzumab in the front-

line setting, prior to

stem transplant.

Future There are several exciting new therapies. One promising

agent is chimeric antigen receptor T-cells commonly referred

to as CAR-T cells. This therapy uses a patient’s own immune

T-cells that are engineered to attack a specific protein on a

myeloma cell such as CD-19 or BMSA.

10 11

Among stem cell transplant programs, one quality measure stands out: accreditation by the Foundation for the Accreditation of Cellular Therapy (FACT).

FACT is an international accreditation created to establish

and certify clinical excellence in process and outcomes and

is the threshold for excellence in cellular therapy (stem cell

transplantation). FACT accredited organizations voluntarily seek

and maintain FACT accreditation through a rigorous process,

demonstrating their belief that patient needs are paramount.

Accreditation is based on compliance with comprehensive

evidence-based standards set by international teams of world-

renowned experts vested in the improvement and progress of

cellular therapy. FACT centers have a reputation as centers of

excellence that exert adequate quality control over the entire

cellular therapy process. Accredited programs maintain the

confidence of medical professionals, third-party payers,

and regulators in the quality of the organization’s cellular

therapy services. This accreditation, which is often required by

insurance payers, applies to all patients receiving Autologous

stem cell transplantation at Nebraska Methodist Hospital. The

Autologous stem cell transplant program received initial full

three-year FACT accreditation in 2014. Compliance with FACT

standards is an ongoing process; successful accreditation is

attributed to strong collaboration among departments and

staff members who care for transplant patients.

Dedicated to improving survival, treatment, and quality of life

for transplant patients, Nebraska Methodist Hospital voluntarily

FACT ACCREDITATION: Foundation for the Accreditation of Cellular TherapyKim Bland, DNP, APRN-NP, FNP, AOCN

participates in the Center for International Blood & Marrow

Transplant Research Program (CIBMTR). The CIBMTR has a

network of more than 500 centers worldwide that contribute

detailed research data on hematopoietic cell transplants. The

primary goal of this research program is to improve the safety

and effectiveness of hematopoietic cell transplantation.

Patients receiving stem cell transplantation are invited to

take part in this research database, which is overseen by

Nebraska Methodist Hospital Institutional Review Board.

Information about participation is provided and patients

must sign a consent form to participate. There are no costs

or reimbursements to the patient and participants may

withdrawal from the study

at any time. The goal of this

research is to find ways to make

hematopoietic transplants and

other cellular therapies work

better, to help future patients

who need a transplant or

cellular therapy.

Nebraska Methodist Hospital has a stem cell transplantation

multidisciplinary team focused on the philosophy of holistic,

individualized patient-centered care. All treatment decisions

are a partnership between the care team, the patient and

family, from initial diagnosis through treatment and follow up.

Quarterly stem cell transplant committee meetings are

conducted to review the program, provide education for staff

members, and to continually improve patient care. In addition

to participating in the on-site accreditation inspection by FACT

surveyors, Methodist Hospital also voluntarily submits annual

reports of transplant activities to FACT and the Methodist

Cancer Committee. Patients receiving Autologous stem cell

transplantation at Methodist Hospital, a FACT accredited

organization, can be assured that they are in good hands.

All treatment decisions are

a partnership between the

care team and the patient

and family.

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Community Outreach Activity Summary 2016

Standard 1.8Monitoring Community Outreach

Community Outreach Coordinator monitors the effectiveness

of community outreach activities on an annual basis. The

activities and findings are documented in a community

outreach activity summary that is presented to the Cancer

Committee annually.

Standard 4.1Prevention Programs

Each year the cancer committee provides at least one cancer

prevention program that is targeted to meet the needs

of the community and should be designed to reduce the

incidence of a specific cancer type. The prevention program

is consistent with evidence-based national guidelines for

cancer prevention. (ACS and NCCN screening and prevention

recommendations used as reference at MECC.)

Standard 4.2Screening Programs

Each year, the cancer committee provides at least one cancer

screening program that is targeted to decreasing the number

of patients with late-stage disease. The screening program is

based on community needs and is consistent with evidence-

based national guidelines and evidence-based interventions.

A process is developed to follow up on all positive findings.

Audience Program Location DateNumber of Participants

Beauty in Bloom - Project Pink’d program via Inner Beauty – Breast Cancer Survivors

Fighting Cancer With a Fork – Educational Talk

Omaha, NE 2/4/16 20

A Time to Heal – Survivorship Program

Fighting Cancer With a Fork – Educational Talk

First United Methodist, Omaha, NE

3/21/16 12

A Time to Heal – Survivorship Program

Fighting Cancer With a Fork – Educational Talk

Methodist Estabrook Cancer Center, Omaha, NE

3/22/16 12

Multiple Myeloma Support Group

AICR Prevention Guidelines – Nutrition During and After Treatment

Omaha, NE 8/17/16 16

Project Pink’d - The Chef’s Table – Breast Cancer Survivors

Fighting Cancer With a Fork – Educational Talk & Cooking Demo

Omaha, NE 8/4/16 16

A Time to Heal – Survivorship Program

Fighting Cancer With a Fork – Educational Talk

First United Methodist, Omaha, NE

10/24/16 18

A Time to Heal – Survivorship Program

Fighting Cancer With a Fork – Educational Talk

CHI Bergan Mercy’s Cancer Center, Omaha, NE

10/20/16 12

Metro area 3rd grade students

No Tobacco Challenge

Metro area 3rd grade classrooms

October 2016

1945

2016 Prevention Programs:

14 15

2016 Screening Programs:

Screening Type

Location Date Number of Participants

Number Requiring F/U

Colorectal Community-wide as part of the Great Plains Colon Cancer Task Force

March 2016 16 1

Breast Black Family Health & Wellness Fair; North High School

3/19/16 34 0

Oral, Head & Neck

Black Family Health & Wellness Fair; North High School

3/19/16 57 6

Colorectal Community-wide as part of the Great Plains Colon Cancer Task Force

April 2016 95 0

Oral, Head & Neck

MECC 4/9/15 56 1

Colorectal Community-wide as part of the Great Plains Colon Cancer Task Force

May & June 2015

17 0

Breast and Cervical

See, Test & Treat Screening Program at Charles Drew Health Center

7/9/16 40 3

Oral, Head & Neck

Oral Cancer Foundation Walk at Chalco Hills

8/13/16 14 0

Prostate Cruising for a Cure Car Show; 8511 Dodge Street, Omaha

9/11/16 121 7

Breast BiNational Health Week; One World, Omaha

10/5/16 77 12

Satisfaction surveys are provided post-nutrition education

talk. Participants are encouraged to provide feedback and of

the participants responding, they evaluated the nutrition talk

effectiveness as the following:

n 100 percent of participants felt staff communicated clearly and answered questions.

n 91 percent of participants plan on adopting changes as a result of information.

n 100 percent of participants felt it was a worthwhile use of their time and would recommend services to friends.

Screening Patient Follow-up ProcessAll participants who attend a community screening receive a

thank-you letter with information and contact numbers for

the cancer prevention program and Methodist Health System.

A letter is given to them as they leave the screening.

Any participant with an abnormal finding gets an

individualized letter reminding them of the findings and

recommendation to contact their personal health care

provider within one to two weeks after screening. If they don’t

list a personal healthcare provider, information about the

Methodist Health System physician referral line is provided.

If the participant has listed a healthcare provider and signed

a medical release of information, a letter is sent to the

physician along with a copy of the screening results.

Any participant with an abnormal finding will receive a

phone call from the cancer prevention staff within one month

of screening to determine if they have had follow-up, if they

needed assistance with follow-up, and/or results of follow-up.

Notes and copy of contacts are kept with screening charts.

Screening charts are kept for one year in the cancer

prevention department.

16 17

Primary Sites Total Analytic Non-Analytic

LIP 5 5 0

TONGUE 46 40 6

GUM 15 14 1

FLOOR OF MOUTH 8 7 1

PALATE 5 5 0

MOUTH 7 7 0

PAROTID GLAND 12 10 2

SALIVARY GLAND 1 1 0

TONSIL 31 25 6

OROPHARYNX 2 2 0

NASOPHARYNX 3 3 0

PYRIFORM SINUS 2 2 0

HYPOPHARYNX 3 2 1

ORAL CAVITY 2 2 0

ESOPHAGUS 19 17 2

STOMACH 24 19 5

SMALL INTESTINE 7 6 1

COLORECTAL 124 146 8

ANUS 10 6 4

LIVER 7 7 0

GALLBLADDER 2 2 0

BILIARY TRACK 5 5 0

PANCREAS 50 43 7

NASAL CAVITY 2 1 1

SINUS 2 2 0

LARYNX 26 16 10

TRACHEA 0 0 0

LUNG 153 143 10

THYMUS 0 0 0

HEART-PLEURA-MEDIASTINUM 3 3 0

BONES-JOINTS-CARTILAGE 5 4 1

BLOOD SYSTEM 40 33 7

CLL 10 5 5

ALL 4 4 0

Primary Sites Total Analytic Non-Analytic

SKIN 182 175 7

MELANOMA 166 161 5

AUTONOMIC NERVOUS SYSTEM 0 0 0

PERITONEUM 9 9 0

CONNECTIVE TISSUE 20 20 0

BREAST 353 337 16

VULVA 55 36 19

VAGINA 3 3 0

CERVIX UTERI 38 34 4

CORPUS UTERI 226 219 7

UTERUS 0 0 0

OVARY 62 58 4

FEMALE GENITAL 16 14 2

PLACENTA 0 0 0

PENIS 2 2 0

PROSTATE 240 208 32

TESTIS 13 10 3

MALE GENITAL 0 0 0

KIDNEY 60 57 3

RENAL PELVIS 1 1 0

URETER 4 4 0

BLADDER 68 62 6

URINARY ORGANS 4 3 1

EYE 1 0 1

MENINGES 18 13 5

BRAIN 11 11 0

CENTRAL NERVOUS SYSTEM 8 8 0

THYROID 118 110 8

ADRENAL GLAND 0 0 0

ENDOCRINE 5 1 4

LYMPH NODES 37 31 6

UNKNOWN 16 16 0

OTHER 0 0 0

TOTALS 2221 2020 201

2016 Cancer Cases

18 19

Male 695 100%

PROSTATE 208 30%

HEAD/NECK 108 16%

MELANOMA,SKIN 98 14%

COLORECTAL 76 11%

LUNG & BRONCHUS 54 7%

BLADDER 52 7%

KIDNEY & RENAL PELVIS 39 6%

PANCREAS 25 4%

BLOOD SYSTEM 21 3%

LYMPH NODES 14 2%

Female 1,046 100%

BREAST 337 32%

CORPUS UTERI 219 21%

HEAD/NECK 127 12%

LUNG & BRONCHUS 89 8%

MELANOMA,SKIN 75 8%

COLORECTAL 70 7%

OVARY 58 6%

CERVIX 34 3%

KIDNEY & RENAL PELVIS 19 2%

PANCREAS 18 1%

AJCC Stage at Diagnosis

INSITU 123 6%

I 500 25%

II 353 17%

III 121 6%

IV 199 11%

NA 97 4%

UNKNOWN 627 31%

Age at Diagnosis Male Female

10-19 0 0% 1 0%

20-29 11 1% 15 1%

30-39 24 1% 78 4%

40-49 49 2% 127 6%

50-59 159 8% 254 13%

60-69 287 14% 351 17%

70-79 186 9% 245 12%

80-89 74 4% 132 6%

90+ 12 1% 15 1%

Totals 802 1218

2016 Top Ten Cancer Sites AJCC Stage & Age at Diagnosis

20 21

n Achieved Commission on Cancer re-accreditation with commendation and the Outstanding Achievement Award

n Achieved Radiation Oncology re-accreditation

n Achieved 14 percent patient enrollment in clinical research trials of the total number of patients screened. Achieved 7 percent enrollment specific to treatment trials

n Collaborated with Methodist Jennie Edmundson to establish a lung cancer screening program at Methodist Jennie Edmundson

n Implemented the electronic health record in the Hereditary Cancer Risk Program

n Incorporated Palliative Care into the Lung Cancer Clinic

n Coordinated Omaha Fashion Week’s Cancer Survivor Style Show

n Created an Inner Beauty satellite location on the Inpatient Oncology Unit

n Completed refurbishment of the Infusion Center

n Increased Oncology Dietitian coverage at MECC to better support growing demand for services

n Implemented education and training on Cardizem protocol application for patients on the Inpatient Oncology Unit having heart rate control issues to allow treatment on the unit versus transferring to a higher level of care

n Created a database for tracking and monitoring of adherence to NCCN guidelines for pancreatic cancer

n Increased effectiveness of clinic to hospital coordination for surgical oncology clinic patients

n Collaborated with Charles Drew to offer mastectomy fitting services to the low income and uninsured population they serve

n Continued development and implementation of CPOE chemotherapy protocols for GYN Oncology

n Provided ongoing education to MECC clinics and departments regarding behavioral health services

n Implemented FEES (Fiberoptic Endoscopic Evaluation of Swallowing) Procedure in the Head and Neck Surgical Oncology Clinic

n Partnered with the American Lung Association to create and facilitate a lung cancer support group

n Offered an educational workshop for laryngectomy patients and their families

n Partnered with Leap-for-a-Cure to host a neuro-oncology conference for patients/families and healthcare professionals

n Collaborated with Children’s Hospital to implement a Children’s Thyroid Clinic at Children’s Hospital

2016 Accomplishments

22 23

n Install and implement a replacement CT scanner equipped with 4-dimensional capabilities

n Install and implement a CT contrast injector

n Partner with Komen Great Plains to provide mobile mammography services in the Omaha metro area

n Implement Digital Breast Tomosynthesis at MECC

n Achieve >12 percent patient enrollment in clinical research trials of the total number of patients screened. Achieve >5 percent enrollment specific to treatment trials

n Launch a new website specific to Methodist Estabrook Cancer Center

n Design and implement an oncology rehab program

n Host a head & neck cancer symposium

n Host a lung cancer symposium

n Achieve FACT Stem Cell re-accreditation

n Integrate complex illness support services at MECC

n Explore telemedicine options for psychiatry consultation services at Methodist Women’s Hospital

n Establish a centralized outpatient infusion scheduling and financial clearance process for the health system

n Develop reports to track NCCN evaluation and treatment compliance for pancreatic cancer in the Surgical Oncology Clinic

n Fully transition the Head & Neck Surgical Oncology program to Methodist

n Enhance marketing strategies for Harper’s Hope physical wellness classes

n Implement referral process with Oncology Research team for use of distress screening and appropriate social work referrals

n Investigate quarterly partnership with Project Pink’d to continue cancer prevention nutrition classes for breast cancer survivors

n Support Oncology Certification for nursing by participating in the ONCC FreeTake Certification Program with a goal of 10 inpatient and 4 outpatient nurses achieving Oncology Certification in 2017

n Implement Enhanced Recovery for GYN Oncology patients undergoing a hysterectomy

n Enhance teamwork and communication between inpatient and outpatient services for breast cancer care

2017 MECC Goals

24 25

Geetha Palaniappan, MD

Ann Polich, MD

Irina Popa, MD

Diane RandolphHome Health and Hospice

James Reilly, MDCancer Liaison Physician

Sharlon Rodgers Radiation Oncology

M. Shashidharan, MD

William Shiffermiller, MD Medical Staff Administration

Kathryn Simone Breast Care Center

Russell Smith, MD

Yungpo Su, MD

Stefano Tarantolo, MD

Jane Theobald, MD

Jackie ThielenPalliative Care*

Teri TiptonNursing Administration

Kimberly TomeiSurgical Oncology Clinic

* Designates individuals or positions that are required by the American College of Surgeons Cancer accreditation program.

Robert Langdon, MDCo-Chairman*

Daniel Lydiatt, DDS, MDCo-Chairman* Medical Director, Cancer Center

Josie AbboudMethodist Hospital Administration

Amy BamburgTumor Registry*

Kathryn BartzOncology Research*

Patty Bauer Cancer Center Administration*

Margaret Block, MD

Cheryl BohacekInpatient Oncology

Wendy BuchholzOncology Rehab*

Kathy ChristiansenCancer Prevention & Hereditary Risk*

David Crotzer, MD

Jason DavisQuality*

George Dittrick, MDSurgical Oncologist*

Randy Duckert, MDRadiation Oncologist*

John Edney, MD

Steve Goeser Methodist Hospital Administration

David Hilger, MD

Tien-Shew Huang, MD

Timothy Huyck, MD

Peggy JarrellOncology Social Worker*

Richard Kutilek, MDRadiologist*

Stephen Lemon, MD

Patrick Leu, MD

Lou Lukas, MD

Fred MassoomiPharm.D.

Deb MeyersLung/Thoracic Oncology Clinic*

Alireza Mirmiran, MD

Peter Morris, MD

Charles Mosher, MDPathologist*

2016 Cancer Committee Members

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© 2017 Methodist Estabrook Cancer Center