Embed Size (px)
Citation preview
HealthEast Prostate Care
Annual Report 2010
1
• More than 2 million men in the United States are prostate cancer survivors.
• Prostate cancer is the second most common type of cancer in American men.
• 1 in 6 men will be diagnosed with prostate cancer in their lifetime.
• 1 man in 36 will die from prostate cancer.
• In 2010 it is estimated there will be about 217,730 new cases of prostate cancer.
• In 2010 there will be about 32,050 deaths from prostate cancer.
• (source: American Cancer Society)
Prostate Cancer Overview
2
• The HealthEast Prostate Care Program is a community
based program that offers comprehensive and state of
the art services for patients diagnosed with prostate
cancer.
• HealthEast offers free screening clinics, modern
diagnostic tools, latest staging modalities and state of
the art treatment facilities.
• St John’s Hospital has been recognized by U.S. News &
World Report as one of “America’s Best Hospitals” for
urology care.
HealthEast Prostate Care
3
• The HealthEast Prostate Program strives to be the best by offering patients a compassionate, integrative, and multidisciplinary approach to treatment and care.
• HealthEast offers a wide variety of treatment options including surgery with the da Vinci surgical system. The da Vinci system is operated by a team of expert surgeons who are pioneers in this surgical method.
• Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. Radioactive seed implantation is also offered.
• CyberKnife--stereotactic radiosurgery that delivers concentrated, high doses of radiation. Using image-guidance, robotics and dynamic respiratory motion tracking, the CyberKnife system delivers superb accuracy and conformality.
Benchmark for Quality
4
• PSA Screening:
– One of the most effective methods for detecting prostate cancer. Recommended for all men between 50 and 75 years of age and for those who are high risk after 40 years of age.
• Digital Rectal Exam:
– Detects nodules or any other changes in the prostate. Recommended annually for men above 50 years.
• Prostate Biopsy:
– Done by urologist to establish the diagnosis.
• Bone Scan/CT Scan/PET Scan/MRI
– Used for staging purposes prior to treatment.
Diagnostic Evaluation
5
• Observation
• Surgery
– Robotic Prostatectomy
– Open Prostatectomy
– Cryotherapy
– TURP
• Radiation Therapy
– IMRT
– Seed Implantation
– Stereotactic Radiation therapy
• Hormone (Anti-Androgen) Therapy
• Chemotherapy
• Bisphosphonate Therapy
Treatment Options
6
• Age
• Stage
• Gleason Score
• PSA Value at diagnosis
– Total and Free PSA
Prognostic Factors
7
2009 HealthEast Prostate Cancer Treatment
Treatment* Total Patients
da Vinci Robotic Prostatectomy 256
Open Prostatectomy 11
Cryotherapy 22
CyberKnife 5
External Beam Radiation 1
Hormone Therapy 10
Active Surveillance 16
Total Patients 321
*Table summarizes treatment for newly diagnosed cancer patients. Data above is hospital based. A great percentage of patients receive outpatient treatments, i.e.
active surveillance and hormone therapy, which is not reflected in the data shown.
8
Treatment Summary Stage 2 Stage 3 Stage 4 Grand Total
da Vinci Prostatectomy (DVP) 207 46 3 256
DVP 187 29 1 217
DVP, Hormone 19 7 1 27
DVP, Radiation, Hormone 5 1 6
DVP, Radiation 1 5 6
Open Prostatectomy 8 2 1 11
Open Prostatectomy 3 2 5
Open Prostatectomy, Hormone 1 1
*Prostatectomy 5 5
Cryotherapy 22 22
Cryotherapy 18 18
Cryotherapy, Hormone 4 4
Radiation Therapy 6 6
CyberKnife 5 5
External Beam (Prostate), Hormone 1 1
Hormone Therapy 1 9 10
Hormone Therapy 1 8 9
Hormone, Radiation (Met Site) 1 1
Active Surveillance 16 16
Grand Total 260 48 13 321
HealthEast Prostate Cancer
Initial Therapy by AJCC Stage
Table summarizes treatment for newly diagnosed cancer patients. Data above is hospital based. A great percentage of patients
receive outpatient treatments, i.e. active surveillance and hormone therapy, which is not reflected in the data shown.
*Prostatectomy – patients with an incidental diagnosis of prostate cancer at the time of cystoprostatectomy for
bladder cancer.
9
TNM
Designation TNM Definition* Stage 2 Stage 3 Stage 4 Total
T1a Tumor incidental histologic finding in 5% or
less of tissue resected 9 9 (3%)
T1b Tumor incidental histologic finding in more
then 5% of tissue resected 2 2 (1%)
T1c Tumor identified by needle biopsy (e.g.
because of elevated PSA) 21 21 (7%)
T2 Tumor confined to prostate 6 8 (2%)
T2a Unilateral, one-half of one lobe or less 48 48 (15%)
T2b Unilateral, involving more than one-half of
lobe but not both lobes 7 7 (2%)
T2c Bilateral disease 167 167 (52%)
T3a Extraprostatic extension 38 38 (12%)
T3b Seminal vesicle invasion 10 10 (3%)
T4 Invasion of bladder, rectum 2 2 (1%)
N1 Metastasis in regional node(s) 4 4 (1%)
M1b Metastasis in bone(s) 5 5 (2%)
M1c Metastasis in other site(s) with or without
bone disease 2 2 (1%)
Grand Total 261 (81%) 48 (15%) 13 (4%) 321 (100%)
2009 HealthEast Prostate Cancer
AJCC Stage at Diagnosis
In 2009, eighty-one percent of our patients were diagnosed with a localized prostate cancer while 19 percent
had advanced prostate cancer at the time of diagnosis.
10
1 (0.3%)
12 (4%)
93 (29%)
145 (45%)
56 (17%)
11 (3%)
3 (1%)
0
20
40
60
80
100
120
140
160
<40 40-49 50-59 60-69 70-79 80-89 >90
Num
ber
of
Patients
Age Distribution
Age at Diagnosis
N=321
2009 HealthEast Prostate Cancer
In 2009, forty-five percent of our patients were diagnosed between the ages of 60-69; 33 percent under
the age of 60, and 21 percent at age 70 and above.
11
91 95
43
90 92 94
40
90
81
90 91
37
87
0
20
40
60
80
100
Stage 1 Stage 2 Stage 3 Stage 4 Overall
Perc
ent
HealthEast
Minnesota
National
5-Year Observed Survival by AJCC Stage*
Prostate Cancer
HealthEast observed survival rates by AJCC stage meet or exceed state and national outcomes.
*National Cancer Data Base/Commission on Cancer
Minnesota/National: Dx Year - 2003
HealthEast: Dx Year 2003 – 2005
Observed survival – calculations include all patients regardless of their cause of death.
12
• St. John’s Hospital is affiliated with the Community Clinical Oncology Program
(CCOP)
• CCOP is a network for testing and validating medical interventions against cancer,
and for delivering the benefits of scientific discovery to the public and community
physicians.
• HealthEast has the opportunity to participate in more than 100 phase II and III trials
each year.
• Currently there are 4 studies (2 adjuvant/early stage trials and 2 advanced stage
trials) open to prostate cancer patients at HealthEast. However, in 2009 there were
no studies available.
Clinical Trials
13
• In 2009, HealthEast offered 3 free prostate cancer screenings to
gentlemen in the community.
• Our focus is to reach out to those who are uninsured or
underinsured as well as high risk gentlemen.
• Screenings include a PSA test and a digital rectal exam (DRE).
• We continue to offer free screenings annually.
Prostate Cancer Screenings
14
• Our free prostate screenings were made available because of the generous donations from the following groups.
• The Cancer Benefit Fund. A group of community leaders that annually raise funds for the HealthEast Cancer Care Center and the University of Minnesota Cancer Research Program. In 2009 this group hosted a special event to designate funds for the Prostate Care Program.
• Elk River Syttende Mai Run. Funds from this group came from Mary Anderson and the Anderson Race Management Company. Mary and her company helped sponsor the annual Prostate Care 5K road race at Lake Nokomis. Through the registration fees of the run and corporate sponsorships, the HealthEast Prostate Care Program was awarded a wonderful contribution.
• Four individual private contributions were designated specifically for the Prostate Care Program.
Funding for Prostate Care
15
• There are a wide variety of treatment options available to gentlemen with
prostate cancer including: surgery, radiation, cryotherapy, and active
surveillance/watchful waiting.
• There are also several life-altering side effects that may occur as a result of
these treatments including erectile dysfunction and urinary incontinence.
• Because of this gentlemen can find their time of diagnosis to be extremely
stressful and confusing.
• Based on the above we have built a support network that is both traditional
and non-conforming to meet the individual needs of our patients.
Prostate Cancer Support
16
• The HealthEast Prostate Cancer Support Group is co-facilitated by
both a registered nurse and a psychotherapist. This group meets on
a monthly basis and has been on-going for over 18 years.
Gentlemen meet to discuss their diagnosis, prognosis, side effects
and overall thoughts on prostate cancer. This support group
continues to be one of our most highly attended support groups.
• Frequent guest speakers include: urologists, radiation oncologists,
specialists in erectile dysfunction, urinary incontinence, nutrition,
spiritual care and alternative therapies.
• We focus on both support and education.
Traditional Support
17
• Because a group setting isn’t the right option for everyone, we also provide the option for support in a number of ways on a 1 to 1 basis.
• One to one support offered by a Prostate Cancer Survivor. This can take place over the phone, face to face, in a single or multiple meetings or a combination of all based off the needs of each individual.
• Post-prostatectomy visiting program. Prostate Cancer Survivors who have already had their surgery, share their own post surgical experience to gentlemen one day after surgery.
• A psychotherapist, whose only focus is on cancer patients, is available for scheduled meetings.
One to One Support
18
• A monthly urology tumor conference is held so cancer care
team members can discuss treatment options for new patients
and evaluate the progress of current patients.
• Urology tumor conference is well attended by a multidisciplinary
group of dedicated physicians including urologists, radiation
oncologists, medical oncologists, radiologists, and pathologists.
• In 2009, 70% of urology cases discussed were prostate cancer.
Urology Tumor Conference
19
• Review of pathology of Robotic Prostatectomy specimens revealed higher than expected rate of positive margins. This was identified as quality improvement initiative.
• A thorough review of data was done in a multidisciplinary setting with active participation of surgeons, pathologists and clinical council. Opportunities for improvement were identified and implemented.
• By continuing to meet and evaluate the margin status, Our surgeons are continually looking for ways to improve or evaluate different methods they have tried.
Quality Improvement Initiative
Positive Surgical Margins
20
62
201
236
306
246 263
77 73 78
48 13 3
0
50
100
150
200
250
300
350
2004 2005 2006 2007 2008 2009
Num
ber
of
Pro
cedure
s
Metro Urology
da Vinci Prostatectomy Open Prostatectomy
HealthEast Prostatectomy
The first da Vinci prostatectomy performed in HealthEast occurred on May 17, 2004. Data for 2004 reflects a partial year.
All procedures performed by Metro Urology.
Patient selection – newly diagnosed prostate cancer patients; patient's undergoing prostatectomy after previous prostate
cancer treatment or active surveillance.
21
2.4
1.9
1.2 1.2 1.1 1.2
3.3
3.7
3.4 3.3
2.6 2.6
1.0
1.5
2.0
2.5
3.0
3.5
4.0
2004 2005 2006 2007 2008 2009
Num
ber
of
Days
Average Length of Stay
da Vinci Prostatectomy Open Prostatectomy
Quality and Outcome Measures
22
43.5
31.3 30.9
26.1
16.3 15.6
0
10
20
30
40
50
2004 2005 2006 2007 2008 2009
% P
ositiv
e
Positive Margin Rate – All pT Tumors da Vinci Prostatectomy
Quality and Outcome Measures
23
39.3
27.0 26.5
19.7
9.5 8.3
0
10
20
30
40
50
2004 2005 2006 2007 2008 2009
% P
ositiv
e
Positive Margin Rate – pT2 Tumors da Vinci Prostatectomy
Quality and Outcome Measures
24
133 111 78 95 89 99
593 580 602
513
612
933
0
200
400
600
800
1000
2004 2005 2006 2007 2008 2009
Blo
od L
oss (
ml)
Average Blood Loss
da Vinci Prostatectomy Open Prostatectomy
Quality and Outcome Measures
25
Quality and Outcome Measures
12.0
12.4 12.5
12.4 12.4 12.2
11.0
10.7
11.5
11.2
10.3
10.9
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
2004 2005 2006 2007 2008 2009
Hgb (
g)
Postoperative Hemoglobin (Median)
da Vinci Prostatectomy Open Prostatectomy
