COMPREHENSIVE CANCER CENTER DESERT REGIONAL MEDICAL CENTER

2018 COMMUNITY OUTREACH SUMMARY AND OUTCOMES REPORT

The Health Assessment and Research for Communities (HARC) survey is conducted by a non-profit organization that serves the Coachella Valley (Cathedral City, Coachella, Desert Hot Springs, Indian Wells, La Quinta, Palm Desert, Palm Springs and Rancho Mirage) in Riverside County every three years. The HARC report contains information on population, health status, health behaviors, major diseases, top five cancer sites, and risk factors.

The Cancer Center uses the HARC report to identify and prioritize health care needs, develop programs to address needs, and educate the community regarding healthy lifestyles. Barriers to care identified were language preference, understanding insurance coverage, transportation, and home care. (1) HARC also identified chronic illnesses as a leading cause of death and disability that can take years to progress. (2)

Initial discussion about prevention and screening needs began at the first cancer committee meeting in January. The Committee decided to target our top five cancer sites, breast, lung, colon, prostate, and endometrium. (3) In 2018, two prevention programs that outlined controllable behaviors that increase risk for chronic disease and cancer were provided by Cancer Center physicians and staff. The focus of the programs was healthy lifestyle practices that included physical exercise for a population at higher risk for chronic disease.

An additional site-specific program, Paradigm Shift Series Part II “The New Standard of Care in Breast Cancer,” is planned for December 11, 2018. Breast was chosen because it is the most common cancer at Desert Regional Medical Center, the Coachella Valley, and nationally. The target audience is women over 40 years of age, when most breast cancers are diagnosed. (4) Our hope is that the program will raise awareness of early detection and improve stage at diagnosis. (5) The outcome will be reported to Cancer Committee in January, 2019.

Comparison with the latest data from Commission on Cancer Benchmark reports show Desert Regional Medical Center is similar to national statistics for patients diagnosed in 2015. (4)

Comparison with the latest data from Commission on Cancer Benchmark reports show Desert Regional Medical Center is similar to national statistics for patients diagnosed in 2015. (5)

Prevention Programs Completed To Date:

• “What to Know About Stress, Anxiety and Depression” – April 27, 2018
  • Discussed and planned at Cancer Committee: March 19, 2018
  • Discussed and effectiveness analyzed at Cancer Committee: May 7, 2018
    • Number of Participants: 20 , attendance tracked by sign-in forms
    • Identified Areas (type of cancer): breast, lung, colon, prostate & endometrium
    • National Guidelines:
      • National Institute of Mental Health (6)
      • American Cancer Society (7)
      • National Cancer Institute (8)
      • American Institute of Cancer Research (9)
    • Effectiveness:
      • Lessons Learned, Value and Impact: Based on pre and post-presentation surveys, participants responded that they were planning to:
        • Routinely practice stress-reduction techniques weekly (including but not limited to meditation, yoga, mindfulness, fatigue/stress management strategies, weekly hobbies/leisure activities) [pre-presentation 10/20; post-presentation 20/20]
        • Exercise 3 – 5 times per week [pre-presentation 13/20; post-presentation 20/20]
        • Marketing efforts included advertising in the local newspaper, videos on social media, and posting in public locations (physician office waiting rooms, senior centers and libraries). The criteria for seminar venues were target audience, ease of access, and central location.
        • Recommendations: The Cancer Committee reviewed the program and pre/post-presentation surveys provided to measure retention of the material. Participants were able to identify the need for and plan to practice stress-reduction techniques and exercise. Research shows a proven benefit in the risk reduction for colon, breast and endometrial cancer. (10) Committee members stated the program was effective and recommended it be repeated in 2019.
• “Healthy Habits Caregivers Special: How to Be Healthy When Caring for Others” – August 16, 2018
  • Discussed and planned at Cancer Committee: July 16, 2018
  • Discussed and effectiveness analyzed at Cancer Committee: September 17, 2018
    • Number of Participants: 18, attendance tracked by sign-in
    • Identified Areas (type of cancer) breast, colon, prostate & endometrium
    • National Guidelines:
      • American Psychological Association (11)
      • American Cancer Society (12)
    • Effectiveness:
      • Lessons learned, value and impact: Based on pre and post-presentation surveys, participants stated they would:
        • Develop and/or maintain a plan to exercise 3 – 5 days per week [pre-presentation 9/18; post-presentation 18/18]
        • Participate in 1 leisure activity per week [pre-presentation 9/18; post-presentation 18/18
        • Marketing included advertising in the local newspaper, videos on social media and posting in public locations (physician office waiting rooms, senior centers and libraries). The criteria for seminar venues will continue to be target audience, ease of access and central location.
        • Recommendation: The Cancer Committee reviewed the program and pre/post-presentation surveys provided to measure retention of the material. Participants were able to identify the need to develop and maintain a weekly exercise program. Research shows a proven benefit in risk reduction for colon, breast and endometrial cancers for people who are physically active. (13) Committee members stated the program was effective and recommended the program be repeated quarterly.

Screening Programs Completed to Date:

An ongoing screening program focused on lung cancer because it is the leading cause of cancer death in the United States (14) and is frequently diagnosed in the late stage of disease.

• Lung Nodule Program –
  • Discussed and planned at Cancer Committee: January 15, 2018
  • Discussed and reviewed at each Cancer Committee meeting:(March 19, 2018, May 7, 2018, July 16, 2018, September 17, 2018)
  • 2018 to date, 42 patients were screened with 0 positive findings; 19 were evaluated by the Lung Nodule Program team and 12 chose to be enrolled in the program.
  • Identified Areas (type of cancer): lung (61% diagnosed at stage III or IV at DRMC) (15).
  • National Guidelines:
  • National Cancer Center Network (NCCN) (16)
    • Process:
    • All Lung CT Scans completed on the campus of Desert Regional Medical Center are reviewed and nodules greater than 6 millimeters are referred to the Lung Nodule Program Panel for evaluation.
    • A letter inviting the patient to participate in the LNP and a copy of the CT report is sent to the ordering physician.
    • Upon admission to the LNP, patient’s CT Scan and history are presented to the LNP Panel
  • The LNP Panel is comprised of a pulmonologist, thoracic surgeon, and oncologist.
  • The LNP Panel makes a recommendation for follow-up and patients are assigned a follow-up physician who contacts the ordering physician to provide an update and obtain additional orders as needed.
  • If the LNP Panel recommends a biopsy which has a positive result, the follow-up physician communicates with the ordering physician and requests a consult with the appropriate specialty. The patient is admitted to the provider’s service for follow-up.
    • Effectiveness:
      • Noted that to date there have been no positive findings, but committee felt that reviewing all chest CT with lung nodule of 6 mm or greater and offering the ordering or primary physician the option of having their patients monitored by the LNP was worthwhile, due to the high percentage of stage III & IV lung cancer diagnoses. The Cancer Committee will continue to monitor the screening program for effectiveness.
      • Marketing efforts for lung cancer screening included an introductory letter to the primary care community physicians describing the LNP and benefit to their patients. Information is also sent to ordering physicians whose patients have lung nodules of 6 mm or greater to ask if their patients want to be enrolled.
      • Recommendations:
        • Continue the LNP and encourage follow-up physicians to use the communication with ordering/primary care physicians to provide education regarding possible symptoms of lung cancer.
        • Even though there were no positive findings to date, several patients were admitted to the program and continue to be followed for repeat imaging due to the size and characteristics of the lung nodules noted on the original CT.
        • As new primary care physicians establish practices or join a physician group within the Coachella Valley, letters should be sent to introduce the LNP program.

Program Plans for 2019:

• Continue to target top 5 sites diagnosed at DRMC and community needs identified by the HARC report.
• Develop, implement, and evaluate the effectiveness of prevention programs with the goals to increase awareness of the benefits of early detection and encourage positive behavior changes in the community.
• Evaluate venues to determine which locations provide the best environment for optimal attendance.
• Provide an Oral Cancer Screening program.

References

1 Health Assessment and Research for Communities (HARC), Coachella Valley Community Health Survey 2016, published 2017, page 24
2 Health Assessment and Research for Communities (HARC), Coachella Valley Community Health Survey 2016, published 2017, page 44
3 Health Assessment and Research for Communities (HARC), Coachella Valley Community Health Survey 2016, published 2017, page 45
4,5 2015 Benchmark Reports, Commission on Cancer
6 National Institute of Mental Health, 2015
7 American Cancer Society, 2015
8 National Cancer Institute, 2017
9 American Institute Cancer Research, 2017
10, 13 www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity
11 American Psychological Association 2012, 2016
12 www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/guidelines.html
14 American Cancer Society, 2016 Facts and Figures, pages 15-16
15 Desert Regional Medical Center/Community Cancer Center, Tumor Registry, 2017 Site Table
16 NCCN Clinical Practice Guidelines in Oncology (NCCN), Non-Small Cell Lung Cancer Screening, Version 2.2019, August 27, 2018