SMHC Cancer Care Outcomes

napbc mhccn logosSouthern Maine Health Care (SMHC) is a proud partner of the MaineHealth Cancer Care Network. This powerful collaboration brings together nearly 300 of the most talented cancer care providers in northern New England, with the support of the Harold Alfond® Foundation. ¬≠Network physicians and patient navigators help patients access care in the most appropriate locations so they receive the right care, in the right location, while minimizing the time and expense of travel.

Advanced Cancer Care, Close to Home

Below we summarize some of the SMHC cancer care outcomes and achievements for the year 2019, as required by the Commission on Cancer (CoC) Standard 1.12. Read on to learn more about how our screening programs, clinical measures, and quality improvement initiatives compare to national standards.

Early Detection Saves Lives

Breast and colon cancer are among the top four cancers in Maine, which has the highest rate of cancer deaths in the nation. The good news is that mammography and colonoscopy procedures are excellent screening tools that can catch cancer early, when it’s easier to treat. Early detection can result in a shorter course of treatment for the patient and improves outcomes.

Lung cancer is the leading cause of all cancer deaths but early detection and treatment of lung cancer typically provides more favorable outcomes. Annual screenings are recommended for people who are at high risk of lung cancer.

SMHC Breast Cancer Screening and Outcomes

Breast Cancer Screening 

Breast cancer is the most common cancer among American women after skin cancer. Our cancer specialists offer comprehensive breast cancer services that include screening for early detection, diagnostic imaging, and personalized treatment. A family history and other factors may increase the risk of breast cancer.

Breast Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

ONCOLOGY METRIC Number of SMHC Cases Submitted CoC Required Performance Rate SMHC Performance Rate
Radiation is administered within 1 year (365 days) of diagnosis for women under age of 70 receiving breast conserving surgery for breast cancer. (Accountability)
18 80% 100%
Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III, or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC stage III (node positive) colon cancer. (Surveillance) 35 90% 97.1%
Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with > = 4 1 positive regional lymph nodes. (Accountability) 1 90% 100%
Image or palpitation-guided needle biopsy (core or FNA) of the primary site is performed to establish diagnosis of breast cancer. (Quality Improvement) 78 80% 98.7%

Why choose SMHC for breast care?

  • In 2018, SMHC was the first hospital in Maine to introduce a new procedure called magnetic seed localization, or Magseed, for breast cancer patients. This dramatically improved the patient experience while maintaining surgical accuracy and quality outcomes.
  • We now offer the Axillary Reverse Mapping (ARM) procedure to clinically-eligible breast cancer patients. At the time of surgery, breast cancer patients will often need lymph nodes removed to see if the cancer has spread. The ARM procedure helps lower the risk of arm swelling, or lymphedema, that can sometimes occur after lymph node removal. During the ARM procedure, particles are injected into the breast to find the correct lymph nodes to remove. A blue dye is also injected into the arm to help indicate which nodes are key to arm drainage. This helps us avoid the removal of lymph nodes that are key to draining the arm.
  • We are also working to bring Magtrace to Maine. Magtrace is a way to lower lymphedema risk to zero in certain mastectomy patients. Currently, patients who have stage zero breast cancer and choose mastectomy need to have lymph nodes removed in case the final pathology shows stage one cancer. Magtrace allows us two weeks to return to surgery and remove nodes only in patients who end up with stage one cancer. This means that patients who's cancer remains at stage zero after surgery have no nodes removed. Therefore, their lymphedema risk is essentially zero. 
  • 2019 we were re-accredited by NAPBC (National Accreditation Program for Breast Centers). We passed with no deficiencies and the surveyor was so impressed with our documentation that she requested a template to use as an example for others to use. 

SMHC Colon Cancer Screening and Outcomes

Colon Cancer Screening

Colon cancer typically grows slowly, and colonoscopy is the most common screening test used to detect it. For people at average risk for developing colorectal cancer, the recommended age to begin screening is 50. In 2018 SMHC exceeded the average national colonoscopy rate for patients 50 and older, by screening 75% of patients.

Colon Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

ONCOLOGY METRIC Number of SMHC Cases Submitted CoC Required Performance Rate SMHC Performance Rate
At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. (Quality Improvement) 11 85% 100%
Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III, or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC stage III (node positive) colon cancer. (Surveillance) 2 85% 100%

SMHC Lung Cancer Screening and Outcomes

Lung Cancer Screening 

Annual CAT scans, or LDCT screenings, are recommended for people at high risk of lung cancer. This includes people who meet all three criteria:

  • Between 55 and 80 years old
  • Who currently smoke or quit smoking in the last 15 years, and
  • Have a history of smoking at least one pack a day for 30 years, or two packs a day for 15 years.

Lung Cancer Outcomes

SMHC exceeded the Commission on Cancer’s (CoC) required performance expectations for the most recent reporting period.

ONCOLOGY METRIC Number of SMHC Cases Submitted CoC Required Performance Rate SMHC Performance Rate
Radiation is administered within 1 year (365 days) of diagnosis for women under age of 70 receiving breast conserving surgery for breast cancer. (Accountability)
1 85% 100%

What is a 30-Pack Year?

Number of Packs Smoked Daily How Long
1
30 years
1.5 20 years
2 15 years
3 10 years

SMHC Genetics - Cutting Edges Becomes Standard of Care

Improving Access to Genetic Counseling in Oncology at SMHC 

Genetic testing has become an integral part of cancer care. Over the last few years, Southern Maine Health Care and Maine Medical Center has made it a priority to create access to genetic services in the same clinics where they are receiving their cancer care. With a limited number of genetic counselors in the state of Maine, some patients have to travel long distances to receive in-person genetic counseling and wait times for appointments can be several months. At SMHC, a genetic counseling is available in Biddeford and Sanford locations and patients can have access to this service at a location convenient to them. Wait times are also reduced by having a genetic counselor dedicated to SMHC patients only at two days a week with available slots for urgent appointments are available to meet the patient’s needs.

A genetic counselor is a health care provider with advanced training in human genetics and counseling. When working with patients, they gather detailed personal and family history, provide risk assessment and education to the patients, explain genetic testing options and possible impact of genetic testing results, and provide support to patients and their families for the emotional and psychological impact of genetic information. Within oncology at SMHC, patients are screened for red flags for hereditary risk for cancer. Partnering closely with the Nurse Navigators, a patient’s personal and family history is assessed and a referral for genetic counseling is initiated when indicated. This partnership in screening patients and facilitating referrals is critical in increasing access to genetic services and improving patient care. From January through August of 2019 almost 200 patients were screened by the Nurse Navigators for indications for genetics. A genetic counselor also attends SMHC Oncology and Breast Cancer tumor conferences as another opportunity to screen patients for referral and to share in the multi-disciplinary discussion regarding the management of oncology patients. Referral indications for genetic counselling and genetic testing have established by many professional organizations including the National Comprehensive Cancer Network (NCCN). In addition, the Cancer Risk and Prevention Program provides referral guidelines supported by the MaineHealth Cancer Care Network which are available here.

In the last year, accessed from October of 2018 through September of 2019, 104 patients were seen by the genetic counselor at Southern Maine Health Care with 55% of those patients seen in Biddeford and 45% in Sanford. After a comprehensive genetic counseling appointment, patients are able to make an informed decision about pursing genetic testing. Of the patients seen at SMHC, 76% decided to undergo genetic testing. Integration of genetics screening and collaboration with Nurse Navigator, Helene Langley RN, BS, CBCN, CN-BN, ONN-CG, has been very successful with SMHC Center for Breast Care over the last few years. Of the patients seen by a genetic counselor, 65% of those patients were referred from the breast cancer team, making this the highest volume of patients seen for genetic counseling.

A recent update in recommendation form the American Society of Breast Surgeons (Consensus Guideline on Genetic Testing for Hereditary Breast Cancer; approved Feb 10, 2019) states that “Genetic testing should be made available to all patients with a personal history of breast cancer.” This has been a shift from pervious, criteria-based approaches to referral and indication for genetic testing. This opens the door to exploring a new way of discussion about genetic testing options with patients with breast cancer and gives an opportunity for providers to engage their patients in shared decision making about whether or not to pursuing genetic risk assessment. Based on hospital analytics for new breast cancers diagnosed at SMHC in 2018, it can be extrapolated that approximately 62% of all breast cancer patients were referred for genetic counseling. In our practice, of those patient’s referred from the SMHC Breast Center 78% decided to undergo genetic testing after their genetic counseling visit.

The impact of genetic testing results on a patient’s care plan can be seen in many ways. For mutations in high-risk breast cancer genes, such as the BRCA1 and BRCA2 genes, there is an increased risk for a second primary breast cancer leading to discussion of management options of remaining healthy breast tissue including high risk surveillance after surgery or a prophylactic surgery to remove the at risk tissue. The BRCA1 and BRCA2 genes also carry risk for ovarian, fallopian tube, and primary peritoneal cancers leading to a recommendation for a risk-reducing salpingo-oophorectomy (RRSO). Often thought to be a management recommendation separate from breast treatment, this could become relevant if a patient’s systemic therapy for breast cancer would involve ovarian suppression and discussion of suppression versus RRSO could be considered. Other genes may increase a patient’s sensitivity to ionizing radiation, in which case consideration of management options and possible avoidance of therapeutic radiation could be explored. Numerous clinical trials have been opened for systemic therapy based on germline mutations in many of the genes included on genetic testing panels for cancer risk and a patient’s genetic testing may inform their eligibility for such trials.  Beyond the patient, genetic testing impact their family members who very often make up part of the community we serve at SMHC. When a mutation for hereditary cancer risk is identified, at-risk family members can undergo genetic testing to determine their status and better understand their risk. Those who share the same hereditary risk for cancer can be followed with high risk management considerations with the goal of early detection and possibly risk-reduction. This cascade approach to testing hopes to reduce cancer rates and save the lives of those facing a higher risk for certain cancers.

The integration with genetic risk assessment and testing within the patient’s with breast cancer at SMHC has set a strong example of how other cancer sites can be served by genetic counseling. Future goals are to continue to bring this expert care to patients at SMHC and increase access to this care across the Oncology teams. This increase in access means more patients are getting the most cutting edge information about their cancer risk and management, more patients are being assessed for new advancements in personalized medicine and therapies, and we can help reduce additional cancer risks for our patients and their families, all while keeping that care close to home.

 

2020 MaineHealth Oncology Outcomes & Innovation Report

Treating cancer is a battle, but MaineHealth is a relentless partner in fighting it. View our 2020 report to learn more about our key achievements, outcomes and innovations in cancer care.

Clinical Trials

The MaineHealth Cancer Care Network has been awarded a six year, $5.1 Million award from the National Cancer Institute (NCI) which will expand cancer research in the state of Maine. Click to learn more about our clinical trials program.
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