Cancer Registry - Assignment Example

Cancer registry The Sunshine Hospital in Marin County, California has 1220 employees and 698 multidisciplinary physicians, with renowned regionalcardiology and oncology programs. The Oncology program is JCAHO and URAC accrediated, with cancer research funding available from the NIH upto 2010. It is chaired by the chief Oncologist and the regular members include a diagnostic radiologist, a pathologist, an anaesthesiologist and various surgeons of different specialties, a lead oncology nurse and several Directors. This Committee establishes the direction in which the Oncology program will move, it evaluates the protocols and the quality of care available using both external and internal sources of data and puts forward recommendations that could help to bring about improvements to meet the required regulatory standards. Oncology Program Narrative Report: The total number of patients treated for cancer this year was 590, of which 268 were male and 249 were female. Lung and breast cancer reported the highest incidence of cancer; among the males the highest incidences were of lung and colon cancer, while among the females, the highest incidences were of breast and cervical cancer. The largest number of all cancer types occurs between the ages of 41 to 60, followed by the ages 61 to 75. During the diagnosis stage, 262 cancer cases were localized, while 230 were regional. In most instances, i.e., 49 cases, diagnosis was made by bronchoscopy, while 22 were made by percutaneous biopsy. There has been a steady rise in the number of lung cancer cases from 2001 to 2005, with the steepest rise occurring between 2003-4. The most common age when a lung cancer diagnosis has been made is between the ages of 65 to 74. The Oncology standards at this hospital are quite high, because the primary purpose of the Oncology Committee is to direct and evaluate the Oncology program and to suggest recommendations for improvement. The organization has received commendation by the Commission on Cancer, which is also the reason why it has received funding. The hospital specializes in lung cancer, but various other forms of cancer are also treated. Mr. Johannson, the CEO has set achievement of quality as one of the most important organizational goals, which has led to the achievement of awards and accreditation for the hospital. The head of the Oncology program is Nancy Turlick and she has been the prime mover behind implementing these quality of care standards and based upon the results the hospital has achieved, the standards of care at the hospital have been revised. Hospital data is carefully preserved and contains information on births, deaths, admissions, discharges, pharmacy and claims that have been made. This information is collected into various databases and a coding system is used to identify and collate specific elements of the data and use them as a basis for analysis and comparison. The data is used to assess the number of cases of various types of cancer against the clinical outcomes, as well as arrive at assessments of age and gender distribution of cases, progression or deterioration in outcomes over the years and similar assessments. Analysis of data: The total number of patients suffering from one form of cancer or the other was 590, of which there were more males, i.e, 268, as compared to 249 females. The distribution of cancers among the patients and the proportion of males to females are shown in the graphs below: This graph shows that the other kind of cancers appear to be the most prevalent and these are the unusual kinds of cancer that tend to affect only a few people. Of the common varieties of cancerr, it may be noted that the highest prevalences appear to be occuring in the case of lung, colon and breast cancer, with the former two being prevalent among males and the latter being common among females. The graph showing the stage at which the diagnosis has been made appears as follows: As may be noted, most cancers are detected when they are either localized or regional. The appearance of localized symptoms suggests that detection is being carried out at a fairly early stage, because when this is viewed concurrently with the number of cases detected in situ, it may be noted that the latter are relatively small. Detection at the in situ stage would mean that the cancer had progressed quite considerably and as a result, treatment options would be more limited. From the result however, a laerge number of cases have also been detected at the regional stage, which is somewhat more advanced than the appearance of localized symptoms. Thus, where the detection of cancer is concerned, it appears to be more or less evenly distributed between those that have bene detected at an early stage and those that have been detected at a much later stage. It may be possible to explain some of the other results which are set forth later in this report, i.e., the hiugh incidence of lunbg and berast cancer cases to a possible deficiency in early detection systems. Representation showing male versus female cancer patients: The graph above shows that more males as opposed to females are suffering from cancer, and this could be due to the high incidence of lung and colon cancers among men. The most striking feature that is immediately evident upon a general study of the number of cases is the large incidence of lung cancer cases among men and breast cancer cases among women. The following graph shows the high to low ratio of incidence of cases among the two genders. Men Women Lung cancer 67 10 Breast cancer 9 63 Bearing in mind that over a five year period ranging from 2001 to 2005, the number of cancer cases has been steadily increasing, except for a slight decline between 2002 to 2003, the results above indicate that the incidence of lung and breast cancer among the two sexes respectively has been increasing. This is also shown in the distribution of lung cancer cases over the five year period from 2001 to 2005, as depicted in the graph below: As evident from the graph, the number of lung cancer cases has been rising steadily, but the sharpest rise was posted from 2003 to 2004. The rise is less steep from 2004 to 2005, indicating that clinical outcomes may have improved slightly. As was discussed earlier, the stage at which the diagnosis of cancer was made was localized and regional in a large number of cases, showing a more or less even distribution between those detected early and those detected late. It is quite likely that Sunshine Hospital may need to look into methods to improve their detection techniques, so that more cancer cases are detected at an early stage, rather than later, because the prognosis for recovery would also be higher if the cancers could be detected earlier. The mode of diagnosis for cancer used most consistently is bronchoscopy, but percutaneous biopsy has also been used rather a lot. There may be a possibility that the use of the latter method may have contributed to quicker diagnosis and treatment, it may be worthwhile to examine data on use of diagnosis method versus outcomes for 2003 to 2004 as well, to see what was done differently between the two ensuing years. It may also be worthwhile to examine the extent to which the other diagnostic methods have been used as well. The data also suggests that the age groups between 55 to 64 and 65 to 74 might be the most vulnerable age groups. This significant finding may suggest that the Oncology program could examine methods to encourage males and females from these age groups to regularly come in for breast cancer checks through mammograms and similarly for lung cancer as well. Early detection is most helpful in a favourable prognosis for cancer, therefore mammograms may need to be promoted and used more frequently. Conclusions: The Oncology department at Sunshine Hospital has been receiving accreditation and funding due to its high quality of care standards and the fact that this has been made the goal of the oncology program. The regular data analyses which are made are targeted at identifying trends in the data as well as significant changes and correlations which could then be examined more closely in order to arrive at explanations and conclusions. It must therefore be observed that obviously, the Oncology program at Sunshine Hospital is very good in terms of achieving quality of care and it has also been achieving good clinical outcomes, which is why it has been receiving support from the Government in the form of accreditation and funding. The standards which have been set, i.e, quality of care, therefore appear to be step in the right direction. In terms of specific clinical outcomes, as demonstrated in the graph showing the incidence of lung cancer, there does not appear to be a significant improvement in terms of reduction in the number of cases, the reduction is only slight. Over a five year period, the variation in the number of cases has been from 2030 to 2080 and the figures have never dropped to the levels that existed in 2001. As a result, the hospital does not appear to be succeeding in terms of improving the cure rates, it may need to improve its diagnosis parameters or methods. It is also likely that there are other factors contributing to the increase, i..e., that more people who did not come forward earlier are now suddenly coming forward to be treated for cancer, having developed the symptoms. Thus, on the whole, it appears that a closer study of the data may be necessary to assess the actual performance of the hospital in respect of clinical outcomes. Read More