Cancer Center at Douglas County Hospital

2015 AnnualOncology Report

Based on 2014 Data

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Douglas County Hospital OncologyAnnual ReportCancer touches many lives. The Cancer Treatment Team at Douglas County Hospital takes pride in serving the needs of the community and surrounding areas by addressing each patient with a full spectrum of care to meet the highest standards available. Douglas County Hospital’s Oncology Center stands as a model of excellence in cancer care within our community, our dedication to quality is demonstrated by maintaining our accreditation status with the Commission on Cancer.

The focus of this year’s annual report is the care and treatment provided for patients with lung cancer. Lung cancer continues to be a predominant cause of cancer-related mortality for both men and women in the U.S. It is estimated that approximately 220,000 Americans will be diagnosed with lung cancer in 2015 with mortality afflicting approximately 160,000 patients; this accounts for about 27% of all cancer deaths. Although the survival rate of advanced lung cancer remains low, with early detection, the survival rate is 60% and more than 430,000 people are survivors today. Lung cancer screening is an important tool for early detection and treatment.

On behalf of the DCH Cancer Committee, we encourage you to review our annual report which displays our dedication to the patients and the community we serve as well as provides meaningful and helpful information.

Thank youThe Douglas County Hospital Cancer Committee

Inside this reportWelcome ........................................................ 1

Hallmarks of Success ................................. 2

DCH Pride ...................................................... 3

Cancer Center Care Team .......................16

Cancer Services ............................................ 4

Quality/Outcomes .....................................12

Patient Story .................................................. 8

Focus on Lung Cancer ............................... 6

Professional Education/Community Outreach ......................................................... 7

Keeping you well for generations.

Commission on Cancer (CoC): The CoC was established by the American College of Surgeons in 1922, with an aim to improve survival and quality of life for cancer patients and their families. This is achieved through setting standards, prevention, research, education, support, navigation, and monitoring quality of care. DCH achieved its first accreditation with the CoC in 2011 with an Outstanding

Achievement Award (OAA) recognizing the efforts to meet and exceed the CoC expectations. In July 2014 DCH underwent the re-accreditation process and again achieved full CoC accreditation for three years.

Other Accreditation: DCH is a community-based hospital located in West Central Minnesota, accredited by the

Douglas County Hospital Cancer Center The DCH Cancer Center strives to provide personal care and treatment that encompasses both the physical and emotional needs of the patient and family. A wide range of patient-centered cancer care may include: medical oncology (chemotherapy), radiation oncology, diagnostic and interventional radiology, surgery, consultation, navigating the cancer experience, survivorship care planning and supportive services.

Healthcare Facilities Accreditation Program (HFAP). HFAP was founded by the American Osteopathic Association (AOA) and is nationally recognized by the federal government, state governments, insurance carriers and managed care organizations.

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Hallmarks of Success

DCH Pride:• American Osteopathic Association Laboratory Accreditation (Received July 2014)

• Alexandria Clinic earned the distinction of becoming a Minnesota Department of Health Certified Health Care Home in November of 2014.

• Certificate of Participation: Douglas County Hospital was recognized for participation with the MHA Partnership for Patients Hospital Engagement Network. December 2011 to December 2014.

• Douglas County Hospital is FluSafe. 82% of staff were vaccinated against influenza for the 2013 – 2014 season (Received August 2014)

• Received designation from MDH for being an “Acute Stroke Ready Hospital”. Designation period is January 1, 2015 to December 31, 2017

• Team STEPPS Training: All staff and providers completed training. (November 2015). Team STEPPS is an evidence based teamwork system designed for healthcare professionals to improve patient safety, teamwork skills and communication.

Douglas County Hospital Cancer CommitteeThe DCH Cancer Committee is a multidisciplinary committee which provides leadership to maintain quality cancer care to patients and their families. The Cancer Committee works in conjunction with a sub-committee to establish and implement annual goals, improvements and ensures compliance with CoC accreditation standards and evidence-based best practice.

DCH 2014 Cancer CommitteeMarion Raflores, M.D. Medical Oncologist, Cancer Liaison Physician, Cancer Committee ChairpersonMandy Larum, RHIT, CTR Cancer Program Administrator, Cancer Registry Quality Coordinator Bonnie Freudenberg, RN, CPHQ Quality Improvement CoordinatorJacqueline Nicolay, CTR Cancer Conference Coordinator, Cancer RegistrarKelly Helmbrecht, LSW Psychosocial Services CoordinatorSteve Luchau, RN Clinical Research Coordinator

Other MembersGary Paulson, M.D. General SurgeryMark Spanbauer, M.D. PathologyJonathan Dehart, M.D. PathologyRamon De Guzman, M.D. RadiologySteven Ferguson, M.D. Family PracticeKathy Fredin, RN, OCN Oncology Clinical Nurse ManagerJason Peterson, RTT Radiation Oncology ManagerDavid Gray, RPh Director of PharmacyMargaret Kalina, RN, PhD Chief Nursing OfficerCarl Vaagenes, CEO Douglas County Hospital AdministratorRoberta Strom, RD, LD DieticianSue Quist, RN Hospice and Palliative Care of Douglas CountyBarbara Schneider, RN Associate Director of NursingPamela Mason American Cancer Society Representative

Cancer CenterCare Team

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Meet Our OncologistsMarion B. Raflores, MD, Oncologist & Hematologist Sanford Health Broadway Clinic

Marion B. Raflores, MD received her bachelor and medical degree from the University of the Philippines. She completed her Internal Medicine and Hematology Oncology fellowship at the Western Pennsylvania Hospital/Allegheny General Hospital in Pittsburgh, PA. She is board certified in Medical Oncology and Hematology. She treats adults with cancer, bleeding and clotting disorders, and other hematological problems. She is married with two children and enjoys traveling, snorkeling, and swimming.

Wade Swenson, MD, Hematology and Medical Oncology

Internal Medicine

Originally from Moorhead, Dr. Swenson received his BA in Chemistry at Minnesota State University in Moorhead. He received his Doctor of Medicine from the University of North Dakota in Grand Forks.Dr. Swenson completed his internship and residency in Internal Medicine at the University of Iowa in Iowa City. He completed his fellowship in Hematology and Medical Oncology at the University of Iowa, where he also received a Master’s Degree in Public Health specializing in Epidemiology. Certified by the American Board of Internal Medicine, Dr. Swenson is a member of the American Society of Clinical Oncology and the American Society of Hematology. Dr. Swenson and his wife, Lisa, have two children.

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The Cancer Services at Douglas County Hospital

Medical OncologyThe medical oncology unit features:

A variety of diagnostic and interventional radiology studies are available at the Alexandria Center for Diagnostic Imaging (ACDI) which is located at the Douglas County Hospital. The following advanced imaging services are available:

CDI Imaging Services

• High Field 1.5T MRI (Magnetic Resonance Imaging) – ACR Accredited. Services include Neuro, Spine, Orthopedic, Body, Breast, and Prostate Scans.

• 64 slice CT (Computed Tomography) – ACR Accredited. Some of our CT services offered include Neuro, Spine, Body, Cardiac, Orthopedic and Biopsy procedures.

• Nuclear Medicine – ACR Accredited. Including Cardiac, Bone, Lymphangiography and Thyroid.

• PET/CT (Positron Emission Tomography/Computed Tomography) – ACR Accredited. PET/CT can be used to assist your physician with initial staging and restaging of certain types of cancer.

• Ultrasound – ACR Accredited.

Some ultrasound services include Body, Breast, Vascular, Biopsy procedures, Paracentesis and Thoracentesis.

• Digital Mammography ACR Accredited.

• Stereotactic Breast Biopsy

• X-Ray

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CentraCare Radiation Oncology at Douglas County Hospital is a collaborative relationship between CentraCare Health System-Melrose and Douglas County Hospital. Our professionals are committed to providing patients with personal care and treatment.

CentraCare Radiation Oncology uses leading edge cancer treatment planning and technology:• Varian iX Linear Accelerator – Delivers dual energy photon and electron

therapy. The accelerator has the capability to preform 3-D conformal imaging, intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT).

• Philips Brilliance Computed Tomography (CT) Simulator – Delivers multi-slice imaging that enables retrospective respiratory gating with added treatment planning accuracy and capability.

• Philips Pinnacle Treatment Planning System. • MIM Maestro Planning Software.

Radiation Oncology

• Eleven private, comfortable, individual treatment areas

• Oncology-Certified Nursing Staff• Nutritional Counseling• Navigation and Survivorship

Services• Individual Patient and

Family Education

• Rehabilitation Services • Onsite Laboratory Services• Psychosocial Support and Services• Access to Research Programs• Referrals for Clinical Trials • Referrals for Other Services

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Treating the Whole Patient

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Supportive services expand our care to encompass more than just the physical needs of our patients.

Rehabilitation ServicesThere are a variety of rehabilitation services available on site. These services are directed to maintaining function and mobility, reducing pain, and assisting the individual to return to previous level of functioning and independence.

The following rehabilitation services are available:• Physical Therapy• Occupational Therapy Palliative CarePalliative Care can be offered simultaneously with life prolonging curative therapies for patients living with serious illness. Palliative Care guides patients and their families as they journey through the changing goals of care and assists in better understanding of treatment options. Palliative care nurse visits are not direct-care skilled nurse services, but rather focus on assessment, information, referral, and teaching.

Hospice is a special way of caring for people with terminal illnesses. It is not about giving up hope but rather about choosing quality of life while letting go of treatments that are no longer helpful. Hospice care focuses on relieving suffering and achieving the best possible quality of life for patients and families. Hospice of Douglas County and other hospice agencies provides care wherever a patient calls home:

• Managing pain and symptoms so each day can be lived to its fullest. • Involving patients and their families in their decision to maintain independence and dignity. • Addressing physical, emotional, social and spiritual needs.

PathologyThe pathologists assist the cancer team by diagnosing the presence of a neoplasm and classifying tumor type. Important characteristics such as tumor grade and extension are described, as is the adequacy of the surgical resection from the relevant tissue margins. Occasionally, in follow-up specimens, the response to previous therapy is also assessed.

Over half of lung adenocarcinomas contain one of a number of identifiable genetic alterations. The laboratory can perform specialized testing of specific gene loci, to assist the oncologist in determining appropriate targets for specific therapeutic inhibitors. This information may also be useful for enrollment in appropriate clinical trials.

Social ServicesRecognizing that Cancer affects the whole person, supportive services are provided on-site or coordinated with local agencies and facilities to our patients and their families.

Licensed Social Workers/Discharge Planners are part of the Multidisciplinary Cancer Center Care Team. They assess the patient’s coping skills, support systems and family dynamics. They assist & arrange for appropriate discharges, whether to home with services, hospice or another facility along with educating patients and their families on community resources available to them.

By connecting with Licensed Social Workers patients can better understand their own needs and the resources available to support quality of life. Community resources that may be available to them include but not limited to:

• Home Health Services• Financial Resources• Meals on Wheels• Durable Medical Equipment • Transportation Needs

• Speech Therapy• Lymphedema Program

• Health Care Directives• Psychosocial Needs• Nursing Home Placement• Hospice and Palliative Care Services

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Established in 1998, the Cancer Registry at Douglas County Hospital is an essential component of the Cancer Program. The Cancer Registry provides support for cancer program development, works to ensure compliance with regulatory reporting requirements/standards and serves as a resource for statistical cancer information. The Registry also coordinates the Commission on Cancer

2014 Cancer Data Summary During 2014, a total of 298 analytic cases were accessioned into the registry database. Analytic cases are patients whose cancers have been diagnosed and/or received first-course treatment at DCH.

(CoC) accreditation process and ensures that Douglas County Hospital meets or exceeds all CoC Program Standards. In addition to the primary functions of collecting relevant data on each cancer patient and conducting lifetime follow up, the Cancer Registry is involved in the managing and analyzing of cancer data. This clinical information is collected and analyzed for the purpose of education, research, quality of care

and outcomes measurement. Cancer data is submitted to the Minnesota Cancer Surveillance System (MCSS) and the American College of Surgeons (ACoS) Commission on Cancer’s (CoC) National Cancer Data Base so it can be used as a clinical surveillance mechanism to review patterns of care, outcomes and survival, with the ultimate goals of preventing and treating cancer effectively.

2014 Site Incidence of Top Five Cancers: Compared to total number of cases diagnosedThe top 5 cancer sites were Breast, Prostate, Colorectal, Lung and Bladder. Compared with state and national data, our incidences of colon and breast cancers at DCH are much higher than state and national averages. Likewise, lung cancer incidence is lower at DCH in comparison to state and national averages.

Site DCH Minnesota* Nationwide*

Breast (Female) 20.3% 13.0% 14.0%

Prostate 12.8% 13.2% 14.0%

Colorectal 15.9% 7.6 8.2%

Lung 7.4% 10.5% 13.5%

Bladder 6.8% 4.2% 4.5%

* MN & National statistics from ACS Facts & Figures (estimated new cases for 2014)

2014 Douglas County Hospital

Cancer Registry

Digestive 66 34 32Esophagus 3 3 0Stomach 4 2 2Colon 29 14 15Rectum 18 9 9Anus/Anal Canal 0 0 0Liver 0 0 0Pancreas 7 4 3Other 4 1 3

2014 Site Incidence Data – DCH Total Male Female

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Oral Cavity 9 9 0Lip 0 0 0Tongue 3 3 0Oropharynx 2 2 0Hypopharynx 2 2 0Other 2 2 0

Respiratory 23 13 10Nasal/Sinus 0 0 0Larynx 1 0 1Lung/Bronchus 22 13 9Other 0 0 0

Blood & Bone Marrow 18 11 7Leukemia 11 6 6Multiple Myeloma 3 3 0Other 4 2 2

Bone, Connective Tissue, Skin 11 6 5Connective, subcutaneous and other 1 1 0Bone 0 0 0Skin (excluding basal and squamous cell carcinoma) 10 5 5

Female Genital 16 0 16Cervix Uteri 4 0 4Corpus Uteri 5 0 5Ovary 6 0 6Vulva 1 0 1Other female genital 0 1 0

Breast 60 0 60Male Genital 40 40 0

Prostate 38 38 0Testis 0 0 0Other male genital 2 2 0

Urinary 28 25 3Bladder 20 19 1Kidney/Renal 5 4 1Other 3 2 1

Brain & CNS 5 1 4Brain (Benign) 0 0 0Brain (Malignant) 2 0 2Other 2 0 2

Lymphatic System 13 4 9Hodgkin’s Disease 3 1 2Non-Hodgkin’s 10 3 7

Endocrine 6 0 6Thyroid 6 0 6Other 0 0 0

Unknown Primary 3 2 1Other/Ill-Defined 0 0 0Total 298 145 153

Patient Satisfaction Douglas County Hospital’s Cancer Center staff and physicians value the patients experience of care and overall satisfaction with the services provided by the Oncology Team. To measure cancer program satisfaction, patients are surveyed six months after their initial visit. The goal is to meet or exceed the minimum standard of 90% in all survey areas. • 51 patients completed the survey. The highest

rating was achieved in 6 out of 7 categories

Studies of Quality Each year the Cancer Committee chooses studies to perform to measure our quality and/or outcomes of our patients with cancer. In 2014 the Cancer Committee wanted to take a closer look at hospice service utilization at the local level, we partnered with Hospice of Douglas County to complete the study. The Cancer Committee looked at the average number of day’s hospice cancer patients utilize hospice services before passing away. The data showed in 2012 the average length of stay for cancer patients on Hospice of Douglas County was 50.5 days; compared to the national average of 71.8 days for patients.

(Based upon 2012 data from Hospice and Palliative Care of Douglas County, compared to National Hospice and Palliative Care Organization study.)

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Cancer Program Practice Profile Reports (CP3R) for Lung Cancers Diagnosed 2013 The Cancer Program Practice Profile Report (CP3R) offers local providers and clinicians’ comparative information to assess adherence to and consideration of standard of care therapies for major cancers. This reporting tool provides a platform from which to promote continuous practice improvement to increase the quality of patient care at the local level and also permits hospitals to compare their care for these patient populations relative to that of other providers. The estimated performance rates for lung cancer in 2013 shown below provide our cancer program with an estimate of the proportion of patients concordant with measure criteria.

Rapid Quality Reporting Systems (RQRS) Monitoring adherence to quality cancer measures in real time. In order to facilitate quality improvements that will have the ability to encourage evidence-based care in a timely manner, the CoC has developed a mechanism called the Rapid Quality Reporting System (RQRS). RQRS enables accredited cancer programs to report data on patients concurrently to provide hospitals notification of treatment expectations, and show a hospital its year-to-date concordance rate relative to the state and national levels. The primary objective of RQRS is to promote evidence-based cancer care at the local level.

Lung At least 10 regional lymph nodes are removed and pathologically examined for AJCC Stage IA, IB, IIA, and IIB resected NSCLC 100%

Lung Surgery is not the first course of treatment for cN2, M0 lung cases 100%

2014 Douglas County Hospital

Cancer Registry

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Estimated Performance Rate

2013Lung Measures

Breast Measures

Colon Measures

2014 Cancer Center Survey Results

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Treating the Whole Patient

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Monitoring Compliance with Evidence Based Guidelines: Yearly, our Cancer Committee, headed by a physician monitors the hospitals compliance with the use of evidence based guidelines in the treatment of cancer patients. This year, we focused on three separate areas to ensure compliance. Firstly we looked at the use of imaging prior to third cycle of chemotherapy to assess response in Stage IV Non-Small Cell Lung Cancer. Then we focused on the inappropriate use of bevacizumab in Squamous Non-Small Cell Lung Cancer. Finally we looked at cases with treatment of Platinum Combination chemotherapy as first line treatment in Stage IV Non-Small Cell Lung Cancer without EGFR mutation. Retrospective chart review was completed on all analytic cases for Stage IV Non-Small Cell Lung Cancer treated by the two Medical Oncologists at DCH from 1/1/2012 to 1/6/2015. 93% of patients received platinum combination chemotherapy as first line treatment in Stage IV Non-Small Cell Lung Cancer without EGFR mutation. 91% had imaging done prior to 3rd cycle of chemotherapy to assess response. No patients inappropriately received bevacizumab.

Patient Navigation and Survivorship: Based on the 2015 Douglas County Hospital Cancer Center Community Needs Assessment the Cancer Committee determined that financial disparities are prevalent in our community and the surrounding counties. Based on the needs assessment, we implemented a patient navigation program that focuses on newly diagnosed Lung Cancer Patients to address each patients individual needs related to the financial impact of diagnostic, treatment and follow-up care with Lung Cancer; this program is a collaboration between patients, providers, nursing, social services and the business office to provide a patient centered approach to care and financial planning.

At the same time the Cancer Committee oversaw the process for implementing Survivorship Care Plans being delivered to breast cancer patients at the 5 year survivor mark. These Care Plans summarize the diagnosis, treatment and future follow-up each survivor can use to continue to guide them on their journey of survivorship.

Quality ImprovementBased on the findings from the Cancer Committees study on hospice service utilization the Cancer Committee promoted the utilization of hospice services and increased the number of timely and appropriate referrals through education to clinical and medical staff at Douglas County Hospital. Douglas County Hospital presented 2 offerings of the in-services partnering with the Targeting Resource Use Effectively (TRUE) Hospice Utilization Improvement Project on the topic of “End of Life Conversations.” Hospice of Douglas County also presented Optimizing End of Life Care for Breast Cancer Patients during the Breast Cancer Symposium in 2014.

Psychosocial ScreeningTo help meet the psychological, social and financial complexities experienced by patients, and to provide the highest quality cancer care, a psychosocial distress screening needs assessment was completed in 2013. This screening evaluates patient distress that can interfere with treatment plans or adversely affect a patient’s outcome. Psychosocial distress should be recognized, monitored and treated promptly. The initial needs assessment in 2013 is the framework for systematic follow-up and reevaluation.

Like so many of us from central Minnesota, Linda Ferley is a small town cliché. She grew up on the family farm just outside Bertha, MN, where it was faster for her and her three siblings to walk to school rather than ride the bus. She married her high school sweetheart at the tender age of 19 and began a family of her own. What is not cliché about Linda is her tough as nails attitude and warrior spirit. It is that spirit that serves as an inspiration to others and a beacon for those with waning hope.

Linda was married to Blayne, her longtime boyfriend, after a year of higher education at Wadena Technical College. They wasted little time starting a family and oh what a family they had. The thought of raising five children makes most people tired just thinking about it, but adding a child born with Spina Bifida amplifies everything. Their fourth child and only son, Mark, was born with this acute condition.

Doctors were not giving Mark favorable odds but that did not keep Linda from having faith that he would make it. Faith enough to bring Mark home from Children’s Hospital Minneapolis in a dresser drawer lined with blankets. After two months of caring for her baby who had an exposed spinal cord, the doctors at the University of Minnesota were shocked to see this little man thriving, rare for Spina Bifida babies. They actually told her Mark was putting on too much weight before a planned surgery to aide in Mark’s Spina Bifida. After it was all said and done, the surgery was a success and Mark returned home to be with his parents and three older sisters. They also had one more daughter just to round out their brood. All of their children, spouses and grandchildren, remain a close-knit group. There’s Tammy and Darren Gorder (seven children), Theresa and Ryan Boettcher (four children), Jodi and Clint Gray (two children), Mark Ferley, and Jennifer and Josh Hinrichs (three children). The definition of ‘close-knit’

is put to the test around the holidays when 25 people and a few dogs stay at Linda and Blayne’s two-bedroom, two-bath home in Parkers Prairie. If you are claustrophobic, it would be wise to get to the house early to claim the vacant bedroom, or else you will be sleeping in the ‘barracks’ downstairs.

Linda’s faith and fighter’s attitude were put to the test once again in May, 2012. Linda had noticed that she had been losing weight at a faster rate than normal. She was a smoker at the time, and had been since she was 17 years old. One day at work, Linda collapsed and was taken to Douglas County Hospital via ambulance. They initially found that Linda had a blood clot in her leg, which had made its way to her lung. She was put on Coumadin and that was the beginning of her week-long stay in the hospital.

In June, Linda still was not gaining weight and recovering like she should. She ended up going to St. Cloud Hospital where she had a chest x-ray and biopsy. Linda was diagnosed with stage 3, non-small cell lung cancer. She made the decision to fight it at the Douglas County Hospital Oncology Center under the care of Dr. Marion Raflores and Dr. David Pence.

Unfortunately, this was not Linda’s first experience with cancer in her family. Linda’s mother passed away from breast cancer at 45. Linda’s sister was diagnosed with breast cancer in 2009 and had a double mastectomy. Most recently, Linda’s brother passed away from lung cancer in June of 2015. Linda knew what she was in for. She anticipated the struggles with chemotherapy, radiation therapy, and the delicate balance of medications needed to treat her.

When Linda started chemotherapy, she was nervous. Her weight had fallen to 117 pounds and she was unsure how she was going to handle the expected weight loss that chemo so often carries. Linda amazingly gained 30 pounds while receiving her six cycles of chemo and 16 radiation treatments. She responded so favorably to the treatments that she was cancer free for six months! At one of Linda’s routine scans, the cancer reared its ugly head again. This time, it had moved into Linda’s opposite lung, changing her cancer from stage 3 to stage 4, a much more serious diagnosis.

For Linda, there was no time for a pity party. It was time to get back in the ring and continue the fight. As is common with chemotherapy, the second round brought with it a new concoction of medications. This new chemo cocktail was not as agreeable as her first round. It knocked her down and it took some time to

Linda Ferley Patient Testimonial

Patient Story: Lung Cancer

“She recalls reciting The Lord’s Prayer, with one

sentence laying heavy on her mind - ‘thy will be done.’

That is where Linda finds solace, where she derives her

strength, and where she finds peace in the struggle.”

Thy Will Be Done.

▶ Reach to RecoveryReach to Recovery volunteers are specially trained individuals who are available to provide support and education from lung cancer diagnosis throughout the continuum of care for lung cancer. Patients are matched to volunteers based on similar lung experience, age, language or other important personal characteristics. A Reach to Recovery visit can be scheduled upon a request for a visit or by referral.

www.cancer.org/Treatment/SupportProgramsServices/reach-to-recovery

▶ Look Good Feel BetterLook Good Feel Better is a free service program for women with cancer to manage appearance related side effects from treatments such as chemotherapy, radiation or other forms of treatment and help restore their appearance and self-esteem through the use of makeup, wigs, scarves and other accessories. www.lookgoodfeelbetter.org

▶ Relay for LifeRelay for Life is not a race – it is a celebration and awareness raising event for cancer survivors. It is a wonderful source of inspiration for thousands of people year after year. Resourced by volunteers and supported by many community-minded businesses, Relay for Life unites the community in the fight against cancer. In 2015, Douglas County Hospital raised $14,818 and reached over 950 residents to increase educational efforts around lung health and early detection at the event. In total, $142,881 was raised at the 2015 Relay for Life of Douglas County in Alexandria. Dollars raised enable more cancer patients to receive programs, services and resources and increased health and wellness messaging in our local community.

www.relayforlife.org

A Community of Care

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balance the correct amount of steroids for her to function again. No matter how tough she felt, Linda remained grateful to have the strength and health to receive the treatments. For the next 18 months, she received maintenance chemotherapy.

In November of 2014, Linda’s regular scan indicated the cancer was once again growing, so another round of chemotherapy was prescribed. Through the extended chemotherapy treatments, newly introduced oral medications and prayer, the cancer continued to grow. In July of 2015, Dr. Raflores, in conjunction with other medical oncologists, decided Linda was a prime candidate for a new treatment, immunotherapy. Also known as biologic therapy, immunotherapy is a type of cancer treatment designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to improve, target, or restore immune system function. After four treatments, more improvement was found. This new immunotherapy appears to be working for Linda. While it isn’t as fast as traditional therapy, it appears to be working for her.

Linda still works five days a week at St. Williams Living Center in Parkers Prairie, the same place she has been employed for 27 years. She enjoys her work as a certified nurse’s assistant, and activity aide where she leads activities and monitors entertainment for residents. Linda is also an avid golfer, bowler, and grandmother who enjoys chasing the young family members around.

Linda feels fortunate that her cancer has not spread outside her lungs for the past four years. She counts this as one of her many blessings. Her children and grandchildren are also blessings, giving her 25 reasons to continue the fight of her life against this disease. Linda has the support and love of so many, including her family and friends, her co-workers, and healthcare providers. However, it is her faith in God that carries her through, she says. She recalls reciting The Lord’s Prayer, with one sentence laying heavy on her mind - ‘thy will be done.’ That is where Linda finds solace, where she derives her strength, and where she finds peace in the struggle.

Focus on Lung CancerEach year DCH makes an effort to raise awareness about one of the top five sites of cancer seen in our Cancer Center. In 2015, based upon DCH cancer registry data, DCH chose to highlight Lung Cancer. Our hope is to educate the community and reduce the incidence of a late-stage Lung Cancer diagnosis.

Is Lung Cancer Screening Right for You?Lung Cancer Screening: Douglas County Hospital offered the Lung Cancer Screening Tool developed internally based on NCCN guidelines for low-dose CT lung cancer screening. This screening tool was offered during the Douglas County Relay for Life Event July 10, 2015 and again during the Women’s Showcase October 1, 2015. During those events staff offered a screening tool to determine if patients were candidates for the low dose CT exams. The materials and screening tool promoted a discussion within the community on screening options for Lung Cancer that are available to patients locally. The Cancer Committee felt this education was important in our community due to the elevated incidence level that our program sees of Stage IV Lung Cancer.

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• March 7 & 8, 2015 at the KXRA Radio Spring Home and Garden Show

• March 28, 2015 at the Life-Home-Health and Family Expositions in both Alexandria and Melrose

• April 11, 2015 at the Viking Plaza Mall Home, Garden and Health Show

• July 10, 2015 at the American Cancer Society Relay for Life Event

• August 20-23, 2015 at the Douglas County Fair

• October 1, 2015 at the Women’s Showcase

2015 Professional Education and Community Outreach Professional Education: Professional training is an essential component in DCH’s commitment to providing ongoing quality cancer care to individuals in our surrounding area reliant upon our Cancer Center for the best care. The DCH Cancer Program has a sub-committee who organizes annual professional educational events, based upon identified needs, targeting diagnoses, current treatment modalities and best practice guidelines related to Lung Cancer in 2015. The 2015 professional education event was held November 4th at Douglas County Hospital. The event was titled: Lung Cancer Symposium. The event educated staff and providers on the causes, symptoms and contributing risk factors of lung cancer as well as the staging and prognosis of lung cancer.

Community Outreach; Focus on Lung Cancer Education, Prevention and Screening: Community Outreach (education, prevention, and screening) is an essential component in our commitment to provide ongoing quality cancer care to our patients and the surrounding area. The Cancer Committee continually assesses and organizes educational events that address our community’s needs.

To promote lung cancer awareness in the community, and prevent late-stage lung cancer diagnosis, DCH organized the Cancer Program representatives attending various area activities in and around the community in 2015. The focus at these events included providing educational materials, encouraging screenings and promotion of creating a tobacco free community. DCH partnered with Horizon Tobacco-Free Communities funded by the Minnesota Department of Health to promote a healthier community.

DCH was present at the following community events promoting the Cancer Center and the Lung Cancer Education:

How does CT lung cancer screening work?• Your doctor or other qualified provider must evaluate you and provide a

referral for lung cancer screening. We encourage you to check with your insurance provider before having the CT scan.

• Lung cancer screening exam is done using a CT scan (computed tomography).• A CT is a painless exam that can find even the tiniest of lung nodules long

before they cause symptoms.

If you have a referral from your provider you may schedule your screening by calling: 320-762-6040.

Learn more at myCDI.com/LungCancerScreening

* Pack years means: (number of packs smoked per day) x (number of years smoked). For example, a person who smoked two packs of cigarettes per day for 20 years has a history of 40 pack years of smoking. This person would be eligible for lung cancer screening.

Is Lung Cancer Screening Right for You?More people in the U.S. die from lung cancer than any other type of cancer. This is due to the fact that most people discover lung cancer too late. Now there’s an exam that can help detect lung cancer at its earliest stage, when it’s most treatable. At Alexandria Center for Diagnostic Imaging (CDI), a service of Douglas County Hospital, we offer a broad range of medical imaging and related services, including CT lung cancer screenings. Most insurers and Medicare will cover the cost of a lung cancer screening exam as long as you meet the eligibility criteria.

Who can have the screening?You may be eligible if you:• Are 55-80 years old• Are a current smoker• Are a former smoker who has quit in the past 15 years • Have a history of at least 30 pack years* of smoking• Currently do not have signs or symptoms of lung cancer • You may also qualify if you are a non-smoker who has had occupational

exposure to environmental hazards such as asbestos.

Creating Tobacco-Free Communities Horizon Tobacco-Free Communities is a project funded by the Minnesota Department of Health, which started in 2013. The goal of the project is to reduce the use of tobacco products in West Central Minnesota and reduce youth access to tobacco products. Horizon’s Tobacco-Free Communities builds on the momentum of proven strategies to help people quit using tobacco, reducing harmful second-hand exposure and making tobacco products less enticing for youth.

No level of tobacco exposure is safe. Every year, 5,900 Minnesotans die as a result of direct tobacco use. Tobacco exposure kills more than 400 infants and 41,000 adult nonsmokers every year and many more suffer from tobacco-related illnesses. Horizon Tobacco Free Communities works to help protect children and adult nonsmokers from secondhand smoke in the places they live, visit and work by using proven methods to eliminate smoking.

Significant reductions in tobacco use and exposure have occurred since the inception of Horizon Tobacco-Free Communities. Some of the outstanding measures of success are: more than 400 residents in 16 buildings now can breathe easy with comprehensive smoke-free policies, 5 municipalities have strengthened their tobacco ordinances to toughen penalties to those who sell to minors and more than 40 retailers have been trained to prevent the sale of tobacco to minors.

Horizon TFC also worked to educate more than 100 students in 4 different schools to be leaders in tobacco prevention. These student-based coalitions worked in their schools and communities to raise awareness of the dangers of tobacco, electronic cigarettes and flavored products. More than 4,000 students and staff have been reached by this targeted tobacco-free information.By building on what has already been accomplished, Horizon TFC will strive to continue to reduce and prevent the harms of tobacco and give individuals the knowledge, incentive and tools to live healthier lives.

111 17th Avenue East - Alexandria, MN 56308 | www.dchospital.com | 320-762-1511

Thank You. The Cancer Center staff at Douglas County Hospital understands that your cancer experience is unique. Our staff is here to guide you and your family through your cancer journey. Your cancer treatment may include medical oncology (chemotherapy), radiation oncology, diagnostic and interventional radiology, surgery, and possibly consulting or supportive services.

Our Mission is to provide quality health care to meet the needs of our customers and demonstrate our commitment to excellence.