Cancer Liaison Meeting - 12-13-00

Attendance:

Jon M. Greif, DO, FACS	State Chair	Kaiser Permanente Medical Center
Robert Barone, MD, FACS	Liaison	Sharp Memorial Hospital
Michael Bouvet, MD, FACS	Liaison	VA Medical Center
David W. Easter, MD, FACS	Liaison	UCSD Medical Center
Bernard D. Morris, MD, FACS	Liaison	Scripps Memorial Hospital
Lisa Orloff, MD, FACS	President	San Diego Chapter ACS
Jeff Rosenburg, MD, FACS	Councilor	San Diego Chapter ACS
Anna Seydel, MD	Councilor	San Diego Chapter ACS
John R. Wilkinson, MD	Liaison	Alvarado Hospital Medical Center
Phillip Wise, MD, FACS	Liaison	Scripps Mercy Medical Center
Phillip G. Zentner, MD	Liaison	Sharp Chula Vista Medical Center
Selina Travers	Cancer Control Officer	American Cancer Society
Edna Delacruz, BS, CTR	Registrar	UCSD Medical Center
Lynne Early, RN, CETN	Enerostomal Therapist	Kaiser Permanente
Aaron P. Hanson, MSIV	Medical Student	Western University

1. The upcoming campaign of the American Cancer Society for Colorectal cancer screening was described by Dr. Greif and
    Ms. Travers.
        -It was brought up that family practitioners should especially be targeted in this campaign, as they will be responsible for
          seeing that the FOB cards are follow up on. They will also play an important role in selling the need for having FOB
          studies done.
        -Suggestions for the distribution of FOB screening cards to primary care physicians, and to patients were made.
        -It was suggested that each hospital have a booth or table set up in their entryways to advertise and distribute the cards.
2. The targets of this campaign were described as the major hospital systems in the area.
3. A concern was raised that with increased colorectal screening there will not be additional Treatment funds, and that some
    patients who don’t have Medicare and can’t afford medical insurance won’t have a venue for treatment, as was the case in
    the early detection of breast cancer programs running in the area.
4. It was suggested that various incentives should be brought to bear on physicians to increase the use of FOB cards including:
        - Having a colorectal screening stamp for all charts delinquent in colorectal screening, similar to what was done with
          mammos and vaccinations
        - Have bonuses for primary care physicians for high percentages of patients screened for colorectal CA
        - Having billing code available to primary care for colorectal screening
    It was suggested that the public needs to be targeted until they demand their colorectal screening as happened with breast
   CA screening. It was pointed out that once malpractice claims from patients become an issue physicians will change.
5. Liaisons were reminded of the fact that all pathologists are recommended to use the CAP system for pathologic reports in
   2001 and required to use it after 2001. Most in the room agreed that their hospital was abiding by this recommendation
   already.
6. It was presented that JCAHO now recognizes COC survey for meeting cancer requirements for a hospital. It was pointed
   out that because the COC survey is much more comprehensive, that this probably did not have much impact on COC
   approved hospitals.
7. Questions were raised regarding which form of staging is required for registering CA patients. A registrar attending pointed
   out that SEER, TNM, and EOD are required. It was pointed out that all registries are moving towards a nationally
   standardized database and reporting form. CAP is a national requirement all others are state and local.
8. The format of effective tumor boards was discussed.
        - Have more specialists by not subdividing the meetings into specialties such as GYN, or ENT
        - Making the cases proactive
        - Always hold them at the same place and time
        - Keep meetings to under an hour
        - Feed those attending
        - Make sure meetings are quality assurance approved. This makes the discussions non-discoverable.
        - It was brought up that the nondiscoverability of the meetings only cover the meetings itself, and discussions become
          discoverable if transferred into the patient’s record.
        - CMA credits help, also, with attendance.
        - Reviewing all new cancer cases can help discover “interesting” cases for Tumor Board discussion. But “mundane”
          cases are important, too.
9. The current recommendation that 2% of all CA patients be enrolled in clinical trials. This is going to be increased to
     possibly 10% in the near future.
10. It was suggested that a quarterly mailing be distributed to the CA liaisons re: updates, and studies.
11. It was suggested that the next meeting focus on the issue of Sentinel Lymph Node is not standard of care, and the studies
     underway to prove or disprove its validity.
12. It was recommended that someone from the American Cancer Society’s public relations department, such as Robin
     Brown, who could cover the event in local papers.
13. Next meeting will be scheduled for the 2nd Wednesday in April, 2001 (April 11, 2001, same time and location)
      and will focus on Sentinel Lymph Node Biopsy issues, and will feature one or more guests prominent in this
      area.

The meeting was adjourned at 08:00 12/13/00.