Baptist Cancer Institute
2012
CA N C ER P ROG RA M
Annual Report
Table of Contents 2
Cancer Committee Report
6
Tumor Registry Report
18 Tumor Review: Hodgkin’s Disease 24 Tumor Review: Soft Tissue Sarcomas 30 Quality Assurance 32 Clinical Research and Education 36 Distinguished Individual in Cancer Care 38 Philanthropy
Baptist Cancer Institute
2012 Annual Report
1 Baptist Cancer Institute (BCI) is affiliated with
Baptist Cancer Institute is one of the most
Baptist Health, the only locally governed,
active clinical research institutes in the state
faith-based health system in Northeast Florida.
of Florida, with open studies in breast cancer,
Baptist Health, a Magnet™ Health Care
lung cancer, gastrointestinal malignancies,
System honored for excellence in patient
lymphoma, leukemia, head and neck cancer
care, is comprised of Baptist Medical Center
and brain tumors. We work in collaboration
Jacksonville, Baptist Medical Center Beaches,
with physicians across the state and the
Baptist Medical Center Nassau, Baptist Medical
nation to conduct clinical trials that lead to
Center South, Wolfson Children’s Hospital and
improved diagnostic approaches, reductions
Baptist Clay Medical Campus.
in toxicities and new ways to fight these often devastating diseases.
Cancer Committee Report
Troy H. Guthrie Jr., MD, Cancer Committee Chairman
As the world progresses to electronic information, Baptist Medical Center and Baptist Cancer Institute (BCI) have followed suit. This year, 2011, will be the second year the Cancer Committee report will be exclusively online. The Baptist hospital systems – Baptist Jacksonville, Baptist South, Baptist Beaches, and Baptist Nassau – are now complete EMR hospitals. As chairman of the Cancer Committee, we will continue to follow the electronic medical record impetus and make this report both concise and informative. The Cancer program has continued to be healthy, offering a wide breadth of services and high-quality care for cancer patients in Northeast Florida and Southeast Georgia. Cutting-edge programs in neuro-oncology, breast care, and lung cancer treatment are active in offering a high level of care which translates into high satisfaction for patients. Baptist Health offers a wide variety of not only cancer treatments, but educational programs for both physicians and the public. At Baptist Jacksonville, palliative care offers a multi-step program for our cancer patients. Close communications with Hospice of Northeast Florida allows hospice to step in when more intensive care is
Baptist Cancer Institute
2012 Annual Report
3 to be offered by George Royal, PhD, and more recently, nutritional, physical therapy, and needed at the patient’s home. These programs allow
occupational therapy programs are offered
patients and their families to make every minute count
through our multi-disciplinary cancer program.
toward the highest quality of life. Clinical research programs continue to be extremely active at BCI,
The Cancer Committee at Baptist Medical
with research programs in breast cancer, lung cancer,
Center Jacksonville continues to meet
melanoma, neurological malignancies, prostate cancer,
quarterly to provide leadership direction and
hematological malignancies, and other solid tumors.
review of all aspects of the cancer program
Research studies are offered through the auspices of the
and services as mandated by the American
National Cancer Institute clinical study groups, as well as
College of Surgeons. At each meeting, the
pharmaceutical-sponsored industry trials.
activities of the tumor registry and current clinical research, as well as goals of the
Screening programs in breast cancer, colon cancer,
Cancer Committee, are reviewed.
prostate cancer, and skin cancers continue to expand, offering education to the public as well as active
Current leadership for the Cancer Committee
intervention. The genetic assessment program, under
includes:
the leadership of Melinda Fawbush, MSN, ARNP, remains extremely active concentrating primarily on breast cancer.
• Troy H. Guthrie, Jr., MD, Chairman, Cancer Committee;
• Mark Augspurger, MD, Liaison to the American Multi-disciplinary conferences in breast cancer
College of Surgeons; Patricia Woods, RN, BSN,
are offered weekly, lung cancer bi-weekly, and
OCN, Quality Improvement Coordinator;
neuro-oncology monthly. These programs are teleconferenced to satellite hospitals so that education can be received by physicians and health care staff in their own hospital. Psychosocial support continues
• Paul Oberdorfer, MD, Community Outreach Coordinator;
• Melissa McCarthan, RHT, CTR, Tumor Registrar; and • Jan Peer, CCRP, Research Coordinator.
At each meeting, the Cancer Committee reviews,
Other Baptist Cancer Institute activities include:
revises, and reapproves current program goals to
• Major conferences for oncology nurses • Prevention and community education programs • Continued participation in the American Cancer
determine whether they are being met and if they are aligned with the latest requirements of the American College of Surgeons. This Annual Report, as required by the American College of Surgeons, will include a prospective 4
and retrospective study of cancer disease sites, as well as assess the quality of data provided by the tumor registry. This year, Hodgkin’s disease and soft tissue sarcoma will be the areas of review. In 2011, more than 10 percent of all analytic cases were reviewed on a prospective basis by physician volunteers to ensure continued quality and timeliness of data entered into the Baptist Tumor Registry. In 2011, for the second time in a row, there was a drop in the number of cases accessed with the total number of analytic cases being 1,624 compared to 1,656 the previous year. The total number of analytic cases fell at Baptist South, likewise, from 533 cases to 458 analytic cases. The slight drop in analytic cases at Baptist Jacksonville appeared to be spread out among tumor sites. Currently, the Tumor Registry includes a total of 26,414 analytic cases accrued since 1990. In 2011, the cancer clinical research program included active participation in the National Surgical Adjuvant Breast and Bowel Project, Eastern Cooperative Oncology Group, Radiation Therapy Oncology Group, and Mayo Clinic Cancer Research Consortium, as well as pharmaceutical industry sponsored research trials. In 2011, approximately 50 percent of the research patients participated in NCI group studies and 50 percent were patients registered on pharmaceutical studies.
Society and Leukemia and Lymphoma Society Committees
• Special oncology nursing programs for community support of education in breast and lung cancer
• Smoking cessation assistance programs for the community as well as employees of Baptist Health
• Cutting-edge prostate cancer treatment programs, including seed implants and the state of the art da Vinci Robotic Surgery unit
• Continued expansion of the stereotactic radiosurgery radiation program with a marked increase in the number of body sites being treated
• Continued expansion of the limited breast radiation program using the Mammosite® technique
• Continued expansion of the digital breast cancer-screening program with movement to centralized diagnostic studies at the Baptist Cancer Institute
• Participation in in-patient quality improvement programs, including infection control
• Expansion of the chemotherapy and radiopharmaceutical embolization programs for treatment of liver malignancies
• Continued participation of indigent programs, including the highly successful We Care program
• Continued expansion of a hospital-based chemotherapy infusion unit
• On-site involvement of hospice and palliative
• Continued expansion and utilization of the
care programs for optimum support for both
comprehensive breast health program with
the cancer patient and family
nurse coordinator at Baptist Jacksonville,
• Continued expansion of the Genetic Risk Assessment Screening program, now focusing
Baptist South and Baptist Beaches
• Rapid expansion of the Neuro-oncology
on breast cancer, but also includes melanoma,
program, with continued expansion of the
and colon cancers
radiosurgery program, as well as increased
• Continued active participation in the oncology
sophistication of the Neurosurgery suites
training program for the medical oncology
and continued expansion of Neuro-oncology
fellows from the University of Florida
clinical research studies
Jacksonville and the Radiation Therapy residents at Mayo Clinic Jacksonville As Cancer Committee Chairman since 2005, it gives me great pleasure to see the continued expansion of cancer services offered in Northeast Florida and Southeast Georgia in the year 2011. State-of-theart programs which run the entire spectrum of hematologic and solid tumor malignancies are being offered in a multi-disciplinary approach to patients of all walks of life. A close collaboration of physicians, hospital administrators, and allied professional staff has enabled the Baptist Cancer Institute to remain at the forefront of care in this region for cancer patients.
Troy H. Guthrie Jr., MD Cancer Committee Chairman Medical Director, Education and Research Baptist Cancer Institute
5
Tumor Registry Report Troy H. Guthrie Jr., MD, Cancer Committee Chairman Melissa McCarthan, RHIT, CTR April Stebbins, RHIT, CTR Rassy Sprouse, BSc The Tumor Registry at Baptist Cancer Institute has been approved since 1990 by the Commission on Cancer of the American College of Surgeons. As part of our approval, the Tumor Registry collects data on cancer screenings annually in terms of incidence, tumor site, kinds of treatment provided, and survival outcomes. Its data is then entered into the Florida State Tumor Registry and ultimately accumulated at the national level as SEER data. This process enables all American College of Surgeons accredited cancer centers to compare their own outcomes in terms of diagnoses, stage, effectiveness of cancer treatment, and ultimate outcome in terms of survival, to each other. This enables Baptist Cancer Institute through its Tumor Registry, as well as other accredited programs, to assess their level of care when compared to others both within the state of Florida, as well as at the national level and see if standards of care are met to assess areas where quality improvement is needed to address deficits within each program.
Baptist Cancer Institute
2012 Annual Report
The registry assists the Cancer Committee with
943 female cases and 681 male cases (Figure
evaluating outcomes, quality of medical care,
2). Table 1 demonstrates the incidence of the
and assessment of treatment, recurrence, and
most common primary sites seen at Baptist
survival rates. Currently, the Baptist Tumor
Medical Center Jacksonville with breast cancer
Registry has accumulated data from both
accounting for 434 cases or 27 percent, prostate
Baptist Medical Center Jacksonville since 1990
cancer 199 cases or 12 percent, Lung cancer
and Baptist Medical Center South, where data
186 cases or 11 percent and female genital
collection began in 2005. Physician volunteers
cancers 106 cases or 7 percent. Of great interest,
from both Baptist Jacksonville and Baptist South
melanoma came in as the sixth-most common
assist tumor registry in assessing the accuracy of
site with 90 cases or 6 percent. Colorectal,
analytic case data accumulation for each year.
a much more common malignancy, had only
Ten percent of all cases are evaluated by these
89 cases or 5 percent and central nervous
physician volunteers for accuracy of data as well
system malignancies or neuro-oncology had 85
as timeliness of reporting.
cases or 5 percent. In 2011, there continued to be a decrease in prostate cancer, although
Figure 1 demonstrates the number of cases
less dramatic when compared to 2010 and a
accumulated from 1990 through 2011 at Baptist
relatively dramatic drop in lung cancer cases
Medical Center Jacksonville. As you can see,
was seen compared to 2010, with only 186
for the second year in a row, there is a drop in
cases being registered in 2011. Melanoma and
the number of patients seen compared to 2010.
urinary bladder as primary sites showed the most
This decrease in the number of patients is less
substantial increase in patient numbers accrued
dramatic than the previous year, but represents
to the 2011 Tumor Registry. Table 2 shows the
the second year in 21 years that the Tumor
frequency of primary sites seen at Baptist South
Registry has seen a decline in cases. Since 1991,
which has a somewhat different incidence of
the Tumor Registry at Baptist Jacksonville has
primary sites than Baptist Jacksonville with an
seen a total of 26,414 analytic cases. Similar
increased percentage of lung, colorectal, thyroid,
to previous years, there remains a female
and kidney primaries and a marked decrease in
predominance of analytic cases with 2011 having
the frequency of melanoma, brain tumor, and
7
1624
1656
1779 2009
1630 1253
1999
1265
1998
1138
1041
1996
972
1995
965
1992
865
1991
928
807
688
1000
764
1200
964
1004
1102
1400
2004
2005
1139
1308
1600
N o . of Pa ti en ts
2008
1467
1800
800 600 400 200 0
1990
1993
1994
1997
2000
2001
2002
2003
2006
2007
2010
2011
Yea r
200
Mal e
Female
1624
1656
1200 800
458
400
1600
533
600
0
2000
No . of Pat i ent s
681
1000 800
Fig ure 3 Analytic Cases: 2010 - 2011 (Baptist Jacksonville and Baptist South)
943
Figu re 2 Male & Female Malignancies: 2011 (Baptist Jacksonville)
No . of Mal i g nanci es
8
1744
Figu re 1 Baptist Cancer Institute Analytic Cases by Year
2010
2011
400 0 2010
2011
Ba pt is t Ja ck s onville
Ba pt is t Sout h
female genital tract incidence. These differences
institutions. There was a drop for the second
between sites seen at each hospital again
year in a row of 32 analytic cases of Baptist
references the difference in terms of referral
Jacksonville and a decrease for the first time of
pattern with expertise in melanoma and neuro-
total cases seen at Baptist South from 533 cases
oncology being located at Baptist Jacksonville
to 458 cases (Figure 3). These decreases in total
and only a modest presence of gynecologic
cases seen are almost certainly multi-factorial but
oncology at Baptist South. These tables also
recent campaigns by other hospitals to attract
indicate the male and female predominance
cancer cases may be a factor. Table 3 compares
of malignancies by the primary site at both
the incidence of the five most common primary
Tab le 1 Primary Sites : Baptist Medical Center Jacksonville (2011)
Site
Total
%
Male
Female
Breast
434
27%
3
431
Prostate
199
12%
199
0
Lung
186
11%
89
97
Female Genital
106
7%
0
106
Melanoma
90
6%
53
37
Colorectal
89
5%
50
39
Brain & CNS
85
5%
37
48
Other Sites
63
4%
37
26
Other Sites
57
4%
30
27
Blood & Bone Marrow
62
4%
36
26
Kidney
51
3%
30
21
Pancreas
51
3%
28
23
Urinary Bladder
49
3%
38
11
Lymph Node
47
3%
24
23
Stomach
21
1%
13
8
Unknown Primary
17
1%
7
10
Esophagus
11
1%
10
1
Liver
10
1%
7
3
Total
1,624
100%
681
943
sites seen at Baptist Jacksonville compared to
this is a modest decrease in the number of
state and national statistics. Similar to previous
prostate and lung cancer cases seen at Baptist
years, there is an essential doubling of the
Jacksonville compared to both Florida and the U.
incidence of breast cancer seen at Baptist Cancer
S. average. A 5 percent incidence of colorectal
Institute compared to both Florida and the
cancer seen at Baptist Jacksonville unfavorably
United States and likewise a marked increase
compares to the overall national incidence
in the number of female genital and melanoma
of 9 percent. This variance most probably
cancer cases seen compared to again the state
represents referral patterns of this primary site
of Florida and the U.S. average. Offsetting
to gastroenterologists for endoscopy and then
9
Tab l e 2 Primary Sites : Baptist Medical Center South (2011)
Site
10
Total
%
Male
Female
Breast
127
27%
0
127
Lung
50
10%
24
26
Colorectal
47
10%
19
28
Thyroid
31
7%
5
26
Kidney
29
6%
18
11
Urinary Bladder
27
6%
19
8
Prostate
21
5%
21
0
UGI
19
4%
14
5
Other Sites
15
4%
7
8
Lymph Nodes
18
4%
13
5
Blood & Bone Marrow
17
4%
11
6
Melanoma
16
4%
11
5
Brain & CNS
12
3%
4
8
Pancreas
10
2%
5
5
Female Genital
9
2%
0
9
Head & Neck
6
1%
6
0
Unknown Primary
4
1%
2
2
458
100%
179
279
Total
for surgery. Baptist Jacksonville fell within the
disciplinary breast conference, neuro-oncology
national average percentage for other primary
conference, and lung cancer conferences.
sites except for melanoma and CNS tumors
Participation at these conferences assures the
which certainly represent our active neuro-
adequate representation of all primary sites
oncology program, as well as the expertise in
are discussed as mandated by the American
melanoma care at Baptist Jacksonville.
College of Surgeons to maintain a commission on cancer certified tumor registry. Separate
The Tumor Registry also maintains a list of
multi-disciplinary breast conferences are held at
individual cases discussed and attendance at
Baptist Jacksonville, Baptist South, and Baptist
the Tumor Board as well as that of the multi-
Beaches. All multi-disciplinary conferences
Tab l e 3 Comparison Data with Florida and United States
Organ Site
Baptist Cancer Institute
Florida
United States
Breast
27%
14%
14%
Lung
11%
15%
14%
Prostate
12%
15%
15%
Female Genital
7%
3%
4%
Melanoma
6%
5%
4%
“Fig ures fo r Fl o r i da an d U.S. are esti mates from Cancer Fact s and Fi g u res 2 011�
as well as Tumor Board are patient focused
Medical Center Beaches has a separate Tumor
discussions regarding diagnoses and treatment
Registry. All data is reviewed prior to entering
approaches. Continued medical education (CME)
it into the Tumor Registry and a composite 10
and continuing education units (CEU) credits
percent of patients are then further reviewed by
are available by the Baptist Health continuing
physician volunteers for accuracy and timeliness
education program for these conferences. The
of data entry. Currently, Melissa McCarthan,
Tumor Registry is also available for questions
RHIT, CTR; April Stebbins, RHIT, CTR; and
concerning treatment outcomes or any other
Rassy Sprouse, BS, staff the Tumor Registry
questions that arise from medical staff or
and are supervised by Linda Huntley, Director
community.
of Oncology Services, as well as physician supervisors Troy Guthrie, Jr., MD, and Mark
The Tumor Registry also reviews the organization of the weekly multi-disciplinary tumor conference as well as assists the Cancer Committee in evaluation outcomes, quality of medical care, assessment of complications, recurrence, and survival rates. Currently, the Baptist Tumor Registry accumulates data from Baptist Jacksonville as well as Baptist South. Baptist
Augsperger, MD.
11
Breast Cancer
12
The number of breast cancer cases which are
the breast health program spent its first full year
accrued to the Baptist Health Tumor Registry
in the Hill Breast Center at the Baptist Outpatient
at Baptist Jacksonville consistently exceeds the
Center. Two nurse navigators assisted patients
state of Florida and national average. In 2011,
and physicians to optimize patient convenience as
there were a total of 434 cases entered into the
well as patient care. A breast survivorship program
tumor registry representing 27 percent of all cases
with nutrition, physical therapy and psychosocial
which exceeds the national and state of Florida
support is in place to enhance the overall
average of 13 percent. Similar to previous years
experience in patients seen at the Hill Breast
and similar to the national average, the majority of
Center. Cutting-edge surgery programs with
these cases are early stage breast cancer (Figure
intraoperative radiation began in the fall of 2012.
4). Seventy-nine cases or 18 percent were DCIS,
Limited breast radiation with the MammoSite
190 cases (44 percent) were Stage I and 113
and more recently IntraBeamÂŽ for intraoperative
or 26 percent were Stage II. These early stage
breast radiation are in place. Cutting-edge
breast cancers represent 88 percent of all breast
research programs both in the adjuvant and the
cancers seen and we would expect that all but a
more advanced metastatic setting are offered at
few of these women would ultimately be cured of
the Baptist Cancer Institute, through both medical
their breast cancer. Stage III was 33 or 8 percent
oncology with cooperative group studies as well
in which many of the patients would ultimately
as pharmaceutical sponsored and the radiation
die of their breast cancer and Stage IV was 18
therapy through the RTOG research group. Other
patients or 4 percent and we would expect all
assets for optimizing the care of breast health
of the patients to ultimately die of their breast
patients at the Baptist Cancer Institute through
cancer. Out of these 434 cases, only one or less
the Hill Breast Center program include genetic
than one percent is classified as unknown stage
risk assessment led by Melinda Fawbush, MSN,
assessing to the tenacity of our Tumor Registry in
ARNP, which assists patients and their families in
adequately staging the patients.
making decisions for both the type of surgery and other long-term preventive programs if they are
Breast cancer consistently represents a very
know to have increased genetic risks. Psychosocial
high percentage of the cases seen at the Baptist
support is provided by George Royal, PhD, and
Cancer Institute compared to the U.S. average.
an increasing involvement in breast survivorship
This attests to the effective network in which
services include nutrition, physical therapy, and
primary care physicians work with our digital
lymphedema treatment. All of these services
mammogram screening program to diagnose
continue to enhance the breast health program
patients at an early stage and move them into
and increase Baptist Cancer Institute’s share of
the organized breast cancer program run through
breast care patients within Northeast Florida and
the multi-disciplinary Hill Breast Clinic. In 2011,
Southeast Georgia.
Fi gu re 4 Baptist Cancer Institute Breast Cancer Staging: 2011
60
44
Pe rce n t
50
40
26
30
13
18
8
20
0
4
10
0
0
1
2
3
4
Unknown
St a ge
Fi gure 5 Baptist Cancer Institute Breast Cancer-DCIS Accrual
68 39
43
50
10
60 55
30
17
20
23
25
30
29
34
40
40
50
60
55
56
61
70
8
N umber of P a t ient s
71
80
79
80
81
85
90
0 1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Figure 5 shows the number of cases of ductal
situ will be cured with local therapy and represent
carcinoma in situ seen at Baptist Cancer Institute
a success of the wide use of screening digital
since the establishment of the Tumor Registry
mammograms within our system.
in 1990. Seventy-nine cases were seen in 2011, which is essentially the same as the previous year in 2010. All of these cases of ductal carcinoma in
Lung Cancer for at least the patients seen in 2011. Recently,
lung cancer in 2011. As in past years, the patients
the role of low-dose screening CT scans has been
who were accrued in our Tumor Registry were
reaffirmed at the national level, but is not widely
predominantly advanced cases. Unfortunately, 77
accepted since the number of false negatives and
cases were Stage IV, representing 41 percent of all
unnecessary biopsies is a troublesome handicap
lung cancer seen. Twenty-five or 13 percent were
for its widespread use. One bright spot in lung
Stage III, who have approximately a 20 percent
cancer at Baptist Health is the multi-disciplinary
chance of being cured. Fourteen patients were
lung cancer program led by Bridget Rossi, RN,
Stage II, in which the cure rate is approximately 35
MSN, OCN, nurse navigator. She has established
percent, and 58 or 32 percent were Stage I in which
a foundation to assist needy patients in all aspects
over half the patients are cured with local therapy
of their care from diagnosis to end of life. The role
(Figure 6). The proportion of patients with lung
of the stereotactic radiosurgery program at Baptist
cancer seen at Baptist Jacksonville is 11 percent,
Cancer Institute has likewise expanded since
slightly lower than the 14 percent seen nationally.
selected patients with Stage I, particularly who are
This percentage of patients, as well as total
frail, has become accepted. Research areas within
numbers, represented a drop from the previous
the Baptist Cancer Institute include the continued
years of 241 patients, which was 15 percent of
participation in a cooperative group adjuvant
the cancer seen last year. Similar to statistics both
non-small cell lung cancer, as well as innovative
in Florida and the United States, the majority of
targeted therapies for metastatic and recurrent
patients with lung cancer are Stage III and IV, which
non-small cell lung cancer.
are poorly curable. This presentation in advanced stage represents no accepted screening program
Fi gu re 6 Baptist Cancer Institute Lung Cancer Staging: 2011
41%
50
32%
40
13%
30
8%
20
6%
10 0%
Perc ent
14
Baptist Cancer Institute saw 186 patients with
0 0
1
2
3
St a ge
4
Unknown
Prostate Cancer In 2011, Baptist Cancer Institute Tumor Registry
(Figure 7). Those patients generally were cases which
assessed 199 prostate cancer cases, which was little
were referred outside our institute prior to completing
changed from 2010 when 204 cases were registered.
staging workup. The Baptist Cancer Institute continues
This still represents a dramatic drop from 2009 and
the prostate screening program which has been
2008, when more than 300 cases were assessed each
sponsored by both Baptist Cancer Institute and
year. This drop in prostate cancer accrual represents a
the NFL Jacksonville Jaguars for many years. The
clear cut change in referral patterns in the community
prostate cancer prevention program trial was closed
where many patients are now being both biopsied
in 2011 and unfortunately found no benefit from the
and referred to outside treatment facilities. However,
use of antioxidants either in the form of Selenium
as in previous years, the vast majority of patients
or vitamins in decreasing the incidence of prostate
are either Stage I (60 patients), which represented
cancer. Radiation treatment at Baptist Cancer Institute
30 percent of the patients seen, or Stage II (124
includes the state-of-the-art IMRT Radiation Therapy,
patients), which represented 62 percent of patients.
seed implants, and urologic surgeons have the da
Thus 92 percent of patients were either Stage I or
Vinci Robotic Surgery Program. Patients entered on
Stage II in which the vast majority will be cured with
an innovated immunotherapy program with the use
either surgery or some form of radiation treatment.
of Ipilimumab for advanced castrate resistant prostate
Only four patients or 2 percent and six patients or 3
cancer continue to be followed in 2011 and 2012.
percent were Stage III and Stage IV respectively. Five
The use of innovative new treatments for patients
patients or 3 percent were unknown stage which again
previously considered refractory to hormone treatment
represents a success for our Tumor Registry which
has improved with two new drugs being approved by
accurately staged all but 3 percent of the patients
the FDA for castrate resistant prostate cancer patients seen at Baptist Cancer Institute.
62%
Fi gure 7 Baptist Cancer Institute Prostate Cancer Staging: 2011
60
50
30%
30
20
1
2
S t a ge
3%
0
3%
0
2%
10 0%
Percent
40
3
4
Unknown
15
Female Genital Track Cancer properly stage. This high percentage of patients
Baptist Cancer Institute continued to be active in
in early stage represents a success in American
terms of numbers of patients with 104 patients
cancer management with a high utilization by
seen in the calendar year 2011. As illustrated in
American women of standard guidelines for
Figure 8, 59 percent or 62 patients were Stage
pelvic exam and Pap smear. The percentage of
I and II which in general are felt to be readily
female genital cancer seen at Baptist Cancer
curable by surgery or surgery plus radiation. Only
Institute (6 percent) reflects favorably with the
28 percent of patients were Stage III and IV and
5 percent average reported in other United
7 or 7 percent had inadequate information to
States tumor registries.
Fi gu re 8 Baptist Cancer Institute Gynecological Cancer Staging: 2011
55%
60
50
40
10%
20
0
0
4%
10
7%
18%
30
6%
P ercent
16
In 2011, the Gynecologic Cancer Program at
1
2
3
St a ge
4
Unknown
Melanoma In 2011, Baptist Cancer Institute tumor registry
and accrued into our Registry compares favorably
assessed 90 cases of patients diagnosed with
with the 5 percent rate for the state of Florida
melanoma. This mirrors a trend which started
and the 4 percent rate for the United States.
in 2005 with steadily increasing numbers of
This high percentage of melanoma patients
melanoma patients seen at Baptist Jacksonville.
seen at Baptist Cancer Institute almost certainly
Most of those patients represented early stage
represents the surgical and medical oncology
either Stage 0, which is in situ disease which
expertise in this tumor site which is recognized
accounted for 12 patients or 13 percent, Stage I,
throughout Northeast Florida and Southeast
43 patients or 48 percent and Stage II, 15
Georgia. State-of- the-art surgical approaches
patients or 17 percent. Overall, these Stages 0-II
include lymph node mapping, and expertise in
represent a total of 78 percent of the patients
wide local excision from melanomas occurring
in early stage with an expectation of around 90
in all sites of the body is present. Likewise,
percent of those patients will be cured (Figure
medical oncology has extensive expertise in
10). Unfortunately, six patients or 7 percent and
the use of immunotherapy as both an adjuvant
two patients or 2 percent were Stages III and IV,
treatment and a systemic treatment for metastatic
most of whom would not be expected to survive
melanoma. A wide variety of research studies
five years. Another troublesome aspect is that
including innovative adjuvant treatment protocols
12 patients or 13 percent were unknown stage,
through the ECOG study group and multiple
most probably representing leaving the institution
studies investigating the role of Ipilimumab
prior to completing staging and having their
in metastatic melanoma was in place in 2011.
treatment elsewhere.
Multiple patients were referred from outside the institution for involvement in those
These patients which represented 6 percent of
research studies.
all cancer cases seen at Baptist Cancer Institute
12% 2%
6%
12%
25
15%
43%
50
0%
P ercent
Figu re 10 Melanoma Cancer Staging: 2011
0
Stages
0
1
2
St a ge
3
4
Unknown
17
Tumor Review: Hodgkin’s Disease at Baptist Cancer Institute Mark Augspurger, MD, Radiation Oncologist
Each year, approximately 7,500 new cases of Hodgkin’s disease (HD) will be diagnosed in the United States. In contrast to the increase in incidence of Non-Hodgkin’s lymphoma over the past several decades, the annual incidence of Hodgkin’s disease has remained stable. There has been an increase in the accuracy of diagnosis and staging, as well as an increasing utilization of combination chemotherapy for the treatment of HD. More than 75 percent of newly diagnosed Hodgkin’s disease lymphoma cases will be cured.
Baptist Cancer Institute
2012 Annual Report
Epidemiology and Etiology
than African Americans. There are no well
established etiologic factors causing HD. Case
Hodgkin’s disease has a slight increased
match studies show that it’s slightly higher in a
incidence of male cases to female, approximately
familiar cluster pattern and is also more likely to
1.3:1. The age of onset of Hodgkin’s disease is
occur in those of higher economic status. There
a bimodal presentation with the largest group
has been extensive ongoing debate whether the
of patients in the second and third decade of
Epstein Barr virus is implicated in the etiology
life and a second smaller peak after age 50. The
of Hodgkin’s disease but to date this remains
second peak is probably an artifact of histologic
unsettled. Patients infected with the Human
misclassification since recent studies have shown
Immune Deficiency Virus (HIV) seem to have
that many of these cases diagnosed as Hodgkin’s
a higher incidence of Hodgkin’s disease when
disease in the older age group were in fact Non-
compared to age match control, but it is unclear
Hodgkin’s lymphoma. In terms of race, Hodgkin’s
why this association occurs.
disease is much more common in Caucasians
19
48
39
70
40
60
20 10 0
Mal e
Female
50 40 30 20 10 0
Signs, Symptoms and Diagnosis
5
30
14
No . of Ca ses
20
N o . of Ca ses
50
Fig ure 2 Cases by Race (2001 - 2011)
68
Figu re 1 Cases by Gender (2001 - 2011)
W h i te
Bla ck
Ot her
pruritis. These symptoms occur more frequently in older patients and have a negative impact
on prognosis. Diagnosis is made by a biopsy
Hodgkin’s disease is a lymph node based
of a suitable lymph node and histopatholigic
malignancy and commonly presents as an
examination by an experienced pathologist.
asymptomatic lymphadenopathy which may
The diagnostic Reed-Sternberg cell is found
progress to symptomatic disease. The majority
within the appropriate lymph node milieu and
of patients, more than 80 percent, present
these cells on histopathologic exam are typically
with lymphadenopathy above the diaphragm
CD30+ and CD15+ by immunohistochemical
involving the anterior mediastinum, cervical
staining. Flow cytometry is generally not
and less commonly axillary and below the
helpful in making a definitive diagnosis of
diaphragm adenopathy. Only in the latest stages,
Hodgkin’s disease. Staging is typically based
is visceral disease such as lung, liver, and bone
on the number of lymph node sites involved,
marrow involved. Involvement of Waldeyer’s
whether these lymph node sites are above or
ring is quite uncommon. Approximately 40
below the diaphragm and whether or not the
percent of patients present with systemic
patient is asymptomatic (A) or symptomatic (B.)
symptoms. Classically these B symptoms
Typically, these cases of Hodgkin’s lymphoma
include sweats, fever, weight loss and chronic
are separated into four histologic categories:
lymphocyte predominant, nodular sclerosing,
disease involving high cervical nodes. For Stages
mixed cellularity, and lymphocyte depleted.
IB to Stage IVB, combination chemotherapy,
At one time, histopathologic subtype was
classically the ABVD (Adriamycin, Bleomycin,
important, but more recently it has been found
Vinblastine, and Dacarbazine regimen) is
that the pathologic stage trumps histologic
employed with radiation therapy reserved for
subtype in terms of long-term prognosis. The
bulky lymphadenopathy usually given at the
staging system used is a modified Ann Arbor
completion of combination chemotherapy. For
staging system and consists of the following:
most patients, four to six cycles of chemotherapy is employed. Surgery other than lymph
• Stage I is involvement of a single lymph node region;
• Stage II is involvement of two or more
node biopsy for diagnosis has no role in the therapeutic management of Hodgkin’s disease. Outcome is based on primarily stage with
lymph node regions on the same side of the
obviously earlier stage disease doing significantly
diaphragm;
better than later stage disease. Overall, for
• Stage III is involvement of lymph node regions on both sides of the diaphragm;
• and Stage IV is involvement of extra nodal
Stage I, approximately 85-90 percent of patients will be expected to be disease free at five years, for Stage II 75-80 percent will be disease free
sites such as lung, liver or bone marrow and
at five years, for Stage III 55-65 percent will
not contiguous to a known nodal site.
be alive and disease free at five years, and for Stage IV 45-55 percent will be alive and free
The designation A means no symptoms and B
of disease at five years. Adverse prognostic
means the presence of fever, drenching sweats,
factors include age greater than 50 years, bulky
weight loss or intractable chronic pruritis. Bulky
disease, and advanced stage. Patients with
disease is considered a maximum diameter
other immunodeficiencies such as HIV or post-
of a lymph node mass greater than 9cm. In
transplant, likewise, do poorer. For patients
general, Hodgkin’s disease is staged clinically
who reoccur, combination chemotherapy with a
with imaging studies such as CT scans or PET CT
different chemotherapy regimen plus autologous
scans rather than surgical pathologic staging.
transplant appears to cure 25-30 percent of
Treatment and Outcome
those patients. A new targeted therapy is currently available, brentuximab; a monoclonal
antibody to CD30 and appears to have high
Treatment of Hodgkin’s disease involves the
response rates in the 70-80 percent range but
application of combination chemotherapy with
has been commercially available only for two
selective cases receiving radiation therapy
years and its exact role remains to be defined.
particularly for bulky disease. Currently, in 2013,
the only patients who are treated with radiation
At Baptist Health, the Tumor Registry of Baptist
alone are typically those who have Stage IA
Cancer Institute accrued a total of 87 cases
21
Figu re 3 Cases by Stage (2001 - 2011)
30
34
40
30
3
4
1
7
10
7
8
20
0
22
Nu mb e r of Ca se s
50
0 0
1
2
Unknown
N/A
St a ge
between 2001 and 2011, an average of 8.7
chemotherapy actually received chemotherapy
cases were seen yearly. Out of those patients,
as outpatients and were not captured by the
48 were male and 39 were female for the
tumor registry. Survival was extremely good as
expected slight male predominance of 1.3:1.0,
would be expected in more than 80 percent of
as seen in national databases (Figure 1). Again,
Stages I, II, and III being five year survivors and
similar to national databases, there is a strong
only Stage IV dropping down to 57 percent and
predominance of caucasian patients with 68
as essentially expected in the national database
being caucasian, 14 being African American
(Figure 4).
and five being other races (Figure 2). Staging showed that predominance of patients were
Thus, in summary, the information on Hodgkin’s
early stage with 34 of 87 being Stage I, 30 of 87
disease was flawed by a large number of cases
being Stage II, seven were Stage III, seven were
in which treatment was done outside of the
Stage IV, eight were stage unknown and one was
hospital and was not captured by the tumor
non-analytic (Figure 3). In terms of treatment,
registry. However, all other aspects of the data
there was a major problem with our data. On the
including number of cases, male to female ratio,
initial data run, 50 of 89 were listed as having
race, stage, and long-term survival appeared
received no therapy and seven of 89 were listed
consistent with that seen at the national level.
as receiving surgery or biopsy only. This data will be reviewed under our article for quality assurance but to briefly summarize, most of these patients listed as receiving surgery alone or no
Fi gure 4 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005) 100 95 90 85 80
Cu mu l at ive Sur vi va l Ra tes
75 70 65
23
60 55 50 45 40 35 30 25 20 15 10 5 0 0.0
1.0
2.0
3.0
4.0
Year s from Di ag nos i s Stag e I
Stag e II
Stag e III
Stag e IV
5.0
Tumor Review: Soft Tissue Sarcomas at Baptist Cancer Institute Troy Guthrie, MD, Medical Director, Baptist Cancer Institute
Soft tissue sarcomas are a group of rare, but anatomically and histologically quite diverse neoplasms. This is due to their varying location within the soft tissues of nearly all body sites. Currently, there are more than three dozen recognizable histological distinct subtypes occurring within the body. Each year approximately 7,000 new cases of soft tissue sarcoma are identified and approximately 4,000 patients die of this disease. The age adjusted incidence is two cases/100,000 persons.
Baptist Cancer Institute
2012 Annual Report
Epidemiology and Etiology
Signs, Symptoms, and Diagnostic Workup
In soft tissue sarcomas, there is a slight male predominance with the male to female ratio
In terms of signs and symptoms, the majority
being approximately 1.1:1. Approximately 50
of soft tissue sarcomas present either in the
percent of soft tissue sarcomas will occur in
extremities or superficial trunk as a mass lesion
adults older than 60 years and 50 percent below
either exerting pressure or causing pain due to
age 60. The vast majority of soft tissue sarcomas
mass expansion. Many of these malignancies are
occur in caucasians, 86 percent, 10 percent in
found incidental to self-examination or physician
African Americans, and 4 percent in other ethnic
examination. Approximately, 15 percent of soft
groups. There is no geographical distribution.
tissue sarcomas arise in the retroperitoneal and
In terms of risk factors, soft tissue sarcomas
present as an abdominal mass with about half
clearly have been reported to originate within
of patients reporting pain. Physical exams of
previously irradiated fields and often develop
patients with soft tissue sarcomas usually reveal
decades after radiation. The majority of those
a palpable mass but little else is noted. General
malignancies arising within radiation fields are
laboratory testing likewise is non-diagnostic.
high grade lesions. Chemical exposures in certain
Imaging studies are the most important
occupations such as those working in factories
evaluation procedures and usually include either
making plastics or solvent exposure have likewise
CTs or MRIs of the affected area as well as CT
been reported as a risk factor. There are rare
scans, primarily of the lung looking for metastatic
genetic syndromes such as von Recklinghausen
lesions. Diagnosis is usually obtained either by
disease, tuberous sclerosis, and others which
image guided core needle biopsy or excisional
have likewise been linked to specific types of soft
biopsy performed by an experienced surgeon.
tissue sarcomas. In general, however, the vast
In general, if the lesion is on the extremity, the
majority of soft tissue sarcomas are not linked to
pathway of the biopsy should be planned such
any specific etiology.
that it can be resected in total within a definitive surgical procedure later since there is some risk of seeding the tract with malignant cells and having secondary lesions develop within the biopsy tract if not completely excised.
25
Histopathology
small and advanced stage lesions are lesions
In general, the histopathological diagnosis
metastatic lesions. Because soft tissue sarcomas
is made of the tissue of origin, for example,
tend to be asymptomatic until reaching a large
fibrosarcoma from fibrous tissue or
stage SEER data shows that most adult soft
rhabdomyosarcoma from striated muscle
tissue sarcomas present in more advanced Stage
cells. The most important determinant of
III or Stage IV stages.
that are high grade, large lesions and may have
prognosis is the grade of the tumor, with grading being Grade I low grade, Grade II
Treatment
intermediate grade, or Grade III high grade tumors. Some histopathological types, such as
The treatment of the primary lesion is surgical
rhabdomyosarcoma or fibrous histiocytoma, are
resection with wide margins. In particular, for
automatically assigned a high grade status. The
soft tissue sarcomas occurring in the extremities,
staging of soft tissue sarcomas depends on four
it is felt when possible that the surgery should
factors: primary tumor, which is based on size
be done by an experienced surgical oncologist
either greater than 5cm or less than 5 cm and
so that limb sparing when possible can be
whether or not they are superficial a. deep, b.
achieved. If initial surgical resection of a soft
grade of the tumor: being well differentiated
tissue sarcoma is impossible then preoperative
grade I; moderately differentiated grade II;
treatment with both radiation therapy and in
poorly differentiated grade III or undifferentiated
certain circumstances either systemic or limb
grade IV, presence or absence of lymph node
arterial perfusion of chemotherapy is advised.
involvement, and presence or absence of
Most often it is felt that patients needing this
metastatic lesions. In general, early stage lesions
treatment should be referred to medical centers
are low grade or intermediate lesions that are
where a multi-disciplinary team experienced in
10 5 0
Mal e
Female
25 20 15 10
15
N o . of Cases
30
10 5 0
3
17
20
35
22
25
Fig ure 2 Cases by Race (2001 - 2011)
26
Figu re 1 Cases by Gender (2001 - 2011)
N o . of Cases
26
W h i te
Bla ck
Ot her
Fi g u re 3 Cases by Stage (2001 - 2011)
14
20
10 3
4
7
10
1
5 0
Nu mb e r of Ca se s
15
0
27 0
1
2
3
4
Unknown
N/A
St a ge
managing soft tissue sarcomas is available. Thus
and radiation. Typically, response rates to
often soft tissue sarcomas, while diagnosed in
chemotherapy are low. Complete remissions are
one institution, are referred outside for definitive
rarely produced and the duration of response
treatment particularly of the primary lesion.
is quite short. Chemotherapy drugs used to
In general, there is a low incidence of lymph
treat soft tissue sarcomas include doxorubicin,
node involvement for soft tissue sarcomas and
ifosfamide, dacarbazine, and occasionally
routine lymph node dissection during surgical
other chemotherapy agents. Response rates
procedures is not done.
to combinations of chemotherapy agents such as doxorubicin, ifosfamide +/- dacarbazine
The role of radiation therapy is both preoperative
are higher but do not seem to translate into
and postoperative in the definitive management
a long-term survival advantage. In general,
of the primary site. In patients who have locally
chemotherapy is reserved for improving local
advanced lesions, deployment of radiation
control preoperatively and palliative treatment of
therapy either with or without adjuvant
metastatic disease. Of note, some patients with
chemotherapy has resulted in higher rates
surgically resectable metastatic disease do seem
of definitive resection of the primary site. In
to benefit from surgical resection particularly
patients who have been resected up front and
if the metastases are in the lungs. Targeted
who have either positive or close margins and a
therapy for certain soft tissue sarcomas, such as
high histological grade, there have been both
dermatofibrosarcoma and certain other soft tissue
retrospective and prospective studies showing
sarcomas, has an evolving role. These soft tissue
application of radiation therapy to the primary
sarcomas (PDGFÎą) express a target such as c-KIT
site results in a drop in local recurrence rates.
or platelet derived growth factor alpha and can
be treated with targeted agents such as Imatinib
The role of chemotherapy in soft tissue sarcomas
or Dasatinib.
is much less well defined compared to surgery
Figu re 4 Cases by Treatment (2001 - 2011)
15 11
12
None
Surgery/Chemo
4
4
10 5
5
3
Nu mb e r of Ca ses
20
0
Surgery
28
Surgery/ Radiation
Chemo
All Others
The records of the Baptist Cancer Institute Tumor
plus chemotherapy. A total of 27 of the 39 or
Registry were reviewed from 2001 to 2011.
69.2 percent received some form of surgical
The cases were analyzed and compared to the
treatment as would be expected from national
national cancer database. During this time, 39
databases. Five or (12.8 percent) were listed as
patients with soft tissue sarcoma have been an
receiving no specific therapy but were referred
accession to our Tumor Registry averaging four
out and probably received standard care. Three
patients each year. Of those 39 patients, 17 were
patients received chemotherapy alone in palliative
male and 22 were female–slightly different from
treatment. These percentages would be the same
the usual male/female ratio reported (Figure 1).
as expected in national averages. Figure 5 shows
In terms of race, 26 were caucasian, 10 African
five year survival for our 39 patients and shows
American, and three represented another ethnic
81 percent of Stage I were alive at five years and
group (Figure 2). Staging showed seven were
67 percent of Stage II were alive, 47 percent of
Stage I, three were Stage II, 10 were Stage III,
Stage III and only 14 percent of Stage IV had
one was Stage IV, 14 were unknown stage and
survived five years. This is comparable to what is
four were non-analyzable (Figure 3). This higher
published and shows that management of soft
proportion of non-analyzable and unknown stage
tissue sarcomas is quite similar to that practiced
represents the fact that a large portion of patients
throughout the United States and end results
were referred to outside institutions, particularly
appear to be similar.
Mayo Clinic and the University of Florida
Gainesville for a specialized multi-disciplinary
Thus this review of soft tissue sarcomas seen at
team to treat these rare malignancies.
Baptist Cancer Institute from 2001 to 2011 shows
similar epidemiologic factors, similar treatments
Treatment, in general, followed the same lines
except a higher percentage of patients referred
as that reported in national databases (Figure 4).
outside to receive specialized care. Our survival
Twelve of the patients or 30.8 percent received
data is likewise similar to that reported in national
surgery, 11 (28.2 percent) received surgery plus
SEER data.
radiation, and four (10.3 percent) received surgery
Fi gure 5 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005) 100 95 90 85 80
Cu mu l at ive Sur vi va l Ra tes
75 70 65
29
60 55 50 45 40 35 30 25 20 15 10 5 0 0.0
1.0
2.0
3.0
4.0
Year s from Di ag nos i s Stag e I
Stag e II
Stag e III
Stag e IV
5.0
Quality Assurance Troy H. Guthrie Jr., MD, Medical Director, Education and Research, Baptist Cancer Institute,
Melissa McCarthan, RHIT, CTR; April Stebbins, RHIT, CTR; and Rassy Sprouse, BS
The Tumor Registry and its database are necessary for quality of care monitoring provided by Baptist Cancer Institute. The accuracy and dependability of this essential service was evaluated and examined as directed by the American College of Surgeons and the Commission on Cancer. A review of the data that resulted in patient accrual management and lifespan was assessed during a 10-year period for Hodgkin’s disease from 2001 through 2011. The abstracts were reviewed for accuracy and charts were pulled when deemed necessary.
Baptist Cancer Institute
2012 Annual Report
The following are the results of the assessment
accuracy of data will continue to be reviewed
on the 87 patients entered by our Tumor Registry
so that we can have accurate long-term follow-
during the above-mentioned time period. The
up on Hodgkin’s disease patients from this time
results are summarized as follows:
period of 2001 to 2011; Kaplan-Meier curves were readily available and appear to be accurate;
• Abstracts contained adequate information to assess accuracy;
• There were no errors in the classification of the Hodgkin’s patients identified in terms of
and demographics were available and appear to be accurate. Recommendations for correction include:
histology;
• Therapy of Hodgkin’s patients had many problems in terms of identifying treatment.
• 50 out of 89 patients were listed as having no
• Education was presented to the Tumor Registry concerning treatment of Hodgkin’s disease so that a red flag will be raised
therapy, and seven out of 89 patients were
if no therapy or surgery alone is listed as
listed as being treated with surgery alone.
treatment;
• Suggestions have been made to work Clearly this was inaccurate so charts were pulled
more closely with the clinicians of record
from the offices of 21st Century Oncology and
concerning any patient in whom the accuracy
reviewed by Troy H. Guthrie, MD, and from the
of staging, treatment or survival including
office of Cancer Specialists of North Florida
phone calls would be warranted;
and reviewed by Unni Thomas, MD. Of the
• Cancer physicians should be involved in
50 patients listed as having no treatments,
the abstraction process particularly up front
currently 10 have been identified as receiving
if information is missing or appears to be
chemotherapy and three have been identified
inaccurate; and
as receiving chemotherapy plus radiation. Of
• Request additional information from
the seven patients listed as receiving surgery
physicians who refer patients for
alone to date, two have been listed as receiving
management outside the institution so long
chemotherapy and one receiving chemotherapy
term follow-up can be accurate in terms of
plus radiation. This is a laborious task and the
treatment and survival.
31
Clinical Research and Education In 2011, cancer research for the Baptist Cancer Institute continued to function at a high level on multiple sites, including the Baptist Cancer Institute, Florida Radiation Oncology Group, and Cancer Specialists of Northeast Florida. At any one time throughout all campuses approximately 60 to 70 research protocols were available for patients with diverse cancer sites including breast, lung, gastrointestinal, brain, melanoma, pancreatic, hematologic malignancies, and other less common sites. All protocols were available for patients at Baptist Medical Center Jacksonville and Baptist Medical Center South, as well as having referrals from outside the Jacksonville area, including Southeast Georgia. Studies were available to patients originating from both national cooperative groups, including the National Surgical Adjuvant Breast and Bowel Project (NSABP), Eastern Cooperative Oncology Group (ECOG), North Central Cancer Treatment Group (NCCTG), and Radiation Therapy Oncology Group (RTOG), as well as many studies which came through pharmaceutical companies and private research organizations (PRO).
Baptist Cancer Institute
2012 Annual Report
On campus, approximately 50 percent of the
pressure on physicians to deal with increasing
studies were through National Cancer Institute
patient volume, increasing complexity of
(NCI)-sponsored cooperative group studies
insurance and third party payment, as well as
and the other half were industry sponsored
reluctance of patients to participate in studies
pharmaceutical studies.
that may cause economic pressure. Hopefully, patient accrual will increase in 2012 to above
All studies done on campus, either NCI-
50 patients close to years past.
sponsored or pharmaceutical-sponsored were reviewed by the Baptist Medical
Baptist Cancer Institute continues to be an active
Center Institutional Review Board (IRB) for
community cancer education program offering
appropriateness of research, conflict of interest
CME sessions at the multi-specialty breast cancer
and protection of human rights. All studies were
conference, neuro-oncology conference, and
then described in language understandable
lung cancer conference and tumor board. Table
by the public in an informed consent and
2 lists the subjects of the annual tumor board
also published on the Baptist Cancer Institute
for 2012. Table 3 lists the active participants in
website. Phases of studies including phase I,
the cooperative groups at Baptist Health, as
phase II, and phase III, were available in 2011.
well as those involved in the research programs of the NSABP, and RTOG study groups. In
In 2011, studies through the Baptist Cancer
summary, the Baptist cancer program continues
Institute led to FDA approval for a number of
to offer exciting clinical projects through
drugs, including Ipilimumab for the treatment
both cooperative group mechanisms as well
of metastatic melanoma, Aldo-herceptin for the
as pharmaceutical studies. A great deal of
treatment of HER2+ breast cancer, and afatinib
enthusiasm on the campus exists for continuing
for the treatment of EGFR mutation positive
to increase patient accrual and increasing the
non-small cell lung cancer. In addition to
relevance of clinical trials for everyday treatment.
treatment protocols, a number of registry studies were done that include SystHERs in HER2+ breast cancer that is metastatic, treatment approaches in metastatic melanoma, as well as studies in chronic myelocytic leukemia and paroxysmal nocturnal hemoglobinuria. The 2011 patient accrual for all participants consisted of 35 patients compared to the 65 patients in 2010 (Table 1). Accrual throughout the campus has remained well below 100 patients per year due to diverse reasons, including increasing
33
Table 1 Clinical Research BCI : 2008 – 2011
34
Year
# of Patients
2008
88
2009
90
2010
65
2011
35
Table 2 Tumor Board : 2012 Breast Cancer Prevention Troy Guthrie, MD Volatile Organic Compounds and the Early Detection of Lung Cancer
Nir Peled, MD
Hosts of Lymphoma Troy Guthrie, MD Melanoma Staging and Treatment
Troy Guthrie, MD
Contemporary Head and Neck Oncology and Reconstructive Surgery
Phillip Pirguosis, MD
Interventional Pain Management for the Spine
Christopher Roberts. MD
Chronic Myeloid Leukemia Overview
Troy Guthrie, MD
Melanoma Metastatic to Regional Lymph Nodes
John Crump, MD
Post-mastectomy Radiation Therapy: Update and Indications
Nicole Anderson, MD
Head and Neck Cancer Naeem Latif, MD Multiple Myeloma Troy Guthrie, MD Triple Negative Breast Cancer Dimitrios Agaliotis, MD Non Small Cell Lung Cancer
Troy Guthrie, MD
Cervix and Endometrial Cancer: Case Discussion and Brief Overview
Michael Olson, MD
Prostate Cancer Naeem Latif, MD The Management of Prostate Cancer
Mark Augspurger, MD
Melanoma Update Gary Bowers, MD Management of Anorectal Melanoma
Hank Hill, MD
Neuro Oncology Tumor Board Multiple Presenters
Table 3
Cooperative Group Trials (BCI)
RTOG
Dimitrios Agaliotis, MD, PhD – Medical Oncology
Cynthia Anderson, MD – Radiation Oncology
Jeff Bubis, DO – Medical Oncology
Mark Augspurger, MD – Radiation Oncology
Stephen Buckley, MD – Gynecologic Oncology
Jessica Bahari, MD – Radiation Oncology
Catherine Bush, RN, OCN, BSN – Study coordinator
Abhijit V. Deshmukh, MD – Radiation Oncology
Andrea Canto – Study Coordinator
Kenneth Goldstein, MD – Radiation Oncology
Carlos Castillo, MD – Medical Oncology
Troy Guthrie, MD – Medical Oncology
Roxane Green – Regulatory Coordinator
Jeffrey Harris, MD – Medical Oncology
Troy Guthrie, MD – Principal Investigator, ECOG, NSABP, Mayo Trials Group
Douglas W. Johnson, MD – Principal Investigator
Zhen Hou, MD, PhD – Medical Oncology
Anand Kuruvilla, MD – Radiation Oncology
Douglas W. Johnson, MD – Sub-Investigator, Radiation Oncology
Carla Malott, RN – Clinical Research Associate
Robert A. Joyce, MD – Medical Oncology
Thomas Marsland, MD – Medical Oncology
Mohammad Khan, MD – Medical Oncology
Lois Morgan, RN – Clinical Research Associate
Mathew Luke, MD – Medical Oncology
Michael Olson, MD – Radiation Oncology
Alan Marks, MD – Medical Oncology
Niraj Pahlajani, MD – Radiation Oncology
Joseph Mignone, MD – Medical Oncology
Shyam Paryani, MD – Radiation Oncology
Yuval Naot, MD – Medical Oncology
Jan Peer, CCRP – Clinical Research Associate
Jeanine Richmond, RN, BSN, OCN, - Study Coordinator
Sonya Schoeppel, MD – Radiation Oncology
Matthew Robertson, MD - Gynecologic Oncology
Neenad Sha, MD – Radiation Oncology
Mila Shteyn, MA - Study Coordinator
Dwelvin Simmons, MD – Radiation Oncology
Alexander Moore – Study Coordinator
Robert Still, MD – Surgeon
Unni Thomas, MD – Medical Oncology
J. Wynn Sullivan, MD – Medical Oncology
Maria Valente – Medical Oncology
Linda Sylvester, MD – Medical Oncology Mitchell Terk, MD – Radiation Oncology Carlos Vargas, MD – Radiation Oncology
Prevention (NSABP and SWOG) Andrea Canto – STAR Program Coordinator
John Wells, MD – Radiation Oncology Larry Wilf, MD – Nuclear Medicine Radiologist Michal Wolski, MD – Radiation Oncology
Troy Guthrie Jr., MD – Principal Investigator
Cancer Risk Assessment and Genetics Melinda Fawbush, ARNP, MSN Troy Guthrie Jr., MD – Principal Investigator
35
Distinguished Individual in Cancer Care: E. Dayan Sandler, MD Each year the Annual Report honors an individual who has made a significant contribution to the cancer program at Baptist Health and to Baptist Cancer Institute progress. In past issues, we have honored both physicians and nonphysicians. This year we are honoring Dayan Sandler, MD, Chief of Pathology at Baptist Health. Dr. Sandler has made numerous contributions to the cancer program since joining the physician faculty in 1993. Dayan obtained her Doctorate of Medicine from the University of California School of Medicine San Francisco, Calif., where she had previously obtained a Doctor of Pharmacy. She did her post-graduate training in the department of pathology at University of California San Francisco from 1986-1990. She received intensive training in Cytology, Dermopathology, and Hematopathology. After completing her pathology residency, she received further training with a fellowship in nuclear medicine,
Baptist Cancer Institute
2012 Annual Report
37
E. Dayan Sandler, MD
within the Department of Radiology again at the
sought by both fellow pathologists and clinicians
University of California San Francisco in
for her opinions within the pathology field.
1990-1991. She became a staff pathologist at
She has been an active member of the Cancer
St. Mary’s Hospital in San Francisco from 1991
Committee for 12 years, and more recently, has
to 1992 prior to joining the clinical faculty at
served as committee chair of Baptist Health’s
Baptist Medical Center Jacksonville in 1993.
System Breast Program Leadership.
Here she has served in many positions, including director of Immunohistochemistry, Histology,
She has been an active member of Tipping the
Flow Cytometry Analysis Laboratory, and has
Scale Program, serving as both committee chair
served as the director of Laboratory Medicine
and as a mentor. She has mentored four young
from 1997 to the present. She also served as
ladies, all of whom have gone to college.
the director of the Stem Cell Laboratory when it functioned at Baptist Jacksonville from
On a personal note, her husband, Dr. Jeffrey
1996-1999. She has been Chief of Pathology
Sandler, is an Ear, Nose and Throat surgeon at
since 2004 at Baptist Health. Dr. Sandler has
Baptist Medical Center South. They have three
made numerous contributions to the cancer
children, Jonathan, Laura and Zachary, all of
program at Baptist Health, particularly in the
whom are in college. Her greatest passion is
field of breast cancer. She has a breast cancer
being with her family; all of them are outdoor
consultation service and is the pathologist for the
enthusiasts, and she loves kayaking, photography
Breast Conference. She also serves as primary
and traveling.
pathologist and as a major participant within the recently established neuro-oncology multi-disciplinary program. Dr. Sandler is widely
Baptist Cancer Institute Donors | Calendar Year 2012
38
Ms. Julie K. Abbott
Dr. and Mrs. Perry G. Carlos
Mr. and Mrs. Jim Furyk
Mrs. Mary W. Ackerly
Ms. Marge Cash
Jim and Tabitha Furyk Foundation
Acosta Sales and Marketing Co., Inc.
Ms. Debbie Castroverde
Mr. and Mrs. James R. Gabrielsen
Adelante Group, Inc
Mr. and Mrs. George Catallo
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Gannett Foundation
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Anonymous
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Mr. and Mrs. Douglas Coleman
Goodall Family Foundation
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Ms. J. A. Grunther
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Drs. Mori, Bean & Brooks, PA
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Benchmark Custom Luxury Homes, Inc
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Benchmark Homes Realty, Inc.
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Fernandina Beach High School
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Ms. Susan E. Forster
J. McLaughlin
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Parker & Pennington, PA
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Lilly USA, LLC
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PGA Tour, Inc.
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PhRMA
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Ms. Julia E. Lord
Ms. Gussie D. Pokorny
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LuLu’s Waterfront Grille
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Robert Williams Design, LLC
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