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Mark Bandyk, MD Urologic Oncology
Richard Boothby, MD Gynecologic Oncology
HelEn Chan, MD Surgical Oncology
Donna DiSanti, ARNP Surgical Oncology and Screening
Jennifer Gilbertsen, Physician AssistanT Urologic Oncology
Graham Greene, MD Urologic Oncology
Kris Guerrier, MD Radiation Oncology
G. Byron Hodge, MD Urologic Oncology
Cindy Jo Horrell, ARNP Medical Oncology and Screening
Frances Martin, MD Urologic Oncology
Sushma Nakka, MD Medical Oncology/Hematology
Manuel Molina, MD Surgical Oncology
Solange Pendas, MD Surgical Oncology
Matthew Smith, MD Urologic Oncology
Arvind Soni, MD Radiation Oncology
Madhavi Venigalla, MD Medical Oncology / Hematology
OUR VISION Lakeland Regional Cancer Center, the first choice in cancer care. OUR CORE PURPOSE/MISSION Delivering exceptional cancer care through early detection, treatment, research and the relentless pursuit of a cure.
2 A Community Hospital Comprehensive Cancer Program approved by the Commission on Cancer of the American College of Surgeons
Administrative Report Lakeland Regional Cancer Center (LRCC) has grown significantly over the past several years, and we are pleased to share our progress with you in this annual report. We have achieved so many milestones and accolades that distinguish our physicians, staff and beautiful Cancer Center as a recognized and premier provider of comprehensive cancer services. Despite our growth and increases in volumes across all programs, the Cancer Center has maintained its personal touch for caring for our special patients in a compassionate and warm manner. We have 13 Fellowship-trained oncologic specialists who have come to LRCC from some of the top oncology training programs in the country. For example, MD Anderson, Memorial Kim E. Walker Sloan-Kettering and Johns Hopkins have trained many of our cancer specialists, and our Cancer Center Administrator/ physicians continue to have close relationships with these institutions to bring the latest cancer Associate Vice President of Ambulatory Services treatment advances to our community. Currently, we have five Urologic Oncologists, two Medical Oncologists, two Radiation Oncologists, a GYN Oncologist, three Surgical Oncologists and four health care extenders to provide exceptional cancer care for our patients who come to us from our local community, throughout Florida and from many cities across America. All of LRCC’s oncologists are Board Certified in their specialty area. It is because of this talented group of caring physicians that we have soared to new heights in our efforts to find a cure for cancer and to provide outstanding care for all of our patients. We have more than 52,000 patient visits at our Cancer Center and perform cancer screenings on more than 4,200 patients on an annual basis. To accommodate this patient load, we broke ground on a $6.8 million expansion plan in early 2010. The goal of this project was to provide additional clinical space so that we could continue all of our programs and services under one roof for our patients. In June 2011, we opened a beautiful addition to our facility that included 26 more exam rooms and a special procedures area capable of performing minor surgeries, cystoscopies and HDR therapy. Our total square footage is now at 72,000. Although we have enlarged our footprint, we have not lost focus on providing exceptional service to our patients and their families, which is measured by an independent customer satisfaction rating agency. The Cancer Center consistently receives ratings exceeding 95 percent from our patients regarding their overall satisfaction with our services. Our screening program, which includes breast, colorectal, prostate, skin and osteoporosis screenings, consistently has customer satisfaction scores exceeding 98.5 percent from the more than 4,200 employees we screen at local businesses. Our physicians are complemented by an outstanding staff of approximately 140 caregivers who include oncology certified nurses, radiation therapists, medical technologists, a clinical pharmacist, a social worker, a mammography technologist, research nurses, a physicist, dosimetrists, certified coders, certified medical office assistants, business office staff, a patient advocate, as well as many other specialized staff who ensure our patients receive the best care and experience available when they visit us. As our building and staffing have grown, so have our programs. We have a wonderful Survivorship Clinic which is the only one offered in our community. We added a hepatobiliary tumor conference because of the growth of our specialized work Continued on page 27
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Chairman’s Report
Kris M. Guerrier, MD
The Cancer Committee’s main focus is to continue to improve upon the excellent cancer care provided at Lakeland Regional Cancer Center (LRCC) by identifying community needs, keeping pace with national outcome standards, and bringing special technologies and services to our center to better serve our patients. We have provided our patients with a strong robotics program in Urology, Gynecologic Oncology and Gastroenterology, along with offering Intensity-Modulated Radiation Therapy (IMRT) via RapidArc, and Stereotactic Radiotherapy to improve precision and patient comfort while minimizing patient symptoms. Patients enjoy strong support during their treatment through their contact with our Breast Navigator and for our comprehensive Breast Program, which is accredited by the National Accreditation Program for Breast Centers (NAPBC), as well as a Prostate Nurse Navigator for our Prostate Center of Excellence (PCE). Our Navigators help facilitate timely access to the appropriate health professionals, provide educational and emotional support, while helping to promote patient compliance. Additionally, we have an onsite Social Worker to help with free medication assistance applications as well as contacting community and state resources for many patients for financial, emotional, transportation and housing aid. Patients can also participate in our Survivorship Clinic to redirect their focus to their physical and emotional wellness after active treatment has been completed. The LRCC Cancer Committee assists LRMC in maintaining its accreditation by the American College of Surgeons by sponsoring a weekly, multidisciplinary cancer conference, a weekly prostate conference and a bi-weekly hepatobiliary conference. These conferences require the participation of physicians from Lakeland Regional Cancer Center and Lakeland Regional Medical Center. The conferences satisfy LRMC’s requirements for regular cancer conferences and help to improve and coordinate patient care at LRCC. Physicians present specific case presentations to discuss the evaluation and management of patients with various types of cancer. We present the majority of all cases that are new to our practices, as well as updates on a number of other cases throughout their treatment. The types of cases presented include our top five cancer sites, as well as various other sites and types of cancer treated by both LRMC and LRCC. Physicians involved represent all oncologic disciplines including Medical Oncology, Surgical Oncology, Urologic Oncology, Radiation Oncology, Gynecologic Oncology, Diagnostic and Interventional Radiology and Pathology with treatment recommendations in accordance with NCCN Guidelines, evidence-based medicine or clinical trials. It is this multidisciplinary approach along with the support of our strong clinical trials team that provides patients with various diagnoses appropriate and evidence-based care regardless of their socioeconomic status. The conferences are approved to provide continuing education credits through Lakeland Regional Medical Center and are open to all physicians, nurses and other health professionals. We are proud to sponsor and present to you the following LRCC Annual Report.
Kris M. Guerrier, MD, Radiation Oncologist Chairman Cancer Committee
Cancer Committee Membership 2011
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CANCER PROGRAM ADMINISTRATOR/ASSOCIATE VICE PRESIDENT OF AMBULATORY SERVICES Kim E. Walker, M.S.H.H.A.
PROGRAM LEADER MEDICAL ONCOLOGY/ HEMATOLOGY Madhavi Venigalla, MD
CANCER COMMITTEE CHAIRMAN/ PROGRAM LEADER RADIATION ONCOLOGY Kris Guerrier, MD
ONCOLOGY NURSING /QI PROFESSIONAL/ SOCIAL WORK/CASE MANAGER Robin Stewart, RN, PhD, OCN, CCRC
GENERAL/ONCOLOGY SURGERY Mark Bandyk, MD
CERTIFIED TUMOR REGISTRAR (CTR) Cindy Tillman RHIT, CTR
LRCC Programs and Services 2011 Surgical Oncology
Cancer Screening
Minimally invasive surgical techniques when appropriate n Lymphatic mapping and sentinel lymph node biopsy n Hyperthermic isolated limb perfusions (HILP) n On-site minor special procedure rooms n Radiofrequency ablation
n
n
Medical Oncology/Hematology Clotting disorders Benign and malignant hematological disease n Pain and palliative care n Chemotherapy n Immunotherapy n Hormonal therapy n Growth factor support n Use of targeted biological agents n Intravenous supportive therapy n Bone marrow biopsy and aspirations n n
Urologic Oncology/General Adult Advanced early detection techniques n Minimally invasive surgical procedures as appropriate for both malignancy and benign urologic disorders n Cryosurgical ablation n Robotic surgical technique n Nerve sparing radical cystectomies for prostatectomies and partial nephrectomies n Orthotropic reconstructive surgery
Cancer screening health fairs for schools, churches and businesses n Cancer screening educational materials
Imaging Services PET/CT scan (provided by a mobile unit from Radiology and Imaging Specialists) n Image-guided breast biopsy n Ultrasonography n Mobile mammography services n Fixed-site screening and diagnostic mammography with digital technology n
Multidisciplinary Cancer Conferences n
Discussion of cases with an oncology team that includes surgical oncology, medical oncology, radiation oncology, pathology, radiology and our clinical trials research team to assure the best possible treatment plan for each patient
Laboratory Services n
On-site laboratory services
n
GYN Oncology & General Gynecology Radical and ultraradical surgery for gynecologic malignancies n Minimally invasive surgical techniques (including robotic surgery) for malignant and benign gynecology disorders n Chemotherapy (including intraperitoneal) n Pelvic prolapse surgery n Colposcopy and management of HPV n
Radiation Oncology CT simulation and treatment planning technology for external beam and HDR brachytherapy n Linear accelerators featuring MultiLeaf Collimation (MLC) and digital portal imaging n 3D conformal radiation therapy n Intensity modulated radiation therapy (IMRT) n Image-guided radiation treatment (IGRT) with on-board imager (OBI) and cone-beam CT (CBCT) n Low dose rate intracavitary brachytherapy (including prostate brachytherapy) n High dose rate (HDR) brachytherapy n Accelerated partial breast irradiation (Mammosite, SAVI, Contura and 3-D external/IMRT) n Concurrent chemo-radiation therapy n Stereotactic Radiosurgery (SRS) n Volumetric Arc Therapy (VMAT) n
Pathology Services n
Provided by Lakeland Pathologists, PA
PHARMACY Services n n
On-site pharmacy with chemotherapy mixing capabilities On-site clinical pharmacist
Genetic Testing and Counseling Genetic testing for cancers including breast, ovarian, melanoma and colon n Genetic counseling regarding a patient or family members’ individual risk of carrying an inherited genetic mutation n
Boutique On-site Certified Mastectomy Fitter Breast cancer patient consultations and fittings n Specialty items including post-mastectomy apparel n n
Support Services Patient advocacy specialist Social worker n Patient education material and library n Nutritional support n Complementary medicine services n Support groups n Survivorship clinic and educational programs n n
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Cancer Care Services PAIN AND PALLIATIVE CARE The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients facing life-threatening or debilitating illness
Goals and Objectives of Palliative Care Translate comprehension of the clinical and scientific
n
basis of advanced disease processes, symptoms and
and their families, regardless of the stage of the disease
symptom management into improved patient care.
or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured
Assess patient pain and other symptoms and side
n
effects, and recommend a care plan based upon the
system for delivering care.
best available evidence.
As leaders in promoting excellence in cancer care, our palliative care program combines our physicians’ and
Identify psychological, spiritual, social and cultural
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nurses’ expertise to advance the field, thus meeting the
aspects of patient care, and integrate support of those
joint goal of improving the quality of life for patients and
aspects of patient care into an overall plan of care.
families facing serious or life-threatening conditions. The palliative care program at LRCC continues to grow with
Develop patient plans of care that incorporate
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interdisciplinary assessments and symptom management
expert care to serve the residents of Polk County and
across all domains of care that are ultimately based on
beyond. We will pursue opening clinical trials for this
the expressed values, goals and needs of the patient
patient population. We at LRCC provide a comprehensive,
and family.
multidisciplinary approach to the treatment of cancer patients and strive to provide state-of-the-art treatment
Apply effective communication principles with patients,
n
families and interdisciplinary teams.
modalities combined with novel therapy approaches, using well-trained, experienced medical and ancillary personnel,
Identify ethical and legal concerns related to hospice
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giving compassionate care and support. Our interest and experience in providing pain and palliative care is complemented by Lakeland Regional Medical Center’s new
and palliative care. Discuss the effective strategies and challenges for the
n
delivery of hospice and palliative care in diverse settings.
inpatient pain and palliative care unit.
Facilitate future research in hospice and palliative care.
n
Sushma Nakka, MD Medical Oncologist/Hematologist
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Breast Oncology Lakeland Regional Cancer Center (LRCC) provides a multidisciplinary approach to the treatment of breast cancer. LRCC has developed a comprehensive breast program so that patients have access to the newest treatment modalities and clinical trials. Furthermore, different treatment options are constantly being updated so that breast cancer patients receive the most modern and effective cancer therapies. This year alone, more than 200,000 new cases of breast cancer will be diagnosed in the United States. In addition, one in eight women will develop breast cancer during their lifetime, and every 12 minutes a woman dies from the disease. To respond to our community need, Lakeland Regional Cancer Center has developed a comprehensive breast cancer program. As a surgical oncologist, I am dedicated to breast conservation techniques and minimally invasive surgery for the treatment and cure of breast cancer. Dr. Madhavi Venigalla, our participating medical oncologist, and Dr. Kris Guerrier, our participating radiation oncologist, also share a strong interest in treating breast cancer patients. Radiation therapy plays an essential role in breast conservation for pre-invasive and invasive disease. Radiation also decreases local recurrence and improves survival in all breast cancer patients. We strive to provide accurate and efficient care to obtain the best outcomes with minimal side effects. Currently, we are providing a select group of breast cancer patients with the option of partial breast radiation therapy, which involves the placement of a balloon brachytherapy catheter. This treatment is given over five days versus the standard whole-breast radiation therapy, which is given over six to seven weeks. Our breast program has expanded many of its services. For example, the lymphedema program, high-risk breast program and clinical research program all contribute to the scope of services offered our breast patients. LRCC started a breast cancer survivor group program, which meets several times a year with the main goal of empowering women through education and emotional support. The first meeting was held on January 24, 2008 and it has been quite a success since that time. We are now offering a High-Risk Breast Cancer Clinic for patients without breast cancer who possess certain risk factors for developing a future breast cancer. This will tremendously aid our early detection and prevention efforts.
The National Accreditation Program for Breast Centers (NAPBC) has recognized LRCC as the first center of excellence in Polk County and the second program in the state of Florida accredited for the treatment of benign and malignant breast diseases. This is a unique recognition given to selected centers that have voluntarily committed to the highest level of quality breast care. The Lakeland Regional Cancer Center breast program was awarded this prestigious designation and was able to meet the 27 rigorous NAPBC standards without any deficiencies. Breast centers that achieve NAPBC accreditation demonstrate a firm commitment to deliver state-of-the-art health care and offer women every significant advantage in their battle against breast cancer. LRCC provides our breast cancer patients with digital mammography imaging services and was one of the first in Polk County to do so. This technology improves resolution of images and enhances tumor characterization to help promote early detection. In addition, we are now able to offer patients breast MRI, and we also have MRI breast biopsy capabilities through our partnership with Radiology Imaging Specialists (RIS). RIS has a dedicated 1.5 tesla breast coil with MRI breast biopsy capabilities. We also have an educational patient guide that includes educational material and breast cancer websites, which will help navigate and educate newly diagnosed breast cancer patients through their treatment. We are excited to enhance our patients’ experience with a breast cancer nurse navigator, who will help navigate and coordinate all newly diagnosed breast cancer patients in regards to their various appointments, treatments and support services. At our cancer center, women are given the opportunity to participate in life-saving clinical trials that are only offered in comprehensive breast cancer centers like Lakeland Regional Cancer Center. Finally, at our institution, we continue the fight against breast cancer through early detection, a modern women’s health program offering annual mammograms, research and clinical trials, and through our state-of-the-art screening bus and rigorous screening program.
Solange Pendas, MD, Surgical Oncologist Program Leader of Breast Oncology 7
Cancer Care Services continued CUTANEOUS ONCOLOGY The Cutaneous Oncology Program (COP) at the Lakeland
to define the prognosis and natural history of many of
Regional Cancer Center continues to be one of the largest
the melanoma populations; (3) patient safety is enhanced
referral centers for patients with melanoma in the state of
and universal access to the EMR provides for an efficient
Florida. Due to the epidemic of skin cancer in the Sunshine
clinic operation. In progress is the implementation of our
State, melanoma is one of the highest incidences of cancer
institutional database to a national database (Casis) in order
registered at LRCC with more than 300 new patients being
to allow better interchanges of information with other major
diagnosed and cared for annually.
cancer centers.
The program offers unique protocols to the community
Physicians at LRCC continue to participate in programs to
and the state of Florida. LRCC is the only center in the
focus awareness on melanoma and skin cancer screening
state to offer clinical trials involving new agents such
programs, which are reasons for the early detection and
as Ipilimumab for Melanomas in stages III and IV. The
better prognosis.
Surgical Oncology team is pioneering new surgical treatments for metastatic melanoma, making them one of the few in the country to offer robotic surgery for groin lymphadenectomy. This procedure offers patients a lower rate of procedure-related complications, while maintaining the oncological principles for the treatment of melanoma metastatic to the groin lymph nodes. Recently, LRCC has entered the CARIS Database registry,
Difficult to treat squamous cell and basal cell carcinomas of the skin, due to size or location, are also specialties of the clinic. Major resections including head and neck skin cancers are performed with immediate reconstruction by Plastic Surgery securing the best cosmetic results possible. The future is bright for the Cutaneous Oncology Program at LRCC as we strive to deliver cutting-edge care and resources to patients in the state of Florida.
offering genetic analysis of advanced melanomas and other tumors. This project allows LRCC to offer more personalized treatments, including testing for all known genetic mutations and also testing for chemosensitivity via Target Now, providing more therapeutic options after failure of first- and second-line chemotherapies. One of the special features of the Cutaneous Oncology Program is the presence of an electronic medical record (EMR) database that is used on a daily basis to take care of patients. Some features of the database are as follows: (1) as new patients are registered with the program, letters are mailed to the referring physicians the same day helping to keep them up-to-date; (2) variables collected in the database can be queried for research projects
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Manuel Molina, MD, Surgical Oncologist
HEPATOBILIARY AND FORGUT ONCOLOGY Lakeland Regional Cancer Center offers a multidisciplinary
radiofrequency ablations are offered to poor surgical
treatment approach for tumors in the Forgut
candidates.
and Hepatopancreatobiliary organ systems. The multidisciplinary Hepatobiliary and Gastrointestinal conference was initiated to fulfill the need of specialized treatment of these difficult-to-treat malignancies. Currently, every case is studied in detail by all the members on the team, including Surgical Oncologist, Radiation Oncologists, Medical Oncologists, Interventional Radiologists, Research Nurses, Social Workers, Pathologist, etc. A comprehensive plan of care is carefully documented for every patient. All patients are evaluated for participation in clinical trials. Currently, LRCC offers the latest and best available treatments for esophageal cancer including adequate staging with PET and EUS, neoadjuvant chemo-radiation, followed by transhiatal esophagectomy and adjuvant
All major hepatic, bile duct and pancreatic resections are performed by LRCC surgeons. The surgical team of two surgical oncologists performs the majority of these procedures. This team approach provides good outcomes and decreases complications. Chemo-radiation is offered to all resected pancreatic cancer patients, based on national standards. LRCC also participates in national multicentric trials involving neoadjuvant chemotherapy for resectable and borderline resectable pancreatic cancer patients. Other specialized procedures including EUS with biopsy and celiac nerves block for palliation, laparoscopy, percutaneous biliary procedures, and other procedures involving the bile ducts and pancreas are also offered at LRMC.
chemotherapy as indicated. This is achieved minimizing
LRCC proudly offers to all Polk County patients the
toxicity and side effects to patients and preserving a
latest approaches to cancers of the Foregut and
good quality of life. The ICU offers aggressive pulmonary
Hepatopancreatobiliary organ systems. This program
toilette protocols for post esophagectomy patients with
continues to grow, making LRCC a top center for
daily bronchoscopies in high risk patients. This approach
treatment of these kinds of cancers.
decreases the risk for postoperative pneumonia. Early evaluations and interventions by speech pathology are
Manuel Molina, MD, Surgical Oncologist
done when necessary. The patients are also evaluated by nutritionists to encourage proper nutrition after surgery. LRCC also offers national preoperative chemotherapy trials for metastatic colon cancer to the liver, focusing on decreasing the chemo-induced hepatotoxicity. Guidelinebased approaches to hepatocellular carcinoma are routinely utilized at LRCC. We offer clinical trials for advanced hepatomas including participation in multicentric trials with Sorafenib based combination chemotherapy. Chemo-embolization, portal vein embolization and
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Cancer Care Services continued GASTROINTESTINAL (GI) ONCOLOGY The Lakeland Regional Cancer Center (LRCC) Gastrointestinal (GI) Oncology Program has a dedicated staff focused on cancers of the esophagus, stomach, bile ducts, liver, pancreas, colon, rectum and anus. The program is based on a multi-specialty team approach. In this way each patient’s care is coordinated with expert input from all the cancer specialties. Our multidisciplinary approach is like getting multiple second opinions at one setting. All of the physicians treating gastrointestinal cancer meet to review the cases at a weekly conference. This includes the surgical oncologist, medical oncologist, radiation oncologist, pathologist, radiologist and clinical trials staff. We believe it is critical for all the LRCC cancer physicians to discuss the patient’s care before starting treatment. This often assures the best and safest approach. The GI oncology team is committed to fighting cancer, and all of the members have completed specialized training for the care of patients with cancer. Cancers of the GI system account for the second highest number of cancer deaths in the US. Colorectal cancer is the most common GI malignancy in the US. One in 17 individuals will develop colorectal cancer. If diagnosed with colorectal cancer, your chance of dying from this disease is much higher than patients with a diagnosis of breast or prostate cancer. This is in spite of the fact that colorectal cancer can be detected early with routine screening and also actually prevented in most cases by colonoscopy and removal of polyps before they ever develop into a cancer. All men and women beginning at age 50 should be screened for colorectal cancer (screening should begin earlier in certain situations including when there is a family history of colon or rectal cancer). Undergoing colorectal cancer screening has been shown to significantly decrease the likelihood of dying from this disease and allows these tumors to be identified at an early stage when they have an excellent chance of cure with surgery alone. Despite these figures, only approximately 40 percent of the eligible US population is screened for colorectal cancer. The GI oncology program at LRCC offers colorectal cancer screening and educational programs designed to inform our community about the need and benefits of colorectal cancer screening. At LRCC, most patients with colorectal cancer are eligible to get robotic as well as laparoscopic surgery. Robotic and laparoscopic surgeries are less invasive yet are equally effective in removing the cancer and the mesenteric lymph nodes. The patients benefit from a faster and less painful recovery.
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The lymph nodes are typically the first place a cancer will spread. One of the critical steps in treating colorectal cancer, along with surgically removing the tumor, is also making sure enough lymph nodes have been surgically removed and examined by the pathologist. Adequate staging and lymph node sampling is a major focus of the surgical team at LRCC. Many studies have shown that an appropriate surgical procedure can have a dramatic effect on someone’s chance of cure from gastrointestinal cancer. LRCC is actively enrolling patients in a study to help find out if performing sentinel lymph node biopsy in patients with cancer of the colon helps find disease in the lymph nodes that would otherwise be missed. Beyond the lymph nodes, colorectal cancer frequently spreads to the liver. With new and effective chemotherapies, response rates and survival for these tumors is dramatically increased from what it was just a few years ago. In some cases, even with spread to the liver, cure is still possible. Cancers that have metastasized to the liver can now often be surgically removed for potential cure or ‘burnt’ with new techniques such as radiofrequency ablation. As a colorectal cancer gets close to the anus, the concern for a permanent colostomy bag becomes more likely. The GI program at LRCC is committed to sphincter preservation. We utilize a number of methods for this goal including treating the tumor first with radiation and chemotherapy to shrink it. LRCC and our patients are fortunate to participate in a number of studies, many of which allow new exciting treatments to be offered that may not otherwise be available for years. One of our current trials is trying to identify a group of patients whose tumor genes suggest a low chance of recurrence and can thus avoid chemotherapy. Another of our colon cancer trials is for the treatment of colon cancer with targeted drugs. These drugs have been shown to be so effective in patients with metastatic disease that they are now approved by the FDA. They are used as standard treatment across the country in these patients. The GI program at LRCC continues to grow with expert care to serve the residents of Polk County and beyond.
Helen Chan, MD, Surgical Oncologist Program Leader of Gastrointestinal Oncology
GYNECOLOGIC (GYN) ONCOLOGY & GENERAL GYNECOLOGY PROGRAM Gynecologic Oncology represents the prevention, early diagnosis and treatment of women with cancers of the female reproductive tract. This includes the treatment of pre-cancerous and invasive diseases of the vulva, vagina, cervix, uterus, fallopian tubes, ovaries and peritoneum (lining of the abdomen and pelvis). The American Cancer Society has estimated that there will be 80,000 new cases and 28,000 deaths from a gynecologic cancer in 2009. Clearly, these women deserve treatment by a caring cancer team focused on cutting-edge solutions. The Lakeland Regional Cancer Center’s Clinical Trials team is an Affiliate Member of the Gynecologic Oncology Group (GOG). The GOG is one of the National Cancer Institute’s (NCI) funded cooperative cancer research groups, which focuses on research for women with pelvic malignancies. The Gynecologic Oncology Group has emerged as a leader in developing new strategies in the treatment of women’s cancers and has, therefore, continued to set the standard for research and treatment of these cancers. As an affiliate member of the GOG, the Lakeland Regional Cancer Center is able to offer interested patients the option to participate in research trials. These research trials sometimes result in the discovery of new surgical treatments, chemotherapy drugs and/or radiation techniques, which become the new standard of care. One example is the use of intraperitoneal (IP) chemotherapy for some women with ovarian cancer. It has been shown in certain circumstances to be better than conventional chemotherapy. We have extensive experience in administering IP chemotherapy to women with ovarian cancer. Many gynecologic cancers require radiation therapy as a form of treatment. Intensity modulated radiation therapy (IMRT) techniques have been used to target tumor cells, while avoiding adjacent normal tissue. Image guided radiation therapy (IGRT) is used to assess tumor volume prior to each radiation treatment. These state-of-the-art techniques have been used in the treatment of gynecologic
cancers at Lakeland Regional Cancer Center. We also offer state-of-the-art radiation treatments for brachytherapy including High Dose Rate Afterloading techniques which decrease the risks of side effects for our patients. The Gynecologic Oncology Program launched the minimally invasive (laparoscopic) surgery using the DaVinci surgical robot in December 2005. Performing surgeries using this technology, which is currently available at Lakeland Regional Medical Center, offers several advantages for patients. Patients have smaller incisions, less blood loss, less complications, less pain and shorter recovery time after surgery. We have considerable experience in the use of both conventional laparoscopy and robotic surgery in dealing with gynecologic cancers. The members of the Gynecologic Oncology Program strive to advance the cure of women’s cancers, while stressing the importance of quality of life. Ultimately we strive to attain the core purpose and mission of the Lakeland Regional Cancer Center – Delivering exceptional cancer care through prevention, early detection, treatment, research and the relentless pursuit of a cure. In General Gynecology, we offer extensive experience in pelvic floor reconstruction for patients who have uterine and vaginal prolapse, cystocoele and rectocoele problems. In collaboration with our Urology Department we also offer care for female patients with urinary incontinence. We also have extensive experience in dealing with menopausal symptoms for patients, especially breast cancer survivors.
Richard Boothby, MD, Gynecologic Oncologist Program Leader of Surgical and Gynecologic Oncology & Women’s Health
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Cancer Care Services continued HEAD AND NECK ONCOLOGY PROGRAM Cancers of the head and neck region are tumors that occur in the nasal cavity, nasal pharyngeal passages, oral cavity (mouth), oral pharyngeal passages (tonsils, oropharynx), areas above (supraglottic), including (glottic), and below (subglottic), the larynx (voice box). This also includes salivary glands, local-regional spread of such cancers to the neck, and skin cancers involving the scalp, face and neck regions, e.g. basal cell carcinoma, squamous cell carcinoma, melanoma and Merkel cell carcinoma. Although head and neck cancers comprise only three to four percent of the total cancers referred to LRCC this past year, these tumors can cause significant disfigurement, loss of speech, swallowing or other organ dysfunction affecting quality of life and often cause death. This type of cancer can be especially prevalent in people who heavily consume alcohol, abuse tobacco products, have extensive sun exposure and have oral HPV exposure. However, these risk factors are not a definitive requirement for the development of head and neck cancer. The Head and Neck Oncology Program at LRCC is a multidisciplinary, comprehensive care program designed to provide for all aspects of patient care required by the head and neck cancer patient. The program includes services to manage all aspects of patient care from initial diagnosis to multidisciplinary treatment options including surgery, radiation oncology, medical oncology, subsequent follow-up and rehabilitation. All patients are presented at a multidisciplinary tumor board that includes all specialties involved with the care of these patients. Special attention is given for preserving organ function, when appropriate, and quality of life. We have community board-certified Otolaryngologists who possess extensive clinical experience and expertise in the initial diagnosis, work-up and surgical intervention required for managing these patients. Board-certified Radiation Oncologists Arvind Soni, MD and myself have training and extensive experience prescribing, designing radiation treatments, and managing head and neck patients undergoing such treatment. Head and neck patients are provided sophisticated immobilization, treatment planning with PET/CT fusion with treatment planning scans, imageguided radiation therapy (IGRT) delivery with on-board imaging for improved daily targeted treatments, and daily cone-beam CT, combined with Intensity Modulated
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Radiation Therapy (IMRT), which allows for unprecedented normal tissue sparing in our head and neck cancer patients. We now offer IMRT via RapidArc to deliver treatments in just a few minutes as opposed to 25-30 minutes, which improves patient comfort while employing an additional technique to minimize motion during treatment. We also provide superficial electro therapy for eyelid, lip, ear and nose skin cancers. Terry Boston, PhD, boardcertified medical physicist, provides expertise in the special construction of custom bolus, lead-lined intraoral obturators and other treatment devices to provide extra protection for normal tissues. Drs. Soni and myself are also experienced in the administration of normal tissue protectants during radiation treatment. Board Certified Medical Oncologists Madhavi Venigalla, MD and Sushma Nakka, MD also possess expertise and specialty interests in treating and managing all types and stages of head and neck patients with chemotherapy and systemic biologic agents, administering radioprotectants, and working in close collaboration with the aforementioned physician specialists and very supportive ancillary personnel. LRCC possesses an active clinical research program available for our head and neck cancer patients, supported by well-trained clinical research associates. We are constantly looking to open new trials for patient enrollment to provide patients the opportunity to receive stateof-the-art treatment with novel therapies and therapy combinations. There are a number of trials available for our head and neck melanoma patients as well, and we will pursue opening additional trials for this patient population. We at LRCC provide a comprehensive, multidisciplinary approach to the treatment of head and neck cancer patients, including preventive dental and nutritional support evaluations, as well as speech therapy to preserve organ function. We strive to provide state-of-the art treatment modalities combined with novel therapy approaches, using well-trained, experienced medical and ancillary personnel, providing compassionate care and support.
Kris Guerrier, MD, Radiation Oncologist Program Leader of Radiation Oncology
THORACIC ONCOLOGY PROGRAM The National Cancer Institute (NCI) estimates that 221,130
to innovative comprehensive treatment options, including
men and women will be diagnosed with lung cancer in
IMRT with image-guided radiation therapy (IGRT) treatment
2011. Though death rates in lung cancer have been falling
delivery and daily cone-beam CT capability. This accounts for
since 1993, 156,940 men and women are estimated to die
daily variations in patient motion and on-going changes in
of lung and bronchial cancer in 2011. The National Cancer
tumor volume, enabling us to offer more accurate treatment
Institute (NCI) estimates that the expected overall five-year
of thoracic malignancies. We are constantly in the process of
survival rate is only about 15 percent.
adding novel technologies once proven safe and effective.
Lung cancer patients will benefit from closely coordinated,
We are in the forefront of new and innovative methods and,
multi-specialty care services such as those provided by
whenever appropriate and available, we offer patients access
the Lakeland Regional Cancer Center Thoracic Oncology
to participation in the latest national cooperative group
Program. This program is focused on providing state-of-
clinical trials. Our dedicated clinical research associates,
the-art therapy of lung and chest cancers. Our board-
who coordinate the process from enrollment and treatment
certified physicians, who represent different specialties and
through regular follow-up visits, discuss the applicable study
treatment disciplines, work together to design an optimal
individually with the patient. Currently, open trials for lung
treatment regimen. During our weekly multidisciplinary
cancer include first-line and second-line chemotherapy for
tumor board meetings, pathologists, diagnostic
locally advanced and metastatic lung cancer. The LRCC
radiologists, medical oncologists, surgical oncologists,
Thoracic Oncology Program is focused on striving to improve
radiation oncologists, and ancillary support personnel meet
outcomes of patients with lung cancer. We provide excellent
to present and discuss each case individually to offer the
and carefully coordinated care in a patient-oriented,
best individualized treatment recommendations for our
compassionate environment.
patients. Surgical oncologists are available for surgical options. Medical Oncologists Madhavi Venigalla, MD, and Sushma Nakka, MD provide expertise in administering
Kris Guerrier, MD, Radiation Oncologist Program Leader of Radiation Oncology
chemotherapy alone, novel systemic targeted therapies and chemotherapy concurrently with radiation therapy. As board-certified Radiation Oncologists, Arvind Soni, MD and myself are experienced specialists who prescribe and custom design the radiation treatment based on sophisticated imaging. This includes PET/CT imageregistered information fused to the planning images used during the treatment planning process. Radiation treatment options range from conventional 3D-conformal
13
Cancer Care Services continued UROLOGIC ONCOLOGY & GENERAL UROLOGY The Urologic Oncology program at Lakeland Regional Cancer Center includes five board-certified and fellowship-trained urologic oncologists (Dr. Matthew Smith, Dr. Byron Hodge, Dr. Mark Bandyk, Dr. Graham Greene and Dr. Frances Martin), two physician extenders (Michelle Guess, ARNP and Jennifer Gilbertsen, PA) and support staff that see a broad range of men and women with urologic problems. Services include urologic oncology and general adult urology. Lakeland Regional Cancer Center pioneered the use of robotic surgery in Central Florida, and now robotic radical prostatectomy with numerous potential benefits is our standard of care. For those patients who are not candidates for robotic surgery, traditional open nerve-sparing prostatectomy is offered. High intensity focused ultrasound therapy (HIFU) is also offered for select patients with prostate cancer. Lakeland Regional Cancer Center initiated the use of cryosurgical ablation of prostate and kidney tumors in our area. For appropriately selected patients, cryosurgical ablation includes a shortened recovery time, a lower risk of potential side effects and a quicker return to normal daily activities. Cryosurgical treatment options for kidney cancer include either a percutaneous or hand-assisted laparoscopic approach. Kidney cancer is being treated with robot assisted laparoscopic partial nephrectomies for smaller tumors and hand-assisted laparoscopic and open radical nephrectomies for larger masses. For patients with invasive bladder cancer, nerve sparing radical cystectomies with orthotropic reconstructive surgery (no urinary stoma) is offered for both men and women. This allows for voiding through the native urethra. In 2010, Lakeland Regional Cancer Center developed its Prostate Cancer Center of Excellence. This center is led by a nurse navigator and directed by Dr. Graham Greene. It provides close and coordinated care for all of our prostate cancer patients. All of our patients are entered into a database, undergo stringent tumor staging and are placed on an appropriate treatment pathway. This is a coordinated effort involving the urologic, medical and radiation oncologists. Our goal is to individualize therapy for each patient based on their overall health and anticipated outcomes. Every newly diagnosed patient with prostate cancer is presented at our weekly tumor board where their pathologic slides are reviewed for a second time along with any of their pertinent x-ray studies. This center is currently evaluating quality outcome measures such as pathologic state, margin status, length of stay in the hospital, continence and erectile dysfunction. In addition, we offer a very active clinical trials program for our patients with advanced prostate cancer who have exhausted the normal surgical, radiation and chemotherapy treatment options. During the past year we have been actively evaluating the
14
use of dynamic contrast MRI imaging of the prostate to allow us to localize early prostate cancers and, in some cases, to direct focal therapy. This modality is useful for finding hard-todiagnose prostate cancer and in following and staging prostate cancer for those who are undergoing active surveillance. Full radiation therapy services are available at Lakeland Regional Cancer Center including image modulated radiation therapy (IMRT), image guided radiation therapy (IGRT with onboard imaging and SonArray ultrasound guidance, permanent radioactive seed implants and temporary high dose brachytherapy for prostate cancer. Lakeland Regional Cancer Centers’ newest linear accelerator offers IMRT with RapidArc and IGRT including cone-beam CT localization. In addition to surgical and radiation therapies, Lakeland Regional Cancer Center, in conjunction with our medical oncologists, provides comprehensive chemotherapy and immunotherapy treatment options for urologic malignancies. The physicians in the Urologic Oncology Department at Lakeland Regional Cancer Center work side by side with their colleagues in Medical Oncology and Radiation Oncology in a single facility which provides a warm and caring environment along with comprehensive and integrated cancer care for our patients. During the last year, we expanded our facility to include additional examination rooms, treatment and diagnostic facilities. Weekly cancer conferences are held to review treatment plans for our patients allowing us the ability to obtain state-of-the-art treatment recommendations and clinical trial eligibility from a multi-disciplinary panel of physicians. We strive to provide precise patient-oriented and accurate care with up-to-date information for our patients regarding the treatment of various cancers as well as methods of rehabilitation from treatment-related side effects. We work in a coordinated fashion to present the patients with all available treatment options so that they can make informed decisions. Treatment plans are addressed from an individual perspective, and an appropriate approach is taken with each patient. Patients are screened for a variety of clinical trials including prevention, adjuvant and advanced metastatic protocols that are all available through our facility. Our highly trained nurses and our support staff care for our patients’ needs by providing patient education and information, a dedicated patient advocate, social support and complimentary medical therapy to increase the patients’ ability to apply coping and problem-solving techniques to their illness. Our general urology services include minimally invasive treatment options, as well as conventional treatment options, for patients with bladder outlet obstruction secondary to benign prostatic hyperplasia. A new state-of-the-art urodynamics facility has been opened for evaluation of patients
with incontinence and voiding dysfunction. Kidney stone disease is managed with a combination of medical evaluation and surgical treatment. Outpatient ureteroscopic laser lithotripsy, as well as extracorporeal shockwave lithotripsy, is used in the management of small kidney stones. Larger stones are treated with percutaneous stone extraction using ultrasound and laser destruction. Metabolic stone evaluation
is performed for all patients with recurrent stone disease. Our physicians and staff also offer evaluation, as well as medical and surgical treatment options, for patients with impotence, incontinence and recurrent urinary tract infections.
Matthew Smith, MD Program Leader of Urologic Oncology
Cancer Screening Lakeland Regional Cancer Center (LRCC) has a dedicated cancer screening program that was developed over seven years ago to provide a service to decrease the mortality of cancer through early detection, risk assessment and education. Our program is staffed with two nurse practitioners, a registered mammography technologist and a screening coordinator. LRCC provides the following cancer screenings: breast, prostate, fecal occult blood (colon cancer), skin and osteoporosis. Our screening program is supervised by LRCC physicians. Finding cancer early offers greater hope for a cure. To achieve our goal of early detection, LRCC has implemented strategies that promote health and awareness, and we actively participate in community, civic and church activities that encourage annual cancer screenings. Our mobile screening program contracts with several large corporations in Polk and Hillsborough counties to provide on-site mobile screenings for more than 4,200 employees. This service offers a unique venue for those employees who may not otherwise take time off from work to get their annual cancer screenings. Our specially equipped Airstream mobile screening bus travels to more than 160 local school sites a year and to other local contracted businesses to perform our cancer screenings. Educational sessions are also offered at these sites to promote the need and value of cancer screenings. We also participate in multiple health fairs throughout the year at various church, civic and corporate settings. We provide our cancer screenings at some of these events; once again, in an effort to provide convenient access, awareness and education on the benefits of annual cancer screenings for early detection of cancer or pre-cancerous conditions. From our annual cancer screenings for the Polk County School Board retirees, to a health fair event at a local church and to educational sessions held at various retirement communities, we actively promote the benefits and convenience of the screening services we offer. Our physicians provide many educational presentations throughout the year that also promote screening services as an effective cornerstone for the prevention and early detection of cancer. They offer lunch and learn educational sessions, dinner programs and formal community presentations that focus on the benefits of early cancer detection through routine screening mammograms, prostate exams and PSA tests, skin examinations and colorectal screenings. Having a strong cancer screening program enables our Cancer Center to fulfill our mission to deliver exceptional cancer care through prevention, early detection, treatment, research and the relentless pursuit of a cure. We are proud of the important service this program provides to our community and our business partners but, more importantly, we are pleased with the early detection of many cancers that we have found by bringing our expert team to businesses and community venues.
Kim E. Walker, MSHHA Cancer Center Administrator/Associate Vice President Ambulatory Services
15
A Place For Her – A Special Boutique At A Place for Her, our pre- and post-mastectomy and reconstruction specialists help women who have undergone breast surgery regain their natural form and boost their self-confidence. Our certified mastectomy fitters offer on-site fittings from our complete line of soft, comfortable, natural-looking breast forms, brassieres, camisoles and swimwear. Products from all leading manufacturers are used to assure our ladies are receiving the exceptional fittings they deserve. Forms and bras are created for ultimate comfort and can bring peace of mind during the post-op process and for many years afterwards. Each surgery site is different, and A Place for Her fitters assist each lady personally to achieve her comfort and confidence. A Place for Her bills most insurances including Medicare, Medicaid, Cigna, Aetna, Blue Cross Blue Shield, Humana, United Healthcare, and more. We will assist with getting the necessary prescriptions from the doctors and authorizations from the insurance companies. A Place for Her is open Tuesdays and Wednesdays in the Lakeland Regional Cancer Center. A second location in Clearwater is open Monday through Friday and also offers free in-home visits throughout central Florida. Both locations also have scarves, jewelry and accessories available.
Debbie McNichol, RN, BSN
Genetic Testing & Counseling Lakeland Regional Cancer Center offers genetic testing and counseling for a number of cancers. Most cancers are thought to be caused by multiple factors and, therefore, not directly inherited from one’s parents. However, about five to ten percent of cancers are felt to be the result of an inherited genetic mutation (directly passed in the genes from parent to child). As a result of advances in the understanding of genetics, it is now possible to test for some of the defective genes by a simple blood test. The abnormal gene known to be associated with breast and ovarian cancer is the BRCA gene (Breast Cancer gene). The average female living in the United States has approximately a 12 percent risk of developing breast cancer and a one percent risk of developing ovarian cancer in their lifetime. For women with a genetic mutation in the BRCA gene, the risks are up to 87 percent and 44 percent respectively. As a result, recommendations for breast cancer screening and treatment in women with a mutation in the BRCA gene are different than a female at average risk. A hereditary risk for breast or ovarian cancer should be considered in individuals with multiple members of their family affected by breast or ovarian cancer and individuals diagnosed at a very young age (usually before age 50). Also, individuals with cancer in both breasts and males with breast cancer should consider being counseled regarding their risk of carrying a genetic mutation. Genetic testing is also available for other diseases such as colon cancer and melanoma. At LRCC, individuals felt to be at risk for carrying a genetic mutation are counseled about the advantages and disadvantages of having a blood test to see if they have a genetic mutation. Early screening such as colonoscopy, breast MRI, skin exam and digital photography are considered in certain high-risk individuals. Knowing if a genetic mutation is present can be instrumental in offering the best individualized treatment plan. Sometimes, prophylactic or risk-reducing surgery is offered to patients with a genetic mutation to prevent cancer before it even develops.
Solange Pendas, MD, Surgical Oncologist Program Leader of Breast Oncology 16
Patient Advocacy At Lakeland Regional Cancer Center (LRCC), our goal is to meet the patient’s healthcare needs by providing a team approach to patient care. We help patients experience a better sense of control during treatment by becoming their partner in cancer care. The LRCC team believes that it is our responsibility to provide patients the most accurate and understandable information about cancer and to educate patients about the services we provide. The Patient Advocacy Specialist assists patients and others in understanding programs and services available at Lakeland Regional Cancer Center and serves as a point of contact for patients. New patients are oriented to LRCC’s facilities and services. For those patients who receive treatment at LRCC, the orientation process includes a patient guide, “A Journey to Recovery.” Each patient guide is customized for the patient as they go through the treatment process and is Haines City patient Merle Clark and LRCC RN Robin S. Stewart
designed to provide valuable information about LRCC, along with tools to assist them during treatment.
The guide includes information such as: n
An introduction to LRCC (our medical team, administration and support team);
n
Information about our website, patient library, boutique and healing garden;
n
Information about managing common side effects;
n
A listing of local support groups;
n
An explanation of laboratory tests used during diagnosis, treatment and follow-up and a table to track results
n
Helpful hints for patients and their friends and relatives.
Paul Leonard with LRCC hematologist oncologist Dr. Madhavi Venigalla
All patients are encouraged to contact our Patient Advocacy Specialist should they have questions or concerns. After their first visit, and then periodically throughout their care, communication continues with patients via the LRCC patient satisfaction survey. The LRCC team steadily strives to consistently meet patient expectations and, utilizing this survey process, monitors patient satisfaction very closely. Additionally, the LRCC team includes a dedicated group of volunteers that enhance LRCC’s services through heartfelt compassion, talent and energy. Our volunteers greet patients and guests with a warm welcome and a helping hand, providing wheelchair assistance, library assistance and guidance to the appropriate clinic/department. In addition, they also lend their talents and support to many departments through our organization.
Alice Varnadore, Patient Advocacy Specialist
17
Support Services Learning about a cancer diagnosis of a family member, friend or oneself can be devastating in many ways: emotionally, spiritually and physically. That is why Lakeland Regional Cancer Center offers a wide array of support services to help patients and their families get through this traumatic journey in their lives. Since its inception, the philosophy at Lakeland Regional Cancer Center has been to help families through a holistic healing approach. This includes addressing the patient’s immediate physical needs and by offering complementary medicine programs and individual support services. Our on-site Oncology Social Worker meets newly diagnosed patients and assesses initial and potential needs. This contact and ongoing counseling with the patient and family continues through the duration of treatment. The needs assessment includes emotional well-being, available community resources and financial resources. Other help may include providing or solving transportation issues and helping patients obtain medications through the financial assistance programs sponsored by drug manufacturers. We also maintain information on local resource organizations and make referrals as needed. Our Breast Cancer Support Group is available to any person diagnosed with breast cancer. The group helps patients and families develop strategies to manage and overcome issues that arise during this stressful time. Our Survivorship Program helps survivors maximize their health and quality of life after active treatment has been completed. In the Survivorship Program, individual wellness plans are created for each cancer survivor tailored to their specific needs and concerns. In addition to wellness plans, monthly educational programs are available with topics such as survivorship and spirituality, tai chi, meditation for stress relief and healthy eating.
Alice Varnadore, Patient Advocacy Specialist
LRMC Foundation LRMC Foundation – Touching Lives Through Philanthropic Support The LRMC Foundation and the Lakeland Regional Cancer Center form a unique partnership that provides hope, research and support services to cancer patients in the Lakeland community, Polk County and the surrounding area. The LRCC healthcare team provides the day-to-day treatment and emotional support for the patients while the LRMC Foundation works to secure charitable gifts from the community to provide funds for a wide range of critical activities, equipment and education. In this past year the Foundation: n
n
continued efforts to raise funds for the Cancer Center and its programs, helping provide the special touches that make LRCC unique, continued to offer the opportunity for family and friends to show their love and support to cancer patients and survivors by expanding the Windows of Hope Commemorative Giving Program. This unique stained glass display represents the flowers and wildlife of Florida and hangs in the chemotherapy treatment area at LRCC,
n
raised awareness of women’s healthcare issues and charitable support through the Women In Philanthropy program.
n
provided continued funding for the $2.5 million Trilogy Linear Accelerator.
An additional feature of the partnership with the Cancer Center was the Foundation’s underwriting of the Victorian Tea, Cancer Survivors’ Day and community education. This support comes from the generosity of individuals, businesses and foundations. Three hundred and sixty one donors made more than 4,851 gifts totaling more than $50,000 to the LRMC Foundation designated for LRCC.
18
Clinical Trials Lakeland Regional Cancer Center continually strives to bring new and innovative treatment options to our patients. This includes offering unique clinical trials that reflect the cancer needs of our community. 2011 has been a year of firsts for the clinical trial patients at LRCC. We were the first institution in the country to offer a new drug used in combination with chemotherapy for advanced prostate cancer. The first patient to receive the drug was here at LRCC. At the same time, LRCC was also the first facility to offer a drug that helps to control the side effects of radiation and chemotherapy in patients with head and neck cancer. The first patient treated on this clinical trial was at LRCC. This year LRCC has partnered with a biotechnical company that is working on a new blood test that can confirm the presence of colon or rectal cancer. It is not meant to replace a colonoscopy, but the test can assist physicians in finding the disease early and beginning life-saving treatments. LRCC was the first facility in the United States to offer this test to our patients. Although chemotherapy is still the standard treatment for most cancers, companies are creating biological or “targeted” therapies that work together with chemotherapy to destroy cancer cells more effectively. These new therapies “target” a particular chemical connection so that the treatment becomes more personalized to a patient’s actual cells. Through collaborations with small biotechnical companies, we have been able to bring several of these new, exciting treatments to LRCC. Currently we are using these targeted agents in clinical trials for breast, colon, lung, melanoma, pancreas and prostate cancers. Each new clinical trial includes additional blood sub-studies where blood is collected and shipped to an off-site location. Researchers look at all of this blood to see what is the same and different among patients with similar cancer types. This information helps researchers to develop even more potential treatments for the future. Each of our patients is helping future generations of cancer patients through their participation in clinical trials. LRCC remains dedicated to providing these innovative options to all of our patients. We know that the cure for cancer will come through a clinical trial, and LRCC patients will be leading the way!
Robin Stewart, RN, PhD, OCN, CCRC Manager of Clinical Research
19
Community Outreach 2010 In addition to the 138 Polk County school sites where LRCC performed cancer screenings, LRMC/LRCC was represented at the following health fairs and community events via presentations and educational/promotional materials:
n
Lakeland Junction Mobile Home Park (1/7/10)*
n
Tampa Maid Foods (6/22/10)
n
Estates at Carpenter (1/13/10)
n
Ben Hill Griffin (6/28/10)*
n
Schalamar Creek (1/18/10)
n
Lazy Days RV Center (7/23/10)
n
Cypress Lakes (2/4/10)
n
City of Auburndale (8/5/10)
n
Rooms To Go in Lakeland (2/10/10 & 2/11/10)
n
Florida Southern College (9/15/10)
Polk County School Board retiree health fair (2/12/10)
n
Coca Cola (9/20/10)
n
JBT Food Tech (9/22/10)
n
City of Haines City (10/2/10)
n
Geico (10/6/10)
n
Polk County School Board Food Services (10/9/10)
n
n
n
Polk State College (2/12/10) Rooms To Go in Seffner (2/17/10 & 2/18/10)
n
Hillsborough Community College (2/25/10)
n
New Highlands Self Storage (3/1/10)*
Motorcycle Poker Run to benefit Susan G. Komen Breast Cancer Foundation (10/9/10)
Polk County School Board (3/6/10)
n
Polk County Leisure Services (3/13/10)
n
Making Strides Against Breast Cancer (10/16/10)
n
Florida’s Natural Growers (3/25/10)
n
Polk County Parks & Recreation (10/16/10)
n
City of Winter Haven (4/16/10)
n
Polk County Government (10/28/10, 10/29/10,10/30/10)
n
Southern Wine & Spirits (5/5/10)
n
ButterKrust Bakery (10/28/10)
n
State Farm (5/19/10)
n
Pepperidge Farm (10/28/10)
n
National Kidney Foundation of Florida, Kidney Early Evaluation Program (5/22/10)
*Provided educational/promotional materials only.
20
n
n
Presentations Cynthia Brown, ARNP-BC, CCRN, CRNI presented “Cancer Prevention/Signs and Symptoms” to the Ridge Association of Health Underwriters held at Cleveland Heights Golf & Country Club. (2/23/10)
n
Helen Chan, MD presented “Intra-abdominal Cancers” to Badcock employees. (3/16/10)
n
n
n
Mark Bandyk, MD presented “The Robotic Surgery Revolution: A New Option for Urologic Surgery” (4/10/10) Manuel Molina, MD presented at “Hope Blooms” Cancer Survivors Day (6/6/10)
n
Richard Boothby, MD & Chris Guerrier, MD presented “Stand Up to Cancer” (WTSP-TV) (9/10/10)
n
Solange Pendas, MD & Richard Boothby, MD presented at LRCC’s annual Victorian Tea community event
n
Solange Pendas, MD presented “Screening for Breast Cancer” to Insurance Professionals of Polk County. (10/25/10)
LUNCH & LEARN Presentations n
Solange Pendas, MD presented “Partial Breast Irradiation Therapy” (6/14/10)
n
Manuel Molina, MD presented “Sun Safety” (7/23/10)
n
Solange Pendas, MD presented “Breast Pain” (10/7/10)
DISCUSSED AVAILABILITY OF ON-SITE CANCER SCREENINGS WITH THE FOLLOWING BUSINESSES: n
Lazy Days RV Center (July)
ON-SITE CANCER SCREENINGS AND/ OR EDUCATION FOR THE FOLLOWING BUSINESSES: n
Coca Cola (9/20/10)
21
Oncology Data Services Oncology Data Services has been collecting data in accordance with state and national software guidelines on cancer cases that are diagnosed and/or treated at Lakeland Regional Cancer Center since 2002. The data collected includes demographic, cancer identification (primary site, histology, stage of disease, treatment), follow-up and survival data. Our data is routinely reported to the Florida Cancer Data System (FCDS), Florida’s Central Registry. The LRCC data is also incorporated into the LRMC database and reported to National Cancer Data Base (NCDB). In addition to being utilized at cancer conferences and in our annual report, the medical staff, administration, other departments and other cancer registries also utilize the data. The data is used as a clinical surveillance mechanism to review patterns of care and outcomes and in long-range planning for services. Oncology Data Services also assists in the compilation of data for research studies, cancer-related publications and other cancer-related accreditations (i.e. NSABP breast program accreditation). Since LRCC is a research-oriented facility, lifetime follow-up is performed on our patients (both analytic and non-analytic) on at least an annual basis. Ongoing follow-up benefits patients by reminding them that routine medical examinations are recommended to ensure early detection of recurrence or new primary malignancies and benefits physicians by potentially bringing lost patients back under medical supervision. In addition, the follow-up information is used to compare outcome results with regional, state and national standards. We would like to express our appreciation to the cancer committee, administration, medical staff, cancer center staff, hospital staff and the community for their continued support throughout the year.
Staff: Angie Droz, CTR, Data Specialist II Krisha McDonald, Data Assistant Cicely Parrish, Data Assistant Cindy Tillman, RHIT, CTR Manager Oncology Data Services
22
Data Summary 2010 Top Sites The top sites accessioned (total and analytic) at Lakeland Regional Cancer Center (LRCC) (Tables 1a and 1b) in 2010 are displayed below. Comparison of our incidence rate to Florida and the U.S. is demonstrated. The top five sites (for both analytic and total) are prostate, skin (excluding basal and squamous cell carcinomas), breast, bladder and kidney respectively in 2010. Table 1a Total Cases All Sites Prostate Skin Breast Bladder Kidney
LRCC 961 267 153 104 84 58
28% 16% 11% 9% 6%
FLORIDA 107,000 14,610 4,980 14,080 5,600 2,853
14% 5% 13% 5% 3%
U.S. 1,529,560 217,730 74,010 209,060 70,530 58,240
14% 5% 14% 5% 4%
Table 1b Analytic Cases All Sites Prostate Skin Breast Bladder Kidney
LRCC 695 177 118 75 60 48
25% 17% 11% 9% 7%
FLORIDA 107,000 14,610 4,980 14,080 5,600 2,853
14% 5% 13% 5% 3%
U.S. 1,529,560 217,730 74,010 209,060 70,530 58,240
14% 5% 14% 5% 4%
RACE Race distribution (Table 2) of the analytic cases in 2010 reveals that 89 percent of the patients were Caucasian, 9 percent African American and 14percent Other (Asian, Oriental, Other). A breakdown is as shown below: Table 2 RACE Caucasian African American Other
616 65 14
23
Data Summary 2010 continued ETHNICITY
Table 3
Ethnicity analysis (Table 3) of the analytic cases
Ethnicity
reveals that the majority was of non-Spanish
NON-SPANISH
descent. The breakdown is shown to the right.
SPANISH, NOS; HISPANIC, NOS; LATINO, NOS
COUNTY OF RESIDENCE AT DIAGNOSIS Analysis of county of residence at diagnosis reveals that the majority of the analytic and total patients’ county of residence at diagnosis in 2010 was Polk County. The breakdown is shown below.
NBR
%
663
95.5%
18
2.6%
MEXICAN
4
0.6%
CUBAN
3
0.4%
PUERTO RICAN
2
0.3%
UNKNOWN WHETHER SPANISH OR NOT
2
0.3%
SOUTH OR CENTRAL AMERICAN – NOT BRAZIL
1
0.1%
OTHER SPANISH
1
0.1%
Table 4
24
Analytic
Total
Diagnosis County Volume Percentage
Diagnosis County Volume Percentage
BREVARD 3 0.4% BROWARD 1 0.1% CITRUS 1 0.1% DUVAL 1 0.1% GLADES 1 0.1% HARDEE 12 1.7% HIGHLANDS 28 4.0% HILLSBOROUGH 50 7.2% INDIAN RIVER 4 0.6% LAKE 7 1.0% LEE 1 0.1% MANATEE 5 0.7% MARTIN 3 0.4% OKEECHOBEE 1 0.1% ORANGE 14 2.0% OSCEOLA 4 0.6% OUT OF STATE 7 1.0% PASCO 17 2.4% PINELLAS 6 0.9% POLK 523 75.3% PUTNAM 1 0.1% SARASOTA 1 0.1% ST. LUCIE 2 0.3% VAN BUREN 2 0.3% TOTAL CASES 695 100.0%
BREVARD 5 0.5% BROWARD 1 0.1% CITRUS 1 0.1% DUVAL 2 0.2% GLADES 1 0.1% HARDEE 14 1.5% HIGHLANDS 39 4.1% HILLSBOROUGH 62 6.5% INDIAN RIVER 8 0.8% LAKE 7 0.7% LEE 1 0.1% MANATEE 5 0.5% MARTIN 4 0.4% OKEECHOBEE 1 0.1% ORANGE 20 2.1% OSCEOLA 7 0.7% OUT OF STATE 65 6.8% PALM BEACH 1 0.1% PASCO 24 2.5% PINELLAS 11 1.1% POLK 665 69.2% PUTNAM 1 0.1% SARASOTA 2 0.2% SEMINOLE 3 0.3% ST. LUCIE 2 0.2% SUMTER 3 0.3% UNKNOWN 3 0.3% VAN BUREN 2 0.2% VOLUSIA 1 0.1% TOTAL CASES 961 100.0%
AGE AND SEX Of the analytic cases, 423 (61%) were males and 272 (39%) were females in 2010. The majority of males and females were both diagnosed between the ages of 60-69. Table 5 Age Range
Male
Female 0
10-19
1
20-29
4
5
30-39
8
10
40-49
22
23
50-59
70
68
60-69
139
77
70-79
128
59
80-89
47
26
90-99
4
4
423
272
TOTALS
TREATMENT Treatment analysis of first-course therapy reveals that a single-modality therapy is the most prevalent in 2010. A detailed breakdown can be seen below: Table 6 Treatment
Incidence Rate
None/Observation 66 (10%) Single-Modality Therapy 406 (65%) – Surgery Only 337 – Radiation Only 23 – Hormone Therapy Only 11 – Chemotherapy Only 34 – Other Treatment Only 1 Multi-Modality Therapy 223 (35%)
LRCC/LRMC VOLUME TRENDS (NUMBER OF PRIMARIES) 2002 - 2010 Table 7
3500 3000 2500 2000 1500 1000 500 0 2002
2003
2004
2005
2006
2007
2008
2009
2010
LRCC ANALYTIC
201
420
555
752
811
868
782
779
695
LRCC NONANALYTIC
322
590
540
451
523
566
330
331
256
LRCC TOTAL
523
1010
1095
1203
1334
1434
1112
1110
961
LRMC ANALYTIC
1569
1749
1822
1892
2024
2252
2243
2232
2019
LRMC NONANALYTIC
734
745
774
783
1101
1013
773
791
700
LRMC TOTAL
2303
2494
2596
2675
3125
3265
3016
3023
2719
25
Primary Site by Class of Case, Sex and Stage - 2010 PRIMARY SITE
CLASS
SEX
STAGE (ANALYTIC CASES ONLY)
A
N/A
M
F
0
I
II
III
IV UNK N/A
ALL SITES ORAL CAVITY
961 9
695 5
266 4
586 8
375 1
40 0
95 0
91 0
48 0
50 5
19 0
46 0
LIP TONGUE OROPHARYNX HYPOPHARYNX OTHER
0 2 1 1 5
0 1 1 0 3
0 1 0 1 2
0 2 1 1 4
0 0 0 0 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 1 0 4
0 0 0 0 0
0 0 0 0 0
102
75
27
55
47
5
10
19
9
5
4
2
ESOPHAGUS STOMACH COLON RECTUM ANUS/ANAL CANAL LIVER PANCREAS OTHER
9 3 41 23 4 2 14 6
9 2 28 18 2 2 10 4
0 1 13 5 2 0 4 2
9 2 19 11 1 2 7 4
0 1 22 12 3 0 7 2
0 0 3 1 1 0 0 0
1 0 4 3 0 1 1 0
0 1 10 6 0 0 1 1
1 0 4 0 0 3 1 0
1 1 0 0 0 0 3 0
1 1 0 1 0 0 1 0
0 2 0 0 0 0 0 0
RESPIRATORY SYSTEM
53
37
16
35
18
0
20
0
9
20
2
0
NASAL/SINUS LARYNX LUNG/BRONCHUS OTHER
0 6 45 2
0 2 34 1
0 4 11 1
0 5 28 2
0 1 17 0
0 0 0 0
0 1 19 0
0 0 0 0
0 1 8 0
0 0 20 0
0 0 2 0
0 0 0 0
BLOOD & BONE MARROW
28
17
11
8
20
0
0
0
0
0
0
23
LEUKEMIA MULTIPLE MYELOMA OTHER
8 6 14
4 5 8
4 1 6
1 1 6
7 5 8
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
13 4 6
0 2 153
0 1 118
0 1 35
0 2 92
0 0 61
0 0 3
0 1 11
0 0 5
0 0 4
0 0 1
0 0 1
0 0 0
149 4
114 4
35 0
88 4
61 0
3 0
10 1
4 1
4 0
1 0
1 0
0 0
104 56
75 43
29 13
0 0
104 56
10 1
17 15
14 3
0 9
4 3
3 0
0 4
13 16 14 11 2
13 14 10 6 0
0 2 4 5 2
0 0 0 0 0
13 16 14 11 2
0 0 0 1 0
0 13 1 0 1
0 3 0 0 0
2 3 3 0 1
0 1 2 0 0
0 0 0 0 0
0 3 1 0 0
MALE GENITAL
267
187
80
267
0
0
0
47
7
3
3
0
PROSTATE TESTIS OTHER
256 8 3
177 8 2
79 0 1
256 8 3
0 0 0
0 0 0
0 0 0
47 0 0
6 0 1
3 0 0
1 2 0
0 0 0
URINARY SYSTEM
DIGESTIVE SYSTEM
BONE CONNECT/SOFT TISSUE SKIN
MELANOMA OTHER
BREAST FEMALE GENITAL
CERVIX UTERI CORPUS UTERI OVARY VULVA OTHER
146
112
34
104
42
21
18
1
4
3
3
1
BLADDER KIDNEY/RENAL OTHER
84 58 4
60 48 4
24 10 0
64 37 3
20 21 1
19 1 1
2 15 1
1 0 0
0 4 0
1 2 0
0 3 0
0 1 0
BRAIN & CNS
7
6
1
1
6
0
0
0
0
0
0
6
BRAIN (BENIGN) BRAIN (MALIGNANT) OTHER
0 6 1
0 5 1
0 1 0
0 1 0
0 5 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 3 3
ENDOCRINE
11
4
7
3
8
0
3
1
2
1
1
2
THYROID OTHER
10 1
3 1
7 0
3 0
7 1
0 0
3 0
1 0
2 0
1 0
1 0
0 2
LYMPHATIC SYSTEM
18
10
8
10
8
0
0
1
4
5
2
0
HODGKIN’S DISEASE NON-HODGKIN’S
2 16
1 9
1 7
2 8
0 8
0 0
0 0
0 1
1 3
3 2
0 2
0 0
UNKNOWN PRIMARY OTHER/ILL-DEFINED
3 2
3 2
0 0
1 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
7 1
26
TOTAL
Definition of Terms AJCC Staging Tumor, node and metastasis staging (also known as TNM staging) of the American Joint Committee on Cancer.
Analytic A patient who was initially diagnosed or received all or part of the first course of therapy at Lakeland Regional Cancer Center.
National Cancer Data Base (NCDB) A program that is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society designed to facilitate hospital, state and national assessment of patient care.
Non-Analytic A patient who was diagnosed and received all of the first-course therapy at another institution, a patient who was diagnosed and/or received all or part of the first-course therapy at Lakeland Regional Cancer Center before the registry’s reference date (2002), or a patient who was diagnosed at autopsy.
Primary Site The anatomical location considered the point of origin for the malignancy.
Treatment Modality The treatment regimen planned for the patient. Single modality consists of one type of treatment; multi-modality consists of a combination of two or more types of treatment.
References Cancer Facts & Figures 2010 - Published by the American Cancer Society NCDB, Commission on Cancer, ACoS, Benchmark Reports Lakeland Regional Cancer Center - Oncology Data Services Database
Administrative Report Continued from page 3 in this area. We developed a comprehensive Prostate Center of Excellence to benchmark and highlight the impressive work done in this area. Several of our skilled surgeons brought new robotic procedures to our community and to Central Florida. We formalized our relationship with a local plastic and reconstruction surgeon who now has a clinic in our facility for our breast and surgical oncology patients. We initiated new treatment regimens in Radiation Oncology with the installation of the latest Varian generation linear accelerator. We brought several new clinical trials to our Cancer Center that are not offered anywhere else in Florida. We celebrated as our breast program became the second program in the state of Florida (and fiftysecond nationwide) to achieve accreditation from the National Accreditation Program for Breast Centers. We also received Accreditation with Commendation from the Commission on Cancer for our last survey and eagerly await our next survey in 2012. Our Women’s Imaging Center received designation as a Center of Excellence from the American College of Radiology. All of our achievements and awards demonstrate the strength of our programs and our strong commitment to finding a cure for cancer. Each of us at Lakeland Regional Cancer Center remains committed to providing the best cancer care available for our patients, and this is done in an extraordinary, respectful and caring manner, each and every day.
Kim E. Walker, M.S.H.H.A. Cancer Center Administrator / Associate Vice President of Ambulatory Services
27