DISCOVERY AND HOPE FUEL THE HUMAN SPIRIT
MCGHealth System Cancer Report 2010
2 0 0 9 A N A LY S I S :
LY M P H O M A S Lymphomas are a heterogeneous group of related cancers of the lymph nodes that often involve various organs including the blood, bone marrow and the spleen. According to the American Cancer Society, an estimated 74,030 patients will be diagnosed with various lymphomas in the United States in 2010. Of those, approximately 1,600 will be in Georgia. Despite signiďŹ cant improvements in treatment options that have resulted in a steady decline in mortality rates over the last decade, 21,530 Americans will succumb to this illness in 2010. Another closely related disorder is Chronic Lymphocytic Leukemia (CLL), which is considered to be the most common leukemia in the Western Hemisphere. An estimated 14,990 patients will be diagnosed with CLL in 2010 according to the American Cancer Society.
Dr. Farrukh T. Awan Assistant Professor of Medicine Division of Hematology/Oncology and Bone Marrow Transplant Georgia Health Sciences University
Figure 1
Figure 2
Lymphoid Malignancies Seen from 2000-2009
Stage of Non-Hodgkin Lymphomas Diagnosed 2000-2007
MCGHealth
MCGHealth vs. Teaching Research Hospitals in All States 2000 40
2002
35
Percentage of Cases
2001
2003 2004 2005 2006 2007 2008
30 25 20 15 10
2009 0
20
10
5 30
0
Number of Cases Non-Hodgkin Lymphoma
40 I
Hodgkin Lymphoma
II
III
IV
Unknown
Stage at Diagnosis MCGHealth
Other
Sources: National Cancer Database, Commission on Cancer, American College of Surgeons. Benchmark Reports, v9.0 – May 21, 2009
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Lymphomas and CLL can present with a myriad of signs and symptoms, but fevers, night sweats, unexplained weight loss and persistent lymph node swelling are the most common presenting complaints. Diagnosis usually requires a biopsy, and PET/CT scans and bone marrow biopsies are performed to assess the stage of the disease. According to numbers tabulated by the Cancer Registry (Figure 1), more than 300 patients with CLL and various lymphomas have been treated at MCGHealth over the last decade. The annual number of patients and their severity of illness have shown a steady increase over the last few years, partly due to the availability of novel diagnostic and therapeutic options including bone marrow transplantation and clinical trials utilizing exciting new therapeutic agents (Figures 2, 3 and 4). Twenty-six percent of all our patients were African-American, which affords us a unique ability to study and learn more about racespecific cancer variables (Figure 5). Treatment for CLL and lymphomas usually involves chemotherapy and more recently immunotherapy. Unlike conventional therapy, immunotherapy
targets the cancer cells more specifically and may even utilize the patient’s own immune system in an effort to eradicate the tumor. Recent advancements in the discovery of targeted treatments, especially tumor-specific antibodies, have resulted in significant improvements in outcomes, but a cure still remains an elusive goal for the majority of our patients with these diseases (Figures 6 and 7). We are very excited to offer multiple early phase clinical trials, through our Clinical Research Unit. Most of these clinical trials are evaluating the use of novel targeted therapies for our patients with both CLL and other lymphomas. The targeted agents are developed using modern bioengineering technologies by various pharmaceutical companies in an attempt to limit side effects, while maximizing the killing of cancer cells. Some of these trials are based on work done at our Cancer Research Center on patient tumor cells obtained through the Georgia Tumor Bank, which is also housed at GHSU. We also collaborate very closely with our basic science colleagues, and together we have been successful in creating an extremely productive translational research environment
Figure 3
Figure 4
Stage of Hodgkin Lymphomas Diagnosed 2000-2007
2009 Lymphoid Malignancies, Age at Presentation
40 35
8
30 25 20 15
6 4 2 0
10
0-29
5
30-39
40-49
50-59
60-69
Age Range
0 I
II
IV
III
Unknown
Stage at Diagnosis MCGHealth
Other
Sources: National Cancer Database, Commission on Cancer, American College of Surgeons. Benchmark Reports, v9.0 – May 21, 2009
2
MCGHealth 10
Number of Cases
Percentage of Cases
MCGHealth vs. Teaching Research Hospitals in All States
70-79
80-89
Figure 5
that allows for rapid development of new cancer treatments.
2009 Lymphoid Malignancies by Race MCGHealth
Our goal is to provide the best care for our patients and develop novel approaches that are both effective and safe. We also believe that the collaborative efforts of our clinical and basic science teams will result in exciting new developments in the management of patients with CLL and lymphomas. Our future holds tremendous promise and an opportunity to provide the most advanced innovative and compassionate care for our patients.
25.8%
74.2% Caucasian
African-American
Figure 6 Observed Survival for Non-Hodgkin Lymphomas (NHL) - Nodal, NHL - Extranodal Cases Diagnosed 1998 - 2002 Data from 1,396 Programs (National) 100
Percent Surviving
We are dedicated to providing our patients a comprehensive diagnostic and prognostic assessment. This allows us to reliably determine the extent of their disease and predict the course of their illness. Having dedicated providers who are focused solely on lymphoid malignancies gives us the opportunity to continually develop and enhance our expertise in this ďŹ eld. Since some of the lymphomas are slow-growing and progress over a long period of time, they can impart a signiďŹ cant psychosocial burden on our patients. We feel that it is imperative to attend to the disease as well as address psychological needs. Specialized clinical patient care managers and oncology social workers are integral components of our team. They also enable us to establish a cordial and caring relationship with our patients, which is extremely important in helping them through a potentially curative stem cell transplant.
80 60 40 20 0 2
1
3
4
5
Years Survival Stage I
Stage II
Stage III
Stage IV
WARNING: This information is not to be used for clinical decision making.
Figure 7 Observed Survival for Hodgkin - Extranodal, Hodgkin - Nodal Cases Diagnosed 1998 - 2002 Data from 1,328 Programs (National)
Dr. Farrukh T. Awan Assistant Professor of Medicine Division of Hematology/Oncology and Bone Marrow Transplant Georgia Health Sciences University
Percent Surviving
100 80 60 40 20 0 2
1
3
4
5
Years Survival Stage I
Stage II
Stage III
Stage IV
WARNING: This information is not to be used for clinical decision making.
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CANCER REGISTRY AND S TAT I S T I C A L S U M M A R Y The Cancer Registry is an information system that collects data and monitors all types of cancer diagnosed and/or treated at MCGHealth. The information documented in the Cancer Registry database is fundamental to the cancer program. The Cancer Registry provides physicians, administrators and hospital staff with information needed to evaluate and plan cancer services. Cancer data are submitted monthly to the Georgia Comprehensive Cancer Registry and annually to the National Cancer Data Base. In both of these larger databases, our data are pooled with data from other participating facilities. The resulting statistics illustrate statewide and nationwide trends in cancer incidence and help clinicians and researchers evaluate the efficacy of various treatments.
The registry was ďŹ rst established in 1985, and since then nearly 18,000 cases have been accessioned in the registry. In 2009, 1,505 analytic and nonanalytic cancer cases were added to the registry. One thousand eighty-nine patients were diagnosed or received ďŹ rst course treatment at MCGHealth, and 415 were treated for recurrence or progression of their cancer. In 2009, MCGHealth’s gender distribution showed that more males than females were treated for cancer: 568 (52 percent) of the cancers diagnosed or treated were male patients, and 521 (48 percent) were female patients. The top analytic sites for MCGHealth are: lung, 22 percent; breast, 20 percent; prostate, 19 percent; blood, 9 percent; thyroid, 8 percent; skin, 5 percent; brain, 5 percent; corpus uteri, 4 percent; lymph nodes, 4 percent; and kidney, 4 percent. In comparison, nationally the top sites are: lung, 15 percent; breast,
2009 Analytic Cases: Site by Gender Lymph Nodes Thyroid Gland Brain Kidney Prostate Corpus Uteri Breast Skin (Melanoma) Hematology Lung 0
20
40
60
80
100
Number of Cases Male
4
Female
120
140
160
13 percent; prostate, 13 percent; colon, 8 percent; bladder, 5 percent; and other sites, 46 percent. The registry staff follows more than 7,000 patients annually to obtain disease status and survival information and maintains a 90 percent follow-up rate. A Cancer Registry Manager, a Registry Services Specialist II, and a Registry Services Specialist I staff the Cancer Registry. The registry coordinates the facility Cancer Conferences and the quarterly Cancer Committee Meetings, helps to prepare for
the triennial Commission on Cancer accreditation survey, contributes to the Annual Report, and reports data to clinicians and administrators. For more information about the activities of the Cancer Registry, please call 706-721-1768. Reference: Cancer Facts and Figures: 2009, American Cancer Society
2005-2009 Analytic Cases: Incidence
2009 Analytic Cases: Age at Diagnosis
1100
350
1050
300 250
Number of Cases
Number of Cases
1000 950 900 850
200 150 100
800 50
750 700
0 2005
2006
2007
2008
Year of First Contact
2009
0–29
30–39 40–49 50–59 60–69 70–79 80–89
90 +
Age Range
5
CANCER COMMIT TEE LEADERSHIP E. James Kruse, DO Cancer Committee Chair/Surgical Oncology* James McLoughlin, MD Cancer Liaison Physician/Quality of Cancer Registry Data Program Coordinator/Surgical Oncology*
Deborah Humphrey, MA Community Outreach Coordinator/ Public Relations* Lonnetta Colton, RHIA, CTR Cancer Conference Program Coordinator/ Registry Services*
Erica Steed, MBA Quality Improvement Program Coordinator/Planning*
MEMBERS Nicole Aenchbacher, RN, BSN Breast Health
Melissa Jarriel, RHIA, CTR, CHP Health Information Management Services
Lindsay Baker, RD, LD Dietary
Melanie Kumrow, RN Patient Care Services
Paul Biddinger, MD Pathology*
David Scott Lind, MD Surgical Oncology
Steven Black, MBA Oncology Services Administration*
Amanda May, MD Hematology/Oncology*
Annie Blount, MSW Social Service*
Colleen McDonough, MD Pediatric Hematology/Oncology
Pamela Bourbo, RN, BSN, MPH, OCN, CCRC Cancer Clinical Trials*
Todd Merchen, MD General Surgery
Kim Cheely, RN, BSN, OCN Patient Care Services*
James Rawson, MD Radiology*
Kelly Drake, MD Radiation Oncology
Tracey Slagle, RN, BSN, OCN Patient Care Services
Nettie Engels Patient Advisor
Jane Willson, SLP.D. Rehabilitation Services
Summer Garrison American Cancer Society
* Position required for accreditation by the American College of Surgeons Commission on Cancer
Judith Giri, PhD Tumor Bank 6