Oncology Annual Report 2014 by Lexington Medical Center

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Table of Contents Cancer Committee

A Message from the Cancer Committee Chair

Quillin Davis, MD

A Message from the Cancer Liaison Physician Ronald G. Myatich, MD, FACS

A Message from the Manager of Cancer Programs Deirdre Young, RN, BSN, OCN, CBCN

2014 Cancer Center Goals and Clinical Trials

Clinical Services

Clinical Laboratory & Pathology Services 20 Radiology Services 23 Radiation Oncology 29 Medical Oncology 31 Surgery 31 Inpatient Oncology 33 Multidisciplinary Conferences 34

Patient Support Nurse Navigators 39 Lymphedema Prevention & Management Program 40 Breast Health Services 41 Becky’s Place 42 Oncology Social Services 43 Pastoral Care 44 Comprehensive Guide for Cancer Patients 44 Integrative Therapies for Patients 45 Wellness Workouts 46 Freedom from Smoking 46 Support Groups and Patient Programs 47

Serving Our Community Community Outreach Lexington Medical Center Foundation

50 53

Statistics and Research Cancer Spotlight — Breast Cancer 56 Clinical Research 59 Cancer Registry 61 Site Distribution 66

Survivorship

48 54

LEXINGTON MEDICAL CENTER ACCREDITATION

Quality Cancer Care: Recognizing Excellence

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For more than 25 years, patients at Lexington Medical Cancer Center have been able to rely on one constant: our unwavering commitment to providing quality cancer care. The expertise of our medical and support staff, combined with quality services and state-of-the-art technology, allows Lexington Medical Cancer Center to offer one of the most advanced cancer treatment programs available. Since we began providing comprehensive cancer care, our Cancer Center has served as a benchmark throughout the country for supporting patients with the highest quality technology and services, providing them with compassionate care and the knowledge to achieve the best possible outcomes. Using a multidisciplinary approach between our medical oncologists, radiation oncologists and surgeons with crucial support from highly trained radiologists, pathologists and other health professionals, we offer a complete care strategy for every patient. The most advanced technology and state-of-the-art tools enable our physicians and staff to provide the latest in cancer diagnostics and treatment. We were the first hospital in South Carolina to perform microwave ablation and one of the first hospitals in the state to offer intensity-modulated radiation therapy. In addition, our cancer center, which is accredited with commendation by the American College of Surgeons, supports research initiatives that contribute to treatments and solutions in cancer care. Participation in this research allows us to receive information and results to stay at the forefront of current methodologies, procedures and treatments. We are also affiliated with Duke Cancer Institute, which provides our patients with access to Dukeâ&#x20AC;&#x2122;s excellence in cancer care, clinical research and education. This affiliation establishes Lexington Medical Cancer Center as the premier cancer program in the Midlands. Our comprehensive care goes beyond diagnosis and treatment. We understand that a cancer diagnosis can leave patients asking questions and looking for support. Thatâ&#x20AC;&#x2122;s why we have created a variety of resources and support groups that address the emotional, psychological and spiritual needs of our patients and their families. Meeting the health care needs of our community is more than a commitment at Lexington Medical Cancer Center; itâ&#x20AC;&#x2122;s our mission. With help from our multidisciplinary team of board-certified physicians and experienced staff, our patients can receive the highest quality care in cancer diagnosis and treatment, and access to comprehensive education, support and clinical research.

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2014

LEXINGTON MEDICAL CANCER CENTER

Cancer Committee

LEX I NG TON M EDI C A L C A N C E R C E N T E R

CHAIR

Quillin Davis, MD Medical Director of Cancer Services

VICE CHAIR

Steven A. Madden, MD Medical Oncology/ Medical Executive Committee Representative

CANCER LIAISON PHYSICIAN Ronald G. Myatich, MD, FACS Surgery

COMMITTEE MEMBERS Quillin Davis, MD Radiation Medicine/Medical Director of Cancer Services Fred Kudrik, MD Medical Oncology Steven A. Madden, MD Medical Oncology/ Medical Executive Committee Representative M. Shirin Sabbaghian, MD Surgical Oncology Jayne Moffatt, MD Pathology Ronald G. Myatich, MD Surgery Beth Siroty-Smith, MD Radiology Theresa Altman, RN, BSN, NE-BC Oncology Nursing Blake Barnhill, LMSW Psychosocial Services/ Social Work Emily Jordon, CGC Genetics Counselor Natalie J. Copeland, RHIA, CTR Cancer Registry/CTR Nannette “Nan” Faile, MS, RN, CCRP Clinical Research Jan Lemond, RN, BSN, CHPN Palliative Care Case Manager Mary Tanner, RN, MBA, CPHQ Quality Assurance/ Center for Best Practices Melissa Taylor, RN Oncology Nursing — Oncology Unit Director Connie Watson Community Outreach Deirdre Young, RN, BSN, OCN, CBCN Cancer Programs/ Nurse Navigator/American Cancer Society Representative Stacy Bannister, MBA, CMPE Physician Network Services — Outpatient Oncology Ann Wingate Volunteer Services Tori Gude, MPT, DPT, CLT Physical Therapy Claudine James, BS RT (R)(T) Radiation Medicine Donna Peele, MDiv, BCC Chaplaincy Cindy Rohman, RN, MS, NEA-BC Chief Nursing Officer/ Administration — Patient Care Services Jennifer Wilson Marketing

ACTIVITY COORDINATORS Dr. Quillin Davis Cancer Conferences Natalie Copeland Cancer Registry Quality Mary Tanner Quality Improvement Connie Watson Community Outreach Blake Barnhill Psychosocial Services Nan Faile Clinical Research

ONCOLOGY SERVICES 2014 ANNUAL REPORT

A Message from the

Cancer Committee Chair Quillin Davis, MD It’s been a very exciting year in oncology at Lexington Medical Cancer Center. Our outstanding inpatient and outpatient oncology staff continue their ongoing efforts to provide the best care for our patients. There are so many people working together to create the kind of excellence that marks the hospital’s cancer center; thanks to all of them, our cancer program is outstanding. We move forward with the latest techniques available in cancer treatment. Lexington Medical Cancer Center now has robotic surgery techniques with the da Vinci® robot, and more specialties and surgical disciplines are involved in that effort every day. Stereotactic radiosurgery is up and running at Lexington Medical Cancer Center, with the TrueBeam™ linear accelerator online and treating patients. We have seen robust growth in our stereotactic program in the first part of this year. Now, in partnership with our neurosurgeons for cranial and spinal treatments, no head frame is required for TrueBeam cranial

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procedures with a frameless real-time imaging system that allows for a highly accurate, less invasive treatment option for patients. TrueBeam also gives us the ability to treat with stereotactic body radiation, definitively and curatively treating lesions in the lungs, liver and other parts of the body. Our research program is second to none. We continue to add complex clinical trials to our repertoire through our Duke affiliation, and we are reaching out into the dynamic area of genetic targeting of tumors and guided treatment. As an example, we have opened very important national clinical trials right here at Lexington Medical Cancer Center, including Lung-MAP and ALCHEMIST, two nationwide randomized clinical trials that focus on genetic testing in lung cancer and treatment selection based on the results. In our ongoing participation with the National Surgical Adjuvant Breast and Bowel Project, a national breast cancer protocol group, we have opened NSABP B-51, a national trial studying the effect of chemotherapy on lymph node positivity in breast cancer. We are also one of the only hospitals in the region to treat low-risk breast cancer with just three weeks of radiation, which is half of the conventional radiation dose based on the outcome results of several study trials. This regimen is now a nationwide recommendation, but many facilities have been slow to adopt it. Quality of treatment is always our primary concern. We continue to work through the American College of Surgeons Commission on Cancer, maintaining our quality standards with cooperation from the Cancer Committee and our

Cancer Registry, and through Duke Oncology Network. Lexington Oncology became Quality Oncology Practice Initiative (QOPI®) certified, one of only four medical oncology practices in the state to meet this crucial quality metric. Our multidisciplinary focus through tumor conferences and coordination with Duke continues as well, ensuring that we provide high-quality care. In cooperation with the hospital’s ongoing growth into electronic health records, patients can access their information via the Internet through the patient portal. We reach out into the community with key screening initiatives, such as the lung cancer screening program, and grow in our patient care efforts with robust nurse navigation throughout the care cycle. In addition, complementary programs, including pastoral care and palliative care, help patients and their families during a difficult time. Lexington Medical Center is your hospital. It has grown so much in so many ways over the years, always striving to bring the best medical care to our families and friends, and to us. We are hard at work in the oncology program, building a strong foundation as a true regional cancer center to provide unmatched oncology care for the Midlands, today and tomorrow. I am honored to be a part of it, and I appreciate all of the people in our hospital who work together to make this goal a reality.

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A Message from the

Cancer Liaison Physician Ronald G. Myatich, MD, FACS the unsung efforts of these skilled professionals who work largely out of the spotlight.

Lexington Medical Cancer Center made great strides in cancer treatment and care during the past year. Through the tireless efforts of countless individuals throughout the year, both in front of the camera and behind the scenes, tremendous progress in cancer care occurred at the hospital. We proudly opened our newest addition in Radiation Oncology, a stereotactic accelerator that will allow Lexington Medical Cancer Center to remain at the forefront of radiation oncology treatment in the Midlands. Our Radiation Oncology department also welcomed Mary “Katie” Matzko, a nurse practitioner working with Drs. Quillin Davis and Joshua Lawson, to provide additional support to meet the needs of our oncology patients. The excellent work of our cancer database registrars, whose work involves recording vital cancer data into state and national databases, received a 100 percent rating from the South Carolina Central Cancer Registry. Their work serves as the basis for significant scientific study into cancer treatment. Our hardworking registrars consistently rank among the best in the nation, and our cancer patients benefit daily from

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Lexington Medical Center plunged into the field of robotic cancer surgery with the addition of our first da Vinci suite. This technology allows oncologic surgeons at our medical center to provide stateof-the-art minimally invasive robotic surgical procedures as varied as prostatectomy and colectomy to those in our community who would benefit from this approach. Benefits of robotic surgery include less-invasive incisions, faster recovery and reduced time in the hospital. Our Surgery department also initiated Same Day/ Next Day Surgery, a referral program designed to expedite surgical patients through our system. This program allows some patients to be evaluated by a surgical specialist and offered surgical intervention within 24 hours. We understand that waiting for procedures can result in stress and anxiety for our cancer patients, and Same Day/Next Day Surgery is designed to speed up the process in an effort to reduce waiting times and anxiety. Improvements occurred throughout many areas of cancer treatment at Lexington Medical Cancer Center this past year, including the expansion of our Pastoral Care services, and improvements to palliative care and music therapy programs. Our holistic approach to cancer care results in a wide range of therapeutic services for our patients. They can select the services best suited to their individual needs and preferences. The hospital also opened a patient portal, a window into the world of electronic health records that provides quick and easy access to medical records. Patients now have the ability to securely access their confidential medical information online at their convenience.

In 2014, we marked milestones in lung cancer treatment at Lexington Medical Center with the start of our new screening program and the initiation of high-risk lung cancer conferences. Computed tomography scans of the lungs are available to select patients who meet the criteria of approved risk factors for lung cancer. These patients and their scans are presented at weekly multidisciplinary conferences attended by cancer treatment professionals, including surgeons, medical and radiation oncologists, and pulmonologists. The addition of high-risk lung cancer conferences augments our existing breast cancer and oncology conferences, which occur weekly at the hospital and are attended by a wide range of cancer care professionals in conjunction with Duke Cancer Institute. Through the efforts of our breast cancer navigators this past year, Lexington Medical Center started Survive and Thrive, a breast cancer class for women who have completed their cancer treatment. Our nurse navigators provide invaluable service to oncology patients, assisting them as they navigate through the increasingly complex environment of cancer treatment services. These specially trained nurses provide expertise with a comforting human touch. We are so grateful for their specialized knowledge, and our patients benefit tremendously from their hard work. Lexington Medical Center remains committed to the needs of our community. Throughout our network, we continually add to and improve patient care services. I hope this brief glimpse into the progress we’ve made in the past year prompts you to take a closer look into the wonderful community resources right in your own backyard. We encourage you to get involved, and we welcome your input and support. Our success depends on you!

A Message from the

Manager of Cancer Programs Deirdre Young, RN, BSN, OCN, CBCN For those of us who work at Lexington Medical Cancer Center, 2014 offered numerous opportunities to refine and improve our programs and services to ensure that our patients and families received the best cancer care possible. The privilege of working at Lexington Medical Center for the past 25 years — all of them in oncology — gives me a unique perspective to reflect upon where we have been and where we hope to be in the future. In 2014, we had a landmark year. It marked the 25th anniversary of the formal opening and dedication of the inpatient oncology unit at Lexington Medical Center. Inpatient oncology began on the hospital’s 6th floor with a 13-bed unit that was staffed by registered nurses and ancillary staff dedicated to the care and support of people undergoing treatment for various cancers. The opening of that inpatient unit was a giant first step toward building the program we have today. We owe a tremendous debt of

gratitude to our board of directors and hospital administrators for guiding and supporting us as we watched a community cancer program evolve into one of the best programs in the state. Today, the oncology unit is a 30-bed private unit that is patient- and family centered. Our program holds accreditations from the American College of Surgeons Commission on Cancer and the National Accreditation Program for Breast Centers. We certainly have come a long way.

in on-site clinical trial enrollment, and expansion of our hospital’s palliative care program. Patient care portals in the electronic health record allowed patients never-before access to their records and test results from the privacy of their homes. Our medical oncology practice, Lexington Oncology, passed its Quality Oncology Practice Initiative certification, making it one of only four practices in the state to achieve this quality benchmark.

Despite our distinguished history, however, it is important to remember that the pursuit of excellence in cancer care is ongoing. We never cross the finish line, and our work is never done. Just as the field of oncology is a dynamic, ever-changing specialty that sees new drugs and therapies emerge every day, the work we do here is ongoing.

Every week saw changes and improvements to the program, all to better meet the needs of the people in our community. Lexington Medical Center treated more than 1,400 new cases of cancer in 2014, underscoring the importance of the work that we do. As we enter the new year, everyone on the oncology team — surgeons, oncologists, pathologists, radiologists, nurses and other specialists — remains committed to continuing the work that started so long ago. By striving toward this goal, we improve the health of the people in our community and ensure a better, healthier future for all.

In 2014, we implemented more than 25 major quality improvements in care, including the new stereotactic radiosurgery unit in Radiation Oncology, a robotic surgery unit, significant increases

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2014 CANCER CEN

GOALS AND CLIN

LEX I NG TON M EDI C A L C A N C E R C E N T E R

NTER

Cancer Center The Lexington Medical Cancer Center continues to grow and prosper as we add new services and technology to meet our goal of consistently delivering patient-centered care.

NICAL TRIALS

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2014 Goals 2014 Cancer Cancer Center Services Goals CLINICAL GOAL:

Complete the stereotactic radiosurgery capability in Radiation Oncology. RATIONALE/ OPPORTUNITY IDENTIFIED

Having stereotactic radiosurgery capability will allow patients to receive treatments at Lexington Medical Center and not require them to go to other facilities.

METHODOLOGY/ PROCESS

Installation of a new linear accelerator involves multiple hospital departments and contractors, including Lexington Medical Center Engineering and Information Services, general contractor Kahn, Inc. and its subcontractors, and installation will be by Varian, the accelerator’s manufacturer. The hospital is managing the construction project, as well as the technical component and training, in partnership with the architects and contractors.

MEASUREMENT

Successful implementation of the project in fall/winter 2014. The measure of completion is the initiation of treatment with stereotactic radiosurgical techniques on the new TrueBeam accelerator.

RESPONSIBILITY STATUS

Quillin Davis, MD, will provide updates to the Cancer Committee as necessary. Goal met and stereotactic radiotherapy available October 2014.

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2 0 1 4 C ANC E R C E NT E R GOALS AND CLINICAL TRIALS

PROGRAMMATIC GOAL:

Implement the new lung cancer screening program. RATIONALE/ OPPORTUNITY IDENTIFIED

Lexington Medical Cancer Center treats a majority of stage III and IV non-small cell lung cancer (NSCLC) patients. Our five-year survival data for these patients is low. By offering lung cancer screenings to high-risk individuals in our community, we can affect the overall survival of these patients.

METHODOLOGY/ PROCESS

Positive lung cancer screening findings will be followed by a nurse navigator and referred to physicians involved in the program per an algorithm that identifies the appropriate physician or the need for further follow-up scans. Primary care physicians will identify appropriate patients; however, self-referral will be welcomed. Self-referrals who do not meet the screening criteria will be referred to a PCP within the Lexington Medical Center Network of Care. Self-referrals with positive studies will be referred to a designated on-call provider within the hospital’s network for a lung cancer screening. The lung cancer screening program will utilize the screening criteria as outlined in the NCCN Guidelines®. In addition to an absence of symptoms or signs of lung cancer, the following criteria will be applied: Category 1 Category 2 • Age >/= 50 years and • Age 55–74 and • >/= 20 pack-year history of smoking and • >/= 30 pack-year history of smoking and •O ne additional risk factor • Smoking cessation <15 years prior (other than secondhand smoke)* *Smoking history may be present or past. Additional risk factors may include radon exposure, occupational exposure, personal cancer history (not to include previous history of lung cancer), family history of lung cancer, and disease history (chronic obstructive pulmonary disease or pulmonary fibrosis).

MEASUREMENT RESPONSIBILITY

STATUS

Completion of goal will be measured by screening the first patient into the new lung cancer screening program. Lung Cancer Screening Program subcommittee will be comprised of staff from pertinent departments, such as Radiology, Radiation Oncology, Surgery, Cancer Programs and Cancer Registry, as well as representatives from Administration and at least one physician practice. This group will be responsible for development, launch and monitoring of the lung cancer screening program. Pertinent statistics and other details from subcommittee meetings will be shared with the Cancer Committee as necessary. Goal met. First patient screened February 24, 2014. ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

2014 Trials Goals 2014 Clinical Cancer Services Clinical Trials at Lexington Medical Cancer Center RADIATION MEDICINE

 RTOG-1005: A Phase III Trial of Accelerated Whole Breast Irradiation with Hypofractionation Plus Concurrent Boost vs. Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer Principal Investigator: Quillin Davis, MD / Enrolled: 28  RTOG-1115: Phase III Trial of Dose Escalated Radiation Therapy and Standard Androgen Deprivation Therapy (ADT) with a GnRH Agonist vs. Dose Escalated Radiation Therapy and Enhanced ADT with GnRH Agonist with TAK-700 for Men with High Risk Prostate Cancer Principal Investigator: Quillin Davis, MD / Enrolled: 1

MEDICAL ONCOLOGY

 S1007: A Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients with 1–3 Positive Nodes, Hormone Receptor-Positive and HER2-Negative Breast Cancer with Recurrence Score (RS) of 25 or Less Principal Investigator: Steve Madden, MD / Enrolled: 21  X-TRAP: Phase I/II Study of Capecitabine plus Ziv-Aflibercept in Metastatic Colorectal Cancer Principal Investigator: James Wells, MD / Enrolled: 3  S1400: Open Label, Multi-Center IRESSA™, Clinical Access Program Phase II/III Biomarker-Driven Master Protocol for Second Line Therapy of Squamous Cell Lung Cancer Principal Investigator: James Wells, MD / Enrolled: Opened December 2014

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2 0 1 4 C ANC E R C E NT E R GOALS AND CLINICAL TRIALS

Collaborative Trials: Radiation Medicine and Medical-Oncology Collaborative trials between Radiation Medicine and Medical-Oncology represent an area of active growth at Lexington Medical Center. Because of the interdepartmental coordination required to implement collaborative trials, Lexington Medical Cancer Center proudly offers the community many emerging innovative radiation and chemotherapy treatment options.

 NSABP-B-43: A Phase III Clinical Trial Comparing Trastuzumab Given Concurrently with Radiation Therapy and Radiation Therapy Alone for Women with HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy Principal Investigator: Quillin Davis, MD / Enrolled: 3  L CSRT: A Prospective Registry Trial of Low-Dose Lung Cancer Screening for Adults with High Risk of Developing Lung Cancer Principal Investigator: Quillin Davis, MD / Enrolled: 42

BREAST SURGERY

 ACOSOG- Z11102: Impact of Breast Conservation Surgery on Surgical Outcomes and Cosmesis in Patients with Multiple Ipsilateral Breast Cancer (MIBC) Principal Investigator: Lynn Tucker, MD, FACS / Enrolled: 2

Cancer Registry Research  African-American Cancer Epidemiology Study (AACES): Through its active Cancer Registry department, Lexington Medical Center is collaborating with nine local institutions to explore risk factors and prognostic characteristics for African-American women diagnosed with ovarian cancer and, ultimately, to improve the 5-year survival rate of 38 percent for African-American women. Enrolled: 2  Medullary Thyroid Carcinoma (MTC) Registry: The purpose of this post marketing study is to systematically monitor the annual incidence of medullary thyroid carcinoma and identify any possible increase in incidence related to the introduction of a new diabetes medication, Liraglutide. Enrolled: 2 ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

da Vinci Robot

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2 0 1 4 C ANC E R C E NT E R GOALS AND CLINICAL TRIALS

2014 Cancer Center Quality Improvements Lexington Medical Cancer Center continues to grow and prosper as we add new services and technology to meet our goal of consistently delivering patient-centered care. • Acquired da Vinci robot for minimally invasive prostate surgeries and other surgeries • Launched Southern Surgical Group’s Same Day/Next Day Surgery program with consults scheduled daily and procedures performed that same afternoon or the next morning • Awarded $3,200 grant for the lymphedema program to assist uninsured and underinsured patients with supplies • Received a quality rating of 100 percent from the S.C. Central Cancer Registry for data submissions • Set a formal goal of accruing two– three enrollments per month and increase cooperative group trial participation • Acquired a stereotactic accelerator for Radiation Oncology

• Expanded music therapy • Performed nursing competencies each year, including chemotherapy check-offs and safe handling • Added 0.5 full-time Pastoral Care employee with oncology experience • Launched the Survive and Thrive Survivorship School for breast cancer patients who have completed active treatment, led by breast cancer nurse navigator • Received computer updates for Lexington Oncology and Lexington Radiation Oncology to assist in meeting Commission on Cancer standard requiring survivorship care plans and treatment summaries • Received College of American Pathologist accreditation in July

• Added a second palliative care nurse

• Opened additional Women’s Imaging mammography screening site at Vista Women’s Healthcare in April, bringing the total number of mammography machines in the network to nine

• Launched Lung Cancer Screening Program according to NCCN Guidelines in February 2014

• Implemented patient care portal in May to give patients access to records and results

• Hired a nurse practitioner for Lexington Radiation Oncology

• Partnered with Palmetto Dermatology to perform skin cancer screening for 90 patients in June • Revived partnership with the American Cancer Society to better address transportation needs of patients and engagement with ACS account representative for hospital systems • Passed Quality Oncology Practice Initiative certification at Lexington Oncology, making it one of four in the state with this designation • Initiated weekly High Risk Lung Conference at end of Oncology Conference to present lung cancer screening CT scans with a score of Lung-RADS™ 4 or 5 • Implemented chlorhexidine gluconate baths on inpatient oncology unit • Created a structured process for safer delivery and administration of chemotherapy between inpatient unit and Pharmacy • Built new report into Epic to show expected admissions and date of projected admission

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CLINICAL

SERVICES

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Lexington Medical Center Laboratory The laboratory is fully centralized and designed to function as an around-the-clock STAT lab, which allows for optimum laboratory monitoring of patients undergoing therapy.

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Clinical Laboratory & Pathology Services As one of the busiest hospitals in South Carolina, itâ&#x20AC;&#x2122;s no surprise that Lexington Medical Center encounters patients with a wide range of issues. Within the field of oncology alone, we routinely see cases involving prostate cancer, breast cancer, lung cancer, cervical cancer, skin cancers, gastrointestinal cancers, lymphomas, leukemias and bone marrow abnormalities. In order to effectively address the full range of oncologic cases, we have worked hard to establish a highly specialized department that is led by 10 pathologists, each of whom is board certified in anatomic and clinical pathology, as well as many subspecialties and related expertise. These skilled and dedicated professionals are well supported by our Laboratory Testing Facility and Transfusion Support. The laboratory is fully centralized and designed to function as an around-the-clock STAT lab, which allows for optimum laboratory monitoring of patients undergoing therapy. Additionally, special tests to identify infections in our immunocompromised patients are available on-site with rapid turnaround on results.

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Cancer is a complex disease that requires multiple specialties to provide the best, most comprehensive care.

CLINICAL SERVICES

Working in conjunction with the American Red Cross Blood Donor Program, our transfusion services routinely meet the high demand for transfusion products. Intraoperative red cell salvage and blood product management practices are also key components. The following are specific cancers and our role in diagnosing them: BREAST CANCER

We are extremely proud that our Cancer Center’s rapid-diagnosis philosophy has become a national benchmark. With the support of our “Five Day Detection to Diagnosis” breast cancer program, office-based and hospital-based diagnostic needle aspirates and core biopsies are carefully processed and, in most cases, the information is reported back to the physician and patient within 24 hours. This rapid-diagnosis system supports all breast specimens and breast fluid analyses, fine-needle aspirates, standard-needle biopsies, stereotactic CT-guided biopsies, ultrasound-guided biopsies and lumpectomies of all types. The “intense protocol for lymph node processing in breast cancer and melanoma cases” we use has proven to be another invaluable tool.

CERVICAL CANCER

For as long as cancer screenings have been in use, the Pap smear has been the most successful test by far. In 2002, we made it even more effective by implementing liquid-based samples, processing and becoming the first lab in South Carolina to utilize supplementary robotic image analyzer screening of all cases. Human papillomavirus (HPV) testing has also been employed.

LUNG CANCER

Since 1995, our hospital has offered a systematic evaluation of patients with a lung mass and, over the years, our approach has become increasingly refined. Today, we possess processing techniques that make it possible to achieve a diagnosis in an unusually high percentage of first attempts at either fine-needle or bronchoscopic biopsies in the outpatient setting. Our focused and dedicated lab team moves efficiently and effectively to provide a definitive diagnosis that enables optimized treatment to begin promptly. Sophisticated molecular testing can provide personalized therapy options for certain types of lung cancer. We also provide support and evaluation of specimen adequacy in an immediate fashion for endobronchial ultrasound-guided biopsies and aspirates. In 2014, we began offering a low-dose CT scan to provide screening to detect early-stage lung cancer.

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SKIN CANCER

Skin cancer is often treated using surgery or radiation therapy. For more than 20 years, Lexington Medical Centerâ&#x20AC;&#x2122;s pathology group has been actively involved in enhancing outpatient surgical treatment of ordinary and complex skin cancers through use of a pathology-specimen mapping technique that allows the surgeon to preserve as much healthy skin as possible. This is critically important given the large numbers of skin cancers that occur on the face and head. In addition, our radiation program is one of the few in the state that possesses state-of-the-art equipment and highly trained radiation oncologists to employ skin-conserving methods of superficial radiation therapy.

BLOOD DISORDERS

In 2011, our program implemented in-house flow cytometry analysis, which allows more directed and precise testing, diagnosis and classification of benign and neoplastic disorders of bone marrow and lymph nodes. Our expert team can add more esoteric molecular-based testing as indicated in the most effective manner.

BRAIN & CENTRAL NERVOUS SYSTEM CANCERS

Our departments have extensive training and the highest subspecialty certification in the state for diagnoses of tumors and diseases of the brain and central nervous system.

ONLINE RESOURCES

Our pathology group provides a comprehensive website, PalPath.com, with more than 400 pages of information. Most of the information is devoted to cancer and our methods of working with and reporting on cancer cases.

TISSUE BANKING

In July 2007, we became active contributors of research tissue from surgically removed tumors to the South Carolina Biorepository System for cancer research in the Midlands.

CONSULTANT NETWORKING

In 1972, we began developing an extensive roster of world-renowned experts in the specification of rare types of cancer, whom we consult when needed. Having emphasized optimal handling and processing of specimens in our lab, the opinions of these experts are easily accessible.

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CLINICAL SERVICES

Lexington Radiology Associates Not pictured: William P. Brehmer, MD, and Nicholas D. Mayes, MD

Radiology Services As technological progress continues to rapidly advance, the Radiology team at Lexington Medical Cancer Center is constantly updating diagnostic equipment, imaging protocols and interventional techniques to better serve the oncologic community. For example, the hospital added a 128-slice CT (computed tomography) scanner in 2012. This technology provides faster scanning times with capabilities for cardiac gating, which decreases artifacts from heart motion during CT examinations of the chest. Cancer is a general term that encompasses a number of distinct entities, each requiring its own framework for detection, staging and treatment. This section will describe a few of the more pertinent radiology advancements by discussing common individual forms of malignant disease. LUNG CANCER Since early detection of lung cancer is the best hope for a favorable outcome, Lexington Medical Cancer Center remains focused on finding lung tumors while they are still small and asymptomatic. Lexington Medical Center Radiology offers low-dose CT lung cancer screenings to asymptomatic patients, who meet the established criteria, with the goal of detecting lung cancer at an earlier stage to initiate effective therapy.

Hospital nurse navigators follow these patients as they receive appropriate follow-up imaging and clinical referrals. Possible treatment paths include surveillance CT for lowsuspicion nodules and PET (positron emission tomography)/ CT or biopsy for larger, more suspicious nodules. The success of previously identifying incidental nodules and referring cases to nurse navigators resulted in the creation of this new service at Lexington Medical Cancer Center.

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In the realm of tumor characterization, PET/CT has been the undisputed gold standard to determine which nodules need immediate biopsy when the diagnosis remains uncertain. Furthermore, it provides detailed staging of the disease process to assist surgeons and oncologists in guiding proper management and offering a prognosis to patients before contemplating major surgery. Those patients with advanced disease at the time of initial diagnosis and staging may be spared unnecessary surgery as well. In addition, radiologists at Lexington Medical Cancer Center have provided image-directed percutaneous biopsy of suspicious lung lesions for more than 25 years. As technology improves, the average size and accessibility of targeted lesions continue to diminish, so the skill set necessary to maintain high success rates (above 90%) has to evolve. Recently, radiologists have been working with the Pathology department at Lexington Medical Center to increase the number of biopsy specimens obtained during percutaneous CT-directed biopsy. Newer techniques in pathology allow for more accurate histologic diagnosis through a variety of special stains and immunohistochemical markers as well as molecular testing; such results help pinpoint appropriate drug strategies targeted specifically to the tumor profile. BREAST CANCER Lexington Medical Center has long been a proponent of screening for breast cancer and, despite some controversies in the lay press, the preponderance of evidence endorses yearly mammography in women older than age 40. Women’s Imaging Center at Lexington Medical Center offers screening mammography at its Lexington, Irmo and Chapin locations as well as the hospital’s Mobile Mammography Van. All diagnostic mammograms and interventional procedures are performed at Women’s Imaging Center, which is always staffed by a full-time radiologist. Among Lexington Radiology Associates,

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five radiologists, who have combined mammographic experience of more than 100 years, provide expertise in this area. On a day-to-day basis, Women’s Imaging Center performs ultrasound-guided core biopsy to diagnose breast cancer. Lexington Medical Cancer Center routinely uses ultrasounds to survey the axilla on the affected side for any sign of lymph node metastasis, extending the biopsy procedure to that area when necessary. Metallic clips are uniformly placed within all targets at the time of biopsy to mark the area for future reference. In some cases, this action is instrumental in guiding the surgeon to the proper site for lumpectomy, such as when neoadjuvant chemotherapy is administered with the intent of downstaging a larger primary mass prior to surgery. Occasionally, the drug therapy is so successful that the lesion is essentially ablated with only the clip left to demarcate its former location. Stereotactic biopsy is used primarily to diagnose microcalcifications in the absence of a mass detectable by ultrasound. It continues to offer a high success rate in the diagnosis of breast cancer, particularly the earliest stage, ductal carcinoma in situ (DCIS).

CLINICAL SERVICES

The Radiology team at Lexington Medical Cancer Center is committed to offering the very best in equipment, image interpretation and patient experience. Magnetic resonance (MR)-directed biopsy of lesions visible only at breast MR is now a viable option for determining tissue diagnosis. Such lesions must be carefully chosen beforehand, but this service now fills a previous void in patient evaluation by providing an alternative means of performing a biopsy for lesions that cannot be accurately localized by mammography or ultrasound. PET/CT is not used routinely in the initial staging of breast cancer, as sentinel node imaging is superior in this regard. PET/CT is invaluable, however, in the restaging of patients with suspected recurrence. PET and bone scans are complementary tools in the detection of tumor burden within the skeletal system, each method finding bone metastases that the other method misses. PET/CT services have been expanded from two days per week to three days per week because of the needs of the community. In addition to the standard PET/CT imaging using tagged glucose, Lexington Medical Center now offers PET/CT imaging using tagged fluoride for improved imaging of bones. In some patients, the PET/CT fluoride “bone scan” may be more sensitive for bone lesion detection. Lexington Medical Cancer Center increased the number of PET/CT appointments available by offering an additional scanning day in 2014. Radiology participates in the interdisciplinary breast conference every Thursday afternoon to discuss the diagnosis and treatment options for breast cancer patients. Every patient diagnosed at Lexington Medical Cancer Center is discussed at this forum after initial detection. Radiologists and pathologists communicate closely in breast diagnoses to ensure the concordance of imaging and pathologic findings.

Coming soon to the diagnostic armamentarium is a technique called tomosynthesis, a prospective method of 3-D mammography that allows radiologists to add the critical third dimension of depth to standard 2-D digital images. This tool may allow more accurate discrimination between benign and malignant breast diseases to further improve the positive predictive value for breast biopsies. PROSTATE CANCER Unlike lung and breast cancer, the vast majority of patients with prostate cancer are already biopsy-proven upon imaging referral. Radiology’s role in that setting, after initial tissue diagnosis has been made, is to determine whether the tumor burden is confined to the prostate or not, thereby helping the urologist, radiation oncologist and medical oncologist determine the proper treatment strategies. MR of the prostate has been shown to be an accurate means of determining extracapsular spread of disease. Lexington Medical Cancer Center recently adjusted its protocol to eliminate the need for placement of an endorectal balloon coil before scanning; extracorporeal coils provide diagnostically equivalent images and, as a result, patients tolerate the study much better. Another area of improvement — no less than a vast upgrade in imaging quality — is prostate-specific membrane antigen. Lexington Medical Center Radiology proudly offers the SPECT (single-photon emission computed tomography)/CT version of the ProstaScint® scan; imaging ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

occurs with SPECT nuclear medicine and standard CT data co-registered anatomically. Since CT data eliminates guessing about the potential meaning of a particular pattern of radiopharmaceutical uptake, the need for previously required blood pool scans has been eliminated. The study is eminently more readable and intuitive. SPECT/ CT transforms the readability of the ProstaScint study, markedly increasing the accuracy of several other cancerspecific studies, including the OctreoScan® for somatostatin receptor-positive tumors such as carcinoid and MIBG (metaiodobenzylguanidine) scans for tumors of adrenal medullary origin (e.g., pheochromocytoma).

advance allows for successful imaging of many patients who are unable to remain motionless for the examination, such as the obtunded cancer patient with brain metastases. MR spectroscopy has a limited role in distinguishing brain neoplasms from other entities, including infarctions and infection.

CENTRAL NERVOUS SYSTEM TUMORS

Techniques have advanced to reduce the severe pain that typically defined the post-embolization syndrome on the basis of tissue infarction; the newer delivery system utilizes Adriamycin® and drug-eluting beads of a specific number and diameter to occlude target tissue capillary beds while not producing wholesale stoppage of arterial blood flow. This method ameliorates pain and allows a longer direct infusion of the chemotherapeutic agent into the intended tissue target.

Preoperative embolization is a technique offered at Lexington Medical Cancer Center to assist neurosurgeons in the treatment of hypervascular tumors. Delivering embolic material to the arterial supply to such tumors, most frequently meningiomas, shrinks the tumor, makes resection easier and reduces blood loss at the time of surgery. MR techniques continue to evolve so that very few impediments interfere with an interpretable study. For example, both of the MR units at the main hospital are capable of specialized pulse sequences that can shave precious minutes off normal acquisition times. This

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GASTROINTESTINAL TUMORS Interventional radiology plays an important role in management of certain tumors of gastrointestinal origin. For example, hepatic artery chemoembolization provides palliative control of primary and metastatic liver malignancies.

Microwave ablation of certain liver tumors is now available as well. Although both radiofrequency (RF) and microwave ablation destroy tissue by inducing thermal injury, the physics behind these methods differ. In organs with extensive large-vessel perfusion such as the liver, the socalled “heat sink” effect is encountered in which tumors located near major arteries or veins are more resistant to successful extirpation because the constant flow of nonheated blood in the proximity of the tumor counteracts the heating effect of the ablation probe(s). Microwave ablation is less prone to the heat sink effect as it produces faster and greater local heating, so the trend is toward using microwave ablation in the liver. As a side note, since the conductivity of lung tissue is far lower than other solid organs, pulmonary lesions are more amenable to microwave ablation compared with RF ablation.

CLINICAL SERVICES

Percutaneous biliary drainage procedures are often instrumental in diverting the flow of bile in patients with ductal obstructions due to a variety of malignancies, primarily pancreatic head carcinoma. The transhepatic tract created during this procedure may be used to place internalized biliary stents or secure generous biopsies of malignant strictures for histologic diagnosis as well. Nutritional needs of cancer patients may be met by placement of percutaneous gastrostomy and jejunostomy tubes for continued enteral feedings.

Percutaneous nephrostomy is a long-standing technique of rapidly resolving renal obstruction in the setting of many pelvic malignancies, including prostate and gynecologic subtypes. Urinary diversions by this method prevent ischemic damage to the nephrons of the affected kidney and stems, and the likelihood of superimposed urinary tract infection, which may be devastating in the context of an obstructed kidney. As in the biliary tree, the percutaneous tract is also useful for additional downstream procedures, including ureteral stenting and biopsy.

GENITOURINARY TUMORS

THYROID TUMORS

Radiofrequency ablation is an increasingly accepted means of treating select renal masses via minimally invasive methods. The ideal tumor is 3 cm or less in diameter, although slightly larger masses may also be treated by RF ablation.

Radiology is involved in detection, biopsy and treatment as well as follow-up post treatment. If a thyroid lesion is suspected, patients may undergo imaging with an ultrasound and/or nuclear medicine for diagnosis.

Using multiple probes and strategic injections of saline to intentionally create a water boundary between the tumor target and a critical adjacent structure, such as bowel (hydrodissection), increase the applicability of this exciting new technique. Performed in CT, many patients undergoing this procedure require only conscious sedation. Results have been extremely encouraging.

Ultrasound-guided fine needle aspiration (FNA) is often performed if a suspicious nodule is identified. In appropriate patients, thyroid ablations are performed using radioactive iodine for therapy. Often, patients are treated with surgery for thyroid cancers. After treatment, they are followed with laboratory studies as well as nuclear medicine to evaluate for residual thyroid ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

tissue or metastatic disease. A new service offered at Lexington Medical Cancer Center is ThyrogenÂŽ stimulation prior to thyroid remnant ablation, as well as Thyrogen stimulation for follow-up laboratory testing. Thyrogen stimulates any residual thyroid tissue, increasing the sensitivity of testing to detect smaller lesions and improve the efficacy of treatment. GENERAL Certain procedures in Interventional Radiology apply to many cancer patients at Lexington Medical Cancer Center regardless of organ of origin. PICC (peripherally inserted central catheter) and arm port insertions are performed rapidly and accurately with a combination of ultrasound and fluoroscopic guidance. PICC combines the ease and safety of peripheral insertion with the advantage of central termination within a large vein, allowing versatile utility of such a line in cancer patients for the administration of chemotherapy, infusion of parenteral nutrition, and delivery of antibiotics and other intravenous medications as needed. There is still an exposed segment of the catheter that is prone to inadvertent dislodgement or infection, so the fully internalized arm port may be preferable to some cancer patients. Patients suffering with malignant accumulation of fluid in the chest (pleural effusion) or the abdomen (ascites) may benefit from periodic drainage with ultrasound guidance. Such procedures are performed many times each week at Lexington Medical Cancer Center for palliative care, particularly when patients grow increasingly dyspneic. In a subset of patients with recurrent pleural effusions, placement of a permanent drainage catheter with an external drain bag may be more convenient, enabling patients to manage fluid collection at home and avoid multiple trips to the hospital for drainage. Finally, percutaneous vertebroplasty or kyphoplasty is available for treatment of painful malignant compression 28

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fractures of the spinal column in patients who develop vertebral metastases. The pain associated with a compression fracture may be severe, and these procedures characteristically offer rapid and sometimes dramatic pain relief. Since pain control rather than height restoration is the primary focus of this intervention in the setting of malignancy, vertebroplasty is applied more often in this context. CONCLUSION The preceding discussion touches on some of the services available in the diagnosis and treatment of cancer at Lexington Medical Cancer Center. In addition to these specific advancements and interventions, the lionâ&#x20AC;&#x2122;s share of work in the area of oncology continues to revolve around MR, CT, ultrasound, nuclear medicine and PET for the diagnosis, staging and restaging of cancer. Our state-of-the-art cross-sectional imaging is available for management of cancer patients whenever the need arises. The Radiology team at Lexington Medical Cancer Center is committed to offering the very best in equipment, image interpretation and patient experience. We are proud of our important role within the collective team of physicians, nurses, technologists and other health care providers at Lexington Medical Cancer Center in the relentless fight against cancer.

CLINICAL SERVICES

Lexington Radiation Oncology

Radiation Oncology Based on the past, present and future of cancer care, challenges continue for those in the medical community. As our patient population ages, we have been seeing an influx of younger diagnoses. Our workforce is becoming smaller, technology is advancing and, with the advent of the electronic health record, patient needs are ever increasing. One factor has never changed â&#x20AC;&#x201D; the demand for value in services. For more than 20 years, Lexington Medical Center Radiation Oncology has consistently built upon the value of services provided to Lexington County and its surrounding communities. In 2014, Radiation Oncology added a third linear accelerator to offer access to some of the most advanced technology in the fight against cancer. With targeted therapy and advanced imaging, patients no longer have to travel miles from home to receive the level of care found at large research institutions. In 2014, Radiation Oncology also added a nurse practitioner to help support the growing volume of cancer patients. Breast, prostate and lung cancers continue to be the primary diagnoses that the facility treats. We also perform brachytherapy treatments (e.g., prostate implants and radioisotope injections) more often. The department has

completely transitioned to an electronic health record with patient portal access, and we are currently building a survivorship electronic portal. In 2014, Radiation Oncology received a grant from the Lexington Medical Center Foundation to offer nutritional services to patients who need access to this information. The hospital continues to recognize that patients not only need medical treatment for their cancer â&#x20AC;&#x201D; their financial, social and psychological stressors require attention as well. Annually, these reports highlight the advancement in technologies and services provided by Lexington Medical Cancer Center. But the commitment to provide quality health care that meets the needs of the people of Lexington County remains the same, and Radiation Oncology is proud to be a part of the Lexington Medical Center family.

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Lexington Oncology

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CLINICAL SERVICES

Medical Oncology The skill and expertise of Lexington Medical Cancer Center’s medical oncologists and their outstanding nurse practitioners are an integral part of the clinical services for our cancer center. These medical oncologists provide care and oversight of the drug regimens that are used in the fight against cancer. The roles of these stellar physicians and nurse practitioners extend far beyond the management and prescription of chemotherapy and biotherapy. At some point, most cancer patients will require the services of a medical oncologist. Lexington Oncology, a Lexington Medical Center physician practice, is composed of five boardcertified oncologists/hematologists: Dr. Steven Madden;

Dr. James Wells; Dr. Vijaya Korrapati; Dr. Asheesh Lal; and Dr. Chelsea Stillwell. In addition, Lexington Oncology has four nurse practitioners: Paula Cox; Cindy Frick, Shannon Hallman; and Teresa Bowers. The following medical oncologists at South Carolina Oncology Associates are active partners in clinical conferences, discussions regarding clinical trials and best plans of care: Dr. Chaudhry Mushtaq; Dr. Fred Kudrik; Dr. Anne Hutchison; and Dr. James Williams.

Surgery Surgery is the oldest documented treatment for cancer, dating back to the Egyptian Middle Kingdom (circa 1600 BC). It remains one of the primary modalities used in the treatment of most cancers, along with radiation and chemotherapy. At Lexington Medical Cancer Center, surgeons play an integral role in tissue collection for histological purposes as well as staging a patient’s disease. Correct staging of the disease ensures that the patient receives the best and most appropriate treatment plan. The surgeons at Lexington Medical Cancer Center also collaborate with the physicians of other specialties at twice-weekly cancer conferences to share information, review pathology and scans, and develop multidisciplinary care plans. The cancer center relies on the skill and expertise of a wide range of surgeons — Lexington Surgical Associates, Riverside Surgical Group, Southern Surgical Group, as well as the expertise of neurosurgeons, urologists, dermatologists, ENT physicians and specialists. Their efforts have made this cancer program one of which we are rightfully proud. We greatly appreciate all of our surgeons.

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Lexington Oncology Nurse Practitioners 32

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CLINICAL SERVICES

Inpatient Oncology Providing comprehensive and compassionate care to patients, Lexington Medical Centerâ&#x20AC;&#x2122;s Inpatient Oncology Unit is a 30-bed unit specializing in the care and treatment of patients with cancer. The 54 staff members include a nurse manager, registered nurses, nursing technicians and unit secretaries.

is ready to go home, the discharge is as clear and seamless as possible.

The Inpatient Oncology unit uses the care management system, which assigns a care manager to each patient throughout his or her hospitalization. The care manager ensures the patient has a plan of care that is welldefined and easy to understand. The care manager also monitors patient progress toward set goals and outcomes. Importantly, care managers work as a part of an interdisciplinary team to assure the needs of the patients are met while in the hospital, and that when the patient

The hospitalâ&#x20AC;&#x2122;s Oncology Unit insists on the highest quality of care and the highest standards. Nurses on the unit must be certified in chemotherapy and biotherapy, meeting the standards set by the National Oncology Nursing Society. Sixteen registered nurses have also achieved certification in oncology nursing. A clinical mentor also serves on the unit as a resource to ensure the staff remains current and competent in the many specialized skills oncology care entails. ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

Multidisciplinary Conferences On Tuesdays and Thursdays each week, Lexington Medical Cancer Center employs two cancer conferences for the specific purpose of prospective treatment planning and multidisciplinary collaboration in patient care. Multidisciplinary treatment planning is widely considered to be both the foundation and gold standard of oncology care in the best cancer centers throughout the world. Cancer is a disease that requires the efforts of multiple medical specialties. Thatâ&#x20AC;&#x2122;s why physicians representing those specialties participate in these conferences. While there are numerous medical and surgical specialists who attend and participate in specific cases, there are five areas that must be represented to meet minimum accreditation standards: radiology; surgery; medical oncology; pathology; and radiation oncology. Lexington Medical Cancer Center is deeply indebted to its entire medical staff for providing the expertise needed to create and sustain these weekly multidisciplinary conferences. During these conferences, treatment plans are created with input from all physicians who participate in the patientâ&#x20AC;&#x2122;s care. Thursday conferences are specifically dedicated to newly diagnosed breast cancer cases, 100 percent of which are discussed and reviewed. The Tuesday conferences are the setting to discuss all other cancer sites. 34

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By 12:00 p.m. on Mondays, physicians can schedule oncology conference cases through the Cancer Registry department at: oncconf@lexhealth.org The Pathology department coordinates the breast conferences. Contact Susie Greenthaler at: sbgreenthaler@lexhealth.org (803) 791-8226

CLINICAL SERVICES

ONCOLOGY CONFERENCE ACTIVITY Lexington Medical Cancer Center Year-End Summary for 2014

Conference Type

Total Conferences

Total Cases Presented*

Percentage of Top 5 Sites Presented

Prospective Cases Presented*

Attendance Percentage by Required Specialties**

Breast Oncology Conference

95.8%

General Oncology Conference

100%

Combined

818*

77.9% (637/818)

98.5*

Percentage of Cases Where Treatment Guidelines Were Discussed

Percentage of Eligible Cases With Clinical or Working Stage Discussed

98.5%

97.6%

97.9%

PRESENTATION REQUIREMENTS — COC STANDARDS * For case presentations, CoC requires a minimum of 15 percent of the annual analytic caseload and the prospective presentation rate of a minimum of 80 percent or a maximum of 450 of the analytic caseload discussed at cancer conferences. ** Required specialties mandated by CoC include medical oncology, radiation oncology, surgery, pathology and diagnostic radiology. CASES TO BE PRESENTED — CANCER CONFERENCE P&P At a minimum, 15 percent of the annual analytic caseload is to be presented at weekly cancer conferences. While both prospective and retrospective cases from all the major cancer sites are presented and discussed, at least 80 percent of the cases presented will be prospective according to CoC standards. Of the cases presented, the “Top 5 Sites” seen at the facility shall represent 75 percent.

In 2014, the Oncology and Breast Conferences featured four “Lunch & Learn” lectures. FEBRUARY 6, 2014

MAY 27, 2014

“Management of Metastatic Breast Cancer”

“Rectal Cancer: Standards and Future Directions”

Dr. Kimberly L. Blackwell

Dr. Linda M. Farkas

Duke University Medical Center

APRIL 29, 2014

SEPTEMBER 9, 2014

“ New Approaches in the Management of Advanced Melanoma”

“ Gene Signatures and Prediction of Treatment Benefit in Cancer and Risk-Adapted Therapy for Pre-Cancer”

Dr. April K.S. Salama Duke University Medical Center

Dr. Michael Alvarado University of California San Francisco ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

PATIENT

SUPPORT

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Pet Therapy The physical and psychological benefits of pet therapy are especially important for cancer patients as they commonly experience high levels of stress and depression, particularly those who have no family members with them.

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Nurse Navigators

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PATIENT SUP P ORT

Nurse Navigators Patient navigation is not a new concept at Lexington Medical Cancer Center. While many hospital cancer programs around the country have started to implement types of patient navigation, we actually hired our first oncology nurse navigator in 1997 when launching our “Five-Day Detection to Diagnosis” breast cancer program. The nurse navigator is a key member of the breast cancer team. She serves as a liaison for patients in search of a diagnosis and the rest of the health care team. The breast cancer nurse navigator assists women and men by coordinating tests to achieve a timely diagnosis of any perceived breast problem or abnormality. Once diagnosed, the patient can rely on the navigator to help educate him or her about the disease, how it is treated and what to expect in the future. In short, the navigator is an educator, scheduler, listener and, most importantly, a patient advocate. Several years ago, our hospital made a commitment to patients: everyone diagnosed with cancer, no matter how rare the type, would have access to a nurse navigator if they wanted one. Keeping this promise required looking at how we deliver navigator services and making some adjustments. While the most popular form of navigation is assigning a specific nurse to people with one type of cancer and this nurse seeing only patients with that cancer, we created the general cancers nurse navigator role. Handpicking oncology nurses for their knowledge base and educational background, certifications and stellar people skills, Lexington Medical Cancer Center makes these navigators available to people with different types of cancer, so all patients have a formal advocate.

It takes a special person and an extraordinary oncology nurse to be a navigator as they meet patients who are in varying stages of illness. These nurses must be comfortable working with patients and their families at times of high distress and assessing the patients’ needs, and coordinating with other team members to develop a plan of care that is effective and timely. Navigators must be effective time managers, outstanding communicators, and genuinely love and be interested in the patients they serve. Lexington Medical Cancer Canter is proud to utilize three navigators — one breast cancer navigator and two general cancers navigators. The cancer program manager is also trained and certified as a nurse navigator to ensure that care is not interrupted if a navigator is on vacation or ill. In 2014, the general cancers navigators met and assisted 1,197 newly diagnosed patients, and continued to help 511 patients over a period of months. The breast cancer nurse navigator assisted 758 women who needed diagnostic intervention, and 267 subsequently received a breast cancer diagnosis. Our nurse navigators are an integral part of our oncology team and one of our proudest achievements.

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Lymphedema Prevention & Management Program Lexington Medical Cancer Center has an established hospital-based lymphedema prevention and treatment program. This program provides treatment in the outpatient setting for patients who have been diagnosed with lymphedema. In addition, inpatient therapists educate patients after breast surgery on lymphedema and precautions to help prevent it. Lymphedema can develop after having breast surgery, chemotherapy or radiation therapy, and frequently affects quality of life. Years of research have improved treatment options, often enabling patients to return to their previous level of function with few restrictions. A certified lymphedema therapist sees patients who are referred to physical therapy for treatment. The program consists of manual lymphatic drainage, bandaging, exercise, skincare and patient education. The Lexington Medical Center Foundation continues to support the lymphedema program by helping to provide supplies and compression garments for patients who are uninsured or underinsured. Because of this support, all patients have access to lymphedema treatment.

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For five years, the hospitalâ&#x20AC;&#x2122;s lymphedema support group has helped to educate patients and their families about lymphedema, and encourage those who face challenges associated with lymphedema. The support group, which meets eight times per year, establishes social networks for patients to share information with others who have had similar experiences with lymphedema. Currently, Lexington Medical Cancer Center has two certified lymphedema therapists who provide specialized care and education to patients undergoing breast cancer treatment. Patients work with the breast health specialist and their physician to determine if they need outpatient services for lymphedema prevention and management.

PATIENT SUP P ORT

Breast Health Services Breast Health Services is an integral part of the oncology program’s roster of services and one of which we are rightfully proud. Developed in 1997, physicians at Lexington Medical Cancer Center established this program from the realization that opportunities existed to redesign the diagnostic workup for men and women with suspected breast cancer. These physicians led the hospital’s efforts to research current best practices and find a model that best suited our needs. The result was “Five-Day Detection to Diagnosis,” a landmark initiative that offered patients a definitive diagnosis within five working days of detecting a breast problem. Since then, the program has grown to include support programs to assist patients who need assistance and diagnostics, but the underlying philosophy remains the same. Today, a board-certified oncology nurse, who is also a certified breast cancer nurse navigator, spearheads this program. This navigator identifies and assists patients with suspicious clinical breast findings and shepherds them through their examination and diagnosis. If doctors detect a breast cancer, the navigator works with the patient to coordinate appointments with appropriate physician specialties, educates the patient about the disease and treatment options, and presents the patient’s case before a multidisciplinary panel of physicians for discussion and treatment planning. The navigator, acting as the patient’s advocate, also ensures that the patient has access to support groups, appearance-related educational offerings and, when the patient completes treatment, a course on survivorship or life after cancer. There are many reasons why Breast Health Services has been successful. Expediting the entire diagnostic process to eliminate needless delays and waiting has served to eliminate much of the

stress that accompanies a call for help. Radiologists have done an outstanding job of being sensitive to the need for timely answers by performing breast biopsies, when needed, within 24 hours of initial assessment. Equally important is the work of our pathologists, who provide a diagnosis within 24 hours of the biopsy in the hope of alleviating the patient’s distress. Once cancer is detected, the Breast Health Services team is ready to help, mapping out the best treatment options and partnering with the patient. Breast Health Services is a National Accreditation Program for Breast Centers-accredited program and serves as a model for other hospitals. This program has assisted hundreds of patients since its inception and will continue to offer unparalleled care in the future. ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

Becky’s Place Since opening in October 2000, Becky’s Place has served individuals throughout the Southeast as the only hospital-based appearance and resource center in the Midlands.

Named in memory of Rebecca “Becky” Johnson, a hospital volunteer and Lexington Medical Center Foundation board member, the boutique is conveniently located on the ground floor of Lexington Medical Park 1 on the hospital’s main campus.

For medically covered services, the boutique accepts most major medical insurance and will file all claims on behalf of the client. For women who have no insurance, assistance is available for those who meet the requirements. Seventy-six women received assistance in 2014.

Offering a wide variety of head coverings, wigs and prosthetic garments, Becky’s Place helps individuals to minimize and manage changes in their appearance resulting from surgery and cancer treatment. In 2014, more than 1,270 individuals diagnosed with cancer received services from Becky’s Place.

In addition, Becky’s Place carries a large selection of Vera Bradley® handbags and accessories. The boutique donates 10 percent of the net proceeds from Vera Bradley breast cancer awareness items to the Vera Bradley Foundation for Breast Cancer Research.

The staff has received special training and certification through the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., and the Board of Certification/ Accreditation, International. They are able to assist women who have undergone surgery for breast cancer, offering one-on-one assistance in a private and caring atmosphere.

Accredited by The Joint Commission’s Home Care Accreditation Program, Becky’s Place plays an important role in the recovery process of individuals who have been diagnosed with and treated for cancer, and will continue to be a resource to the community in the future.

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PATIENT SUP P ORT

Oncology Social Services The oncology social workers in the Lexington Medical Cancer Center interact with patients throughout their journey. They are dedicated to oncology patients in both the inpatient and outpatient areas. The inpatient social worker, Nicole Sorrent, LMSW, works with cancer patients in the oncology unit and assists with discharge planning, medication assistance, community referrals, assessments and more. The outpatient oncology social worker, Blake Barnhill, LMSW, works with cancer patients who receive outpatient services through Lexington Radiation Oncology, Lexington Oncology and other Lexington Medical Centeraffiliated physician practices. Together, they work to bridge the gap in services during our cancer patients’ transition from inpatient to outpatient. These social workers effectively assess every patient and family for psychological, social and/or practical needs, and assist them with navigating the medical and social systems. They also collaborate with other health care team members to meet these needs. After identifying the barriers between a patient and his or her treatment, the oncology social workers utilize an array of community resources to overcome those barriers. For example, there may be limitations in insurance coverage regarding specialty medications for oncology patients. Our social workers, in conjunction with the hospital’s oncology financial counselor, can assist patients in obtaining copay assistance through various foundations to ensure that they receive treatment.

These social workers also attend to the emotional and social needs of our oncology patients. The outpatient oncology social worker facilitates weekly support group sessions, such as Losing Is Not an Option, and serves as a crisis interventionist for patients and their families during periods of high stress.

2014 STATISTICS  Average of 12 attendees for the weekly Losing Is Not an Option support group  Average value of $389,000 in medication assistance per month More than 4,000 patient encounters 

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Pastoral Care The Pastoral Care department at Lexington Medical Cancer Center provides support to the patients, family members and staff of the Inpatient Oncology unit. A dedicated oncology chaplain helps meet the specialized needs of our cancer patients. In addition to daily visits for new admissions and follow-up visits with those requesting visits, chaplains and associate chaplains revisit patients who have been in the hospital for 11 days or longer. These visits promote socialization as well as encourage patients and their families. Patient visits may include spiritual assessment, spiritual community contact, rituals, prayer support or spiritual readings. Patients and their family members can also find Care Notes with cancer-specific titles on the Inpatient Oncology unit. Books on a variety of topics are available for people of all ages. For children, puppets assist with identifying feelings and fears, and verbalizing questions. Additionally, a weekly support group, which is staffed by a chaplain and a nurse, gives family members a safe place to address and discuss their concerns. These resources are helpful in times of treatment or grief.

Comprehensive Guide for Cancer Patients A cancer diagnosis starts a new journey filled with complex terminology, treatments and emotions.

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Lexington Medical Cancer Center’s “Survivor from Day 1” cancer patient binder is a guide to help patients through diagnosis, treatment and survivorship. This guide consists of easy-to-understand information with bright, detailed illustrations and photography that encourages patients to retain the information and use the comprehensive guide as a helpful reference throughout their journey. Since the launch of the “Survivor from Day 1” patient binder in March 2013, Lexington Medical Cancer Center has distributed nearly 150 copies each month to patients and their families.

PATIENT SUP P ORT

Integrative Therapies for Patients At Lexington Medical Cancer Center, patients have access to a comprehensive and integrative approach to fighting cancer â&#x20AC;&#x201D; combining the traditional treatments for fighting cancer with complementary programs, including animal-assisted, music and visual art therapies. One of the most popular programs is pet therapy, which began at Lexington Medical Center in 2008. The hospital currently has 12 pet therapy teams that visit patient areas several times a week. All dogs must be certified through Therapy Dogs, Inc., and complete a physical exam to participate in this program. The physical and psychological benefits of pet therapy are especially important for cancer patients as they commonly experience high levels of stress and depression, particularly those who have no family members with them. Pet therapy has also been shown to reduce depression in patients receiving chemotherapy. Lexington Medical Center also offers a music therapy program called Relaxing Rhythms. This program, which began in 2010, provides soothing music to patients and

visitors in the Inpatient Oncology unit as well as in the Oncology Infusion Center. Relaxing Rhythms transforms these clinical areas into peaceful and serene settings. Led by Heidi Darr-Hope, founder and executive director of Healing IconsÂŽ, Lexington Medical Centerâ&#x20AC;&#x2122;s art therapy program demonstrates the importance that visual arts have in the healing process. Through participatory workshops, seminars and lectures, patients create a visual reminder of their journey and develop new coping strategies. With leadership from Ann Wingate, director of Volunteer Services, and support from the Lexington Medical Center Foundation and the Cancer Committee, these complimentary programs provide patients with ongoing opportunities to find mental respite from daily treatment regimens.

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

Freedom from Smoking Tobacco use is the leading preventable cause of death in the U.S. In fact, cigarette smoking causes about 1 of every 5 deaths in the nation annually.

Wellness Workouts Lexington Medical Cancer Center’s exercise program is designed for anyone who has been diagnosed or treated for cancer and released by his or her doctor for exercise therapy. Certified cancer exercise trainer Thad Werts, ACSM CET, ACSM HFS, leads the program. The goal is to support recovery by emphasizing the importance of exercise and how to integrate it into health care. By participating in Wellness Workouts, patients receive an initial assessment, an individual exercise prescription, eight one-on-one training sessions and a follow-up evaluation. In 2014, Lexington Medical Cancer Center and our Foundation provided exercise therapy to 87 survivors with 99 percent completing the program with an increased level of activity, strength and endurance.

LEX I NG TON M EDI C A L C A N C E R C E N T E R

DEMOGRAPHICS PARTICIPANTS Men

87 6

Women

Minimum Age

Maximum Age

Groups Trained

Hours Spent by CET New Memberships

761.5 17

MEASURABLE IMPROVEMENTS Increased Ability to Handle Tasks

94%

Decreased Stress Level

74%

Increased Self-esteem

79%

Increased Activity Level

100%

Increased Endurance

99%

Increased Strength

99%

Increased Flexibility

85%

Increased Proper Nutrition

57%

According to the Surgeon General, quitting smoking is the single most important step a smoker can take to improve the length and quality of his or her life. And research has shown that success rates for all quit methods are higher if combined with a support program. In November 2012, Lexington Medical Center offered its first Freedom from Smoking clinic, which was taught by a certified smoking cessation facilitator. Seven people completed the program at the hospital’s community medical center in Lexington — one quit smoking and remains tobacco-free today. Today, the smoking cessation clinics are free for the community through a grant from the Lexington Medical Center Foundation. The hospital conducted three clinics in 2014. Lexington Medical Center continues to promote this program through our community and network. The hospital’s program has become a national gold standard in successful smoking cessation clinics. It is also listed on the American Lung Association’s website as one of the few ongoing programs offered in S.C.

PATIENT SUP P ORT

Support Groups and Patient Programs Support groups are an integral part of a patient’s care plan at Lexington Medical Cancer Center. We strongly believe in the value of a therapeutic setting — a place where patients and caregivers can voice fears and concerns, and draw strength from the experiences of others. We provide a place of confidentiality for patients and privacy is paramount. Our support groups strive to provide an appropriate venue for people with all types of cancer. SUPPORT GROUPS

PATIENT PROGRAMS

 LOSING IS NOT AN OPTION Blake Barnhill, LMSW, leads this weekly support group for people with any type of cancer and their caregivers.

 LOOK GOOD…FEEL BETTER A partnership of the American Cancer Society, Personal Care Products Council, Professional Beauty Association and Lexington Medical Center, this monthly class assists women with the cosmetic effects of cancer treatment.

 WOMAN TO WOMAN Led by Kelly Jeffcoat, BSN, OCN, CBCN, breast cancer nurse navigator, this monthly support group is for women with breast cancer.  LYMPHEDEMA SUPPORT GROUP Tori Gude, MPT, DPT, CLT, facilitates this monthly meeting for people who experience lymphedema as a side effect of their cancer treatment.  LIVING WITH CHANGE Donna Peele, chaplain, leads this weekly group meeting for caregivers of people with life-threatening illnesses.  SUPPORT FOR LUNG CANCER PATIENTS The American Lung Association’s Midlands chapter coordinates this monthly support group for patients and their caregivers. Call 803-779-5864 for additional information.

 HEALING ICONS® Led by Heidi Darr-Hope, this program assists patients in dealing with the emotional and psychological effect of a cancer diagnosis using various art forms.  WELLNESS WORKOUTS A certified cancer exercise specialist leads this strength and exercise program specifically designed to meet the needs of people recovering from cancer treatment.  PET THERAPY Accompanied by certified trainers and handlers, pet therapy dogs offer therapeutic diversion and respite during inpatient visits.

 US TOO Led by Libby Daniels, RN, OCN, general cancers nurse navigator, this monthly support group is for men with prostate cancer and their partners. ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

SERVING OUR

COMMUNITY

LEX I NG TON M EDI C A L C A N C E R C E N T E R

Womenâ&#x20AC;&#x2122;s Night Out The sold-out event raised more than $20,000 to benefit the Crystal Smith Breast Cancer Fund.

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Colon Cancer Challenge

Community Outreach PARTNERSHIP WITH CENTER FOR COLON CANCER RESEARCH — SCREENING COLONOSCOPIES In 2014, Lexington Medical Center partnered with the Center for Colon Cancer Research to provide screening colonoscopies to medically underserved and uninsured patients from Lexington Medical Associates, Lexington Medical Center Swansea and Lexington Medical Center Batesburg–Leesville in an effort to reduce the morbidity of colorectal cancer in South Carolina. CCCR has received funding from the BlueCross BlueShield Foundation, Duke Endowment, and the

LEX I NG TON M EDI C A L C A N C E R C E N T E R

S.C. legislature to screen more than 800 individuals and to support navigators who work directly with patients to enhance the success of the program. Lexington Medical Center is the first hospital to partner with CCCR. South Carolina Colon Cancer Prevention Network will also donate $50 to the hospital’s foundation for each referred patient completing a colonoscopy. Donations will be used to provide gas cards to patients with transportation issues.

SERVING OUR COMMUNITY

LUNG CANCER SCREENING PROGRAM In February 2014, Lexington Medical Cancer Center launched a lung cancer screening program, following the National Lung Screening Trial criteria and guidelines. In order to be eligible for screening, a patient must meet the eligibility criteria that identifies the patient as at high-risk for developing lung cancer based on age, smoking history and personal health history. The cost of the screening was set at $149, which was below the average of other programs nationwide, and required a physician order. The Lung-RADS classification system assessed the patient’s findings, with a Lung-RADS of 4 classified as suspicious and a Lung-RADS 5 as a known malignancy. A nurse coordinator reviews all reports and faxes the results to the ordering physician for follow up. A multidisciplinary team reviews all Lung-RADS 4 and 5 cases at a weekly high-risk lung conference. All screened patients who currently smoke are referred to free tobacco-cessation classes offered by the hospital. A credentialed nurse teaches the classes. In September 2014, the program expanded to accept self-referrals with the requirement that patients who self-referred must meet the screening eligibility criteria set forth by the NLST. The goal of this program is to decrease the numbers of patients in our community who are stage III and IV at time of diagnosis. According to the 2013 Lexington County Community Health Needs Assessment, adult smoking in Lexington County was measured at 21 percent, with tobacco use identified as one of the primary issues facing Lexington County. Caucasian youth in Lexington County were much more likely than African-American youth to smoke cigarettes (25 percent vs. 12 percent). In addition, lung cancer is the second most commonly diagnosed cancer at Lexington Medical Cancer Center. The hospital’s five-year survival rate was slightly lower than national data when compared stage-to-stage. In 2010,

commensurable with national data, more than half of NSCLC patients did not survive one year from diagnosis. For all of these reasons, Lexington Medical Cancer Center believes the lung cancer screening program is an important addition to its offering. SKIN CANCER SCREENING On June 27, 2014, Lexington Medical Cancer Center supported a free skin cancer screening due to the high incidence of skin cancer in Lexington County. Providers screened 71 participants and identified more than 23 suspicious lesions. Patients were referred to local dermatologists for follow-up care. SC STATE FAIR PINK TENT Lexington Medical Cancer Center employees, along with volunteers from cancer survivor groups, provided breast cancer information and support to breast cancer survivors and their families at the South Carolina State Fair for six days in October 2014. In partnership with Palmetto Health and Providence Hospitals, this campaign was a statewide effort to increase breast cancer awareness. On the last day, volunteers asked fairgoers to participate in a “pink ribbon picture” in an attempt to make the world’s largest pink ribbon. Additional “Pink” Activities

• F amilies placed a pink ribbon on a Christmas tree in honor of a breast cancer survivor or someone who has succumbed to the disease. The tree is on display at Becky’s Place, Lexington Medical Center’s appearance and resource boutique. •V olunteers shared information about Susan G. Komen mammograms. •Y oung survivors and Woman to Woman members shared their stories with fairgoers and encouraged women of age to get their mammograms on time. •C hildren dressed in pink accessories and posed for pictures with their families and friends.

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Infusion Center Healing Garden Supported by the Cancer Care Fund

LEX I NG TON M EDI C A L C A N C E R C E N T E R

SERVING OUR COMMUNITY

Lexington Medical Center Foundation The Lexington Medical Center Foundation was founded in 1990 to develop resources for providing quality health services that meet the needs of the many patients served by the hospital. Today, through the generous donations received from individuals and businesses, the Foundation continues to touch the lives of those throughout the Midlands. CANCER CARE FUND

CRYSTAL SMITH FUND

In 2014, the Lexington Medical Center Foundation supported several areas of care at Lexington Medical Cancer Center, including the purchase of vital supplies for cancer patients, and assistance with utilities and other living expenses to enhance their quality of life. Specifically, the Foundation provided 635 cancer patients with gas vouchers, 580 patients with medication vouchers, and 219 patients with transportation vouchers. The Cancer Care Fund provided more than $9,500 in financial support to help patients with their basic monthly expenses while undergoing treatment. In addition, the Foundation supported cancer programs through staff education and certification.

The Crystal Smith Fund provides breast cancer patients with essential items and services, including supplies and medications during treatment, and wigs and prostheses. The fund also meets the emergency needs of breast cancer patients and provides post-surgical kits for every mastectomy patient at Lexington Medical Cancer Center, ensuring that women have what they need, regardless of their ability to pay. Seventy patients received peace and dignity through this initiative in 2014.

MOBILE MAMMOGRAPHY UNIT Last year, the Mobile Mammography Unit traveled to 164 sites, screening 3,015 women and detecting 8 cancers. The Foundation continues to support this program by providing the necessary funds for gas and maintenance to travel throughout the community. The Mobile Mammography Unit gives women access to life-saving screenings in a quick, comfortable and convenient way.

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STATISTICS

AND RESEARCH

LEX I NG TON M EDI C A L C A N C E R C E N T E R

Statistics and Research Worldwide, cancer research is in the midst of a decade of unprecedented growth and discovery. Understanding the significance of this new frontier, Lexington Medical Cancer Center has positioned itself as an active participant in the highly promising field of modern-day cancer research.

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

Cancer Spotlight — Breast Cancer Breast cancer is very common, affecting 1 in 8 women in their lifetime. In fact, more than 3 million women living in the U.S. have a diagnosis of breast cancer. Last year, approximately 232,670 cases were diagnosed in the United States, with 3,750 in South Carolina. And each year, there are an estimated 40,000 deaths nationwide, with approximately 670 in South Carolina. Mortality for breast cancer since the 1990s has decreased by 34 percent, especially among women younger than age 50, in which there has been a decrease in mortality of 3.1 percent per year. This decrease is a result of access to new treatments and better screening.

SCREENING The American Cancer Society recommends that women receive an annual mammogram beginning at age 40. It is especially important that women are regularly screened to increase the chance that a breast cancer would be detected early before it has spread. Recommended screening intervals are based on the duration of time a breast cancer is detectable by mammography before symptoms develop. Combined results from randomized screening trials suggest that mammography reduces the risk of dying from breast cancer by 15 to 20 percent. Screenable breast cancers are usually found by routine mammograms; however, some women do present with unscreenable breast cancers that they find on their own. These breast cancers present as palpable masses in the breast or axilla, or as subtle changes in the skin, nipple or shape of the breast. Women are encouraged to be “breast aware” and contact their physician if they have persistent changes in their breasts. 56

LEX I NG TON M EDI C A L C A N C E R C E N T E R

RISK FACTORS AND CLINICAL MANIFESTATIONS The main risk factors for breast cancer are gender and advancing age. Other risk factors of note include atypical hyperplasia on a previous biopsy and mammographydense breasts. Lexington Medical Cancer Center now offers 3-D tomosynthesis for mammography of dense breasts, which improves visualization and provides a better screening option for these high-risk women. Another noteworthy risk factor is genetic mutations of the BRCA1 and BRCA2 genes. While this mutation is found in less than 1 percent of the population, it does increase the risk of breast cancer by 50 to 75 percent over a woman’s lifetime. Genetic counseling is offered at Lexington Medical Cancer Center to assist this small group of high-risk women.

STATISTICS AND RESEARCH

Factors That Increase the Risk for Breast Cancer in Women RELATIVE RISK >4.0

Site, Histology and Laterality of Breast Neoplasms LEXINGTON MEDICAL CANCER CENTER — 2014 ACCESSION YEAR RIGHT

FACTOR

SITE

LEFT

Age (>65 vs. <65 years, although risk increases until age 80)

C50.0

Nipple

0.63

0.00

Biopsy-confirmed atypical hyperplasia Certain inherited genetic mutations for breast cancer (BRCA1 and/or BRCA2) Lobular carcinoma in situ

C50.1

Central Portion

0.63

0.94

8.18

2.20

C50.4 Upper-outer quadrant 82 25.79 58 LEXINGTON LEXINGTON MEDICAL MEDICAL CENTER CENTER -- 2014 2014 ACCESSION YEAR YEAR Lexington ACCESSION Medical Center

18.24

C50.2 Upper-inner quadrant 24 7.55 Site, Histology and Laterality of Breast Neoplasms Site, Histology and Laterality of Breast Neoplasms

Mammography-dense breasts

C50.3

Lower-inner quadrant

LEXINGTON MEDICAL CENTER - 2014 ACCESSION YEAR

C50.5

Lower-outer quadrant

C50.6 Axillary tail Lexington Lexington Medical Medical Center Center

RIGHT

Personal history of early onset (<40 years) breast cancer

Site C50.0 C50.1 C50.2 C50.3 C50.4 C50.5 C50.6 C50.8 C50.9

Two or more first-degree relatives with breast cancer diagnosed at an early age

Nipple Central portion Upper-inner quadrant Lower-inner quadrant Upper-outer quadrant Lower-outer quadrant Axillary tail Overlapping lesion NOS Total

N 2 2 24 12 82 15 0 26 10 173

C50.8

Overlapping lesion

C50.9

NOS

% 0.63 0.63 7.55 3.77 25.79 4.72 0.00 8.18 3.14 54.40

Personal Site Site history of breast cancer (>40 years) C50.0 C50.0 Nipple Nipple High endogenous estrogen or testosterone levels (postmenopausal) C50.1 C50.1 Central Central portion portion C50.2 C50.2 Upper-inner Upper-inner quadrant quadrant High-dose radiation to chest Lower-inner Lower-inner quadrant quadrant C50.3 C50.3 First-degree relative with breast cancer C50.4 C50.4 Upper-outer Upper-outer quadrant quadrant C50.5 C50.5 Lower-outer Lower-outer quadrant quadrant 1.1–2.0 Alcohol consumption Axillary Axillary tail tail C50.6 C50.6 Ashkenazi (Eastern European) Jewish heritage Overlapping Overlapping lesion lesion C50.8 C50.8 C50.9 C50.9 NOS NOS Diethylstilbestrol (DES) exposure Total Total Early menarche (<12 years)

8520/3 8521/3 8230/2 8480/3 8000/3 8522/3 8201/2 8501/2 8140/3 9020/3 8510/3 8520/2 ----/-

Height (tall) High socioeconomic status Late age at first full-term pregnancy (>30 years) Late menopause (>55 years)

Lobular carcinoma, NOS (C50._)

8500/3 Infiltrating duct carcinoma, NOS (C50._) Infiltrating ductular carcinoma (C50._) Ductal carcinoma in situ, solid type (C50._)

Mucinous adenocarcinoma 8500/2 Intraductal carcinoma, non-infiltrating, NOS NEOPLASM, malignant Infiltrating duct and lobular carcinoma (C50._) Cribiform carcinoma in situ (C50._) Comedocarcinoma, non-infiltrating (C50._) Adenocarcinoma, NOS Phyllodes tumor, malignant (C50._) Medullary carcinoma, NOS Lobular carcinoma in situ, NOS (C50._) Other/Unknown

8520/3

Lobular carcinoma, NOS (C50._)

8521/3

Infiltrating ductular carcinoma (C50._)

8230/2

Ductal carcinoma in situ, solid type (C50._)

8480/3

Mucinous adenocarcinoma

8000/3

3.46

0.00

10.06

318 318

173 317

TOTAL

RIGHT RIGHT LEFT LEFT N N % % N N % % 22 0.63 0.63 00 0.00 0.00 22 0.63 0.63 33 0.94 0.94 24 24 7.55 7.55 26 26 8.18 8.18 12 12 3.77 3.77 77 2.20 2.20 82 82 25.79 25.79 58 58 18.24 18.24 15 15 4.72 4.72 11 11 3.46 3.46 00 0.00 0.00 00 0.00 0.00 26 26 8.18 8.18 32 32 10.06 10.06 10 10Histology 3.14 3.14 88 2.52 2.52 8500/3 Infiltrating duct carcinoma, NOS (C50._) 173 173 HISTOLOGY 145 54.40non-infiltrating, NOS 145 45.60 45.60 8500/2 Intraductal 54.40 carcinoma,

2.1–4.0

0 26

4.72

Reportable Cases

318

LEFT N % 0 0.00 3 0.94 26 8.18 7 2.20 58 18.24 11 3.46 0 0.00 32 10.06 8 2.52 145 45.60

3.77

8.18 3.14

Reportable Reportable Cases Cases

54.40 1

99.69%

2.52

145

45.60

0.31%

317 317 99.69% 99.69% N 207 27 27 7 5 5 4 4 4 4 3 3 2 2 14

% 65.09 8.49 8.49 2.20 1.57 1.57 1.26 1.26 1.26 1.26 0.94 0.94 0.63 0.63 4.40

11 0.31% 0.31% N

207

65.09

8.49

2.20

1.57

Neoplasm, malignant

1.26

8522/3

Page 1 of 2 Infiltrating ductal and lobular carcinoma (C50._)

1.26

8201/2

Cribriform carcinoma in situ (C50._)

1.26

8501/2

Comedocarcinoma, non-infiltrating (C50._)

1.26

8140/3

Adenocarcinoma, NOS

0.94

Personal history of endometrium, ovary or colon cancer

9020/3

Phyllodes tumor, malignant (C50._)

0.94

Recent and long-term use of menopausal hormone therapy containing estrogen and progestin

8510/3

Medullary carcinoma, NOS

0.63

8520/2

Lobular carcinoma in situ, NOS (C50._)

0.63

----/-

Other/Unknown

4.40

Never breastfed a child No full-term pregnancies

Postmenopausal obesity/adult weight gain

Recent oral contraceptive use American Cancer Society Breast Cancer Facts & Figures, 2013–2014

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

TREATMENT AND SURVIVAL We now know there are many different types of breast cancer with their own unique features, and we have developed targeted treatments based on these features. For example, hormonal therapy is administered for estrogen-receptor positive/progesterone-receptor positive (ER/PR+) tumors and can be combined with chemotherapy for higher risk tumors. For ER/ PR+ and HER2/neu-negative invasive breast cancers, the Oncotype DX® Breast Cancer Assay predicts chemotherapy benefit and the likelihood of distant breast cancer recurrence. Approximately 20 percent of breast cancers are HER2/neu positive. Herceptin®-based chemotherapy is used for these tumors that carry the HER2/neu oncogene. In fact, adding Herceptin to standard chemotherapy for early stage, HER2/neu-positive breast cancer reduces the risk of recurrence by 52 percent and death by 33 percent. These tumors are commonly found at later stages, and preoperative chemotherapy is typically given with complete pathologic response rates greater than 65 percent. Approximately 10 percent of breast cancers are triple negative (i.e., ER-, PR- and HER2/neu negative). These cancers are usually unscreenable and more likely to metastasize at any early stage. Fortunately, most people respond to chemotherapy, which is now given more frequently preoperatively since these cancers present at a later stage. From a surgical standpoint, lumpectomy is the preferred form of surgical treatment. The timing of surgery is based on the American Joint Committee on Cancer stage, with higher stages receiving hormonal therapy or chemotherapy preoperatively. Radiation usually follows a lumpectomy with duration determined by tumor features. 58

LEX I NG TON M EDI C A L C A N C E R C E N T E R

AJCC STAGE DISTRIBUTION Breast Cancer by AJCC Stage 2014 Analytic Cases 9 19 44

318

TOTAL CASES

158

 STAGE 0  STAGE I (IA, IB)  STAGE II (IIA-IIB)

 STAGE III (IIIA-IIIB)  STAGE IIIC

 STAGE IV  UNKNOWN

* Unknown stage: Cases whereby AJCC is not applicable due to histology (e.g., Phyllodes) and/or there was not enough information to provide appropriate clinical AJCC staging.

PREVENTION Women can modify their risk for breast cancer by doing the following: • Have a child before age 30. • Breastfeed their children. • Never start smoking.

• Keep alcohol consumption to one or less per day. • Participate in moderate exercise. • Maintain a healthy weight.

SUMMARY Breast cancer — next to skin cancer — is the most common cancer in women. Fortunately, with today’s treatment options, most women have full and productive lives. Women are encouraged to know their risk factors and be “breast aware.” Sources: NCCN Guidelines, Breast Cancer, Version 3. 2014; American Cancer Society, Inc., Breast Cancer Facts & Figures 2013–2014

STATISTICS STATISTICS AND & RESEARCH

Worldwide, cancer research is in the midst of a decade of unprecedented growth and discovery. Understanding the significance of this new frontier, Lexington Medical Cancer Center has positioned itself as an active participant in the highly promising field of modern-day cancer research.

Clinical Research Most notably, in 2014, Lexington Medical Cancer Centerâ&#x20AC;&#x2122;s Clinical Research department experienced its highest growth to date in the number of clinical trials available to cancer patients, the number of patients participating in clinical trials at the hospital, and the diversity of trials available to the community. As an affiliate of the Duke Cancer Network, our community and patients benefit from access to and support from the Duke Clinical Research Team. Lexington Medical Cancer Center also supports the local scientific community by partnering with university-based investigators involved in projects, such as cancer genomics research, medication administration and cancer disparities research. Lexington Medical Cancer Centerâ&#x20AC;&#x2122;s Clinical Research department has long pursued the goal of developing a research program where the community could benefit from an array of research activities. Anchored by a diverse team of doctors, nurses, Cancer Registry staff and research personnel, Lexington Medical Cancer Center Clinical Research is committed to bringing progressive and innovative care to our patients.

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

TISSUE BANKING PROGRAM AND CANCER GENOMICS RESEARCH The hospital’s Tissue Banking Program continues to support one of the most significant areas of cancer research — cancer genomics. The study of cancer

genomics involves diverse and highly promising cancer research activities, such as cancer detection, treatment and prevention.

TISSUE BANKING STATISTICS 2014 YEAR

BREAST

COLON

LUNG

RENAL

GYN

OTHER

YEARLY TOTAL

2014

Grand Total

131

146

598

40 35

 BREAST

 COLON

 LUNG

20 15

 RENAL

 GYN

 OTHER

0 2007

2008

2009

2010

2011

2012

2013

2014

CLINICAL RESEARCH: 2015 AND BEYOND

COMING 2015

Clinical Research at Lexington Medical Cancer Center doesn’t expect its growth to slow in 2015. Currently, four clinical trials are pending approval and another six trials are under consideration. We expect 2015 to be another exciting year of growth for clinical research at Lexington Medical Cancer Center.

 NSABP B-51/RTOG 1304:

 ALCHEMIST: Randomized Double

Randomized Phase III Clinical Trial Evaluating Post-Mastectomy Chest Wall and Regional Nodal XRT and PostLumpectomy Regional Nodal XRT in Patients with Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy

Blind Placebo Controlled Study of Erlotinib or Placebo in Patients with Completely Resected Epidermal Growth Factor Receptor (EGFR) Mutant Nonsmall Cell Lung Cancer (NSCLC)

LEX I NG TON M EDI C A L C A N C E R C E N T E R

Principal Investigator: Quillin Davis, MD

Principal Investigator: James Wells, MD

STATISTICS AND RESEARCH

Cancer Registry The Cancer Registry at Lexington Medical Cancer Center has been operating since 1992 as an integral part of the hospital’s Cancer Services, which became accredited by the American College of Surgeons Commission on Cancer in 2005. The primary function of the Cancer Registry is to maintain an electronic database encompassing the most accurate and timely data on eligible cancer cases diagnosed and/or treated at Lexington Medical Cancer Center. Registry staff collect and analyze numerous data fields on each cancer case, including patient demographics, primary site, histology, diagnostic testing, prognostic indicators, treatment modalities, stage of disease, recurrence and lifetime annual follow up. This data is used to review patient outcomes, conduct statistical analyses and special studies, and fulfill reporting requirements to the South Carolina Central Cancer Registry, the Rapid Quality Reporting System and the National Cancer Data Base. By maintaining our own database and submitting data to these regional and national databanks, our cancer team is able to monitor patient outcomes and trends not only at Lexington Medical Center, but also within our state, region and nation. In addition to collecting and submitting cancer-related data, the Cancer Registry also manages internal and external requests for cancer data. Internal requests include, but are not limited to, Administration, physician and

nursing staff, Clinical Research and Pathology. In 2014, the Cancer Registry fulfilled 123 requests for cancer data. The Cancer Registry staff also coordinates quarterly Cancer Committee meetings, monthly subcommittee/workgroup meetings and two weekly oncology conferences.  ONCOLOGY CONFERENCES Schedule cases by email to oncconf@lexhealth.org.  CANCER DATA REQUESTS Natalie J. Copeland, Cancer Registry Manager (803) 936-4175 / njcopeland@lexhealth.org Important: Please be aware that release of data containing protected health information is subject to federal Health Insurance Portability and Accountability Act regulations and Institutional Review Board approval.

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

CANCER REGISTRY ACTIVITY Lexington Medical Cancer Center 2014 Statistical Year

TOTAL CASES

2,308

Analytical Cases

1,467

% Analytical Cases

64%

Follow-Up Rate (5 Year) CoC target of 90%

90%

Follow-Up Rate (Reference Year) CoC target of 80%

93%

Numbers have been rounded.

GEOGRAPHIC DISTRIBUTION OF CANCER CASES Analytical Cases by County at Diagnosis 26 17

COUNTY OF DIAGNOSIS

(with some counties combined under “Other SC Counties”)  AIKEN

 OTHER SC COUNTIES

 CALHOUN

 OUT OF STATE

 FAIRFIELD

 RICHLAND

 KERSHAW

 SALUDA

 LEXINGTON

 SUMTER

 NEWBERRY

 UNKNOWN

 ORANGEBURG

LEX I NG TON M EDI C A L C A N C E R C E N T E R

337 4 10 12

39 40 TOTAL: 1,467

878

STATISTICS AND RESEARCH

ETHNOLOGICAL DISTRIBUTION OF CANCER CASES Analytical Cases By Race 8

(1%)

 WHITE

268

 BLACK

(18%)

 ASIAN INDIAN OR PAKISTANI, NOS (NOT OTHERWISE SPECIFIED)  OTHER RACE (OTHER ASIAN, LAOTIAN, VIETNAMESE, OTHER)

8 (1%) 6 (1%)

 AMERICAN INDIAN, ALEUTIAN OR ESKIMO (INCLUDES ALL INDIGENOUS POPULATIONS OF THE WESTERN HEMISPHERE)

TOTAL: 1,467

1,177 (80%)

GENDER AND SITE DISTRIBUTION COMPARISON OF CANCER CASES Lexington Medical Cancer Center — 1,467 Analytical Cases for 2014

MALE ALL SITES

12 (1.82%)

BRAIN & NERVOUS SYSTEM

6 (0.74%)

25 (3.80%)

LIP, ORAL CAVITY, PHARYNX, LARYNX

10 (1.24%)

12 (1.82%)

ESOPHAGUS

4 (0.49%)

112 (17.02%)

657 BREAST 1 (0.15%) PROSTATE 117 (17.8%)

LUNG

107 (13.21%)

12 (1.82%)

STOMACH

16 (1.98%)

24 (3.65%)

PANCREAS

28 (3.46%)

62 (9.42%)

COLON, RECTUM

51 (6.29%)

39 (5.93%)

KIDNEY

10 (1.23%)

44 (6.69%)

URINARY BLADDER

13 (1.60%)

32 (4.86%)

FEMALE ALL SITES

810 BREAST 317 (39.14%) OVARY 14 (1.73%) CORPUS UTERI 39 (4.81%) CERVIX 6 (0.74%)

OTHER DIGESTIVE ORGANS 16 (1.97%)

39 (5.93%)

MELANOMA OF SKIN

24 (2.96%)

46 (6.99%)

NON-HODGKIN’S LYMPHOMA

46 (5.68%)

26 (3.95%)

LEUKEMIA

21 (2.59%)

54 (8.21%)

ALL OTHER SITES

82 (10.10%)

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

COMPARATIVE ANALYSIS OF NEW CANCER CASES Lexington Medical Cancer Center vs. American Cancer Society — South Carolina 57.6%

60%

56.3%

55% 50% 45% 40% 35% 30% 25%

21.7%

20% 15%

14.2%

14.9%

15.6%

15.2% 8.0%

10%

7.7%

8.3%

5.4% 3.0%

Breast

Lung

Prostate

Colorectal

Lexington Medical Center

Grand Total

Bone Marrow

American Cancer Society — South Carolina

TOP 5 CANCER SITES 2014 Analytical Cases

 BREAST  LUNG  PROSTATE

318

113

 COLORECTAL  BONE MARROW

TOTAL: 846

117

219 64

LEX I NG TON M EDI C A L C A N C E R C E N T E R

STATISTICS AND RESEARCH

STAGE DISTRIBUTION OF CANCER CASES Analytical Cases

TOTAL: 1,467

 STAGE OC (Occult)*  STAGE 0 (O, Oa, Ois)**

STAGE

 STAGE I (I, IA, IAe, IB-IB1, IBe, IC)****

427 275

 STAGE II (II, IIAe, IIA-IIC, IIBs)****

167

 STAGE III (III, IIIAe-IIIAes, IIIAs, IIIA-IIIB, IIIC-IIIC1)****

263

 STAGE IV (IV, IVA-IVC)

153

 STAGE 88***

86 0

 UNKNOWN 100

150

200

250

300

350

400

450

* Stage OC: Occult stage; applicable to lung primary only ** Stage 0a, 0is: Applicable only to non-invasive papillary carcinoma (0a) of bladder and carcinoma in situ/ “flat tumor” (0is) of bladder *** Stage 88: No applicable AJCC staging schema for site or site-histology combination **** Stage ending in e, s or es: Applicable only to lymphoid neoplasm sites and denotes origination in extranodal site (e), involvement of spleen (s), or both (es).

ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

SITE DISTRIBUTION â&#x20AC;&#x201D; 2014 Statistical Summary of Cancer Registry Data Primary Site ORAL CAVITY & PHARYNX

Analytic

Non-Analytic

External Lower Lip, Lower

Base of Tongue

Other & Unspecified Parts of Tongue

Gum

Floor of Mouth

Palate

Other & Unspecified Parts of Mouth

Parotid Gland

Other & Unspecified Major Salivary Glands

Tonsil

Oropharynx

Nasopharynx

Pyriform Sinus

Hypopharynx

Other & Ill-defined Sites in Lip, Oral Cavity & Pharynx

403

259

144

DIGESTIVE ORGANS Esophagus

Stomach (Includes GE Junction)

Small Intestine

Colon (Excluding Rectum)

145

Rectosigmoid Junction

Rectum

Anus & Anal Canal Liver & Intrahepatic Bile Ducts Gallbladder Other & Unspecified Parts of Biliary Tract Pancreas Other & Ill-defined Digestive Organs RESPIRATORY SYSTEM

342

238

104

Nasal Cavity & Middle Ear

Accessory Sinuses

Larynx Lung & Bronchus

314

219

Thymus

Heart, Mediastinum & Pleura

BONES, JOINTS & ARTICULAR CARTILAGE

Bones, Joints & Cartilage of Limbs

Bones, Joints & Cartilage of Other

161

143

HEMATOPOIETIC & RETICULOENDOTHELIAL SYSTEMS Blood Bone Marrow Spleen

Total Cases

SKIN

141

Melanoma

137

LEX I NG TON M EDI C A L C A N C E R C E N T E R

STATISTICS AND RESEARCH

Primary Site SKIN

Total Cases

Analytic

Non-Analytic

141

Other Non-Epithelial

PERIPHERAL NERVES & AUTONOMIC NERVOUS SYSTEM

PERITONEUM & RETROPERITONEUM

Peritoneum

Retroperitoneum

BREAST

496

318

178

FEMALE GENITAL ORGANS

CONNECTIVE, SUBCUTANEOUS & OTHER SOFT TISSUES

110

Vulva

Vagina

Cervix

Corpus Uteri

Uterus, NOS

232

125

107

Ovary Other & Unspecified Female Genital Organs MALE GENITAL ORGANS Penis Prostate Testis Other & Unspecified Male Genital Organs URINARY TRACT Kidney Renal Pelvis

219

117

102

147

113

Ureter

Bladder

Meninges

Brain

Other & Unspecified Urinary Organs BRAIN & OTHER PARTS OF CENTRAL NERVOUS SYSTEM, EYE Eye & Adnexa

SPINAL CORD, CRANIAL NERVES & OTHER PARTS OF CENTRAL NERVOUS SYSTEM

Spinal Cord

Optic Nerve

THYROID & OTHER ENDOCRINE GLANDS

Acoustic Nerve

Thyroid

Adrenal Gland

Pituitary Gland

OTHER & ILL-DEFINED SITES LYMPH NODES

UNKNOWN PRIMARY SITE

2,308

1,467

841

GRAND TOTAL

Of these totals, extra-nodal lymphoma primaries accounted for 8 cases and non-skin melanoma primaries accounted for 2 cases. ONC OL OGY SE R VIC E S 2 014 ANNUAL REP ORT

Building Cancer Survivorship For a person diagnosed with cancer, life is forever changed after completing active treatment. Many people are left with emotional and physical changes that can affect their quality of life. At Lexington Medical Cancer Center, we recognize that surviving cancer may come with challenges that are more easily managed and dealt with if they are recognized and treated early. For that reason, we offer the following services and programs for cancer survivors:

 Survive and Thrive is offered quarterly to all women who have

completed active treatment for breast cancer. In this class, Kelly Jeffcoat, RN, BSN, OCN, CBCN, addresses many of the common concerns and issues facing breast cancer survivors. Topics include healthy lifestyles and diet, sexuality, life after treatment, side effects of treatment, and developing an active lifestyle. For information, contact (803) 791-2521.

 Health management classes promote better health or help

manage existing conditions. Choose from yoga, Pilates, cycling and other programs.

 Smoking-cessation classes are available free at Lexington

Medical Center. Certified tobacco-cessation therapists lead each eight-week session.

 Nutrition counseling with a registered dietitian is available

by physician referral. Health professionals agree that nutrition therapy is one of the most effective ways to improve conditions, such as heart disease, diabetes, hypertension, obesity, celiac disease and food allergies.

 Support groups, which are disease and condition specific,

offer encouragement for patients. Sharing with others who have common issues and challenges can alleviate feelings of isolation and depression for many people.

 Health screenings are provided free for area businesses,

churches, schools and other organizations. Lexington Medical Center is dedicated to improving the health of the community through early detection and diagnosis of disease and illness.

SURVIVOR from Day 1

 Arts and healing programs for survivors assist in emotional healing following active treatment. Cancer survivorship begins the day a person is diagnosed and lasts throughout his or her life. At Lexington Medical Cancer Center, we continue to care about our patients once they complete active treatment and partner with them in survivorship.

LEX I NG TON M EDI C A L C A N C E R C E N T E R

2720 Sunset Boulevard, West Columbia, South Carolina 29169

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LEX I NG TON M EDI C A L C E N T E R