Oncology Services 2015 Annual Report by Lexington Medical Center

ONCOLOGY SERVICES 2015 ANNUAL REPORT

SURVIVORSHIP

LEXINGTON MEDICAL CANCER CENTER

ne challenge in cancer care today is creating a plan of care that fits within the confines of a patient’s life — someone who has the desire to remain active in the workplace and live productively. These patients often have to choose between a doctor’s appointment or a job commitment, a support group meeting or completion of an important proposal for their employer. This issue leads to the following questions: what will cancer care be in the future for these patients, and how can health professionals best empower them to become survivors?

At Lexington Medical Cancer Center, the first step of survivorship is providing patients with education to prepare them for life after cancer treatment. With doctors diagnosing more people with cancer yearly, and people living longer and surviving cancer, part of the answer lies in transitioning healthy patients back to primary care providers who are knowledgeable and equipped to deal with cancer survivors and their unique needs. Patients treated with curative intent now receive a survivorship care plan, or “roadmap,” to help them understand what follow-up tests they may need in the future. Survivors also receive a summary of their cancer treatment, names of drugs and doses, and a list of potential long- and short-term side

effects. The patient’s primary care provider receives copies of these documents as well, so he or she will know about the patient’s overall cancer treatment. The goal is to better prepare people for life after cancer and help them become active partners in their own recovery. Never has survival looked better for people with cancer. Society is on the forefront of a new era with drugs and treatment modalities that can take patients further into recovery and survival. For the first time, researchers stand poised on the brink of a cure. Cancer is no longer an automatic death sentence; it’s a chronic disease that patients can successfully manage.

Never has survival looked better for people with cancer.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

LEXINGTON MEDICAL CANCER CENTER

TABLE OF CONTENTS A MESSAGE FROM QUILLIN DAVIS, MD........................................... Cancer Committee Chair and Medical Director of Cancer Services A MESSAGE FROM RONALD G. MYATICH, MD, FACS..................... Cancer Liaison Physician A MESSAGE FROM DEIRDRE YOUNG, RN, BSN, OCN, CBCN ..... Cancer Programs Manager GOALS AND IMPROVEMENTS............................................................. Clinical Goals 8 Programmatic Goals 9 Quality Improvements 9 CLINICAL RESEARCH....................................................................... CLINICAL SERVICES......................................................................... Clinical Laboratory and Pathology Services 13 Radiology Services 15 Radiation Oncology 21 Medical Oncology 22 Inpatient Oncology 23 Surgery 23 Multidisciplinary Conferences 24

4 6 7 8

10 12

PATIENT SUPPORT........................................................................... Nurse Navigators Breast Health Services Lymphedema Prevention and Management Program Beckyâ&#x20AC;&#x2122;s Place Oncology Social Services Pastoral Care Integrative Therapies Wellness Workouts Support Groups and Patient Programs Freedom from Smoking

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28 29 30 31 32 32 33 33

SERVING THE COMMUNITY............................................................ Community Outreach 35 Lexington Medical Center Foundation 37 STATISTICS......................................................................................... Cancer Spotlight: Head and Neck Cancer 39 Cancer Registry 43

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LEXINGTON MEDICAL CENTER ACCREDITATION

Quality Cancer Care: Recognizing Excellence

ONCOLOGY SERVICES 2015 ANNUAL REPORT

A MESSAGE FROM QUILLIN DAVIS, MD Cancer Committee Chair and Medical Director of Cancer Services

t Lexington Medical Cancer Center, we continue to dedicate ourselves to providing the very best oncology care in our region. We believe that our people make the difference. The medical staff and support personnel work together every day to give care and support to our patients to help them during and after treatment. The spectrum of care required to make our cancer program the best available to our patients involves many different disciplines. Moving onward and upward with our oncology provider groups, we continue to recruit the best physicians, providers and staff. We have added a clinical oncology pharmacist who is dedicated to the safety of our patients as they transition from the outpatient to inpatient setting, and helps to coordinate chemotherapy administration in the office and hospital environments.

Another crucial component to providing the best in oncology care is participation in clinical research. We are affiliated with Duke Health, which provides our connection to the National Cancer Institute clinical trial groups, to enroll patients into clinical research trials. With groundbreaking clinical trials such as the Lung Cancer Master Protocol (Lung-MAPS), we forge ahead in the genetic identification of cancer and tailoring of treatments, including immunotherapy specifically selected for the individual patient. In addition, our Duke affiliation helps us to coordinate quality control efforts in cancer care, including practice certifications through Quality Oncology Practice Initiatives (QOPI®). Lexington Medical Center continues to grow and mature our clinical research program throughout the organization. To help us with

LEXINGTON MEDICAL CANCER CENTER

improved coordination of research and regulatory elements in the complex administration of clinical trial enrollment and accrual, we have empowered a centralized clinical research team, working together with our providers and practices to streamline the identification, approval and accrual of patients into clinical trials in oncology and across the organization. We continue to maintain our certifications with the American College of Surgeons Commission on Cancer (CoC) and National Accreditation Program for Breast Centers. Both certifications help us focus on quality initiatives and process improvements to provide the very best care for our cancer patients as well as concentrate on the standards that continue to evolve as needs of cancer patients are brought to the forefront.

The best in cancer care continues to require an ongoing effort in technology and capital investment, as the pace of scientific advancements proceeds ever faster. We initiated a stereotactic radiosurgery program with the installation of a TrueBeam™ linear accelerator more than one year ago. Patients have experienced faster treatment and fewer side effects since the adoption of this technology. This outcome has created the need for a second TrueBeam unit, which will be installed in 2016. Our robotic surgery program has also grown by leaps and bounds. Many surgical specialties utilize the da Vinci® robot for surgeries, including procedures for cancer patients. The evolution of tailored chemotherapies and immunotherapy, as well as the potential for increasing oral chemotherapy agents,are driving an outpatient oncology pharmacy within our oncology practice to better assist patients in navigating the complex issues with oral chemotherapy.

2015 CANCER COMMITTEE

We are in process of transitioning to a new electronic record for oncology, which will deliver more robust information about our patients and help us provide better care for them throughout the system.

A very important part of coordination of care is our focus on survivorship. Nationwide, CoCaccredited oncology organizations are developing and implementing a survivorship process that is centered on the patient as he or she completes cancer care and moves forward with his or her life. This process also includes providing patients and their physicians with ongoing information about their care. Our evolution and improvement in the electronic record will help us communicate with the patient about his or her ongoing needs and expectations, as well as share this information with his or her providers of care throughout the organization. Continued excellence across the organization makes our hospital a special place, from providing a continuum of cancer care, offering community screening initiatives and helping patients through the treatment process with navigation services to the spectrum of people, facilities and technology that work together to provide the best care. Having a team entirely devoted to cancer patients is what makes us different.

You aren’t alone in your fight against cancer. We are Lexington Medical Cancer Center, and it’s our fight, too.

Quillin Davis, MD – Chair Radiation Medicine Medical Director of Oncology Services Steven A. Madden, MD – Vice Chair Medical Oncology Ronald G. Myatich, MD, FACS – Cancer Liaison Physician Surgery Theresa Altman, RN, BSN, NE-BC Oncology Nursing Natalie J. Copeland, RHIA, CTR Cancer Registry Nannette Faile, RN, MS, CCRP Clinical Research Stephanie Fulmer, LMSW Psychosocial Services and Social Work Emily Jordon, CGC Genetics Counselor Jan Lemond, RN, BSN, CHPN Palliative Care Jayne Moffatt, MD Pathology Chaudhry Mushtaq, MD, FACP Medical Oncology Beth M. Siroty-Smith, MD Radiology Mary Tanner, RN, MBA, CPHQ Center for Best Practice Melissa Taylor, RN Oncology Nursing Connie Watson Community Outreach Deirdre Young, RN, BSN, OCN, CBCN Cancer Programs

ONCOLOGY SERVICES 2015 ANNUAL REPORT

A MESSAGE FROM RONALD G. MYATICH, MD, FACS Cancer Liaison Physician

t is with pride and great satisfaction that I can report to our medical community and health services district about a number of improvements in cancer care at Lexington Medical Cancer Center. Recent groundbreaking ceremonies on our main campus will result in another inpatient bed tower along with eight additional operating rooms, as well as increased capacity in pharmacy services and Labor and Delivery. Another medical office building is underway, allowing expansion of outpatient care on campus, and a large parking deck with the capacity to accommodate more than 950 vehicles will help to alleviate parking issues that have been a result of our tremendous growth.

Alongside these construction projects, a number of service and personnel improvements have occurred in the past year. Our efforts to improve lung cancer screening in the Midlands have been rewarded with a Lung Cancer Alliance “Screening Center of Excellence” designation. We are proud to have earned this recognition as a leader in the field of lung cancer screening, providing state-of-the-art cancer detection services to our community. Lexington Medical Cancer Center can also claim a “first in the Midlands” distinction for our adoption of 3-D tomosynthesis, the latest development in breast imaging and cancer diagnosis/detection. The addition of these technologies will allow cancer treatment physicians to more rapidly and accurately detect and diagnose lung and breast cancers, enabling faster treatment and improved outcomes. Our affiliation with Duke Health has enabled Lexington Medical Cancer Center genetic counselors to interact with experts in genetics at Duke via telemedicine conferences to provide

LEXINGTON MEDICAL CANCER CENTER

rapid and up-to-date genetics counseling for our cancer patients. Through the tireless efforts of countless community volunteers and medical center staff, this year’s Colon Cancer Challenge raised more than $10,000 to promote colon cancer screening for the underserved medical community. We are grateful to those who devote their time and energy to this worthwhile project on an annual basis. A generous grant from the Lexington Medical Center Foundation has been directed toward improving nutritional access and resources for our patients with head and neck cancer. Members of our community and medical staff donated funds, which provide invaluable community outreach and resources, at our annual Women’s Night Out breast cancer awareness event in October. This year’s event was the largest and most successful to date, and we encourage you to participate this fall. Our guest speaker, silent auction, medical provider meet-and-greet, dinner and fashion show are highlights of this must-attend annual event.

I want to thank all of our community volunteers and the members of our medical community who work behind the scenes to make Lexington Medical Cancer Center such a wonderful resource for our region. Because of the efforts of these selfless individuals, we all benefit from a medical center that continues to grow and lead our region in quality health care while preserving the down-home comfort found in our local community. I encourage you to take advantage of the wonderful services found in your own backyard, and jump in and volunteer to serve your community as a member of one of our many outreach services. I know you’ll find it a rewarding and gratifying experience. We look forward to working with you.

A MESSAGE FROM DEIRDRE YOUNG, RN, BSN, OCN, CBCN Cancer Programs Manager

uring the past year, Lexington Medical Cancer Center faced the challenges of creating our identity as a comprehensive cancer center and choosing the goals that would be key to our success. The hospital also experienced many changes. Our longstanding chief executive officer Michael J. Biediger retired, but he left us in the very capable hands of Tod Augsburger, our new CEO. Quillin Davis, MD, chief of Radiation Oncology, continued to lead us through a series of innovative and exciting projects. Our hospital Foundation restructured with new leadership, and the addition of 3-D tomosynthesis for improved breast imaging was a first in the Midlands.

We were fortunate to welcome several physicians to our hospital practices. Their unique skills promise to enhance our standing in the community. Our weekly videoconferences with Duke Health were enhanced after the installation of new video and stethoscope technology, which allowed for better imaging of pathology slides and radiology. Physician offices grew to accommodate more patients in exam rooms and provide greater comfort for our patients and families. All of these changes were even more exciting when viewed in the context of the next new building on our hospital campus. We have come so far in the past few years and continue to take great pride in the growth of our programs and services.

Nowhere is that growth more evident than in the field of oncology. During the past 26 years, we have grown from a small 13-bed unit to a 32-bed unit Radiation Oncology department and medical oncology office with its own infusion center, dedicated financial counselor, social workers and nurse navigators. Our Cancer Registry has grown from two registrars to four with a stellar manager. Our appearance center serves people from all over the Midlands, and our lymphedema therapists and exercise specialists continue to help patients. We are proud to be on the cutting edge of technology.

I would like to extend my gratitude to our Administration for all of their support as we have grown to what we are today. We could have never achieved all of these goals without their leadership.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

GOALS AND IMPROVEMENTS

Clinical Goals Launch of the breast tomosynthesis (3-D mammography) program (developed December 2, 2014) RATIONALE/OPPORTUNITY IDENTIFIED: Research indicates that breast tomosynthesis currently offers superior breast tissue imaging when used for patients with dense breast tissue. Implementation of breast tomosynthesis gives LMC an opportunity to detect subtler lesions at earlier stages, leading to better overall survival. METHODOLOGY/PROCESS: The purchase and installation of the breast tomosynthesis equipment will be a major clinical quality improvement.

LEXINGTON MEDICAL CANCER CENTER

MEASUREMENT: The hospital will measure the success and achievement of this goal by the installation and use of the needed equipment to perform breast tomosynthesis. WHO/RESPONSIBILITY: Beth M. Siroty-Smith, MD, will provide updates to the Cancer Committee as necessary. Department of Radiology and Women’s Imaging Center staff will be responsible for this goal.

STATUS: Goal met (reported at March 2, 2015, Cancer Committee meeting). Dr. Siroty-Smith reported the new 3-D machine is in place, and staff have completed all applications and obtained required continuing medical education (CME) units. Women’s Imaging Center hired two new schedulers and received approval for a “swing scheduler,” enabling the department to stay open later and in anticipation of the increase in volume. Lexington Medical Cancer Center launched the new technology to the public in April.

GOALS AND IMPROVEMENTS

Programmatic Goals Documentation of cancer conference minutes in Epic (developed December 2, 2014) RATIONALE/OPPORTUNITY IDENTIFIED: The treatment recommendations assigned to each case presented at weekly cancer conferences represent the multidisciplinary treatment planning offered to patients at Lexington Medical Cancer Center. The treatment recommendations are the collaborative efforts of the required specialties in accordance with the National Comprehensive Cancer Network treatment guidelines for each particular type of cancer. By placing the recommendations in the patient record, providers improve the flow of communication and ensure that all physicians involved in that patient’s care know the

consensus regarding his or her treatment. Easy access to conference treatment recommendations promotes a more cohesive approach to care and benefits the patient. METHODOLOGY/PROCESS: Quillin Davis, MD, will work with the Epic team to create a location for this document in patients’ electronic records. A designated medical records liaison from Lexington Oncology will accompany Dr. Davis to weekly conferences and create a conference note that includes treatment recommendations to be placed electronically in the patient record.

MEASUREMENT: Achievement of this goal will be measured by the creation of a documentation application for the patient’s electronic medical record and by the transfer of weekly conference recommendations to each patient’s record. Target date to complete all aspects of this project is December 31, 2015. WHO/RESPONSIBILITY: Dr. Davis will provide updates to the Cancer Committee as necessary. STATUS: Active

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. • I ncreased social worker staff by 0.5 FTE. • I mplemented 3-D tomosynthesis in April 2015; the first facility in the Midlands to offer this type of mammography. •H ired additional schedulers in Women’s Imaging Center to enable the department to stay open late and in anticipation of the increase in volume due to the 3-D tomosynthesis implementation. • E stablished a 2:00 p.m. cut-off time for pharmacy to receive chemotherapy orders to decrease delays and errors. • I mplemented second review of all new breast cancer cases by the Pathology department.

• Implemented second review of all positive breast cancer margin cases by the Pathology department.

• Received Komen grant funds to offer screening mammograms to underserved women.

• All new cases of breast cancer receive a second read by pathologists. Any positive breast cancer margin case receives a double read by pathologists.

• Earned Lung Cancer Screening Center of Excellence designation from the Lung Cancer Alliance.

• Raised approximately $10,000 through the Colon Cancer Challenge to help fund colon cancer screenings for the underserved population.

• Implemented closed system transfer devices (CSTD) in Lexington Oncology’s pharmacy and infusion center in August 2015. • Increased palliative care nursing staff.

• Received a Lexington Medical Center Foundation grant to fund dietitian consults and follow-up appointments for selected head and neck cancer patients. 9

ONCOLOGY SERVICES 2015 ANNUAL REPORT

CLINICAL RESEARCH For research to be successful, collaboration is essential.

LEXINGTON MEDICAL CANCER CENTER

CLINICAL RESEARCH

exington Medical Cancer Center strives to provide collaborative care for its patients. Whether studies are housed in Radiation Oncology, Medical Oncology or Surgery, patients benefit from a diverse team of doctors, nurses, Cancer Registry staff and research personnel. This collaboration also extends into the community through the hospital’s affiliation with the Duke Cancer Network and by partnering with local researchers.

CLINICAL TRIALS MEDICAL ONCOLOGY S 1007: 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: Steven A. Madden, MD Enrolled: 1 S1400: Biomarker-Driven Master Protocol for Second-Line Therapy of Squamous Cell Lung Cancer Principal Investigator: James Leroy Wells III, MD Enrolled: 1 (patient qualified and enrolled into sub-study S1400B) EA1131: A Randomized Phase III Postoperative Trial of Platinum-Based Chemotherapy vs. Observation in Patients with Residual Triple-Negative Basal-Like Breast Cancer Following Neoadjuvant Chemotherapy Principal Investigator: Steven A. Madden, MD E4512: A Phase III Double-Blind Trial for Surgically Resected Early Stage Non-Small Cell Lung Cancer: Crizotinib Versus Placebo for Patients with Tumors Harboring the Anaplastic Lymphoma Kinase (ALK) Fusion Protein Principal Investigator: James Leroy Wells III, MD AO81105 and E4512 are treatment components of the ALCHEMIST Trials TRAP: Phase I/II Study of Capecitabine plus Ziv-Aflibercept in Metastatic Colorectal Cancer Principal Investigator: James Leroy Wells III, MD Enrolled: 3

CABOMAB: Cabozantinib (XL184) With Panitumumab in Subjects with KRAS Wild-Type Metastatic Colorectal Cancer and Cabozantinib Monotherapy in Subjects with MET Amplified Treatment-Refractory Colorectal Cancer Principal Investigator: James Leroy Wells III, MD PALLAS: PALbociclib CoLlaborative Adjuvant Study: A Randomized Phase III Trial of Palbociclib with Standard Adjuvant Endocrine Therapy Versus Standard Adjuvant Endocrine Therapy Alone for Hormone Receptor-Positive (HR+)/Human Epidermal Growth Factor Receptor 2 (HER2)-Negative Early Breast Cancer Principal Investigator: Steven A. Madden, MD A151216: Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST) Principal Investigator: James Leroy Wells III, MD AO81105: Randomized Double Blind Placebo Controlled Study of Erlotinib or Placebo in Patients with Completely Resected Epidermal Growth Factor Receptor (EGFR) Mutant Non-Small Cell Lung Cancer (NSCLC) Principal Investigator: James Leroy Wells III, MD

RADIATION ONCOLOGY LCSRT: A Prospective Registry Trial of LowDose Lung Cancer Screening for Adults with High Risk of Developing Lung Cancer Principal Investigator: Quillin Davis, MD Enrolled: 141

COLLABORATIVE: RADIATION AND MEDICAL ONCOLOGY NSABP B-51/RTOG 1304: A Randomized Phase III Clinical Trial Evaluating Post-Mastectomy Chestwall and Regional Nodal XRT and Post-Lumpectomy Regional Nodal XRT in Patients with Positive Axillary Nodes Before Neoadjuvant Chemotherapy Who Convert to Pathologically Negative Axillary Nodes After Neoadjuvant Chemotherapy Principal Investigator: Quillin Davis, MD

SURGERY ACOSOG- Z11102: Impact of Breast Conservation Surgery on Surgical Outcomes and Cosmesis in Patients with Multiple Ipsilateral Breast Cancer (MIBC) Principal Investigator: Lynn M. Tucker, MD, FACS Enrolled: 1 ————————————————————————————

UPCOMING STUDIES

TIP TOP Study: Tobacco Intervention in Primary Care Treatment Opportunities for Providers Conducted with the Medical University of South Carolina and the Care Coordination Institute CE City: HER2+ Breast Cancer NeoAdjuvant Coordination of Care Program ————————————————————————————

T ISSUE BANKING PROGRAM AND CANCER GENOMIC 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. In 2015, 12 cases were submitted for tissue banking.

Lexington Medical Cancer Center Clinical Research has long pursued the goal of developing a research program where the community could benefit from an array of research activities. The department is committed to bringing progressive and innovative care to patients. 11

ONCOLOGY SERVICES 2015 ANNUAL REPORT

CLINICAL 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.

LEXINGTON MEDICAL CANCER CENTER

CLINICAL SERVICES

Clinical Laboratory and Pathology Services

ithin 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. 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:

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. Lexington Medical Center was the first lab in South Carolina to utilize supplementary robotic image analyzer screening of all cases. Human papillomavirus (HPV) testing is also offered here.

LUNG CANCER The hospital has offered a systematic evaluation of patients with a lung mass since 1995 and continues to refine its approach. 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.

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, officebased 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, standard13

ONCOLOGY SERVICES 2015 ANNUAL REPORT

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 earlystage lung cancer.

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-theart equipment and highly trained radiation oncologists to employ skin-conserving methods of superficial radiation therapy.

BRAIN AND 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.

TISSUE BANKING We are active contributors of research tissue from surgically removed tumors for cancer research in the Midlands.

LEXINGTON MEDICAL CANCER CENTER

BLOOD DISORDERS

CONSULTANT NETWORKING

Our program uses 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.

We continue to rely on 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.

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

CLINICAL SERVICES

Radiology Services

s 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 3-D screening mammography in 2015. Studies in The Journal of the American Medical Association have shown that 3-D mammography increases breast cancer detection, and reduces false positives and unnecessary callbacks for patients with dense breast tissue. 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.

BREAST CANCER Lexington Medical Cancer 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 for women older than age 40. Lexington Medical Center offers screening mammography at its West Columbia, Lexington, Irmo and Chapin locations, as well as with the hospital’s Mobile Mammography Van. The service is also available downtown at Vista Women’s Healthcare, and in northeast Columbia at Sandhills Women’s Care, two of Lexington Medical Center’s physician practices. As part of a comprehensive program for the diagnosis of breast cancer, Lexington Medical Cancer Center now offers 3-D mammography. This new breast cancer screening tool uses a low-dose X-ray to create images of the breast that allow doctors to view tissue one millimeter at a time. The technology creates multiple images within seconds that are similar to the “slices” of images in a CT scan. 3-D mammography, also known as digital breast tomosynthesis (DBT), is currently

recommended for women who are having their first screening mammogram or who have dense breast tissue. The term “dense breasts” refers to the appearance of breast tissue on a mammogram. Dense breast tissue appears as a solid white area, which makes it difficult to see through. Non-dense breast tissue appears dark and transparent. Dense breast tissue can make it more difficult to interpret a

mammogram, since cancer and dense breast tissue both appear white on a mammogram. Very dense breasts may increase the risk that cancer won’t be detected on a mammogram. Available since last spring, Lexington Medical Center was the first facility in the Midlands to offer this technology. Women who have completed a 3-D mammography screening at Lexington Medical Center also report that the procedure is less painful and more tolerable than the traditional 2-D mammogram. The FDA-approved procedure uses the same type of equipment as a 2-D mammogram and a similar dose of radiation. Women who have questions about whether or not they should receive a 3-D mammogram should talk to their doctor. Patients may be more likely to have dense breasts if they’re young. Breast tissue tends to become less dense with age, although some women have dense breast tissue at any age. Premenopausal women and women who take hormone therapy for menopause are also more likely to have dense breast tissue.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

LEXINGTON RADIOLOGY ASSOCIATES

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

The Radiology team at Lexington Medical Cancer Center is committed to offering the very best in equipment, image interpretation and patient experience. Women who are having a first screening mammogram or whose doctors have told them they have dense breast tissue may schedule a 3-D mammogram at Lexington Medical Center’s Women’s Imaging Center on the main hospital campus in West Columbia or at Sandhills Women’s Care, a Lexington Medical Center physician practice, in Northeast Columbia. In addition to being an American College of Radiology Breast Imaging Center of Excellence, Lexington Medical Cancer Center’s breast program has accreditation from the National Accreditation Program for Breast Centers and the cancer program has accreditation with commendation from the American College of Surgeons Commission on Cancer. 16

LEXINGTON MEDICAL CANCER CENTER

Women’s Imaging Center performs all diagnostic mammograms and interventional procedures, and is staffed by a full-time radiologist. Among Lexington Radiology Associates, 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

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 (positron emission tomography)/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 â&#x20AC;&#x153;bone scanâ&#x20AC;? 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.

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 followup imaging and clinical referrals. Possible treatment paths include surveillance CT for low-suspicion nodules and PET/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.

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 percent) 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.

PROSTATE CANCER Unlike lung and breast cancer, the vast majority of patients with prostate cancer are already biopsy-proven upon imaging referral. Radiologyâ&#x20AC;&#x2122;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 17

ONCOLOGY SERVICES 2015 ANNUAL REPORT

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 prostatespecific membrane antigen. Lexington Medical Center Radiology proudly offers the SPECT (single-photon emission computed tomography)/CT version of the ProstaScint® scan; imaging 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 cancer-specific studies, including the OctreoScan® for somatostatin receptorpositive tumors such as carcinoid and MIBG (metaiodobenzylguanidine) scans for tumors of adrenal medullary origin (e.g., pheochromocytoma).

LEXINGTON MEDICAL CANCER CENTER

CENTRAL NERVOUS SYSTEM TUMORS 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 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.

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. 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. 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 so-called “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 non-heated 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

CLINICAL SERVICES

The Radiology team at Lexington Medical Cancer Center is committed to offering the very best in equipment, image interpretation and patient experience. 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. 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.

GENITOURINARY TUMORS

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.

THYROID TUMORS 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. 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 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,

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. 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. Percutaneous nephrostomy is a longstanding technique of rapidly resolving 19

ONCOLOGY SERVICES 2015 ANNUAL REPORT

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 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

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,

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.

The Radiology team is 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. 20

LEXINGTON MEDICAL CANCER CENTER

CLINICAL SERVICES

Radiation Oncology

hen looking at the past, present and future of cancer care, the medical community continues to face challenges. Technology is advancing and, with the advent of the electronic health record, patient needs are increasing. One factor has never changed â&#x20AC;&#x201D; the demand for value in services. For more than 20 years, Lexington Medical Cancer 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 (Varian TrueBeamâ&#x201E;˘) to offer access to some of the most advanced technology in the fight against cancer. With targeted therapy and advanced imaging, stereotactic radiosurgery (SRS/SBRT) patients no longer have to travel miles from home to receive the level of care found at large research institutions. In 2016, Radiation Oncology will replace an existing accelerator with another TrueBeam, thereby increasing its capacity to

treat stereotactic radiosurgeries. Since initiating stereotactic radiosurgery in 2014, Radiation Oncology has administered more than 600 SRS/SBRT treatments. Breast, prostate and lung cancers continue to be the primary diagnoses that the facility treats. Radiation Oncology 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 it is currently building a survivorship electronic portal. This electronic access offers patients, family members and primary care physicians immediate access to patient charts regarding diagnoses, treatment and follow-up care. The hospital continues to recognize patients who not only need medical treatment for their cancer, but their financial, social, nutritional and psychological stressors require attention as well. Lexington Medical Cancer Center offers access to these support services. 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 that mission.

LEXINGTON RADIATION ONCOLOGY

ONCOLOGY SERVICES 2015 ANNUAL REPORT

Medical Oncology

he skill and expertise of Lexington Medical Cancer Center’s medical oncologists and nurse practitioners are integral to the clinical services for the hospital’s cancer program. These medical oncologists and clinicians provide care and oversight of drug regimens used in the fight against cancer. Their roles 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, provides physicians

and ancillary staff who demonstrate quality in oncology care. Lexington Oncology is one of 286 facilities in the United States that has achieved Quality Oncology Practice Initiative

LEXINGTON ONCOLOGY

Oncology Pharmacists

exington Medical Center added a dedicated oncology pharmacist to its inpatient oncology unit. Oncology pharmacists play an integral role in patient care.

The oncology pharmacist optimizes outcomes by ensuring adherence to the correct drug, dose, schedule and sequence of chemotherapy and supportive medications. The pharmacist also provides support to oncologists so they can focus on treating the patient, serving as a liaison between physicians, nurses and the hospital’s central pharmacy. 22

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(QOPI®) certification. It initially achieved certification in 2014, and QOPI recertified the practice in 2016. Lexington Oncology is primarily composed of board-certified oncologists/hematologists. These physicians advance the standard of specialty medical care nationwide for improved outcomes and better patient experiences. The providing oncologists at Lexington Oncology are: Steven A. Madden, MD; James Leroy Wells III, MD; Vijaya Korrapati, MD; Asheesh Lal, MD; and Chelsea Rainwater Stillwell, MD. These oncologists work collaboratively with five nurse practitioners: Paula Cox; Cindy Frick; Shannon Hallman; Teresa Bowers; and Katie Matzko. In addition to board-certified physicians and advanced practice nurses, several other health care professionals at Lexington Oncology hold certifications in their respective fields. The practice has a total of seven oncology-certified nurses and a board-certified oncology pharmacist-oncharge. Board certification at Lexington Oncology demonstrates the exceptional expertise in oncology of its health care providers, which is instrumental to the integrity of medical specialty care.

CLINICAL SERVICES

Surgery Surgery remains one of the primary modalities used in the treatment of most cancers, along with radiation and chemotherapy.

Inpatient Oncology

roviding comprehensive and compassionate care to patients, Lexington Medical Center’s Inpatient Oncology Unit is a 30-bed unit specializing in the care and treatment of patients with cancer. The 56 staff members include a nurse manager, registered nurses, nursing technicians and unit secretaries.

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

The hospital’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. An oncology pharmacist provides patient-centered medication therapy management. In addition, a clinical mentor serves on the unit as a resource to ensure the staff remains current and competent in the many specialized skills oncology care entails.

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. Our surgeons also collaborate with the physicians of other specialties at twiceweekly 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.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

Multidisciplinary Conferences

hen discussing patient services, the importance of multidisciplinary treatment planning cannot be overstated. In fact, Oncology Roundtable has ranked this component of cancer care as the most sought-after factor when patients decide where to be treated. Simply put, multidisciplinary treatment planning means every medical specialty involved in the treatment of cancer has input into a patient’s care plan. These conferences ensure all aspects of care and possible outcomes have been considered as they relate specifically to individual patients. All information is confidential and considered part of the quality improvement process. At each treatment planning conference, hospital pathologists bring a wealth of information about the type of cancer someone has and how rapidly it appears to be growing. In cases of melanoma, they can help to explain the depth of invasion. Radiologists assist by sharing the images taken of a patient’s cancer and explaining the story behind those pictures. Lexington Medical Cancer Center physicians use all of this

LEXINGTON MEDICAL CANCER CENTER

information to assign a stage or grade to the patient’s cancer to accurately convey the extent of disease. Staging of cancer cases is one of the most important tasks for physicians as it helps ensure that the team selects the correct treatment. Referencing National Comprehensive Cancer Network treatment guidelines or other appropriate guidelines, Lexington Medical Cancer Center surgeons translate the significance of what is on film to possible surgical options for the patients. The medical and radiation oncologists map out the subsequent phases of the treatment plan, determining the role that chemotherapy drugs and adjuvant radiation therapy may play. Armed with all of this information, appropriate treatment recommendations can be presented to the patient’s managing physician. Final

therapeutic decisions, however, rest with the managing physician and the patient. The cancer conferences are held twice weekly: one for breast cancer cases only (breast conference held every Thursday) and another for all other types of cancer (oncology conference held every Tuesday). Attendance and participation at these conferences requires dedication and commitment from physicians in all relevant specialties. In addition, Lexington Medical Cancer Center appreciates the support and participation of its ear, nose and throat physicians, neurologists, pulmonologists and urologists. In addition to case presentations at the pre-treatment planning conferences, Lexington Medical Cancer Center also provides on-site cancer-related education for its physicians, nurses and allied health staff to build on their knowledge of cancer diagnosis and treatment.

CLINICAL SERVICES

Oncology Conference Activity Lexington Medical Cancer Center Year-End Summary for 2015

Total Cases Presented*

Percentage of Top 5 Sites Prospective Cases Presented Presented*

Attendance Percentage by Required Specialties**

Conference Type

Total Conferences

Breast Oncology Conference

89.1%

General Oncology Conference

96%

Combined

856

87.4% (748/856)

100*

92.7% (89/96)

Percentage of Cases Where Treatment Guidelines Were Discussed

Percentage of Eligible Cases With Clinical or Working Stage Discussed

86.3%

74.6%

Case Presentation Requirements –- Commission on Cancer Standards *CoC requirements for case presentations: 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 presented prospectively. **Required specialties as mandated by CoC: medical oncology; radiation oncology; surgery; pathology; and diagnostic radiology.

Cases to be Presented –- Lexington Medical Cancer Center At a minimum, 15 percent of the annual analytic caseload is presented at the 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 as per CoC standards. Of the cases presented, 75 percent shall be represented by the top five sites seen at the facility.

In 2015, hospital physicians attended three “Lunch & Learn” lectures at the oncology and breast conferences.

MAY 28, 2015

SEPTEMBER 22, 2015

OCTOBER 1, 2015

Radiotherapy in Breast Cancer: Decision-Making After Mastectomy and Neoadjuvant Chemotherapy Janet Horton, MD Duke University Medical Center

Optimal Management of Stage IIIA Non-Small Cell Lung Cancer Thomas D’Amico, MD Duke University Medical Center

Advances in Breast Cancer: Highlights from ASCO Kelly Westbrook Mitchell, MD Duke University Medical Center

Physicians can schedule oncology conference cases by noon on Mondays through the Cancer Registry department at oncconf@lexhealth.org.

The Pathology department coordinates the weekly breast conference. Contact Susie Greenthaler at (803) 791-8226 or sbgreenthaler@lexhealth.org. 25

ONCOLOGY SERVICES 2015 ANNUAL REPORT

PATIENT SUPPORT Cancer diagnosis and treatment can be a difficult time for patients and their loved ones.

LEXINGTON MEDICAL CANCER CENTER

PATIENT SUPPORT

Dealing with cancer, both during and after treatment, is a unique experience for each individual. Lexington Medical Cancer Center provides support services through the time of diagnosis, treatment, recovery and survival, as well as through the circumstances surrounding end of life.

Nurse Navigators

ncology nurse navigators are registered nurses with clinical management expertise who guide patients, families and caregivers to informed decision making. They also collaborate with a multidisciplinary team to allow for timely cancer screening, diagnosis and treatment, and increased support across the continuum of care (National Coalition of Oncology Nurse Navigators, 2013).

In 1990, Harold Freeman, MD, pioneered the concept of navigating underserved patients into the health care system to improve screening and detection of breast cancer and to reduce mortality rates. Since then, nurses have worked to expand that role, ensuring patients receive information to better equip them to deal with cancer treatments, side effects and psychosocial results, and partner with them to achieve the best outcomes. Nurse navigators are oncologytrained nurses proficient in teaching patients about chemotherapy and what to expect while undergoing treatment. These nurses are selected for their interpersonal and problem-solving skills,

and their ability to support patients and families. They perform a myriad of roles â&#x20AC;&#x201D; teacher, champion, listener, counselor â&#x20AC;&#x201D; to guide newly diagnosed cancer patients throughout their illness. Lexington Medical Cancer Center currently employs three board-certified nurse navigators: one navigator specifically assists breast cancer patients, and two general cancer navigators help people with any other type of cancer. Their wealth of knowledge enables patients and their families to anticipate and cope with any treatment side effects. There is no fee for navigator services, which are available through self-referral or by physician, nursing or Pastoral Care referral.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

Breast Health Services

n 1997, Breast Health Services became the cornerstone of the hospital’s cancer program and established a new standard of care for women with breast cancer. In the past, women faced many delays when undergoing diagnostic evaluations. Benchmarking data showed that women often waited four to six weeks before being scheduled for tests and biopsies, and receiving a diagnosis.

Under the guidance and direction of a multidisciplinary committee, including physicians involved in the treatment and diagnosis of breast cancer, the hospital created a plan of care that would take a woman from detection of a breast lump or abnormality to a definitive diagnosis within five working days. Clinicians found the concept of expediting a diagnosis in record time exciting and completely feasible. Offering the promise of “Five-Day Detection to Diagnosis,” the health care team

works together to access a breast abnormality and provide biopsy results within 24 hours. Patients are provided with a breast cancer nurse navigator who serves as an emotional support person, educator and case manager. The National Accreditation Program for Breast Centers offers a structured way of facilitating this effort through its survey and accreditation process. In 2006, NAPBC’s governing board sought to define the modern multidisciplinary breast center. NAPBC identified 27 standards for

breast cancer care, divided into categories of leadership, clinical management, research, community outreach, professional education and quality improvement. These standards illustrate what constitutes a center of excellence in breast cancer care. In July 2013, Lexington Medical Cancer Center’s Breast Health Services proudly announced that it received NAPBC accreditation. NAPBC only grants accreditation to centers that voluntarily commit to providing the best possible care to patients with diseases of the breast. To be accredited, a center must undergo a rigorous evaluation and review of its performance and compliance with NAPBC standards. To maintain accreditation, a center must undergo an on-site review every three years.

Lymphedema Prevention and Management Program

exington Medical Cancer Center established a comprehensive hospital-based lymphedema prevention and treatment program in 1998, and it has continued to grow and expand over the years.

The program provides outpatient treatment in the Physical Therapy department for patients who have been diagnosed with lymphedema. Inpatient therapists educate patients after breast surgery on lymphedema and precautions they can take to help prevent lymphedema. Lymphedema can develop after having breast surgery, chemotherapy or radiation therapy and often affects quality of life. Years of research have improved the way clinicians treat lymphedema patients, and they are often able to return to their previous level of function with few restrictions. A certified

LEXINGTON MEDICAL CANCER CENTER

lymphedema therapist treats referred patients in the outpatient setting. The program consists of manual lymphatic drainage, bandaging, exercise, skin care and patient education. In 2010, Lexington Medical Cancer Center started a lymphedema support group to help educate patients and their families about lymphedema, as well as provide support for some of the challenges that occur with it. The support group meets monthly and allows patients to establish social networks to share information with others who may have similar experiences with lymphedema. Currently, Lexington Medical Cancer Center

has three certified lymphedema therapists on staff to provide specialized care and education to women undergoing breast cancer treatment. Patients work with the breast health specialist and their physician to determine if they need outpatient services.

PATIENT SUPPORT

Becky’s Place

ince opening in October 2000, Becky’s Place has served individuals throughout South Carolina as well as other areas in the Southeast. Owned and operated by Lexington Medical Center, the boutique is unique as it is 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 in West Columbia. Offering a wide variety of head coverings, wigs and prosthetic garments, Becky’s Place helps individuals minimize and manage the changes in their appearance as a result of surgery for cancer and its treatment. The staff at Becky’s Place has received special training and certification through the American Board

for Certification in Orthotics, Prosthetics and Pedorthics and the Board of Certification/ Accreditation, International. Through this special training, staff members are able to assist women who have undergone surgery for breast cancer and offer one-on-one assistance in a private and caring atmosphere. In 2015, more than 1,195 individuals diagnosed with cancer received services from Becky’s Place. The boutique accepts most major medical insurance and files all claims on behalf of the client. Financial assistance is available for

women who do not have insurance through a gift from Mid-Carolina Electric Cooperative Women Involved in Rural Electrification (WIRE) if they meet eligibility requirements. In 2015, more than $13,500 helped to provide 70 women with assistance. Becky’s Place also carries a large selection of Vera Bradley handbags and accessories. The boutique donates 10 percent of the net proceeds from the sale of Vera Bradley breast cancer awareness items to the Vera Bradley Foundation for Breast Cancer Research. Accredited by the Joint Commission’s Home Care Accreditation program, Becky’s Place continues to play an important role in the recovery process of individuals diagnosed with and treated for cancer, and will continue to be a resource to them in the future.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

Oncology Social Services

he oncology social workers in the Lexington Medical Cancer Center interact barriers. For example, there may be limitations in insurance coverage regarding with patients throughout their journey. They are dedicated to oncology specialty medications for oncology patients. 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 services staff, Stephanie Fulmer, LMSW, and Branna Owens, LMSW, works with cancer patients who receive outpatient services through Lexington Radiation Oncology, Lexington Oncology and other Lexington Medical Center-affiliated 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

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.

2015 STATISTICS 

A verage of 12 attendees for the weekly Losing Is Not an Option support group



A verage value of $277,290 in medication assistance per month

 More than

4,100 patient encounters 30

LEXINGTON MEDICAL CANCER CENTER

PATIENT SUPPORT

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

Pastoral Care

he Pastoral Care department supports the Inpatient Oncology unit by visiting each newly admitted patient and conducting follow-up visits. Available at the request of the patient, his or her family, doctor or staff, visits can include conversation, counseling, spiritual assessment and support through readings and prayer. 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 and grief.

We strongly believe in a therapeutic setting where patients and caregivers can voice fears and concerns and draw strength from the experiences of others. 31

ONCOLOGY SERVICES 2015 ANNUAL REPORT

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.

Integrative Therapies

t Lexington Medical Cancer Center, patients have access to a comprehensive and integrative approach to fighting cancer — combining the traditional treatments for fighting cancer with complementary programs, including animal-assisted and music therapies.

PET THERAPY

RELAXING RHYTHMS

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. Accompanied by certified trainers and handlers, pet therapy dogs also offer therapeutic diversion and respite during inpatient visits.

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. With leadership from Ann Wingate, director of Volunteer Services, and support from the Lexington Medical Center Foundation and the Cancer Committee, these complementary programs provide patients with ongoing opportunities to find mental respite from daily treatment regimens.

LEXINGTON MEDICAL CANCER CENTER

Certified cancer exercise trainer Thad Werts, ACSM EP-C, ACSM CET, leads the program, which supports 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 2015, Lexington Medical Cancer Center and the hospital’s Foundation provided exercise therapy to 105 survivors. Ninety-four percent of participants completed the program and achieved an increased level of activity, strength and endurance.

PATIENT SUPPORT

Support Groups and Patient Programs

cancer diagnosis can be frightening for patients and their families. There is the fear of the unknown, worries about financial and caregiver burdens, and uncertainty about the future. Lexington Medical Cancer Center provides a safe place to express fears and concerns, and search for a sense of peace and well-being. The staff at Lexington Medical Cancer Center understands the emotional burdens that a cancer diagnosis places on families. These trained caregivers are adept at reaching out to the people around them and creating a safe place of understanding and caring to share thoughts and fears. In these support groups, patients and families can also rely on other patients and survivors for support.

Lexington Medical Cancer Center offers the following support groups:

LIFE AFTER CANCER

A new class for cancer survivors who have completed their treatment.

US TOO

This support group is for men diagnosed with prostate cancer and their partners.

WOMAN TO WOMAN

LIVING WITH CHANGE

The breast health navigator facilitates this support group for women recently diagnosed with breast cancer.

LOSING IS NOT AN OPTION

Lexington Medical Cancer Center also offers several complementary programs to give patients an integrative approach to coping with cancer.

A Lexington Medical Center chaplain leads this weekly meeting for caregivers of people with life-threatening illnesses. Facilitated by a licensed social worker, this support group is open to people with any type of cancer as well as their partners and caregivers.

LYMPHEDEMA SUPPORT

During this monthly meeting with a certified lymphedema therapist, people who experience lymphedema as a side effect of cancer treatment share information and get encouragement.

SHARING HOPE

Women with either metastatic or recurrent breast cancer find support in this group, which is facilitated by the breast health navigator.

SURVIVE AND THRIVE

A class for breast cancer survivors who have completed their treatment.

LOOK GOOD, FEEL BETTER

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

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.

Freedom from Smoking Tobacco use is the leading preventable cause of death in the U.S. In fact, cigarette smoking causes about one of every five deaths in the nation annually. 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. Lexington Medical Center regularly offers Freedom from Smoking clinics to the community at no cost through a grant from the Lexington Medical Center Foundation. The program boasts a 60 to 70 percent success rate of smokers who successfully kick the habit — an impressive statistic given the national rate of 13 to 14 percent. 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 South Carolina.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

SERVING THE COMMUNITY 34

LEXINGTON MEDICAL CANCER CENTER

SERVING THE COMMUNITY

Community Outreach

exington Medical Center serves the community through many efforts including providing health screenings and health fairs, and sponsoring fundraising events for breast and colon cancer research.

COLON CANCER CHALLENGE Lexington Medical Center held its sixth annual Colon Cancer Challenge on Saturday, April 18, 2015. The event included 65-, 50-, 25- and 15-mile bike rides to raise awareness about colon cancer. More than 135 riders from the Midlands participated in the ride. Through the dedicated work of 40 hospital employee volunteers and community members, the Colon Cancer Challenge raised approximately $10,000. Individuals who donated $60 to the Lexington Medical Center Foundation received a cycling jersey. Educational opportunities prior to and throughout the event included: • a radio interview on “The Point” with Keven Cohen on April 14, 2015 featuring March Seabrook, MD, and Barbara Willm, vice president of

Development and Community Relations; • a television segment on WLTX-19 with Chelsea Stillwell, MD, and Barbara Willm, which aired on April 17, 2015; • designated rest stop banners as “The Polyp Stop,” “Screen at 50” and “Get Behind It”; and • colon cancer survivor success story at the opening ceremonies. The Colon Cancer Challenge began in 2010 with a grant from the University of South Carolina to raise awareness about colon cancer and help underserved patients receive appropriate screening. The event has helped to provide more than 150 screening colonoscopies.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

PARTNERSHIP WITH CENTER OF COLON CANCER RESEARCH (CCCR) AT THE UNIVERSITY OF SOUTH CAROLINA With a mission to reduce the morbidity of colorectal cancer in South Carolina, CCCR provides statewide infrastructure for education and screening colonoscopy programs in medically underserved and uninsured regions of the state. Lexington Medical Center has granted CCCR access to patient medical records through a business associate agreement to work with its patients at Lexington Medical Associates and the hospital’s rural community medical centers in Swansea and Batesburg-Leesville. Prior to this partnership, CCCR only allowed patients from free medical clinics and federally qualified health centers to participate. Part of this program, establishes partnerships with board-certified gastroenterologists who waive professional fees and charge facility fees only. Working with CCCR for screening colonoscopies allows the hospital to use the Foundation’s colon cancer fund to fill in the care gaps for diagnostic colonoscopies. In addition, the South Carolina Colon Cancer Prevention Network donates $50 to the Lexington Medical Center Foundation for each referred patient completing a colonoscopy. This donation will be used to provide gas cards to patients with transportation issues. Navigator Responsibilities • Determine eligibility • Schedule screening • Follow through with patients Hospital Staff Responsibilities • Identify patients who live below the poverty line, between the ages of 50–64 (45–64 for African Americans) and have not had a previous colonoscopy • Notify CCCR

LEXINGTON MEDICAL CANCER CENTER

2015 Colon Cancer Screening Data Total in Database: 73 Colonoscopies Completed: 5 Pending: 1 Scheduling in Progress: 3 Unable to Contact: 9 Need to Follow Up: 7 Pending Reports: 4 Attempting to Contact: 10 Ineligible: 18 Follow Up Required: 6 Withdrew Interest: 1 Effective August 1, 2015, Lexington Medical Cancer Center made changes to the financial criteria for the colon cancer screening program. Patients who have insurance that does not cover colon cancer screening services will be considered for the program. The goal is to provide underinsured people with access to these services.

LUNG CANCER SCREENING PROGRAM Lexington Medical Cancer Center continues to offer a lung cancer screening program, which follows 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 high risk for developing lung cancer based on age, smoking and personal health history. 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. In 2015, there were 240 lung cancer screenings performed. The Lung-RADS™ classification system assesses the patient’s findings, with a Lung-RADS of 4 classified as suspicious and a Lung-RADS 5 as a known malignancy. 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 tobaccocessation classes offered by the hospital. A credentialed nurse teaches the classes.

COMMUNITY EDUCATION Jeffery K. Smith, MD, at Palmetto Dermatology conducted a “Sunscreen: More Harm Than Good” seminar on April 27, 2015.

SKIN CANCER SCREENING On September 11, 2015, Lexington Medical Cancer Center, in partnership with Palmetto Dermatology, supported free skin cancer screenings because of the high incidence of skin cancer in Lexington County. Providers screened 63 patients and identified 20 suspicious lesions. Clinicians referred these patients to local dermatologists for follow-up care.

SERVING THE COMMUNITY

Lexington Medical Center Foundation

he 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

MOBILE MAMMOGRAPHY UNIT

In 2015, 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.

Last year, the Mobile Mammography Unit traveled to 164 sites, screening 3,015 women and detecting eight 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.

CRYSTAL SMITH BREAST CANCER FUND 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 postsurgical kits for every mastectomy patient at Lexington Medical Cancer Center, ensuring that women have what they need, regardless of their ability to pay.

The 2015 sold-out event raised funds to benefit the Crystal Smith Breast Cancer Fund.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

STATISTICS

LEXINGTON MEDICAL CANCER CENTER

STATISTICS

CANCER SPOTLIGHT: Head and Neck Cancer

ead and neck cancers (HNC) are a broad category of cancers that occur in the head and neck region. Head and neck cancers account for approximately 3 percent of all cancers in the United States and at Lexington Medical Cancer Center (43 out of 1,676). These cancers are nearly twice as common among men as they are among women. Doctors also diagnose HNC more often among people over age 50 than among younger people. According to the American Cancer Society, each year, clinicians diagnose almost 62,000 people in the United States with HNC. The combined estimate of new HNC cases for the United States is 78,670 (oral cavity and pharynx, 48,330; larynx, 13,430; and esophagus, 16,910), according to ACS Facts and Figures, 2016. HEAD AND NECK CANCERS INCLUDE THE FOLLOWING SITES: • Lip (not skin of lip) • Tongue • Gum • Floor of mouth • Mouth • Palate • Tonsil • Vallecula • Epiglottis • Oropharynx • Nasopharynx • Pyriform sinus • Hypopharynx • Nasal cavity • Larynx • Parotid gland • Other salivary glands • Other head and neck At Lexington Medical Center, cancer of the larynx accounts for nearly 28 percent of HNC followed by tonsil at 25.6 percent. The most prevalent type of HNC at Lexington Medical Cancer Center is squamous cell carcinoma, which accounts for 53 percent of all HNC histologies (see Site and Histology charts on page 40).

RISK FACTORS Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx and larynx. At least 75 percent of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone. Tobacco and alcohol use are not risk factors for salivary gland cancers. Infection with cancer-causing types of human papillomavirus (HPV), especially HPV16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of

the tongue. In the United States, the incidence of oropharyngeal cancers caused by HPV infection is increasing, while the incidence of oropharyngeal cancers related to other causes is falling. OTHER RISK FACTORS FOR CANCERS OF THE HEAD AND NECK INCLUDE THE FOLLOWING: • Preserved or salted foods. Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer. • Oral health. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity. Use of mouthwash that has a high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

SITE AND HISTOLOGY • HEAD AND NECK NEOPLASMS

A N A LY T I C C A S E S 2 0 1 5 • L E X I N G T O N M E D I C A L C A N C E R C E N T E R C30.X C11.X C05.X

MALE 32/74.42%

C09.X C10.X

C00.X

C10.1

C03.X

C13.X

C04.X C02.X

C12.9 C01.X C10.0

FEMALE 11/25.58%

C32.X

SITE

NO.

C00.X Lip 2 4.65 ———————————————————————————— C01.9 Tongue, base of NOS 4 9.30 ———————————————————————————— CO2.X Tongue, excluding base 3 6.98 ———————————————————————————— C03.X Gum 0 0.00 ———————————————————————————— C04.X Floor of mouth 1 2.33 ———————————————————————————— C05.X Palate, uvula 1 2.33 ———————————————————————————— C06.X Mouth, NOS 1 2.33 ———————————————————————————— C09.X Tonsil, NOS 11 25.58 ———————————————————————————— C10.0 Vallecua 0 0.00 ———————————————————————————— C10.1 Epiglottis 0 0.00

HISTOLOGY

SITE

NO.

C10.X Oropharynx 1 2.33 ———————————————————————————— C11.X Nasopharyx 0 0.00 ———————————————————————————— C12.9 Pyriform sinus 0 0.00 ———————————————————————————— C13.9 Hypopharynx 3 6.98 ———————————————————————————— C30.0 Nasal Cavity 1 2.33 ———————————————————————————— C32.X Larynx 12 27.91 ———————————————————————————— C07.9 Parotid gland 3 6.98 ———————————————————————————— C08.X Other salivary glands 0 0.00 ———————————————————————————— C14.X Other head & neck 0 0.00 ————————————————————————————

NO.

8010/3 Carcinoma, NOS 1 2.33 ———————————————————————————————————————————————————————————— 8051/3 Verucuous carcinoma, NOS 1 2.33 ———————————————————————————————————————————————————————————— 8070/3 Squamous cell carcinoma, NOS 23 53.49 ———————————————————————————————————————————————————————————— 8071/3 Squamous cell carcinoma, keratinizing, NOS 5 11.63 ———————————————————————————————————————————————————————————— 8072/3 Squamous cell carcinoma, large cell, non-keratinizing 6 13.95 ———————————————————————————————————————————————————————————— 8073/3 Squamous cell carcinoma, small cell, non-keratinizing 2 4.65 ———————————————————————————————————————————————————————————— 8083/3 Basaloid squamous cell carcinoma 1 2.33 ———————————————————————————————————————————————————————————— 8200/3 Adenoid cystic carcinoma 1 2.33 ———————————————————————————————————————————————————————————— 9473/3 Primitive neuroectodermal tumor, NOS 1 2.33 ———————————————————————————————————————————————————————————— 9680/3 Malignant lymphoma, large B-cell, diffuse, centroblastic, NOS 2 4.65 ———————————————————————————————————————————————————————————— Other/Unknown 0 0.00 40

LEXINGTON MEDICAL CANCER CENTER

• Occupational exposure. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Certain industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity. • Radiation exposure. Radiation to the head and neck for noncancerous conditions or cancer is a risk factor for cancer of the salivary glands. • Epstein-Barr virus infection. Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands. • Ancestry. Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.

CLINICAL MANIFESTATIONS The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty swallowing and a change or hoarseness in the voice. These symptoms may also be caused by less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. The following areas of the head and neck may experience a range of symptoms: • Oral cavity. A white or red patch on the gums, tongue or lining of the mouth; swelling of the jaw that causes dentures to fit poorly or become uncomfortable; unusual bleeding or pain in the mouth. • Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away.

STATISTICS

• Larynx. Pain when swallowing or ear pain; persistent hoarseness or shortness of breath. • Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; problems with dentures. • Salivary glands. Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; pain in the face, chin or neck that does not go away.

PROGNOSTIC FEATURES The main prognostic factors are stage, site of disease and comorbidities. Stage relates to TNM (i.e., tumor size and depth, lymph nodes, metastasis) while comorbidities relate to one or more medical illnesses or disorders present at time of diagnosis of the cancer. Although not a feature of the cancer itself, comorbidity is an important attribute of the patient with cancer because it has a direct impact on the care of patients, selection of initial treatment and evaluation of treatment effectiveness.

TREATMENT Standard management of HNC is based on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for HNC can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments. Early stage disease (stage I and II) is treated with a single modality — surgery or radiotherapy (RT) — depending primarily on tumor location but also on tumor extent, anticipated cure rate, and functional and esthetic outcome. About 80 to 90 percent of early stage patients will go into remission. Advanced stage patients (stage III, IVa and IVb) are treated with multimodal therapy, including surgery, RT and chemotherapy. The

sequencing and combination of therapies are based on stage, tumor location, expertise of treating physicians and patient preference. Despite more aggressive treatment for advanced stage disease, cure rates remain low primarily because of loco-regional recurrence; however, HPV-related HNC is associated with a significantly better prognosis even with stage IV disease, especially in never smokers. Cure rates, often based on 5-year survival rates, for HPVrelated HNC in some large studies approaches 90 percent. The majority of the HNC patients seen at Lexington Medical Center are stage IVa (41.9 percent), which puts them in the advanced-stage disease category for treatment. People who are diagnosed with HPVpositive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment. In addition to multispecialty physicians, rehabilitation specialists and other experts often work with people who experience hearing loss, difficulty eating or difficulty speaking as a result of head and neck cancers.

TREATMENT SIDE EFFECTS Surgery for HNC often changes the patient’s ability to chew, swallow or talk. He or she may look different after surgery, and the face and neck may be swollen. The swelling usually goes away within a few weeks; however, if lymph nodes are removed, the flow of lymph in the area where they were removed may be slower and lymph could collect in the tissues, causing additional swelling. This swelling may last for a long time. After a laryngectomy (surgery to remove the larynx) or other surgery in the neck, parts of the neck and throat may feel numb because nerves have been cut. If lymph nodes in the neck were removed, the shoulder and neck may become weak and stiff. Patients who receive radiation to the head and neck may experience redness, irritation and sores in the mouth; dry mouth or thickened saliva; difficulty swallowing; changes in taste; or nausea. Other problems that may occur during treatment are loss of taste, which may decrease appetite and affect nutrition, and earaches (caused by the hardening of ear wax). Patients may also notice some swelling or drooping of the skin under the chin and changes in the texture of the skin. The jaw may feel stiff, and patients may not be able to open their mouth as wide as before treatment.

HEAD AND NECK CANCERS BY STAGE

A N A LY T I C C A S E S 2 0 1 5 • L E X I N G T O N M E D I C A L C A N C E R C E N T E R

Stage I* Stage II Stage III Stage IVC Stage IVA** Stage 88 Unknown

5 8 1 19 1 1 0

*Stage I includes Stage IeA staging for one extranodal lymphoma *Stage IVA includes Stage IVA staging for one extranodal lymphoma

ONCOLOGY SERVICES 2015 ANNUAL REPORT

FIVE-YEAR RELATIVE SURVIVAL RATES* (%) BY STAGE AT DIAGNOSIS, U.S., 2005–2011

All stages Local Regional Distant

Breast (female)

Ovary

Colon & rectum

Pancreas

Esophagus

Prostate

>99

Kidney†

Stomach

Larynx

Testis

Liver‡

Thyroid

>99

Lung and bronchus

Urinary bladder

Melanoma of the skin

Uterine cervix

Oral cavity and pharynx

Uterine corpus

Rates are adjusted for normal life expectancy and are based on cases diagnosed in the SEER 18 areas from 2005–2011, all followed through 2012. †Includes renal pelvis. Includes intrahepatic bile duct. §Rate for in situ cases is 96 percent. Local: an invasive malignant cancer confined entirely to the organ of origin. Regional: a malignant cancer that 1) has extended beyond the limits of the organ of origin directly into surrounding organs or tissues; 2) involves regional lymph nodes; or 3) has both regional extension and involvement of regional lymph nodes. Distant: a malignant cancer that has spread to parts of the body remote from the primary tumor either by direct extension or by discontinuous metastasis to distant organs, tissues, or via the lymphatic system to distant lymph nodes. Source: Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975–2012, National Cancer Institute, Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, based on November 2014 SEER data submission, posted to the SEER website April 2015. American Cancer Society, Inc., Surveillance Research, 2016 * ‡

SURVIVAL Once treatment is finished, patients should receive a survivorship care plan from their oncologist or surgeon. Since most of the medical care for HNC patients will be provided by their primary care physician following treatment, it is important for the primary care physician to receive a copy of this survivorship care plan as well. The survivorship care plan will outline details about the patient’s head and neck cancer history and how it was treated. It will also inform the primary care physician of what symptoms to watch for and how often to see the patient. Five-year survival varies substantially by subsite, and it is highest for lip (90 percent) and salivary gland (73 percent) and lowest for hypopharynx (32 percent) and floor of mouth (51 percent). The 5- and 10-year relative survival rates for people with cancer of the oral cavity and pharynx are 63 percent and 52 percent, respectively. Less than one-third (31

LEXINGTON MEDICAL CANCER CENTER

percent) of cases are diagnosed at a local stage, for which five-year survival is 83 percent. Overall death rates for cancers of the oral cavity and pharynx have been decreasing over most of the past three decades, partly due to the downturn in the smoking epidemic. The combined estimated death rate for HNC is 28,880; however, from 2003 to 2012, while rates continued to decrease in women (by 1.1 percent per year in whites and 3.5 percent per year in blacks), they stabilized in men, likely due to the increased incidence of HPV-related cancers.

SUMMARY People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus or lungs. The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol.

Because patients who smoke have a higher risk of a second primary cancer, doctors encourage patients who use tobacco to quit. The toll-free number 1-800-QUIT-NOW (1-800-784-8669) also serves as a single point-of-access to state-based telephone quit lines.

STATISTICS

Cancer Registry

he Cancer Registry at Lexington Medical Cancer Center has been in operation since 1992 as an integral part of the cancer program. Since 2005, the American College of Surgeons (ACoS) Commission on Cancer (CoC) has accredited the cancer program. The Cancer Registry staff collects and analyzes 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. In addition, the registry also collects data for research patient registries, such as the lung cancer screening registry trial. The data collected by the Cancer Registry is used for review of patient outcomes, statistical analyses, special studies and reporting

requirements to the South Carolina Central Cancer Registry (SCCCR), the Rapid Quality Reporting System (RQRS) and the National Cancer Data Base (NCDB), as well as to fulfill internal and external requests for cancer data. According to the National Cancer Registrars Association (NCRA), “cancer registrars capture a complete summary of the history, diagnosis, treatment and disease status for every cancer patient. Registrars’ work leads to better information that is used in the management of cancer and, ultimately, cures.”

CONTACT US Oncology Conferences Schedule cases for an oncology conference at oncconf@lexhealth.org. —————————————————————————

Cancer Data Requests

Send data requests to Natalie Copeland, Cancer Registry manager, at njcopeland@lexhealth.org or (803) 936-4175. ————————————————————————— Please note: release of data containing protected health information is subject to federal Health Insurance Portability and Accountability Act (HIPAA) regulations and Institutional Review Board (IRB) approval.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

CANCER REGISTRY ACTIVITY

Lexington Medical Cancer Center: Statistical Year 2015

TOTAL CASES

2,723

Analytic Cases

1,676

% Analytic Cases

61.5%

Follow-Up Rate – Reference Year (CoC Target: 80%)

91.0%

Follow-Up Rate – Five Year (CoC Target: 90%)

94.3%

Numbers have been rounded.

GENDER AND SITE DISTRIBUTION COMPARISON Lexington Medical Cancer Center: 1,676 Analytic Cases 2015

BREAST 8 (1.02%)

9 (1.14%)

BRAIN & NERVOUS SYSTEM

5 (0.56%)

32 (4.07%)

LIP, ORAL CAVITY, PHARYNX, LARYNX

8 (0.89%)

12 (1.52%)

ESOPHAGUS

4 (0.45%)

140 (17.79%) PROSTATE 155 (19.70%)

TOTAL MALES: 787

LEXINGTON MEDICAL CANCER CENTER

LUNG

111 (12.49%)

15 (1.91%)

STOMACH

5 (0.56%)

24 (3.05%)

PANCREAS

35 (3.94%)

75 (9.53%)

COLON, RECTUM

59 (6.63%)

37 (4.70%)

KIDNEY

23 (2.59%)

63 (8.01%)

URINARY BLADDER

16 (1.80%)

37 (4.70%)

OTHER DIGESTIVE ORGANS

26 (2.92%)

43 (5.46%)

MELANOMA OF SKIN

25 (2.81%)

32 (4.07%)

NON-HODGKIN’S LYMPHOMA

20 (2.25%)

26 (3.31%)

LEUKEMIA

19 (2.13%)

79 (10.03%)

ALL OTHER SITES

98 (11.01%)

BREAST 346 (38.92%) OVARY 24 (2.70%) CORPUS UTERI 57 (6.41%) CERVIX 8 (0.90%)

TOTAL FEMALES: 889

STATISTICS

GEOGRAPHIC DISTRIBUTION OF CANCER CASES

Lexington Medical Cancer Center: Analytical Cases by County at Diagnosis 2015

2% 21%

61%

1% 4%

TOTAL 1,676 Lexington 1,028 OTHER COUNTIES Richland

Bamberg

7 5 Beaufort 1 Chester 1 Chesterfield 1 Clarendon 6 Colleton 1 Darlington 1 Dorchester 1 Edgefield 2 Florence 1 Horry 3 Lancaster 1 Laurens 1 Lee 1 Marlboro 1 York 1 (2%) 35

351 Barnwell

Newberry

Orangeburg

Kershaw

Fairfield

Saluda

Aiken

Calhoun

Sumter

Other Counties 35

Out-of-State 7

ONCOLOGY SERVICES 2015 ANNUAL REPORT

TOP 5 CANCER SITES

Lexington Medical Cancer Center: Analytical Cases 2015

Breast

134 155

Lung

357

976 TOTAL

Prostate Colorectal Urinary Bladder

251

STAGE DISTRIBUTION OF CANCER CASES Lexington Medical Cancer Center: Analytical Cases 2015

TOTAL CASES: 1,676 Stage 0 (0, 0a, 0is)*

108

Stage 88*

136 515

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

352

Stage II (II, IIAe, IIA - IIC, IIBs)

257

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

291

Stage IV (IV, IVA - IVC) Stage OC (Occult)* Unknown

1 16 0

50 100 150 200 250 300 350 400 450 500 550

*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).

LEXINGTON MEDICAL CANCER CENTER

STATISTICS

ETHNOLOGICAL DISTRIBUTION OF CANCER CASES Lexington Medical Cancer Center: Analytical Cases by Race 2015

White Black Other Race (Asian Indian or Pakistani, NOS; Korean, Micronesian, Pacific Islander; Other NOS) Other Asian, Asian NOS Hawaiian

1,357

285

American Indian, Aleutian or Eskimo (includes all indigenous populations of the Western hemisphere)

COMPARATIVE ANALYSIS OF NEW CANCER CASES Lexington Medical Cancer Center vs. American Cancer Society 2015

58.2% 58.5%

60% 50% 40% 30% 20%

21.3% 15.0%

15.0% 15.8% 9.2%

10% 0

15.1%

Breast

Lung

Prostate

8.0% 8.3%

Colorectal

4.7% 4.3%

Urinary Bladder

Grand Total

Lexington Medical Center

American Cancer Society – South Carolina

Total New/Analytic Cases – Lexington Medical Center: 1,676

Total Estimated New Cases – ACS, SC: 25,550

ONCOLOGY SERVICES 2015 ANNUAL REPORT

SITE DISTRIBUTION OF CANCER CASES

Lexington Medical Cancer Center: Statistical Summary of Cancer Registry Data 2015 Primary Site

Total Cases

Analytic

Non-Analytic

ORAL CAVITY & PHARYNX

External Lip â&#x20AC;&#x201C; Upper, 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

0 172

467

295

Esophagus

DIGESTIVE ORGANS

Stomach (includes GE junction)

Small Intestine Colon (excluding Rectum)

160

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

480

268

212

Nasal Cavity & Middle Ear

Accessory Sinuses

458

252

206

Larynx (Larynx, Glottis, Supraglottis) Lung & Bronchus Thymus Heart, Mediastinum & Pleura

BONES, JOINTS & ARTICULAR CARTILAGE

Bones, Joints & Cartilage of Limbs

Bones, Joints & Cartilage of Other Specified Sites HEMATOPOIETIC & RETICULOENDOTHELIAL SYSTEMS Blood Bone Marrow Spleen

LEXINGTON MEDICAL CANCER CENTER

151

147

STATISTICS

Primary Site

Total Cases

Analytic

Non-Analytic

SKIN

199

118

Melanoma

181

113

Other Non-Epithelial PERIPHERAL NERVES & AUTONOMIC NERVOUS SYSTEM

PERITONEUM & RETROPERITONEUM

Peritoneum

Retroperitoneum

CONNECTIVE, SUBCUTANEOUS & OTHER SOFT TISSUES BREAST â&#x20AC;&#x201C; NIPPLE, BREAST

489

357

132

FEMALE GENITAL ORGANS

137

102

Vulva

Vagina

Cervix

Corpus Uteri

Uterus, NOS

282

166

116

268

155

113

203

148

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

Ureter

113

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

Meninges

Brain

Spinal Cord

Optic Nerve

THYROID & OTHER ENDOCRINE GLANDS

Acoustic Nerve

Thyroid

Adrenal Gland Pituitary Gland, Other Endocrine Glands OTHER & ILL-DEFINED SITES LYMPH NODES UNKNOWN PRIMARY SITE

GRAND TOTAL

2,723

1,676

1,047

Of these totals, extra-nodal lymphoma primaries accounted for 17 cases and lung cancer screening trials accounted for 133 cases.

ONCOLOGY SERVICES 2015 ANNUAL REPORT

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