2011 Oncology Services Annual Report
L E X I NGTON M E DIC A L C E N T E R
2011 CANCER COMMITTEE MEMBERSHIP E. Myron Barwick, MD, FACS Chair, Department of Surgery
Steve Madden, MD Vice Chair, Medical Oncology
Ronald Myatich, MD, FACS Cancer Liaison Physician, Department of Surgery Theresa Altman, RN, BSN.....................................Oncology Nursing Natalie J. Copeland, RHIA, CTR...........................Cancer Registry/CTR Quillin Davis, MD.................................................Radiation Medicine
TABLE OF CONTENTS The Journey....................................... Message from the Cancer Committee Chair............................... E. Myron Barwick, MD, FACS
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M. Christine “Chris” Gibson, LMSW, OSW-C.......Social Services G. Tripp Jones, MD...............................................Medical Oncology Vijaya Korrapati, MD............................................ Medical Oncology/ Pain Management Jayne Moffatt, MD.................................................Pathology
Message from the Cancer Liaison Physician.............................. Ronald Myatich, MD, FACS
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Cindy Rohman, RN, MS, CNAA/BC......................Administration Ervin Shaw, MD....................................................Pathology Beth Siroty-Smith, MD..........................................Radiology Mary Tanner, RN, BSN, CPHQ............................. Quality Assurance/ Center for Best Practice Melissa Taylor, MSN............................................. Inpatient/Oncology Nursing Connie Watson........................................................ Community Outreach/ Director Deirdre Young, BSN, OCN, CBCN........................Cancer Programs
Message from the Manager of Cancer Programs.......................... Deirdre Young, BSN, OCN, CBCN
Cancer Committee 2011 Goals....... Clinical Services................................
ADDITIONAL MEMBERS Stacey Bannister, MBA, CMPE.............................. Physician Network/LOA Radiation Oncology Ann Bethea...........................................................Volunteer Services Nannette Faile, RN, MS, CCRP.............................Clinical Research Linda Grimes, RHIA............................................. Health Information Management Tori Gude, MPT, DPT, CLT..................................Physical Therapy Claudine Jordan, BS, RT.......................................Radiation Medicine Donna Peele..........................................................Pastoral Care Jennifer Wilson.....................................................Marketing AD HOC Janie Smith...........................................................American Cancer Society ACTIVITY COORDINATORS E. Myron Barwick, MD.......................................... Quality Control of Registry Data Linda Grimes........................................................Cancer Conferences Mary Tanner.........................................................Quality Improvement Connie Watson......................................................Community Outreach
Clinical Laboratory & Pathology Services........................ Radiology Oncology Services.... 12
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Medical Oncology....................18
Patient Support............................. Serving Our Community............ 2011 Statistics and Research......................................... Cancer Spotlight Kidney/ Renal Pelvis Review....................... 33 Research Studies.............................37 Clinical Trials......................................37 Cancer Registry............................... 39
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The Journey Since we began our journey toward providing comprehensive cancer services, the Cancer Program at Lexington Medical Center has served as a benchmark for programs throughout the country by supporting patients with the highest quality technology, compassionate care and the knowledge to achieve the best possible outcomes. We offer exceptional services and patient care in cancer diagnostics, treatment and support to our community. Utilizing the most advanced technology and state-of-the-art tools to help patients through their journeys, our physicians and staff continuously move forward through research and implementation of the latest technologies. We were the first hospital in South Carolina to perform Microwave Ablation and one of the first hospitals in the state to offer Intensity Modulated Radiation Therapy. Our Cancer Program, which is accredited by the American College of Surgeons, supports research initiatives that contribute to treatments and solutions in cancer care. Involvement in this research allows us to receive the latest information and results, so we can stay at the forefront of current methodologies, procedures and treatments. In addition, we’ve affiliated with Duke Cancer Institute, which allows our patients access to Duke’s excellence in cancer patient care, clinical research and education. This new step in our journey establishes Lexington Medical Center’s Cancer Program as the premiere cancer program in the Midlands. Our comprehensive care goes beyond diagnosis and treatment. We understand that battling cancer can leave patients asking questions and looking for support. And we know that each patient’s journey is unique. That’s why we have created a variety of resources and support groups that address the emotional, psychological and spiritual needs of our patients and their families. With the help of our multidisciplinary team of board-certified doctors and experienced staff, our path has led us here — a facility where patients can receive the highest quality care in cancer diagnosis and treatment, and access to comprehensive education, support and clinical research.
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MESSAGE FROM THE CANCER COMMIT TEE CHAIR
E. Myron Barwick, MD, FACS As chair of the Lexington Medical Center Cancer Committee, I am actively involved in the ongoing efforts of our team to find opportunities to improve the process of care, systems, support programs and other services that facilitate better outcomes for our patients who have cancer. Every year we are challenged to find ways to deliver the highest standard of care without adding greater expense or hardship to the people we serve.
Our cancer committee and multidisciplinary team of surgeons, medical and radiation oncologists, pathologists and radiologists, assisted by specialists from Pulmonary, ENT services, and nurse navigators, see ourselves as patient advocates first and foremost. As the voice for our patients, we see patient
Our cancer committee and multidisciplinary team of surgeons, medical and radiation oncologists, pathologists and radiologists, assisted by specialists from Pulmonary, ENT services, and nurse navigators, see ourselves as patient advocates first and foremost. As the voice for our patients, we see patient advocacy as our greatest responsibility and privilege. In 2011, this sense of advocacy led us to seek and receive funding from the Susan G. Komen Foundation to provide no-cost screening mammograms for women in our community who would not meet Best Chance Network criteria. In addition, our long-awaited Palliative Care service officially launched. The Cancer Program increased the number of cancer nurse navigators in an effort to assist more of our newly diagnosed patients, educate them about their diagnosis and provide emotional support. The hospital added to its Registry staff to better track the increasing numbers of new diagnoses at our facility. A desire to improve clinical care resulted in the availability of endobronchial ultrasounds in July 2011. And revisions to staging, abstracting and registry quality assurance forms improved data quality. Throughout the year, we made numerous improvements and changes to upgrade the quality of our program. We are proud of the things we accomplished and have a renewed sense of dedication and commitment to our cause. Whether it is the growth of our Clinical Research department or successful fundraising to assist patients in need, all indicators point to an exciting future for oncology services in the coming year.
advocacy as our greatest responsibility and privilege.
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MESSAGE FROM THE CANCER LIAISON PHYSICIAN
Ronald Myatich, MD, FACS As cancer liaison physician, I serve as a conduit between the American College of Surgeons Commission on Cancer ® and the Lexington Medical Center Cancer Committee. In 2011, the hospital experienced an exciting and productive year for cancer treatment. A number of dynamic cancer care programs are at work here with the goal of providing comprehensive, compassionate, state-of-the-art cancer treatment to our community. During this past year, many programs and care initiatives brought our medical center and community closer to our objective. The 2011 Colon Cancer Challenge helped to fund screening colonoscopies for uninsured members of our community and a collaborative partnership with the University of South Carolina Center for Colon Cancer Research sponsored a billboard campaign to encourage having colonoscopies. The Cancer Program hosted skin cancer screenings to increase awareness and detection of melanoma, and provided prostate cancer screenings at the Wild Wings® Golf Tournament and Wildcat Jamboree at Lexington High School. These efforts have allowed our cancer treatment program to reach out to our community and enhance their level of care. Lexington Medical Center received a Komen grant to provide uninsured women with screening mammograms, enhancing programs already in place. Also in 2011, the director of Volunteer Services joined the Cancer Committee to help streamline the development of new and complementary cancer care services to those already in place. This resulted in the addition of a music therapy program, upgrades to our patient resource library and the acquisition of literature for children dealing with cancer in their families. We are also proud of our new Palliative Care Case Management service, which will allow the medical center to improve the delivery of these vitally important services to those in need. The Cancer Committee’s continued commitment to improvement is evident in a number of efforts involving cancer registry data, standardized pathology reports, and revised abstracting and reporting quality standards. We are proud of the many accomplishments in 2011 and will strive to make 2012 even more productive and successful. Please join me in supporting the Cancer Program at Lexington Medical Center. Together we can make great strides in our fight against the No. 2 cause of death in South Carolina.
A number of dynamic cancer care programs are at work here with the goal of providing comprehensive, compassionate, state-of-the-art cancer treatment to our community.
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MESSAGE FROM THE MANAGER OF CANCER PROGRAMS
Deirdre Young, RN, BSN, ONC Every area of the Cancer Program experienced some measure of growth and change in 2011. Opportunities abounded and the Cancer Committee’s membership reflected the new projects and partnerships we wanted to build. The director of Volunteer Services joined the committee with the specific goal of helping us build a roster of complementary programs to enhance patient experience. We began offering music therapy with the goal of expanding this service to patients at Lexington Oncology Associates’ Infusion Center. The committee also started discussions with a local artist to partner with the Lexington Medical Center Foundation on a Healing Arts program that our patients may find meaningful. Our hospital chaplain sought the assistance of the Foundation in underwriting the purchase of books for children whose parents have cancer. Those who search to find answers to life’s difficult truths have warmly received these books, which deal with end-of-life issues. The Cancer Program received a grant from the Susan G. Komen Foundation to assist us in our ongoing early detection efforts, specifically targeting women not covered by Best Chance Network guidelines, those who are high risk and lack funding for screenings. Without screening mammography, there is little hope of early detection. The Komen grant has provided us with a way to close one of the gaps in health care services. We looked at the foremost needs of our female patients when we increased the number of Look Good…Feel Better sessions from four per year to six. This has helped us better accommodate the patient demand. The inpatient unit began a massive renovation to ensure that our patients would have an environment tailored to meet their special needs. Our Cancer Program sees more than 1,000 newly diagnosed patients every year and an increased need for staff in key areas comes with those additional patients. As a result, the hospital hired a third certified tumor registrar, ensuring timely abstracts of all new cases. We also hired a second general cancers nurse navigator to better meet the needs of our newly diagnosed patients and their families. It would be impossible to list all of the improvements and upgrades that we have made to our Cancer Program in 2011. We choose to look forward and see what opportunities await us next year.
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2011 Oncology Services Annual Report
Cancer Committee 2011 Goals
CANCER COMMIT TEE 2011 GOAL S
Quality Improvement Provide a wide-scale skin cancer screening effort during calendar year 2011 in hopes of raising awareness about the health risk of melanoma and skin safety tips. •R ationale: Melanoma is the 7th most common cancer diagnosed in South Carolina, and Lexington County has a significantly higher incidence of melanoma than other counties in S.C. Lexington is one of six counties in the state with this distinction; the others are Charleston, Georgetown, Greenville, Horry and Pickens. • Measurement: Establishment of the skin cancer screening in 2011. • Methodology: Partner with one or more dermatologists on staff at Lexington Medical Center to provide the screening effort. Project will be led by Connie Watson, Community Outreach Director. • Monitor: Community Outreach Program Activity Coordinator will present updates on progress at Cancer Committee meetings as needed. • Status: GOAL MET — Screening took place on May 6, 2011 with 80 patients scheduled and 19 on the waiting list.
Development of a standardized education packet for oncology patients. • Rationale: Currently there are at least three points of care in the hospital system where cancer patient education is distributed — patient navigators, the inpatient unit and the doctor’s office. Our goal is to standardize a patient education packet that will ensure patients receive information on symptom management, psychosocial support and community resources. • Measurement: Development and distribution of the packets by August 31, 2011. • Methodology: Create a committee of nurses led by Libby Daniels, Cancer Nurse Navigator. Each nurse would represent one of the above areas of patient care. Once the content of the packet is developed and created, patient education packets would be distributed to all areas to ensure that every patient receives the same information. •M onitor: Cancer Program Coordinator will present updates on progress at Cancer Committee meetings as needed. • Status: ONGOING — Will continue into 2012.
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Programmatic Develop a complementary therapy component for the Cancer Program, such as massage therapy, Reiki and other mediums, to oncology patients at no cost via volunteer providers. • Rationale: Current research shows that a majority of leading cancer programs in the U.S. have some component of complementary therapies available to patients to be used in conjunction with standard medical treatment for cancer. This is an area that has not been fully developed at LMC. Currently we offer pet therapy, but opportunities abound to include massage therapy, Reiki and other mediums. •M easurement: Addition of at least one component by December 31, 2011. •M ethodology: Appoint Ann Bethea, Volunteer Services Director, to the Cancer Committee with the express goal of exploring these opportunities to add complementary therapies to the Cancer Program services. • Monitor: Volunteer Services Director will present updates on progress at Cancer Committee meetings as needed. •S tatus: GOAL MET — LMC began offering Relaxing Rhythms on November 1, 2011. John Finch, a certified music practitioner, volunteers to play for our patients on 8th Oncology every Tuesday from 9:30 to 11:30 a.m. He plays the dulcimer and autoharp.
Clinical Improve access to multidisciplinary treatment planning for newly diagnosed patients by increasing the number of prospective cases placed on the weekly agenda. •R ationale: Multidisciplinary treatment planning facilitates optimal care. •M easurement: Set a target of 10% increase in overall case numbers from 2010. •M ethodology: Set a target of at least seven cases per week to be placed on the agenda; Nurse Navigator will present these cases from Top Five Sites if Physician is unable to do so. Request that physicians place no less than three cases per month on the agenda. Preference is to start by presenting all lung biopsy cases at conference. • Monitor: Cancer Conference Program Activity Coordinator will communicate the number of conference cases presented at Cancer Committee meetings at least quarterly. Keep tally of the number of cases presented by Physician and report to Cancer Committee. • Status: GOAL NOT MET — Physicians presented 28 fewer oncology conference cases in 2011 than in 2010.
Patient Care Improvement Provide screening mammography for uninsured women ages 40 to 47. •R ationale: Best Chance Network guidelines restrict eligibility to women ages 47 to 62; however, the American Cancer Society screening guidelines encourage women to begin screening at age 40. There are currently no funds to pay for underserved women in this age group. • Measurement: Develop funding source to pay for screening mammograms for women ages 40 to 47 who meet financial eligibility guidelines outlined by the Best Chance Network. •M ethodology: Apply for grant from Susan G. Komen and other sources if needed. •M onitor: Numbers of patients served will be reported quarterly by Breast Cancer Nurse Navigator to the Cancer Program Coordinator. •S tatus: GOAL MET — LMC received the Susan G. Komen grant on April 1, 2011 in the amount of $40,000 to provide free screening mammograms and transportation for underinsured and uninsured women.
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CANCER COMMIT TEE 2011 GOAL S
2011 Oncology Quality Improvements & Programs Quality Improvements
Programs
• Purchased books dealing with end-of-life issues for children whose parents have cancer
• 2011 Colon Cancer Challenge to fund screening colonoscopies for uninsured
• Increased Look Good…Feel Better sessions from four per year to six per year to accommodate more patients • Added second general cancer nurse navigator • Obtained Susan G. Komen grant to provide screening mammograms for uninsured women not eligible for Best Chance Network services • Added new Baker hood in Pharmacy for increased safety in mixing chemotherapy
• Skin Cancer Screening to increase awareness of melanoma risk • PSA Screens at Wild Wing Café Golf Tournament and Wildcat Jamboree
• Added the Director of Volunteer Services to the Cancer Committee to expedite the development of complementary therapies for Cancer Programs
• Partnership with Center for Colon Cancer Research at the University of South Carolina for media blitz and billboard campaign to encourage having colonoscopies
• Obtained funding for lymphedema treatment supplies for uninsured women from the hospital’s Foundation
• Co-sponsored the S.C. Pain Management Conference
• Opened Palliative Care Case Management service
• Community lectures on colon cancer by Drs. March Seabrook and Laura Long
• Started music therapy in inpatient units • Began offering EBUS in July 2011 • Increased cancer registry staffing to improve data recovery
• Dr. Phil Buckholtz held tissue banking lecture
• Converted Pathology reports to synoptic format to improve and standardize reporting
• Nurse navigator expanded services
• Became a Provenge® provider at Lexington Oncology Associates
• Susan G. Komen mammography project for uninsured women
• R eviewed all treatment orders by nurse practitioners against National Comprehensive Cancer Network guidelines •U pgraded Patient Resource Center in the hospital library • Launched Give HOPE program to raise funds for cancer patient needs • I mplemented eOutcomes to expedite staging of new cases
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Clinical Services
CLINICAL SERVICES
Clinical Laboratory & Pathology Services As one of the busiest hospitals in South Carolina, it’s no surprise that Lexington Medical Center encounters patients with a wide range of issues. Within the field of oncology alone, we routinely see cases involving prostate cancer, breast cancer, lung cancer, cervical cancer, skin cancers, gastrointestinal cancers, lymphomas, leukemias and bone marrow abnormalities. In order to effectively address the full range of oncologic cases, we have worked hard to establish a highly specialized department that is led by 11 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 chemotherapy and biotherapy. Additionally, special tests to identify infections in our immuno-compromised 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. Intra-operative red cell salvage and blood product management practices are also key components. The following are specific cancers and our role in diagnosing them:
Breast Cancer/Gastrointestinal Cancer We are extremely proud that our Cancer Program’s rapid-diagnosis philosophy has become a national benchmark. With the support of our “Five Days From Detection to Diagnosis” Breast Cancer Program, office-based and hospitalbased diagnostic needle aspirates and core biopsies are carefully processed, and the information is reported back to the physician and patient within 24 hours. This rapid-diagnosis system supports all breast specimens and breast fluid analyses, fine needle aspirates, standard-needle biopsies, stereotactic CT-guided biopsies, ultrasound-guided biopsies, and lumpectomies of all types. In November 2002, we instituted an “intense protocol for lymph node processing in breast cancer and melanoma cases” that has proven to be another invaluable tool.
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Cervical Cancer For as long as cancer screening has been in use, the PAP smear has been the most successful test by far. In 2002, we made it even more effective by implementing liquid-based samples processing and becoming the first lab in South Carolina to implement supplementary robotic image analyzer screening of all cases. HPV testing has also been employed.
Lung Cancer Since 1995, our hospital has offered a systematic evaluation of patients with a lung mass and, over the years, our approach has become increasingly refined. Today we possess processing techniques that make it possible to achieve a diagnosis in an unusually high percentage of first attempts at either fine needle or bronchoscopic biopsies in the outpatient setting. Our focused and dedicated lab team moves efficiently and effectively to provide a definitive diagnosis that enables optimized treatment to begin promptly. Sophisticated esoteric testing can provide personalized therapy options.
Skin Cancer Skin cancer is often treated using surgery or radiation therapy. For more than 20 years, our 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 both the state-of-the-art equipment and the highly trained radiation oncologist to employ skin-conserving methods of superficial radiation therapy.
Blood Disorders In 2011, our program implemented in-house flow cytometry analysis, which allows more directed and precise testing, diagnosis and classification of benign and neoplastic disorders of bone marrow and lymph nodes. Our expert team can add more esoteric testing as indicated in the most effective manner.
Brain & Central Nervous System Cancers Our departments have extensive training and the highest subspecialty certification in the state for diagnoses of tumors and diseases of the brain and central nervous system.
Online Resources Lexington Medical Center’s pathology group provides a comprehensive website, www.palpath.com, with more than 400 pages of information. Most of the information is devoted to cancer and our methods of working with and reporting on cancer cases.
Tissue Banking In July 2007, we became active contributors of research tissue from surgically removed tumors to the South Carolina Biorepository System for cancer research in the Midlands.
Consultant Networking In 1972, we began developing an extensive roster of world-renowned experts in 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 only 24 hours away in any location in the United States and, with the implementation of email consults in 2004, frequently faster.
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CLINICAL SERVICES
Radiology Services Progress in technology continues to occur swiftly, and the Radiology department at Lexington Medical Center is constantly updating diagnostic equipment, imaging protocols and interventional techniques to better serve our oncologic community. Since cancer is a general term that encompasses a number of distinct entities, each requiring its own framework for detection, staging and treatment, we will describe a few of the more pertinent advances in radiology by discussing the common individual forms of malignant disease. Lung Cancer Since early detection is the best hope for a favorable prognosis, our efforts are focused on finding lung tumors when they are still small and asymptomatic. With the establishment of the Nurse Navigator program for lung masses, we can ensure that incidentally detected pulmonary nodules are followed up for proper evaluation. For example, many such nodules are discovered during a chest CT examination for another reason, including the search for pulmonary emboli or the assessment of non-responsive clinical pneumonia. Lexington Medical Center has a system in place now to earmark such cases for careful follow-up by oncology nursing personnel to make sure that the patient has been placed into the proper treatment track. Possible treatment paths would include surveillance CT for low-suspicion nodules and PET/CT or biopsy for larger more suspicious nodules. 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 the surgeon and oncologist in guiding proper management and offering a prognosis to the patient before contemplating major surgery. Those patients with advanced disease at the time of initial diagnosis and staging may be spared unnecessary surgery as well. Radiologists at Lexington Medical 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 our target lesions continue to diminish, so the skill set necessary to maintain high success rates (above 90%) remains challenging. Most recently, we 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.
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Breast Cancer Lexington Medical Center has long been a strong proponent of screening for breast cancer and, despite some controversies in the lay press over the years, the preponderance of evidence endorses the premise of yearly mammography in women older than age 40. In addition to the well-appointed and convenient Women’s Imaging Center at the main hospital facility, Lexington Medical Center offers screening mammography at its Lexington, Irmo and Chapin locations, as well as the Mobile Mammography Van. All diagnostic mammograms and interventional procedures are performed at Women’s Imaging Center, which is always staffed by a full-time radiologist. Among Lexington Radiology Associates, 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. We now routinely use ultrasound to survey the axilla on the affected side for any sign of lymph node metastases, 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 for the diagnosis of 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). 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 new service now fills a previous void in patient evaluation by providing an alternative means of performing a biopsy for lesions that cannot be accurately localized by mammography or ultrasound. PET/CT is not used routinely in the initial staging of breast cancer, as sentinel node imaging is superior in this regard. PET/CT is invaluable, however, in the restaging of patients with suspected recurrence. We have found that 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. 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 Center is discussed at this forum after initial detection. The radiologist and pathologist communicate closely in breast diagnoses to ensure the concordance of imaging and pathologic findings. Coming soon to the diagnostic armamentarium is a technique called tomosynthesis, a prospective method of 3-D mammography that allows the radiologist to add the critical third dimension of depth to standard 2-D digital images. This tool may allow more accurate discrimination between benign and malignant breast diseases to further improve the positive predictive value for breast biopsies.
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CLINICAL SERVICES
Prostate Cancer Unlike lung and breast cancer work-ups in radiology, the vast majority of patients with prostate cancer are already biopsy-proven upon imaging referral. Our 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 proper treatment strategies. MR of the prostate has been shown to be an accurate means of determining extracapsular spread of disease. We recently adjusted our protocol to eliminate the need for placement of an endorectal balloon coil before scanning; extracorporeal coils provide diagnostically equivalent images and, as a result, our patients tolerate the study much better. Another area of improvement — no less than a vast upgrade in imaging quality — has occurred with ProstaScint® imaging. ProstaScint is a radioactively tagged antibody to prostate-membrane-specific antigen and, therefore, it accumulates in foci of prostate cancer. Until late last year, imaging of the ProstaScint distribution within the body was extremely crude and required a steep learning curve for interpretation. Now we proudly offer the SPECT/CT version of the ProstaScint scan; imaging occurs with both SPECT nuclear medicine and standard CT data co-registered anatomically. Since the CT data eliminate any guessing about the potential meaning of a particular pattern of radiopharmaceutical uptake, the previously required blood-pool scan needed for image subtraction has been eliminated. The study is eminently more readable and intuitive. Without a doubt, the introduction of SPECT/CT technology to the Nuclear Medicine department represents one of the biggest improvements in the area of oncologic imaging over the last year. Not only does SPECT/CT transform the readability of the ProstaScint study, but it also markedly increases the accuracy of several other cancer-specific studies, including OctreoScan™ for somatostatin receptor-positive tumors such as carcinoid and MIBG scan for tumors of adrenal medullary origin-like pheochromocytoma.
Central Nervous System Tumors Preoperative embolization is a technique offered at Lexington Medical Center to assist our 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 there is less 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 our 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 infarction and infection.
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Gastrointestinal Tumors Interventional radiology plays an important role in management of certain tumors of gastrointestinal origin. For example, hepatic artery chemoembolization provides palliative control of liver malignancies both primary and metastatic. 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 AdriamycinŽ 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 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 RF ablation is an increasingly accepted means of treating select renal masses via minimally invasive means. The ideal tumor is 3cm or less in diameter, although slightly larger masses may also be treated by RF ablation. Using multiple probes and strategic injection 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 long-standing technique of rapidly resolving renal obstruction in the setting of many pelvic malignancies, including prostate and gynecologic subtypes. Urinary diversion by this method prevents ischemic damage to the nephrons of the affected kidney and stems 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.
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CLINICAL SERVICES
General Certain procedures in Interventional Radiology apply to many cancer patients at Lexington Medical Center regardless of organ of origin. PICC (peripherally inserted central catheter) and arm port insertions are performed rapidly and accurately with a combination of ultrasound and fluoroscopic guidance. PICC combines the ease and safety of peripheral insertion with the advantage of central termination within a large vein, allowing versatile utility of such a line in cancer patients for the administration of chemotherapy, the infusion of parenteral nutrition, and the delivery of antibiotics and other IV medications as needed. Of course, 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 in some cancer patients. Patients suffering with the 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 Center for palliative care, particularly when patients grow increasingly dyspneic. In a subset of patients with recurrent pleural effusion, placement of a permanent drainage catheter with an external drain bag may be more convenient, as the patient can manage the 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 The preceding discussion touches on some of the services available in the diagnosis and treatment of cancer at Lexington Medical Center. In addition to these specific advancements and interventions, the lion’s share of work performed 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 our cancer patients whenever the need arises. The Radiology team at Lexington Medical Center is committed to offering the very best in equipment, image interpretation and patient experience. We are proud of our important role within the collective team of physicians, nurses, technologists and other health care workers at Lexington Medical Center in the relentless fight against cancer.
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Radiation Oncology Dr. Joshua Lawson, Dr. Quillin Davis and the staff in the Radiation Oncology department are an essential part of the oncology program at Lexington Medical Center. Twice weekly, Dr. Davis and Dr. Lawson bring their clinical expertise to the table at cancer conferences to weigh in on treatment recommendations for select cases. Using state-of-the-art technology, radiation therapy may be administered in several different ways. IGRT, IMRT, brachytherapy, seed implants and access to Gamma Knife速 technology based in Columbia all play an important role in the treatment of cancer. Radiation may be used to cure, slow or stop the growth of cancer cells and, in cases where a cure is not possible, radiation may be used to shrink tumors in order to relieve pressure and alleviate pain. Often radiation may be given before, during or after surgery, or in addition to chemotherapy. Radiation therapy is usually well tolerated and is administered on an outpatient basis, allowing patients to drive themselves to and from appointments. In 2011, the department of Radiation Medicine saw 565 new patients.
TREATMENT NEW STARTS BY DIAGNOSIS Lexington Medical Center 2011 Statistical Year Patients Receiving External Beam Radiation: 454 Sarcoma: 1% Multiple Myeloma: 1%
Skin: 2%
Benign or Prophylactic: 2%
Lymphoma/Leukemia: 4% Bladder/Urological: 3%
Breast 31%
Brain Primary 2%
Metastatic 26%
Lung 9%
GI Digestive 6%
Head & Neck 2%
Prostate 11%
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CLINICAL SERVICES
Medical Oncology Cancer is a complex disease that requires multiple specialties to provide the best, most comprehensive care. And medical oncology is an integral component of this care. Most newly diagnosed cancer patients require the oversight of a medial oncologist who provides cancer care, including the selection and management of chemotherapy as part of his or her treatment plan. The role of the medical oncologist, however, is more than prescribing cancer medications. The oncologists at Lexington Oncology Associates and South Carolina Oncology Associates combine compassionate care with innovative and all-inclusive medical oncology services. Dr. Steve Madden, Dr. Asheesh Lal, Dr. James Wells, Dr. Vijay Korrapati, Dr. Chaudhry Mushtaq, Dr. Fred Kudrik, Dr. Anne Hutchison, and Dr. Jimmy Williams (gynecologic oncology) care for patients from the moment of diagnosis throughout treatment and into survivorship. These board-certified oncologists educate each patient about his or her particular type of cancer and its stage of development. Once treatment begins, the oncologists monitor each patient’s progress and treat any side effects or symptoms. Importantly, they also work with each patient to improve his or her quality of life.
Surgery Considered one of the oldest and most successful approaches to treating cancer, surgery remains a mainstay of cancer treatment at Lexington Medical Center. Surgery plays a key role not only in obtaining a true diagnosis of cancer, but also in eradicating the disease from the body. Our surgeons are instrumental in obtaining tissue for a definitive diagnosis and, once the diagnosis is established, our surgeons are critically important in staging the extent of disease and its treatment. At weekly cancer conferences, our surgeons lend their expertise and offer input as to what types of definitive surgical treatment would most benefit particular cancers. We rely on our surgeons to help with the treatment of oncologic emergencies and provide surgery for palliative care, as well as reconstruction and rehabilitation. The cancer program at Lexington Medical Center owes a tremendous debt of gratitude to the surgeons of Lexington Surgical Associates, Riverside Surgical Group and Southern Surgical Group for their time, efforts and talents. We are also deeply indebted to our urologists, reconstructive surgeons, ENT surgeons, neurosurgeons and dermatologists, whose skills and expertise allow us to offer our patients the best in oncology care and services.
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Patient Satisfaction Patient satisfaction is a top priority at Lexington Medical Center; it’s part of our culture. And as such, the hospital monitors the overall patient experience including amenities, staff interaction, tests and treatment, clinician bedside manner and discharge with surveys through Press Ganey, a well-known company in the health care industry that collects patient, employee and physician perspectives on hospitals. As an industry leader for health care performance improvement, Press Ganey benchmarks health care settings and compares results to similar settings throughout the country. These surveys gauge patient satisfaction throughout the hospital’s network of care. For the third year in a row, Lexington Medical Center received the prestigious “Summit Award” from Press Ganey for sustaining excellence in quality of care and providing the best possible experience for patients and families. The hospital won three Summit Awards in 2011: one each for Lexington Medical Center Ambulatory Surgery, Lexington Medical Center Irmo Ambulatory Surgery and Lexington Medical Center Lexington Ambulatory Surgery. The Summit Award is the most prestigious designation from Press Ganey. To qualify, a hospital must rank in the 95th percentile or above in patient satisfaction for a minimum of three consecutive years. Other departments at Lexington Medical Center have consistently ranked above the 95 percentile as well. In fact, the Inpatient Oncology unit at Lexington Medical Center ranked in the 99 percentile overall for hospitals with 300–449 beds in 2011.
Inpatient Care Providing comprehensive and compassionate care to patients, the Oncology unit is a 30bed unit that specializes in the treatment of patients with cancer. The 60 staff members include registered nurses, 14 of whom are board certified, nursing technicians and unit secretaries. LMC utilizes the care management system for our patients. With this system, a care manager is assigned to each patient, ensuring they have a well-defined care plan that is easy to understand. Goals and outcomes related to patient progress are also monitored. This system works primarily as part of an interdisciplinary team to assure the needs of the patients are met while in the hospital. It also works to assure that patient discharge is clear and as seamless as possible. Our unit strives to deliver the highest quality of care and meet the highest of standards. Oncology nurses must become certified in chemotherapy and biotherapy within one year of hire. These standards meet those set by the national Oncology Nursing Society. A clinical mentor ensures that our staff remains current and competent in many skills that are specialized for Oncology patients.
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Patient Support
Multidisciplinary Pre-treatment Planning Conferences When 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 are deciding where to be treated. Simply put, multidisciplinary treatment planning means that every medical specialty involved in the treatment of cancer has input in a patient’s care plan. This ensures that all aspects of care and possible consequences have been considered as they relate specifically to individual patients. At each treatment planning conference, our 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 many images taken of a patient’s cancer and explaining the story behind those pictures. Our surgeons translate the significance of what is on film to possible surgical options for the patient. Our 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. Together these physicians assign a stage or grade to the patient’s cancer that will accurately convey the extent of disease and help ensure that our team selects the correct treatment. Staging of cancer cases is one of the most important tasks our physicians undertake. The cancer conferences are held twice weekly, one conference for breast cancer cases only and another for all other types of cancer. Attendance and participation at these conferences requires dedication and commitment from our physicians in all relevant specialties. In addition, Lexington Medical Center appreciates the support and participation of our urologists, ENT physicians, pulmonologists and GYN-oncologists.
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PATIENT SUPPORT
Nurse Navigators Ask any cancer survivor about the greatest difficulties faced with a cancer diagnosis and no doubt you will hear, “trying to assimilate the information in a short period of time” and “trying to understand the treatment options.” In 1997, Lexington Medical Center began its Nurse Navigation program to address the concerns of women who were newly diagnosed with breast cancer. The nurse navigator was a board-certified oncology nurse whose experience enabled her to answer questions and work with physicians to ensure the delivery of high-quality, comprehensive care. Women found that having access to a nurse navigator alleviated many stressors and improved their overall treatment and recovery. LMC hired a second nurse navigator in 2010 to serve the needs of people with other types of cancer. The second board-certified navigator, also chosen for years of experience and communication skills, assisted people with various types of cancer instead of just one type. In 2011, LMC determined that we needed another general cancer nurse navigator to assist all newly diagnosed patients seen at our hospital.
Kelly Jeffcoat, BSN, OCN, CBCN Breast Cancer Navigator • (803) 791-2521 Libby Daniels, OCN General Cancer Navigator • (803) 791-2289 Jennifer Peagler, OCN General Cancer Navigator • (803) 791-2617
Our program, grown to three nurse navigators, ensures that no patient who desires access to navigation services will be without them. Navigators provide not only disease-specific education, but also emotional support for patients and families. They are skilled at locating resources within the community that the patient might otherwise not know about. In 2011, nurse navigation assisted 562 women with breast cancer, and 716 men and women with general cancers.
Physicians or nurses refer patients to a navigator or they may self-refer by calling for assistance.
Combined, our oncology nurse navigators bring more than 50 years of experience, knowledge and compassion to their patients. There is no charge for nurse navigator services.
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Medical Social Services The Oncology social workers interact on an ongoing basis with patients in the Cancer Program at Lexington Medical Center. The two social workers for this program are involved with inpatient and outpatient areas. Inpatient social worker Nicole Sorrent is primarily involved with the hospital’s cancer patients on the 8th Floor. Outpatient social worker Chris Gibson primarily works with the cancer patients receiving outpatient services through Medical Day Care, Radiation Oncology, Infusion and Lexington Medical Center-affiliated physicians and practices. Even though the areas covered by the inpatient social worker and the outpatient social worker are different, they work closely as a team to ensure that patients and families receive the information, support and assistance they need. Cancer affects both the patient and the family, creating many needs and concerns. These social workers not only effectively assess the patient and family for emotional, physical, spiritual, mental and financial needs, but they also collaborate with health care team members to effectively meet those needs. After identifying these needs, the patient is connected with the appropriate resources in their health network as well as any state, federal, national or community resources. The inpatient social worker also assesses for discharge planning and makes referrals to the outpatient social worker as needed.
2011 STATISTICS
• More than 2,634 patient contacts, including visits and phone calls • More than 276 new patient consultations • $801,783 provided for medication assistance • 115 patients attended New Patient Orientation • Average of 14 attendees at the Losing is not an Option support group
Another important role of these social workers is to provide medication assistance through various resources such as Welvista, limited medication vouchers and specific pharmaceutical assistance programs to meet immediate and long-term medication needs. They also help arrange transportation by using Lexington Medical Center and community resources, provide assistance with Disability and Medicaid applications, make referrals to financial counselors and apply for financial assistance through foundations such as Cancer Care, American Cancer Society, and Leukemia and Lymphoma Society. Oncology social workers provide cancer resource materials as well. The outpatient Oncology social worker provides a Chris Gibson, LMSW, Certified Outpatient presence in the professional community with involvement Oncology Social Worker in the American Cancer Society, the South Carolina Cancer Alliance, University of South Carolina and other community organizations. And the Outpatient Oncology social worker works within the geographical community by joining with the other community social workers and discharge planners in patient-centered projects such as the annual Christmas Family Adoption Program. The outpatient oncology social worker facilitates several cancer support groups operated at LMC: Losing is Not an Option, a support group for all adult cancer patients and their caretakers at 11:30 a.m. every Wednesday; New Patient Orientation, which meets every Tuesday at 8:30 a.m. in Lexington Oncology Associates; and The Next Step, which is an educational class for cancer patients who have completed active treatment, meeting the first Tuesday of each month in Lower Level Classroom 3 of the hospital’s North Tower.
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PATIENT SUPPORT
Lymphedema Prevention and Management Program Lexington Medical Center established a comprehensive hospital-based lymphedema prevention and treatment program in 1998, which has continued to grow and expand. The program provides outpatient treatment in the Physical Therapy department for patients diagnosed with lymphedema and educates inpatients after breast surgery on lymphedema and precautions that can help prevent it. Lymphedema can develop after having breast surgery, chemotherapy or radiation therapy, and frequently affects quality of life. Years of research have improved treatment, often enabling patients to return to their previous level of function with few restrictions. A certified lymphedema therapist sees patients who are referred to the outpatient setting for lymphedema treatment. The program consists of manual lymphatic drainage massage, bandaging, exercise, skin care and patient education. In 2011, LMC evaluated 51 patients with lymphedema as a result of breast cancer and treatment, and 86% completed the program. In 2010, LMC started a support group to help educate patients and their families about lymphedema as well as provide support for some of the challenges that occur with lymphedema. The monthly support group allows patients to establish social networks and share information with others who are having a similar experience with lymphedema. Currently, LMC 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.
Integrative Therapies for Patients Lexington Medical Center began its Pet Therapy program in 2008. Pet Therapy teams visit any unit at the hospital that has previously requested this service; teams are often found with our inpatient Oncology patients. Other nursing units also request visits. All dogs must be certified through the Delta Society or Therapy Dogs, Inc., to participate in this program. Staff members inform patients when the teams will arrive and ask if they would like a visit. This volunteer service is popular with patients, staff and families. We currently have 10 pet therapy teams that visit several times a week. In addition to pet therapy, Lexington Medical Center began a music therapy program with John Finch, who provides soothing music to patients in the Infusion Center and inpatient areas.
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Pastoral Care On average, Pastoral Care visits approximately 3,060 patients annually. Chaplains see patients in the Oncology unit, Intensive Care Unit, other units and, occasionally, in the Emergency department. In addition, Pastoral Care has provided parenting books to families with children to help them deal with medical crises, guided families on how to tell children about a diagnosis, used coloring books to educate children about cancer, and provided end-of-life information, memory keeper books and vigil books to Oncology patients. Pastoral Care has also provided a concert for patients with members of the University of South Carolina band, presented a newly diagnosed USC student with a signed baseball and football, and performed a hospital wedding for a military family. The family member support group continues to meet on Thursdays, and cancer-specific care notes are available for Oncology and the Infusion Center.
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PATIENT SUPPORT
Support Groups and Patient Programs Support groups are an integral part of a patient’s care plan at Lexington Medical Center . We strongly believe in the value of a therapeutic setting — a place where patients and caregivers can voice fears and concerns, and draw strength from the experiences of others. We provide a place of confidentiality for patients and privacy is paramount. Our support groups strive to provide an appropriate venue for people with all types of cancer. Support Groups with Regular Meetings •L iving with Change — Facilitated by Donna Peele, Pastoral Care, this weekly support group is for caregivers of those with life-threatening illnesses.
•L ook Good…Feel Better — Presented in collaboration with the American Cancer Society, the National Cosmetology Association and the National Toiletry and Fragrance Association, this monthly class is designed to help women deal with the cosmetic effects of cancer treatment. Registration is required and all participants receive a free gift box of make-up.
•L osing is Not an Option — Facilitated by Chris Gibson, LMSW, OSCW, this weekly meeting is open to any cancer patient and his/her caregiver.
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•L ymphedema Support Group — Facilitated by Tori Gude, MPT, DPT, CLT certified lymphedema therapist, this monthly group benefits those who are experiencing lymphedema as a side effect of their cancer treatment. •N ew Patient Orientation — New Patient Orientation helps newly diagnosed patients and their caregivers locate and identify the appropriate hospital resources that are available. Various health care team members attend the weekly orientation session to introduce themselves to new patients.
•S haring Hope — This monthly group is for women with recurrent or metastatic breast cancer and is facilitated by Kelly Jeffcoat, BSN, OCN, CBCN.
L E X I NGT ON M E DIC A L C E N T E R
•U s Too — This prostate cancer support group is for men and their significant others; men interested in prostate health issues are welcome, too. This monthly meeting is facilitated by Deirdre Young, RN, BSN, OCN, CBCN.
•W oman to Woman — Led by Kelly Jeffcoat, BSN, OCN, CBCN, this monthly support group is for women with breast cancer.
•W e Have Cancer — This support group for families and caregivers is facilitated by Donna Peele, Pastoral Care, and meets every Thursday at 1:00 p.m. in the 8th Floor Oncology Conference Room.
Serving Our Community
SERVING OUR COMMUNIT Y
Breast Health Services Breast Health Services, now in its 14th year of operation, remains the cornerstone of cancer services at Lexington Medical Center. This program offers rapid response to women and men suspected of having a breast cancer. With the promise of “Five Days from Detection to Diagnosis,� the health care team works together to assess 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. We recognize that providing top-quality breast cancer care depends on ongoing efforts to evaluate and improve the performances of all specialties involved in the treatment of this disease. The National Accreditation Program for Breast Centers offers a structured way of facilitating this effort through its survey and accreditation process. In 2006, the NAPBC governing board sought to define the modern multidisciplinary breast center by identifying 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. To receive accreditation, a center must undergo a rigorous evaluation and review of its performance and compliance with NAPBC standards. In July 2010, Lexington Medical Center proudly announced that its Breast Cancer Program received NAPBC accreditation, which is granted only to those centers that voluntarily commit to providing the best possible care to patients with diseases of the breast. To maintain accreditation, a center must undergo an on-site review every three years.
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Becky’s Place Owned and operated by Lexington Medical Center, Becky’s Place opened in October 2000. Now in our 11th year, we continue to serve women throughout South Carolina, North Carolina and Georgia. Becky’s Place is the only hospital-owned Appearance and Resource Center in the Midlands. Named in memory of Rebecca “Becky” Johnson, a hospital volunteer and LMC Foundation board member, the boutique is conveniently located on the ground floor of Lexington Medical Park 1 on the hospital’s main campus. The knowledgeable and compassionate staff can suggest a variety of ways to minimize the physical effects of cancer therapies such as radiation, chemotherapy and breast surgeries. By offering a wide variety of head coverings, including hats, scarves, turbans and wigs, Becky’s Place helps cancer patients look and feel their best during and following cancer treatment. For women who have had surgery for breast cancer, Becky’s Place offers the most current and up-to-date prosthetic merchandise. Certified by the American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., and the Board of Certification/Accreditation, International, the staff provides one-onone assistance in a private and caring atmosphere. The boutique accepts most major medical insurance and files all claims on behalf of the client. For people without insurance, funds are available for those who meet the guidelines for assistance. In addition, Becky’s Place carries a large selection of Vera Bradley handbags and accessories. Ten percent of net proceeds from Vera Bradley breast cancer awareness items are donated to their Breast Cancer Research Foundation. In 2011, more than 1,160 women received services from Becky’s Place. And in 2012, we will expand our services for men who have been diagnosed with cancer by providing a line of hats, wigs and other accessories. We will also add a third fitting room to accommodate our growing number of clients.
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SERVING OUR COMMUNIT Y
Community Outreach Community Outreach at Lexington Medical Center held several cancer screening events in 2011 to support the hospital’s Cancer Program. More than 139 cyclists registered for the 2nd annual Colon Cancer Challenge March 2011. Through community sponsorships and event registration, Community Outreach raised $7,000 to provide colon cancer screenings for underinsured and uninsured patients. Event participants and families also received educational information to share with others.
n Colon Cancer Challenge March 25, 2011
On May 6, 2011, Lexington Medical Center partnered with Palmetto Dermatology to provide a free skin cancer screening at the hospital. Eighty-four participants were screened for melanoma and several were referred for further treatment. With the high incidence of skin cancer in Lexington County, this screening was a great way to serve the public and prevent individuals from dying of melanoma. Participants also received educational information about skin cancer.
n PSA Cancer Screening Wildcat Jamboree August 19, 2011
n Skin Cancer Screening May 6, 2011
n Women’s Night Out October 11, 2011 n WIS-TV Men’s Cancer Screening November 3, 2011
A special PSA screening took place on August 19, 2011 at the Wildcat Jamboree at Lexington High School from 5:30–9:00 p.m. Parents from more than eight schools attended the event and Community Outreach offered all men a free PSA cancer screen. Thirty-two men participated. The event also advertised the importance of having a PSA screen with radio announcements, scrolling billboard displays and fence banners. Women’s Night Out 2011 was a huge success! More than 500 people attended the sold-out event on October 11 at the Embassy Suites in Columbia that included a health and wellness fair, a silent auction, a fashion show featuring cancer survivors and dinner. Emory Austin, cancer survivor and motivational speaker, shared her story of surviving cancer and loving life. The event generated more than $20,000 for the Crystal Smith Breast Cancer Fund, which provides wigs, lymphedema garments, mastectomy kits and prostheses for women who are undergoing cancer treatment and cannot afford these items. WIS-TV and Lexington Medical Center hosted a Men’s Cancer Screening on Thursday, November 3, 2011 from 11:00 a.m.–1:00 p.m. and 4:00–6:30 p.m. The screening included a blood test for prostate cancer and anemic conditions that may be due to cancer, hemoccult card for colorectal cancer, and thyroid and skin cancer screenings performed by Dr. Charles Harmon and Dr. Nicholas Limperos. More than 50 individuals were screened and all abnormal findings were referred to area physicians. Lexington Medical Center also strives to improve the overall health of our community by offering a free monthly physician lecture series. Special cancer-related topics included Colon Cancer with Dr. Mark Seabrook and Dr. Laura Long, Melanoma with Dr. Jeff Smith and Parathyroid Disease with Dr. Will Harmon.
We will continue to provide cancer screenings throughout the Greater Columbia area in 2012. Through early detection
and education, we also hope to continue saving the lives of many in our community.
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Lexington Medical Center Foundation The Lexington Medical Center Foundation was founded in 1990 to develop resources for providing quality health services that meet the needs of the many patients served by Lexington Medical Center. Today, through the generous donations received from individuals and corporations, the Foundation continues to touch the lives of those throughout the Midlands each day. Cancer Care Fund The Foundation supports many areas of cancer care at LMC, including the purchase of vital medications and supplies for patients in need, and assistance with utilities and other living expenses. The Foundation’s Cancer Care Fund also provides items for the Infusion Center to make treatment more comfortable for our cancer patients. In the fall of 2011, the Foundation embarked on a special campaign to increase awareness and support throughout the community for the Cancer Care Fund. This campaign began with a special event with Ray Tanner on August 23, 2011, which generated more than $60,000 for cancer patients at LMC.
Mobile Mammography Unit The Mobile Mammography Unit screens more than 2,500 women per year. And last year, clinicians detected 19 cases after visiting more than 84 sites. Now supported by the LMC Volunteer Auxiliary, this program became a reality because of the Foundation’s inaugural gift of more than $100,000. Partnering with the Lexington Woman’s Club through an $11,000 grant, the Foundation continues to support this vital program, which saves the lives of women in our community.
Crystal Smith Fund The Crystal Smith Fund provides breast cancer patients with essential items and services, including necessary supplies and medication during treatment, and wigs and prostheses. The Foundation ensures that women have what they need, regardless of their ability to pay. This fund also provides post-surgical kits for every mastectomy patient at Lexington Medical Center.
WIRE Sponsorship Care Fund/Becky’s Place This annual grant from Mid-Carolina Electric Cooperative’s WIRE (Women in Rural Electrification) provides wigs and prostheses for residents of Lexington County who are undergoing treatment for breast cancer and cannot pay for these items. After donating $10,000 in 2011, WIRE’s contributions to Becky’s Place have totaled more than $92,000 in the past 13 years.
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2011 Statistics and Research
CANCER SPOTLIGHT
Kidney/Renal Pelvis Review In 2012, an estimated 64,770 individuals will be diagnosed with kidney cancer in the U.S. and 13,570 people will die from their disease. Renal cell carcinoma (RCC) represents 3 percent of all malignancies diagnosed with an increasing relative incidence of 2 percent per year for unknown reasons. RCC accounts for 90 percent of renal tumors, with 85 percent of these neoplasms composed of clear cell pathology.
Risk Factors Smoking and obesity are environmental risk factors in the development of RCC. Hereditary types of RCC, however, also exist with von Hippel-Lindau disease, the most common type, due to an autosomal dominant mutation in the VHL gene leading to a predisposition for clear cell carcinomas.
Clinical Manifestations With the increasing incidence of routine radiographic imaging, it is becoming more common that RCC is detected incidentally and in an asymptomatic state. Common symptomatic complaints associated with RCC can be associated with gross hematuria or flank pain. In addition, symptoms of distant metastatic disease may be evident with bone pain, fevers, weight loss and general constitutional symptoms as common clinical findings.
Prognostic Features National Comprehensive Cancer Network (NCCN) Guidelines速 summarize the poor survival risk prognostic features for RCC. Greater than or equal to three of the following are predictors of a shortened survival and overall poor prognosis. These factors include a serum lactate dehydrogenase level greater than 1.5 times the upper limit of normal (ULN), anemia, serum calcium greater than 10, interval history of less than a year from diagnosis to start of systemic therapy, Karnofsky Performance status less than 70 and greater than two sites of organ metastases.
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2011 S TATIS TICS AND RESE ARCH
Stage Distribution KIDNEY & RENAL PELVIS — ANALYTIC CASES Stage 0 (oA, ois)
0
Stage I
4
Stage II Stage III Stage IV
22 2
2
Treatment and Survival NCCN Guidelines® summarize the most current evidence-based recommendations for treatment options for treating physicians. Surgery, which includes radical nephrectomy or nephron-sparing surgery, is an effective treatment for early-stage RCC in appropriate candidates.
FIRST COURSE TREATMENT FOR KIDNEY & RENAL PELVIS CANCER 3%
0% Surgery Only Surgery & Chemotherapy Other Specified Therapy No 1st Course Rx
13%
84%
With T1a and T1b tumors (less than 7 cm) and with a normal contralateral kidney, nephron-sparing surgery demonstrates equivalent results to radical nephrectomy. Stage I RCC diagnosed at Lexington Medical Center has demonstrated a 71 percent five-year survival in comparison to the National Cancer Data Base average of 84 percent five-year survival.
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For Stage II and III patients, a radical nephrectomy is the preferred treatment. Unfortunately, after surgical excision, 20 to 30 percent of patients relapse. Most often, lung metastases are the most common site, occurring in 50 to 60 percent of these patients with most relapses occurring in the first couple of years. Observation remains the standard of care after nephrectomy with no current proven adjuvant therapy to reduce relapse risk. Stage III RCC disease at Lexington Medical Center has demonstrated a five-year survival matching the national benchmark of 58 percent. Stage IV patients with RCC, unlike many other cancers, may benefit from upfront surgical resection of the primary tumor. Cytoreductive nephrectomy before systemic therapy is recommended in patients with surgically resectable primary disease and resectable metastases. The patients that are shown to benefit most often are those with symptomatic hematuria, lung-only metastases and good prognostic features and performance status. Cytoreductive nephrectomy may also benefit patients who are symptomatic with pain or hematuria from their primary renal tumor. Until recently, first-line systemic therapy options were very limited in RCC patients. Cytokine therapy with Interleukin-2 (IL-2) and Interferon (IFN) had response rates in the 5 to 27 percent range with significant levels of toxicity which only a select subset of patients could tolerate. The overall picture for treatment of metastatic renal cell cancer has been dramatically changed with the advent of targeted systemic therapies over the past few years.
LMC Observed Survival for Kidney & Renal Pelvis Cases DIAGNOSED IN 2003–2004 100 90
SURVIVAL RATE
80 70 60 50 40 30 20 10 0
Dx 100 100 100 100 100
1 YEAR 100.0 93.8 100.0 58.3 25.0
2 YEAR 100.0 90.7 100.0 58.3 16.7
3 YEAR 100.0 84.5 100.0 58.3 0
4 YEAR 100.0 81.2 100.0 58.3 0
5 YEAR 100.0 71.5 100.0 58.3 0
YEARS FROM DIAGNOSIS *Stage 0 reflects AJCC 6th edition staging for renal pelvis only; no Stage 0 applicable for kidney site. Sources: NCCN Guidelines® Version 2.2012 — Kidney Cancer, National Cancer Database
TE
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2011 S TATIS TICS AND RESE ARCH
SURVIVAL RATE
Targeted therapy with tyrosine kinase inhibitors (TKI), vascular endothelial growth factor receptor inhibitors and 100 mammalian target of rapamycin (mTOR) inhibitors has allowed for multiple new agents to be introduced that are 90 higher response rates than previous cytokine treatments. Sunitinib, bevacizumab and better tolerated and offer 80 for initial systemic therapy in patients with metastatic disease. Temsirolimus is an mTOR pazopanib are approved 70 inhibitor that is also approved as initial systemic therapy in patients with metastatic RCC with poor prognostic 60 features. Sorafenib, everolimus and axitinib are TKI therapies that are approved post first-line systemic therapy for metastatic disease. 50 40 For non-clear cell carcinoma pathologic subtypes, temsirolimus is the only agent that has shown demonstrated 30RCC. Recent expanded access trials using sunitinib and sorafenib have shown some promise activity in non-clear cell 20 in non-clear cell RCC. Adjunctive therapy with added bisphosphonates and zoledronic of offering palliative benefit 10 acid or RANK ligand inhibitors with denosumab are also shown to be of benefit in prolonging the time before first 0 skeletal-related event and are administered with standard treatment. Dx
1 YEAR
2 YEAR
3 YEAR
4 YEAR
5 YEAR
100.0 100.0 Medical 100.0 100 The overall five-year survival for Stage IV RCC at Lexington Center was100.0 0 percent as100.0 compared to a 12 81.2 93.8 90.7 84.5 71.5 100 percent five-year survival nationally. Upon review of the patients of the specified subset (Stage IV), it was determined 100.0 100.0 100.0 100.0 100.0 100 58.3 58.3 58.3 58.3 58.3 100 that age, co-morbid conditions and overall poor performance status precluded eligibility for treatment with high dose 0 25.0 16.7 0 0 100 IL-2. Of note, the survival data for metastatic disease overall is likely to be better in the future given the improvement in YEARS FROM DIAGNOSIS the number and efficacy of systemic treatment options.
NCDB Observed Survival for Kidney & Renal Pelvis Cancers CUMULATIVE SURVIVAL RATE
DIAGNOSED IN 2003-2004 • DATA FROM 1,396 NATIONAL FACILITIES 100 90 80 70 60 50 40 30 20 10 0 n=465 n=20123 n=4094 n=5411 n=7522
Dx 100 100 100 100 100
1 YEAR 94.6 96.3 94.4 86.9 40.5
2 YEAR 90.6 93.3 89.1 76.5 24.8
3 YEAR 84.9 90.2 84.1 68.8 18.2
4 YEAR 79.5 87.2 79.9 63.2 14.7
YEARS FROM DIAGNOSIS *Source: National Cancer Database by jbanasiak@facs.org
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L E X I NGT ON M E DIC A L C E N T E R
5 YEAR 74.9 83.9 75.3 57.5 12.2
Research Studies Lexington Medical Center’s Research department has continued to experience growth each year through its active tissue banking program and expanding clinical trials program. Involvement these programs places Lexington Medical Center on the leading edge to receive the latest information and results, keeping the hospital at the forefront of current methodologies, procedures and treatments and providing patients with access to new medications and innovative treatments options.
Clinical Trials In 2011, 13 patients enrolled in clinical trials for breast, lung and prostate cancers at Lexington Medical Center. XAGastic Phase II Study of Oxaliplatin, Capecitabine and Bevacizumab in the Treatment of Metastatic Esophagogastric Adenocarcinomas (Duke Medicine trial – gastric) Principal Investigator: Steve Madden, MD Enrolled to date: 0
ACOSOG Z1071 Phase II Study Evaluating the Role of Sentinel Lymph Node Surgery and Axillary Lymph Node Dissection Following Preoperative Chemotherapy in Women with Node Positive Breast Cancer (T0-4, N1-2, M0) at Initial Diagnosis Principal Investigator: Lynn Tucker, MD Enrolled to date: 5
S0819 Randomized, Phase III Study Comparing Carboplatin/ Paclitaxel or Carboplatin/Paclitaxel/Bevacizumab with or without Concurrent Cetuximab in Patients with Advanced Non-Small Cell Lung Cancer (NSCLC) Principal Investigator: Asheesh Lal, MD Enrolled to date: 0
CALGB 70604 Randomized, Phase III Study of Standard Dosing versus Longer Dosing Interval of Zoledronic Acid in Metastatic Cancer (breast, prostate, multiple myeloma) Principal Investigator: Steve Madden, MD Enrolled to date: 4
S1007 Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients with 1-3 Positive Nodes, Hormone ReceptorPositive and HER2-Negative Breast Cancer with Recurrence Score (RS) of 25 or Less Principal Investigator: Steve Madden, MD Enrolled to date: 3
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2011 S TATIS TICS AND RESE ARCH
RTOG 1005
IRESSA™
Phase III Trial of Accelerated Whole Breast Irradiation with Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer Principal Investigator: Quillin Davis, MD Enrolled to date: 5
Open Label, Multi-center IRESSA, Clinical Access Program of Gefitinib 250mg (Iressa) for the Continued Treatment of Patients in the United States Who Are Currently Benefiting or Have Benefited from Gefitinib Treatment (expanded access, pharmaceutical trial for lung cancer) Principal Investigator: Asheesh Lal, MD Enrolled to date: 0
PROCEED P10-3 Registry of Sipuleucel-T Therapy in Men with Advanced Prostate Cancer (pharmaceutical trial) Principal Investigator: Steve Madden, MD Enrolled to date: 0
Active Tissue Banking Studies Specimen collections through Lexington Medical Center’s tissue banking program supported two tissue-banking related studies in 2011. These contributions to the South Carolina Biorepository System continue to further cancer genetics research. Factors Associated with Anti-tumor Immunity in Cancer Patients
Genetics of Aging and Cancer Principal Investigator: Phillip Buckhaults, Ph.D.
Principal Investigator: Juhua Zhou, Ph.D.
TISSUE BANKING STATISTICS 2011 Year
Breast
Colon
Lung
Renal
GYN
Other
Yearly Total
RPMI to Date
2011
17
26
18
5
21
11
98
2
Grand Total
99
86
47
50
20
65
465
92
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L E X I NGT ON M E DIC A L C E N T E R
Cancer Registry The Cancer Registry is an essential component of the Cancer Program at Lexington Medical Center, which is accredited by the American College of Surgeons Commission on Cancer (CoC). The primary function of the Cancer Registry is to maintain an electronic database encompassing the most accurate and timely data on eligible cancer cases diagnosed and/or treated at the hospital. The Registry collects and analyzes more than 300 data fields on each cancer case including patient demographics, primary site, histology, diagnostic testing, site-specific prognostic indicators, treatment modalities, stage of disease, recurrence and lifetime annual follow-up. The data collected by the Cancer Registry is used to support Cancer Program development, quality improvement initiatives and cancer research. Armed with this data, physicians also can study their effectiveness in treating patients. It is only by constant evaluation that we can ensure we are providing the best possible care for all patients.
CANCER REGISTRY ACTIVITY Total Cases in Database — Reference Year 2002
16,520
Total Cases
2,162
Analytic Cases
1,131
Follow-Up Rate (5 Year) CoC Target 90% Persons
93.7%
Cases
93.8%
Follow-Up Rate (Reference Year) CoC Target 80%
91.0% Persons The Cancer Registry submits data to the South Carolina Central Cancer Registry (SCCCR) 91.2% Cases monthly and to the National Cancer Data Base (NCDB) annually. Maintaining our own database and submitting data to both regional and national data banks allows the cancer team to monitor patient outcomes and trends not only at Lexington Medical Center, but also within our region, state and nation. For the 2011 accession year, the Cancer Registry staff collected data on 1,131 new cancer cases. Data also was collected on an additional 1,031 non-analytic cases that included, but were not limited to: active (recurrent or persistent) cancers previously diagnosed and treated elsewhere; cases seen at the hospital for diagnostic work-up or treatment planning only; cases reviewed by pathology only; and cases with specific histologies required for collection by SCCCR. In all, data was collected on 2,162 cancer cases, which represents a 22.87 percent increase versus 2010 collected cases.
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2011 S TATIS TICS AND RESE ARCH
Cancer Conference In addition to the collection and analysis of cancer data, the Cancer Registry staff also coordinates monthly Cancer Committee meetings, quarterly Breast Program Leadership meetings and two weekly Oncology conferences. Oncology conferences represent Lexington Medical Center’s long-standing institutional commitment to the multidisciplinary approach to treatment. At these conferences, physicians, medical and nursing staff, and allied health professionals discuss appropriate management plans in relation to nationally recommended treatment guidelines.
ONCOLOGY CONFERENCE ACTIVITY Cases Presented
Prospective Cases Presented*
Attendance % by Required Specialties**
50
543
543 (100%)
99.6%
General
51
242
229 (94.6%)
100%
Combined
101
785
772 (98.3%)
99.8%
Conference Type
Conferences
Breast
Percent of cases where treatment guidelines were discussed
Percent of eligible cases with clinical or working stage discussed
99.8%
98.6%
* CoC requires at least 75% of cases discussed at cancer conferences are presented prospectively. ** Required specialties as mandated by CoC include medical oncology, radiation oncology, surgery, pathology and diagnostic radiology.
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L E X I NGT ON M E DIC A L C E N T E R
Stage Distribution ANALYTIC CASES
92 146
0
50
361
195
Stage I (I, IA, IB, IB2, IC) Stage II (II, IIA, IIB, IIC)
223
97
17
Stage 0 (0, 0A, 0is)
Stage III (III, IIIA, IIIB, IIIC, IIIC1, IIIC2) Stage IV (IV, IVA, IVB, IVC) Stage 88*
100
150
200
250
300
350
Unknown
400
*Stage 88: No applicable AJCC staging schema for site or site-histology combination.
Geographical Distribution COUNTY AT DIAGNOSIS: ANALYTIC CASES
4%
62% 21% 1%
2%
3%
Lexington
Aiken
Orangeburg
Calhoun
Newberry
Bamberg
Richland
Saluda
Kershaw
Fairfield
Other S.C. Counties/Out of State
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2011 S TATIS TICS AND RESE ARCH
Gender Distribution ANALYTIC CASES
ANALYTIC STATISTICAL COMPARISON Lexington Medical Center American Cancer Society – National 60
Male
57.47%
50
481
51.50%
40
48.50%
42.53%
30
650
20 10 Female
0 Female
Male
Source: Cancer Facts & Figures 2011©, American Cancer Society
Site Distribution All Cases ANALYTIC AND NON-ANALYTIC
351
Breast
292 251
Prostate Lung
155 145 128
Hematopoietic/ Bone Marrow Colorectal Skin/Melanoma
840 0
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100
200
300
400
L E X I NGT ON M E DIC A L C E N T E R
500
600
700
800
900
All Other Sites
Top Sites ANALYTIC CASES Lexington Medical Center 300
269
25
200
23.8% 23.5%
20
150
97 90
100
American Cancer Society – South Carolina
Breast
Colorectal Lung
Corpus Uteri
26.8%
24.7%
17.7%
15
44
50 0
Lexington Medical Center
30
250 200
ANALYTIC STATISTICAL COMPARISON
13.3% 8.6%
10
8.0%
5
7.6% 4.1% 3.9% 3.8%
Prostate
0
Breast
Lung
Colorectal
Prostate
Corpus Uteri
Melanoma
Source: Cancer Facts & Figures 2011©, American Cancer Society
Cancer Registry Highlights for 2011 • Added additional full-time employee for abstracting/data collection. • Met the established quality and timeliness criteria for all analytic data submissions to the National Cancer Database (NCDB) Calls for Data in 2011. • R eviewed more than 32,834 pathology reports to determine inclusion of cases in the cancer registry database. • Fulfilled 85 data requests (from researchers, nurses, physicians, health care facilities, administrators), which represents approximately a 29 percent increase versus data requests fulfilled in 2010. • Began participation in RQRS, a reporting and quality improvement tool that provides real clinical time assessment of hospital-level adherence to National Quality Forum-endorsed quality of cancer care measures for breast and colorectal cancers. • Began electronic staging via eOutcomes®, which enables the Registry to streamline staging workflow processes and helps to eliminate the manual processes associated with obtaining and managing outcomes information. • Participated in NCDB’s Cancer Program Practice Profile Reports (CP3R) for colon and breast cancer cases, a Web-based program that offers local providers comparative information to assess adherence to and consideration of standard of care therapies for major cancers. The aim is to empower clinicians, administrators and other staff to work collaboratively in order to identify problems in practice and delivery, and implement best practices that will diminish disparities in care across CoC-accredited cancer programs.
To learn more about the Cancer Registry or to submit a data request, please contact: Natalie J. Copeland, Cancer Registry Manager • (803) 936-4175 • njcopeland@lexhealth.org. For data requests, please understand that release of data containing protected health information is subject to federal HIPAA regulations and may also be subject to Institutional Review Board approval.
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2011 S TATIS TICS AND RESE ARCH
Site Distribution STATISTICAL SUMMARY OF CANCER REGISTRY DATA Total Cases
Analytic
Non-Analytic
Oral Cavity & Pharynx
68
27
41
Base of Tongue
7
4
3
Other & Unspecified Parts of Tongue
6
3
3
Floor of Mouth
3
1
2
Palate
5
4
1
Other & Unspecified Parts of Mouth
8
2
6
Parotid Gland
5
2
3
Tonsil
8
4
4
Oropharynx
3
1
2
Nasopharynx
5
4
1
Pyriform Sinus
1
0
1
Hypopharynx
3
2
1
Other & Ill-defined Sites in Lip, Oral Cavity & Pharynx
14
0
14
Digestive Organs
285
184
101
Esophagus
11
3
8
Stomach
26
13
13
Small Intestine
11
10
1
Colon (Excluding Rectum)
106
73
33
Rectosigmoid Junction
10
6
4
Rectum
29
18
11
Anus & Anal Canal
4
3
1
Liver & Intrahepatic Bile Ducts
21
13
8
Gallbladder
7
5
2
Other & Unspecified Parts of Biliary Tract
3
3
0
Pancreas
54
36
18
Other & Ill-defined Digestive Organs
3
1
2
PRIMARY SITE
272
212
60
Nasal Cavity & Middle Ear
1
0
1
Accessory Sinuses
4
3
1
Respiratory System
Larynx
10
5
5
Lung & Bronchus
251
200
51
Thymus
1
1
0
Heart, Mediastinum & Pleura
5
3
2
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L E X I NGT ON M E DIC A L C E N T E R
Site Distribution STATISTICAL SUMMARY OF CANCER REGISTRY DATA Total Cases
Analytic
Non-Analytic
Bones, Joints & Articular Cartilage
6
1
5
Bones, Joints & Cartilage of Limbs
4
1
3
Bones, Joints & Cartilage of Other
2
0
2
158
25
133
2
0
2
155
25
130
PRIMARY SITE
Hematopoietic & Reticuloendothelial Systems Blood Bone Marrow Spleen
1
0
1
Skin
138
44
94
Melanoma
128
43
85
Other Non-Epithelia
10
1
9
Peripheral Nerves & Autonomic Nervous System
1
1
0
Retroperitoneum & Peritoneum
7
6
1
Peritoneum
7
6
1
Connective, Subcutaneous & Other Soft Tissues
19
12
7
Breast
351
269
82
Female Genital Organs
201
62
139
Vulva
9
3
6
Vagina
2
1
1
Cervix
63
1
62
Corpus Uteri
56
44
12
Uterus, NOS
20
0
20
Ovary
44
11
33
Other & Unspecified Female Genital Organs
7
2
5
Male Genital Organs
308
94
214
Prostate
292
90
202
Testis
15
4
11
Other & Unspecified Male Genital Organs
1
0
1
Urinary Tract
83
68
15
Kidney
37
27
10
Renal Pelvis
4
3
1
Ureter
3
3
0
Bladder
39
35
4
Brain & Other Parts of Central Nervous System, Eye
63
42
21
Eye & Adnexa
2
0
2
Meninges
25
20
5
Brain
36
22
14
Spinal Cord, Cranial Nerves & Other Parts of Central Nervous System
4
2
2
Spinal Cord
2
2
0
Optic Nerve
1
0
1
Acoustic Nerve
1
0
1
Thyroid & Other Endocrine Glands
60
33
27
Thyroid
42
25
17
Adrenal Gland
2
1
1
Pituitary Gland
16
7
9
Other & Ill-Defined Sites
8
0
8
Lymph Nodes
93
32
61
Unknown Primary Site
GRAND TOTAL
37
17
20
2,162
1,131
1,031
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