MERCY HEALTH SYSTEM 2010 ANNUAL REPORT
Cancer Program
1
table of contents Message from the President ......................2
Mercy’s clinical trial program ............23-24
Mercy Cancer Committee
Genetic testing for hereditary
chairman’s report..................................3
cancer syndromes ..............................25
2010 Cancer Committee ......................3-4
What our patients say: Sharon Krueger ....26
Mercy Regional Cancer Center
Mercy Regional Cancer Center:
team phone numbers ............................4 A new view for patients ........................5-6 Mercy Cancer Registry report ..............7-11 How the Mercy Cancer Registry benefits our patients ..............................8 Mercy Hospital and Trauma Center’s
radiation oncology ............................27 From our partners: Bonnie Anderson Eichstedt ..................28 Mercy Regional Cancer Center: surgical oncology ..............................29 From our partners: Phyllis Garner ............30
hospitalist program ............................11
From our partners: Heidi Canfield............31
Tumor Board conferences ......................12
What our patients say: Joan Brayer ........32
Kidney cancer at Mercy Hospital
What our patients say: Coreen Smith ......33
and Trauma Center: 1994-2009 ....13-15 American Cancer Society ......................16 Radiofrequency ablation of renal cell carcinoma ..........................17 Mercy Hospice Care:
Mercy Regional Urology Center: compassionate care for special concerns34 Mercy Institute of Neuroscience ..............35 da Vinci Si HD Dual-Console Surgical System..................................36
offering comfort, support and caring ......18
Support services ..............................37-41
Mercy Palliative Care Program................19
Support groups ....................................41
Pathology’s role in cancer treatment ........20
Mercy MyChart
Mercy Regional Cancer Center:
helps you manage your life ..................42
hematology/medical oncology clinic ....21 From our partners: Angela Butters ............22
We’re dedicated to offering the best cancer care in the area. In fact, our oncology program has been recognized with commendation by the Commission on Cancer of the American College of Surgeons as offering the very best in cancer care. It is a recognition of the quality of our comprehensive, multidisciplinary patient care. We’re proud to have brought the very best in today’s cancer treatment closer to home.
Message from the president Dear friends, When I started here in 1989, Mercy Hospital’s cancer program offered excellent, but limited, cancer services. Patients and their families had to drive to nearby cities to receive most of their care. Having cancer is enough of a hardship without the added burden and stress of having to drive far for appointments. I thought we could do better—and we did. On October 7, 1990, we celebrated the establishment of the Mercy Regional Cancer Center and the new building housing our state-of-theart radiation therapy program. That Regional Cancer Building is now joined by the Sister Michael Berry Building to its south. Almost 20 years to the day—October 23, 2010—the Sister Michael Berry Building celebrated its own open house. In addition to neuroscience, trauma care, men’s health, urology and gastroenterology, the building also houses our new medical oncology department, formerly located on the ground floor of Mercy Hospital. Learn more and see the department’s beautiful views on p. 5-6. As part of our open house, and in recognition of the many transformations that have taken place on the entire Mercy Campus in Janesville, we changed the name of our hospital to Mercy Hospital and Trauma Center. We have grown in many other ways in these 20 years. We’ve made significant investments in technology to detect and treat a wide range of cancer types. We take part in national clinical trials and offer cancer-related genetic testing and counseling. Our palliative care program is available for consultation and symptom management. We help get patients back on their feet through many modes of rehabilitation, support services and home health care. In 2010, we welcomed two new doctors. Dr. James Richardson is a progressive radiation oncologist who now leads the development of that program. Dr. Douglas Puffer joined our excellent hematology and medical oncology team. I also welcome Michelle Leverence, MSW, as our newest oncology social worker. Michelle has developed a new support group to bring patients, families and others together to discuss their challenges and victories. As cancer care continues to evolve and improve, the Mercy Regional Cancer Center will keep pace—just as it has for 20 years. Sincerely,
Javon R. Bea President/CEO, Mercy Health System
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Mercy Cancer Committee: chairman’s report B. K. Wasiljew, MD, FACS Chairman, Mercy Cancer Committee The work continues …. Each year, many aspects of our cancer program are enhanced. Since the summer of 2009, advanced robotic surgery was added to our armamentarium for treating malignancies. Robotic procedures are now routinely available in urology, gynecology and general surgery. Electronic medical records are being rolled out to more and more clinics and offices to complete the outpatient side of Epic implementation. At the same time, work is ongoing to convert inpatient care from paper to electronic charts. Hospitalists have become integral members of the team as they took on the responsibility of caring for inpatient medical oncology patients. Their contribution to our program is featured in our recent Annual Reports, including this one. A member of the hospitalist team has been added to the Cancer Committee to assure timely communication and collaboration. A new and much larger medical oncology clinic is now operating on the top floor of the Sister Michael Berry Building on the Mercy Hospital and Trauma Center campus. This ensures continued growth of medical oncology services. The lower level of that building provides needed covered parking spaces.
Early this year we were happy to welcome Dr. James Richardson, radiation oncologist, who joined our team and took over the department of radiation oncology. Dr. Richardson has been the object of compliments and praises from patients, staff and physicians. An informal campaign across our large service area uses print, billboards, electronic media to feature cancer program physicians and patients. It is a big success! Some individuals were featured on YouTube, which had many “hits.” My sincere thanks to all of you who work so hard to make our Cancer Program such a great success.
Physician members Gregory Denison, MD Ronald Garcia, MD Patricia Garner, MD Thomas Haas, DO Francis Kaveggia, MD Masood Khan, MD Meridyth Munns, MD Gary Peplinski, MD Douglas Puffer, MD James Richardson, MD Emily Robinson, MD Shahid Shekhani, MD B.K. Wasiljew, MD
Radiology Rehab Services General Surgery/Liaison Pathology Urology Hospitalist GYN General Surgery Medical Oncology Radiation Oncology Medical Oncology/Hematology Medical Oncology/Hematology General Surgery/Committee Chair
Science ... services ... support Since 1990, the Center has helped thousands of cancer patients and their families meet the challenges of cancer head on. Our comprehensive cancer care program offers the full
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Your Mercy Regional Cancer Center team American Cancer Society ........................................................(800) 227-2345 American Cancer Society Navigator .........................................(608) 833-4555 Mercy Cancer Registry ............................................................(608) 756-6139 Mercy Hospice Care ...............................................................(800) 369-2201 Mercy Hospital and Trauma Center..................(608) 756-6000/(800) 756-4147
range of resources necessary to
Administrative director, oncology .............................................(608) 756-6871
detect and treat cancer, and help
Clinical trials data manager ...................................................(608) 756-6871
our patients not only recover,
Dietitian/nutritionist ...............................................................(608) 756-6151
but thrive. Our entire staff—
Financial counselor ...............................................................(608) 756-6500
with our combined knowledge
Genetic counseling ...............................................................(608) 756-6871
and expertise—understands what
Hematology/medical oncology .....................(608) 756-6871/(800) 928-1103 Inpatient special care unit (SCU) .............................................(608) 756-6897
each patient is experiencing.
Manager, oncology ..............................................................(608) 756-6770
We know that our patients require
Oncology social worker ........................................................(608) 756-6871
not only state-of-the-art technology
Outpatient transfusion/infusion (Treatment Coordination Center) ....(608) 756-6601
to heal, but also the human touch.
Pastoral care .......................................................................(608) 756-6000
It is this spirit of compassion and
Radiation oncology .....................................(608) 756-6500/(800) 261-6565
kindness that makes our Center
Surgical oncology ................................................................(608) 756-7277
stand out. How do we know? Our patients tell us, every day.
Non-physician members Tani Abendroth Jan Botts, RN Linda Brethauer, APNP, AOCN Amy Carey Shawn Davenport, PT Rev. Doug Dowling Nedra Hanson, RHIT Rachel Hill Smith Erik Hollander Karol Huenerberg, APNP, OCN Don Janczak, PharmD Carol Johnson, RN Janice Johnson, RN Michelle Leverence Tricia Obrecht, CTR Sue Ripsch Martha Roberts
Urology ..............................................................................(608) 741-6990 Mercy Pain Center..................................................................(608) 756-6049
2010-2011 Cancer Committee Membership Marketing Director, Quality Management Medical Oncology / Hematology Community Outreach Director Chaplain Medical Management Marketing American Cancer Society Administration Pharmacy Mercy Assisted Care Hospice Care Clinical Research Social Services Cancer Registry Vice President Cancer Registry
Front: Janice Johnson, RN; Martha Roberts; Shahid Shekhani, MD. Standing: Emily Robinson, MD; Tricia Obrecht, CTR; Karol Huenerberg, APNP, CN; B.K. Wasiljew, MD; Keith Konkol, MD; Patricia Garner, MD; Rev. Doug Dowling; Michelle Leverence. Not shown: Tani Abendroth; Linda Brethauer, APNP, AOCN; Jan Botts, RN; Amy Carey; Shawn Davenport, PT; Gregory Denison, MD; Ronald Garcia, MD; Thomas Haas, DO; Nedra Hanson, RHIT; Rachel Hill Smith; Don Janczak, PharmD; Erik Hollander; Carol Johnson, RN; Francis Kaveggia, MD; Masood Khan, MD; Meridyth Munns, MD; Gary Peplinski, MD; Douglas Puffer, MD; James Richardson, MD; Sue Ripsch, VP.
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A new view for patients To serve its patients better, the hematology and medical oncology departments of the Mercy Regional Cancer Center have relocated to a more spacious and comfortable area on the Mercy Campus in Janesville. Hematology and medical oncology are now located within the Mercy Michael Berry Clinic, on the second floor of the new Sister Michael Berry Building. For patients’ convenience, the building offers two floors of indoor parking and a skywalk to Mercy West Clinic and Mercy Hospital and Trauma Center. The new area offers a Cancer Resource Center, more state-ofthe-art chemotherapy stations with a bird’s-eye view of the Rock River, and an on-site laboratory.
Our new medical oncology and hematology unit has been expanded to 16 chemotherapy treatment bays and creates a calm, relaxing environment for our patients. Each state-of-the-art bay provides a scenic view overlooking the Rock River.
Our new skywalk connects the Mercy Michael Berry Clinic, Mercy West Clinic and the Mercy Hospital and Trauma Center with a two-story indoor parking plaza.
Mercy Campus Skywalk
Mercy Cancer Registry report
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Patient volume by class of case Figure 1 shows the variability in the total number of cancer cases reported since the registry’s inception in 1994. The incidence for 2009 was 675 cancer cases, up approximately 5 % from 2008. Ninety-four percent of these cases (632) were newly diagnosed and/or received the first course of treatment within Mercy Health System. These are designated as “analytic� cases and all further analyses are restricted to these data.
The Cancer Registry of the Mercy Cancer Program provides data management services to comply with mandatory state cancer reporting regulations, as well as the data needs of clinicians, administrators and other qualified users. In addition, the registry also provides data to national-level cancer surveillance organizations for incidence measurement and epidemiological studies. Since its inception in 1994, the registry has collected data on more than 9,200 cancer patients, with 675 new cases entered for the calendar year 2009, the last complete year of data collection. The local registry database contains demographic and clinical information from diagnosis through treatment, as well as annual lifetime follow-up data. The follow-up process, in addition to providing critical information about disease status and treatment outcomes, also performs a valuable service for physicians and patients by reminding them that regular reassessment of the disease is vital for early detection of recurrences or subsequent primaries. Currently, the registry is actively following more than 4,500 living patients.
Age distribution The median age at diagnosis for cancer of all sites was 66 years of age according to the SEER National Database from 2003-2007. Approximately 1% were diagnosed under the age of 20; 3% between 20 and 34; 6% between 35 and 44; 14% between 45 and 54; 22% between 55 and 64; 25% between 65 and 74; 22% between 75 and 84; and 8% at 85+ years of age.
Mercy Health System
800
Number of Cases
700 600 500 400 300 200 100 0
1995
1997
1999
2001
2003
2005
2007
2009
Year
Trends in Cancer Incidence by Year Analytic
Non-Analytic
Figure 1
Mercy Cancer Registry report, continued The age range for females diagnosed at Mercy Hospital Janesville between 2005 and 2009 was 15-101 years of age with a median age of 63. Eighty percent of all females were diagnosed at age 50 and older. The median age of males diagnosed at Mercy in the same timeframe was 64, with the ages ranging from 10-98 years of age. Eighty-eight percent of all males were diagnosed at age 50 or greater. The age distribution compares quite similarly with national statistics, with 84% of all our patients diagnosed with cancer in their 50s or older.
HOW THE
MERCY
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CANCER
REGISTRY BENEFITS OUR PATIENTS Our concern for our patients with cancer continues long after they leave treatment. That’s why each person who is diagnosed with cancer at Mercy Health System
Age at Diagnosis - Females
100
becomes part of the Mercy Cancer Registry.
80
Our primary responsibility is to provide
60
lifetime follow-up on all registry patients, and either the patient or his physician
40
will be contacted at least annually to see
20
0
how the patient is doing. At all times, strict 0-29
30-39
40-49
2005
50-59
2006
60-69
2007
70-79
2008
80-89
90+
confidentiality is maintained. Maintaining regular contact helps us follow our patients’
2009
treatment, if any, and identify new or recurring physical problems they might
Age at Diagnosis - Males
100
have. It also helps us assess the need for
80
future cancer programs.
60
It is important that we are able to maintain
40
contact with all our past cancer patients. 20
0
Patients who move or change their phone 0-29
30-39
40-49
2005
50-59
2006
60-69
2007
70-79
2008
2009
80-89
90+
number are asked to call the Mercy Cancer Registry at (608) 756-6139.
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Mercy Cancer Registry report, continued Probability of developing cancer The lifetime probability (or risk) of developing or dying from cancer refers to the chance a person has, over the course of his or her lifetime (from birth to death), of being diagnosed with or dying from cancer. These risk estimates, like annual incidence and mortality data, provide another measure of how widespread cancer is. These numbers are average risks for the overall U.S. population. The probability of being diagnosed with an invasive cancer is higher for men (44%) than for women (38%). However, because of the earlier median age of diagnosis for breast
cancer compared with other major cancers, women have a slightly higher probability of developing cancer before age 60 years. An individual’s risk may be higher or lower than these numbers, depending on their particular risk factors; e.g., differences in exposure and/or genetic susceptibility. While only approximately 5% of all cancers are hereditary, all cancers are a result of malfunction in the genes that control cell growth and division. This table demonstrates the lifetime probability of developing the most frequent diagnosed cancers.
Probability of Developing Invasive Cancers Over Selected Age Intervals by Sex, US, 2004-2006* American Cancer Society - Facts and Figures 2010 Birth to 39 (%)
40 to 59 (%)
60 to 69 (%)
70 and older (%)
Birth to Death (%)
All sites
Male Female
1 in 70 1 in 48
1 in 12 1 in 11
1 in 6 1 in 10
1 in 3 1 in 4
1 in 2 1 in 3
Urinary bladder
Male Female
1 in 4,741 1 in 10,613
1 in 257 1 in 815
1 in 106 1 in 385
1 in 27 1 in 99
1 in 26 1 in 84
Breast
Female
1 in 206
1 in 27
1 in 29
1 in 15
1 in 8
Colon and rectum
Male Female
1 in 1,296 1 in 1,300
1 in 110 1 in 139
1 in 67 1 in 94
1 in 22 1 in 24
1 in 19 1 in 20
Leukemia
Male Female
1 in 603 1 in 798
1 in 475 1 in 690
1 in 299 1 in 504
1 in 84 1 in 128
1 in 66 1 in 92
Lung and bronchus
Male Female
1 in 3,461 1 in 3,066
1 in 105 1 in 126
1 in 43 1 in 57
1 in 15 1 in 21
1 in 13 1 in 16
Melanoma of skin
Male Female
1 in 638 1 in 360
1 in 155 1 in 183
1 in 138 1 in 274
1 in 56 1 in 126
1 in 37 1 in 56
Non-Hodgkin lymphoma (NHL)
Male Female
1 in 782 1 in 1,172
1 in 225 1 in 315
1 in 171 1 in 227
1 in 58 1 in 72
1 in 44 1 in 52
Prostate
Male
1 in 9,422
1 in 41
1 in 16
1 in 8
1 in 6
Uterine cervix
Female
1 in 648
1 in 374
1 in 755
1 in 552
1 in 145
Uterine corpus
Female
1 in 1,453
1 in 136
1 in 121
1 in 81
1 in 40
Mercy Cancer Registry report, continued Primary sites The distribution of the most prevalent cancers seen at MHS has changed very little over the last decade. The top seven cancer sites account for more than 62% of all newly diagnosed cancers seen at MHS. Comparable to the national data, the most common sites seen include breast, prostate, lung and colorectal cancers. In 2009, MHS saw a significant increase in the number of new melanoma cancers treated (greater than 50% from 2008). This can be attributed to the continuous efforts of skin cancer screenings, patient education and awareness programs. In addition, the number of newly diagnosed colorectal cancers continues to decline as more patients are routinely screened.
Most Common Analytic Sites
120 100 80 60 40 20 0
Male Incidence Comparison Nat’l Prostate 28% Lung 15% Colorectal 9% Melanoma 5% Bladder 7% Kidney 4% NHL 4% All Others 28%
Breast
Prostate
Lung
2005
MHS 20% 13% 10% 9% 8% 3% 6% 31%
Colorectal
2006
2007
Bladder
2008
Melanoma Hematopoietic
2009
Female Incidence Comparison MHS Nat’l Breast 25% 28% Lung 14% 14% Colorectal 5% 10% Melanoma 6% 4% Uterine 6% 6% Thyroid 2% 5% Ovary 1% 3% All others 41% 30%
The most frequent cancer sites in women at MHS were breast, lung and colorectal. In men, the most frequent sites were prostate, lung and colorectal cancers. Compared with national data, our incidence of prostate is somewhat lower with the incidence rates being comparable for both lung and colorectal cancers and somewhat higher for melanomas of the skin. Our incidence of breast and colorectal cancers was somewhat lower when compared to the national average with the incidence of lung cancers being comparable. Higher and lower incidence rates may be due to our wide range of screening, diagnostic and treatment services.
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Mercy Cancer Registry report, continued Stage at diagnosis Staging describes the extent or severity of an individual’s cancer based on the extent of the original (primary) tumor and the level of spread in the body. Knowing the stage of the disease helps the physician plan a patient’s treatment and estimate prognosis. Cancers with the same stage usually have comparable outlooks and are often treated similarly. For most cancers, the stage is based on three main factors: • T – the original (primary) tumor’s size and/or extent of the tumor into regional tissues • N – whether or not the cancer has spread to nearby lymph nodes • M – whether or not the cancer has spread to distant areas of the body Once the T, N and M are determined, a stage group of I, II, III or IV is assigned, with a stage I being early and stage IV being advanced.
national database of 30%. Sixty-eight percent of all patients had a stage III or earlier cancer. Again, this compares favorably with the national data at 65%. Mercy’s continual goal is to increase the number of patients diagnosed with an earlier, more treatable stage. We do this with continued public awareness and patient education programs, screening and prevention programs and earlier detection.
AJCC Stage at Diagnosis All 2004-2008 Analytic Cases
NA 14%
Unknown In Situ 1% 7%
Stage 1 25%
Stage 4 17%
Stage 3 14%
Thirty-two percent of all patients diagnosed with cancer during 2005-2009 were staged in the earliest stages. This compares similarly with the
Stage 2 22%
Mercy Hospital and Trauma Center’s hospitalist program Mercy’s cancer team works closely with hospitalists at Mercy Hospital and Trauma Center to offer the best care for our cancer patients during their hospital stays. Mercy hospitalists are on-site 24/7 and are ready to see patients as soon as they are admitted to Mercy Hospital and Trauma Center. Mercy hospitalists are available for evaluations, treatments and consultations, and they communicate with the patient’s primary physician. Majed Al-Hamwi, MD Juan Hernandez, MD Masood Ali Khan, MD Balvindar S. Sareen, MD, MBA Syed-Saleem Shamsee, MD Javed Sheikh, MD Gabriel Szekely, MD
Hospitalist, Board certified internal medicine Hospitalist, Board certified family medicine Hospitalist, Board certified internal medicine Hospitalist Medical Director, Board certified internal medicine Hospitalist, Board certified family medicine Hospitalist, Board certified internal medicine Hospitalist, Board certified family medicine
Tumor Board conferences Tumor Board conferences are held with the intenfeatured. In cooperation with the Continuing tion of providing a multidisciplinary, consultative Medical Education office, seven didactic forum to openly discuss, plan and educate on the presentations were given in 2009: diagnosis, treatment and appropriate follow-up of 1. “Case Studies in Chronic Pain: cancer patients at Mercy TUMOR BOARD A Multi-Modal Approach,” Health System. Physicians SITES DISCUSSED Dr. Vikram Patel submit current cases to Colon/Rectum 13 registry staff the week prior 2. “Palliative Medicine: An to the conference. Patient Lung 11 Overview,” Dr. Dena Green selection is often determined Lymphoma 10 3. “Society of Thoracic Surgeons by criteria such as: cases Breast (not including National Surgical Database: 6 that are prospective, interestBreast Conference) Paradigm for Outcome ing or challenging. A brief Thyroid 4 Reporting,” clinical presentation and Dr. Kenneth Wolnak Melanoma 3 a synopsis of diagnostic 4. “A New Era of Minimally Soft tissue 3 and pathologic studies are Invasive Surgery at Mercy Unknown primary 3 prepared. The moderators Hospital: Multi-Specialty encourage a consultative Anal canal 2 Implementation of the daVinci approach regarding Brain 2 Si Robotic Platform,” recommended surgical and Bladder 1 Dr. Nick Gianitsos therapeutic options along Esophagus 1 5. “Targeted Therapies in Lung with providing educational Gallbladder 1 Cancer,” Dr. Toby Campbell, information concerning University of Wisconsin Larynx 1 staging, innovative therapies, as well as additional various 6. “Update on the Evaluation Liver 1 related topics. Following the of Hematuria,” Ovary 1 presentation of all pertinent Dr. A. Vishnu Moorthy, Parotid 1 information, discussion University of Wisconsin Benign 2 regarding further recommen7. “Cancer Screening Total 66 dations is encouraged. Guidelines,” In March 2009, a multi-disciplinary Breast Case Conference was initiated to enhance the cooperative care of the breast cancer patients at Mercy Health System. Much like Tumor Board, the intent has been to create a consultative environment conducive to planning the best possible course for these patients. Each conference includes breast cancer cases diagnosed at Mercy Health System from the previous month. In 2009, 38 breast cases were presented at Breast Conference. Periodically, educational speakers with informative forums on a range of cancer-related subjects are
Dr. Shahid Shekhani Tumor Board conference is held on the first, third and fifth Thursday of each month. Breast Conference is held the second Thursday of each month. Attendees include physicians, residents, nurses, medical students and other allied health professionals. Educational value is available to those who attend. For more information regarding Breast Conference or Tumor Board, or to inquire about having a case presented, please contact Martha Roberts in the Cancer Registry at (608) 756-6107.
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Kidney cancer at Mercy Hospital and Trauma Center: 1994-2009 Francis F. Kaveggia, MD, FACS Department of Urologic Surgery Mercy Health System Although kidney cancer is primarily a surgical disease, its diagnosis may involve several medical specialties because these cancers have many presenting signs and symptoms. In fact, its initial diagnosis is often made incidentally during abdominal ultrasound, CAT scan, or MRI imaging performed for other reasons. The incidence of kidney cancer has risen over the past 20 years and represents about 2-4% of all cancers. These tumors account for 38,000 cases annually and approximately 13,000 cancer-related deaths. Thirty percent of patients have metastatic kidney cancer. The female to male ratio is approximately 2:1 and is most common in patients between the fifth and seventh decades of life. The incidence is highest in Scandinavia and lowest in Asia. It is more common in urban settings. Although most cases are sporadic, occasionally kidney cancer is associated with von Hippel-Lindau disease, tuberous sclerosis complex or other rare syndromes. The etiology of kidney cancer or renal cell carcinoma is unknown, however, several interesting associations have been found. There is a positive correlation between the incidence of renal carcinoma and a high consumption of fats, oils, milk and sugar. Obesity is also a risk factor. The strongest risk factor for developing
kidney cancer is tobacco use, with a twofold increased relative risk. Administration of estrogens in hamsters has been noted to produce renal carcinoma. Approximately 20 years ago, it was recognized that patients with renal failure who are undergoing hemodialyasis or peritoneal dialysis have increased risk for developing multiple kidney cysts and occasional kidney cancer. Mercy’s Tumor Registry provided data for Mercy Hospital and Trauma Center and comparison data from the Nation Cancer Database (NCDB) for years 1994-2009. Overall, the frequency of kidney tumors has been slowly but steadily increasing. During these 16 years, we treated over 200 patients with kidney cancer. The majority of kidney cancers are now found as asymptomatic incidental masses on imaging studies obtained for another purpose. The classical triad of hematuria, flank pain and a palpable mass is found in approximately 11% of patients. General symptoms such as weight loss, fever, anemia and night sweats are common. Paraneoplastic syndromes can also occur with kidney cancer with hypercalcemia, abnormal liver function test evaluation, or amyloidosis. Ninety percent of kidney tumors are comprised of renal cell carcinoma, with benign tumors such as oncocytoma and angiomyolipoma being less frequent. Other rare pathologic types of kidney tumor include sarcoma, hemangiopercytoma, lymphoma, and occasionally, tumors that metastasized from other sites.
Kidney cancer, continued Renal neoplasms are highly resistant to nonsurgical forms of therapy such as chemotherapy, radiation therapy, hormonal manipulation and immunotherapy. In the past few years, sunitinib and sorafenib have shown response in selected patients. Radical nephrectomy is the gold standard treatment for localized renal cell carcinoma with a normal contralateral kidney. Nephron-sparing surgery has also become more popular with absolute indications including solitary kidney, bilateral kidney tumors, and pre-existing chronic renal insufficiency. Laparoscopic and robotic-assisted surgery—either radical nephrectomy or partial nehrectomy— have become newer modalities of minimally invasive treatment. Renal artery emobolization or angioinfarction can be used to shrink the large hypervascular tumors before surgery, and to control bleeding as well as pain in symptomatic patients with inoperable renal cell carcinoma. Occasionally, tumor involvement of the vena cava can pose technical challenges.
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Gender Distribution - Kidney and Renal Pelvis Cancers
80 70 60 50 40 30 20 10 0
NCDB
MHS
62% 56% 44% 38%
Female
Male
Age Distribution - Kidney and Renal Pelvis Cancers 35
NCDB
MHS
30 25 20 15 10
Carcinoma of the renal pelvis and uterer account for 5% of urothelial neoplasms. The vast majority of these tumors are transitional cell carcinoma with etiologies similar to those of transitional cell
30
5 0
Mercy Health System Volume of Analytic Kidney and Renal Pelvis Cases by Year
80 70 60 50 40 30 20 10 0
Number of Cases
25 20 15 10 5 1995
1997
1999
2001 Year
2003
2005
2007
50-59 60-69 70-79
Pediatric 20-29 30-39 40-49
2009
80-89
90+
Stage Distribution - Kidney and Renal Pelvis Cancers MHS
NCDB
63% 48%
10% 9% 0%
10%
13%
16% 16%
2%
Stage 0
11% 1%
Stage I
Stage II
Stage III
Stage IV
Unknown
15
Kidney cancer, continued carcinoma of the bladder. Persons who consume large quantities of analgesics containing either aspirin or phenacitin have a nine-fold greater risk of developing transitional cell cancer of the renal pelvis. Balkan nephropathy, an environmental interstitial kidney disease of unknown cause, is also a risk factor. Certain occupational exposures to solvents also will pose a risk factor for carcinoma of the renal pelvis and ureter. Renal pelvic tumors and tumors of the upper ureter are best treated by radical nephrouretecomy where the kidney, adrenal, ureter, and a cuff of bladder is removed. The overall five-year survival rate following this type of surgery is 84%.
First Course Treatment for Kidney and Renal Pelvis Cancers
80 70 60 50 40 30 20 10 0
73%
18%
Stage 0
Stage 1
Tumor stage is the most important predictor of prognosis. Disease-specific survival after radical nephrectomy for five to 10 years for stage I disease are 90% and 85% respectively. For stage II disease, the five- to 10-year survival rates are 80% and 70% respectively. The phenomenon of spontaneous tumor regression is extremely rare and estimated at less than 1%. Metastatic disease most commonly goes to the lung, followed by lymph nodes, liver, bone and adrenal gland.
19%
8%
3% Stage 2
Stage 3
Stage 4
5-year Survival Rates for Kidney and Renal Pelvis Cancers 1998-2002 MHS
100
Percutaneous biopsy of kidney tumors is usually not recommended due to the high incidence of false negative biopsies. Kidney tumor biopsy may be indicated when lymphoma is suspected, for patients with a history of another primary malignancy to rule out metastatic disease, and for complex cysts for cytologic examination.
NCDB
MHS
79%
82%
80
74%
NCDB
75%
72% 63%
56%
60 40
29%
20 0
10% 9% NA Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
American Cancer Society Having cancer is hard. Finding help shouldn’t be. No matter what you need, the American Cancer Society can help. • Easy-to-understand information to help you make decision about your care • Referral for day-to-day questions such as financial, insurance, transportation and lodging • Connection to others who have been there for emotional support
American Cancer Society Cancer Resource Network goals • Reach more newly diagnosed patients, with a focus on the medically underserved • Deliver timely information and support programs • Promote informed decision-making • Enhance quality of life for cancer patients, survivors and caregivers
The American Cancer Society is able to provide support to cancer patients through its fundraising efforts. Events such as Daffodil Days, Walk/Run, and Relay for Life, supply the necessary funding to continue the mission of the American Cancer Society. Mercy Health System is proud to continue to be partners with the American Cancer Society, through sponsorships and support services. In 2010, the American Cancer Society raised more than $89,000 in the Janesville area, with the assistance of Mercy Health System participants.
• Enhance our relationships with patients, survivors and caregivers • Allow for a coordinated approach to promote ACS programs and services
Dr. Shahid Shekhani speaks to walkers/runners at the American Cancer Society’s Janesville Run/Walk, in June 2010
American Cancer Society Cancer Resource Network offerings: Information • 24-hour free phone help: (800) 227-2345 • On the Internet: www.cancer.org • Advice on clinical trials • Tools to help with your treatment Day-to-day help • Help finding transportation and lodging • Help with prescription questions • Help with financial and insurance questions
Emotional support • Help finding local support groups • Cancer education classes • An online community for cancer survivors and their families
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Radiofrequency ablation of renal cell carcinoma Gregory L. Denison, MD Department of Interventional Radiology Radiofrequency ablation is a new, minimally invasive alternative to surgery for the treatment for renal cell carcinoma. With this technique, a specialized, needle-like probe is placed into the tumor under CT scan or ultrasound guidance, and radiofrequency energy is applied. The radiofrequency energy generates heat that kills the cancer cells. Ablation is quite precise, so there is minimal to no damage to the kidney itself, thus preserving kidney function. For optimum patient comfort and safety, the procedure is usually performed under general anesthesia, although it can potentially be performed under conscious sedation. Patients whose health might not permit a more invasive surgery are the ideal candidates for radiofrequency ablation. Advantages of the procedure include shorter procedure time, very little post-procedure discomfort, and minimal recovery time—most patients go home the following morning. Radiofrequency ablation is particularly effective for tumors smaller than 3.5 cm. Five-year, disease-free, survival in patients with these small tumors is comparable to more invasive surgery, and if the tumor does recur, it can be safely re-ablated.
Radiofreqency ablation of renal cell carcinoma is performed in the interventional radiology department at Mercy Hospital and Trauma Center. For more information, call (608) 756-3005. 1. Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE. Oncologic Efficacy of CT-Guided Percutaneous Radiofrequency Ablation of Renal Cell Carcinomas. Am. J. Roentgenol., Aug 2007; 189: 429-436. 2. Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer. 2010 Jul 1;116(13):3135-42.
Mercy Hospice Care: offering comfort, support and caring Since 1994, the Mercy Hospice Care team
Mercy Hospice Care offers
has been committed to ensuring that every
comfort (palliative) care and
terminally ill person we serve lives out his
hospice home care services
or her remaining days in comfort. Mercy
for patients with life-limiting
Hospice Care provides a special team-
conditions. The hospice care
oriented concept of care to provide comfort
team addresses all symptoms of
and support to clients and their families when
disease with a special emphasis
a life-limiting illness no longer responds to
on controlling a patient’s pain
cure-oriented care. Members of the hospice
and discomfort and the emotional,
care team include the:
social and spiritual impact of the disease on the patient and their
• Patient
family members.
• Family members • Hospice medical director
In addition, specially trained
• Patient’s primary care physician
Mercy Home Health Care staff,
• Registered nurses
including nurses and aides,
• Social workers
provides comfort care to patients
• Spiritual counselors
with chronic or life-threatening
• Bereavement counselors
conditions including heart,
• Volunteers
respiratory, neurological and
• Hospice aides and others
orthopaedic diseases or cancer. These patients may continue to receive treatment, including chemotherapy, and other cure-oriented services. For more information, please call (608) 755-6920 or toll-free (800) 369-2201.
MercyAssistedCare.org
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Mercy Palliative Care Program Keith A. Konkol, MD Director of Mercy Palliative Care Program Since January 5, 2009, Mercy Hospital and Trauma Center has had an active in-hospital palliative care consultative service. The World Health Organization has succinctly stated that, “palliative care affirms life and regards dying as a normal process, neither hastens nor postpones death, provides relief from pain and other distressing symptoms, integrates the psychological and the spiritual aspects of care, offers a support system to help patients live as actively as possible until death, offers a support system to help the family cope during the patient’s illness and in their own bereavement.” In light of that definition, the Mercy Palliative Care Program strives to offer a high-quality service for patients, and their families with serious or life-limiting illness who are seeking life-prolonging or curative care, or are nearing the last stages of life. The Mercy Palliative Care Program accomplishes these goals by using an interdisciplinary team approach. This team includes the patient’s primary care physicians, medical and nursing specialists in palliative care, direct care nurses, clergy and discharge planners. By using the interdisciplinary team, patients and their families have the opportunity to discuss and plan the complicated goals of care, code status, transition to hospice, symptom management and their care at the end of life.
Many studies have shown that effective palliative care can manage fatigue, anxiety, breathlessness, nausea, depression, constipation and other distressful patient symptoms. A recent study demonstrated patients with advanced lung cancer actually lived longer when they were involved with early palliative care intervention in their diagnosis when compared to those patients who were not offered palliative care until later. Although this report focuses on patients with cancer, the benefits of palliative care can also be used in patients with congestive heart failure, emphysema, AIDS and other serious illnesses. The Mercy Palliative Care Program strives to coordinate complicated medical decisions through communication and excellent medical care to provide the highest quality of life possible for our patients with serious and life-limiting illnesses.
Pathology’s role in cancer treatment Over time, cancer has become a more common disease, killing more people every year and becoming more commonplace. With renal and other cancer rates steadily rising each year, early detection has become the best way to stop the spread of cancer, and leading the charge are pathologists around the world. Imagine you’re in the hospital getting a basic checkup, but your doctor finds something wrong during your physical examination. You come back for further testing and a small lump is found. Your doctor will test this area, most likely taking a tissue or fluid sample for further diagnosis. But does the doctor find out what the lump is himself? No, it is sent to the pathology department, where the material will be analyzed to determine the disease. Unsung heroes of the medical world, pathologists deal in determining the nature, cause of and ultimate treatment of disease in patients. The vast majority of cancer diagnoses are made or confirmed by pathologists. While pathologists don’t see patients directly, they act as consultants to other physicians, offering their advice and diagnoses.
Pathology, by definition, is the study and diagnosis of disease through examination of organs, tissues, bodily fluids and whole bodies. Using hospital laboratories, pathologists and lab technicians work to tirelessly test samples and diagnose disease through molecular, microscopic and chemical testing, ensuring that no patient leaves without the correct diagnosis and treatment. The Mercy Health System Pathology Department is here for the diagnosis and determination of the disease. Ensuring that all patients are cared for correctly and comfortably is a big part of Mercy Health System’s commitment to the communities it serves, and our pathology department is on the front lines of stopping disease in its tracks.
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Mercy Regional Cancer Center: hematology/medical oncology clinic The hematology/medical oncology clinic of Mercy Regional Cancer Center is located on the second floor of the Sister Michael Berry Building on the Mercy Campus, Janesville. Services are also offered at Mercy Walworth Hospital and Medical Center.
Mercy Regional Cancer Center hematology/oncology clinic
mission statement
The clinic treats patients with hematology or cancer diagnoses. The care team includes oncologists, a nurse practitioner, registered nurses (83% are oncology certified nurses), medical assistants, a social worker, a patient financial counselor, a dietitian and support
The Hematology/Oncology
personnel, including a receptionist and medical records clerk. All care
Clinic of Mercy Health
team members work together with the common goal of providing
System exists to provide
quality, compassionate care to the patients who enter through the
patients superior care and
doors seeking hematology or oncology services. On-going communi-
state-of-the-art therapy
cation with the patient’s primary care physician, radiation oncologist
for cancer and blood disorders. The Mercy
and/or surgical oncologist is maintained to ensure continuity of care. Individualized chemotherapy treatments are administered to patients
Hematology/Oncology
in the hematology/oncology clinic by specially trained RNs under
Clinic will achieve a high
the directive of the medical oncologist. Patients receive their treat-
level of patient satisfaction
ments in a comfortable environment. Chemotherapy treatment plans
through coordination of
are individualized based on numerous factors, including cancer type
treatment, commitment
and stage of disease. Leading-edge chemotherapy treatments are
to quality, superior patient
available to patients. Supportive treatments for patients are also
care, and an exceptional
available in the treatment room, including other intravenous infusions,
degree of caring and compassion for our patients and their families.
lab draws and injections. Our hematology/oncology patients also have the option to participate in clinical trials. Mercy’s hematology/oncology clinic is affiliated with the Eastern Cooperative Oncology Group of the
608•756•6871 800•928•1103
National Cancer Institute, as well as the Wisconsin Oncology Group. Chemotherapy treatments for breast cancer, lung cancer and colorectal cancer are just some of the clinical trials available through these affiliations.
From our partners …
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“I want to be there for them to take care of them in every aspect. Whether they have an emotional or physical need, I want to be there for them. “I am proud to be a Mercy partner. I think we have a great group of people that work here. I have my own doctors here for my family and find them to all be very caring people with very caring staff. I am probably most proud of my department. I feel we are a unique crew that goes the extra mile. We are there for our patients and for each other.
Angela Butters “I am a 42-year-old mother of a little boy who turned three in November. I enjoy gardening, cooking and reading books. But what I enjoy most is spending time with my son, whether it
Why I work in oncology ... That is an easy answer. I do it for the patients. Angela
is swimming or playing with cars. “I have been a registered nurse for 14 years and have worked as an oncology nurse for 12 years. I work in Mercy’s medical oncology department as a triage nurse for Dr. Shahid Shekhani. “I am asked repeatedly why I work in oncology and how I can handle doing what I do. That is an easy answer. I do it for the patients. Oncology patients are very special and have special needs.
“My patients and my co-workers keep me motivated. My biggest reward is knowing that I do whatever I can on any given day to take care of whatever my patients need. Sometimes it might be something beyond my control (such as financial issues), but just listening or pointing them in some directions for financial help goes a long way. More than anything, patients just want to know that they are being listened to and that you care.”
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Mercy’s clinical trial program Emily Robinson, MD Department of Medical Oncology Mercy Health System At the Mercy Regional Cancer Center, we continually strive to offer cutting-edge treatments in a coordinated care approach to ensure the best possible patient experience and provide access to the latest advances in cancer care, close to home. When patients with newly diagnosed cancer are seen in the medical oncology clinic, they are often considered for clinical trials. As members of the Eastern Cooperative Oncology Group and the Wisconsin Oncology Network, we have several phase II and phase III trials available for patients with the most common diagnoses. Our clinical trial program opened in 1997, and we currently have 18 trials open for accrual in breast cancer, lung cancer, colorectal cancer, multiple myeloma, and chronic lymphocytic leukemia/small lymphocytic lymphoma. Most of the trials open at Mercy Regional Cancer Center are large, phase III clinical trials comparing promising new treatments with standard treatments. We also have a few phase II trials that are testing new treatments in smaller groups of patients to determine effectiveness. Our patients have recently participated in trials that led to the FDA approval of several new cancer therapies. The clinical trial program closely works with the Mercy Health System Institutional Review Board (IRB) to make sure the patient’s needs are being
met. The IRB is made up of physicians, community representatives and clergy. The IRB approves all studies before they are opened, and monitors the research on a regular basis. The role of the IRB is to protect the rights of research participants and to ensure the safety of the patients participating on trials. Our research team consists of the patient’s oncologist, the research nurse and data manager, the principal investigator, the chemotherapy nurse, and the oncology nurse practitioner. Each member has a specific role in making sure patients participating on research studies are treated according to the protocol in a safe manner. One advantage of clinical trials is the extra attention patients receive before, during and after their treatments. Clinical trials are an opportunity for patients to benefit from advances in cancer care. Through our community program, many patients are able to receive the newest treatments close to home, without having to travel to a larger city. If there is not a clinical trial available for patients locally, our research team has access to researchers at nearby major universities and cancer centers, and is able to help interested patients navigate the way to appropriate care.
clinical trial program, continued Your cancer clinical research team Oncologist • Identifies patient for clinical trial • Conducts discussion of risks and benefits • Obtains informed consent • Directs study treatment as outlined by the protocol • Monitors response and side effects
If you’d like more information about
Research nurse/data manager • Screens patient for eligibility • Monitors treatment plan, response and toxicity • Collects data to send to study sponsor • Reports adverse events to sponsor and the National Cancer Institute • Communicates with IRB
Center at (608) 756-6871 or
Principal investigator • Reviews potential studies for participation • Presents new studies and follow-up reports to IRB regularly • Oversees adherence to study protocol • Reviews adverse events in study patients Oncology social worker/counselor • Meets with all new cancer patients • Provides emotional support before, during and after treatment • Provides resources for patients as needed Chemotherapy-certified oncology nurse • Administers study treatment • Monitors side effects Oncology nurse practitioner • Monitors patients between visits with oncologist • Assesses for side effects
your suitability as a clinical trial participant, talk to your doctor or call the Mercy Regional Cancer
toll-free (800) 928-1103.
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Genetic testing for hereditary cancer syndromes Linda Brethauer, APNP, AOCN Department of Medical Oncology Mercy Health System Genetic information and testing is a part of cancer care. Those patients who are diagnosed with breast, ovarian, colon and/or other specific cancers before the age of 50, or have a strong family history of those cancers, are recommended to receive personalized information and counseling for hereditary cancer syndromes. Some families have a gene mutation that can be passed on from parent to child, causing increased risk for particular cancers. At Mercy, we provide counseling and assistance with testing for hereditary breast/ovarian cancer syndrome and hereditary colon cancer. Most patients tested will not have the gene mutation. Less than 10% of patients tested are found to have the gene mutation that increases the risk of cancer. Patients who have the gene mutation are offered treatment options that significantly decrease their risk of cancer. Family members may also undergo testing. If there is a gene mutation in the family, each person has a 50% chance of inheriting it. Genetic testing is recommended when certain risk factors or “red flags” are present.
These include: • Diagnosed breast, colon, intestinal or uterine cancer before the age of 50, or ovarian cancer at any age. • Three successive generations of a combination of these cancers in a family, with one person diagnosed before age 50. Genetic testing can be a valuable tool for decreasing the risk of cancer in families with these gene mutations, and for decreasing anxiety in individuals without the gene mutation. If you or your family have any of the red flags for risk of having hereditary colon cancer syndrome, or hereditary breast/ovarian cancer syndrome, talk to your doctor about your concern and for referral.
What our patients say ... “I cannot imagine anyone having better cancer treatment than I have had at Mercy, and with integrated, state-of-the art treatment. Dr. Robinson and her outstanding team of nurses and health professionals provided everything I needed to be able to continue working and managing my day-to-day activities throughout my treatments. “No one wants a cancer diagnosis, but my journey to remission was made easier by the Mercy Regional Cancer Center, and the team of professionals that brought me back to enjoying each day. I am thankful for having had excellent cancer care at Mercy Health System.” Sharon Krueger Lymphocytic leukemia survivor “From the time of my diagnosis with chronic lymphocytic leukemia during the summer of 2008, the Mercy Health System staff worked as a team to provide excellent care. “My team consisted of: Dr. Jane Anderson – primary care physician Dr. B.K. Wasiljew – surgeon Dr. Alan Muraki – radiologist Dr. Emily Robinson – oncologist Rev. Doug Dowling – chaplain “Each member provided his or her expertise in preparing me for the months of treatment that I faced.
I cannot imagine anyone having better cancer treatment than I have had at Mercy. Sharon
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Mercy Regional Cancer Center: radiation oncology Mercy Regional Cancer Center’s radiation oncology department is located adjacent to Mercy Hospital and Trauma Center and Mercy West Clinic . Patients receiving radiation therapy have easy access to many services. Radiation therapy is performed by multiple members of the care team. Team members include the radiation oncologist, a nurse practitioner, a medical physicist, dosimetrists, radiation therapists, plus a registered nurse, social worker, patient financial counselor and dietitian. Support services are provided by the receptionist and cancer registry staff. The care team carefully coordinates the therapy to be administered to the patient, assuring quality care. On-going communication is maintained with the patient’s primary care physician, and referring specialty physician such as the urologist, gynecologist, otolaryngologist, medical oncologist, and/or surgical oncologist to ensure continuity of care.
State-of-the-art radiation treatment options are available at the Mercy Regional Cancer Center. These options include external beam radiation therapy, intensity modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), high-dose radiation therapy (HDR) and Mammosite®. Radiation treatments are individualized based on numerous factors including cancer type, stage of disease and site to be treated. The goal of all therapy is to deliver a high dose of radiation directly to the tumor while minimizing damage to surrounding healthy tissue. The Mercy Regional Cancer Center uses the PRIMATOM™ treatment system to deliver its radiation treatments. Patients receiving radiation therapy at the Mercy Regional Cancer Center also have the option to participate in clinical trials through an affiliation with the Radiation Therapy Oncology Group.
608•756•6500
800•261•6565
From our partners ... “I am so glad that I applied for this job and was hired in August 1995. It has been 15 years since I started and the years have flown by. I do not consider the receptionist job a ‘job.’ It’s fun, rewarding, and I meet wonderful people every day. I can help them forget about their illness through humor and conversation. I decorate the department to keep it festive and bring in my flowers to keep it cheerful. Many of the patients I have met return to say ‘hi’ or enjoy a cookie on our Wednesday cookie days, even though their treatment was 10 years ago.
Bonnie Anderson Eichstedt Receptionist “Growing up, I always knew I would have a job that would help people. I graduated from college in 1980 with a Bachelor of Science degree in recreation. I became a travel agent, but my husband’s job relocated me to Janesville. I needed a job.
“I have many duties: answering phones, checking in patients, making up charts, requesting medical records, taking co-pays, etc. These keep me busy between greeting my new friends as they enter the clinic for their new consults, return for their follow-up appointments, or just come in for their daily treatment. Each and every patient needs a little tender loving care every day.
Growing up, I always knew I would have a job that would help people.
“I treat each patient, as well as my Mercy “I am so grateful that partners, as I would Mercy Health System like to be treated. I hired me as part of its feel that smiling is family in April 1990. I the simplest thing I Bonnie was an admitting clerk can do to make and then went on to someone feel better, become a receptionist even if the day is at Mercy Clinic South when the family medicine not going the way we want it to. residency program began. I was asked by a Mercy partner if I would like to work at the “This is my home away from home. I look Cancer Center as their receptionist. I told her forward to coming to work every day.” I didn’t know anything about cancer, but she reassured me that it wasn’t necessary. She said that with my people skills and personality, this would be the job for me.
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Mercy Regional Cancer Center: surgical oncology Patients whose cancer treatment regimen requires surgery look to the Mercy Regional Cancer Center’s surgical oncology department, staffed by board certified surgeons and support professionals with years of experience. Our surgeons’ offices are located at the Terrace Building, just across the parking lot from Mercy Hospital and Trauma Center, where the surgical procedures are performed. The surgical oncology department employs: Technologically advanced procedures, including minimally invasive techniques that use a small scope. The small incision needed for the scope to enter the body offers the advantages of faster in-hospital recovery, faster healing, less pain, and minimum risks as compared to traditional surgical techniques. Screening, surveillance and diagnostic upper and lower gastrointestinal fiberoptic endoscopy is also provided by the department. A wide variety of cancer-related surgeries for all stages of cancer treatment. These include removing cancer that has spread (metastasized) beyond the original tumor; removing the majority of malignant tissue (called debulking) in preparation for chemotherapy; and reconstructive surgeries that help patients look and feel their best, leading to emotional healing. Continuous multidisciplinary review of individual cases, through pathways such as the Tumor Board and the Mercy Cancer Registry. In this way, the surgical oncologists review and implement quality controls, provide and receive ongoing physician education, and evaluate existing technology to guarantee our patients receive quality care that’s held to the highest standards.
608•756•7277
From our partners ...
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to comfort them with a smile or words, and I become their guide through the many appointments and questions, offering them a shoulder to cry on. “Recently, one of my patients stopped by and she was crying because her phone had been turned off, since she needed to use her money to make the house payment. She did not know what time to be at the hospital the next day for surgery. I called the job center and was able to help her receive emergency financial assistance. I like that my patients feel they can count on me to help them when they have a need—no matter what type of need arises. Phyllis Garner “I’m motivated by my ability to make a difference for my patients. “I have been a Mercy partner for 18 years, and my nursing career spans 40 years. I feel privileged to be spending the last years before my retirement at Mercy. “The great satisfaction I get from making a true difference in someone's life gets me to the job every day. While I have been with Mercy, I have always worked in the surgery department, working with Dr. Wasiljew for 17 years. “The word teamwork applies across the board, and our department staff truly expresses Mercy’s mission. “Every day, I deal with patients who are scared of the unknown. With just a few words—’you have cancer’—their life has changed. It is my job
“It gives me great satisfaction to be stopped and told, ‘You truly made a difference when I was scared.’ “Every Mercy partner has one agenda and that is to help the patient at one of his or her most vulnerable times. What we as health care providers need to remember is that an extra smile, kind word or just a listening ear, can make all the difference for our patients.”
I’m motivated by my ability to make a difference for my patients. Phyllis
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From our partners ... I was impressed with Mercy’s many multi-specialty clinics and hospitals in Wisconsin and Illinois, and my original intention was to work for the Mercy Regional Plastic Surgery, Skin & Laser Center. “To get my foot in the door, I accepted a position as a medical assistant in the general surgery department and have decided to stay! I’m grateful for the opportunity to work with four meticulously skilled and reputable surgeons. “Along with assisting the surgeons in taking care of the physical needs of our patients, my main goal is to instill quality assurance. Every patient I meet is greeted with a warm smile, kind words of compassion, and occasional hugs when needed. I am the first person the patient sees before meeting the surgeon. I strive to ease their fear and anxiety of surgery, and assure them they are in good hands.
Heidi Canfield, CMA “My name is Heidi Canfield, and I've been a certified medical assistant for 14 years. I am also a licensed esthetician and a certified professional coder. I work in the general surgery department at Mercy Terrace as a medical assistant. I live in South Beloit with my husband, Chris, and my feisty feline, Petee. “While job hunting for a position as a medical esthetician, I learned about Mercy Health System.
I strive to ease their fear and anxiety of surgery, and assure them they are in good hands. Heidi
“Last fall I had the pleasure of meeting a patient who had just been diagnosed with breast cancer. On her initial visit, she was sporting a Boston Red Sox jersey, a baseball hat and carrying a baseball bat. She informed me that her bat and attire symbolizes her fight against breast cancer. Her motto is ‘I'm gonna knock this outta the park.’ This woman is amazing. Her positive attitude, determination and inner strength are contagious. “Being a baseball fan myself, I put a call into a friend who works for the Louisville Slugger Company. That friend sent me a regulation-size, pink, Susan G. Komen Foundation bat, personally engraved with the patient’s name. “Unannounced to the patient at her next post-operative visit, I presented her with the pink bat. She was flabbergasted and could not find words to thank me enough, but the look of joy on her face was all the thanks I needed. The pink bat now displays signatures of Mercy partners who have been involved in her care throughout her journey. “As health care professionals, we have the ability to make a difference in this game of life.”
What our patients say ...
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“There are not enough adjectives to describe Dr. Garner; she is very professional, gentle, compassionate and honest. I’ll never forget my first visit to see her. She acted like she had all the time in the world for me.” Ms. Brayer had a mastectomy on her right breast shortly after she was diagnosed with cancer. Several months later, she opted to have a mastectomy on her left breast. “If you have breast cancer in one breast, that increases the chances of getting cancer in the other breast,” she said. “And I told the cancer, ‘I’m not giving you another chance.’”
Joan Brayer Breast cancer survivor
A year after her diagnosis, Ms. Brayer is healthy and cancer free. She credits her well-being to the early detection of her cancer and the medical staff at Dr. Garner’s office.
Joan Brayer was diagnosed with breast cancer at the tender age of 58. That day, September 24, 2009, will forever be etched in her memory. Her battle with breast cancer and her journey to recovery started with a routine mammogram in early September 2009.
“Each and every visit to Dr. Garner’s office— from the receptionists to the nurses—was super personal. They treat you like you’re the only one there. It’s like a family. I was very impressed.”
Ms. Brayer, a baseball enthusiast, was told she needed to have a repeat mammogram on her right breast and then a stereotactic biopsy. “It didn’t surprise me,” Ms. Brayer said. “I had a suspicion something was wrong. But you don’t ever think that you’ll ever hear those words.” Those words, considered fighting words to her, were difficult to digest. But Ms. Brayer was ready for the battle. “I’m a sports person. I love baseball. And in baseball if you don’t step up to the base, you’ll never know what would happen. I have always been a fighter and this cancer doesn’t know who it’s dealing with.” Ms. Brayer remained under the medical care and guidance of Dr. Patricia Garner, who stood by her every step of the way.
I have always been a fighter and this cancer doesn’t know who it’s dealing with. Joan Dr. Garner’s staff also presented Ms. Brayer with a pink Louisville Slugger. The bat, which she carries around as a symbol of strength and her love for the game, is a constant reminder of her journey from cancer patient to cancer survivor. “Baseball is comparable to life,” Ms. Brayer said. “You can’t get to home unless you go to first, second, and third base. And you never know what’s going to happen in between.”
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What our patients say ... Coreen started her first round of chemotherapy May 5. “Dr. Emily Robinson sent me for a heart scan to make sure my heart was strong enough to handle all of the chemo drugs. I was on the low end of normal, so she decided to not start me on a certain drug. I haven’t had any nausea with my radiation treatments, which has helped.” Coreen also met with Dr. Bart Schmidt in the radiology department. “The radiology department has been awesome. Dr Schmidt explained the entire procedure to me, and what to expect. It was still very painful, but I was prepared for it because of him. Mercy did an awesome job.”
Coreen Smith Breast cancer survivor Coreen had just graduated from Blackhawk Technical College with a certified nurse’s assistant diploma. But when she discovered a lump on her left breast, she realized that she was going to have to get it taken care of as soon as possible. Her plans for searching for a CNA position were put on hold. Coreen went to her family doctor and was referred to the hospital for a mammogram. That same day, she was sent for an ultrasound and three days later was given her results. “They told me I had a very aggressive, fast-spreading cancer, but it was caught in Stage 1.” With this shock to her system, Coreen changed her plans. Instead of pursuing a career in nursing, she would become a survivor. “I thought that there are so many survivors out there, I will be one of them too.” She met with Dr. Bud Wasiljew, who did her lumpectomy on April 5. “Dr. Wasiljew did an amazing job, and his nurse, Phyllis, is a sweetheart.”
… there are so many survivors out there, I will be one of them too. Coreen
Coreen says she can give a lot of advice to someone with a similar diagnosis. “Follow your doctors’ orders, and don’t be petrified of what is going to happen to you. You are going to lose your hair really quick, but get a short haircut. Who cares if people see you bald? It’s easier to lose two inches of hair than really long hair like I had.” As of July 2010, Coreen was still undergoing treatments at the Mercy Regional Cancer Center, and was taking things “one day at a time.”
Compassionate care for special concerns The expert staff at the Mercy Regional Urology Center knows how uncomfortable and difficult it can be to discuss sexual and urologic health problems. In fact, many people hesitate to seek treatment because of the very private nature of these concerns. There are two important facts you need to know. First, these problems are almost always treatable, often with excellent results. Second, we specialize in making you feel at ease throughout diagnosis, treatment and follow-up care for your personal needs. The Mercy Regional Urology Center treats all general adult and pediatric urologic concerns. Beyond using the latest technology such as laser therapy and da Vinci robotic surgery, we also have a number of special treatment programs for men and women.
For men – • Treatment for erectile dysfunction • Vasectomy reversal • Treatment for all prostate and bladder problems • Seed implantation therapy for prostate cancer • Treatment for cancers of the urinary tract • Treatment for urinary tract infections • Treatment for infertility problems • Therapy for voiding dysfunction • Treatment for kidney and bladder stones • Microwave Laser therapy for enlarged prostate For women – • Treatment for sexual dysfunction • Treatment for cancers of the urinary tract • Therapy for voiding dysfunction • Infertility problems • Treatment for kidney and bladder stones • Stress incontinence treatment, including • SPARC female sling system Services offered by the Mercy Regional Urology Center are located in Janesville and Lake Geneva, Wisconsin, and Harvard and Woodstock, Illinois. For more information, call Mercy HealthLine at (866) 39-MERCY.
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Mercy Institute of Neuroscience The Mercy Institute of Neuroscience is proud to offer personalized, multi-disciplinary care for neuro-oncology patients. Consistent with the Institute’s mission to provide comprehensive, coordinated care for all neurological patients, the Neuro-Oncology Focus Group was developed to ensure that patients with brain or spinal tumors also receive this level of high-quality care. Specialists from a variety of disciplines, including neurosurgery, medical and radiation oncology, neuro-radiology, pathology, pain management, and health and rehabilitation psychology, are involved in the group. The central goals of the Neuro-Oncology Focus Group involve tailoring treatment to the individual patient’s needs as well as facilitating ongoing communication among involved practitioners, the primary care provider, and the patient. Once a patient is referred to the group, a treatment team is developed as indicated by the patient’s initial presentation, and a meeting between the patient and team is arranged. The first half of the meeting includes discussion of the patient’s case among the team practitioners and development of a tentative treatment plan based on review of medical records and imaging. The patient and his or her support persons (e.g., family, friends) are invited to the second half of the meeting to meet treatment team members, hear the team discuss the diagnosis and treatment plan, and ask any questions they have. Following the meeting, the Institute’s administrative staff schedules and informs the patient of initial appointments.
608•756•6830 866•901•MIND Neuroscience.MercyHealthSystem.org
The Institute then continues to coordinate care among providers and serves as a central resource for the patient regarding any concerns he or she may have as treatment progresses. In accordance with recommendations from the American Cancer Society, efforts are made to keep the patient informed and actively engaged in his own treatment and decision-making. The patient receives a folder that includes information about his treatment plan and providers, as well as a personal notebook to document important information during his treatment (e.g., test results, symptoms, appointment schedules, side effects, questions). Information about education and support resources are also given to the patient by the hematology/ oncology clinic. Practitioners have reported their appreciation of this team-based approach that allows them to more easily facilitate coordinated, and thus, higher quality, care for their patients, while patients continue to appreciate the involvement they have in their care throughout this interactive treatment process.
da Vinci Si HD Dual-Console Surgical System Mercy’s new da Vinci Si HD DualConsole Surgical System provides surgeons with an alternative to traditional laparoscopic or open surgeries, putting a surgeon’s eyes and hands at the controls of a state-ofthe-art robotic platform. The da Vinci system enables Mercy surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision. To a surgeon, da Vinci surgery looks and feels like traditional surgery, but with more intricate robotic capabilities. With greater color magnification and depth of field, the da Vinci Surgical System’s high-resolution 3-D vision provides surgeons improved clarity and detail of tissue and anatomy—critical factors when performing delicate procedures. Da Vinci’s dual consoles also allow two Mercy surgeons to simultaneously collaborate during surgery. This ensures that two surgeons—meaning two sets of eyes, hands and skills—are involved in the surgery. To learn more about the da Vinci, visit daVinci.MercyHealthSystem.org, or call (877) 922-2350.
©2009 Intuitive Surgical, Inc.
Benefits to our patients: • • • • • • • • •
Reduced complications Reduced hospital stays Reduced recovery time Requires just a few tiny incisions for minimal scarring Faster post-surgery recovery (days versus weeks) Significantly less pain and less blood loss Less risk of infection Faster return to normal activities Overall increased satisfaction
Surgeries performed:
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support services American Cancer Society Cancer Resource Network One call puts you in contact with experts trained to give in-depth information to cancer patients, their families and their caregivers. They’ll put you in touch with community resources, including those offered at Mercy Health System, and help you deal with the multiple medical, financial, emotional and social concerns of having cancer. See p. 16 for more information. These experts are available 365 days a year and can be reached at (800) 227-2345. Mercy Regional Breast Center Breast cancer is the second leading cause of cancer death in women in the U.S. Regular screening, including monthly breast self-exams, is vital in order to find and treat breast cancer early. The Mercy Regional Breast Center now offers digital diagnostic and screening mammography, plus breast MRI, breast ultrasound, stereotactic breast biopsy, and DEXA bone density testing. For more information, call the Center at (608) 741-6999. Especially for breast cancer patients Whether you’ve had a lumpectomy or a mastectomy, Mercy’s certified post-mastectomy fitters at the new Women’s Boutique at the Mercy Health Mall in Janesville can enhance your quality of life by helping you find just the right breast forms and bras. They meet with each woman privately to assess her needs and suggest products for a natural appearance and all-day comfort. The Women’s Boutique carries the top brands in breast forms and bras, and also offers breast form covers, bra extenders, swimwear, lingerie, lymphedema sleeves and pumps, turbans, hats, lotions and product cleansers. For appointments and more information, call (608) 755-7989 or toll-free (800) 279-5810.
Community cancer screenings For most cancers, finding and treating them early are the keys to living a longer life and enjoying a better quality of life. Early detection is key to winning the war on cancer. Mercy Health System offers periodic cancer screenings— most are free—throughout the year. Call Mercy HealthLine at (888) 39-MERCY or visit MercyHealthSystem.org for more information about upcoming screenings. Mercy Complementary Medicine Center True health requires a delicate balance of physical, emotional and spiritual wellness. When that balance goes awry—as it often does with cancer—your health may require several forms of medical treatment. That’s where complementary medicine’s greatest strength lies. As its name implies, it is used as a complement to conventional medicine, and the two together can offer powerful medicine that can restore health. Whether you choose acupuncture, chiropractic or massage therapy as a complement to your traditional treatment, you’ll find the experience and understanding you want at the Mercy Complementary Medicine Center, located inside the Mercy Health Mall, Janesville. While its practitioners work closely with Mercy’s physicians, a physician referral is not required to make an appointment. For more information, call the Center at (608) 741-6799.
support services Mercy Health System Foundation Since the late 1800s, Mercy Health System has saved thousands of lives, brought tens of thousands of babies into this world and improved the health and wellbeing of millions of individuals throughout southern Wisconsin and northern Illinois. In the work that we do, there is no one and nothing more important than our patients and their experiences with us. Help for emotional healing Having cancer means more than treatment for the disease itself. Some individuals struggle with anxiety, depression and other emotional problems that require more than talking with family members or friends. When life seems overwhelming, the mental health therapists, psychologists and psychiatrists at Mercy Options Behavioral Health Services are here to listen and help you heal. For referral information, please call (800) 341-1450. Exercise programs: Journey to Health Exercise Program This is an exercise and stress management program designed to help cancer patients combat the effects of cancer treatment and improve their quality of life. Offered at the Mercy Cardiac Fitness Center at the Mercy Health Mall, Janesville. For complete information, call (608) 755-7996. Financial counseling Mercy’s oncology patient financial counselor assists patients with their concerns about the unexpected costs of treatment and/or lack of insurance coverage. This includes help deciphering forms and referrals to appropriate community resources. For more information, call (608) 756-6500.
If you have benefited from our efforts, perhaps you would consider becoming part of our Grateful Patient donor program as a way to show your appreciation. Your gift of gratitude becomes an instrument of healing for others and can be used in any number of ways at your request. Your gift can be earmarked to any of the following areas: • General fund • Holly J. Barten Memorial Fund to help cancer patients and their families • House of Mercy Homeless Center • Mercy Hospice Care • Mercy Health System Family Medicine Residency Program • Mercy Medical Technology Fund • Mercy Regional Cancer Center • Mercy Regional Plastic Surgery, Skin and Laser Center For complete information about the Mercy Foundation, please call (608) 741-2422 or visit MercyHealthSystem.org.
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support services A health library at your fingertips You may have general questions about your condition outside of your doctor’s appointment. If you have access to the Internet, you have access to the comprehensive health library at Mercy Health System’s website, MercyHealthSystem.org. Here you’ll find a huge online library that discusses conditions, procedures, medications, natural and alternative treatments, plus offers a dictionary, interactive tools and more—in English or Spanish.
Lymphadema Treatment Program Cancer treatment that includes radiation therapy or removal of lymph nodes can sometimes lead to lymphedema, a condition characterized by uncontrolled swelling of a limb. If left untreated, the damage caused by lymphedema is irreversible and progressive. Prevention is the key. However, if it does occur, Mercy’s Lymphedema Treatment Program can be very effective in helping individuals learn to control their condition and improve their quality of life.
Comprehensive Inpatient Rehabilitation Some cancers require only a quick fix. But others may require hospitalization and rehabilitation to address serious side effects caused by treatment. When these patients are discharged from the hospital, but are not yet ready to return home, the Comprehensive Inpatient Rehabilitation Unit (CIR) at Mercy Hospital and Trauma Center provides an excellent option. CIR’s experienced team of physicians,therapists and rehabilitation nurses design patient-specific treatment plans to help each patient achieve his or her greatest level of function and independence. When patients are almost ready to return home, a therapist will visit the home and assess it for safety concerns and make recommendations. Acute care coordinators will also coordinate any services needed after discharge from the CIR. A physician’s referral is required to enter CIR programs.
A physician’s referral is required to begin therapy. For more information, call the Mercy Sports Medicine and Rehabilitation Center in Janesville at (608) 755-7880, or in Lake Geneva (Mercy Walworth Sports Medicine and Rehabilitation Center) at (262) 245-4980. Nutrition counseling According to the American Cancer Society, a third of all cancers are related to diet and activity factors. Maintaining a healthy weight—and thus lowering your risk of getting cancer—is made easier by knowing what to eat. Knowing what to eat is also a concern for those battling cancer. Mercy Health System has several registered dietitians who can help you make healthy choices. A physician’s referral is required. For more information, or to make an appointment, call Mercy HealthLine at (608) 756-6100 or (888) 39-MERCY. Mercy Orthotics and Prosthetics Center Some cancer treatments can affect walking and movement or require the removal of a limb. The certified orthotists and prosthetists at the Mercy Orthotics and Prosthetics Centers are experts at fabricating and custom-fitting orthopaedic braces and prosthetic devices to help improve the patient’s quality of life. To find a center near you, call Mercy HealthLine at (888) 39-MERCY.
support services Mercy Pain Center The physicians and nurses at the Mercy Pain Center, located on the ground floor of Mercy Hospital and Trauma Center, offer consultation for complex pain problems, whether chronic or acute. Upon referral by a physician or health care professional and acceptance into the program, the patient receives a comprehensive evaluation and individualized pain management plan. For more information, call the Center at (608) 756-6049.
Pastoral care Part of Mercy’s mission is to meet the spiritual needs of all patients, including those in our cancer treatment programs. When indicated or requested, our hospital chaplain will meet with patients and family members to assess spiritual needs. We are happy to make a referral to the patient’s own faith group for spiritual care and our chaplain will provide direct care when there is no faith group affiliation or when that person is unavailable. We also provide a chapel and healing garden at Mercy Hospital and Trauma Center as serene spaces for prayer, meditation, and reflection. For more information about Mercy’s pastoral care, call (608) 756-6000.
Mercy Regional Plastic Surgery, Skin and Laser Center The plastic surgeons at the Mercy Regional Plastic Surgery, Skin and Laser Center perform some of the most advanced medical procedures in the world with the eye of an artist, bringing new shape and attractiveness to the human form. They can refashion and repair to wholeness the unique features that once were present but chance has altered. Our estheticians (Janesville) can help show cancer patients how to improve their skin tone and texture, and ways to apply makeup to minimize the visible side effects of treatment. The Center has locations in Janesville and Lake Geneva, Wisconsin, and Woodstock and Vernon Hills, Illinois. For more information, please call (800) 236-6868 or visit MercyPlasticSurgery.org. Effective treatment for skin cancer As with most cancers, early detection and treatment of skin cancer is the key to a cure. Because some skin cancers can be large with an extensive root system, traditional treatments do not always detect and remove these deep areas of cancerous tissue. One very successful way to treat skin cancer is with Mohs micrographic surgery. Only cancerous tissues are removed, which spares healthy tissue in the affected area. Due to the methodical way in which tissue is removed and examined, Mohs surgery has one of the highest reported cure rates of all skin cancer treatments. Manish Gharia, MD, board certified dermatologist and Mohs surgeon, practices at Mercy Walworth Hospital and Medical Center. For complete information, call the Center at (877) 893-5503.
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support services Transfusion/infusion services Outpatient transfusion and infusion services are not only cost-efficient, but save time for our patients. Education sessions describing treatment, alternatives and possible side effects allow patients the opportunity to have their questions answered. Transfusion services are coordinated through the Mercy Treatment Coordination Center. For complete information, call (608) 756-6601.
Wigs for Patients For many people, especially women and children, the loss of hair due to medical conditions can often lead to a loss of self-esteem and self-confidence. The Mercy Health System Association of Volunteers established its award-winning Wigs for Patients program because it knows that when people look good, they feel good. And when they feel good, they can deal with health challenges with confidence and a hopeful attitude.
Mercy Regional Urology Center People with cancer of the bladder, prostate, testes and other urological cancers will find expert care at the Mercy Regional Urology Center. Here, the board certified urologists and support staff offer the latest diagnostic tests, procedures, therapies and ongoing treatments available. Services are offered in Janesville and Lake Geneva, Wisconsin, and Harvard and Woodstock, Illinois. For general referral information, call (608) 741-6991 or (866) 486-6991.
The Wigs for Patients program offers high-quality wigs, free or at limited cost, to patients in need. Features Hair & Nail Company and Coulterz Cutz in Janesville have specially trained cosmetologists available to consult with our patients, cut and style their wigs, and teach them how to properly care for their new wigs at home. For more information, or to make an appointment for a confidential appointment in a private room, call Features Hair & Nail Company at (608) 756-0307 or Coulterz Cutz at (608) 752-2490.
Support Groups Bereavement Support Group For individuals who are grieving the loss of a loved one For complete information: (608) 754-2201 Cancer Support Group For individuals affected by cancer and their support person Location: Mercy Hospital Janesville For complete information: (608) 756-6824
Commit to Quit Support Group For individuals who seek support in their efforts to quit smoking Location: Henry Palmer Building, Janesville For complete information: (608) 741-2411 Mercy Health System also offers support groups for stroke and polio survivors, children and adults with diabetes, individuals with multiple sclerosis, and those affected by sleep apnea. For complete information, call Mercy HealthLine at (608) 756-6100 or toll-free (888) 39-MERCY.
Mercy MyChart helps you manage your life Battling cancer often means seeing different doctors, having a lot of tests and taking several medications. Mercy MyChart takes the hassle out of juggling all that information. It’s free, it’s easy, it’s secure and confidential. Best of all, you can check your information any time of the day or night. All you need is an Internet connection.
What you’ll find at Mercy MyChart View your medical information online • Review your medications, immunizations, allergies and medical history. • Review new and past test results. • Review health education topics and discharge instructions provided by your physician. • Alerts will be sent to your personal email address when new information has been added to your account.
How to sign up for Mercy MyChart
Stay in touch with your physician • Communicating with your physician is as simple as sending an email— but even more secure. • Request renewals of your medications.
4 easy steps
1 . To request an activation code, go online to https://MyChart.MercyHealthSystem.org
2 . Click on “Sign Up Now” 3 . Complete the online form and click “Submit” 4 . Your activation code will be mailed to you in 5-10 business days The activation code allows you to log on and create a Mercy MyChart ID and password. Use these to log on to our secure site. Mercy MyChart is available at no charge to our patients.
Mercy MyChart support
when you need it—24/7
For assistance concerning Mercy MyChart, call us anytime at (888) 99-MYCHART or (888) 996-9242.
Manage your appointments • Request your next appointment. • View summaries of your past and upcoming appointments. Access your family’s records • Access family members’ records, including your children or other family members you care for (authorization required).
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MERCY REGIONAL CANCER CENTER 1000 MINERAL POINT AVE., JANESVILLE