Pardee Cancer Annual Report 2018 by Pardee UNC Health Care

2018 Annual Cancer Report

Maintaining accreditation status with

Contents TABLE OF

these respected organizations is of the utmost importance to Pardee Cancer Center. These achievements demonstrate Pardee’s high standards for providing the best care possible to our cancer patients, in both a safe and ethical environment. Accreditation standards are very patient centered. They ensure that we, as health care professionals, continually set new goals for our cancer program, which ultimately benefit the people who matter most – our patients and their families.

Chairman’s Report

A Year in Review & Looking Ahead

A Year in Photos

Spiritual Care at Pardee

THOMAS L. EISENHAUER, MD, FACS

DEBRA J. McDANIEL, BSHCS, MBA

TOM VALLIE

Community Outreach SARAH HINSON, MHPM, CHES, CHC

Cancer Research Report

Words of Thanks

Commission on Cancer Accreditation

Why I Chose Cancer Care

Lung Cancer Outcomes Study

Cancer Incidences & Cancer Registry

KAREN MORRIS, RN, BSN, CCRP

PARDEE CANCER CENTER PATIENTS

CAROL P. BROWN, CTR, ABA

JENNIFER McALISTER, MD YASEEN ZIA, MD JAMES RADFORD, MD JOHN HILL, MD NAVIN ANTHONY, DO

THOMAS L. EISENHAUER, MD, FACS

CAROL P. BROWN, CTR, ABA

Chairmanâ&#x20AC;&#x2122;s Report T H O M A S L . E I S E N H AU E R , M D , FAC S

Pardee Cancer Center received a three year accreditation from the American College of Surgeons (ACS) Commission on Cancer during its 2018 certification survey. The accreditation process is a careful review of the entire scope of services that Pardee has to offer for cancer patients in Henderson and the surrounding counties. The surveyor, who represents the ACS Commission on Cancer, evaluates all aspects of cancer services at Pardee for the three years prior to the survey. This evaluation ensures that the hospital being surveyed provides up-to-date cancer care, enrolls patients in national clinical trials for the advancement of cancer treatment, educates physicians and patients regarding cancer, and reports their cancer cases to the National Cancer Database. Ultimately, Pardee excelled in all of these categories, receiving multiple awards with commendation and had no deficiencies. With the increasing complexity of oncology services, obtaining this accreditation with zero deficiencies is becoming much more difficult to attain. One of the best components of our cancer program continues to be the weekly cancer conferences. This meeting provides a forum where multiple physicians of various specialties meet to discuss unusual or difficult types of cancers, and attendance at these conferences continues to grow. This group allows us to anonymously review certain patients and gather a variety of ideas regarding patient care. These discussions greatly benefit those patients because their care is reviewed frequently by more than thirty physicians, nurses, and other allied health providers. While the Commission on Cancer requires our program to discuss 15 percent of our newly diagnosed malignancies, we discussed in detail almost 40 percent of our newly diagnosed cancer patients in 2018. Pardee Cancer Center continues to provide excellent cancer care. New techniques and treatment options are being utilized on a regular basis. Tracking patient outcomes with respect to their specific type of cancer allows us to assess our ability to care for cancer patients, which has shown that we provide them with excellent oncologic care. We consider it an honor and a privilege to provide this service to our community and the entire region of Western North Carolina. â&#x2014;&#x2020; PARDEE CANCER ANNUAL REPORT 2018

A Year in Review D E B R A J . Mc D A N I E L , BSHCS, MBA Administrative Director, Pardee Oncology Services

At Pardee Cancer Center, we feel very fortunate to call our place in the Health Sciences Center “home.” Patients receive all of their cancer care under one roof, and we will be forever grateful to everyone who played a role in making that happen. Since opening in December 2016, we continue to expand and further develop the program by offering additional cancer treatment services, while incorporating the latest technology. Here are some of our proudest accomplishments that took place in 2018:

BLOOD TRANSFUSIONS Blood transfusions were first offered in January 2018. We have performed approximately 15 transfusions each week. Our patients can now have their blood transfused, under the care of their chemotherapy nurse, in one of two private infusion suites located in the cancer center instead of going to the main hospital.

BREAST HEALTH PROGRAM Fellowship-trained breast surgeon, Dr. Jennifer McAlister, has joined us and leads the Pardee Breast Surgery team to ensure quality care and breast health awareness in our community.

Looking Ahead to 2019 • A financial navigator will be hired to assist cancer patients in understanding their insurance benefits, obligations and financial options. • Community screenings and educational programs will be expanded. • Our quality and tumor registry program will be optimized. • Our cancer research team will continue to drive patient enrollment in research studies and protocols.

LUNG CARE NAVIGATOR We added a new Registered Nurse (RN) to our navigation team. Cathy Jenkins came from our research department and has a special interest in navigating lung cancer care for those patients. She also coordinates community education and lung cancer screenings with Pardee providers.

NEW CANCER TREATMENT Radiation Oncology implemented Stereotactic Body Radiation Therapy (SBRT), an advanced form of cancer treatment that is safe and effective for patients with early-stage lung cancer and early-stage prostate cancer who are not candidates for surgery.

RESEARCH PROGRAM An additional research nurse, Kathy Cantrell, who came from our infusion department, was added to the research program due to the increase of patients enrolled in cancer research studies. We currently have over 60 patients enrolled and have exceeded the Commission on Cancer’s national standard of four percent and six percent commendation, with a 10 percent enrollment.

SPEECH THERAPY For head and neck cancer patients, we can now perform voice assessment with the rigid and flexible scope, as well as a FEES-fiberoptic endoscopic evaluation of swallow, which is a procedure designed to assess swallowing function.

SPIRITUAL CARE Our prayer room opened in June 2018 and was purposely painted and furnished to help relax and ease our patients, caregivers and staff. Pardee’s Chaplin, Tom Vallie, wrote a beautiful prayer book that offers inspiration for all spiritual beliefs. Pardee’s cancer program has, once again, been awarded a three-year reaccreditation with the Commission on Cancer. Our breast health program has also received a three-year reaccreditation with National Consortium of Breast Centers. Patients have praised the care they have been given by Pardee Cancer Center and tell us how much they appreciate having all physicians and treatment options under one roof, making their difficult journey a little bit easier. ◆

A Year in Photos

Cancer survivors were celebrated at the Survivor Dinner and Talent Show in August, and caregivers were honored at a special luncheon in November 2017.

PARDEE CANCER ANNUAL REPORT 2018

Spiritual Care at Pardee TO M VA L L I E Pardee Cancer Center Chaplain Spirituality, which is in the heart of every person, looks for ultimate meaning amid life’s mysteries. Medicine brings cures to those who suffer from cancer, but many times patients need an equal dose of spiritual care in order to make it through the uphill battle of their cancer journey. One truth guides the way we provide spiritual care at Pardee UNC Health Care: “You can’t practice excellent patient care if you don’t practice excellent spiritual care.” (Christina Puchalski, MD). We provide spiritual care with trained and certified chaplains. However, it’s the staff throughout the health system who provide true, loving, spiritual support to patients and their families. Patients openly comment about how much they appreciate our help during a time when they need it most. Spiritual care at Pardee is both implicit and explicit in everything we do. Recently, we have focused on ways to better address grief in our patients and in ourselves. Helping everyone grow and find spiritual peace is why we are here and what we hope to achieve with each and every cancer patient that comes our way. ◆

Community Outreach

S A R A H H I N S O N , MHPM, CHES, CHC, Director, Pardee @Work

Through the dedicated support of health care providers and outreach health professionals, many people in the community were able to participate in cancer screenings and educational opportunities. Pardee Cancer Center continues to remain focused on cancer prevention by reaching as many people in the community as possible, either by traveling to their place of employment, attending a community venue, helping people on-site, or engaging them through social media. The strong collaboration by Pardee’s cancer and outreach teams has led to a successful year, and demonstrates our devotion to meeting the needs of the community.

114

SCREENINGS & PREVENTION 114 individuals participated in a total of 11 skin, head and neck, and prostate cancer screenings and prevention programs, resulting in 36 referrals for follow-up care and one head and neck cancer diagnosis.

TOBACCO CESSATION In conjunction with the Pardee @Work outreach team, 46 individuals completed tobacco cessation courses offered throughout the year.

992

EXPANDING OUTREACH In celebration of Breast Cancer Awareness month in October, Pardee held a Facebook Live event with Dr. Jennifer McAlister presenting about breast health. A post-event analysis revealed that 992 people were reached via their social media feeds, and 470 viewed the recorded video. 187 people shared, liked or commented on Dr. McAlister’s video.

EDUCATION OUTREACH

Approximately 320 participants were reached through organized events at business and locations. Cancer navigators were able to provide direct education to event attendees.

320

Cancer Research R E P O R T K A R E N S . M O R R I S , R N , B S N , C C R P, Research Coordinator / Manager

Pardee’s research program has enrolled over 975 patients in oncology clinical trials since 1999. Some of these trials resulted in changes to how we treat cancer and manage patient side effects. The national average for adult oncology patients who participate in clinical trials is three to five percent. At Pardee Cancer Center, 67 patients enrolled in clinical trials in 2017, which is 11 percent of our patients. We have approximately 40 to 50 clinical trials open for enrollment in hopes of offering at least one trial to every patient. A successful research program requires many different pieces to come together – dedicated physician investigators, certified research nurses, and a proficient, well-organized Institutional Review Board (IRB). Compliance with rules and regulations governing research and patient safety is paramount to the program. Quality care for patients enrolled in clinical trials is assured through our continuous monitoring of their cases. Our program is audited annually by at least one of the National Cancer Institutes (NCI) sponsored research groups. The purpose of the audit is to document the accuracy of data, and to verify investigator compliance with protocol and regulatory requirements. These NCI sponsored group audits involve experts evaluating three components of the program – regulatory documentation, pharmacy operations, and individual patient case reviews, including properly executed informed consent, eligibility of the study participant, correct treatment, dose modifications, evaluation of disease outcome, tumor response, reporting of adverse events, and the general quality of the data collected. Each of these three components is assigned an assessment of either acceptable, acceptable but needs follow-up, or unacceptable based

lymphoma (1)

oral/head/neck (1)

rectum (3) breast (21)

pancreas (7)

multiple myeloma (7)

lung (8) melanoma (8)

prostate (11)

on findings at the time of the audit. We have consistently received “acceptable” scores for all three categories included in the audit. Our IRB is inspected by the FDA every three years, at a minimum, to determine whether Pardee’s IRB procedures for the protection of human subjects comply with FDA regulations pertaining to clinical investigations. Our IRB has always done well with these inspections with no deficiencies found. ◆

PARDEE CANCER ANNUAL REPORT 2018

Words of Thanks PA R D E E C A N C E R C E N T E R PAT I E N T S

My nurse, Alice, is a

treasure beyond measure. All of the technicians I got to know were so kind and gentle. They really know what they are doing and take a personal interest in every patient.

We tell everyone that Pardee Cancer Center is a wonderful place to be treated.

Everyone always greeted my husband and me with a smile, treated us with , and

respect offered comfort when needed.

I never knew the difference a nurse navigator makes in the lives of people until now. Thank you for the

extraordinary care from Cathy and all of the team.

Your kindness and caring means so much to me. It was a very satisfying experience to deal with a team of folks who

genuinely care. The Cancer Center is a place no one wants to be But once inside you will be surprised on this we will agree Immediately, we are greeted with a smile from Dee Dee Then it’s on to the lab where Darrell and the girls we will see After the lab Dr. Radford is our next stop His expertise, sincere and caring way is tops He is honest and direct in the most loving way And always uses such sensitivity when he speaks to Fay Now we have a date with Kathy, Deana and Renee Or it could be Tamara and Cheryl depending on the day Tom is also there to comfort you and pray It’s always a happy time however long we stay Cathy is the last one that we need to see She always makes sure we know when and where to be So now I think we can all agree All the kind and caring people make it not such a bad place to be.

We have been treated with love, respect, compassion and much more.

Thank you

for all you do and for making a difficult time a lot easier.

life savers

You are all . Thank you so much for your

professionalism, your kindness, and your TLC with all of my appointments, treatments and injections.

Commission on Cancer Accreditation

Everyone I met along the way reminds me how important it is to

serve your calling.

C A RO L P. B ROW N , C T R , A B A Cancer Program Coordinator, Cancer Registrar

It takes

special

doctors like Dr. Anthony, nurses too many to name, and aides to work for a cancer center. We are very

blessed

We always leave our appointments

to have such a great facility close to home.

with hope. All of you have become part of our family.

Everyone has been so kind and

compassionate.

It made my treatment so much easier.

Your kind patience and thorough explanations were comforting.

Pardee Cancer Center has been accredited by the American College of Surgeons’ Commission on Cancer many times over the years. This is a voluntary accreditation that demonstrates our commitment to providing the highest quality care to our cancer patients. The COC standards are patient centered, meaning they cover areas that are very important to patients and survivors, such as clinical trials, patient navigation, survivorship and psychosocial distress screening. The standards hold us accountable for providing quality care to our patients, as well as educating our community about cancer prevention and cancer screenings to lower their chances of being diagnosed with late stage cancer. Our community outreach efforts have taken place on Pardee’s main hospital campus, Mission Pardee Health Campus, and in business and industry settings. For patients who have been diagnosed with cancer, we offer support groups to them and their caregivers. We also have celebrations throughout the year to honor our survivors and their caregivers. Every three years, our cancer program has an on-site visit from the American College of Surgeons’ Commission on Cancer. The surveyor attends one of our cancer conferences, meets with our cancer committee and hospital administration, and key members of the cancer team. They review three years of data, statistics, minutes and community outreach activities. Our most recent survey took place in August 2018, and we were once again awarded with a three-year full accreditation. The surveyor was very complimentary of our entire program and we are proud to have once again been granted full accreditation. ◆

The whole team has loved him, him,

supported and guided

us to important resources. PARDEE CANCER ANNUAL REPORT 2018

Why I Chose Cancer Care The physicians of Pardee Cancer Center are not only board certified and highly skilled in cancer care, they are very passionate about what they do. Hear their compelling stories behind why they chose this field, and how early life experiences molded their chosen career path.

In some ways, breast surgery chose me. I began my surgical career directly out of residency as a general surgeon. My practice was in a rural area with limited access to health care. Since I was the only female surgeon in the county, I began to see many patients with breast health issues, including cancer. I found that our facilities were behind the times as far as imaging and biopsy capabilities for our breast patients. I became an advocate for them, which allowed us to expand breast care in our community. More importantly, I discovered that I developed personal relationships with my patients due to the many follow-up appointments that continue for years after treatment. Finally, I took a year off of my general surgery practice to complete a fellowship in breast surgery. This allowed me to learn the nuances of breast care. I always felt I was taking good care of my patients. However, my additional fellowship training has allowed me to take patient care to the next level and not only provide them with the care they need, but to give them the excellent care they deserve. JENNIFER McALISTER, MD

My decision to become a radiation oncologist was one of self discovery that continues to this day. My earliest exposure to the field of radiation oncology was observing the dedication, precision, and compassion that was displayed towards my grandmother while she underwent treatment for head and neck cancer. I was reacquainted with the field during my medical school rotations where my initial impression was only strengthened and reinforced. I was able to transition from being an observer of someoneâ&#x20AC;&#x2122;s struggle to overcome cancer, to being an active participant that could aid them back to health. Developing bonds with the patients and their families, while helping them to overcome their disease, is incredibly rewarding. The incorporation of the latest technologies that allow for pinpoint accuracy to the tumor, while minimizing the dose to the normal tissues, added another facet to my interest in the field. As I have gone from observer, to student, to radiation oncologist, my interest and passion for radiation oncology has only grown with each step along the way. I hope to emulate those dedicated and compassionate radiation oncologists that I observed many years ago, while providing the very best cancer care possible to my patients. YASEEN ZIA, MD

Why someone chooses a specific career can sometimes be complex, but in my case it was not. I became an oncologist for two reasons. First, my mother was diagnosed and treated for breast cancer during my second year in college. She was treated by a very good surgeon and did well. However, this was before medical oncology became a specialty and before anyone was available to answer our unending questions, to provide other treatment options, or to help us learn how to deal with this gut wrenching life event. This experience made me want to be that person. Secondly, I feared boredom. Oncology may be frustrating, stressful, interesting, exciting, puzzling, joyful, and tragic; however, I have never been bored over the years and love learning and experiencing something new in my profession each and every day. JAMES RADFORD, MD

In high school, a dear friend of mine was diagnosed with sarcoma, a rare type of cancer that affects connective tissue. After surgery, she received chemotherapy to remove the tumor. Naturally, we hoped the chemotherapy would be all that she needed to overcome the cancer. Unfortunately, a mass was found in her lung just a few months later. She then had part of her lung removed and went through another round of chemotherapy. I watched her endure all of the worst symptoms and side effects of cancer, including profound fatigue, nausea, and hair loss. I did not realize it then, but going through that experience planted the seed that would ultimately lead me to becoming an oncologist. I am thankful she is now 45 years old, married, and has three healthy sons. She also faced and overcame breast cancer a few years ago and will forever be my inspiration. While the science of oncology is fascinating, and the latest discoveries are exciting, the personal relationships I develop with my patients is what drives me most, and itâ&#x20AC;&#x2122;s why I chose to be an oncologist. JOHN HILL, MD

The human body has always been a mystery to me. How we are born, grow and adapt to the world is an incredibly interesting process. In the world of medicine, oncology and hematology are very unique. To me, the study of what can go wrong in the body is almost as intriguing as everything that goes right, and the scientist in me loves this interaction. Even more fascinating is the courage, strength and resilience in each of us. Living with cancer is undeniably a terrible and frightful experience. The people I meet everyday who are dealing with this disease are truly amazing. Beyond the biology of our bodies is the human spirit that evades all of the hardship, and somehow rises up to fight a ruthless disease. The patients are what keep me going because they, above everyone else, have to be leaders in their own battle against cancer. The science of cancer is profound, but the patients are what drive my passion to do better, and to fight a disease that we cannot allow to break us. NAVIN ANTHONY, DO

PARDEE CANCER ANNUAL REPORT 2018

Lung Cancer Study T H O M A S L . E I S E N H AU E R , M D , FA C S

Lung cancer continues to be a formidable health issue in the United States and locally in our region. It is the second most common malignancy in both men and women, with prostate and breast cancers being the most common for the respective sexes. This disease also continues to be the leading cause of cancer deaths for all. While lung cancers can develop in nonsmokers, tobacco abuse is the leading cause of this problem. This has been known for many years and labeling regulations were created in 1965 to be certain that consumers were aware of the risks of tobacco usage. Immediately following, there has been a downward trend in tobacco usage over the past 50 years, but there was a significant rise in tobacco exposure by high school students at the turn of the century. We are now seeing the ill effects of tobacco exposure.

Trends in Cigarette Smoking by High School Students*and Adults** United States, 1965-2014 Students Adults

45% 40%

PERCENT (%)

35% 30% HP 2020 GOAL

25% 20%

18.8% 16.7%

15%

Youth 18% Adults 12%

10% 5% 0% 1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2011 2012 2013 2014

2020

YEAR

*Percentage of high school students who smoked cigarettes on one or more of the 30 days preceding the survey (Young Risk Behavior Survey, 1991-2013). **Percentage of adults who are current cigarette smokers (National Health Interview Survey, 1966-2014).

Lung cancer prognosis is directly dependent upon the stage of the disease at the time of the diagnosis. Early stage disease is much more effectively treated and can realistically be cured. Historically, however, 75 percent or more of our lung cancers were diagnosed at stage III or stage IV, when a cure is essentially unachievable (see Chart #1). Computed tomography (CT scan) has been very effective in evaluating masses in the lungs. This has required a moderate amount of radiation exposure and a substantial cost, which made it inappropriate as a screening tool. Newer technology has enabled physicians to do â&#x20AC;&#x153;low doseâ&#x20AC;? chest CT scans as a screening study. This test has much less radiation, closer to the dosage from a regular chest x-ray, and significantly lower cost. Insurance providers also understand the benefits of this and have started paying for the exam when performed for individuals that meet screening guidelines. Pardee has recently created such a screening program for lung cancers using a low dose CT scan protocol. This is much more effective at finding smaller tumors than a routine chest x-ray, which is what had been done in the past. As a direct result of this program, many more malignancies are found at an earlier stage of their development (see Chart #2).

Chart #1 – Stage of the Disease 60% 50% 40% 30% 20% 10% 0% STAGE 1

STAGE 1I

STAGE III

2011

STAGE 1V

2013

Chart #2 – Stage of the Disease 60% 50% 40% 30% 20% 10% 0% STAGE 1

STAGE 1I

2011

STAGE III

2013

STAGE 1V

2017

As with most malignancies, lung cancer may be treated with surgery, radiation, or chemotherapy. Newer forms of chemotherapy, including immunotherapy, have been helpful adjuncts to the treatment of lung cancer. Special forms of radiation therapy can also be helpful as first line treatment, or as part of the combined modality treatment. The mainstay of treatment historically has been to surgically remove the malignant growth. This continues to be the best option for non-small cell lung cancers when they are relatively small and have not spread to other areas. Additional advancements in surgical technology give us the option of doing the surgery for lung cancers using a minimally invasive technique. Video Assisted Thorascopic Surgery (VATS) or thoracoscopy allows the surgeon to perform a complete, oncologic surgery by removing the diseased portion of the lung and adjacent lymph nodes using much smaller incisions. The benefit to the patient is less post-operative pain, shorter or no intensive care unit stay, briefer hospital stay, and faster return to normal activities. While lung cancers continue to cause significant morbidity and mortality, the changes to the methods of diagnosis and treatment are exciting and very beneficial to our patients. Pardee UNC Health Care is proud to offer these advanced levels of care to the people of Western North Carolina. ◆ PARDEE CANCER ANNUAL REPORT 2018

Cancer Incidence MALE

FEMALE TOTAL

Blood / Bone Marrow

MALE

FEMALE TOTAL

Lymphatic System

Leukemia

Hodgkin’s Disease

Multiple Myeloma

Non-Hodgkin’s

Other

Prostate

Testis

Bone 1

Brain & Central Nervous System

Male Genital

Brain (Benign)

Oral Cavity

Brain (Malignant)

Hypopharynx

Other

Lip

Oropharynx

Other

Tongue

Larynx

Lung / Bronc-Small Cell

Lung / BroncNon Small Cell

Nasal / Sinus

Other

Other Bronchus & Lung

Bladder

Kidney / Renal

Other

281

295

576

Breast 1

114

115

Connective / Soft Tissue 3

Digestive System

Other / Ill-Defined Respiratory System

Anus/Anal Canal

Colon

Esophagus

Liver

Other

Pancreas

Rectum

Stomach

Endocrine

Skin Melanoma

Thyroid

Other

Female Genital

BY SITE 2017

Cervix Uteri

Corpus Uteri

Other

Ovary

Vulva

Urinary System

Unknown Primary Site TOTALS

Cancer Cases

IN 2017

A cancer registry provides information for a variety of cancer control efforts done through education, partnerships and research, and is required by state law to be reported to the North Carolina Central Cancer Registry. Pardee takes great pride in ensuring that detailed records we have kept on our cancer patients since 1993 are as accurate and thorough as possible. Under 20 20-29 30-39

1 2 5

RACE

AGE

40-49

50-59

60-69

151 171

70-79 80-89

110

90+

20 0

120

160

COUNTY

Buncombe (37)

Henderson (436)

Polk (35)

WHITE

557 BLACK 13 OTHER 6

Transylvania (25) Rutherford (19) Out of State (13) Other NC (8) Haywood (3)

Insurance, NOS Managed Care

121

Medicaid

PAYOR

Medicare

109

Medicare with Medicaid Medicare with Supplement TriCare

27 263

295

MALE

FEMALE

Uninsured VA

281

21 3 0

100

150

200

250

GENDER PARDEE CANCER ANNUAL REPORT 2018

Cancer Services Pardee Cancer Center . . . . . . . . . . . . . . . . . . . . . . . . (828) 694-4300 Cancer Navigators Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7334 General Cancer . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7317 Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . (828) 698-7364 Cancer Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . (828) 696-4716 Mammography Services . . . . . . . . . . . . . . . . . . . . . (828) 696-1305 Medical Oncology . . . . . . . . . . . . . . . . . . . . . . . . (828) 692-8045 Pardee Breast Surgery . . . . . . . . . . . . . . . . . . . . . . . (828) 694-8438 Radiation Oncology . . . . . . . . . . . . . . . . . . . . . . . (828) 696-1330 Surgical Oncology . . . . . . . . . . . . . . . . . . . . . . . (828) 693-7230 Pardee UNC Health Care 800 North Justice Street Hendersonville, NC 28791

Pardee Cancer Center 805 6th Avenue West, Suite 100 Hendersonville, NC 28739

“ANOTHER BEAUTIFUL DAY” Carol Beth Icard The featured cover art is a painting in the permanent collection at Pardee Cancer Center. Icard says she “feels an overwhelming sense of joy that this painting may bring light or meaning to others who are on their path of healing.”

9020-275 (12/07/2018)

pardeehospital.org