XXXXXXXXXXXXXXXXXXXXX
2012cancer annual report
administrative director: jennifer badiu, msha 2011 saw the renewal of Commission on Cancer accreditation of Memorial Hospital of Carbondale, with six commendations where standards were exceeded. The CoC is phasing in new standards, emphasizing the continuum of patient care and measurement of quality. SIH Cancer Institute is progressing in the same direction, expanding community outreach, patient navigation, psychosocial services, palliative care and clinical trials, all with leadership by specialized and experienced administrators and physicians. In 2011 and 2012 SIH added specialists; site specific treatment planning groups expanded; the region’s first High Risk Breast Clinic opened; a Pulmonary Nodule Clinic is developing; we enrolled our first cancer patient in a national cooperative group clinical trial. And in 2012, SIH undertook to build a state of the art cancer center facility, the first of its kind in southern Illinois. We are honored by the outpouring of support for the Hope is Home Campaign as we work to make the cancer center a reality. So much growth, so many people helped, but still we can do more, as we strive to provide the best of the best for our families, friends and neighbors.
cancer liaison physician: george kao, md, dabr The role of the CLP is to form a bridge between the Commission on Cancer and the local program - by evaluating and reporting program performance and accomplishments to the Cancer Committee and to SIH Cancer Institute leadership. The National Cancer Data Base information advises and defines these quality improvement activities. The CLP also serves as the program’s liaison with the American Cancer Society. For several years now, we monitor performance on diverse cancer care quality measures, some mandated by the Commission on Cancer and some developed locally. We promote and adhere to the universally respected National Comprehensive Cancer Network (NCCN) evidence based clinical practice guidelines in all our treatment recommendations. Our surgeons, medical oncologists and radiation oncologists deserve acclamation for aspiring to provide the highest quality care – appropriate, comprehensive care rendered with compassion – to those with cancer in the communities we serve.
medical director: mary rosenow, phd, md, facs Successful cancer program advancement is physician driven; there are now over 35 physicians formally affiliated with SIH Cancer Institute who participate in multidisciplinary treatment planning conferences, continuing medical education and peer review. We applaud these affiliated physicians and appreciate the unique way they and SIH administration work together to develop services to provide true comprehensive care of the highest quality. In our affiliation with the Simmons Cancer Institute of Southern Illinois University School of Medicine, collegial relationships are developing as we share videoconferencing and research grants. We are glad for the opportunity to share resources with another very strong institution, dedicated to high quality patient care and research. This annual report presents Southern Illinois Healthcare’s concept of the comprehensive community hospital cancer program – where we have been, where we are now, and where we are going.
2
CANCER ANNUAL REPORT 2012
table of contents 2 4
Introduction Cancer Care Services
CLINICAL EXCELLENCE
6 Diagnostic and Interventional Services 8 Radiation Oncology 9 Medical Oncology 10 Oncologic Surgery 11 The Breast Center 12 Site Specific Multidisciplinary Groups 14 Oncology Nursing 14 Cancer Rehabilitation 15 Hospice 15 Clinical Trials 15 Palliative Care EDUCATION AND SUPPORT
16 Screening 16 Cancer Prevention and Community Awareness 17 Patient Navigation 17 Nutrition Consultation 17 Survivorship 18 Support Groups 18 Pastoral Care 19 The Future FOCUS ON LUNG CANCER
20 21 22 23
Non Small Cell Lung Cancer Overview Lung Cancer Treatment Lung Cancer in Southern Illinois SIH Cancer Institute Lung Cancer Statistics
CANCER REGISTRY
24 25
Cancer Registry Activities 2011 Accessions
ADMINISTRATION
26 27 28 28
Cancer Committee Site Specific Groups Contacts References and Resources
3
CLINICAL EXCELLENCE
Cancer Care Services Department The ten members of the Cancer Care Services staff, under Administrative Director Jennifer Badiu, coordinate and document numerous cancer related activities; they support community programs, physicians’ efforts, and direct patient care, while managing cancer program essentials such as treatment planning conferences, research and case reporting. Commission on Cancer Accreditation. Accredited for over 25 years, and a three year renewal awarded in 2011; Memorial Hospital of Carbondale will now enter the Comprehensive Community Program category due to expansion of services and rising case volume. Maintaining accreditation involves continuous documentation of key elements of cancer care, including cancer program structure, clinical services, support services, outreach agendas, case reporting, case conferences, quality improvements and patient outcomes. The 34 Commission on Cancer Standards are the point of reference for achieving excellence in comprehensive cancer care. Cancer Committee. The Cancer Committee is a multidisciplinary group of expert professionals focused on cancer patient care: physicians, nurses, and allied specialists. The Cancer Committee meets quarterly to review standards and all program developments, and provides leadership and professional guidance to SIH Cancer Institute. Cancer Registry. Four registrars abstract and follow up on all reportable cancer cases. This Annual Report contains a registry summary of 2011 cases as well as an examination of SIH Cancer Institute’s statistics on lung cancer. Cancer Conferences. Cancer Care Services staff compiles imaging and pathology information, case summaries and literature references that allow fruitful discussion of each individual case by the multidisciplinary site specific treatment planning groups. Physicians, nurses, therapists and other allied professionals maintain continuing education accreditation. Research and Clinical Trials. Cancer Care Services contributes to the administration of the system wide SIH Clinical Trials Office. The Clinical Trials Nurse Manager supports cancer research activities which include treatment related clinical trials as well as cancer prevention and cancer control research. Grants. Cancer Care Services compiles and supports applications for grants to supplement program development efforts at all phases of the cancer care continuum. Cancer Patient Navigation. The navigators form a branch of Cancer Care Services, and they utilize the resources of the program and the community to help ensure that each patient’s care is complete and timely. Palliative Care. Cancer Care Services and the Palliative Care Program collaborate to see that cancer patients have ongoing access to patient centered services that address quality of life issues. A palliative care professional is a member of the Cancer Committee. Community Outreach. Community awareness of cancer related issues will do more to reduce overall cancer mortality than any treatment program. Screening programs, prevention programs and educational activities about cancer risks and healthy habits are examples of community outreach efforts. Cancer Care Services joins forces with SIH Community Benefits as well as local and national cancer organizations to offer and coordinate year round community outreach activities.
4
CANCER ANNUAL REPORT 2012
CLINICAL EXCELLENCE
Achieving excellence in comprehensive cancer care.
5
CLINICAL EXCELLENCE
Diagnostic and Interventional Services Diagnostic imaging Under the direction of Justin Hodge, MD, and with interpretation by the board certified radiologists of Cape Radiology, leading edge technology provides the analytic ability to meet the growing demands of cancer patient diagnosis and treatment. Services provided include: - General, thoracic and abdominal radiologic imaging - 64 and 128 slice CT scanning - CT angiography - PET/CT fusion scanning - 3T MRI and MR angiography - Neuroradiology - Ultrasound - General nuclear medicine imaging All imaging is digital and is stored on the Amicas Picture Archiving Communications System (PACS), so that it can be viewed via a Web based approach. Physicians can easily review, share and compare images and reports in their offices, during sessions with patients, in the operating room, on the inpatient units and during treatment planning conferences. Interventional Radiology Minimally invasive radiologic procedures have expanded to include not only diagnostic but also therapeutic interventions. Skilled interventionalists are vital components of the multidisciplinary cancer treatment planning groups. Procedures available include: - CT, ultrasound and MRI guided biopsy and aspiration - Stereotactic biopsy - Sentinel node mapping - Image guided drainage of effusions and ascites - Image guided biliary and ureteral stent placement - Port placement for chemotherapy - Nerve blocks for pain control - Tumor ablation by cryo or radiofrequency, chemoembolization, radioembolization. Diagnostic Pathology The pathology report is fundamentally central to treatment planning. SIH Cancer Institute pathologists utilize the College of American Pathologists (CAP) protocols so that reports contain all data elements needed by oncologists for complete understanding of the diagnosis and staging of the cancer. For specialized description of cancer specimens, additional diagnostic services are utilized. Depending on the cancer type, these may include cytopathology, immunohistochemical markers, cytogenetics, FISH procedures, molecular profiling, gene expression analysis and mutational status, and analysis of other tumor characteristics. Diagnostic Pathology is staffed by three pathologists: Chandrashekar Padmalatha, MD, Moses Adeyanju, MD and Abdallah Azouz, MD. The pathologists are available for review of individual cases and for intraoperative consultation; they present pathology cases and educational information at multidisciplinary treatment planning conferences.
6
CANCER ANNUAL REPORT 2012
CLINICAL EXCELLENCE
7
CLINICAL EXCELLENCE
Radiation Oncology The Radiation Oncology Department saw over 10,900 patient visits in 2011. Led by Dr. George Kao and Radiation Oncology Manager Cary Mosley, the radiation oncology staff consists of a radiation physicist, certified medical dosimetrist, certified radiation technologists, and oncology specialized nurses.
The Radiation Oncology Department saw over 10,900 visits in 2011.
In 2012 Dr. Michael Little, recent graduate from residency at the University of Michigan, joined the practice. Dr. Little adds expertise in stereotactic radiosurgery and stereotactic body radiation therapy, as well as brachytherapy for gynecologic and prostate cancers; his special interests include utilizing ablative therapies concurrent with systemic therapy in the management of patients with limited metastatic disease. Radiation therapy treatment protocols are available at both locations in Carbondale and Marion, Illinois. Modalities utilized are tailored to each patient’s needs, and include: 3D CONFORMAL EXTERNAL ELECTRON BEAM RADIATION THERAPY WITH COMPUTERIZED TREATMENT PLANNING. Now the standard for many forms of cancer, 3DCRT delivers highly focused radiation while sparing normal adjacent tissue. 3DCRT begins with a virtual ‘simulation’ CT scan of the region of interest; scanned images are then linked into treatment planning software that visualizes the lesion in three dimensions. Physicians can select radiation beam angle and intensity to precisely target the tumor. Treatments use a Varian 2100EX linear accelerator that can be rotated around the patient to send beams from the most favorable angles. This technique has made possible the treatment of tumors that in the past were considered too close to vital organs for radiation therapy, such as those adjacent to the spinal cord. INTENSITY MODULATED RADIATION THERAPY. IMRT is an advanced form of 3DCRT that uses dynamic multi-leaf collimators with numerous moveable ‘leaves’ to shape the beam and alter the dose to the requirements of the tumor from any angle, protecting adjacent tissue as much as possible. IMAGE GUIDED RADIATION THERAPY. IGRT uses an on-board imager to monitor the position and size of the target tumor, which may vary slightly from one treatment to the next. This allows adjustment of the patient’s positioning just prior to each treatment and reduces the size of the treatment field needed to reliably include the entire tumor. STEREOTACTIC RADIOSURGERY: Available in 2013. SRS provides the most precise targeting and beam delivery for primary and metastatic brain tumors. It delivers a highly concentrated dose of radiation to the target while minimizing the radiation that passes through normal brain tissue. SRS can be administered in patients who also have whole brain radiation therapy. It reaches into the deepest recesses of the brain not accessible by surgery.
8
CANCER ANNUAL REPORT 2012
CLINICAL EXCELLENCE
Medical Oncology The majority of cancer patients receive some type of systemic treatment, administered by a medical oncologist. Systemic therapy divides into several categories: CHEMOTHERAPY. The medical oncologist determines the type of cytotoxic drug(s) indicated, often simultaneously using multiple drugs with different mechanisms of action for maximum effect. Chemotherapy may be the sole treatment or combined with surgery or radiation; it may be used in the neoadjuvant (prior to surgery), adjuvant (added to successful surgery), concurrent (with radiation therapy), sequential or palliative settings. HORMONAL THERAPY. Hormonal therapies act by altering the production or activity of particular hormones known to influence the growth of certain cancers. Adjuvant endocrine therapy is a powerful treatment for breast cancer and prostate cancer.
The medical oncologist educates patients about their types of cancer and staging, discussing treatment options and making recommendations, and monitoring care and treatment.
BIOLOGICAL THERAPY. The immune system can be modified to fight cancer. Biological therapies include interferons, interleukins, colony stimulating factors, monocloncal antibodies and nonspecific immune modulating agents. TARGETED THERAPY. This newest class of drugs blocks specific cell functions involved in tumor growth, such as cell growth signaling and tumor blood vessel development. Targeted therapy is available for most types of cancer and includes tyrosine kinase inhibitors and epidermal growth factor receptor blockers; because abnormal cancer cell functions are targeted, the drugs have less toxicity for normal cells. Dr. Alberto Cuartas, Dr. Peter Graham and Dr. Sujatha Rao, SIH Cancer Institute affiliated physicians, provide systemic therapies of all types in Carbondale, Marion and surrounding communities. They treat a wide variety of solid cancers: breast, lung, colorectal, gastrointestinal, skin, kidney, prostate, ovarian, other gynecologic, hepatic, biliary, pancreatic, neuroendocrine cancers and lymphomas. Although cancer treatment is multidisciplinary, the medical oncologist is often the patient’s central healthcare provider, who coordinates and oversees care from diagnosis through treatment and survivorship. The medical oncologist educates patients about their types of cancer and staging, discussing treatment options and making recommendations, and monitoring care and treatment. They also work with patients to improve quality of life by addressing side effects, emotional distress, and managing pain and other symptoms.
9
CLINICAL EXCELLENCE
Oncologic Surgery Surgery may be called for in a variety of circumstances: CURATIVE SURGERY: when it is likely that all of the cancer can be physically removed. DIAGNOSTIC SURGERY: when a tissue sample must be removed for analysis and noninvasive approaches are not feasible. STAGING SURGERY: to determine the extent of spread of cancer to nearby structures such as lymph nodes. DEBULKING SURGERY: removing the majority of the cancer when complete removal is not possible, allowing radiation or systemic therapies to be more effective PALLIATIVE SURGERY: to relieve symptoms such as pain, obstruction, bleeding or infection. SUPPORTIVE SURGERY: to assist with other forms of treatment, such as providing vascular access for chemotherapy. RECONSTRUCTIVE SURGERY: to improve appearance or function following major cancer surgery, for example tissue flaps, bone grafts and breast implants. PROPHYLACTIC SURGERY: removal of precancerous tissue such as colon polyps, or removal of entire organs such as the breast or ovaries in patients with genetic cancer predispositions. Surgeons with specialty training and experience provide head and neck surgery, thoracic surgery, urologic surgery, CNS surgery, gynecologic surgery, breast surgery, colorectal and gastrointestinal surgery, and plastic/reconstructive surgery. The surgical suites at Memorial Hospital of Carbondale are equipped with the technology and instrumentation needed to perform the most effective and minimally invasive operations: video assisted thoracoscopic surgery (VATS), advanced laparoscopic surgery, daVinci robotic surgery, and procedures guided by ultrasound, fluoroscopy and radioisotope localization.
10
CANCER ANNUAL REPORT 2012
CLINICAL EXCELLENCE
The Breast Center Breast cancer is a common disease, and its diagnosis and management are increasingly complex. The Breast Center’s commitment is to provide cancer prevention, early detection, rapid diagnosis, and leading edge therapies, with a variety of support, education, and community outreach programs. An initial phone call sets the comprehensive program into motion, whether the issue is abnormal screening, a new physical finding or concern about breast cancer risk factors. BREAST CENTER SERVICES: Screening and community outreach: - Digital screening mammography with CAD, without a physician’s order - Screening at no cost for those who qualify - Educational programs on breast health - BeMyBra and Buddy Check awareness programs - Breast cancer self exam and awareness classes - Lymphedema screening Breast cancer risk evaluation: - Risk assessment - High risk consultation - Genetic counseling - Genetic testing - Medical and surgical breast cancer preventive treatment - Long term follow-up
Medical Director, Dr. Marsha Ryan
Diagnostic imaging: - Digital diagnostic mammography and ultrasound - Breast MRI - Diagnostic services at no cost for those who qualify Breast cancer procedures: - Image guided core biopsy: ultrasound guided, MRI guided and stereotactic - Surgical consultation and management - Preoperative and intraoperative image guided localization for biopsy - Surgical procedures for staging and treatment - Post mastectomy reconstruction Breast cancer treatment and support: Each newly diagnosed breast cancer patient’s case is discussed for individualized treatment planning at the weekly Multidisciplinary Breast Cancer Conference. The Breast Cancer Group is committed to offering state of the art treatment using minimally invasive methods. Each woman receives education about all aspects of her disease by the surgeon and the navigator.
Breast Care Manager, Dana West, RT (R, M, CM)
The consultation includes surgical and medical treatment options, taking into account her unique needs. The navigator provides guidance and practical assistance as needed at every step of the way. The navigator also facilitates the breast cancer support group, Women with Hope. BREAST CENTER LEADERSHIP AND STAFF: Medical Director: Dr. Marsha Ryan Breast Care Manager: Dana West, RT (R,M,QM) Breast Surgeon: Dr. Cynthia Aks Lead Interpreting Physician: Dr. Terrence Chambers Lead Technologist: Denise Foster, RT (R,M) Patient Navigator: Donna Crow, RN, CBCN The Breast Center achieved early accreditation by the National Accreditation Program for Breast Centers and is designated an Imaging Center of Excellence by the American College of Radiologists. In August, 2012, Breast Center expansion commenced which will include additional space for tomosynthesis, dedicated MRI, complementary therapy and a cancer resource center.
11
CLINICAL EXCELLENCE
Collaborative treatment teams improve patient care.
Site Specific Multidisciplinary Groups
12
Current cancer treatment almost always involves more than one modality – surgery, systemic therapy and/or radiation therapy. The centerpiece of the effective cancer program is the site specific group conference, a gathering of specialists to evaluate patients considered for a multidisciplinary approach. The SIH Cancer Institute has five site specific groups: each is composed of representatives from all disciplines involved in the evaluation and treatment of that type of cancer. Regular meetings take place for visual review of imaging and histology, and face to face communication between specialists for planning and coordination of treatment. The groups understand that each cancer case has unique aspects, whether newly diagnosed, currently undergoing treatment, or recurrent, and they find that all kinds of issues are uncovered and discussed during the meetings. The group discussions enhance communication, increase efficiency, and ensure that care delivery is consistent with the best available evidence. Studies show that when site specific multidisciplinary groups plan and manage treatment, patient outcomes significantly improve. CANCER ANNUAL REPORT 2012
CLINICAL EXCELLENCE
LUNG CANCER GROUP: meets twice each month Pulmonology Thoracic Surgery Medical Oncology Radiation Oncology Pathology Diagnostic and Interventional Radiology Palliative Care Patient Navigation Clinical Trials Office Cancer Registry BREAST CANCER GROUP: meets weekly Breast Surgery Medical Oncology Radiation Oncology Pathology Breast Imaging and Interventional Radiology Palliative Care Cancer Rehabilitation Patient Navigation Clinical Trials Office Cancer Registry GASTROINTESTINAL CANCER GROUP: meets once each month GI Surgery Medical Oncology Radiation Oncology Pathology Diagnostic and Interventional Radiology Palliative Care Patient Navigation Clinical Trials Office Cancer Registry GENITOURINARY CANCER GROUP: meets once each month Urologic Surgery Medical Oncology Radiation Oncology Pathology Diagnostic and Interventional Radiology Palliative Care Patient Navigation Clinical Trials Office Cancer Registry HEAD AND NECK CANCER GROUP: meets once each month Head and Neck Surgery Medical Oncology Radiation Oncology Pathology Diagnostic and Interventional Radiology Palliative Care Cancer Rehabilitation Patient Navigation Clinical Trials Office Cancer Registry For treatment planning, SIH Cancer Institute physicians endorse and utilize the American Joint Commission on Cancer (AJCC) Tumor Node Metastasis (TNM) Staging System and National Comprehensive Cancer Network (NCCN) evidence based clinical practice guidelines. The Cancer Conference Coordinators are Susan Culton, CTR, and Amy Behrens.
13
CLINICAL EXCELLENCE
Oncology Nursing Oncology nurses are the heart and soul of patient care; theirs is a vocation more than a career. Nurses practice along the entire continuum of cancer care and across care delivery settings. They may work directly with physicians seeing patients, administer chemotherapy and monitor for reactions, or work with patients on symptom management. They serve on the hospital inpatient units, outpatient units, the Radiation Oncology Department, private offices, in home health and in hospice. They administer physical and psychological and spiritual assessment, care and education of their patients. The Oncology Nursing Society’s chemotherapy program requires a cancer specific knowledge base and demonstrated clinical expertise in cancer care; it validates that a nurse has the competence to administer chemotherapy. Nurses can further demonstrate their proficiency by becoming an Oncology Certified Nurse; an OCN must meet stringent requirements and engage in about double the continuing education activities as an RN to maintain certification. The SIH Infusion Therapy Unit is located at St. Joseph’s Memorial Hospital; the service covers all of southern Illinois and enables patients to receive periodic infusion therapy for cancer and other conditions as conveniently as possible, with continuity of care. Under Infusion Services Manager Lisa DaSilva, RN, BS, the unit provides chemotherapy, immunotherapy, blood product administration and port maintenance for cancer patients. The nursing staff works with supervision from the patients’ medical oncologists and includes an Oncology Certified Nurse.
14
CANCER ANNUAL REPORT 2012
Oncology nurses are the heart and soul of patient care.
cancer rehabilitation Although aggressive treatments are life saving, they may leave cancer patients with debilitating fatigue, pain, stiffness, weakness and limited mobility. Other treatment sequelae related to a particular cancer may be speech or swallowing difficulty, bladder or bowel dysfunction, skin breakdown or lymphedema of an extremity. Southern Illinois Healthcare affiliated with the Rehabilitation Institute of Chicago in 1997 to bring advanced rehab services to the region, including an Acute Rehab Center, inpatient therapy, and outpatient therapy at several Rehab Unlimited and Fit for Work area locations. Dena Kirk, Administrative Director, leads the SIH outpatient rehab services. In addition to those already available, cancer specific rehab services applying the RIC model will be available in southern Illinois during 2013. Individualized rehabilitation plans may employ a physiatrist, nurse, physical therapist, occupational therapist, pain management specialist, speech/language pathologist and/or certified lymphedema therapist. Rehabilitation could happen during and after cancer treatments, coordinating around chemotherapy cycles, radiation therapy and surgery. To aid recovery following cancer treatment or long term for chronic conditions, additional therapy and supervision is also possible.
CLINICAL EXCELLENCE
Hospice When cure is not possible, care is. When treatment no longer holds the disease in abeyance, the hospice organization offers specialized care and support focused on relief of symptoms – physical, emotional or spiritual. The team provides assistance so that pain and discomfort are controlled, supports caregivers in keeping their loved ones at home at the end of life, and ensures that patients have comfort, dignity and tranquility in familiar surroundings. They offer bereavement and grief support and counseling to families before and after the death of a loved one. SIH Cancer Institute enjoys a gratifying referral and organizational relationship with Hospice of Southern Illinois (HSI) as well as other hospice providers. Vickie Griffin, RN, MSN represents for HSI on the SIH Cancer Institute Cancer Committee.
When cure is not possible, care is.
Clinical Trials Research is an essential component of a comprehensive cancer program. People who enter clinical research trials can play a more active role in their own health care, gain access to new treatments before they are widely available, and help others by contributing to advances in medical knowledge. During 2012, investigators at SIH Cancer Institute enrolled their first patients into national cooperative group clinical trials through the Central Illinois Community Clinical Oncology Program (CICCOP) chartered by the National Cancer Institute. The CCOP offers trials from cooperative groups such as SWOG, ECOG, NSABP and research bases such as University of Rochester Wilmot Cancer Center, Wake Forest Comprehensive Cancer Center and MD Anderson Cancer Center. Following approval by the Institutional Review Board, the Clinical Trials Office administers these trials, managed by Tonica Anderson, RN, OCN, who coordinates enrollment, follow-up and data collection.
Palliative Care Palliative care focuses on the pain, symptoms and stress of serious life limiting illness. Members of the palliative care team coordinate care among multiple physicians and help patients navigate the complexities of the health care system. They guide patients in making plans for living well, based on personal needs and goals for care. They assist patients in making difficult medical decisions. And they provide patients and loved ones with emotional and spiritual support and guidance. Patients who take advantage of palliative care services tend to have fewer acute care visits for pain and symptom control, fewer redundant imaging studies and procedures, and fewer and shorter hospital admissions. Palliative care is not end of life care, although it addresses the needs of patients with advanced disease whose goals for treatment may be changing to accommodate the reality of a poor prognosis. Palliative care and active cancer treatment may coincide. A landmark 2010 study concluded that the median survival of patients with advanced lung cancer was lengthened by the early incorporation of palliative care into their treatment plans. Under Medical Director Elbert Fasnacht, MD, and Coordinator Abby Woods, FNP, the Palliative Care Team consists of representatives from case management, social services, nursing and pastoral care. The team does inpatient consultations in all three SIH facilities in collaboration with each patient’s personal physician.
15
EDUCATION & SUPPORT
Screening for Cancer
Screening is effective if: (1) a test is available to detect cancer prior to symptoms and (2) evidence shows that earlier treatment results in an improved outcome.
Screening is effective if: (1) a test is available to detect cancer prior to the occurrence of symptoms and (2) evidence shows that earlier treatment results in an improved outcome. SIH Cancer Institute applies national evidence-based screening guidelines for early detection of cancers where screening is known to increase survival and decrease morbidity. In 2011, the Breast Center completed over 14,000 screening mammograms, over ten percent offered at no cost. In addition,192 new patients presented with breast cancer. SIH Cancer Institute participates in a statewide Colorectal Cancer Education and Screening Initiative with the American Cancer Society; the media campaign raises awareness about colorectal cancer screening in general, ACS funds screening colonoscopies for eligible uninsured patients, and SIH covers the cost of treatment for any cancers detected. Physicians also provide screening for cervical cancer (Papanicolaou testing), prostate cancer (examination with or without PSA testing), and skin cancer (surveys for melanoma). A new challenge is the implementation of lung cancer screening, recently shown by the National Cancer Institute’s National Lung Screening Trial to reduce lung cancer deaths by 20% when applied to the high risk population.
Cancer Prevention and Community Awareness Cancer prevention programs identify risk factors and develop strategies to modify attitudes and behaviors to reduce the incidence of cancer, consistent with national evidence based guidelines for cancer prevention. An example is the High Risk Clinic at the Breast Center. Risk factor assessments help identify women with a high lifetime breast cancer risk, and enhanced screening in addition to preventive therapies can drastically reduce their prospects for developing or dying from breast cancer. SIH Cancer Institute contributes to community awareness about cancer prevention by publishing the quarterly newsletter, Cancer Connections, with a circulation of 3000; by participating in the 2012 Lung Cancer and Radon Awareness in Southern Illinois seminar; by providing lectures and articles for the SIH Second Act program, which reaches over 9000. SIH Cancer Institute works with SIH Community Benefits as it joins with the Healthy Southern Illinois Delta Network, facilitating Healthy Communities Coalitions in surrounding counties by bringing together social service agencies, health care providers, public health and community groups to address health issues at local levels. Examples of programs include SIH collaboration with schools to provide nursing and health education in rural school districts and aiding the region’s congregations through training and support of the Health Ministry program.
16
SIH Cancer Institute participates with the American Cancer Society in local cancer awareness programs such as Relay for Life in several counties, the annual Great American Smokeout, and Cold Turkey Bowling; SIH Cancer Institute and SIU Carbondale co-sponsor the annual BeMyBra competition, the Black Out Cancer football game, the volleyball team’s Dig for the Cure, basketball’s Pink Out game and softball’s Strikeout Cancer game. CANCER ANNUAL REPORT 2012
EDUCATION & SUPPORT
More people than ever before are surviving at least five years and leading full and productive lives during and after treatment.
Patient Navigation Cancer patient navigation involves individualized help offered to patients to help overcome complex health care system barriers and get timely access to quality care. In a more personal sense, navigators help with the often devastating economic, cultural and emotional challenges faced by cancer patients and their families, at a point when they are confronting the trial of their lives. Whether it is assistance with transportation to keep appointments, or education about the rationale for treatment, or just plain moral support, navigators assist patients in completing the journey through diagnosis, staging and treatment. Patients with access to a navigator have statistically significantly better outcomes due to an enhanced likelihood of proceeding through complete treatment and follow-up. Donna Crow, RN, Cynthia Davis, RN, and Tonica Anderson, RN provide patient navigation services at SIH Cancer Institute.
Nutrition consultation Eating a well balanced, healthy diet during cancer treatment can help preserve strength, energy and the body’s natural defenses. Further, cancer patients may have varying dietary needs, as well as side effects that lead to eating problems. Registered licensed dietitians, who are experts with extensive training, offer nutrition consultation. Services include assessment and counseling in management of treatment side effects, special feeding regimens like tube feeding, and nutrition education for patients, families and caregivers. Jan Danley, MS, RD, LDN supervises cancer patient nutritional consultations.
Survivorship: Living With and Beyond Cancer More people than ever before – about 65% of cancer patients overall - survive at least five years and they lead full and productive lives during and after treatment. Survivors’ needs include follow-up health care and knowledge plus help for the late or long term effects of cancer and treatment. Expanding on the Lance Armstrong Foundation model, SIH Cancer Institute, John A. Logan Community College and Dr. Phil Anton of the SIUC Department of Kinesiology jointly administer the Strong Survivors Program. The three part series incorporates a twelve week exercise and nutrition education program, with extended long term participation available as well as individually supervised exercise testing and training for cancer survivors. The program, offered three times a year, also provides data for ongoing research on cancer treatment as it relates to fatigue, quality of life, strength, balance and motor skills. Supported by a Livestrong Community Impact Project Grant, the Cancer Transitions program is a six week program that further addresses the long term effects of cancer treatment. It incorporates support groups, education sessions, nutrition and physical exercise, as well as addressing emotional and medical management issues. Participants learn how to formulate an ongoing personal action plan for survivorship. Tonica Anderson, RN, OCN coordinates Survivorship programs within the SIH Cancer Institute. SIH Cancer Institute holds an annual cancer survivors’ celebration at which a Star Survivor, nominated by friends, family and caregivers, receives recognition. The 2012 SIH Star Survivor is Catherine Caldwell of Carbondale.
17
EDUCATION & SUPPORT
Spiritual care is a source of hope, prayer, solace reflection and healing for patients, family and staff alike.
Support Groups
Pastoral Care
The Cancer Reach Out Support System Group (CROSS), established in 2011, is rapidly the foremost regional gathering to offer moral support, solace, community and education to those confronted by a recent cancer diagnosis. SIH Cancer Institute refers numerous patients to this private general cancer support group, and contributes to the education programs offered by CROSS.
Spiritual care is a vital part of a holistic approach to health care. Under Director of Spiritual Care Stephen Pyle, M.Div., BCC, assistance is there to support cancer patients and their families as they draw on faith or spiritual values to cope with cancer. Spiritual Care at all three SIH facilities is a source of hope, prayer, solace, reflection and healing for patients, family and staff alike. The service is interfaith, personal and specific for the people in need.
The breast cancer support group, Women With Hope, is administered through the Breast Center and facilitated by its originator, Donna Crow, RN.
18
CANCER ANNUAL REPORT 2012
EDUCATION & SUPPORT
the future Sometimes life takes a wrong turn. Cancer happens on its own timetable. At that point, life as we know it is in upheaval. It is why those who live in southern Illinois want the best cancer care and services possible. Quality, state-of-the-art care. Close to home. Convenient. Compassionate. That is the foundation for the SIH Hope Is Home fundraising campaign to build a new cancer center. For far too long, many cancer patients and their families have had the perception that they need to travel long distances to receive the care they require. That is a viewpoint that must – and will – change with Hope Is Home. SIH has the physicians, specialists, advanced technology, expertise and nationally accredited care within our healthcare system. With a new center, patients and their families will greatly benefit from having their providers under one roof. In the last year, SIH Cancer Institute diagnosed and/or treated over 800 patients with cancer. That number increases exponentially when you factor in how one cancer diagnosis ultimately affects tens of thousands of southern Illinoisans as caregivers, relatives, colleagues or friends.
Studies show that, on average, most cancer patients will make 100 trips for treatments and related tests and services in the first year alone. Research has shown this treatment is more likely to be successful when patients are able to remain close to home, family and their normal routines. Spearheaded by the SIH Foundation and a volunteer committee that understands the needs and benefits of the project, Hope Is Home continues to make strides towards our fundraising goal of $10 million every day.
Opportunities exist for one-time gifts or five year pledges. To become part of this facility that will save lives in southern Illinois, please visit www.sih.net/hopeishome.
19
FOCUS ON LUNG CANCER
Lung cancer is the largest cause of cancer mortality and is part of the nation’s largest public health dilemma!
Lung Cancer Overview Lung cancer is the largest cause of cancer mortality and is part of the nation’s largest public health dilemma! Approximately 226,000 new cases and 160,000 lung cancer deaths will occur in the USA during 2012. Lung cancer is directly related to smoking and to exposure to other carcinogens such as radon and asbestos. In the absence of smoking, over 80% of lung cancers would never occur. The great majority of lung cancers are of the non small cell type (NSCLC). The overall five year survival from NSCLC is about 16%. Diagnosis tends to occur late in the disease because early lung cancer may not produce symptoms such as cough, shortness of breath or bloody sputum. In fact, the lung cancer is often discovered incidentally during imaging evaluation for unrelated complaints. Lung cancer patients tend to be elderly and to suffer from chronic health conditions that make them unable to tolerate aggressive cancer treatment. But the news is not all dismal. Incremental but noteworthy advances are arising which have the potential to improve this picture. - Annual lung cancer mortality measures have reached a plateau and begun to decline, especially among males, mostly because public health campaigns against smoking are having some effect in reducing smoking rates.
20
CANCER ANNUAL REPORT 2012
- In 2011 the National Lung Screening Trial showed a 20% lung cancer mortality reduction in high risk older smokers who were screened with annual low dose CT scans. This is because the five year survival rate for Stage I NSCLC is 40-60%, and cases diagnosed as a result of screening were more likely to be at Stage I. - Appropriate treatment depends on the accuracy of staging, and minimally invasive staging modalities have been developed – PET/CT scanning, endobronchial ultrasound – which are very precise and well tolerated. - Platinum based adjuvant chemotherapy has increased survival rates by 5-10% in Stage IB, II and IIIA patients with completely resected tumors, including those with positive lymph nodes. This effect is similar to the effect of adjuvant chemotherapy in breast and colon cancers. - New treatments with targeted drugs such as erlotinib (Tarceva) and bevacizumab (Avastin) have extended survival in patients with advanced disease of susceptible types, and there is reason to hope that these benefits may be extended to earlier stage patients. - Ancillary histologic studies have improved pathologists’ ability to classify tumors, and to identify specific molecular abnormalities which predict sensitivity to the growing number of new therapies.
FOCUS ON LUNG CANCER
Lung Cancer TREATMENT The chart summarizes NSCLC treatment according to stage. Surgery is the mainstay of treatment for early stage lung cancer; survival improves by the addition of adjuvant chemotherapy, except in the earliest circumstance. Concurrent chemotherapy and radiation therapy is appropriate for locally advanced lung cancer; this treatment may render some Stage III cases amenable to surgical resection following a good response to the chemoradiation. Palliative chemotherapy and targeted therapy are suitable in hopes of slowing the progression of metastatic disease and easing its symptoms. Palliative radiation therapy may also be added for specific complications of bronchial and vascular obstruction. In this devastating disease, with its countless potential local and distant sites of damage, the advantage of a given treatment must be weighed against the ability of the patient to tolerate it. Best supportive care should be available for all patients to lessen suffering.
Lung Cancer TREATMENT
EARLY STAGE 5 YEAR SURVIVAL
TREATMENT
I
II 40-60%
LOCALLY ADVANCED IIIA IIIB 20%
5%
METASTATIC IV 1%
SURGERY RADIATION THERAPY adjuvant
systemic therapy concurrent
palliative
21
FOCUS ON LUNG CANCER
lung cancer in southern illinois Lung cancer is more common and more deadly in southern Illinois. Table 1 shows that the incidence and mortality rates for Illinois are higher than the national average; further, the rates for the sixteen county Southern Illinois Delta region and for the seven individual counties within Southern Illinois Healthcare’s primary service area are markedly higher than the Illinois average. Furthermore, while specific lung cancer mortality in the USA and in Illinois has been declining with each measured period since about 1995, lung cancer mortality in southern Illinois has not declined at all. In the period 1993-1995 it was 65/100,000 population and in the period 2003-2007 it was 68/100,000 population for the sixteen county SI Delta region and for the SIH primary service counties. This amounts to a 26-28% greater mortality rate compared to Illinois and the USA, and means that from 2003-2007 over 300 lives were lost to lung cancer in the SI Delta counties beyond those expected from the state average. TABLE 1. LUNG CANCER INCIDENCE AND MORTALITY PER 100,000 POPULATION
INCIDENCE/YEAR 2004-2008 DEATHS/YEAR 2003-2007
USA................................... 63..............................53 ILLINOIS............................ 72..............................54 SI DELTA (16 counties)...... 91..............................68 Jackson County................. 66..............................53 Williamson County............ 91..............................68 Franklin County............... 108..............................77 Johnson County................ 99..............................64 Union County..................... 81..............................70 Saline County.................... 96..............................83 Perry County...................... 86..............................60
Table 2 shows the percent of adults who smoke across the USA, within Illinois and in the SIH primary service area counties. As expected, the elevated lung cancer rates roughly correlate with the smoking rates, which are elevated compared to the national average. TABLE 2. SMOKING RATES % OF RESIDENTS WHO SMOKE USA.....................................................................19 ILLINOIS..............................................................19 Jackson County...................................................26 Williamson County..............................................29 Franklin County...................................................28 Johnson County..................................................22 Union County.......................................................28 Saline County......................................................20 Perry County........................................................24
22
CANCER ANNUAL REPORT 2012
Healthy Southern Illinois Delta Network SIH Service area
The SIH Cancer Institute saw 126 non small cell lung cancer cases in 2010, 67% diagnosed at Stages III or IV; for 2011, 60% of 124 cases were Stage III or IV. Over the USA as a whole, this proportion has been 59%, and for the state of Illinois 61% in recent years. This slightly skewed stage distribution at diagnosis may contribute to elevated lung cancer mortality in southern Illinois. The reasons for elevated smoking, cancer incidence and cancer mortality rates in southern Illinois are multifactorial and complex. It is likely that poverty rates, lack of insurance coverage and delays in treatment are also determining factors. Table 3 compares the ‘time to first treatment’ for Memorial Hospital of Carbondale lung cancer patients and lung cancer patients seen at all Commission on Cancer hospitals in the state of Illinois, for the years 2007, 2008 and 2009 (analytic cases only). Over the three year period, the proportion of patients whose treatment started 21 days or less from the date of first contact was significantly lower for MHC patients than for IL patients as a whole; conversely, the proportion of patients whose treatment started 22 days or more from the date of first contact was significantly higher for MHC patients. In summary, if diagnosis or treatment is delayed by factors related to patient willingness or ability to seek evaluation or to delay within the health care system itself, such delay may be expected to contribute to elevated mortality. TABLE 3. TIME TO FIRST TREATMENT: MEMORIAL HOSPITAL OF CARBONDALE LUNG CANCER PATIENTS VS. ALL ILLINOIS LUNG CANCER PATIENTS DAYS TO TREATMENT 2007 MHC/IL 2008 MHC/IL 2009 MHC/IL AVERAGE < 6......................................................................... 20%/24%............ 15%/22%............14%/22%............ 16%/23% 7-21....................................................................... 23%/26%............ 15%/25%............12%/24%............ 17%/25% 22-40..................................................................... 25%/24%............ 26%/26%............26%/26%............ 26%/25% > 41....................................................................... 32%/26%............ 44%/27%............47%/28%............ 41%/27%
In February, 2012, the American Cancer Society awarded a $250,000 grant to SIU School of Medicine and Dr. David Steward, Principal Investigator, for a community based participatory research study of lung cancer disparities in southern Illinois. Southern Illinois Healthcare, the Illinois State Cancer Registry and several regional public health organizations are active partners. The recipients work with existing community coalitions to identify and address barriers that prevent people from quitting smoking and from getting proper attention for issues related to lung cancer. The grant will also help to support the SIH Cancer Institute Pulmonary Nodule Clinic, developed to review abnormal imaging studies and work to see that patients with abnormalities receive timely evaluation and are not lost to follow-up. Patients can be seen by a specialist at the first sign of abnormality, and a navigator and office staff will track the patients from start to finish of the evaluation.
FOCUS ON LUNG CANCER
MEMORIAL HOSPITAL OF CARBONDALE NON SMALL CELL LUNG CANCER STATISTICS 2011 case abstracts together with National Cancer Data Base information is used to make comparisons between our own lung cancer patient experience and that of Commission on Cancer hospitals as a diverse group comprised of community, veterans’ and teaching institutions. A. PATIENT POPULATION CHARACTERISTICS STAGE DISTRIBUTION COMPARED TO ALL NCDB HOSPITALS STAGE MHC % 2010 MHC % 2011 NCDB % 2009 I..........................................................24.............................. 24................................ 26 II...........................................................6.............................. 11.................................. 6 III........................................................27.............................. 22................................ 23 IV........................................................40.............................. 39................................ 37 Other/Unknown....................................3................................ 4.................................. 8 III + IV.................................................67.............................. 59................................ 60 Total Cases.......................................126............................ 124........................ 127272
The proportion of lung cancers diagnosed at each stage is quite comparable between MHC and all NCDB hospitals. The data compares from the most recent years available. For 2010, the sum of the advanced stages is 67% for MHC which is greater than the sum of Stages III and IV for MHC in 2011 and for NCDB hospitals in 2009. It is necessary to remain alert for trends toward later diagnosis in our region. AGE DISTRIBUTION COMPARED TO ALL NCDB HOSPITALS AGE MHC 2009 MHC 2000-2009 NCDB 2000-2009 30-39..............................................0%............................... 0%................................1% 40-49..............................................2%............................... 4%................................5% 50-59............................................ 17%............................. 19%..............................16% 60-69............................................37%............................. 34%..............................30% 70-79............................................26%............................. 32%..............................34% 80-89............................................15%............................. 10%..............................14% >90.................................................4%............................... 1%................................1% Total Patients ................................101...............................992....................... 1165863
The age distribution for lung cancer patients seen at MHC is skewed slightly toward younger age groups compared with all NCDB hospitals. This pattern, noted for 2009, is borne out by composite data for all cases from 2000-2009. 57% of MHC patients were under 70 at the time of diagnosis, compared to 52% of all NCDB patients. Conversely, 43% and 49% respectively were diagnosed at age 70 or older. This is despite the fact that the southern Illinois population is overall somewhat older than the population of the state of Illinois as a whole, and may reflect a greater prevalence of risk factors in our region, such as youth smoking. DISTANCE TRAVELED COMPARED TO ALL NCDB HOSPITALS 2000-2009 DISTANCE MHC% NCDB% <10 MI............................................................................15................................... 42 10-24 MI.........................................................................41................................... 26 25-49 MI.........................................................................27................................... 14 >50 MI............................................................................17................................... 12 Total patients...............................................................992......................... 1165863
Lung cancer patients seen at MHC tend to travel further for their care than patients seen at all NCDB hospitals as a whole, not a surprising statistic for any health system serving rural areas.
B. TREATMENTS AND OUTCOMES FIRST COURSE OF TREATMENT AT MHC COMPARED TO ALL NCDB COMPREHENSIVE COMMUNITY HOSPITALS 2009 TREATMENT MHC% NCDB% Surgery Only...................................................................14................................... 20 RTX Only.........................................................................22................................... 13 Surgery + CTX..................................................................3..................................... 5 RTX + CTX......................................................................23................................... 21 CTX Only...........................................................................7................................... 14 Surgery, RTX + CTX..........................................................4..................................... 3 Other................................................................................4..................................... 2 None...............................................................................24................................... 22 Total Patients...............................................................101........................... 127272
14% of MHC patients had surgery only compared to 20% for comparable programs elsewhere. Conversely, more patients opted for definitive radiation therapy at MHC than elsewhere, leaving the totals for single modality first course of treatment approximately equal. A total of 21% of MHC patients were candidates for curative surgery in 2009, with or without other forms of treatment; this compares to 28% for patients seen at comparable hospitals elsewhere. Approximately equal proportions of patients in the two groups received no treatment at all. NSCLC FIVE YEAR SURVIVAL WITH CONFIDENCE INTERVAL, AT MHC COMPARED TO ALL NCDB HOSPITALS 1998 – 2002 CASES NCDB...................................................................... 16.7%..................16.5-16.8 MHC....................................................................... 21.5%..................15.6-27.4 2003-2005 NCDB...................................................................... 16.5%..................16.3-16.6 MHC....................................................................... 18.0%........................13-23 Survival statistics for MHC patients compare favorably with those for all USA NCDB hospitals as a whole. The confidence intervals overlap in each case. Thus, although the numbers appear at variance, this is likely due to MHC’s relatively small case volumes; there is no statistically significant difference demonstrated. In summary, although MHC’s patient population is somewhat younger and more rural than average, the stage distribution at diagnosis, the treatment(s) employed and the long term outcomes are very close to the national experience.
Data suggests that lung cancer is more common in southern Illinois, making our mission clear.
23
CANCER REGISTRY
Review of Cancer Registry Activity The Cancer Registry accessioned 611 analytic cases (diagnosed and/or treated here) for Memorial Hospital of Carbondale in 2011; in addition the registry abstracted 200 cases from Herrin Hospital and 110 cases from St. Joseph Memorial Hospital, making a total of 921 SIH cases for the year, reported to the NCDB and the Illinois State Cancer Registry combined. Top sites continue to be breast, lung, colorectal, prostate and nonHodgkins lymphoma. These five sites comprise two thirds of the cases reported. There are cumulatively 7,036 Memorial Hospital patient abstracts of cases from 2001 through 2011, and each case followed indefinitely. As a Commission on Cancer program, the registry is required to periodically audit case finding, abstracting timeliness, follow-up rates, and to respond on time to calls for data from the NCDB. An annual quality control plan concentrates on optimizing the quality of abstracted data through ongoing abstract review for each registrar. The registry also reviews and corrects Clinical Program Practice Profile Review data generated by the NCDB and pinpoints areas where data quality needs improvement. Cancer data from the Registry and the NCDB is available for use by the medical staff and administration for education, research and studies comparing quality of care and outcomes. This database is an important patient care and quality assessment tool. The Cancer Registry is adapting to sweeping updates in reporting. The AJCC Rapid Reporting Requirement will reduce the turnaround time for abstracting, as will the CoC Rapid Quality Reporting System which supports real time clinical assessment of quality of care measures for breast and colorectal cancers. The Cancer Registry includes Sue Williams, CTR, Susan Culton, CTR and Erica Evers, RHIT. Christena Vallerga, recently elected president of the Cancer Registrars of Illinois association, is the Cancer Information Supervisor.
top primary sites for mhc 2011 cases
22.98% 31.37%
31.37% BREAST BRONCHUS & LUNG COLON BLOOD & BONE MARROW PROSTATE GLAND LYMPH NODES SKIN LARYNX UNK PRIMARY OTHER
2.29% 2.29% 3% 3.59% 3.92% 4.41%
24
4.74%
21.41% CANCER ANNUAL REPORT 2012
4.74%
21.41%
CANCER REGISTRY
Cancer Registry 2011 2011 ACCESSIONS: MEMORIAL HOSPITAL OF CARBONDALE PRIMARY SITE TOTAL SEX AJCC STAGE M F 0 I II III IV UNK N/A ALL SITES....................................................... 611........................... 249........... 362............................... 39.............. 153.......... 100................. 76............108................ 68............... 67 ORAL CAVITY.................................................. 19............................. 15.............. 4.................................. 0................. 1.............. 0.................... 6...............9................... 3................. 0 TONGUE.......................................................... 4............................... 4............... 0.................................. 0................. 0.............. 0.................... 1...............2................... 1................. 0 OROPHARYNX................................................ 2............................... 0............... 1.................................. 1................. 0.............. 0.................... 2...............0................... 0................. 0 OTHER............................................................ 13............................. 10.............. 3.................................. 0................. 1.............. 0.................... 3...............7................... 2................. 0 DIGESTIVE SYSTEM...................................... 75............................. 46............. 29................................. 4................ 12............ 10.................. 20.............20.................. 8................. 1 ESOPHAGUS................................................... 9............................... 9............... 0.................................. 0................. 0.............. 1.................... 5...............3................... 0................. 0 STOMACH....................................................... 3............................... 1............... 2.................................. 0................. 1.............. 0.................... 0...............0................... 2................. 0 COLON........................................................... 26............................. 17.............. 9.................................. 4................. 3.............. 3................... 10..............6................... 0................. 0 RECTUM......................................................... 10.............................. 6............... 4.................................. 0................. 7.............. 1.................... 1...............1................... 0................. 0 ANUS/ANAL CANAL...................................... 4............................... 2............... 2.................................. 0................. 1.............. 0.................... 0...............0................... 3................. 0 LIVER............................................................... 3............................... 2............... 1.................................. 0................. 0.............. 0.................... 0...............2................... 1................. 0 PANCREAS...................................................... 9............................... 6............... 3.................................. 0................. 0.............. 2.................... 1...............5................... 1................. 0 OTHER............................................................ 11.............................. 3............... 8.................................. 0................. 0.............. 3.................... 3...............3................... 1................. 1 RESPIRATORY SYSTEM............................... 149............................ 85............. 64................................. 0................ 35............ 16.................. 32.............59.................. 7................. 0 NASAL/SINUS................................................ 1............................... 1............... 0.................................. 0................. 0.............. 0.................... 0...............1................... 0................. 0 LARYNX......................................................... 14............................. 12.............. 2.................................. 0................. 5.............. 1.................... 4...............4................... 0................. 0 LUNG/BRONCHUS........................................ 131............................ 69............. 62................................. 0................ 29............ 15.................. 27.............53.................. 7................. 0 OTHER............................................................. 3............................... 3............... 0.................................. 0................. 1.............. 0.................... 1...............1................... 0................. 0 BLOOD & BONE MARROW.......................... 25............................. 11............. 14................................. 0................. 0.............. 0.................... 0...............0................... 0................ 25 LEUKEMIA...................................................... 11.............................. 4............... 7.................................. 0................. 0.............. 0.................... 0...............0................... 0................ 11 MULTIPLE MYELOMA..................................... 7............................... 4............... 3.................................. 0................. 0.............. 0.................... 0...............0................... 0................. 7 OTHER............................................................. 7............................... 3............... 4.................................. 0................. 0.............. 0.................... 0...............0................... 0................. 7 BONE................................................................. 1............................... 0............... 1.................................. 0................. 0.............. 1.................... 0...............0................... 0................. 0 CONNECT/SOFT TISSUE................................ 6............................... 5............... 1.................................. 0................. 1.............. 1.................... 1...............1................... 2................. 0 SKIN - MELANOMA....................................... 17............................. 11.............. 6.................................. 2................. 2.............. 4.................... 1...............2................... 6................. 0 BREAST.......................................................... 192............................. 4............. 188............................... 32............... 65............ 46................... 9...............6.................. 34................ 0 FEMALE GENITAL.......................................... 19.............................. 0.............. 19................................. 0................. 9.............. 2.................... 5...............1................... 2................. 0 CERVIX UTERI................................................. 5............................... 0............... 5.................................. 0................. 3.............. 1.................... 1...............0................... 0................. 0 CORPUS UTERI................................................ 8............................... 0............... 8.................................. 0................. 4.............. 0.................... 2...............0................... 2................. 0 OVARY............................................................ 4............................... 0............... 4.................................. 0................. 1.............. 0.................... 2...............1................... 0................. 0 OTHER............................................................. 2............................... 0............... 2.................................. 0................. 1.............. 1.................... 0...............0................... 0................. 0 MALE GENITAL............................................... 25............................. 25.............. 0.................................. 0................. 7............. 15................... 0...............3................... 0................. 0 PROSTATE...................................................... 24............................. 24.............. 0.................................. 0................. 6............. 15................... 0...............3................... 0................. 0 TESTIS............................................................. 1............................... 1............... 0.................................. 0................. 1.............. 0.................... 0...............0................... 0................. 0 URINARY SYSTEM......................................... 15............................. 10............. 15................................. 1................. 8.............. 2.................... 0...............2................... 2................. 0 BLADDER........................................................ 4............................... 3............... 1.................................. 1................. 1.............. 2.................... 0...............0................... 0................. 0 KIDNEY.......................................................... 11.............................. 7............... 4.................................. 0................. 7.............. 0.................... 0...............2................... 2................. 0 BRAIN & CNS................................................. 22.............................. 6.............. 16................................. 0................. 0.............. 0.................... 0...............0................... 0................ 22 BRAIN (BENIGN)............................................. 4............................... 1............... 3.................................. 0................. 0.............. 0.................... 0...............0................... 0................. 4 BRAIN (MALIGNANT)..................................... 7............................... 3............... 4.................................. 0................. 0.............. 0.................... 0...............0................... 0................. 7 OTHER............................................................ 11.............................. 2............... 9.................................. 0................. 0.............. 0.................... 0...............0................... 0................ 11 ENDOCRINE..................................................... 8............................... 5............... 3.................................. 0................. 4.............. 1.................... 1...............0................... 0................. 2 THYROID......................................................... 5............................... 3............... 2.................................. 0................. 4.............. 0.................... 1...............0................... 0................. 0 OTHER............................................................. 3............................... 2............... 1.................................. 0................. 0.............. 1.................... 0...............0................... 0................. 2 LYMPHATIC SYSTEM.................................... 24............................. 16.............. 8.................................. 0................. 9.............. 2.................... 1...............5................... 4................. 3 HODGKINS DISEASE...................................... 2............................... 2............... 0.................................. 0................. 0.............. 0.................... 0...............1................... 1................. 0 NON HODGKINS............................................ 22............................. 14.............. 8.................................. 0................. 9.............. 2.................... 1...............4................... 3................. 3 UNKNOWN PRIMARY................................... 14............................. 10.............. 4.................................. 0................. 0.............. 0.................... 0...............0................... 0................ 14 This report excludes carcinoma in situ of cervix, basal and squamous cell carcinoma of skin and intraepithelial neoplasia cases.
25
ADMINISTRATION
cancer committee Mary Rosenow, MD Chair
Srinivas Rajamahanty, MD Surgery
Jennifer Badiu, MHSA Administration
Michael Little, MD Radiation Oncology
Valerie Baker Cancer Care Services Community Outreach Coordinator
Abby Woods, FNP Palliative Care
Lynn Torres, RN Quality Improvement Quality Improvement Coordinator Susan Culton, CTR Cancer Registry Cancer Conference Coordinator Christena Vallerga, CTR Cancer Information Supervisor Cancer Registry Quality Coordinator George Kao, MD Radiation Oncology Cancer Liaison Physician Justin Hodge, MD Diagnostic Radiology Peter Graham, MD Medical Oncology Moses Adeyanju, MD Pathology Chandrshekar Padmalatha, MD Pathology Cynthia Aks, DO Surgery David Clutts, MD Surgery
26
CANCER ANNUAL REPORT 2012
Donna Crow, RN Patient Navigation Tonica Anderson, RN, OCN Survivorship and Clinical Trials Office Vicki Griffin, RN Hospice Cindy Davis, RN Patient Navigation Lisa DaSilva, RN Oncology Nursing Stephen Pyle, M. Div, BCC Pastoral Care Dawn Harriett, LMSW Social Services Diane Land, MPH Community Benefits Office Jan Danley, RD, MS Nutrition Services Sue Williams, CTR Cancer Registry Lisa Mann American Cancer Society Penni Quitsch American Cancer Society
ADMINISTRATION
southern illinois healthcare cancer institute site specific groups: affiliated physicians MEDICAL ONCOLOGY Alberto Cuartas, MD Peter Graham, MD Sujatha Rao, MD THORACIC SURGERY John Watson, MD Cristian Sarateanu, MD GI SURGERY Naresh Ahuja, MD Judson Brewer, MD David Clutts, MD Neal McCain, MD Deepu Sudhakaran, MD
RADIATION ONCOLOGY George Kao, MD Michael Little, MD BREAST SURGERY Cynthia Aks, DO Marsha Ryan, MD UROLOGIC SURGERY Srinivas Rajamahanty, MD HEAD/NECK SURGERY David Hohuan, MD David Mann, MD Paul Schalch, MD
NEUROSURGERY Jeff Jones, DO Jon Taveau, DO
DIAGNOSTIC RADIOLOGY Justin Hodge, MD Cape Radiology Group
BREAST IMAGING Terrence Chambers, MD
INTERVENTIONAL RADIOLOGY Tom Brumitt, DO Blair Gill, MD
DERMATOLOGY Sean Burke, MD PALLIATIVE CARE Elbert Fasnacht, MD
PATHOLOGY Moses Adeyanju, MD Abdallah Azouz, MD Chandrashekar Padmalatha, MD
PULMONOLOGY Fadi Adra, MD Suhail Istanbouly, MD Raymund Pineda, MD Parviz Sanjabi, MD Dani Tazbaz, MD
southern illinois healthcare cancer institute site specific groups: allied health professionals REHABILITATION Jennifer Aspen,OTR/L Lynn Atteberry, COTA/L, CLT/ LANA PATIENT NAVIGATION Tonica Anderson, RN, OCN Donna Crow, RN, CBCN Cindy Davis, RN
PALLIATIVE CARE Abby Woods, FPN CLINICAL TRIALS OFFICE Tonica Anderson,RN,OCN CANCER REGISTRY Christena Vallerga, CTR
CONFERENCE COORDINATION Susan Culton, CTR Amy Behrens
27
CONTACTS CANCER CARE SERVICES CALL CENTER.......................877-803-1212 ADMINISTRATIVE DIRECTOR...........................................457-5200 x67128 or x67129 MEDICAL DIRECTOR..........................................................457-5200 x67107 CONFERENCE COORDINATOR..........................................457-5200 x67134 BREAST CANCER GROUP.................................................457-2281 x68059 LUNG CANCER GROUP......................................................457-5200 x67160 GI CANCER GROUP.............................................................457-5200 x67160 GU CANCER GROUP...........................................................457-5200 x67133 HEAD AND NECK CANCER GROUP.................................457-5200 x67133 SURVIVORSHIP SERVICES................................................457-5200 x67133 PALLIATIVE CARE SERVICE...............................................457-5200 x67161 CANCER CLINICAL TRIALS OFFICE.................................457-5200 x67133 CANCER REGISTRY.............................................................457-5200 x67116 THE BREAST CENTER........................................................457-2281 PULMONARY NODULE CLINIC.........................................457-5200 x67137
references and resources American Cancer Society www.cancer.org
Illinois State Cancer Registry
www.idph.state.il.us/about/epi/cancer_registry.htm
National Cancer Data Base www.facs.org/cancer/ncdb
National Cancer Institute
www.cancer.gov/cancertopics/types/lung
National Cancer Institute Surveillance and Epidemiology and End Results (SEER) Program www.seer.cancer.gov
National Comprehensive Cancer Network www.nccn.org
New England Journal of Medicine
NEJM 2010;363;733 Early Palliative Care for Patients with Metastatic Non Small Cell Lung Cancer