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The Valley Hospital Cancer Program
2008 Annual Report
December 2009
T he Staff of T he Val le y Hospital Ca nce r Ce nte r
The 2008 Valley Hospital Cancer Committee
Robert J. Korst, M.D.
Chairman, Cancer Committee;
Physician Liaison,
American College of Surgeons
Commission on Cancer;
Director, Thoracic Surgery;
Medical Director,
Blumenthal Cancer Center
Anusak Yiengpruksawan, M.D.
Vice Chairman
Subspecialty Director,
Surgical Oncology
Arthur Antler, M.D.
Gastroenterology
Harold Bruck, M.D.
Surgery (General)
William Burke, M.D.
Gynecologic Oncology
Lisa Cannon, M.D.
Pulmonology
Allen Chinitz, M.D.
Oncology/Hematology
Chad DeYoung, M.D.
Radiation Oncology
Barry Fernbach, M.D.
Medical Oncology
Howard Frey, M.D.
Urology
Ganepola A.P. Ganepola, M.D.
Surgery
Andrey Gritsman, M.D.
Director, Pathology & Laboratory Medicine
Noah Goldman, M.D.
Gynecologic Oncology
Peter Kaye, M.D.
Colorectal Surgery
Eli Kirshner, M.D.
Medical Oncology
Dawn Lazarus, M.D.
Diagnostic Imaging
Linda Marcus, M.D.
Director, Dermatology
Viswanathan Rajaraman, M.D.
Neurosurgery
Thomas Rakowski, M.D.
Medical Oncology
Mitchell Rubinstein, M.D.
Vice President, Medical Affairs
Arnold Scham, M.D.
Psychiatry
Metin Taskin, M.D.
Pathology
Robert Tassan, M.D.
Medical Oncology
Michael Wesson, M.D.
Medical Director, Radiation Oncology
Ignatios Zairis, M.D.
Thoracic Surgery
Jeff Lieto
Vice President, Ambulatory &
Strategic Development
Sandy Balentine
Director, Clinical Oncology
Cynthia Brady
Chaplain, Pastoral Care
Patricia Caputo
Director, Radiation Oncology
Veronica Dalcero
Oncology Social Worker
Moises Junchaya, Rh.P.
Clinical Pharmacy Specialist
Nancy Librera
Assistant Vice President,
Oncology Service
Kris MacMillan, R.N., M.S.N.
Director, Valley Hospice
Nancy Palumbo, R.N., B.S.N.
Oncology Program Coordinator
Cheryl Parish, R.N., B.S.N., M.B.A.
Manager, Clinical Trials
Kim Marie Robles, R.N.
Director, Quality Assessment/Improvement & Regulatory Compliance
Nina Rubin, R.D.
Supervisor, Nutrition & Wellness
Patrice Wilson, R.N., M.S.N., M.A., C.S.
Manager, Inpatient Oncology
A Message from the Chairman
It is with great pride that I present our 2008 Annual Report on behalf of the physicians
and staff of the Daniel and Gloria Blumenthal Cancer Center.
Last year was an exemplary year for The Center as many of our newest programs and innovations established themselves
through clinical excellence, outstanding patient care and exceptional service to patients throughout the region.
Valley has earned a formidable reputation as a leader in the prevention, diagnosis and treatment of the most prevalent
cancers we face: lung, prostate, gynecologic, breast, and gastrointestinal, among others.
In demonstration of our commitment, we have performed what I believe to be world-class research through our clinical
trials, genomic studies and laboratory work. Our appointment in 2007 of a research scientist for our Center for Cancer
Research and Genomic Medicine is proof of our growing commitment to finding clues to cancer’s most complex questions.
I would like to acknowledge the many staff members and doctors who participated in the planning and presentation of
our annual symposium: “Breast Cancer 2008: Contemporary Management Issues.”
In this publication, you will find reports on cancers of the pancreas and prostate. I am grateful to Anusak Yiengpruksawan,
M.D., and Howard Frey, M.D., for their analyses, and Allen Chinitz, M.D., for his insightful commentaries.
As Cancer Committee Chairman I extend gratitude to my colleagues at the Daniel and Gloria Blumenthal Cancer Center
for their continuing dedication to our patients and for their ongoing efforts to provide the excellent, compassionate care
for which Valley is known.
I look forward to another exceptional year.
Sincerely,
Robert J. Korst, M.D.
Medical Director, Daniel and Gloria Blumenthal Cancer Center
Director, Thoracic Surgery
Chairman, Cancer Committee
From the Assistant Vice President, Oncology Service
I am pleased to present our 2008 Annual Report. Over the past year, I have had the privilege of working with the
region’s most accomplished physicians, dedicated nurses and skilled support staff. It is an honor to serve alongside
you every day.
It is a significant time for cancer care at The Valley Hospital. With a cutting edge research laboratory, new applications
in minimally invasive and robotic surgery, and the highest caliber diagnostic and treatment tools, Valley has distinguished
itself among cancer programs in the region. In addition to our strong commitment to diagnosis and treatment, our
efforts towards survivorship and meeting the needs of those living with and beyond the cancer diagnosis have taken
center stage. Our cancer team has pledged to lead the way in developing systems to support and promote the needs
of cancer survivors.
We remain committed to providing excellent clinical care, innovative programs and technology, promising clinical trials
and a compassionate and respectful environment for patients and their families.
We appreciate and thank you for your continued support.
Sincerely,
Nancy Librera
Assistant Vice President, Oncology Service
Highlights and Accomplishments
SITE
2006
2007
2008
■ ■ ■ ■ ■ ■ ■ ■
13
24
24
Digestive System
303
319
358
Respiratory System
190
210
244
5
11
7
24
45
30
Breast
337
348
292
Female Genital
102
153
123
Male Genital
177
243
220
Urinary
90
108
117
Brain and other Nervous System
28
41
75
Endocrine System
53
59
72
Lymphoma
59
77
84
Myeloma
6
10
11
Leukemia
18
24
32
1
6
10
36
39
47
1443
1717
1746
Oral Cavity/Pharynx
Soft Tissue
Skin (excl Basal & Squamous)
Mesothelioma
Unknown Primary
TOTAL
Valley Sees Rise in
Analytical Cases
The Valley Hospital's Cancer
Program experienced another
rise in the number of cancer
patients treated. The total
number of analytic cases in
2008 was 1,746. At left, is
a three-year comparison.
Surgeon First to Complete New Fellowship Program ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Valley’s MIS Fellowship is a one-year training program
aimed at providing advanced training to surgeons in
minimally invasive (laparoscopic) GI/abdominal surgery,
robotic surgery, and interventional endoscopy.
With the advent of minimally invasive surgery over the
last 2 decades, a need has arisen for training programs
dedicated exclusively to these techniques, since surgery
residents graduating from general surgery training
programs do not get adequate experience in advanced
laparoscopic/robotic/endoscopic techniques.
2
In 2008, Jesse Moskowitz, M.D., became the first surgeon
to complete the program.
Program Directors are Robert J. Korst, M.D., and Anusak
Yiengpruksawan, M.D. Faculty members are: Daniel Davis,
D.O. (Bariatrics), Joseph Licata, M.D. (General Surgery),
Thomas Ahlborn, M.D. (General Surgery), William Burke,
M.D. (Pelvis/Gyn), Anusak Yiengpruksawan, M.D.
(Oncology/Abdomen, Endoscopic Ultrasound), and
Robert J. Korst, M.D. (Esophagus, Interventional Endoscopy).
Highlights and Accomplishments
Department of Radiation
Oncology Awarded
Re-accreditation
In 2008, the Radiation Oncology
Department of The Valley Hospital
was once again awarded a three-year
accreditation by the American College
of Radiology (ACR).
The ACR awards accreditation to
facilities for the achievement of high
practice standards after a peer-review
evaluation. Evaluations are conducted
by board-certified physicians and
medical physicists who are experts in
the field. They assess the qualifications
of the personnel and the adequacy
of facility equipment. The surveyors
report their findings to the ACR’s
Committee on Accreditation, which
subsequently provides the practice
with a comprehensive report.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
G ynecologic Cancer Specialist
Appointed to Medical Staff
Last year, The Valley Hospital welcomed
gynecologic oncologist Noah A.
Goldman, M.D., to the Medical Staff.
Dr. Goldman joins William M. Burke,
M.D., in the Subspecialty of Gynecologic Oncology.
Board certified in Obstetrics and Gynecology and in Gynecologic Oncology,
Dr. Goldman specializes in the surgical
treatment of all types of gynecologic
cancers and is a specialist in the use of
minimally-invasive surgical techniques
– including the use of the DaVinci
Robotic Surgical System™ — for the
treatment of gynecologic malignancies.
Dr. Goldman received his medical
degree from the University of Medicine
and Dentistry of New Jersey and
completed his residency in Obstetrics
and Gynecology at Mount Sinai School
of Medicine. He completed a Galloway
Fellowship in Gynecologic Oncology
at Memorial Sloan Kettering Cancer
Center during his residency, and
a 3-year fellowship in Gynecologic
Oncology at the Albert Einstein
College of Medicine and Montefiore
Medical Center.
CT Simulator
The Department of Radiation Oncology
acquired a new GE Lightspeed CT
Simulator with 4D capability. The
new technology has the ability to
capture the full range of motion of
critical internal structures and lesions
during a respiratory cycle. The system’s
powerful software can process 2,000
images within 5 minutes.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Research Scientist
Appointed
David H. Chang, Ph.D., was appointed
Research Scientist for The Valley
Hospital Center for Cancer Research
and Genomic Medicine, part of the
Daniel & Gloria Blumenthal Cancer
Center. The Research Center brings
the latest research methods to Valley's
physicians, surgeons and scientists
in order to help develop better diagnostic and treatment plans for cancer
patients.
The lab integrates physicians’ clinical
knowledge with scientists’ experimental techniques to study cancer using
tissue samples collected at Valley.
On-premises research already underway includes projects on colon cancer,
bladder tumors and lung cancer.
Upcoming studies include work on
prostate, pancreatic and breast cancers.
Dr. Chang received his doctorate from
Columbia University, and completed
his postdoctoral training at the
Rockefeller University. His work
includes research on dendritic cell
vaccines, anti-tumor immunity and immunotherapy, cancer gene regulation
and signal transduction, and multiple
myeloma and lymphoma studies.
Five Gold Seals
In 2008, Valley’s cancer program
was the recipient of an impressive
five Gold Seals of Approval for
healthcare quality from the Joint
Commission. Valley now holds Joint
Commission Disease-Specific Care
Certification for colorectal cancer,
lung cancer, breast cancer, pancreatic
cancer and prostate cancer. To earn
this distinction, Valley underwent
an extensive, on-site evaluation by a
team of Joint Commission reviewers.
Valley is the only hospital in New Jersey
with five gold seals for cancer care.
”Valley’s cancer program
was the recipient of an
impressive five Gold
Seals of Approval for
healthcare quality from
the Joint Commission.”
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
3
Highlights and Accomplishments
Surgical Oncologist Hosts
Colleagues from China
Tumor Registry
Receives Award
In 2008, Anusak Yiengpruksawan,
M.D., Director of Minimally Invasive
and Robotic Surgery at The Valley
Hospital, hosted physicians from
Beijing, China. The physicians, who
are on staff at the People's Liberation
Army Second Artillery Corps General
Hospital, visited Valley to meet with
Dr. Yiengpruksawan to discuss his use
of the da Vinci® Surgical System to
perform minimally invasive robotic
surgeries.
The Valley Hospital’s Tumor Registry
received the Award for Excellence
from The Oncology Registrars
Association of New Jersey (ORANJ)
in recognition of the timely and
complete reporting of cancer data
to the state. ORANJ, formerly known
as the Tumor Registrars Association
of New Jersey (TRANJ), is a non-profit
professional organization that has
been representing New Jersey Cancer
Registrars since 1983.
The physicians from China sought out
Dr. Yiengpruksawan’s expertise as a
result of his clinical reputation in the
field of robotic surgery. They were
particularly interested in learning
about Dr. Yiengpruksawan’s techniques for performing liver surgery
using the daVinci System.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Cancer Research
Director the First Physician
Ever Invited to Annual
Global Forum
Ganepola A.P. Ganepola, M.D., F.A.C.S.,
Medical Director of The Center for
Cancer Research and Genomic
Medicine at The Valley Hospital,
was the first doctor to participate
in last year’s Performance Theatre in
New Delhi, India. The annual forum,
sponsored by The Performance
Theater Foundation in Oslo, Norway,
typically seeks chairmen and CEOs
of Fortune 500 companies and Nobel
Laureates to discuss global economic
and social issues, making Dr. Ganepola’s
invitation most noteworthy.
Dr. Ganepola was chosen to participate
because of his background in traveling
to many parts of the world as a visiting professor to promote healthcare
education.
4
Clinical Trials Honored
Valley’s Department of Oncology
Clinical Trials was honored in 2008
by the American College of Surgeons
Oncology Group as a "Top 3 Performer"
in the country for data, patient
eligibility, and follow-up.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Valley Health System’s Oncology Programs and Services
Barrett’s Esophagus and GERD Center
Brachytherapy
Brain Lab
Butterflies Program
Cancer Genetics Program
Cancer Resource Center
Center for Cancer Research and
Genomic Medicine
Center for Colorectal Cancer
Center for Complementary Therapies
Center for Prostate Cancer
Clinical Pathology
Clinical Trials and Research
Comprehensive Breast Center
Cytodiagnostic Center
Data Management
Diagnostic Imaging
Genetic Testing and Counseling
Gynecologic Oncology
Home Care
Hospice and Palliative Care
I-ELCAP Lung Cancer Screening Program
Image Recovery Center
Infusion Center
Inpatient Oncology
Institute for Robotic and
Minimally Invasive Surgery
Integrative Healing Services
Journeys
Mammosite (Breast Brachytherapy)
Medical Oncology
Multidisciplinary Cancer Treatment
Planning Conferences
Multimodality Therapy
Nutritional Counseling
Lung Cancer Center
Oncology Registry
Oncology Social Work
Outcomes Assessment
Pain Management
Pastoral Care Services
PET Scanning
Pet Therapy
Pharmacy Consultation
Professional and Community
Education
Pulmonary Nodule Center
Radiation Oncology
Retail Pharmacy
Rehabilitation Services
Screening and Early Detection
Smoking Cessation
Specimen Bank
Stereotactic Radiosurgery
Support Services
Surgical Oncology
Targeted Therapy
TomoTherapy
Focus on Pancreatic Cancer
by Anusak Yiengpruksawan, M.D., Subspecialty Director of Surgical Oncology and
Medical Director of The Valley Hospital Institute for Robotic and Minimally Invasive Surgery
Since 1995, we have seen small improvements in the 5-year survival rates for pancreatic cancer (from 3% in 1995 to
5% in 2006). Nevertheless pancreatic cancer remains one of the most lethal cancers.
In 2009, deaths caused by pancreatic cancer nationally are
estimated to be 35,240 (6% of all cancer deaths). It is the
fourth leading cause of death in both men (behind lung,
prostate and colorectum) and women (behind lung, breast,
and colorectum). In New Jersey, estimated deaths due to
pancreatic cancer are projected to be 1,080 out of 16,480
cancer deaths.
Although there has been significant progress in all fronts
of cancer diagnosis and treatment, the impact on pancreatic cancer remains small. The majority of patients with
pancreatic cancer die within a year of diagnosis. Even in
patients with node-negative resectable disease, the best
5-year survival rate is still below 30%. At the present time,
early detection is the only hope at improving this grim
number.
At Valley, our efforts have been to raise awareness
of pancreatic cancer both within the hospital and the
community through outreach education programs,
newsletters, and tumor board conferences. We established
the pancreatobiliary center of excellence in 1995 and
initiated multidisciplinary consultation for pancreatic
cancer patients to help guide them through the process of
diagnosis and treatment. Through these combined efforts
at the community level, patients are now more educated
and more aware of signs and symptoms of pancreatic cancer. Primary care physicians are also increasingly sensitive
to the warning signs of pancreatic cancer such as the sudden onset of type II diabetes in elderly patients, weight loss
of unexplained etiology, and unusual abdominal symptoms
associated with chronic pancreatitis or diabetes. A patient
with one of these signs is now aggressively investigated
using diagnostic imaging techniques and biomarkers such
as the blood level of CA19-9. As a result, we have seen
a steady increase not only in the number but also in the
percentage of early stage cancer cases referred from both
local physicians and outside the area.
On the diagnostic front, along with the increasing sophistication of imaging technology such as dynamic spiral CT
performed according to a defined pancreas protocol, our
radiologists, with accumulating experience dealing with
pancreatic cancer, are more aware of early subtle changes
that occur within the pancreas, which may signify cancer.
These changes include focal pancreatitis, localized stricture
of main pancreatic duct with distal dilatation, and cystic
dilatation of the main or branch duct associated with irregularity. A strong recommendation for further investigation
by a radiologist alerts the primary physician to pursue the
next step such as MRI or endoscopic ultrasound, both of
which are available at Valley.
Our center was one of the first in Bergen County to offer
an endoscopic ultrasound (EUS) service. EUS is a complementary diagnostic imaging to CT for diagnosing pancreatic
cancer but it is more valuable for differentiating subtle
lesions which might suggest the presence of a cancer.
EUS-guided fine needle aspiration cytology/biopsy is recommended in an unresectable pancreatic cancer patient
whose tissue diagnosis is required to determine the course
of therapy. Generally it is not necessary or advised for
those who have resectable lesions since it poses the risk,
albeit small, of seeding of malignant cells along the needle
tract. For palliative purposes, EUS-guided celiac plexus
neurolysis is offered for patients with tumor-associated
abdominal pain. Other services offered at our endoscopic
center include ERCP. ERCP with placement of biliary stent
provides relief for patients with obstructive jaundice from
an unresectable tumor. Currently, we are in the process of
expanding our capability to establish a diagnosis of pancreatic
cancer earlier by adding more sophisticated equipments
along with the recruitment of skilled interventional
endoscopists, Dr. Peter Stevens, and Dr. Rosario Ligresti.
Pancreas Cases Diagnosed Comparison
TVH Cases
N J Cases
National Cases
60
3.4%
1440
3.1%
44,270
3.1%
5
Focus on Pancreatic Cancer
■ ■
■ ■ Surgical treatment – Current Status
According to recent literature, surgery for pancreatic cancer should be done at high volume institutions defined as
greater than 20 resections per year. We, in fact, are such an institution. For the past ten years, we have been performing
more than 20 complex pancreatic resections annually with excellent outcomes that equal that seen at the top national
institutions. Current criteria defining resectability include no distant metastases, clear fat plane around major vascular
structures (celiac and superior mesenteric artery) and patent superior mesenteric and portal veins.
Minimally invasive surgery (MIS) has been applied increasingly for various pancreatic lesions. Its use for malignant tumor,
although controversial, has the support from several clinical trials, which compared MIS to open surgery for GI malignancies
such as colorectal and stomach and showed no significant difference between them. The most obvious benefit for patients
is less trauma and pain, which translates into earlier recovery and a shorter hospital stay.
Valley is one of the first hospitals to offer MIS for pancreatic resection. We were the first to successfully use the daVinci
surgical system to remove the pancreas in both proximal (Whipple’s procedure) and distal sites. Patients who underwent
this approach were found to recover much sooner and leave the hospital earlier and with fewer complications.
■ ■ Chemoradiotherapy –
■ ■ Current Status
Pancreas Cancer - Stage of Disease at Diagnosis
2008 TVH Compared TVH 2006 and 2006 NCDB
Unfortunately, there has been no significant breakthrough in chemotherapy for pancreatic cancer.
Currently, 5-FU-based chemoradiation or gemcitabinebased chemotherapy continues to be the first line
therapy for patients with locally advanced disease,
or as adjuvant therapy. The CONKO trial supports
the use of post-operative gemcitabine as adjuvant
chemotherapy in resectable pancreatic cancer.
Pancreas Cancer - Age at Diagnosis
TVH 2008 Compared to TVH 2006 and NCDB 2006
Stage O
Stage I
Stage II
Stage III
Stage IV
■ TVH 2008
■ TVH 2006
■ NCDB 2006
The use of gemcitabine-based chemotherapy is
frequently combined, sequentially, with 5-FU based
chemoRT. For metastatic disease, gemcitabine is
considered standard frontline therapy. Second-line
therapy may consist of cepecitabine, FOLFOX, or
CapeOx. More recently, a targeted therapy utilizing
Erlotinib (Tarceva) in combination with gemcitabine
has been shown to be of value in treating advanced
disease and we have been participating in clinical
trials to assess this combination in the adjuvant setting.
Other targeted agents are being tested in clinical
trials as well.
6
Focus on Pancreatic Cancer
Observed Survival
for Pancreas
Cases Diagnosed
in 1998-2001
■ Valley
■ National
At the forefront of pancreatic cancer management,
we are involved in basic research aimed at discovering the
presence of pancreatic cancer at the earliest possible stage.
Such efforts could greatly enhance our ability to increase
the cure rate. Under the leadership of Dr. Ganepola A.P.
Ganepola, the project to discover biomarkers associated
with pancreatic cancer has been ongoing since 2007.
The specific goals of this research are to identify sensitive,
specific and reliable surrogate markers from tumor tissue
and corresponding patient’s plasma to hopefully result in
the early diagnosis of pancreatic cancer as well as help
in designing new therapeutics. The approaches we use
include: comparing the protein profiles of plasma samples
from pancreatic cancer patients to samples obtained from
normal subjects; and depending on the availability,
comparing the protein profiles of pancreatic cancer
tissues (from pancreatic patients) with non-cancerous
tissues (from normal or non-pancreatic cancer subjects).
Extensive proteomics technologies are employed to achieve
these goals. Although not yet conclusive, preliminary
data have shown some promising results.
In summary, although the management of pancreatic
cancer has not significantly changed over the past several
decades, there has been an increase in the awareness of
this disease. Early physical signs and symptoms are more
aggressively pursued. Diagnostic and therapeutic decisions
increasingly involve multidisciplinary consultation and are
driven by standards of care as referenced by the National
Comprehensive Cancer Network (NCCN). When resection
is required, it is generally recommended that it should be
done at a high volume institution (>20 pancreatic resections
annually) like Valley. Minimally invasive surgery for pancreatic
cancer has gradually replaced open surgery and has proven
to improve short-term outcome for patients with this dismal
disease. Early detection via identification of reliable biomarkers may greatly impact the treatment and hopefully
improve the prognosis of patients with pancreatic cancer.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
7
Update on Prostate Cancer
by Howard Frey, M.D.
Prostate cancer remains the cancer most frequently diagnosed in men with 186,000 estimated cases for 2008. There will be
28,000 deaths in 2008 reflecting the second most common cause of death in men from cancer exceeded only by lung cancer.
Clearly prostate cancer remains a significant cause of morbidity and mortality despite the generally accepted attitude
that men “will die with prostate cancer and not because of it.” Colon, pancreatic, liver, leukemia, esophageal, bladder,
lymphoma and, kidney all produce fewer deaths in men than prostate cancer yet none of these are thought to be
insignificant. However, prostate cancer presents the additional challenge that the ratio of incidence to death is higher
than in other cancers making many of these prostate cancers in fact insignificant.
Controversy over the benefits of screening for the detection of prostate cancer appeared with the publication of a
New England Journal of Medicine article from March 18, 2009, showing little overall benefit from screening. An American
study the Prostate Lung Colorectal Ovary Cancer Screening Trial, PLCO, showed no mortality benefit while the European
study, European Randomized Study of Screening for Prostate Cancer Trial, ERSPC, showed a 20% relative reduction in
mortality from prostate cancer screening. This latter study estimated that 48 prostate cancer patients needed to be
treated for every life saved. The potential risks involved with the treatment of some prostate cancer patients that might
do well without any treatment highlights the clinical dilemma facing these patients and their physicians. The challenge,
of course, will be to devise a molecular test to differentiate the lethal prostate cancer from the benign form that will allow
treatment of only those patients who definitely need it.
Prostate Cancer - Age at Diagnosis
TVH 2008 Compared to TVH 2006 and NCDB 2006
■ ■
Age at Diagnosis
■ ■
Prostate cancer occurs predominantly in an older population
approximately 80% occurring after age 60. It is often
assumed that men over the age of 80 have some prostate
cancer whether it is diagnosed or not. The assumption
comes from autopsy studies in which complete autopsies
are done in men who have died of unrelated (no-cancer)
deaths. More than 50% will have an incidental prostate
cancer. Projections now estimate that life expectancy will
increase from one million men over age 80 currently to
seven million men by the year 2050. Additionally of the 30
thousand deaths from prostate cancer, 2/3 currently occur
in men older than 75. Thus, as life expectancy increases,
prostate cancer may become a more significant disease
in the elderly.
■ ■
Percentage by Stage
■ ■
■ TVH 2008
■ TVH 2006
■ NCDB 2006
Since PSA testing, the stage at diagnosis has improved.
Stage II disease, localized prostate cancer, potentially curable
predominates in sharp contra-distinction to the years prior
to PSA testing when Stage III and Stage IV occurred at least
as often as Stage I and II. Whether this has made a difference in mortality from prostate cancer is controversial.
The PLCO study and the ERSPC study have cast doubt on
the benefits of PSA screening in saving lives. However, the
mortality from prostate cancer has decreased approximately
4% each year since 1992 approximately five years after
PSA testing began and when one might expect to see a
beneficial result from PSA screening.
8
Prostate Cancer - Stage of Disease at Diagnosis
2008 TVH Compared TVH 2006 and 2006 NCDB
Update on Prostate Cancer
■ ■
Initial Treatment
■ ■
Prostate Cancer - Initial Treatment
2008 TVH Compared to 2006 ACS Eastern Division
Initial treatment at The Valley Hospital was split between
radiation and surgery. Improved radiation techniques with
less morbidity have evolved. Intensity modulated radiation
therapy causes less side effects and allows for higher
radiation doses that are necessary for tumorcidal effects.
Cesium 131 has largely replaced palladium for brachytherapy
at The Valley Hospital. Cesium offers advantages of higher
energy with a shorter half life yielding more homogeneous
radiation with fewer side effects. Treatment guidelines
as referenced by the National Comprehensive Cancer
Network serve as a model for treatment planning.
Minimally invasive robotic radical prostatectomy offers
less morbidity than open surgery and therefore has
become a more advantageous option for the patient.
■ ■
Five Year Survival Table
■ ■
The five year mortality for prostate cancer remains
excellent. Data between 1998 and 2001 show The Valley
Hospital to be at 91.5 % overall (inclusive of all stages)
five year survival which compares favorably to national
data of 84.9% overall five year survival.
Prostate Cases Diagnosed Comparison
TVH Cases
NJ Cases
National Cases
215
12%
5090
11.1%
186,320
13%
Observed Survival for Prostate Cases
Cumulative Survival Rate
Diagnosed in 1998-2001
■ TVH
■ ACS East Division
■ ■
Conclusion
■ ■
Prostate cancer causes significant morbidity and mortality
as reflected in the number of diagnoses made and the
number of deaths that occur annually in the United
States. Controversy concerning the role of PSA screening
in preventing deaths exists and needs to be more accurately defined. Regardless, the mortality from prostate
cancer has decreased by approximately 4% yearly since
1992. Whether this reflects the role of PSA screening,
better radiation or surgical techniques, or other unknown
factors has not yet been clarified. Separating prostate
cancer that will progress and cause death from prostate
cancer that is inconsequential remains a significant
challenge. Observation may become increasingly important
and the Multidisciplinary Prostate Cancer Center at
The Valley Hospital may play a prominent role in helping
patients make very difficult treatment decisions.
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
■ TVH
■ National
0
1
2
3
4
5
Years from Diagnosis
9
Clinical Commentary on Studies in this Report
Allen Chinitz, M.D., Medical Oncologist, comments below on the two studies included
in this report: “Focus on Pancreatic Cancer” by Anusak Yiengpruksawan, M.D., and
“Update on Prostate Cancer” by Howard Frey, M.D.
In this annual report, data and analysis are presented concerning two cancers – pancreatic and prostate. These two cancers
illustrate the remarkable clinical and biological diversity that can exist among cancers arising in different organs.
Pancreatic cancer develops in an organ which is situated deep in the abdominal cavity and it usually becomes symptomatic
only late in its development, when it has unfortunately usually spread locally or metastasized to a distant organ such as
the liver. As is illustrated in Dr. Yiengpruksawan’s discussion this presents difficulties in both arriving at an early diagnosis
and in planning effective therapy. To date, the outlook for most patients who develop pancreatic cancer is poor. The
results achieved here at The Valley Hospital generally equal or exceed what has been accomplished at major institutions
throughout the United States.
The prostate gland is an organ which is more accessible
than the pancreas and as seen in Dr. Frey’s presentation
the diagnosis is usually made at an earlier stage (i.e. stage II).
The prognosis of prostate cancer can be quite variable and
is dependent upon many factors including the stage and
the grade of the tumor (i.e. Gleason score). The utility
of a commonly measured biomarker in prostate cancer
(the PSA) has been brought into question but it remains
in widespread use. There is yet to be developed a biomarker to serve as a useful tool for the early diagnosis
of pancreatic cancer.
There are unfortunately limited therapeutic options available
to treat pancreatic cancer. There are multiple therapeutic
options available to treat prostate cancer. This availability
of therapeutic options to treat prostate cancer often results
in confusion for the patients and their families and that has
led us here at The Valley Hospital to create a Multidisciplinary
Prostate Cancer Center to guide patients in their treatment
selection. The treatment spectrum spans choices from no
treatment (observation only) to surgery (robotic or otherwise) to radiation utilizing a variety of techniques (seed
implantation, external beam or a combination of both) as
well as the consideration of certain hormonal therapies
or chemotherapy. All of these treatments may be offered
individually or in some combination. Again the therapeutic
results achieved here at The Valley Hospital in treating
prostate cancer equal or exceed what has been documented in the National Cancer Database.
10
What is common, however, to these two tumor types is the
promise that is offered by ongoing studies focusing on the
genetic profiling of these tumors as well as the characterizing
of proteins that they may produce and secrete, and which
might be measurable in the patient’s blood. These studies,
some of which are conducted here at this hospital could
yield valuable information which might translate into an
ability to detect both of these cancers at earlier stages and
which could result in more effective therapies. Another
benefit of such research could be to enable us to offer
more precise prognostications, particularly with regard
to prostate cancer so as to allow us to determine who
requires early treatment and who can be safely observed
and thus avoid potential adverse consequences associated
with treatment. It is realistically anticipated that for
cancer patients generally and more specifically for those
who already have cancer of either the pancreas or of the
prostate the future will indeed be brighter.
”The therapeutic results achieved here at
The Valley Hospital in treating prostate cancer
equal or exceed what has been documented
in the National Cancer Database.”
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
Distribution of Five Major Sites
”Valley has earned a formidable reputation as a leader in the prevention,
diagnosis and treatment of the most prevalent cancers we face: lung,
prostate, gynecologic, breast, and gastrointestinal, among others.“
Robert J. Korst, M.D.
Medical Director,
Daniel and Gloria Blumenthal Cancer Center
11
Timeline of Achievement
January – April
May – August
The Valley Hospital Center for
Complementary Therapies and Jodie
Katz, M.D., present a course on
Mindfulness Based Stress Reduction.
This unique meditation technique
enables individuals to develop a
heightened awareness of their body
and emotions, to take charge of their
lives, and to learn to consciously
and systematically work with stress,
pain, illness and the demands of
everyday life.
The Radiation Oncology Department
of The Valley Hospital was once again
awarded a three-year accreditation
by the American College of Radiology
(ACR). The ACR awards accreditation
to facilities for the achievement of
high practice standards after a peerreview evaluation. Evaluations are
conducted by board-certified physicians
and medical physicists who are experts
in their field.
Colorectal Cancer Screening is held.
Cancer Committee approves the goal
of planning a Cancer Survivorship
Program.
Arthur Antler, M.D., and John McConnell, M.D., present lectures to
Valley employees on the importance
of being screened for colon cancer.
”Our cancer team has pledged
to lead the way in developing
systems to support and promote
the needs of cancer survivors.”
Nancy Librera
Assistant Vice President, Oncology Services
September – December
Valley’s cancer program earns an
impressive five Gold Seals of Approval
for healthcare quality from the Joint
Commission. Valley holds Joint Commission Disease-Specific Care Certification for colorectal cancer, lung cancer,
breast cancer, pancreatic cancer and
prostate cancer. To earn this distinction,
Valley underwent an extensive, on-site
evaluation by a team of Joint Commission reviewers.
The Valley Hospital’s John C. McConnell, M.D., completes his 5,500
mile bicycle ride to raise awareness of
colorectal cancer and to raise money
for the Blumenthal Cancer Center.
His trek ends in Key West, Florida.
Free Skin Cancer Screenings are
conducted. Each screening includes
a close physical examination by a
board-certified dermatologist, and
participants receive a profile sheet
indicating if a significant lesion is
present, a preliminary diagnosis, and a
list of board certified dermatologists if
further medical care is recommended.
The Valley Hospital’s John C. McConnell,
M.D., begins a 5,500 mile bicycle ride
to raise awareness of colorectal
cancer and to raise money for the
Blumenthal Cancer Center. His trek
begins in Fairbanks, Alaska, and takes
him across the United States.
Jesse Moskowitz, M.D., is the first
surgeon to complete Valley’s MIS
The colorectal surgeon spread the
message that colorectal cancers are
preventable and raised more than
$100,000 for Valley’s cancer program.
A symposium titled “Breast Cancer
2008: Contemporary Management
Issues” is presented for physicians,
nurses and other healthcare
professionals from throughout New
Jersey and southern New York. The
conference featured speakers from
Cooper Cancer Institute, Memorial
Sloan-Kettering Cancer Center, Mayo
Clinic College of Medicine, and Valley.
Prostate Cancer Screening is presented
by The Valley Hospital and Valley
Health Medical Group.
Fellowship, a one-year training
program aimed at providing advanced
training to surgeons in minimally
invasive (laparoscopic) GI/abdominal
surgery, robotic surgery, and interventional endoscopy.
Valley Hospital’s Blumenthal Cancer
Center honored cancer survivors with
”A Celebration of Life,” a special program honoring the personal victories
made against cancer. The theme was
”Journey Through Survivorship.”
A special exhibition of Lilly Oncology
on CanvasSM – an art exhibition
honoring the journeys traveled by
millions of people affected by cancer
worldwide – was on display. Attendees
also had the opportunity to hear a
presentation from Robert J. Korst,
M.D., Medical Director, Blumenthal
Cancer Center; learn about Living
Strong, Living Well, sponsored by
the Ridgewood YMCA; and chart their
years of survivorship on the Ladder
of Life.
Valley and Tenafly Middle School partner
for a Walk-a-Thon that raises more than
$14,000 for Valley’s Cancer Program.
Valley participates in the American
Cancer Society's Relay for Life, raising
$18,200.
Representative Scott Garrett tours
The Valley Hospital Breast Center in
an event that complemented his recent
Certificate of Excellence award from
the National Breast Cancer Coalition
(NBCC) for his perfect voting record
on breast cancer issues. Garrett praised
Valley’s professionals for their continuing leadership in improving breast care
for both women and men in the area.
A new patient station is added to
Ambulatory Infusion, bringing to 21
the number of stations.
Maureen Bottiglieri, massage therapist
for Integrative Healing Services,
becomes certified as a Certified
Practitioner in Clinical Aromatherapy.
2008 Analytical Cases
Oral Cavity & Pharynx
Lip
24
0
Female Genital System
123
Cervix Uteri
12
Tongue
6
Corpus Uteri
64
Salivary Glands
8
Uterus, Nos
1
Floor of Mouth
0
Ovary
32
Gum & Other Mouth
1
Vagina
5
Nasopharynx
2
Vulva
7
Tonsil
3
Other Female Genital Organs
2
Oropharynx
2
Male Genital System
220
Hypopharynx
Other Oral Cavity & Pharynx
Digestive System
Esophagus
Stomach
Small Intestine
Colo/Rectal
Anus & Anal Canal
Liver
Intrahepatic Bile Duct
Gallbladder
2
0
358
19
45
7
184
3
13
1
11
Prostate
Testis
Penis
Other Male Genital Organs
Urinary System
Urinary Bladder
Kidney & Renal Pelvis
Ureter
Other Urinary Organs
Brain & Other Nervous System
Brain
215
5
0
0
117
67
48
1
1
75
25
Other Biliary
Pancreas
Retroperitoneum
Peritoneum, Omentum
Other Digestive Organs
Respiratory System
Nose, Nasal Cavity & Middle
Larynx
Lung & Bronchus
Pleura
Trachea & Mediastinum
Bones & Joints
Soft Tissue-Including Heart
Skin Excl Basal & Squamous
Melanomas - Skin
Other Non-Epith Skin
Breast
10
60
0
4
1
244
2
12
229
1
0
0
7
30
24
6
292
Cranial Nerves, Other Nerves
Eye & Orbit
Endocrine System
Thyroid
Other Endocrine Including Thymus
Lymphoma
Hodgkin Disease
Non-Hodgkin Lymphomas
Myeloma
Leukemia
Lymphocytic
Myeloid & Monocytic
Other
Mesothelioma
Kaposi Sarcoma
Misc - Unknown Primary Site
50
0
72
57
15
84
8
69
10
24
11
20
1
10
0
47
TOTAL
1,746
Five Gold Seals from the Joint Commission
Recipient of “Gold Seals of Approval” for cancer care.
Breast. Colorectal. Lung. Pancreatic and Prostate.
Community Hospital Comprehensive Cancer Program
w w w. v a l l e y h e a l t h c a n c e r c e n t e r. c o m
223 North Van Dien Avenue, Ridgewood, NJ 07450