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The Power of Community-Based Cancer Care: Live Life Well CANCER PROGRAM ANNUAL REPORT 2011-2012 The full circle of health and wellness dedicated to excellence. Cancer Program at a Glance Bar ry Free Tobia Student H s ealth S Awa cree Hea Smo rene ning lth A king ss s/ F i tness and Ce Cen Le Wel ssa lne te ss Ce tion nte r Star a nd gy olo ath c yP acti on) tor i eot ra ter calizat ,S bo hy e Lo La rap edl og t Ne as er: ent C s es gram en Pro r e a es f a w ur eS s ct Mol m Trial n a • r o i r og nt Pr reve •P Diagnos tic R adio log Women’s y (P Heal ET, th C Needle Biop CT sy, B ente ,M reas r (D RI t Ul i )• tra gital sou M nd am ,B m re Rehabilitation Services ls r ia c lT On a ica al Cl i n •P T dic Me ion MR O I us l Inf n , ica nt a t i o rg t at i e Su Outp mp l an dI ( See or •I nt og erve nt i y in ona , I Ma • Nu l Ra cle GR na diolog a y g nc T rM edic olo , HD emen i ne t• R gy – R , S t e Radiat r io eo t ob ac t i n Oncology : otic c Rad Sur i os u r g er y ) gery ol Pe dia en t r ic , M tar Onco l y ogy u s Th e i y c a rap i – es nd W Re i ou ki nd Ca re • Sur v i vo r Da y Genetic Counseling p Cam t al i Qu Ly y f l em mp a g e o C ss p Ma ra e h aT m ede mp h For more information about the Cancer Center at CentraState, call 1-855-411-CANCER or visit www.centrastate.com/cancercenter. Our Mission To enhance the health and well-being of our communities through the compassionate delivery of quality healthcare. President’s Message At CentraState Medical Center, we are looking at cancer care as an all-encompassing array of services designed to fulfill the patient’s needs and offer all the treatment options for the best possible outcomes. From prevention through survivorship, The Cancer Center at CentraState Medical Center provides a coordinated approach by primary care physicians and cancer care specialists, nurses and nurse navigators, counselors and therapists to guide patients and their families through every step of their journey. With advanced treatment options leading to increased survivor rates, cancer is beginning to resemble a chronic disease. CentraState’s primary care physicians, experienced in attending to the needs of cancer survivors, can help guide patients toward continued wellness by keeping cancer under surveillance, screening for other cancers, providing general preventive health, and managing any ongoing health issues. Plus, CentraState patients have access to cancer rehabilitation and wellness services such as integrative therapies like yoga and meditation; specialized occupational, speech and physical therapies, including lymphedema and aquatic therapies; and a medically supervised Fitness and Wellness Center. Driving hours to a specialized center for a cancer diagnosis and for frequent treatments can take a toll on a cancer patient and family members during an already stressful time. CentraState’s cancer patients can stay in their own community and with the physicians they’re familiar with for their treatment—saving them undue stress, without sacrificing clinical quality and expertise. It also allows them to receive an unmatched level of customized, personal care that’s hard to match at a distant cancer center. In the spring of 2012, CentraState, in collaboration with ProCure Treatment Centers and Princeton Radiation Oncology, brought the first and only proton therapy center to the New Jersey/New York area. This $160-million, 60,000-square-foot ProCure Proton Therapy Center in Somerset, New Jersey is one of only 10 centers in the United States. Proton therapy, an FDA-approved alternative to traditional X-ray radiation, is an advanced form of radiation treatment to combat several types of cancerous tumors. The treatment is performed using proton beams directed precisely to the cancerous tumor, only with fewer damaging side effects to nearby tissue than occurs with traditional radiation therapy. At CentraState, community-based cancer care is provided by world-class oncologists who are trained at renowned national cancer centers, including Harvard, Memorial Sloan-Kettering, and the Hospital of the University of Pennsylvania. Our skilled surgeons are trained in the latest minimally invasive procedures, including two thoracic surgeons who were among the first in the world to perform groundbreaking, video-assisted, thoracic surgery. It’s also advanced treatments like robotic surgery and proton therapy, and the latest clinical trials with promising new developments—all right here in our community at CentraState. The Power of Community-Based Cancer Care: LIVE LIFE WELL Sincerely, John Gribbin, FACHE President and CEO; CentraState Healthcare System CentraState Healthcare Foundation — Cancer Campaign To help support our growing cancer center, the CentraState Healthcare Foundation Board of Trustees approved a campaign that will run through the end of 2013 with a goal to raise $5 million. The funds raised will be used for: • New construction and equipment for the expansion of our radiation oncology and Women’s Health Center. • Seed funding for new programs such as the Melanoma and Skin Cancer Center and colorectal cancer program. • An endowment to provide a stable source of revenue for cancer services that operating revenues alone can’t sustain or that are provided free to patients and families. • An endowment to provide a stable source of revenue for our Family Practice Residency Program with its survivorship training. Community support of this campaign is an investment that assures that the most comprehensive cancer care is available close to home. 2 Cancer Committee: The Cancer Committee is a standing committee of CentraState Medical Center’s (CSMC) Medical and Dental staff. The mission of the committee is to enhance the health and well-being of our communities through the compassionate delivery of quality health care. The committee is responsible for ensuring compliance with the American College of Surgeons (ACoS) Commission on Cancer standards and promoting the best possible standard of care for cancer patients treated at CentraState Medical Center. The committee meets quarterly to plan, assess and implement all cancer-related programs and activities at the hospital. The committee’s goal is to ensure CentraState offers a coordinated, multidisciplinary approach to cancer prevention and treatment supported by state-of-the-art technology and specially trained staff. The committee strives to continually improve patient survival and outcomes to enhance the quality of life for all cancer patients, regardless of diagnosis. 2012 Cancer Committee Goals: Each year, the Cancer Committee establishes, implements, and monitors clinical, programmatic, quality improvement and community outreach goals for the improvement of cancer-related care. These goals are accomplished with an emphasis on wellness, education, prevention, survivorship, research and stringent monitoring of comprehensive, quality cancer care. Each goal is evaluated and discussed at least twice per year by the Cancer Committee. The following are examples of clinical and programmatic goals: Clinical Goals: 1. To offer early, palliative care on all appropriate patients by optimally utilizing palliative care resources offered through the Cancer Center at CSMC. 2. To ensure all biopsies, generated within physician offices for patients receiving definitive surgery at CSMC, are made available to the pathology department and are scanned into the electronic health information record. Programmatic Goals: To continue to support new and upgraded services implemented within the medical center that directly or indirectly relate to cancer care: 1. Recruitment of tumor site specific surgeons 2. A new and technologically upgraded Radiation Oncology suite 3. ProCure Proton Therapy Center strategic partnership 3 Programmatic Achievements (For the period of July 2011 through June 2012) Kim Kelly, RN, MS, NEA-BC, FACHE Vice President, Clinical Services Robert Braun, MA, M.Ed., RN, OCN, RT (T)(R) Assistant Vice President, Cancer Services Physician Recruitment Thomas Kayal, MD, a board-certified colorectal surgeon has joined the surgical team of CentraState Healthcare System. Princeton Brain & Spine: Mark McLaughlin MD, Nirav K. Shah, MD, Dani Bidros, MD, and Seth Joseffer MD, have joined the surgical team of CentraState Healthcare System. Cancer Navigator: An Advanced Practice Nurse (APN) has been hired for the further development of the cancer service line. Her capacity is multifunctional with a role as a surgical oncology APN, as well as a cancer navigator. ProCure/Proton Therapy: Underscoring a united commitment to advancing patient care for the treatment of cancer, ProCure Treatment Centers and Princeton Radiation Oncology, in collaboration with CentraState, have brought the first and only proton therapy center to the New Jersey/New York area. The center is the third to open in a national network of proton centers being developed by ProCure. It is one of only 10 centers that offer proton therapy nationwide. On March 20, 2012, ProCure hosted a ribbon cutting ceremony to officially open the new Proton Therapy Center. Testimonials were provided by proton therapy patients regarding the need for proton therapy within the community. Website Revised: In order to more clearly demonstrate to patients the comprehensive services of the Cancer Center at CentraState Medical Center, the cancer service line launched a new website: www.centrastatecancercenter.com. This new website provides a list of all services offered through the Cancer Center, including radiation oncology, infusion therapy, surgical services, diagnostic services, patient navigation, rehabilitative services, physician contacts, survivorship and alternative complementary services. Survivorship Program Development: Survivor Care Plan—A Roadmap for the Patient’s Future Health and Well-being: Survivorship Care Plan, of the American College of Surgeons Commission on Cancer Standard 3.3 states, “The cancer program of an accredited facility must ‘develop a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing treatment’.” The Cancer Committee developed focus groups to review existing survivorship plans within the marketplace to develop a customized plan to be used within the CentraState Medical Center Cancer Program. In addition, surveys were sent to patients to elicit feedback from survivors themselves, to better understand the survivor’s needs. The program will be phased in beginning in 2015. E-Share Document (Dietary, Radiation Oncology, Palliative Care) An e-share document was developed with the assistance of an outside vendor to better facilitate the exchange of information between entities within the cancer service line. The e-share document is an electronic intake form which shares patient information between ProCure, CentraState and radiation oncology. Other areas of the service line are in the process of implementing the use of the e-share document, including nutrition and palliative care. • All patients receiving radiation therapy now receive a social work consult as part of their comprehensive care. • The Manor at CentraState Healthcare System opened two dedicated hospice beds for patients requiring such services. • CentraState Medical Center hosted the Annual Lymphedema Certification Course and a clinical course on edema management for breast cancer patients. More than 50 physical and occupational therapists attended. • CentraState Medical Center, along with the American Cancer Society (ACS), developed a program to allow CentraState volunteers to be used for the ACS Road to Recovery Program. • The American College of Surgeons, Commission on Cancer, has posted CentraState’s “2010-2011 annual report” and the “cancer committee policy” under their “Best Practice Repository” section. • Uzma Rizwan successfully delivered a lecture on “Registry Experience: On Rapid Quality Reporting System” at the annual meeting of the New York and New Jersey Chapter for ACoS on September 17, 2011. 4 Clinical Achievements (For the period of July 2011 through June 2012) Jeffrey Silberberg, MD, FACP Chair, Cancer Committee Enrollment of Subjects in Research Studies: In 2011, more than 40 subjects were enrolled in research studies offered at CentraState Medical Center or by referral, which exceeded the cancer committee’s clinical compliance goal. Thoracic Symposium: A Lung Symposium was held on June 7, 2011.The symposium’s speakers included Drs. Caccavale, Spector, Croce, Bocage, Balar and Tsai. The goal of the program was to provide an in-depth discussion for primary care physicians regarding the diagnosis and treatment of lung cancer. CMEs and CEUs were provided. PAC-3 Research with ACS: CSMC partnered with the ACS on a research study known as Cancer Prevention Study-3 (CPS-3). We were the first health care organization within Monmouth County to enroll participants. The study is an Epidemiology Research Program that invites men and women, between the ages of 30 and 65 who have no personal history of cancer, to participate. The purpose of CPS-3 is to better understand the lifestyle, behavioral, environmental and genetic factors that cause or prevent cancer, and to ultimately eliminate cancer as a major health problem for this and future generations. CSMC hosted the event on July 24th and 25th; 176 people were enrolled. Physician Honors: Jarrod Kaufman, MD, FACS, board-certified surgeon on staff at CentraState Medical Center, was selected by the American College of Surgeons Commission on Cancer (CoC) Cancer Liaison Program as a recipient of the Commission on Cancer State Chair Outstanding Achievement Award for 2010-11, for his cancer liaison work throughout the state. He was presented the award at the CoC Annual Meeting held in San Francisco. Chinese Physician visit: In May, a group of eight radiologists from China visited CentraState to learn new techniques in interventional radiology for breast cancer. The group of physicians trained with internationally distinguished interventional radiologist, Ken Tomkovich, MD, medical director of Interventional Radiology at CentraState and with Freehold Radiology Group. The visit marked the first time that a program for education on breast imaging and minimally invasive biopsy has taken place between the United States and a group of doctors from China. During their visit to CentraState, the physicians from China were thoroughly instructed in breast cancer diagnosis and ultrasound and stereotactic biopsy— procedures that are not widely used in China. “We reviewed cases together, shared thoughts with one another and, through mutual respect and trust, built friendships that will last forever,” Dr. Tomkovich says. “Most importantly, they will return to China with a new knowledge and ability to treat their patients that they did not have before. My hope is that they will be able to share this knowledge with other doctors in China and ultimately save more lives.” “My positive attitude about cancer comes from my doctors who have always encouraged me. Patients should have confidence in their CentraState doctors and never give up hope” – Carol Murphy 5 Clinical Trials Offered at CSMC (2011 - 2012) Janice Breen, PhD, PHCNS-BC Manager, Clinical Research The comprehensive Cancer Program at CentraState Medical Center offers eligible patients the opportunity to participate in promising new developments in cancer treatment and prevention through clinical trials. CentraState Medical Center participates in pharmaceutical company trials and is a clinical research affiliate of the Eastern Cooperative Oncology Group (ECOG) and the Cancer Institute of New Jersey’s Oncology Group (CINJOG). CentraState Medical Center currently has open clinical trials/research studies in the areas of breast, gastrointestinal, lung, pancreatic, prostate and renal cancer. To find information on available clinical trials and the eligibility criteria, please visit CentraState Medical Center’s website at www.centrastatecancercenter.com. 6 Tumor Board/Cancer Conference Coordinator Report: Henry K. Tsai, MD, FACP Radiation Oncology The Tumor Board Conference at CSMC provides a multidisciplinary forum to discuss a patient's diagnosis and the most appropriate treatment options available. Physicians participate in regularly scheduled Tumor Board Conferences where cancer specialists discuss the best treatment plans for new and existing cancer patients at CentraState. This specialized team consists of board-certified medical oncologists, radiation oncologists, surgeons, diagnostic radiologists, pathologists, nurses, research coordinators and a cancer registrar. At each Tumor Board Conference, the discussion involves the review of individual patients’ medical histories, imaging studies, pathology reports and current methods of treatment. Appropriate staging is discussed for applicable cases. National Comprehensive Cancer Network (NCCN) treatment guidelines or other appropriate guidelines are referenced to ensure treatment plans are in line with nationally recognized standards. In addition, any applicable clinical trials are reviewed and discussed. Treatment recommendations are formulated based on a multidisciplinary consensus and presented to the patient’s managing physician. Final therapeutic decisions rest with the managing physician and the patient. Ninety-five percent of cases presented at the conference are prospective case discussions. All information presented at these conferences is confidential and considered part of the quality improvement process. Attendees who complete an evaluation form can receive continuing medical education credit. The Tumor Board activities’ grids are used to monitor the discussion of staging, treatment guidelines, prognostic indicators and the availability of applicable clinical trials. The General Tumor Board (GTB) meets bimonthly. One meeting convenes either the first or second Tuesday and the other is held on the third Friday of the month. A combination of different cancer sites is discussed at each meeting. In 2011, a total of 20 General Tumor Board meetings were held. Total sites/cases presented from January to December = 86 cases. The prospective case presentation = 97%. In 2011, total lung Tumor Board meetings = 20 Total sites/cases presented from January to December = 51 cases. Prospective case presentation = 97% In addition to regular cancer conferences, the cancer program offered eight lectures to medical staff and other allied health professionals. The required physician attendance at the Tumor Board Conference is 80% per specialty. General Tumor Board Conference physicians’ attendance from the period of January to December 2011 is as follows. 7 YEAR Category Medical Oncology Attendance Radiation Oncology Attendance Surgery Radiology Attendance Pathology Attendance Diagnostic Attendance 2011 GTB 100% 100% 96% 100% 96% Community Outreach COMMUNITY EVENT: (For the period of July 2011 through June 2012) Maryann Roper, RN, MSN Director, Star and Barry Tobias Health Awareness Center Free Spa Day held on Dec. 6, 2011: The ABC Spa provided a one-day, free spa treatment to 30 patients that were treated at CentraState. The services included manicures, facials and massages. Taste of the Towns: Was held on March 26 at the American Hotel. Taste of the Towns is a fundraising event organized by the Noontime Optimist Club of Freehold and CentraState Associated Auxiliaries. Money raised from the Taste of the Towns supported the children and families’ housing needs at the ProCure Treatment Center in Somerset, NJ; Camp Quality NJ, a camp for children with cancer; and youth activities and scholarships sponsored by the Noontime Optimist Club of Freehold. CentraState Celebrates Cancer Survivorship with Current and Former Patients-June 10, 2012: An estimated 325 cancer survivors, family and friends joined CentraState Medical Center staff on June 10 for an afternoon of sharing, encouragement and education to celebrate National Cancer Survivors Day. A survivor is anyone living with a diagnosis of cancer. Keynote speaker, Aubrey Barr, survivor of childhood acute lymphocytic leukemia (ALL) and an avid runner, along with several CentraState cancer survivors, inspired the audience with their personal stories. All visitors received complimentary materials including the book “Complete Guide to Nutrition for Cancer Survivors” (American Cancer Society). The day’s events also included music, a healthy cooking demonstration, luncheon and mini health fair. Skin Cancer Awareness and Screening Efforts: MoleSafe Program: MoleSafe was introduced to CentraState in June 2010. This program uses advanced technology for the early detection of melanoma, thereby identifying skin cancer at a treatable stage. The process begins with a comprehensive, full-body exam, digital imaging and dermoscopic scan. Images are examined and reviewed by a MoleSafe dermatologist. In 2011, more then 200 people were examined, compared to the first two quarters of 2012, when 100 people were examined. Choose Your Cover: On July 21, 2012, CentraState’s Star and Barry Tobias Health Awareness Center (HAC) partnered with the Monmouth County Cancer Coalition to participate in a statewide event called Choose Your Cover, a skin cancer awareness, education and screening program. Choose Your Cover brings free skin cancer screenings and complimentary sunscreen, along with vital skin safety information, to an at-risk population of people who spend extended periods of time in the sun. CentraState participated and sponsored the event at Belmar Beach. There were 134 participants screened. Screenings and Community Lectures: In the area of prevention and education, CentraState Medical Center is a leader in the central New Jersey service area. Screenings and lectures offered include: July through December 2011, more than 100 people received free skin cancer screenings and attended prevention lectures. January through June 2012, more than 120 people received free skin cancer screenings and attended prevention lectures. On April 26, 2012, there was an oral cancer screening and lecture–8 individuals were screened; 12 attended the lecture. CentraState partnered with the Monmouth Ocean Cancer Coalition to offer a Living with Chronic Disease seminar for the community with 35 in attendance. Support Groups: • Bereavement • Breast Cancer • Colorectal Cancer Self-Help Group • Leukemia/Lymphoma/Multiple Myeloma/Myelodysplasia • Lymphedema • Patient and Family Cancer Support • Prostate Cancer Psychosocial Support: Between the months of July and December 2011, more than 165 new radiation patients were seen by a social worker. They were assessed for a variety of needs, with appropriate referrals made at that time. 8 Quality Improvements & Physician Liaison Report Amit Kharod, MD, FACS Board-Certified Surgeon Each year, the Cancer Committee conducts several quality improvement (QI) reviews in an effort to ensure that a high-quality standard of care was provided to our patients. The QI review involved representation from physicians and non-physician members of the Cancer Committee. Multiple departments were represented including cancer registry, cancer navigator, Outpatient Infusion, 4-East oncology, palliative care, pharmacy and Radiation Oncology. In 2012 alone, more than 22 QI activities were reported to the Cancer Committee. CoC, ACR, OCN or oncology dashboard measures from the advisory board. Some of the QI activities were selected from the Press Ganey scores. The QI activities also provide an opportunity to improve upon quality care and outcomes. In addition, the Cancer Committee continues to participate in the Rapid Quality Reporting System. This involves concurrent reporting on breast, colon and rectal cases to the National Cancer Data Base. QI indicators were selected based on compliance with national standards of care including NCCN guidelines, Cancer Registry/Commission on Cancer (CoC) Supervisor Report Uzma Rizwan, BS, CCS, CTR Commission on Cancer Program Supervisor The Cancer Registry (CR) continues to provide timely statistics and quality improvement studies to the Cancer Committee and the Cancer Service Line Committee. This reporting aids in identifying trends and opportunities for improved patient care, and ensures compliance with national cancer care and treatment guidelines. Cancer registry also requires that CentraState Medical Center submit cancer data to the New Jersey State Cancer Registry (NJSCR) and National Cancer Data Base (NCDB). In addition, the registry supplies statistics to the Facility Information Profile System (FIPS), which is part of the American College of Surgeons. The FIPS is a datasharing project that benefits consumers and providers of cancer care. FIPS Level II data is information composed of cancer caseload data, which includes cancer cases diagnosed and treated at the hospital within a specified year (by site and stage). 9 This data is also available to the public. To ensure the accuracy of collected data, the CoC program supervisor, quality improvement coordinator and Cancer Committee physicians and CoC surveyor performed a quality review on cancer registry data. In 2011, 15 percent of all analytical cases were reviewed for accuracy. Cancer Registry Data Requested/Presented Cancer site demographics were presented to the Community Outreach Committee to assist in identifying unique patient population needs. This information is utilized to develop screening programs that will be of most benefit the community. In addition, the cancer registry continues to assist the research department in identifying patients who meet the eligibility criteria for a specific clinical trial or study. Statistical Summary of Cancer Registry Data Primary Site Table: Newly Diagnosed and/or Treated Cases Seen at CSMC — 2011 Sex Primary Site Total (%) M Status F Stage Distribution - Analytic Cases Only Alive Exp Stg 0 Stg I Stg II Stg III Stg IV Stg N/A 88 Unknown ORAL CAVITY & PHARYNX 13 (1.5%) 7 6 12 1 1 5 2 1 3 0 1 Lip Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Tonsil Oropharynx 3 (0.3%) 2 (0.2%) 1 (0.1%) 2 (0.2%) 2 (0.2%) 1 (0.1%) 2 (0.2%) 1 1 1 0 2 1 1 2 1 0 2 0 0 1 3 2 1 2 1 1 2 0 0 0 0 1 0 0 0 1 0 0 0 0 0 2 1 0 2 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 DIGESTIVE SYSTEM 141 (16.3%) 73 68 123 18 9 26 32 25 28 4 17 Esophagus 6 (0.7%) 4 2 5 1 1 1 3 0 0 0 1 Stomach Small Intestine Colon Excluding Rectum Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Retroperitoneum Peritoneum, Omentum & Mesentery Other Digestive Organs 17 (2.0%) 1 (0.1%) 67 (7.8%) 15 5 20 1 4 2 13 7 15 (1.7%) 1 (0.1%) 3 (0.3%) 3 (0.3%) 10 (1.2%) 14 (1.6%) 1 (0.1%) 1 (0.1%) 9 1 34 6 3 7 1 1 2 9 5 10 0 0 1 7 5 1 0 8 0 33 9 2 13 0 3 0 4 2 5 1 3 2 3 9 0 1 14 1 59 15 5 17 1 3 2 11 5 13 1 3 3 9 11 1 1 3 0 8 0 0 3 0 1 0 2 2 2 0 0 0 1 3 0 0 2 0 4 1 0 2 0 0 0 1 0 2 0 0 0 0 0 0 0 2 0 19 2 3 8 1 1 0 4 0 2 0 1 0 0 1 0 0 1 1 15 4 2 5 0 2 0 1 1 5 0 0 1 1 5 0 0 3 0 16 5 0 2 0 1 1 6 1 2 1 0 2 0 1 0 0 6 0 8 3 0 2 0 0 0 1 2 4 0 0 0 4 5 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 3 0 4 0 0 1 0 0 1 0 2 0 0 2 0 4 2 0 1 2 (0.2%) 1 1 2 0 0 0 0 0 0 2 0 RESPIRATORY SYSTEM 98 (11.4%) 50 48 72 26 1 15 7 26 40 2 7 Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus 1 (0.1%) 0 1 0 1 0 0 0 0 0 1 0 3 (0.3%) 94 (10.9%) 3 0 47 47 2 70 1 24 1 0 1 14 0 7 0 26 1 39 0 1 0 7 BONES & JOINTS 1 (0.1%) 0 1 1 0 0 0 0 0 1 0 0 SOFT TISSUE 5 (0.6%) 3 2 5 0 0 3 2 0 0 0 0 SKIN EXCLUDING BASAL & SQUAMOUS 33 (3.8%) 14 19 31 2 14 9 3 1 1 0 5 Melanoma—Skin Other Non-Epithelial Skin 29 (3.4%) 4 (0.5%) 13 16 1 3 28 3 1 1 14 0 9 0 2 1 0 1 0 1 0 0 4 1 BREAST 176 (20.4%) 1 175 173 3 39 76 33 16 7 0 5 10 Statistical Summary of Cancer Registry Data Primary Site Table: Newly Diagnosed and/or Treated Cases Seen at CSMC — 2011 Sex Primary Site Total (%) M Stage Distribution - Analytic Cases Only Alive Exp Stg 0 Stg I Stg II Stg III Stg IV Stg N/A 88 Unknown FEMALE GENITAL SYSTEM 39 (4.5%) 0 39 37 2 0 18 2 6 4 1 8 Cervix Uteri Corpus & Uterus, NOS Ovary Vulva 4 (0.5%) 31 (3.6%) 2 (0.2%) 2 (0.2%) 0 4 0 31 0 2 0 2 4 29 2 2 0 2 0 0 0 0 0 0 0 17 0 1 1 1 0 0 1 5 0 0 1 2 0 1 0 1 0 0 1 5 2 0 MALE GENITAL SYSTEM 133 (15.4%) 133 0 130 3 0 62 57 9 4 0 1 Prostate 126 (14.6%) 126 0 123 3 0 56 57 9 4 0 0 Testis 7 (0.8%) 7 0 7 0 0 6 0 0 0 0 1 URINARY SYSTEM 98 (11.4%) 65 33 94 4 15 52 12 3 8 0 8 Urinary Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs 64 (7.4%) 32 (3.7%) 1 (0.1%) 1 (0.1%) 46 17 1 1 18 15 0 0 60 32 1 1 4 0 0 0 14 0 0 1 36 15 1 0 9 3 0 0 0 3 0 0 3 5 0 0 0 0 0 0 2 6 0 0 BRAIN & OTHER NERVOUS SYSTEM 10 (1.2%) 5 5 8 2 0 0 0 0 0 10 0 Brain Cranial Nerves Other Nervous System 8 (0.9%) 2 (0.2%) 4 1 4 1 6 2 2 0 0 0 0 0 0 0 0 0 0 0 8 2 0 0 ENDOCRINE SYSTEM 21 (2.4%) 1 20 21 0 0 9 1 6 1 0 4 Thyroid 21 (2.4%) 1 20 21 0 0 9 1 6 1 0 4 LYMPHOMA 41 (4.8%) 17 24 38 3 0 17 4 5 8 2 5 Hodgkin Lymphoma 8 (0.9%) 2 6 8 0 0 3 3 1 1 0 0 Hodgkin - Nodal 7 2 5 7 0 0 3 2 1 1 0 0 Hodgkin - Extranodal 1 0 1 1 0 0 0 1 0 0 0 0 Non-Hodgkin Lymphoma 33 (3.8%) 15 18 30 3 0 14 1 4 7 2 5 NHL - Nodal 21 9 12 20 1 0 8 1 4 5 0 3 NHL - Extranodal 12 6 6 10 2 0 6 0 0 2 2 2 MYELOMA 3 (0.3%) 3 0 3 0 0 0 0 0 0 3 0 LEUKEMIA 14 (1.6%) 9 5 10 4 0 0 0 0 0 14 0 Lymphocytic Leukemia 3 (0.3%) 2 1 3 0 0 0 0 0 0 3 0 1 0 1 1 0 0 0 0 0 0 1 0 Chronic Lymphocytic Leukemia 2 Acute Lymphocytic Leukemia 11 Status F 2 0 2 0 0 0 0 0 0 2 0 Myeloid & Monocytic Leukemia 11 (1.3%) 7 4 7 4 0 0 0 0 0 11 0 MESOTHELIOMA 3 (0.3%) 3 0 3 0 0 0 0 0 0 1 2 MISCELLANEOUS 34 (3.9%) 14 20 27 7 0 0 0 0 0 34 0 Total 863 398 465 788 75 79 292 155 98 105 71 63 Please note that in 2011 there were 55 cases that were clinically and/or radiologically diagnosed. Out of 55 cases, 30 cases were diagnosed @ CSMC and went elsewhere for treatment. Nine cases were with unknown primary sites; all of which were reviewed for quality assurance purposes. 2011 Cancer Registry Case Reporting In 2011, the American Cancer Society estimated* around 1,596,670 new cancer cases would be diagnosed in the U.S., including 49,080 in New Jersey, and 571,950 cancer deaths would occur in the U.S., including 16,370 in New Jersey In 2011, the cancer registry at CentraState abstracted and/or accessioned 863 new analytical cases. These statistics do not reflect localized basal and squamous cell carcinoma of the skin, follicular neoplasm of the thyroid and positive urine cytology cases. 156 246 461 (0) Diagnosis @ CS all 1st course treatment elsewhere (1) Diagnosis @ CS, all or part of 1st course treatment @ CS (2) Diagnosis @ another facility, part or all of 1st course treatment@ CS Analytical cases: Patients were diagnosed and/or received treatment for their newly diagnosed cancer at CSMC. In addition to newly diagnosed cases, approximately 530 patients (non-analytical) utilized CSMC services for consultation, diagnostic workup, transient care, management of recurrent disease or for treatment of benign conditions (with active cancer diagnosis). Data was compiled by Uzma Rizwan, BS, CCS, CTR and reviewed and critiqued by Drs: Amit Kharod, MD, FACS, Henry K. Tsai, MD, JeanPhilippe Bocage, MD, FACS, Bhavesh Balar, MD, Robert Braun, MA, M.Ed., RN, OCN, RT (T)(R), Janice Breen PhD, RN, PHCNS-BC 12 Newly Diagnosed and/or Treated Cases Seen at CSMC By First Year of Contact (2001-2011) DIAGNOSED YEAR 806 635 674 661 691 814 836 813 863 685 486 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Five Body Systems Comparative Analysis of Newly Diagnosed Cases Seen at CSMC 2009–2011 Table 1: BODY SYSTEM DIGESTIVE SYSTEM RESPIRATORY SYSTEM BREAST MALE GENITAL SYSTEM URINARY SYSTEM 2009 2010 2011 152 92 187 99 72 153 96 161 118 78 141 98 176 133 98 In 2011, there was a significant increase in the number of urological cancer cases compared to the preceding year. This case mix includes prostate, kidney and bladder cancers. Top Five Primary Sites Comparative Analysis of Newly Diagnosed Cases Seen at CSMC 2009-2011 Table 2: PRIMARY SITES Breast Colon & Rectal Bronchus & Lung Prostate Gland Urinary Bladder 2009 2010 2011 187 103 86 93 61 161 98 85 114 52 176 82 95 126 63 According to the ACS, the top four cancer sites represent 51.8% of all new cases and 48.5% of all new cancer deaths within Monmouth County. These sites include lung, breast, colorectal and prostate cancers. 13 Newly Diagnosed and/or Treated Cases Seen at CSMC continued By First Year of Contact (2001-2011) At CSMC, there was continued growth in the number of prostate cancer patients in 2011 compared to 2009 and 2010. This increase was attributed to CentraState offering the full spectrum of care, which includes a surgical treatment option (da Vinci S™ Surgical System), as well as advanced radiation therapy—two of the most commonly utilized treatments for prostate cancer. In 2011, CentraState demonstrated an increase in the number of total breast cancer diagnoses; however there was a decrease in the number of colorectal patients diagnosed and treated. In 2012, Thomas Kayal, MD, boardcertified and fellowship-trained colorectal surgeon was recruited to join the medical staff to add additional surgical expertise in the area of colorectal surgery at CSMC. 2011 Top Five Cancer Sites at CSMC by Best Collaborative/AJCC Stage STAGE COLON LUNG BREAST PROSTATE Stg 0 4 0 39 0 Stg I 19 14 76 56 Stg II 15 7 33 57 Stg III 16 26 16 9 Stg IV 8 39 7 4 Stg N/A 0 2 0 0 Unknown 4 7 5 0 COUNT 66 95 176 126 The table above reflects CSMC diagnosed and treated predominantly early stage cancers. This is attributed to individuals within the community having access to CentraState’s screening and healthy lifestyle programs offered through the Star and Barry Tobias Health Awareness Center. 14 Breast Cancer Comprehensive Care at CSMC Breast cancer represented the largest percentage of all cancer diagnoses and treatments at CSMC. The graph below demonstrates a comparative analysis of the total number of breast cases diagnosed at CSMC vs. The National Cancer Data Base (NCDB). Comparative analysis of Number of Breast Cancer cases Diagnosed from 2000- 2010. Reported to NCDB by CSMC vs. Comprehensive Hospitals in State of New Jersey 14% 12% 10% CSMC 8% NCDB 6% 4% 2% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 In 2011, the American Cancer Society estimated female breast cancer accounted for 14.6% of all cancer cases and 8.3% of all cancer deaths. In 2011, CentraState Medical Center diagnosed and/or treated 176 new patients. The Cancer Center at CentraState provides comprehensive breast cancer services from diagnosis through survivorship, utilizing a dedicated multidisciplinary team approach composed of breast and general surgeons, radiation oncologists, medical oncologists, pathologists and diagnostic radiologists. The table below reflects a breast cancer treatment compliance measure of CSMC compared to the National Cancer Data Base (NCDB) of facilities participating in the Rapid Quality Reporting System (RQRS) study. Measure: Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Facility Comparison Groups 15 Performance Rates 2008 2009 2010 CentraState Healthcare System 95% 92% 94% Comprehensive Cancer Program (36) 92% 92% 91% NJ (15) 84% 83.2% 86% CINJ Affiliate Hospitals 88% 80% 85% Breast Cancer Comprehensive Care at CSMC continued The current clinical trials that are available for breast cancer at CSMC include: Women’s Health Center: 2) Study Title: A Randomized Study to Prevent Lymphedema in Women Treated for Breast Cancer The Women Health Center (WHC) at CentraState has been named a Breast Imaging Center of Excellence for digital mammography and other diagnostic procedures. In addition, the WHC was designated as a certified Pink Ribbon Facility by HologicTM, the makers of digital mammography. This designation is a distinction awarded only to an elite group of health care facilities who offer the latest, state-of-the-art, digital technology for breast cancer detection. 3) Study Title: Effect of DNA Variations on Breast Cancer Risk. Breast Cancer Screenings and Lectures: 1) Study Title: A Phase III Clinical Trial Comparing Trastuzumab Given Concurrently with Radiation Therapy and Radiation Therapy Alone for Women with HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy For details about available clinical trials and eligibility criteria, please visit www.centrastatecancercenter.com Lymphedema Program: Ocean First Rehabilitation Center has eight certified therapists, four of which are members of the Lymphedema Association of North America (LANA). CentraState’s Lymphedema Program is one of only a few programs in New Jersey that is recognized by the National Lymphedema Network. In 2011, more than 200 lymphedema patients were referred and treated within the program. During the Susan G. Komen grant cycle, in October 2011, free mammographies and lectures were provided. CSMC collaborated with the Visiting Nurse Associations of America (VNAA) through the Cancer Education and Early Detection (CEED) Grant. The screening program provided a breast exam and a prescription for a free mammogram. There were 19 participants who benefited from the grant, which focuses on uninsured and underinsured women. An annual “manicure and mammogram” campaign was kicked off in October at the WHC, where CSMC provided a gift certificate for a free manicure to every woman who came in for a digital mammography during the month of October (National Breast Cancer Awareness month). “Everyone I encountered at CentraState was clearly part of team- from the receptionist to the technicians to Dr. Cahlon- and they took time to get to know me. I became a part of the team, not just a patient walking in the door periodically. You don’t see that kind of care everywhere.” – Angela Cali, a breast cancer patient 16 Prostate Cancer Care at CSMC In 2011, the American Cancer Society estimated Prostate Cancer accounted for 14.4% of all cancer cases and 4.1% of all cancer deaths. Prostate cancer is the most common cancer after skin cancer in men and can be cured if detected early. The comparative data below reflects CSMC diagnosed and treated prostate cancers which were primarily early stage cancers compared with the cases diagnosed in New Jersey reported to NCDB. Comparative analysis of Prostate Carcinoma by AJCC Stage Diagnosed in 2010. Reported to NCDB by CSMC vs. Comprehensive hospitals in NJ 70% 60% 50% CSMC 40% NCDB 30% 20% 10% 0% Stg I Stg II Stg III Treatment: The majority of patients diagnosed with prostate cancer at CSMC in 2010 had early-stage, localized disease and received either surgery or radiation as their initial therapy which is in line with National Comprehensive Cancer Network (NCCN) guidelines. Treatment options vary depending on stage and grade of the cancer as well as the patient’s age and other medical conditions. Appropriate patients may be counseled regarding active surveillance or “watchful waiting.” The Cancer Center at CentraState offers all potential treatment options including surgery (open, laparoscopic, or robot-assisted), intensity modulated radiation therapy, radioactive seed implantation (lowdose and high-dose brachytherapy), and now proton 17 Stg IV Stg Unknow n therapy through the hospital’s partnership with ProCure. Other treatment options may include hormonal therapy and/or chemotherapy for more advanced cases. In 2011, CentraState diagnosed and treated 126 newly diagnosed cases. Approximately 90% of CSMC patients were diagnosed with early stage cancer. Early detection and accurate diagnosis gives patients the best chance to survive the diagnosis. Prostate screenings and lectures were offered throughout the year through CentraState’s Star and Barry Tobias Health Awareness Center. The Center not only reaches out to the local community but also extends the screening efforts to the neighboring counties. Prostate Cancer Care at CSMC continued 2011 Prostate cases by AJCC Stage 60 N0; OF CASES 50 40 30 20 10 0 Stg 0 Stg I Stg II Stg III Stg IV AJCC STAGE Clinical Trial: Support Group: The current clinical trials available at CSMC include: Prostate cancer is not just a man’s disease, but also involves the family and friends of everyone affected by it. CSMC, in collaboration with the American Cancer Society (ACS), provides an on-site, man-to-man support group that meets regularly. 1) Study Title: A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer 2) Study Title: A Phase III Trial of Short-Term Androgen Deprivation with Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy For more information about support group, visit www.centrastatecancercenter.com. For details about available clinical trials and eligibility criteria, visit www.centrastatecancercenter.com 18 Lung Cancer Care at CSMC According to the National Cancer Institute, lung cancer is the second most common cancer among both men and women. The American Cancer Society estimates lung and bronchus cancers accounted for 12.8% of all cancer cases and 25.8% of all cancer deaths in 2011. The Comprehensive Lung Program at CentraState Medical Center offers advanced services, expertise, and technology for diagnosing, treating and helping patients recover from lung cancer. Because CentraState’s focus is on the whole person, not simply the disease, we also offer guidance on maintaining lung health and complementary therapies to support self-healing and emotional well-being, while patients maximize the benefits of conventional treatment. The Comprehensive Lung Program at CentraState Medical Center includes: • A dedicated, multidisciplinary tumor board • Patient navigation services • Advanced, diagnostic imaging technology, including a low-dose lung CT screening program • Treatment options including state-of-the-art, imageguided radiation therapy, infusion therapy and advanced surgical options including video-assisted thoracic surgery (VATS) performed by board-certified thoracic surgeons who were pioneers in the procedure and have performed more than 6,000 procedures. In 2011, the Cancer Center at CentraState diagnosed and treated 95 new patients. More than 75% of these patients were reviewed at the multidisciplinary Lung Tumor Board meetings. The tumor board reviews the patient’s medical history, imaging studies, pathology and current methods of treatment. This specialized team consists of board-certified medical oncologists, radiation oncologists, surgeons, diagnostic radiologists, pathologists, cancer navigator nurses, palliative nurses, a cancer registrar and research coordinators. Comparative data between cases reported to the NCDB by CentraState vs. New Jersey hospitals reflects more patients have been seen at CSMC with earlier stage cancers; this may show improvement in survival. Comparative analysis of Non- Small Cell Lung Carcinoma by AJCC Stage Diagnosed in 2010 Reported to NCDB by CSMC vs. Comprehensive hospitals in NJ 45% 40% 35% 30% 25% CSMC NCDB 20% 15% 10% 5% 0% Stg I Stg II Stg III Stg Unknow n Clinical Trials: Prevention Program: (For details about available clinical trials and eligibility criteria, visit www.centrastatecancercenter.com The leading cause for lung cancer is smoking and exposure to industrial toxins such as asbestos. The best prevention however, is not to smoke. The Star and Barry Tobias Health Awareness Center at CentraState offers a comprehensive smoking cessation program. CentraState Medical Center, in collaboration with Freehold Radiology offers a low-cost screening program for high-risk individuals. For more information, call 855-411-CANCER. 1) Study Title: A Phase III Randomized Trial of Adjuvant Chemotherapy with or without Bevacizumab for Patients with Completely Resected Stage 1B (less than or equal to 4cm)-IIIA Non-Small Cell Lung Cancer (NSCLC). 19 Stg IV Colorectal Cancer Care at CSMC In 2011, the American Cancer Society estimated colorectal cancer accounted for 9.9% of all cancer cases and 10.4% of all cancer deaths. Colorectal cancer is one of the top four cancers diagnosed and treated at CentraState. The graph below reflects the number of newly diagnosed colon cancer cases treated at CentraState Medical Center compared to the number of cases diagnosed in other New Jersey comprehensive cancer programs, as reported to National Cancer Data Base. Comparative analysis of Number of Colon Cancer cases Diagnosed from 2000- 2010. Reported to NCDB by CSMC vs. Comprehensive Hospitals in State of New Jersey 12% 10% 8% CSMC NCDB 6% 4% 2% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 In 2011, CSMC diagnosed and treated 82 new colorectal cases. The American Joint Committee on Cancer (AJCC) staging data below shows that CSMC provided treatment to patients of all stages. CSMC 2011 COLON CASES BY AJCC STAGE 19 16 NO: OF CASES 15 8 4 4 Stg 0 Stg I Stg II Stg III Stg IV Stg Unknow n The Cancer Center at CentraState provides comprehensive care to patients diagnosed with colorectal cancer. This comprehensive care is multidisciplinary and includes a dedicated team of surgeons, medical oncologists, radiation oncologists, pathologists and diagnostic radiologists. In early 2012, Thomas Kayal, MD, board-certified colorectal surgeon, joined the surgical team of CentraState Healthcare System. CentraState is one of only a few hospitals in the United States that provides daVinci Robotic colorectal surgery. 20 Colorectal Cancer Care at CSMC continued Colon Cancer Treatment Meeting National Guidelines to Improve Disease Survival Rates: In the fourth quarter of 2011, the Cancer Committee conducted a quality improvement study based upon an article published in the Journal of the American Medical Association (JAMA). The article suggested induction of adjuvant chemotherapy in a timely manner to eligible colon cancer patients to assist in improving survival rate. Adjuvant chemotherapy is routinely recommended after curative surgical resection of stage III (node-positive) colon cancer, and/or stage II (node-negative) colon cancer in high-risk patients. Community Outreach and Prevention Efforts: According to the American Cancer Society (ACS), New Jersey statewide data reflects lower screening and early detection rates for colon cancer. CentraState provides colon cancer screening and lectures throughout the year. March is designated as Colorectal Cancer Awareness Month. The following were activities held at CentraState during the month of March: March 1st – Paint the Town Blue March 2nd – Wear Blue to Work Day National guidelines, including the American College of Surgery’s Commission on Cancer, recommend patients be evaluated or begin chemotherapy within 120 days of surgery. New data published within JAMA recommended initiation of chemotherapy within four weeks to improve disease survival rates. Retrospective and concurrent reviews were performed on newly diagnosed chemotherapy eligible stage III colon cancer patients at CentraState. It was noted that all eligible patients were referred to medical oncologists for chemotherapy consultations, thus meeting 100% compliance with the treatment guidelines. Dr. Balar commented, “This represents the strong commitment by The Cancer Center at CSMC to provide the best care possible to our community” Clinical Trials: 1) Study Title: Phase III Trial of Irinotecan/5FU/Leucovorin or Oxaliplatin/5-FU/Leucovorin with Bevacizumab, or Cetuximab (C225), or with the Combination of Bevacizumab and Cetuximab for Patients with Untreated Metastatic Adenocarcinoma of the Colon or Rectum 2) Study Title: A Randomized Phase II Study of Irinotecan and Cetuximab with or without the AntiAngiogenic Antibody, Ramucirumab, in Advanced, K-ras Wild-type Colorectal Cancer Following Progression on Bevacizumab-Containing Chemotherapy For details about available clinical trials and eligibility criteria, visit www.centrastatecancercenter.com 21 March 18th – 3rd Annual Paulette Steps Toward Cancer Wellness 5k Run/Walk In order to raise awareness about the importance of colorectal cancer screenings in the community, a colorectal cancer self-help group is available and led by a colorectal cancer survivor, diagnosed and treated at CentraState. The group provides a supportive environment and is a resource for survivors and caregivers. 2011 - 2012 Cancer Committee Members Physician Members: Bhavesh Balar, MD Medical Oncologist Jarrod Kaufman, MD, FACS General Surgeon Amit Kharod, MD, FACS Cancer Liaison General Surgeon Michael McGinnis, MD, FCAP, FASCP, DLM (ASCP), CHCQM Director—Pathology Jeffrey Silberberg, MD, FACP Medical Oncologist Chair—Cancer Committee Kenneth Tomkovich, MD, FACP Diagnostic and Interventional Radiologist Henry Tsai, MD, FACR Radiation Oncology Donna Keehn Quality Improvement Kim Kelly, RN, MS, NEA-BC, FACHE Vice President—Clinical Services Rev. Lisa Lancaster, MDiv, ThM, BCC Chaplain—Pastoral Care Michele Langevin, RN, MSN Oncology—Orthopedics Nurse Manager Sharon Lorfing, RN, MSN, APN-CNurse Practitioner—Cancer Navigator Brian Mason Clinical Director—Rehabilitation Services—Physical Therapy Trudy Mercurio, CCS Financial Data Coordinator—HIM Dan Messina, PhD, FACHE, LNHA Sr. VP/Chief Operating Officer Yvonne Elsey, RN, BSN (VNA) Director of Hospice Clinical Staff Members Guests: Jack Dworkin, MD, MBA, FACC Vice President—Chief Medical Officer Molly Gabel, MD Director, CINJ Network Mark Kroll, MD Medical Oncologist T. Rose, MD Medical Oncologist Edward Soffen, MD, FACP Radiation Oncologist Jennifer Beukers, BSN, RN Research Nurse Cathy Janzekovich, RNC, MA, NEA-BC AVP Nursing Justin Leighton Genetic Counselor Valerie Pratz Marketing Manager-Public Relations & Marketing Robert Braun, MA, M.Ed., RN, OCN, RT (T)(R) Assistant Vice President—Cancer Services Terry Beck, RN, MPA, CHPN Chief Mission Officer Vice President—Communication Initiatives: VNACJ Janice Breen, PhD, RN, PHCNS-BC Manager—Clinical Research Barbara Yuhas, BSN, RN-BC, NE-BC Director of Nursing—Med/Surg Division Nicole Buccino, RN, BS, CCRN Nurse Manager—Ambulatory Services Uzma Rizwan, BS, CCS, CTR CoC Program Supervisor Janice Breen, PhD, RN, PHCNS-BC Diana Chiaro, RN, MSN, AOCN, APN, C. Oncology Nurse Maryann Roper, RN, MA Director—Star and Barry Tobias Health Awareness Center Kim Kelly, RN, MS, NEA-BC, FACHE Mary Ann Cole, RNC Palliative Care Nurse Leonard Thomas, RN Director—Patient/Family Services: ACS John DiMatteo, MS, RPH Clinical Director—Pharmacy Deb Turi-Smith, BA, CSW Support Service Social Work Jan Dragotta, BS, RT (R,T) Clinical Director—Radiation Oncology Mandi Wortman Clinical Director—Radiology References: American Cancer Society, Cancer Facts & Figures, 2011 ** Estimate based on average annual cases and deaths 2004-2008 NJ DOH & SS, State Cancer Registry, 2011 NJ State Cancer Plan: http://www.state.nj.us/health/ccp/ccc_plan.htm NCCN guidelines, National Cancer Data Base 2011 - 2012 Contributing Efforts Robert Braun, MA, M.Ed, RN, OCN, RT (T)(R) Patricia Cullen Maryann Roper, RN, MA Mandi Wortman Amit Kharod, MD Uzma Rizwan, BS, CCS, CTR The full circle of health and wellness dedicated to excellence. 901 West Main Street • Freehold, NJ 07728 (732) 294-7080 • www.centrastate.com TM 350 - 12/12 - XX