Download OncOlOgy and HematOlOgy annual RepORt

Oncology and Hematology Annual Report
2008: A Focus on Colon Cancer
What’s Inside
Program News
3
Survivor Story
5
Colon Cancer Quality Indicators
7
Research
9
2007 Cancer Registry Data
10
News & Achievements
Oncology Fellowship Program
Regions Cancer Care Center
is a top-rated site for training
by University of Minnesota
Hematology and Oncology
fellows who rotate through the
cancer center as part of their
University fellowship program.
Many of the fellows that
train at Regions find jobs as
community oncologists in the
Twin Cities.
Language Interpreters
Interpreters for five different
languages, as well as sign
language interpreters are
available on-site.
OCN Certification
The vast majority of our
nurses are oncology certified.
This means they have special
education and expertise
caring for cancer patients
and have passed a rigorous
state-administered nursing
exam.
Outreach
The HealthPartners/Regions
Hematology and Cancer Care
program delivers care to
seven smaller communities
in Minnesota and western
Wisconsin, providing local
access to cancer services.
U of M Connections
Many of our physicians are
assistant professors at the
University of Minnesota; Dr.
Dan Anderson and Dr. Randy
Hurley are instructors in
the University of Minnesota
second year medical student
hematology course.
2
Randy Hurley, MD
Chairperson
Cancer Program
Dear Friend,
I am excited to present this year’s Annual Report. In 2008, we had several noteworthy
changes. We were fortunate to have Marge Watry join our team as administrative
director; she brings our program a wealth of oncology-related experience. Dr. Jeff Jaffe
also stepped down as department head. Dr. Jaffe guided us for nearly 20 years and
developed our cancer program into what it is today: state-of-the-art facilities with a full
range of oncology services. We commend him for his vision and leadership.
In September, I took over as medical director. I am proud of our facility and services, but
I would argue what really makes the difference in our program is our people: the doctors,
nurses, coordinators and staff that devote their lives to serving patients with cancer and
blood disorders.
This year’s annual report focuses on colorectal cancer. It is the second leading cause of
cancer deaths in America and nearly 1 in 20 Americans will develop colon cancer in
their lifetime. We compare our five-year survival statistics by stage to baseline norms
and compare our treatment data to benchmarks of quality indicators for cancer care. We
also highlight the free colonoscopy colorectal cancer screening program offered by the
HealthPartners Gastroenterology Department to serve uninsured, underinsured and lowincome patients. Caring for the entire community, including the indigent and under-served
is part of our mission.
New this year, we highlight the people that deliver the care at our cancer centers. I
am extremely proud of the service we provide to patients and their families, but I am
especially proud of the people that deliver this care.
Randy Hurley, MD
Medical Director
HealthPartners/Regions Hematology and Cancer Care Program
Assistant Professor of Medicine
Division of Hematology, Oncology and Transplantation
University of Minnesota
New Faces
Program News
Image-Guided Radiation and Stereotactic Radiosurgery
The Regions
Radiation Therapy
Department
recently added
a second linear
accelerator offering
new capabilities
and treatment
delivery options.
One new feature,
Image Guided Radiation Therapy (IGRT),
localizes the tumor through images obtained
by the linear accelerator just before each
treatment.
IGRT images allow for accurate and rapid
robotic alignment of the patient to the
radiation. This makes it possible for doctors to
pinpoint and treat the cancer, while avoiding
nearby critical structures and healthy tissue
for each daily treatment. This robotic IGRT
delivery has been important in improving
outcomes and reducing side effects.
The Radiation Therapy Department will also
be starting a new Stereotactic Radiosurgery
program. This is a technique in which a
focused, large dose of radiation is given to a
defined area to destroy tumors. It is most often
used when the target volume is small. Examples
include early stage lung cancers, tumors which
have metastasized to the brain, or re-treating
tumors in critical areas, such as tumors close
to the spinal cord. The procedure is usually
performed in one to five treatments and is
made possible with rigid immobilization and
improved precision through IGRT techniques.
Stereotactic Radiosurgery has greatly improved
the treatment results of early stage lung cancer,
and makes it possible for some tumors to be
re-treated and eradicated with large doses of
radiation.
MRI-Guided Breast Biopsy
In 2008, Regions Breast Health Center
introduced MRI-guided breast biopsy
technology. MRI biopsy is performed for
lesions found on MRI that cannot be seen
with ultrasound or mammography. Use
of the technology allows doctors to more
accurately target suspicious areas and obtain
better samples.
The procedure is less invasive than surgical
biopsy, causes less tissue damage, leaves
little or no scarring and can be performed
in less than an hour. For lesions that can be
seen with ultrasound and mammography,
stereotactic and ultrasound biopsy are still
the preferred testing method.
New Survivorship Services and Initiatives
Oncologist Kurt Demel, MD, is
championing the effort to bring better posttreatment care to our cancer patients. In
2008, many inroads were made including:
•Advocating for the need of identifying
cancer survivorship as a distinct phase of
care with insurance carriers and medical
professionals.
•Opening an interdisciplinary posttreatment cancer clinic in November 2008.
•Developing a comprehensive cancer care
summary and follow-up plan for patients
that is clearly explained at completion
of initial cancer treatment. The plan is
incorporated into the patient’s electronic
medical record so patient’s primary care
physicians have access to data.
Marge Watry is the new
director of
oncology
services.
Katherine Fuhrmann, genetic
counselor, joined our program
in 2008. She provides
genetic counseling services
for patients and families with
a history of cancer.
Dr. Bal Jahagirder joined our
team in 2008. In addition to
being a staff
physician,
he is also
an assistant
professor of
medicine,
division of
hematology,
oncology and transplantation
at the University of Minn.
He brings to us a wealth of
experience, including awards
for clinical excellence and
outstanding clinical mentor.
Gobind Tarchand, PA. is the
newest addition to our team.
He was previously a certified
senior physician assistant
with a large oncology
group, as well as a clinical
laboratory scientist. He is
involved in the evaluation
and treatment of patients,
as well as the survivorship
program.
Continued on pg. 9
3
Faces & Places
Dr. Kurt Demel, director
of survivorship programs,
performed
volunteer
medical
work at
Brembereke
Hospital
in Benin,
Africa.
Benin, nestled in the crux of
western Africa, is one of the
world’s poorest counties.
Mark Towsley, MS, DABR, physicist
radiation therapy department,
is past president of the
American Association of
Physicists in Medicine.
Dr. Colleen Morton
coordinates the Hemostasis
and
Thrombosis
program
and was
an invited
speaker
at the
recent National Alliance
for Thrombosis and
Thrombophilia seminar in
Minneapolis.
Dr. Victoria Elmer, breast
cancer surgeon,
served as a volunteer
physician to provide medical
care to participants in the
2008 Breast Cancer 3-Day
Walk. Several employees also
participated as part of a team
or volunteer crew, including
Cheryl Moulton, RN. Her team
raised nearly $35,000 for
breast cancer research.
4
Program News
Support Groups and More
In order to treat the whole person, not just
the disease, we offer a wide range of support
groups and complementary care services.
These resources are designed to help
decrease pain and anxiety levels and promote
relaxation. A range of services are available,
including music and pet therapy, healing
touch and massage therapy, guided imagery
and much more.
Many support groups are also available,
including:
•
Wellness Within – for those living with
leukemia, lymphoma and myeloma
•
Lung Cancer – for patients and families
•
Taking Charge – for women facing
breast cancer
For more information, call 651-254-2215.
Riverside Cancer Care Center Expands
Cancer patients receiving care at Riverside
Clinic in Minneapolis can now benefit
from renovated space. The new, larger
cancer center, located on the 2nd floor of
the HealthPartners Riverside Clinic, was
designed to improve privacy and provide a
calm, healing environment.
For patients receiving chemotherapy,
personal DVD players and a wide range
of popular entertainment movies are now
available for checkout. The movies can help
relieve anxiety and stress during difficult
chemotherapy treatments.
Services available at Riverside include
medical oncology/hematology, genetic
counseling, clinical trials, chemotherapy,
palliative care and pain managment.
A few of our Riverside oncology staff including, front:
Donna Larson, RN, back left to right: Kerri Lofgren, RN,
Jan Larson, RN, Jane Thompson, pharmacist,
Matt Schmit, pharmacy tech.
Robotic-Assisted Surgery Offers Quicker Recovery
Robotic-assisted surgery has become a
welcome option for many cancer patients.
Using the robotic system, surgeons operate
through much smaller incisions, leading to
dramatically easier and faster recovery for
most patients.
HealthPartners surgeons Goya Raikar, Leslie
Sharpe and Parker Eberwein (Metro Urology)
use the new robotic system when appropriate
for many types of surgeries including:
• Prostate cancer
• Kidney cancer
• Lung cancer (coming soon)
• other applications include gynecology
and heart surgeries
Faces & Places
Program News
Colon Cancer: Understanding the Patient, Not Just the Disease
Shortly after J.
Alex Acker turned
50, she went in
for a routine colon
cancer screening.
Four hours later,
she was in surgery
having two feet of
her colon removed.
Alex Acker
Colon cancer survivor
The prognosis was
not good: stage 4 colon cancer. The cancer had
also spread into her lymph nodes and liver.
Although Alex was very scared by the
diagnosis and worn down by her surgery,
she vowed to do whatever it would take
to beat the disease. So did her oncologist
and multidisiplinary care team. Together,
they partnered to develop an aggressive
plan of attack, including several surgeries,
chemotherapy and a diabetes management
plan.
Today, nearly two years after her initial
diagnosis, Alex is feeling fabulous and her
prognosis is bright. According to Alex,
“I’m living today because of the aggressive
treatment of the Regions and HealthPartners
cancer team. They understood my fears and
helped me laugh again, even through very
tough times. I’m still dealing with my liver, but
I’m no longer scared. I know I will survive.”
Colonoscopy Screening Program for the Underserved
More than 800 Minnesotans die of
colorectal cancer (CRC) every year.
Unfortunately, only 40% of CRC cases
are detected early when the CRC is more
successfully treated. Until this year, no
program existed in Minnesota to provide
free CRC screening to low-income
individuals.
In May 2008, Regions Hospital and
HealthPartners were proud to partner with
the Minnesota Department of Health,
the American Cancer Society and the
Colon Cancer Coalition to provide a free
colonoscopy screening clinic for low-income,
uninsured, or underinsured individuals.
Through our community partnerships,
we also provide free screenings for other
cancers, including breast and prostate
cancer. Please help us spread the word
on the importance of early detection and
cancer screenings.
“Our goal is to reduce health
disparities by providing care
not varying in quality because
of gender, ethnicity, geographic
location or socioeconomic
status.”
Brian Rank, MD
Medical Director, HPMG
As part of the ongoing expansion at Regions Hospital, the inpatient
hematology/oncology unit will move into new facilities in 2009
featuring private rooms.
Dr. Todd Morris, medical
director of the Breast Health
Center,
served his
second tour of
duty in Anbar
Province,
Iraq, this past
year. He is
the principal
investigator of a study
evaluating navy medical care
in Iraq.
The Breast Health Center,
led by Judy Cannon, was a
corporate sponsor of the 2008
Susan G. Komen Race for the
Cure. Many staff members
also raised money for and
participated in the race.
Carol Jirik, RN, ONC, and Diana
Christensen Johnston, RN,
ONC, are nurse managers of
our outpatient cancer centers
at Riverside and Regions.
Together, they have more than
48 years experience.
Dr. Randy Hurley received the
2008 HealthPartners Thomas
Wilbur Community Service
Award for volunteer work in
Tanzania with Global Health
Ministries and with the Boy
Scouts of America.
Sheryl Bendickson, RN,
helped raise $250,000 for
the American
Cancer
Society (ACS).
Bendickson
is chair of the
White Bear
Lake ACS
chapter. She directed the
White Bear Lake Relay for Life
fundraiser.
5
Colorectal Cancer
Measures of Quality Care
Randy Hurley, MD
The 1999 Institute of Medicine report, Ensuring Quality
Cancer Care, highlighted the known variations in cancer
care throughout the country and called for a quality
monitoring and reporting system.(1) To this end, the
American Society of Clinical Oncology (www.asco.org)
and National Comprehensive Cancer Network
(www.nccn.org) have developed quality measures for
several cancers, including colorectal cancer.(2)
The ASCO/NCCN panel has recommended four quality
measures for colorectal cancer:
1.Whether patients younger than age 80 with T4N0
or stage 3 rectal cancer receive post-operative
chemotherapy
Compliance
HealthPartners/Regions Cancer Care Center data
indicate that 87.5% of patients in 2007 had at least 12
nodes removed and examined. The mean number of
nodes examined was 21, the median 20.
Examination of 12 or more regional lymph nodes is
associated with improved staging and survival.(4) Data
for number of nodes examined was not included in
the original NICCQ survey. Reported benchmarks for
the 12-node measure are: 78% for National Cancer
Institute-designated Clinical Cancer Centers, 53% for
other academic cancer centers and VA Hospitals and
34% for community hospitals.(4)
2.The use of radiation therapy for patients younger than
age 80 with T4N0 or stage 3 rectal cancer
3.Whether adjuvant chemotherapy is initiated for patients
with stage 3 colon cancer
4.Whether patients with stage 2 and 3 colon cancer
(who have not undergone pre-operative chemotherapy
or radiation therapy) have 12 or more lymph nodes
removed and examined at the time of surgery
Regions cancer care compares quite
favorably with NICCQ colon and rectal
cancer care data.
In 2006, The National Initiative for Cancer Care
Quality (NICCQ), a collaboration between the
American Society of Clinical Oncology, the RAND
Corporation and Harvard University, published baseline
data regarding the observed variation in compliance for
these measures occurring in five metropolitan areas in
the USA.(3)
Table 1 examines Regions Tumor Registry data for stage
2 and 3 colon cancer (2007 n=24) and T4N0 and stage
3 rectal cancer (2006 & 2007 n=9) and compares it to
reported variation observed in the NICCQ benchmarks.
TABLE 1
Parameter
Regions
Benchmarks
1. % rectal cancers
receiving post op
chemotherapy
100%
72-92% (3)
2. % rectal cancers
receiving radiation
therapy
100%
58-92% (3)
3. % stage 3 colon
cancer receiving
chemotherapy
100%
78-100% (3)
4. % of patients having
12 or more lymph
nodes removed and
examined at the
time of surgery
87.5%
34-78% (4)
(1) Hewitt M, Simone J. Ensuring Quality Cancer Care. Washington DC, National Academy Press 1999 (2) J Clin Oncol 2008 (3) Malin JL, Epstein A, Adams J et al:
Results for the National Initiative For Cancer Care Quality: How can we improve the quality of cancer care in the United States? J Clin Oncol 2006;24:626-634 (4) Bilimoria
KL, Bentrem DJ, Stewart AK, et al. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst 2008;100:1310-1317
6
Colorectal Cancer
Other Quality Measures
Staging
Other quality measure guidelines for colorectal cancer are
emerging. These include the use of follow-up colonoscopy,
CEA (carcinoembryonic antigen) blood tests and office
visits after curative colon cancer surgery.(5) In a recently
published large Medicare database study, 73% of patients
received a recommended colonoscopy within three years of
colon cancer surgery.(5) Decreased use of colonoscopy was
associated with advanced age, African-American race, and
increased co-morbidity.
American Joint Committee on Cancer (AJCC) staging of
CRC is described in Table 2. Diagnosis is often made by a
gastroenterologist at the time of colonoscopy. Surgical resection
with en-bloc resection of the tumor and draining lymphatics
is required for all but very early stage and the most advanced
stages of disease.
The Regions Cancer Care Center Tumor Registry database
indicates that in 2006, 33 patients underwent a curative
resection for colon cancer surgery. Two patients died in
the following year due to unrelated causes. The follow up
colonoscopy rate was 71% in the remaining 31 patients. The
mean age of those that did not receive a follow-up colonoscopy
is 88 years (range 85-91 years) suggesting that advanced age
and possible co-morbid conditions were also a factor for not
undergoing follow-up colonoscopy. Thirteen percent of these
patients were non-caucasian minorities, all of which received
appropriate follow-up colonoscopy.
TABLE 2 – AJCC STAGING CATEGORIES FOR CRC
AJCC TNM Staging of Colorectal Cancer
T1:
Tumor confined to the submucosa of the colon/rectum
wall
T2:
Tumor penetrating into the muscle layer of the colon/
rectum wall
T3:
Tumor penetrating through the wall of the colon/
rectum
T4:
Tumor penetrating through the colon/rectum and into
adjacent structures
N0:
No involved regional lymph nodes
N1:
1-3 regional nodes involved
N2:
4 or more regional nodes involved
Incidence
M0:
No distant metastatic disease
Approximately 149,000 new cases of colorectal cancer (CRC)
are diagnosed in the United States each year. Indeed, nearly 1
in 20 Americans will develop CRC in their lifetime. Colorectal
cancer is second only to lung cancer as the leading cause of
cancer deaths in the USA. Ninety percent of CRC occurs after
the age of 50, and there has been a shift to the diagnosis of
more “right-sided” ascending colon lesions over the past several
decades. The incidence of colon cancer declined slightly (by
3%) between 1998 and 2003.
M1:
Distant spread is present
Therapy
Therapy of colorectal cancer requires multi-disciplinary
planning with involvement of primary care physicians,
gastroenterologists, radiologists, surgical oncologists, medical
oncologists, and radiation oncologists. HealthPartners electronic
medical record system facilitates seamless communication
between all members of a multidisciplinary care team.
STAGE GROUPINGS
Stage 1:
T1N0M0; T2N0M0
Stage 2A:
T3N0M0
Stage 2B:
T4N0M0
Stage 3A:
T1N1M0; T2N1M0
Stage 3B:
T3N1M0; T4N1M0
Stage 3C:
Any T, N2M0
Stage 4:
Any T, Any N, M1
Adjuvant Chemotherapy
Adjuvant chemotherapy improves survival in stage 3 colon
cancer. Adjuvant radiation and chemotherapy given either preoperatively or post-operatively can improve local control and
survival in locally advanced and stage 3 rectal cancer.
(5) Cooper GS, Kou TD, Reynolds HL. Receipt of guideline-recommended follow-up in older colorectal cancer survivors. Cancer 2008; 113:2029-37
7
Colorectal Cancer
Palliative Chemotherapy
Palliative chemotherapy can lengthen survival and improve
quality of life in patients with metastatic disease. New
chemotherapeutic agents such as oxaliplatin, cetuximab,
bevicizumab and panitumumab have been FDA approved
since 2002 and have significantly improved the median
survival of patients with stage 4 disease.
Comparison of Colorectal Cancer Outcomes at
Regions with National Benchmarks
Forty-eight cases of colorectal cancer were diagnosed and
treated at Regions Cancer Care Center in 2002 whereas 81
cases were diagnosed and treated in 2007. Examination of
data from 2002 allows comparison of five-year survival
rates to published benchmarks. These benchmarks include
Surveillance Epidemiology and End Result (SEER) data and
the National Cancer Data Base (NCDB).(6, 7)
SEER Data Comparison
The median age at diagnosis of CRC at Regions in 2002
was 69 years compared to 70 years in the SEER database.
At Regions, 60% of patients were male and 90% were
caucasian. In the SEER database, 40% of cases were
localized (AJCC stage 1 and 2) compared to 45.8% at
Regions Hospital. Thirty six percent of SEER cases were
regionally advanced (AJCC stage 3) compared with 29.2%
at Regions. Nineteen percent were metastatic (stage 4) at
diagnosis and 5% were unstaged in the SEER database.
This compares to 25% of cases found to be metastatic at
the time of diagnosis at Regions. All cases at Regions were
fully staged at the time of diagnosis.
survival was 49% compared to 63% at Regions. The NCDB
five year survival of stage 4 patients was 6% compared to
0% at Regions.
Risk Factors for Developing Colorectal Cancer
1.Genetic Syndromes: Familial Adenomatous Polyposis
Syndrome (FAP); Hereditary Non-Polyposis Colorectal
Cancer Syndrome (HNPCC)
2.Personal or family history of colon cancer or
adenomatous polyps
3. Inflammatory bowel disease
4. Diabetes mellitus
Possible Protective Factors
1. High dietary intake of fruits, vegetables and fiber
2. Calcium supplementation
3. Physical activity
4. Aspirin and non-steroidal anti-inflammatory agents
5. “Statin” type cholesterol drugs
NCDB Comparison
Observed five-year survival for NCDB database stage 1
patients was 74%. Only six patients with stage 1 colon
cancer were diagnosed at Regions in 2002. Four of these
patients died in the subsequent five years of non-cancer
related causes (giving an observed five-year survival of
33%). The median age of these four patients who died was
85 years. The five-year NCDB survival of stage 2 CRC was
63% compared to 57% at Regions. The NCDB stage 3
(6) SEER: http://SEER.cancer.gov/statfacts/html.colorect.html (7) NCDB: http://survival.facs.org
8
“Microscopic view of the transition from normal to
malignant colonic mucosa. Normal, orderly, mucinproducing colonic mucosa cells on the left hand part
of the slide are adjacent to an area of disorganized,
dysplastic cells typical of colon cancer on the right.”
Image submitted by Doug Olson, MD
Cancer Research
Cancer Research Network
Through our partnership with the
HealthPartners Research Foundation, cancer
patients benefit from our collaboration with
the Cancer Research Network (CRN).
The CRN is a consortium of 14 nonprofit research centers. Collectively, these
organizations provide care to nearly 11
million individuals. CRN research focuses
on characteristics of patients, clinicians,
communities and health systems that lead
!
to the best possible outcomes in cancer
prevention and care.
HealthPartners/Regions involvement with
CRN has included several research studies as
well as the involvement in several community
relationships. We have established a
formalized agreement with the University
of Minnesota Cancer Center to foster
collaborations and are actively involved in the
Minnesota Cancer Alliance.
Marshfield Clinical
Survivorship Services (continued from pg. 3)
•
Identifying professionals to work with
our patients on issues such as diet
and nutrition, exercise, physical and
emotional rehabilitation, managing
chronic pain, etc.
•Offering educational seminars on
nutrition and physical activity, such as
the “Anticancer, A New Way of Life”
presentation in September 2008 by
national expert Dr. Servan-Schreiber.
Oncologist Kurt Demel, MD and Scott Cruse, MSW, are
leading the efforts to bring better post-treatment care to
cancer survivors.
Research News
Cheri Rolnick, PhD, MPH,
serves as the principal
investigator for the
Cancer Research Network
collaboration. She is actively
involved in research related to
breast, colorectal and cervical
cancer.
Dan Anderson, MD, is the
director of the Minnesota
Cooperative Group Outreach
Program (CGOP), a consortium
of providers and researchers
from HealthPartners, Virginia
Piper Cancer
Institute,
HealthEast
and Hennepin
County Medical
Center. The
Cooperative
provides access to clinical
trials for cancer patients.
Minnesota CGOP
HealthPartners/Regions
enrolls the largest number
of patients to the National
Cancer Institute sponsored
clinical trials of any
institution affiliated with the
Minnesota CGOP Program.
Through this program, our
patients have access to
National Cancer Institute
sponsored clinical trials
through the North Central
Cancer Treatment Group
(NCCTG: headquartered at
the Mayo Clinic), the Eastern
Cooperative Oncology Group
(EGOG) and the National
Surgical Adjuvant Breast and
Bowel Program (NSABP).
Awards
Regions Hospital, Division
of Hematology, has been
nominated for the 2009 ASCO
Clinical Trials Participation
Award by MeritCare Hospital.
9
Cancer Registry 2007
Since 1984, our Cancer Registry has accumulated
nearly 16,000 cancer cases, and is actively
following more than 5,200 patients.
To request registry data, please contact
our registry team at: 651-254-2821
The main goal of the Cancer Registry is to serve as a
primary source of cancer information for cancer care
professionals. The Cancer Registry contains a wealth of
valuable data, including demographics, histology and
staging, treatment modalities and clinical outcomes. Our
registrars also spend time on follow-up of these cases,
resulting in a 93% follow-up rate.
The Registry also is responsible for scheduling weekly cancer
conferences. A significant number of our cancer patients
have their diagnosis and treatment discussed weekly by a
multidisciplinary group of cancer care professionals.
The American College of Surgeons requires that managing
physicians be responsible for documenting accurate staging
of cancer. Our Cancer Registry has a 98% accuracy rate for
cancer staging.
Sue Braaten and Margo Hess
Regions Hospital cancer registrars
Regions Hospital Cancer Registry 2007
Total Cases in Cancer Registry
(total cases since January 1, 1984)
Total Actively Followed Cases in the Cancer Registry in 2007
15,921
5,193
New Cases in 2007
New Analytic Cases in 2007
(cases initially diagnosed and/or treated at Regions Hospital)
New Non-analytic Cases in 2007
(cases that receive subsequent treatment/care at Regions Hospital
following initial diagnosis and treatment at another facility)
Total New Cases in 2007
10
1052
81
1133
Cancer Diagnosis and Care
Trends in Cancer Diagnosis at Regions Hospital
Comments: A careful review of the five-year trends in cancer diagnosis shows a continued increase in the number of breast
cancer patients treated in our system. This indicates an increasing role of Regions Breast Health Center as a regional referral
center for breast cancer rather than a true increase in incidence. This may also explain the recent increase in prostate cancer cases
as well. Cases of melanoma continue to rise; this may reflect the known trend of increased melanoma incidence nationwide.
300
Breast
Le uk emia /
Lu ng
288
Colore ctal
Gynec olo g ic
Lymphoma
280
Prostate
Head & Nec k
Melanom a
(excluding CIN III)*
270
249
240
210
202
196
180
150
145
131
126
120
123
114
111
107
102
98
93
90
81
75
77
67
60
60
60
48
43
44
39
33
30
0
37
36
38
31
26 25
‘03
‘04
‘05 ‘06
‘07
‘03 ‘04 ‘05 ‘06 ‘07
‘03 ‘04
‘05 ‘06 ‘07
‘03
‘04 ‘05 ‘06 ‘07
‘03 ‘04 ‘05 ‘06 ‘07
35 36
28
26
28
33
22
‘03 ‘04 ‘05
‘06 ‘07
‘03 ‘04 ‘05 ‘06 ‘07
‘03 ‘04 ‘05 ‘06 ‘07
Major Cancer Sites – 2007, Regions Hospital
SITE
Male
PERCENT
SITE
Female
PERCENT
Leukemia/Lymphoma . . . . . . . . . . . . . . . . . 21%
Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44%
Prostate. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14%
Leukemia/Lymphoma . . . . . . . . . . . . . . . . . 14%
Lung. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13%
Lung. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11%
All others. . . . . . . . . . . . . . . . . . . . . . . . . . . 11%
Colorectal . . . . . . . . . . . . . . . . . . . . . . . . . . . 6%
Colorectal . . . . . . . . . . . . . . . . . . . . . . . . . . 10%
All others. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5%
Urinary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9%
Gynecologic (excluding CIN III)*. . . . . . . . . . 4%
Melanoma. . . . . . . . . . . . . . . . . . . . . . . . . . . 7%
Melanoma. . . . . . . . . . . . . . . . . . . . . . . . . . . 4%
Head and Neck. . . . . . . . . . . . . . . . . . . . . . . 6%
Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4%
Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4%
Urinary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%
Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3%
Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2%
Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1%
Head and Neck. . . . . . . . . . . . . . . . . . . . . . 1.5%
Stomach/Small Bowel. . . . . . . . . . . . . . . . . . 1%
Stomach/Small Bowel. . . . . . . . . . . . . . . . 1.5%
*Excluding cervical intraepithelial neoplasia (CIN) III, and benign and borderline malignancies
50
Professional Organizations and Certifications
American Society of Clinical Oncology
American Freestanding Radiation Oncology Centers
American Medical Association
American Society of Radiologic Technologists
American Association of Medical Dosimetrists
American Registry of Radiologic Technologists
American Society of Therapeutic Radiology and Oncology
Oncology Nursing Society
American Association of Physicists in Medicine: local chapter secretary
American Association of Physicists in Medicine: local chapter president
State Advisory Board for Radiation and Radioactive Material
American Association of Physicists in Medicine: faculty member and presenter
American Society of Hematology
Minnesota Society of Clinical Oncology
American College of Physicians
International Association of Hospice and Palliative Care
Local Community Service
Relay for Life
Big Brothers Big Sisters
Children’s Hospital
Twin Cities Marathon
Habitat for Humanity
Humane Society
League of Women Voters
Rushford Flood Relief Clean Up
Girl and Boy Scouts
Global Health Ministries
Shoulder to Shoulder
Sunday School Teachers
Volunteer Firefighter
American Red Cross
MS/150 Bike Ride
Al-Anon
Hearing Loss Association of America
People and Experience Ambassador
Local Women’s Shelter Volunteers, including President of the Board
Mission Trip Volunteers
Local Food Shelves Volunteers
Classroom and Youth Group Volunteers
Recent Publications
Anderson DM, Rolnick SJ, Jackson J, Amundson J, Asche SE, Loes LM. Impact of chemotherapy in
women with metastatic breast cancer diagnosed 1990-2003. Clinical Breast Cancer. 2007 Oct; 7(10):8013.
Anderson DM, Jackson J, Butani A, Asche S, Rolnick C. Statin use is associated with a reduced risk of
colon cancer recurrence. Proc Am Soc Clin Oncol 2007; 25 18S: 4114.
Tan WW, Hillman DW, Salim M, Northfelt D, Anderson DM, et al. N0332 Phase II trial of weekly
irinotecan hydrochloride and docetaxel in refractory metastatic breast cancer: a north central cancer treatment
group (NCCTG) trial. Annals of Oncology: in press [Manuscript]
Anderson DM, Rolnick SJ, Jackson J, Amundson J, Asche SE, LoesLM. Impact of chemotherapy in
women with metastatic breast cancer diagnosed 1990-2003. Clin Breast Cancer. 2007 Oct;7(10):801-3.
Hurley RW. Anemia in Immigrants. In: Walker PF, Barnett ED, eds. Immigrant Medicine. Saunders
Elsevier, Philadelphia, Pennsylvania, USA, 2007
Hussein K, Jahagirdar B, Gupta P, Burns L, Larsen K, Weisdorf D. Day 14 bone marrow biopsy in
predicting complete remission and survival in acute myeloid leukemia. Am J Hematol. 2008 Jun;83(6):44650.
Williams B, Morton C. Cerebral vascular accident in a patient with reactive thrombocytosis: a rare cause
of stroke. Am J Med Sci. 2008 Sep;336(3):279-81.
Patnaik MM, Haddad T, Morton CT. Pregnancy and thrombophilia. Expert Review of Cardiovascular
Therapy, 5 (4), 753-765 July 2007
Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic
mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007
Nov 20;25(33):5203-9.
Rank B. Executive physicals — bad medicine on three counts. N Engl J Med. 2008 Oct 2;359(14):14245.
Jackson JM, Rolnick SJ, Coughlin S, Neslund-Dudas C, Hornbrook M, Darbinian J, Bachman D,
Herrinton L. Social support among women who died of ovarian cancer. Support Care Cancer 2007; 197204.
Altschuler A, Nekhlyudov L, Rolnick SJ, Greene SM, Elmore JG, West CN, Herrinton LJ, Harris EL,
Fletcher SW, Emmons KM, Geiger AM. Positive, negative, and disparate: women’s differing long-term
psychosocial experiences of bilateral or contralateral prophylactic mastectomy. Breast J. 2008 Jan-Feb;
14(1):25-32.
Fenton JJ, Rolnick SJ, Harris EL, Barton MB, Barlow W, Reisch LM, Herrinton LJ, Geiger AM,
Fletcher SW, Elmore JG. Specificity of clinical breast examination in community practice. J of General
Internal Medicine 2007;22:332-337.
Herrinton LJ, Neslund-Dudas C, Rolnick SJ, Hornbrook MC, Bachman DJ, Darbinian JA, Jackson JM,
Coughlin SS. Complications at the end of life in ovarian cancer. J Pain Symptom Manage 2007:22 1-7.
Rolnick SJ, Jackson J, Nelson W, Butani A, Herrinton LJ, Hornbrook M, Neslund Dudas C, Bachman D,
Coughlin SS, Pain management in the last six months of life for women who died of ovarian cancer. J of
Pain and Sym Management 2007; 33: 24-31.
Rolnick SJ, Altschuler A, Nekhlyudov L, Elmore JG, Greene SM, Harris EL, Herrinton LJ, Barton MB,
Geiger AM, Fletcher SW. What women wish they knew before prophylactic mastectomy. Cancer Nurs.
2007 Jul-Aug; 30(4):285-91.
Bruist DSM, Ichikawa L, Prout MN, Yood MU, Field TS, Owusu C, Geiger AM, Quinn VP, Wei F,
Silliman RA. Receipt of appropriate primary breast cancer therapy and adjuvant therapy are not associated
with obesity in older women with access to health care. J Clin Oncol 2007: Aug 10:25(23):3428-36.
640 Jackson Street
St. Paul, MN 55101
2220 Riverside Avenue South
Minneapolis, MN 55454
651-254-3572
612-349-8374
Hematologists/Oncologists
Dan Anderson, MD
Kurt Demel, MD
Randy Hurley, MD
Gretchen Ibele, MD
Bal Jahagirdar, MD
Jeffrry Jaffe, MD
Colleen Morton, MD
Brian Rank, MD
Daniel Schneider, MD
Gobind Tarchand, PA
Physician Hotline
(for physician questions/consultations only)
651-254-3505
Appointment Scheduling
952-967-7616
Website
www.regionshospital.com/cancer
www.healthpartners.com/cancer
Multidisciplinary Team
Specialized Surgical Oncologists
Radiation Oncologists and Therapists
Oncology-Certified Nurses
Clinical Laboratory Technicians
Pathologists
Pain Management Providers
Genetics Counselor
Social Workers
Psychotherapy
Pharmacists
Medical Assistants
Home Care & Hospice
Caregivers
Dietitians
Chaplains
Cancer Registrars