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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