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200 Delafield Road, Pittsburgh, PA 15215 2013 UPMC ST. MARGARET CANCER PROGRAM: SUMMARY REPORT Part of the UPMC CancerCenter Published December 2013 Accredited by the American College of Surgeons Commission on Cancer as a Comprehensive Community Cancer Program with commendation and Outstanding Achievement Award UPMC CancerCenter at UPMC St. Margaret is dedicated to providing excellent, state-of-the-art oncology care in the community setting. We believe that a multidisciplinary team approach provides the best in patient care. Weekly patient-centered cancer conferences and regular communication between specialty services and primary care physicians assures that our patients receive comprehensive cancer care. UPMC St. Margaret’s dedication to excellent cancer treatment is recognized by the accrediting body for cancer programs, the American College of Surgeons Commission on Cancer (COC). The program received the Outstanding Achievement Award for the last two accreditation periods. The Cancer Registry department collects data on all new cases of cancer diagnosed and treated at UPMC St. Margaret for submission to the National Cancer Data Base (NCDB) and the Pennsylvania Cancer Registry (PCR). Case reporting to these databases provides a wealth of information about risk factors, incidence, and treatment effectiveness, and it helps guide developments in cancer prevention, detection, and treatment. In this report, UPMC St. Margaret uses our most recently available data, as well as previous years’ data when necessary to compare our findings with the latest available from the NCDB. FIGURE 01 AGE AT DIAGNOSIS OF BREAST CANCER UPMC St. Margaret vs. NCDB-Comprehensive Community Cancer Programs (2000-2011) 30 25 20 15 Percent 10 5 0 30-39 40-49 50-59 60-69 70-79 80-89 90+ UPMC SMH 2 12 22 25 23 15 2 NCDB 4 18 25 24 19 9 1 This year’s report focuses on breast cancer. Figure 1 compares patients’ age at diagnosis at UPMC St. Margaret with the NCDB. At UPMC St. Margaret, 65 percent of those diagnosed are at least 60 years old, compared to 53 percent nationally. In addition, at UPMC St. Margaret 50 percent are 70 or older. FIGURE 02 BREAST CANCER: AJCC STAGE AT DIAGNOSIS UPMC St. Margaret vs. NCDB-Comprehensive Community Cancer Programs (2011) Percent of patients 50 45 40 35 30 25 20 15 10 5 0 Stage at Diagnosis 3 4 UNK STAGE 0 1 2 UPMC St. Margaret 18 45 23 8 5 1 NCDB 20 42 24 8 4 2 Evaluation of the amount and spread of cancer is referred to as the stage of disease. Stage, pathologic and molecular data, and patient-specific factors help determine the best treatment regimen for the individual patient. Generally, the lower the stage of disease, the greater the likelihood of successful treatment. Figure 2 shows that for diagnosis year 2011 (the last full year available), UPMC St. Margaret is in keeping with the national trend toward diagnosing breast cancer at an earlier stage: stages 0, 1, and 2. Both UPMC St. Margaret and the NCDB show that 86 percent of patients were diagnosed at these earlier stages. Survival statistics are based on deaths from all causes, not just deaths from breast cancer. FIGURE 03 BREAST CANCER: SURVIVAL BY AJCC STAGE UPMC St. Margaret vs. National Cancer Data Base (2003-2006) Percent of patients surviving Stage 100 90 80 70 60 50 40 30 20 10 0 1 2 3 4 UPMC SMH 87 86 56 24 NCDB 92 85 66 21 Figure 3 compares UPMC St. Margaret patient survival by stage of disease at diagnosis to the NCDB database. The last year of statistics available from the NCDB is 2006. In most cases UPMC St. Margaret’s statistics are comparable to national rates. The lower stage 1 and 3 survival rates can be explained by the significantly higher age at diagnosis for UPMC St. Margaret patients: 50 percent of our patients were age 70 or over at diagnosis, compared to the NCDB rate of 29 percent. Since survival statistics include death from all causes, it is likely that many of these patient died as a result of some other medical condition. FIGURE 04 BREAST CANCER: NATIONAL STANDARDS UPMC St. Margaret vs. National Data (2009-2011) SELECT BREAST MEASURES ESTIMATED PERFORMANCE RATES 2009 2010 2011 Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. [BCS/RT] 100% 100% 100% Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under age 70 with AJCCT1c N0 M0, or Stage II or III ERA and PRA negative breast cancer. [MAC] 100% 100% 100% Tamoxifen or third generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCCT1c N0 M0, or Stage II or III ERA and/or PRA positive breast cancer. [HT] 100% 100% 100% Figure 4 shows that the UPMC St. Margaret program treated patients according to the following national standards 100 percent of the time over the last three years for which data is available. The Commission on Cancer and other national cancer specialty organizations determine standards that all accredited programs are to meet to ensure appropriate treatment. The Cancer Program Practice Profile Report is updated yearly and records how well each program meets these important patient treatment standards. Our oncology team understands the importance of providing the most advanced prevention, detection, treatment, and support services to meet the cancer care needs of our community.