Download Outcomes - Cleveland Clinic

Taussig Cancer Institute
2011
Outcomes
To promote quality improvement, Cleveland Clinic has created a series of
Outcomes books similar to this one for many of its institutes. Designed for a
physician audience, the Outcomes books contain a summary of our surgical and
medical trends and approaches, data on patient volumes and outcomes, and a
review of new technologies and innovations.
Although we are unable to report all outcomes for all treatments provided at
Cleveland Clinic — omission of outcomes for a particular treatment does not
necessarily mean we do not offer that treatment — our goal is to increase
outcomes reporting each year. When outcomes for a specific treatment are
unavailable, we often report process measures associated with improved
outcomes. When process measures are unavailable, we may report volume
measures; a volume/outcome relationship has been demonstrated for many
treatments, particularly those involving surgical techniques.
In addition to our internal efforts to measure clinical quality, Cleveland Clinic
supports transparent public reporting of healthcare quality data and participates
in the following public reporting initiatives:
• Joint Commission Performance Measurement Initiative (qualitycheck.org)
• Centers for Medicare & Medicaid Services (CMS) Hospital Compare (hospitalcompare.hhs.gov)
• Ohio Department of Health (ohiohospitalcompare.ohio.gov)
• Cleveland Clinic Quality Performance Report (clevelandclinic.org/QPR)
Our commitment to providing accurate, timely information about patient care also
will help patients and referring physicians make informed healthcare decisions.
We hope you find these data valuable, and we invite your feedback. Please send
comments and suggestions to us at [email protected]. To view
all our Outcomes books, please visit Cleveland Clinic’s Quality and Patient Safety
website at clevelandclinic.org/outcomes.
Dear Colleague:
Welcome to Cleveland Clinic’s 2011 Outcomes
books. They include data on clinical outcomes,
patient volumes, innovations and publications.
Cleveland Clinic pioneered the collection and
annual publication of outcomes data. This initiative
has become part of the national discussion on
lowering costs and improving the quality of
healthcare.
Cleveland Clinic uses data to manage outcomes
across the full continuum of care. Clinical services
are delivered through patient-centered institutes,
each based around a single disease or organ
system. Institutes combine medical and surgical
services, along with research and education, under
unified leadership. Each institute defines quality
benchmarks for its specialty services and reports
longitudinal progress.
Cleveland Clinic Outcomes books are available
in print and online. Additional data is available
through our online Quality Performance Report
(clevelandclinic.org/QPR). The site offers data in
advance of national and state public reporting sites
in key areas, including heart attack, heart failure,
stroke and infection prevention.
We hope you will find this information useful.
Sincerely,
Delos M. Cosgrove, MD
CEO and President
what’s inside
Chairman’s Letter
04
Upper Aerodigestive Tract
54
Institute Overview
06
Esophageal Cancer
54
Hypopharyngeal Cancer
56
Laryngeal Cancer
57
Major Salivary Gland Cancer
59
Sinonasal Cancer
59
Nasopharyngeal Cancer
60
Oral Cancer
61
Oral Cavity and Pharynx Cancer
63
Oropharyngeal Cancer
65
Palliative Medicine
67
Solid Tumor Oncology28
Patient Experience
76
Gastrointestinal28
Innovations80
Quality and Outcomes Measures
Outcomes Data 16
Hematologic Oncology and Blood Disorders
17
Acute Leukemia/Myelodysplastic Syndromes 17
Bone Marrow Failure
20
Bone Marrow Transplant
21
Lymphoma
24
Multiple Myeloma
26
Colon Cancer
28
Quality Measure
31
Genitourinary
32
Prostate Cancer
32
Contact Information
100
Renal Cell Cancer
39
Institute Locations
101
Gynecological/Women’s Cancer
41
Improving Quality, Safety
Breast Cancer
41
and the Patient Experience
102
Quality Measure
45
About Cleveland Clinic
107
Cervical Cancer
46
Resources
109
Respiratory
48
Lung Cancer
48
Non-Small Cell Lung Cancer
51
Small-Cell Lung Cancer
53
Selected Publications
88
Staff Listing
96
Prefer an e-version?
Visit clevelandclinic.org/OutcomesOnline, and
we’ll remove you from the hard copy mailing list
and email you when next year’s books are online.
Chairman’s Letter
On behalf of Cleveland Clinic’s Taussig Cancer Institute, I am
pleased to share our 2011 outcomes. We are committed to
transparency and strive to make data collection easily
accessible for our patients. Transparency also allows us to
know our strengths and cultivate them, and at the same time,
identify areas for improvement.
Our institute is home to more than 250 top cancer specialists,
researchers, nurses and technicians dedicated to delivering the
most effective medical treatments and offering access to the latest
clinical trials for our patients. In recognition of these and other
contributions, U.S.News & World Report has ranked Cleveland
Clinic as one of the top cancer centers in the nation.
2011 was our busiest year to date with more than 300,000 patient
visits. As a National Cancer Institute (NCI)-designated cancer
center, Taussig Cancer Institute enrolled nearly 1,800 patients
in 347 clinical trials, including 185 patients enrolled at our regional sites. Ninety of these trials were investigator
initiated, further illustrating our commitment to exploring the most cutting-edge treatment options for our patients.
Taussig Cancer Institute is a member of the Case Comprehensive Cancer Center (Case CCC), a partnership
organization supporting all cancer-related research efforts of Case Western Reserve University, University Hospitals
Case Medical Center and Cleveland Clinic. In October, the Case CCC received an N01 consortium contract to conduct
Phase II and early clinical trials of the NCI Cancer Therapy Evaluation Program (CTEP) drugs to determine their
clinical benefit. The Case CCC is one of only seven centers in the nation to receive an N01 contract. This contract
gives our patients access to clinical trials on new anti-cancer agents, especially translational research to identify
molecular targets and mechanisms of drug effects.
4
Outcomes 2011
Our physicians are nationally and internationally known for their contributions to cancer breakthroughs and their ability to
deliver superior outcomes for our patients. Last year, 33 of our physicians were recognized for excellence in cancer care in
Cleveland Magazine’s Best Doctors rankings. Taussig staff also authored more than 650 publications in high-impact journals,
including results from the pivotal Phase 3 AXIS 1032 trial featured in The Lancet, by Brian Rini, MD, Staff Physician in the
Department of Solid Tumor Oncology. Axitinib, the drug under investigation in the AXIS 1032 trial, was approved by the FDA
to treat advanced renal cell carcinoma in January 2012.
Providing cancer care close to home is integral to our mission. In addition to providing care to more than 28,000 patients
annually on our main campus, we offer treatment at 12 other locations in Northeast Ohio including our newest facility,
Cleveland Clinic Cancer Center, North Coast campus in Sandusky. Cancer services were also added to the new Twinsburg
Family Health & Surgery Center and the Richard E. Jacobs Family Health Center in Avon, Ohio.
In the pages that follow, I am proud to share examples of our strengths in clinical excellence, innovation and patient-centered
care. We are inspired by our patients to challenge the status quo, developing new ways to treat cancer today with an ultimate
goal of eradicating it in the future.
Brian J. Bolwell, MD, FACP
Chairman, Taussig Cancer Institute
Taussig Cancer Institute
5
Institute Overview
Comprehensive support
services to promote
patients’ well-being
and address financial,
practical, physical,
psychological and
social concerns:
•Art and music therapy
•Chemotherapy and other
anti-cancer treatments
orientation classes
•Community outreach
•Financial services
•Genetic counseling
and testing
•High Tea at Taussig
•Pain management and
palliative medicine
•Pastoral care
•Reflections Wellness
(a variety of complementary
and aesthetic services)
•Social workers, support
groups, psychology and
psycho-oncology programs
•The Scott Hamilton
CARES Initiative (Cancer
Alliance for Research,
Education and
Survivorship), which
includes The 4th Angel
Mentoring Program and
Chemocare.com
6
Cleveland Clinic Taussig Cancer Institute is committed to providing each patient
with advanced cancer treatment and an extensive range of support programs
suited to each patient’s unique needs. At Taussig Cancer Institute, highly skilled
and experienced physicians, nurses, physician assistants, social workers,
researchers and other specialists work together to provide superior patient care
in a collaborative, compassionate and innovative healthcare practice.
Multidisciplinary teams include specialists from surgery, medical oncology and
radiation oncology who communicate and collaborate to tailor treatment plans
for each patient, consult about specialized treatment needs and coordinate
patient care.
Patients benefit from access to the latest, most advanced technology in radiation
oncology treatment and pioneering surgical techniques. Clinical trials to evaluate
the newest cancer drugs and treatment may provide additional treatment options
for individuals with cancer or benign hematologic conditions.
In addition to clinical trials, physicians and researchers at Taussig Cancer
Institute conduct internationally recognized basic and translational research to
bring scientific advances in the laboratory to advance patient care.
Providing the best possible care for patients includes access to services and
programs to help patients navigate the changes and challenges that come
with living with cancer. Taussig Cancer Institute offers a wide range of support
services to meet the unique needs of patients and their caregivers.
Taussig Cancer Institute regional locations provide convenient access to medical
services, radiation oncology treatment, clinical trials, and support services. In
2011, North Coast Cancer Care of Sandusky joined Taussig Cancer Institute to
provide outpatient radiation therapy and medical oncology at three locations in
Sandusky, Clyde and Norwalk, OH.
Outcomes 2011
Therapies and Volumes
Provided below is an overview of the number of patients seen and range of therapies provided at Taussig Cancer
Institute in 2011.
Number of Epic Visits by Department (N = 309,839)
2011
Number
350,000
300,000
Department
2011
2010
Hematology & Medical Oncology
94,747
88,291
250,000
200,000
Regional Medical Oncology
71,576
68,251
150,000
Radiation Oncology
95,169
110,886
100,000
Regional Radiation Oncology
45,405
44,683
North Coast Cancer Care
50,000
0
2,942*
--
2011
*Volumes since acquisition on 11/16/2011 only.
Epic visits represent all outpatient visits with a Taussig Cancer Institute clinical provider or resource at main campus, family health centers (Avon,
Beachwood, North Coast Cancer Care, Independence, Strongsville, Twinsburg and Willoughby Hills) and professional visits at Cleveland Clinic community
hospitals (Fairview, Hillcrest and Medina).
Source: Epic
National Cancer Institute (NCI)-Designated Cancer Center—
Cleveland Clinic Taussig Cancer Institute is a member of the Case
Comprehensive Cancer Center (Case CCC), an NCI-designated cancer
center. The Case CCC is a partnership organization supporting all
cancer-related research efforts at Case Western Reserve University,
University Hospitals Case Medical Center and Cleveland Clinic.
Taussig Cancer Institute
7
Institute Overview
Number of Professional Visits by Department (N = 139,723)
2011
Number
150,000
Department
120,000
90,000
60,000
30,000
0
2011
2010
Hematology & Medical Oncology
80,786
79,110
Regional Medical Oncology
46,359
46,749
Radiation Oncology
7,161
7,153
Regional Radiation Oncology
3,173
3,248
North Coast Cancer Care
2,244*
--
2011
*Volumes since acquisition on 11/16/2011 only.
Professional (evaluation and management) inpatient and outpatient visits by Taussig Cancer Institute physician staff at main campus, family health
centers (Avon, Beachwood, North Coast Cancer Care, Independence, Strongsville, Twinsburg, Willoughby Hills) and Cleveland Clinic community
hospitals (Fairview, Hillcrest and Medina).
Source: Professional Revenue Statistics.
Taussig Cancer Institute ranked
as the top cancer center in Ohio
and
8
9th in the nation by U.S.News & World Report in 2011.
Outcomes 2011
Number of New Patient Visits by Department (N = 14,168)
2011
Number
15,000
12,000
9,000
6,000
3,000
0
Department
2011
2010
Hematology & Medical Oncology
6,015
6,119
Regional Medical Oncology
3,312
3,444
Radiation Oncology
2,770
2,815
Regional Radiation Oncology
1,550
1,435
North Coast Cancer Care
521*
NA
2011
*Volumes since acquisition on 11/16/2011 only.
New patient professional (evaluation and management) outpatient visits by Taussig Cancer Institute physician staff at main campus, family
health centers (Avon, Beachwood, North Coast Cancer Care, Independence, Strongsville, Twinsburg, Willoughby Hills) and Cleveland Clinic
community hospitals (Fairview, Hillcrest and Medina).
Source: Professional Revenue Statistics.
2011, 1,754 patients participated in 347 clinical trials
conducted at the Taussig Cancer Institute
including 185 patients participating in 65 clinical trials at regional locations.
In
Taussig Cancer Institute
9
Institute Overview
Number of Inpatient and Outpatient Visits by Department
2011
Number
100,000
80,000
Hematology & Medical Oncology
60,000
Regional Medical Oncology†
Radiation Oncology
40,000
Regional Radiation Oncology†
20,000
0
North Coast Cancer Care*
Outpatient
Inpatient
2011
Department
2011 Visits
Outpatient Inpatient
2010 Visits
OutpatientInpatient
Hematology and Medical Oncology
46,100
34,686
45,273
33,836
Regional Medical Oncology†
35,105
11,254
34,467
12,282
Radiation Oncology
6,790
371
6,737
417
Regional Radiation Oncology†
2,901
272
2,981
267
North Coast Cancer Care*
2,203*
41*
--
--
Total
93,099
46,624
89,458
46,802
*Volumes since acquisition on 11/16/2011 only. †Does not include treatment volumes (for chemotherapy and radiation therapy) at Cleveland Clinic
community hospitals.
Professional (evaluation and management) inpatient and outpatient visits by Taussig Cancer Institute physician staff at main campus, family health
centers (Avon, Beachwood, North Coast Cancer Care, Independence, Strongsville, Twinsburg, Willoughby Hills) and Cleveland Clinic community
hospitals (Fairview, Hillcrest and Medina).
Source: Professional Revenue Statistics.
10
Outcomes 2011
Inpatient Admissions
Number
3,500
3,000
2,500
2,000
1,500
1,000
500
0
2010
2011
Represents number of patients discharged at main campus by Taussig Cancer Institute physician staff.
Source: Professional Revenue Statistics.
Beds and Chemotherapy Chair Capacity
Inpatient beds* 100
Outpatient chemotherapy chairs
•33 for patients with solid tumors
73 main campus
• 22 for patients undergoing bone marrow transplantation
63 regional locations*
•22 for patients with leukemia
• 23 for patients receiving palliative care
Taussig Cancer Institute
* Excluding Cleveland Clinic community hospitals.
11
Institute Overview
Number of Chemotherapy and Radiation Treatment Visits (N = 90,162)
2011
Number
100,000
Department
80,000
60,000
2011
2010
Hematology & Medical Oncology*
36,940
32,446
Regional Medical Oncology*
17,671
15,117
27,636
30,315
7,915
5,412
Radiation Oncology
40,000
†
Regional Radiation Oncology
†
20,000
0
2011
*Chemotherapy. †Radiation therapy.
Regional data represents treatment visits at Taussig Cancer Institute family health centers, excluding main campus
and treatment volumes at Cleveland Clinic community hospitals.
Sources: Epic (chemotherapy data); Revenue Statistics (radiation oncology data).
12
Outcomes 2011
Patient Treatment Visits by Location
Regional
Main Campus
Treatment Visits
Patient Visits
23%
37%
77%
63%
100%
33%
28%
67%
72%
100%
2010
2011
2010
Chemotherapy Treatment Visits
Radiation Therapy Treatment Visits
48%
17%
22%
83%
78%
32%
100%
100%
52%
2010
2011
68%
2011
2010
2011
Source: EPIC (chemotherapy data); Revenue Statistics (radiation oncology data). Patients seen by Taussig Cancer Institute staff at main campus,
family health centers (Avon, Beachwood, North Coast Cancer Care, Independence, Strongsville, Twinsburg and Willoughby Hills) and professional
visits at Cleveland Clinic community hospitals (Fairview, Hillcrest and Medina).
Taussig Cancer Institute
13
Institute Overview
Outpatient and Inpatient Visits by Disease Group or Cancer Site
Number of Visits
20,000
2010 (N = 135,667)
2011 (N = 137,088)
15,000
10,000
5,000
0
Breast
GI
Benign Leukemia Lung Lymphoma GU
Heme
Myeloma Head
& Neck
MDS Sarcoma
CNS Melanoma GYN
All
Other
GI = Gastrointestinal; Heme = Hematology; GU = Genitourinary; MDS = Myelodysplastic syndromes;
CNS = Central nervous system; GYN = Gynecological.
Source: EPSi. Patients seen by Taussig Cancer Institute staff at main campus, family health centers (Avon, Beachwood, North Coast Cancer Care,
Independence, Strongsville, Twinsburg and Willoughby Hills) and professional visits at Cleveland Clinic community hospitals (Fairview, Hillcrest
and Medina).
Radiation Oncology Procedures by Treatment Type
1% Hyperthermia (N = 10)
5% Eye plaques (N = 57)
9% High-dose-rate brachytherapy
(N = 112)
3% Eye plaques (N = 40)
10% High-dose-rate brachytherapy
(N = 135)
28% Stereotactic body radiosurgery
(N = 362*)
28% Stereotactic body radiosurgery
(N = 330)
100%
29% Low-dose-rate brachytherapy
(N = 378)
30% Low-dose-bratebrachytherapy
(N = 360)
30% Gamma Knife (N = 383)
27% Gamma Knife (N = 324)
2010
1,193
N=
2011
1,298
*Lung (N = 180); Spine (N = 133); Brain (N = 26); Other (N = 23).
Source: Mosaiq.
14
Outcomes 2011
Expanding Patient Access in the Region
Taussig Cancer Institute significantly expanded cancer
treatment services throughout northern Ohio.
“The strength of cancer care at Cleveland Clinic is
the access to outpatient and inpatient services in the
community. No matter where you live in northern Ohio,
the No. 1 cancer program in Ohio is close to home,” says
Timothy Spiro, MD, Chairman, Department of Regional
Oncology. A total of 26 hematology and medical oncology
physicians work out of 12 Cleveland Clinic community
hospitals and family health center locations.
•The Twinsburg Family Health & Surgery Center opened
in July 2011 and is a 190,000 square-foot facility
offering specialty services including hematology and
medical oncology, with six exam rooms and 14
chemotherapy infusion chairs.
Taussig Cancer Institute
•The Richard E. Jacobs Family Health Center in Avon
opened in December 2011, housing six exam rooms for
hematology and medical oncology outpatient visits and
10 chemotherapy infusion chairs.
•Taussig Cancer Institute also announced in November
2011 that North Coast Cancer Care of Sandusky would
join Taussig as the Department of North Coast Cancer
at Taussig Cancer Institute. North Coast Cancer Care
is a full-service cancer treatment center with a team of
seven physicians and 70 support staff. North Coast
provides outpatient cancer services, including radiation
therapy and medical oncology, from three locations in
Sandusky, Clyde and Norwalk, OH.
15
Outcomes Data
Taussig Cancer Institute maintains an extensive tumor registry, which is the source
for much of the outcomes data presented in this book. Data included in the
outcomes graphs derived from the tumor registry are from patients receiving initial
treatment at Cleveland Clinic. Data on more than 147,000 patients have been
recorded.
In the case of radiation oncology treatment, the Department of Radiation Oncology
also maintains a database. For prostate cancer, radiation and surgery patients are
tracked in a single database. Currently, treatment and follow-up data on more than
12,000 patients have been recorded.
Data for some outcomes measures is from Institutional Review Board approved
research studies conducted by Cleveland Clinic investigators.
Outcomes measures of survival are presented as overall survival or relative survival
as indicated in the title. Overall survival measures include all causes of death (in
addition to cancer); relative survival measures include only deaths from cancer.
Where possible, outcome measures include reference to a publicly available source
for comparison, such as the Surveillance, Epidemiology, and End Results (SEER)
Program of the National Cancer Institute (http://seer.cancer.gov). Inclusion of these
references does not and is not intended to represent controlled, direct comparisons.
In cases where data similar to or related to the measure presented is available in
another known, published source, the source is provided for your reference.
16
Outcomes 2011
Hematologic Oncology and Blood Disorders
| Acute Leukemia/Myelodysplastic Syndromes
Acute Lymphocytic Leukemia
Absolute Lymphocyte Count at Day 28 Independently Predicts Event-Free and Overall Survival in Adults
with Newly Diagnosed Acute Lymphocytic Leukemia (N = 198*)
1996 – 2010
Percent Survival
1.0
0.75
≥ 350 cells/µL
< 350 cells/µL
P = 0.007
0.50
0.25
0
0
12
24
36
48
60
Months Since Start of Induction Chemotherapy
*112 patients from Cleveland Clinic, 86 patients from Stanford.
The absolute lymphocyte count (ALC) at Day 28 of induction chemotherapy can be an indicator of bone
marrow recovery, as it may be a marker of the body’s immune surveillance against malignant cells. We
showed that an ALC ≥ 350/µL on Day 28 predicted for improved overall survival compared with lower ALC.
Further characterization of higher risk patients allows for modifications to therapeutic regimens, which may
translate into improvements in long-term survival. In addition, these data suggests that targeting the immune
system to improve ALC may be a worthwhile strategy in acute lymphocytic leukemia.
Sun D, Elson P, Liedtke M, Medeiros BC, Earl M, Alizadeh AA, Bates J, Sekeres M, Coutre SE, Kalaycio M, Sobecks R, Copelan E,
Advani AS. Absolute Lymphocyte Count At Day 28 Independently Predicts Event-Free and Overall Survival in Adults with Newly
Diagnosed Acute Lymphocytic Leukemia. Blood (ASH Annual Meeting Abstracts). 2011:118: Abstract 2552. http://abstracts.
hematologylibrary.org/cgi/content/abstract/118/21/2552?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=independently+&searchi
d=1&FIRSTINDEX=0&volume=118&issue=21&resourcetype=HWCIT. Accessed May 2, 2012.
Taussig Cancer Institute
17
Hematologic Oncology and Blood Disorders
| Acute Leukemia/Myelodysplastic Syndromes
Acute Myeloid Leukemia
Hospital Admission Rates for Febrile Neutropenia (FN) in Patients with Acute Myeloid Leukemia (AML)
Undergoing Post-Remission Chemotherapy with Fluoroquinolone Prophylaxis (N = 80)
1997 – 2008
Percent Admission for FN
100
P < 0.001
80
60
40
20
0
N=
Admissions
Cycles
Treatment Group
Control
52
28
75
42
148
50
FN = Febrile neutropenia.
Patients with acute myeloid leukemia (AML) treated with high-dose cytarabine (HIDAC) chemotherapy followed by
fluoroquinolone prophylaxis (treatment group) had fewer and shorter hospital admissions due to febrile neutropenia
compared with patients with no fluoroquinolone prophylaxis (control group). Patients treated with fluoroquinolone
were at increased risk of developing antibiotic-resistant bloodstream infections with organisms like methicillin-resistant
staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and E. coli, however.
Kusick K, Earl M, Gallagher EM, Yeh J-Y, Advani AS, Kalaycio M, Copelan EA, Sekeres M. Fluoroquinolone Prophylaxis in Acute Myeloid Leukemia (AML)
Patients Undergoing Post-Remission Chemotherapy Reduces Hospital Admission Rates. Blood (ASH Annual Meeting Abstracts). 2011;118: Abstract
2570. http://abstracts.hematologylibrary.org/cgi/content/abstract/118/21/2570?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=fluoroquinolone&sear
chid=1&FIRSTINDEX=0&volume=118&issue=21&resourcetype=HWCIT. Accessed May 2, 2012.
18
Outcomes 2011
Myelodysplastic Syndromes
Risk of Developing Myelodysplastic Syndromes (MDS) Following Radiation Treatment for Localized
Prostate Cancer (N = 11,015)
1986 – 2011
Percent Cumulative Incidence
10
Prostate interstitial brachytherapy (PI) (N = 2,936)
Radical prostatectomy (RP) (N = 5,896)
External beam radiotherapy (EBRT) (N = 2,183)
7.5
PI vs EBRT
PI vs RP
RP vs EBRT
5.0
2.5
0
0
5
10
15
20
25
P = 0.32
P = 0.010
P = 0.015
30
Years
Hazard Ratio for Developing MDS with Therapeutic Radiation: Competing Risk Regression Analysis
Factor
EBRT vs RP
PI vs RP
Unadjusted HR (95% CI)
P Value
Adjusted HR (95% CI)
P Value
2.62 (1.0, 6.91)
0.051
1.24 (0.42, 3.67)
0.700
5.87 (2.11, 16.32)
< 0.001
2.85 (0.92, 8.8)
0.069
PI vs EBRT
2.24 (0.89, 5.61)
0.086
2.29 (0.95, 5.53)
0.065
Age
1.14 (1.09, 1.20)
< 0.001
1.13 (1.07, 1.2)
< 0.001
CI = Confidence interval;
EBRT = External beam
radiotherapy;
RP = Radical prostatectomy;
PI = Prostate interstitial
brachytherapy.
In a study using Cleveland Clinic databases from surgical, radiation oncology, and medical oncology groups of more than
11,000 patients, it was found that those who underwent definitive radiation treatment for localized prostate cancer did
not appear to have a significantly increased risk of subsequent myelodysplastic syndromes (MDS) compared with those
undergoing radical prostatectomy, in analyses that controlled for age and incorporated length of follow-up. A trend for
MDS development was present for those undergoing radiation with prostate interstitial brachytherapy. These findings are
encouraging for both patients and providers who have concerns about the potential effects of therapeutic radiation on
development of MDS.
Mukherjee S, Reddy C, Ciezki J, Tiu RV, Copelan EA, Advani AS, Saunthararajah Y, Paulic K, Maciejewski JP, Bolwell BJ, Klein EA, Sekeres M. Radiation
Treatment for Localized Prostate Cancer and the Risk of Developing Myelodysplastic Syndromes. Blood (ASH Annual Meeting Abstracts). 2011;118:
Abstract 120. http://abstracts.hematologylibrary.org/cgi/content/abstract/118/21/120?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=radiation+trea
tment&searchid=1&FIRSTINDEX=0&volume=118&issue=21&resourcetype=HWCIT. Accessed May 2, 2012.
Taussig Cancer Institute
19
Hematologic Oncology and Blood Disorders
| Bone Marrow Failure
Myeloproliferative Neoplasms
Number of New Patients with Myeloproliferative Neoplasms
Number of Patients
100
80
60
40
20
0
July 2010 – March 2012
Myeloproliferative neoplasms (MPN) are a group of diseases of the bone marrow causing excess
production of cells. Cytopenias, acute myeloid leukemia progression, thrombosis and fibrosis
are examples of MPN. The MPN program at Cleveland Clinic includes a data registry, blood and
bone marrow sample repository, clinical trials, and clinical and translational research.
20
Outcomes 2011
Hematologic Oncology and Blood Disorders
| Bone Marrow Transplant
Overall Survival of Patients with Amyloidosis Receiving Autologous Bone Marrow Transplants (N = 13)
2007 – 2011
Percent Survival
100
80
60
Modern techniques have reduced the risk of
high-dose chemotherapy for patients with
amyloidosis, resulting in improved survival
after autologous bone marrow transplant.
40
20
0
0
1
2
3
4
5
Years Since Transplantation
For reference, the largest study of patients with amyloidosis receiving autologous bone marrow transplants was reported in Blood.
2011;118(16):4346-52.
Overall Survival of Patients with Acute Myeloid Leukemia or Myelodysplastic Syndromes Receiving Allogeneic
Bone Marrow Transplants During First Complete Response (N = 80)
Percent Survival
100
1995 – 2000 (N = 21)
2001 – 2005 (N = 25)
2006 – 2010 (N = 34)
80
60
40
20
0
0
2
4
6
8
10
Years Since Transplantation
Survival outcomes have not changed despite the increased proportion of high-risk patients receiving allogeneic bone marrow
transplants. Fewer patients with low-risk disease, as identified by cytogenetics and molecular markers, are being treated
with allogeneic bone marrow transplant.
Taussig Cancer Institute
21
Hematologic Oncology and Blood Disorders
| Bone Marrow Transplant
100-Day Mortality of All Patients Receiving Autologous Bone Marrow Transplants
Percent Mortality
50
40
30
20
10
0
N=
2009
2010
2011
78
98
99
The Center for International Blood and Marrow Transplant Research (CIBMTR) reports 100-day mortality after autologous bone marrow transplant
to be about 5% for patients with acute leukemia, 12% for patients with non-Hodgkin lymphoma, 10% for patients with Hodgkin disease and 1%
for patients with multiple myeloma. Pasquini MC, Wang Z. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary
Slides, 2011. Available at: http://www.cibmtr.org.
Overall Survival of Patients with Multiple Myeloma Receiving Autologous Bone Marrow Transplants (N = 225)
2000 – 2009
Percent Survival
100
80
60
40
Although multiple myeloma remains an incurable
disease, the inclusion of high-dose chemotherapy in
the treatment strategy has lengthened the median
duration of remission to approximately six years.
20
0
0
2
4
6
8
10
Years Since Transplantation
The Center for International Blood and Marrow Transplant Research (CIBMTR) reports the 5-year survival for patients with multiple myeloma
receiving autologous bone marrow transplant (2000 – 2009) to be approximately 56%. Pasquini MC, Wang Z. Current use and outcome of
hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011. Available at: http://www.cibmtr.org.
22
Outcomes 2011
Overall Survival of Patients with Diffuse Large B-Cell Lymphoma Receiving Autologous Bone Marrow Transplants (N = 242)
2000 – 2009
Percent Survival
100
80
60
40
All our patients with large-cell lymphoma are
chemo-sensitive leading up to the autologous
transplant, and we cure approximately half of them.
20
0
0
2
4
6
8
10
Years Since Transplantation
The Center for International Blood and Marrow Transplant Research (CIBMTR) reports the 5-year survival for patients with diffuse large B-cell
lymphoma (chemo-sensitive) receiving autologous bone marrow transplant (2000 – 2009) to be approximately 58%. Pasquini MC, Wang Z. Current
use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011. Available at: http://www.cibmtr.org.
Overall Survival of Patients with Follicular Lymphoma Receiving Autologous Bone Marrow Transplants (N = 109)
2000 – 2009
Percent Survival
100
80
Outcomes following autologous transplant for
patients with follicular lymphoma are nearly
identical to those for patients with large-cell
lymphoma, yet the oncology community has been
less willing to accept the possibility that patients
with follicular lymphoma can be cured.
60
40
20
0
0
2
4
6
8
10
Years Since Transplantation
The Center for International Blood and Marrow Transplant Research (CIBMTR) reports the 5-year survival for patients with follicular lymphoma
receiving autologous bone marrow transplant (2000 – 2009) to be approximately 66% for chemo-sensitive patients and 50% for chemo-resistant
patients. Pasquini MC, Wang Z. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides, 2011. Available at:
http://www.cibmtr.org.
Taussig Cancer Institute
23
Hematologic Oncology and Blood Disorders
| Lymphoma
Patients with lymphoma receive state-of-the-art therapy at Taussig Cancer Institute. As
part of our mission to improve outcomes for our patients, we constantly update and review
our standard-of-care treatments, participate in clinical trials of new treatment approaches,
and work closely with our Bone Marrow Transplant Program. The results of this carefully
coordinated and cutting-edge care are reflected in the outcomes shown in the survival
curves below. These results are outstanding and among the best reported in major cancer
centers in the nation.
Five-Year Overall Survival of Patients with Diffuse Large B-Cell Lymphoma (N = 280)
1991 – 2011
Percent Survival
100
80
60
40
20
0
0
1
2
3
4
5
Years Since Transplantation
Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma.
This figure shows the survival for all recent patients with diffuse large B-cell lymphoma
treated at Taussig Cancer Institute. The five-year survival is 54.6% (95% CI, 43.1
– 66.0), showing excellent results that compare favorably with those of other major
centers.
CI = Confidence interval.
For reference, published data similar to or related to the measure presented here can be found at:
Blood. 2010;116(12):2040–5.
24
Outcomes 2011
Five-Year Overall Survival of Patients with Mantle Cell Lymphoma (N = 65)
1995 – 2011
Percent Survival
100
80
Mantle cell lymphoma is a rare type of non-Hodgkin
lymphoma and is challenging to treat. The survival
rates for patients treated at Taussig Cancer Institute,
shown in this figure, are outstanding, reflecting
our use of intensive treatment strategies and new
therapies in the context of clinical trials. The fiveyear survival is 51.6% (95% CI, 30.9 – 72.2).
60
40
20
0
0
1
2
3
4
5
Years Since Transplantation
CI = Confidence interval.
Five-Year Overall Survival of Patients with Hodgkin Lymphoma (N = 186)
1980 – 2011
Percent Survival
100
80
Hodgkin lymphoma most commonly affects
individuals in their 20s and 30s. This figure shows
the very good survival for all recent patients with
Hodgkin lymphoma treated at Taussig Cancer
Institute. The five-year survival is 80.7% (95% CI,
70.6 – 90.9).
60
40
20
0
0
1
2
3
4
5
Years Since Transplantation
CI = Confidence interval.
The Surveillance, Epidemiology and End Results (SEER) program reports the overall 5-year relative survival (2001-2007 from 17 SEER geographic
areas) for patients with Hodgkin lymphoma was 83.9%. http://seer.cancer.gov/statfacts/html/hodg.html.
Taussig Cancer Institute
25
Hematologic Oncology and Blood Disorders
| Multiple Myeloma
Patients with the plasma cell disorders multiple myeloma and light-chain amyloidosis seen at Taussig Cancer
Institute between 2007 and 2010 have outcomes that compare favorably with outcomes reported elsewhere.
These data may reflect care by a specialized healthcare team, common use of maintenance therapy and access to
novel therapies, including within the context of clinical trials.
Five-Year Overall Survival of Patients with Multiple Myeloma by Number of Prior Treatments (N = 300)
2007 – 2010*
Percent Survival
100
Prior treatments
0 (N = 143)
1 (N = 85)
2 (N = 34)
3 (N = 14)
≥ 4 (N = 24)
80
60
40
20
0
0
1
2
3
4
5
Years Since Consult
*Patient followed through early 2012.
Most patients with multiple myeloma are seen for relapsed or refractory disease, usually years after diagnosis.
As such, analysis of survival “since diagnosis” can include patients with asymptomatic myeloma who are often
followed for years before they require treatment, artificially improving survival data. This analysis is based on
symptomatic myeloma only.
Based on SEER data, patients with multiple myeloma diagnosed between 2001 and 2007 have five-year relative
survival rates of 41.1%.† In our referral base, patients with newly diagnosed symptomatic myeloma have a
median five-year overall survival (Kaplan-Meier) of 60.5% (95% confidence interval [CI] 47.0 – 74.0%).
Patients who are seen after exposure to 3 or more different regimens commonly have myeloma resistant to
bortezomib and the immunomodulatory drugs lenalidomide and thalidomide, this group of patients has an
expected median survival of 9 months† † compared with 14.8 months (95% CI 7.6 – 34.6) in our most
extensively pretreated (≥ 4) patient population.
26
Outcomes 2011
Five-Year Overall Survival of Patients with Light-Chain Amyloidosis Without High-Dose
Chemotherapy Treatment (N = 57)
2007 – 2010*
Percent Survival
100
80
60
40
20
0
0
1
2
3
4
5
Years Since First Treatment
*Patient followed through early 2012.
Patients with light-chain amyloidosis who either elected not to undergo high-dose
chemotherapy or were not felt to be candidates for this approach, usually because of
severe cardiac involvement, had an expected five-year survival from first treatment of
> 45%. This compares favorably with a report from Boston University where patients
selected for high-dose melphalan and autologous stem cell transplantation based on
performance status, age, and cardiopulmonary function had an expected five-year survival
of 47%.† It may reflect our standard use of intravenous or subcutaneous bortezomibbased therapy since late 2008. Our experience with high-dose melphalan, usually after
bortezomib-based induction, is shown in the bone marrow transplant section.
Skinner M, Sanchorawala V, Seldin DC, et al. Ann Intern Med. 2004;140(2):85-93.
†
Taussig Cancer Institute
27
Solid Tumor Oncology
| Gastrointestinal
Multidisciplinary teams comprising surgeons and physicians from the departments of Colorectal and General Surgery,
Gastroenterology, Interventional Radiology, Medical Oncology and Radiation Oncology tailor treatment regimens for
patients with gastrointestinal cancer. Treatment regimens include adjuvant therapy following surgical resection for
tumors at risk for recurrence, as well as systemic therapies for inoperative, incurable advanced disease. Clinical trials
provide important treatment options to patients.
Provided below are outcomes for colorectal cancer, which demonstrate superior healthcare outcomes in advanced
stage cancer. Disparities in healthcare are a concern at Cleveland Clinic and eliminating healthcare outcomes
disparities in underserved populations is a priority.
Colon Cancer
Five-Year Relative Survival of Patients with All Stages of Colon and Rectum Cancer (N = 3,713)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
70.9
67.1
Years Since Diagnosis
Percent Survival =
91.8
82.2
75.8
American Joint Committee on Cancer (AJCC) stage I – IV colon and rectum cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07). Software: Surveillance
Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance,
Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research
Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S.,
1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011
(updated 10/28/2011), based on the November 2010 submission.
28
Outcomes 2011
Five-Year Relative Survival of Patients with Colon and Rectum Cancer by Stage (N = 3,713)
1996 – 2007
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
20
0
0
1
2
3
4
I CC (N = 1,066)
I Ref
II CC (N = 955)
II Ref
III CC (N = 1,087)
III Ref
IV CC (N = 605)
IV Ref
5
Years Since Diagnosis
Percent Survival by Stage
Years Since Diagnosis
Stage
1
2
3
4
5
I
97
94.7
91.8
89
85.6
II
97.6
92.5
88
84
79.7
III
96.9
86.3
78.2
71.7
6
IV
64.5
37.4
25
18.4
15.9
American Joint Committee on Cancer (AJCC) stage I – IV colon cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07).
Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat)
version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat
Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub
(1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS,
Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the
November 2010 submission.
Taussig Cancer Institute
29
Solid Tumor Oncology
| Gastrointestinal
Five-Year Relative Survival of Patients with All Stages of Colon and Rectum Cancer by Race (N = 3,596)
1996 – 2007
Percent Survival
100
Black CC (N = 386)
Black Ref
White CC (N = 3,210)
White Ref
80
60
40
20
0
0
1
2
3
4
5
Years Since Diagnosis
Percent Survival by Race
Years Since Diagnosis
Race
1
2
3
4
5
Black 79.3
67
59.6
56.3
53.9
White 90.2
81.2
75.1
70.1
66.2
Cleveland Clinic is actively participating in efforts to address outcome disparities due to race and other factors. One method
employed by the Taussig Cancer Institute is the dissemination of information at minority health fairs and other community
education events, including encouraging individuals to complete the recommended cancer screenings that can lead to early
detection and treatment of disease and improve treatment outcomes.
American Joint Committee on Cancer (AJCC) stage I – IV colon and rectum cancer.
CC = Cleveland Clinic.
Ref = Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program, National Cancer Institute. http://seer.cancer.gov/
faststats. (Accessed on 5-11-2012). Linked to Data Type – SEER Survival; Statistic Type – Relative Survival Rates by Survival Time; Year Range – 1988 –
2008 (SEER 9); Race/Ethnicity – Black (includes Hispanic), White; Sex – Both; Age Range – All Ages; Cancer Site – Colon and Rectum.
30
Outcomes 2011
Quality Measure
Removal and Pathological Examination of at Least 12 Regional Lymph Nodes for Patients
Undergoing Colon/Rectal Cancer Resection* (N = 208)
2007
12% (N = 26) < 12 lymph nodes
88% (N = 182) ≥ 12 lymph nodes
100%
*Patients ≥ 18 years of age at diagnosis; first or only cancer diagnosis, primary tumor of the colon or rectum;
invasive solid tumors only; no clinical or pathological evidence of metastatic disease; all or part of first course of
treatment performed at Cleveland Clinic.
At least 12 regional lymph nodes were removed and pathologically examined for 182 of
208 (88%) patients undergoing colon/rectal cancer resection.
Less Than 12 Lymph Nodes Removed and Examined by Stage of Disease
Stage
All Cases
Cases of Less Than 12 Lymph Nodes
0
4
1
I
60
10
II
64
5
III
80
10
TOTAL208
26
The National Cancer Data Base (NCDB) is a nationwide oncology outcomes database and is a joint
program of the Commission on Cancer (CoC) and the American Cancer Society (ACS).
Taussig Cancer Institute
31
Solid Tumor Oncology
| Genitourinary
Taussig Cancer Institute’s Genitourinary (GU) Oncology Program has made
advancements in the treatment of adrenal, bladder, renal, testicular and prostate
cancer through research and innovation. The program’s multidisciplinary approach
offers exceptional clinical care using surgery, chemotherapy, radiation therapy and
innovative clinical treatments for patients in all stages of disease.
Prostate Cancer
Five-Year Relative Survival of Patients with All Stages of Prostate Cancer (N = 6,869)
In 2011, the
Radiation
Oncology
Department
performed
more than
375 prostate
brachytherapy
procedures, the
most ever in a
single year.
32
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
100
100
Years Since Diagnosis
Percent Survival =
100
100
100
American Joint Committee on Cancer (AJCC) stage I – IV prostate cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99,
SEER 17 00-07). Software: Surveillance Research Program, National Cancer Institute SEER*Stat
software (www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and
End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17
Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (19732008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer
Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011
(updated 10/28/2011), based on the November 2010 submission.
Outcomes 2011
Biochemical Relapse-Free Survival of Patients with Low-Risk Prostate Cancer by Treatment Type
(N = 3,865)
1996 – 2011
Percent Biochemical Relapse-Free Survival
100
External beam radiotherapy (N = 479)
Low-dose-rate brachytherapy (N = 1,359)
Radical prostatectomy (N = 2,027)
80
60
40
20
0
P = 0.57
0
1 2
3
4 5
6
7
8 9 10 11 12 13 14
Years Since Treatment
Percent Biochemical Relapse-Free Survival and (Number at Risk)
Treatment Type
5-Year10-Year
External beam radiotherapy
95 (279)
83 (49)
Low-dose-rate brachytherapy
95 (481)
87 (54)
Radical prostatectomy
93 (641)
86 (102)
P-value from log-rank test. Mantel N. Evaluation of survival data and two new rank order statistics arising in its
consideration. Cancer Chemother Rep. 1966;50(3):163–170.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN)
criteria. NCCN Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National
Comprehensive Cancer Network, Inc.
Taussig Cancer Institute
33
Solid Tumor Oncology
| Genitourinary
Biochemical Relapse-Free Survival of Patients with Intermediate-Risk Prostate Cancer by
Treatment Type (N = 2,470)
1996 – 2011
Percent Biochemical Relapse-Free Survival
100
External beam radiotherapy (N = 497)
Low-dose-rate brachytherapy (N = 860)
Radical prostatectomy (N = 1,113)
80
60
40
P < 0.001
20
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13
Years Since Treatment
Percent Biochemical Relapse-Free Survival and (Number at Risk)
Treatment Type
5-Year10-Year
External beam radiotherapy
85 (232)
74 (50)
Low-dose-rate brachytherapy
90 (181)
75 (16)
Radical prostatectomy
82 (294)
73 (60)
P-value from log-rank test. Mantel N. Evaluation of survival data and two new rank order statistics arising in its
consideration. Cancer Chemother Rep. 1966;50(3):163–170.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN)
criteria. NCCN Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National
Comprehensive Cancer Network, Inc.
34
Outcomes 2011
Biochemical Relapse-Free Survival of Patients with High-Risk Prostate Cancer by Treatment Type (N = 1,728)
1996 – 2011
Percent Biochemical Relapse-Free Survival
100
External beam radiotherapy (N = 762)
Low-dose-rate brachytherapy (N = 285)
Radical prostatectomy (N = 681)
80
60
40
20
0
P < 0.001
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15
Years Since Treatment
Percent Biochemical Relapse-Free Survival and (Number at Risk)
Treatment Type
External beam radiotherapy
Low-dose-rate brachytherapy
Radical prostatectomy
5-Year10-Year
74 (310)
52 (66)
74 (42)
NR (0)
60 (157)
47 (23)
NR = Not reached.
P-value from log-rank test. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration.
Cancer Chemother Rep. 1966;50(3):163–170.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN) criteria. NCCN
Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National Comprehensive Cancer
Network, Inc.
Taussig Cancer Institute
35
Solid Tumor Oncology
| Genitourinary
Cumulative Incidence of Death Due to Prostate Cancer of Patients with Low-Risk Prostate Cancer by
Treatment Type (N = 4,050)
1996 – 2009
Percent Cumulative Incidence of Death
20
External beam radiotherapy (N = 494)
Low-dose-rate brachytherapy (N = 1,347)
Radical prostatectomy (N = 2,209)
15
P < 0.021
10
5
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13
Years Since Treatment
Percent Cumulative Incidence of Death Due to Prostate Cancer and (Number at Risk) by
Treatment Type
Treatment Type
5-Year
10-Year
External beam radiotherapy
1.1 (314)
2.6 (54)
Low-dose-rate brachytherapy
0.3 (416)
4.2 (39)
Radical prostatectomy
0.1 (755)
0.5 (143)
P-value is for comparing the cumulative incidence among groups, using Gray’s test. Gray, RJ. A class of K-sample tests for
comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–1154.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN) criteria. NCCN
Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National Comprehensive Cancer
Network, Inc.
36
Outcomes 2011
Cumulative Incidence of Death Due to Prostate Cancer of Patients with Intermediate-Risk Prostate Cancer by
Treatment Type (N = 2,446)
1996 – 2009
Percent Cumulative Incidence of Death
20
P = 0.11
15
External beam radiotherapy (N = 495)
Low-dose-rate brachytherapy (N = 735)
Radical prostatectomy (N = 1,216)
10
5
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13
Years Since Treatment
Percent Cumulative Incidence of Death Due to Prostate Cancer and (Number at Risk) by
Treatment Type
Treatment Type
5-Year
10-Year
External beam radiotherapy
1.1 (266)
6.6 (59)
Low-dose-rate brachytherapy
0.3 (157)
2.8 (16)
Radical prostatectomy
0.3 (371)
3.0 (91)
P-value is for comparing the cumulative incidence among groups, using Gray’s test. Gray, RJ. A class of K-sample tests for
comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–1154.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN) criteria. NCCN
Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National Comprehensive Cancer
Network, Inc.
Taussig Cancer Institute
37
Solid Tumor Oncology
| Genitourinary
Cumulative Incidence of Death Due to Prostate Cancer of Patients with High-Risk Prostate Cancer by
Treatment Type (N = 1,717)
1996 – 2009
Percent Cumulative Incidence of Death
20
External beam radiotherapy (N = 770)
Low-dose-rate brachytherapy (N = 234)
Radical prostatectomy (N = 713)
P = 0.56
15
10
5
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13
Years Since Treatment
Percent Cumulative Incidence of Death Due to Prostate Cancer and (Number at Risk) by
Treatment Type
Treatment Type
External beam radiotherapy
Low-dose-rate brachytherapy
Radical prostatectomy
5-Year
10-Year
5.9 (420)
13.9 (59)
3.1 (38)
6.6 (1)
4.0 (251)
9.6 (54)
P-value is for comparing the cumulative incidence among groups, using Gray’s test. Gray, RJ. A class of K-sample tests for
comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–1154.
Low-, intermediate- and high-risk stratification done per National Comprehensive Cancer Network (NCCN) criteria. NCCN
Clinical Practice Guidelines in Oncology – Prostate Cancer. Version 2.2007, 4/9/2007. National Comprehensive Cancer
Network, Inc.
38
Outcomes 2011
Renal Cell Cancer
Five-Year Relative Survival of Patients with All Stages of Renal Cell Cancer (N = 2,930)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
78.4
75.9
Years Since Diagnosis
Percent Survival =
91.6
86
81.7
Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant renal cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER
17 00-07). Software: Surveillance Research Program, National Cancer Institute SEER*Stat software
(www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER)
Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research Data +
Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008 varying) - Linked To County
Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research
Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November
2010 submission.
Taussig Cancer Institute
39
Solid Tumor Oncology
| Genitourinary
Five-Year Relative Survival of Patients with Renal Cell Cancer by Stage at Diagnosis (N = 2,930)
1996 – 2007
Percent Survival
100
Localized disease CC (N = 2,137)
Localized disease Ref
Regional disease CC (N = 430)
Regional disease Ref
Distant disease CC (N = 363)
Distant disease Ref
80
60
40
20
0
0
1
2
3
4
5
Years Since Diagnosis
A higher percentage of patients with regional renal cell cancer treated at Cleveland Clinic were lymph node-positive, which
in part may explain the lower survival outcome for patients with regional disease compared with the SEER reference data.
Percent Survival by Stage
Stage
Years Since Diagnosis
1
2
3
4
5
Localized 100
98
96.1
93.8
92.1
Regional 86
73.9
64.2
57.3
53.2
52.4
35.1
26.1
22
17.6
Distant Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant renal cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07). Software: Surveillance Research
Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results
(SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases,
Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance
Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission.
40
Outcomes 2011
Solid Tumor Oncology
| Gynecological/Women’s Cancer
Breast Cancer
Patients newly diagnosed with breast cancer are seen in the multidisciplinary Breast Center, a
single location comprising surgeons, medical oncologists and radiation oncologists specializing
in breast cancer. This arrangement is convenient for patients and allows the closest possible
collaboration among physicians to develop an integrated treatment plan.
Five-Year Relative Survival of Female Patients with All Stages of Breast Cancer (N = 5,389)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
93.9
91.8
Years Since Diagnosis
Percent Survival =
100
98.4
96.3
American Joint Committee on Cancer (AJCC) stage I – IV breast cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07).
Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/
seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov)
SEER*Stat Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases,
Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National
Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated
10/28/2011), based on the November 2010 submission.
Taussig Cancer Institute
41
Solid Tumor Oncology
| Gynecological/Women’s Cancer
Five-Year Relative Survival of Patients with Breast Cancer by Stage at Diagnosis (N = 5,389)
1996 – 2007
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
20
0
0
1
2
3
Years Since Diagnosis
4
I CC (N = 2,651)
I Ref
II CC (N = 2,027)
II Ref
III CC (N = 514)
III Ref
IV CC (N = 197)
IV Ref
5
Percent Survival by Stage
Stage
Years Since Diagnosis
1
2
3
4
5
I
100100100 100100
II
100
99.5
97.4
94.7
91.5
III
96.8
88.3
81.1
76.6
71.6
IV
81.9 63.3
49.9
34.4
27.5
American Joint Committee on Cancer (AJCC) stage I – IV breast.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07).
Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/
seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov)
SEER*Stat Database: Incidence - SEER 17 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases,
Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National
Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated
10/28/2011), based on the November 2010 submission.
42
Outcomes 2011
Overall Survival of Patients with Early-Stage Breast Cancer Treated with Radiation (N = 2,003)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
20
0
0
1
2
3
4
0 CC (N = 287)
0 Ref
I CC (N = 979)
I Ref
IIA CC (N = 470)
IIA Ref
IIB CC (N = 267)
IIB Ref
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
0
99.3
(270)
97.4
(240)
96.5
(215)
94.6
(196)
94.6
(182)
I
99.3
(934)
98.5
(877)
97.2
(821)
95.2
(772)
94.4
(732)
IIA
97.6
(441)
95.3
(406)
91.0
(371)
87.5
(340)
85.9
(327)
IIB
95.4
(248)
90.0
(225)
86.3
(207)
83.3
(187)
79.6
(171)
Patients who received radiation therapy at Cleveland Clinic main campus.
CC = Cleveland Clinic.
Ref = Reference group data from the National Cancer Data Base (Commission on Cancer of the American College of
Surgeons and the American Cancer Society) 2001–2002, as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC
Cancer Staging Manual. 7th ed. New York, NY: Springer Science & Business Media; 2010.
Taussig Cancer Institute
43
Solid Tumor Oncology
| Gynecological/Women’s Cancer
Overall Survival of Patients with Late-Stage Breast Cancer Treated with Radiation (N = 445)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
20
0
0
1
2
3
4
IIIA CC (N = 156)
IIIA Ref
IIIB CC (N = 86)
IIIB Ref
IIIC CC (N = 30)
IIIC Ref
IV CC (N = 173)
IV Ref
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
IIIA
96.7
(141)
89.6
(120)
85.6
(102)
83.0
(91)
79.1
(78)
IIIB
90.5
(74)
78.2
(63)
78.2
(62)
73.1
(57)
70.5
(55)
IIIC
89.3
(23)
75.9
(14)
63.7
(9)
55.8
(6)
55.8
(4)
IV
63.0
(109)
49.7
(86)
39.5
(54)
30.7
(34)
27.1
(29)
Patients who received radiation therapy at Cleveland Clinic main campus.
CC = Cleveland Clinic.
Ref = Reference group data from the National Cancer Data Base (Commission on Cancer of the American College of
Surgeons and the American Cancer Society) 2001–2002, as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC
Cancer Staging Manual. 7th ed. New York, NY: Springer Science & Business Media; 2010.
44
Outcomes 2011
Quality Measure
Consideration or Administration of Tamoxifen or Third-Generation Aromatase Inhibitor Within 365 Days of
Diagnosis for Women with Hormone Receptor-Positive Breast Cancer* (N = 292)
2009
0.7% (N = 2)
Not Considered,
Not Administered
99.3% (N = 290)
Considered
Of those for whom
tamoxifen was
considered, 280 patients
received therapy;
10 patients did not
receive therapy.
*Women diagnosed in 2009; ≥ 18 years of age at diagnosis; first or only cancer
diagnosis; primary tumor of the breast; invasive solid tumors only; no clinical or
pathological evidence of metastatic disease; American Joint Commission on Cancer
(AJCC) stage T1C, N0, M0 or stage II or III hormone receptor-positive breast cancer;
all or part of first course of treatment performed at Cleveland Clinic.
Tamoxifen or Third-Generation Aromatase Inhibitor Administered or Not Administered to Patients by Stage
Stage No. of Patients
No. of Patients Administered No. of Patients Not Administered
T1C, N0, M0
84
79
3*, 1†, 1‡
II
165
158
3*, 1†, 1‡, 1§, 1
III
43
43
NA
292
280
12
Total
NA = Not applicable.
*Patient refused hormonal therapy. †Contraindicated condition. ‡Not offered hormonal therapy (Stage I patient seen by outside oncologist).
§
Patient chose alternative therapy. Observation only.
Cleveland Clinic compliance with this National Cancer Data Base (NCDB) standard of care quality goal was 99.4%
for 2009.
The NCDB is a nationwide oncology outcomes database and is a joint program of the Commission on Cancer (CoC) and the American Cancer
Society (ACS).
Taussig Cancer Institute
45
Solid Tumor Oncology
| Gynecological/Women’s Cancer
Cervical Cancer
Radiation oncologists and medical oncologists specializing in the treatment of gynecologic cancers work in close
collaboration. Gynecologic tumor sites include the vulva, vagina, cervix, uterine body and uterine adnexa. Standard
treatment employs high-dose-rate brachytherapy and external beam radiotherapy.
Overall Survival of Patients with Early-Stage* Cervical Cancer Treated with Radiation by Stage at Diagnosis (N = 208)
1996 – 2011
Percent Survival
100
80
Stage
Stage
Stage
Stage
Stage
Stage
60
40
20
0
0
1
2
3
Years Since Treatment
4
IB CC (N = 132)
IB Ref
IIA CC (N = 29)
IIA Ref
IIB CC (N = 47)
IIB Ref
5
Percent Survival and (Number at Risk) by Stage*
Years Since Treatment
Stage
1
2
3
4 5
IB
93.8 (117)
89.7 (107)
86.1 (92)
81.2 (78)
79.0 (68)
IIA
100 (28)
92.7 (25)
88.9 (22)
80.2 (17)
80.2 (15)
IIB
88.6 (36)
81.1 (32)
75.8 (27)
73.0 (25)
69.9 (21)
*Data for Stage 0, IA and IIIA not shown due to N < 10.
CC = Cleveland Clinic.
Ref = Reference group data from the National Cancer Data Base (Commission on Cancer of the American College
of Surgeons and the American Cancer Society) 2000-2002, as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer Science & Business Media; 2010.
46
Outcomes 2011
Overall Survival of Patients with Late-Stage* Cervical Cancer Treated with Radiation by
Stage at Diagnosis (N = 151)
1996 – 2011
Percent Survival
100
80
Stage
Stage
Stage
Stage
Stage
Stage
60
40
20
0
0
1
2
3
Years Since Treatment
4
IllB CC (N = 106)
IllB Ref
IVA CC (N = 12)
IVA Ref
IVB CC (N = 33)
IVB Ref
5
Percent Survival and (Number at Risk) by Stage*
Years Since Treatment
Stage
1
2
3
IIIB
71.3 (67) 57.2 (52) 51.5 (43) 49.0 (38) 46.3 (31)
IVA
77.8 (4)
77.8 (4)
77.8 (4)
55.6 (2)
55.6 (1)
IVB
66.7 (17)
42.4 (10)
33.0 (6)
27.0 (4)
27.0 (3)
4 5
*Data for Stage 0, IA and IIIA not shown due to N < 10.
CC = Cleveland Clinic.
Ref = Reference group data from the National Cancer Data Base (Commission on Cancer of the American College
of Surgeons and the American Cancer Society) 2000-2002, as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer Science & Business Media; 2010.
Taussig Cancer Institute
47
Solid Tumor Oncology
| Respiratory
The Thoracic Oncology Program at the Taussig Cancer Institute offers patients with thoracic malignancies state-of-the-art,
multidisciplinary care. In consultation with patients, collaborative teams of surgical, medical and radiation oncologists
tailor treatment plans to the needs of each patient. An active clinical research program provides patients with additional
treatment options to consider.
The Department of Radiation Oncology actively participates in Cleveland Clinic in-house protocols and is a full member
of the Radiation Therapy Oncology Group (RTOG). The department is one of the lead institutions nationally for accrual of
patients to RTOG lung cancer clinical trials.
Lung Cancer
Five-Year Relative Survival of Patients with All Stages of Lung Cancer (N = 3,543)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
27.7
25
Years Since Diagnosis
Percent Survival =
58.5
40
32.1
American Joint Committee on Cancer (AJCC) stage I – IV lung cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07). Software: Surveillance Research
Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results
(SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases,
Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance
Research Program, Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission.
48
Outcomes 2011
Five-Year Relative Survival of Patients with Lung Cancer by Stage at Diagnosis (N = 3,543)
1996 – 2007
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
20
0
0
1
2
3
4
I CC (N = 957)
I Ref
II CC (N = 222)
II Ref
III CC (N = 1,118)
III Ref
IV CC (N = 1,246)
IV Ref
5
Years Since Diagnosis
Percent Survival by Stage
Stage
Years Since Diagnosis
1
2
3
4
5
I
88.3
76.6
68.3
62.1
56.7
II
83.4
57
49.5
42.3
38.6
III
60.2
37.1
27.6
23.1
20.2
IV
29.5
11.4
5.6
3.2
3.1
American Joint Committee on Cancer (AJCC) stage I – IV lung cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17
00-07). Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.
seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER) Program
(www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina
Impacted Louisiana Cases, Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S.,
1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics
Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission.
Taussig Cancer Institute
49
Solid Tumor Oncology
| Respiratory
Overall Survival of Patients with Medically Inoperable Stage I Lung Cancer
Treated with Stereotactic Body Radiation Therapy (N = 319)
2003 – 2011
Percent Survival
100
CC
Ref
80
60
40
Since the program
began in 2003,
Cleveland Clinic has
treated more than
300 patients with
stage I lung cancer
using stereotactic
body radiotherapy.
50
20
0
0
1
2
3
4
5
31.9
(34)
18.5
(16)
Years Since Treatment
Percent Survival
(Number at Risk) =
80.9
(258)
56.9
(131)
38.9
(64)
American Joint Committee on Cancer (AJCC) stage I – IV lung cancer.
CC = Cleveland Clinic.
Ref = Reference group reported in: Fakiris AJ, McGarry RC, et al. Stereotactic body radiation
therapy for early stage non-small cell lung carcinoma: Four-year results of a prospective phase II
study. Int J Radiation Oncology Biol Phys. 2009;75(3):677-682.
Outcomes 2011
Non-Small Cell Lung Cancer
Overall Survival of Patients with Stage II Non-Small Cell Lung Cancer Treated
with Radiation (N = 113)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
IIA
IIA
IIB
IIB
CC (N = 22)
Ref
CC (N = 91)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Diagnosis
Stage
1
2
3
4
5
IIA
80.0 (14)
62.2 (10)
49.1 (7)
49.1 (6)
49.1 (6)
IIB
70.5 (59)
51.9 (40)
46.6 (34)
39.6 (28)
38.1 (24)
CC = Cleveland Clinic.
Ref = Reference group: International Association for the Study of Lung Cancer (IASLC) database as reported
in: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (Eds.). AJCC Cancer Staging Manual.
7th ed. New York, NY: Springer Science & Business Media; 2010: 261.
Taussig Cancer Institute
51
Solid Tumor Oncology
| Respiratory
Overall Survival of Patients with Stage III and IV Non-Small Cell Lung Cancer
Treated with Radiation (N = 1,110)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
Stage
Stage
80
60
40
IIIA CC (N = 391)
IIIA Ref
IIIB CC (N = 322)
IIIB Ref
IV CC (N = 397)
IV Ref
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Diagnosis
Stage
1
IIIA
63.5 (237)
IIIB
53.1 (164)
31.3 (95)
25.9 (76)
23.5 (68)
21.0 (55)
IV
30.1 (117)
16.9 (65)
14.0 (42)
11.7 (23)
9.5 (17)
2
3
4
48.3 (166) 40.8 (131) 36.2 (104)
5
34.4 (91)
CC = Cleveland Clinic.
Ref = Reference group: International Association for the Study of Lung Cancer (IASLC) database as reported
in: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (Eds.). AJCC Cancer Staging Manual.
7th ed. New York, NY: Springer Science & Business Media; 2010: 261.
52
Outcomes 2011
Small-Cell Lung Cancer
Overall Survival of Patients with Stage III and IV Small-Cell Lung Cancer Treated
with Radiation (N = 145)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
III
III
IV
IV
CC (N = 88)
Ref
CC (N = 57)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
III 55.6 (45)
33.1 (26)
22.7 (17)
20.0 (15)
14.3 (9)
IV 29.8 (17) 11.7 (6) 11.7 (4) 11.7 (2)
11.7 (2)
CC = Cleveland Clinic.
Ref = Reference group: International Association for the Study of Lung Cancer (IASLC) database
as reported in: Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (Eds.). AJCC Cancer
Staging Manual. 7th ed. New York, NY: Springer Science & Business Media; 2010: 261.
Taussig Cancer Institute
53
Solid Tumor Oncology
| Upper Aerodigestive Tract
Esophageal Cancer
At Cleveland Clinic, patients with esophageal cancer benefit from our
multidisciplinary care involving a complete assessment by surgical, medical
and radiation oncologists. Individualized treatment plans for patients with these
malignancies are developed through the collaborative efforts of all specialists.
Patients with potentially curable disease typically receive surgery as the foundation
of their treatment plan. Clinical research is primarily driven by in-house protocols.
Five-Year Relative Survival of Patients with All Stages of Esophageal Cancer (N = 634)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
31
27.9
Years Since Diagnosis
Percent Survival =
58.8
42.5
35.9
Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant esophageal cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17
00-07). Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.
seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and End Results (SEER) Program
(www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Research Data + Hurricane Katrina
Impacted Louisiana Cases, Nov 2010 Sub (1973-2008 varying) - Linked To County Attributes - Total U.S.,
1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics
Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission.
54
Outcomes 2011
Five-Year Relative Survival of Patients with Esophageal Cancer by Stage at Diagnosis (N = 634)
1996 – 2007
Percent Survival
100
Localized disease CC (N = 191)
Localized disease Ref
Regional disease CC (N = 259)
Regional disease Ref
Distant disease CC (N = 184)
Distant disease Ref
80
60
40
20
0
0
1
2
3
Years Since Diagnosis
4
5
Percent Survival by Stage
Stage
Years Since Diagnosis
1
2
3
4
5
Localized 81.9
69.7
65
61
56.1
Regional 61.3
41.8
33.7
26.2
23.4
Distant 30.7
15
9
6.9
5.3
Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant esophageal cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99, SEER 17 00-07). Software:
Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 7.0.9.
Data: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence SEER 17 Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008 varying) - Linked
To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute, DCCPS, Surveillance Research Program,
Cancer Statistics Branch, released April 2011 (updated 10/28/2011), based on the November 2010 submission.
Taussig Cancer Institute
55
Solid Tumor Oncology
| Upper Aerodigestive Tract
Hypopharyngeal Cancer
Overall Survival of Patients with Stage III and IV Hypopharyngeal Cancer Treated with Radiation (N = 72)
1996 – 2011
Percent Survival
100
80
Stage
Stage
Stage
Stage
60
40
III
III
IV
IV
CC (N = 16)
Ref
CC (N = 56)
Ref
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Stage
Years Since Treatment
1
2
3
4
5
III
62.5 (10) 56.3 (9)
50 (8)
43.8 (7)
43.8 (6)
IV
71.4 (40)
54.7 (28)
46.9 (24)
42.7 (19)
38.1 (16)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. New York,
NY: Springer Science & Business Media; 2010.
56
Outcomes 2011
Laryngeal Cancer
Overall Survival of Patients with Stage I and II Laryngeal Cancer Treated with Radiation (N = 159)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
I CC (N = 88)
I Ref
II CC (N = 71)
II Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
I
1
95.4 (82)
2
86.9 (69)
3
85.7 (67) 4
77.7 (56) 5
74.9 (53)
II
90.0 (62)
85.4 (53)
77.2 (46)
70.2 (38)
66.4 (35)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed. New York,
NY: Springer Science & Business Media; 2010.
Taussig Cancer Institute
57
Solid Tumor Oncology
| Upper Aerodigestive Tract
Overall Survival of Patients with Stage III and IV Laryngeal Cancer Treated with Radiation (N = 190)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
III
III
IV
IV
CC (N = 65)
Ref
CC (N = 125)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
III
87.4 (54) 72.4 (42) 68.8 (35) 68.8 (32) 66.5 (28)
IV 74.2 (84) 59.8 (65) 53.2 (55) 51.1 (47) 47.7 (39)
3
4
5
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual.
7th ed. New York, NY: Springer Science & Business Media; 2010.
58
Outcomes 2011
Major Salivary Gland Cancer
Overall Survival of Patients with Stage IV Cancer of the Major Salivary Glands Treated with Radiation (N = 39)
1996 – 2011
Percent Survival
100
CC
Ref
80
CC = Cleveland Clinic.
60
Ref = Reference Group as
reported in: Edge SB, Byrd DR,
Compton CC, et al. AJCC Cancer
Staging Manual. 7th ed. New
York, NY: Springer Science &
Business Media; 2010.
40
20
0
0
1
2
3
4
5
44.1
(12)
36.4
(9)
Years Since Treatment
Percent Survival
(Number at Risk) =
68.4
(25)
60.2
(22)
51.2
(15)
Sinonasal Cancer
Overall Survival of Patients with Stage IV Sinonasal Cancer Treated with Radiation (N = 56)
1996 – 2011
Percent Survival
100
CC
Ref
80
CC = Cleveland Clinic.
60
Ref = Reference Group as reported
in: Edge SB, Byrd DR, Compton
CC, et al. AJCC Cancer Staging
Manual. 7th ed. New York, NY:
Springer Science & Business
Media; 2010.
40
20
0
0
1
2
3
4
5
46.2
(15)
42.8
(11)
Years Since Treatment
Percent Survival
(Number at Risk) =
Taussig Cancer Institute
78.6
(44)
60.2
(24)
49.3
(16)
59
Solid Tumor Oncology
| Upper Aerodigestive Tract
Nasopharyngeal Cancer
Overall Survival of Patients with Stage III and IV Nasopharyngeal Cancer Treated with Radiation (N = 54)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
III
III
IV
IV
CC (N = 21)
Ref
CC (N = 33)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
III 85.0 (16) 79.5 (14) 79.5 (13) 73.2 (11) 73.2 (11)
IV
87.1 (25) 87.1 (23) 83.2 (21) 74.7 (16) 65.1 (13)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed.
New York, NY: Springer Science & Business Media; 2010.
60
Outcomes 2011
Oral Cavity Cancer
Overall Survival of Patients with Stage I and II Oral Cavity Cancer Treated with Radiation (N = 39)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
I CC (N = 13)
I Ref
II CC (N = 26)
II Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Stage
Years Since Treatment
1
2
3
4
5
I
84.6 (11)
76.6 (9) 57.4 (5) 57.4 (5) 57.4 (5)
II
79.6 (18) 74.8 (14) 69.4 (13) 69.4 (13) 63.9 (11)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed.
New York, NY: Springer Science & Business Media; 2010.
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Solid Tumor Oncology
| Upper Aerodigestive Tract
Overall Survival of Patients with Stage III and IV Oral Cavity Cancer Treated with Radiation (N = 151)
1996 – 2011
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
III
III
IV
IV
CC (N = 39)
Ref
CC (N = 112)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
III
79.5 (31) 60.9 (22) 52.6 (19) 47.1 (17) 47.1 (16)
IV
67.3 (67) 55.8 (51) 50.0 (40)
45.9 (30) 38.1 (24)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual.
7th ed. New York, NY: Springer Science & Business Media; 2010.
62
Outcomes 2011
Oral Cavity and Pharynx Cancer
Five-Year Relative Survival of Patients with All Stages of Oral Cavity and
Pharynx Cancer (N = 902)
1996 – 2007
Percent Survival
100
CC
Ref
80
60
40
20
0
0
1
2
3
4
5
68
65.3
Years Since Diagnosis
Percent Survival =
87.9
77.6
72.5
Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant oral cavity
and pharynx cancer.
CC = Cleveland Clinic.
Ref = Surveillance, Epidemiology and End Results (SEER). SEER 1996-2007 (SEER 13 96-99,
SEER 17 00-07). Software: Surveillance Research Program, National Cancer Institute SEER*Stat
software (www.seer.cancer.gov/seerstat) version 7.0.9. Data: Surveillance, Epidemiology, and
End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17
Regs, Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2010 Sub (1973-2008
varying) - Linked To County Attributes - Total U.S., 1969-2009 Counties, National Cancer Institute,
DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2011 (updated
10/28/2011), based on the November 2010 submission.
Taussig Cancer Institute
63
Solid Tumor Oncology
| Upper Aerodigestive Tract
Five-Year Relative Survival of Patients with All Stages of Oral Cavity and Pharynx Cancer by Race (N = 881)
1996 – 2007
Percent Survival
100
CC
Ref
CC
Ref
80
60
Black (N = 97)
Black
White (N = 784)
White
40
20
0
0
1
2
3
Years Since Diagnosis
4
5
Percent Survival by Race
Race
Years Since Diagnosis
1
2
3
4
5
Black 76.9 68.2 61.2 53.1
50.9
White 86.8 76.7 71.9 67.8
65.3
Surveillance, Epidemiology and End Results (SEER) stage localized, regional or distant oral cavity and
pharynx cancer.
CC = Cleveland Clinic.
Ref = Fast Stats: An interactive tool for access to SEER cancer statistics. Surveillance Research Program,
National Cancer Institute. http://seer.cancer.gov/faststats. (Accessed on 5-11-2012). Linked to Data Type
– SEER Survival; Statistic Type – Relative Survival Rates by Survival Time; Year Range – 1988 – 2008
(SEER 9); Race/Ethnicity – Black (includes Hispanic), White; Sex – Both; Age Range – All Ages; Cancer
Site – Oral Cavity and Pharynx.
64
Outcomes 2011
Oropharyngeal Cancer
Overall Survival of Patients with Stage I and II Oropharyngeal Cancer Treated
with Radiation (N = 39)
1996 – 2009
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
I CC (N = 10)
I Ref
II CC (N = 29)
II Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
I
80 (8) 70 (7) 60.0 (6) 60.0 (6)
60.0 (6)
II
93.1 (27) 93.1 (26) 85.8 (23) 85.8 (23) 81.8 (19)
CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual.
7th ed. New York, NY: Springer Science & Business Media; 2010.
Taussig Cancer Institute
65
Solid Tumor Oncology
| Upper Aerodigestive Tract
Overall Survival of Patients with Stage III and IV Oropharyngeal Cancer Treated with Radiation (N = 542)
1996 – 2010
Percent Survival
100
Stage
Stage
Stage
Stage
80
60
III
III
IV
IV
CC (N = 108)
Ref
CC (N = 434)
Ref
40
20
0
0
1
2
3
4
5
Years Since Treatment
Percent Survival and (Number at Risk) by Stage
Years Since Treatment
Stage
1
2
3
4
5
III
93.3 (95) 84.3 (83) 81.2 (74) 76.6 (64) 69.1 (52)
IV
85.9 (344) 70 (178) 68.3 (148)
78.3 (259) 72.9 (216) CC = Cleveland Clinic.
Ref = Reference Group as reported in: Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging Manual. 7th ed.
New York, NY: Springer Science & Business Media; 2010.
66
Outcomes 2011
Palliative Medicine
The Harry R. Horvitz Center for Palliative Medicine, part of Taussig Cancer Institute, is the only medical program in
the United States recognized as a European Society of Medical Oncology (ESMO) Designated Care Center of Integrated
Oncology and Palliative Care. The program is also a World Health Organization (WHO) Demonstration Project in
Palliative Medicine.
Advanced Directives Discussed with Patient (N = 938)
2011
Percent of Patients Reporting “Yes”
100
2010 (N = 947)
2011 (N = 938)
80
60
40
20
0
N=
Discussed at
Admission/Transfer
752
Discussed
by Discharge
705
807
771
A total of 938 inpatients were discharged from service or expired.
Symptoms Present at Admission and at Discharge (N = 734)
2011
Percent of Patients Reported
100
Present at Admission/Transfer
Present at Discharge
80
60
40
20
0
N=
Anorexia
Anxiety
Constipation
Delirium
Depression
Drowsiness
Fatigue
Nausea
Pain
Shortness of
Breath/Dyspnea
Weakness
337 273
151 143
207 116
62 51
71 49
66 46
441 368
242 104
550 439
123 118
221 203
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
Taussig Cancer Institute
67
Palliative Medicine
Anorexia Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
133 147
Same
193 169
Worse
36 63
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
Anxiety Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
44 66
Same
70 79
Worse
29 53
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
68
Outcomes 2011
Constipation Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
147 149
Same
65 51
Worse
39 45
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
Delirium Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011* (N = 435)
80
60
40
20
0
N=
Better
77 37
Same
41 22
Worse
35 19
*Through 7/31/2011.
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
Taussig Cancer Institute
69
Palliative Medicine
Depression and Drowsiness Status at Discharge (N = 299)
Aug 2011 – Dec 2011
Percent of Patients Reported
100
80
Better
Same
Worse
60
40
20
0
N=
Depression
38
30
14
Drowsiness
50
24
26
Symptoms as reported by inpatients who did not expire on service or received comfort
measures only.
Fatigue Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
125 175
Same
317 237
Worse
56 74
Symptoms as reported by inpatients who did not expire on service or received comfort
measures only.
70
Outcomes 2011
Nausea Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
203 186
Same
52 53
Worse
19 25
Symptoms as reported by inpatients who did not expire on service or received comfort
measures only.
Pain Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
520 389
Same
59 138
Worse
9
44
Symptoms as reported by inpatients who did not expire on service or received comfort
measures only.
Taussig Cancer Institute
71
Palliative Medicine
Shortness of Breath (Dyspnea) Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011 (N = 734)
80
60
40
20
0
N=
Better
130 87
Same
64 63
Worse
19 32
Symptoms as reported by inpatients who did not expire on service or received comfort
measures only.
Weakness Status at Discharge
Percent of Patients Reported
100
2010 (N = 628)
2011* (N = 435)
80
60
40
20
0
N=
Better
127 52
Same
241 153
Worse
43 42
*Through 7/31/2011.
Symptoms as reported by inpatients who did not expire on service or received comfort measures only.
72
Outcomes 2011
Comfortable End-of-Life Care
Percent of Patients Reported
100
80
Comfortable “Yes”
Comfortable “No”
60
40
20
0
N=
2010
(N = 319)
288
31
2011
(N = 204)
179
25
For 2011, comfort as reported by 204 patients, including inpatients prior to
death in the hospital and patients transferred or admitted to facilitate discharge
planning or placement receiving comfort measures only.
Taussig Cancer Institute
73
Palliative Medicine
Response to Music Therapy Sessions (N = 339)
2011
Percent of Patient Reported
100
80
96%
79%
Positive
Negative
Ambivalent
No response
Asleep/unresponsive
60
40
20
0
13%
1%
4%
3%
0%
Patients
4%
0%
0%
Family
Response as reported by patient and family members.
Music therapists had 339 music therapy visits (talking with or without music
therapy) with patients hospitalized at Cleveland Clinic main campus palliative
medicine unit in 2011. Both patients and family were present during music therapy.
For patients able to vocalize consent during music therapy sessions, in 99% of the
sessions (200 of 201 sessions), patients agreed to the music therapist returning.
A total of 163 patients received music therapy.
74
Outcomes 2011
Symptom Status Immediately Following Music Therapy (N = 143)
2011
Percent of Patients Reported
100
Better
Same
Worse
80
60
40
20
0
N=
Anxiety
Depression
Mood
Pain
Shortness
of breath
16
2
78
43
4
Patient reported mood was rated using a pictorial scale (0 = happy face to 4 = sad face), whereas anxiety, depression,
pain and shortness of breath were based on patient reported status scale (0 = none to 10 = worst possible) as reported
before and after music therapy.
A total of 163 patients received music therapy while hospitalized at Cleveland Clinic main campus palliative medicine
unit in 2011. Some patients participated in multiple sessions and not every symptom was assessed in every session.
Symptoms not present at (or rated at) the beginning and end of music therapy were not included in this data.
Taussig Cancer Institute
75
Patient Experience
Cleveland Clinic is dedicated to delivering excellent clinical
outcomes and the best possible experience for our patients and
their families. Patient feedback is critical in driving priorities and
assessing results. Based on this feedback, Cleveland Clinic’s Office
of Patient Experience implements training programs to improve
service and communication as well as educational initiatives to help
patients understand what to expect when they are in our care.
Outpatient — Taussig Cancer Institute
Overall Rating of Outpatient Care and Services During Outpatient Visit
2010 – 2011
Percent
100
2010 (N = 1,580)
2011 (N = 2,297)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
Source: Press Ganey, a national hospital survey vendor
76
Outcomes 2011
Rating of Outpatient Care Provider
2010 – 2011
Percent
100
2010 (N = 1,580)
2011 (N = 2,297)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
Source: Press Ganey, a national hospital survey vendor
Likelihood of Recommending Outpatient Care Provider
2010 – 2011
Percent
100
2010 (N = 1,580)
2011 (N = 2,297)
80
60
40
20
0
Very Good
Good
Fair
Poor
Very Poor
Source: Press Ganey, a national hospital survey vendor
Taussig Cancer Institute
77
Patient Experience
Inpatient — Taussig Cancer Institute
The Centers for Medicare and Medicaid Services (CMS) requires United States hospitals that treat Medicare
patients to participate in the national Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) survey, a standardized tool that measures patients’ perspectives of hospital care. Results collected
for public reporting are available at hospitalcompare.hhs.gov.
HCAHPS Overall Assessment
2010 – 2011
Percent
100
80
2010 (N = 523)
2011 (N = 611)
76%
81%
82%
84%
60
40
20
0
Rate Hospital
Would Recommend
% 9 or 10
(0 - 10 scale)
% “definitely yes”
Source: Press Ganey, a national hospital survey vendor
78
Outcomes 2011
HCAHPS Domains of Care
2010 – 2011
Percent
100
2010 (N = 523)
2011 (N = 611)
80
60
40
20
0
Discharge
Doctor
Information Given Communication
% yes
Nurse
Communication
Pain
Management
Room
New Medications Responsiveness
Clean
Communication
to Needs
% always
(Options: always, usually, sometimes, never)
Quiet at
Night
Source: Press Ganey, a national hospital survey vendor
Taussig Cancer Institute
79
Innovations
International Phase III Study Compares Treatments for Kidney Cancer
90
Number of investigatorinitiated clinical trials
conducted in 2011
347
Number of active clinical
trials through 2011
1,754
Number of patients
participating in clinical
trials in 2011
Cleveland Clinic oncologist Brian Rini, MD, is the Principal Investigator
for an international Phase III trial comparing the investigational agent
axitinib with sorafenib in patients with previously treated advanced
renal cell carcinoma. The AXIS 1032 trial is the first trial to compare
two targeted therapies against each other in patients with kidney cancer
who have relapsed or been unresponsive to previous treatment.
The Phase III study results were presented at the American Society of
Clinical Oncology (ASCO) 47th Annual Meeting in June 2011. Study
data revealed a delay in cancer progression by an average of two months
for patients treated with axitinib versus sorafenib.
“Before this study, we had limited proven options for previously treated
patients. Now, we can better understand how to build an effective
sequence of treatments for patients with relapsed or refractory kidney
cancer,” says Dr. Rini.
The AXIS trial included 723 patients in 22 countries including
nine patients treated at Cleveland Clinic. Previous Phase III studies of
other FDA-approved drugs compared their effectiveness against placebo
or cytokines.
Certain subgroups of patients in the study showed even greater response
to axitinib. For example, in patients who were previously treated with
cytokines, axitinib extended median progression-free survival to more
than a year. Complete or partial response to treatment more than
doubled in patients treated with axitinib compared to sorafenib.
Researchers are now conducting a front-line trial of axitinib and sorafenib
in a head-to-head study in both previously treated and previously
untreated patients with advanced kidney cancer.
Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE, Michaelson MD,
Gorbunova VA, Gore ME, Rusakov IG, Negrier S, Ou YC, Castellano D, Lim HY, Uemura
H, Tarazi J, Cella D, Chen C, Rosbrook B, Kim S, Motzer RJ. Comparative effectiveness of
axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3
trial. Lancet. 2011;378(9807):1931-9.
80
Outcomes 2011
The Fellowship of the Ring: the
Tale of the SF3B1 Gene and Its
Importance in Ring Sideroblast
Formation in MDS
Myelodysplastic syndromes
(MDS) represent a diverse
group of hematologic cancers
characterized by low blood
counts, most commonly
decreased red blood cells.
Myelodysplastic syndromes
categories have traditionally
been based on the number of
abnormal-looking immature
cells (blasts), the degree of cell
shape distortion and the type
of chromosomal abnormalities
present. Ring sideroblasts (RS)
are abnormal iron deposits that form around the cell nucleus. The presence of RS in patients with
other clinical and laboratory findings suggestive of MDS suggests a diagnosis of refractory anemia
with ring sideroblasts (RARS), a type of MDS. Why RS are present and their relevance to MDS are
unknown. Researchers from the laboratory of Ramon V. Tiu, MD, of Cleveland Clinic announced
findings suggesting that mutations in a gene called SF3B1 are responsible for the formation of RS
and contribute to the pathogenesis of MDS. The product of SF3B1 is important in a normal bodily
process called splicing, whereby RNA is modified after transcription (creation of complementary
RNA copy of the DNA sequence), leading to a protein product important in sustaining normal
physiologic function. These findings are the first to implicate the splicing mechanism in the
pathogenesis of MDS.
Visconte V, Makishima H, Jankowska AM, Traina F, Szpurka H, Rogers HJ, Jerez A, O’Keefe CL, Cohen Slatkin S,
Bupathi M, Guinta KM, Clemente MJ, Saunthararajah Y, Advani AS, Kalaycio M, Koseki H, Isono K, Singh J, Padgett RA,
Sekeres MA, Maciejewski JP, Tiu RV. Association of SF3B1 with ring sideroblasts in patients, In Vivo, and In Vitro models
of Spliceosomal dysfunction. [Abstract 457]. Presented at: 53rd ASH (American Society of Hematology) Annual Meeting
and Exposition; Dec 10-13, 2011; San Diego, CA. Related: Leukemia. 2012;26:542-5.
Taussig Cancer Institute
81
Innovations
National Cancer Institute Consortium Contract for Cancer Clinical Trials
Determining the clinical benefit of emerging new cancer drugs is
fundamental to improving treatment outcomes for patients. Collaboration
and partnership with other organizations is essential to evaluate new drugs
and share results for the benefit of patients with cancer.
As a member of the Case Comprehensive Cancer Center (Case CCC),
Taussig Cancer Institute will expand its collaborative efforts to determine
the clinical benefit of emerging new cancer drugs. Last October, Case CCC
received an N01 consortium contract to conduct Phase II and early clinical
trials of National Cancer Institute (NCI) Cancer Therapy Evaluation Program
(CTEP) drugs to determine their clinical benefit.
The N01 consortium is a partnership between Case CCC, The Ohio
State University, Georgetown University and Roswell Park. Case CCC is a
partnership organization that supports all cancer-related research efforts at
Case Western Reserve University, University Hospitals Case Medical Center
and Cleveland Clinic.
The CTEP is a program within the Division of Cancer Treatment and
Diagnosis that plans, assesses and coordinates all aspects of cancer
clinical trials and testing of drugs in the clinic. The mission of the CTEP is
to improve the lives of patients with cancer by finding better ways to treat,
control and cure cancer.
82
Outcomes 2011
New Radiation Therapy Technology Shortens
Treatment Time
Mobile Linear
Accelerator for
Intraoperative
Radiotherapy
A new mobile
linear accelerator
in use at
Cleveland
Clinic Taussig
Cancer Institute
increases the
efficiency and
safety of delivering
intraoperative radiotherapy.
Mobetron (IntraOp Medical Corp.)
is a relatively small and lightweight linear accelerator
system for intraoperative radiotherapy. The mobile linear
accelerator eliminates transferring patients from the
operating room to radiation therapy and back again. This
process improvement decreases the overall procedure
time, resulting in reduced exposure to anesthesia for
the patient and lower risk of infection associated with
transporting the patient.
Taussig Cancer Institute
Taussig Cancer Institute radiation oncologists
began treating patients using a new type of
radiation therapy delivery technology that greatly
reduces setup and treatment times. Volumetric
arc therapy delivers radiation to the entire volume
of the area targeted for treatment as opposed to
a fixed-beam direction, which delivers radiation
slice by slice. Our Varian (Palo Alto, CA) and
Elekta (Stockholm, Sweden) linear accelerators
are equipped to deliver volumetric arc technology,
improving dose accuracy and reducing treatment
times to three to five minutes.
Precision Patient Positioning for
Radiation Therapy
The physical positioning of patients and
monitoring for accurate positioning during
treatment is critical during radiation therapy.
Taussig radiation oncologists have employed new
tools to ensure precise patient position prior to
each radiation treatment. AlignRT (Vision RT Inc.,
UK) uses nonradiation optical imaging technology
to verify patient position in real time. Cleveland
Clinic is one of the first hospitals in Ohio to use
AlignRT for daily setup for patients with breast
cancer, a particularly useful application of the
technology. This 3-D imaging technology also
provides monitoring of patient movement and
positioning during treatment.
83
Innovations
Cleveland Clinic Original Member Site of Cancer
Immunotherapy Trials Network (CITN)
Immunotherapy holds promise as an alternative to
traditional treatments such as chemotherapy, surgery
and radiation. Developing new immunotherapy
treatments requires experience, laboratory expertise
to support research, and collaboration with other
researchers and institutions in immunotherapy trials.
Cleveland Clinic Taussig Cancer Institute was selected
as one of 27 original member sites in the U.S. and
Canada to participate in the Cancer Immunotherapy
Trials Network (CITN). The CITN is charged with
accelerating the development of new compounds that
have been discovered but are not readily available for
treating patients with cancer. The network’s mission
is to select, design and conduct early-phase trials using
priority agents with known and proven biologic function
and to provide the high-quality research data essential to
develop cancer treatments for patients.
Immunotherapy “trains” the immune system to recognize
a cancer cell as a foreign invader, similar to the way the
immune system recognizes a virus. The immune system
then locates and destroys residual tumor cells, typically
with minimal side effects.
Headquartered at Fred Hutchinson Cancer Research Center
(Seattle, WA), the CITN will establish a network of leading
academic immunologists to conduct multicenter research.
These immunologists will examine promising new agents
that boost patients’ immune systems to fight cancer. The
initiative is funded by the National Cancer Institute.
84
Bench to Bedside: FDA Approves Investigational New Drug
(IND) for Phase I Clinical Trial in Patients with High-Risk
Sickle Cell Disease
Research developed in the laboratory of Yogen
Saunthararajah, MD, of Cleveland Clinic moves to the
bedside in a Phase I clinical trial. Dr. Saunthararajah has
obtained investigational new drug (IND) approval from
the Food and Drug Administration for a Phase I clinical
trial of combination therapy using oral decitabine and oral
tetrahydrouridine in high-risk sickle cell disease.
In the laboratory, Dr. Saunthararajah and collaborators have
demonstrated that combination oral decitabine and oral
tetrahydrouridine can produce beneficial results. Specifically,
the combination produces a unique epigenetic effect that
does not damage DNA in cells and addresses multiple
pharmacologic limitations of decitabine alone. In a Phase I
trial, this combination therapy will be evaluated in treating
patients with high-risk sickle cell disease and some types
of cancer.
Lavelle D, Vaitkus K, Ling Y, Ruiz MA, Mahfouz R, Ng KP, Negrotto S,
Smith N, Terse P, Engelke KJ, Covey J, Chan KK, Desimone J,
Saunthararajah Y. Effects of tetrahydrouridine on pharmacokinetics and
pharmacodynamics of oral decitabine. Blood. 2012;119(5):1240-7.
Ng KP, Ebrahem Q, Negrotto S, Mahfouz RZ, Link KA, Hu Z, Gu X,
Advani A, Kalaycio M, Sobecks R, Sekeres M, Copelan E, Radivoyevitch T,
Maciejewski J, Mulloy JC, Saunthararajah Y. p53 independent epigeneticdifferentiation treatment in xenotransplant models of acute myeloid
leukemia. Leukemia. 2011;25(11):1739-50.
Outcomes 2011
Chemo Robot Improves Quality, Patient Safety and
Employee Safety
Preparing and handling chemotherapy medications is a
dangerous task that requires extreme precision in order to
provide high-quality care to patients and maintain patient
and employee safety.
Taussig Cancer Institute is the first location in the U.S. to
implement the APOTECAchemo Robot, a new robotic device
developed by Loccioni Humancare (Italy) for the preparation
of patient-specific doses of chemotherapy medications.
Testing of the robotic device started in mid-2011 and
the first patient dose was prepared in October. The robot
uses barcodes, vial characteristics and photographic label
verification to identify drugs and fluids. It uses the density
of each drug and precision weight measurements at each
step of the process to verify the accuracy of the medication
being prepared.
According to Angela Yaniv, PharmD, Cleveland Clinic
Pharmacy, “This is the first IV compounding robot that is
fully functional in a real-life situation.” Once the device
is fully validated and approved by the Ohio Board of
Pharmacy, the number of doses prepared by the robot will
increase over time as it is incorporated in the work flow
requirements of the pharmacy.
Taussig Cancer Institute
85
Innovations
A
Adaptive Drug Resistance in Lung Cancer Cells
B
C
86
Targeted therapies for cancer are limited by recurrence
of resistant disease after an initial response to treatment.
Research led by Patrick Ma, MD, MS, of Cleveland Clinic is
uncovering the adaptive response among tumor cells that
gives rise to early drug resistance in lung cancer cells. Results
indicate that a subpopulation of lung cancer cells that escape
epidermal growth factor receptor (EGFR) kinase inhibitors
are therapeutically susceptible to B-cell lymphoma 2 (Bcl-2)
homology domain 3 mimetic agents. This discovery provides
information about resistant disease that may advance efforts
to cure mutated EGFR lung cancer. Cancer Res. 2011
Jul 1;71(13):4494-4505.
Time-lapse video microscopy images of epidermal growth factor
receptor (EGFR) kinase inhibitor (erlotinib)-sensitive cells treated with
erlotinib for up to nine days shows “early” survivors that evade tyrosinekinase inhibitor (TKI) treatment. (A) Tyrosine-kinase inhibitor-resistance
cells in erlotinib sensitive cell lines. (B) After up to nine days of erlotinib
treatment, cytoskeletal functions and cell proliferation are highly
inhibited. (C) Reversal of cytoskeletal function and cell proliferation
inhibition after 11 days of erlotinib withdrawal.
Outcomes 2011
Genetic Markers Linked to Barrett’s Esophagus, Esophageal Adenocarcinoma
and Thyroid Cancer
Research conducted by Charis Eng, MD, PhD, Hardis/ACS Professor and Chair and
Director of the Genomic Medicine Institute of Cleveland Clinic Lerner Research
Institute, has identified mutations in three genes specific to patients with Barrett’s
esophagus (BE) and esophageal adenocarcinoma (EAC). Barrett’s esophagus
is thought to be a precursor to EAC. However, EAC is typically diagnosed at an
advanced stage when the prognosis is poor.
Dr. Eng led researchers at 16 U.S. institutions to identify and evaluate 298 patients
with BE, EAC or both. Three genes, MSR1, ASCC1 and CTHRC1, were mutated in
11% of patients. These mutations “reflect what is normally considered a moderateto high-penetrance genetic load for a disease,” notes Eng. Identifying genetic markers
for BE and EAC could help assess risks, accelerate early detection and improve
disease management.
In a separate study, Dr. Eng and her team found that inherited alterations in one of
three genes appears to increase the risk of developing thyroid cancer. Mutations in
the PTEN gene were associated with a higher risk of follicular cancer and the SDH
and KLLN genes confer a higher risk of papillary thyroid carcinoma. Identifying the
genes involved in cancer is important because gene-specific personalized surveillance
and management can be implemented. Approximately 3,000 patients were examined
and tracked in the study.
Orloff M, Peterson C, He X, Ganapathi S, Heald B, Yang YR, Bebek G, Romigh T, Song JH, Wu W, David S,
Cheng Y, Meltzer SJ, Eng C. Germline mutations in MSR1, ASCC1, and CTHRC1 in patients with Barrett
esophagus and esophageal adenocarcinoma. JAMA. 2011;306(4):410-9.
Ngeow J, Mester J, Rybicki LA, Ni Y, Milas M, Eng C. Incidence and clinical characteristics of thyroid
cancer in prospective series of individuals with Cowden and Cowden-like syndrome characterized by
germline PTEN, SDH, or KLLN alterations. J Clin Endocrinol Metab. 2011;96(12):E2063-71.
Taussig Cancer Institute
87
Selected Publications
Taussig Cancer Institute staff authored
over 655 publications in 2011.
For a complete list, go to
clevelandclinic.org/outcomes.
Hematologic Oncology and Blood Disorders
Benign Hematology
Lichtin AE. Clinical practice guidelines for the use of
erythroid-stimulating agents: ASCO, EORTC, NCCN.
Cancer Treat Res. 2011;157:239-248.
McCrae KR. Sutton’s law and anti-β2GPI antibodies.
Blood. 2011 Mar 24;117(12):3253-3255.
Saraf S, Farooqui M, Infusino G, Oza B, Sidhwani S,
Gowhari M, Vara S, Gao W, Krauz L, Lavelle D,
DeSimone J, Molokie R, Saunthararajah Y. Standard
clinical practice underestimates the role and significance
of erythropoietin deficiency in sickle cell disease. Br J
Haematol. 2011 May;153(3):386-392.
Valent J, Schiffer CA. Thrombocytopenia and platelet
transfusions in patients with cancer. Cancer Treat Res.
2011;157:251-265.
Bone Marrow Transplant
Askar M, Sobecks R, Morishima Y, Kawase T, Nowacki A,
Makishima H, Maciejewski J. Predictions in the face of
clinical reality: HistoCheck versus high-risk HLA allele
mismatch combinations responsible for severe acute graftversus-host disease. Biol Blood Marrow Transplant. 2011
Sep;17(9):1409-1415.
88
Avalos BR, Lazaryan A, Copelan EA. Can G-CSF cause
leukemia in hematopoietic stem cell donors? Biol Blood
Marrow Transplant. 2011 Dec;17(12):1739-1746.
Kalaycio M, Bolwell B, Rybicki L, Absi A, Andresen S,
Pohlman B, Dean R, Sobecks R, Copelan E. BU- vs
TBI-based conditioning for adult patients with ALL. Bone
Marrow Transplant. 2011 Nov;46(11):1413-1417.
Malik S, Bolwell B, Rybicki L, Copelan O, Duong H,
Dean R, Sobecks R, Kalaycio M, Sweetenham J,
Pohlman B, Andresen S, Tench S, Koo A, Figueroa P,
Copelan E. Apheresis days required for harvesting CD34+
cells predicts hematopoietic recovery and survival following
autologous transplantation. Bone Marrow Transplant. 2011
Dec;46(12):1519-1525.
Mickelson DM, Sproat L, Dean R, Sobecks R, Rybicki L,
Kalaycio M, Pohlman B, Sweetenham J, Andresen S,
Bolwell B, Copelan EA. Comparison of donor chimerism
following myeloablative and nonmyeloablative allogeneic
hematopoietic SCT. Bone Marrow Transplant. 2011
Jan;46(1):84-89.
Outcomes 2011
Sobecks RM, Copelan E, Kalaycio M, Askar M, Rybicki L, Serafino S,
Serafin M, Macklis R, Dean R, Pohlman B, Andresen S, Bolwell BJ. Multiple
unit umbilical cord blood transplantation with total body irradiation, etoposide
and antithymocyte globulin for adult haematological malignancy patients. Br J
Haematol. 2011 Jan;152(1):116-119.
Sproat L, Bolwell B, Rybicki L, Dean R, Sobecks R, Pohlman B, Andresen S,
Sweetenham J, Copelan E, Kalaycio M. Vitamin D level after allogeneic
hematopoietic stem cell transplant. Biol Blood Marrow Transplant. 2011
Jul;17(7):1079-1083.
Bone Marrow Failure
Afable MG, II, Wlodarski M, Makishima H, Shaik M, Sekeres MA, Tiu RV,
Kalaycio M, O’Keefe CL, Maciejewski JP. SNP array-based karyotyping:
differences and similarities between aplastic anemia and hypocellular
myelodysplastic syndromes. Blood. 2011 Jun 23;117(25):6876-6884.
Afable MG, Shaik M, Sugimoto Y, Elson P, Clemente M, Makishima H,
Sekeres MA, Lichtin A, Advani A, Kalaycio M, Tiu RV, O’Keefe CL,
Maciejewski JP. Efficacy of rabbit anti-thymocyte globulin in severe
aplastic anemia. Haematologica. 2011 Sep;96(9):1269-1275.
Jankowska AM, Szpurka H, Calabro M, Mohan S, Schade AE, Clemente M,
Silverstein RL, Maciejewski JP. Loss of expression of neutrophil proteinase-3:
a factor contributing to thrombotic risk in paroxysmal nocturnal hemoglobinuria.
Haematologica. 2011 Jul;96(7):954-962.
Serio B, Selleri C, Maciejewski JP. Impact of immunogenetic
polymorphisms in bone marrow failure syndromes. Mini Rev Med Chem.
2011 Jun 1;11(6):544-552.
Leukemia/Myelodysplastic Syndromes
Advani AS, Gibson S, Douglas E, Diacovo J, Elson P, Kalaycio M, Copelan E,
Sekeres M, Sobecks R, Sungren S, Lagoo A, Rizzieri D, Hsi E. Histone
H4 acetylation by immunohistochemistry and prognosis in relapsed acute
lymphocytic leukaemia (ALL). Br J Haematol. 2011 May;153(4):504-507.
Advani AS. Blinatumomab: A novel agent to treat minimal residual disease in
patients with acute lymphoblastic leukemia. Clin Adv Hematol Oncol.
2011 Oct;9(10):776-777.
Taussig Cancer Institute
89
Selected Publications
Clemente MJ, Wlodarski MW, Makishima H, Viny AD,
Bretschneider I, Shaik M, Bejanyan N, Lichtin AE, Hsi ED,
Paquette RL, Loughran TP, Jr., Maciejewski JP. Clonal drift
demonstrates unexpected dynamics of the T-cell repertoire
in T-large granular lymphocyte leukemia. Blood. 2011 Oct
20;118(16):4384-4393.
Sekeres MA, Gundacker H, Lancet J, Advani A,
Petersdorf S, Liesveld J, Mulford D, Norwood T,
Willman CL, Appelbaum FR, List AF. A phase 2 study of
lenalidomide monotherapy in patients with deletion 5q
acute myeloid leukemia: Southwest Oncology Group Study
S0605. Blood. 2011 Jul 21;118(3):523-528.
Jankowska AM, Makishima H, Tiu RV, Szpurka H,
Huang Y, Traina F, Visconte V, Sugimoto Y, Prince C,
O’Keefe C, Hsi ED, List A, Sekeres MA, Rao A,
McDevitt MA, Maciejewski JP. Mutational spectrum
analysis of chronic myelomonocytic leukemia includes
genes associated with epigenetic regulation: UTX, EZH2,
and DNMT3A. Blood. 2011 Oct 6;118(14):3932-3941.
Sekeres MA, Kantarjian H, Fenaux P, Becker P, Boruchov A,
Guerci-Bresler A, Hu K, Franklin J, Wang YM, Berger D.
Subcutaneous or intravenous administration of
romiplostim in thrombocytopenic patients with lower
risk myelodysplastic syndromes. Cancer. 2011 Mar
1;117(5):992-1000.
Makishima H, Jankowska AM, McDevitt MA, O’Keefe C,
Dujardin S, Cazzolli H, Przychodzen B, Prince C, Nicoll J,
Siddaiah H, Shaik M, Szpurka H, Hsi E, Advani A,
Paquette R, Maciejewski JP. CBL, CBLB, TET2, ASXL1, and
IDH1/2 mutations and additional chromosomal aberrations
constitute molecular events in chronic myelogenous
leukemia. Blood. 2011 May 26;117(21):e198-e206.
Ng KP, Ebrahem Q, Negrotto S, Mahfouz RZ, Link KA,
Hu Z, Gu X, Advani A, Kalaycio M, Sobecks R, Sekeres M,
Copelan E, Radivoyevitch T, Maciejewski J, Mulloy JC,
Saunthararajah Y. p53 independent epigeneticdifferentiation treatment in xenotransplant models of
acute myeloid leukemia. Leukemia. 2011
Nov;25(11):1739-1750.
O’Keefe CL, Sugimori C, Afable M, Clemente M, Shain K,
Araten DJ, List A, Epling-Burnette PK, Maciejewski JP.
Deletions of Xp22.2 including PIG-A locus lead to
paroxysmal nocturnal hemoglobinuria. Leukemia. 2011
Feb;25(2):379-382.
90
Sekeres MA, Maciejewski JP, Erba HP, Afable M,
Englehaupt R, Sobecks R, Advani A, Seel S, Chan J,
Kalaycio ME. A Phase 2 study of combination therapy
with arsenic trioxide and gemtuzumab ozogamicin in
patients with myelodysplastic syndromes or secondary
acute myeloid leukemia. Cancer. 2011
Mar 15;117(6):1253-1261.
Sekeres MA, Maciejewski JP, List AF, Steensma DP, Artz A,
Swern AS, Scribner P, Huber J, Stone R. Perceptions of
disease state, treatment outcomes, and prognosis among
patients with myelodysplastic syndromes: results from an
internet-based survey. Oncologist. 2011;16(6):904-911.
Sekeres MA, O’Keefe C, List AF, Paulic K, Afable M,
Englehaupt R, Maciejewski JP. Demonstration of additional
benefit in adding lenalidomide to azacitidine in patients
with higher-risk myelodysplastic syndromes. Am J Hematol.
2011 Jan;86(1):102-103.
Sekeres MA. If Nostradamus were treated for MDS. Blood.
2011 Jan 13;117(2):374-375.
Outcomes 2011
Sekeres MA. Lenalidomide in MDS: 4th time’s a charm.
Blood. 2011 Oct 6;118(14):3757-3758.
Tiu RV, Gondek LP, O’Keefe CL, Elson P, Huh J,
Mohamedali A, Kulasekararaj A, Advani AS,
Paquette R, List AF, Sekeres MA, McDevitt MA,
Mufti GJ, Maciejewski JP. Prognostic impact of SNP
array karyotyping in myelodysplastic syndromes and
related myeloid malignancies. Blood. 2011 Apr
28;117(17):4552-4560.
Tiu RV, Traina F, Sekeres MA. Clofarabine for
myelodysplastic syndromes. Expert Opin Investig Drugs.
2011 Jul;20(7):1005-1014.
Lymphoma
Bennani-Baiti N, Daw HA, Cotta C, Martin P, Mitchell KW,
Ambinder RF, Macklis R, Pollock R, Spiro T. Low-grade
follicular lymphoma of the small intestine: a challenge for
management. Semin Oncol. 2011 Dec;38(6):714-720.
Burdick MJ, Neumann D, Pohlman B, Reddy CA,
Tendulkar RD, Macklis R. External beam radiotherapy
followed by (90)y ibritumomab tiuxetan in relapsed or
refractory bulky follicular lymphoma. Int J Radiat Oncol
Biol Phys. 2011 Mar 15;79(4):1124-1130.
Hill BT, Rybicki L, Bolwell BJ, Smith S, Dean R,
Kalaycio M, Pohlman B, Tench S, Sobecks R, Andresen S,
Copelan E, Sweetenham J. The non-relapse mortality
rate for patients with diffuse large B-cell lymphoma is
greater than relapse mortality 8 years after autologous
stem cell transplantation and is significantly higher than
mortality rates of population controls. Br J Haematol. 2011
Mar;152(5):561-569.
Hill BT, Rybicki L, Smith S, Dean R, Kalaycio M,
Pohlman B, Sweetenham J, Tench S, Sobecks R,
Andresen S, Copelan E, Bolwell BJ. Treatment with
hyperfractionated cyclophosphamide, vincristine,
doxorubicin, and dexamethasone combined with cytarabine
and methotrexate results in poor mobilization of peripheral
blood stem cells in patients with mantle cell lymphoma.
Leuk Lymphoma. 2011 Jun;52(6):986-993.
Mandawat A, Alraies MC, Miller K, Ondrejka S, Smith S.
Cauda equina lymphoma: a case report including
postmortem examination. Clin Adv Hematol Oncol. 2011
May;9(5):414-420.
Smith SD, Bolwell BJ, Rybicki LA, Kang T, Dean R,
Advani A, Thakkar S, Sobecks R, Kalaycio M, Pohlman B,
Sweetenham JW. Comparison of outcomes after auto-SCT
for patients with relapsed diffuse large B-cell lymphoma
according to previous therapy with rituximab. Bone Marrow
Transplant. 2011 Feb;46(2):262-266.
Smith SD, Moskowitz CH, Dean R, Pohlman B, Sobecks R,
Copelan E, Andresen S, Bolwell B, Maragulia JC, Vanak
JM, Sweetenham J, Moskowitz AJ. Autologous stem cell
transplant for early relapsed/refractory Hodgkin lymphoma:
results from two transplant centres. Br J Haematol. 2011
May;153(3):358-363.
Sweetenham JW, Freedman AS. Early initial therapy of
advanced follicular lymphoma: the need for vigilance. Leuk
Lymphoma. 2011 Mar;52(3):355-357.
Sweetenham JW, Polliack A. Progressive transformation
of germinal centers and Hodgkin lymphoma: more insights
but maybe more confusion? Leuk Lymphoma. 2011
Nov;52(11):2041-2042.
Sweetenham JW. “Pet Negativity” — The new goal of
cytoreductive therapy in Hodgkin’s lymphoma? Biol Blood
Marrow Transplant. 2011 Nov;17(11):1569-1570.
Taussig Cancer Institute
91
Selected Publications
Sweetenham JW. Molecular signatures in the diagnosis and
management of diffuse large B-cell lymphoma. Curr Opin
Hematol. 2011 Jul;18(4):288-292.
Multiple Myeloma
Cheriyath V, Kuhns MA, Kalaycio ME, Borden EC.
Potentiation of apoptosis by histone deacetylase inhibitors
and doxorubicin combination: cytoplasmic cathepsin B as
a mediator of apoptosis in multiple myeloma. Br J Cancer.
2011 Mar 15;104(6):957-967.
Hematology — Unspecified
Sekeres MA, Steensma DP. A piece of my mind. The road
warriors. JAMA. 2011 Aug 24;306(8):805-806.
Sekeres MA. The baby whisperer. J Clin Oncol. 2011 Dec
1;29(34):4584-4585.
Solid Tumor Oncology
Adenocarcinoma
Lazaryan A, Kalmadi S, Almhanna K, Pelley R, Kim R.
Predictors of clinical outcomes of resected ampullary
adenocarcinoma: A single-institution experience. Eur J
Surg Oncol. 2011 Sep;37(9):791-797.
Central Nervous System
Ahluwalia MS, Patel M, Peereboom DM. Role of
tyrosine kinase inhibitors in the management of highgrade gliomas. Expert Rev Anticancer Ther. 2011
Nov;11(11):1739-1748.
Ahluwalia MS, Patton C, Stevens G, Tekautz T, Angelov L,
Vogelbaum MA, Weil RJ, Chao S, Elson P, Suh JH,
Barnett GH, Peereboom DM. Phase II trial of ritonavir/
lopinavir in patients with progressive or recurrent high-grade
gliomas. J Neurooncol. 2011 Apr;102(2):317-321.
92
Hercbergs AH, Lin HY, Davis FB, Davis PJ, Leith JT.
Radiosensitization and production of DNA doublestrand breaks in U87MG brain tumor cells induced by
tetraiodothyroacetic acid (tetrac). Cell Cycle. 2011 Jan
15;10(2):352-357.
Marina O, Suh JH, Reddy CA, Barnett GH, Vogelbaum MA,
Peereboom DM, Stevens GHJ, Elinzano H, Chao ST.
Treatment outcomes for patients with glioblastoma
multiforme and a low Karnofsky Performance Scale score
on presentation to a tertiary care institution. J Neurosurg.
2011 Aug;115(2):220-229.
Murphy ES, Barnett GH, Vogelbaum MA, Neyman G,
Stevens GH, Cohen BH, Elson P, Vassil AD, Suh JH.
Long-term outcomes of Gamma Knife radiosurgery in
patients with vestibular schwannomas. J Neurosurg. 2011
Feb;114(2):432-440.
Murphy ES, Suh JH. Radiotherapy for vestibular
schwannomas: a critical review. Int J Radiat Oncol Biol
Phys. 2011 Mar 15;79(4):985-997.
Scott JG, Suh JH, Elson P, Barnett GH, Vogelbaum MA,
Peereboom DM, Stevens GH, Elinzano H, Chao ST.
Aggressive treatment is appropriate for glioblastoma
multiforme patients 70 years old or older: a
retrospective review of 206 cases. Neuro Oncol.
2011 Apr;13(4):428-436.
Eye
Triozzi PL, Aldrich W, Singh A. Effects of interleukin-1
receptor antagonist on tumor stroma in experimental
uveal melanoma. Invest Ophthalmol Vis Sci.
2011;52(8):5529-5535.
Triozzi PL, Singh AD. Blood biomarkers of uveal melanoma
metastasis. Br J Ophthalmol. 2011 Jan;95(1):3-4.
Outcomes 2011
Gastrointestinal
Kim R, Tan A, Lai KK, Jiang J, Wang Y, Rybicki LA, Liu X.
Prognostic roles of human equilibrative transporter 1
(hENT-1) and ribonucleoside reductase subunit M1
(RRM1) in resected pancreatic cancer. Cancer. 2011 Jul
15;117(14):3126-3134.
Genitourinary
Basappa NS, Elson P, Golshayan AR, Wood L, Garcia JA,
Dreicer R, Rini BI. The impact of tumor burden
characteristics in patients with metastatic renal cell
carcinoma treated with sunitinib. Cancer. 2011 Mar
15;117(6):1183-1189.
Bennani-Baiti N, Daw HA. Review: primary hyperfibrinolysis
in liver disease: a critical review. Clin Adv Hematol Oncol.
2011 Mar;9(3):250-252.
Dreicer R, Bajorin DF, McLeod DG, Petrylak DP, Moul JW.
New data, new paradigms for treating prostate cancer
patients VI: Novel hormonal therapy approaches. Urology.
2011 Nov;78(5 Suppl):S494-S498.
Dreicer R, Garcia J, Hussain M, Rini B, Vogelzang N,
Srinivas S, Somer B, Zhao YD, Kania M, Raghavan D. Oral
enzastaurin in prostate cancer: A two-cohort phase II trial
in patients with PSA progression in the non-metastatic
castrate state and following docetaxel-based chemotherapy
for castrate metastatic disease. Invest New Drugs. 2011
Dec;29(6):1441-1448.
Dreicer R, Gleave M, Kibel AS, Thrasher JB, Moul JW.
Targeting the androgen receptor — theory and practice.
Urology. 2011 Nov;78(5 Suppl):S482-S484.
Garcia JA, Hutson TE, Shepard D, Elson P, Dreicer R.
Gemcitabine and docetaxel in metastatic, castrate-resistant
prostate cancer: Results from a phase 2 trial. Cancer. 2011
Feb 15;117(4):752-757.
Taussig Cancer Institute
Garcia JA, Mekhail T, Elson P, Triozzi P, Nemec C,
Dreicer R, Bukowski RM, Rini BI. Clinical and
immunomodulatory effects of bevacizumab and lowdose interleukin-2 in patients with metastatic renal cell
carcinoma: results from a phase II trial. BJU Int. 2011
Feb;107(4):562-570.
Gilligan T. Are we scanning testis cancer patients too often?
Cancer. 2011 Sep 15;117(18):4108-4111.
Moul JW, Evans CP, Gomella LG, Roach M, III, Dreicer R.
Traditional approaches to androgen deprivation therapy.
Urology. 2011 Nov;78(5 Suppl):S485-S493.
Moul JW, Kibel AS, Roach M, III, Dreicer R. Indications and
practice with androgen deprivation therapy. Urology. 2011
Nov;78(5 Suppl):S478-S481.
Negrotto S, Hu Z, Alcazar O, Ng KP, Triozzi P, Lindner D,
Rini B, Saunthararajah Y. Noncytotoxic differentiation
treatment of renal cell cancer. Cancer Res. 2011 Feb
15;71(4):1431-1441.
Rini B. Kidney cancer: Does hypothyroidism predict clinical
outcome? Nat Rev Urol. 2011 Jan;8(1):10-11.
Rini BI, Cohen DP, Lu DR, Chen I, Hariharan S, Gore ME,
Figlin RA, Baum MS, Motzer RJ. Hypertension as a
biomarker of efficacy in patients with metastatic renal cell
carcinoma treated with sunitinib. J Natl Cancer Inst. 2011
May 4;103(9):763-773.
Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C,
Hutson TE, Michaelson MD, Gorbunova VA, Gore ME,
Rusakov IG, Negrier S, Ou YC, Castellano D, Lim HY,
Uemura H, Tarazi J, Cella D, Chen C, Rosbrook B, Kim S,
Motzer RJ. Comparative effectiveness of axitinib
versus sorafenib in advanced renal cell carcinoma
(AXIS): a randomised phase 3 trial. Lancet. 2011 Dec
3;378(9807):1931-1939.
93
Selected Publications
Rini BI, Stein M, Shannon P, Eddy S, Tyler A,
Stephenson JJ, Jr., Catlett L, Huang B, Healey D,
Gordon M. Phase 1 dose-escalation trial of tremelimumab
plus sunitinib in patients with metastatic renal cell
carcinoma. Cancer. 2011 Feb 15;117(4):758-767.
Rini BI. Targeted therapy for patients with renal-cell
carcinoma. Lancet Oncol. 2011 Nov;12(12):1085-1087.
Salem M, Garcia JA. Abiraterone acetate, a novel adrenal
inhibitor in metastatic castration-resistant prostate cancer.
Curr Oncol Rep. 2011 Apr;13(2):92-96.
Salem M, Gilligan T. Serum tumor markers and their
utilization in the management of germ-cell tumors in adult
males. Expert Rev Anticancer Ther. 2011 Jan;11(1):1-4.
Schelman WR, Liu G, Wilding G, Morris T, Phung D,
Dreicer R. A phase I study of zibotentan (ZD4054) in
patients with metastatic, castrate-resistant prostate cancer.
Invest New Drugs. 2011 Feb;29(1):118-125.
Schwandt A, Garcia JA, Elson P, Wyckhouse J, Finke JH,
Ireland J, Triozzi P, Zhou M, Dreicer R, Rini BI. Clinical
and immunomodulatory effects of celecoxib plus interferonalpha in metastatic renal cell carcinoma patients with
COX-2 tumor immunostaining. J Clin Immunol. 2011
Aug;31(4):690-698.
Gynecological/Women’s Health
Bencsath KP, Reu F, Dietz J, Hsi ED, Heresi GA. Idiopathic
systemic capillary leak syndrome preceding diagnosis of
infiltrating lobular carcinoma of the breast with quiescence
during neoadjuvant chemotherapy. Mayo Clin Proc. 2011
Mar;86(3):260-261.
Sekeres MA. The Avastin story. N Engl J Med. 2011 Oct
13;365(15):1454-1455.
94
Melanoma
Khan N, Khan MK, Almasan A, Singh AD, Macklis R. The
evolving role of radiation therapy in the management of
malignant melanoma. Int J Radiat Oncol Biol Phys. 2011
Jul 1;80(3):645-654.
Phase I/Experimental Therapeutics
Rini BI, Schiller JH, Fruehauf JP, Cohen EEW, Tarazi JC,
Rosbrook B, Bair AH, Ricart AD, Olszanski AJ, Letrent KJ,
Kim S, Rixe O. Diastolic blood pressure as a biomarker of
axitinib efficacy in solid tumors. Clin Cancer Res. 2011
Jun 1;17(11):3841-3849.
Rini BI. Review: Thyroid function abnormalities in patients
receiving VEGF-targeted therapy. Clin Adv Hematol Oncol.
2011 Apr;9(4):337-338.
Rosen LS, Senzer N, Mekhail T, Ganapathi R, Chai F,
Savage RE, Waghorne C, Abbadessa G, Schwartz B,
Dreicer R. A phase I dose-escalation study of tivantinib
(ARQ 197) in adult patients with metastatic solid tumors.
Clin Cancer Res. 2011 Dec 15;17(24):7754-7764.
Upper Aerodigestive
Adelstein DJ, Rodriguez CP. What is new in the
management of salivary gland cancers? Curr Opin Oncol.
2011 May;23(3):249-253.
Fan W, Tang Z, Yin L, Morrison B, Hafez-Khayyata S, Fu P,
Huang H, Bagai R, Jiang S, Kresak A, Howell S, Vasanji A,
Flask CA, Halmos B, Koon H, Ma PC. MET-independent
lung cancer cells evading EGFR kinase inhibitors are
therapeutically susceptible to BH3 mimetic agents.
Cancer Res. 2011 Jul 1;71(13):4494-4505.
Jeremic B, Videtic GMM. Chest reirradiation with external
beam radiotherapy for locally recurrent non-small-cell lung
cancer: a review. Int J Radiat Oncol Biol Phys. 2011 Jul
15;80(4):969-977.
Outcomes 2011
Palliative Medicine
Aktas A, Walsh D. Methodological challenges in supportive
and palliative care cancer research. Semin Oncol. 2011
Jun;38(3):460-466.
Davis MP, Kirkova J, Lagman R, Walsh D, Karafa M.
Intolerance to mirtazapine in advanced cancer. J Pain
Symptom Manage. 2011 Sep;42(3):e4-e7.
Davis MP. Reversal of cancer cachexia and wasting
prolongs survival. J Pain Symptom Manage. 2011
Mar;41(3):656-657.
Estfan B. Essential drugs in supportive care. Semin Oncol.
2011 Jun;38(3):413-423.
Haddad A, Shepard D. Geriatric oncology and palliative
medicine. Semin Oncol. 2011 Jun;38(3):362-366.
Herrstedt J, Walsh D. Introduction: Supportive care
and palliative medicine. Semin Oncol. 2011
Jun;38(3):335-336.
Translational Hematology and Oncology Research
Allen KL, Hamik A, Jain MK, McCrae KR. Endothelial cell
activation by antiphospholipid antibodies is modulated
by Kruppel-like transcription factors. Blood. 2011 Jun
9;117(23):6383-6391.
Hu Z, Gu X, Baraoidan K, Ibanez V, Sharma A, Kadkol S,
Munker R, Ackerman S, Nucifora G, Saunthararajah Y.
RUNX1 regulates corepressor interactions of PU.1. Blood.
2011 Jun 16;117(24):6498-6508.
Makishima H, Maciejewski JP. Pathogenesis and
consequences of uniparental disomy in cancer. Clin
Cancer Res. 2011 Jun 15;17(12):3913-3923.
Triozzi PL, Aldrich W, Ponnazhagan S. Inhibition and
promotion of tumor growth with adeno-associated virus
carcinoembryonic antigen vaccine and Toll-like receptor
agonists. Cancer Gene Ther. 2011 Dec;18(12):850-858.
Triozzi PL, Borden EC. VB-111 for cancer. Expert Opin Biol
Ther. 2011 Dec;11(12):1669-1676.
Yie SM, Hu Z. Human leukocyte antigen-G (HLA-G) as
a marker for diagnosis, prognosis and tumor immune
escape in human malignancies. Histol Histopathol. 2011
Mar;26(3):409-420.
Yin L, Rao P, Elson P, Wang J, Ittmann M, Heston WD. Role
of TMPRSS2-ERG gene fusion in negative regulation of
PSMA expression. PLoS ONE. 2011;6(6):e21319.
Ebrahem Q, Qi JH, Sugimoto M, Ali M, Sears JE, Cutler A,
Khokha R, Vasanji A, Anand-Apte B. Increased
neovascularization in mice lacking tissue inhibitor
of metalloproteinases-3. Invest Ophthalmol Vis Sci.
2011;52(9):6117-6123.
Grozav AG, Willard BB, Kozuki T, Chikamori K, Micluta MA,
Petrescu AJ, Kinter M, Ganapathi R, Ganapathi MK.
Tyrosine 656 in topoisomerase IIβ is important for the
catalytic activity of the enzyme: Identification based on
artifactual +80-Da modification at this site. Proteomics.
2011 Mar;11(5):829-842.
Taussig Cancer Institute
95
Staff Listing
Chairman
Brian Bolwell, MD
Vice Chairman, Clinical Research
John Sweetenham, MD
Vice Chairman, Operations
Director, Scott Hamilton CARES Initiative
Brad Pohlman, MD
Institute Experience Officer
Timothy Gilligan, MD
Quality Improvement Officer
Declan Walsh, MD
Department of Hematologic Oncology and Blood Disorders
Brian Bolwell, MD
Chairman
Anjali Advani, MD
Steven Andresen, DO
Edward Copelan, MD
Robert Dean, MD
Hien Duong, MD
Brian Hill, MD, PhD
Leonard Horwitz, MD
Matt Kalaycio, MD
Anna Koo, MD
Some physicians may practice in
multiple locations. For a detailed list
including staff photos, please visit
clevelandclinic.org/staff.
96
Alan Lichtin, MD
Keith McCrae, MD
Brad Pohlman, MD
Frederic Reu, MD
Outcomes 2011
Christy Samaras, DO
Daesung Lee, MD
Yogen Saunthararajah, MD
Vincent Lee, MD
Mikkael Sekeres, MD, MS
Roger Macklis, MD
Bernard Silver, MD
Anthony Mastroianni, JD, MD
Ronald Sobecks, MD
Erin Murphy, MD
John Sweetenham, MD
Betty Obi, MD
Department of North Coast Cancer Care
Steven Roshon, MD
Chairman
Kevin Stephans, MD
G. Phillip Engeler, MD
Carmen Vermont, MD
James Fanning, MD
Gregory Videtic, MD
Eugene Huang, MD
Jennifer Yu, MD, PhD
Brian Murphy, MD
Khalid Siddiqui, MD
Alfred Vargas, MD
Rahul Tendulkar, MD
Andrew Vassil, MD
Medical Physics
Ping Xia, PhD
Head of Medical Physics
Department of Radiation Oncology
John Suh, MD
Chairman
Ned Began, MS
May Abdel-Wahab, MD
Matthew Kolar, MS
Henry Blair, MD
Anthony Magnelli, MS
Phillip Catanzaro, MD, PhD
Lama Muhieddine Mossolly, MS
Samuel Chao, MD
Gennady Neyman, PhD
Jay Ciezki, MD
Michael Ohm, MS
Toufik Djemil, PhD
Andrew Godley, PhD
John Greskovich Jr., MD
Shlomo Koyfman, MD
Margaret Kranyak, MD
Taussig Cancer Institute
97
Referral
Staff Listing
Contact Information
Malika Ouzidane, PhD
Lapman Lun, MD
Curtis Reece, MSc
Vinit Makkar, MD
Maria Rybak, MS
Paul Masci, DO
Michael Strongosky, MMSc
Prateek Mendiratta, MD
Eric Tischler, MS
Seema Misbah, MD
Matthew Vossler, MS
Michael Nemunaitis, MD
Douglas Wilkinson, PhD
Gary Schnur, MD
Naichang Yu, PhD
Ila Tamaskar, MD
Tingliang Zhuang, PhD
Department of Regional Oncology
Timothy Spiro, MD
Chairman
Mir Yusuf Ali, MD
Rajesh Bagai, MD
Byron Coffman, MD
Hamed Daw, MD
Bachar Dergham, MD
Donald Eicher, MD
Aric Greenfield, MD
Abdo Haddad, MD
Mansour Isckarus, MD
Kevin Kerwin, MD
Omer Koc, MD
Mark Kyei, MD
98
Jason Valent, MD
Kenneth Weiss, MD
Department of Solid Tumor Oncology
Robert Dreicer, MD
Chairman
David Adelstein, MD
G. Thomas Budd, MD
Mellar Davis, MD
Bassam Estfan, MD
Jorge Garcia, MD
Timothy Gilligan, MD
Mona Gupta, MD
Terence Gutgsell, MD
Ruth Lagman, MD
Susan LeGrand, MD
Michael McNamara, MD
Outcomes 2011
Halle Moore, MD
Researchers
Kathleen Neuendorf, MD
Manuel Afable II, MD
Armida Parala-Metz, MD
Quteba Ebrahem, MD
David Peereboom, MD
Shunji Egusa, PhD
Robert Pelley, MD
Mahrukh Ganapathi, PhD
Nathan Pennell, MD, PhD
Xiaorong Gu, PhD
Brian Rini, MD
Reda Mahfouz, MD, PhD
Nooshin Hashemi Sadraei, MD
Hideki Makishima, MD, PhD
Marc Shapiro, MD
Bei Morrison, MD
Dale Shepard, MD, PhD
Kwok-Peng Ng, PhD
Pierre Triozzi, MD
Sergei Vatolin, PhD
T. Declan Walsh, MD
Susan Vaziri, PhD
Department of Translational Hematology
and Oncology Research
Jaroslaw Maciejewski, MD, PhD
Chairman
Lihong Yin, PhD
Ernest Borden, MD
Ram Ganapathi, PhD
Daniel Lindner, MD, PhD
Patrick Ma, MD, MS
Ramon Tiu, MD
Taussig Cancer Institute
99
Contact Information
General Patient Referral
24/7 hospital transfers or physician consults
800.553.5056
Taussig Cancer Institute Appointments/Referrals
• Listings of resources, such as wigs, transportation and lodging
On the Web at clevelandclinic.org/cancer
216.444.7923 or toll-free 866.223.8100
Additional Contact Information
Bone Marrow Transplant Program Appointments/Referrals
General Information
This internationally recognized program offers autologous,
allogeneic, reduced-intensity, related and unrelated transplants.
Cell sources include bone marrow, peripheral stem cell and
umbilical cord blood transplants for treating patients with
leukemias, lymphomas, and other hematological malignancies
and bone marrow failure states.
216.445.5600 or 800.223.2273, ext. 55600
Bone Marrow Failure Clinic Appointments/Referrals
This subspecialty clinic offers expertise in aplastic anemia,
myelodysplasia, single-lineage cytopenias, paroxysmal nocturnal
hemoglobinuria, large granular lymphocytic leukemia and other
immune-mediated hematologic diseases.
216.445.5962 or 800.223.2273, ext. 55962
Radiation Oncology Appointments/Referrals
216.444.5571 or 800.223.2273, ext. 45571
Cancer Answer Line
100
• Listings and registration for support groups and other patient related events
216.444.2200
Hospital Patient Information
216.444.2000
General Patient Appointments
216.444.2273 or 800.223.2273
Referring Physician Center and Hotline
Cleveland Clinic’s Referring Physician Center has established
a 24/7 hotline — 855.REFER.123 (855.733.3712) — to
streamline access to our array of medical services. Contact
the Referring Physician Hotline for information on our clinical
specialties and services, to schedule and confirm patient
appointments, for assistance in resolving service-related issues,
and to connect with Cleveland Clinic specialists.
Request for Medical Records
216.445.2547 or 800.223.2273, ext. 52547
For questions or concerns about cancer, or to schedule a
second opinion (Monday through Friday, 8 a.m. to 5 p.m.)
Medical Concierge
216.444.7923 or toll-free 866.223.8100
800.223.2273, ext. 55580, or email [email protected]
Helen Meyers McLoraine Patient Resource Center
Global Patient Services/International Center
Staffed by two clinical nurse specialists and an administrative
coordinator, the center is open Monday through Friday, 8 a.m.
to 5 p.m. Resources include:
Complimentary assistance for international patients and families
• Free pamphlets and informational brochures
Cleveland Clinic Florida
• Computer for Internet access and searches
Toll-free 866.293.7866
• A room for nurse/patient discussions, teaching and educational
video viewing
For address corrections or changes, please call
Complimentary assistance for out-of-state patients and families
001.216.444.8184 or visit clevelandclinic.org/gps
800.890.2467
Outcomes 2011
Institute Locations
Cleveland Clinic Main Campus
Taussig Cancer Institute
9500 Euclid Ave./R35
Cleveland, OH 44195
216.444.7923 or toll-free 866.223.8100
Beachwood Family Health and Surgery Center
26900 Cedar Road
Beachwood, OH 44122
216.839.3000
Fairview Hospital
Moll Cancer Pavilion
18101 Lorain Ave.
Cleveland, OH 44111
216.476.7000
Hillcrest Hospital
6780 Mayfield Road
Mayfield Heights, OH 44124
440.312.4500
Independence Cancer Center
6100 Westcreek Road, Suites 15, 16
Independence, OH 44131
Medical oncology: 216.524.7979
Radiation oncology: 216.447.9747
Lorain Family Health and Surgery Center
5700 Cooper Foster Park Road
Lorain, OH 44053
440.204.7400 or 800.272.2676
Medina Hospital
Medina Office Building
970 E. Washington St.
Medina, OH 44256
330.721.5700
Taussig Cancer Institute
North Coast Cancer Centers – Clyde
509 W. McPherson Highway
Clyde, OH 43410
419.547.9500
North Coast Cancer Centers – Norwalk
272 Benedict Ave.
Norwalk, OH 44857
419.660.2637
North Coast Cancer Centers – Sandusky
417 Quarry Lakes Drive
Sandusky, OH 44870
419.626.9090
Richard E. Jacobs Health Center
33100 Cleveland Clinic Blvd.
Avon, OH 44011
440.695.4000
Strongsville Family Health and Surgery Center
16761 SouthPark Center
Strongsville, OH 44136
440.878.2500 or 800.239.1098
Twinsburg Family Health and Surgery Center
8701 Darrow Road
Twinsburg, OH 44087
330.888.4000
Willoughby Hills Family Health Center
2570 SOM Center Road
Willoughby Hills, OH 44094
440.943.2500 or 800.807.2888
Wooster Milltown Specialty and Surgery Center
721 E. Milltown Road
Wooster, OH 44691
330.287.4500 or 800.451.9870
101
Improving Quality, Safety and the Patient Experience
Overview
Cleveland Clinic uses a scorecard approach to measure quality, safety and patient experience. In addition, realtime dashboard data are leveraged to drive performance improvement. Although not an exact match to publicly
reported data, more timely internal data provide transparency for leaders at all levels of the organization to
support improved care in their clinical locations. The following are examples of Cleveland Clinic’s 2011 focus
areas and main campus results.
Appropriateness of Care
Mortality
2010 – 2011
2010 – 2011
Percent of Patients
100
O/E Ratio
1.0
98
0.8
96
0.6
94
92
Cleveland Clinic performance
Cleveland Clinic target
90
88
86
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
Cleveland Clinic’s goal is for all patients to receive all
the recommended care for which they are eligible. An
aggregated “all or nothing” measurement approach to
monitoring multiple publicly reported process-of-care
measures for heart failure, acute myocardial infarction,
pneumonia and surgical patients is trending positively.
102
0.4
Cleveland Clinic*
UHC academic medical
center 50th percentile*
0.2
0.0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
*Source: Performance Accelerator Suite Program maintained
by the University HealthSystem Consortium (UHC)
https://www.uhc.edu/
Cleveland Clinic’s observed/expected (O/E) mortality
ratio outperformed the University HealthSystem
Consortium (UHC) academic medical center 50th
percentile throughout 2011.
Outcomes 2011
Patient Safety Indicators (PSIs)
Central Line-Associated Bloodstream Infections — ICUs
2011
2010 – 2011
Number of PSIs*
200
Rate per 1,000 Line Days
4
150
3
100
2
50
1
0
Jan
Mar
May
July
Sep
Nov
* PSI 3 Stage III/IV Pressure Ulcers, PSI 6 Iatrogenic Pneumothorax,
PSI 7 CLABSI, PSI 8 Post-Op Hip Fracture, PSI 9 Post-Op Hemorrhage/
Hematoma, PSI 11 Post-Op Respiratory Failure, PSI 12 Post-Op PE or
DVT, PSI 13 Post-Op Sepsis, PSI 14 Post-Op Wound Dehiscence, PSI
15 Accidental Puncture/Laceration
Cleveland Clinic focused on reducing the
incidence of 10 Agency for Healthcare
Research and Quality PSIs. Cleveland Clinic
achieved a reduction of more than 60
percent in the total number of these PSIs in
2011 through a combination of clinical and
documentation improvement activities.
Taussig Cancer Institute
0
Q1
Q2
Q3
2010
Q4
Cleveland Clinic performance
Cleveland Clinic target
Q1
Q2
Q3
Q4
2011
Cleveland Clinic established a 2011 target
ICU surveillance rate of 1.33 central lineassociated bloodstream infections (CLABSIs)
per 1,000 central line days, with the goal of
reducing our rate by an additional 50 percent
over the 2010 results. This 2011 target was
met by the end of the year.
103
Improving Quality, Safety and the Patient Experience
Hospital-Acquired Pressure Ulcers — ICUs
Patient Falls — Stepdown Units
2010 – 2011
2010 – 2011
Pressure Ulcer Prevalence (%)
14
Fall Rate per 1,000 Patient Days
4.0
12
3.5
3.0
10
2.5
8
2.0
6
1.5
4
Cleveland Clinic ICUs
Benchmark: NDNQI* ICUs
2
0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
Hospital-acquired pressure ulcers in Cleveland
Clinic ICU patients were below the national
average in 2010 and 2011.
Cleveland Clinic Stepdown Units
Benchmark: NDNQI* Stepdown Units
1.0
0.5
0
Q1
Q2
Q3
2010
Q4
Q1
Q2
Q3
Q4
2011
*The National Database of Nursing Quality Indicators® (NDNQI®) is owned by
the American Nurses Association. The database collects and evaluates unitspecific nurse-sensitive data from hospitals domestically and globally with over
1800 hospitals participating. The comparison data represented here are based
on a third of all hospitals in the U.S. participating. © 2012 American Nurses
Association, All Rights Reserved. https://www.nursingquality.org/
Falls in Cleveland Clinic stepdown unit patients were
below the national average for most of 2010 and 2011.
In 2011, Cleveland Clinic supplemented proactive fallsreduction strategies with after-event huddles to evaluate
causality and develop prevention strategies.
104
Outcomes 2011
Critical Response Outcomes
Medical Emergency Team Event Volume*
2009 – 2011
Events
3,000
2,500
2,000
1,500
1,000
500
0
2009
2010
2011
*Excluding events originating in ORs and ICUs
Percent of Medical Emergency Team Events Resulting in ICU Transfer
2009 – 2011
Percent
40
30
20
10
0
2009
2010
2011
Medical Emergency Teams (METs) bring critical care experience to patients across the hospital and
provide early intervention that can prevent unplanned transfers to ICUs. As adult MET activations
increased from 2009 through 2011, post-event adult ICU transfers decreased.
Taussig Cancer Institute
105
Improving Quality, Safety and the Patient Experience
Patient Experience — Cleveland Clinic
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is the standard national
tool for measuring patients’ perspectives of hospital care. Results are available at hospitalcompare.hhs.gov.
HCAHPS Rate and Recommend Hospital
2010 – 2011
Percent (Best Response)
100
80
60
40
20
0
Rate Hospital
% 9 or 10
(0 – 10 scale)
Would Recommend Hospital
% “definitely yes”
Cleveland Clinic 2010*
Cleveland Clinic 2011*
*Source: Press Ganey, a national hospital survey vendor
HCAHPS Hospital Domain Scores
National Average 7/1/2010 – 6/30/2011
2010 – 2011
Source: hospitalcompare.hhs.gov.
Percent (Best Response)
100
80
60
40
20
0
Nurse
Communication
Responsiveness
to Needs
Doctor
Communication
Room
Quiet at
Clean
Night
% always
(Options: always, usually, sometimes, never)
Pain
Management
New Medications
Discharge
Communication Information Given
% yes
“Patients First” is the guiding principle of Cleveland Clinic, which was among the first major academic medical centers to make
improving the patient experience a strategic goal. The Office of Patient Experience collaborates with physician and nursing
leadership to establish best practices and implement standardized protocols that ensure delivery of patient-centered care.
Campus-wide HCAHPS survey results are trending favorably in every domain.
106
Outcomes 2011
About Cleveland Clinic
Overview
Cleveland Clinic is a nonprofit multispecialty academic medical center
that integrates clinical and hospital care with research and education.
Across the health system, 2,800 Cleveland Clinic physicians and scientists
practice in 120 medical specialties and subspecialties, annually recording
more than 4.6 million physician visits and nearly 188,000 surgeries.
Patients come for treatment from every state and from more than 125
countries annually.
Cleveland Clinic’s main campus, with 50 buildings on 180 acres in
Cleveland, Ohio, includes a 1,400-bed hospital, outpatient clinic, specialty
institutes, and supporting labs and facilities. The hospital currently has the
highest CMS case-mix index in America. Cleveland Clinic also operates 18
family health centers, eight community hospitals, one affiliate hospital, a
rehabilitation hospital for children, Cleveland Clinic Florida, Cleveland Clinic
Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada,
and Sheikh Khalifa Medical City. Cleveland Clinic Abu Dhabi (United Arab
Emirates), a multispecialty care hospital and clinic, is scheduled to open
in 2013. With 41,000 employees, Cleveland Clinic is the second largest
employer in Ohio and is responsible for an estimated $9 billion of economic
activity every year.
The Cleveland Clinic Model
Cleveland Clinic was founded in 1921 by four physicians who had served
in World War I and hoped to replicate the organizational efficiency of
military medicine. The organization has grown through the years by
adhering to the model set forth by the founders. All Cleveland Clinic staff
physicians receive a straight salary with no bonuses or other financial
incentives. The hospital and physicians share a financial interest in
controlling costs, and profits are reinvested in research and education.
In 2007, Cleveland Clinic restructured its practice, bundling all clinical
specialties into integrated practice units called institutes. An institute
combines all the specialties surrounding a specific organ or disease system
under a single roof. Each institute has a single leader and focuses the
energies of multiple professionals on the patient. Institutes are improving
the patient experience at Cleveland Clinic.
Taussig Cancer Institute
107
About Cleveland Clinic
Cleveland Clinic Lerner Research Institute
At the Lerner Research Institute, hundreds of principal
investigators, project scientists, research associates
and postdoctoral fellows are involved in laboratorybased, translational and clinical research. Total research
expenditures from external and internal sources exceeded
$240 million in 2010. Research programs include
cardiovascular, cancer, neuralgic, musculoskeletal, allergic
and immunologic, eye, metabolic, and infectious diseases.
Cleveland Clinic Lerner College of Medicine
Celebrating its 10th anniversary in 2012, the Lerner College
of Medicine of Case Western Reserve University is known
for its small class size, unique curriculum and full-tuition
scholarships for all students. The program graduated 31
students as physician investigators in 2011.
Graduate Medical Education
In 2011, nearly 1,800 residents and fellows trained at
Cleveland Clinic and Cleveland Clinic Florida, the most
ever hosted by Cleveland Clinic and part of a continuing
upward trend.
U.S.News & World Report Ranking
Cleveland Clinic is consistently ranked among the top
hospitals in America by U.S.News & World Report, and our
heart and heart surgery program has been ranked No. 1
since 1995.
For more information about Cleveland Clinic, please visit
clevelandclinic.org.
108
Outcomes 2011
Resources
Referring Physician Center and Hotline
Cleveland Clinic’s Referring Physician Center has
established a 24/7 hotline – 855.REFER.123
(855.733.3712) – to streamline access to our array of
medical services. Contact the Referring Physician Hotline
for information on our clinical specialties and services, to
schedule and confirm patient appointments, for assistance
in resolving service-related issues, and to connect with
Cleveland Clinic specialists.
Remote Consults
Online medical second opinions from Cleveland Clinic’s
MyConsult are particularly valuable for patients who wish
to avoid the time and expense of travel. Cleveland Clinic
offers online medical second opinions for more than 1,000
life-threatening and life-altering diagnoses. For more
information, visit clevelandclinic.org/myconsult, email
[email protected] or call 800.223.2273,
ext. 43223.
Request Medical Records
216.444.2640 or 800.223.2273, ext. 42640
Track Your Patient’s Care Online
DrConnect offers referring physicians secure access to their
patients’ treatment progress while at Cleveland Clinic. To
establish a DrConnect account, visit clevelandclinic.org/
drconnect or email [email protected].
Medical Records Online
Cleveland Clinic continues to expand and improve electronic
medical records (EMRs) to provide faster, more efficient
and accurate care by sharing patient data through a
highly secure network. Patients using MyChart can renew
Taussig Cancer Institute
prescriptions and review test results and medications from
their personal computers. MyChart provides a link to Microsoft
HealthVault, a free online service that helps patients securely
gather and store health information. It connects to Cleveland
Clinic’s social media and Internet site, currently the most
visited hospital website in America. For more information,
visit clevelandclinic.org/mychart.
Critical Care Transport Worldwide
Cleveland Clinic’s critical care transport team and fleet of
mobile ICU vehicles, helicopters and fixed-wing aircraft serve
critically ill and highly complex patients across the globe.
To arrange a transfer for STEMI (ST elevated myocardial
infarction), acute stroke, ICH (intracerebral hemorrhage), SAH
(subarachnoid hemorrhage) or aortic syndrome, call toll-free
877.379.CODE (2633).
For all other critical care transfers, call 216.444.8302 or
800.553.5056.
CME Opportunities: Live and Online
Cleveland Clinic’s Center for Continuing Education operates
one of the largest and most successful CME programs
in the country. The Center’s website (ccfcme.com) is an
educational resource for healthcare providers and the public.
Available 24/7, it houses programs that cover topics in 30
areas – if not from A to Z, at least from Allergy to Wellness
­– with a worldwide reach. Among other resources, the
website contains a virtual textbook of medicine (Disease
Management Project) and myCME, a system for physicians
to manage their CME portfolios. Live courses, however,
remain the backbone of the Center’s CME operation. Most
live courses are held in Cleveland, but outreach plans are
under way. In 2011, the Center offered 15 simultaneous
courses at Arab Health, a major world healthcare forum. 109
This project would not have been possible without
the commitment and expertise of a team led by
Mikkael Sekeres, MD; Ruth Lagman, MD; Mary Cusick; and Megan Kilbane.
© The Cleveland Clinic Foundation 2012
9500 Euclid Avenue, Cleveland, OH 44195
ClevelandClinic.org