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Baptist Cancer Institute
2013
CA N C ER P ROG RA M
Annual Report
Table of Contents
4
Cancer Committee Report
8
Tumor Registry Report
20 Tumor Review:
Anal Cancer
24 Tumor Review:
Chronic Myelocytic Leukemia
28 Quality Assurance
30 Clinical Research and Education
Baptist Cancer Institute
2013 Annual Report
Baptist Cancer Institute is one of the most active
Health, the only locally governed, faith-based health
clinical research institutes in the state of Florida,
system in Northeast Florida. Baptist Health, a
with open studies in breast cancer, lung cancer,
Magnet™ Health Care System honored for excellence
gastrointestinal malignancies, lymphoma, leukemia,
in patient care, is comprised of Baptist Medical
head and neck cancer and brain tumors. We work in
Center Jacksonville, Baptist Medical Center Beaches,
collaboration with physicians across the state and the
Baptist Medical Center Nassau, Baptist Medical
nation to conduct clinical trials that lead to improved
Center South, Wolfson Children’s Hospital and Baptist
diagnostic approaches, reductions in toxicities and
Clay Medical Campus.
new ways to fight these often devastating diseases.
3
Baptist Cancer Institute 2013 Annual Report
Baptist Cancer Institute (BCI) is affiliated with Baptist
Cancer
Committee
Report
Troy H. Guthrie Jr., MD, Cancer Committee Chairman
Similar to last year, the Baptist Cancer
Institute Annual Report for the year
2012 at Baptist Hospital Systems will be
electronic. This follows a trend used by
most hospital systems throughout the
nation. For the second year, the Cancer
committee report will be accessible at
the Baptist Health System website for
review. This year the cancer program has
continued to be healthy offering a wide
breadth of services and high quality care for
patients throughout Northeast Florida and
Southeast Georgia. Cutting edge programs
in neuro-oncology, breast care, as well as active
clinical research in the fields of medical oncology and
radiation oncology are offered to physicians and their
patients for participation. The development of a palliative
care program as well as close communication with Hospice of
Northeast Florida allows a continuity of care for patients moving
from active treatment towards supportive care only. These palliative
care programs allows the patients and their families to make every minute
count towards the highest quality of life and to enjoy, hopefully, most of their
Baptist Cancer Institute
2013 Annual Report
time within the home setting. Clinical research programs
cancer program. This is mandated by the American
continue to be active with research programs in breast
College of Surgeons and the Commission on Cancer.
cancer, lung cancer, melanoma, brain tumors, prostate
At each meeting, the activities of Tumor Registry and
cancer, hematologic malignancies, as well as radiation
current clinical research as well as goals of the Cancer
therapy. Research studies are offered through the
Committee are reviewed. Current leadership for the
auspices of both National Cancer Institute clinical study
Cancer Committee include Troy H. Guthrie, Jr., MD,
groups as well as pharmaceutical programs. Screening
chairman, Cancer Committee; Mark Augspurger,
programs in breast cancer, colon cancer, prostate cancer
MD, liaison to the American College of Surgeons;
and skin malignancies continue to be offered by both
Patricia Wood, RN, BSN, OCN, quality improvement
private physicians as well as the hospital system. The
coordinator; Paul Oberdorfer, MD, community outreach
Genetics Assessment program under the leadership of
coordinator; and Melissa McCarthan, RHT CTR, Tumor
Melinda Fawbush, MSN, ARNP continues to expand
Registry. At each meeting the committee reviews,
and has recruited grants for underserved patients. Multi-
revises and reapproves current program goals to
disciplinary conferences in breast cancer are offered
determine whether they are being met and if they are
weekly at Baptist Jacksonville and at longer intervals by
aligned with the latest requirements of the American
the other Baptist hospitals. The lung cancer conference
College of Surgeons. This Annual Report, as required
is bi-weekly and the neuro-oncology conference is
by the American College of Surgeons, will include
monthly. These programs are teleconferenced to
prospective and retrospective studies of two cancer
satellite hospitals so that education and discussion can
primary sites as well as assessment of the quality of
be received by those physicians and health care staff in
data provided to review those sites by the Tumor
their own hospital. Psycho-social support continues to
Registry. This year anal cancer and chronic myelocytic
be offered by George Royal, PhD, and more recently
leukemia will be the areas of review. In 2012, more
nutritional, physical therapy and occupational therapy
than ten percent of all analytical cases were reviewed
programs are offered primarily to our breast cancer
on a prospective basis by physicians who volunteered
patients and are open to all hospitals for referral.
as required by the American College of Surgeons
The Cancer Committee at Baptist Medical Center
to ensure continued quality and timeliness of data
Jacksonville continues to meet quarterly to provide
submitted into the Tumor Registry. In 2012, the total
leadership, direction and review of all aspects of the
number of all analytic cases was 1,625. Currently,
Baptist Cancer Institute 2013 Annual Report
5
40 to 50 protocols were offered throughout the campus
28,000 analytic cases since 1990. (Figure 1) The Cancer
for patients to be entered into clinical research. In 2012,
Clinical Research program includes active participation
an evolving trend is that over 50 percent of the cases
in the Eastern Cooperative Oncology Group, Radiation
were entered into pharmaceutical trials compared to
Therapy Oncology Group, Mayo Clinic Cancer Research
past years when the number of NCI group sponsored
Consortium, as well as pharmaceutical sponsored
and pharmaceutical trials were approximately equal.
research trials. At any one time in 2012, approximately
As Cancer Committee Chairman since 2005, it gives me great pleasure to see the
6
continued expansion of cancer services offered at Baptist Jacksonville and at satellite
hospitals. State-of-the-art programs which run the gamut from hematologic to solid
tumor malignancies are being offered in a multi-disciplinary approach to patients
of all walks of life. This has been brought forth through a close collaboration of
physicians, hospitals administrators, and allied professional staff which has enabled
the Baptist Cancer Institute to remain at the forefront of cancer care in this region.
Troy H. Guthrie Jr., MD
Cancer Committee Chairman
Medical Director, Education and Research
Baptist Cancer Institute
2005
1656
1625
2004
1624
1253
1138
1265
1999
1139
1308
1998
1041
972
1996
965
1995
865
1102
928
800
807
1000
764
1004
1200
688
N o . of Pa t ient s
1600
1400
1779
1467
1630
1800
1744
Fi gu re 1 Baptist Cancer Institute Analytic Cases by Year
964
Baptist Cancer Institute 2013 Annual Report
with those cases, the Tumor Registry has accrued over
2011
2012
600
400
200
0
1990
1991
1992
1993
1994
1997
2000
Yea r
2001
2002
2003
2006
2007
2008
2009
2010
Baptist Cancer Institute 2013 Annual Report
7
Tumor Registry
Report
Troy H. Guthrie Jr., MD, Cancer Committee Chairman
Melissa McCarthan, RHIT, CTR
April Stebbins, RHIT, CTR
Rassy Sprouse, BSc
The cancer program at Baptist Cancer
Institute (BCI) continues to maintain
a preeminent position in Northeast
Florida and Southeast Georgia.
The program is a multi-faceted unit
designed to meet the important needs
of the public and medical community.
Baptist Cancer Institute is housed at the
Williams Cancer Center a few blocks from
the Baptist Jacksonville campus. However,
with the use of telecommunications,
conferences and programs have been
developed in the affiliated hospitals at Baptist
South, Baptist Beaches, and Baptist Nassau.
BCI is approved as a community hospital
comprehensive program by the American College
of Surgeons; the most recent audit was in 2011 and
an upcoming audit is in February 2014. BCI’s interest in
leadership in cancer care, education and clinical research
are recognized throughout the community. Programs have been
developed that include breast, prostate, colorectal and skin cancer
screening for those common cancers. Other major assets of the Baptist Cancer
Baptist Cancer Institute
2013 Annual Report
Institute include the most comprehensive digital
sites needed to remain certified by the American
based telecommunication screening program for
College of Surgeons. In 2012, the Cancer Registry of
breast cancer. This program is preeminent within the
Baptist Cancer Institute added 1,625 new analytical
geographic area. Other major programs include a
cases to the preexisting cancer database that has
Brain Tumor multi-disciplinary program; preeminent
resulted in a total accumulation of 28,039 cases over
melanoma treatment including biologics as well
a span of 23 years. Currently, the Tumor Registry
as surgery and radiation; genetic risk assessment
analyzes cases from Baptist Jacksonville, which it has
programs; psycho-social support and quality of life
been doing since 1990 as well as those cases from
programs including palliative care. Nurse navigator
Baptist South which has been accumulated since 2005.
their diagnosis and care exist in breast and lung cancer.
Post-treatment programs in nutrition, physical therapy,
psycho-social support and pain management are an
active facet of our program.
The 1,625 cases seen in 2012 are the same as was
seen in 2011 (1,624.) As in previous years, there
was a female predominance with 956 cases of 1,625
being female and 669 cases being male (Figure 2).
This strong female predominance represents the high
The Cancer Committee of Baptist Health meets
number of both breast cancer and Gyn malignancies
quarterly and provides leadership, directions, and
seen at Baptist Health system. Table 1 demonstrates
a review of overall activities. Currently, the Cancer
the primary sites seen at Baptist Cancer Institute
Committee represents all active disciplines both
downtown. The five most common sites include breast
medical and supportive care. Annually, the committee
(27 percent) with a total of 440 cases; lung (15 percent)
reviews and reapproves its objectives and the newest
with 238 cases; prostate (9 percent) with 155 cases;
recommendations from the American College of
female genital cancer (7 percent) with 116 cases and
Surgeons. Direct supervision is provided over BCI’s
colorectal cancer (5 percent) with 87 cases, which was
cancer conferences, cancer registry, quality control
essentially tied with brain and CNS with 86 cases or 5
data, quality improvement of cancer related issues
percent. Table 2 demonstrates the primary sites seen
and community outreach. Each year the Cancer
at Baptist Medical Center South which is somewhat
Committee approves two goals to be addressed in
different with breast at 148 cases or 26 percent and
the quality improvement program, one retrospective
lung at 65 cases with 11 percent being the two most
and one prospective. Each year the Baptist Tumor
common sites. Colorectal was at 49 cases or 9 percent,
Registry’s data is reviewed by physicians for quality of
thyroid at 46 cases or 9 percent, urinary bladder at
data. Ten percent of all cases are personally reviewed
41 cases or 7 percent and kidney cancer at 35 cases
by physician volunteers. Prospective case analyses
or 6 percent. which is different than that seen at
on breast cancer and lung cancer as well as brain are
Baptist Jacksonville. This represents most probably
reviewed in sub-specialty conferences. The Tumor
the colorectal surgery presence as well as endocrine
Board reviews in terms of prospective case analysis
surgery and urology presence at Baptist South.
most of the other malignancies and covers all primary
9
Baptist Cancer Institute 2013 Annual Report
programs to assist patients throughout all aspects of
669
1000
800
Table 1 Primary Sites : Baptist Medical Center Jacksonville (2012)
956
2012 (Baptist Jacksonville)
N o . of Ma l i gn a nci es
Baptist Cancer Institute 2013 Annual Report
10
Figu re 2 Male & Female Malignancies:
600
400
200
0
Mal e
Female
Site
Total
%
Male
Female
Breast
440
27%
3
437
Lung
238
15%
119
119
Prostate
155
9%
155
0
Female Genital
116
7%
0
116
Colorectal
87
5%
53
34
Brain & CNS
86
5%
46
40
Melanoma
65
4%
37
28
Kidney
58
4%
33
25
Other Sites
57
4%
30
27
Lymph Node
52
3%
26
26
Urinary Bladder
47
3%
41
6
Blood & Bone Marrow
43
3%
23
20
Pancreas
41
3%
25
16
Unknown Primary
31
2%
18
13
Head & Neck
30
2%
21
9
Stomach
28
2%
13
15
Thryoid
24
1%
7
17
Liver
20
1%
15
5
Esophagus
7
0%
4
3
1,625
100%
669
956
Total
Table 3 illustrates the difference in prevalence patterns
malignancy, only 9 percent were seen at Baptist Cancer
of the Baptist Cancer Institute compared to Florida and
Institute compared to 15 percent in both Florida and
the United States SEER data. As you can see, breast
the United States SEER data. Female genital cancer at
cancer with 27 percent is far above that seen in Florida,
7 percent at BCI is markedly increased compared to 3
13 percent, and in the United States, 14 percent.
percent in Florida and 5 percent in the United States.
Lung cancer, the second most common malignancy
Colorectal cancer again is similar to prostate cancer,
at 15 percent at Baptist Cancer Institute is similar to
being low at 5 percent compared to 9 percent in both
Florida at 15 percent and the U.S. data at 14 percent.
Florida and the United States.
If one looks at prostate cancer, the third most common
Tabl e 2 Primary Sites : Baptist Medical Center South (2012)
Total
%
Male
Female
Breast
148
26%
0
148
Lung
65
11%
29
36
Colorectal
49
9%
18
31
Thyroid
46
9%
17
29
Urinary Bladder
41
7%
34
7
Kidney
35
6%
19
16
UGI
25
4%
13
12
Lymph Nodes
24
4%
12
12
Blood & Bone Marrow
22
4%
15
7
Female Genital
19
3%
0
19
Melanoma
18
3%
12
6
Pancreas
16
3%
10
6
Other Sites
15
3%
10
5
Prostate
14
2%
14
0
Head & Neck
13
2%
9
4
Unknown Primary
9
2%
2
7
Brain & CNS
8
2%
0
8
567
100%
214
353
Total
11
Baptist Cancer Institute 2013 Annual Report
Site
Tabl e 3 Comparison Data with Florida and United States
Organ Site
Baptist Cancer
Institute
Florida
United States
Breast
27%
13%
14%
Lung
15%
15%
14%
Prostate
9%
15%
15%
Female Genital
7%
3%
5%
Colorectal
5%
9%
9%
Figu res for F l orida a nd U.S. a re e sti m ate s from Ca n cer Fac t s a n d Fi g u res 2 01 2
Baptist Cancer Institute 2013 Annual Report
12
These variations in data certainly represent referral
Tumor Registry. In 2012, at least 10 percent of all
patterns as well as expertise in programs located at the
analytic cases were reviewed on a prospective basis
Baptist Cancer Institute. For example, breast cancer
by physician volunteering to ensure the accuracy of
is represented in a high proportion because of the
data. Other aspects of the data, including timeliness of
preeminence of the Hill Breast screening program.
data input into the Tumor Registry, are also reviewed.
As well as the surgical expertise and radiation
In 2012, the number of cases seen was essentially
preeminence with technology, such as the IntraBeam ,
similar to that seen in 2011 (1625 vs. 1624). This still
intraoperative treatment program. Likewise, the region
represents a decline of cases compared to the peak
wide digital breast cancer imaging program, housed at
of 1,779 seen in 2009. (Figure 1) Currently, the Tumor
Baptist Jacksonville, serves all the catchment areas of
Registry includes over 28,000 cases seen and accrued
this region. Expertise in medical oncology, as well as
since 1990.
®
research programs in both early and late breast cancer
also bring a large number of referrals. The increased
number of female genital malignancies is almost
certainly accounted primarily by the gynecologic
malignancy preeminence of the surgery group which
operates primarily at Baptist Jacksonville.
In 2012, the cancer clinical research programs included
active participation in Eastern Cooperative Oncology
Group (ECOG), Radiation Therapy Oncology Group
(RTOG), and the Alliance group which represents
the old Mayo Clinic Cancer Consortium. Likewise,
cutting edge pharmaceutical industry sponsored
As required by the American College of Surgeons,
studies continue. In all, a total of 42 patients were
one prospective as well as one retrospective study of
accrued in 2012 with approximately 30 percent
cancer disease sites, respectively, anal and chronic
participating in NCI group studies and 70 percent in
myelocytic leukemia are reviewed in the 2013 Annual
the pharmaceutical industry studies.
Report to assess the quality of data provided by the
• M
ajor conferences for oncology nurses
• P
revention and community education programs
• C
ontinued participation in the American Cancer
Society and Leukemia and Lymphoma Society
Committees
• Special
oncology nursing programs for community
support of education in breast and lung cancer
• Smoking
cessation assistance programs for the
• C
ontinued participation of indigent programs,
including the highly successful We Care program
• C
ontinued expansion of a hospital-based
chemotherapy infusion unit
• O
n-site involvement of hospice and palliative care
programs for optimum support for both the cancer
patient and family
• C
ontinued expansion of the Genetic Risk Assessment
Screening program, now focusing on breast cancer,
community as well as employees of Baptist Health
but also includes melanoma and colon cancers
• C
utting-edge prostate cancer treatment programs,
• C
ontinued active participation in the oncology
including seed implants and the state-of-the-art
training program for the medical oncology fellows
da Vinci Robotic Surgery unit
from the University of Florida Jacksonville and
• C
ontinued expansion of the stereotactic radiosurgery
radiation program with a marked increase in the
number of body sites being treated
• C
ontinued expansion of the limited breast radiation
program using the Mammosite® technique
• Continued expansion of the digital breast cancerscreening program with movement to centralized
diagnostic studies at the Baptist Cancer Institute
• Participation in in-patient quality improvement
programs, including infection control
• Expansion of the chemotherapy and
the Radiation Therapy residents at Mayo Clinic
Jacksonville
• C
ontinued expansion and utilization of the
comprehensive breast health program with nurse
coordinator at Baptist Jacksonville, Baptist South and
Baptist Beaches
• R
apid expansion of the Neuro-oncology program,
with continued expansion of the radiosurgery
program, as well as increased sophistication of the
Neurosurgery suites and continued expansion of
Neuro-oncology clinical research studies
radiopharmaceutical embolization programs for
treatment of liver malignancies
As Cancer Committee Chairman, I can state that despite continued troublesome economic times in Northeast
Florida in the year 2012 the Cancer program at Baptist Hospital Systems has continued to expand compared to
2011. This collaboration has brought the Baptist Cancer Institute to its preeminent status which has maintained
over time. In 2014, as Chairman, I look forward to seeing the continued expansion of our patient care, cancer
research, cancer prevention, and education programs for physicians and public throughout Northeast Florida and
Southeast Georgia. Exciting developments in the program hopefully will come forth from the possible alliance
of Baptist Health with the Flagler Hospital System in St. Augustine, Florida and the Southeast Georgia Hospital
System in Brunswick, Georgia.
13
Baptist Cancer Institute 2013 Annual Report
Other Baptist cancer activities include:
Baptist Cancer Institute 2013 Annual Report
14
Breast Cancer
The number of breast cancer cases which are accrued
A breast survivorship program with nutrition, physical
to the Baptist Hospital Tumor Registry at Baptist
therapy and psychosocial support has continued to
Jacksonville consistently exceeds the state of Florida
grow and enhance the overall experience in patients
and national average. In 2012, there were a total of 440
seen at the Hill Breast Center. Cutting-edge surgery
cases entered into the tumor registry representing 27
programs with intraoperative radiation began in the
percent of all cases exceeding the national and state
fall of 2012. Limited breast radiation with IntraBeam®
of Florida average of 13 percent. Similar to previous
for intraoperative breast radiation has expanded.
years and similar to the national average, the majority
Cutting-edge research programs both in the adjuvant
of these cases are early stage breast cancer. (Figure 3)
and the more advanced metastatic setting are offered
Seventy-nine cases or 18 percent were DCIS, 194 cases
at the Baptist Cancer Institute, through both medical
(44 percent) were Stage I and 105 or 26 percent were
oncology groups with cooperative group studies as well
Stage II. These early stage breast cancers represent 88
as pharmaceutical sponsored and the Baptist radiation
percent of all breast cancers seen and we would expect
therapy through the RTOG research group. Other assets
all but a few of these women would ultimately be cured
for optimizing the care of breast health patients at the
of their breast cancer. Stage III was 35 or 8 percent in
Baptist Cancer Institute through the Hill Breast Center
which many of the patients would ultimately die of their
program include genetic risk assessment led by Melinda
breast cancer. Stage IV was 23 patients or 4 percent and
Fawbush, MSN, ARNP which assists patients and their
we would expect all of the patients to ultimately die of
family in making decisions for both the type of surgery
their breast cancer. (Table 3) Out of these 440 cases only
and other long-term preventive programs if they are
four or less than one percent is classified as unknown
known to have increased genetic risks. Psychosocial
stage attesting to the tenacity of our Tumor Registry in
support is provided by George Royal, PhD and an
adequately staging the patients.
increasing involvement in breast survivorship services
Breast cancer consistently represents a very high
percentage of the cases seen at the Baptist Cancer
Institute compared to the U.S. average. This speaks to
the effective network in which primary care physicians
work with our digital mammogram screening program
include nutrition, physical therapy, and lymphedema
treatment. All of these services continue to enhance
the breast health program and increase Baptist Cancer
Institute’s share of breast care patients within Northeast
Florida and Southeast Georgia.
to diagnose patients at an early stage and move them
Figure 4 shows the number of cases of ductal carcinoma
into the organized breast cancer program and through
in situ (DCIS) seen at Baptist Cancer Institute since the
the multi-disciplinary Hill Breast Clinic. In 2012, the
establishment of the Tumor Registry in 1990. Seventy-
breast health program spent its second year in the Hill
nine cases were seen in both 2011 and 2012. All of
Breast Center at the Baptist Outpatient Center. Two
these cases of ductal carcinoma in situ will be cured with
nurse navigators assisted patients and physicians to
local therapy and represent a success of the wide use of
optimized patient convenience as well as patient care.
screening digital mammograms within our system.
Fi gure 3 Baptist Cancer Institute Breast Cancer Staging: 2012
250
194
200
150
105
79
100
0
1
2
4
Unknown
3
Baptist Cancer Institute 2013 Annual Report
0
4
35
15
50
23
No. of Pa t ie n t s
300
S ta g e
Fi gure 4 Baptist Cancer Institute Breast Cancer-DCIS Accrual
79
79
2011
2012
55
55
50
23
1992
1993
30
17
20
25
30
29
40
34
39
40
43
50
10
60
61
56
60
2010
68
71
70
8
N umber o f Pa t ient s
80
80
81
85
90
0
1990
1991
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Baptist Cancer Institute saw 238 patients with lung cancer
no accepted screening program for at least the patients
in 2012. As in past years, the patients who were accrued
seen in 2012. Recently, the role of low-dose screening CT
to in our Tumor Registry were predominantly advanced
scans has been reaffirmed at the national level, but is not
cases. Unfortunately, 83 cases were Stage IV representing
widely accepted since the number of false negatives and
35 percent of all lung cancer seen. (Figure 5) Forty or
unnecessary biopsies is a troublesome handicap for its
17 percent were Stage III, who have approximately a
widespread use. One bright spot in lung cancer at Baptist
20 percent chance of being cured. Twenty four patients
Hospital is the multi-disciplinary lung cancer program
were Stage II in which the cure rate is approximately 35
led by Bridget Rossi, RN, MSN, OCN, nurse navigator.
percent and 89 or 37 percent were Stage I in which over
Through her efforts, a foundation has been established
half the patients are cured with local therapy (Figure
to assist needy patients in all aspects of their care from
5). The proportion of patients with lung cancer seen at
diagnosis to end of life. The role of the stereotactic
Baptist Jacksonville is 15 percent, which is similar to the
radiosurgery program at Baptist Cancer Institute has
14 percent seen nationally. This percentage of patients,
continued to expand for selected patienta with Stage I
as well as total numbers, represented a rise from the
particularly who are frail and medically inoperable.
previous years of 186 patients, which was 11 percent
Research areas within the Baptist Cancer Institute include
of the cancer seen last year. Similar to statistics both in
the continued participation in a cooperative group
Florida and the United States, the majority of patients
adjuvant non-small cell lung cancer study, as well as
with lung cancer are Stage III and IV, which are poorly
innovative targeted therapies for metastatic and recurrent
curable. This presentation in advanced stage represents
non-small cell lung cancer.
Fi gu re 5 Baptist Cancer Institute Lung Cancer Staging: 2012
83
88
100
80
40
60
24
40
3
20
0
N o. of Pati ents
Baptist Cancer Institute 2013 Annual Report
16
Lung Cancer
0
0
1
2
3
S ta ge
4
Unknown
Prostate Cancer
staging workup. The Baptist Cancer Institute continues the
155 from the 189 cases registered in 2011. This represents
prostate screening program which has been sponsored
a dramatic drop from 2009 and 2008 when over 300
by both Baptist Cancer Institute and the NFL Jacksonville
cases were assessed each year. This drop in prostate
Jaguars for many years. The prostate cancer prevention
cancer accrual represents a clear cut change in referral
trial was closed in 2011 and unfortunately found no benefit
patterns in the community where many patients are now
to the use of antioxidants either in the form of Selenium
being both biopsied and referred to outside treatment
or vitamins in decreasing the incidence of prostate cancer.
facilities. However, as in previous years, the vast majority of
Radiation treatment at Baptist Cancer Institute includes
patients are either Stage I (42 patients) which represented
the state-of-the-art IMRT Radiation Therapy, or seed
27 percent of the patients seen or Stage II (97patients)
implants, and urologic surgeons have the daVinci Robotic
which represented 63 percent of patients. (Figure 6) Thus
Surgery Program. Patients entered on an innovated
90 percent of patients were either Stage I or Stage II in
immunotherapy program with the use of Ipilimumab for
which the vast majority will be cured with either surgery
advanced castrate resistant prostate cancer continue to
or some form of radiation treatment. Only eight patients
be followed in 2012 and 2013. The use of innovative new
or 5 percent and four patients or 3 percent were Stage III
treatments for patients previously considered refractory
and Stage IV, respectively. Four patients or 3 percent were
to hormone treatment has improved with two new drugs
unknown stage that again represents a success for our
being approved by the FDA for castrate resistant prostate
Tumor Registry which accurately staged all but 3 percent
cancer patients seen at Baptist Cancer Institute.
of the patients. Those patients generally were cases who
were referred outside our institute prior to completing
97
Fi gure 6 Baptist Cancer Institute Prostate Cancer Staging: 2012
80
42
60
40
0
1
2
3
S ta g e
4
0
4
8
20
0
No. of Pati ents
100
4
Unknown
17
Baptist Cancer Institute 2013 Annual Report
In 2012, the number of prostate cancer cases dropped to
In 2012, the gynecologic cancer program at Baptist
to properly stage. This high percentage of patients in
Cancer Center Jacksonville continued to be active in
early stage represents a success in American cancer
terms of numbers of patients with 116 patients seen
management with a high utilization by American women
this calendar year. As illustrated in Figure 7, 74 percent
of standard guidelines for pelvic exam and Pap smear.
or 63 patients were Stage I and II which in general is
The percentage of female genital cancer seen at Baptist
felt to be readily curable by surgery or surgery plus
Cancer Institute (7 percent) reflects favorably with the
radiation. Only 26 percent of patients were Stage III
5 percent average reported in United States SEER data.
and IV and 9 or 8 percent had inadequate information
Fi gu re 7 Baptist Cancer Institute Gynecological Cancer Staging: 2012
54%
60
50
40
10
8%
9%
20
9%
17%
30
4
Unknown
3%
P ercent
Baptist Cancer Institute 2013 Annual Report
18
Female Genital Track Cancer
0
0
1
2
3
S ta ge
Colorectal
Colorectal cancer represented 5 percent of all cancer
89 cases of patients diagnosed with colorectal cancer.
cases seen at Baptist Cancer Institute and accrued into
This mirrors the same total access in 2011 of colorectal
our Registry compares unfavorably with the 9 percent
cases seen at Baptist Jacksonville. Most of those
rate for the state of Florida and the 9 percent rate for
patients represented late stage either Stage III, which
the United States. This low percentage of colorectal
is regional diseases accounting for 26 patients or 30
patients seen at Baptist Cancer Institute almost certainly
percent, and Stage IV which was 23 patients or 26
represents referral outside the system as well as
percent. Overall, these Stages II-IV represent a total of
performing biopsies and colonoscopy in freestanding
83 percent of the patients being in later stages with an
ambulatory surgical centers. Reversing this trend by
expectation of around 50 percent of those patients will
primary care education and perhaps upgrading facilities
be cured (Figure 8). Unfortunately, the 28 patients or 26
and improving access to Baptist facilities should be a
percent of patients who were Stage IV most of whom
top priority. A wide variety of research studies including
will die within five years. A bright spot is that only one
innovative metastatic treatment protocols through
patient was unknown stage, who most probably left the
the pharmaceutical studies as well as state-of-the-art
institution prior to completing staging and having his
radiation for rectal cancer are available at both Baptist
treatment elsewhere.
Jacksonville and Baptist South.
30%
Fi gure 8 Baptist Cancer Institute Colorectal Cancer Staging: 2012
26%
26%
16%
20
1%
10
0%
Perc ent
30
0
0
1
2
3
S ta g e
4
Unknown
19
Baptist Cancer Institute 2013 Annual Report
In 2012, Baptist Cancer Institute tumor registry assessed
Tumor Review:
Anal Cancer at
Baptist Cancer
Institute
Mark Augspurger, MD, Radiation Oncologist
Each year approximately 2,000 cases
of anal cancer which is a relatively
rare malignancy will be seen in the
United States. Because of its location
proper treatment which will result in
retention of bowel continuity is important.
Treatment approaches have evolved over
the last three decades. In the 70’s and early
80’s, the primary therapy was an abdominalperineal resection which resulted in loss of bowel
continuity and a permanent colostomy. Treatment
has now evolved to the point that most patients are
treated upfront with chemoradiation followed by a biopsy
for residual tumor and the vast majority will remain continent
and cured of their malignancy.
Baptist Cancer Institute
2013 Annual Report
As stated, anal cancer is rare and is the cause of only
when more advanced disease is found CT scans of the
chest and when clinically appropriate bone scans.
1 percent of large bowel cancers. Most are squamous
Staging
cell cancers with other histologies being rarely seen.
Anal cancer is usually seen in people over the age of
Staging is based on an AJCC system that includes
60 and is slightly more common in men than in women.
classification by T stage, by size and invasion, and N
In terms of etiology, the human papilloma virus (HPV)
stage by nodal base involvement, sub-classified by
has been strongly linked to squamous cell carcinoma
anatomic region. Metastases are usually present or
of the anus particularly in younger individuals.
absent. A T1 is any tumor less than or equal to 2cm.
Analysis for HPV within the tumor cells currently finds
T2 is greater than 2cm but less than 5cm. T3 is greater
approximately 30 percent of patients being positive on
than 5cm in greatest diameter. T4 is any tumor that
immunofluourescent stains. Chronic inflammation such
invades adjacent organs such as the vagina, bladder,
as fistulas have also been implicated as risk factors.
and urethra or stuck to the pelvic walls. Regional
nodes are N1, perirectal lymph node involvement, N2,
Most cancers arise from the anal canal which the
metastases to unilateral internal ileac or inguinal nodes
American Joint Commission on Cancer defines as
and N3 metastases to perirectal and inguinal nodes or
the region from the anal rectal ring to the anal verge.
bilateral internal iliac or bilateral inguinal lymph nodes.
They can generally be divided into those that are
As stated, M is any distant metastases. In terms of final
keratinizing and those that are not which are much
stage, Stage I is a T1N0M0 which is cured in greater
less common. There is no difference between the two
than 95 percent of patients. Stage II is either a T2 or T3
histologies in overall clinical outcome.
and is cured in approximately 90 percent of patients.
T3A is a T1 to T3 with N1 disease or a T4N0 in which
Signs, Symptoms and Diagnosis
approximately 70 percent of patients will be cured.
T3B is a T4N1 or any T with N2 to N3 disease in which
Most tumors present with bleeding and diagnosis
the survival rate drops to 50 percent or less. Stage IV
can be delayed since many patients regards these
which is any metastatic site, long term survival is only
symptoms as representing hemorrhoids or anal fistulas.
around 5 to 10 percent at five years.
Regional spread is commonly in inguinal lymph
nodes and less common spread distally to sites such
as the liver, lung, and bone. Other areas of regional
involvement include pelvic nodes, iliac nodes and
retroperitoneal lymph nodes. Clinical presenting signs
and symptoms besides bleeding include pain, change
in bowel movements and palpable lymph nodes.
Treatment
For anal cancers that are Stage I, surgery alone with
wide local excision and careful follow up is usually
sufficient. Those tumors that reoccur locally should be
treated preferably with concurrent chemoradiation and
Diagnosis is usually made by digital exam with
again excellent long term survival expected. For Stages
palpation and biopsy. Other testing should include
II through IIIB, current therapy is very standardized.
anoscopy and rectal ultrasound. Further extent of the
The standard treatment is radiotherapy combined
disease should include either a CT scan of the pelvis
with 5FU and mitomycin. Radiation therapy dosage is
and abdomen or MRI of the pelvis and abdomen and
usually around 45Gy with chemotherapy being given
during the six week time period of radiation therapy.
21
Baptist Cancer Institute 2013 Annual Report
Epidemiology
Table 1 Cases by Gender (2003 - 2012)
5
5
6
Site
4
4
4
4
5
4
2
2
3
2
1
N o . of Pa ti ents
1
0
Baptist Cancer Institute 2013 Annual Report
Fi gure 1 Baptist Cancer Institute Anal Cases by Year
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
Total
Male
Female
Anus &
Anal Canal
31
13
18
Total
Cases
31
13
18
2012
Year
Ta ble 2 Site by AJCC Stage Tabulation
22
Site
Total
Stg 0
Stg I
Stg II
Stg III
Stg IV
UNK
Anus &
Anal Canal
31
3
4
11
8
3
2
Overall
Totals
31
3
4
11
8
3
2
After radiation is complete, six weeks later complete
Despite our small population size the survival of our
restaging and biopsy are done. If there is residual
patients was very similar to U.S. statistics. In Figure 2,
disease, an additional boost of radiation therapy
as you can see, the five-year survival for Stage 0, in
usually combined with further therapy such as 5FU and
situ disease, and Stage I is greater than or equal to 95
cisplatin is given. For patients whose primary tumors
percent. Stage II is approximately 85 percent and even
were larger such as T3 or T4 approximately 50 percent
Stage III which is regional disease remains good at 58
will need an abdominal peritoneal resection with
percent. Stage IV is somewhat high at 20 percent this
permanent colostomy. Fortunately, for most patients
is most likely due to the fact that only three patients
the malignancy is localized for many years and overall
were Stage IV. In terms of treatment, Table 2,
survival, except for those who present as Stage IIIb and
there is a small problem with our data. As stated,
IV, is good. At Baptist Health, the Tumor Registry at
most patients with Stage 0 or I would be treated with
Baptist Cancer Institute accumulated 31 cases of anal
surgery alone and that figure of five is compatible with
cancer between the years of 2003 and 2012 (Figure 1).
the national standards. However, Stages II through IIIb
Of those patients, 13 were male and 18 were female
would usually be treated with either chemotherapy
(Table 1) which is not consistent with national average
plus radiation or all three forms of therapy, surgery,
but probably represents our small number of patients.
radiation and chemotherapy. Our Tumor Registry has
In terms of stage, (Table 2) three were in situ disease,
only 15 patients treated with these modalities with
four were Stage I, 11 Stage II, eight Stage III, three
12 being treated with chemotherapy plus radiation
Stage IV and two were stage unknown. This is similar
and three being treated with surgery, radiation and
to national statistics where most patients are Stage I
chemotherapy. This is somewhat problematic since
and II. In terms of ethnic status of our 31 patients seen
we have within our staging 11 patients in Stage II and
at Baptist Cancer Institute, 24 were Caucasian, five
eight patients in Stage III for a total of 19 patients who
were African American, one was Asian and one was
should have been treated with either chemoradiation
ethnic status undetermined.
or chemoradiation followed by surgery. Stage IV for
lost to follow up after the original diagnostic biopsy.
would be treated with chemotherapy alone or perhaps
Thus in summary, information on anal cancer although
palliative radiation plus chemotherapy and this is
small number of cases generally represent that seen
consistent with our two patients being treated with
elsewhere where most patients are early stage and their
chemotherapy alone. The most concerning data is
survival is excellent. The male-to-female ratio most
seven patients are listed as receiving no therapy which
certainly represents the small patient sample and there
would be very unlikely and most probably represents
is no possibility that mistakes in gender were made
patients being referred elsewhere for their therapy for
through the Tumor Registry. On the other hand, the
which we have not been able to capture the treatment
number of patients, seven out of 31, listed as having
data. This data will be discussed further under our
no therapy are problematic in the sense that they have
article for quality assurance but to briefly summarize
been lost to follow up at least for treatment status and
most of these patients listed as receiving no therapy,
thus survival status may be somewhat clouded as well.
seven out of 31 or 23 percent probably represent being
This is discussed under the quality assurance article.
Figu re 2 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2006)
100
95
90
85
80
Cu mu lati ve Su r vi val Rates
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
0.0
1.0
2.0
3.0
4.0
5.0
Year s from Di ag nos i s
Stag e 0
Stag e I
Stag e II
Stag e III
Stag e IV
23
Baptist Cancer Institute 2013 Annual Report
which Baptist Cancer Institute recorded three patients
Tumor Review:
Chronic Myelocytic
Leukemia at
Baptist Cancer
Institute
Troy Guthrie, MD, Medical Director,
Baptist Cancer Institute
Chronic Myelocytic Leukemia is a clonal
chronic myeloproliferative leukemia
associated with a unique chromosomal
abnormality named the Philadelphia (Ph)
chromosome. The Philadelphia chromosome
is a balanced translocation from chromosome
9 to chromosome 22. This unmasks two
genes, the ABL, which is on chromosome
9, and the BCR, which is on chromosome 22.
This chromosome abnormality produces a fusion
protein BCR-ABL which is thought responsible for
the emergence of the leukemia clone and uncontrolled
proliferation. Chronic myelocytic leukemia represents
approximately 15 to 20 percent of all leukemia diagnosed. In 2012,
it was estimated that approximately 4,500 cases would be diagnosed
within the United States. The average age at diagnosis is between 40-60
Baptist Cancer Institute
2013 Annual Report
percent of cases. The BCR-ABL protein can be detected
cases to female cases. In terms of etiology, the only
by two techniques, the polymerase chain reaction
known risk factor is exposure to ionizing radiation
(PCR) or the fluorescent in situ hybridization (FISH) and
which can either be therapeutic or environmental such
should be likewise present in 98 percent of the cases.
as nuclear power reactor accidents or those exposed
Currently, those cases approximately 2 to 3 percent that
in Japan to the atomic bombs. There are no linked
are “Philadelphia chromosome negative” are usually
genetic factors nor any other environmental exposures.
managed as non CML cases.
Presentation
Treatment
Typically, CML has a biphasic course where in modern
Chronic myelocytic leukemia in the last ten years
times, 90 percent of patients present in what is called
has evolved into the most successfully treated
a chronic phase characterized primarily by mature
hematologic malignancy occurring in man. The unique
myeloid precursors in both the peripheral blood and
Philadelphia chromosome abnormality which is the
bone marrow and about ten percent in what is called
driving force for CML is down regulated by multiple
a blastic phase where they appear to be in an acute
new drugs which are called tyrosine kinase inhibitors.
leukemic stage either myeloid or lymphoid. In recent
These drugs include imatinib (Gleevec), dasatinib
years, approximately half of all patients are found
(Sprycel) and others. In the chronic phase as frontline
accidentally on review of blood counts and about half
therapy virtually 100 percent of patients will achieve
of the patients present with symptoms such as fatigue,
a complete hematologic remission with normalization
weight loss, or left upper abdominal pain or fullness
of blood and bone marrow. Depending on the
related to splenomegaly. More uncommonly, people
drug used, approximately 70 to 80 percent will also
will present with bleeding, overt hepatosplenomegaly,
achieve a cytogenetic remission with disappearance
or signs and symptoms of acute leukemia.
of the Philadelphia chromosome. More importantly,
molecular probes, such as PCR, for the BCR-ABL fusion
The diagnosis is made by examination of the
protein become negative in up to 50 percent of cases
peripheral blood and bone marrow with cytogenetic
treated today. The appearance of either a cytogenetic
and molecular analysis for the presence of the
remission or molecular remission is associated with
Philadelphia chromosome and its fusion protein, the
a five year survival of greater than 90 percent. There
BCR-ABL protein. In chronic phase, the peripheral
is even some evolving evidence that patients in
blood will usually have leukocytosis between 30,000
cytogenetic remission or more importantly molecular
and 50,000 with the majority of the cells being mature
remission for a prolonged period of time can have
and less than 5 percent myeloblasts. Likewise, the bone
the treating drug discontinued and about half of the
marrow will be very hypercellular with the majority of
patients remain undetectable as far as their chronic
the cells again mature myeloid precursor. Cytogenetic
myelocytic leukemia.
analysis reveals the Philadelphia chromosome in 98
25
Baptist Cancer Institute 2013 Annual Report
years of age. There is a slight predominance of male
inhibitors. (Table 3) Eleven were assessed as having no
frequently in the 1990’s through 2004, has virtually
therapy which is inconceivable since modern therapy
disappeared except for treatment of the most
over the last years would be to treat those patients
refractory patients or patients who present in blast
with oral tyrosine kinase inhibitors. Thus, it is suspected
crisis. Chemotherapy as a form of treatment for CML
that those 11 patients were lost to follow up as far
is essentially no longer used in the United States.
as treatment data. As stated in the other primary
Likewise, alpha interferon, which had some success in
site review, anal cancer, this issue will be reviewed
the late 1990’s, is no longer used.
and steps taken to alleviate this problem. In terms of
survival data, the SEER data does not produce survival
Baptist Cancer Institute
Statistics
by stages since chronic myelocytic leukemia has no
stage. As stated, the five year survival is close to a 100
percent which our patients achieved.
The records of the Baptist Cancer Institute Tumor
Registry from 2003 to 2012 were reviewed and a total
In summary, chronic myelocytic leukemia is a relatively
of 31 cases were identified. As can be seen in Figure 1,
rare leukemia accounting for only 15 to 20 percent of
the number of cases in any year was quite variable.
all leukemias, which can be seen by our small number
Similar to national statistics, there was a slight male
of 31 this is similar to our data. There is a slight male
predominance with 16 cases being male and 15 cases
to female predominance which our data also showed.
female. In terms of ethnicity, 20 cases were Caucasian
Survival is essentially 100 percent at five years which
and 11 cases were African American. (Table 1 and 2) In
our patients achieved. In terms of treatment, our data
looking at treatment, similar to anal cancer, the other
is lacking since in the United States no patient with
primary site, once again a problem with treatment is
CML would go untreated and we had 11 or 33% listed
identified. Only 20 were listed as being treated with
as having no treatment.
chemotherapy, which includes the tyrosine kinase
8
Fi gu re 1 Baptist Cancer Institute Chronic Myelocytic Leukemia Cases by Year
8
6
7
6
4
4
5
4
4
2
2
3
2
0
1
1
0
No . of Pat ients
Baptist Cancer Institute 2013 Annual Report
26
Allogenic transplant, which used to be employed
0
2003
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Tabl e 1 Cases by Gender (2003 - 2012)
Site
Total
Male
Female
Blood &
Bone Marrow
31
16
15
Total Cases
31
16
15
27
Site
Total
White
Black Asian Oriental Mer India
Blood &
Bone Marrow
31
19
11
0
0
0
1
Overall
Totals
31
19
11
0
0
0
1
Baptist Cancer Institute 2013 Annual Report
Tab l e 2 Site by Race Tabulation
Other
Tabl e 3 Site by Treatment Tabulation
Total
Chemo
None
Surgery
Radiation
Surgery/
Radiation
LL
Others
Blood &
Bone Marrow
31
20
11
0
0
0
0
Overall
Totals
31
20
11
0
0
0
0
Site
Quality Assurance
Troy H. Guthrie Jr., MD, Medical Director, Education and
Research, Baptist Cancer Institute,
Melissa McCarthan, RHIT, CTR;
The Tumor Registry and its database are
necessary for quality of care, monitoring
provided within the confines of Baptist
Healthcare Systems. The Baptist Cancer
Institute reviews each year the accuracy
and dependability of this essential
service. This year, two primary sites
chronic myelocytic leukemia and anal
cancer were evaluated and examined
as directed by the American College of
Surgeons and the Commission on Cancer.
The review of the 31 cases of anal canal cancer
and 31 cases of chronic myelocytic leukemia
resulted in an analysis of their diagnosis as well
as treatment and survival over a 10 year period of
2003 through 2012. The abstracts were reviewed for
accuracy and charts will be pulled for remedial data clear
up as deemed necessary. The following are the results of
the assessment of the 31 cases with anal canal and 31 cases of
chronic myelocytic leukemia in our Tumor Registry during the above
mentioned time period:
Baptist Cancer Institute
2012 Annual Report
• Recommendations for corrections include: periodic
accuracy. There were no errors in the classification of
education for the Tumor Registry concerning standard
anal canal cancer and chronic myelocytic leukemia
treatment of primary sites so that when a patient
patients identified in terms of diagnosis.
is labeled as having no therapy this error can be
• T
herapy of both anal cancer and chronic myelocytic
corrected early. My plan is to provide a table of the
leukemia had the same problems in identifying
standard treatments given to common malignancies at
treatment.
specific stages so that the Tumor Registry can review
• O
f the 31 cases of anal caner, seven or 23 percent
were listed as having no therapy. Likewise, 11 or 33
percent of the 31 cases of chronic myelocytic leukemia
to see if our data matches the standard of care for
2013 and on.
• This issue will be brought up at Cancer Committee
were listed as having no therapy. Clearly, this is
so that the physicians’ staff will be more cooperative
considered unlikely, so charts will be pulled from the
in providing information including treatment to the
patient’s last listed treating physician so that hopefully
Tumor Registry.
an accurate treatment can ultimately be entered into
• Cancer physicians again will be urged to be more
the patient’s tumor registry record and provided to
involved in the abstract process particularly when the
the Florida Cancer Registry as updated. This will be
Tumor Registry has inconsistent data with standard of
one of our cancer quality improvement projects for the
care or the patient appears to be lost to follow up.
upcoming year. This will be a laborious task but will
be necessary so that we can have accurate long term
follow up on both sites.
• K
aplan Meyer survival curves were available and
appeared to be accurate for anal canal. Demographics
in terms of male and female ratio as well as ethnic
status are likewise accurate.
29
Baptist Cancer Institute 2013 Annual Report
• A
bstracts contained adequate information to assess
Clinical Research
and Education
In 2012, cancer research for the Baptist
Cancer Institute continued to function at
a high level at multiple sites including
the Baptist Cancer Institute, Florida
Radiation Oncology Group and Cancer
Specialists of Northeast Florida.
Patients could access approximately
fifty to sixty research protocols for
consideration for patients with diverse
cancer sites including breast, lung,
gastrointestinal, brain, melanoma,
pancreatic, hematologic malignancies, and
other less common sites. Protocols were
available for patients at both Baptist Medical
Center Jacksonville and Baptist Medical Center
South for both local patients and referrals from
outside the Jacksonville area, including southeast
Georgia. Studies were available to patients from
both national cooperative groups including the National
Surgical Adjuvant Breast and Bowel Project (NSABP), Eastern
Cooperative Oncology Group (ECOG), North Central Cancer
Treatment Group (NCCTG), and Radiation Therapy Oncology Group
(RTOG), as well as many studies which came through pharmaceutical
companies and private research organizations (PRO). On Campus, approximately
Baptist Cancer Institute
2013 Annual Report
patient accrual for all participants consisted of 42
cooperative group studies and 70 percent were
patients compared to the 35 patients in 2011 (Table 1).
industry sponsored pharmaceutical studies. This turn
Accrual throughout the campus has remained well
to industry trials was forced by poor reimbursement by
below 100 patients per year due to diverse reasons
NCI trials.
including increasing pressure on physicians to deal
All studies done on campus, either NC-sponsored
or pharmaceutical-sponsored were reviewed by the
Baptist Medical Institutional Review Board (IRB) for
appropriateness of research, conflict of interest and
protection of human rights. All studies were then
described in language understandable to the public in
with increasing patient volume, increasing complexity
of insurance and third party payment, as well as
reluctance of patients to participate in studies that may
cause economic pressure. Hopefully, patient accrual
will increase in 2013 to above 50 patients close to
years past.
an informed consent and also published on the Baptist
Baptist Cancer Institute continues to be an active
Cancer Institute website. Phases of studies including
community cancer education program offering CME
phase I, phase II and phase III were available in 2012.
sessions at the multi-specialty breast cancer conference,
In 2012, studies followed at the Baptist Cancer Institute
had led to FDA approval recently of Ipilimumab for
the treatment of metastatic melanoma, Aldo-herceptin
for the treatment of HER2+ breast cancer and afatinib
for the treatment of EGFR mutation positive non-small
cell lung cancer. In addition to treatment protocols,
a number of registry studies were done that include
SystHERs in HER2+ breast cancer that is metastatic,
treatment approaches in metastatic melanoma, as
well as studies in chronic myelocytic leukemia and
paroxysmal nocturnal hemoglobinuria. The 2012,
neuro-oncology conference, lung cancer conference
and tumor board. Table 2 lists the subjects of the
annual tumor board for 2013. Table 3 lists the active
participants in the cooperative groups at Baptist
Medical Center, as well as those involved in the research
programs of the NSABP and RTOG study groups. In
summary, the Baptist cancer program continues to
offer exciting clinical projects through both cooperative
group mechanisms as well as pharmaceutical studies.
A great deal of enthusiasm on the campus exists for
continuing to increase patient accrual and increasing the
relevance of clinical trials for every day treatment.
31
Baptist Cancer Institute 2013 Annual Report
30 percent of the studies were through NCI-sponsored
Baptist Cancer Institute 2013 Annual Report
32
Ta ble 1 Clinical Research BCI: 2009 – 2012
Year
# of Patients
2009
90
2010
65
2011
35
2012
42
Ta ble 2 Tumor Board: 2013
Gallbladder Cancer 1/713
John Crump, MD
Lung Cancer Staging 2/21/13
Harry D’Agastino, Jr., MD
Two Interesting Head and Neck 4/11/13
Troy Guthrie, MD
Accuboost Lumpectomy 4/18/13
Michal Woolski, MD
Myelodysplastic Syndrome 5/9/13
Troy Guthrie, MD
Portal Vein Thrombosis 5/16/13
Dimitrios Agaliotis. MD
Management of Uterine Cancer 5/3013
Mark Augspurger, MD
Two Strange Cancer Patients 6/6/13
Troy Guthrie, MD
New Options for the Management of Bone 6/13/13
Cynthia Anderson, MD
What’s my “cell” line? 6/20/13
Paul Oberdorfer, MD
Brain Metastases 8/8/13
Troy Guthrie, MD
Two Interesting but Unfortunate 9/19/13
Dimitrios Agaliotis, MD
From daVinci to Disruptive Innovation 9/5/13
John Murray, MD
Genetic Update 2013 10/17/13
Melinda Fawbush, MSN,ARNP
The Management of Prostate Cancer 12/1913
Mark Augspurger, MD
Table 3
RTOG
Dimitrios Agaliotis, MD, PhD – Medical Oncology
Cynthia Anderson, MD – Radiation Oncology
Jeff Bubis, DO – Medical Oncology
Mark Augspurger, MD – Radiation Oncology
Stephen Buckley, MD – Gynecologic Oncology
Jessica Bahari, MD – Radiation Oncology
Catherine Bush, RN, OCN, BSN – Study coordinator
Abhijit V. Deshmukh, MD – Radiation Oncology
Andrea Canto – Study Coordinator
Kenneth Goldstein, MD – Radiation Oncology
Carlos Castillo, MD – Medical Oncology
Troy Guthrie, MD – Medical Oncology
Roxane Green – Regulatory Coordinator
Douglas W. Johnson, MD – Principal Investigator
Troy Guthrie, MD – Principal Investigator, ECOG, NSABP, Mayo Trials Group
Anand Kuruvilla, MD – Radiation Oncology
Zhen Hou, MD, PhD – Medical Oncology
Carla Malott, RN – Clinical Research Associate
Douglas W. Johnson, MD – Sub-Investigator, Radiation Oncology
Thomas Marsland, MD – Medical Oncology
Robert A. Joyce, MD – Medical Oncology
Lois Morgan, RN – Clinical Research Associate
Mohammad Khan, MD – Medical Oncology
Michael Olson, MD – Radiation Oncology
Mathew Luke, MD – Medical Oncology
Niraj Pahlajani, MD – Radiation Oncology
Alan Marks, MD – Medical Oncology
Shyam Paryani, MD – Radiation Oncology
Joseph Mignone, MD – Medical Oncology
Jan Peer, CCRP – Clinical Research Associate
Yuval Naot, MD – Medical Oncology
Sonya Schoeppel, MD – Radiation Oncology
Jeanine Richmond, RN, BSN, OCN, - Study Coordinator
Neenad Sha, MD – Radiation Oncology
Matthew Robertson, MD - Gynecologic Oncology
Dwelvin Simmons, MD – Radiation Oncology
Mila Shteyn, MA - Study Coordinator
Robert Still, MD – Surgeon
Unni Thomas, MD – Medical Oncology
J. Wynn Sullivan, MD – Medical Oncology
Maria Valente – Medical Oncology
Linda Sylvester, MD – Medical Oncology
Mitchell Terk, MD – Radiation Oncology
Carlos Vargas, MD – Radiation Oncology
Prevention (NSABP and SWOG)
Andrea Canto – STAR Program Coordinator
John Wells, MD – Radiation Oncology
Larry Wilf, MD – Nuclear Medicine Radiologist
Michal Wolski, MD – Radiation Oncology
Troy Guthrie, MD – Principal Investigator
Cancer Risk Assessment
and Genetics
Melinda Fawbush, ARNP, MSN
Troy Guthrie, MD – Principal Investigator
33
Baptist Cancer Institute 2013 Annual Report
Cooperative Group Trials (BCI)
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Jacksonville, Florida 32207
904.202.2273
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