Download Oncology Services Annual Report

Oncology Services
Annual Report
2008 Program Update (2007 Statistical Review)
Friends and Colleagues
We are very proud to present the Oncology Services Annual Report for Miami
Valley Hospital (MVH). This year’s report includes an overview of the services
available at MVH, a detailed discussion about the diagnosis and treatment of
pancreatic cancer, and the statistical review for calendar year 2007.
Building on the American College of Surgeon’s Commission on Cancer approval
with Commendation in 2006, MVH has expanded its surgical oncology, breast
cancer, gynecologic, and outreach/education programs. The expansion of these
programs demonstrates our commitment to offer comprehensive cancer care
with a full range of quality services and equipment.
Paula Termuhlen, MD, became the medical director of Surgical Oncology at
MVH in 2007. In this role, Dr. Termuhlen has strengthened the interdisciplinary
team of cancer care specialists available at MVH. For example, she worked with
Cancer Liaison Physician Stan Jenkins, MD, and numerous others to develop the
High Risk Breast Cancer Clinic planned to open in 2009. This team was also
instrumental in bringing a second breast cancer coordinator to the program.
Nancy Thoma, RN, BSN, has already joined Amy McKenna, RN, BSN, assisting
women from the point of abnormal mammography through cancer diagnosis,
treatment, and on to recovery.
Table of
Contents
Pancreatic Cancer............1
The Cancer Team ............7
Cancer Prevention and
Education..........................11
Support Groups ............12
Oncology Information
Center ................................13
Primary Site Incidence
Report (2007)..................14
Cancer Conferences
(2007) ................................16
Glossary ............................16
Miami Valley Hospital
Tom Reid, MD, medical director of the region’s only Gynecologic Oncology Center,
and the center’s staff designed and moved into a new facility on the MVH campus.
The new center offers women with gynecologic cancers outstanding care by an
interdisciplinary team in one location. Additionally the Gynecologic Oncology
Center welcomed Jackie Roethlisberger, RN, NP, as nurse practitioner in 2008.
Cancer awareness and outreach programs offered screening information to MVH
employees, physicians, volunteers and visitors. During the year, we expanded
our offerings to include colorectal, skin, gynecologic, prostate, breast and lung
cancers, reaching more than 3,000 people.
Cancer care requires a team effort involving surgical oncologists, gynecologic
oncologists, general surgeons skilled in oncology, radiation oncologists, medical
oncologists, pathologists, radiologists, dietitians, social workers, care coordinators,
clinical nurse specialists and nurse practitioners, oncology certified nurses,
clinical research nurses, pastoral care staff, physicists, dosimetrists, technicians,
administrators, volunteers and numerous other health care providers. Through
the efforts of these team members, MVH excels at offering high quality cancer
care to patients throughout our region. We would like to thank the team for
their continued efforts to provide exceptional cancer care!
For more information on Miami Valley Hospital cancer programs, select the
Cancer Care link on our Web page, mvh.org.
Sincerely
Basel Yanes, MD
Medical Oncologist
Chairman, Oncology Committee
Claire Rodehaver, RN, MS, NE-BC
Director of Oncology and Nursing
Pancreatic Cancer Diagnosis
and Evaluation
By Lisa Stone, MD, Gastroenterology
Pancreatic cancer remains a devastating disease
for those who are unfortunate enough to acquire
it. At the time of diagnosis, only 15-20 percent of
tumors are deemed resectable through surgery.
Several imaging modalities are available and
vary in the information provided. Computed
tomography (CT) and/or transabdominal ultrasound are frequently done first, with the mass
often visualized easily. Magnetic resonance
imaging sometimes is done, but usually provides
similar information to CT. Endoscopic retrograde
cholangiopancreatography (ERCP) will demonstrate strictures of the pancreatic and/or
common bile duct if the tumor encompasses
these structures. Sampling can be done at ERCP
by brushing the duct; however, obtaining cells
can be difficult from these scirrhous tumors
and the sensitivity is only about 50 percent.
Much of the difficulty arises from the lack of
symptoms until late in the disease and the
aggressive nature of the cancer. A five-year
review of patients treated at Miami Valley
Hospital found that 73 of 157 cases were
classified as AJCC (American Joint Committee
on Cancer) Stage IV (see table below). Of the
73 Stage IV cases, 65 were confirmed to have
metastatic lesions in the bone, CNS, liver, lung,
adrenal gland, pleura, supraclavicular lymph
node and/or peritoneum.
A newer imaging modality, endoscopic ultrasound (EUS), has become quite useful and
important in diagnosing and staging pancreatic
cancer. EUS uses a small transducer attached to
the end of a specialized endoscope which is
passed through the mouth to the duodenum.
A small working channel is incorporated in
the scope, which allows for passage of a fine
needle used to aspirate tissue or fluid.
Commonly, patients will present with painless
jaundice, weight loss, anorexia, dark urine and
light stools. Some may present with severe
abdominal pain, but no jaundice. Diagnosis
rests largely on imaging and biopsy if a mass
is demonstrated and is amenable to biopsy.
The tumor marker CA19-9 is helpful, but a
normal result does not exclude cancer, nor
does an elevated result prove the diagnosis, as
other conditions such as pancreatitis can cause
an elevation.
Because the transducer is within a few
millimeters of the pancreas, resolution is
superior and structures less than 1 millimeter
can be visualized.
Pancreatic Cancer Incidence
Miami Valley Hospital, 2001-2005
Year
2001
2002
2003
2004
2005
Total
Cases
26
39
30
33
29
Gender
Race
M F W B CH
14
17
14
18
15
12
22
16
15
14
21
33
29
29
23
5
5
1
4
6
157 78 79 135 21
30-39 40-49
Age Range
50-59 60-69 70-79 80-89
90+
0
I
AJCC Stage
II III IV UNK
0
2
6
3
2
9
4
9
1 10
4
1
3
2
5
B/B
0
1
0
0
0
0
0
2
0
0
2
1
2
1
1
4
8
5
8
1
6
10
8
6
9
8
12
10
12
9
4
8
3
5
8
2
0
0
1
1
0
0
0
0
0
16
23
13
11
10
4
3
2
6
0
0
3
1
1
3
1
2
7
26
39
51
28
4
0 13 33 15 73
15
8
Oncology Services Annual Report • 1
Since EUS is invasive, it is usually not the first test done. Typically when a mass is seen on CT, EUS is
done for fine needle aspirate (FNA) and staging, which is important in determining resectability.
Literature has shown that management decisions change up to 50 percent of the time after
EUS is completed. A tumor initially thought to be resectable may not be, due to previously
unseen metastasis or major arterial encasement.
During EUS, direct measurements can be taken for accurate T staging; lymph nodes can be
aspirated for N staging; and at times if present, lesions suspicious for metastasis to the liver,
left kidney, adrenal gland, stomach or duodenum can be sampled as well. Overall, various
studies have shown that EUS with FNA has a sensitivity of 70-90 percent, a specificity of
100 percent, and an accuracy of 76-92 percent. The sensitivity can remain quite high if a
cytopathologist is present at the bedside. The ultrasonographer can continue making needle
passes until sufficient tissue is acquired.
False negative rates are quite low, as are complication rates. Pancreatitis occurs in less than
1 percent of cases. Bleeding is quite rare largely due to the ability to employ color flow Doppler
and avoid vessels when aspirating. Overall, EUS has become an important tool in the diagnosis
and staging of pancreatic carcinoma.
2 • Miami Valley Hospital
By Thav Thambi-Pillai, MD, Hepato-Biliary and Pancreatic Surgery
More than 37,000 people are diagnosed with
pancreatic carcinoma each year in the United
States. Surgical resection along with systemic
and radiation therapy is the only chance of cure
for these patients. Unfortunately, due to late
presentation of the disease, only about
20 percent of patients are candidates for
curative surgery. Others may be candidates
for either palliative bypass surgery and/or
chemotherapy and radiation therapy (see table
page 4).
The type of surgery required for each patient depends on two factors:
location and stage of the cancer. In some instances, the surgery may be
performed laparoscopically, which has the benefit of a shorter hospital
stay, less pain and earlier return to normal activities.
For tumors in the head of pancreas, pancreatico-duodenectomy –
better known as the Whipple procedure – is the surgery of choice.
Pylorus-preserving pancreatico-duodenectomy is an option for small
tumors of the head of the pancreas or for periampullary cancers. Distal
pancreatectomy is the surgery of choice for tumors in the body or tail of
the pancreas. Total pancreatectomy is rarely performed for pancreatic
carcinoma since it is associated with higher morbidity and mortality.
Centers specializing in Hepato-Biliary and Pancreatic (HBP) surgery,
including Miami Valley Hospital, offer curative surgery and multimodality therapy for locally advanced pancreatic cancers. These complex
cases are managed by a team of experts in HBP representing the fields
of Surgery, Gastroenterology, Medical Oncology, Radiation Oncology
and Interventional Radiology.
About three decades ago, the perioperative mortality for the above
listed surgeries was as high as 15 percent. Now, in high-volume
institutions such as MVH, the mortality is less than 4 percent. Our
cumulative data over a period of five years indicate that our rate of
curative surgery and long-term patient survival are comparable to
that of other high-volume centers (see graph right).
Unfortunately, there are no good screening tools available for pancreatic
carcinoma. The cornerstone for successful therapy for pancreatic tumors
is early diagnosis. In a few instances, in order to avoid misdiagnosis, we
operate on patients without a tissue diagnosis just based on clinical,
radiological and/or laboratory findings.
Miami Valley Hospital, 2001-2005
Site
Head of pancreas
Body of pancreas
Tail of pancreas
Duct of pancreas
Other area of pancreas
Overlapping of pancreas
Pancreas, NOS
Total
Cases
Percent
85
10
23
1
2
9
27
54.1%
6.4%
14.6%
0.6%
1.3%
5.7%
17.2%
157
100.0%
Histology
Miami Valley Hospital, 2001-2005
Histologies
Cases
Percent
Adenocarcinoma
Carcinoma, NOS
Duct carcinoma
Islet cell carcioma
Mucious
adenocarcinoma
Carcinoid tumor
Large cell carcinoma
Mucin-producing
adenocarcinoma
Neoplasm
Acinar cell
carcinoma
Adenosquamous
carcinoma
Gastrointestinal
stromal sarcoma
Leiomyosarcoma
Neuroendocrine
carcinoma
Spindle cell carcinoma
121
10
6
3
77.1%
6.4%
3.8%
1.9%
3
2
2
1.9%
1.3%
1.3%
2
2
1.3%
1.3%
1
0.6%
1
0.6%
1
1
0.6%
0.6%
1
1
0.6%
0.6%
Total
157
100.0%
Comparative Observed
Survival (20 months)
Surgical Treatment – Miami Valley Hospital, 2001-2005
100
90
80
70
60
50
40
30
20
10
0
Percent
Surgical Treatment Options
in Pancreatic Carcinoma
Subsites of Pancreas
At 3
Dx
MVH
6
9
12 15 18 20
Months
CIRF
Oncology Services Annual Report • 3
First Course of Therapy – Pancreatic Cancer
Miami Valley Hospital, 2001-2005
No Cancer-Directed Surgery
No treatment
No treatment lymph node distant site
Palliative
Chemotherapy
Chemotherapy distant site
Radiation therapy
Radiation therapy and chemotherapy
Total
Surgical Treatment
Percent
77
1
1
21
1
2
20
49%
0.6%
0.6%
13%
0.6%
1%
13%
123
78%
Cases
Percent
Partial pancreatectomy, NOS
Local pancreatectomy without gastrectomy
Whipple procedure
Extended pancreatoduodenectomy
Surgery, NOS
7
1
22
3
1
5%
0.6%
14%
2%
0.6%
Total
34
22%
157
100.0%
Accumulative First Course of Therapy Total
4 • Miami Valley Hospital
Cases
Pancreatic Cancer: Recent Advances in
Medical Therapy
By Malek Safa, MD, Medical Oncology
The role of chemotherapy in the treatment of
pancreatic cancer has been largely palliative
because of the condition’s poor prognosis.
Despite this palliative goal, the overwhelming
majority of chemotherapy trials conducted
during the past two decades measured
tumor response and survival rates to evaluate
efficacy. In recent years, clinical trials in
advanced pancreatic cancer have also in
corporated symptom improvement end points
as additional evidence of clinical benefit.
Cytotoxic Chemotherapy
Historically, 5FU was considered the standard
treatment in advanced pancreatic cancer with
reported response rates of less than 20 percent
and without documented improvement in
disease-free or overall survival. Gemcitabine,
a purine analogue, was compared to 5FU in a
randomized trial of 126 patients with
advanced pancreatic cancer. The number of
patients experiencing a clinical benefit was
significantly greater among the group
randomized to Gemcitabine than in the 5FU
treated group. There was also a statistically
significant improvement in overall and
progression of survival in patients treated
with Gemcitabine over 5FU. Subsequently,
Gemcitabine was used as the backbone
agent in future clinical trials using combined
chemotherapy. Several clinical trials focused
on new combination cytotoxic chemotherapy
with or without Gemcitabine; however, none
showed any improvement in survival as
compared to Gemcitabine alone.
pancreatic cancer. Erlotinib, a tyrosine-kinase
inhibitor of EGFR, was tested in combination
with Gemcitabine in a large phase III study
conducted by the National Cancer Institute of
Canada. Patients who received Gemcitabine
plus Erlotinib have a modest improvement
in 1-year survival as compared to patients
receiving Gemcitabine alone (23.8 percent vs.
19.4 percent) with hazard-ratio of 0.81. Based
on this trial, the FDA approved Erlotinib to be
used in combination with Gemcitabine for
patients with advanced pancreatic cancer.
A phase III trial of Southwest Oncology Group
(SWOG) presented at the American Society of
Clinical Oncology (ASCO) 2007 failed to show
any improvement in outcome for patients
treated with Gemcitabine plus Cetuximab (a
monoclonal antibody against EGFR) verses
Gemcitabine alone. Similarly, a phase III study
conducted by Cancer and Leukemia Group B
(CALGB) did not demonstrate superiority for
the combination of Gemcitabine plus
Bevacizumab (a monoclonal antibody against
Molecular-Targeted Therapy
Several compounds have been tested and
showed real promise in clinical benefit for
some solid tumors like colorectal cancers.
Many of these agents have been combined
with Gemcitabine in the treatment of
Oncology Services Annual Report • 5
VEGF) as compared to Gemcitabine alone.
Other targeted and novel agents are currently
being investigated for the treatment of
pancreatic cancer.
Adjuvant Therapy
In patients with pancreatic cancer who
successfully undergo complete tumor
resection, the risk of recurrence remains high
and is attributed to microscopic local and
metastatic disease. Therefore, the current
practice in the United States for adjuvant
therapy includes chemotherapy and
radiation therapy. Most patients will start
with chemotherapy (Gemcitabine) followed
by concurrent chemoradiation (either 5FU
or Capecitabine).
Radiotherapy and Pancreatic Cancer
By Douglas W. Ditzel, DO, Radiation Oncology
Pancreatic cancer remains a difficult problem.
While surgery is the mainstay of treatment,
adjuvant therapy has been documented to
provide modest benefits in survival. Despite
optimal surgery, only 10-20 percent of the
patients are alive in five years.
In cases where primary treatment fails,
approximately one third are due to local
recurrence, one third due to distant metastasis,
and one third to both. This suggests that
local control is of the utmost importance,
and thus the rationale for adjuvant radiation
therapy. Morbidity associated with local
recurrence includes pain, biliary obstruction
and bowel obstruction. In addition, one could
argue that if local control is optimized, there
will be a survival benefit.
Historically, two randomized trials have
suggested a survival advantage with the
addition of postoperative adjuvant
radiotherapy and chemotherapy. These
finding were disputed by a European
randomized trial suggesting a detrimental
effect with the addition of radiation therapy.
A lack of centralized quality assurance
prompted controversy about the study’s
results. A more recent cooperative study
from Johns Hopkins and Mayo Clinic has
again supported the results of the earlier
trials.
In view of this and the obvious need for local
control for quality of life issues, we continue
to offer postoperative radiotherapy, with or
without chemotherapy, in the appropriate
good performance status patients. This
recommendation is supported by the
National Comprehensive Cancer Network
(NCCN) guidelines. Optimally, we should
enroll these patients in well-designed clinical
trials to better advance our knowledge and
control of this devastating disease.
6 • Miami Valley Hospital
The Cancer Team
Inpatient Units
Miami Valley’s nursing staff provides
inpatient care, specializing in surgical care,
chemotherapy administration, central venous
access devices, infusion services, cardiac
monitoring and the management of
immuno-suppressed patients. Three nursing
units are dedicated to the care of cancer
patients and their families: 5E/SE is a 28-bed
surgical/gynecologic oncology unit; 5NE is a
20-bed medical oncology unit and BMT is a
5-bed blood and marrow transplant unit. Many
of the staff are oncology-certified nurses.
Integrative Care Management
The Integrative Care Management team is
responsible for coordinating the care of
oncology patients during their hospital stay.
Members of the team include nurse care
coordinators, a social worker and an oncology/
surgical clinical nurse specialist. The ICM
team works closely with all members of the
health care team in providing comprehensive
care and a seamless discharge transition.
Additionally, breast cancer coordinators are
available to assist women through the diagnosis and treatment of breast cancer. The
breast cancer coordinators provide patients
with educational information regarding breast
cancer and breast cancer treatments as well
as information on supportive services at
Miami Valley Hospital and in the community.
Oncology Services Annual Report • 7
energy in food (the gas, if you will) is what
allows your body to run. Foods that meet the
National Cancer Institute’s guidelines for
prevention can provide the “premium grade”
gas for your body to function at peak levels.
These guidelines include:
• Increase the amount of fruits, vegetables
and whole grains that you eat each day.
These foods contain natural protective
benefits, and are better eaten rather than
taken in pill form.
• Moderate your intake of fat.
Nutrition in Pancreatic Cancer
By Natalie Fuller, RD, LD
Nutrition plays an important role in both
health and disease. When pancreatic cancer is
diagnosed, patients often will wonder, “What
did I eat to cause this?” There is no definitive
link between diet and pancreatic cancer,
however, what you eat and how much you
eat is linked to an improved feeling of
wellness during treatment and recovery.
Pancreatic cancer may present challenges
to good nutrition, but these challenges can
be met.
Before diagnosis, some patients may experience
a lack of appetite. Decreased food intake,
coupled with the disease, can lead to weight
loss. Pancreatic cancer can also result in altered
insulin and digestive enzyme production,
making adequate nutrition difficult.
Treatment-related fatigue and stress may
also lead to altered food intake.
As members of the treatment team, the
registered dietitian and registered dietetic
technician are available to offer strategies to
make food more enjoyable and desirable. They
can identify your specific nutrient needs and
assist you in developing a plan that will fit
your individual tastes, tolerances and lifestyle.
These professionals, along with other members
of your treatment team, can help you get
through this bump in the road to recovery.
Everyone knows that without gas your car will
not run. The same applies to your body. The
8 • Miami Valley Hospital
• Achieve and maintain a healthy weight.
Healthy eating and healthy lifestyle are both
important to your recovery and survival. The
nutrition professionals at Miami Valley
Hospital are committed to partnering with
you to help you achieve both.
Pharmacy Services
Providing optimal care to each individual
patient often requires a multidisciplinary
team approach, and Pharmacy Services is a
part of the team.
One of the major roles of the pharmacist is to
prepare and dispense medications while ensuring that these drugs are safe and effective for
each patient. Pharmacists review medication
orders and evaluate the medication profile
for drug interactions, duplicate therapy,
patient allergies, and appropriate dosing.
Pharmacists provide drug information to
the medical and nursing staff as well as to
patients. Pharmacy Services works with
Nutrition Services to implement and manage
parenteral nutrition for oncology patients.
With each treatment modality, there may
be side effects that must be managed to
preserve or improve the patient’s quality of life.
Pharmacists can offer recommendations for
medications to help control side effects such
as nausea, vomiting, pain and anemia.
Throughout their interaction with other health
care professionals – physicians, nurses and
support staff – Miami Valley Hospital
pharmacists constantly strive to ensure high
quality care for oncology patients.
Pastoral Care and Counseling
A diagnosis of cancer can test personal
emotional boundaries. A chaplain from the
Department of Pastoral Care and Counseling
can provide compassionate care in times of
physical, emotional, and spiritual stress. Our
professionally trained chaplains respond to
requests 24 hours a day for patient visits and
referrals to assess spiritual needs.
We provide church notification and affirmation
of the patient’s own faith and values. In addition, we offer comfort to the patient and grief
support for family and friends at the end of
life. The hospital’s Interfaith Chapel is a quiet
respite for prayer and medication, available
around the clock for patients and their
families, friends and caregivers.
The chaplain can be contacted at any time
by phone during office hours, 8 a.m. to
4:30 p.m., at (937) 208-2499.
Oncology Services Annual Report • 9
Palliative Care
Clinical Trials
Cancer can be a serious illness that patients
and their families face together. Symptoms of
cancer or its treatments may be uncomfortable. Additionally, families facing cancer may
have a lot of new information to understand.
Cancer clinical trials are research studies,
conducted with volunteer participants, to
assess the safety and efficacy of new
approaches to prevent, detect, diagnose and
treat cancer. Standard treatments used today
are the direct result of clinical trials of the
past. About 50 Miami Valley Hospital patients
enroll in clinical trials each year (see Primary
Site Incidence Report, pp. 14-15). Access to
clinical trials is through the Dayton Clinical
Oncology Program (DCOP) and Wright State
University Boonshoft School of Medicine. To
learn more about local clinical trials, call Patti
Adams, RN at (937) 208-2387 or visit
www.med.wright.edu/dcop.
The Centers to Advance Palliative Care (CAPC)
state that, “The goal of palliative care is to
relieve the pain, symptoms and stress of
serious illness, whatever the diagnosis or
prognosis. It is appropriate for people of any
age and at any point in an illness. It can be
delivered along with treatments that are
meant to cure you.”
The Palliative Care team at Miami Valley
Hospital helps patients and families feel
more comfortable, informed and empowered,
focusing on improving quality of life.
Cancer Liaison
Physician
By Stan Jenkins, MD
Members of the Palliative Care team work
closely with the oncology care team and
hospice organizations, when appropriate,
promoting a comforting environment for
cancer patients and their families.
The cancer liaison
physician serves as a
physician champion of
the cancer program,
as the liaison between
the program and the
Commission on Cancer,
and as a community change agent.
These volunteer individuals manage clinically
related cancer activities in their local institution
and surrounding community. The physician
ensures compliance with the Commission on
Cancer standards and supports improving the
quality of care delivered to cancer patients.
Community outreach includes strengthening
relationships with the American Cancer Society
to reduce the burden of cancer in the
community.
Miami Valley Hospital has outstanding oncology
services. The hospital contributes to community
activities by offering cancer education,
prevention, and screening activities. MVH is
an active member of the American Cancer
Society supporting community outreach
activities. In addition, as part of the community quality of life group, we assist in facilitating an annual survivorship presentation.
10 • Miami Valley Hospital
Cancer Prevention and
Education
On behalf of Miami Valley Hospital, Premier
Community Health (PCH) offers community
health programs focusing on prevention,
early detection and disease self-management
of four chronic disease areas. One of those
areas is cancer. The cancer sites targeted are
breast, colorectal, skin, prostate and lung.
Breast and Cervical Cancer
PCH houses the Breast and Cervical Cancer
Early Detection Program (BCCP), which is
funded by the Ohio Department of Health with
a grant from the Centers for Disease Control.
This program provides free mammograms,
Pap testing and some advanced diagnostics
for women who do not have health insurance.
Other grants to PCH provided an additional
480 free mammograms for uninsured or
underinsured women who were ineligible for
BCCP in 2007.
Colorectal Cancer
To promote early detection, MVH participates
in an annual colorectal cancer screening
campaign called Test for Life. This program is
a collaborative effort of PCH, MVH, Good
Samaritan Hospital, Atrium Medical Center,
WDTN-TV2, Kroger pharmacies, the National
Cancer Institute’s Cancer Information Service,
and Vectren. Test for Life distributed free fecal
occult blood test kits to more than 11,000
people in 2007. Of those, 4,051 (36.8 percent)
sent a results card after taking the test.
Skin Cancer
Each May, Miami Valley Hospital collaborates
with the Wright State University Boonshoft
School of Medicine’s Department of
Dermatology, the American Cancer Society,
Good Samaritan Hospital and Kettering
Medical Center to offer free skin screenings
at locations throughout the area. In 2007,
577 people were screened at eight locations.
Oncology Services Annual Report • 11
Prostate Cancer Screening
Miami Valley Hospital and other Premier
Health Partners hospitals offer prostate
screening each September. Men age 50 and
older (45 if African American) can receive a
free PSA blood test and a digital rectal exam
(DRE) performed by a physician. In 2007,
106 men obtained screening at Miami Valley
Hospital.
Lung Cancer Prevention and
Awareness
Individuals who smoke and are hospitalized
at MVH can be referred for one-on-one
counseling by respiratory therapists who are
certified smoking cessation counselors.
Premier Community Health offers the services
of a certified smoking cessation counselor
free of charge. MVH staff members also sit
on the local Smoke Free Task Force.
Support Groups
Continuing the Journey
Adults who have undergone or are considering
a blood and/or bone marrow transplant are
invited to attend this free monthly support
group. Family members and friends also are
welcome
Meets: fourth Wednesday of each month
from 10 - 11 a.m.
Contact: Ellen Cato, (937) 208-2252
Still Me of the Greater Dayton Area
Breast cancer patients, their families and
friends are welcome to join this group,
which provides cancer information, hotline
counseling, education, and self-help
meetings. Free refreshments and parking.
Meets: third Tuesday of each month from
7 - 8:30 p.m.
Contact: Nancy Thoma, (937) 208-2743
These additional resources are available to
Miami Valley Hospital patients and families.
For information on program dates, contact
the American Cancer Society, (800) 227-2345.
I Can Cope
I Can Cope is a free series of workshops geared
toward helping newly-diagnosed cancer
patients, their families and friends. Sessions
help to dispel cancer myths by presenting
straightforward facts about cancer, as well as
providing answers to cancer-related questions.
Man to Man
For men coping with prostate cancer, Man to
Man offers support to both patients and their
families. Participants learn about prostate
cancer, how to manage the disease and its
treatment, including side effects.
Myeloma Support Group
Look Good … Feel Better – for Women
This group is for patients with multiple
myeloma and their families and friends. The
meeting includes information sharing and
discussion. Free refreshments and parking.
This group program is facilitated by a trained,
volunteer cosmetologist who teaches women
how to cope with skin changes and hair loss,
the most common appearance-related side
effects of cancer treatment. Free self-help
materials are also available by calling the
Look Good … Feel Better toll-free number,
(800) 395-5665.
Meets: first Thursday of each month from
6 - 7 p.m.
Contact: Leukemia & Lymphoma Society,
(866) 671-2873
12 • Miami Valley Hospital
American Cancer Society Community
Programs
Oncology Information Center
By Iris Daniels, CTR
In more than 1,400 Commission on Cancerapproved cancer programs, data specific to
cancer patients are collected. Cancer data
collection is done in 49 of the 50 states. In
Dayton, Miami Valley Hospital has the largest
cancer program. Our program’s reference year
is 1967.
Miami Valley Hospital’s Oncology Information
Center, commonly known as the Registry, is a
data system for the collection, management
and analysis of information on all cancer
patients diagnosed and treated at our facility.
The Registry is maintained for both educational and research purposes as well as for
lifetime patient follow-up. It also serves as a
reminder to patients and doctors to schedule
regular examinations so any recurrence of
the disease can be detected early. Specialists
in data collection record essential information about disease management. Certified
tumor registrars ensure that the information
is complete and accurate.
What information is collected by
the Registry?
The information collected by the Registry
includes:
• Demographic information: age, sex, race
and place of residence.
• Medical history: medical findings, date of
original diagnosis and details of any prior
treatment.
Data collected by the Registry
is used to:
• Calculate survival rates by site, stage of
disease and other variables.
• Provide follow-up information on cancer
patients for evaluation of patient care,
treatment, survival and early detection of
disease recurrence.
• Group and tabulate information by selected
variables specified by doctors and other
researchers to help in future understanding
of the disease.
• Develop guidelines and procedures for
patient management.
• Aid the hospital Oncology Committee to
evaluate the hospital’s cancer program.
• Analyze referral patterns of cancer
patients to identify needs for future
health care facilities and programs.
• Develop education programs and material
for medical personnel, patients and the
public.
• Monitor activities of Miami Valley Hospital’s
cancer program, which is approved by the
American College of Surgeons
Commission on Cancer*
For more information about our data, please
call (937) 208-2349 or (937) 208-2731.
*Miami Valley Hospital is an
accredited Teaching Hospital
Category Cancer Program of the
American College of Surgeons
Commission on Cancer (CoC).
The CoC is dedicated to reducing
the morbidity and mortality of
cancer through education, standard setting and monitoring of
quality of care.
• Diagnostic findings: types, dates and
results of procedures and techniques.
• Treatment modalities: surgery,
chemotherapy, hormonal therapy,
radiation therapy and other types.
Patient information is strictly confidential. The
data is analyzed and reported to the state (as
required by law) and to the National Cancer
Data Base (NCDB). Individual cancer patients
are never identified outside the Registry system.
Oncology Services Annual Report • 13
Oncology
Information Center
2007 Activities
Report
Total caseload since
1967: 51,441
Analytic case follow-up rate: 91 percent
Requests for data: 29
Studies reported:
• Carcinoma of Pancreas: 2001-2005
• Stage III Colon Cancer: 1998-2004
Reported aggregate data to:
• Every month, data is submitted to the
Ohio Department of Health via their
central registry, Ohio Cancer
Incidence Surveillance System (OCISS),
to comply with the state standard
that cancer is a reportable disease.
• All approved cancer programs submit
data to the National Cancer Data
Base (NCDB). The call for data occurs
in December of each year. Data
review was completed for each case
identified by GenEdits data check.
• Answered the Commission on
Cancer Call for Special Study on:
– 2003-2004 Performance
Standards for Breast Cancer
under the age of 70
– 2003-2004 Performance
Standards for Colon Cancer
Continuing education attendance:
• Quarterly Miami Valley Cancer
Registrars Association
• Annual Ohio Cancer Registrars
Association
• National Cancer Registrars
Association
Registry staff:
There are three certified tumor
registrars on staff of 4.6 FTEs.
14 • Miami Valley Hospital
2007 Primary Site Incidence Report
Topography
Head and Neck Sites
Tongue
Salivary Glands
Floor of Mouth
Gum & Other Mouth
Nasopharynx
Tonsil
Oropharynx
Hypopharynx
Other Oral Cavity
& Pharynx
Total Head & Neck
Total Gender Class of Case
Cases M F ANAL N/ANAL 0
1
AJCC’s TNM Stage
Clinical
2 3 4 UNK N/A B/B Trials
3
4
4
3
0
4
1
0
2
3
4
2
0
4
1
0
1
1
0
1
0
0
0
0
2
4
4
3
0
3
1
0
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
1
1
0
0
0
0
1
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
1
2
3
1
0
0
1
0
0
0
0
1
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
19
0 0
16 3
0
17
0
2
0
0
0
3
0
2
0
1
0
8
0
3
0
0
0
0
0
0
0
3
0
2
3
0
0
1
2
1
5
0
0
2
0
0
0
3
0
0
0
1
0
0
Digestive System
Esophagus
Stomach
Small Intestine
Large Intestine
Cecum
Appendix
Ascending Colon
Hepatic Flexure
Transverse Colon
Splenic Flexure
Descending Flexure
Sigmoid Colon
Large Intestine, NOS
Colon, Excluding Rectum
4
14
5
3 1
10 4
5 0
3
14
5
1
0
0
0
0
0
19
1
17
5
13
3
2
32
10
102
9
0
9
5
3
1
1
14
6
48
10
1
8
0
10
2
1
18
4
54
19
1
17
5
13
3
2
32
5
97
0
0
0
0
0
0
0
0
5
5
2 2 6
0 0 0
1 1 8
1 2 1
1 5 3
0 0 1
0 1 0
2 4 7
0 0 0
7 15 26
5 3
0 0
5 2
0 1
2 2
1 1
1 0
12 6
1 4
27 19
1
0
0
0
0
0
0
1
0
2
0
1
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
6
Rectosig Junction
Rectum
Rectum & Rectosig Junct
9
23
32
3 6
15 8
18 14
8
23
31
1
0
1
0
3
3
0
4
4
2
7
9
1
6
7
4
2
6
1
1
2
0
0
0
0
0
0
0
0
0
Anus Canal
Liver
Intrahepatic Bile Duct
Total Liver & Intrahep Bile
1
15
1
16
0
12
0
12
0
14
1
15
1
1
0
1
0
0
0
0
0
3
0
3
0
1
0
1
0
1
1
2
0
3
0
3
0
6
0
6
0
0
0
0
0
0
0
0
0
0
0
0
Gallbladder
Biliary Tract Parts
Pancreas
Other Digestive Organs
Total Digestive System
6
2
6
2
30 21
0
0
220 123
4
6
4
6
9 30
0
0
97 212
0
0
0
0
8
0
0
0
0
10
4 0
3 0
2 6
0 0
35 48
0 1 1
1 2 0
5 11 2
0 0 0
45 51 15
0
0
4
0
8
0
0
0
0
0
0
0
1
0
7
Respiratory System
Accessory Sinus
Larynx
Non-small Cell Lung
Small Cell Lung
Trachea, Mediastinum
Total Respiratory System
0
0
16 12
146 82
32 17
0
0
194 111
0
0
4 16
64 140
15 31
0
0
83 187
0
0
6
1
0
7
0 0 0
0 8 1
0 29 12
0 1 2
0 0 0
0 38 15
0 0 0
2 4 1
35 56 8
9 17 2
0 0 0
46 77 11
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
1
0
3
1
3
1
4
Bones and Joints
1
1
0
1
0
0
0
0
0
0
1
0
0
0
Skin
Melanoma
Non-melanoma Skin
Total Skin Sites
25
3
28
15 10
2 1
17 11
22
2
24
3
1
4
0 12
0 1
0 13
0
0
0
6
1
7
1
0
1
3
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7
5
1
2
6
3
7
5
0
0
0
0
1
0
0
0
1
0
0
2
1
2
4
1
0
0
0
1
Peripheral Nerves
Retroperitoneum &
Peritoneum
Connective Tissue
2007 Analytic Cases
Topography
Breast
Total Gender Class of Case
AJCC’s TNM Stage
Clinical
Cases M F ANAL N/ANAL 0 1 2 3 4 UNK N/A B/B Trials
247 2 245 237 10 49 85 68 22 7 6 0 0
15
Female Organs
Cervix Uteri
Corpus Uteri
Uterus, NOS
Ovary
Vagina
Vulva
Other Female Genital
Total Female Organs
30
78
1
32
1
13
2
157
Male Organs
Prostate
Testis
Penis
Other Male Organs
Total Male Organs
156 156 0
10 10 0
1
1 0
1
1 0
168 168 0
27
77
1
30
0
11
2
148
3
1
0
2
1
2
0
9
0 13 4
1 49 3
0 1 0
0 6 4
0 0 0
2 4 2
0 0 0
3 73 13
150
10
1
1
162
6
0
0
0
6
0
0
1
0
1
0 131 10
6 1 1
0 0 0
0 0 0
6 132 11
30
78
1
32
1
13
2
157
4 4
14 6
0 0
14 6
0 0
2 1
1 1
35 18
2
2
0
0
0
0
0
4
0
2
0
0
0
0
0
2
0
0
0
0
0
0
0
0
6
2
0
2
0
0
0
10
6
0
0
0
6
3
2
0
0
5
0
0
0
1
1
0
0
0
0
0
5
0
0
0
5
3
4
1
0
8
6
6
0
0
12
2
4
0
0
6
0
1
0
0
1
0
0
0
0
0
0
1
0
0
1
0
0
0
0
0
0
0 0
0 22
0
2
0
2
Breast
Lung
Prostate
Colon/Rectosig
Junct/Rectum
Corpus Uteri
Urinary Bladder
Kidney & Renal Pelvis
Non-Hodgkins
Lymphoma
Pancreas
Uterine Cervix
All Sites Remaining
10
24
1
0
35
49
47
2
0
98
2
2
0
0
4
22
0
0
0
22
10 6
28 4
1 0
0 0
39 10
1
25
1 0
16 9
0
24
1
1
0
0
0
0
1
0
1
1
0
0
0
0
0
0
0
0
1
0
Total
27
17 10
25
2
0
0
0
0
0
0 22
3
2
Lung cancer is the second most common
cancer. Of 171 analytic lung cases, there
are 140 non-small cell lung cases.
Top 10 Major sites
2007 Analytic Cases by Gender
Genitourinary
Urinary Bladder
51
Kidney & Renal Pelvis
49
Ureter
2
Other Urinary Organs
0
Total Genitourinary System 102
Central Nervous System
Eye and Adnexa
Brain
Other Central Nervous
System
Total Central Nervous
System
0
0
0
0
0
0
0
0
Breast cancer continues to be the most
common form of cancer diagnosed and/or
treated at Miami Valley Hospital. Eightyfive percent of the newly diagnosed breast
cases were staged zero, one and two.
41
25
1
0
67
Primary Site
Cases Male Female
237
171
150
2
96
150
235
75
0
128
77
49
47
64
0
39
25
64
77
10
22
36
30
27
293
13
21
0
149
23
9
27
144
1245
559
686
Analytic Comparative Data*
Endocrine System
Thyroid
Other EndocrineIncluding Thymus
Total Endocrine System
21
3 18
20
1
0 13
2
2
1
2
0
0
0
4
25
2 2
5 20
4
24
0
1
0 0
0 13
0
2
0
2
0
1
0
2
2
2
2
2
0
0
Lymphoid System
Hodgkins Disease
ExtraNodal Hodgkins
Non-Hodgkins Lymphoma
ExtraNodal Lymphoma
Total Lymph Node
6
0
29
12
47
5
0
12
4
21
6
0
25
11
42
0
0
4
1
5
0 0
0 0
0 6
0 6
0 12
2
0
3
2
7
0
0
5
3
8
2
0
9
0
11
2
0
2
0
4
0
0
0
0
0
0
0
0
0
0
0
0
2
0
2
Hematopoietic and Reticuloendothelial Systems
Leukemia
15 7 8 14
Multiple Myeloma
13 5 8 12
Total Hemato/Reticulo
28 12 16 26
1
1
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 14
0 12
0 26
0
0
0
3
2
5
Mesothelioma
Kaposi Sarcoma
Unknown Primary Site
Accumulative Total
0
0
3
63
0
0
0
85
0
0
0
318
0
0
0
297
0
0
0
186
0
0
0
194
0
0
0
63
0
0
0
5
0
0
0
51
1
0
17
8
26
1
1 0
1
0
0 0
0
32 20 12 29
1308 584 724 1245
1
0
29
97
Note: the American Joint Committee on Cancer (AJCC) limits its classification to specific anatomical sites
and applicable to carcinoma, sarcoma, lymphoma, and melanoma.
Unknown stage = UNK
No applicable stage via TNM = N/A
Borderline malignancy/benign = B/B
Future statistics may vary slightly due to “late finding” cases.
Primary Site
MVH
Ohio1
USA2
Breast
Lung
Prostate
Colon/
Rectosigmoid/
Rectum
Corpus Uteri
Urinary Bladder
Kidney & Renal
Pelvis
Non-Hodgkins
Lymphoma
Pancreas
Uterine Cervix
16%
15%
13%
15%
16%
14%
15%
15%
12%
10%
6%
4%
12%
3%
5%
10%
3%
4%
4%
2%
3%
2%
3%
2%
4%
2%
0%
4%
3%
1%
*All percentages are calculated minused any
in situ lesions (except bladder); basosquamous
cell of skin; and benign/uncertain behavior.
1. Ohio Cancer Facts & Figures 2007, Ohio
Cancer Incidence Surveillance System (OCISS)
2. National Cancer Data Base (NCDB),
American College of Surgeons Commission
on Cancer
Oncology Services Annual Report • 15
Glossary
Cancer Conferences
Miami Valley Hospital cancer conferences met or exceeded all
of the following Commission on Cancer standards in 2007:
• Hold a minimum of 47 cancer conferences annually
• Maintain a log of cases presented
• Present at least 75 percent prospective cases
• Monitor for 80 percent multidisciplinary attendance (imaging,
surgery, pathology, medical oncology and radiation oncology)
• Discuss 10 percent of analytic caseload with emphasis on
five major sites
• Provide case presentation with lecture updates and/or new
information series
Total Cancer Conferences held
136
Meetings Multidisciplinary
Held
Attendance
Conference Types
Breast Care Conference: weekly
Gynecologic Oncology Conference:
weekly
Thoracic Oncology Conference:
semi-monthly
Tumor Board Conference: weekly
48
✓
26
✓
19
43
✓
✓
Attendance
Conferences are open to all oncologic interests.
Multidisciplinary attendance at cancer conference is required
and specified separate of general attendance for each meeting.
Total
Percent
Physicians
Residents
Non-physicians
1,361
290
919
53
11
36
Total attendance
2,570
100
Recommended for use by the American
College of Surgeons Commission on Cancer
since 1983. During the 1990s the Commission
mandated use of AJCC staging in approved
cancer programs to ensure consistent cancer
reporting.
The staging classification, either clinical or
pathological or both, determines:
In situ carcinoma or local tumor growth (T)
Regional lymph node involvement (N)
Distant metastasis (M)
Stage Grouping condenses the combinations (TNM) into a convenient number of
zero to four. The grouping adopted ensures
that each stage group is relatively homogeneous with respect to survival and that the
survival rates of these stage groupings for
each cancer site are distinct.
Analytic Cases
Cases diagnosed at MVH only, cases diagnosed
and treated at MVH, and cases referred to
MVH for part of first course of treatment
(a network clinic or outpatient center
belonging to the facility is considered part
of the facility).
Cancer Information Reference File (CIRF)
is a national database of IMPAC MRS Systems,
which contains more than 1.6 million cases.
Conference Formats
All conferences offer case presentation. The overall proportion
of prospective analytic cases presented was 41.4 percent of
1245 analytic cases, far exceeding the Commission on Cancer’s
10 percent mandate.
# of cases
Number first prospective case presentations
Number follow-up presentations
Number retrospective presentations
458
58
0
Total prospective presentations
516
Didactic Lecture Topics
Topics/Updates
Speakers
Cervical Cancer in Younger Women
Patrick J. Connelly, MD
16 • Miami Valley Hospital
AJCC (American Joint Committee on
Cancer) Staging
First Course of Therapy
includes all methods of treatment recorded
in the treatment plan and administered to
the patient before disease progression or
recurrence. “No therapy” is a treatment option
that occurs if the patient refuses treatment,
the family or guardian refuses treatment, the
patient dies before treatment starts, or the
physician recommends no treatment.
Oncology Committee
National Cancer Data Base (NCDB)
A joint program of the American College of
Surgeons Commission on Cancer (CoC) and
the American Cancer Society (ACS), NCDB is a
nationwide oncology outcomes database
containing approximately 20 million records
from 1,400 Commission-approved cancer
programs in the United States and Puerto
Rico.
Non-analytic Cases
Cases presenting for the first time at MVH
with recurrent cancer or never disease-free
with first course of treatment elsewhere,
diagnosed at autopsy, diagnosed and treated
in physician's office, pathology only.
Ohio Cancer Incidence Surveillance
System (OCISS)
Located at the Ohio Department of Health,
OCISS collects and analyzes cancer incidence
data for all Ohio residents. All Ohio providers
of medical care are charged, by law, with
reporting to the OCISS all cancers diagnosed
and/or treated in Ohio.
Basel Yanes, MD
Chairman
Social Services
Claire Rodehaver, RN, MS,
NE-BC
Stuart Merl, MD
Director, Oncology Services
Medical Oncology
Patti Adams, RN, MSN, OCN
Protocol Nurse
Elena Mikalauskas, RN,
MS, OCN, CNS
Lora Bogan, RN, MS, NE-BC
Oncology/Surgical Clinical
Nurse Specialist
Manager 5E/SE, 5NE, BMT
Rebecca Paessun, MD
Patrick J. Connelly, MD
The Life-table (Observed/Actuarial) Survival
Rate is a measure of survival of a patient group
for a specific period of time after diagnosis
(or treatment). Deaths from other causes are
treated just like deaths from cancer. Therefore,
the observed survival rate should be interpreted
as the likelihood of surviving all causes of death
for a certain time after cancer diagnosis, not
the likelihood of surviving that cancer. (The
closing date of the study is 12/31/2007.)
Radiation Oncology
Pathology/Cytopathology
Paula Pickering, RHIT
Iris Daniels, CTR
Pamela Engle, CTR
Health Information
Management
Oncology Information Center
Craig Pleiman, RPh
Elizabeth Delaney, RN,
CNS/CNP, OCN, BC-PC
Clinical Pharmacist
Nurse Practitioner
Jeanne Ponziani, RN, MSA,
NE-BC
Douglas W. Ditzel, DO
GYN Oncology Center
Radiation Oncology
Thomas Reid, MD, FACS
H. Stanley Jenkins, MD,
FACS
Gynecologic Oncology
General Surgery
ACOS Commission on Cancer
Liaison Physician
James Sabiers, MD
Medical Oncology
Paula M. Termuhlen, MD
Naomi M. Kane, MD
Survival Calculation Method
Jennifer Masny-Bushman,
MSW, LISW
Surgical Oncology
Diagnostic Radiology
Donald L. Wamsley, MD
Tom Kerschner, MDiv
Neurology
Chaplain, Pastoral Care
Burhan Yanes, MD
Jhansi Koduri, MD
Medical Oncology
Medical Oncology Chair
Registry Resource Physician
Alexander Little, MD
General Surgery
Oncology Services Annual Report • 17
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