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2008 Cancer Program Annual Report Comprehensive Cancer Care Close to Home A publication reviewing the 2008 Cancer Program Activities and Data 2008 Cancer Program Report 2008 marked four years of providing cancer services at Tammy Walker Cancer Center. The future poses more challenges, including increasing competition from cancer centers in surrounding areas, increasing costs of delivering cancer care, decreasing reimbursement for services delivered, difficulties recruiting and retaining staff and difficulties participating in clinical trials. It is important that we face these challenges with renewed vigor and see solutions rather than resign ourselves to defeat. We must be willing to think “outside the box” in out search for solutions. We can be proud of our accomplishments this past year. Our Avon grant was renewed, allowing us to continue cancer prevention and detection services in the region. The Cancer Center once again sponsored a Breast Cancer Forum for the public W.F. Cathcart-Rake with speaker, Kim Carlos, author of “Nordies at Noon”. We also provided the public M.D. free skin cancer screening and prostate cancer screening clinics and worked with the Kansas Department of Health and Environment (KDHE) to provide information and hemoccult kits to the public during the month of March. Tumor conferences continue to be held twice monthly, year-round. Educational opportunities provided included an Oncology Fair for nurses and Quarterly ONS chemo certification classes at Wesley Hospital in Wichita, Kansas. A great deal has been accomplished in the first 4 years of existence of Tammy Walker Cancer Center but much remains to be done. It is important that all members of the team remain united in the fight against the scourge of cancer. Respectfully, William Cathcart-Rake, MD Cancer Registry The cancer registry of Salina Regional Health Center collects, manages and analyzes cancer information on all cancer patients, which have been diagnosed and/or treated at our facility. Since 1994 the Salina Regional Health Center cancer registry has developed a data base of 9, 850 tumors in 9,331 patients. In 2008 the registry entered 649 new cancer cases into the database. Of the 649 cases 358 (56%) were male and 275 (43%) were female. The top five cancer sites for this year were: Prostate, Breast, Lung, and Colon/Rectum. (See graphs for more information on the 2008 cases). Colon/Rectal Cancer Colorectal cancers are the fourth most common cancer treated in our area. Salina Regional Health Center has seen the number of colorectal cases decline until the present year at 56 cases. The average number of colorectal cancers treated and reported in the cancer registry is 58 cases per year. Colon/Rectal Cancer ct’d The American Cancer Society estimates in 2009 that 106,100 new cases of colon cancer will be diagnosed and 40,870 new cases of rectal cancer will be diagnosed. Death will occur for 49,920 persons. This cancer affects both men and women. In our data base in the years 2003 – 2008, it has equally affected men and women. The American Cancer also states this is a cancer which occurs equally in men and women. Colorectal Cases C olorec tal C as es 80 72 70 66 60 56 56 53 50 46 40 Number of Cases 30 20 10 0 2008 2007 2006 2005 2004 2003 ex of P atient Sex Sof patients 173 Male Female 178 In comparing staging with the National Cancer Data Base (NCDB) we see in 2003, Salina Regional Health Center staged more Stage 1 and Stage 3 cancers than those diagnosed elsewhere. Stage 2 and Stage 4 cases were lower than the average in the NCDB data. Using the latest staging information 2006 from NCDB, our 2008 cases were very much in line with NCDB except for the Stage 4 cases for which we have fewer cases. Each March, the Tammy Walker Cancer Center provides free hemoccult kits to area pharmacies for persons to check their stools for hidden blood. We have collaborated with the American Cancer Society and Kansas Department of Health and Environment (KDHE) to provide these free kits to the public. Also included in the kits is information about prevention of colon/rectal cancers. KDHE provides advertising about colon/rectal cancers through the media with help from a CDC (Center for Disease Control) grant. Stage at Diagnosis - 2008 S tage at Diagnos is 2008 (2006) Stage of Diagnosis - 2003 S tage at Diagnos is (2003) 35 30 30 25 25 20 20 SRHC NCDB Percent 15 SRHC (08) 15 NCDB (06) Percent 10 10 5 5 0 0 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unknown Colon/Rectal Cancer ct’d Screening for colon/rectal cancer is recommended to begin at 50 years of age, or earlier if there is a family history of colon/rectal cancer. Greater than 90% (93%) of the patients diagnosed with colon/rectal cancer from 2003-2008 were diagnosed over the age of 50. Seven percent (7%) of the patients were in there 30s and 40s. Signs and Symptoms of colorectal cancer: • A change in bowel habits such as diarrhea, constipation or narrow stool that lasts for more than a few days • A feeling that you need to have a bowel movement that doesn’t go away after doing so • Rectal bleeding, dark stools or blood in the stool • Cramping or stomach pain • Weakness and tiredness Age at Diagnosis - 2003-2008 Age at Dx( 2003-2008) 120 113 100 80 60 54 Number of cases 40 21 18 20 4 0 30-39 40-49 50-59 60-69 70-79 80-89 90+ Survival of colon/rectal cancer depends on many factors including stage at diagnosis, age of the patient, and adequacy of surgical resection and administration of chemotherapy. Survival Comparison with NCDB S urvival C omparis on 2003 with2003 NC DB 90 80 70 60 50 SRHC NCDB percent 40 71 70 Survival data for 2003 from NCDB and SRHC are very comparable as shown in the graph at left. 30 20 10 0 1year 2 year 3 year 4 year 5 year In summary, our comparisons to NCDB are very comparable. We will continue to offer colon/rectal cancer education to promote early detection of colon/rectal cancers. We will promote this information at health fairs and every March for colon/rectal cancer screening month. We will also encourage participation in clinical trials when appropriate. Summary of all 2008 Cases Age at Diagnosis - 2008 Age at Diagnos is - 2008 PrimaryP rimary Sites (SRHC - SSH) 2008 s ites 2008 (S R HC & S S H) 250 Prostate 135 Breast 4 105 4 200 200 Lung 103 0 172 Colon/Rectum 56 Pancreas 35 Bladder 31 Bone Marrow 30 Kidney 18 Head & Neck 16 Thyroid 16 7 150 0 SRHC 12 SSH 106 0 0 50 37 2 All Other 104 20 40 60 80 100 15 12 5 1 16 0 0-19 0 101 100 0 120 140 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ 160 S ite Top 5 Sites - 2008 Top 5 S itesComparison C omparis on - 2008 Stage at Diagnosis - 2008 S tage at Diagnos is - 2008 35 450 402 30 400 28.7 26 350 25 22.3 21.9 300 20 20 SRHC - 2008 14.4 15 Percent of Cases 14.9 250 KCR - 2006 16 15 NCDB - 2007 14 200 11.9 10.9 150 135 10 7.4 100 5 2.2 50 2.5 37 35 40 Distant Unknown 0 0 Prostate Breast Lung Colon/Rectum In Situ Pancreas Localized Regional 2008 Tumor Conference Cases = 77 Patient County of Origin 2 6 10 19 3 2 18 23 41 4 7 6 16 26 1 1 3 2 3 4 16 2 21 248 5 47 5 1 9 7 3 1 76 2 3 1 1 Out of State = 4 Breast 11 Unknown Primary 2 Head & Neck 1 Cervix 1 Bone Marrow 9 Renal Pelvis 2 Lung 8 Stomach 1 Lymph Nodes 3 Soft Tissue 2 Blood 2 Thyroid 2 Bladder 4 Bone 1 Kidney 1 Esophagus 2 Colon/Rectum 6 Liver 2 Prostate 3 Uterus 2 Myeloproliferative Disease 1 Small Bowel 2 Pancreas 2 Ampula 1 Ovary 3 Abdomen 2 Common Bile Duct 1 Brain 1 Skin 1 511 S. Santa Fe • Salina, KS 67402-3617 Cancer Committee Members – 2008 Larry Beck, MD – Chairman – Medical Oncology William Cathcart-Rake, MD – Medical Oncology Phillip Munoz, MD – Pathology Arnold Cabrera, MD – Diagnostic Radiology Claudia Perez-Tamayo, MD – Radiation Oncology Jody Neff, MD. – Surgery Brian Smith, MD – Physician Liaison – Urology Richard Gomendoza, MD – Internal Medicine Allied Health Members: Linda Goodwin, RN – Administration Rebecca Troyer – Radiation Therapy Sr. Mary Augustine – Chaplain Pam Ehlts, CTR – Cancer Registry Lorraine Meyer – Quality Improvement Terry Hauschel, RT – Diagnostic Radiology Jill Smith-Barker, LBSW – Cancer Care Coordinator Mary Quinley, RN – Medical Oncology Steve Blanner, Rph – Pharmacy Charlotte Craig, RHIA – Cancer Registry Lesli Schrader, RN – Hospice of Salina, Inc. Jeanne Byquist, LD – Dietary Janet Ingram, RN – Outreach Services Ruth Cathcart-Rake, PT – Physical Therapy Joel Phelps – Administration