2016 Cancer Care Center Annual Report to the Community
Message from Leadership Dear Colleagues and Community Members, 2016 was an eventful year for Rush-Copley’s Cancer Care Center. We are excited by our enhanced relationship with Rush University Medical Center, which will help enhance our clinical programs and increase access to academic medicine. Rush-Copley’s Cancer Care Center is a leader in the field of cancer care treatment and support services for patients, families and loved ones. We continue to evaluate our service area and the landscape of healthcare to ensure Rush-Copley is addressing the growing needs of our patient population. As part of our commitment to enhancing patient care, we’ve added a dedicated oncology pharmacist and new patient navigator. The addition of these highly skilled healthcare professionals maximizes our ability to provide a full continuum of care in one, central location. Also, these two positions are integral components of the Oncology Care Model. The Oncology Care Model is a pilot program developed by the Center for Medicare and Medicaid Innovation designed to improve the effectiveness and efficiency of specialty care. Patient care for those undergoing chemotherapy will be aligned with national guidelines, quality measures, comprehensive care plans, efficiency and patient experience. Rush-Copley’s Cancer Care Center was selected to participate in this pilot program in conjunction with Rush University’s Division of Hematology and Oncology. In reading this year’s annual report, you’ll learn more about these initiatives as well as new programs and services, highlights of the year, statistics from the cancer registry and a special report by Radiation Oncologist, Ying Zhang, M.D. We are proud to be the leading provider of health services in the greater Fox Valley area and will continue to identify opportunities to advance the future of medicine so that all of our patients receive extraordinary care. Sincerely,
Judi Bonomi, RN, MS, MSN, OCN, NE-BC Director, Rush-Copley Cancer Care Institute
Rush-Copley Cancer Care Center Annual Report
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Table of Contents 1 3-4
Message from Leadership Cancer Care Services Overview
5
Support Services – Patient Spotlight
6
2016 Highlights
7-8
Cancer Registry Report and Analytic Data
9-12
Rectal Cancer Report
13-14
Oncology and NAPBC Committee
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References
Rush-Copley Cancer Care Center
CLINICAL SERVICES Advanced Illness Support Clinic The clinic offers supportive care from specialists trained to provide medical intervention through all phases of illness that focus on comfort, maintaining or improving daily function by reducing and controlling symptoms, as well as counseling and support services to assist with difficult medical decisions. Please contact us at 630-692-5962 for assistance as services are available for people of all ages and stages of illness as well as those currently living in a home or in assisted environments.
Clinical Trials and Research Access to the latest, nationwide clinical research trials close to home. These studies test promising new approaches to cancer diagnosis and treatment. Rush-Copley invites eligible patients to participate in clinical trials and contribute to the development of new medical knowledge. Patients at Rush-Copley have access to NCIsponsored, pharmaceutical-sponsored and investigator-initiated studies with the goal of improving the treatment of cancer.
Connection to Academic Medicine Our enhanced relationship with Rush University Medical Center will increase access to academic medicine to fully integrate clinical, research, education and community-based needs. A direct benefit of this newly formed partnership is the collaboration on patient care cases. Physicians from both organizations have the ability to consult one another on cases via real-time, stateof-the-art teleconferencing that includes pathology and imaging. The purpose of this practice is to improve care by providing each and
every patient with the best team of physicians and resources available.
Genetic Counseling Some families have a hereditary, or genetic, factor that can greatly increase their chances of developing cancer. Identifying these families and educating them about available cancer screenings, risk reduction and prevention options can significantly reduce their risk for some types of cancer. Our genetics program provides risk assessment, genetic counseling and testing, and referral to a genetics specialist, if appropriate. Speak to your physician to learn if genetic testing is right for you.
Integrative Medicine Rush-Copley’s integrative medicine services complement traditional cancer care. We offer massage and music therapy, as well as exercise programs to improve strength and promote relaxation. To learn more about these programs and services feel free to visit waterfordcrc.com or call 331-301-5280.
Recognized for Outstanding Cancer Care Rush-Copley ‘s Cancer Care Institute is the area’s first Comprehensive Community Cancer Program and is accredited by the Commission on Cancer of the American College of Surgeons and the National Accreditation Program for Breast Centers. The center’s breast imaging program has been recognized as a Breast Imaging Center of Excellence by the American College of Radiation for outstanding mammography, ultrasound, and MRI breast services.
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SUPPORT SERVICES Financial Counseling Financial counseling is available to patients and families to help understand the costs of treatment, insurance coverage and financial responsibility. For more information please stop by the center to speak with our financial coordinators or feel free to call 630-978-6244.
Freedom From Smoking® This seven-week workshop is sponsored by the American Lung Association to provide support and skills needed to quit smoking. Sessions are held in a friendly, comfortable environment and led by an experienced facilitator, who understands the unique challenges of quitting.
Nurse Navigation Specialists Experts in navigating complex healthcare situations, nurse navigators serve as patient care advocates and coordinators for patients, families and their healthcare providers. They are available as a point of contact, providing advice, support and direction as needed. Rush-Copley’s Cancer Care Center employs two nurse navigators and a breast health navigator.
NutriTherapy Nutrition Counseling Rush-Copley offers a comprehensive and proactive nutrition support program. Nutritional services are provided by a certified dietitian who has extensive experience counseling patients. The dietitian works in concert with the patient’s care team to help reduce the risk of dietcomplications during and after cancer treatment.
Psycho-Social Counseling Cancer may be one of the most difficult challenges a person can face. Along with the physical illness, many individuals may feel overwhelmed by a range of emotions that without treatment can lead to social withdrawal, neglect of care, and in severe cases, self4
destructive behavior. Our center has a licensed clinical social worker to help patients and their families cope with their cancer and to assist them in dealing with psychological or social barriers to their treatment.
Spiritual Care Spiritual beliefs can be a great source of strength and comfort during cancer treatment. RushCopley’s clinically trained chaplains are available to meet with our patients and their families any time during the course of treatment or after treatment is complete.
Survivorship Program At Rush-Copley, we are dedicated to helping cancer survivors live their lives to the fullest after treatment. Our team works with survivors to monitor for signs of cancer recurrence and focus on identifying, preventing and controlling any long-term and late effects associated with cancer and its treatment. Survivors receive a detailed care plan outlining their treatment as well as a plan for follow-up care that can be shared with the primary care physician. All survivors should continue scheduling regular checkups with a primary care physician to prevent, detect and treat any complications that may have resulted from treatment as well as receive routine screenings.
Waterford Place Cancer Resource Center Waterford Place is where services and support, free of charge, are available to anyone impacted by a cancer diagnosis. Waterford Place staff and volunteers aim to provide comforting, understanding and fortifying resources for those in any stage of treatment or survivorship – along with their loved ones. Waterford Place offers yoga, cooking demos, support groups, a wig boutique, massage, children and family programs and more. Learn more at waterfordcrc.com or call 331-301-5280.
Rush-Copley Cancer Care Center Annual Report
Support Services – Patient Spotlight In 2014, Maria Estrada a 14 - year cancer survivor met with Rush-Copley’s Breast Health Nurse Navigator/Genetic Counselor, Mira Vujovic, to discuss genetic testing. She was unaware of how life saving this test would be. It took several occasions for Maria to get the test completed since insurance approval was needed. Maria, a member of the Spanish breast cancer support group, reached out to the support group leader for assistance. The support group leader, Mariana Martinez, accompanied her to the genetic consult appointment to serve as a friend and interpreter. At the appointment the genetic counselor explained how the test works, the meaning of the results and implications of a positive test. Three weeks later the results were in and Maria was seen by the Genetic Counselor. The results came back positive for BRCA Gene Mutation. Once again, Mariana was there to provide support and interpret. The results were discussed at length and Maria then met with her Medical Oncologist, Kaushik Patel, M.D., to discuss next steps. She was advised to share the test results with her siblings and to discuss testing for her children. As of Maria, the next step was to have scans performed to determine if any cancer was present. The scans revealed suspicious areas in both breasts and Maria was referred to a surgeon, Allen Bloom, M.D., for a left MRI biopsy and right ultrasound biopsy. The results came back positive for breast cancer in both breasts. Maria met with Dr. Bloom to discuss surgery options and it was determined she would need a bilateral mastectomy and bilateral oophorectomy followed by reconstruction.
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Maria then met with the Mira and Mariana to review all of her options and decided to have the surgery done. At that moment, Maria was grateful that both individuals were there to support and guide her through the genetic testing. She made it clear to both that genetic testing was put off in the past but when the Breast Health Nurse Navigator reached out to her is was a sign. After the surgery was performed, the team at Rush-Copley worked with Maria to setup an appointment with the plastic surgeon, James Ferlmann, M.D. The first phase of reconstructive surgery was done followed by chemotherapy, radiation therapy and a final reconstructive surgery. During chemo and radiation, she was visited regularly by the Mira and Mariana. Throughout all of this Maria continued to attend the support group. She shared her story to increase awareness within the support group about genetic testing and reconstructive surgery. Today Maria continues to adjust to her new normal and her motto is “Positive Mind Positive Life”. She is now enjoying things that she never has done before. She is living life to the fullest and appreciating every blessing. When she shares her story she reflects back to her guardian angels in the Rush-Copley Cancer Care Center, Mira and Mariana.
Rush-Copley Cancer Care Center Annual Report
2016 Highlights
This past year was an exciting one for the cancer care center. It began with the opening of
Waterford Place Cancer Resource Center, then our selection into the Oncology Care Model, the addition of an oncology
pharmacist and nurse navigator, and the enhanced relationship with Rush University Medical Center, all of which position our
center strategically for expanded services to meet the needs of our growing community.
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Rush-Copley Cancer Care Center Annual Report
Cancer Registry Report Rush-Copley’s Cancer Registry Department supports the activities of the Oncology Committee and the Cancer Care Institute. The registry staff oversees the collection, quality assurance, lifetime follow-up and analysis of data from patients diagnosed with cancer who receive all or part of their care at Rush-Copley and those other deemed reportable. The registry provides vital statistics and information to clinicians and researchers as well as local, state and national cancer databases and cancer-related organizations. This contribution of information advances the body of knowledge in the field of cancer and ultimately has a positive impact on cancer patient care. The world of a cancer registrar is ever changing, and so are the guidelines that registrars use to conduct accurate data abstracting. Cancer centers report specifics of diagnosis, stage of disease, medical history, patient demographics, laboratory data, tissue diagnosis and medical, radiation and surgical methods of treatment for
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each cancer diagnosed at the facility. The data is used to observe cancer trends and provide a research base for studies into the possible causes of cancer with the goal of reducing cancer death and illness. Registry data also serves as an ongoing resource to the Oncology Committee in determining the most effective allocation of resources, for developing community education and outreach initiatives as well as monitoring program quality. For Rush-Copley’s data to be comparable to those collected at other programs around the country, the registrars adhere to data rules established by the collecting and credentialing organizations. Keeping up with these changes can be challenging, but Rush-Copley registrars understand the significance of their work and are experts in their field.
Rush-Copley Cancer Care Center Annual Report
Primary Site Distribution Rush-Copley 2015 Analytical Cases SITE
Analytical Cases
% Anal. Stage Stage 1 Stage 2 Stage 3 Stage 4 Not Cases 0 Staged
Unknown
Breast
223
31%
58
86
52
13
10
0
4
Lung & Bronchus
88
12%
0
18
2
15
50
1
2
Colorectal
69
10%
14
17
13
11
13
0
1
Other Digestive
56
8%
0
6
14
7
24
1
4
Female Genital System
49
7%
0
29
2
12
5
0
1
Endocrine System
43
6%
0
30
3
4
0
6
0
Prostate
34
5%
0
6
19
3
6
0
0
Lymphoma
34
5%
0
7
12
4
10
0
1
Skin (excluding basal & squamous) Urinary System
26
4%
3
10
5
5
2
0
1
20
3%
7
7
2
0
3
0
1
Brain & CNS
19
3%
0
0
0
0
0
19
0
Oral Cavity & Pharynx
17
2%
1
4
0
3
7
0
2
Leukemia
12
2%
0
0
0
0
0
12
0
Myeloma
3
0%
0
0
0
0
0
3
0
Larynx
5
0%
0
3
1
0
1
0
0
Soft Tissue
3
0%
0
0
1
1
1
0
0
Testis
4
0%
0
3
1
0
0
0
0
Nose, Nasal Cavity & Middle Ear
1
0%
0
0
0
1
0
0
0
Kaposi Sarcoma
1
0%
0
0
0
0
0
1
0
Mesothelioma
1
0%
0
0
0
1
0
0
0
Miscellaneous
13
2%
0
0
0
0
0
13
0
Total
721
100%
83
226
127
80
132
56
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Rush-Copley Cancer Care Center Annual Report
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Rectal Cancer Report Ying Zhang, M.D.
INTRODUCTION Rectal cancer is a disease in which cancer cells form in the tissues of the rectum. In the United States, approximately 39,220 rectal cancers are diagnosed annually. Rectal cancer is more likely to develop as people get older, and more than 90% of people with this disease are diagnosed after age 50 according to the American Society of Colon and Rectal Surgeons (ASCRS Rectal Cancer, 2016).
RISK FACTORS A risk factor is anything that increases the chance of getting a disease, such as cancer. Risk factors for rectal cancer include but are not limited to: age, hereditary conditions, personal medical history and family medical history. Rectal cancer is more likely to occur as people age, and more than 90% of people with this disease are diagnosed after age 50. According to the National Cancer Institute (NCI), having certain hereditary conditions, such as familial adenomatous (gland-like growths) polyposis (FAP) and nonpolyposis colon cancer (HNPCC or Lynch syndome) can increase the risk. FAP is an inherited condition in which numerous polyps form on the inside walls of the colon and rectum. It increases the risk of rectal cancer. HNPCC is also an inherited disorder in which affected individuals have a higher-than-normal chance of colorectal cancer, often before the age of 50. Having a personal history of any of the following can lead to higher risk for rectal cancer: colorectal cancer, polyps (small pieces of bulging tissue) in the colon and rectum, ovarian cancer, endometrial cancer, or breast cancer.
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First-degree relatives (parents, siblings, children) with a history of colorectal cancer or polyps can also increase the risk.
SIGNS AND SYMPTOMS The American Society of Colon and Rectal Surgeons find that many rectal cancers cause no symptoms at all and are detected during routine screening examinations. The most common signs and symptoms of rectal cancer are a change in bowel habits, such as constipation or diarrhea, narrow shaped stools, or blood in the stool. A person may also experience pelvic or lower abdominal pain, unexplained weight loss or feel tired all the time.
SCREENING AND DIAGNOSIS There are numerous tests used to detect and diagnose rectal cancer. These include physical exam and medical history, Digital Rectal Exam (DRE), colonoscopy, protoscopy, biopsy and lab testing. Physical Exam - An exam of the body is performed to check general signs of health, including signs of disease or anything that seems abnormal. A history of the patient’s health habits, illnesses and treatments is collected. Digital Rectal Exam - The physician or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything that seems unusual. In women, the vagina may also be examined. Colonoscopy - A procedure that looks inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope, a thin, tube-like instrument with a light and a lens for viewing, is used during this procedure.
Rush-Copley Cancer Care Center Annual Report
SCREENING AND DIAGNOSIS Protoscopy - An office-based exam of the rectum using a protoscope, which is inserted into the rectum. Biopsy - The removal of cells or tissues so they can be viewed under a microscope to check for signs of disease. The tumor tissue removed during a biopsy may be checked to see if the patient is likely to have the gene mutation that causes HNPCC. Reverse-transcription polymerase chain reaction (RT-PCR) test - Laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes. Immunohistochemistry - A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. Carcinoembryonic angiten (CEA) assay - A test that measures the level of CEA in the blood. CEA is released into the bloodstream for both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of rectal cancer or other conditions.
STAGING The Tumor Node Metastases (TNM) staging system of the American Joint Committee on Cancer is the preferred staging method for rectal cancer. This system is based on the depth of the local tumor invasion (T stage), the extent of regional lymph node involvement (N stage), and the presence of distant metastasis (M stage). Generally, the smaller the tumor and a lack of spread to other structures, the better the prognosis and overall survival. Staging may also involve the use of CEA assay, CT scan, Endoscopic Ultrasound, MRI or PET scans.
diagnosed at Rush-Copley. The majority of these cases, 63%, were diagnosed as being stage 0 – II. This is above both the state and national average for the NCDB in 2014 as seen below (Figure 1).
RushStage Copley 2014 0 3 I 3 II 1 III 3 IV Unknown 1
RushCopley 2015 1 1 3 3 -
Illinois US 2014 2014 30 96 56 95 48 17
678 2,823 2,029 2,388 1,398 749
Figure 1. Rectal Cancer diagnoses by Stage at Rush-Copley compared to Illinois and U.S. from the NCDB 2014
Additionally, Rush-Copley rectal cancer patients were more often diagnosed in the 40 – 59 year age range when compared to state and national averages (Figure 2). Age Group 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+
RushCopley 2014 1 1 3 4 1 1
RushCopley 2015 1 1 2 1 3 -
Illinois
US
1 10 36 106 93 51 33 12
64 254 1042 2629 2699 1989 1161 227
Figure 2. Rectal Cancer diagnoses by Age at Rush-Copley compared to Illinois and U.S. from the NCDB 2014
TREATMENT A treatment decision is made by the patient and the physician after careful consideration and discussion. This can be determined based upon stage, biological characteristics of the cancer itself, the patient’s age and other health conditions, the patient’s personal wishes, and –
In 2015, eight new cases of rectal cancer were Rush-Copley Cancer Care Center Annual Report
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TREATMENT the risks and benefits associated with each treatment protocol. The majority of rectal cancers are treated with a combination of surgery, radiation therapy, and chemotherapy. Stage 0 and I rectal cancer is generally treated with surgery alone. Stage II and III involves surgery, chemotherapy and radiation therapy. Chemotherapy and radiation are usually given prior to surgery (neoadjuvant) and additional chemotherapy is sometimes given after surgery (adjuvant). Stage IV is treated most often with chemotherapy and in some cases surgery and radiation therapy if needed.
SURGERY Depending on the stage, size and location of the tumor, surgery may be performed either locally (through the anus) or radically (through the abdomen).
Local excision is the recommended surgical procedure for patients with early-stage rectal cancer without high-risk features. Additionally, this type of surgery can be for patients with more advanced diseases but who are not medically fit for radical surgery. Local excision removes both the tumor and adjoining rectal tissue. This type of surgery is less invasive and requires a shorter length of stay as compared to radical surgery. Radical excision is performed transabdominally with either a sphincter-saving reconstruction or an abdominal perineal resection. If both the anus and rectum are removed, the remaining intestine will be attached to an opening in the skin on the abdomen. That opening is called a colostomy and requires a bag to be placed over the opening to collect bowel movements.
CHEMOTHERAPY Neoadjuvant chemoradiotherapy may be administered to rectal cancer patients prior to surgery. This treatment is used to shrink the 11
tumor before it is removed, can reduce the risk of the cancer returning and may reduce the need for a permanent colostomy. The two most common ways to administer chemotherapy during radiation treatment are either with a 5-FU pump or daily doses of a pilled called capecitabine. The pump fits into a pack that is worn around the waist and delivers medicine into a port (an IV in the chest) continuously for about six weeks. The alternative method, capecitabine, is taken on days of radiation treatment and is considered as effective as the 5-FU pump.
Adjuvant chemotherapy or chemoradiotherapy are sometimes provided after surgery depending on the stage of cancer as well as the treatment prior to surgery. Patients who did not have chemotherapy and radiation before surgery will mostly likely receive the combination afterwards. Those receiving chemoradiotherapy or radiation therapy alone, prior to surgery , will most likely need approximately four to six months of chemotherapy after surgery.
RADIATION THERAPY External beam radiation therapy is most commonly administered for rectal cancer patients. This form of radiation is focused on treating cancer from a machine outside of the body. There are two possible approaches to delivering radiation therapy prior to surgery. The first treatment option is daily treatments over 5 days without chemotherapy followed by surgery within one to two weeks. The second treatment option is daily treatments over five to six weeks with concurrent administration of 5-FU or capecitabine followed by surgery eight to twelve weeks later. Additionally, radiation therapy can be administered to patients that are not healthy enough for surgery or to lessen symptoms (palliative) for individuals with advanced cancer. These treatments are provided daily over five to six weeks or daily over two to three weeks, respectively.
Rush-Copley Cancer Care Center Annual Report
CONCLUSION In 2016, an in-depth analysis was performed on Rush-Copley’s 2015 analytical cases for rectal cancer. There were a total of eight cases, 100% were reviewed, to ensure the entire course of treatment was in accordance with the National Comprehensive Cancer Network (NCCN) Guidelines for rectal cancer. A review of each case determined that seven followed the NCCN Guidelines and one did not. The case that did not meet the guidelines was because the patient declined NCCN recommended treatment even though it was offered. These findings were presented to the Oncology Committee and continue to show that Rush-Copley provides advanced evidence-based medicine and extraordinary care to all of our patients.
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Rush-Copley Cancer Care Center Annual Report
Oncology Committee Oncology Committee is a designated multidisciplinary body for the administrative oversight, development and review of cancer care services at Rush-Copley. Members include physician representatives from diagnostic and treatment specialties along with representatives from supporting services involved with the care of patients with cancer.
Physician and Oncology Committee Members Kaushik Patel, MD
Hematology/Medical Oncology, Chairman
Salitha Reddy, MD
Radiation Oncology, Vice-Chair
Kurian Abraham, MD
Pathology, Cancer Liaison Physician
Syed Akbar, MD
Diagnostic Radiology
Suzanne Bergen, MD
Gynecologic Oncology Surgeon
Alice Daniele, MD
Palliative Medicine
Ted Kulczycki, MD
Internal Medicine
Joseph Meschi, MD
Hematology/Medical Oncology
Ho Myong, MD
Hematology/Medical Oncology
Non-Physician Members of Oncology Committee
Judi Bonomi, RN, MS, MSN, OCN, NE-BC
Director, Inpatient Nursing and Cancer Care Center
Mary Shilkaitis, RN, MS, MBA
Vice President, Patient Care Services & Chief Nursing Officer
Jeff Coleman, RN, MSN, CMSRN, CNML
Clinical Manager, Cancer Care Center, Quality Coordinator
Ryan Alvarez, MS
Business Manager, Cancer Care Center
Laura Rollins, LSW
Oncology Social Worker, Psychosocial Services Coordinator
Marianna Martinez
Community Health Outreach Coordinator
Amanda Baker, CCRP
Clinical Research
Stephanie Beam, PharmD
Pharmacy
Vickie Burdick, RHIT, CTR
Tumor Registry
Jennifer King, RN, MSN, OCN
Oncology Nursing
Ashley Lach
American Cancer Society Representative
Prema Ramakrishnan, RHIT, CTR
Tumor Registry
Jillian Smallwood
Living Well Representative
Mira Vujovic, APN, MSN, CBCN
Breast Care Navigator and Genetics Counselor
Jeni Aguina, RN
Patient Navigator
Katie Giudice, MS, RD, LPN
Nutritionist
Leanne Brand, RN, BA, MA, CGRN
Digestive Health Center
Mona Seaver, APN
Gynecologic Oncology
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Breast Program Leadership Committee Breast Program Leadership Committee is a designated multidisciplinary body committed to improving the quality of breast health care by coordinating the best care and treatment options available at RushCopley. Members include physician representatives from diagnostic and treatment specialties along with representatives from supporting services involved with the care of patients with breast cancer.
Physicians and Breast Program Leadership Team Committee Members Kurian Abraham, MD
Pathology, Cancer Liaison Physician
Mohsen Anwar, MD
Imaging Services
Ho Myong, MD
Hematology/Medical Oncology
Salitha Reddy, MD
Radiation Oncology
Nancy Whereatt, MD
Surgeon
Judi Bonomi, RN, MS, MSN, OCN, NE-BC
Director, Inpatient Nursing and Cancer Care Center (CCC)
Allen Bloom, MD
Surgeon
Joseph Meschi, MD
Hematology/Medical Oncology
Kaushik Patel, MD
Hematology/Medical Oncology
Ying Zhang, MD
Radiation Oncology
Non-Physician Breast Program Committee Members
Mary Shilkaitis, RN, MS, MBA
Vice President, Patient Care Services & Chief Nursing Officer
Ryan Alvarez, MS
Business Manager, Cancer Care Center
Jozef Reczek
Clinical Manager, Radiation Oncology
Marianna Martinez
Community Health Outreach Coordinator
Amanda Baker, CCRP
Clinical Research
Vickie Burdick, RHIT, CTR
Tumor Registry
Michelle DeHass
Nurse Navigator, Midwest Center for Advanced Imaging
Tisha Hailey
Manager, Therapy Services
Gloria Hall
Director, Midwest Center for Advanced Imaging
Julie Kwait
Therapy Services
Tom Markuszewski
Director, Imaging Services
Prema Ramakrishnan, RHIT, CTR
Tumor Registry
Laura Rollins, LSW
Oncology Social Worker, Psychosocial Services Coordinator
Mira Vujovic, APN, MSN, CBCN
Breast Care Navigator and Genetics Counselor
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References Althumairi, Azah A., and Gearhart, Susan L. “Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond.” Journal of Gastrointestinal Oncology, Vol. 6, no. 3, 2015, pp. 296-306. American Society of Colon and Rectal Surgeons. Rectal Cancer, 2015. https://www.fascrs.org/patients/disease-conditins/rectal-cancer. Accessed 5 December 2016. American Society of Colon and Rectal Surgeons. Colon and Rectal Cancer Follow-up Care Expanded Versions, 2015. https://www.fascrs.org/patients/disease-condition/colon-and-rectal-cancer-followcare-expanded-version. Accessed 5 December 2016. Bleday, Ronald, MD, and Shibata, David, MD. “Rectal Cancer: Surgical techniques.” http://www.uptodate.com/contents/rectal-cancer-surgicaltechniques?source=search_result&search=rectal+cancer&selectedTitle=3%7E145. Accessed 22 December 2016. Dorudi, Sina, et. al. “Surgery for colorectal cancer.” British Medical Bulletin, Vol. 64, 2002, pp. 101-118. Macrae, Finlay, MD, and Bendell, Johanna , MD. “Clinical presentation, diagnosis, and staging of colorectal cancer.” http://www.uptodate.com/contents/clinical-presentation-diagnosis-andstaging-of-colorectal-cancer?source=search_result&search=rectal+cancer&selectedTitle=2%7E145. Accessed 6 December 2016.
Monson, J. R. T., et al. “Practice Parameters for the Management of Rectal Cancer (Revised).” Diseases of the Colon and Rectum, Vol. 56, no. 5, 2013, pp. 535-550. National Cancer Institute. Rectal Cancer Treatment (PDQ) – Patient Version, 2016. https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq. Accessed 5 December 2016. Rodriguez – Bigas, Miguel A., MD, and Grothey, Axel, MD. “Patient education: Colon and rectal cancer (Beyond the Basics). http://www.uptodate.com/contents/colon-and-rectal-cancer-beyond-thebasics?source=search_result&search=rectal+cancer&selectedTitle=36%7E145. Accessed 14 December 2016.
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