BCI Annual Report 2012

Baptist Cancer Institute

2012

CA N C ER P ROG RA M

Annual Report

Table of Contents 2

Cancer Committee Report

6

Tumor Registry Report

18 Tumor Review: Hodgkin’s Disease 24 Tumor Review: Soft Tissue Sarcomas 30 Quality Assurance 32 Clinical Research and Education 36 Distinguished Individual in Cancer Care 38 Philanthropy

Baptist Cancer Institute

2012 Annual Report

1 Baptist Cancer Institute (BCI) is affiliated with

Baptist Cancer Institute is one of the most

Baptist Health, the only locally governed,

active clinical research institutes in the state

faith-based health system in Northeast Florida.

of Florida, with open studies in breast cancer,

Baptist Health, a Magnet™ Health Care

lung cancer, gastrointestinal malignancies,

System honored for excellence in patient

lymphoma, leukemia, head and neck cancer

care, is comprised of Baptist Medical Center

and brain tumors. We work in collaboration

Jacksonville, Baptist Medical Center Beaches,

with physicians across the state and the

Baptist Medical Center Nassau, Baptist Medical

nation to conduct clinical trials that lead to

Center South, Wolfson Children’s Hospital and

improved diagnostic approaches, reductions

Baptist Clay Medical Campus.

in toxicities and new ways to fight these often devastating diseases.

Cancer Committee Report

Troy H. Guthrie Jr., MD, Cancer Committee Chairman

As the world progresses to electronic information, Baptist Medical Center and Baptist Cancer Institute (BCI) have followed suit. This year, 2011, will be the second year the Cancer Committee report will be exclusively online. The Baptist hospital systems – Baptist Jacksonville, Baptist South, Baptist Beaches, and Baptist Nassau – are now complete EMR hospitals.

As chairman of the Cancer Committee, we will continue to follow the electronic medical record impetus and make this report both concise and informative. The Cancer program has continued to be healthy, offering a wide breadth of services and high-quality care for cancer patients in Northeast Florida and Southeast Georgia. Cutting-edge programs in neuro-oncology, breast care, and lung cancer treatment are active in offering a high level of care which translates into high satisfaction for patients.

Baptist Health offers a wide variety of not only cancer treatments, but educational programs for both physicians and the public. At Baptist Jacksonville, palliative care offers a multi-step program for our cancer patients. Close communications with Hospice of Northeast Florida allows hospice to step in when more intensive care is

Baptist Cancer Institute

2012 Annual Report

3 to be offered by George Royal, PhD, and more recently, nutritional, physical therapy, and needed at the patient’s home. These programs allow

occupational therapy programs are offered

patients and their families to make every minute count

through our multi-disciplinary cancer program.

toward the highest quality of life. Clinical research programs continue to be extremely active at BCI,

The Cancer Committee at Baptist Medical

with research programs in breast cancer, lung cancer,

Center Jacksonville continues to meet

melanoma, neurological malignancies, prostate cancer,

quarterly to provide leadership direction and

hematological malignancies, and other solid tumors.

review of all aspects of the cancer program

Research studies are offered through the auspices of the

and services as mandated by the American

National Cancer Institute clinical study groups, as well as

College of Surgeons. At each meeting, the

pharmaceutical-sponsored industry trials.

activities of the tumor registry and current clinical research, as well as goals of the

Screening programs in breast cancer, colon cancer,

Cancer Committee, are reviewed.

prostate cancer, and skin cancers continue to expand, offering education to the public as well as active

Current leadership for the Cancer Committee

intervention. The genetic assessment program, under

includes:

the leadership of Melinda Fawbush, MSN, ARNP, remains extremely active concentrating primarily on breast cancer.

• Troy H. Guthrie, Jr., MD, Chairman, Cancer Committee;

• Mark Augspurger, MD, Liaison to the American Multi-disciplinary conferences in breast cancer

College of Surgeons; Patricia Woods, RN, BSN,

are offered weekly, lung cancer bi-weekly, and

OCN, Quality Improvement Coordinator;

neuro-oncology monthly. These programs are teleconferenced to satellite hospitals so that education can be received by physicians and health care staff in their own hospital. Psychosocial support continues

• Paul Oberdorfer, MD, Community Outreach Coordinator;

• Melissa McCarthan, RHT, CTR, Tumor Registrar; and • Jan Peer, CCRP, Research Coordinator.

At each meeting, the Cancer Committee reviews,

Other Baptist Cancer Institute activities include:

revises, and reapproves current program goals to

• Major conferences for oncology nurses • Prevention and community education programs • Continued participation in the American Cancer

determine whether they are being met and if they are aligned with the latest requirements of the American College of Surgeons.

This Annual Report, as required by the American College of Surgeons, will include a prospective 4

and retrospective study of cancer disease sites, as well as assess the quality of data provided by the tumor registry. This year, Hodgkin’s disease and soft tissue sarcoma will be the areas of review.

In 2011, more than 10 percent of all analytic cases were reviewed on a prospective basis by physician volunteers to ensure continued quality and timeliness of data entered into the Baptist Tumor Registry. In 2011, for the second time in a row, there was a drop in the number of cases accessed with the total number of analytic cases being 1,624 compared to 1,656 the previous year. The total number of analytic cases fell at Baptist South, likewise, from 533 cases to 458 analytic cases. The slight drop in analytic cases at Baptist Jacksonville appeared to be spread out among tumor sites. Currently, the Tumor Registry includes a total of 26,414 analytic cases accrued since 1990. In 2011, the cancer clinical research program included active participation in the National Surgical Adjuvant Breast and Bowel Project, Eastern Cooperative Oncology Group, Radiation Therapy Oncology Group, and Mayo Clinic Cancer Research Consortium, as well as pharmaceutical industry sponsored research trials. In 2011, approximately 50 percent of the research patients participated in NCI group studies and 50 percent were patients registered on pharmaceutical studies.

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 community as well as employees of Baptist Health

• Cutting-edge prostate cancer treatment programs, including seed implants and the state of the art da Vinci Robotic Surgery unit

• Continued expansion of the stereotactic radiosurgery radiation program with a marked increase in the number of body sites being treated

• Continued expansion of the limited breast radiation program using the Mammosite® technique

• Continued expansion of the digital breast cancer-screening 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 radiopharmaceutical embolization programs for treatment of liver malignancies

• Continued participation of indigent programs, including the highly successful We Care program

• Continued expansion of a hospital-based chemotherapy infusion unit

• On-site involvement of hospice and palliative

• Continued expansion and utilization of the

care programs for optimum support for both

comprehensive breast health program with

the cancer patient and family

nurse coordinator at Baptist Jacksonville,

• Continued expansion of the Genetic Risk Assessment Screening program, now focusing

Baptist South and Baptist Beaches

• Rapid expansion of the Neuro-oncology

on breast cancer, but also includes melanoma,

program, with continued expansion of the

and colon cancers

radiosurgery program, as well as increased

• Continued active participation in the oncology

sophistication of the Neurosurgery suites

training program for the medical oncology

and continued expansion of Neuro-oncology

fellows from the University of Florida

clinical research studies

Jacksonville and the Radiation Therapy residents at Mayo Clinic Jacksonville As Cancer Committee Chairman since 2005, it gives me great pleasure to see the continued expansion of cancer services offered in Northeast Florida and Southeast Georgia in the year 2011. State-of-theart programs which run the entire spectrum of hematologic and solid tumor malignancies are being offered in a multi-disciplinary approach to patients of all walks of life. A close collaboration of physicians, hospital administrators, and allied professional staff has enabled the Baptist Cancer Institute to remain at the forefront of care in this region for cancer patients.

Troy H. Guthrie Jr., MD Cancer Committee Chairman Medical Director, Education and Research Baptist Cancer Institute

5

Tumor Registry Report Troy H. Guthrie Jr., MD, Cancer Committee Chairman Melissa McCarthan, RHIT, CTR April Stebbins, RHIT, CTR Rassy Sprouse, BSc The Tumor Registry at Baptist Cancer Institute has been approved since 1990 by the Commission on Cancer of the American College of Surgeons. As part of our approval, the Tumor Registry collects data on cancer screenings annually in terms of incidence, tumor site, kinds of treatment provided, and survival outcomes. Its data is then entered into the Florida State Tumor Registry and ultimately accumulated at the national level as SEER data. This process enables all American College of Surgeons accredited cancer centers to compare their own outcomes in terms of diagnoses, stage, effectiveness of cancer treatment, and ultimate outcome in terms of survival, to each other. This enables Baptist Cancer Institute through its Tumor Registry, as well as other accredited programs, to assess their level of care when compared to others both within the state of Florida, as well as at the national level and see if standards of care are met to assess areas where quality improvement is needed to address deficits within each program.

Baptist Cancer Institute

2012 Annual Report

The registry assists the Cancer Committee with

943 female cases and 681 male cases (Figure

evaluating outcomes, quality of medical care,

2). Table 1 demonstrates the incidence of the

and assessment of treatment, recurrence, and

most common primary sites seen at Baptist

survival rates. Currently, the Baptist Tumor

Medical Center Jacksonville with breast cancer

Registry has accumulated data from both

accounting for 434 cases or 27 percent, prostate

Baptist Medical Center Jacksonville since 1990

cancer 199 cases or 12 percent, Lung cancer

and Baptist Medical Center South, where data

186 cases or 11 percent and female genital

collection began in 2005. Physician volunteers

cancers 106 cases or 7 percent. Of great interest,

from both Baptist Jacksonville and Baptist South

melanoma came in as the sixth-most common

assist tumor registry in assessing the accuracy of

site with 90 cases or 6 percent. Colorectal,

analytic case data accumulation for each year.

a much more common malignancy, had only

Ten percent of all cases are evaluated by these

89 cases or 5 percent and central nervous

physician volunteers for accuracy of data as well

system malignancies or neuro-oncology had 85

as timeliness of reporting.

cases or 5 percent. In 2011, there continued to be a decrease in prostate cancer, although

Figure 1 demonstrates the number of cases

less dramatic when compared to 2010 and a

accumulated from 1990 through 2011 at Baptist

relatively dramatic drop in lung cancer cases

Medical Center Jacksonville. As you can see,

was seen compared to 2010, with only 186

for the second year in a row, there is a drop in

cases being registered in 2011. Melanoma and

the number of patients seen compared to 2010.

urinary bladder as primary sites showed the most

This decrease in the number of patients is less

substantial increase in patient numbers accrued

dramatic than the previous year, but represents

to the 2011 Tumor Registry. Table 2 shows the

the second year in 21 years that the Tumor

frequency of primary sites seen at Baptist South

Registry has seen a decline in cases. Since 1991,

which has a somewhat different incidence of

the Tumor Registry at Baptist Jacksonville has

primary sites than Baptist Jacksonville with an

seen a total of 26,414 analytic cases. Similar

increased percentage of lung, colorectal, thyroid,

to previous years, there remains a female

and kidney primaries and a marked decrease in

predominance of analytic cases with 2011 having

the frequency of melanoma, brain tumor, and

7

1624

1656

1779 2009

1630 1253

1999

1265

1998

1138

1041

1996

972

1995

965

1992

865

1991

928

807

688

1000

764

1200

964

1004

1102

1400

2004

2005

1139

1308

1600

N o . of Pa ti en ts

2008

1467

1800

800 600 400 200 0

1990

1993

1994

1997

2000

2001

2002

2003

2006

2007

2010

2011

Yea r

200

Mal e

Female

1624

1656

1200 800

458

400

1600

533

600

0

2000

No . of Pat i ent s

681

1000 800

Fig ure 3 Analytic Cases: 2010 - 2011 (Baptist Jacksonville and Baptist South)

943

Figu re 2 Male & Female Malignancies: 2011 (Baptist Jacksonville)

No . of Mal i g nanci es

8

1744

Figu re 1 Baptist Cancer Institute Analytic Cases by Year

2010

2011

400 0 2010

2011

Ba pt is t Ja ck s onville

Ba pt is t Sout h

female genital tract incidence. These differences

institutions. There was a drop for the second

between sites seen at each hospital again

year in a row of 32 analytic cases of Baptist

references the difference in terms of referral

Jacksonville and a decrease for the first time of

pattern with expertise in melanoma and neuro-

total cases seen at Baptist South from 533 cases

oncology being located at Baptist Jacksonville

to 458 cases (Figure 3). These decreases in total

and only a modest presence of gynecologic

cases seen are almost certainly multi-factorial but

oncology at Baptist South. These tables also

recent campaigns by other hospitals to attract

indicate the male and female predominance

cancer cases may be a factor. Table 3 compares

of malignancies by the primary site at both

the incidence of the five most common primary

Tab le 1 Primary Sites : Baptist Medical Center Jacksonville (2011)

Site

Total

%

Male

Female

Breast

434

27%

3

431

Prostate

199

12%

199

0

Lung

186

11%

89

97

Female Genital

106

7%

0

106

Melanoma

90

6%

53

37

Colorectal

89

5%

50

39

Brain & CNS

85

5%

37

48

Other Sites

63

4%

37

26

Other Sites

57

4%

30

27

Blood & Bone Marrow

62

4%

36

26

Kidney

51

3%

30

21

Pancreas

51

3%

28

23

Urinary Bladder

49

3%

38

11

Lymph Node

47

3%

24

23

Stomach

21

1%

13

8

Unknown Primary

17

1%

7

10

Esophagus

11

1%

10

1

Liver

10

1%

7

3

Total

1,624

100%

681

943

sites seen at Baptist Jacksonville compared to

this is a modest decrease in the number of

state and national statistics. Similar to previous

prostate and lung cancer cases seen at Baptist

years, there is an essential doubling of the

Jacksonville compared to both Florida and the U.

incidence of breast cancer seen at Baptist Cancer

S. average. A 5 percent incidence of colorectal

Institute compared to both Florida and the

cancer seen at Baptist Jacksonville unfavorably

United States and likewise a marked increase

compares to the overall national incidence

in the number of female genital and melanoma

of 9 percent. This variance most probably

cancer cases seen compared to again the state

represents referral patterns of this primary site

of Florida and the U.S. average. Offsetting

to gastroenterologists for endoscopy and then

9

Tab l e 2 Primary Sites : Baptist Medical Center South (2011)

Site

10

Total

%

Male

Female

Breast

127

27%

0

127

Lung

50

10%

24

26

Colorectal

47

10%

19

28

Thyroid

31

7%

5

26

Kidney

29

6%

18

11

Urinary Bladder

27

6%

19

8

Prostate

21

5%

21

0

UGI

19

4%

14

5

Other Sites

15

4%

7

8

Lymph Nodes

18

4%

13

5

Blood & Bone Marrow

17

4%

11

6

Melanoma

16

4%

11

5

Brain & CNS

12

3%

4

8

Pancreas

10

2%

5

5

Female Genital

9

2%

0

9

Head & Neck

6

1%

6

0

Unknown Primary

4

1%

2

2

458

100%

179

279

Total

for surgery. Baptist Jacksonville fell within the

disciplinary breast conference, neuro-oncology

national average percentage for other primary

conference, and lung cancer conferences.

sites except for melanoma and CNS tumors

Participation at these conferences assures the

which certainly represent our active neuro-

adequate representation of all primary sites

oncology program, as well as the expertise in

are discussed as mandated by the American

melanoma care at Baptist Jacksonville.

College of Surgeons to maintain a commission on cancer certified tumor registry. Separate

The Tumor Registry also maintains a list of

multi-disciplinary breast conferences are held at

individual cases discussed and attendance at

Baptist Jacksonville, Baptist South, and Baptist

the Tumor Board as well as that of the multi-

Beaches. All multi-disciplinary conferences

Tab l e 3 Comparison Data with Florida and United States

Organ Site

Baptist Cancer Institute

Florida

United States

Breast

27%

14%

14%

Lung

11%

15%

14%

Prostate

12%

15%

15%

Female Genital

7%

3%

4%

Melanoma

6%

5%

4%

“Fig ures fo r Fl o r i da an d U.S. are esti mates from Cancer Fact s and Fi g u res 2 011�

as well as Tumor Board are patient focused

Medical Center Beaches has a separate Tumor

discussions regarding diagnoses and treatment

Registry. All data is reviewed prior to entering

approaches. Continued medical education (CME)

it into the Tumor Registry and a composite 10

and continuing education units (CEU) credits

percent of patients are then further reviewed by

are available by the Baptist Health continuing

physician volunteers for accuracy and timeliness

education program for these conferences. The

of data entry. Currently, Melissa McCarthan,

Tumor Registry is also available for questions

RHIT, CTR; April Stebbins, RHIT, CTR; and

concerning treatment outcomes or any other

Rassy Sprouse, BS, staff the Tumor Registry

questions that arise from medical staff or

and are supervised by Linda Huntley, Director

community.

of Oncology Services, as well as physician supervisors Troy Guthrie, Jr., MD, and Mark

The Tumor Registry also reviews the organization of the weekly multi-disciplinary tumor conference as well as assists the Cancer Committee in evaluation outcomes, quality of medical care, assessment of complications, recurrence, and survival rates. Currently, the Baptist Tumor Registry accumulates data from Baptist Jacksonville as well as Baptist South. Baptist

Augsperger, MD.

11

Breast Cancer

12

The number of breast cancer cases which are

the breast health program spent its first full year

accrued to the Baptist Health Tumor Registry

in the Hill Breast Center at the Baptist Outpatient

at Baptist Jacksonville consistently exceeds the

Center. Two nurse navigators assisted patients

state of Florida and national average. In 2011,

and physicians to optimize patient convenience as

there were a total of 434 cases entered into the

well as patient care. A breast survivorship program

tumor registry representing 27 percent of all cases

with nutrition, physical therapy and psychosocial

which exceeds the national and state of Florida

support is in place to enhance the overall

average of 13 percent. Similar to previous years

experience in patients seen at the Hill Breast

and similar to the national average, the majority of

Center. Cutting-edge surgery programs with

these cases are early stage breast cancer (Figure

intraoperative radiation began in the fall of 2012.

4). Seventy-nine cases or 18 percent were DCIS,

Limited breast radiation with the MammoSite

190 cases (44 percent) were Stage I and 113

and more recently IntraBeamÂŽ for intraoperative

or 26 percent were Stage II. These early stage

breast radiation are in place. Cutting-edge

breast cancers represent 88 percent of all breast

research programs both in the adjuvant and the

cancers seen and we would expect that all but a

more advanced metastatic setting are offered at

few of these women would ultimately be cured of

the Baptist Cancer Institute, through both medical

their breast cancer. Stage III was 33 or 8 percent

oncology with cooperative group studies as well

in which many of the patients would ultimately

as pharmaceutical sponsored and the radiation

die of their breast cancer and Stage IV was 18

therapy through the RTOG research group. Other

patients or 4 percent and we would expect all

assets for optimizing the care of breast health

of the patients to ultimately die of their breast

patients at the Baptist Cancer Institute through

cancer. Out of these 434 cases, only one or less

the Hill Breast Center program include genetic

than one percent is classified as unknown stage

risk assessment led by Melinda Fawbush, MSN,

assessing to the tenacity of our Tumor Registry in

ARNP, which assists patients and their families in

adequately staging the patients.

making decisions for both the type of surgery and other long-term preventive programs if they are

Breast cancer consistently represents a very

know to have increased genetic risks. Psychosocial

high percentage of the cases seen at the Baptist

support is provided by George Royal, PhD, and

Cancer Institute compared to the U.S. average.

an increasing involvement in breast survivorship

This attests to the effective network in which

services include nutrition, physical therapy, and

primary care physicians work with our digital

lymphedema treatment. All of these services

mammogram screening program to diagnose

continue to enhance the breast health program

patients at an early stage and move them into

and increase Baptist Cancer Institute’s share of

the organized breast cancer program run through

breast care patients within Northeast Florida and

the multi-disciplinary Hill Breast Clinic. In 2011,

Southeast Georgia.

Fi gu re 4 Baptist Cancer Institute Breast Cancer Staging: 2011

60

44

Pe rce n t

50

40

26

30

13

18

8

20

0

4

10

0

0

1

2

3

4

Unknown

St a ge

Fi gure 5 Baptist Cancer Institute Breast Cancer-DCIS Accrual

68 39

43

50

10

60 55

30

17

20

23

25

30

29

34

40

40

50

60

55

56

61

70

8

N umber of P a t ient s

71

80

79

80

81

85

90

0 1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Figure 5 shows the number of cases of ductal

situ will be cured with local therapy and represent

carcinoma in situ seen at Baptist Cancer Institute

a success of the wide use of screening digital

since the establishment of the Tumor Registry

mammograms within our system.

in 1990. Seventy-nine cases were seen in 2011, which is essentially the same as the previous year in 2010. All of these cases of ductal carcinoma in

Lung Cancer for at least the patients seen in 2011. Recently,

lung cancer in 2011. As in past years, the patients

the role of low-dose screening CT scans has been

who were accrued in our Tumor Registry were

reaffirmed at the national level, but is not widely

predominantly advanced cases. Unfortunately, 77

accepted since the number of false negatives and

cases were Stage IV, representing 41 percent of all

unnecessary biopsies is a troublesome handicap

lung cancer seen. Twenty-five or 13 percent were

for its widespread use. One bright spot in lung

Stage III, who have approximately a 20 percent

cancer at Baptist Health is the multi-disciplinary

chance of being cured. Fourteen patients were

lung cancer program led by Bridget Rossi, RN,

Stage II, in which the cure rate is approximately 35

MSN, OCN, nurse navigator. She has established

percent, and 58 or 32 percent were Stage I in which

a foundation to assist needy patients in all aspects

over half the patients are cured with local therapy

of their care from diagnosis to end of life. The role

(Figure 6). The proportion of patients with lung

of the stereotactic radiosurgery program at Baptist

cancer seen at Baptist Jacksonville is 11 percent,

Cancer Institute has likewise expanded since

slightly lower than the 14 percent seen nationally.

selected patients with Stage I, particularly who are

This percentage of patients, as well as total

frail, has become accepted. Research areas within

numbers, represented a drop from the previous

the Baptist Cancer Institute include the continued

years of 241 patients, which was 15 percent of

participation in a cooperative group adjuvant

the cancer seen last year. Similar to statistics both

non-small cell lung cancer, as well as innovative

in Florida and the United States, the majority of

targeted therapies for metastatic and recurrent

patients with lung cancer are Stage III and IV, which

non-small cell lung cancer.

are poorly curable. This presentation in advanced stage represents no accepted screening program

Fi gu re 6 Baptist Cancer Institute Lung Cancer Staging: 2011

41%

50

32%

40

13%

30

8%

20

6%

10 0%

Perc ent

14

Baptist Cancer Institute saw 186 patients with

0 0

1

2

3

St a ge

4

Unknown

Prostate Cancer In 2011, Baptist Cancer Institute Tumor Registry

(Figure 7). Those patients generally were cases which

assessed 199 prostate cancer cases, which was little

were referred outside our institute prior to completing

changed from 2010 when 204 cases were registered.

staging workup. The Baptist Cancer Institute continues

This still represents a dramatic drop from 2009 and

the prostate screening program which has been

2008, when more than 300 cases were assessed each

sponsored by both Baptist Cancer Institute and

year. This drop in prostate cancer accrual represents a

the NFL Jacksonville Jaguars for many years. The

clear cut change in referral patterns in the community

prostate cancer prevention program trial was closed

where many patients are now being both biopsied

in 2011 and unfortunately found no benefit from the

and referred to outside treatment facilities. However,

use of antioxidants either in the form of Selenium

as in previous years, the vast majority of patients

or vitamins in decreasing the incidence of prostate

are either Stage I (60 patients), which represented

cancer. Radiation treatment at Baptist Cancer Institute

30 percent of the patients seen, or Stage II (124

includes the state-of-the-art IMRT Radiation Therapy,

patients), which represented 62 percent of patients.

seed implants, and urologic surgeons have the da

Thus 92 percent of patients were either Stage I or

Vinci Robotic Surgery Program. Patients entered on

Stage II in which the vast majority will be cured with

an innovated immunotherapy program with the use

either surgery or some form of radiation treatment.

of Ipilimumab for advanced castrate resistant prostate

Only four patients or 2 percent and six patients or 3

cancer continue to be followed in 2011 and 2012.

percent were Stage III and Stage IV respectively. Five

The use of innovative new treatments for patients

patients or 3 percent were unknown stage which again

previously considered refractory to hormone treatment

represents a success for our Tumor Registry which

has improved with two new drugs being approved by

accurately staged all but 3 percent of the patients

the FDA for castrate resistant prostate cancer patients seen at Baptist Cancer Institute.

62%

Fi gure 7 Baptist Cancer Institute Prostate Cancer Staging: 2011

60

50

30%

30

20

1

2

S t a ge

3%

0

3%

0

2%

10 0%

Percent

40

3

4

Unknown

15

Female Genital Track Cancer properly stage. This high percentage of patients

Baptist Cancer Institute continued to be active in

in early stage represents a success in American

terms of numbers of patients with 104 patients

cancer management with a high utilization by

seen in the calendar year 2011. As illustrated in

American women of standard guidelines for

Figure 8, 59 percent or 62 patients were Stage

pelvic exam and Pap smear. The percentage of

I and II which in general are felt to be readily

female genital cancer seen at Baptist Cancer

curable by surgery or surgery plus radiation. Only

Institute (6 percent) reflects favorably with the

28 percent of patients were Stage III and IV and

5 percent average reported in other United

7 or 7 percent had inadequate information to

States tumor registries.

Fi gu re 8 Baptist Cancer Institute Gynecological Cancer Staging: 2011

55%

60

50

40

10%

20

0

0

4%

10

7%

18%

30

6%

P ercent

16

In 2011, the Gynecologic Cancer Program at

1

2

3

St a ge

4

Unknown

Melanoma In 2011, Baptist Cancer Institute tumor registry

and accrued into our Registry compares favorably

assessed 90 cases of patients diagnosed with

with the 5 percent rate for the state of Florida

melanoma. This mirrors a trend which started

and the 4 percent rate for the United States.

in 2005 with steadily increasing numbers of

This high percentage of melanoma patients

melanoma patients seen at Baptist Jacksonville.

seen at Baptist Cancer Institute almost certainly

Most of those patients represented early stage

represents the surgical and medical oncology

either Stage 0, which is in situ disease which

expertise in this tumor site which is recognized

accounted for 12 patients or 13 percent, Stage I,

throughout Northeast Florida and Southeast

43 patients or 48 percent and Stage II, 15

Georgia. State-of- the-art surgical approaches

patients or 17 percent. Overall, these Stages 0-II

include lymph node mapping, and expertise in

represent a total of 78 percent of the patients

wide local excision from melanomas occurring

in early stage with an expectation of around 90

in all sites of the body is present. Likewise,

percent of those patients will be cured (Figure

medical oncology has extensive expertise in

10). Unfortunately, six patients or 7 percent and

the use of immunotherapy as both an adjuvant

two patients or 2 percent were Stages III and IV,

treatment and a systemic treatment for metastatic

most of whom would not be expected to survive

melanoma. A wide variety of research studies

five years. Another troublesome aspect is that

including innovative adjuvant treatment protocols

12 patients or 13 percent were unknown stage,

through the ECOG study group and multiple

most probably representing leaving the institution

studies investigating the role of Ipilimumab

prior to completing staging and having their

in metastatic melanoma was in place in 2011.

treatment elsewhere.

Multiple patients were referred from outside the institution for involvement in those

These patients which represented 6 percent of

research studies.

all cancer cases seen at Baptist Cancer Institute

12% 2%

6%

12%

25

15%

43%

50

0%

P ercent

Figu re 10 Melanoma Cancer Staging: 2011

0

Stages

0

1

2

St a ge

3

4

Unknown

17

Tumor Review: Hodgkin’s Disease at Baptist Cancer Institute Mark Augspurger, MD, Radiation Oncologist

Each year, approximately 7,500 new cases of Hodgkin’s disease (HD) will be diagnosed in the United States. In contrast to the increase in incidence of Non-Hodgkin’s lymphoma over the past several decades, the annual incidence of Hodgkin’s disease has remained stable.

There has been an increase in the accuracy of diagnosis and staging, as well as an increasing utilization of combination chemotherapy for the treatment of HD. More than 75 percent of newly diagnosed Hodgkin’s disease lymphoma cases will be cured.

Baptist Cancer Institute

2012 Annual Report

Epidemiology and Etiology

than African Americans. There are no well

established etiologic factors causing HD. Case

Hodgkin’s disease has a slight increased

match studies show that it’s slightly higher in a

incidence of male cases to female, approximately

familiar cluster pattern and is also more likely to

1.3:1. The age of onset of Hodgkin’s disease is

occur in those of higher economic status. There

a bimodal presentation with the largest group

has been extensive ongoing debate whether the

of patients in the second and third decade of

Epstein Barr virus is implicated in the etiology

life and a second smaller peak after age 50. The

of Hodgkin’s disease but to date this remains

second peak is probably an artifact of histologic

unsettled. Patients infected with the Human

misclassification since recent studies have shown

Immune Deficiency Virus (HIV) seem to have

that many of these cases diagnosed as Hodgkin’s

a higher incidence of Hodgkin’s disease when

disease in the older age group were in fact Non-

compared to age match control, but it is unclear

Hodgkin’s lymphoma. In terms of race, Hodgkin’s

why this association occurs.

disease is much more common in Caucasians

19

48

39

70

40

60

20 10 0

Mal e

Female

50 40 30 20 10 0

Signs, Symptoms and Diagnosis

5

30

14

No . of Ca ses

20

N o . of Ca ses

50

Fig ure 2 Cases by Race (2001 - 2011)

68

Figu re 1 Cases by Gender (2001 - 2011)

W h i te

Bla ck

Ot her

pruritis. These symptoms occur more frequently in older patients and have a negative impact

on prognosis. Diagnosis is made by a biopsy

Hodgkin’s disease is a lymph node based

of a suitable lymph node and histopatholigic

malignancy and commonly presents as an

examination by an experienced pathologist.

asymptomatic lymphadenopathy which may

The diagnostic Reed-Sternberg cell is found

progress to symptomatic disease. The majority

within the appropriate lymph node milieu and

of patients, more than 80 percent, present

these cells on histopathologic exam are typically

with lymphadenopathy above the diaphragm

CD30+ and CD15+ by immunohistochemical

involving the anterior mediastinum, cervical

staining. Flow cytometry is generally not

and less commonly axillary and below the

helpful in making a definitive diagnosis of

diaphragm adenopathy. Only in the latest stages,

Hodgkin’s disease. Staging is typically based

is visceral disease such as lung, liver, and bone

on the number of lymph node sites involved,

marrow involved. Involvement of Waldeyer’s

whether these lymph node sites are above or

ring is quite uncommon. Approximately 40

below the diaphragm and whether or not the

percent of patients present with systemic

patient is asymptomatic (A) or symptomatic (B.)

symptoms. Classically these B symptoms

Typically, these cases of Hodgkin’s lymphoma

include sweats, fever, weight loss and chronic

are separated into four histologic categories:

lymphocyte predominant, nodular sclerosing,

disease involving high cervical nodes. For Stages

mixed cellularity, and lymphocyte depleted.

IB to Stage IVB, combination chemotherapy,

At one time, histopathologic subtype was

classically the ABVD (Adriamycin, Bleomycin,

important, but more recently it has been found

Vinblastine, and Dacarbazine regimen) is

that the pathologic stage trumps histologic

employed with radiation therapy reserved for

subtype in terms of long-term prognosis. The

bulky lymphadenopathy usually given at the

staging system used is a modified Ann Arbor

completion of combination chemotherapy. For

staging system and consists of the following:

most patients, four to six cycles of chemotherapy is employed. Surgery other than lymph

• Stage I is involvement of a single lymph node region;

• Stage II is involvement of two or more

node biopsy for diagnosis has no role in the therapeutic management of Hodgkin’s disease.

Outcome is based on primarily stage with

lymph node regions on the same side of the

obviously earlier stage disease doing significantly

diaphragm;

better than later stage disease. Overall, for

• Stage III is involvement of lymph node regions on both sides of the diaphragm;

• and Stage IV is involvement of extra nodal

Stage I, approximately 85-90 percent of patients will be expected to be disease free at five years, for Stage II 75-80 percent will be disease free

sites such as lung, liver or bone marrow and

at five years, for Stage III 55-65 percent will

not contiguous to a known nodal site.

be alive and disease free at five years, and for Stage IV 45-55 percent will be alive and free

The designation A means no symptoms and B

of disease at five years. Adverse prognostic

means the presence of fever, drenching sweats,

factors include age greater than 50 years, bulky

weight loss or intractable chronic pruritis. Bulky

disease, and advanced stage. Patients with

disease is considered a maximum diameter

other immunodeficiencies such as HIV or post-

of a lymph node mass greater than 9cm. In

transplant, likewise, do poorer. For patients

general, Hodgkin’s disease is staged clinically

who reoccur, combination chemotherapy with a

with imaging studies such as CT scans or PET CT

different chemotherapy regimen plus autologous

scans rather than surgical pathologic staging.

transplant appears to cure 25-30 percent of

Treatment and Outcome

those patients. A new targeted therapy is currently available, brentuximab; a monoclonal

antibody to CD30 and appears to have high

Treatment of Hodgkin’s disease involves the

response rates in the 70-80 percent range but

application of combination chemotherapy with

has been commercially available only for two

selective cases receiving radiation therapy

years and its exact role remains to be defined.

particularly for bulky disease. Currently, in 2013,

the only patients who are treated with radiation

At Baptist Health, the Tumor Registry of Baptist

alone are typically those who have Stage IA

Cancer Institute accrued a total of 87 cases

21

Figu re 3 Cases by Stage (2001 - 2011)

30

34

40

30

3

4

1

7

10

7

8

20

0

22

Nu mb e r of Ca se s

50

0 0

1

2

Unknown

N/A

St a ge

between 2001 and 2011, an average of 8.7

chemotherapy actually received chemotherapy

cases were seen yearly. Out of those patients,

as outpatients and were not captured by the

48 were male and 39 were female for the

tumor registry. Survival was extremely good as

expected slight male predominance of 1.3:1.0,

would be expected in more than 80 percent of

as seen in national databases (Figure 1). Again,

Stages I, II, and III being five year survivors and

similar to national databases, there is a strong

only Stage IV dropping down to 57 percent and

predominance of caucasian patients with 68

as essentially expected in the national database

being caucasian, 14 being African American

(Figure 4).

and five being other races (Figure 2). Staging showed that predominance of patients were

Thus, in summary, the information on Hodgkin’s

early stage with 34 of 87 being Stage I, 30 of 87

disease was flawed by a large number of cases

being Stage II, seven were Stage III, seven were

in which treatment was done outside of the

Stage IV, eight were stage unknown and one was

hospital and was not captured by the tumor

non-analytic (Figure 3). In terms of treatment,

registry. However, all other aspects of the data

there was a major problem with our data. On the

including number of cases, male to female ratio,

initial data run, 50 of 89 were listed as having

race, stage, and long-term survival appeared

received no therapy and seven of 89 were listed

consistent with that seen at the national level.

as receiving surgery or biopsy only. This data will be reviewed under our article for quality assurance but to briefly summarize, most of these patients listed as receiving surgery alone or no

Fi gure 4 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005) 100 95 90 85 80

Cu mu l at ive Sur vi va l Ra tes

75 70 65

23

60 55 50 45 40 35 30 25 20 15 10 5 0 0.0

1.0

2.0

3.0

4.0

Year s from Di ag nos i s Stag e I

Stag e II

Stag e III

Stag e IV

5.0

Tumor Review: Soft Tissue Sarcomas at Baptist Cancer Institute Troy Guthrie, MD, Medical Director, Baptist Cancer Institute

Soft tissue sarcomas are a group of rare, but anatomically and histologically quite diverse neoplasms. This is due to their varying location within the soft tissues of nearly all body sites. Currently, there are more than three dozen recognizable histological distinct subtypes occurring within the body. Each year approximately 7,000 new cases of soft tissue sarcoma are identified and approximately 4,000 patients die of this disease. The age adjusted incidence is two cases/100,000 persons.

Baptist Cancer Institute

2012 Annual Report

Epidemiology and Etiology

Signs, Symptoms, and Diagnostic Workup

In soft tissue sarcomas, there is a slight male predominance with the male to female ratio

In terms of signs and symptoms, the majority

being approximately 1.1:1. Approximately 50

of soft tissue sarcomas present either in the

percent of soft tissue sarcomas will occur in

extremities or superficial trunk as a mass lesion

adults older than 60 years and 50 percent below

either exerting pressure or causing pain due to

age 60. The vast majority of soft tissue sarcomas

mass expansion. Many of these malignancies are

occur in caucasians, 86 percent, 10 percent in

found incidental to self-examination or physician

African Americans, and 4 percent in other ethnic

examination. Approximately, 15 percent of soft

groups. There is no geographical distribution.

tissue sarcomas arise in the retroperitoneal and

In terms of risk factors, soft tissue sarcomas

present as an abdominal mass with about half

clearly have been reported to originate within

of patients reporting pain. Physical exams of

previously irradiated fields and often develop

patients with soft tissue sarcomas usually reveal

decades after radiation. The majority of those

a palpable mass but little else is noted. General

malignancies arising within radiation fields are

laboratory testing likewise is non-diagnostic.

high grade lesions. Chemical exposures in certain

Imaging studies are the most important

occupations such as those working in factories

evaluation procedures and usually include either

making plastics or solvent exposure have likewise

CTs or MRIs of the affected area as well as CT

been reported as a risk factor. There are rare

scans, primarily of the lung looking for metastatic

genetic syndromes such as von Recklinghausen

lesions. Diagnosis is usually obtained either by

disease, tuberous sclerosis, and others which

image guided core needle biopsy or excisional

have likewise been linked to specific types of soft

biopsy performed by an experienced surgeon.

tissue sarcomas. In general, however, the vast

In general, if the lesion is on the extremity, the

majority of soft tissue sarcomas are not linked to

pathway of the biopsy should be planned such

any specific etiology.

that it can be resected in total within a definitive surgical procedure later since there is some risk of seeding the tract with malignant cells and having secondary lesions develop within the biopsy tract if not completely excised.

25

Histopathology

small and advanced stage lesions are lesions

In general, the histopathological diagnosis

metastatic lesions. Because soft tissue sarcomas

is made of the tissue of origin, for example,

tend to be asymptomatic until reaching a large

fibrosarcoma from fibrous tissue or

stage SEER data shows that most adult soft

rhabdomyosarcoma from striated muscle

tissue sarcomas present in more advanced Stage

cells. The most important determinant of

III or Stage IV stages.

that are high grade, large lesions and may have

prognosis is the grade of the tumor, with grading being Grade I low grade, Grade II

Treatment

intermediate grade, or Grade III high grade tumors. Some histopathological types, such as

The treatment of the primary lesion is surgical

rhabdomyosarcoma or fibrous histiocytoma, are

resection with wide margins. In particular, for

automatically assigned a high grade status. The

soft tissue sarcomas occurring in the extremities,

staging of soft tissue sarcomas depends on four

it is felt when possible that the surgery should

factors: primary tumor, which is based on size

be done by an experienced surgical oncologist

either greater than 5cm or less than 5 cm and

so that limb sparing when possible can be

whether or not they are superficial a. deep, b.

achieved. If initial surgical resection of a soft

grade of the tumor: being well differentiated

tissue sarcoma is impossible then preoperative

grade I; moderately differentiated grade II;

treatment with both radiation therapy and in

poorly differentiated grade III or undifferentiated

certain circumstances either systemic or limb

grade IV, presence or absence of lymph node

arterial perfusion of chemotherapy is advised.

involvement, and presence or absence of

Most often it is felt that patients needing this

metastatic lesions. In general, early stage lesions

treatment should be referred to medical centers

are low grade or intermediate lesions that are

where a multi-disciplinary team experienced in

10 5 0

Mal e

Female

25 20 15 10

15

N o . of Cases

30

10 5 0

3

17

20

35

22

25

Fig ure 2 Cases by Race (2001 - 2011)

26

Figu re 1 Cases by Gender (2001 - 2011)

N o . of Cases

26

W h i te

Bla ck

Ot her

Fi g u re 3 Cases by Stage (2001 - 2011)

14

20

10 3

4

7

10

1

5 0

Nu mb e r of Ca se s

15

0

27 0

1

2

3

4

Unknown

N/A

St a ge

managing soft tissue sarcomas is available. Thus

and radiation. Typically, response rates to

often soft tissue sarcomas, while diagnosed in

chemotherapy are low. Complete remissions are

one institution, are referred outside for definitive

rarely produced and the duration of response

treatment particularly of the primary lesion.

is quite short. Chemotherapy drugs used to

In general, there is a low incidence of lymph

treat soft tissue sarcomas include doxorubicin,

node involvement for soft tissue sarcomas and

ifosfamide, dacarbazine, and occasionally

routine lymph node dissection during surgical

other chemotherapy agents. Response rates

procedures is not done.

to combinations of chemotherapy agents such as doxorubicin, ifosfamide +/- dacarbazine

The role of radiation therapy is both preoperative

are higher but do not seem to translate into

and postoperative in the definitive management

a long-term survival advantage. In general,

of the primary site. In patients who have locally

chemotherapy is reserved for improving local

advanced lesions, deployment of radiation

control preoperatively and palliative treatment of

therapy either with or without adjuvant

metastatic disease. Of note, some patients with

chemotherapy has resulted in higher rates

surgically resectable metastatic disease do seem

of definitive resection of the primary site. In

to benefit from surgical resection particularly

patients who have been resected up front and

if the metastases are in the lungs. Targeted

who have either positive or close margins and a

therapy for certain soft tissue sarcomas, such as

high histological grade, there have been both

dermatofibrosarcoma and certain other soft tissue

retrospective and prospective studies showing

sarcomas, has an evolving role. These soft tissue

application of radiation therapy to the primary

sarcomas (PDGFÎą) express a target such as c-KIT

site results in a drop in local recurrence rates.

or platelet derived growth factor alpha and can

be treated with targeted agents such as Imatinib

The role of chemotherapy in soft tissue sarcomas

or Dasatinib.

is much less well defined compared to surgery

Figu re 4 Cases by Treatment (2001 - 2011)

15 11

12

None

Surgery/Chemo

4

4

10 5

5

3

Nu mb e r of Ca ses

20

0

Surgery

28

Surgery/ Radiation

Chemo

All Others

The records of the Baptist Cancer Institute Tumor

plus chemotherapy. A total of 27 of the 39 or

Registry were reviewed from 2001 to 2011.

69.2 percent received some form of surgical

The cases were analyzed and compared to the

treatment as would be expected from national

national cancer database. During this time, 39

databases. Five or (12.8 percent) were listed as

patients with soft tissue sarcoma have been an

receiving no specific therapy but were referred

accession to our Tumor Registry averaging four

out and probably received standard care. Three

patients each year. Of those 39 patients, 17 were

patients received chemotherapy alone in palliative

male and 22 were female–slightly different from

treatment. These percentages would be the same

the usual male/female ratio reported (Figure 1).

as expected in national averages. Figure 5 shows

In terms of race, 26 were caucasian, 10 African

five year survival for our 39 patients and shows

American, and three represented another ethnic

81 percent of Stage I were alive at five years and

group (Figure 2). Staging showed seven were

67 percent of Stage II were alive, 47 percent of

Stage I, three were Stage II, 10 were Stage III,

Stage III and only 14 percent of Stage IV had

one was Stage IV, 14 were unknown stage and

survived five years. This is comparable to what is

four were non-analyzable (Figure 3). This higher

published and shows that management of soft

proportion of non-analyzable and unknown stage

tissue sarcomas is quite similar to that practiced

represents the fact that a large portion of patients

throughout the United States and end results

were referred to outside institutions, particularly

appear to be similar.

Mayo Clinic and the University of Florida

Gainesville for a specialized multi-disciplinary

Thus this review of soft tissue sarcomas seen at

team to treat these rare malignancies.

Baptist Cancer Institute from 2001 to 2011 shows

similar epidemiologic factors, similar treatments

Treatment, in general, followed the same lines

except a higher percentage of patients referred

as that reported in national databases (Figure 4).

outside to receive specialized care. Our survival

Twelve of the patients or 30.8 percent received

data is likewise similar to that reported in national

surgery, 11 (28.2 percent) received surgery plus

SEER data.

radiation, and four (10.3 percent) received surgery

Fi gure 5 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005) 100 95 90 85 80

Cu mu l at ive Sur vi va l Ra tes

75 70 65

29

60 55 50 45 40 35 30 25 20 15 10 5 0 0.0

1.0

2.0

3.0

4.0

Year s from Di ag nos i s Stag e I

Stag e II

Stag e III

Stag e IV

5.0

Quality Assurance Troy H. Guthrie Jr., MD, Medical Director, Education and Research, Baptist Cancer Institute,

Melissa McCarthan, RHIT, CTR; April Stebbins, RHIT, CTR; and Rassy Sprouse, BS

The Tumor Registry and its database are necessary for quality of care monitoring provided by Baptist Cancer Institute.

The accuracy and dependability of this essential service was evaluated and examined as directed by the American College of Surgeons and the Commission on Cancer. A review of the data that resulted in patient accrual management and lifespan was assessed during a 10-year period for Hodgkin’s disease from 2001 through 2011. The abstracts were reviewed for accuracy and charts were pulled when deemed necessary.

Baptist Cancer Institute

2012 Annual Report

The following are the results of the assessment

accuracy of data will continue to be reviewed

on the 87 patients entered by our Tumor Registry

so that we can have accurate long-term follow-

during the above-mentioned time period. The

up on Hodgkin’s disease patients from this time

results are summarized as follows:

period of 2001 to 2011; Kaplan-Meier curves were readily available and appear to be accurate;

• Abstracts contained adequate information to assess accuracy;

• There were no errors in the classification of the Hodgkin’s patients identified in terms of

and demographics were available and appear to be accurate.

Recommendations for correction include:

histology;

• Therapy of Hodgkin’s patients had many problems in terms of identifying treatment.

• 50 out of 89 patients were listed as having no

• Education was presented to the Tumor Registry concerning treatment of Hodgkin’s disease so that a red flag will be raised

therapy, and seven out of 89 patients were

if no therapy or surgery alone is listed as

listed as being treated with surgery alone.

treatment;

• Suggestions have been made to work Clearly this was inaccurate so charts were pulled

more closely with the clinicians of record

from the offices of 21st Century Oncology and

concerning any patient in whom the accuracy

reviewed by Troy H. Guthrie, MD, and from the

of staging, treatment or survival including

office of Cancer Specialists of North Florida

phone calls would be warranted;

and reviewed by Unni Thomas, MD. Of the

• Cancer physicians should be involved in

50 patients listed as having no treatments,

the abstraction process particularly up front

currently 10 have been identified as receiving

if information is missing or appears to be

chemotherapy and three have been identified

inaccurate; and

as receiving chemotherapy plus radiation. Of

• Request additional information from

the seven patients listed as receiving surgery

physicians who refer patients for

alone to date, two have been listed as receiving

management outside the institution so long

chemotherapy and one receiving chemotherapy

term follow-up can be accurate in terms of

plus radiation. This is a laborious task and the

treatment and survival.

31

Clinical Research and Education In 2011, cancer research for the Baptist Cancer Institute continued to function at a high level on multiple sites, including the Baptist Cancer Institute, Florida Radiation Oncology Group, and Cancer Specialists of Northeast Florida. At any one time throughout all campuses approximately 60 to 70 research protocols were available for patients with diverse cancer sites including breast, lung, gastrointestinal, brain, melanoma, pancreatic, hematologic malignancies, and other less common sites.

All protocols were available for patients at Baptist Medical Center Jacksonville and Baptist Medical Center South, as well as having referrals from outside the Jacksonville area, including Southeast Georgia. Studies were available to patients originating 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).

Baptist Cancer Institute

2012 Annual Report

On campus, approximately 50 percent of the

pressure on physicians to deal with increasing

studies were through National Cancer Institute

patient volume, increasing complexity of

(NCI)-sponsored cooperative group studies

insurance and third party payment, as well as

and the other half were industry sponsored

reluctance of patients to participate in studies

pharmaceutical studies.

that may cause economic pressure. Hopefully, patient accrual will increase in 2012 to above

All studies done on campus, either NCI-

50 patients close to years past.

sponsored or pharmaceutical-sponsored were reviewed by the Baptist Medical

Baptist Cancer Institute continues to be an active

Center Institutional Review Board (IRB) for

community cancer education program offering

appropriateness of research, conflict of interest

CME sessions at the multi-specialty breast cancer

and protection of human rights. All studies were

conference, neuro-oncology conference, and

then described in language understandable

lung cancer conference and tumor board. Table

by the public in an informed consent and

2 lists the subjects of the annual tumor board

also published on the Baptist Cancer Institute

for 2012. Table 3 lists the active participants in

website. Phases of studies including phase I,

the cooperative groups at Baptist Health, as

phase II, and phase III, were available in 2011.

well as those involved in the research programs of the NSABP, and RTOG study groups. In

In 2011, studies through the Baptist Cancer

summary, the Baptist cancer program continues

Institute led to FDA approval for a number of

to offer exciting clinical projects through

drugs, including Ipilimumab for the treatment

both cooperative group mechanisms as well

of metastatic melanoma, Aldo-herceptin for the

as pharmaceutical studies. A great deal of

treatment of HER2+ breast cancer, and afatinib

enthusiasm on the campus exists for continuing

for the treatment of EGFR mutation positive

to increase patient accrual and increasing the

non-small cell lung cancer. In addition to

relevance of clinical trials for everyday treatment.

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 2011 patient accrual for all participants consisted of 35 patients compared to the 65 patients in 2010 (Table 1). Accrual throughout the campus has remained well below 100 patients per year due to diverse reasons, including increasing

33

Table 1 Clinical Research BCI : 2008 – 2011

34

Year

# of Patients

2008

88

2009

90

2010

65

2011

35

Table 2 Tumor Board : 2012 Breast Cancer Prevention Troy Guthrie, MD Volatile Organic Compounds and the Early Detection of Lung Cancer

Nir Peled, MD

Hosts of Lymphoma Troy Guthrie, MD Melanoma Staging and Treatment

Troy Guthrie, MD

Contemporary Head and Neck Oncology and Reconstructive Surgery

Phillip Pirguosis, MD

Interventional Pain Management for the Spine

Christopher Roberts. MD

Chronic Myeloid Leukemia Overview

Troy Guthrie, MD

Melanoma Metastatic to Regional Lymph Nodes

John Crump, MD

Post-mastectomy Radiation Therapy: Update and Indications

Nicole Anderson, MD

Head and Neck Cancer Naeem Latif, MD Multiple Myeloma Troy Guthrie, MD Triple Negative Breast Cancer Dimitrios Agaliotis, MD Non Small Cell Lung Cancer

Troy Guthrie, MD

Cervix and Endometrial Cancer: Case Discussion and Brief Overview

Michael Olson, MD

Prostate Cancer Naeem Latif, MD The Management of Prostate Cancer

Mark Augspurger, MD

Melanoma Update Gary Bowers, MD Management of Anorectal Melanoma

Hank Hill, MD

Neuro Oncology Tumor Board Multiple Presenters

Table 3

Cooperative Group Trials (BCI)

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

Jeffrey Harris, MD – Medical Oncology

Troy Guthrie, MD – Principal Investigator, ECOG, NSABP, Mayo Trials Group

Douglas W. Johnson, MD – Principal Investigator

Zhen Hou, MD, PhD – Medical Oncology

Anand Kuruvilla, MD – Radiation Oncology

Douglas W. Johnson, MD – Sub-Investigator, Radiation Oncology

Carla Malott, RN – Clinical Research Associate

Robert A. Joyce, MD – Medical Oncology

Thomas Marsland, MD – Medical Oncology

Mohammad Khan, MD – Medical Oncology

Lois Morgan, RN – Clinical Research Associate

Mathew Luke, MD – Medical Oncology

Michael Olson, MD – Radiation Oncology

Alan Marks, MD – Medical Oncology

Niraj Pahlajani, MD – Radiation Oncology

Joseph Mignone, MD – Medical Oncology

Shyam Paryani, MD – Radiation Oncology

Yuval Naot, MD – Medical Oncology

Jan Peer, CCRP – Clinical Research Associate

Jeanine Richmond, RN, BSN, OCN, - Study Coordinator

Sonya Schoeppel, MD – Radiation Oncology

Matthew Robertson, MD - Gynecologic Oncology

Neenad Sha, MD – Radiation Oncology

Mila Shteyn, MA - Study Coordinator

Dwelvin Simmons, MD – Radiation Oncology

Alexander Moore – 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 Jr., MD – Principal Investigator

Cancer Risk Assessment and Genetics Melinda Fawbush, ARNP, MSN Troy Guthrie Jr., MD – Principal Investigator

35

Distinguished Individual in Cancer Care: E. Dayan Sandler, MD Each year the Annual Report honors an individual who has made a significant contribution to the cancer program at Baptist Health and to Baptist Cancer Institute progress. In past issues, we have honored both physicians and nonphysicians. This year we are honoring Dayan Sandler, MD, Chief of Pathology at Baptist Health. Dr. Sandler has made numerous contributions to the cancer program since joining the physician faculty in 1993.

Dayan obtained her Doctorate of Medicine from the University of California School of Medicine San Francisco, Calif., where she had previously obtained a Doctor of Pharmacy. She did her post-graduate training in the department of pathology at University of California San Francisco from 1986-1990. She received intensive training in Cytology, Dermopathology, and Hematopathology. After completing her pathology residency, she received further training with a fellowship in nuclear medicine,

Baptist Cancer Institute

2012 Annual Report

37

E. Dayan Sandler, MD

within the Department of Radiology again at the

sought by both fellow pathologists and clinicians

University of California San Francisco in

for her opinions within the pathology field.

1990-1991. She became a staff pathologist at

She has been an active member of the Cancer

St. Mary’s Hospital in San Francisco from 1991

Committee for 12 years, and more recently, has

to 1992 prior to joining the clinical faculty at

served as committee chair of Baptist Health’s

Baptist Medical Center Jacksonville in 1993.

System Breast Program Leadership.

Here she has served in many positions, including director of Immunohistochemistry, Histology,

She has been an active member of Tipping the

Flow Cytometry Analysis Laboratory, and has

Scale Program, serving as both committee chair

served as the director of Laboratory Medicine

and as a mentor. She has mentored four young

from 1997 to the present. She also served as

ladies, all of whom have gone to college.

the director of the Stem Cell Laboratory when it functioned at Baptist Jacksonville from

On a personal note, her husband, Dr. Jeffrey

1996-1999. She has been Chief of Pathology

Sandler, is an Ear, Nose and Throat surgeon at

since 2004 at Baptist Health. Dr. Sandler has

Baptist Medical Center South. They have three

made numerous contributions to the cancer

children, Jonathan, Laura and Zachary, all of

program at Baptist Health, particularly in the

whom are in college. Her greatest passion is

field of breast cancer. She has a breast cancer

being with her family; all of them are outdoor

consultation service and is the pathologist for the

enthusiasts, and she loves kayaking, photography

Breast Conference. She also serves as primary

and traveling.

pathologist and as a major participant within the recently established neuro-oncology multi-disciplinary program. Dr. Sandler is widely

Baptist Cancer Institute Donors | Calendar Year 2012

38

Ms. Julie K. Abbott

Dr. and Mrs. Perry G. Carlos

Mr. and Mrs. Jim Furyk

Mrs. Mary W. Ackerly

Ms. Marge Cash

Jim and Tabitha Furyk Foundation

Acosta Sales and Marketing Co., Inc.

Ms. Debbie Castroverde

Mr. and Mrs. James R. Gabrielsen

Adelante Group, Inc

Mr. and Mrs. George Catallo

Mrs. Mary Louise Gallagher

Mrs. Letitia R. Aitken

Dr. and Mrs. Michael A. Chanatry

Mrs. Charlene K. Gamewell

All About Blinds

Ms. Robin C. Chandler

Mrs. Jane W. Gamewell

Mrs. Lucile W. Allsopp

Claude Nolan Cadillac, Inc.

Gannett Foundation

Amanda Morrow LLC

Mr. and Mrs. Gary A. Close

Mrs. Margaret Gates

Anonymous

Coldwell Banker Walter Williams Realty, Inc.

Georgia Xpress Lubes, Inc

Arlington Toyota

Mr. C. Randolph Coleman

Mr. and Mrs. Robert T. Golitz

Mr. and Mrs. John Arnold

Mr. and Mrs. Douglas Coleman

Goodall Family Foundation

Mr. Sheridan T. Arnold

Mr. and Mrs. Donald Cox

Mrs. Helene C. Gorab

Mr. and Mrs. Paul M. Arvia

Ms. Esther G. Cruikshank

Ms. Mary Ann Graham

Mr. and Mrs. Douglas C. Asper

Ms. Sarah B. Dann

Mr. and Mrs. Michael J. Grebe

Atlantic Companies

Mr. Earle Mauldin, III and Ms. Debbie L. Davidoff

Ms. J. A. Grunther

Mr. and Mrs. Steven E. Austin

Mr. and Mrs. John C. Davis

Mrs. Melody T. Gurney

Mr. and Mrs. Stephen E. Bachand

Ms. Carol DeGregorio

Mrs. Pauline W. Guzek

Mr. Robert B. Bailey

Mr. and Mrs. Greg Delaney

Ms. Dorothy E. Hall

Ms. Kathy Baker

Mrs. Susan S. Delfs

Mr. and Mrs. Y. E. “Chipper” Hall

Mr. and Mrs. Thompson S. Baker II

Ms. Michelle Denbesten

Hamilton Family Foundation

Ms. Purisima Balgos

Mr. and Mrs. Derek E. Dewan

Hanaya Enterprises LLC

Ms. Jacquelyn D. Bates

Ms. Elana Dietz

Mrs. Maureen L. Hannan

Ms. Cathy Battreall

Mr. and Mrs. Patrick S. Doran

Ms. Millie G. Harrison

Ms. Joan M. Bauer

Mrs. Robin Doyle

Ms. April Hart

Ms. Beverly R. Beck

Drs. Mori, Bean & Brooks, PA

Ms. Elizabeth L. Harther

Mrs. Beverly J. Behrens

Mr. and Mrs. Charles N. Dunn, Jr.

Mr. Greg Hartley

Benchmark Custom Luxury Homes, Inc

Mrs. Lillian D. Durden

Dr. and Mrs. Gregory W. Hartley

Benchmark Homes Realty, Inc.

Mr. and Mrs. Gary Ehlig

Mr. John Haswell

Mr. and Mrs. Gerald Bertisch

Mr. Tucker W. Elliott

Ms. Lisa Hathaway

Mr. Robert E. Berwick

Mrs. Sharon A. Ellis

Ms. Marion D. Haynes

Mr. Otto J. Betz, Jr.

Mr. and Mrs. John H. Erstling

Mrs. Shonda J. Heath

Mrs. Lucy Boesel

Mr. Gerard R. Evan

Major General Patricia P. Hickerson

Mr. Robert Bon Durant

Mr. Lawrence W. Evans

Major General Patricia Hickerson

Ms. Connie Bones

Mr. and Mrs. William S. Fellner

Mr. and Mrs. Robert E. Hill, Jr.

Mr. Mac Bracewell

Mr. and Mrs. Paul S. Ferber

Mr. Hal Hitch

Ms. Kari M. Bracy

Ferguson Enterprises

Ms. Susan Hitch

Ms. Lauren Braren

Fernandina Beach High School

Mr. and Mrs. Howard I. Hodor

Mrs. Kay Brooks

Ms. Donna M. Fiedorowicz

Mr. John J. Hofstetter

Mr. John E. Buckey

First Coast Supply, Inc.

Mrs. Jill I. Hornsby

Mr. and Mrs. Malcolm A. Buckey, Jr.

First Radiation & Oncology Group

Mr. David K. Hunt

Mrs. Shirley J. Budden

Mr. and Mrs. Thomas J. Flanigan

Mrs. Sharon Hunt

Ms. Margaret A. Bulin

Florida Blue

In the Pink Boutique, Inc

Mr. and Mrs. Phillip Burnaman

Florida Propane Partners, LLC

Innovations By Shelley

Ms. Lynn Y. Cabrera

Ms. Judith Y. Flynn

Ms. Melissa Intemann

Mrs. Gretchen H. Calvert

Ms. Kathleen Foley

Iridium Holding, Inc.

Cambridge Prep Academy

Fore In One Golf Services, Inc

Ms. Roxanne Isaacs

Mrs. Anastasia Cameron

Ms. Susan E. Forster

J. McLaughlin

Mr. Michael D. Cantrell

Mrs. Marie E. Frankiewicz

Jacksonville Jaguars Booster Club, Inc

Ms. Esther F. Cantus

Ms. Virginia M. Fritz

Ms. Patricia A. Jensen

Mr. and Mrs. Walter Jewett

Mr. and Mrs. Eric B. Morris

Mr. and Mrs. Shepard C. Spink

Mr. and Mrs. Richard O. Jones

Mr. and Mrs. Richard G. Morrison

Mrs. Martha Stachitas

Ms. Lucinda Jordan

Ms. Amanda Morrow

Mrs. L. Elaine Stallings

K. Fehling & Associates

Mr. Charles A. Morrow, Jr.

Ms. Kimberly A. Steedman

Mr. and Mrs. Ralph O. Kaufman, Jr.

Mrs. Christine C. Moyer

Mr. and Mrs. C. L. Strickland

Mr. Raphael M. Kelly

Mrs. Mary Murphy

Mr. and Mrs. Thornton M. Swisher

Ms. Shirley Ketchum Patterson

Mr. and Mrs. Randal P. Nader

Swisher International, Inc.

Mrs. Gail A. Killion

ND Industrial Corp

Mr. and Mrs. John Tancredi

Ms. Beverly A. Koerner

Dr. Kevin L. Neal, DDS

Mrs. Cathleen C. Taylor

Ms. Nancy Koob

NFL Affiliate of the Susan G. Komen Foundation, Inc.

Mr. Joe T. Taylor

Ms. Duffy M. Kopriva

Mrs. Barbara Orr

Mrs. Cynthia L. Thatcher

Ms. Jennifer Lada

Parker & Pennington, PA

The Edna Sproull Williams Foundation

Ms. Shelley Laird

Mrs. Ann Patsiga

The Haskell Company

Mrs. Margaret V. Lehman

Ms. Danielle Payne

The Jacksonville Jewish Foundation

Mr. and Mrs. Herb LeMoyne

Ms. Sharon Peacock

The RITA Foundation Inc.

Lender Processing Services

Mr. and Mrs. Joseph Pearce

Mr. and Mrs. Joseph A. Thompson

Mr. and Mrs. Paul Lichlyter

Mrs. Gigi Pelletier

Mr. Kerry Tobin

Lilly USA, LLC

Dr. Patricia B. Pereira

Mr. Randolph Totten

Ms. Lynda Linforth

Mrs. Marie C. Perry

Underwood Jewelers Corporation

Mr. Jeffrey Locke

PGA Tour, Inc.

Valentine Sales

Mrs. Jenny H. Lockett

PhRMA

Mrs. Julie Van Voorhis

Ms. Julia E. Lord

Ms. Gussie D. Pokorny

Mrs. Julie Vermeulen

LuLu’s Waterfront Grille

Ponte Vedra Properties Realty LLC

Ms. Tilghman H. Waesche

Mr. and Mrs. William B. Lynch

Ms. Jane D. Porter

Mr. Ralph D. Wagoner

Ms. Susan E. Mack

Mrs. Rose Puleo

Mrs. Amy F. Wallman

Ms. Diana Mackoul

Ms. Leigh Quijano

Mr. and Mrs. Christopher W. Ware

Magnolia Point Women’s Club

Mr. and Mrs. Brady L. Rackley

Ms. Suzannah Warren

Mrs. Virginia B. Maloney

Ms Selina Rainey

Ms. Elizabeth B. Watkins

Mr. and Mrs. James T. Mann

Mr. Bernard E. Reidy

Mr. Charles R. Weed

Ms. Barbara S. Maple

Ms. Barbara Resnick

Mrs. Barbara T. Welch-Salmon

Marchese Communications

Mr. and Mrs. Raymond S. Rizzo

Mrs. Janette O. Wells

Mr. Randy Marshall

Robert Williams Design, LLC

Ms. Donna WeMett

Ms. Beth McCague

Ms. Cathleen Roden

Mrs. Nancy M. Wertheimer

Ms. Alison McCallum

Mr. A.C. Roemhild

Mrs. Frances W. West

Mr. and Mrs. Donald C. McGraw III

Mr. and Mrs. Jack P. Rothacker

Dr. and Mrs. Robert E. Wharen, Jr.

Mr. and Mrs. Rodney A. McLauchlan

Ms. Nancy C. Rowe

Ms. Peggy A. Widicus

Mrs. Christin McManus

Mr. and Mrs. William T. Roy

Ms. Debra H. Widner

Mr. and Mrs. Jeffrey G. McNeill

S.R.F.

Mr. and Mrs. John F. Wilbanks

Mr. and Mrs. C. Keith Meiser

Mrs. Robin Saltman

Ms. Lisa J. Williamson

Mrs. Damara F. Merten

Dr. Brenda M. Samara, PhD

Mr. and Mrs. James T. (Tylee) Wilson

Ms. Marzena Mignone

Mr. and Mrs. James R. Scielzo

Ms. Tane M. Wilson

Mrs. Barbara P. Miller

Mr. and Mrs. Francis Seabrook

Ms. Janis A. Wotiz

Ms. Betsy A. Miller

Seaside National Bank & Trust

Mr. Richard Yocolano

Mr. and Mrs. James R. Miller

Mr. Donald C. Shaffer

Mr. and Mrs. Richard Zanard

Mr. Phillip Mills, CPA

Mrs. Gail W. Shave

Mr. John Minor

Mr. and Mrs. John H. Shields II

Mr. and Mrs. Michael Monaghan

Mrs. Theodora P. Siragusa

Mrs. Melissa Morgan

Ms. Kerrie J. Slattery and Mr. Paul Lambert

Ms. Shelley Morgan

Mr. and Mrs. James P. Smith, Jr.

39

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