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2012 Cancer Annual Report Saint Francis Cancer Treatment Center

Better Cancer Care, Close to Home


Saint Francis Medical Center

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Cancer Committee Members The Cancer Committee is comprised of representatives from primary and specialty care physicians, as well as representatives from ancillary departments involved in the care of cancer patients. The multidisciplinary committee meets quarterly to evaluate overall program activity, evaluate the quality of the program, and set goals for future growth.

Physician Members M. Sitki Copur, MD, FACP, Medical Director of Oncology, Cancer Committee Chairman Melhem Jabbour, MD, Medical Oncology Ryan Ramaekers, MD, Medical Oncology Mark Bolton, PhD. MD, Radiation Oncology Michael Hein, MD, Vice President of Medical Affairs Brant Luebbe, MD, Surgery, Cancer Liaison Physician George Antaki, MD, Diagnostic Radiology Kris Mleczko, MD, Pathology Steven Schneider, MD, Surgery, Guest Member Rebecca Steinke, MD, Family Practice James Omel, MD, Patient Advocate Joshua Anderson, MD, Neurosurgery

Non-Physician Members Dale Hartwig, Vice President Ancillary Services Max Norvell, PharmD, D  irector of Oncology Services Mary Mickey, RN, OCN, Cancer Center Manager Marlene Hinrichs, BSRS, (R)(T), R  adiation Oncology Manager Heather Benzel, RN, CRA, Center for Translational Research Cathy Ferguson, RN, H  ospice Connie Hameloth, RN, O  utreach, Community Outreach Coordinator Sherry Huffman, M Ed, CHI Nebraska Physician CME Program Manager Mary Ann Kalinay, MS, LMHP, Social Work, Psychosocial Services Coordinator Jill Koch, American Cancer Society Sandra Krolikowski, RN, Director of Med Surg Ortho/Oncology Colleen Kunzman, BSRA (R)(T), R  adiation Oncology Jacque Langford BSN, CBPN-IC, Breast Nurse Navigator Erin Martinez, Marketing and Communications Leslie Mlinar, CTR, Cancer Program Coordinator, Cancer Registry Quality Coordinator Stephanie Percich, MS, CGC, Genetic Counselor Jennifer Scott, RN, OCN, C  linical Trials, Clinical Research Coordinator Patty Tripp, CTR, RHIT, Caner Data Analyst, Cancer Conference Coordinator Ann Tvrdy, MSN, CRNI, Oncology Project Coordinator Deb Wilson, RN, Quality Management, Quality Improvement Coordinator Ashley Wissing, MA, P atient Navigator


Saint Francis Cancer Treatment Center 2012 Program Highlights

M. Sitki Copur, MD, FACP ••

Saint Francis Medical Center was awarded accreditation from the National Accreditation Program for Breast Centers (NAPBC), as a result of our July on-site survey. Compliance was achieved for 27 of 27 standards.

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Saint Francis Medical Center became a Certified Participant in the National Quality Measures for Breast Centers Program (NQMBC).

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Dr. Ramaekers, Breast Program Leader, attended the National Interdisciplinary Breast Center Conference in February.

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Dr. Sitki Copur, Medical Director of Oncology, was promoted from Associate Professorship to Full Professorship at UNMC adjunct faculty.

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• • Saint Francis Cancer Center became a QOPI (Quality Oncology Practice Initiative) Certified practice, participating in voluntary chart audit looking at 70+ quality measures. QOPI Certification scoring requirements were met. Documentation was provided to demonstrate compliance with selected ASCO/ONS Safe Administration of Chemotherapy Standards.

Dr. Sitki Copur, Medical Director of Oncology presented “Efficacy and safety of halfdose pegfilgastrim in cancer patients receiving cytotoxic chemotherapy” at the 2012 American Society of Clinical Oncology convention in Chicago. Breast Nurse Navigator received CBPN-IC certification (Certified Breast Patient Navigator – Imaging and Cancer).

Ryan Ramaekers, MD

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A second general multidisciplinary cancer conference was added to our monthly cancer conference schedule, bringing the number of tumor conferences to four per month, two general and two breast cancer focused.

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Four new clinical trials were opened in 2012, for a total of 31 open studies with 215 patients enrolled.

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Dr. Douglas Clark, Radiation Oncologist, was hired as the new Radiation Oncology Medical Director. He will begin employment on July 29, 2013.

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Mosaiq was purchased as the department’s new electronic medical record.

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Completed Lean Six Sigma project related to patient missed appointments. New process developed to help decrease missed appointments.

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TeleHealth utilized to broadcast Cancer Conferences to Hastings clinic and Melhem Jabbour, MD Memorial Health Center to enable a larger number of staff to participate.

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Conducted Community needs assessment for outreach and screening.

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Community Outreach Coordinator and Oncology Project Coordinator received facilitator certification from the American Lung Association for “Freedom from Smoking” program.

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Freedom from Smoking classes offered to the public in August and October.

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Expanded “A Time to Heal” to include all cancer patients. A Time to Heal is a 12 week program designed to help men and women through the transition after treatment has ended. This program was previously available only to breast cancer patients.


Cancer Annual Report

• • Continued to be a participant in the Commission on Cancer’s Rapid Quality Reporting System (RQRS). • • Started the National Electronic Health Record chemotherapy library regimen.

Rita Hays, APRN

• • Published the following articles in peer viewed journals:

o Behne T, Copur MS. Biomarkers for Hepatocellular Carcinoma. Intern J HepatolInternational Journal of Hepatology 2012, Article ID 859076, doi:10.1155/2012/859076. http://www. hindawi.com/journals/ijhep/2012/859076/ o Copur MS, Obermiller A, Ramaekers R. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Eng J Med 2012;366:1256-1257. o Ramaekers R, Jabbour M, Copur MS. Anastrozole and fulvestrant in metastatic breast cancer.N Engl J Med. 2012;367(17):1662-3. o Ramaekers R, Olsen J, Obermiller AM et al. Efficacy and safety of half-dose pegfilgastrim in cancer patients receiving cytotoxic chemotherapy. J Clin Oncol 2012. ••

o Chu E, Obermiller A, Harrold LJ, Tiedemann D, Copur MS Chemotherapeutic and Biologic Drugs. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 5-395;2012. o Copur MS, Tiedeman D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 396-413;2012. o Copur MS, Annie P, Harrold LJ, Deshpande H, Levy AL, Chu E. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 414544;2012. o Deshpande H, Copur MS, Harrold LJ, Chu E, Levy AL, Antiemetic Agents for the Treatment of Chemotherapy Induced Nausea and Vomiting. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 545-583;2012.

Megan Schriner, PA

Published the following book chapters: o Copur MS, Obermiller A., Medical management options for hepatocellular carcinoma. In. Hepatocellular Carcinoma – Clinical Research, WanYee Lau ISBN978-9535151-0112-3, 2012. http:// www.intechopen.com/ articles/show/title/medicalmanagementoptions-forhepatocelluar-carcinoma.

Deborah Nelson, APRN 5


Saint Francis Cancer Treatment Center 2012 Data Presentation M. Sitki Copur, M.D. FACP Medical Director, Saint Francis Cancer Treatment Center Chair Person, Saint Francis Cancer Treatment Center Cancer Committee Professor, Department of Internal Medicine Division of Hematology/Oncology, Adjunct Faculty University of Nebraska Medical Center

Two thousand and twelve has been another outstanding year with growth, accomplishment, and excellence in all aspects of cancer care at Saint Francis Cancer Treatment Center. Among so many accomplishments this year I will mention a few highlights here. This year our breast cancer program was surveyed and accredited by the National Accreditation Program for Breast Centers (NAPBC). With the two prior accreditations from the American College of Radiology/Breast Imaging Centers of Excellence (ACR/BIOCE) and first level accreditation by National Quality Measures for Breast Centers (NQMBC) last year, we are well on our way to Breast Centers of Excellence (BCOE) recognition.

In 2012, there were a total of 558 newly diagnosed cancer cases, 525 were analytic, 33 were non-analytic (Figure 1). Breast cancer occupied the first place with a 20% incidence followed by lung 13% prostate 12%, colorectal 12%, and bladder 5% (Figure 2).

Another highlight of this year was American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI) certification. Saint Francis was among the first 100 practices across the nation to receive this award. This year our clinical trial enrollment rate reached 35%, which is ten times the national average.

Twenty percent incidence of breast cancer this year was above both national and Nebraska state incidences of 14%. Now, on our way to becoming a Breast Center of Excellence, Saint Francis Cancer Treatment Center remains the main referral center in central Nebraska. Our strong surgery, radiology, medical and radiation oncology teams along with a large variety of available clinical trials make Saint Francis Cancer Treatment Center the best place for multidisciplinary breast cancer care. Our cancer program meets all aspects of breast cancer care, including multidisciplinary breast conferences as well as excellence in radiation oncology, pathology, radiology, surgery, medical oncology, nurse navigation, genetic counseling, nursing, clinical trials, and community outreach.

Continued availability of resources provided by the National Community Cancer Centers Pilot (NCCCP) grant at its 5th year, along with the support by the National Oncology Service Line (NOSL) of our mother Institution Catholic Health Initiatives (CHI), Saint Francis Cancer Center continues to excel in all areas of cancer care. We are aiming for another Outstanding Achievement Award-OAA, for our upcoming American College of Surgeons survey next year.

Lung cancer took the second place this year with 13% barely passing the incidence of prostate cancer. This is higher than last year and very similar to national and state average of 13 to 14%. Saint Francis Cancer Center has teamed up with University of Nebraska and Eppley Cancer Center and is able to offer all of the multidisciplinary services needed for lung cancer patients. Our smoking cessation program has been very active in our efforts for educating the patients and their

New Cases at Saint Francis Medical Center 620 600 580 560 540 520 500

564 541

555

573 550

Figure 1. 6

604

600

558


Cancer Annual Report

*Estimated Cancer Cases from: The American Cancer Society Facts and Figures 2012

Figure 2. 2012 Comparison data for most frequently diagnosed sites families as well as helping our patients to quit smoking which is a primary prevention effort. We are now exploring the possibilities of implementing a lung cancer screening program which will be a secondary prevention effort for this deadly disease. We do continue to offer several national clinical trials both in adjuvant and metastatic setting utilizing novel targeted therapies. Our Multidisciplinary Care Research Study involving lung and colorectal cancers, an NCCCP-ARRA #9 project, is coming to its conclusion and will be submitted for presentation. This year prostate cancer took the third place with an incidence of 12% which is slightly lower than both national and state average of 14 to 15%. Saint Francis Cancer Center continues to offer radical prostatectomy, radiation, chemotherapy hormonal therapy as well as a variety of clinical trials for prostate cancer patients. Colorectal cancer shared the same incidence with prostate cancer and kept its place at 12%, same as the past year. This is slightly higher than state and national average of 10 to 9%. A universal Lynch Syndrome screening project is underway through our collaboration with CHI-National Oncology Service Line and our local pathology and surgery departments. Saint Francis Cancer Treatment Center

is taking part in NCCCP-ARRA #9 project, which is a Multidisciplinary Care Research Study involving colorectal cancer patients at NCCCP sites. The Saint Francis cancer team’s surgical and pathology departments continue to provide an excellent rate of more than 12 lymph nodes examination after their surgery. Our Cancer Program Practice Performance (CP3R) data from 2009 and 2010 for this measure is 91.3% and 87.5% respectively, Table1. Bladder cancer was the fifth most common cancer site this year, with an incidence of 5%. This is a very similar incidence to both state and national averages of 5 and 4%. Our urology surgeons and radiation oncology departments along with our medical oncology team have been instrumental in providing the multidisciplinary care in this disease. Saint Francis Cancer Treatment Center’s team is on its way to new national recognitions. I am honored and privileged to state the fact that Saint Francis Cancer Treatment Center is “The Leader” in the whole continuum of cancer care with an exceptional team. My sincere thanks and gratitude to all. M. Sitki Copur, MD, FACP

At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Facility Comparison Groups Saint Francis Cancer Treatment Center Nebraska All CoC Approved Programs

Performance Rates 2010 2009 91.3% 87.5% 88.4% 89.6% 84.9% 86.6%

Table 1. CP3R data from 2009 -2010 7


Saint Francis Cancer Treatment Center 2012 Comparison of Cancer Data At Saint Francis Cancer Center there were 558 new cases of cancer and other reportable disease accessioned to the Cancer Registry in 2012. Of those, 525 were analytic and 33 were non-analytic.

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Cancer Annual Report

Distribution by Gender

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Saint Francis Cancer Treatment Center CP3R Performance Rates for all Eligible Cases 2009-2010 Reported by the National Cancer Database The Cancer Program Practice Profile Report (CP3R) is designed to provide comparative information to help providers assess their utilization of accountability measures endorsed by the National Quality Forum (NQF). The following tables show a comparison of data submitted to the National Cancer Database from our facility, against other COC accredited hospitals. 1. Adjuvant chemotherapy is considered or administered w/in 4 months of diagnosis for patients under age 80 with AJCC Stage III (lymph node positive) colon cancer. Facility Comparison Groups Saint Francis Cancer Treatment Center Nebraska All CoC Approved Programs

Performance Rates 2009 2010 100.0% 100.0% 91.2% 94.7% 91.7% 93.5%

2. At least 12 regionl lymph nodes are removed and pathologically examined for resected colon cancer. Facility Comparison Groups Saint Francis Cancer Treatment Center Nebraska All CoC Approved Programs

Performance Rates 2009 2010 91.3% 87.5% 88.4% 89.6% 84.9% 86.6%

3. Radiation therapy is considered or administered w/in 6 months of diagnosis for patients under age 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. Facility Comparison Groups Saint Francis Cancer Treatment Center Nebraska All CoC Approved Programs

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Performance Rates 2009 2010 100.0% 83.3% 91.2% 96.8% 93.1% 92.7%


Cancer Annual Report 2012 Support Programs ACS Cansurmount: Co-sponsored by Saint Francis Medical Center, Cansurmount is a monthly support group designed to help individuals with cancer and their families to continue to live each day with hope and gain strength to look towards the future. This goal is accomplished through mutual sharing and caring of individual group members. United Ostomy Association: This program aids in the rehabilitation of all ostomates. Saint Francis Medical Center’s Wound, Ostomy, Continence Nurse is an advisor of this program. ACS Reach For Recovery: This is a patient-to-patient visitation program for women who have been diagnosed with breast cancer. Visits are made in the acute care setting. Wig Bank: Located at a local beauty salon, this program provides patients with a free wig, depending on availability. Look Good/Feel Better: This program is designed to help the patient handle the personal appearance changes that may result from chemotherapy or radiation treatment. Cosmetologists, along with volunteers, work with patients diagnosed with cancer at the Saint Francis Cancer Treatment Center, offering ideas on makeup, hairstyling and accessorizing. Look Good Feel Better is a public service program presented through a collaboration between the American Cancer Society, the Personal Care Products Foundation, and the Professional Beauty Association/National Cosmetology Association. From Surviving To Thriving: This is a support group designed to help those dealing with life after cancer treatment. Surviving cancer is a life experience that needs to be shared and understood. From Surviving to Thriving is designed to provide cancer survivors with opportunities for increased support and education. Those attending will also learn about resources available to improve quality of life. Men’s Luncheon: This informal lunch, at a Grand Island restaurant, is sponsored by Saint Francis Hospice and offers men who have experienced the death of someone they love the opportunity to share at a monthly luncheon. Breast Cancer Support Group: This monthly support group is designed to help women with breast cancer develop coping strategies. This is accomplished through mutual sharing and caring of individual group members. The goal of the group is to provide support to each individual, recognizing the personal, emotional and spiritual needs that are unique to women. Male Caregivers Support Group: This support group is available for men who are offering care to their loved ones experiencing cancer. It is a safe place to share concerns, thoughts and feelings and receive support, care and understanding in a confidential setting. A Time to Heal: This is a 12 week holistic rehabilitation program designed to assist cancer survivors in regaining their physical, emotional, and spiritual health after cancer treatment. The program is offered to survivors who have completed surgery and chemotherapy and/or radiation for a first diagnosis of cancer. This program is offered twice a year. Healing Spirit Newsletter: Published quarterly and sent to cancer patients and survivors of the Saint Francis Medical Center Cancer Treatment Center. Metastatic Breast Cancer Support Group: This group is offered to assist women with the unique challenges of having a metastatic breast cancer diagnosis. This group is offered monthly. 11


Saint Francis Cancer Treatment Center 2012 Director’s Report

Max Norvell, PharmD Cancer Center Director

Saint Francis Cancer Treatment Center, accredited by the American College of Surgeons with commendation, is committed to being a leader in the continued evolution of cancer treatment. This commitment begins at prevention, continues with diagnosis, and does not end with treatment.

Saint Francis has three board certified medical oncologists, a board certified radiation oncologist, a certified oncology physician assistant and two certified nurse practitioners. The leadership of these professionals has positioned the Cancer Treatment Center as a leader in clinical trials, consistently exceeding accrual goals in National Cancer Institute trials. Because of our staunch commitment to research, patients have the opportunity to receive cutting-edge therapy close to home. As the patient, family, and oncologist make treatment decisions, a team of medical professionals guides patients through each stage of their cancer care. Specialized oncology nurses provide compassion, knowledge, and professionalism to patient care. An on-site pharmacy provides expertise regarding side effects, drug interactions, and current therapy practices. The rehabilitation team, which consists of social work, dietary, pastoral care, occupational therapy, physical therapy, speech therapy, physicians, nursing, and home health, is present to assist in any way possible. The cancer rehabilitation coordinator provides direction of the team by conducting meetings with patients and assessing their individual needs. A patient and family counselor assists patients and their families in learning to cope with the social and emotional concerns associated with cancer. The genetic counselor provides hereditary cancer risk 12

assessment, education of genetic testing and risk management. The breast cancer nurse navigator acts as the liaison between breast cancer patients and our entire team of cancer professionals, guiding the patient through the treatment process. A variety of support groups, including tobacco cessation classes, are also available to assist patients and families during this difficult time. The nurse navigator played a pivotal role this year in the growth of our multidisciplinary care program (MDC) for breast cancer patients. Multidisciplinary care is an integrated approach to cancer care in which a team of health care professionals collaborate to develop an individual treatment plan for each patient. MDC begins at diagnosis, ensuring each patient is given all treatment options prior to surgery. The nurse navigator will meet with the patient at the first appointment after an abnormal biopsy, before surgery has taken place. The navigator will then follow the patient through surgery, treatment and survivorship, assisting with appointment scheduling, answering questions and providing any needed support. Because of the success of this program with our breast patients, a second navigator was added to assist colorectal patients. The MDC team brings together the medical and radiation oncologists, pathologists, radiologists and surgeons, along with the navigators and other key members of the care team. This comprehensive team meets formally on a bi-weekly basis to review new cases and share insights from their own patient care and research. This collaborative approach leads to the most appropriate and well-rounded treatment plan for each patient. Multidisciplinary care coordination is part of the Cancer Treatment Center’s larger goal to become a Catholic Health Initiatives Breast Center of Excellence. This designation is given to breast centers that have achieved accreditation in three pillars – radiology and imaging, standard of care and quality.


Cancer Annual Report Saint Francis Medical Center’s Mammography Center completed the first pillar in 2012, achieving three-year terms of accreditation from the American College of Radiology (ACR) in Stereotactic Breast Biopsy, Ultrasound and Mammography. Achieving all three of these accreditations earned the Mammography Center the designation as a Breast Imaging Center of Excellence by the American College of Radiology. The second pillar was also achieved last year. In July 2012 the National Accreditation Program for Breast Centers (NAPBC) granted the Cancer Treatment Center a three-year/full accreditation designation. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance. To achieve this designation, a center must demonstrate compliance with 27 evidence-based standards of care for treating women who are diagnosed with the full spectrum of breast disease. The Cancer Treatment Center’s achievement of NAPBC accreditation demonstrates a firm commitment to offer its patients every significant advantage in their battle against breast disease. The quality pillar, which involves meeting 30 standards set by the National Quality Measures for Breast Centers (NQMBC), is the most involved. Three levels within this pillar must be achieved before we are designated a Certified Quality Breast Center of Excellence. Two of the three levels have been reached, and the third is expected to be completed in early 2014. Saint Francis Cancer Treatment Center continues to be a participant in the National Cancer Institute’s Community Cancer Centers Program (NCCCP). A member of the pilot program since 2007, Saint Francis, along with Good Samaritan Cancer Center in Kearney and Saint Elizabeth Cancer Institute in Lincoln, was awarded funding to continue participation in the program through

2014. The NCCCP pilot program allows us to reach out to disparate populations, open clinical trials that were previously restricted to NCI-designated academic centers, enhance quality of care, expand survivorship and palliative care, contribute tissue samples to a national biospecimen bank, and implement the use of electronic health records. Saint Francis is one of five cancer centers within Catholic Health Initiatives (CHI) and 21 cancer centers nationwide to participate in this National Cancer Institute-sponsored program. Saint Francis Cancer Treatment Center also earned a three-year certification from the Quality Oncology Practice Initiative (QOPI®) Certification, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI® Certification Program provides a three-year certification for outpatient hematology-oncology practices that meet the highest standards for quality cancer care. Our participation in the QOPI® program reflects a commitment to excellence and quality of care that will lead to fundamental changes in the clinical practice of oncology. Another area in which we are focusing on our commitment to quality is Saint Francis Medical Center’s journey to Magnet status, which recognizes all nurses who have achieved professional credentialing within their field. The Cancer Treatment Center currently has 12 certified nurses, and nine more who are currently working toward their bachelor’s degree. Cancer not only affects the individual, but the family as well. Thousands of Nebraska households will experience the challenge of a cancer diagnosis this year. Healing the whole person - mind, body, and spirit – will be important elements of their treatment. Saint Francis Cancer Treatment Center is proud to have established itself as a leader in treating these aspects of cancer care. Max Norvell, Pharm.D. 13


Saint Francis Cancer Treatment Center HealthConnect at Home — Saint Francis Medical Center HealthConnect at Home Saint Francis Medical Center provides Home Health Care to people in Hall, Nance, Merrick, and portions of Howard, Adams, and Buffalo counties who have a need for Skilled Nursing Services, Physical Therapy and/or Speech Therapy. If the patient has a skilled care need, they may also qualify for additional services such as Occupational Therapy, Personal Care Aide, Social Work and in home Tele-monitoring Services. Patients may use Home Health Care to bridge the gap between home and the hospital or Nursing Home. Home Health Care is ordered by a physician and is paid for by Medicare, Medicaid, the Veteran’s Administration and many insurance policies, when criteria for coverage are met. Home Health Care Staff are available to help determine if you qualify and meet the payment criteria for home health care. Home Health Professionals in our program provide many of the services usually associated with a hospital: such as giving injections, inserting and caring for urinary catheters, wound management and Wound VACs, Infusion Access devices and the management and maintenance, helping patients with complex medication regimens and helping to arrange for equipment such as hospital beds, wheelchairs and walkers. Home Health Aides are available Monday through Friday for assistance with bathing and personal care needs on an intermittent basis. Patients may be discharged from the hospital knowing Home Health will help them and their caregiver manage their complex health needs in their home or place of residence. A registered nurse is on-call 24 hours each day for patients who have symptoms needing assessment and instruction. Services are provided for all ages, infant through elderly. Ruth Frerichs Director of Clinical Services of Home Health

Referrals are accepted from Physicians, hospitals, families, patients, friends and interested agencies. HealthConnect at Home Saint Francis Medical Center is Medicare Certified, and has been serving patients for over 40 years. For further information, please call 308.398.2600 or 800.353.4894.

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Cancer Annual Report HealthConnect at Home Hospice — Saint Francis Medical Center Hospice is a philosophy of care which believes that when a cure is no longer possible, a special kind of caring can enhance the quality of life remaining for both the patient and his or her family. Hospice approaches death as a natural part of life and assists the patient and family to deal with the often complicated problems which accompany terminal illness. Hospice care is directed by an interdisciplinary team comprised of the patient’s primary physician, the Hospice Medical Director, nurses, aides, social worker, pastoral services, dietician, bereavement counselor, pharmacist, and volunteers. The Hospice team works to achieve physical comfort but also emotional, psychosocial and spiritual well-being. Care is primarily provided in the home but also in contractual facilities, such as nursing Cathy Ferguson RN, CHPN, care facilities. HealthConnect at Home Saint Francis Hospice Clinical Coordinator HealthConnect at has contracts with nursing home facilities in our service areas Home Hospice and provides respite or inpatient care at Saint Francis Medical Center or the local hospitals. A physician’s order is required prior to admission and the physician must certify that he/she believes the patient’s prognosis to be six months or less if the disease follows its normal course. Hospice is fully paid for by Medicare and Medicaid, and most private insurances also have a hospice benefit. Bereavement care is provided for family members and includes support through visits, phone calls, education and counseling about grief for 13 months after the death of the patient, allowing for support to the family through all major holidays and important anniversaries. A memorial service is also provided for patient’s families and the Hospice staff annually. HealthConnect at Home Saint Francis Medical Center Hospice is Medicare Certified and serves persons in Hall, Hamilton, Merrick, Howard, Nance and Boone counties and portions of Adams, Buffalo, and Platte counties. For further information, please call 308.398.2600 or 800.353.4894

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Saint Francis Cancer Treatment Center Scientific Publications from Saint Francis Cancer Treatment Center 1. Copur MS, Ledakis P. Weekly docetaxel and estramustine in hormone refractory prostate cancer. Can Con Highlights, 4;6-9, 2000. 2. Copur MS, Ledakis P, Novinski D, Bolton M. Two cases of hormone refractory prosate cancer treated with weekly docetaxel/estramustine. Case Stud Onc 2;2-6,2000. 3. Copur MS, Ledakis P, Muhvic J. Patients 65 years of age or older in cancer treatment trials. N Engl J Med 343(20);1531,2000. 4. Copur MS, Ledakis P, Norwell M. Prevention of delayed emesis caused by chemotherapy. N Engl J Med 343(12):888-890,2000. 5. Copur S, Matamaros A, Capadano M, Goertzen T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemothrapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. J Clin Oncol 19;2404-2412:2001. 6. Copur S, Ledakis P, Muhvic J. Fludarabine for chronic lymphocytic leukemia. N Eng J Med 344;1166-1168:2001. 7. Copur MS, Ledakis P, Lynch J, Hauke R, Tarantolo S, Bolton M, Norwell M, Muhvic J, Hake L, Wendt J. Weekly docetaxel and estramustine in patients with hormone refractory prostate cancer. Semin Oncol 27(4); 2001. 8. Copur S, Ledakis P, Novinski D, Mleczko K, Frankforter S, Bolton M, Fruehling R,Van Wie E, Norvell M, Muhvic J. Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy. Clin Colorectal Can 1;55-58:2001. 9. Copur MS, Ledakis P, Bolton M, Norwell M, Muhvic J. Is arimidex superior to tamoxien. J Clin Oncol, 19;25782581:2001. 10. Copur S, Ledakis P, Bolton M, Morse AK, Werner T, Norvell M, Muhvic J, Chu E. An adverse interaction between warfarin and capecitabine: a case report and review of the literature. Clin Colorectal Can 1(3);182-184:2001. 11. Copur S, Matamoros A, Capadano M, Goertzen T, McCowan T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. Proc ASCO 18;249:1999. 12. Copur S, Tarantolo S, Ledakis P, Bolton M, Muhvic J, et al.Weekly estra-mustine taxotere and dexamethasone in patients with hormone refractory prostate cancer. Proc ASCO 19;347:2000. 13. Ledakis P, Copur MS, Norvell M, Lynch J, Bolton M, Elson J, March W, Woodman S, Muhvic J, Mickey M, Stroup N, Nott J, Hays R, Fuller C, Haire W. Continuous infusion versus bolus instillation of tissue plasminogen activator(tpa) in restoring the patency of occluded central venous access devices(CVADs). Proc ASCO 20;397a: 2001. 14. Copur MS, Ledakis P, Bolton M, Lynch J, Termuhlen P, Brand R, Norvell M, Muhvic J, Swantek S, Frost V, Vanpelt E, Mleczko K, Frankforter S. Weekly cisplatinum and gemcitabine in patients with locally advanced metastatic pancreatic cancer. Proc ASCO 20:156a;2001. 15. Copur MS, Chu E. Commentary on “Thymidylate Synthase Pharmacogenetics in Colorectal Cancer� Clin Colorectal Can 1(3):167-168:2001.

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Cancer Annual Report

16. Copur MS, Ledakis P, Norvell M. Nephrectomy for metastatic renal cancer. N Eng J Med 346;1095-1096:2002. 17. Copur MS, Ledakis P, Bolton M. Molecular profiling of lymphoma. N Eng J Med 347;1376-1377:2002. 18. Copur S, Matamoros A, Capadano M, Goertzen T, McCowan T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. Proc ASCO 18;249:1999. 19. Copur S,Tarantolo S, Ledakis P, Bolton M, Muhvic J, et al. Weekly estra-mustine taxotere and dexamethasone in patients with hormone refractory prostate cancer. Proc ASCO 19;347:2000. 20. Ledakis P, Copur MS, Norvell M, Lynch J, Bolton M, Elson J, March W, Woodman S, Muhvic J, Mickey M, Stroup N, Nott J, Hays R, Fuller C, Haire W. Continuous infusion versus bolus instillation of tissue plasminogen activator (tpa) in restoring the patency of occluded central venous access devices (CVADs). Proc ASCO 20;397a: 2001. 21. Copur MS, Ledakis P, Bolton M, Lynch J, Termuhlen P, Brand R, Norvell M, Muhvic J, Swantek S, Frost V, Vanpelt E, Mleczko K, Frankforter S. Weekly cisplatinum and gemcitabine in patients with locally advanced metastatic pancreatic cancer. Proc ASCO 20:156a;2001. 22. Copur MS, Ledakis P, Bolton M, Lynch J, Norvell M, Muhvoc J, Marsh W, Novinski D, Allen J, Swantek S, Beran M, Reynolds J, Folk J, Woodward S. Weekly Docetaxel and irinotecan in previously treated metastatic non-small cell lung cancer. Proc ASCO 20: 2002. 23. Ledakis P, Copur MS, Bolton M, Lynch J, Reynolds J, Norvell M, Muhvic J, Mickey M, Beisner D, Stroup N, Frost V, Mleczko KL, Frankforter S. Weekly Paclitaxel and carboplatin with concurrent radiation followed by paclitaxel carboplatin consolidation for locally advanced non-small cell lung cancer. Proc ASCO 20:2002. 24. Copur MS, Ledakis P, Bolton M, Lynch J, Norvell M, Muhvic J, Lundgreen K, Mondolfo N, Reynolds J. Capecitabine and irinotecan on a two-week on one-week off schedule for previously treated metastatic colorectal cancer. Proc ASCO 22:2003. 25. Maung K, Lee D, DeGrendele HC, Schilsky R, Chu E, Jain VK, Copur S. Highlights from 27th congress of the European Society for Medical Oncology. Nice, France, October18-22, 2002. Clin Colorectal Cancer. 2(3);140145:2002. 26. Hightower M, Klem J, Lee D, Chu E, Copur S,Vain KJ. Highlights from 14th EORTC-NCI-AACR symposium on molecular targets and cancer therapeutics. Clin Colorectal Cancer 3(1);10-14:2003. 27. Maung K, Copur MS, Jain VK. New Strategies for the treatment of chemotherapy induced diarrhea. Supportive Cancer Therapy 1(2);70-74:2004. 28. Copur MS, Ledakis P, Novinski D, Fu K, Hutchins M, Frankforter S, Mleczko, Sanger WG, Wing CC. An unusual case of composite lymphoma involving chronic Lymphocytic leukemia follicular lymphoma and Hodgkin disease. Leukemia & Lymphoma 45(4);1071-1076:2004. 29. Copur MS, Deshpande A, Mleczko K, Norvell M, Hrnicek GJ, Woodward S, Frankforter S, Mandolfo N, Fu K, Chan WC. Full clinical recovery after topical acyclovir treatment of Epstein-Barr virus associated cutaneous B-cell lymphoma in patient with mycosis fungoides. Croat Med J 2005;46:458-462.

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Saint Francis Cancer Treatment Center Scientific Publications from Saint Francis Cancer Treatment Center 30. Copur MS, Norvell M, Obermiller A. Chemotherapy and immunotherapy in metatstatic colorectal cancer. N Eng J Med 2009;360:2135. 31. Copur MS. Sorafenib in advanced hepatocellular carcinoma.N Eng J Med 2008;359:2498. 2498-9. 32. Abuzetun JY, Loberiza F,Vose J, Bierman P, Bociek RG, Enke C, Bast M, Weisenburger D, Armitage JO; Nebraska Lymphoma Study Group. The Stanford V regimen is effective in patients with good risk Hodgkin lymphoma but radiotherapy is a necessary component. Br J Haematol. 2009 Feb;144(4):531-7. Epub 2008 Nov 26. 33. Copur MS. Impact of older age on the efficacy of newer adjuvant chemotherapy regimens in colon cancer, a subgroup analysis of a meta-analysis: Practice changing? Certainly not; Hypothesis generating? Perhaps Clin Colorectal Can 2009 Oct;8(4):190-1. 34. Saif MW, Kaley K, Chu E, Copur MS. Safety and Efficacy of Panitumumab Therapy after Progression with Cetuximab experience at two Institutions. Clin Colorectal Cancer 2010;9:315-318. 35. R.P. Lackner, A. Ganti, W. Zhen, M.D. Copur, I. A.Vaziri, M. Bolton, T. Hlavaty, K. P. Trujillo, M. A. Kessinger,; Trimodality therapy for locally advanced non-small cell lung cancer. J Clin Oncol 2010:28 (abstr e17529). 36. Robert NJ, Saleh MN, Paul D, Generali D, Gressot L, Copur MS, et. Al. Sunitinib plus paclitaxel versus bevasizumab plus paclitaxel for first-line treatment of patients with advanced breast cancer: a Phase III, randomized, open-label trial. Miami Breast Conference. March 2010. 37. Benzel H., Fuller C., Gulzow M., Obermiller A., Mickey M., Norvell M., Copur MS, A Clinical Trial Accrual System: What a Coordinator Can Do. Experience from a Community Based Cancer Center in Rural Nebraska April 2010. http://university.asco.org/CT2010. 38. Copur MS, Benzel H, Haynatzki G, Obermiller A, Fuller C, Gluzow M, Mickey M, Norvell M; Clinical Trial Accrual and Related Activities in a Rural Nebraska Hospital before and after National Community Cancer Centers Program (NCCCP) April 2010. http://university.asco.org/CT2010. 39. Copur MS, Obermiller, A. Largest randomized trial of biliary tract cancer treatment with cisplatin plus gemcitabine versus gemcitabine alone: An excellent opportunity to evaluate the prognostic value of tumor marker Ca 19-9. Clin Colorectal Cancer 2011;10:70-71. 40. Kummar S, Copur MS, Rose M, Wadler S, Stephenson J, O’Rourke M, Brenckman M, Tilton R, Liu S-H, Jiang Z, Su T, Cheng Y, Chu E. A Phase I Study of the Chinese Herbal Medicine PHY906 as a Modulator of IrinotecanBased Chemotherapy in Patients with Advanced Colorectal Cancer Clin Colorectal Cancer 2011;10:85-96. 41. Copur MS, Obermiller A. An Algorithm for the Effective Management of Hypertension in the Setting of Vascular Endothelial Growth Factor Signaling Inhibition. Clin Colorectal Cancer 2011;10:151-156. 42. Fulvestrant High Dose versus Lodaing Dose versus Approved Dose, Have we found the optimum dose? Obermiller A, Copur MS. Clin Breast Cancer 2011;11:195. 43. Obermiller AM, Copur MS. The longstanding quest for a better endocrine therapy Continues High Dose Fulvestrant: Have we found the effective dose, combination, setting, or sequence. Contemporary Oncology 2011;34-37.

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Cancer Annual Report

44. Sherman S, Shats O, Fleissner E, Bascom G,Yiee K, Copur M et al. Multicenter breast cancer collaborative registry. Cancer Informatics 2011;10:217-226. 45. Copur MS, Obermiller A. Ipilimumab plus dacarbazine in melanoma. N Engl J Med 2011;365:1256-1257. 46. Copur MS, Obermiller AM, Ramaekers R et al. Letrozole and fulvestrant combination in second line or more for estrogen receptor positive metastatic breast cancer.Efficacy and predictive factors of response. Copur et al., J Cancer Sci Ther 2011, S2. 47. Behne T, Copur MS. Biomarkers for Hepatocellular Carcinoma. Intern J HepatolInternational Journal of Hepatology 2012, Article ID 859076, doi:10.1155/2012/859076. http://www.hindawi.com/journals/ ijhep/2012/859076/. 48. Copur MS, Obermiller A, Ramaekers R. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Eng J Med 2012;366:1256-1257. 49. Ramaekers R, Jabbour M, Copur MS. Anastrozole and fulvestrant in metastatic breast cancer.N Engl J Med. 2012;367(17):1662-3. 50. Ramaekers R, Olsen J, Obermiller AM et al. Efficacy and safety of half-dose pegfilgastrim in cancer patients receiving cytotoxic chemotherapy. J Clin Oncol 2012. Book Chapters 1. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 31-366;2002. 2. Copur MS, Harrold L, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians Cancer Chemotherapy Drug Manual. Chu E DeVita VT ed. 441-475;2002. 3. Chu E, Mota A, Bromberg M, Copur S, Harrold LJ, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicicans’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 21-369;2003. 4. Chu E, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur S. Common Chemotherapy Regimens in Clinical Practice In: Physicians` Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 391-469;2003. 5. Copur MS, Harrold LJ, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians` Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 471-506;2003. 6. Chu E, Mota A, Bromberg M, Copur S, Harrold LJ, Tiedemann D, Fogarasi M. Chemo-therapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed.21-375;2004. 7. Chu E, Noronha V, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians` Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed.397-488;2004. 8. Copur MS, Harrold LJ, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-527;2004.

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Saint Francis Cancer Treatment Center Scientific Publications from Saint Francis Cancer Treatment Center 9. Copur MS, Rose M, Chu E. Miscellaneous Chemotherapeutic Agents In: Cancer Principles & Practice of Oncology DeVita VT, Hellman S, Rosenberg SA 7th edition, 2004. 10. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 21-373;2005. 11. Chu E, Noronha V, Roy S, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-487;2005. 12. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2005. 13. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D, Roy S, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 23-374;2006. 14. Chu E, Noronha V, Roy S, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2006. 15. Chu E, McGowan M, Elfiky A, Harrold L, Tiedemann D, Roy S, Copur S Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 15-378;2007. 16. Chu E, Noronha V, Roy S, Harrold LJ, Tiedemann D, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual.Chu E,DeVita VT ed. 393-530;2007. 17. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2007. 18. Chu E, McGowan M, Elfiky A, Harrold L, Tiedemann D,Roy S, Copur S Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 15-378;2008. 19. Chu E, Noronha V, Roy S, Harrold LJ, Tiedemann D, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2008. 20. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2008. 21. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2009. 22. Copur MS, Tiedemann D, Chu E. Guidelines for chemotherapy and dosing modifications In Physicians’ Cancer Chemotherapy Drug Manual. Chu E,DeVita ed. 382-400;2009. 23. Copur MS, Chu E, Rosado MF et al. Common chemotherapy regimens in clinincal practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2009. 24. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2009.

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Cancer Annual Report

25. Chu E, Harrold LJ, Tiedemann, Copur MS. Chemotheraputic and Biologic Drugs. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 7-386;2010. 26. Copur MS, Tiedemann D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 387-403;2010. 27. Copur MS, Chu E, Harrold LJ et al. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 404-514;2010. 28. Deshpande H, Copur MS, Harrold LJ et al. Antiemetic Agents for the Treatment of Chemotherapy Induced Nausea and Vomiting. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 515-551;2010. 29. Copur MS. Rose M, Gettinger S. Miscellaneous Chemotherapeutic Agents In: Cancer Principles & Practice of Oncology DeVita VT, Lawrence TS, Rosenberg SA 455-458 9th edition, 2011. 30. Chu E, Obermiller A, Harrold LJ, Tiedemann D, Copur MS Chemotherapeutic and Biologic Drugs. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 5-395;2011. 31. Copur MS, Tiedeman D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 396-413;2011. 32. Copur MS, Chu E, Harrold LJ, Deshpande H, Levy AL. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 414-542;2011. 33. Deshpande H, Copur MS, Harrold LJ, Chu E, Levy AL. Antiemetic Agents for the treatment of ChemotherapyInducued Nausea and Vomiting In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 543581;2011. 34. Copur MS, Obermiller A., Medical management options for hepatocellular carcinoma. In: Hepatocellular Carcinoma – Clinical Research, Wan-Yee Lau ISBN978-953-5151-0112-3, 2012. http://www.intechopen.com/ articles/show/title/medical-managementoptions-for-hepatocelluar-carcinoma. 35. Copur MS, Tiedeman D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 396-413;2012. 36. Copur MS, Annie P, Harrold LJ, Deshpande H, Levy AL, Chu E. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 414-544;2012. 37. Deshpande H, Copur MS, Harrold LJ, Chu E, Levy AL, Antiemetic Agents for the Treatment of Chemotherapy Induced Nausea and Vomiting. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 545583;2012.

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2012 Cancer Annual Report  
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