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2012

Oncology Annual Report

Comprehensive Cancer Care


Oncology

This Philosophy and Mission Statement is Specific to the FHNP

Program

As one of the premier providers of cancer care in Pinellas and Pasco County, we exist to offer comprehensive care to our patients and families from early detection through screening, efficient diagnosis, cutting edge treatment, and compassionate end-of-life care. Our commitment is to provide the latest technology and compassionate care to each individual. It is our goal to meet your physical, emotional and spiritual needs throughout your health care experience.

Statistical Data from 2011

Comprehensive Cancer Care

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OUR MISSION

Extending CHRIST the healing ministry of

Our Values Adventist Health System employees draw motivation and direction from six strongly held principles. These principles guide the manner in which we treat each other and those we serve.

Christian Mission We exist to serve the needs of our communities in harmony with Christ’s healing ministry and incorporate Christian values at every level of service.

Quality and Service Excellence We strive to meet or exceed both the service standards of the health care industry and the expectation of the patients we serve and measure our success through continuous surveying of patient satisfaction.

Compassion We are sensitive to the needs of the individuals and families we serve and meet their needs with kindness and empathy.

Focus on Community Wellness We commit time, talent and financial support to educate our neighbors in the principles of illness prevention and healthful living.

High Ethical Standards We conduct our business with integrity, honesty and fairness. As responsible stewards, we use our financial resources wisely by choosing business practices which are cost-effective, productive and result in a fair return on investment.

Cultural Diversity We value the diversity of our patients, employees, business colleagues and visitors and treat them with kindness and respect regardless of their background, race, religion or culture. 2


TABLE OF CONTENTS Oncology Philosophy and Mission Statement Florida Hospital North Pinellas Mission Table of Contents Cancer Committee Cancer Committee Members Cancer Committee and Sub-Committee Members Annual Report Editorial Board Oncology Credentialed Physicians Oncology Services Directory Spiritual Care Chairman’s Report Administrative Report 2012 Programs and Services Oncology Program Highlights

1 2 3 4 6 7 8 10 11 13 14-15 17 18-19 20

Breast Health Program Melanoma and Cutaneous Oncology Program Gastrointestinal Oncology Plastic and Reconstructive Surgery Thoracic Oncology Program Urologic Oncology and General Urology Community Outreach Community Education and Outreach Florida Hospital North Pinellas and the American Cancer Society Support Services Cancer Screening

21-23 24-25 26 27 28 29 30 31 32

Oncology Research Genetic Counseling and Testing Multidisciplinary Cancer Conference Imaging Department Pathology Department Care Navigation Palliative Care Program Patient Experience Specialist Case Management Supportive Services: Continuum of Care FHNP American Cancer Society Partnership Cancer Registry Data Summary 2011 Definition of Terms Helen Ellis Memorial Foundation Looking Forward

35 36 37 38-39 40 41 42 43 44 45 46 47 48-49 50 51 52

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Cancer Committee

to patient management, oversee monthly consultative Cancer Conferences (Tumor Boards), review patient care evaluation studies, oversee performance improvement activities, identify and implement clinical research protocols, supervise the Cancer Registry to ensure accuracy, and to provide leadership for community screening and education programs. Florida Hospital North Pinellas is seeking the prestigious American College of Surgeons (ACoS) Commission on Cancer (CoC) accreditation in 2015. Nationally, including Puerto Rico, CoC-accredited programs represent 30% of the general medical-surgical hospitals and provide care to close to 70% of patients who are newly diagnosed with cancer each year.

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Rosemary Giuliano, ARNP, MSN

Sincerely,

Florida Hospital North Pinellas organized a Cancer Committee for the purpose of providing superior and guideline-driven care to patients with cancer. It is a multidisciplinary committee comprised of medical staff and representatives from each of the departments involved with the care of cancer patients. The committee convenes every other month and provides leadership and professional guidance for the Florida Hospital North Pinellas Oncology Program. The focus of this committee is to develop annual goals and objectives for programs related to cancer, promote an organized approach

Rosemary Giuliano, ARNP, MSN Director, Oncology Program Florida Hospital North Pinellas Clinical Instructor USF School of Nursing West Coast Medical Group - Surgical Institute


Florida Hospital North Pinellas Oncology Services Directory

Administration (727) 942-5107 Fax: (727) 942-5161

Nutrition (727) 942-5000 x2997 Fax: (727) 943-3492

American Cancer Society (727) 812-7012 Fax: (727) 545-3753

Oncology Program Director (727) 934-6797 Fax: (727) 942-6503

Cancer Registry (813) 615-7859 Fax: (813) 615-8115

Pathology (727) 942-5014 Fax: 727-942-5016

Chaplain’s Office (727) 943-3668

Patient Experience Specialist (727) 943-3621 Fax: (727) 942-5161

Comprehensive Breast Center (727) 942-5012 Fax: 727-942-5117 Genetic Counseling at USF (813) 259-8772 Fax: (813) 259-87717 Health Information (727) 942-5024 Fax: 727-943-3673 Helen Ellis Memorial Foundation in support of Florida Hospital North Pinellas

(727) 943-3651 Fax: (727) 756-7684 Imaging (727) 942-5012 Fax: (727) 942-511

Nurse Educator (727) 942-5089 Nursing Supervisor (727) 942-5000

Pharmacy (727) 942-5030 Fax: (727) 942-5085 Rehabilitation Services (727) 942-5033 Fax: (727) 943-3436 Social Services (727) 942-5188 Fax: (727) 945-5185 University of South Florida (813) 974-2201 Volunteer Program (727) 942-5000 Fax: (727) 756-7630 West Coast Medical Group Surgical Institute (727) 934-6797 Fax: 727-942-6503

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Florida Hospital North Pinellas Cancer Committee Members Pictured, top left to right: Gerald Niedzwiecki, MD, Jeffrey Smith, MD, Karen Owensby, MSN, Phyllis Pinon, MA, Bobbi Sheffield, RD, Christine Longley, MS, Melody Konrad, RN Pictured sitting, left to right: Louis Astra, MD, Debora Ryder, ARNP, Douglas Reintgen, MD, Rosemary Giuliano, ARNP, Lawrence Hochman, DO Not photographed: Francine Baia, RN, Larry Black, DMin, Robert Breakiron, MBA, Deborah Casler-Nieves, RN, Ryan Grella, PT, Stacy Orloff, Ed.D, Randy Slavens, CTR, Lorraine Van Fossan, RT, David Wenk, MD

Comprehensive Cancer Care


Florida Hospital North Pinellas Cancer Committee Members

Louis I. Astra, MD, FACS Cancer Conference Coordinator Florida Hospital North Pinellas

Gerald A. Niedzwiecki, MD, FSIR Interventional Radiology Florida Hospital North Pinellas

Francine Baia, RN, MHA, CPUR, CPHQ, LHCRM Quality Improvement Coordinator Florida Hospital North Pinellas

Stacy Orloff Ed.D., LCSW, ACHP-SW Palliative Care, Psychosocial Services Coordinator Suncoast Hospice

Larry Black, DMin, MDiv, BCC Chaplain Florida Hospital North Pinellas

Karen Owensby, MSN, RN Vice President, Chief Clinical Officer Florida Hospital North Pinellas

Robert Breakiron, MBA Patient Service Manager American Cancer Society

Douglas S. Reintgen, MD, FACS Chairman, Liaison Florida Hospital North Pinellas

Deborah Casler-Nieves, RN Director of Case Management Florida Hospital North Pinellas

Debora L. Ryder, MSN, ACNP-BC Clinical Navigator Florida Hospital North Pinellas

Maria Delgado, CTR Cancer Registry Florida Hospital Tampa

Bobbi Sheffield, RD, L/D Clinical Nutrition Manager Florida Hospital North Pinellas

Rosemary Giuliano, ARNP, MSN Clinical Research Representative, Oncology Nurse Practitioner Florida Hospital North Pinellas

Randy Slavens, CTR Cancer Registry, Cancer Registry Quality Coordinator Florida Hospital North Pinellas

Ryan J. Grella, PT, DPT, OCS Physical Therapy Florida Hospital North Pinellas Lawrence Hochman, DO, FACRO Radiation Oncology Florida Cancer Affiliates Melody Konrad, RN, BSN Clinical Education Specialist Florida Hospital North Pinellas

Jeffrey Smith, MD Pathology, Quality of Registry Data Coordinator Florida Hospital North Pinellas Lorraine Van Fossan, RT (R)(M), CBPN-IC Breast Care Coordinator Florida Hospital North Pinellas David T. Wenk, MD Medical Oncology Florida Cancer Specialists & Research Institute

Christine Longley, MS, BS Community Outreach Coordinator Florida Hospital North Pinellas

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Florida Hospital North Pinellas Committee and Sub-CommitteE Members Pictured, top left to right: Andrew Carson PA-C, Rushir Choksi, MD, Uday Dandamudi, MD, John Hamill, MD, Idelfia Marte, MD, Gerald Niedzwiecki, MD, Bobbi Sheffield, RD, Phyllis Pinon, MA, Jeffrey Smith, MD, Christine Longley, MS, Julie Claar, MD, Melody Konrad, RN Pictured sitting, left to right: Jose Berrios, MD, Debora Ryder, ARNP, Louis Astra, MD, , Douglas Reintgen, MD, Rosemary Giuliano, ARNP, Lawrence Hochman, DO

Comprehensive Cancer Care


2012 Florida Hospital North Pinellas Annual Report Editorial Board

Paul M. Arnold, MD, FACS Urology Urology Specialists of West Florida

Courtney Jack Director, Imaging Florida Hospital North Pinellas

Danielle M. Rucker Patient Experience Coordinator Florida Hospital North Pinellas

Louis I. Astra, MD, FACS Thoracic/Vascular/General Surgery WCMG Surgical Institute Florida Hospital North Pinellas

Christine Longley, MS, BS Community Outreach Coordinator Florida Hospital North Pinellas

Debora L. Ryder, MSN, ACNP-BC Surgical Hospitalist WCMG Surgical Institute Florida Hospital North Pinellas

Larry Black, DMin, MDiv, BCC Chaplain Florida Hospital North Pinellas Deborah Casler-Nieves, RN Director of Case Management Florida Hospital North Pinellas Rushir J. Choksi, MD Medical Oncology/Hematology Florida Cancer Specialists & Research Institute Maria Delgado, CTR Quality Improvement/ Cancer Data Manager Florida Hospital Tampa Rosemary Giuliano, ARNP, MSN Director, Oncology Program Florida Hospital North Pinellas Clinical Instructor University of South Florida School of Nursing Ryan J. Grella, PT, DPT, OCS Director of Rehabilitation Florida Hospital North Pinellas Paul S. Hoover Jr. Vice President Business Development Florida Hospital North Pinellas

Stephen F. Morris, MD, FCAP Pathologist Florida Hospital North Pinellas Department of Pathology and Laboratory Medicine Laboratory Medical Director/ Laboratory Services Director Stacy F. Orloff Ed. D., LCSW, ACHP-SW Vice President Palliative Care and Community Programs Suncoast Hospice Karen Owensby, MSN, RN Vice President, Chief Clinical Officer Florida Hospital North Pinellas Effie Pappas Politis, MD Plastics/Reconstructive Surgery Assistant Professor Division of Plastic & Reconstructive Surgery Diplomat of the American Board of Plastic Surgery University of South Florida

Bobbi Sheffield RD,LDN Clinical Nutrition Manager Morrison Healthcare Food Service Florida Hospital North Pinellas Jeffrey B. Smith, MD, FCAP Associate Pathologist Florida Hospital North Pinellas Terry B. Smither Executive Director Helen Ellis Memorial Foundation in support of Florida Hospital North Pinellas Lorraine Van Fossan, R.T. (R)(M), CBPN-IC Breast Care Coordinator Florida Hospital North Pinellas Gail L. Shaw Wright, MD, FACP, FCCP Medical Oncology Florida Cancer Specialists & Research Institute

Douglas S. Reintgen, MD, FACS Surgical Oncology Director, Cancer Initiatives Professor of Surgery University of South Florida

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Florida Hospital North Pinellas Oncology Credentialed Physicians

Ear/Nose/Throat

Radiology: Diagnostic

Jose A. Berrios, MD

Julie Claar, MD Gerald A. Niedzwiecki, MD Stanley A. Ordman, MD

Dermatology Roger W. Altman, MD John Hamill, MD David A. Lam, MD Panayiotis Vasiloudes, MD Hospice/Palliative Medicine Robert B. Killeen, MD Medical Oncology/Hematology Roberto A. Araujo, MD Jorge Ayub, MD Rushir J. Choksi, MD Uday Dandamudi, MD Robert L. Drapkin, MD Madhu Goyal, MD Sneh L. Gupta, MD Robert B. Killeen, MD Idelfia A. Marte, MD Edgar Gerardo Miranda, MD Gerald H. Sokol, MD Nathan I. Visweshwar, MD David T. Wenk, MD Gail Wright, MD Pathology Stephen F. Morris, MD Jeffrey B. Smith, MD Plastic/Reconstructive Effie Pappas Politis, MD Radiation Oncology Norman J. Brodsky, MD Michael D. Gauwitz, MD Vivian D. Griffin, MD Lawrence D. Hochman, DO Arthur Matzkowitz, MD Purendra P. Sinha, MD

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Radiology: Interventional Gerald A. Niedzwiecki, MD Surgery William W. Angell, MD Louis I. Astra, MD Keith G. Chisholm, MD Peter T. DiNapoli, MD Hadi A. Hakki, MD Venkit S. Iyer, MD Isidoros J. Moraitis, MD Lester C. Ordiway, MD Louis M. Palermo, MD Effie Pappas Politis, MD Daniel Ramirez, MD Douglas S. Reintgen, MD Lourdes T. Santiago, MD Michael J. Sakellarides, MD John J. Zelis, MD Urology Paul M. Arnold, MD Yaser S. Bassel, MD David J. DiPiazza, MD Brian Hale, MD Ramon Perez, MD Sobhy D. Shehata, MD Paul M. Vazquez, DO


SPIRITUAL CARE TOTAL PATIENT CARE Florida Hospital North Pinellas is a faith-based hospital that believes total patient care involves attention to the spiritual and emotional, as well as the physical needs of each patient. Thus, spiritual care is included in the treatment of the patients and families who visit our hospital.

Team members consist of a variety of Christian faith traditions, both liturgical and non-liturgical. Patients and families may choose to receive visits from the Spiritual Care team or they may request assistance in contacting a representative from their own faith community.

This care is undertaken by the Chaplain and spiritual caregivers who use our guest’s specific spiritual or religious tradition to address the present needs within his or her unique circumstances, frameworks of meaning and spiritual expression.

Additional services provided by our Spiritual Care team include: spiritual assessment and consultations on advanced directives, end-of-life decisions and ethical concerns.

The Spiritual Care team works with and is included in the multidisciplinary care team. And as part of the multidisciplinary care team, the Chaplain and spiritual caregivers offer integrated care — psychological and spiritual, when responding to the diverse spiritual and emotional concerns experienced by patients and those who care for them—their family, friends and health care staff.

Sincerely, Larry Black, DMin, MDiv, BCC Chaplain Florida Hospital North Pinellas

Members of the Spiritual Care team are available to offer counseling and emotional support, as well as provide a support system to our patients, families, and health care staff, to help them cope during a patient’s illness and if necessary, afterwards during their own bereavement.

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Chairman’s Report

cosmetic practice of injections, fillers and lifts to beautify patients with these services in the community.

Douglas S. Reintgen, MD, FACS

I would like to take this opportunity to welcome our readers and our patients to the first annual Cancer Report for Florida Hospital North Pinellas (FHNP). It has been an interesting and exciting year at the former Helen Ellis Memorial Hospital, with the purchase of the hospital by the Adventist Health System. Adventist Health is a national hospital chain of 47 hospitals, with 27 in the state of Florida. With their brand they have invested $40 million in the facility, with fresh paint on the exteriors, refurbished wards and rooms in the hospital, the latest technology in radiology, the vascular suite and the OR and new staffing. Adventist Health has also entered into a partnership with the University of South Florida (USF) to build Surgical Institutes and Centers of Excellence in various hospitals throughout the state of Florida. And so the Surgical Institute of FHNP was created to serve the needs of the local community in Tarpon Springs, North Pinellas and Pasco counties. This partnership brought myself, a Professor of Surgery and Director of Cancer Initiatives at USF, to practice at FHNP. While at USF in the 1990’s I was part of the team that helped develop the lymphatic mapping and sentinel node biopsy technique for the surgical treatment of melanoma and breast cancer, a technique that quickly became the standard of care throughout the world. I specialize in the surgical treatment of early stage breast cancer and melanoma, the most deadly skin cancer. Effie Pappas Politis, MD, a Plastic Surgeon with a Greek Heritage was also recruited to the FHNP team. Dr. Politis specializes in breast reconstruction after mastectomies, but also helps care for patients with skin cancers in the head and neck region. In addition, she has opened a

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Another key team member is Louis Astra, MD, a thoracic, vascular and general surgeon. Dr. Astra is a very talented physician, skilled in multi specialties. With a high-volume practice he provides for the surgical care of patients with lung cancer and the technically demanding surgery for esophageal tumors. A recent recruit to the Surgical Institute is Lourdes Santiago, MD, a colorectal and general surgeon. She will be adding her expertise to patients with tumors of the lower gastrointestinal tract. Dr. Astra’s right-hand team member is Debora Ryder, an ARNP who is usually the first contact for his patients. The Surgical Institute team is pleased to work with Peter Dinapoli, MD, a general surgeon who has provided surgical services in the Tarpon Springs community for several years. The person that holds all this together and provides the day-to-day direction and organization for the Oncology Program is Rosemary Giuliano, ARNP, who is also the Director of Oncology at FHNP. Most patients will enter into the Oncology Program of an organization through the surgical service, as surgery is usually the first treatment with either a biopsy or definitive treatment being performed. However, to achieve the best results with many of the adult cancers, multi-disciplinary care is needed. Community medical and radiation oncologists have embraced their role in the cancer program, participating in the monthly Tumor Boards and prioritizing appointments for cancer patients in the system. One can see from the list of participants in this report that community support is vital for the success of the program. A monthly Tumor Board has been established to discuss difficult or controversial cases in order to develop a consensus on how best to treat the patients. Cases are presented with pathology and radiology input, clinical guidelines are discussed and clinical research eligibility is ascertained. Clinical research can be important in a community setting, since it gives local patients access to the newest drugs, techniques or treatments for their cancer. Recently the Multi-Institutional Neo-adjuvant Therapy (MINT) trial was instituted for our Cancer Program, which is a nationwide trial evaluating the role of gene expression profiles in the treatment of women with advanced breast cancers. Other trials are available through the community medical and radiation oncology practices.


Technology for cancer patients has been upgraded at FHNP through Digitial mammography with CAD. This technology eliminates the need for film and developing agents and allows all the images to be digitialized and universally available throughout the campus. Breast MRI, a more sensitive examination than mammography, is also available for women who are younger and those with dense breast tissue. The hospital recently opened a Women’s Center, where women can have the utmost privacy for the workup of their abnormal mammograms. One day each week a mobile PET/CT scanner comes to the campus so that cancer patients can have an examination and see their physician on the same day. This technology can be costly. Many thanks go out to the Adventist Health System for bringing these improvements to the community. Teaching is an important function of any academic organization and the best hospitals in the country are associated with medical schools. The FHNP partnership with the University of South Florida allows for such an interaction, as the faculty of the Surgical Institute teach an Introductory Cancer 101 Course to first and second year medical students at USF. In addition, FHNP supports and hosts a summer internship program on campus where undergraduate students from the community interested in a medical career can shadow physicians from the Surgical Institute and the community. The students become active participants in the care of the cancer patients as they see patients in the clinic, participate in hospital rounds and scrub into the OR to assist. Rotations this past summer were in surgical oncology, plastic surgery, thoracic and vascular surgery, radiology, pathology, anesthesiology, urology and nutrition. Students were also challenged to participate in a clinical research project or to write a case report that could be published in medical literature. By doing this, their CV’s may be improved for applications to medical schools and residencies. The following are two publications from this summer’s group:

The first paper is important since it has the potential of changing the current staging system for melanoma. The major fundraiser for FHNP took place on November 10, 2012 and featured “Doctor Idol Tampa Bay,” a competition of physician bands performing for the attendees. The evening was a huge success and much fun for the audience. The main benefactor for the gala was “Operation Sunshine.” In this program staff of the Surgical Institute will hit the streets in a Toyota Tundra, generously donated by Sun Toyota, to provide on-site skin cancer education and screening to schools and industry in the North Pinellas area. Skin cancer and melanoma are an epidemic in the state of Florida, and with this community program, staff and employees of local businesses will not have to take personal time to receive what may be a life-saving screen. The future is bright for the oncology program at FHNP and excitement is at an all time high. We invite the community to attend our community outreach education programs and encourage your employer to participate in “Operation Sunshine.” Above all, I invite you to get to know and support your community hospital as investments continue to be made in the health and well-being of Tarpon Springs and its surrounding areas. Respectfully submitted, Douglas S. Reintgen, MD, FACS Surgical Oncologist USF Professor of Surgery Director of Cancer Initiatives FHNP Commission on Cancer Chairman and Liaison West Coast Medical Group - Surgical Institute

1. R  eintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS. Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol., in press. 2. M  atz D, Kerivan L, Reintgen M, Akman K, Lozicki A, Causey T, Clynes C, Giuliano R, Acs G, Cox J, Cox C, Reintgen DS. Breast Preservation in women with Giant Fibroadenoma, Clinical Breast Cancer, in press.

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Administrative Report

four major areas of cancer program activity, including the interdisciplinary Tumor Board, cancer registry data, quality improvement activities and community outreach. Additionally, the Cancer Committee is responsible for development and evaluation of the Cancer Program, including establishing annual goals and objectives for clinical, education, research and program activities related to the prevention, screening, diagnosis and treatment of cancer.

Karen Owensby, MSN, RN

The Oncology service line and Cancer Committee at Florida Hospital North Pinellas are pleased to present the 2012 Annual Report. Our Cancer Committee includes board-certified physicians - surgeons, medical and radiation oncologists. Other Committee members include nurses, dietitians, cancer registry staff, case managers, physical therapists, chaplains, community outreach specialists and hospital administration. Community members of the Committee include hospice and palliative care. This report reflects the quality of cancer care and scope of services within the Cancer Program at Florida Hospital North Pinellas.

Lastly, our Cancer Program is focused on early detection as the key to fighting cancer. We are dedicated to educating the community on cancer prevention methods risk factors and early detection. Our ultimate goal is to eliminate suffering, debilitation and death due to cancer in Pinellas and neighboring counties. The programs and services detailed in this report will describe the highlights and accomplishments of our Cancer Program in 2012 and give insight into plans for the future. Sincerely, Karen Owensby, MSN, RN Vice President, Chief Clinical Officer Florida Hospital North Pinellas

2012 has been an exciting time for cancer care at our hospital. We have experienced growth in providers, services and technology. The Cancer Committee, responsible for cancer program activities at Florida Hospital North Pinellas, has focused on

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FLORIDA hospital north pinellas 2012 Programs and Services

Surgical Oncology Minimally invasive surgical techniques when appropriate u  Lymphatic mapping and sentinel lymph node biopsy for breast cancer and malignant melanoma u Hyperthermic isolated limb perfusion (HILP) u Nipple sparing mastectomy u Radiofrequency ablation u Molecular assay evaluation for breast cancer u Plastics/Reconstruction u Oncologic Head and Neck Surgery u Microvascular Surgery u Craniofacial Surgery u Maxillofacial and Extremity Trauma Surgery u Colon and Rectal Cancer u Video-Assisted Thoracoscopy u Mediastinoscopy/Mediastinotomy u Esophagectomy u

Medical Oncology/Hematology Clotting disorders Benign and malignant hematological disease u Pain and palliative care u Chemotherapy u Immunotherapy u Hormonal therapy u Growth factor support u Use of targeted biological agents u Intravenous supportive therapy u Bone marrow biopsy and aspirations u u

Urologic Oncology/General Adult Advanced early detection techniques Minimally invasive surgical procedures as appropriate for both malignancy and benign urologic disorders u Cryosurgical ablation u Nerve sparing radical cystectomies for prostatectomies u Orthotropic reconstructive surgery u u

Radiation Oncology – Community Supported  T simulation and treatment planning technology for external C beam and HDR brachytherapy u  4D PET/CT treatment planning and delivery u  Linear accelerators featuring MultiLeaf Collimation (MLC) and digital portal imaging u  3D conformal radiation therapy u  Intensity modulated radiation therapy (IMRT) u  Image-guided radiation treatment (IGRT) with on-board imager. (OBI) u  Low dose rate intracavitary brachytherapy (including prostate brachytherapy) u  High dose (HDR) brachytherapy u  Accelerated partial breast irradiation (Mammosite, SAVI and 3-D external/IMRT) u  Concurrent chemo-radiation therapy u  Stereotactic Radiosurgery (SRS) u  Stereotactic Ablative Body Radiotherapy (SABR) u

Cancer Screening u u

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 ancer screening and education at health fairs C Operation Sunshine – skin cancer education and screening in schools, industry, and the community.


Imaging Services  ET/CT scan P Image-guided breast biopsy - Stereotactic and Ultrasound guided u  Ultrasonography u  MRI u  Dedicated women’s health/breast center with site screening and diagnostic digital mammography with CAD u u

Multidisciplinary Cancer Conferences u

 iscussion of cases with an oncology team that includes D surgical oncology, medical oncology, radiation oncology, pathology, radiology, nursing, nutrition, palliative care, chaplain services and social services to assure the best possible treatment plan for each patient. Consensus treatment plans are developed.

Laboratory Services/Pathology Services u

 apid Processing of all specimens, special testing/staining R to render illness/diagnosis

Genetic Counseling and Testing University of South Florida and Community Partnership u

 enetic counseling to determine a patient or family members’ G individual risk of carrying an inherited genetic mutation

Support Services u u

 atient Experience Specialist P American Cancer Society Partnership

Pharmacy Services

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Oncology Program Highlights 2012 Oncology Program Highlights Developed Oncology Program u USF/Florida Hospital North Pinellas Affiliation - Surgical Oncologist - Plastic/Reconstructive Surgeon u  Hired a dedicated fellowship-trained Thoracic/ Vascular/General Surgeon u  Hired a dedicated fellowship-trained Colorectal/ General Surgeon u  Hired an Advanced Registered Nurse Practitioner Surgical Hospitalist u  Hired a Patient Experience Coordinator u  Designated Women’s Health/Breast Center - Increased percentage of image guided breast biopsies u  Initiated CPOE u  Initiated Lymphedema Program u  Initiated Pulmonary Rehabilitation Program u  Initiated Palliative Care Program Partnership u  Smoking Cessation Program u  PET/CT Imaging On-Site u  Oncology Specific CME approved Grand-Rounds -E  merging Strategies in relapsed/refractory Non-Hodgkin’s Lymphoma -E  merging Agents in HER2-Positive Breast Cancer; An Oncology Exchange - Emerging Strategies in Advanced Ovarian Cancer u

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Preceptor Programs - Pre-Medical Students - Medical Students - Advanced Registered Nurse Practitioner Students u  Medical Journal publications - Reintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS. Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol., in press. - Matz D, Kerivan L, Reintgen M, Akman K, Lozicki A, Causey T, Clynes C, Giuliano R, Acs G, Cox J, Cox C, Reintgen DS. Breast Preservation in women with Giant Fibroadenoma, Clinical Breast Cancer, in press. - Murray L, Reintgen M, Akman K, Cox C, Cox J, Reintgen D, Greenberg H, Vrcel V. Pleomorphic lobular carcinoma in situ: Treatment options for a new pathologic entity. Clinical Breast Cancer 12: 76-79; 2012 - Howard JH, Thompson J, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses D, Sondak V, Reintgen DS, et. Al.:Metastasectomy for distant metastatic malenanoma: Analysis of data from the first Multicenter Selective Lymphadenectomy Trial (MSLT-1). Ann Surg Oncology 19: 2547-2555; 2012. - Clynes C, Loznicki A, Akman K, Reintgen M, Matz D, Kerivan L, Giuliano R, Reintgen DS. Pigmented skin lesions in patients with malignant melanoma, in press. u


Breast Health Program

Florida Hospital North Pinellas (FHNP) in conjunction with the University of South Florida (USF) Department of Surgery and community physicians, provides a multidisciplinary approach to the treatment of women diagnosed with breast cancer. FHNP has developed a comprehensive program so that patients have access to the newest treatment modalities and clinical trials in a community hospital setting. In 2012, more than 200,000 new cases of breast cancer were diagnosed and breast cancer is the highest incidence cancer cared for at the hospital in women. In 2012, more than 100 new cases of breast cancer were registered in the database of the Surgical Institute of FHNP. The treatment for breast cancer has become more conservative through the years and physician members in our Breast Health Program have led the way in developing and disseminating new techniques to treat the disease. When women are initially diagnosed with breast cancer the first treatment is surgical. The surgical approach to the disease has become more conservative with lumpectomy replacing the more radical mastectomy in removing the primary tumor in the breast. Lumpectomy refers to removing the breast cancer with a rim of normal breast tissue around it and currently 66% of women in the program elect or are candidates to receive this procedure. To determine whether the cancer has spread to the most common site of spread, the lymph nodes under the axilla, surgeons now perform the more conservative lymphatic mapping and sentinel lymph node (SLN) biopsy. This is the technique that FHNP program leaders helped to develop in the 90’s at Moffitt Cancer Center in Tampa. The old treatment involved taking out all the lymph nodes in the axilla. After this procedure about 30% of women develop what is called lymphedema, or swelling of the arm, since the arm’s lymph also drains into the axillary nodes, that now have been removed. Since the lymph nodes are gone the lymph backs up in the arm, which can affect the patient for the remainder of her life. The old standard procedure, the complete node dissection removes on average 15-20 nodes. The SLN procedure removes one or two lymph nodes and arm swelling does not occur. In addition, the staging (determining whether there is any spread of the breast cancer to the lymph nodes) is more accurate since the pathologist has only one-two nodes to examine, and he can perform a more detailed examination with more sections and special stains looking for the breast cancer

cells in the lymph node. The SLN procedure is a win/win for the patient – less morbidity with the operation and at the same time better staging. It very quickly became the standard of care for the nodal staging of patients with breast cancer and members of our Breast Health Program have taught the technique to surgeons, pathologists and radiologists throughout the world. With all lumpectomies the remainder of the breast is treated with external beam radiation. This allows the rest of the breast to be preserved and is given to treat any other areas of disease that may not be detected on mammograms or physical exam. Radiation plays an essential role in breast conservation for pre-invasive and invasive disease. Radiation also decreases local recurrence and improves survival in all breast cancer patients. The radiation is 28 treatments over a six-week period of time, a little inconvenient for the patient. For this reason the radiation therapy has also become more conservative. Radiation oncologists can now treat the area of the breast where the cancer developed through a catheter that is inserted and stays in place for one week. This is called partial breast radiation and takes advantage of the fact that 95% of recurrences of breast cancer occur in the same quadrant of the breast in which the cancer developed. The radiation schedule goes from six to one week – a tremendous advantage for women. This cutting edge technique is offered in the North Pinellas and Pasco County communities. In women who have larger tumors or multicentric disease (disease in more than one quadrant or area of the breast), mastectomy may be the only option. In this case, all patients receive a preoperative consultation with plastic surgery in order to discuss the various options for breast reconstruction. With newer surgical approaches for performing the mastectomy, such as the nipple and skin sparing mastectomy procedure, 99% of the breast tissue can be removed with an incision hidden below the breast. The start of reconstruction of the breast mound can begin immediately by insertion of a tissue expander. In this way the cosmetic result is unparalleled despite the need for mastectomy.

Continues on next page.

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Breast Health Program Continues from previous page.

Thus the surgical treatment and the radiation therapy in women that are diagnosed with breast cancer have become more conservative through the years. But, to achieve the best results medical oncology participation is key, and our Breast Health Program is fortunate to involve a number of community medical oncologists that have a special interest in treating women diagnosed with breast cancer. Breast cancer chemotherapy is tailored to the patient’s individual tumor characteristics by incorporating the Mammoprint 70-gene assay and the Oncotype 21-gene assay in defining the genetic signature of each cancer. In this way, the need for total body treatments such as chemotherapy or hormonal therapy is evaluated and individualized to minimize side effects and maximize clinical benefit. In addition, women are given the opportunity to participate in life-saving clinical trials that are offered in the community. The Multi-Institutional Neoadjuvant Therapy (MINT) trial is one such example that attempts to evaluate the role of gene expression profiling in women with advanced tumors, since it previously has been shown to be a predictive of benefit in patients with earlier stage disease. One of the special features of our Breast Health Program is the presence of an electronic medical record (EMR) database that is used on a daily basis to care for patients. Some features of the database are as follows: (1) summarizes the entire chart into a single page of the most critical elements for the patient to streamline clinic visits, (2) more than 100 variables are collected for each patient in the database that can then be queried for research projects to define the prognosis and natural history of many breast cancer populations, (3) efficient clinical trial eligibility determination and (4) universal access to all the clinical information on any patient at the fingertips of members of the Program. From this database two papers were published this last calendar year that may have impact on how patients with breast cancer are treated: 1. M  urray L, Reintgen M, Akman K, Cox C, Cox J, Reintgen D, Greenberg H, Vrcel V. Pleomorphic lobular carcinoma in situ: Treatment options for a new pathologic entity. Clinical Breast Cancer 12: 76-79; 2012 2. M  atz D, Kerivan L, Reintgen M, Akman K, Loznicki A, Causey T, Clynes C, Giuliano R, Acs G, Cox J, Cox C, Reintgen D. Breast preservation in women with giant fibroadenoma, Clinical Breast Cancer, in press.

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The physicians and nurse practitioners of our Breast Health Program are excited to be part of the expansion of the “Operation Sunshine” Program that will eventually lead to breast cancer screening and early detection programs in Pinellas County. Funding for the program will be provided by the “Doctor Idol Tampa Bay” event of the Helen Ellis Memorial Foundation. This is the major fundraiser for FHNP and the Breast Health Program is grateful for the support that in turn will allow the program to offer a community service not available at this time. For this groundbreaking program for the Adventist Health Care System, a Toyota Tundra, generously donated by Sun Toyota, will travel throughout the county to schools and industry to perform on-site education about breast cancer screening. In this way, employees do not have to take self-time to receive these services for the early detection that may in turn be life-saving. Participants will be queried about their breast cancer screening activities and, if lacking, will be offered appointments at FHNP for mammograms and clinical breast exams. There exists plenty of scientific evidence that screening for breast cancer can result in early detection and better prognosis for the patient. Members of our Breast Health Program also participated in the summer internship program designed for undergraduate and advanced registered nurse practitioner students interested in a medical career. Seven students from the University of Florida, Florida State, University of South Florida and Duke University participated in a month long “shadowing” program rotating through the surgical, radiology, pathology, nutrition, urology and medical and radiation oncology departments and programs of the hospital. Highlights of the program include the ability of the students to “scrub” into operations to first assist in the procedure, participating in daily conferences and writing case reports of interesting patients. This allows the student to become published, which may be a distinguishing factor in their applications to medical school or other graduate/Ph.D programs. The students also had the opportunity to attend the annual meeting of the Society of Surgical Oncology and present their research with a poster presentation.


A dedicated Comprehensive Breast Center opened November 7, 2012 at FHNP that offers a comfortable and private environment for women receiving treatment and offers up-to-date technology. This past year digital mammography and CAD was introduced, which improve the resolution of images and enhances tumor characterization to help promote early detection compared to the old film standard. Through the hospital PACS system, digital images are available in the physician offices and clinics where patients are seen in follow-up. With same day appointments for their digital mammograms and clinic appointments, one-stop shopping is offered for patient convenience. Same-day readings are available to lessen patient anxiety and with the mammogram in hand at the time of the clinic visit, any abnormalities identified can be correlated with findings on the clinical breast exam. In addition, our Breast Health Program now offers patients breast MRI that is even more sensitive than digital mammography in identifying abnormalities particularly in younger women with dense breasts. Staging is an important part of caring for the patient with cancer during the follow-up period. In this way, recurrences are detected early when therapy may be possible and the effect of various treatments may be evaluated and monitored. This past year a mobile PET/CT scanner became available to offer this important service on site at FHNP. The PET/CT scanner has replaced the CT scans and bone scans from the past and is the preferred method to stage cancer patients in follow-up clinics. Women with abnormal mammograms or breast ultrasounds are particularly anxious to schedule biopsies for a definitive diagnosis. The Surgical Institute staff offer women in the community same week breast biopsies once they are evaluated with a clinic visit. This is a tremendous community service that holds the promise of alleviating concern and worry for patients and their families. I am thrilled for the future of the Breast Health Program at FHNP, as we strive to deliver cutting-edge personalized care and resources to patients in Pinellas County and throughout the state of Florida. Respectfully submitted, Douglas S. Reintgen, MD, FACS Surgical Oncologist USF Professor of Surgery Director of Cancer Initiatives FHNP Commission on Cancer Chairman and Liaison West Coast Medical Group - Surgical Institute 23


Melanoma and Cutaneous Oncology Program

The Cutaneous Oncology Program (COP) at Florida Hospital North Pinellas (FHNP) is one of the largest referral centers for patients with melanoma in the state of Florida. Melanoma and other skin cancers, like basel cell carcinomas (BCC) and squamous cell carcinomas (SCC), are epidemic in the state of Florida due to the intense sun light exposure and the increasing elderly population. Melanoma is one of the highest incidence cancers being care for in the Surgical Institute and at FHNP. In the 2012 calendar year, Cutaneous Oncology registered more than 100 new patients. Multidisciplinary care is a hallmark of the program, since many times surgical, medical and radiation oncology specialties are needed to give the patient the best chance of cure. This is achieved through the monthly Tumor Board, where interesting or controversial cases are discussed and a consensus is developed as to the best way to treat the patient. Clinical research protocol eligibility is also determined for each patient presented at the conference. A mix of employed FHNP physicians and nurse practitioners, community physicians and doctors from the University of South Florida provide input at the conference to develop the consensus. Unique procedures for the program include lymphatic mapping and sentinel lymph node (SLN) biopsy techniques for the nodal staging of newly diagnosed melanoma. In fact, the members of my team were part of the group to develop this procedure in the ‘90s, when I was the program leader at Moffitt Cancer Center, eventually teaching the technique to more than 3000 physicians worldwide. This surgery is a win/win situation for the patient, resulting in less morbidity from the operation and more accurate staging by the pathologist. Very quickly it became the standard of care for patients with melanoma and women with breast cancer. Another unique surgical procedure offered at FHNP is the hyperthermic isolated limb perfusion (HILP) technique for patients with recurrent melanoma confined to either the upper or lower extremity. In this technique, the circulation of the extremity is isolated from the rest of the body and the affected extremity is treated with high doses of chemotherapy and high temperatures. Patients achieve a complete response rate of 70% with this surgical technique, a rate that is unmatched with most treatments for cancer. FHNP is the only hospital in the state of Florida that offers this technically demanding procedure.

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Two new drugs have been approved by the FDA this year for the treatment of Stage IV melanoma. Ipilimumab and vermuafenib can give objective response rates of 30-40% in appropriate patients. This response rate compares favorably to other total body therapies for melanoma that are used when the disease spreads internally. With the older compounds response rates in the 10% range were obtained, a low figure considering the toxicity of the chemotherapy. The two new drugs give hope to the patients with internal spread and are offered so that patients can receive this advanced care in the community. Staging is an important part of caring for the patient with cancer during the follow-up period. In this way recurrences are detected early when therapy may be possible, and the effect of various treatments may be evaluated and monitored. This past year a mobile PET/CT scanner became available to offer this important service on site at FHNP. The PET/CT scanner has replaced the CT scans and bone scans from the past and is the preferred method to stage cancer patients in follow-up clinics. One of the special features of the Cutaneous Oncology Program is the presence of an electronic medical record (EMR) database that is used on a daily basis to care for patients. Some features of the database are as follows: (1) summarizes the entire chart into a single page of the most critical elements for the patient to streamline clinic visits, (2) over 100 variables are collected for each patient in the database that can then be queried for research projects to define the prognosis and natural history of many of the melanoma populations, (3) efficient clinical trial eligibility determination and (4) universal access to all the clinical information on any patient at the fingertips of members of the Program. From this database two papers were published this last calendar year that may have impact on how patients with melanoma are treated and staged: 1. Howard JH, Thompson J, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses D, Sondak V, Reintgen DS, et. Al.:Metastasectomy for distant metastatic malenanoma: Analysis of data from the first Multicenter Selective Lymphadenectomy Trial (MSLT-1). Ann Surg Oncology 19: 2547-2555; 2012. 2. Reintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS. Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol., in press.


Difficult to treat SCC and BCC of the skin, due to size or location, are also specialties of the clinic. Other skin cancers besides melanoma are also epidemic in the state of Florida, and most of these cancers occur on the sun exposed areas of the body, such as the arms, hands and face. Removing the entire cancer and obtaining clear margins, but also preserving function with the best cosmetic results, are two goals of the clinic for these patients. Major resections including head and neck skin cancers are performed with immediate reconstruction by Plastic Surgery securing the best cosmetic result. The Cutaneous Oncology Program’s medical staff are excited to initiate “Operation Sunshine,” an education and skin cancer screening program for schools and industry in Pinellas County. Funding for the program will be provided by the “Doctor Idol Tampa Bay” event held by the Helen Ellis Memorial Foundation. This is the major fundraiser for FHNP, and the Cutaneous Oncology Program is grateful for the support that in turn will allow the program to offer a community service not available at this time. For this ground breaking program for the Adventist Health Care System a Toyota Tundra, generously donated by Sun Toyota, will travel throughout the county to schools and companies to perform onsite education and skin cancer screening. In this way, employees do not have to take self-time to receive these services for the early detection of skin cancers that may in turn be life-saving. Grade school and teenage participants will learn about sensible sun safety techniques with age-appropriate teaching material. There exists plenty of scientific evidence that if you can diagnosis melanoma early when it is “thin,” it is curable. Eventually, this program will expand into other cancer screenings for lung, breast, colon, cervical and prostate cancers. Members of the Cutaneous Oncology Program also participated in the summer internship program designed for undergraduate and advanced registered nurse practitioner students interested in a medical career. Seven students from the University of Florida, Florida State, University of South Florida and Duke University participated in a month long “shadowing” program rotating through the surgical, radiology, pathology, nutrition, urology, medical and radiation oncology departments and programs of the hospital. Highlights of the program include the ability of the students to “scrub” into operations to first assist in the procedure, participating in daily conferences and writing case reports of interesting patients. This allows the students to get

published, which may be a distinguishing factor in their applications to medical school or other graduate schools. The students also had the opportunity to attend the annual meeting of the Society of Surgical Oncology and present their research with a poster presentation. The following are four papers that are in various stages of publication from the program: 1. Reintgen M, Murray L, Akman K, Giuliano R, Loznicki A, Shivers S, Reintgen DS. Evidence for a better nodal staging system for melanoma: The clinical relevance of metastatic disease confined to the sentinel lymph nodes. Ann Surg Oncol., in press. 2. Murray L, Reintgen M, Akman K, Cox C, Cox J, Reintgen D, Greenberg H, Vrcel V. Pleomorphic lobular carcinoma in situ: Treatment options for a new pathologic entity. Clinical Breast Cancer 12: 76-79; 2012 3. Matz D, Kerivan L, Reintgen M, Akman K, Loznicki A, Causey T, Clynes C, Giuliano R, Acs G, Cox J, Cox C, Reintgen D. Breast preservation in women with giant fibroadenoma, in press. 4. Clynes C, Loznicki A, Akman K, Reintgen M, Matz D, Kerivan L, Giuliano R, Reintgen DS. Pigmented skin lesions in patients with malignant melanoma, in press. The future is bright for the Cutaneous Oncology Program at FHNP, as we strive to deliver cutting-edge personalized care and resources to patients in Pinellas County and throughout the state of Florida. Respectfully submitted, Douglas S. Reintgen, MD, FACS Surgical Oncologist USF Professor of Surgery Director of Cancer Initiatives FHNP Commission on Cancer Chairman and Liaison West Coast Medical Group Surgical Institute

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Gastrointestinal Oncology

certain situations including when there is a family history of colon or rectal cancer). Undergoing colorectal cancer screening has been shown to significantly decrease the likelihood of dying from this disease, and allows these tumors to be identified at an early stage when they have an excellent chance of cure with surgery alone. Despite these figures, only approximately 40 percent of the eligible US population is screened for colorectal cancer. The GI oncology program at FHNP offers colorectal cancer screening and educational programs designed to inform our community about the need and benefits of colorectal cancer screening.

Rushir J. Choksi, MD

The Florida Hospital North Pinellas (FHNP) Gastrointestinal (GI) Oncology Program has a dedicated staff focused on cancer of the esophagus, stomach, bile ducts, liver, pancreas, colon, rectum and anus. The program is based on a multi-specialty team approach. In this way, each patient’s care is coordinated with expert input from all the cancer specialties, creating a personalized treatment plan for each patient. Our multidisciplinary approach is like getting multiple second opinions at one setting. All of the physicians treating gastrointestinal cancer meet to review the cases at a monthly conference. This includes the surgical oncologist, medical oncologist, radiation oncologist, pathologist, radiologist and clinical trials staff. We believe it is critical for all the FHNP cancer physicians to discuss the patient’s care before starting treatment. This often assures the best, safest and individualized approach for each patient, as cancers are not all alike. The oncology team is committed to fighting cancer and all of the members have completed specialized training for the care of patients with cancer. Colorectal cancer is the most common GI malignancy and the third most common cancer in men and women. It accounts for approximately 10 percent of all cancer deaths. One in 17 individuals will develop colorectal cancer. If diagnosed with colorectal cancer, your chance of dying from this disease is much higher than patients with a diagnosis of breast or prostate cancer. This is in spite of the fact that colorectal can be detected early with routine screening using a colonoscopy, and also actually prevented in most cases by colonoscopy and removal of polyps before they ever develop into a cancer. All men and women beginning at age 50 should be screened for colorectal cancer (screening should begin earlier in

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The lymph nodes are typically the first place colorectal cancer will spread. One of the critical steps in the surgical resection of the tumor is making sure enough lymph nodes have been surgically removed to be examined by the pathologist. The surgical technique, including lymph node sampling is a major focus of the surgical team at FHNP. Many studies have shown that having the appropriate surgical procedure can have a dramatic effect on someone’s chance of cure in GI cancer. Beyond the lymph nodes, colorectal cancer frequently spreads to the liver or lungs. With new and effective chemotherapies, response rates and survival for these tumors is dramatically increased from what it was just a few years ago. Even if the colorectal cancer has spread to the liver or lungs, cure may be possible with chemotherapy, surgery, and radiation. That is why bringing together specialists from surgical oncology, medical oncology and radiation oncology is essential in the treatment of each cancer to develop a personalized treatment plan. As a colorectal cancer gets close to the anus, the concern for a permanent colostomy bag become more likely. The GI oncology program at FHNP is committed to sphincter preservation. We utilize a number of methods for this goal, including treating the tumor first with radiation and chemotherapy to shrink it. Just as every person is different, no two GI cancers are the same. That is why a multidisciplinary approach to each cancer will give the patient a better chance of cure and survival. Sincerely, Rushir J. Choksi, MD Medical Oncology/Hematology Florida Cancer Specialists & Research Institute


Plastic and Reconstructive Surgery

general surgery and plastic/reconstructive surgery are able to see patients in the same clinical setting, allowing for patients to be seen on the same day for an expert consensus opinion. This onestop-shopping approach is a tremendous advantage for patients. The mastery of cutting-edge plastic surgery technologies, the provision of compassionate and confidential care and the pursuit of clinical excellence defines our program’s philosophy. As an academic based practice, our physician group is recognized as leaders in education, research and clinical outcomes. Clinical research projects are performed with students to better define the natural history of various patient populations and determine outcomes of new surgical techniques and therapies. Effie Pappas Politis, MD

It is estimated that more than one million reconstructive procedures are performed by plastic surgeons every year. Reconstructive surgery helps patients of all ages and types – whether it’s a child with a birth defect, a young adult injured in an accident, or an adult with a cancer diagnosis. The goals of reconstructive surgery differ from those of cosmetic surgery. Reconstructive surgery is performed on abnormal structures of the body, caused by birth defects, developmental abnormalities, trauma or injury, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. On the other hand, cosmetic surgery is performed to reshape normal structures of the body to improve the patient’s appearance and self-esteem.

Some of the state-of-the-art procedures offered at FHNP include Microvascular Surgery, Breast Reconstruction with flaps and implants, Craniofacial Surgery, Maxillofacial and Extremity Trauma Surgery, Oncologic Head and Neck Surgery with reonstruction as well as fat-grafting and body contouring and scar revisions. We also offer Aesthetic and Rejuvenating procedures that include injections to smooth out aging wrinkles and fillers to do the same. Sincerely, Effie Pappas Politis, MD Plastic and Reconstructive Surgery USF Assistant Professor Division of Plastic & Reconstructive Surgery Diplomat of the American Board of Plastic Surgery West Coast Medical Group - Surgical Institute

The team at Florida Hospital North Pinellas (FHNP) understands the physical and emotional suffering one goes through when they have been diagnosed with a cancer, lost physical attributes due to a traumatic injury, or are born with a congenital deformity. The field of reconstructive surgery has advanced with incredible speed over the past few decades. It is now possible to restore function and improve the overall appearance through an array of surgical reconstruction procedures that can enhance ones selfesteem, especially after undergoing a cancer operation. At FHNP we believe the multidisciplinary team approach ensures that each patient has the best opportunity for a successful outcome – regardless of how small or complex the procedure may be. This is achieved by holding multidisciplinary clinics where the various surgical specialists, such as surgical oncology, thoracic surgery,

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Thoracic Oncology Program

without any retractors that spread or break the ribs. This results in significantly less pain after surgery and much quicker recovery. It can also potentially translate to better long term outcomes from a cancer standpoint, as patients that require adjuvant chemotherapy can receive it sooner and are more likely to tolerate it better.

Louis I. Astra, MD, FACS

The American Cancer Society estimates 226,000 people in the United States will be diagnosed with lung cancer in 2012. Approximately 160,000 people will die from lung cancer in 2012, making this the most deadly form of cancer by far. Each year, more people die from lung cancer than colon, breast, prostate and pancreatic cancer combined. Despite these statistics, some people can be cured from lung cancer. Recent data suggests that screening people at risk with CT scans can not only diagnose patients at an earlier stage, but improve overall survival. Florida Hospital North Pinellas (FHNP) has placed a strong emphasis on cancer treatment. Improving care and outcomes for patients with lung cancer and other thoracic malignancies is the committed objective of the FHNP Thoracic Oncology Program (TOP). Working in a multidisciplinary and collaborative approach, the TOP team is a specialized group of health care professionals who are dedicated to preventing, diagnosing, treating and managing lung cancer and esophageal, pleural, mediastinal and chest wall tumors. Surgery continues to play the most important role in the potential cure for lung cancer. At FHNP most patients that are surgical candidates can be treated via a minimally invasive approach known as VAT Lobectomy. In this approach, the surgery is done with small incisions, using cameras and

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We have also partnered with several oncology groups with expertise in delivering the most up to date chemotherapy regimens as well as participating in clinical trials. Surgeons, medical oncologists and radiation oncologists work together to deliver treatment on an individualized basis. Sometimes patients may receive a combination of surgery, chemotherapy, and radiation therapy. To help us determine which treatment will lead to the best outcomes, staging is critical. FHNP is now able to offer fusion PET/CT scans to allow for more accurate radiologic staging. Liberal use of video mediastinoscopy to sample lymph nodes also allows us to accurately stage patients. Sincerely, Louis I. Astra, MD, FACS Cancer Conference Coordinator CardioThoracic, Vascular/General Surgery West Coast Medical Group - Surgical Institute Florida Hospital North Pinellas


Urologic Oncology and General Urology

 he Holimium 100 watt laser, Bipolar Button Vaporization and T Bipolar TURP and the u The Greenlight XPS Laser which, - Dr. Arnold is internationally recognized and certified as an instructor in this technique. u  The Protouch 1470 laser where FHNP is one of only five centers in the US offering this therapy and - Its 1470 nm wavelength is highly absorbed by both water and hemoglobin making it ideal for ablating soft tissue. As the laser energy ablates tissue, it simultaneously seals off the blood vessels to minimize bleeding. This system allows the surgeon to operate in contact mode, which provides the tactile feel of a scalpel or electrode loop without destroying the fiber. u

Paul M. Arnold, MD, FACS

The Urologic Oncology program at Florida Hospital North Pinellas (FHNP) evaluates a broad range of patients with urologic problems, for men and women. Services include not only urologic oncology, but also general adult urology. FHNP has pioneered the use of cryosurgical ablation of prostate and kidney tumors in our area. Cryosurgical ablation includes a shortened recovery time, a lower risk of potential side effects and a quicker return to normal daily activities. Open and laparoscopic nephrectomies, radical cystectomy with bladder reconstructive surgery for patients with advanced bladder cancer, open and perineal prostatectomy for prostate cancer are all offered at FHNP. Full radiation therapy services are available in the community including image-guided RT (IGGRT with SonArray ultrasound guidance combined with IMRT), and permanent radioactive seed implant (brachy therapy) for prostate cancer.

The urologists at FHNP work side-by-side with their colleagues in medical and radiation oncology, providing comprehensive and integrated cancer care for our patients. In addition, monthly cancer conferences are held to review treatment plans for our patients, allowing us the ability to obtain state-of-the-art treatment recommendations from a multidisciplinary panel of physicians and providers. We strive to provide precision-oriented, accurate care and up-to-date information to patients regarding the treatment of various cancers as well as methods of rehabilitation from treatment-related side effects. All available treatment options are presented to patients so they can make informed decisions. Treatment plans are addressed from an individual perspective, and an appropriate approach to treatment is taken with each patient. Sincerely, Paul M. Arnold, MD, FACS Urology Specialists of West Florida

Our physicians and staff also offer evaluation as well as medical and surgical treatment for patients with impotence, urinary incontinence, stone disease, and urinary tract infections. FHNP offers minimally invasive treatment options for benign prostatic hyperplasia that offers the same results of traditional TURP without the bothersome side effects, since this minimally invasive technique uses a laser to vaporize tissue, creating a channel through which men can urinate more freely.

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Community Outreach

At Florida Hospital North Pinellas we are committed to extending the healing ministry of Christ to those we serve through our care, compassion and expertise. Offering state-of-the-art care as a benefit to our community means not only providing the latest in testing and treatment, but also focusing on prevention and education. To better serve the many health needs of our community, we have established a community health team dedicated to serving our region with a personalized and compassionate approach. As an organization, we have also developed a community health assessment that looks closely at our local community and identifies the main health needs and concerns. These needs drive the screening, education, outreach, sponsorship, and support that our organization seeks to provide. During the past year, we have touched the lives of more than 6,000 people, hosted more than 70 screenings, and facilitated greater than 600 referrals for

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additional services. These events are minimal to no cost to the participants and are aimed at reaching out and enriching the lives of our community. To find out more about our wide variety of Healthy Happenings events, please visit FHNorthPinellas.com or call (727) 943-3600. We look forward to seeing you at a Healthy Happenings event, as we work together to enrich the health and wellness of our community. Sincerely, Paul S. Hoover Jr. Vice-President of Business Development Florida Hospital North Pinellas

Christine Longley, MS, BS Community Outreach Coordinator Florida Hospital North Pinellas


Community Education and Outreach

The community Education and Outreach program offered a variety of programs, classes, health fairs and screenings for our community. In 2012 the following Community Education Forums were held: Cancer Screenings Health Fair at St Petersburg College (4/11/12) -5  0 skin screenings performed u Melanoma Monday at FHNP (5/7/12) -7  8 skin screenings performed u Men’s Only Morning (7/28/12) -7  7 participants in prostate, skin, vascular u

Presentations Operation Sunshine (4/5/12) -R  osemary Giuliano, ARNP -H  elen Ellis Memorial Foundation, Tarpon Springs -F  lorida Hospital North Pinellas, Tarpon Springs u The Role of the Plastic/Reconstructive Surgeon (5/2/13) -E  ffie Pappas Politis, MD -T  arpon Springs Rotary Club, Tarpon Springs u Melanoma-From Diagnosis to Treatment (5/31/12) -E  ffie Pappas Politis, MD -T  arpon Springs Rotary Club, Tarpon Springs u Breast Cancer (6/2/12) -E  ffie Pappas Politis, MD -F  lorida Breast Cancer Foundation -S  heraton Sand Key, Clearwater u  PSA Testing “Pros & Cons” Presentation and Panel Discussion (8/29/12) -V  ipul Patel, MD, Paul Arnold, MD, Yaser Bassel, MD, David Jacob, MD — Flamestone Grill, Oldsmar u

Lung Cancer and What You Need to Know (9/20/12) - Louis Astra, MD - Tarpon Springs Rotary Club, Tarpon Springs u Reconstruction Surgery after Weight Loss (9/24/12) - Effie Pappas Politis, MD - Club Reduce, Tarpon Springs u Erectile Dysfunction or Enlarged Prostate? (9/27/12) - Paul Arnold, MD - Florida Hospital North Pinellas, Tarpon Springs u  Breast Cancer Awareness “A Reason To Celebrate” – Dine with a Doc (10/10/12) – - 22 hospital/vendor participants - 29 physicians hosting dinner tables “Dine with a Doc” - Panel of 4 physicians, 1-ARNP moderator for discussion - 264 attended - Innisbrook, Palm Harbor u  USF Grand Rounds “Current Treatment in Malignant Melanoma” (10/15/12) - Douglas Reintgen, MD - TGH MacInnes Auditorium, Tampa u  Florida Hospital North Pinellas General Medical Staff Meeting “Cancer Staging” (12/4/12) - Douglas Reintgen, MD - Florida Hospital North Pinellas, Tarpon Springs u

Interviews u

DayTime Television Interview “Sun Safety” (11/5/2012) - Douglas Reintgen, MD - WFLA TV News Channel 8 Studio, Tampa

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Florida Hospital NOrth Pinellas and the American Cancer Society support services

Supportive Services Pet Therapy u Smoking Cessation u

The following are some of the programs and services that the American Cancer Society offers to cancer patients and their families:

 

Gift Closet – with wigs, turbans, breast prostheses, ostomy supplies, etc. Road to Recovery – transportation for cancer patients to and from treatment. Reach to Recovery – one-on-one patient visitation by breast cancer survivors. Look Good…Feel Better – professional cosmetologists offer advice and tips for dealing with hair loss and changing skin due to cancer treatments. Man to Man – prostate cancer education and support program. 1-800-ACS-2345 and www.cancer.org – provides 24-hour accurate information about diagnosis, treatment, recovery, prevention, detection, local community resources and more.

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Cancer Survivors Network – provides information and unites cancer survivors and caregivers. Can be reached through 1-877-333-4673 (HOPE) or www.cancer.org Hope Lodge – free lodging during cancer treatment. Pain relieving medication assistance. R.O.C.K. (Reaching Out to Cancer Kids) Camp – Summer camp for children with cancer. College Scholarships – for students with a history of cancer.


Cancer Screening

The Florida Hospital North Pinellas (FHNP) Cancer Screening Program was developed to provide a community service for people to decrease the mortality of cancer through early detection, risk assessment and education. This program uses state-of-the-art technology, equipment, and a highly skilled, dedicated staff. It is a fixed site based program located on the FHNP campus. The purpose of cancer screening is to detect cancer before it is clinically apparent, early in its natural history before it has become systemic and spreads internally. Early detection can result in more effective treatment that may be less of a cost for the health care system. An abnormal screening test in this situation leads to further diagnostic evaluation, including other diagnostic tests or biopsy to determine if cancer is present, and to subsequent treatment if cancer is detected. Expected benefits of screening are reduction in the death rate from the targeted cancer, reduced morbidity from the disease, and reduced health care costs. In addition to an earlier return to work and a productive life, there is less of a cost to the community. For this reason, the support of any cancer screening program must take the long term view of a community’s health, since apparent benefits to the population may not be available for years after the institution of cancer screening. Studies have shown that up to 75% of health care dollars are spent in the last year of life, prolonging the inevitable death of the patient when it is largely a hopeless situation. Perhaps these dollars should be spent up-front preventing the cancers and diagnosing them early when they are curable with simple surgical techniques. Additional benefits of cancer screening include improved length and quality of life, reduced pain, anxiety and disability. Cancer screenings that are provided by FHNP at their fixed site include screening mammography, clinical breast examination, total body skin examination, osteoporosis screening, prostate screening by digital rectal exam and prostate specific antigen testing (PSA) (blood test), low-dose spiral CT scan screening for lung cancer and colorectal screening. An effort will be made to provide these services to the community, major corporations throughout the county and the Pinellas County School Board. Screenings will be performed on site, at industry centers or at the FHNP Screening Center. All screening recommendations adhere to the American Cancer Society and National Osteoporosis Foundations guidelines to identify populations at risk and are appropriate to screen. In addition, mobile screening services are

an effective way to increase public awareness with education and to reach out to the under-served population. For those who are at high risk for developing cancer due to family history or other risk factors, the FHNP Cancer Screening Program provides education, cancer prevention strategies, and surveillance plans for early detection. Genetic screening services, such as counseling and genetic testing, are available for individuals who are at risk for breast and/or ovarian cancer, colon cancer, malignant melanoma and familial adenomatosis polyposis. In these instances of family with a strong history of cancer, a comprehensive evaluation of personal and family history is obtained and this information is used to develop a personal pedigree identifying the genetic history and potential cancer risk. Operation Sunshine: A Sun Safety Program for the Pinellas/ Tarpon Springs Community was initiated this year with the support of the Helen Ellis Memorial Foundation. Through this effort, a mobile skin cancer screening program will focus on sun-safety education and on-site skin cancer examinations for the schools and industry in Pinellas County, as well as other community organizations. This ground-breaking program at FHNP proudly recognizes Sun Toyota, who generously donated a 2012 Toyota Tundra that will travel throughout the county to schools and companies to perform on-site education and skin cancer screening. Eventually this program will expand into other cancer screenings for lung, breast, colon, cervical and prostate cancers. The FHNP Cancer Screening Program continuously promotes health and awareness and actively participates in community activities that encourage consumer wellness for the reason that finding cancer early offers greater hope for a cure. Respectfully submitted, Rosemary Giuliano, ARNP, MSN Director, Oncology Program Florida Hospital North Pinellas Clinical Instructor USF School of Nursing West Coast Medical Group Surgical Institute

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Oncology Research

in producing advances in disease prevention, treatment, and rehabilitation for many diseases, including cancer. In addition, because many adult cancer therapies result in disease control as opposed to cure, it is imperative for the scientific community to engage in clinical research to improve outcomes such as survival, side effect profiles, combination therapies, and quality of life.
These advances in cancer care and the development of more effective cancer therapeutics depend largely on an effective clinical trial process.

Rosemary Giuliano, ARNP, MSN

Research is a well-recognized component of clinical excellence. The recent advances in cancer care are largely attributable to participation in clinical trials. Through the University of South Florida (USF) and the community medical and radiation oncologists, we are able to offer patients at Florida Hospital North Pinellas (FHNP) access to numerous clinical trials. Each patient that participates in clinical research helps future generations of cancer patients. It is our goal to improve the quality of life for patients and reduce cancer-related deaths by advancing cancer therapies through clinical research. An estimated 1.6 million (1,638,910) new cancer cases are expected to be diagnosed in the United States in 2012, with more than 577,000 deaths projected (American Cancer Society [ACS], 2012). However, it is important to note that the five-year survival rate for all cancers has improved significantly from 50% for cancers diagnosed between 1975 and 1977, to 66% for those detected between 1996 and 2004 (ACS). This improvement in survival rate reflects the progress made in the diagnosis of certain cancers at earlier stages as well as improvements in treatment. 
Clinical trials are essential for the identification of new, more effective therapies and have played a significant role

As of October 2009, the National Cancer Institute Physician Data Query (PDQ®), which includes the world’s most comprehensive cancer clinical trials registry, includes abstracts of more than 8,000 clinical trials that are open and active for patient accrual, including trials for cancer treatment, genetics, diagnosis, supportive care, screening, and prevention. The PDQ includes trials sponsored by the National Cancer Institute and also many clinical trials sponsored by pharmaceutical companies, medical centers, and other groups from around the world. 
 Clinical research is the basis for advancement in oncology knowledge and treatment. Scientific rigorousness and integrity are essential for the advancement of this knowledge. Research is a well-recognized component of clinical excellence. The Oncology Program at FHNP is proud of their academic affiliation with the University of South Florida and the community medical and radiation oncology partnerships, as they remain an integral part of the FHNP Oncology Program and the community. Respectfully submitted, Rosemary Giuliano, ARNP, MSN Director, Oncology Program Clinical Research Representative Florida Hospital North Pinellas Clinical Instructor USF School of Nursing West Coast Medical Group - Surgical Institute

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Genetic Counseling and Testing

I am a board-certified medical oncologist with experience in genetic testing and counseling. I trained at the National Cancer Institute in Bethesda, Maryland with the Family Studies Section of the Cancer Epidemiology Program. I than subsequently initiated and directed the cancer genetics screening program at the Lifetime Cancer Screening Center at Moffitt Cancer Center, in Tampa, Florida. There I recruited Rebecca Sutphen, MD, to oversee the genetic counseling and testing program. While practicing in the New Port Richey community, I continue to offer cancer genetics counseling and testing to my patients at Florida Cancer Specialists and Research Institute.

Gail L. Shaw Wright, MD, FACP, FCCP

Florida Hospital North Pinellas (FHNP) offers genetic counseling and testing for a variety of cancers through our community medical oncologists as well as through the University of South Florida (USF). Cancer Genetic Counseling is an important part of FHNP’s commitment to providing world-class oncology services. This program serves individuals who are at increased risk for hereditary cancer. Patients and families with many different types of cancers, including breast, ovarian and colon cancer are seen. Cancer Genetic Counseling is an excellent example of FHNP’s dedication to personalized medicine. Through advanced techniques such as genomics, we are optimizing the health of each patient by calculating their risk of developing a cancer. If patients are identified to be at an increased risk, prophylactic surgery or medical treatment may be indicated to lessen their risk.

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Rebecca Sutphen, MD, FACMG, is a board-certified clinical and molecular geneticist with expertise in hereditary cancer. She is an active researcher and professor in the Epidemiology Center, Department of Pediatrics, Morsani College of Medicine. Dr. Sutphen and her staff at the University of South Florida offer genetic counseling and testing to those patients and their families identified to be at high risk. Sincerely, Gail L. Shaw Wright, MD, FACP, FCCP Medical Oncology Florida Cancer Specialists & Research Institute


Multidisciplinary Cancer Conference

Cancer Conferences (Tumor Board) are a major educational element in the Florida Hospital North Pinellas (FHNP) Oncology Program and are a requirement for accreditation by the American College of Surgeons (ACoS).

The ultimate treatment decisions still rest with the managing physician who synthesizes the various opinions and determines the most appropriate care for their patient. Florida Hospital Tampa designates this program for CME Credit 1 category.

Patient-oriented Cancer Conferences are held monthly for discussion of the most appropriate management of cancer patients. This conference consists of a multi-disciplinary team of physicians and ancillary staff members whose primary goal is to educate and improve cancer care at FHNP. The conference provides prospective case review and ensure patient access to consultative services that include pre-treatment evaluation, staging, and treatment strategies, referrals to research protocols and rehabilitation. Discussions are enhanced by formally adopting NCCN Clinical Practice Guidelines in Oncology to adhere to national standards.

In addition to the cancer conference, the hospital CME/Education department identifies educational needs and plans relevant and current oncology-related offerings that are open to the medical and hospital staff. Sincerely, Jeffrey B. Smith, MD, FCAP Associate Pathologist Quality of Registry Data Coordinator Florida Hospital North Pinellas

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Imaging Department Florida Hospital North Pinellas Imaging: The synthesis of people, technology and medicine. Diagnosis and treatment are the foundation blocks of health care. There are few areas of health care that survive independently of an Imaging intervention. Advancements in the global technology here positively impacted the dynamic range of Imaging – widely considered one of the fastest technologically advanced fields. Florida Hospital North Pinellas Imaging - like most hospitals - has embarked on a journey that aims not only to keep pace, but to be on the cutting-edge of these advancements. We believe with the ability to provide early and accurate representations and results, our community of patients and physicians will greatly benefit. Breast cancer diagnosis and treatment guidelines are established to reduce morbidity and mortality. Most patients realize they should follow early detection guidelines and follow-up with their care providers; however, sometimes there are barriers that prevent individuals from following these care guidelines. Barriers may include but are not limited to, access to care, a lack of understanding or fear of the care process, fear of a positive diagnosis, financial barriers to treatment and a myriad of additional psychosocial, emotional and family concerns if there is a positive diagnosis. Accepted cancer care and treatment guidelines have been set forth by many organizations including NCCN, ACR, ACOS, and CAP. Based upon these and other acknowledged sources, the facility establishes its own guidelines to move a breast patient through the continuum of care. The continuum of care for breast patients may differ facility by facility due to many factors, such as, but not limited to, resources, facility protocol, governance and patient population served. Moving a patient through a breast care/cancer continuum is a complex and highly individualized process. The complexity is significantly reduced with the assistance of an individual or individuals who are trained to navigate a patient through the process of care, often referred to as a Breast Navigator. However, just as the breast care/cancer diagnosis and treatment process may differ from facility to facility, so do the definitions, activities, knowledge and job descriptions of a breast patient navigator. In 2009, our Breast Care Coordinator, Lorraine Van Fossan, became one of the first navigators in the country to obtain certification

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in Breast Patient Navigation through the National Consortium of Breast Centers, Inc. Lorraine is the ultimate advocate for our patients. She is extremely passionate about making sure patients are first and foremost educated about the process and procedures. She is a true partner in the process. Lorraine empowers patients in the decision making about their breast health from the initial contact moments through final diagnosis, treatment and recovery. The Federal Mammography Quality Standards Act of 1993 mandates that all mammography facilities provide results within thirty days. However, at Florida Hospital North Pinellas, we take navigation to a whole new level by striving to notify, and complete, all of the recommended additional imaging studies within a thirty day window (when applicable), giving our patients rapid access to oncology services as necessary. Through this process, opportunity improvement initiatives have yielded a process of capturing unassigned practitioners. This now ensures that results are delivered quickly, and there is no break in the results communication chain. Our EMR coupled with radiologist electronic voice recognition technology, has made issuing reports among the fastest in the industry. On-site capabilities for stereotactic intervention provide a single destination with the comfort, continuity and familiarity of the team and environment. We are pursuing the ACR’s Breast Imaging Center of Excellence, and are confident to have this completed first quarter 2013. Achieving BICOE status puts a gold star not just on a hospital’s mammography program but other modalities as well. In addition, all of our physicians, technologists and radiologists have received enhanced training, ensuring all of our customers that the staff is proficient in the most recent breast imaging developments. We strive to be one of the leaders in breast imaging techniques. In fact, we just purchased the latest FDA approved 2D mammography unit with 3D tomosynthesis. This technology, known as 3D mammography, gives clearer views of breast tissue, possibly allowing physicians to spot cancers more easily. Breast intervention is supported by either ultrasonography or stereotactic placement. Radioactive seed implantation is among our immediate pursuits as an alternative to “wire” localizations. Melanoma, Lymphoma, Lung CA, Breast, Esophageal, and Colorectal are among many of the cancer diagnosis served


by our PET imaging. Traditional Nuclear Medicine imaging is also available. Studies provided such as bone scans, are excellent for metastatic imaging of the breast and prostate for example. We offer lymphoscintigraphy and sentinel lymph node biopsy to evaluate treatment planning and accuracy of biopsies. Breast MRI is available in cases of extremely dense tissue; patients with implants preventing adequate tissue compression; rare instances when silicone has been directly injected into the breast tissue, as well as patients with an overall low threshold for tissue compression. Sestamibi parathyroid syntigraphy for parathyroid adenomas; Adrenocortical carcinoma; Lung (Quantitative) Vent Perfusion; Liver tumors/hemangiomas and Muga scans are some of the various procedures being performed within our nuclear medicine modality. With a 1.5T magnet and special coils such as breast, not only is our MR staffed with advanced registry technologists – we boast the prestigious ACR accreditation. MR procedures include brain for metastatic disease; abdomen/Pelvis for kidney cysts/tumors, cervical/uterine cancers; Necks for throat cancers, and all vertebral spine examinations. Our current 16-slice CT scanner will soon be partnered with a 64-slice unit, accompanied with the very best post-processing reconstruction software available. Similarly to our MR evaluations of spines, abdomen and pelvis, we offer biopsies of numerous organs. Invasively, Radio Frequency Ablations (RFA) of the kidneys and liver are available. Traditional X-ray – the foundation imaging modality – has benefited from recent analog to digital conversion. We are now able to provide chest, abdomen, extremities and the traditional double contrast studies with reduced exposure levels. This digital conversion through Computed Radiography (CR), has permitted our radiologists to view images across a broader contrast and density spectrum with greater magnification scales – not available with analog technology. Lung detail for example is far enhanced to detect even the minutest pathology. Our team of radiologists features two very prominent board-certified imaging physicians, Drs. Niedzwiecki and Claar. Sincerely, Courtney Jack Director, Imaging Florida Hospital North Pinellas

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Pathology Department DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE The Florida Hospital North Pinellas (FHNP) Department of Pathology and Laboratory Medicine is a College of American Pathologists-accredited laboratory. By virtue of key partnerships with Florida Pathology Laboratory (Orlando, FL), Integrated Oncology (Irvine, CA), University of South Florida College of Medicine (Tampa, FL), and Agendia (Irvine, CA) the Department is able to provide comprehensive support for all phases of diagnosis and management of cancer patients. The Pathology Department consists of two experienced, board-certified pathologists plus key support staff, which includes histotechnologists, pathology assistants, and office staff. The main Clinical Laboratory consists of a full complement of medical technologists, medical technicians, laboratory assistants, and certified phlebotomists. The Pathology Department team is responsible for confirming prior outside microscopic diagnoses, assisting the surgeons with intraoperative consultations utilizing cytologic and frozen section diagnoses, and making accurate final microscopic diagnoses, which include pathological grading and staging of all cancers that present here. More than 90% of the cancers are diagnosed here only after intradepartmental review and consensus. The department relies on immunohistochemistry and other molecular diagnostic techniques (ie, EGFR mutation analysis by PCR, ALK FISH, and BRAF gene mutation, etc) to assist in determining the type of cancer cells involved, their prognosis, and selection of tumor-specific therapies. At present, the prevailing weight of the tumor diagnoses made by the Department of Pathology consists of cutaneous neoplasms, breast neoplasms, urologic neoplasms, and thoracic neoplasms. Other integral services provided by the department include bone marrow biopsy interpretation, including flow cytometry with cytogenetic analysis, and fine needle aspiration biopsy interpretation of both palpable and deepseated tumors. The pathologists assist clinicians, surgeons, and interventional radiologists during the specimen procurement phase of cancer care to assure specimen adequacy and quality. The pathologists

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are also currently collaborating in the MINT trial, which is a nationwide clinical trial evaluating the role of gene expression profiles in the treatment of women with advanced breast cancers. They assist breast surgeons by obtaining fresh breast tumor tissue for Mammoprint (gene expression profile). During the diagnostic phase of cancer care, the pathologists collaborate with medical oncologists, radiation therapists, and oncologic surgeons to provide the information needed to optimize and even individualize patient therapy. This latter responsibility is further promoted by active participation in the hospital’s monthly Tumor Board where educational and challenging oncologic cases are presented for consensus regarding treatment. Further, the pathologists are instrumental in advancing public awareness and knowledge of common tumors by participating in local community health fairs. During the management phase of cancer patients, the Clinical Laboratory provides a comprehensive menu of key tests to assess patient status and ensure their safety. Monitoring for toxicity of certain chemotherapies, assessing bone marrow response to therapy, and following tumor markers are some of the frequently used tests in this setting. The FHNP Cancer Program has made great strides in the care it provides to our community, and the Department of Pathology and Laboratory Medicine looks forward to participating in the care of these challenging patients. Respectfully Submitted, Stephen F. Morris MD, FCAP Pathologist Laboratory Medical Director/ Laboratory Services Director Department of Pathology and Laboratory Medicine Florida Hospital North Pinellas


Care Navigation

The ARNP can reduce a patient’s anxiety by listening to concerns and helping prioritize and sort through vast amount of information, as well as by reviewing diagnostic results. This education and psychosocial support is designed to improve a patient’s preparedness for treatment and ongoing care. ARNPs help to realize cost savings and efficiency improvements in the complex world of oncology. By addressing problems patients have at home, ARNPs help reduce emergency department visits and inappropriate hospital admissions. They can ensure efficient and effective care is delivered with vigilant symptom management, prevent test duplication, medication management and coordination of appointments. Debora L. Ryder, ARNP, MSN, BC

Care Navigation: Guiding, Educating and Supporting Oncology Patients Care coordination for cancer patients is receiving new emphasis in hospital-based cancer centers. Within the Surgical Institute at Florida Hospital North Pinellas, a program has been initiated to offer individualized assistance to oncology patients. The advanced registered nurse practitioner’s (ARNP) goal is to embrace the cancer patient by ensuring they receive the care and services they need in a timely manner. Ideally, the ARNP becomes a trusted guide, educator, and support person throughout the patient’s cancer experience, while also providing direct patient care. The ARNP keeps open the lines of communication so the patient, family, and care team are all fully informed. This includes serving as a liaison between the cancer specialists and primary care physicians.

Nationally, care navigation and patient-centric oncology care is an emphasis in the quality standards issued by the Commission on Cancer (CoC) of the American College of Surgeons. FHNP is working towards achieving accreditation by the CoC in 2015. Sincerely, Debora L. Ryder, ARNP, MSN, BC Clinical Navigator Surgical Hospitalist Florida Hospital North Pinellas West Coast Medical Group Surgical Institute

Educating patients about the complexities of cancer and treatment choices is a crucial aspect of the ARNP’s role. By improving patient education, the ARNP assists with informed decision-making, obtaining informed consent for procedures as well as providing quick access to resources important to the patient’s well-being.

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Palliative Care Program

Goals of Palliative Care  are is offered throughout the disease trajectory, beginning at C the time of diagnosis. u  Palliative care is offered by an interdisciplinary team and available in the hospital as well as the community. u  Patients and families are partners in care. They, along with the palliative care team, and other health care providers collaborate and communicate about care needs. u The plan of care is based on the best available evidence. u  Palliative care is strength based and reflective of the patient/ family’s culture, religious, and spiritual beliefs. u  Ethical and legal concerns are addressed through the palliative care team and the hospital’s ethics committee as needed. u  Palliative care is offered concurrently with curative care. The palliative care team may assist in the transition to hospice care when the goals of care change. u  Patient and family desire for dignity and serenity during care, through the dying process and after death is maintained. u

Stacy F. Orloff EdD, LCSW, ACHP-SW

Palliative Care The US Department of Health and Human Services Centers for Medicare and Medicaid defines palliative care as,“…patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.” Palliative care is beneficial for individuals and their families who are experiencing pain or other symptoms related to their cancer treatment. The hospitalized patient or family member may ask their oncologist for a referral to the in-patient palliative care team. Out-patients may access support groups offered on the hospital campus as well as different locations throughout the community. Florida Hospital North Pinellas is a strong proponent of palliative care. The hospital is working in partnership with Suncoast Hospice to ensure that all cancer patients and their families have access to palliative care while in the hospital, being treated in the clinic, or living their lives at home (Pinellas County). Palliative care is provided through an interdisciplinary team, including physicians, chaplains, and social workers.

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Stacy F. Orloff EdD, LCSW, ACHP-SW Psychosocial Services Coordinator Vice President-Palliative Care, Suncoast Hospice National Quality Forum. A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report; December 2006. Available at: www.qualityforum. org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=22041. Accessed September 6, 2012 Federal Register. Medicare and Medicaid Programs: Hospice conditions of participation; final rule. June 5, 2008; (73)109:32204.


Patient Experience Specialist

As our key advocate for patient experience, I serve as a link between patient care and our Florida Hospital North Pinellas leadership team. I research all opportunities that may arise for improvement in patient experience, and oversee the changes needed to answer these opportunities. For myself and the entire Florida Hospital North Pinellas family, our goal is to continue to exceed expectations in patient care, while extending the healing ministry of Christ to our patients and their loved ones - just as we would for our own families. Sincerely,

Danielle Rucker

As our Florida Hospital North Pinellas Patient Experience Coordinator, I fill a unique role as a dedicated advocate for the experience of all patients and their families while in our care. I work closely with patients as a care liaison and help to ensure that all ethical, operational and care standards are upheld, and all needs and concerns are addressed.

Danielle Rucker Patient Experience Coordinator Florida Hospital North Pinellas

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Case Management

Learning about the cancer diagnosis of a family member, friend or oneself can be devastating in many ways; emotionally, spiritually and physically. That is why Florida Hospital North Pinellas (FNHP) offers a wide variety of support services to help patients and their families get through this traumatic journey in their lives. The philosophy at FHNP has been to help families through extending the healing ministry of Christ, which includes the Christian Mission, Quality and Service Excellence, Compassion, Community Wellness, High Ethical Standards and Cultural Diversity. We address the patient’s immediate physical needs, as well as provide individual support services. Our on-site Registered Nurse Case Managers meet newly diagnosed patients and assesses initial and potential needs. This contact and ongoing counseling with the patient and family continues through the duration of treatment. Other help may include providing or solving transportation issues, home health, out-patient services, and helping patients obtain medications through the financial assistance programs sponsored by pharmaceutical companies. We also maintain information on local resource organizations and make referrals as needed. FHNP collaborates with the American Cancer Society, Hospice, and other community resources as well. Sincerely, Deborah Casler-Nieves, RN Director of Case Management Florida Hospital North Pinellas

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Supportive Services: Continuum of Care

Lymphedema Rehabilitation Implemented July, 2012 u

 ymphedema is the swelling of the extremity as a result of L lymph node removal or radiation therapy. Amy Brenner, PT, received specialized training in lymphedema rehabilitation. The department ordered supplies, made contacts with vendors, and is now accepting patients for lymphedema rehabilitation. Amy presented a seminar here at Florida Hospital North Pinellas to the general public on lymphedema and its treatment. So far, two patients have been through the program

Pulmonary Rehabilitation Implemented July, 2012 u

 he population is mostly composed of post-operative patients T after lung surgery. Linda Wonderly, RN, and Margaret Luedke, RT, received training at our sister campus in Tampa and run the program, which is housed in the outpatient rehabilitation clinic at Florida Hospital North Pinellas. Linda brings more than 30 years of experience running Cardiac Rehabilitation programs and has run the Cardiac program here at Florida Hospital North Pinellas for more than 10 years. The program was able to utilize most of the equipment already in place, and physical therapists are on hand to address any concerns regarding the functional mobility of patients. Amir Noorani, MD, is the medical director of the program, and currently about nine patients are on caseload

Clinical Nutrition u

 atients with compromised appetites or poor nutritional status P are referred to Nutrition Services. We assess a patient’s nutrition status to provide optimal nutrition for the promotion of healing and to assist patients with food preference/ tolerance before, during and after cancer treatment. In addition, we participate in community events to promote health food habits for proper nutrition. Our staff members are affiliates of the Academy of Nutrition and Dietetics and the practice group Dietitians in Nutrition Support.

Bobbi Sheffield Rd, L/D Clinical Nutrition Manager Florida Hospital North Pinellas

Physical Therapy Occupational Therapy Language Pathology Enterostomal Therapy and Education Advanced Directives Patient Experience Specialist Ryan Grella, PT, DPT, OCS Director of Rehabilitation Florida Hospital North Pinellas

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Florida Hospital NOrth Pinellas and the American Cancer Society Partnership

Rosemary Giuliano, ARNP Director, Oncology Program

Florida Hospital American Cancer Society Pinellas Unit Community Partnership

November 1, 2012 The American Cancer Society is the nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service. In partnership with Florida Hospital North Pinellas, the Pinellas Unit of the American Cancer Society will work closely to ensure more lives are being saved from cancer and more patients being served at your hospital are being positively impacted through education and service. The Pinellas Unit will commit to the following:  atient Service Manager working with and through Patient Navigator to identify and P refer newly diagnosed patients to the American Cancer Society patient services u Representation at Commission on Cancer meetings u Education of staff on resources available for newly diagnosed patients - 24/7 support through 1.800.227.2345 or cancer.org - Road to Recovery - Dietitian on Call - Look Good Feel Better u

The FHNP staff may also refer patients to the R.O.C.K. programs available to children fighting cancer. Reaching Out To Cancer Kids provides children with summer camp, families with ROCK family weekend (helping families cope through classes and support groups for parents and siblings) and college scholarships. In addition, we encourage your staff to utilize the American Cancer Society funding resources available to them for research and continued educational grants. We are appreciative of Florida Hospital North Pinellas taking a precedent-setting role to sponsor and lead the Tarpon Springs Relay For Life event scheduled to take place May 17-18, 2013. With your leadership, this event will position Florida Hospital North Pinellas and The American Cancer Society as liaisons to the community for increased health awareness. Wendy M. Johnson Patty Riddle Area Executive Director Associate Director

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Cancer Registry

The Cancer Registry is responsible for the collection, assimilation and analysis of cancer data. Data is collected according to the current standards of the Commission on Cancer to create a detailed cancer-focused record for all reportable tumors diagnosed and/or treated at Florida Hospital North Pinellas (FHNP). Each record entered into the database contains information on the diagnosis, extent of disease, treatment received, recurrence of disease and lifetime follow-up for each patient. Follow-up services as a reminder to the physicians and patients to schedule regular physical examinations, thus assuring continued medical supervision of patients who have had a diagnosis of cancer. Aggregate data is analyzed and published without patient’s identifiers to protect the confidentiality of each patient entered into the cancer database according to Florida state laws and HIPPA regulations. Florida Hospital North Pinellas (FHNP) utilizes a multidisciplinary team approach to educate, diagnose, and treat their cancer patients. The team encompasses the expertise of surgery, pathology, radiology, medical and radiation oncology, imaging, nursing, occupational therapy, outpatient services, administration, cancer registry staff, and palliative care. The multidisciplinary members meet the first Monday, monthly from 5:00 - 7:00 pm, to discuss case management, diagnostic testing, pathology, and assist in formulating treatment plans for the cancer patients, and compare these options to NCCN guidelines. Clinical and pathological staging are also discussed by using pathology and all imaging studies done, whether in the hospital or as an out-patient. Ninety-six percent of the cases presented from January 2012-August 2012 were prospective cases. These conferences are CME approved. The Cancer Registry staff participated in on-going cancer related education by attending the Florida Cancer Data System (FCDS) and Florida Tumor Registrar’s Association (FCRA) Annual meetings, July 2012. The Cancer Registry consists of two-Certified Tumor Registrars (CTR), one Cancer Conference Coordinator and one Follow-Up Coordinator. The Cancer Registry staff would like to thank the members of the FHNP Cancer Committee, Medical Staff, Administration and Volunteers for your continuing support and dedication. Together we can achieve our goal to receive full accreditation with multiple commendations by the Commission on Cancer in 2015. Maria Delgado, CTR Quality Improvement/Cancer Registry Manager Florida Hospital Tampa/North Pinellas

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Data summary 2011

GENDER

GENDER DISTRIBUTION

Of the total cases, 54 (46%) were males and 62 (54%) were females in 2011.

Male

46%

Femaile

54%

COUNTY OF RESIDENCE AT DIAGNOSIS Analysis of county of residence at diagnosis reveals that the majority of the total patients’ county of residence at diagnosis in 2011 was Pinellas County. The breakdown is shown:

county of residence Hernando

4%

Other Florida Counties

8%

Out of State

8%

Pasco

32%

Pinellas

68%

RACE Race distribution of the total cases in 2011 reveals that 111 of the patients were Caucasian, 2 patients African American and 3 patients Other (Asian, Oriental, Other). A breakdown is shown:

race distribution Caucasian African American Other

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95%

3%

2%


male

TOP SITES BY GENDER The top sites of total cancer cases seen at Florida Hospital North Pinellas (FHNP) 2011 are displayed below. The top five sites for both analytic and total are lung, breast, skin (excluding basal and squamous cell carcinoma), colorectal and bladder respectively in 2011. A majority of the cancer cases were from the primary site of lung. It is one of the most common cancers and accounts for approximately 25% of the total cancer cases seen at this facility.

33% 23% 13% 9%

8% Bladder

Colorectal

11%

3% Lung

Brain/CNS

Prostate

Melanoma/Skin

Other

female

27% 22%

20% 13%

11% 5% Bladder

2% Colorectal

Lung

Brain/CNS

Breast

Melanoma/Skin

Other

Total Cancer Cases

29 20 12

10

6 Bladder

Colorectal

13

Lung

Brain/CNS

Breast

Melanoma/Skin

14

Other

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Definition of Terms

AJCC Staging

Primary Site

American Joint Committee on Cancer’ TNM Staging & Classification system is a method for measuring the extent of disease at the time of diagnosis. Clinical and Pathological staging both are used as appropriate, based on type of cancer.

The anatomical location considered the point of origin for the malignancy.

Analytic A category or class of case which indicates that the cancer was initially diagnosed and/or treated at a specific health care facility and is eligible for inclusion in that registry’s statistical reports of treatment efficacy and survival. National Cancer Data Base (NCDB) A clinically oriented electronic database of cancer cases submitted to the Commission on Cancer by approved cancer programs of American College of Surgeons in the United States, which can be used as a reference database to compare the management of cancer patients in one facility or region with similar patients in other regions or nationally. Non-Analytic A patient who was diagnosed and received all of the first-course therapy at another institution, a patient who was diagnosed and/ or received all or part of the first-course therapy at Florida Hospital North Pinellas before the registry’s reference date, or a patient who was diagnosed by autopsy.

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Treatment Modality The treatment regimen planned for the patient. Single modality consists of one type of treatment; multi-modality consists of a combination of two or more types of treatment. References  ancer Facts & Figures 2012 – Published by the American C Cancer Society u  National Cancer Database, Commission on Cancer, American College of Surgeons, National Benchmark Summary Reports u  Manual for Staging of Cancer, 7th Edition u  Florida Hospital North Pinellas – Oncology Data Services Database u


Helen Ellis Memorial Foundation HELEN ELLIS MEMORIAL FOUNDATION – Touching Lives Through Philanthropic Support The Helen Ellis Memorial Foundation and the West Coast Medical Group Surgical Institute have formed an alliance to provide education and support services to our community. The surgical team provides the day-to-day diagnosis, treatment and emotional support for the patients, while the Foundation works to secure promotion of the team and develop resources for screening and educational programs. In this past year, the Foundation:  rovided the surgical team opportunities to speak to P various community groups, educating on early detection, diagnosis and treatment of various cancers. u  Established an Oncology Internship program to provide stipend assistance to students. u  Underwrote the “Victorian Tea” event where all of the surgical team participated on a panel, providing valuable education to more than 68 community members. u  Worked with the surgical team to develop and underwrite “Operation Sunshine,” a new mobile program to provide melanoma and other skin cancer education and screenings in our community. u

Terry B. Smither Executive Director Helen Ellis Memorial Foundation in support of Florida Hospital North Pinellas

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Looking Forward

Expand the scope of patient education and navigation

s Initiate a lung cancer screening program

s Attain the American College of Surgeons’ Commission on Cancer accreditation

s Develop an Oncology Resource Room for patients and staff

s Become an accredited Breast Center of Excellence

s Form a multi-campus Telemedicine Oncology Conference Series 52


Comprehensive Cancer Care


Comprehensive Cancer Care

1395 South Pinellas Avenue I Tarpon Springs, FL 34689 (727) 942-5000 I FHNorthPinellas.com


Florida Hospital North Pinellas 2012 Cancer Annual Report