A report to the community
Commission on Cancer Approved with Commendation King’s Daughters cancer program has been continuously accredited by the American College of Surgeons Commission on Cancer since 1994. Our program is designated a comprehensive community cancer program by the commission and received its most recent approval, with commendation, in 2009. Commission approval requires successful completion of a rigorous, on-site evaluation process and performance review. Only 25 percent of hospitals in the U.S. have earned such approval. The approval with commendation represents additional levels of compliance with these rigorous standards. Commendation level was awarded in seven of nine key areas, including leadership; quality improvement; clinical services; cancer data management; and community outreach. For more information about any aspect of our program, email us at email@example.com.
Access to cutting-edge treatment and research
King’s Daughters has been participating in cancer research for more than 20 years. We participate in an array of research trials, which allows us to offer patients cuttingedge treatment options right here in their own communities.
Local, State and National Cancer Cases by Type, 2010 KDMC
KDMC and Kentucky State Registry 2010 U.S. statistics are from American Cancer Society Facts & Figures 2010
The field of cancer research is everexpanding, and King’s Daughters works alongside some of the top names in cancer research to advance knowledge and treatment for all patients with cancer. Our Oncology Clinical Research focuses on and takes pride in being able to offer both treatment and prevention options to patients through research trials. Our collaboration with other institutions, such as the University of Kentucky Medical Center and the Kentucky Clinical Trials Network; and sponsors, including the National Surgical Adjuvant Breast and Bowel Project, Southwest Oncology Group, and the National Cancer Institute’s Clinical Trials Support Unit, brings the most recent advances in cancer treatment to you, close to home.
2 | KING’S DAUGHTERS MEDICAL CENTER
Clockwise from front: Shamsa Haroon, M.D., pathologist; Jeffrey Lopez, M.D., radiation oncologist; Khalid Shalaby, M.D., general/surgical oncologist; and Vinay Vermani, M.D., oncologist/hematologist
Jackson 6 cases 0.7%
A Collaborative Approach
Scioto 54 cases 5.9%
Perhaps more than any other medical discipline, the treatment of cancer requires the expertise of many. Medical oncologists, radiation oncologists, surgeons, family physicians, many specialized physicians, nurses, physical therapists, researchers, dietitians, social workers, pastoral care … the team may incorporate some, or all, of these professionals, working together to provide the most effective, evidence-based treatment for patients with cancer.
12 cases 1.3%
130 cases 14.2%
Greenup 115 cases 12.5%
262 cases 28.5%
94 cases 10.2%
Rowan 3 cases 0.3%
Wayne Elliott 11 cases 1.2%
22 cases 2.4%
Lawrence 56 cases 6.1%
For many types of cancer, surgery is the first-line 0.3% treatment of choice, either alone or in combination with other therapies. Our surgical oncology program Magoffin 13 cases offers advanced treatment options for many cancers, 1.4% including those that affect the lungs, chest wall, skin, breast, and digestive systems. Our surgical team is made up of board-certified surgeons, an experienced operating room staff, clinical pathologists and more.
Johnson 42 cases 4.6%
Martin 28 cases 3.1%
27 cases 2.9%
11 cases 1.2%
Oncology Specialty Unit
The Oncology Specialty Unit at King’s Daughters offers personalized and highly skilled nursing care for patients who require hospitalization. The 25-bed unit provides private rooms and a family kitchen. Consistently rated by our customers as providing very good care, the Oncology Specialty Unit strives to give meaningful and specialized care to all cancer patients and families.
King’s Daughters Outpatient Infusion Center offers convenience to patients needing IV therapy. The center is open 12 hours daily, seven days a week. Highly skilled nurses provide treatment for patients. A social worker helps with obtaining social and financial assistance. The infusion team can be reached by calling (606) 408-7076.
New this year is a cardiology program designed to follow up on patients who have received specific types of chemotherapy and/ or radiation. The cardiology team reviews personal treatment plans and evaluates further recommendations to safely assist patients through recovery and survivorship. The Cardio-Oncology Clinic can be reached by calling the Center for Heart Health at (606) 408-6000.
KDMC Cancer Cases by County at Diagnosis, 2010 Counties not shown on map: Cabell County, W.Va. - 3 cases; Gallia, Ohio - 3 cases; Mingo County, W.Va. - 3 cases; Mason, Ky. - 2 cases; Mason, W.Va. - 2 cases; Logan, W.Va. - 2 cases. Other counties, one case each; Menifee, Wolfe, Fleming, Harrison, Knott in Ky.; Elkhart, Ind.; Adams, Meigs, Pike, in Ohio; Hawkins, Tenn.; and Kanawha and Putnam, W.Va.; 3 cases out of region.
Total Cases - 918
CANCER: A REPORT TO THE COMMUNITY 2011 | 3
Physician General Surgeon Mary Legenza, M.D.
The cancer liaison physician’s role is to enhance communication between the Commission on Cancer and the physician champions serving in commission-accredited cancer programs. The liaison is in a leader role within the cancer program and is responsible for evaluating, interpreting and reporting the program’s performance using the National Cancer Data Base to the cancer committee. This helps improve the quality of care; to enhance cancer prevention initiatives; and improve access to care. Other responsibilities include reporting on commission activities, initiatives and priorities to the program’s cancer committee; serving as a liaison to the American Cancer Society; and participating in the commission accreditation survey. The liaison physician plays a vital role in providing the leadership and direction to monitor, maintain, and improve quality in your cancer program. I have served in this voluntary role at KDMC since 1995. This past year, I was named the state chair for Kentucky Commission on Cancer. This is a threeyear appointment elected by the Kentucky Council of the American College of Surgeons. In this role, I represent Kentucky at national meetings of the commission. As state chair, I communicate regularly with cancer liaison physicians throughout the state.
In cancer care, dietitians play a role at every stage. Dietitians are involved with primary prevention, cancer treatment, secondary prevention, and palliative/end-of-life care. Often a dietitian assists patients toward a speedier recovery. Dietitians can consult patients in the hospital or on an outpatient basis. For additional information, please call our dietitians Amy McFann at (606) 408-5021 or Heather Jenkins at (606) 408-6795.
KDMC’s Distress Management program was created this year to assist patients who may be experiencing a wide range of feelings and emotions. Patients are screened for distress and re-evaluated with any change in condition or treatment plan. Referrals can be made at any time by a healthcare provider or by contacting the Center for Healthy Living at (606) 408-5193.
Hereditary Cancer Program
Approximately 5 to 10 percent of cancers can be linked to heredity. Some individuals may be referred to explore their personal risk for cancer. The program is affiliated with the University of Louisville and Joseph Hersh, M.D., Chief of Genetics. For additional information, please call (606) 408-6213.
King’s Daughters palliative care team works to improve the quality of life for patients and families. The palliative care team offers an individualized approach and can be reached by calling Crystal Vance at (606) 408-3836 or email to firstname.lastname@example.org. Palliative care team from left: Courtney Bowman, social worker; Johnny Riley, director of Pastoral Care; and Crystal Vance, palliative care coordinator
State chairs are the connections between the national commission and local cancer liaison physicians. We help hospitals use accreditation standards to improve quality of cancer care; encourage hospitals without accreditation to become accredited; and provide education through the media and conferences.
4 | KING’S DAUGHTERS MEDICAL CENTER
Tobacco Cessation Program
KDMC offers a successful tobacco cessation program that has helped hundreds throughout our community break their addictions to tobacco. Participants meet one hour each week for 24 weeks. The classes are free; participants are responsible for purchasing tobacco cessation products. For more information contact (606) 408-6400.
Cancer Registry King’s Daughters Cancer Registry identifies patients diagnosed and treated for cancer at the medical center. Cancer registrars collect a complete history of patient activity from diagnosis through treatment, with lifetime followup, while maintaining patient confidentiality. Registry data are collected and submitted annually to the Kentucky Cancer Registry and the National Cancer Data Base. This provides incidence reporting and assists in developing cancer control efforts. KDMC’s cancer registry currently maintains information on 12,940 patients. King’s Daughters Cancer Registry is staffed by three certified tumor registrars.
AREAS OF SUPPORT In times of crisis, it’s good to have someone to turn to who has traveled the same road. King’s Daughters support groups for patients (and families) dealing with a cancer diagnosis can help. For more information on our support groups, email us at email@example.com.
LOOK GOOD, FEEL BETTER Co-sponsored with the American Cancer Society, this monthly support group provides tips and techniques for those undergoing cancer treatment to help them overcome appearance-related side effects of cancer treatment. This program is offered monthly. For more information, contact Doretha Pridemore at (606) 408-7067.
REACH TO RECOVERY Co-sponsored with the American Cancer Society, this active group of breast cancer survivors provides personal and informative support individually to patients as needed. This program is offered monthly.
ROAD TO RECOVERY Co-sponsored with the American Cancer Society, trained volunteers drive patients to and from physician appointments and therapies. This service is available in several surrounding counties.
Patient Navigators Eva Joseph, R.N., MSN, OCN, our digestive health navigator, assists newly diagnosed patients with cancers of the esophagus, stomach, colon and rectum. Contact her at (606) 408-3741 or firstname.lastname@example.org. Debbie Alexander, R.N., our breast health navigator, assists newly diagnosed patients with cancer of the breast. Contact her by calling (606) 408-4067 or emailing email@example.com. Mary Adams, R.N., MSN, our lung health navigator, assists newly diagnosed patients with lung cancer. To contact her, call (606) 408-6110 or email firstname.lastname@example.org.
CANCER: A REPORT TO THE COMMUNITY 2011 | 5
BREAST CARE CENTER
We take Breast Cancer seriously Accreditation
Breast cancer continues to be an important health issue for women throughout our region. At King’s Daughters, we recognize the impact of a breast cancer diagnosis on women and their families, and do everything we can to promote prevention, early detection, rapid diagnosis, treatment and positive outcomes. In recognition of our efforts, King’s Daughters was awarded accreditation from the National Accreditation Program for Breast Centers, a program of the American College of Surgeons Cancer Program. KDMC was the first in our region to achieve this designation. The NAPBC is a consortium of national, professional organizations dedicated to improving the quality of care and monitoring outcomes of the breast diseases. In earning the accreditation, King’s Daughters met all 44 program standards and components identified by the NAPBC, while ensuring the most efficient and contemporary care available for patients with diseases of the breast. Radiologist Robert Penkava, M.D., and surgeon Mary Legenza, M.D., are co-medical directors of King’s Daughters Breast Care Center.
Women’s Boutique Women facing a cancer diagnosis have special concerns. Will my hair fall out? Where can I find a wig that looks natural? Will my insurance cover it? Where can I find breast forms and mastectomy bras? Is there someone qualified to help fit me? In August 2011, King’s Daughters launched its Women’s Boutique, a specialty shop located inside the Breast Care Center at KDMC’s Center for Advanced Imaging. The boutique offers special swimwear, bras, breast forms, turbans and scarves, as well as other merchandise, such as jewelry, candles and cancer awareness items. Dianna Maynard, a certified mastectomy fitter with 20 years of experience, staffs the boutique. For more information or to arrange a fit appointment, please call (606) 408-2019.
6 | KING’S DAUGHTERS MEDICAL CENTER
Clockwise from front: Cristina Alencar, M.D., oncologist/hematologist; Mary Legenza, M.D., general surgeon; Robert Penkava, M.D., radiologist; Katalin Kovacs, M.D., pathologist; and David Goebel, M.D., oncologist/hematologist
KOMEN FOR THE CURE
Survivors, walkers show strength If breast cancer could be defeated by sheer strength of numbers, the battle would have ended Saturday, Oct. 1, 2011. Nearly 600 people joined forces to participate in the Susan G. Komen for the Cure Lexington I Am the Cure Walk in Ashland’s Central Park. The event was a huge success – exceeding the $80,000 fundraising goal. In all, 564 walkers representing 51 teams registered. Komen for the Cure focuses on helping uninsured and underinsured women get the treatment, screening and education they need to battle breast cancer. Seventy-five percent of the funds raised stay in eastern and central Kentucky and will be used to fund these services. The remaining 25 percent helps fund national research on breast cancer.
Breast Care Center supervisor and breast cancer survivor
What is a breast navigator?
develop this side effect, but some will. The risk of lymphedema is higher for women who have surgery and radiation therapy to treat breast cancer.
Our breast health navigator coordinates care throughout treatment. She can assess the physical, psychological and social needs of the patient. The results are enhanced patient outcomes, increased satisfaction, and reduced cost of care. This may involve different individuals at each point of care.
King’s Daughters provides lymphedema care through two certified lymphedema specialists. Contact our breast health navigator for assistance or email us at email@example.com.
The breast health navigator guides patients with breast abnormalities through additional testing and physician appointments.
Debbie Alexander serves as King’s Daughters breast health navigator. She can be reached by calling (606) 408-4067 or emailing debbie. firstname.lastname@example.org.
Women who have been treated for breast cancer may be at risk for arm, breast, and chest swelling called lymphedema (limf-uh-dee-muh). Most women who have had breast cancer will not
Breast Cancer Support Group Women battling breast cancer have unique questions and concerns. This support group provides a community of women who have faced – or are facing – some of these concerns. By sharing together, each member is strengthened. The group meets quarterly. For more information, contact Doretha Pridemore at (606) 408-7067.
CANCER: A REPORT TO THE COMMUNITY 2011 | 7
FIVE-YEAR CASE STUDY
Prostate Cancer Treatment Prostate cancer is the second leading cause of cancer deaths among American men. The American Cancer Society estimated more than 240,000 new cases of prostate cancer would be diagnosed in 2011, and 33,000 men would die of the disease. Approximately one in six American men will be diagnosed with prostate cancer in his lifetime.
Radiation Oncologist Jeffrey Lopez, M.D.
The goal of KDMC’s Cancer Committee aligns with those of the American Cancer Society: By 2015, we want at least 90 percent of men in our service area to follow age-appropriate detection guidelines for prostate cancer.
It is not completely understood what causes prostate cancer, but researchers have found several factors that may impact risk:
• Age: This is the single strongest risk factor for prostate cancer. The disease is very rare before the age of 40, but the risk rises rapidly after age 50. Two-thirds of cases are found in men age 65 and older. • Race/ethnicity: Prostate cancer occurs more often in African-American men than others. Prostate cancer occurs less often in AsianAmerican and Hispanic/Latino men. • Family History: Prostate cancer can run in families, which suggests that there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease.
• Diet: The exact role of diet is not clear. Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. Some studies suggest that diets high in lycopene (e.g., tomatoes, especially those cooked in oil) may reduce the risk. • Exercise: Some studies have found higher levels of physical activity, particularly in older men, may lower the risk of advanced prostate cancer. • Smoking: A recent study linked smoking to a small increase in the risk of death from prostate cancer.
Signs & Symptoms
Early prostate cancer usually causes no symptoms. It is most often found by a PSA (Prostate-Specific Antigen) test and/or manual exam. Some advanced prostate cancers can slow or weaken the urinary stream or increase frequency of urination. In some cases, kidney blockage can occur. Patients with advanced prostate cancer may have blood in the urine.
8 | KING’S DAUGHTERS MEDICAL CENTER
King’s Daughters Medical Specialties Urology physicians, clockwise from front: William Boykin, M.D.; Timothy Dixon, M.D.; Charles Thorndyke, M.D.; and James Krick, D.O.
Mortality rates for prostate cancer have been declining, and according to some experts, this may suggest early detection using the PSA test or manual exams may be beneficial. However, the results of three large clinical trials designed to determine the efficacy of PSA testing were not in agreement. Two European studies found a lower risk of death from prostate cancer among men receiving PSA screening while a U.S. study did not. Further analysis of these studies is under way. Most experts agree the current evidence is insufficient to recommend for or against routine testing for early prostate cancer detection. In 2010, the American Cancer Society guidelines for the first time provided detailed recommendations to clinicians on core factors related to prostate cancer screening and treatment. The guidelines recommend information should be shared with men and that asymptomatic men who have at least a 10-year life expectancy, and have an opportunity to make an informed decision, should consider having prostate screening. Men at average risk should receive this information beginning at age 50. Men at higher risk should receive this information at age 40 to 45, depending on individual risk profiles.
Urologist William Boykin, M.D. and the da Vinci® system
Unless otherwise noted, data represent KDMC Registry 2010; Kentucky State Registry 2009; and U.S. statistics are from American Cancer Society Facts & Figures 2008.
Prostate Cancer by Age Distribution
The Five-Year 91% KDMC 86% Experience
Each year, the Cancer Committee of 95% 92%an in-depth King’s Daughters provides analysis of a specific89% type of cancer. This year, we are looking at the question: 96% “How 93% does prostate cancer treatment at King’s 92% Daughters compare to that of Kentucky and the U.S.?” 96%
Age at Diagnosis
Approximately 40 percent of men 97% 97% diagnosed with prostate cancer at 97% King’s Daughters were age 60 to 69. Twenty-five percent were 80 85 diagnosed 90 in their 95 70s. 100
KDMC - 101 KY - 2,607 US - 134,723
7% 6% 26% 25% 25%
1% 1% 1%
40% 42% 41%
60-70 21% 22% 24%
50-60 3% 3% 4%
Percent Alive CANCER: A REPORT TO THE COMMUNITY 2011 | 9
Stage at Diagnosis
King’s Daughters physicians are vigilant about promoting and encouraging prostate screening, and our community outreach efforts, which provide free screenings each September, also play an important role.
Treatment – First Course Therapy
The treatment of prostate cancer depends upon the stage at diagnosis, the aggressiveness of the cancer, and the preferences of the patient. Treatment for prostate cancer may include surgery, radiation therapy, chemotherapy, hormone therapy, or a combination of these. At King’s Daughters, 30 percent of patients received surgery as the first course of treatment; 18 percent underwent radiation therapy as the first course of treatment; 14 percent received a combination of radiation and hormone therapy.
1% 4% 6%
8% 6% 5%
2% 8% 8%
89% 82% 79%
100% King’s Daughters survival rates exceed those of Kentucky and the U.S. This is 80% attributed to a higher rate of early diagnosis 60% at KDMC. The five-year survival rate at 40% KDMC was 94 percent; for Kentucky residents, the five-year survival was 91 20% percent. Nationally, the five-year survival rate was 86 percent. 0 I II III IV Unknown
KY - 2,596
US - 134,774
1% 4% 6%
8% 6% 5%
2% 8% 8%
First Course of Therapy Treatments
Radiation & Hormone
Surgery & Other
Chemotherapy & Radiation
Five-Year Prostate Survival 94%
KDMC - 232 KY - 13,278
US - 477,362
93% 92% 96% 95% 95%
97% 97% 97%
Stages 10 | KING’S DAUGHTERS MEDICAL CENTER
Percent Alive KDMC and Kentucky State Registry 2001-2005 U.S. statistics are from the American College of Surgeons NCBD 1998-2002
KDMC - 101 89% 82% 79%
Percent of Patients
In reviewing stages of prostate cancer, the earlier the diagnosis, the greater the chance for improved outcomes. King’s Daughters is above average in the early diagnosis of prostate cancer. Approximately 80 percent of patients at KDMC were diagnosed at Stage II.
Prostate Cancer Stage at Diagnosis
The stage of the cancer at diagnosis is important to treatment planning. King’s Daughters follows the National Comprehensive Cancer Network Guidelines (NCCN) in treatment planning. NCCN guidelines are considered the “gold standard” for treatment of patients with cancer.
PHYSICIANS ONCOLOGY/HEMATOLOGY Tri-State Cancer and Blood Specialists Cristina Alencar, M.D. Vinay Vermani, M.D. 2301 Lexington Ave. | Suite 135 Ashland, Ky. | (606) 324-3333 Tri-State Hematology/ Oncology Mary Edgecomb, D.O. David Goebel, M.D. Medical Plaza A 617 23rd St. | Suite 19 Ashland, Ky. | (606) 325-2221
RADIATION ONCOLOGY Tri-State Regional Cancer Center Terry Justice, M.D. Jeffrey Lopez, M.D. 706 23rd St. | Ashland, Ky. (606) 329-0060
Cardiothoracic Surgeons of Kentucky Eric Bronstein, M.D. Robert Fried, M.D. J.C. MacHannaford, M.D. Medical Plaza B 613 23rd St. | Suite 210 Ashland, Ky. | (606) 326-9847
Ashland Gastroenterology Rajkumar Warrier, M.D. 300 St. Christopher Drive Suite 200 | Ashland, Ky. (606) 836-9644
King’s Daughters Medical Specialties - Surgery Suite Mariano Faresi, M.D. (colorectal) Mary Legenza, M.D. Khalid Shalaby, M.D. Medical Plaza A 617 23rd St. | Suite 13 Ashland, Ky. | (606) 325-1151 Eric Smith, D.O. Roderick Tompkins, M.D. Timothy Wheeler, M.D. Medical Plaza B 613 23rd St. | Suite 440 Ashland, Ky. | (606) 329-2888
King’s Daughters Medical Specialties Neurosurgical Specialists Clark Bernard, M.D. Ondrej Choutka, M.D. Medical Plaza B 613 23rd St. | Suite G20 Ashland, Ky. | (606) 329-1770 Tri-State Christian Neurosurgical Associates James S. Powell, M.D. Medical Plaza A | Suite 15 617 23rd St. | Ashland, Ky. (606) 324-7737
Ear, Nose & Throat Associates of Ashland Jon Brinkman, D.O. William Van Beneden, D.O. 2550 Carter Ave. | Ashland, Ky. (606) 325-3588
King’s Daughters Medical Specialties Gastroenterology Morris Beebe, M.D. Arthur Gaing, M.D. 1200 Central Ave. | Suite 3 Ashland, Ky. | (606) 327-1760
King’s Daughters Medical Specialties - Otolaryngology Gregory Baker, M.D. Medical Plaza B 613 23rd St. | Suite 420 Ashland, Ky. | (606) 324-2600
Tri-State Digestive Disease Associates Cheryl Bascom, M.D. Michael Canty, M.D. Medical Plaza A 617 23rd St. | Suite 11 Ashland, Ky. | (606) 324-3188
Professional Pathology Hayma Al-Ghawi, M.D. Linda Eskew, M.D. Shamsa Haroon, M.D. Malisha Johnson, D.O. Katalin Kovacs, M.D. Diane Marie Pierson, D.O. 2201 Lexington Ave. | Ashland, Ky. (606) 408-4022
Digestive Health & Nutrition Center of Ashland Alla Grigorian, M.D. Houssam E. Mardini, M.D. Medical Plaza B 617 23rd St. | Suite 120 Ashland, Ky. | (606) 329-1049
PLASTIC & RECONSTRUCTIVE SURGERY
King’s Daughters Medical Specialties - Plastic & Reconstructive Surgery W. Bryan Rogers III, M.D. Medical Plaza B | 613 23rd St. Suite 420 | Ashland, Ky. | (606) 324-2600 Kassan Aesthetic & Anti-Aging Centre Martin A. Kassan, M.D. 945 29th St. | Ashland, Ky. (606) 326-9888 Bellefonte Cosmetic and Reconstructive Surgery Phillip Lackey, M.D. 2001 Winchester Ave. | Ashland, Ky. (606) 325-0753
Ashland Medical Group Mohamad Abul-Khoudoud, M.D. Diego Maldonado, M.D. Mahmoud Moammar, M.D. 1061 Kenwood Drive Russell, Ky. | (606) 833-5864 King’s Daughters Medical Specialties - Pulmonary & Critical Care Scott Nelson, M.D. Gregory Stark, M.D. Bjorn Thorarinsson, M.D Medical Plaza B 613 23rd St. | Suite G30 Ashland, Ky. | (606) 329-1185
Tri-State Radiology Mayola Boykin, M.D. Erik Fraley, M.D. Candy Howard, M.D., PhD Wes Lewis, M.D. Mukesh Kumar Madupur, M.D. Ash Motimaya, M.D. Pho Nguyen, M.D. Robert Penkava, M.D. Stella Powell, M.D. Alvin Schwarz, M.D. Amina Tariq, M.D. Charl Van Wyk, M.D. 2201 Lexington Ave. | Ashland, Ky. (606) 408-4627
King’s Daughters Medical Specialties - Urology William Boykin, M.D. Timothy Dixon, M.D. James Krick, D.O. Charles Thorndyke, M.D. 336 29th St. | Suite 101 Ashland, Ky. | (606) 324-4404
CANCER: A REPORT TO THE COMMUNITY 2011 | 11
For more information on any of our programs or sevices for patients and families dealing with cancer, please email us at email@example.com.
(606) 408-4000 | kdmc.com/cancer