St. Luke's Cancer Center Annual Report - 2015

S T. L U K E ’ S C A N C E R C E N T E R

2015 Annual Report and Outcomes

ACTIVITIES AND ACHIEVEMENTS St. Luke’s University Health Network’s Integrated Network Cancer Program offers a comprehensive range of services, delivered by a dedicated team of professionals using the latest technology. It is committed to providing our patients with exceptional care tailored to their individual needs.

We are pleased to present to you the 2015 Cancer Program Annual Report, recognizing the hard work and many achievements of the St. Luke’s University Health Network cancer team.

In addition to reviewing this 2015 annual report, we encourage you to visit our St. Luke’s University Health Network website to familiarize yourself with all of our cancer-related programs and services.

2015 Highlights and Accomplishments: • The Clinical Trials Office at St. Luke’s provides support to our clinical investigators on all activities related to the successful conduct of clinical trials and research from protocol inception through closeout. This includes patient recruitment, clinical coordination, data and regulatory management, and financial and contract management. The staff consists of a mix of administrators, research nurses, research coordinators and research assistants trained in regulations and compliance, clinical trials financial operations, oncology and other clinical areas, clinical trials in general, and Good Clinical Practice (GCP). Our staff provides patients with the most up-to-date information on treatments that are available to them, as we believe in putting the patient first by ensuring that we present all available treatment options, including participation in a clinical trial.

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St. Luke’s Cancer Center

The St. Luke’s Oncology Clinical Trials team offers studies that are sponsored by industry pharmaceutical companies, government-sponsored studies through NCI’s National Clinical Trials Network (NCTN), such as ECOG-ACRIN and NRG, as well as investigator-initiated trials (IITs) originating at St. Luke’s, some of which are multi-site trials with St. Luke’s serving as the lead coordinating center. With this centralized infrastructure and implementation of streamlined processes, the St. Luke’s Clinical Trials Office has made significant achievements: • In 2015, 222 patients were enrolled; 9 percent of our cases were enrolled on clinical trials.

• As the local leader in cancer clinical trials, St. Luke’s Cancer Center offers more leading-edge immunotherapies than anyone else in the region.

• St. Luke’s immunotherapy program includes treatment of melanoma, lung cancer, head and neck cancer, bladder cancer, kidney cancer, stomach cancer, breast cancer, pancreatic cancer, prostate cancer, ovarian cancer and multiple myeloma.

• St. Luke’s Cancer Center offers clinical trials for immunotherapy that are not available anywhere else in the region. These studies are offered for the newly diagnosed and for patients with advanced disease.

• The clinical trials office enrolled the first patient for one of our lung studies. Oncology clinical trials was acknowledged for identifying the first study patient globally and subsequently enrolling the patient in the study.

• The clinical trials office was the first in the US to open several studies, including cancer trials in melanoma, lung, renal and bladder cancer.

• St. Luke’s offers clinical trials which consist of newly FDA-approved drugs, as well as expanded access trials (awaiting FDA approval), providing the latest and most innovative therapies, including novel, unapproved therapies, to our patients.

• Within the last two years we have increased the number of trials and strive to open studies within 75 days.

• Our lung studies were the number one enrollment in 2015, with 68 patients enrolled in a lung study.

• A robust staffing infrastructure was put into place, including a director of clinical trials, regulatory staff, financial staff, oncology manager and oncology nurses, study coordinators and data manager to ensure coverage of all aspects involved in the clinical trials workflow.

• Disease Management Meetings identify any gaps in patient treatment options as well as future needs for clinical trials for specific patient populations.

• Research coordinators attend disease-specific tumor boards to help identify patients for clinical trials.

• Operational excellence has been achieved in patient recruitment and treatments, as well as coordination of care with other clinical services.

• St. Luke’s Oncology Clinical Trials offer patients a variety of clinical research trials, quality service, education and support across the continuum of care of the patient.

2015 Annual Report and Outcomes

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ACTIVITIES AND ACHIEVEMENTS cont.

• The clinical trials press release, “St. Luke’s enrolls first patient in new trial that attacks cancer cells with virus,” was published in The Express Times on April 4, 2015. It is also on St. Luke’s Provider News Network.

• St. Luke’s Anderson Campus is the first and only hospital in the region to offer Frameless Stereotactic Radiosurgery, the most advanced and best technology available for patients with brain tumors. Frameless SRS uses 3-D computerized planning and imaging to deliver a concentrated dose of radiation to a targeted tumor or lesion, minimizing the amount of radiation exposure to normal, healthy tissue. The patient no longer has to be immobilized with a heavy device and pins that pierce the skin and embed into the skull. Frameless SRS provides a more comfortable and faster treatment and recovery experience for our patients.

As the local leader in cancer clinical trials, St. Luke’s Cancer Center offers more leading-edge immunotherapies than anyone else in the region.

• An Optical Surface Monitoring System, the newest technology available in radiation oncology, will allow for real time monitoring of the patient’s motion during treatment. This technology will automatically turn off the beam should any motion be outside of the treatment parameters.

• A “breath hold” procedure was implemented in radiation oncology at all campuses to help reduce the radiation dosage to the heart for left-sided breast cancer patients less than 65 years of age meeting criteria.

• The newest St. Luke’s Women’s Imaging Center at West End Medical Center opened in June 2015. It is home to the region’s lowest dose 3D mammography system-GE’s SenoClaire breast tomosynthesis and the new Sensory Suite. The 3D technology uses a low-dose, short X-ray sweep around the compressed breast, and is designed to separate the tissues and reduce the overlapping of structures, which represents a limiting factor in standard 2D mammography. GE’s Sensory Suite allows a woman to choose the environmental ambiance she prefers. The suite stimulates sight, sound and smell simultaneously to reduce anxiety.

• The survivorship process was developed throughout 2014 and implemented in 2015. Over 10 percent of eligible patients received a Survivorship Care Plan. The survivorship plan includes a treatment summary and follow-up plan which summarizes what transpired during active cancer treatment and recommendations for follow-up care and surveillance testing.

• A St. Luke’s cancer resource guide was developed and implemented to educate patients and family on community resources. Patients receive this helpful resource guide upon diagnosis. It is also available on the Internet.

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St. Luke’s Cancer Center

Our staff provides patients with the most up-to-date information on treatments that are available to them, as we believe in putting the patient first.

• The NCCN-endorsed distress thermometer (DT) was administered to patients at all designated cancer care sites affiliated with each of the campuses. Distress screenings are given to all newly diagnosed patients coming in for their first medical oncology appointment, first chemotherapy treatment or at the first radiation therapy treatment. Patients are screened at least once during a pivotal visit. Results are reviewed and patients that are identified with moderate or severe distress are contacted by a member of the patients’ oncology team.

• St. Luke’s Cancer Social Work Fund continued to help underserved patients receiving care through St. Luke’s Cancer Centers. The fund continues to support patients who need financial assistance with medications, mortgage or rent payments, and paying utility bills.

• The Cancer Support Community started bringing their programming directly to the patients being treated in the infusion centers (Allentown, Bethlehem and Anderson). Patients are offered art therapy, yoga and tai chi/meditation. Patient responses have been favorable. In addition, the Cancer Support Community offers a substantial number of Hope & Healing Series classes at their central location. A newsletter/calendar is available to our patients.

• The Artist in Residence program has continued in the infusion centers. While receiving treatment, patients with cancer and other chronic diseases work one-on-one with a resident artist and are given the opportunity to explore their inner creative talents as they meet the challenges of diagnosis, treatment and survivorship. Patient benefits include relief from anxiety, distraction from pain, a respite from boredom and a safe outlet for emotions.

• A Cancer Center Facebook page was created and went live in February 2015. Posts continue at least weekly.

• St. Luke’s Cancer Connection is distributed and posted to St. Luke’s website quarterly to help patients connect with St. Luke’s cancer programs and services and to introduce them to caregivers from St. Luke’s Cancer Center team.

2015 Annual Report and Outcomes

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ACTIVITIES AND ACHIEVEMENTS cont.

• Multidisciplinary comprehensive cancer conferences took place throughout 2015, encompassing all campuses. Tumor Board/Cancer Conferences provide a forum in which experts from varied oncology disciplines are able to collaboratively discuss the clinical stage of disease, the different treatment options recognized by national treatment guidelines, as well as available clinical trials when applicable. Cases presented throughout the year are determined by incidence volume and tracked statistically to assure all sites are covered, or unusual or rare cancers are discussed. In addition to Tumor Board, cancer case discussion also takes place at regularly scheduled site-specific working groups.

• Th e evaluation of the 128 Tumor Board/Cancer Conferences that took place throughout 2015 shows that conference frequency, format, attendance and case presentation all met established goals.

• St. Luke’s University Health Network facilities participate annually in the National Cancer Database (NCDB) through the Cancer Registry and utilize the Cancer Program Practice Profile Reports (CP3R) for breast, colon, rectum, lung, gastric and cervical cancers as a mechanism to assess and monitor concordance with standards of care.

•A ccountability and quality improvements measure rates for SLUHN facilities were above the Commission on Cancer expected performance rates, indicating our patients are consistently treated according to evidence-based national guidelines.

• S t. Luke’s Cancer Program actively participates in the Commission on Cancer’s Rapid Quality Reporting System (RQRS) through the Cancer Registry. RQRS is a reporting and quality improvement tool which provides real clinical time assessment of hospital-level adherence to nationally endorsed quality of cancer care measures for breast and colorectal cancer.  Throughout 2015, St. Luke’s consistently performed above the statewide and US norms.

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St. Luke’s Cancer Center

• The Network Infusion Centers began offering a new medication delivery device called the “On-Body Injector” for the drug, Neulasta, on April 6, 2015. Neulasta is a medication that is given to some chemotherapy patients in order to decrease the incidence of infection/febrile neutropenia (the white blood cell count) from reaching a very low level. The On-Body Neulasta Injector device is applied to the patient’s skin, either the arm or abdomen the day of chemotherapy treatment. The medication is released slowly into the skin 27 hours after chemotherapy and then removed by the patient and/or family member at home. If the patient meets the criteria for this type of delivery, it eliminates the need for the patient to come back to the infusion center the next day for a subcutaneous injection • The Anderson Campus Infusion Center opened additional chairs to help improve patient access to the Center.

• William Burfeind, MD presented “Lung Cancer Screening in a Community Setting: Medicare Patients Have Similar Outcomes to Younger Patients,” to the American College of Surgeons.

• Dr. Burfeind also spoke at the World Conference for Lung Cancer in Denver in early September 2015 on the bio view study for the early detection of lung cancer.

• Trish Kelly, MD, and Joe Russo, MD, presented a CME lecture entitled, “Breast Health Update,” for primary care physicians on June 25, 2015. The content covered the new paradigm for breast imaging, why breast density assessment is important and the indications for the Breast Screening Algorithm.

• Tian Xue, chief radiation physicist, represented St. Luke’s in Japan, June 7-11, 2015, at the International SRS Conference, showcasing a multiple lesion SRS treatment plan.

• Xoling Song, medical physicist, Radiation Oncology, represented St. Luke’s at the AAPM conference, July 12-16, 2015, in Anaheim, CA. He presented three posters on: (1) QA method for single isocenter multiple lesion SRS treatments, (2) QA measurement results for gated RapidArc treatments and (3) a model study of dose distribution and isocenter location.

• The Women’s 5K Classic has been supporting women’s breast cancer initiatives throughout the Greater Lehigh Valley since 1993. Over its 22-year history, $2.5 million has been distributed to local not-for-profit organizations, including St. Luke’s Cancer Center. This year, St. Luke’s received a grant to purchase a software program for our genetic counseling program that will help to identify a woman’s risk for inherited diseases and determine personalized treatment options.

• The “Beat Cancer with the Best” campaign kicked off in June 2015 with billboards, TV commercials and direct mail focusing throughout all St. Luke’s markets. This campaign continued until August.

• Kathleen Katchur, epidemiologist, under the direction of Bonnie Coyle and our Community Health Department, oversaw the cancer program’s community needs assessment which is completed every three years. The goal of the assessment is to identify critical health disparities faced among residents within the community, as well as to identify gaps in service among cancer care services. Data was gathered from SLUHN’s community needs assessment, tumor registry, Cancer Center annual reports, cancer incident rates in the appropriate demographics, interviews with key informants, a focus group with former/current patients and a focus group of oncology service line managers and support staff.

• Dr. Sanjiv Agarwala, chief of medical oncology, was selected for inclusion in “Best Doctors in America” for 2015-2016. He is also participating in the Global Performance Improvement project for an international clinical trial using PV-10 in melanoma.

2015 Annual Report and Outcomes

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ACTIVITIES AND ACHIEVEMENTS cont.

• Sanjiv Agarwala, MD, section chief of hematology/oncology, is a co-author of a recently published article titled, “Nivolumab and Ipilimumab Versus Ipilimumab in Untreated Melanoma.” The paper has been published in the New England Journal of Medicine, April 20, 2015. The article can be accessed online. The other co-authors were from Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, Cleveland Clinic Foundation, Harvard and Duke University, among other prestigious institutions. This achievement highlights St. Luke’s University Health Network as a World-Class Cancer Center, both clinically and in research.

• Abstracts were submitted and accepted by the ASRT and AAPM for presentations at the national conferences. Robyn Plesniarski, network manager of radiation oncology, represented St. Luke’s with her abstract on “Meaningful Use” in October 2015 in San Antonio, Texas. Charlene Song, PhD, represented St. Luke’s on three abstracts at the AAPM meeting in Anaheim, CA: (1) a new QA test method for single isocenter multiple target SRS treatments, (2) QA verification of gated RapidArc treatments and (3) a model study of gantry angle/MLC aperture/distance to isocenter effect on dose distribution of a small target.

• St. Luke’s Allentown Infusion Center received 15 new infusion recliners. The recliners were purchased with $10,000 from the Auxiliary along with SLA capital dollars.

• The second GE low dose 3-D mammography system and automated breast ultrasound opened at St. Luke’s Perkiomen Outpatient Center – Sensory Suite. A press conference and open house was held on November 18, 2015. An article on LVB.com highlighted the new technology.

• Our Cancer Survivor’s Day celebration at Tony Orlando’s Great American Christmas Show at The Sands Event Center on Sunday, December 6, 2015, was such a great success and hit with cancer survivors, we are teaming up again with Sands and Tony Orlando to host it again on November 27, 2016.

• The Circle of Hope Society membership for 2015 increased by four new members as a result of year-end gifts of $1,000 or more that were made to our cancer program. Twenty-four individuals/ couples have joined the Circle of Hope Society since kicking off the initiative in November 2015.

• An oncology-specific financial counseling program was implemented to help reduce financial barriers to the underinsured and uninsured patient population. When financial need is indicated, financial counselors work closely with patients to assist them in obtaining financial sponsorship from outside agencies and charitable programs.

Throughout 2015, St. Luke’s consistently performed above the statewide and US norms.

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St. Luke’s Cancer Center

2015 — CANCER COMMITTEE MEMBERS Our optimal clinical outcomes are due to the collective efforts of the Cancer Committee and the medical staff. The Cancer Committee is composed of representatives of primary and specialty care physicians, as well as team members involved in the care of our cancer patients. This multidisciplinary committee of dedicated professionals meets at least quarterly to review and evaluate the quality and direction of the overall cancer program, and makes recommendations for improvement, thus ensuring that our patients receive the highest level of care from diagnosis through treatment and survivorship.

Lee B. Riley, MD, PhD INCP Committee Chair Surgical Oncology Darius Desai, MD Cancer Liaison Physician Surgical Oncology Sanjiv Agarwala, MD Medical Oncology David Anderson, MD Pathology Ric Baxter, MD Palliative Care Neil Belman, DO Medical Oncology William Burfeind, MD Thoracic Surgery Bonnie Coyle, MD Community Health Nimisha Deb, MD Radiation Oncology Edward Gilkey, MD VP, Medical Affairs Warren Campus Hugh Moulding, MD Neurosurgery Subhash Proothi, MD Medical Oncology Laurie Sebastiano, MD Radiology

John Smith, MD Medical Oncology

Kathleen Katchur, MPH Community Health

Thomas J. Tachovsky, MD Oncology Quality Oversight

Kristen Maggipinto, RN Med-Surg Nursing Anderson Campus

Nicholas Taylor, MD Gynecologic Oncology David Yen, MD Otolaryngology Cheryl Belman, RN, OCN Neuro-Oncology Nursing Mary Brophy Cancer Data Associate Debra Bubba, MSN, RN Administrative Director, Oncology

Linda Moller, RNC Hospice Erin Moskel American Cancer Society Kathy Nunemacher, RN, CPN, CPHQ Quality Resources Joseph Pinto VP, Network Operations

Donna Bydlon, RN, OCN Oncology Nursing

Robyn Plesniarski Manager, Radiation Oncology Oncology Community Outreach

Rose Cabral, RN, OCN Clinical Trials

Susan Ross Communication and Marketing

Beth Ciliberti, RDN, LDN, CSO Oncology Nutrition

Jen Sinclair Cancer Support Community

Debbie Cooper, RD Nutrition Services Elizabeth Gregg, RN Oncology Nursing John Flenner, MEd Cancer Counselor Kathleen A. Hedges, CTR Cancer Registry Manager

Andrea Smith, CGC Genetic Counselor Brian Waldron, RPh Pharmacy Mari Wahlgren, PT Rehabilitation Brenda West, RHIT, CTR Cancer Data Registrar

2015 Annual Report and Outcomes

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ST. LUKE’S COMMUNITY OUTREACH EVENTS

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Month January

Event The Peak - Managing Stress Through Yoga

Participants viewers

February

The Peak: A Survivor’s Journey

viewers

February

*Talk With Your Doctor: viewers “Second Opinions”

April

3rd Annual Oncology Symposium

April

Talk With Your Doctor: viewers “Colon Cancer”

April

Evening with the Artist

100

April

Carbon-Schuylkill Cancer Telethon

viewers/live broadcast

April

FOCUS on Health

PBS39 viewers

St. Luke’s Cancer Center

60

Outcome Tricia Kelly, MD, showed how practicing regular yoga gives you the ability to relax, be strong and decompress from a demanding and intense environment.

Breast cancer and leukemia survivor shared her journey in fight against cancer with medical oncologist Subhash Proothi, MD; to discuss the types of leukemia, presenting symptoms and latest advancements.

Lee Riley, MD, surgical oncologist, discussed the value of second opinion for patients diagnosed with cancer.

Presentations included Breast Imaging, Personalized Medicine and Genomics; The Immune System and Cancer; and a panel discussion on Hot Topics in Cancer.

Ihab Abdelaal, MD, Daniel Eyvazzadeh, MD; and Berhanu Geme, MD, discussed colon cancer.

SLQ’s Evening with the Artist event benefitted the Women’s Cancer Services at Quakertown.

Over 100 people attended the inaugural event that was held on April 17. Dr. Taylor spoke at the event, indicating the importance of this support to the care of our patients.

Joe Russo, MD, shared information about women’s imaging services and new modalities available within St. Luke’s Network.

Sanjiv Agarwala, MD, chief of medical oncology, discussed melanoma prevention, diagnosis and treatment options, including clinical trials. Producer Laura McHugh discussed how genetic testing aids in the battle against many different cancers with St. Luke’s gynecologic oncologist Israel Zighelboim, MD, associate clinical professor of obstetrics, gynecology and reproductive services at Temple University School of Medicine. In a separate discussion, Laura spoke with Andrea Smith, MS, CGC, LGC, certified and licensed genetic counselor, about how and why patients would consider genetic testing and what the results mean in the prevention, diagnosis and treatment of cancers.

Month April

May

Event Participants Hematology Oncology 100s Today - Melanoma & Cutaneous Malignancies Breakthrough 60 Over Breakfast: “What You Need to Know about Women’s Cancers, But Are Afraid to Ask”

May

Relay for Life

150

May

Skin Cancer Screening

85

May

Talk With Your Doctor: viewers “How to Find the Best Cancer Care”

July

Pancreatic Cancer

60

September

25

September

Prostate Cancer Screening Prostate Cancer Screening Prostate Cancer

140

September

Yoga for Hope

15

September

13

Outcome Dr. Sanjiv Agarwals, chief of medical oncology, was program director as well as presenter at this two-day event in New York City.

This successful program was held May 16, 2015, at Hawke Point Golf Club in Washington, NJ. The master of ceremonies for the event was Dr. Abo. The program included an overview of St. Luke’s Cancer Program followed by an extensive question and answer session with St. Luke’s women’s cancer specialists (Drs. Riley, Taylor, Russo, Deb, Nakajima and Bucich).

Tricia Kelly, MD, spoke on leading a healthy lifestyle. She participated in survivor’s lap and was available to talk with everyone and answer questions.

Free skin cancer screenings were offered at Allentown Cancer Center, Bethlehem 3rd Street Clinic and Warren Campus.

Doug Eberhart and Dr. Lee Riley discussed “How to Find the Best Cancer Care” on Talk With Your Doctor, May 4, 2015, on Channel 69 (WFMZ-TV). Guests included Dr. Asim Ali, Dr. Nicholas Cardiges, Dr. Darius Desai and Dr. Emily Miller.

Dr. Quiros spoke at a Pancreatic Cancer awareness fundraiser event held at the Comfort Inn & Suites in Bethlehem on Saturday, July 25, 2015.

Prostate cancer screening was held at Warren Campus.

Free PSA testing was done at multiple sites within St. Luke’s Health Network.

St. Luke’s Anderson Campus was the host for the 3rd Annual Blue Ribbon Race on September 27, 2015. There were over 140 participants, raising $16,000 through sponsorships, netting over $7,000 to support men’s cancer initiatives.

Tricia Kelly, MD, instructed a Yoga class for the Cancer Support Community’s Wings of Hope Butterfly Release at Cedar Crest College on September 12, 2015.

2015 Annual Report and Outcomes

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ST. LUKE’S COMMUNITY OUTREACH EVENTS cont.

Month October October

12

Event Breast Cancer Screening Women’s 5K

Participants 9 1,000

Outcome Breast cancer screening was held at Warren Campus.

The Oncology Service Line participated in the 23rd Annual Women’s 5K Expo on Friday, October 16, 2015. Staff from several departments in the service line, including infusion, radiation oncology, genetics, tumor registry, surgical oncology and oncology administration, were on hand to participate in the event. Lee Riley, MD, donated more than 500 glass pendants as a symbol of hope to cancer survivors.

Lee Riley, MD (surgical oncology), Hikaru Nakajima, MD (medical oncology) and Nimisha Deb, MD (radiation oncology) presented a program on October 24, 2015, in Monroe County.

October

Breakthrough Over Breakfast: “Updates in Breast Cancer”

16

October

Breakthrough Over Breakfast: “Updates in Digestive Cancer”

15

Asim Ali, MD (medical oncology) and Rod Quiros, MD (surgical oncology) presented this in Lehigh County.

October

Dig Pink Event

Community

Missy Lynn, head coach of the Liberty High School Girls Volleyball team, organized a fundraiser to pay tribute to a former teacher and coach who was diagnosed and, unfortunately, lost her battle with breast cancer four years ago. The Dig Pink volleyball game was held on October 1 to kick off Breast Cancer Awareness Month. Over $1,200 was raised and designated to St. Luke’s Cancer Compassion Fund to help cancer patients overcome some of the financial challenges they may face during their treatment and recovery.

St. Luke’s Cancer Center

Month October

Event Breast Cancer Awareness

October

“Come Laugh With Me” Community

October

Head and Neck Cancer 15

October

Health Fair

October

Talk With Your Doctor: viewers “Survivorship”

October

“Hablando con su Doctor”

listeners

October

Breast Cancer

20

October

Quakertown Lecture Series: “Obesity and Cancer” Quakertown Lecture Series: “Today’s Targeted Therapies”

10

October

Participants Community

Outcome Peg, Dick and Jeff Fegley, owners of Fegley’s Brew Works, believe it’s important to give back to the community that helps to make them successful. One way they demonstrate that belief is by routinely opening their business to host fundraising events for worthy causes. For the past several years, the Fegleys dedicated the month of October to raising awareness and money for breast cancer. Last year, the proceeds from the month-long effort were designated to the Cancer Compassion Fund to help breast cancer patients who are having financial difficulties as a result of their cancer diagnoses.

Luz Brandon, cancer survivor and grateful patient, organized this event to help ensure that the highly-skilled physicians and nurses at St. Luke’s have access to the most advanced technology and innovative treatments available to care for cancer patients just like her close to home.

Dr. Andolino spoke to the community at a head and neck cancer program coordinated by the Cancer Support Community.

200

4

Tricia Kelly, MD, surgical oncology, and Amy Schippers, PA-C, medical oncology, were guests on this Channel 69 program and discussed St. Luke’s Survivorship Program.

Tricia Kelly, MD, was a guest on St. Luke’s new Spanish health information radio program on Radio Ola in Allentown. Dr. Kelly spoke on breast density, screening and genetics.

Subhash Proothi, MD, spoke to a support group at the Allentown YMCA regarding breast cancer education and updates on October 13, 2015.

Nick Taylor, MD, spoke at St. Luke’s Quakertown lecture series on October 20, 2015.

Asim Ali, MD, medical oncology, spoke at St. Luke’s Quakertown lecture series on “Today’s Targeted Therapies,” on October 5, 2015.

2015 Annual Report and Outcomes

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ST. LUKE’S COMMUNITY OUTREACH EVENTS cont.

Month October

Event “Lung Cancer Screening in a Community Setting”

November

Breakthrough Over Breakfast: “Updates in Immunotherapy and Skin Cancer” Breakthrough Over Breakfast: “Updates in Prostate Cancer” Lehigh Valley Style’s “Live Well” Event

November

November

November

Breast Cancer seminar

Participants

Outcome

100s

William Burfeind, MD, presented “Lung Cancer Screening in a Community Setting: Medicare Patients Have Similar Outcomes to Younger Patients,” at the American College of Surgeons conference.

As part of the community education series, Sanjiv Agarwala, MD, presented this seminar on November 7, 2015.

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19

Yacoub Faroun, MD, and Zachariah Goldsmith, MD, presented this educational lecture on November 21, 2015.

20

Tricia Kelly, MD, Nick Taylor, MD, and Andrea Smith, genetic counselor, represented St. Luke’s Cancer Center at Bear Creek Mountain Resort. Dr. Kelly discussed the topic of breast health.

Subhash Proothi, MD, presented a general seminar on breast cancer and St. Luke’s breast cancer services to the Luther Crest Retirement Community on November 23, 2015.

Residents of Luther Crest

Financial counselors work closely with patients to assist them in obtaining financial sponsorship from outside agencies and charitable programs.

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St. Luke’s Cancer Center

Month December

Event “Hablando con su Doctor”

Participants viewers

Outcome Roderick Quiros, MD, was a guest on “Hablando con su Doctor,” St. Luke’s new Spanish language health information radio program on Radio Ola hosted by Leo Claros, MD. He discussed the topic which was recently in the news: “Does Eating Meat Cause Cancer?”

Tony Orlando’s Great American Christmas December St. Luke’s Survivor’s 1,400 Show at The Sands Event Center on Sunday, Day Celebration December 6th, was a great success. More than 1,400 people attended the event (which included over 750 survivors, their guests, volunteers, physicians and donors).

Complimentary tickets to the event were offered on a first come-first served basis to St. Luke’s cancer survivors, who were able to bring a guest to accompany them for a nominal fee. Prior to the show, guests were treated to a pre-concert reception in the Visions Bar where they mingled with St. Luke’s cancer specialists, oncology nurses, volunteers and support staff. The event was supported through philanthropic funds from The Sands Event Center, Tony Orlando, the St. Luke’s Auxiliary and Boutique at the Rink and The Regina Patient and Family Support Endowment Fund. * St. Luke’s award-winning, Nielsen-rated television program, Talk with Your Doctor, on WFMZ-TV Channel 69 is a 30-minute live, weekly call-in show featuring expert physician hosts from St. Luke’s University Health Network. TWYD is estimated to have 1 million viewers throughout the region, including Lehigh Valley and Berks, Philadelphia, Poconos and portions of New Jersey and Delaware.

2015 Annual Report and Outcomes

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CANCER DATA MANAGEMENT & STATISTICS The Cancer Registry is the data collection component of our Cancer Program. It is a depository of confidential patient information that provides the whole picture of the patients’ disease. The Network Cancer Registry is staffed by a team of data specialists trained as Certified Tumor Registrars (CTRs) and Cancer Data Associates. They collect information about the occurrence (incidence) of cancer, types of cancer, locations within the body, extent of cancer at the time of diagnosis (disease stage) and types of treatment patients receive. Cancer Registry data provides hospital administrators with statistics for research, education and strategic planning.

Data for all cancer cases diagnosed or treated within the Network is reported to a central statewide cancer registry. Data collected by state cancer registries enables public health professionals to better understand and address the cancer burden.

Reliable registry data is fundamental to a variety of research efforts, including those aimed at evaluating effectiveness of cancer prevention, control or treatment programs. In recent years, higher education and certification standards for Cancer Registrars were mandated to ensure the accuracy of the collected data.

Cancer Registry data goes through electronic edits as well as quality review processes.

Each patient in the database is followed annually in order to acquire necessary information on disease recurrence, subsequent treatment and survival data that is vital for continued patient care. Our current follow-up rate is 92 percent, which exceeds the established benchmark mandated by the Commission on Cancer (CoC) and attests to the continued teamwork approach to patient care at St. Luke’s.

Following are some cancer statistics for our Network:

2014 Summary by Body System, Sex, Class, Status and Best CS/AJCC Stage Report Class of Case

Sex

Status

Primary Site

Total (%)

M

F

Oral Cavity & Pharynx Lip Tongue

75 (2.5%) 2 (0.1%) 23 (0.8%)

55 0 16

20 2 7

65 1 22

10 1 1

51 2 16

24 0 7

Salivary Glands

9 (0.3%)

5

4

8

1

7

2

3 4 3 19 5 438 28 27 14

0 4 0 3 0 53 4 3 3

Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Hypopharynx Digestive System Esophagus Stomach Small Intestine

3 (0.1%) 8 (0.3%) 3 (0.1%) 22 (0.7%) 5 (0.2%) 491 (16.5%) 32 (1.1%) 30 (1.0%) 17 (0.6%)

3 0 6 2 0 3 21 1 4 1 259 232 25 7 18 12 6 11

Stage Distribution*

Analy NA Alive Exp 0

I

II

III IV 88 Unk

1 0 0

8 1 3

3 0 2

10 38 0 0 4 11

0 0 0

5 0 2

0

3

0

1

0

0

0 0 0 0 0 8 0 0 0

0 0 1 1 1 29 2 3 0

4

1 2 0 1 1 0 1 4 4 1 0 0 0 3 2 1 0 0 0 1 1 18 4 0 0 0 3 15 1 4 0 0 0 1 3 283 208 54 73 80 82 112 11 21 2 1 10 7 6 14 16 1 6 3 1 13 14 3 0 1 3 9 1

*Analytic Cases Only 16

St. Luke’s Cancer Center

Class of Case

Sex Primary Site Colon Excluding Rectum Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid Rectosigmoid Junction

Total (%)

Status

Stage Distribution*

M

F

193 (6.5%) 106 42 23 13 6 38 23 9 3 14 7 7 4 12 4 43 30 15 6 79 (2.7%) 40

87 19 7 15 6 7 3 8 13 9 39

177 39 11 37 8 14 7 12 39 10 61

16 3 2 1 1 0 0 0 4 5 18

140 29 11 27 6 8 5 11 33 10 63

53 13 2 11 3 6 2 1 10 5 16

34 30 35 37 32 6 3 7 13 9 0 5 3 2 1 8 8 5 6 6 4 1 2 1 0 2 2 5 3 2 1 1 2 3 0 1 1 5 3 1 12 9 4 5 7 0 0 2 1 6 14 13 8 13 7

0 0 0 0 0 0 0 0 0 0 0

9 1 0 4 0 0 0 1 2 1 6

6

13

15

4

15

4

2

1

4

4

2

0

2

34

26

46

14

48

12

12 12

4

9

5

0

4

3

6

7

2

7

2

3

0

1

0

2

0

1

22

14

34

2

10

26

0

12

3

6

8

3

2

18 4 4 2 30 1

11 3 2 5 41 2

28 6 6 7 66 3

1 1 0 0 5 0

8 2 2 2 16 0

21 5 4 5 55 3

0 0 0 0 0 0

10 3 2 0 1 1 1 1 8 14 0 1

6 0 0 0 4 0

5 3 4 2 37 0

2 1 0 1 0 1

2 0 0 2 3 1

0

5

5

0

4

1

0

0

5

0

0

0

3 335

0 19

0 6

0 0 0 0 3 88 24 68 136 2

0 11

4

0

0

0

1

1

22 308

2 17

5 1

5 3 4 4 1 83 20 64 130 0

0 10

19

Rectum 60 Anus, Anal Canal 9 (0.3%) & Anorectum Liver & Intrahepatic 36 (1.2%) Bile Duct Liver 29 Intrahepatic Bile Duct 7 Gallbladder 6 (0.2%) Other Biliary 7 (0.2%) Pancreas 71 (2.4%) Retroperitoneum 3 (0.1%) Peritoneum, Omentum 5 (0.2%) & Mesentery Other Digestive Organs 3 (0.1%) Respiratory System 354 (11.9%) Nose, Nasal Cavity & 4 (0.1%) Middle Ear Larynx 24 (0.8%) Lung & Bronchus 325 (10.9%) Trachea, Mediastinum & 1 (0.0%) Other Respiratory Organs Bones & Joints 3 (0.1%) Bones & Joints 3 (0.1%)

2 1 193 161 3

1

16 8 174 151

Analy NA Alive Exp 0

0 3 170 184 2

2

19 5 149 176

I

II

0

1

III IV 88 Unk

0

1

0

1

1

0

0

1

0

0

0

0

1

0

0

2 2

1 1

2 2

1 1

2 2

1 1

0 0

0 0

0 0

0 0

1 1

0 0

1 1

*Analytic Cases Only 2015 Annual Report and Outcomes

17

CANCER DATA MANAGEMENT & STATISTICS cont.

Class of Case

Sex

Status

Primary Site

Total (%)

M

F

Soft Tissue Soft Tissue (Including Heart) Skin excluding Basal & Squamous Melanoma - Skin Other Non-Epithelial Skin Basal & Squamous Skin Basal/Squamous Cell Carcinomas of Skin Breast Breast Female Genital System Cervix Uteri Corpus & Uterus, NOS Corpus Uteri Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs Male Genital System Prostate Testis Penis Other Male Genital Organs Urinary System Urinary Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs Brain Brain & Other Nervous System

20 (0.7%)

15

5

16

4

15

5

20 (0.7%)

15

5

16

4

15

201 (6.7%) 121

80

139

62

197 (6.6%) 120 4 (0.1%) 1 3 (0.1%) 3

77 3 0

135 4 0

Stage Distribution*

Analy NA Alive Exp 0

I

II

III IV 88 Unk

0

4

4

3

4

0

1

5

0

4

4

3

4

0

1

185

16

31 62 15 23

6

1

1

62 0 3

181 4 3

16 0 0

31 61 14 22 0 1 1 1 0 0 0 0

6 0 0

0 1 0

1 0 0

0

0

0

39 22 39 22 35 22 0 2 18 9 17 8 1 1 9 8 0 1 3 2

0 0 3 0 0 0 0 0 0 0

15 15 4 0 3 3 0 0 0 0

3

1

3 (0.1%)

3

0

0

3

3

0

0

0

0

0

472 (15.8%) 472 (15.8%) 220 (7.4%) 13 (0.4%) 120 (4.0%) 115 5 49 (1.6%) 3 (0.1%) 22 (0.7%)

6 6 0 0 0 0 0 0 0 0

466 466 220 13 120 115 5 49 3 22

435 435 172 10 111 108 3 29 1 9

37 37 48 3 9 7 2 20 2 13

435 435 186 11 101 99 2 40 2 20

37 37 34 2 19 16 3 9 1 2

79 79 2 0 0 0 0 0 0 0

179 179 90 6 73 72 1 6 0 4

101 101 16 2 8 8 0 6 0 0

13 (0.4%)

0

13

12

1

12

1

2

1

0

5

0

326 (10.9%) 310 (10.4%) 9 (0.3%) 6 (0.2%) 1 (0.0%) 231 (7.7%) 136 (4.6%) 86 (2.9%) 4 (0.1%) 5 (0.2%) 120 (4.0%)

326 310 9 6 1 169 109 55 1 4 58

0 0 0 0 0 62 27 31 3 1 62

232 217 9 5 1 217 123 85 4 5 111

94 93 0 1 0 14 13 1 0 0 9

303 287 9 6 1 187 111 69 4 3 77

23 23 0 0 0 44 25 17 0 2 43

3 0 0 3 0 66 63 0 2 1 0

48 39 8 1 0 92 31 61 0 0 0

135 134 0 1 0 19 16 2 1 0 0

26 26 0 0 0 6 2 3 1 0 0

16 1 16 0 0 1 0 0 0 0 23 3 9 0 14 0 0 0 0 3 0 111

3 2 0 0 1 8 2 5 0 1 0

54 (1.8%)

36

18

52

2

23

31

0

0

0

0

0

0

52

*Analytic Cases Only 18

St. Luke’s Cancer Center

Class of Case

Sex Primary Site

Status I

II

III IV 88 Unk

0

0

0

0

0

59

0

2 1

0 0

76 10 28 76 10 27

2 2

10 0

3 3

13

1

0

0

0

10

0

21 1 20 14 6 11 11 17 12

88 9 79 52 27 27 27 24 16

41 3 38 27 11 14 14 31 7

0 0 0 0 0 0 0 0 0

27 25 23 24 2 1 4 2 4 0 26 21 21 20 2 11 17 20 12 0 15 4 1 8 2 0 0 0 0 30 0 0 0 0 30 0 0 0 0 38 0 0 0 0 11

7 0 7 5 2 0 0 0 0

3

0

1

2

0

0

0

0

0

3

0

6

7

11

14

4

0

0

0

0

0

7

0

2

0

1

1

1

1

0

0

0

0

0

1

0

30 (1.0%)

20

10

25

5

8

22

0

0

0

0

0

25

0

21

14

7

18

3

4

17

0

0

0

0

0

18

0

2

1

1

2

0

0

2

0

0

0

0

0

2

0

7

5

2

5

2

4

3

0

0

0

0

0

5

0

2 (0.1%) 7 (0.2%) 7 (0.2%) 2 (0.1%) 2 (0.1%)

1 7 7 2 2

1 0 0 0 0

2 7 7 0 0

0 0 0 2 2

0 1 1 2 2

2 6 6 0 0

0 0 0 0 0

0 3 3 0 0

0 1 1 0 0

0 1 1 0 0

0 0 0 0 0

2 1 1 0 0

0 1 1 0 0

Miscellaneous

95 (3.2%)

56

39

79

16

40

55

0

0

0

0

0

79

0

Miscellaneous Total

95 (3.2%) 56 39 79 16 40 55 0 0 0 0 0 79 0 2,981 1,441 1,540 2,553 428 2,213 768 242 750 433 344 406 289 89

Cranial Nerves Other Nervous System Endocrine System Thyroid Other Endocrine including Thymus Lymphoma Hodgkin Lymphoma Non-Hodgkin Lymphoma NHL - Nodal NHL - Extranodal Myeloma Myeloma Leukemia Lymphocytic Leukemia Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia Acute Myeloid Leukemia Acute Monocytic Leukemia Chronic Myeloid Leukemia Other Leukemia Mesothelioma Mesothelioma Kaposi Sarcoma Kaposi Sarcoma

Total (%)

M

F

66 (2.2%)

22

44

59

7

54

12

136 (4.6%) 122 (4.1%)

37 32

99 90

129 118

7 4

134 121

14 (0.5%)

5

9

11

3

129 (4.3%) 12 (0.4%) 117 (3.9%) 79 38 41 (1.4%) 41 (1.4%) 55 (1.8%) 23 (0.8%)

69 6 63 49 14 26 26 37 16

60 6 54 30 24 15 15 18 7

108 11 97 65 32 30 30 38 11

3

2

1

18

12

2

Stage Distribution*

Analy NA Alive Exp 0

0

1

*Analytic Cases Only 2015 Annual Report and Outcomes

19

COUNTY OF RESIDENCE AT DIAGNOSIS FOR CY2014 ANALYTIC CASES 9.45%

PA — Northampton

7.29%

PA — Lehigh

6.19%

NJ — Warren

4.08% 22.89%

3.72% 5.72%

PA — Monroe

4.39% 0.78% 0.55%

PA — Bucks PA — Carbon PA — Schuylkill Other

40.65%

Other PA Counties County at Diagnosis PA — Montgomery PA — Berks PA — Pike PA — Luzerne PA — Lackawanna PA — County unknown PA — Northumberland PA — Cumberland PA — Chester PA — Dauphin PA — Lebanon PA — Wayne Total

20

St. Luke’s Cancer Center

Other PA Counties

Other NJ Counties

Out of State

Out of State Percent 2.23% 1.02% 0.24% 0.31% 0.12% 0.12% 0.12%

Count 57 26 6 8 3 3 3

0.08% 0.04% 0.04% 0.04% 0.04% 4.39%

2 1 1 1 1 112

Percent 0.55% 0.12% 0.08% 0.04% 0.78%

Count 14 3 2 1 20

Other NJ Counties County at Diagnosis NJ — Hunterdon NJ — Ocean NJ — Morris NJ — Cape May Total

County at Diagnosis CA — Contra Costa FL — Bay FL — Gilchrist FL — Lee FL — Palm Beach FL — Pinellas FL — Sarasota FL — Union NC — Northampton NY — Bronx NY — Broom NY — Kings NY — Queens Total

Percent 0.04% 0.04% 0.04% 0.04% 0.04% 0.08% 0.04% 0.04% 0.04% 0.04% 0.04% 0.04% 0.04% 0.55%

Count 1 1 1 1 1 2 1 1 1 1 1 1 1 14

CANCER CASES BY YEAR 3,000

2,743

2,624 Number of Cancer Cases by Calendar Year 2,500

3,000 2,500

2,624 348

2,868

2,743

2,000

390

379

1,000

1,500 2,276

2,478 500

2,364

0

500 0

2011

2012

2013

2,983

390

430

430

Analytic Cases:

1,500

2,000

1,000

348

2,983

379

2,868

2,276

2,364

SLUHN was involved in the diagnosis 2,478 and/or treatment of2,553 the patient during their initial diagnosis of cancer.

2,553

Non-Analytic Cases:

2011

Patients who were initially diagnosed and treated elsewhere and came to 2013 2014 SLUHN for management of recurrent or persistent disease.

2014

2012

Top 6 Most Prevalent Sites of Cancers Treated (Calendar Year) 600

Breast Volume

500

Lung Volume

400

ColoRectal Volume

300

Prostate Volume

200

Melanoma Volume

100

Thyroid Volume

0

2012

2013

2014

Age at Diagnosis of Cancer Cases by Site (Calendar Year) 120 100

Breast Volume

80

Lung Volume

60

ColoRectal Volume

40

Prostate Volume

20 0

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

2015 Annual Report and Outcomes

21

CLINICAL PERFORMANCE DATA The ACoS Commission on Cancer provides tools to accredited facilities to help them improve the quality of their patient care. Two of those tools are the Rapid Quality Reporting System (RQRS) and Cancer Program Practice Profile Reports (CP3R).

RQRS provides real-time tracking of treatments recommended by evidence-based standards. RQRS helps facilities evaluate the timeliness of cancer treatment given at their facilities. Participation in RQRS is voluntary and SLUHN chooses to participate because of our commitment to quality patient care.

CP3R accountability and quality measures, endorsed by the National Quality Forum (NQF); are used by facilities to monitor the use of evidence-based guidelines. SLUHN has a higher rate of eligible patients receiving recommended treatments than national benchmarks (rate for all CoC accredited facilities).

The tables below contain the most recent data obtained from the National Cancer Database (NCDB), Cancer Program Practice Profile Reports (CP3R) along with comparative data from the Pennsylvania Health Care Quality Alliance (PHCQA). Data is updated annually. St. Luke’s consistently performed above the statewide and US norms for breast and colon cancer for both the accountability and quality improvement measures.

Breast Cancer Radiation therapy following breast-conserving surgery Radiation therapy is administered within one year of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer.

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 96 percent and the US rate of 92 percent.

100

100%

96%

92%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Hormone modification therapy for breast cancer Hormone modification therapy is considered or administered within one year of diagnosis for women with AJCC T1c, or stage IB - III hormone receptor positive breast cancer.

100

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 96 percent and the US rate of 92 percent.

40

St. Luke’s Cancer Center

96%

92%

90%

80 60

20 0

22

100%

SLUHN

PA Rate

US Rate CoC Standard

Combination chemotherapy for breast cancer Combination chemotherapy is considered or administered within four months of diagnosis for women under age 70 with AJCC T1c, or Stage IB - III hormone receptor negative breast cancer.

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 95 percent and the US rate of 93 percent.

100%

100

95%

93%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Colon Cancer Adjuvant chemotherapy within four months of surgery Adjuvant chemotherapy is considered or administered within four months of diagnosis for patients under the age of 80 with AJCC Stage III lymph node positive colon cancer.

SLUHN’s compliance with this standard is at 100 percent compared to the PA state rate of 93 percent and the national rate of 90 percent.

100

100%

93%

90%

90%

80 60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

Number of lymph nodes excised during surgery At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

SLUHN’s compliance with this standard was at 96 percent compared to the PA state rate of 88 percent and the national rate of 90 percent.

100

96%

88%

80

88%

80%

60 40 20 0

SLUHN

PA Rate

US Rate CoC Standard

2015 Annual Report and Outcomes

23