2007 St. Tammany Parish Hospital Cancer Annual Report

2007

cancer program annual report

2006 Cancer Committee Jack Saux, MD

Kathy McWhorter, RN, MSN

Hematology/Oncology Cancer Committee Chairman

Director of Nursing, STPH Darlene Melancon, RN

Greg Henkelmann, MD Radiation Oncology Cancer Liaison Physician

Certified Breast Health Navigator Breast Center, STPH David Oubre, MD Hematology/Oncology

Donna Berbling, RN, BSN,

Our Mission: To provide the highest quality cancer care and to meet the needs of the community with educational seminars, support groups and health screenings.

Director of Hospice, STPH

Teresa Palombo, RN, BSN, ET

Debbie Bruno, ART (R)(M)

Department Head Medical Oncology Unit, STPH

Assistant Department Head Imaging Services, STPH

Tonya Jackson-Ramsey Health Initiatives Representative, ACS

Michael Carpenter, MD

General Surgery

Juanita Schenck, LCSW

Case Management, STPH Chryl Corizzo, RN, BSN, OCN

Cancer Program Director, STPH

Susan Stahl

Registry Follow-up Clerk, STPH Vickie Hall, LPN, RT (T)

Director, MBPCC Covington James Lacour, MD Radiology

Teena Strand, RN Department Head Ambulatory Services, STPH Brenda Truxillo, RN

Judy Limbaugh, MD

Pathology

Vice President Radiation Oncology Services, MBPCC

Nicole Magee, CTR

John Verhulst, MD

Cancer Registry Director, MBPCC

General Surgery

Patricia Maltese, RT, MHA Department Head Imaging Services, STPH

Beverly Villemuer, CTR

Registrar, STPH

Lori McCallum, MEd, CTR

Jo Watkins, RPh Clinical Pharmacy Coordinator, STPH

Executive Director, C.A.R.E. Network

II

2007 mbpcc | stph cancer program annual report

chairman’s report As Chairman of the St. Tammany Parish Hospital (STPH) and Mary Bird Perkins Cancer Center (MBPCC) Cancer Committee, I am pleased to present the 2007 Cancer Program Annual Report.

The highlight of this report is to announce that STPH and MBPCC were awarded a three-year approval status with commendation from the Commission on Cancer of the American College of Surgeons (ACoS) as an approved Cancer Program. There are currently over 1,400 approved cancer programs in the nation representing about 25% of all acute care facilities in the United States and Puerto Rico. These approved facilities diagnose and treat 80% of all newly diagnosed cancer patients in the country. To learn more about the Commission on Cancer, the benefits of having an approved cancer program near you, or to view cancer program standards, visit www.facs.org/cancer/publicapproval.

The STPH/MBPCC Cancer Committee was active in numerous aspects of cancer control activities and services provided to patients, caregivers, health professionals, and the community. Members worked to expand the scope and reach of our community based screenings in the West St. Tammany and Washington Parish area with over 900 participants at screenings for breast, skin, colorectal and prostate cancers. The STPH Breast Center was pleased to announce not only the availability of two dedicated radiologists specializing in diseases of the breast, but also the availability of the LORAD Stereotactic biopsy table. This unit is unique in that it is completely digitalized and allows multiple biopsies to be completed if needed. The hospital also announced the development of an outpatient infusion center specifically for chemotherapy, blood and supportive therapy procedures, as well as plans to expand bed capacity by 115 beds to meet the needs and growth of the community.

Numerous quality improvement initiatives were completed, including a study evaluating the management and outcomes of patients with rectal cancer diagnosed and/or treated locally. The results of that study are included in this report.

On behalf of myself and the members of the STPH/MBPCC Cancer Committee, we hope you will enjoy the 2007 Cancer Program Annual Report.

Jack E. Saux, III, M.D. Cancer Committee Chair

Jack E. Saux, III, M.D., Cancer Committee Chair

2007 mbpcc | stph cancer program annual report

Cancer Liaison Physician Report

greg henkelmanN, M.D. Radiation Oncology, MBPCC

During 2006, the Cancer Program of St. Tammany Parish Hospital and Mary Bird Perkins Cancer Center supported the objectives of the American College of Surgeons Commisson on Cancer (ACoS) by participating in several nationwide initiatives.

The Cancer Program contributed its Facility Information Profile System data for review. Data from similar programs throughout the country were compiled, reviewed and released to the American Cancer Society (ACS). In turn, the ACS will use the information to promote the services of ACoS-approved programs to consumers. The ACS also actively worked with the Cancer Program locally to collaborate on program planning for projects in the years ahead.

In accordance with the ACoS standards, the Cancer Committee assigned coordinators to manage four key aspects of the program: cancer conferences, quality control of the cancer registries, quality improvement and community outreach.

The Cancer Liaison Physician is actively involved in facilitation of monthly tumor conferences. These interdisciplinary conferences are held monthly to improve the diagnosis and management of patients with cancer. The cases of both STPH and MBPCC patients are selected for presentation and discussion based on staging, case complexity, unusual presentation of disease or special interest.

Physician representatives from pathology, radiology, surgery, medical and radiation oncology, and other appropriate physicians and allied health professionals attend and actively participate in the conference. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines are available for diagnostic work-up, and treatment planning, and follow-up care. CME credit is provided to physicians attending conferences. During 2006, 49 cases were presented.

To schedule Tumor Conference cases for presentation or to obtain the conference schedule, physicians may call Susan Stahl in the STPH Tumor Registry at (985) 871-5885.

The registry also has pocket guides available to physicians for AJCC staging and the NCCN Clinical Practice Guidelines.

Chryl Corizzo, STPH Cancer Program Director, Judy Limbaugh, MD, Pathology, Angela Buonagura, MD, Surgery, Greg Henkelmann, MD, Radiation Oncology at the monthly Tumor Conference.

2007 mbpcc | stph cancer program annual report

northshore cancer leaders earn national recognition The Commission on Cancer has granted a three year approval status with commendation to the Cancer Program of St. Tammany Parish Hospital and Mary Bird Perkins Cancer Center. This ensures patient access to quality care close to home; comprehensive care, including a range of state-of-the-art-services and equipment; a multidisciplinary team approach to coordinate the best treatment options; information about ongoing clinical trials; new treatment options; education and support; lifelong patient follow-up through a cancer registry that collects data on type and stage of cancers and treatment results; and ongoing monitoring and improvement of care. This approval status is subject to review on-site every three years.

The Cancer Program at St. Tammany Parish Hospital and Mary Bird Perkins Cancer Center is one of 1,400 such accredited programs in the nation and the only approved cancer program in West St. Tammany Parish. This status equates to quality cancer care–only 25% of the hospitals in the country are approved cancer programs, but they diagnose and treat 80% of cancer patients.

Together MBPCC and STPH coordinate the entire continuum of cancer care. Radiation oncology is available at MBPCC and diagnostic and rehabilitative modalities, surgery and medical oncology are available at STPH. Although organizationally independent, MBPCC and STPH collaborate closely with one another to promote a seamless, multidisciplinary cancer treatment delivery system for patients and their families.

MARY BIRD PERKINS cancer CENTER

Serving a 15-parish area, MBPCC treats more patients with radiation therapy than any other facility in the state. The combined size and expertise of the center’s team of 10 medical physicists, six dosimetrists and six radiation oncologists cannot be found elsewhere in Louisiana. Through its joint research and academic partnership with Louisiana State University’s Department of Physics and Astronomy, advances are being made in radiation therapy and medical imagining research.

MBPCC created the C.A.R.E. Network in 2002 to address Louisiana’s inordinately high cancer mortality rates. Intent upon providing increased screening services to the medically underserved and ultimately lowering cancer mortality rates in its service area and beyond, it now has the only mobile medical clinic, the Early Bird, in the area dedicated to comprehensive community cancer screenings.

ST. TAMMANY PARISH HOSPITAL Residents choose STPH, the leading provider of comprehensive medical care on the Northshore, more than any other healthcare resource. As the only approved community hospital cancer program in West St. Tammany Parish accredited by the American College of Surgeons, STPH delivers to patients on the Northshore the highest quality care available. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, the STPH system delivers the very latest technology, the most accomplished specialists and highly personalized, caring staff to ensure patients and their families receive world-class healthcare close to home.

The STPH Cancer Resource Center serves to assist those diagnosed with cancer and their caregivers throughout their cancer experience. Information is available on cancer prevention, early detection, cancer treatment, survivorship and coping resources. The center also provides wigs, scarves and hats for those who need them and a library of print and online cancer resources.

2007 mbpcc | stph cancer program annual report

INTEGRATED CANCER PROGRAM SUPPORTIVE AND CONTINUING CARE SERVICES

DIAGNOSTIC SERVICES

Pathology Laboratory

898-4417

Radiology

898-4427

CT Scanner, Ultrasound, Nuclear Medicine, MRI

898-4427

Breast Center

612-2100

875-2234

Mammography, Bone Density, Stereotactic Needle Biopsy, Ultrasound, Dedicated Radiologists with Specialty in Breast Disease

TREATMENT SERVICES

Inpatient Medical/Oncology Unit

871-5700

Outpatient Infusion Unit - Patient scheduling

871-5665

Radiation Therapy

875-2234

External Beam Radiotherapy

875-2234

Intensity Modulated Radiation Therapy (IMRT)

875-2234

Prostate Seed Implantation

875-2234

898-4581

Radiation Treatment Planning

875-2234

Image Fusion

875-2234

Medical Physics/Dosimetry

875-2234

Computerized Axial Tomography (CT)

875-2234

Simulation

875-2234

Surgery

898-4432

SUPPORTIVE/REHABILITATIVE SERVICES

Cardiac Rehabilitation

898-3780

Cancer Committee

898-4581

Enterostomal/Wound Therapy

898-4053

Ethics Committee

898-4581

Home Health

898-4414

Hospice

871-5976

Nutritional Services

898-4063 875-2234

Pastoral Care/Clergy Community Support

898-4562

Pharmacy

898-4423

Physical/Occupational/Speech Therapy/Certified Lymphedema Therapy

892-4622

Pulmonary Rehabilitation

898-3785

Social Services/Case Management

898-4429 875-2234

875-2234

2007 mbpcc | stph cancer program annual report

COMMUNITY OUTREACH AND EDUCATION

Cancer Risk Assessments/Cancer Screenings

898-4481

875-2234

Cancer Resource Center

898-4581

875-2234

Camp Courage Bereavement Camp for Children

871-5976

Cancer Connection Newsletter

898-4581

Education for Health Professionals

898-4084

875-2234

Continuing Medical Education

898-4084

875-2234

Continuing Nursing/Allied Health Education

898-4084

Multidisciplinary Tumor Conferences

871-5885

Elder Services

898-4043

Genetic Cancer Risk Assessment & Counseling Program

898-4581

Look Good, Feel Better

898-4481

Lymphedema Prevention Clinics & Seminars

875-2234 875-2234 875-2234

Meals on Wheels

898-4062

Patient Library

898-4581

Pain Management

898-4581

875-2234

Patient Transportation

898-4581

875-2234

Reach to Recovery Volunteer Visitation

612-2111

Tobacco Cessation Classes/Information

898-4581

875-2234

Speakers Bureau

898-4581

875-2234

Weight and Stress Control Programs

898-4581

Wig Resource Center

898-4481

SUPPORTIVE CARE SERVICES

Bereavement Support Group (adult & children)

871-5976

Better Breathers Support Group

898-3785

Breast Cancer Support Group

612-2111

Cancer Connection Support Group

898-4581

Caring for the Caregiver Support Group

898-4414

RESEARCH

Clinical Research

875-2234

Cancer Registry

875-2234

2007 mbpcc | stph cancer program annual report

898-4125

THE 2006 MbpCC CANCER REGISTRY REPORT % Sites % Top TopMALE MALECancer Cancer Sites 35 30

MBPCC ACS

25 20 15 10 5 0

Prostate

Lung & Bronchus

Colon & Rectum

Urinary Bladder

Melanoma of Skin

% Top FEMALE Cancer Sites 50

The Cancer Registry is a specialized data system designed for the collection, management and analysis of demographic, diagnostic, treatment and staging data on cancer patients treated at Mary Bird Perkins Cancer Center (MBPCC).

The MBPCC Cancer Registry reference date is 1999 and contains data on 1,901 cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) and the Louisiana Tumor Registry (LTR). High importance is placed on data quality using these guidelines, and a sample of the cases are reviewed by a radiation oncologist for quality assurance. Once part of the registry database, these cases are followed for the life of the patient. The MBPCC Cancer Registry maintains a follow-up rate averaging 94% exceeding the ACoS minimum standard of 80% for all eligible analytic patients from the cancer registry reference date.

Of the 297 newly accessioned cases in 2006, 253 were analytic and 44 were non-analytic*. The top five sites treated were breast, lung, prostate, larynx, and colorectal**.

The Registry maintains cancer data that is available for use by clinical and administrative staff at MBPCC. All information collected is kept completely confidential. During 2006, the Registry received requests for statistical reports including analytic studies, annual statistics, research activities, quality management studies, reporting to the state cancer registry, and reporting to the National Cancer Data Base.

Nicole Magee, C.T.R., Cancer Registry, MBPCC

MBPCC

40

ACS

30

20

10

0

Breast

Lung & Bronchus

Colon & Rectum

Uterine NH Corpus Lymphoma

% Top FEMALE Cancer Sites

* Analytic cases are those receiving all or part of the first course of therapy at Mary Bird Perkins Cancer Center within the first four months of diagnosis. Non-analytic cases are those not seen within the first four months following diagnosis. **Colorectal includes rectum, colon, and anus.

2007 mbpcc | stph cancer program annual report

MBPCC Covington 2006 Distribution Site Table Site Group

total cases

All Sites Blood/Bone Marrrow Myeloma Brain Breast Digestive System Anus, Anal Canal, Anorectum Colon Esophagus Pancreas Rectum & Rectosigmoid Stomach Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Vagina Uterus, NOS Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma Male Genital Penis Prostate Testis Oral Cavity/Pharynx Floor of Mouth Hypopharynx Nasal Cavity, Sinus, Ear Nasopharynx Salivary Glands, Major Tongue Tonsil Respiratory/ Intrathoracic Larynx Lung/Bronchus,Non-Small Cell Lung/Bronchus,Small Cell Skin Melanoma of Skin Other Skin Cancer Soft Tissue Unknown or Ill-Defined Urinary Tract Bladder Kidney and Renal Pelvis

class

sex

AJCC stage at diagnosis*

297 1 1 4 77 36 1 2 6 6 17 4 13 3 5 1 2 1 1 9 1 8 50 1 47 2 13 1 1 2 1 2 3 3

A 253 1 1 3 65 32 1 1 6 6 15 3 11 3 4 0 2 1 1 8 0 8 44 1 41 2 12 1 1 2 1 2 2 3

N/A 44 0 0 1 12 4 0 1 0 0 2 1 2 0 1 1 0 0 0 1 1 0 6 0 6 0 1 0 0 0 0 0 1 0

M 141 1 1 4 1 21 0 1 6 4 7 3 0 0 0 0 0 0 0 2 1 1 50 1 47 2 9 0 1 1 1 1 2 3

F 156 0 0 0 76 15 1 1 0 2 10 1 13 3 5 1 2 1 1 7 0 7 0 0 0 0 4 1 0 1 0 1 1 0

0 13 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

I 50 0 0 0 23 2 0 0 0 0 2 0 4 0 4 0 0 0 0 4 0 4 3 1 1 1 2 0 0 2 0 0 0 0

II 70 0 0 0 15 10 0 0 1 3 6 0 4 2 0 0 1 1 0 2 0 2 27 0 26 1 4 1 1 0 0 1 1 0

III 51 0 0 0 12 8 1 1 3 0 3 0 0 0 0 0 0 0 0 0 0 0 6 0 6 0 2 0 0 0 0 1 1 0

IV 47 0 0 0 2 8 0 0 1 1 3 3 0 0 0 0 0 0 0 2 0 2 6 0 6 0 4 0 0 0 1 0 0 3

N/a 13 1 1 3 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0

Unk 9 0 0 0 1 4 0 0 1 2 1 0 2 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0

74 8 54 12 6 2 4 3

66 8 47 11 4 1 3 2

8 0 7 1 2 1 1 1

44 7 31 6 3 1 2 1

30 1 23 6 3 1 2 2

1 1 0 0 0 0 0 0

9 2 5 2 3 1 2 0

8 0 8 0 0 0 0 0

21 3 13 5 1 0 1 1

25 2 19 4 0 0 0 0

1 0 1 0 0 0 0 1

1 0 1 0 0 0 0 0

5 6 4 2

5 0 0 0

0 6 4 2

2 3 3 0

3 3 1 2

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

5 0 0 0

0 0 0 0

* Staging is based on AJCC/Collaborative staging.

2007 mbpcc | stph cancer program annual report

stph tumor registry report 2006 Comparison 5 year relative survival rates of major sites see at STPH by all stages at diagnosis, 1995–2001 100

STPH ACS

80

60

40

20

0

Breast

Colorectal

Lung

Prostate

Bladder

% Top Male Cancer Sites 35 30 STPH

25

ACS

20 15 10 5 0

40

Prostate

Lung & Bronchus

Colon & Melanoma Rectum

Bladder

% Top Female Cancer Sites

35 30 STPH

25

ACS

20 15

5

The St. Tammany Parish Hospital (STPH) Cancer Registry is an integral part of the Commission on Cancer Approved Cancer Program and functions under the Cancer Committee to collect data on cancer type, stage, and treatment results, and offers lifelong patient follow-up. These cases are reported, as required and per HIPAA standards, to the American College of Surgeons, (ACoS), the Louisiana Tumor Registry (LTR), the National Cancer Data Base (NCDB) and the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute.

When combined with other cancer cases nationally, researchers are able to identify trends in cancer incidence and mortality, as well as patterns in diagnosis, treatment, and survival. The Registry recommends the American College of Surgeons, National Cancer Database, website for “Public Access to Cancer Data” at http://www.facs.org/cancer/ncdb/publicaccess.html to view local, state, and national comparisons of cancer registry data.

In 2006 the Registry abstracted 616 new cancer cases (488 analytical/128 non-analytical). The analytical cases (38% male and 62% female) had a median age of 63 years (age 65 males/age 63 females), a continual drop in age at diagnosis, especially in females since 2003. The majority of patients (82%) were diagnosed with local or regional disease and 89% were diagnosed and treated or treated only at our facility (class 1 and 2) demonstrating confidence in the ability to access quality cancer care close to home. Since our reference date of January 1993, 4,727 total cases have been entered into the Registry with 2,131 requiring follow-up. The current follow-up rates are within the ACoS follow-up standard requirement.

Overall, breast cancer continues to be the major site diagnosed and treated at STPH (25%), with an increase of 62% since 2005. The increase is due in part to the St. Tammany Breast Center now having dedicated radiologists and the increasing use of stereotactic and core biopsies. Comparison of 2006 STPH data with expected 2006 national trends2 showed consistency in the major sites diagnosed. Prostate cancer is typically diagnosed in non-hospital settings, a trend reflected in our data.

Survival rates are consistent with The American Cancer Society’s latest research.3 Now that our reference date is old enough for comparison of survival data, in this year’s report we are including a graph showing 5Yr Relative Survival Rates All Stages at Diagnosis, 1995-20013 of our main cancer sites seen at STPH with the American Cancer Society’s Surveillance Research, 2006 rates.

The Cancer Registry participated in performance improvement activities and served as a valuable data resource providing reports on selected information to physicians at monthly tumor conferences, hospital-wide departments, and even outside sources. Staff continued to act as one of two national hospital advisors (outside of California) and are active members of the Louisiana Cancer Registrars Association.

Beverly F. Villemuer, C.T.R., Cancer Registrar 1 Excerpts from the American College of Surgeons CoC-Approved Cancer Programs at www.facs.org 2 from the American Cancer Society, Cancer Facts & Figures, 2006 3 from the American Cancer Society, Surveillance Research, 2006

10

0

“So, as you begin thinking about treatment and ongoing care for your condition… the care you need may be right in your own community. ….by coming to an approved cancer treatment program, you can be sure that you will receive the best in diagnosis and treatment of cancer…And you can be sure that your condition will be watched carefully through a lifelong program of follow-up care.”1

Breast

Lung & Bronchus

Colon & NH Thyroid Rectum Lymphoma

2007 mbpcc | stph cancer program annual report

stph 2006 distribution site table Site Group

total cases

All Sites Blood/Bone Marrrow Leukemia Myeloma Other Hematopoietic Brain Breast Digestive System Anus,Anal Canal,Anorectum Bile Ducts Colon Esophagus Gallbladder Liver Other Digestive Pancreas Rectum & Rectosigmoid Small Intestine Stomach Endocrine Other Endocrine Thyroid Female Genital Cervix Uteri Cervix In Situ Ca Corpus Uteri Ovary Vulva Other Female Genital Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma** Male Genital Penis Prostate Testis Oral Cavity/Pharynx Gum Mouth, Other & Nos Nasopharynx Oropharynx Pharynx & Ill Defined Salivary Glands, Major Tongue Tonsil Peritoneum,Omentum,Mesent Respiratory/ Intrathoracic Larynx Lung/Bronchus,Non-Small Cell Lung/Bronchus,Small Cell Pleura Skin Melanoma of Skin Other Skin Cancer Soft Tissue Unknown or Ill-Defined Urinary Tract Bladder Kidney and Renal Pelvis

class

sex

616 39 20 9 10 7 145 121 4 3 48 10 2 9 2 10 23 3 7 15 2 13 52 11 7 10 13 10 1 31 2 29 40 1 36 3 8 1 1 1 1 1 1 1 1 1

A 488 28 14 7 7 3 122 104 3 3 45 8 2 8 2 9 15 3 6 14 2 12 44 8 7 9 9 10 1 23 2 21 31 0 28 3 5 1 0 1 1 0 1 1 0 1

N/A 128 11 6 2 3 4 23 17 1 0 3 2 0 1 0 1 8 0 1 1 0 1 8 3 0 1 4 0 0 8 0 8 9 1 8 0 3 0 1 0 0 1 0 0 1 0

M 239 16 12 4 7 2 0 67 1 2 25 8 2 8 1 3 11 1 5 3 1 2 0 0 0 0 0 0 0 13 0 13 40 1 36 3 5 1 0 1 0 1 0 1 1 1

F 377 15 8 5 3 5 145 54 3 1 23 2 0 1 1 7 12 2 2 12 1 11 52 11 7 10 13 10 1 18 2 16 0 0 0 0 3 0 1 0 1 0 1 0 0 0

0 62 0 0 0 0 0 25 11 1 0 6 2 0 0 0 0 2 0 0 0 0 0 15 0 6 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

78 3 70 4 1 34 29 5 5 6 34 19 15

66 3 58 4 1 19 18 1 1 3 24 13 11

12 0 12 0 0 15 11 4 4 3 10 6 4

38 1 35 1 1 19 17 2 1 3 24 13 11

40 2 35 3 0 15 12 3 4 3 10 6 4

1 1 0 0 0 2 2 0 0 0 8 8 0

AJCC Stage at Daignosis* I 116 0 0 0 0 0 45 15 1 0 7 1 0 1 0 1 4 0 0 8 0 8 9 3 0 4 2 0 0 4 0 4 4 0 3 1 1 0 0 0 0 0 1 0 0 0

II 88 0 0 0 0 0 25 22 0 1 12 2 1 2 0 0 4 0 0 3 0 3 3 2 0 1 0 0 0 3 1 2 20 0 19 1 2 0 0 0 1 0 0 1 0 0

III 72 0 0 0 0 0 10 16 1 0 9 0 0 1 0 1 3 0 1 1 0 1 9 3 0 1 5 0 0 4 1 3 6 0 5 1 0 0 0 0 0 0 0 0 0 0

IV 76 0 0 0 0 0 6 23 0 1 7 2 1 2 0 7 1 0 2 0 0 0 5 0 0 3 1 0 1 11 0 11 0 0 0 0 1 0 0 1 0 0 0 0 0 1

NA 53 28 14 7 7 3 1 11 0 0 2 0 0 0 2 0 1 3 3 2 2 0 2 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0

UNK 21 0 0 0 0 0 10 6 0 1 2 1 0 2 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0

8 1 7 0 0 12 11 1 0 0 10 2 8

6 0 6 0 0 2 2 0 0 0 2 1 1

21 1 18 2 0 1 1 0 1 0 3 1 2

26 0 23 2 1 2 2 0 0 0 1 1 0

2 0 2 0 0 0 0 0 0 3 0 0 0

2 0 2 0 0 0 0 0 0 0 0 0 0

*Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.

Note: Sex and AJCC Stage-Analytic Cases only. Abbreviations: M=Male; F=Female; A=Analytical; Unk=Unknown; NA=Not Applicable; AJCC=American Joint Commission on Cancer, *Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.

2007 mbpcc | stph cancer program annual report

discussion of rectal cancer american cancer society screening recommendations for men and women starting at age 50 Have one of these tests: • Test to look for blood in the stool every year –OR– • A flexible sigmoidoscopy to look in the lower part of the colon every 5 years –OR– • Test to check for blood in the stool each year and a flexible sigmoidoscopy every 5 years –OR– • An x-ray of the colon (barium enema) every 5 years –OR– • A test to look at the entire colon (colonoscopy) every 10 years your doctor can help you decide which of these tests are best for you.

Get your free colorectal cancer screening kit by calling the Cancer Resource Center at 898.4581.

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In 2006, approximately 52,000 Americans died from colorectal cancers, and nearly 41,500 new cases were diagnosed. While rare, gastrointestinal stromal tumors can occur in the rectum as well.

Colorectal cancer incidence is higher in individuals with hereditary conditions, such as familial polyposis, hereditary nonpolyposis colon cancer (HNPCC) or Lynch Syndrome Variants I and II and people with a history of ulcerative colitis or Crohn’s colitis. Those groups account for 10% to 15% of colorectal cancers. An additional 23% of colorectal cancers are found in patients with a history of colorectal cancer or adenomas, first degree family history of colorectal cancer or adenomas and a history of ovarian, endometrial or breast cancer.

Therefore, more than 60% of colorectal cancer diagnoses are given to patients who are not in high-risk categories. Because of the frequency of the disease, the slow growth of primary lesions, the better survival of patients with early-stage lesions and the relative simplicity and accuracy of early detection kits, screening for rectal cancer should be routine for adults age 50 and over—especially those with first-degree relatives with colorectal cancer. For those diagnosed with localized disease, rectal cancer is highly treatable and often curable. Surgery is the primary treatment and results in cure in approximately 45% of patients.

Diagnosis & Staging The prognosis of rectal cancer is clearly related to the degree of the tumor’s penetration through the bowel wall and the presence or absence of nodal involvement. These two characteristics form the basis for all rectal cancer staging systems. Preoperative staging procedures include digital rectal examination, computed tomographic scan or magnetic resonance imaging scan of the abdomen and pelvis, endoscopic evaluation with biopsy and endoscopic ultrasound (EU).

As an accurate indicator of tumor stage and the status of the perirectal nodes status, EU can influence therapy by determining which patients may be candidates for local excision (rather than more extensive surgery) and which patients may benefit from preoperative chemotherapy and radiation therapy to maximize the likelihood of resection with clear margins.

The American Joint Committee on Cancer and a National Cancer Institutesponsored panel recommends at least 12 lymph nodes be examined in patients with colorectal cancers to confirm the absence of nodal involvement by tumor. The number of lymph nodes assessed reflects both the aggressiveness of lymphovascular mesenteric dissection and the pathologic identification of nodes in the specimen.

While other prognostic factors have been considered, retrospective studies indicate the number of lymph nodes examined in colon and rectal surgery may be associated with patient outcome.

A large number of studies have evaluated various clinical, pathological, and molecular parameters with prognosis. Clinical and pathologic stage remain the two most important prognostic indicators but progress is being made in stratifying patients based on molecular markers.

In those patients with disease penetration through the bowel wall and/or spread into lymph nodes at diagnosis, local recurrence following surgery is common often ultimately results in death. The radial margin of resection of rectal primaries may also predict for local recurrence.

2007 mbpcc | stph cancer program annual report

Evaluation After Treatment Following treatment of rectal cancer, periodic evaluations may lead to the earlier identification and management of recurrent disease. However, the overall mortality of patients with recurrent rectal cancer is not affected by such monitoring because of the relatively small proportion of patients in whom localized, potentially curable metastases are found.

Carcinoembryonic antigen (CEA) frequently provides information for the management of patients with rectal cancer. CEA has proven to be unreliable as a screening test, so postoperative CEA testing should be restricted to patients who might be candidates for resection of liver or lung metastases. However, routine use of CEA alone for treatment response is not recommended. Unfortunately, since the impact on patient survival is not clear and the quality of data is poor, the optimal regimen and frequency of follow-up examinations are not well defined. CEA immunoscintigraphy and positron tomography are under clinical evaluation.

Adjuvant therapy Staging is determined by disease penetration through the bowel wall, spread to regional lymph nodes or to distant sites. Patients with more advanced stage rectal cancer are at high risk for local and systemic relapse. Adjuvant therapy should address both problems.

Most trials of preoperative or postoperative radiation therapy alone have shown a decrease in the local recurrence rate but no definite effect on survival. Two trials have confirmed fluorouracil (5-FU) plus radiation therapy is effective and may be considered standard treatment. In these trials, combined modality adjuvant treatment with radiation therapy and chemotherapy following surgery resulted in local failure rates lower than with either therapy alone.

Patients treated with postoperative chemotherapy/radiation therapy combination may have more chronic bowel dysfunction compared to those who undergo surgical resection alone. Improved radiation planning and techniques—such as the use of multiple pelvic fields, prone positioning, customized bowel immobilization molds (belly boards), bladder distention, oral contrast visualization of the small bowel and the incorporation of three-dimensional or comparative treatment planning—can minimize treatment-related complications. Ongoing clinical trials comparing preoperative and postoperative adjuvant chemoradiotherapy should further clarify the impact of either approach on bowel function, sphincter preservation and other important quality-of-life issues as well as the more conventional endpoints of disease-free and overall survival.

Advanced Disease Radiation therapy in rectal cancer is palliative in most situations but may have greater impact when used perioperatively. Approximately 10% to 20% of patients receive relief with 5-FU. Several studies suggest the combination of leucovorin and 5-FU improves response rate and palliation of symptoms but not necessarily survival. Irinotecan (CPT-11) and oxaliplatin (alone or combined with 5-FU and leucovorin) has also shown activity in 5-FU refractory patients. Clinical trial participation is also appropriate.

Rectal Cancer Outcomes Study The Cancer Committee compared patterns of treatment and outcomes (survival) of patients diagnosed and treated with rectal cancer at STPH and MBPCC with the National Cancer Data Base(NCDB) Benchmark Report during the 2000-2003 reporting period. Table 1 provides a statistical overview of comparisons. The race and gender of the patients seen at STPH and MBPCC do not differ statistically 2007 mbpcc | stph cancer program annual report

Mary Ella Sanders, MD Radiation Oncology, Mary Bird Perkins Cancer Center

For more information on rectal cancer, visit: www.cancer.org www.nccn.org www.stph.org www.marybird.org 11

The STPH/MBPCC Experience Observed survival rate comparisons (%)

by AJCC stage for rectal cancer causes between NCDB*, STPH and those treated only at STPH/MBPCC

AJCC Stage All stages 0 I II III IV

NCDB* 1998 n=16123

55.9 77.6 73.8 59.4 49.8 6.1

STPH/ STPH MBPCC 1993–2005 1993–2005 n=131 n=65

64.0 70.5 67.5 65.8 72.9 33.9

68.5 # 81.8 62.1 90.0 28.6

AJCC: American Joint Commission on Cancer *NCDB data reported from 1261 Hospitals of all types # - No comparison data

from those in the NCDB Database. The age at diagnosis seems to trend downward with a slightly younger population seen at both STPH and MBPCC compared to NCDB. Adenocarcinoma was as expected the predominant histology seen at both STPH and MBPCC. Both STPH and MBPCC/STPH saw a similar proportion of early (Stage I/II) versus late (Stage III/IV) rectal cancers as NCDB. Comparing treatment at STPH and MBPCC/STPH with NCDB shows certain dramatic shifts toward the use of chemotherapy and radiation.

When done, surgery does not vary greatly between the 3 data sets with two exceptions. Fewer patients having transanal or excisional biopsies were noted in the MBPCC/STPH group because many of the patients were unable to receive radiation.

Also there are twice as many abdominoperineal resections done at MBPCC/STPH as is done at either NCDB or STPH, which may be related to age at diagnosis.

Survival rates appear to be favorable for patients treated at STPH and MBPCC/ STPH when compared with the NCDB database across all stages. However, the small numbers of patients seen locally makes it difficult to evaluate the significance of the NCDB comparison.

TABLE I Rectal cancer statistical overview/comparison NCDB/STPH (2000–2003) benchmark comparison report with patients treated only at STPH/MBPCC (1993–2005)*

GENDER AGE AT DIAGNOSIS

RACE

INSURANCE

HISTOLOGY

AJCC STAGE

TREATMENT

* m ay not equal 100% due to rounding errors; only comparable NCDB data displayed # No comparison data NOS = Not Otherwise Specified ** 17 of the 20 patients having local excisions had trananal biopsies. Of those patients, 9 had post-operative radiation.

Others had comorbidities that negated radiation or radiation was not recommended.

12

SURGERY TYPE

2007 mbpcc | stph cancer program annual report

COMMUNITY SUPPORT GROUPS AND ACTIVITIES BEREAVEMENT SUPPORT GROUPS

CHILDREN’S GRIEF SUPPORT GROUP

LYMPHEDEMA PREVENTION CLINICS

Open to anyone in the community who has experienced a loss from the death of a loved one. The group is held in short sessions (871-5976).

Open to children ages 7–12 in the community who have experienced the death of a loved one (871-5976).

One-on-one assessments with a certified lymphedema therapist are offered free of charge periodically throughout the year to breast cancer survivors who have had lymph nodes removed (1.888.616.4687).

BETTER BREATHERS SUPPORT GROUP

Designed for adults with lung disease interested in better living and their caregivers. (898-3785).

BREAST CANCER SUPPORT GROUP

Designed to provide support and information to individuals diagnosed with breast cancer. Meets on the second Tuesday of each month (612-2111).

CANCER SURVIVORS DAY

Held in June, National Cancer Survivors Day, this program provides support and recognition to individuals within our community who have had a cancer diagnosis and their caregivers, and to celebrate survivorship (898-4581).

GENETIC CANCER RISK ASSESSMENT & COUNSELING PROGRAM

Provides genetic counseling and screening services at no cost to individuals at high risk for cancer development to help patients and their families make informed decisions about their medical options, including screening for early detection, ways to reduce personal risk, and genetic testing. Co-sponsored by St. Tammany Parish Hospital, Mary Bird Perkins Cancer Center, and the Leonard C. Thomas HOS Foundation (898-4581).

HOSPICE VOLUNTEER TRAINING

Offered for those interested in becoming a Hospice volunteer. Volunteers are used in direct patient care, office support, bereavement care, community education, and fundraising events (871-5976).

HOSPICE 101

CANCER CONNECTION SUPPORT GROUP

This monthly support group is for individuals, family members, and friends who are challenged by a diagnosis of cancer. It provides an atmosphere for expressing thoughts, feelings, and expectations. Participants can share experiences and learn to adapt to lifestyle changes. Meetings are the third Wednesday of each month. Call 898-4581 for more information. caring for the CAREGIVER SUPPORT GROUP

This monthly support group is specifically for caregivers to share hope and support in caring for loved ones (898-4414).

Provided for those interested in learning more about Hospice, care of the terminally ill, and compassionate care for those at the end of life (871-5976).

LOOK GOOD, FEEL BETTER

Offers skin, nail, and hair care tips that can enhance appearance and improve self-image while undergoing cancer treatment. Our professionals will help you with a 12-step make-up guide, choosing and caring for a wig, and dealing with skin changes. Cosmetics provided. Held monthly (898-4481).

LUNCH AND LEARN EDUCATIONAL PROGRAMS

Offered frequently throughout the year on a variety of topics for individuals diagnosed with cancer, their families, friends, and caregivers who support them (898-4481).

2007 mbpcc | stph cancer program annual report

meditation education series

Free classes are held throught the year and teach techniques to improve health and well-being during and after cancer treatments (898-4581).

REACH TO RECOVERY

Specially trained breast cancer survivors volunteer to provide one-on-one support to cope with breast cancer. They respond personally to concerns of those facing breast cancer diagnosis, treatment, recurrence, or recovery (612-2111).

SMOKING CESSATION

Classes scheduled throughout the year.

When combined with other smoking cessation efforts, structured classes can greatly increase the chances of quitting for good. Co-sponsored by St. Tammany Parish Hospital and Mary Bird Perkins Cancer Center. Funding provided by the Louisiana Campaign for Tobacco-Free Living (898-4581).

WIG RESOURCE CENTER

This community service program offers wigs, turbans, hats, and scarves at no cost to women undergoing cancer treatment.

Our private fitting area is located in the Cancer Resource Center. Call 898-4481 for more information.

All programs offered at no charge.

Co-sponsored by ACS and STPH.

IV

1202 South Tyler Street Covington, LA 70433

39 Starbrush Circle Covington, LA 70433

www.stph.org

www.marybird.org 2007 mbpcc | stph cancer program annual report