2009 Mary Bird Perkins/St. Tammany Parish Hospital Annual Report

2009 Cancer Program Annual Report

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

2008 Cancer Committee Jack Saux, MD Hematology/Oncology Cancer Committee Chairman Greg Henkelmann, MD Radiation Oncology Cancer Liaison Physician Tumor Conference Coordinator Donna Berbling, RN, BSN Director of Hospice, STPH Robert Capitelli, MD Sr. Vice President, Chief Medical Officer, STPH Chryl Corizzo, RN, BSN, OCN Cancer Program Director, STPH Quality Improvement Coordinator, STPH Renea Austin-Duffin, MPA Vice President, Cancer Programs, MBP Community Outreach Coordinator, MBP Debbie B. Fascio, RT (R) (M) Assistant Department Head Imaging Services, STPH Terry Freeman, CTR Certified Tumor Registrar, MBP Covington Vickie Hall, LPN, RT (T) Director, MBP Covington Judy Limbaugh, MD Pathology CAPS Protocols Coordinator, STPH Nicole Magee, CTR Cancer Registry Director, MBP Registry Quality Control Coordinator, MBP

Kathy McWhorter, RN, MSN Director of Nursing, STPH Debra Miller, RN, OCN Cancer Resource Nurse, STPH Community Outreach Coordinator, STPH David Oubre, MD Hematology Oncology Ty Ovella, MD Radiology Teresa Palombo, RN, BSN, ET Department Head Medical Oncology Unit, STPH Juanita Schenck, LCSW Case Management, STPH Mary Clare Spansel Health Initiatives Representative, ACS Susan Stahl Tumor Registrar, STPH Teena Strand-Parker, RN Department Head Ambulatory Care, Pre-op, Infusion Suite, STPH Brenda Truxillo, RN Vice President, Radiation Oncology Services, MBP Quality Improvement Coordinator, MBP John Verhulst, MD General Surgery Registry Quality Control Coordinator, STPH Beverly Villemuer, CTR Certified Tumor Registrar, STPH

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

Jo Watkins, RPh Clinical Pharmacy Coordinator, STPH

Susan May, RN, BS Department Head Case Management, STPH

Angela Wilkie, PT, CLT Outpatient Rehabilitation, STPH

Chairman’s Report As Chairman of the Mary Bird Perkins Cancer Center (MBP) and St. Tammany Parish Hospital (STPH) Cancer Committee, I am pleased to present highlights of the 2008 Cancer Program annual report.

The Cancer Committee of MBP and STPH provides leadership in ensuring quality patient care through cancer-related activities that benefit not only patients and their families, but our community. As a cancer program approved by the American College of Surgeons (ACoS) Commission on Cancer (CoC), our mission is to ensure residents have access to a full range of medical services, a multidisciplinary approach to patient care and services that improve survival and quality of life. Our program provides an array of services across the entire cancer continuum with a focus on prevention, early diagnosis, pretreatment evaluation, staging, optimal treatment, rehabilitation, recurrent disease surveillance, support services and end-of-life care. Additional information about the CoC, its standards and affiliates is available at www.facs.org/cancer.

Jack E. Saux, III, MD

The Cancer Committee was active in numerous aspects of cancer control activities and services provided to patients, caregivers, health professionals and the community.

Highlights include: • STPH interventional radiologists became the first in the state to perform tumor ablation with kyphoplasty for spinal lesions, reduction of tumor burden and spinal stabilization.

• STPH Breast Center is now a member of the National Consortium of Breast Centers. The affiliation allows STPH to benchmark its quality against other centers throughout the country.

• After careful evaluation of several competing products, STPH pharmacy implemented the Phaseal closed system transfer device to limit medical professionals’ exposure to chemotherapeutic agents during preparation and administration.

• To reduce turnaround times from several days to 24 hours, STPH laboratory purchased an immunostainer and trained staff to process specimens in-house, which resulted in more expedient cancer diagnoses.

• MBP in Covington continued to provide radiation therapy services for many patients, treating over 414 newly-diagnosed cancer patients, providing over 1,230 follow-up visits and over 8,804 treatments.

• MBP continued to treat a wide range of cancers with radiation therapy, including breast (17%); lung (10%); prostate (13%); head and neck (17%); rectum (4%); GYN (5%); and other sites combined (34%).

• The Cancer Program also continued to emphasize early detection and cancer prevention by providing free screenings to the medically underserved. In recognition of major cancer awareness months, together we screened a total of 816 people at no charge for breast, colorectal, prostate and skin cancer in St. Tammany, Washington and Tangipahoa parishes.

• Over 100 people participated in free smoking cessation classes and 1,175 people took advantage of free patient and community education programs offered by the Cancer Program such as lymphedema prevention clinics, genetic counseling and Cancer Survivors’ Day. Every year, MBP and STPH are dedicated to promoting cancer education and prevention for the community we serve and improving all aspects of care across the cancer continuum. We look forward to another successful year of providing vital cancer services to the patients we are privileged to serve.

2009 MBP/STPH Cancer Program Annual Report

1

Integrated Supportive and Continuing Care Services

Diagnostic Services Pathology Laboratory

•

Radiology

•

CT Scanner, Ultrasound, Nuclear Medicine, MRI

•

•

Breast Center Mammography, bone density, stereotactic needle biopsy

•

Ultrasound, dedicated Radiologists specialty in breast disease

•

Endoscopy

•

Pulmonary Lung Navigation for Early Detection of Lung Cancers

•

Treatment Services Inpatient Medical Oncology Unit, Outpatient Infusion Suite

•

Radiation Therapy

•

External Beam Radiotherapy

•

Intensity Modulated Radiation Therapy (IMRT)

•

Radiation Treatment Planning

•

Image Fusion

•

Medical Physics, Dosimetry

•

Computerized Axial Tomography

•

Dental Oncology

•

Simulation

•

Surgery/DaVinci Robotic Surgical System

•

Interventional Radiology Percutaneous Vertebral Augmentation; Coblation of Malignant

•

Spinal Tumors, RF Liver Ablation; Nerve Root Ablation Supportive/Rehabilitative Services Cardiac/Pulmonary Rehabilitation

•

Enterostomal/Wound Therapy

•

Home Health/Hospice

•

Nutritional Services

•

Pastoral Care/Clergy Community Support

•

Physical/Occupational/Speech Therapy/ Certified Lymphedema Therapy

•

Social Services/Case Management

•

•

Cancer Screenings

•

•

Cancer Resource Center

•

Patient Education Forums

•

•

Community Outreach and Education

•

Education for Health Professionals Continuing Medical Education Continuing Nursing/Allied Health Education

•

Multidisciplinary Tumor Conferences

•

Elder Services

•

Genetic Cancer Risk Assessment & Counseling Program

•

Lymphedema Prevention Clinics & Seminars

• • • •

Patient Library (www.librarything.com/catalog/stphcrc)

•

Pain Management

•

•

Speakers Bureau

•

•

Research Clinical Research

•

Cancer Registry

•

2

MBP/STPH Cancer Program Annual Report

•

Cancer Liaison Physician’s Report The Cancer Liaison Physician Program was established in 1963 by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS).

As an ACoS multidisciplinary program, the CoC is dedicated to decreasing morbidity and mortality from cancer through education, standard setting and monitoring quality of care. Cancer Liaison Physicians serve as links between the CoC and the hospitals they represent, manage clinically-related cancer activities within their local institutions and partner with local community agencies, such as the American Cancer Society (ACS), to accomplish community outreach goals regarding education, early detection and prevention of cancer.

This year, the Cancer Committee has strengthened its program by promoting positive change within the CoC’s five priority areas. In 2008, those included: advocacy, quality improvement, ACS partnership, clinical trials and comprehensive cancer control.

Gregory C. Henkelmann, MD

The MBP/STPH Cancer Committee had particular success in following the Commission directives with regard to the following: 1. Implementation of quality improvement indicators to evaluate compliance with National Comprehensive Cancer Network (NCCN) work-up and follow-up guidelines.

2. Usage of NCCN treatment guidelines to determine low, moderate and high-risk patients in prostate cancer management.

3. Collaboration with the YMCA to implement the CancerFit exercise recovery and wellness program for cancer survivors that includes a walking component, in accordance with ACS outreach initiatives.

4. Conversion of STPH and all its satellites to smoke-free facilities with the Kick Butts Day, April 2, 2008. A task force worked for nine months to develop the plan and assist employees and the public in preparation including the ongoing smoking cessation class.

5. Implementation of ACoS staging standards that reflect a shift in priority from pathologic to clinic staging, use of prognostic factors and national treatment guidelines.

Besides focusing on those objectives, I continue to attend the quarterly meetings of the Cancer Committee and coordinate the monthly tumor conferences. I look forward to working with local and national organizations to improve our cancer program in the years ahead.

2009 MBP/STPH Cancer Program Annual Report

3

Together, MBP and STPH coordinate the entire continuum of cancer care.

Our comprehensive cancer program has been accredited with commendation since 2003 by the American College of Surgeons (ACoS) -- the gold standard for outstanding cancer programs. Approval is given only to those facilities that have voluntarily committed to provide the highest level of quality cancer care and undergo a rigorous evaluation process. The comprehensive cancer program is the only approved cancer program in West St. Tammany Parish.

The cancer program of MBP and STPH offers patients the most advanced comprehensive oncology program in the region, with a steadfast dedication to finding cancer and fighting it with our extensive resources and unique clinical expertise.

MBP has been solely dedicated to fighting cancer for over 35 years, serving 18 parishes in Southeast Louisiana. MBP has a variety of the best of class radiation therapy options. This means we can treat the most simple to the most complex cases, without accepting the limitations of a one-size-fits-all solution.

Unique to MBP is its nationally competitive medical physics program with Louisiana State University, one of only 15 affiliated graduate level programs in the country. MBP is home to the largest and most experienced medical physics team in Louisiana, including 13 medical physicists and 9 dosimetrists.

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 ACoS, STPH delivers the highest quality care available to patients on the Northshore. From wellness and prevention to diagnosis, treatment, rehabilitation and recovery, STPH 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 comprehensive cancer program of MBP and STPH provides free prostate, breast, skin and colorectal cancer screenings throughout the year, providing diagnostic and educational services to the under and uninsured populations of the Northshore.

St. Tammany Parish Hospital

4

MBP/STPH Cancer Program Annual Report

In 2002 MBP established its CARE Network outreach and support program, which is funded largely through the generosity of the community. Its mission is to reduce the incidence and mortality of cancer in Southeast Louisiana and to improve the quality of life for those impacted by cancer. Today, the CARE Network is a component of the cancer program of MBP and STPH, and is a best practice model for a partnership-based effort to effectively fight cancer within the community. Regional screening events provide diagnostic and educational services to underserved and uninsured populations throughout the parishes jointly served by the cancer program.

2008 St. Tammany, Washington and Tangipahoa Parishes Breast

Prostate

Colorectal

Skin

Total

Total Participants

444

152

125

95

816

Participants who have never been screened

65

26

60

61

212

Diagnosis of Cancer

1

0

0

2

3

MBP and STPH were proud to sponsor the 9th annual Cancer Survivors Day (CSD) Celebration titled “Living Through and After a Cancer Diagnosis.” Each June, CSD is celebrated in communities all over the country with the specific purpose of acknowledging over 12 million cancer survivors, their caregivers and the health professionals who care for and support them through treatment.

This year’s program was held at STPH and offered a unique opportunity to participate in breakout groups to discuss specific topics with physicians and other health professionals. Many topics were suggested by cancer survivors and included genetics and cancer risk, coping with fatigue, the physical and emotional changes associated with cancer, long-term effects of cancer treatment, pain and other symptoms, post treatment challenges of chemotherapy and radiation therapy, and the fear of cancer recurrence. Over 120 attendees were present at this very successful program. Much appreciation goes to additional program sponsors: Leonard C. Thomas HOS Foundation, The Louisiana Breast Cancer Task Force and Ponchartrain Hematology Oncology.

Mary Bird Perkins Early Bird Screening Van 2009 MBP/STPH Cancer Program Annual Report

5

Prostate Cancer Diagnosis and Management Other than skin cancers, prostate cancer is the most common cancer in men today. Approximately 1 out of 6 men will be diagnosed with prostate cancer during his lifetime. The encouraging news is more than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

In 2008, physicians diagnosed approximately 186,320 new cases of prostate cancer in the United States, and an estimated 28,660 Americans died from the disease.

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer.

About 1 out of 35 men will die of prostate cancer.

Carcinoma of the prostate forms in tissues of the prostate, a gland in the male reproductive system found below the bladder and in front of the rectum.

If localized, the disease may be curable. The cancer frequently responds to treatment even if tumors are widespread. Because tumor growth ranges from very slow to moderately rapid, some patients have prolonged survival even after the cancer has metastasized to bone and other distant sites.

Furthermore, since the median age at diagnosis is 72 years, many patients—especially those with localized tumors—die of other illnesses without the cancer ever causing significant disability. Age, coexisting medical problems and the side effect of medication determine the course of treatment.

The MBP/STPH Prostate Cancer Experience: The MBP/STPH Cancer Committee initially compared patterns of treatment and outcomes (survival) of patients diagnosed and/or treated with prostate cancer at MBP and STPH with data from the National Cancer Data Base (NCDB).

Table 1 presents an overview of prostate cancer entered from all approved cancer programs across the United States into the NCDB (769,534 cases) in comparison with patients with prostate cancer diagnosed and/or treated at MBP/STPH (234 cases) during the years 2000 through 2005. The data does not demonstrate significant variations in demographics, histology or stage. Slightly more radiation and hormonal therapy (androgen deprivation) was seen in patients receiving treatment locally, but small sample sizes make comparison difficult.

Table 1. Prostate Cancer Statistical Overview/Comparison of 2000-2005 Cancer Cases: NCDB Benchmark Data compared to Patients Diagnosed and/or Treated at MBP/STPH*

NCDB (%) 2000-2005

MBP/STPH (%) 2000-2005

Age At Diagnosis

40-49

2.6

2.1

50-59

19.8

20.5

60-69

37.4

31.6

70-79

31.9

37.2

80-89

7.8

8.6

White

78.5

85.5

Black

13.2

11.5

Other/Unknown

8.3

3.0

Adenocarcinomas, NOS Other Specified Types

95.3 4.0

97.9 2.2

Race

Histology

AJCC Mixed Stage

I

1.9

3.0

II

78.6

82.1

III

7.9

7.7

IV

4.9

3.4

Unknown

6.8

3.9

Treatment Summary (Overall)

Surgery Only

38.1

35.0

Radiation Only

22.0

21.8

Radiation Hormone Therapy

18.8

19.2

Surgery/Hormone Therapy

2.9

12.8

Hormone Therapy Only

5.2

4.7

Other Specified Therapy

4.2

3.0

No First Course Treatment

8.8

3.4

* May not equal 100% due to rounding errors; only comparable NCDB data displayed

6

MBP/STPH Cancer Program Annual Report

Integrating Stage and Prognostic Factors Staging of cancer is concerned with the anatomic extent of the disease, and for most cancers, is probably the most important factor in determining prognosis and treatment decisions for patients. But other independent prognostic factors of survival must also be considered, including age, comorbid conditions, histologic tumor grade/Gleason score (GS), prostatic specific antigen (PSA) blood levels, and surgical margin status among others.

Microscopic estimate of the cancer’s aggressiveness, Gleason score (GS), may be the single most important predictor of death from prostate cancer and is the preferred grading system. Scores are obtained by evaluating both the primary and secondary patterns of disease (each with a 1 to 5 range) which are then combined to provide a total score that may range from 2 to 10. The Gleason score is so important to prognosis that the 7th Edition 2010 AJCC Staging Manual will include Gleason score as part of the prognostic factors. Prior to 2010, Gleason score was not included in the staging of prostate cancer. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Prostate Cancer also reflect the importance of Gleason score, PSA level and clinical stage at initial clinical assessment.

The NCCN treatment guidelines for initial therapy of prostate cancer are based on the patient’s recurrence risk category (Table 2). Discussions with patients having low or intermediate risk recurrence disease may include active surveillance (watchful waiting/ observation, expectant management), surgery or radiation depending on risk factors present and the expected patient survival (greater or less than 10 years). Options for patients with high, very high or metastatic recurrence risk disease may include androgen deprivation therapy (ADT or hormone therapy), radiation or surgery, depending on individual risk factors present. Although the NCCN guidelines provide a frame of reference for standards of care, treatment decisions are individualized by the patient and physician based on clinical presentation, risk of recurrence, age and overall health.

Life expectancy and presence of symptoms are also factors in deciding course of treatment options and age is considered in both prognosis and aggressiveness of disease. Determination of the recurrence risk (the likelihood cancer is confined or has spread) based on the above findings guides initial therapy recommendations. The presence of multiple adverse risk factors shifts patients into a higher risk recurrence group.

The Committee elected to stratify Tumor Registry data for prostate cases diagnosed and treated at MBP/ STPH between 2000 and 2005 according to the NCCN risk recurrence categories to determine the use of suggested prognostic factors (stage, Gleason score, PSA levels and life expectancy) and guidelines for initial treatment.

Table 2. Risk Recurrence Categories per NCCN Guidelines Low Recurrence Risk

Meets all criteria: T stage T1-T2a, GS* 2-6 and PSA <10

Intermediate Recurrence Risk

Meets at least one criteria but does not involve higher risk factors: T stage T2b-T2c, GS 7, or PSA 10-20

High Recurrence Risk

Meets at least one criteria but does not involve higher risk factors: T stage T3a, GS 8-10 or PSA >20

Very High Recurrence Risk

T stage T3b-T4 with any GS any PSA but no nodal or metastatic involvement

Metastatic Recurrence Risk

Any T stage with nodal metastasis (N1) or distant metastasis (M1)

* GS = Gleason score NCCN Clinical Practice Guidelines in Oncology for Prostate Cancer â&#x20AC;&#x201C; v.1.2008 available at www.nccn.org

2009 MBP/STPH Cancer Program Annual Report

7

Table 3. MBP/STPH* Prostate Cancer Experience: Initial Therapy Catagorized by Recurrence Risk based on NCCN Clinical Practice Guidelines in Oncology for Prostate Cancer (v.1.2008)

Surg/Rad/Horm

Low Risk: 82 Cases; 93%-5yr Survival

Intermediate Risk: 83 Cases; 80%-5yr Survival

High Risk: 27 Cases; 85%-5yr Survival

Very High Risk: 4 Cases; 50%-5yr Survival

1 1

Surg/Rad

Surg/Rad/Trans

3 2

1 3

Surg/Horm

Surg/Trans

4

16

7 1

26

Surgery

Rad/Horm

Rad

Horm

None

5

1 3

25

14

6

2

7

37

23

4

1 1 1 1

*Cases diagnosed and treated during 2000-2005 at MBP/STPH

*Cases diagnosed and treated during 2000-2005 at MBP/STPH 5 year observed (cumulative) survival rates also documented.

Treatment Decisions For prostate cancer that is considered curable, patients must first decide with their physician if active surveillance is appropriate based on their age and other factors. Active surveillance involves active monitoring of the disease with the intent to provide treatment if the cancer progresses. If treatment is appropriate and the patient elects further treatment, surgery and/or radiation therapy can be effective options.

Table 3 portrays treatment patterns for prostate cancers diagnosed and treated at MBP/STPH. Little variation was seen when compared to the NCCN treatment patterns by recurrence risk category. The use of androgen deprivation therapy in early stage prostate cancer was observed in a small number of patients treated at MBP/ STPH and may be related to individual patient factors and preferences. Observed survival is also shown for MBP/STPH cases; no data is available from NCCN to make survival comparisons. Survival rates for patients treated at MBP/STPH (125 cases) with NCDB West Census Division data for our region (33,460 cases) are difficult to compare because of small sample size (Table 4).

8

MBP/STPH Cancer Program Annual Report

Discussion: The American Cancer Society (ACS) and the American Urological Association, US Preventive Services Task Force (USPSTF), American College of Physicians, National Cancer Institute, American Academy of Family Physicians, and American College of Preventive Medicine have changed their position regarding routine prostate screening. The update resulted from two, large, randomized trials, which demonstrated that wide spread, routine prostate screening does not lower the death rate from prostate cancer or increase survival rates from this disease.

ACS does not currently support routine testing for prostate cancer at this time. The ACS does believe that healthcare professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy.

Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer.

This includes African American men and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than age 65). This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age). If, after this discussion, a man asks his healthcare professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

Table 4. Observed Survival Rate Comparisons (%) for Prostate Cancer Cases Between NCDB* and Patients Treated Only at MBP/STPH

NCDB (%) 1998-2001

MBP/STPH (%) 1998-2001

AJCC Stage All Stages

84

86

I

80

100

II

87

90

III

89

86

IV

41

20

AJCC: American Joint Commission on Cancer * NCDB data compared to other hospitals in our geographic region

(119 cancer programs)

The USPSTF published an update of its recommendations in 2008. It concluded that the risks of screening for prostate cancer outweigh the benefits for men age 75 years or older (as well as for men whose life expectancy is 10 years or fewer). For these men, the USPSTF now recommends against prostate cancer screening. For men younger than 75 years old who have a life expectancy more than 10 years, the USPSTF indicates that the studies completed so far still do not provide enough evidence to know whether the benefits of testing for early prostate cancer outweigh the possible risks. For men in this age group, the USPSTF recommends healthcare providers determine whether the potential benefits and known harms of PSA screening and then allow the patientsâ&#x20AC;&#x2122; personal preferences to guide the decision of whether to order the test.

Prostate screening for men of appropriate age is readily available in primary care practices within our community. Physicians and their patients should determine whether prostate screening is appropriate.

For men who are underinsured or uninsured and meet the criteria MBP/STPH offers free prostate screenings several times per year in St. Tammany, Washington and Tangipahoa parishes. For dates and times, contact the Cancer Resource Center at 898-4581. The MBP/STPH Cancer Committee will be evaluating future prostate screening policies with the area urologists and Cancer Committee members.

References: Greene FL, Page DL, Fleming ID, et al, eds. AJCC Cancer Staging Manual , 6th ed. New York: Springer-Verlag, 2002.

NCCN Clinical Practice Guidelines in Oncology for Prostate Cancer â&#x20AC;&#x201C; v.1.2008 available at www.nccn.org

Detailed Guide: Prostate Cancer: Can Cancer be Found Early? from the American Cancer Society available at www.cancer.org da Vinci Surgical System at www.davincisurgery.com 2009 MBP/STPH Cancer Program Annual Report

9

MBP and STPH Cancer Registry Summary The American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry set guidelines for the collection of cancer cases nationwide by approved programs. High importance is placed on data quality using these guidelines, and a sample of the cases is reviewed by physician members of the Cancer Committee for quality assurance. Once part of the registry database, these cases are followed for the life of the patient.

The registries at MBP and STPH capture a complete summary of the history, diagnosis, treatment and disease status for every cancer patient. Registrars’ work leads to better information that is used in the management of cancer, and, ultimately, cures.

The STPH Cancer Registry reference date is 1993, and it contains data on 6,356 cancer cases. During the year 2008, there were 714 new cancer cases entered into the STPH registry database. Of these, 518 were analytic cases (newly diagnosed and/or received all or part of their first course treatment at this facility).

The top five sites seen were breast, lung, colorectal, non-Hodgkin’s lymphoma and prostate.

The MBP Cancer Registry reference date is 1998, and it contains data on 2,534 cancer cases.

During the year 2008, there were 344 new cancer cases entered into the MBP registry database. Of these, 288 were analytic cases (newly diagnosed and/ or received all or part of their first course treatment at this facility). The top five sites treated were breast, lung, prostate, cervix and rectum/rectosigmoid.

10

MBP/STPH Cancer Program Annual Report

The registries maintain cancer data that is available for use by clinical and administrative staff at STPH and MBP. All information collected is kept completely confidential.

During 2008, the registry received requests for statistical reports including analytic studies, annual statistics, research activities, quality management studies, healthcare delivery, reporting to the NCDB and participation in the Facility Information Profile System (FIPS) on the ACoS Commission on Cancer (CoC) website www.facs.org/cancer.

Data is submitted to the Louisiana Tumor Registry in compliance with state reporting requirements

by SEER to support statewide improvements in cancer detection and treatment. The registry also participates in the NCDB Cancer Program Practice Profile activities.

Beverly Villemuer, C.T.R. Certified Tumor Registrar, STPH President, Louisiana Cancer Registry Association 985-898-4125 Nicole Magee, C.T.R. Cancer Registry Director, MBP 225-215-1237

MBP 2008 Site Distribution Table SITE

TOTAL

GROUP

CASES

A

N/A

M

F

0

I

II

III

IV

NA

301

252

49

154

147

5

59

74

44

48

13

9

3

3

0

2

1

0

0

0

0

0

3

0

ALL SITES Blood/Bone Marrow

CLASS

Sex

AJCC STAGE AT DIAGNOSIS* UNK

Myeloma

3

3

0

2

1

0

0

0

0

0

3

0

Bone

1

0

1

0

1

0

0

0

0

0

0

0

Brain

4

3

1

3

1

0

0

0

0

0

3

0

Breast

69

61

8

2

67

5

28

14

9

3

0

2

Digestive System

34

29

5

22

12

0

4

11

6

5

0

3

Anus, Anal Canal, Anorectum

6

6

0

3

3

0

1

3

1

0

0

1

Colon

4

2

2

3

1

0

0

0

0

1

0

1

Esophagus

2

2

0

2

0

0

1

1

0

0

0

0

Gallbladder

1

0

1

1

0

0

0

0

0

0

0

0

Liver

1

0

1

1

0

0

0

0

0

0

0

0

Pancreas

2

2

0

1

1

0

1

0

0

1

0

0

Rectum & Rectosigmoid

13

12

1

8

5

0

1

6

4

1

0

0

Stomach

5

5

0

3

2

0

0

1

1

2

0

1

Endocrine

2

0

2

1

1

0

0

0

0

0

0

0

Thyroid

2

0

2

1

1

0

0

0

0

0

0

0

Female Genital

25

22

3

0

25

0

6

6

7

3

0

0

Cervix

16

15

1

0

16

0

4

3

5

3

0

0

Corpus Uteri

3

3

0

0

3

0

2

1

0

0

0

0

Ovary

1

0

1

0

1

0

0

0

0

0

0

0

Uterus, NOS

1

1

0

0

1

0

0

0

1

0

0

0

Vulva

3

2

1

0

3

0

0

1

1

0

0

0

Other Female Genital

1

1

0

0

1

0

0

1

0

0

0

0

Lymphatic System

12

8

4

4

8

0

6

1

1

0

0

0

Hodgkin's Disease

1

1

0

0

1

0

0

0

1

0

0

0

Non-Hodgkin's Lymphoma

11

7

4

4

7

0

6

1

0

0

0

0

Male Genital

56

43

13

56

0

0

3

34

0

5

0

1

Prostate

53

40

13

53

0

0

0

34

0

5

0

1

Testis

3

3

0

3

0

0

3

0

0

0

0

0

Oral Cavity/Pharynx

17

17

0

16

1

0

1

3

4

8

0

1

Hypopharynx

2

2

0

2

0

0

0

1

0

1

0

0

Lip

1

1

0

1

0

0

0

0

0

1

0

0

Mouth, Floor of Mouth, Other & NOS

1

1

0

1

0

0

0

0

0

1

0

0

Nasopharynx

4

4

0

3

1

0

1

1

1

1

0

0

Nasal Cavity, Sinus, Ear

1

1

0

1

0

0

0

0

0

1

0

0

Tongue

5

5

0

5

0

0

0

1

1

3

0

0

Tonsil

3

3

0

3

0

0

0

0

2

0

0

1

Other Nervous System

1

1

0

0

1

0

0

0

0

0

1

0

Respiratory/Intrathoracic

57

53

4

35

22

0

10

5

15

20

1

2

Larynx

4

4

0

4

0

0

2

0

1

1

0

0

Lung/Bronchus, Non-Small Cell

49

47

2

28

21

0

8

5

13

18

1

2

Lung/Bronchus, Small Cell

4

2

2

3

1

0

0

0

1

1

0

0

Skin

6

2

4

3

3

0

0

0

0

2

0

0

Melanoma of Skin

5

1

4

2

3

0

0

0

0

1

0

0

Other Skin Cancer

1

1

0

1

0

0

0

0

0

1

0

0

Soft Tissue

3

3

0

2

1

0

1

0

2

0

0

0

Unknown or Ill-Defined

6

5

1

4

2

0

0

0

0

0

5

0

Urinary Tract

5

2

3

4

1

0

0

0

0

2

0

0

Bladder

2

1

1

2

0

0

0

0

0

1

0

0

Kidney & Renal Pelvis

3

1

2

2

1

0

0

0

0

1

0

0

Note: AJCC Stage-Analytic Cases only *Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.

Abbreviations: M=Male; F=Female; A=Analytical; N/A=Non-Analytical; Unk=Unknown; NA=Not Applicable; AJCC=American Joint Commission on Cancer

2009 MBP/STPH Cancer Program Annual Report

11

STPH 2008 Site Distribution Table SITE

TOTAL

GROUP

CASES

A

N/A

M

F

0

I

II

III

IV

NA

UNK

714 45 22 9 14 2 4 165 145 5 3 70 12 1 4 3 14 15 7 11 13 12 1 59 12 4 12 14 4 9 4 39 5 34 36 1 32 3 14 2 3 3 1 5 101 1 86 13 1 26 23 3 6 13 46 19 26 1

518 25 17 3 5 0 1 119 115 3 2 58 7 1 3 2 11 13 5 10 13 12 1 47 9 4 12 9 4 8 1 28 4 24 28 1 25 2 5 0 0 3 0 2 74 1 65 7 1 14 12 2 3 9 37 14 22 1

196 20 5 6 9 2 3 46 30 2 1 12 5 0 1 1 3 2 2 1 0 0 0 12 3 0 0 5 0 1 3 11 1 10 8 0 7 1 9 2 3 0 1 3 27 0 21 6 0 12 11 1 3 4 9 5 4 0

313 27 15 2 10 1 2 1 78 3 2 31 10 0 2 0 6 10 5 9 6 5 1 0 0 0 0 0 0 0 0 24 1 23 36 1 32 3 13 2 2 3 1 5 66 0 61 4 1 16 15 1 1 7 35 14 20 1

401 18 7 7 4 1 2 164 67 2 1 39 2 1 2 3 8 5 2 2 7 7 0 59 12 4 12 14 4 9 4 15 4 11 0 0 0 0 1 0 1 0 0 0 35 1 25 9 0 10 8 2 5 6 11 5 6 0

59 0 0 0 0 0 0 25 10 1 0 8 0 0 0 0 0 0 0 1 0 0 0 15 0 4 0 0 4 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 6 6 0 0

129 0 0 0 0 0 0 43 14 0 0 8 0 1 0 0 0 4 0 1 9 9 0 11 4 0 4 2 0 0 1 5 0 5 2 0 0 2 1 0 0 1 0 0 15 0 15 0 0 7 6 1 1 0 21 6 15 0

106 0 0 0 0 0 0 36 26 1 0 15 3 0 0 0 1 5 0 1 0 0 0 4 1 0 2 0 0 1 0 7 3 4 20 0 20 0 2 0 0 1 0 1 7 0 6 1 0 2 1 1 0 0 2 0 2 0

75 0 0 0 0 0 0 7 21 0 0 13 0 0 2 0 3 1 0 2 2 2 0 8 3 0 2 3 0 0 0 4 1 3 3 1 2 0 2 0 0 1 0 1 20 0 18 1 1 1 1 0 2 0 5 1 3 1

98 0 0 0 0 0 0 6 33 0 2 12 4 0 1 0 7 2 1 4 1 1 0 8 1 0 3 4 0 0 0 12 0 12 3 0 3 0 0 0 0 0 0 0 31 1 25 5 0 1 1 0 0 0 3 1 2 0

43 25 17 3 5 0 1 0 5 0 0 0 0 0 0 2 0 0 3 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 9 0 0 0 0

8 0 0 0 0 0 0 2 6 1 0 2 0 0 0 0 0 1 1 1 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 0 0 0 0 0 0 0 0 0

ALL SITES BLOOD/BONE MARROW Leukemia Myeloma Other Hematopoietic BONE BRAIN BREAST DIGESTIVE SYSTEM Anus, Anal Canal, Anorectum Bile Ducts Colon Esophagus Retroperitoneum Liver Other Digestive Pancreas Rectum & Rectosigmoid Small Intestine Stomach ENDOCRINE-THYROID Thyroid Other Endocrine FEMALE GENITAL Cervix Uteri Cervix In Situ Ca Corpus Uteri Ovary Vagina Vulva Other Female Genital LYMPHATIC SYSTEM Hodgkin’s Disease Non-Hodgkin’s Lymphoma** MALE GENITAL Penis Prostate Testis ORAL CAVITY/PHARYNX Oropharynx Nasopharynx Hypopharynx Nasal Cavity, Sinus, Ear Tongue 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 Other Urinary

Note: AJCC Stage-Analytic Cases only *Staging is based on mixed AJCC/Collaborative staging. **Includes 1 or more lymphoma cases coded to non-lymphatic sites.

12

MBP/STPH Cancer Program Annual Report

CLASS

SEX

AJCC STAGE AT DIAGNOSIS*

Abbreviations: M=Male; F=Female; A=Analytical; Unk=Unknown; NA=Not Applicable; AJCC=American Joint Commission on Cancer

Community Support Groups and Activities Adult/Childrenâ&#x20AC;&#x2122;s Bereavement Groups

Patient Education Forums

For those in the community who have experienced loss from the death of a loved one. Held in brief day or evening sessions (871-5976).

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

Better Breathers Support Group

Lymphedema Prevention Clinics

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

One-on-one assessments with a certified lymphedema therapist are offered periodically throughout the year to cancer survivors who have had lymph nodes removed (1-888-616-4687).

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

Cancer Connection Newsletter Bimonthly newsletter provides information on cancer-related support, education and rehabilitative services across the Northshore for individuals/ families dealing with a cancer diagnosis (898-4581).

Cancer Connection Support Group For individuals, family members and friends who are challenged by a diagnosis of cancer.

It provides an atmosphere for expressing thoughts, feelings and expectations. Meets monthly on the third Wednesday (898-4581).

CancerfitŠ Exercise And Wellness Program Designed for individuals completing cancer treatment or in cancer recovery. Incorporates a supervised personalized fitness program with health and wellness education (898-4581).

Genetic Cancer Risk Assessment and 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. Cosponsored by St. Tammany Parish Hospital, Mary Bird Perkins Cancer Center and the Leonard C. Thomas HOS Foundation (898-4581).

Hospice Volunteer Training For those interested in becoming a Hospice volunteer in direct patient care, office support, bereavement care, community education or fundraising events (871-5976).

Lymphedema Therapy Certified lymphedema therapists specialize in the prevention and management of lymphedema, which can occur after cancer treatments, through compression bandaging, manual lymphatic drainage and patient-specific exercise (898-4622).

Northshore Blood Cancer Support Group For individuals, family members and caregivers with leukemia, lymphoma, myeloma and myelodysplastic syndrome. Cosponsored by the Leukemia and Lymphoma Society and the International Myeloma Foundation.

Meets monthly on the second Saturday (898-4581).

Reach To Recovery Specially trained breast cancer survivor volunteers provide one-on-one support and respond personally to concerns of those facing breast cancer diagnosis, treatment recurrence or recovery (898-4581).

Restorative Yoga Classes For those diagnosed with cancer and their caregivers.

Classes are structured according to individual capabilities. Sponsored by the Leonard C. Thomas HOS Foundation. Classes scheduled routinely (504-975-4430).

Smoking Cessation When combined with other smoking cessation efforts, structured classes can greatly increase the chances of quitting for good. Classes scheduled routinely (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 (898-4481).

Look Good, Feel Better Offers skin, nail and hair care tips that can enhance oneâ&#x20AC;&#x2122;s appearance and improve self-image while undergoing cancer treatment. Our professionals will provide assistance with a 12-step makeup guide, choosing and caring for a wig and dealing with skin changes.

Cosmetics provided. Held bimonthly (898-4481).

Cosponsored by ACS and STPH

2009 MBP/STPH Cancer Program Annual Report

13

39 Starbrush Circle Covington, LA 70433

1202 South Tyler Street Covington, LA 70433

www.marybird.org

www.stph.org