Chairman’s Letter
On behalf of the Cancer Committee of the Cancer Program of Our Lady of the Lake and Mary Bird Perkins, I am pleased to present the 2009 Cancer Annual Report. On the pages that follow, you will read about recent accomplishments of the Cancer Program as well as information from a 10-year study on anal cancer, the disease site chosen to be featured in this year’s report. During 2008, the Cancer Program accomplished many clinical, programmatic, quality improvement and community outreach goals as part of our work with the National Cancer Institute’s (NCI) Community Cancer Centers Program (NCCCP) pilot. Recognizing that 85 percent of cancer patients are treated at community cancer centers across the nation, the NCI intends for the pilot to test the concept that a national network of community cancer centers can deliver the latest, most advanced cancer care to more Americans where they live. It was our second year of participation with NCCCP and we made great strides working toward achieving the pilot’s goals, which are detailed later in this report. I would like to draw your attention to two new initiatives. One is the Cancer Program’s launch of a Multidisciplinary Colorectal Cancer Team dedicated to addressing the entire continuum of colorectal cancer care from prevention and early detection to diagnosis, treatment, recovery and survivorship. Unique components of this program include a patient navigator and genetic counseling. Providing this comprehensive approach to colorectal cancer is a national best practice and one that we are now offering to cancer patients in Baton Rouge. The other is the Cancer Program’s new partnership with the H. Lee Moffitt Cancer Center and Research Institute in Florida to be part of a new frontier in cancer research called Total Cancer Care™. We are one of 18 sites in the country participating in this seminal study aimed to advance the science leading the way toward personalized cancer care. By combining research efforts across the entire country, we are giving our patients access to cutting-edge cancer treatment. The Cancer Program also continued to emphasize early detection and cancer prevention in 2009 by providing free screenings to the medically underserved. In recognition of major cancer awareness months, several thousand people were screened at no charge for breast, colorectal, prostate and skin cancer. On behalf of the Cancer Committee, I would like to thank Kevin Guidry, Administrator, Our Lady of the Lake Cancer Center, for his dedication to the Cancer Program. His many hours of hard work as principal investigator of the NCCCP pilot are greatly appreciated. Additionally, I wish to thank the physicians and administrative staff at both Our Lady of the Lake and Mary Bird Perkins Cancer Center for their dedication to the development of both the Multidisciplinary Colorectal Cancer Team and the Total Cancer Care™ programs. We all look forward to another great year with continued progress in the fight against cancer. Sincerely,
David S. Hanson, MD, FACP
2009 CANCER ANNUAL REPORT
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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 (CLP) 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. During the course of my third year as CLP for the Cancer Program, I have continued to strengthen our 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. We have had particular success in following the Commission directives with regard to relationships with the ACS and our patient care evaluation (PCE) studies: I have worked with representatives from our local ACS to send letters educating area physicians about the services ACS offers their cancer patients. I have also collaborated with ACS to streamline the process involved in securing these services to encourage greater utilization among our local patient population. ACS representatives continue to attend the Cancer Committee’s quarterly meetings to report on their organization’s upcoming activities and initiatives. Their presence has resulted in a more informative and engaging presentation of this important information and an improved relationship overall between the ACS and the Cancer Program. I have continued to be involved with our PCE study regarding the adequacy of lymph node dissection of resection specimens for colon cancer. Interestingly, I have encountered far fewer cases of suboptimal lymph node sampling as a result of our improved practices, which ultimately have improved the quality and accuracy of the pathologic tumor staging. Another project related to quality improvement involves the development of an electronic staging form. This document is now sent directly to the treating physician at the time of pathologic diagnosis to promote complete and timely tumor staging. In addition to the focus areas, I continue to attend the quarterly meetings of the Cancer Committee. There, I report on the quality assurance studies I personally perform regarding the use of College of American Pathologists (CAP) checklists on all pathology reports with a cancer diagnosis. Efforts continue to use these checklists to standardize pathology reports and cancer diagnoses across different institutions within the community to ensure completeness and accuracy. I look forward to working with local and national organizations to improve and strengthen our Cancer Program in the years ahead. Sincerely, Brian W. Webb, MD
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OUR LADY OF THE LAKE | MARY BIRD PERKINS
Cancer-Related Services Treatment
Medical Oncology
Chemotherapy Hormonal/Antihormonal Therapy Immunotherapy Infusion Therapy Peripheral Stem Cell Transplantation
OLOL • • • • •
Radiation Oncology
Radiation Therapy External Beam Radiotherapy High Dose Rate Brachytherapy (HDR) Image Guided Radiation Therapy (IGRT) Intensity Modulated Radiation Therapy (IMRT) Prostate Seed Implants • SirSpheres • Stereotactic Radiosurgery Treatment Planning Computerized Axial Tomography (CT) • Image Fusion (CT, MRI, PET) • Medical Physics/Dosimetry Positron Emission Tomography (PET) • Virtual Simulation
Dental Oncology
•
Surgical Oncology
•
Support Services
MBP
CancerFit Enterostomal Therapy Nutritional Support Occupational, Physical and Speech Therapies Pastoral Care Respiratory Therapy Social Services
• • • • • • •
• • • • • • • • • • • •
•
•
Other Services
Lymphedema Prevention Clinics Pain Management • Patient Transportation
• • •
Education
Professional Education
Allied Health Cancer Grand Rounds Continuing Education (CE) • Continuing Medical Education (CME) • Graduate Medical Education (GME) • Medical Library •
Community Education
Cancer Resource Call Center Cancer Screenings Community Library Community Outreach Elderly Services Speakers Bureau
Case Management
• • • • •
Tumor Conferences
Research
• • • • • •
• • • •
•
•
•
Clinical Research
•
•
Tumor Registry
•
•
2009 CANCER ANNUAL REPORT
3
Tumor Conferences
Multidisciplinary treatment planning conferences are held weekly to improve the care of patients with cancer. The cases are selected for presentation and discussion based on the case complexity, unusual presentation of disease or special interest. The conferences are an educational tool for the medical staff, providing helpful information to assist them in obtaining early diagnoses and determining the most effective treatment. Physician representatives from appropriate disciplines attend and participate in the conferences. In addition to the weekly general tumor conferences, the Head & Neck Center at OLOL, in conjunction with LSU Health Sciences Center Otolaryngology Department, holds a weekly multidisciplinary tumor conference with focus on diseases of the head and neck. On April 9, 2008, the Cancer Committee presented a facility-wide didactic CME conference titled Update in Lung Cancer Staging: Endobronchial Ultrasonography by Brad Vincent, MD. During 2008, 149 cases were presented at the standard weekly tumor conferences. The cases reviewed included neoplasms of the following types and sites. Blood/Bone Marrow..................................1 Brain/Nervous System............................. 20 Breast...................................................... 20 Digestive System..................................... 37 Endocrine..................................................9 Female Genital...........................................2 Lymphatic System......................................3 Male Genital............................................ 11 Oral Cavity/Pharynx...................................6 Respiratory/Intrathoracic......................... 18 Skin...........................................................4 Soft Tissue.................................................8 Unknown Primary......................................1 Urinary Tract..............................................9
To schedule cases for presentation, physicians may call Dianne Griffin at (225) 215-1238. 4
OUR LADY OF THE LAKE | MARY BIRD PERKINS
An Overview: Anal Cancer
Anal cancer is a disease in which malignant (cancer) cells develop from the tissues of the anus. The anus is the outlet of the gastro-intestinal tract through which solid waste or excrement (feces) is eliminated from the body. When digested food enters the large intestine (colon) from the small intestine, feces are formed as the colon absorbs water and liquid from the digested food. The feces are then stored in the distal part of the colon (rectum) until it is passed through the anus as a bowel movement. The anal canal is a three- to four-centimeter tube that connects the rectum to the outside of the body. Its inner lining (the mucosa) is made up of different types of cells (the epithelium). Glands found beneath the mucosa produce mucus that acts as a lubricating fluid. About midway down the anal canal is the dentate line, where most of the glands empty into the anus via the anal ducts. The mucosa of the upper anal canal is comprised of glandular epithelium typical of the rectum along with a more primitive epithelium (transitional epithelium) located just above the dentate line (the anal transitional zone, or ATZ). The mucosa below the dentate line is comprised of flattened squamous epithelium similar to that seen in skin, but lacking hair follicles and other adnexal structures. Two ring-like muscles, called sphincter muscles, open and close the anal opening to let feces pass out of the body. Surrounding the outside of the anus is the peri-anal skin. Tumors in this area are typically regarded as skin tumors rather than true anal cancer. Several different types of cancers can arise from various cells that make up the anus. Squamous cell carcinomas: Over 90 percent of anal cancers are squamous cell carcinomas. These tumors have historically been divided into those arising from the epithelium above the dentate line and those arising beneath it. Carcinomas arising above the dentate line are three times more common than those below, twice as common among women than men and more likely to behave aggressively. Cloacogenic carcinomas (also called basaloid or transitional cell carcinomas) are a subclass of these squamous cell carcinomas that account for 20 percent to 25 percent of anal cancers. They may vary in their histologic appearance as if related to the embryonic cloaca, a common passageway for feces, urine and reproduction present early in human development, which ultimately divides to form the rectum, bladder and genitalia. Carcinomas arising below the dentate line are four times more common in men, more likely to show keratinization and typically less aggressive. Adenocarcinomas: Most adenocarcinomas of the anal canal represent the distal spread of a low-lying rectal adenocarcinoma and do not primarily arise within the anal canal proper. A small number of anal cancers develop in the submucosal anal glands and ducts. These anal-gland carcinomas are twice as common in men, often situated deep within the muscular wall of the anal canal and often more advanced at diagnosis. Adenocarcinomas can also arise within abnormal openings in or around the anus (fistulas). Patients with regional enteritis (Crohn’s disease) are particularly at risk for developing anal fistula tracts. Small cell carcinomas: These rare tumors arise from the neuroendocrine cells found within the mucosa of the anal transition zone and are typically very aggressive with a poor prognosis. Metastasis from primary small cell carcinomas of the lung can also occur. Malignant melanoma: This cancer develops from cells within the mucosa of the anal canal or the peri-anal skin that produces the brown pigment called melanin. Only about 1 percent to 2 percent of anal cancers are melanomas. Although melanomas are far more common on parts of the body that are exposed to sun, the anal canal is the third most common site for malignant melanoma, following the skin and eyes. If melanomas are found at an early stage before they have invaded deeply into the skin or spread to lymph nodes, the outlook for long-term survival is very good. But most anal melanomas are found at a later stage because they are often overlooked or mistaken for hemorrhoids or anal tags.
2009 CANCER ANNUAL REPORT
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An Overview: Anal Cancer — continued
Gastrointestinal stromal tumors: These are rare anal cancers that arise from the muscular sphincters surrounding the anal canal; they are much more commonly found in the wall of the stomach or small intestine. Statistics In 2008, an estimated 5,100 Americans (2,000 men and 3,100 women) will be diagnosed with anal cancer and approximately 700 will die of their disease. Compared to the estimated 150,000 cases of colorectal cancer or 194,000 cases of breast cancer anticipated to be diagnosed in 2009, anal cancer is thankfully a relatively rare disease. However, the incidence of anal cancer is rising. There appears to be a changing trend in the affected population, from older women (often with a history of cervical dysplasia or cancer) to younger men, possibly reflecting an increased spread of oncogenic variants of human papilloma virus (HPV) among those populations. Anal cancer is found mainly in adults, with the average patient’s age in the early 60s. The incidence among Caucasian women is slightly higher than African-American or Hispanic women, while the incidence among African-American men is slightly higher than white or Hispanic men. Both Asian men and women have a relatively low incidence of anal cancer. Risk Factors Human papilloma virus (HPV) infection appears to be one of the most significant risk factors in developing anal cancer. Numerous studies have shown most anal squamous cell carcinomas test positive for the same high-risk types of HPV that have been associated with cervical cancer in women. Activities that risk exposure to HPV, such as multiple sexual partners and receptive anal intercourse, increase the risk of anal cancer. Homosexual and bisexual men are 17 times more likely to develop anal cancer than heterosexual men. Immunosuppression, either related to Human Immunodeficiency Virus (HIV) infection or associated with transplantation, is another significant risk factor for anal cancer. Other risk factors include cigarette smoking, history of pelvic radiation and anal fistulas, as seen with Crohn’s disease. Frequent anal redness, swelling and soreness (related to hemorrhoids or other irritation) may also predispose individuals to the development of anal cancer. Clinical Findings Possible signs of anal cancer include the following: ••
Bleeding from the anus or rectum
••
Pain or pressure in the area around the anus
••
Itching or discharge from the anus
••
Lump near the anus
••
Change in bowel habits or the diameter of stool
••
Swollen lymph nodes in the anal or groin areas
Unfortunately, all of these findings can also be associated with benign anal disorders such as hemorrhoids, anal fissures or abscesses.
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OUR LADY OF THE LAKE | MARY BIRD PERKINS
Screening Anal pap smears similar to those used in cervical cancer screening have been studied for early detection of anal cancer in highrisk individuals. This test has been shown to have a high sensitivity (up to 98 percent) for the detection of precursor lesions of anal cancer, i.e., anal squamous intraepithelial lesions (ASILs) or anal intraepithelial neoplasia (AIN). However, the specificity of anal pap smears for predicting the severity or degree of dysplasia seen on the subsequent biopsy is only about 50 percent, suggesting all atypical anal smears should be followed up using high resolution anoscopy with biopsy. Diagnosis/Staging The diagnosis of anal canal carcinoma requires an anorectal exam, evaluation of inguinal adenopathy and a core or incisional biopsy to obtain a tissue diagnosis. Examination under anesthesia is often required. Additional staging work-up includes flexible sigmoidoscopy or colonoscopy, chest x-ray and CT scans of the abdomen and pelvis. Endorectal ultrasound is a valuable tool for assessing the extent of tumor infiltration and, to some degree, peri-anal lymph node involvement. The role of magnetic resonance imaging is undefined for anal cancer evaluation, although from available experience with rectal cancer, this diagnostic method may warrant further investigation. Treatment Thirty years ago, abdominoperineal resection (APR) with colostomy was considered the standard surgical treatment for anal cancer, with local excision reserved for tumors of the anal margin/perianal skin or sometimes small tumors within the distal anal canal. During the 1970s, Norman D. Nigro, MD, pioneered the use of preoperative chemotherapy (mitomycin C and 5-fluorouracil) combined with 30Gy radiotherapy. At first, the goal was to simply try to convert unresectable cases of anal cancer to resectable cases. Nigro reported three patients who showed a complete response with no residual tumor following this treatment. His experience led to the concept of using combined chemoradiation therapy (CRT) as the initial treatment for most anal cancers. A number of variations of this original Nigro protocol have been developed over the years (including increasing or decreasing the radiation dosage, using radiation alone and other chemotherapeutic agents such as cisplatin) to improve response, while minimizing treatment-related toxicities. Today, surgery is reserved for the salvage of primary treatment failures or an isolated local recurrence. Distant metastatic disease is treated with palliative chemotherapy. Prognosis Because anal cancer is rare, statistics regarding survival are based on relatively small numbers. However, the disease is treatable and generally appears to have a favorable prognosis with an overall five-year relative survival rate estimated to be 60 percent for men and 70 percent for women. As with most cancers, prognosis is related to the stage of the tumor at the time of diagnosis. Smaller lesions localized to the lower portion of the anal canal have a much better chance of being cured (up to 80 percent fiveyear survival) than larger tumors that have spread to the lymph nodes or distant organs (less than 30 percent five-year survival). Thus early detection and adequate treatment are important keys to surviving anal cancer.
2009 CANCER ANNUAL REPORT
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An Overview: Anal Cancer — continued Figure 1: Age at Diagnosis and Comparison with National Statistics Age
# of Cases
Percentage
0-39
7
16%
7%
40-49
11
24%
21%
50-59
7
16%
25%
60-69
7
16%
19%
70-79
9
20%
17%
g OLOL/MBP 1998-2008
80-89
3
6%
10%
90+
1
2%
1%
g NCDB 2000-2006
Total
45
100%
100%
Although anal cancer can be seen across a broad age range, the majority of cases are typically diagnosed between the fifth and eighth decades. Our data parallel the national statistics; however, a slightly higher percentage of cases occurs in our patient population under age 40. That finding may possibly reflect a higher prevalence of HPV-related risk factors in our younger population.
Figure 2: Gender, Race and Comparison with National Statistics All Races Gender
Number
Percentage
Caucasian
African American
All Other Races
Percentage
Percentage
Percentage
Male
16
36%
41%
38%
40%
25%
52%
0%
48%
Female
29
64%
59%
62%
60%
75%
48%
0%
52%
Total
45
100%
100%
100%
100%
100%
100%
0%
100%
g OLOL/MBP 1998-2008
g NCDB 2000-2006
Anal cancer is typically more common in women than in men with a reported male-to-female ratio of more than 3:1. Our local data show a similar ratio and parallel those of the NCBD. When looking at race, our local data show a greater percentage of anal cancer arising in African-American women, while other races appear under represented. This, no doubt, reflects the makeup of our local population, as well as an overall lower incidence in Hispanic and Asian populations.
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OUR LADY OF THE LAKE | MARY BIRD PERKINS
Figure 3: Histologic Types and Comparison with National Statistics The vast majority of anal cancers are squamous cell carcinomas. Adenocarcinomas account for just under 10 percent of tumors. A greater percentage of neuroendocrine carcinomas as well as unclassified carcinomas was seen in the national statistics as compared to our local data.
OLOL/MBP 9%
NCDB 3%
2% 16%
8%
g g g g
89%
73%
Squamous Cell Carcinoma Adenocarcinoma Neuroendocrine Carcinoma Carcinoma, NOS
Figure 4: AJCC Stage at Diagnosis and Comparison with National Statistics AJCC TNM/CS Mixed Stage
# of Cases
 OLOL/MBP
NCDB
Stage 0
6
13%
13%
Stage I
8
18%
17%
Stage II
16
36%
32%
Stage III
10
22%
17%
Stage IV
3
7%
5%
g OLOL/MBP 1998-2008
Unknown
2
4%
16%
Total
45
100%
100%
g NCDB 2000-2006
For the past 10 years (1998-2008), our local data for the distribution of anal cancer by AJCC stage parallel the national statistics but for a smaller number of unstaged tumors.
2009 CANCER ANNUAL REPORT
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An Overview: Anal Cancer — continued Figure 5: Treatment Modalities–First Course and Comparison with National Statistics Treatment Modalities
# of Cases
OLOL/MBP
NCDB
Radiation/Chemotherapy
18
40%
40%
Radiation alone
0
0%
4%
Surgery alone
10
22%
23%
Chemotherapy alone
3
7%
5%
Surgery/Radiation/Chemotherapy
11
24%
18%
Surgery/Radiation
0
0%
3%
None
3
7%
7%
Total
45
100%
100%
g OLOL/MBP 1998-2008 g NCDB 2000-2006
Treatment for anal cancer depends greatly on the extent of disease (i.e., the combined clinical and pathologic stage). Combined chemoradiation therapy (CRT), with or without additional surgery, has become the primary course of treatment for most anal cancers, as reflected in both the local and national statistics. Surgery alone is generally used for small, early stage tumors within the distal anal canal or for isolated recurrences. Our local data closely parallel national statistics with only a slight increase in the percentage of cases requiring surgery in addition to CRT compared to national statistics, probably reflecting the slightly higher percentage of advanced stage tumors present within the local population.
Figure 6: Relative Five-Year Survival Rates and Comparison with National Statistics Anal cancer has an overall five-year survival rate of 60 percent according to national statistics. Our local data reflects an overall survival rate that closely parallels NCBD, but a decreased survival rates for Stage IV cancers (metastatic disease).
90% 80% 70% 60% 50% 40% 30% 20%
g OLOL/MBP 1998-2008
10% 0%
10
g NCDB 1998-2001
Stage 0
Stage I
Stage II
OUR LADY OF THE LAKE | MARY BIRD PERKINS
Stage III Stage IV
Overall
OLOL and MBP Integrated Cancer Registry Summary
The Cancer Registry is an integral component of the Commission on Cancer (CoC) approved program and plays a vital role in the success of the program. The registry collects and analyzes demographic, diagnostic, treatment and staging data on cancer patients treated at OLOL and MBP in Baton Rouge. OLOL Cancer Registry reference date is 1987, and it contains data on 26,442 cancer cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry. High importance is placed on data quality using these guidelines, and physician members of the Cancer Committee review a sample of the cases for quality assurance. Once part of the registry database, these cases are followed for the life of the patient. During 2008, there were 1,488 new cancer cases entered into the OLOL registry database. Of these, 1,283 were analytic cases (newly diagnosed and/or received all or part of their first course of treatment at this facility). The top five sites were lung, prostate, colon, kidney/renal pelvis and bladder. The MBP Cancer Registry reference date is 1989, and it contains data on 11,906 cancer cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry. High importance is placed on data quality using these guidelines, and a radiation oncologist reviews a sample of the cases for quality assurance. Once part of the registry database, these cases are followed for the life of the patient. During 2008, there were 1,050 new cancer cases entered into the MBP registry database. Of these, 965 were analytic cases (newly diagnosed and/or received all or part of their first course of treatment at this facility). The top five sites were breast, lung, prostate, larynx and rectum/rectosigmoid. The registries maintain cancer data that are available for use by clinical and administrative staff at OLOL and MBP. All information collected is kept completely confidential. During 2008, the registries received requests for statistical reports including analytic studies, annual statistics, research activities, quality management studies, healthcare delivery, reporting to the National Cancer Data Base (NCDB) and participation in the Facility Information Profile System (FIPS) on the American Cancer Society’s website at www.cancer.org. Data is submitted to the Louisiana Tumor Registry in compliance with state reporting requirements to support statewide improvements in cancer detection and treatment. The registry also participates in the NCDB Cancer Program Practice Profile activities.
2009 CANCER ANNUAL REPORT
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OLOL 2008 Site Distribution Table ALL SITES
Site Group
Blood/Bone Marrow Leukemia Myeloma Bone Brain Breast Digestive System Anus, Anal Canal, Anorectum Colon Esophagus Liver Pancreas Rectum & Rectosigmoid Small Intestine Stomach Other Digestive Endocrine Thyroid Other Endocrine Female Genital Corpus Uteri Fallopian Tubes Ovary Vagina Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma Male Genital Prostate Testis Oral Cavity/Pharynx Hypopharynx Mouth, Floor of Mouth, Other & NOS Nasopharynx Nasal Cavity, Sinus, Ear Salivary Glands, Major Tongue Tonsil Other Nervous System 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 & Renal Pelvis Ureter Urethra
Total Cases 1488 41 35 6 3 43 86 296 5 125 10 26 31 69 5 22 3 49 45 4 15 4 1 9 1 73 10 63 145 141 4 66 6 15 4 9 5 22 5 59 277 33 207 31 6 44 42 2 21 37 233 124 96 12 1
Class Analytic NonAn 1283 205 34 28 6 3 35 64 258 2 109 7 26 30 57 5 20 2 46 42 4 11 4 1 5 1 60 8 52 134 132 2 51 6 10 2 6 5 19 3 59 259 28 194 31 6 35 33 2 20 33 181 84 86 10 1
7 7 0 0 8 22 38 3 16 3 0 1 12 0 2 1 3 3 0 4 0 0 4 0 13 2 11 11 9 2 15 0 5 2 3 0 3 2 0 18 5 13 0 0 9 9 0 1 4 52 40 10 2 0
Sex M F 867 621
0 82
1 285
Stage II 251
III 177
IV 219
Not App 185
Unknown 84
25 20 5 3 25 1 164 3 72 6 11 16 38 3 13 2 13 10 3 0 0 0 0 0 44 4 40 145 141 4 41 5 8 3 6 1 14 4 22 174 29 126 14 5 29 28 1 13 15 153 83 64 5 1
0 0 0 0 0 5 11 0 7 0 0 0 3 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 1 8 0 0 6 6 0 0 0 50 48 0 2 0
0 0 0 0 0 24 56 0 27 1 3 2 20 0 2 1 19 19 0 2 1 0 1 0 22 4 18 3 3 0 8 0 3 0 2 1 2 0 0 63 9 51 1 2 11 10 1 4 0 73 18 54 1 0
0 0 0 0 0 20 51 2 23 4 3 6 9 0 3 1 6 6 0 1 1 0 0 0 11 3 8 110 109 1 6 0 4 1 0 0 1 0 0 26 4 8 12 2 2 2 0 1 0 17 9 6 2 0
0 0 0 0 0 4 53 0 27 2 5 2 15 0 2 0 6 6 0 1 0 0 1 0 2 0 2 12 11 1 5 0 0 0 1 2 2 0 0 63 7 42 14 0 6 6 0 4 0 21 4 12 5 0
0 0 0 0 0 6 60 0 18 0 6 18 9 0 9 0 8 8 0 5 2 0 3 0 23 1 22 7 7 0 26 5 3 0 1 1 13 3 0 68 5 62 0 1 3 3 0 1 0 12 4 8 0 0
34 28 6 0 35 0 7 0 0 0 1 0 1 3 2 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2 0 0 0 59 6 0 2 4 0 0 0 0 4 33 1 0 1 0 0
0 0 0 3 0 5 20 0 7 0 8 2 0 1 2 0 3 3 0 1 0 1 0 0 2 0 2 2 2 0 4 1 0 1 0 1 1 0 0 24 2 21 0 1 7 6 1 6 0 7 1 5 0 1
16 15 1 0 18 85 132 2 53 4 15 15 31 2 9 1 36 35 1 15 4 1 9 1 29 6 23 0 0 0 25 1 7 1 3 4 8 1 37 103 4 81 17 1 15 14 1 8 22 80 41 32 7 0
NOS: Not Otherwise Specified / A: Analytic / N/A: Non-Analytic / M:Male / F:Female / Not App:Not Applicable
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OUR LADY OF THE LAKE | MARY BIRD PERKINS
MBP 2008 Site Distribution Table Site Group
Total Cases 1050
Blood/Bone Marrow Myeloma Other Hematopoietic Brain Breast Digestive System Anus, Anal Canal, Anorectum Bile Duct Colon Esophagus Gallbladder Liver Pancreas Rectum & Rectosigmoid Small Intestine Stomach Endocrine Thyroid Other Endocrine Female Genital Cervix Uteri Corpus Uteri Vagina Vulva Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma Male Genital Prostate Testis Oral Cavity/Pharynx Hypopharynx Lip Mouth, Floor of Mouth, Other & NOS Nasopharynx Nasal Cavity, Sinus, Ear Orophyarnx Salivary Glands, Major Tongue Tonsil Other Oral Cavity/Pharynx Other Nervous System 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 & Renal Pelvis Ureter
19 18 1 21 301 102 12 2 5 20 1 1 13 38 2 8 6 3 3 27 12 12 2 1 39 6 33 180 174 6 66 4 1 6 6 5 3 6 19 15 1 3 233 38 165 30 3 2 1 10 18 22 7 13 2
ALL SITES
Class Analytic NonAn 965 85 14 13 1 19 293 90 12 1 4 18 1 0 11 35 1 7 5 3 2 23 9 11 2 1 30 6 24 167 163 4 63 4 1 6 5 5 3 5 18 15 1 1 217 36 156 25 2 1 1 8 17 16 6 8 2
5 5 0 2 8 12 0 1 1 2 0 1 2 3 1 1 1 0 1 4 3 1 0 0 9 0 9 13 11 2 3 0 0 0 1 0 0 1 1 0 0 2 16 2 9 5 1 1 0 2 1 6 1 5 0
Sex M F 502 548
0 49
1 177
12 12 0 12 1 63 7 1 3 15 0 1 6 23 1 6 1 0 1 0 0 0 0 0 23 0 23 180 174 6 44 3 1 4 5 4 2 1 13 11 0 0 135 31 90 14 1 1 0 5 13 12 3 9 0
0 0 0 0 47 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 2 0 2 0 0 0 0 0 0 0 0 0 0
0 0 0 0 97 7 0 0 0 0 0 0 1 6 0 0 0 0 0 7 3 4 0 0 12 2 10 4 0 4 3 0 0 1 0 0 0 1 0 1 0 0 44 13 31 0 0 0 0 3 0 0 0 0 0
7 6 1 9 300 39 5 1 2 5 1 0 7 15 1 2 5 3 2 27 12 12 2 1 16 6 10 0 0 0 22 1 0 2 1 1 1 5 6 4 1 3 98 7 75 16 2 1 1 5 5 10 4 4 2
Stage II III 306 161 0 0 0 0 94 30 5 0 0 6 1 0 3 13 0 2 0 0 0 4 2 1 1 0 11 4 7 144 144 0 5 0 0 0 2 0 1 1 0 1 0 0 12 5 7 0 0 0 0 2 0 4 4 0 0
0 0 0 0 28 33 5 1 2 6 0 0 3 12 1 3 0 0 0 5 1 2 1 1 2 0 2 7 7 0 11 0 1 1 1 2 0 2 2 2 0 0 68 5 54 9 1 0 1 2 0 4 1 1 2
IV 165
Not App 60
Unknown 47
0 0 0 0 13 11 1 0 2 3 0 0 1 3 0 1 3 3 0 2 2 0 0 0 5 0 5 5 5 0 36 3 0 4 2 2 1 1 15 8 0 0 82 12 56 14 1 1 0 0 0 7 1 6 0
14 13 1 19 1 0 0 0 0 0 0 0 0 0 0 0 2 0 2 4 0 4 0 0 0 0 0 0 0 0 2 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 17 0 0 0 0
0 0 0 0 13 9 1 0 0 3 0 0 3 1 0 1 0 0 0 1 1 0 0 0 0 0 0 7 7 0 6 1 0 0 0 0 1 0 1 3 0 0 9 1 6 2 0 0 0 1 0 1 0 1 0
NOS: Not Otherwise Specified / A: Analytic / N/A: Non-Analytic / M:Male / F:Female / Not App:Not Applicable 2009 CANCER ANNUAL REPORT
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The Cancer Program of OLOL and MBP
NCCCP Year Two in Summary The pilot phase of the National Cancer Institute’s (NCI) Community Cancer Centers Program (NCCCP) which added a fourth year to the pilot ended its second year by implementing a variety of initiatives to advance clinical research and improve the quality of cancer care at community hospitals. This was done with an emphasis on minority and underserved patients. The NCCCP pilot is exploring what it takes to conduct complex cancer clinical trials and offer state-of-the-art treatment options in a hometown setting so patients do not have to commute to large, university-based medical centers to receive highquality cancer care. The pilot hospitals, located in 14 states across the country, serve patients from a wide range of geographic and demographic localities in rural, small-town and underserved urban areas. This diversity offers a potential framework for a national program of community cancer centers that would be integrated with NCI’s extensive network of cancer research and quality care initiatives.
Looking Forward In the third year of the pilot, the participating hospitals will continue to collaborate with and learn from one another to further strengthen this public-private partnership and share what they learn with community hospitals outside the network. They will also develop a final report for NCI documenting the lessons learned on the best ways to advance state-of-the-art cancer care and research to benefit patients in their home communities. The goals of the NCCCP pilot program are to: Reduce cancer healthcare disparities Draw more patients into clinical trials in community-based settings Link to national computer networks for conducting research and sharing results Explore standards for collecting and storing cancer research specimens
A Few Key Accomplishments by Focus Area: Reduce Cancer Healthcare Disparities by Expanding Patient Navigator Services to All Pilot Sites Since the inception of the pilot in 2007, the Cancer Program has screened 5,964 participants at 212 events and diagnosed 54 cancers. In line with the aims of the pilot’s outreach initiatives, in 2008 the Cancer Program began offering patient navigators to assist patients who had an abnormal screening result for breast, colorectal, skin and prostate cancer. These navigators guide each patient through a complex web of clinical care, social services, and financial counseling.
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OUR LADY OF THE LAKE | MARY BIRD PERKINS
Local Care. National Recognition.
Increase Patient Involvement in Clinical Trials by Increasing Accessibility The Cancer Program is providing cancer patients and their physicians access to clinically relevant research trials that will lead to advances in evidence-based disease management, specifically NCI-sponsored clinical trials made available to pilot sites through NCCCP. In doing so, the Cancer Program has increased the number of patients choosing to participate in a clinical trial, brought leading-edge trials to disparate populations and developed mechanisms to increase minority accruals. Since the inception of the pilot, over one thousand participants were accrued to clinical and pharmaceutical trials. Enhance Information Technology Capabilities by Converting Paper-Based Patient Records to Electronic Health Records The Information Technology (IT) Team of the Cancer Program is designing and implementing replicable strategies to connect the information systems of Our Lady of the Lake, Mary Bird Perkins and private practice physician groups into one unique system containing all oncology related electronic health records (EHR). Integration of patient level data will provide an opportunity for the Cancer Program to assess the needs of its patients, while demonstrating ways in which this data can be effectively utilized for cancer prevention, treatment and care on a national level. Standardize Biospecimen Collection by Implementing NCI Recommendation for Snap-Frozen and Formalin-Fixed Tissues The Cancer Program and H. Lee Moffitt Cancer Center & Research Institute in Florida have partnered to perform state-ofthe-art cancer research called Total Cancer Care™. The Cancer Program is one of only 18 sites in the country participating in this first-of-its-kind study to individualize cancer treatment based on genes that provide a “molecular fingerprint” unique to each tumor. Nationally, the study has the consent of over 30,000 patients and the Cancer Program has accrued 200 patients to participate in this exciting initiative. Improve the Quality of Cancer Care by Offering Genetic Counseling to Determine Risk for Certain Cancers The Cancer Program developed a Multidisciplinary Colorectal Cancer Team whose purpose is to identify and address the entire continuum of care for colorectal cancer from prevention and early detection to diagnosis, treatment, recovery and survivorship. A unique component of this team is genetics counseling. A geneticist is trained to identify high-risk individuals and works with the medical team to address concerns about their personal risk of developing colorectal cancer; conducts a detailed risk assessment of personal or family risk; ensures the individual’s understanding of screening options for early detection and ways to reduce personal cancer risk through lifestyle modification; and provides information to help individuals make informed decisions about medical management options, including the need for genetic testing if indicated. Enhance Survivorship and Palliative Care Services by Offering Educational Programs to Support Survivors An educational series titled “Thriving in Survivorship” – focusing on nutrition for cancer patients coping with side effects and other pertinent topics, survivors and caregivers was offered to Cancer Program patients through a series of workshops. These free workshops were presented to address the needs of new Cancer Program patients, patients completing treatment and longterm survivors. This series was structured in a manner that allowed patients and their family members to progressively build upon information learned. Currently, there are more than 11 million cancer survivors in the U.S. The needs of survivors are unique and important and the Cancer Program is working to make sure they are appropriately addressed.
2009 CANCER ANNUAL REPORT
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The Cancer Program’s Community Outreach
The CARE Network 2008 In 2002 Mary Bird Perkins Cancer Center 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 Our Lady of the Lake and Mary Bird Perkins 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 an 11-parish area jointly served by the Cancer Program. 2008 Screening Data
*Colorectal Skin
Prostate Breast
TOTAL
# of screening events
48
14
18
57
137
# of persons screened
847
551
737
1,914
4,049
# never screened
525
451
245
234
1,455
# of abnormal findings
28
288
86
211
613
-
9
8
18
35
# of cancers
*Colorectal is unique in that it is a take-home kit and the return rate is dependent upon the person returning it. 161 kits were returned (19 percent return rate) and of those returned 29 (18 percent) had abnormal findings.
Minority Cancer Awareness 2008 The Cancer Program of Our Lady of the Lake and Mary Bird Perkins hosted its first annual event in recognition of National Minority Cancer Awareness Week. This successful family health fair held in Baton Rouge promoted the importance of early detection and provided 474 cancer screenings in one day for colorectal, skin, prostate and breast cancers. *Colorectal Skin Prostate Breast
TOTAL
# of persons screened
205
137
90
42
474
# never screened
161
113
62
16
352
2
60
8
2
72
# of abnormal findings
*Colorectal is unique in that it is a take-home kit and the return rate is dependent upon the person returning it. 13 kits were returned (6 percent return rate) and of those returned 2 (17 percent) had abnormal findings. The Cancer Program continues to increase public awareness of prevention and early detection by providing free cancer screenings to those most in need.
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OUR LADY OF THE LAKE | MARY BIRD PERKINS