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2012 ANNUAL REPORT

CANCER CONNECTED


CENTURA HEALTH CANCER NETWORK Penrose Cancer Center is the largest and most established center within the Centura Health Cancer Network (CHCN), which delivers integrated, advanced cancer care across Colorado. The goal of the Centura Health Cancer Network is to position Centura Health as the most recognized, premier cancer provider in Colorado. Centura Health Cancer Network is focused on expanding current cancer care facilities, technologies, programs, physician staffing, and ancillary support personnel, in collaboration with the Centura Health Neighborhoods, to care for the growing number of cancer patients in Colorado communities and surrounding states.

Penrose Cancer Center, since its inception more than 70 years ago, has focused on providing our patients with the most advanced clinical care and a wide variety of support services. Our physician partners continue

CHCN is committed to building a community of cancer care professionals who embrace evidence-based practice, quality improvement, community service, clinical research, and serves the care continuum collaboratively to meet the challenges of health care reform.

to make outstanding contributions. Their commitment to excellent patient care through

In 2012, the network:

Multidisciplinary Conferences has raised

• Recorded 3,927 analytic cases across five accredited sites

• Developed 19 disease-specific multidisciplinary conferences in six locations

• Qualified for Network Accreditation with the American College of Surgeons

program grows, our organization is committed to providing the

• Developed the Healthy Lung Screening Program

investments needed to ensure this legacy will continue. As part of

• Implemented a new electronic medical record system (Meditech)

Centura Health’s Cancer Network, providers across our state are

• Participated in multiple community events across the state, including American Cancer Society Relay for Life and Komen Race for the Cure

working together to provide seamless care in our entire system.

the bar of cancer care in our region. As the

–M  argaret Sabin, President & CEO – Penrose-St. Francis Health Services & Centura South State Operating Group

1 | CANCER CONNECTED | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | CANCER CONNECTED | 2


It has been another outstanding and eventful year for the Penrose Cancer Center. In this year’s annual report, we are highlighting components of our program with a focus on women’s services. While space does not permit a detailed review of all of our services, this year’s report includes more focused information on our gynecologic oncology, breast oncology, and neuro-oncology programs. In addition, we are moving beyond simple statistics on numbers of patients to give you a sense of our emphasis on measuring our progress and our quality, benchmarked against regional and national standards. We hope to help you understand the reasons why Penrose Cancer Center was one of 100 programs nationwide to be recognized by the Commission on Cancer Award of Distinction and selected by the National Cancer Institute as the only Colorado contractor for the National Community Cancer Center Program (NCCCP). Equally important, Penrose Cancer Center has worked hard to be the market leader for cancer services in El Paso County and southern Colorado. Please join us in celebrating our success and resolving to continue to improve and grow. Sincerely yours, James A. Young, MD, MMM

PENROSE CANCER CENTER GROWTH

Number of Cases

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

1,229

1,355

1,350

1,192

1,195

1,225

1,366

1,739

1,708

1,973

2,137

2,431

Penrose Cancer Center Regional Market Share of Cases 80%

70%

% of Market Share

A MESSAGE FROM OUR MEDICAL DIRECTOR

60%

50%

40% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

3 | CANCER CONNECTED | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | CANCER CONNECTED | 4


GYNECOLOGIC CANCER

GYNECOLOGIC CANCER Penrose Cancer Center Total Gynecologic Cancer Cases Trend 250

With the addition of Dirk Pikaart, DO in 2008, Penrose Cancer Center developed the only gynecologic oncology program in southern Colorado. Previously, patients had to seek out subspecialty care out of the region. Now patients with gynecologic cancers can expect excellent multidisciplinary care close to home. Robotic-assisted surgery has revolutionized the care of gynecologic cancers by decreasing complications and length of hospital stay. Gynecologic Oncology Group clinical trials, incorporating the latest thinking on treatment, are now available to Penrose Cancer Center patients.

200

150

100

50

Penrose Hospital Length of Stay for GYN Surgery:

0

3.0

2006 2007 2008 2009 2010 2011

ROBOTIC SURGERY 2.5

n Robotic n Non-Robotic

PENROSE CANCER CENTER TOTAL GYNECOLOGIC CANCER CASES

2.0

Days

The da Vinci Surgical System has revolutionized gynecologic surgery. With this system, small incisions are made and a video port and instrumental ports are placed in the abdominal cavity. The surgeon then operates the robotic instruments from a console with magnified video pictures of the operative field. With this technique, the length of hospital stay and the number of complications have decreased. Dr. Dirk Pikaart performs nearly 200 of these operations annually and is among the most experienced gynecologic robotic surgeons in the state.

1.5

1.0

0.5

0

5 | GYN CANCER | Penrose Cancer Center 2012 Annual Report

Total Abdominal Radical Abdominal Hysterectomy Hysterectomy

2006

2007

2008

2009

2010

2011

Corpus Uteri

10

21

34

75

93

96

Ovary

14

14

20

41

34

36

Cervix Uteri

5

4

7

26

22

31

Vulva

0

0

3

13

13

18

Vagina

0

3

3

4

4

2

Peritoneum, Omentum & Mesentery

2

1

3

7

4

3

Uterus, NOS

1

1

3

7

8

3

Other Female Genital Organs

1

0

0

8

15

13

Penrose Cancer Center 2012 Annual Report | GYN CANCER | 6


PENROSE CANCER CENTER GYNECOLOGIC CANCER SURVIVAL RATES

Ovarian Cancer Survivor

CARA MILLER, NP I am board certified as an adult nurse practitioner through the American Academy of Nurse Practitioners. Currently I am working with the gynecologic oncology program at Penrose Cancer Center where I am part of a team that delivers comprehensive, cutting-edge care to women with gynecologic cancers. I believe in a holistic approach, acquiring a comprehensive evaluation of each patient by taking time to listen and understand their physical, emotional, and spiritual needs. I am passionate about caring for women and their families receiving treatment for gynecological cancer and am proud to be part of the Penrose Cancer Center team.

Uterine Cancer Survival 2000-2008 Survival Probability (%)

100% 80%

Penrose Cancer Center demonstrated superior survival for endometrial cancer, the most common gynecologic cancer, compared to a national cancer center database for 2000-2008.

60% 40% 20% 0%

National Oncology Data Penrose Cancer Center

0 12 24 36 48 60

Observed Survival (Months)

Stage 4 Cervical Cancer Survival 2000-2008 100%

Penrose Cancer Center demonstrated superior survival for advanced cervical cancer compared to a national cancer center database for 2000-2008.

80%

National Oncology Data Penrose Cancer Center

60% 40% 20% 0%

0 12 24 36 48 60

Observed Survival (Months)

Stage 4 Ovarian Cancer Survival 2000-2008 Survival Probability (%)

The most important factor of fighting cancer is the relationship between the patient and the doctor. After being diagnosed with cancer, I live with a new normal and must rely on others to help me fight this terrible disease. From my first appointment with Dr. Pikaart, I knew I was in good hands. There are times when it is difficult to not be overwhelmed, but Dr. Pikaart and his staff continually build me up and keep me going. I love seeing everyone at his office, a place staffed with people who truly care and celebrate every step toward recovery. I was fortunate to have been treated by the hands of healing angels. Their laughter, smiles, and hugs have made a big difference.

Survival Probability (%)

ROSE’S STORY

100% 80% 60%

National Oncology Data Penrose Cancer Center

40% 20% 0%

Penrose Cancer Center demonstrated superior survival for the most advanced form of ovarian cancer compared to a national cancer center database for 2000-2008.

0 12 24 36 48 60

Observed Survival (Months) 7 | GYN CANCER | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | GYN CANCER | 8


SHARON HALLA, RN

KATHLEEN’S STORY

Breast Cancer Nurse Navigator

Breast Cancer Survivor

What is a breast nurse navigator? I am an oncology nurse who assists newly diagnosed breast cancer patients during a potentially overwhelming time in their lives. I help schedule initial consultations and reinforce what was discussed at the medical appointments. I provide educational materials to help patients make necessary medical treatment decisions and continue to offer reassurance throughout the entire treatment course. I utilize community resources for financial, emotional, and physical support for patients. I am a constant person through this cancer journey and a one-person contact. I personally enjoy this role of guiding a woman from the initial shock of a cancer diagnosis to treatment completion.

One thing I’ve learned from my cancer experience is: What a wonderful husband I have! (He typed this as well as went to every doctor’s appointment and chemo treatment I had – and that was quite a few! We’re so glad that’s behind us now.) Life is good thanks to the Penrose Cancer Center.

The Breast Oncology program is Penrose Cancer Center’s oldest and busiest multidisciplinary program. A team comprised of surgeons, radiation oncologists, medical oncologists, genetics professionals, care navigators, clinical trial specialists, and other support staff meets on a weekly basis to discuss management of new breast cancer or high risk breast referrals. We are also accredited by the National Accreditation Program for Breast Centers (NAPBC), which ensures our patients that they will have access to the highest quality, comprehensive care. Toni Green-Cheatwood, DO, breast surgeon and Director of Breast Oncology at the Penrose Cancer Center, joined our staff in 2010 and is the only fellowship-trained breast surgeon in southern Colorado.

Total Breast Cancer Cases Treated and/or Diagnosed at Penrose Cancer Center 400

377

350 300

# of Cases

250 200

260 213

231 195

150

160

100 50

2006 2007 2008 2009 2010 2011

Year

9 | BREAST CANCER | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | BREAST CANCER | 10

BREAST CANCER

BREAST CANCER


QUALITY IMPROVEMENT The Penrose-St. Francis Breast Care Center strives to achieve excellence and continuous improvement. We continually benchmark our program against national standards. The likelihood for a breast cancer cure is dependent upon effective screening, prompt and accurate diagnosis, and high-quality treatment.

In the spring of 2012 we opened a new building on the Penrose Hospital campus – The Penrose Pavilion. It houses our Center for Women’s Imaging and the Penrose-St. Francis Breast Care Center – the office of Dr. Toni Green-Cheatwood. Here, we focus on all aspects of breast health – whether a patient has a specific complaint, needs a routine annual exam, or needs breast surgery. Our relaxing, spa-like atmosphere offers the most advanced screening and diagnostic imaging services in Colorado Springs and we’ve created a soothing environment with calming earth tones, comfortable seating, relaxing music, and a specially designed women’s boutique. Patients can enjoy:

• Free valet parking

• Aromatic hand treatments and plush robes

• Fruit-infused beverages and/or gourmet coffee/tea

• Mother • Daughter • Sister • Friend boutique complete with products designed for breast cancer patients, designer candles, lotions, chocolates, etc.

In 2012, we performed over 2,800 mammograms in our Center for Women’s Imaging with the newest digital mammography machines in southern Colorado. These machines are very effective at determining the need for follow-up screenings and biopsies and allow the technologists to evaluate the quality of the images as they are taken, which means that patients spend less time in the exam room and rarely need to return for repeat imaging.

At Penrose Cancer Center, an abnormal screening mammogram was followed by diagnostic mammography in an average of less than six days, the best performance among Centura Health cancer programs. When patients elect to take the first available appointment, this average dropped to three days.

Average # of Days from Initial Mammogram to Diagnostic Imaging Appointment 10

For every 100 mammograms we perform: % that require a diagnostic mammogram

16% % that require a biopsy

2%

% diagnosed with cancer

.4%

8

Number of Days

OUR NEW SPACE

6

4

2

3

0

Penrose Centura Health Mean

Hospital / Cancer Center

11 | BREAST CANCER | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | BREAST CANCER | 12


EARLY DIAGNOSIS SAVES LIVES

2012 DR. PAUL ANDERSON LECTURE SERIES

Prompt and early diagnosis is crucial to favorable outcomes in breast cancer. At Penrose Cancer Center, a greater proportion of cases are diagnosed at Stage 0 or Stage 1 disease. This, coupled with effective therapy, translates to improved survival compared to similar cancer centers across the country.

In 2012, we hosted the first Dr. Paul Anderson Lecture Series – a quarterly educational session for physicians featuring speakers from around the nation who have made exciting headway in cancer research and/or treatment. In 2012 we were privileged to host:

% of Cancers Diagnosed by Stage 50%

• Dr. Ross Camidge, Director, Thoracic Oncology Program – University of Colorado Cancer Center • Presented: “Targeted Therapy for Lung Cancer”

40%

% of Cases

• Dr. Michael Sarr, Chair, Division of Experimental Surgery – Mayo Clinic • Presented: “Cystic Neoplasms of the Pancreas – Diagnosis and Management in this New Age of Imaging”

n National Oncology Data

30%

• Dr. Thomas Buchholz, Division Head, Department of Radiation Oncology – MD Anderson Cancer Center • Presented: “Changing Management of Axillary Lymph Nodes in Breast Cancer”

n Penrose Cancer Center

20%

10%

0% Stage 0 Stage I Stage II Stage III Stage IV

Cancer Stage Identified

Breast Cancer Overall Survival 2000-2008

Survival Probability (%)

100%

90%

80% National Oncology Data Penrose Cancer Center 70%

60%

12 24 36 48 60

Observed Survival (Months)

13 | BREAST CANCER | Penrose Cancer Center 2012 Annual Report

Dr. Anderson, now retired, is one of the inspirational founding fathers of the Penrose Cancer program, and the 2012 lecture series honors his legacy of leadership. Penrose Cancer Center 2012 Annual Report | BREAST CANCER | 14


CyberKnife at Penrose Cancer Center is used to perform stereotactic radiosurgery that precisely treats sensitive areas of the brain without impacting surrounding tissues.

Our Neurological team uses CyberKnife to treat the following conditions:

• Brain and spine tumors (both malignant and benign)

• Trigeminal Neuralgia

• Acoustic Neuromas

• Meningiomas

• Metastases

• Pituitary Adenomas

• Metastatic lesions from traditionally radiation-resistant cancers

• CyberKnife is also proving to be a highly effective and exciting alternative to both surgery and traditional irradiation.

Glioblastoma multiforme is a very aggressive form of brain cancer and the most common type of brain cancer treated at Penrose. While outcomes are poor, Penrose results are equivalent to the national database. Furthermore, integrated care at PCC brings together sophisticated surgery, high tech radiation oncology, and standard and investigational chemotherapy trials in order to offer hope for these patients. In addition, PCC offers hospice and palliative care services, social services and financial counseling, and on-campus lodging for out-of-town patients and families to assist with all aspects of managing this difficult disease.

100%

80%

Survival Probability (%)

The Penrose Cancer Center leads southern Colorado in its Neurosciences program. With world-class specialized neurosurgeons and the latest technology, we treat both cancerous and non-cancerous brain tumors and lesions. Our team of neurosurgeons, medical oncologists, and radiation oncologists works seamlessly to develop comprehensive treatment plans for patients. Working together with the primary care and specialist communities, we ensure the best possible outcomes for our patients, and this coordinated care is integral to the success of our program.

60% National Oncology Data Penrose Cancer Center 40%

20%

0% 12 24 36 48

60

Observed Survival (Months)

Radiation treatment plan

Neurosurgeon Dr. James Sceats and Radiation Oncologist Dr. Anuj Peddada review a patient’s treatment plan. Dr. James Sceats leads the field in treating pituitary tumors on the CyberKnife at Penrose Cancer Center.

TOTAL PENROSE CANCER CENTER BRAIN CANCER CASES Type of Cancer

Year

Total Analytic Cases at PCC

2006

2007

2008

2009

2010

2011

Brain

31

19

19

30

24

27

Cranial Nerves Other Nervous System

27

34

37

27

42

58

15 | NEUROSCIENCES PROGRAM | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | NEUROSCIENCES PROGRAM | 16

NEUROSCIENCES PROGRAM

NEUROSCIENCES PROGRAM

Penrose Cancer Center Brain Cancer Overall Survival 2000-2008 Glioblastomas


WELCOME, DR. KILANI

2012 MULTIDISCIPLINARY CONFERENCE ATTENDANCE

Ramsey Kilani, MD joined the medical staff of Penrose Hospital in July 2012. A radiologist specializing in neuroradiology and interventions, Dr. Kilani brings a wealth of experience from some of the top medical institutions in the country. After attending medical school at the University of Arizona, Dr. Kilani completed an internship at Northwestern University and his residency at Duke University, where he continued in his career as a fellow and faculty member, establishing himself as a sought-after neuroradiologist. He has authored numerous manuscripts and a radiology textbook chapter, in addition to speaking at multiple national and international medical conferences. He also serves on advisory committees for the American Board of Radiology and the American College of Radiology. Dr. Kilani works closely with Medical and Radiation Oncologists at Penrose Cancer Center, as well as Neurosurgeons and Neurologists to diagnose, treat, and follow complex diseases of the brain, spine, head, and neck.

At the Penrose Cancer Center, we offer a variety of tumor boards and case conferences to discuss patient cases in a multidisciplinary fashion. As an added benefit to our regional partners in southern Colorado, many of these conferences are broadcast live via webcam and we welcome input from other care providers. Entire multidisciplinary teams (oncologists, surgeons, radiologists, pathologists, genetic counselors, nurse navigators, social workers, etc.) are present at each conference and assist with developing a comprehensive treatment plan for select patients. We believe these conferences not only result in the best course of treatment for patients, but they offer a unique learning experience as well.

RANDY’S STORY CyberKnife Patient The doctors and staff at the Penrose Cancer Center were thorough, caring, and professional. They injected lighthearted humor and answered any and all questions put forth by me and my family! One hundred eighty-six radiation beams a day for five days = 930 radiation beams flying through my brain. Amazing! Dr. Anuj Peddada was specific, detailed, and amazing as he explained the math behind the procedure. His depth of knowledge and commitment were transparent, and he treated me with dignity, concern, and personable caring that emulated through all my discussions with him. That carried over with his staff. Susan Anderson was specific and personal on expectations and preparedness. And Dr. James Sceats and the radiation therapists showed me concern, care, and comfort while “secured” on the treatment table. Though I was scared and tense, they created an atmosphere of relaxation and external focus. Though I know my health situation is a waiting game, I truly can say I had a safe, caring, and comfortable staff watching out for all my needs before, during, and after my CyberKnife procedure. Though I know my life is in the hands of God, He allowed me to trust some brilliant, caring, and loving people with the length of my life and a promising, comfortable future.

17 | NEUROSCIENCES PROGRAM | Penrose Cancer Center 2012 Annual Report

# of Conferences # of Cases Presented

Total physician attendance

Total non-physician attendance

Breast – Weekly

45

277

440

810

CNS Tumor – Quarterly

4

19

39

18

Dysphagia – Quarterly

1

4

7

7

GI Tumor – Bi-Monthly

19

86

215

108

GYN – Monthly

10

44

92

56

Head & Neck CA – Monthly

12

83

158

71

Malignant Heme – Monthly

12

93

101

112

Melanoma – Quarterly

3

17

36

16

Thoracic – Weekly

45

297

395

308

Penrose Cancer Center 2012 Annual Report | NEUROSCIENCES PROGRAM | 18


Continued

SUMMARY OF PENROSE CANCER CENTER CASES BY BODY SYSTEM Primary Site

Total %

ORAL CAVITY & PHARYNX

62

3.0%

Lip

2

0.1%

Tongue

22

1.0%

Salivary Glands

13

Floor of Mouth

Primary Site

Total %

Primary Site

Males

Total %

Larynx

13

0.6%

Kidney & Renal Pelvis

65

3.1%

Lung & Bronchus

191

9.1%

Ureter

2

0.1%

Pleura

1

0.0%

Other Urinary Organs

1

0.0%

0.6%

Trachea, Mediastinum & Other Respiratory

1

0.0%

EYE & ORBIT

2

0.1%

3

0.1%

Eye & Orbit

2

0.1%

BONES & JOINTS

1

0.0%

Gum & Other Mouth

7

0.3%

Bones & Joints

1

0.0%

BRAIN & OTHER NERVOUS SYSTEMS

85

4.1%

Nasopharynx

2

0.1%

SOFT TISSUE

14

0.7%

Brain

27

1.3%

Tonsil

11

0.5%

Soft Tissue (including Heart)

14

0.7%

Oropharynx

1

0.0%

58

2.8%

Pancreas – 29 (3%)

Hypopharynx

1

0.0%

SKIN EXCLUDING BASAL & SQUAMOUS

Cranial Nerves Other Nervous Systems

69

3.3%

ENDOCRINE SYSTEM

99

4.7%

293

14.0%

Melanoma – Skin

64

3.1%

Thryoid

83

4.0%

Kidney & Renal Pelvis – 46 (5%)

DIGESTIVE SYSTEM Esophagus

20

1.0%

Other Non-Epithelial Skin

5

0.2%

16

0.8%

Stomach

17

0.8%

BREAST

377

18.0%

Other Endocrine including Thymus

Small Intestine

12

0.6%

Breast

377

18.0%

LYMPHOMA

104

5.0%

Colon Excluding Rectum

112

5.3%

FEMALE GENITAL SYSTEM

198

9.4%

Hodgkin Lymphoma

13

0.6%

Rectum & Rectosigmoid

47

2.2%

Cervix Uteri

31

1.5%

Non-Hodgkin Lymphoma

91

4.3%

Anus, Anal Canal & Anorectum

7

0.3%

Corpus & Uterus, NOS

98

4.7%

MYELOMA

29

1.4%

Ovary

36

1.7%

Myeloma

29

1.4%

Liver & Intrahepatic Bile Duct

11

0.5%

Vagina

2

0.1%

LEUKEMIA

62

3.0%

Gallbladder

4

Vulva

18

0.9%

Lymphocytic Leukemia

31

1.5%

Other Female Genital Organs

13

0.6%

Myeloid & Monocytic Leukemia

29

1.4%

MALE GENITAL SYSTEM

291

13.9%

Other Leukemia

2

0.1%

Prostate

274

13.1%

MESOTHELIOMA

4

0.2%

Testis

15

0.7%

Mesothelioma

4

0.2%

2

0.1%

MISCELLANEOUS

51

2.4%

51

2.4%

0.2%

Other Biliary

1

0.0%

Pancreas

56

2.7%

Retroperitoneum

2

0.1%

Peritoneum, Omentum & Mesenter

3

0.1%

Other Digestive Organs

1

0.0%

Penis

210

10.0%

URINARY SYSTEM

145

6.9%

Miscellaneous

4

0.2%

Urinary Bladder

77

3.7%

TOTAL

RESPIRATORY SYSTEM Nose, Nasal Cavity & Middle Ear

19 | RESEARCH AND STATISTICS | Penrose Cancer Center 2012 Annual Report

Females

Oral Cavity & Pharynx – 50 (5%) Thyroid – 61 (5%)

Lung & Bronchus – 90 (9%)

Lung & Bronchus – 101 (9%) Breast – 374 (33%)

Urinary Bladder – 56 (6%) Colon & Rectum – 84 (9%) Prostate – 274 (28%) Non-Hodgkin Lymphoma – 49 (5%) Melanoma of the Skin – 35 (4%) Leukemia – 37 (4%)

All Other Sites – 222 (23%)

Kidney & Renal Pelvis – 19 (2%) Ovary – 36 (3%) Uterine Corpus – 98 (9%) Colon & Rectum – 75 (7%) Non-Hodgkin Lymphoma – 42 (4%) Melanoma of the Skin – 29 (3%) Leukemia – 25 (2%)

All Other Sites – 264 (23%)

2,096

Penrose Cancer Center 2012 Annual Report | RESEARCH AND STATISTICS | 20

RESEARCH AND STATISTICS

SUMMARY OF CASES BY BODY SYSTEM AND GENDER

RESEARCH AND STATISTICS


OUR CLINICAL TRIAL ACCRUALS

BRACHYTHERAPY RESEARCH – PUBLISHED BY PENROSE CANCER CENTER PHYSICIANS: ALAN T. MONROE, MD, DIRK PIKAART, DO and ANUJ V. PEDDADA, MD

# of Cases in Cancer Registry

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

1,229

1,355

1,350

1,192

1,195

1,225

1,366

1,739

1,708

1,973

2,137

2,431

2,000*

# of Patients in Clinical Studies

10

13

35

21

31

50

49

63

89

87

60

49

55

# of Patients in Prevention Studies/ Registries/Specimen Banking

15

34

14

32

25

0

0

0

0

12

157

255

446

Totals

25

47

49

53

56

50

49

63

89

99

217

304

502

% of Penrose Cancer Patients Involved

Department of Radiation Oncology, Penrose Cancer Center, Colorado Springs, CO, USA & Department of Gynecologic Oncology, Penrose Cancer Center, Colorado Springs, CO, USA

Clinical outcomes of image guided radiation therapy (IGRT) with gold fiducial vaginal cuff markers for high-risk endometrial cancer

2.0% 3.5% 3.6% 4.4% 4.7% 4.1% 3.6% 3.6% 5.2% 5.0% 10.2% 12.5% 25.1%

Estimated

*

John Eckman, MSH, PA (ASCP) and Julie Bergsten, RN

CHI Hospital Oncology Re-Admissions 20%

Re-Admission Percent

Penrose-St. Francis Health Services and the Penrose Cancer Center are part of Catholic Health Initiatives (CHI), a national nonprofit health system that operates in 17 states and ranks as the nation’s second-largest faith-based system. One of the success indicators we track in our Cancer Center is how many patients are re-admitted to the hospital postsurgery or treatment. We believe this is a good indicator of the success of our oncologists and surgeons and compare ourselves to similar-sized hospitals across the CHI system. The lower percentage of re-admissions, the better.

CHI Aggregate

15%

10%

5%

0%

Good Samaritan Mercy Medical Penrose St. Anthony St. Francis St. Mary Corwin CHI Aggregate Hospital Center Hospital Hospital Medical Center Hospital Kearney Des Moines Central

THE CANCER GENOME ATLAS (TCGA) PROJECT Penrose Cancer Center is actively involved in biospecimen research with The Cancer Genome Atlas (TCGA) project and the Center for Translational Research (CTR) of Catholic Health Initiatives. These investigators are charged with collecting fresh specimens, with patient consent, from surgeries on a variety of tumor types, including gynecologic cancers, for sophisticated molecular studies. Samples forwarded from Penrose and its patients have contributed to a vast body of knowledge about the gene changes and mutations occurring in cancer patients, and this information is certain to open doors for innovative new treatments in the future.

Patients with high risk uterine cancer are frequently treated with both chemotherapy and radiation therapy. We studied a novel method of delivering more accurate, pinpoint radiation to the highest risk areas in the pelvis. This method involves placement of tiny gold markers (fiducials) into the body. The markers can be detected by x-rays each day just before radiation is delivered, leading to more focused radiation, minimal side effects, and high cure rates.

Hospital

21 | RESEARCH AND STATISTICS | Penrose Cancer Center 2012 Annual Report

Penrose Cancer Center 2012 Annual Report | RESEARCH AND STATISTICS | 22


STAFF PUBLICATIONS AND PRESENTATIONS Publications

CO NATIONAL COMMUNITY CANCER CENTER PROGRAM (NCCCP) PILLAR REPORT Penrose Cancer Center extended its contract with the • Developed an on-site Outpatient Palliative Care program in National Cancer Institute as the only Colorado facility in the collaboration with Pikes Peak Hospice NCI Community Cancer Centers Program (NCCCP). This program aims to improve quality of care, increase clinical trials, • Continued investment in Multidisciplinary Conferences, including upgraded AV equipment in the cancer conference rooms and provide outreach and education in our community. • Diane Thompson, MD, Psychiatric Oncologist, joined Penrose Clinical Trials Cancer Center in the fall of 2012 • Accrued more than 500 patients on the various clinical trials, registries, and survivorship studies. Outreach and Education • Participated in a community Skin Screening, Prostate Screening, • Contributed to the Centura Health Cancer Network Healthy Lung and Head and Neck Screening Screening Program, led by Matt Blum, MD, Thoracic Oncologist.

• Collaborated with multiple institutions, including the Colorado Cancer Research Program (CCRP) and the University of Colorado, to ensure access to quality clinical trials.

Quality of Care • Continued development and refinement of disease specific nurse navigation programs, including breast, GYN, prostate, head and neck, GI, lung, blood, and survivorship.

AWARDS AND RECOGNITION American College of Surgeons – Commission on Cancer, Outstanding Achievement Award Accredited by the National Accreditation Program for Breast Centers (NAPBC) Designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR); Penrose Hospital is the only imaging center in southern Colorado to hold this designation Penrose-St. Francis Health Services is proud to be named one of “America’s 50 Best Hospitals” for 5 years in a row (2008 - 2012) by HealthGrades, the only recipient in Colorado and the Top 1 percent in the nation

23 | LEADERSHIP AND AWARDS | Penrose Cancer Center 2012 Annual Report

• Participated in multiple community health education events attended by more than 15,000 people • Expanded educational offerings for our patients, including Integrative Therapies, multiple support groups, and grief support • Expanded survivorship programming, including Back to Your Future educational program and individual survivorship navigation • Held Physician-Specific Education Programs through the Paul Anderson Lecture Series

Bear, H.D., Tang, G.…Young, J.A.…Wolmark, N., et al: Bevacizumab Added to Neoadjuvant Chemotherapy for Breast Cancer, New England Journal of Medicine, 366:310-20, 2012. Bulz, Gyöngyvér, M.S., Monroe, Alan T., M.D., Gibbs, Greg L., M.S., Peddada, Anuj V., M.D., White, Gerald A., M.S.: Significant Underdosing Of Small Lung Lesions Using Ray-Trace Algorithm. Green, T; Boughey, J, DCIS and Mastectomy, Advanced Therapy of Breast Disease, 3rd Edition, 437-444, 2012. Monroe, A., Pikaart, D., Peddada, A.: Clinical Outcomes of image guided radiation therapy (IGRT) with Gold Fiducial Vaginal Cuff Markers for High-Risk Endometrial Cancers, Acta Oncologica, 2012. Peddada, A., Sceats, D.J., White, G., et al: CyberKnife Radiosurgery for Trigeminal Neuralgia: Unanticipated latrogenic effect following successful treatment, Journal of Neurosurgery, November 2011, Vol 115(5) pp. 940-4. Swanson, J., Strusowski, P., Asfeldt, T., De Groot, J., Hegejus, P., Krasna, M., Whiite, D.: Expanding Multidisciplinary Care in Community Cancer Centers, Oncology Issues, January/February 2011. Swanson, J., Strusowski, P., Mack, N., De Groot, J.: Growing a Navigation Program, Oncology Issues, July/August 2012. Young, J.A., Peddada, A., Shaeffer, D., Knox, B.: HPV-Associated Oropharynx Cancer: Durable Complete Response to Chemotherapy Alone, submitted for publication April 2012.

“HDR Prostate Brachytherapy in Anatomically Unsuitable Cases,” World Congress of Brachytherapy, Barcelona, Spain, May 10-12, 2012. Martin, Sherry: “A Comprehensive Toolkit for Starting and Sustaining Brain Tumor Support Groups,” American Brain Tumor Association, July 29, 2011, Lincolnshire, Illinois. Martin, Sherry: “Who’s Caring for the Caregiver? Preventing and Managing Caregiver Burnout,” The Leukemia & Lymphoma Society Rocky Mountain Blood Cancer Conference, April 2011, Denver, Colorado. “New Trends in Brachytherapy,” Government of Brazil, IPEN sponsored meeting, Sao Paulo, Brazil, November 3, 2011. Invited lecturer: 1) Advances in GYN Brachytherapy and 2) Breast Brachytherapy: Techniques and Advances. O’Connell, Patty, RN, MS, OCN: “Penrose Cancer Center Pulmonary Nodule Clinic: Improving Outcomes for Lung Cancer,” Oncology Nursing Society annual conference, May 2011. “Outcomes following a community based program of accelerated partial breast irradiation using HDR brachytherapy in early stage breast cancer,” American Brachytherapy Society 2011 Annual Meeting, San Diego, CA April 2011. Peddada, Anuj, MD: “Varian Brachytherapy” Roundtable Event, Debate Moderator for “Real Time Brachytherapy for Prostate Cancer” and “MRI based Cervical Cancer Brachytherapy Planning.” American Brachytherapy Society 2011 Annual Meeting, San Diego, CA, April 2011. Penrose Cancer Center, poster presented at the Cyberknife Society Meeting, Feb. 2011, San Francisco, CA.

Zaren, H., et al…Harr, J….et al: Early Phase Clinical Trials in the Community: Results from the National Cancer Institute Community Cancer Centers Program (NCCCP) Early Phase Working Group Baseline Assessment, Journal of Oncology Practice (Accepted for publication 2012).

Penrose Cancer Center, poster presented at the annual meeting of the American Association of Physicists in Medicine, July 2012, Charlotte, NC.

Presentations

“Prospective Evaluation of Stereotactic Body Radiation Therapy for Low- and Intermediate-risk Prostate Cancer: Emulating High-dose-rate Brachytherapy Dose Distribution,” ASTRO 54th Annual Conference, Boston, MA, October 28-31, 2012.

Flesher-Bratt, Debra, RDH. “The Oral Health Connection.” Presentation at the Colorado Springs Chapter of NPs and PTNA, January 4, 2012. Gibbs, Gregory L., M.S., White, Gerald A., M.S., Bulz, Gyöngyvér, M.S.: “Rapid Assessment of Cyberknife IRIS Variable Collimator Performance using a Commercial Diode Array.”

Peters, Elly, RN, MS, ONC: “An Exemplary Survivorship Program: A Collaboration Between a Hospital-based Cancer Center and an Oncology Private Practice,” Centura Evidence Based Conference, November 2012.

“Rationale for HDR Boost for Treating Prostate Cancer,” ACRO 2011 Annual Meeting, San Diego, CA, February 24-26, 2011. Strait, Elena: “Hereditary Cancer Syndromes: an Overview,” presented at Evans Grand Rounds, June 2012. Penrose Cancer Center 2012 Annual Report | LEADERSHIP AND AWARDS | 24

LEADERSHIP AND AWARDS

LEADERSHIP AND AWARDS


PENROSE CANCER CENTER 2012 PHYSICIAN MEMBERS

PHYSICIAN ADVISORY BOARD

2012 PENROSE CANCER CENTER CANCER COMMITTEE Toni Green-Cheatwood, DO, Chair, CLP Breast Surgery

Breast Surgery

Medical Oncology

Pathology

Radiology

Blum, Matthew, MD, Chair, Thoracic Surgery

Toni Green-Cheatwood, DO

D. Scott Brantley, MD

Douglas Franquemont, MD

Russell Asleson, MD

Hyun Sue Kim, MD

Lorence Tobias Kircher, MD

John B. Campbell, MD

Young, James, MD, Medical Director Penrose Cancer Center, Medical Oncology

Colorectal Surgery

Matthew Logsdon, MD

Barret Lawshe, MD

Steven P. Jensen, MD

Benjamin Delano, MD

Maurice Markus, MD

Daniel Mayes, MD

Keith Grant Limbird, MD

Michaela Carmen Matei, MD

Jerome Myers, MD

Jeff Ross, MD

Gastroenterology

Timothy Murphy, MD

David L. Newton, MD

Douglas Shaeffer, MD

Michael J. Baker, MD

Robert Sayre, MD

Cosimo Sciotto, MD

Jon Snider, MD

Karin B. Cesario, MD

Daniel Tell, MD

Austin Garza, MD

James Young, MD

Plastic Surgery

William Lunt, MD

Charles J. Zinn, Jr., MD

Tad Heinz, MD

Eric Weidman, MD

Aaron D. Smith, MD

Erik Van Os, MD

Neurosurgery

Thoracic Surgery Matthew Blum, MD

Ian G. Walker, MD

General Surgery

Sana Bhatti, MD

John Frerichs, MD

Michael Brown, MD

Pulmonology

David Hamilton, MD

Ronald Hammers, MD

Urology

Chambers, William, MD, General Surgery, Vascular Surgery Coons, Benjamin, MD, Urology Ernster, Joel, MD, Otolaryngology Fisher, Scott, MD, General Surgery Frerichs, John L., MD, General Surgery Garza, Austin, MD, Gastroenterology Green-Cheatwood, Toni, DO, Breast Surgery Monroe, Alan, MD, Radiation Oncology Peddada, Anuj V., MD, Radiation Oncology Pikaart, Dirk, DO, GYN Surgery, GYN Oncology Sayre, Robert, MD, Medical Oncology Sceats, D. James, MD, Neurological Surgery

Jeff Ross, MD Radiology Alan Monroe, MD Radiation Therapy Cosimo Sciotto, MD, PhD Pathology Cancer Registry Data - Coordinator Nat Timmins, MD Palliative Care Dan Smith, MD General Surgery Charles Zinn, MD Internal Medicine/Med. Onc. Retired – Community Representative Cancer Conference – Coordinator

Gary Bong, MD

Alain Eid, MD

Shaeffer, Douglas R., MD, Radiology

Elliot Cohn, MD

William Lechuga, MD

Joseph Illig, MD

Russell Lee, MD

Shrestha, Yogesh, MD, Pulmonology

Benjamin Coons, MD

Michael McCann, MD

Steven Murk, MD

Yogesh Shrestha, MD

Torgerson, Sigurd, MD, Pathology

J. Eric Derksen, MD

Peter Zimmer, MD

D. James Sceats, MD

Lalith Uragoda, MD

Sue Kim, MD Medical Oncology

Jeffrey Ferguson, MD

Clyde Williams, MD

Scott B. Jennings, MD

Associate Members

Jodi Harr, CTR, CCRP Cancer Registry/Clinical Research Clinical Research Representative – Coordinator

Gynecologic Oncology

Otorhinolaryngology

Dirk Pikaart, DO

David Book, MD

Radiation Oncology

James Richard Tomasch, MD

Bryan Davis, MD

Alan Monroe, MD

Richard Walsh, MD

Anuj Peddada, MD

Andrew Tanner, MD

Gynecology Roy Stringfellow, MD

Joel Ernster, MD Edgar Galloway, MD Barton E. Knox, MD Daniel K. Smith, MD Bryan Wilcox, MD

25 | LEADERSHIP AND AWARDS | Penrose Cancer Center 2012 Annual Report

Jeff Moody, MD

Bruens, Dennis, Director Bremer, Cami, Physician Liaison Ferris, Linda, PhD, Centura Health VP Oncology Services Gates, Lisa, Public Information Officer Smith, Jameson, SVP & Chief Administrative Officer, Penrose-St. Francis Health Services

Sherry Martin, MSW, LCSW Oncology Social Worker Psychosocial Services – Coordinator

Judy DeGroot, RN, MSN, AOCN Performance Improvement/ Quality Management Carolyn Cusic, RN, BSN, OCN Clinical Manager, Inpatient Oncology Services Dennis Bruens, MPA Director, Cancer Center Community Outreach – Coordinator Elena Strait, MS, CGC Genetic Counselor – Hereditary Cancer Service

Ex-Officio Members James Young, MD Medical Oncology/Board Certified

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Penrose Cancer Center 2012 Annual Report | LEADERSHIP AND AWARDS | 26


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2012 Annual Report