2018 Cancer Services
Annual Report
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11
14
Contents In This Report Page 2
Table of Contents
Page 3
Introduction
Page 4
Standard 4.4 - CP3R Measures
Page 5
Standard 4.1 Review - Prevention Programs
Page 8
Regional West 3D Tomography/Foundation Support
Page 10
Regional West Paints it Pink
Page 11
Tim Osterholm - Cancer Care Close to Home
Page 12
Standard 4.6 Review - Laryngeal Cancer
Page 14
Standard 4.2 Review – Screening Programs
Page 17
For Additional Information
2 |22018 | 2014Cancer CancerServices ServicesAnnual AnnualReport Report
Introduction
Vincent Bjorling, MD, Cancer Committee Chairman
I’m pleased to share Regional West’s 2018 Cancer Services annual report. In 2018, Regional West saw 401 newly diagnosed cancer patients. Regional West is proud to continue its partnership with the University of Colorado (CU) Cancer Center in collaboration with UCHealth University of Colorado Hospital (UCH). With the partnership, cancer patients in western Nebraska and eastern Wyoming now have improved access to the region’s most advanced cancer care. 2018 saw the debut of two 3D tomography units in the Breast Health Center. We are grateful to Regional West Foundation, who raised $1.3 million to purchase and install the 3D tomography units, which is the latest technology in breast cancer detection. Regional West continues to offer high-quality, patient-centered cancer care at the Cancer Treatment Center in Scottsbluff, including radiation therapy, chemotherapy, and surgery, as well as radiation therapy at the Dorwart Cancer Care Center in Sidney. Outreach clinics for cancer patients are also held at Alliance, Chadron, and Kimball. I’d like to take this opportunity to thank Stephen Johnson, MD, PhD, who recently retired as a radiologist with Radiology Imaging of Nebraska. Since 1990, Dr. Johnson has been a comforting, reassuring presence for many women at Regional West’s Breast Health Center during a stressful time in their lives. We are pleased that radiologist Michael Yung, MD, who joined Regional West in 2017, recently became part of the Breast Health Center team. Special thanks goes out to Regional West’s Cancer Committee members, providers, nurses, and support staff whose work ethic, combined with outstanding patient and family care, serve as the true backbone of this program. At Regional West, we are committed to involving seasoned professionals in every facet of cancer diagnosis, treatment, and follow-up care to ensure the best possible outcome for our patients. Your efforts are noted and appreciated every day. For more information about cancer services, support programs, and activities for cancer survivors and their loved ones, I invite you to call Regional West Physicians Clinic-Oncology at 308.630.2101, the Cancer Treatment Center-Scottsbluff at 308.630.1348, or the Dorwart Cancer Care Center-Sidney at 308.254.9192. Vince Bjorling, MD Chairman, Cancer Committee Regional West| |rwhs.org rwhs.org Regional West Medical Center | 3| 3
American College of Surgeons National Cancer Data Base (NCDB) 2018 CP3R Measures
Standard 4.4
2018 CP3R Measures Regional West Medical Center
Expected Performance Rate
90%
90%
HT – Tamoxifen or a third generation aromatase inhibitor is considered or administered within one year of diagnosis for women with AJCC T1c or Stage IB-III hormone receptor positive breast cancer.
83.3%
90%
MASRT – Radiation therapy is considered or administered following any mastectomy within one year of diagnosis of breast cancer for women with >=4 positive regional lymph nodes.
100%
90%
nBx – Image or palpation-guided needle biopsy to the primary site is performed to establish diagnosis of breast cancer.
100%
80%
12RLN – At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.
100%
85%
RECRTCT – Preoperative chemo and radiation are administered for clinical AJCC T2N0, T4N0, or Stage III; or postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T2N0 and T4N0, or Stage III; or treatment is recommended for patients under the age of 80 receiving resection for rectal cancer.
100%
85%
No data
80%
66.7%
85%
No data
85%
Oncology Metric The American College of Surgeons (ACoS) Commission on Cancer has defined nine Cancer Program Practice Profile Reports (CP3R) that must be evaluated annually by accredited facilities. BCSRT – Radiation therapy is administered within one year of diagnosis for women under the age of 70 who are receiving breast conserving surgery.
G15RLN – At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer. LNoSurg – Surgery is not the first course of treatment for cN2, M0 lung cases. LCT – Systemic chemotherapy is administered within four months to day preoperatively, or day of surgery to six months postoperatively, or it is recommended for surgically resected cases with pathologic lymph node-positive (pN1) and (pN2) NSCLC. 4 |42018 | 2014Cancer CancerServices ServicesAnnual AnnualReport Report
Regional West Cancer Services Standard 4.1 review for 2018 – Prevention Programs HPV Vaccination Clinics 2016 through 2018 From July 1, 2015 through June 30, 2016, 311 HPV vaccinations were given at Regional West with one school outreach. From July 1, 2016 through June 30, 2017, five school outreach clinics and two sports physical clinics were held through Regional West, with 441 HPV vaccinations given. From July 1, 2017 through June 20, 2018, 10 school outreach clinics and two sports physical clinics were held through Regional West, with 452 HPV vaccinations given. Recommendations changed November 2017, with only two vaccinations needed if the series is started by age 15.
Breast Cancer – Mammogram Screenings 2018 through 2019 Regional West is currently reviewing processes for 2018 through 2019 to increase mammogram screenings. We are evaluating those who don’t return to get a mammogram after the three letters are sent by the Breast Health Center.
Regional West will be working with the Scotts Bluff County Health Department/Panhandle Public Health to complete the following: 1. Technical assistance in using the electronic health record reports to analyze data 2. Assessing current policies and processes 3. Identifying evidence-based interventions proven to be effective in increasing breast cancer screening rates 4. Guided quality improvement process 5. Design and develop resources as needed 6. Develop and maintain flow chart outlining processes Regional West Medical Center | rwhs.org | 5
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2018 Cancer Committee Membership Standard 1.2
Mark Hartman, MD Co-Chairman Radiation Oncology
Cindy Keller, CTR Cancer Conference Coordinator Certified Tumor Registrar
Vincent Bjorling, MD Co-Chairman Medical Oncology
Jennifer Hiltgen, BSW Psychosocial Services Coordinator Social Worker
Gitesh Chheda, MD Cancer Liaison Physician Diagnostic Radiology
Regine Leconte, MD Medical Oncology
Margo Ferguson, MT (ASCP) Quality Improvement Coordinator Quality Management
Susan Schoeneman, MSN, ACNP-BC, AOCNP Oncology Nursing
Required Physician Members
(Designated alternate members are italicized) Cancer Committee Chairman/ Co-Chairman • Vincent Bjorling, MD • Mark Hartman, MD Cancer Liaison Physician • Gitesh Chheda, MD • Jason Walsh, MD, FACS, CWS Medical Oncology • Vincent Bjorling, MD • Regine Leconte, MD Radiation Oncology • Mark Hartman, MD • John Horns, MD 6 | 2018 Cancer Services Annual Report 6 | 2014 Cancer Services Annual Report
Pathology • Peter Schilke, MD, FCAP • Randall Williams, MD, FASCP Diagnostic Radiology • Gitesh Chheda, MD • Michael Yung, MD Surgery • Jason Walsh, MD, FACS, CWS • Jason LaTowsky, MD Palliative Care Services • Connie Beehler, MD, FAAHPM • Deborah Moore, GNP-BC
Required Non-Physician Members
Cancer Program Administrator • Jeff Kriewald, MBA, B.S. RT(R)(T) Certified Tumor Registrar • Cindy Keller, CTR • JoAnn Cervantes, CTR Social Worker • Jennifer Hiltgen, BSW • Jodi Willats, MSW Quality Management • Margo Ferguson, MT (ASCP) • Jeannie Miller, BSN, RN
Peter Schilke, MD, FCAP Cancer Registry Quality Coordinator Pathology
Connie Beehler, MD, FAAHPM Palliative Care Services
Jason Walsh, MD, FACS, CWS Surgery
Jeff Kriewald, MBA, B.S. RT(R)(T) Cancer Program Administrator
Ad Hoc Program Members • John Mentgen, FACHE, President, Chief Executive Officer Regional West Health Services • John Rieke, Interim Chief Operating Officer • Tim Osterholm, MPA, Executive Vice President and Chief Operating Officer
Paulette Schnell, MSN, RN Community Outreach Coordinator
Barbara Jensen, RN Clinical Research Coordinator
• Lisa Scheppers, MD, FACP, CPE Chief Medical Officer • Tom Hartley, DNP, RN, FACHE Chief Nursing Officer • Kathy Campbell, MSN, MPA Chief Nursing Officer
Oncology Nursing • Sue Schoeneman, MSN, ACNPBC, AOCNP • Kim Croft, BSN, RN
Community Outreach Coordinator • Paulette Schnell, MSN, RN • Deborah Keener, BSN, RN Clinical Research Coordinator • Barbara Jensen, RN
• John Kabalin, MD Urology • Jeff Kildow, RPh, Pharm.D Pharmacy
• Deborah Jelinek, OTR/L Rehab Center • Wendy Stirnkorb, CRA, RT (R) (MR) MRSO (MRSC) Imaging Services Director • Karen Johnson, RD, CSO, LMNT, Food & Nutrition Services • Clare Shanahan, American Cancer Society representative • Alecia Gonzalez, Medical Staff Office
Regional West| |rwhs.org rwhs.org Regional West Medical Center | 7| 7
Regional West’s Breast Health Center Unveils 3D Tomography The next level in breast cancer screening Quality Improvement By Joanne Krieg, Regional West Marketing and Public Relations Department Mammograms are important screening tools for breast cancer. While 2D mammography has helped physicians detect breast cancer for years, 3D tomography – the latest technology for early breast cancer detection – has allowed the care team at Regional West to enhance their screening options.
“We can better tell whether lesions are suspicious during 3D tomography,” said Gitesh Chheda, MD, medical director of Imaging Services at Regional West. “This helps prevent recalls and additional visits, which can cause a lot of anxiety for patients, while providing more definitive diagnoses.”
“3D tomography helps detect breast cancer sooner, especially for women with dense breast tissue,” said Wendy Stirnkorb, CRA, MRSO, MRSC™, director of Imaging Services at Regional West. “It can also detect other conditions that traditional 2D mammography may miss or misinterpret as a false negative or positive.”
How it works
Discovering areas of suspicion during a mammogram can mean additional tests for patients.
3D tomography works by taking segmented pictures of the breast in “slices” and combining them into an image that provides specialists with a clearer view of lesions or suspicious areas. “2D mammography is like taking a picture of a loaf of bread from the outside and hoping to find a hidden pumpkin seed inside,” Stirnkorb said.
Regional West Foundation Support Makes 3D Tomography a Reality Thanks to contributions from local businesses, donors, and Regional West staff and physicians, Regional West Foundation raised $1.3 million to purchase and install two 3D tomography units and to renovate the treatment rooms in the Breast Health Center. Regional West employees contributed nearly $65,000, and the 2018 annual Foundation Gala raised over $180,000. 3D tomography is the latest technology for breast cancer detection. It is the best technology for detecting breast cancer in dense breast tissue. “This year’s event was more successful than we could have even imagined,” said John Massey, chair of the Regional West Foundation board of directors. “We are humbled by the support providers, staff, and community members have shown for 3D tomography.” More than 300 guests gathered for the Foundation’s signature event, which honored the Regional West Breast Health Center providers and staff. “This is an annual event that brings our community leaders, health system leaders, and guests together to celebrate the advancement of health care through Regional West, and it was a special night for the
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“You won’t see the pumpkin seed, regardless of how you turn the bread. But if you slice the bread up, you have a better chance of finding the seed.” That’s the benefit of 3D tomography; the ability to see inside the breast at multiple angles allows radiologists to better evaluate lesions. With new 3D technology in place, every woman over age 40 is encouraged to schedule her annual mammogram. Mammograms should begin earlier if there is a family history of breast cancer.
Call 308.630.2700, option 1, to schedule a mammogram at the Regional West Breast Health Center.
Breast Health Center, as they realized they will soon have the new 3D tomography,” said Julie Marshall, Regional West Foundation director of development. The 3D tomography units were showcased on April 2 at Breast Health Center open house hosted by the Regional West Foundation.
Regional West Foundation Director of Development Julie Marshall presents a $1.3 million check for the purchase of two new 3D tomography units to Regional West CEO John Mentgen and members of the Imaging Services and Breast Health Center teams. Pictured (l-r): John Mentgen; Stephen Johnson, MD, PhD; Connie Jordening, Sherri Eubanks; Lanna Zulkoski; Tina Romey; Haley Stewart; Julie Marshall; Wendy Stirnkorb; Gitesh Chheda, MD; and Michael Yung, MD.
Regional West Foundation raises, manages, and distributes funds to enhance the services, programs, and projects of Regional West. The Foundation supports projects to strengthen health care services that are essential to the quality and growth of our local medical community, including new technology, building improvements, and health education scholarships. To learn more about Regional West Foundation, call 308.630.2244 or visit RegionalWestFoundation.org.
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Regional West Paints it Pink Honoring Breast Cancer Awareness Month while raising awareness In honor of National Breast Cancer Awareness Month, and to raise awareness about the importance of annual mammograms and early detection, Regional West hosted Paint it Pink on October 1, an evening of fun, prizes, refreshments, and activities for the community. Breast cancer survivors, their families, and friends were encouraged wear pink and attend the free event in memory and support of those who have been
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impacted by breast cancer. Although one in eight women will be diagnosed with breast cancer in her lifetime, better screening and early detection has helped to decrease mortality due to breast cancer since 1990. The event began at 6 p.m. and continued until dark, when pink lights were turned on to light the front of Regional West. The pink lights shone nightly throughout the month of October.
Cancer Care Close to Home Tim Osterholm, MPA Regional West Health Services Executive Vice President and Chief Operating Officer
Comprehensive cancer care close to home is a service we are proud to provide at Regional West through Regional West Cancer Services. Cancer patients in western Nebraska, eastern Wyoming, and northeastern Colorado are provided personalized care addressing the needs of patients and families alike. As a cancer program administrator early in my career, I am personally committed to fighting this terrible disease. I am proud to now be a part of the Regional West team, supporting their commitment to providing comprehensive cancer care services to the region. Through skilled providers and staff, cancer patients are afforded a multidisciplinary approach to their care, which addresses the
whole person, as well as supporting caregivers. In addition, through an affiliation with the University of Colorado Cancer Center, our Regional West team is able to access specialists, seek consultation, and partner in patient care when appropriate. Regional West Cancer Services has been accredited since 1985 with the American College of Surgeons Commission on Cancer, which speaks to our commitment to keeping quality cancer care close to home.
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Monitoring Compliance with Evidence-Based Guidelines Laryngeal Cancer
Completed and reviewed by Vince Bjorling, Regional West Physicians Clinic-Internal Medicine Chairman, Cancer Committee Monitoring compliance for evidence-based guidelines in 2018 involved a review of laryngeal cancer. The time frame for review involved patients diagnosed between 2013 and 2017.
Treatment was evaluated using Version 2.2018 of the Comprehensive Cancer Network (NCCN) Guidelines for Head and Neck Cancers along with the 2018 NCCN Radiation Therapy Compendium.
The review also focused specifically on cancer of the larynx, glottic larynx, and the supraglottic larynx. The criteria yielded 18 cases for review.
Each of the 18 patients had their treatment course reviewed by Vince Bjorling, MD. Ten of the 18 patients received combined modality treatment,
2018 Standard Case #
ICD-10
Site
Stage
Surgery
1
32.1
Larynx
T4aN0M0
N
Y
Y
2A
2
32
Lt. True Vocal Cord
T2N0M0
Debulking
N
Y
2A
3
32
Lt. True VC/Larynx
T3N1M0
N
Y
Y
2A
4
32.9
Larynx
T4aN0M0
N
Y
Y
2A
5
32
Bilateral True Vocal Cords
T4aN1M0
N
Y
Y
2A
6
32
Rt. True Vocal Cord
T2N0M0
N
N
Y
2A
7
32
Lt. True Vocal Cords
TisN0M0
N
N
Y
2A
8
32
Rt. True Vocal Cord
T4aN0M0
N
Y
Y
2A
9
32.9
Larynx
T3N0M0
Y
N
Y
1
10
32
Rt. True Vocal Cord
T1aN0M0
N
N
Y
2A
11
32
Rt. True Vocal Cord
TisN0M0
N
N
Y
2A
12
32
Larynx
T2N1M0
N
Y
Y
2A
13
32
Anterior True Vocal Cords
T1bN0M0
N
N
Y
2A
14
32.1
Supraglottic Larynx
T2N2cM0
N
Y
Y
1
15
32.1
Supraglottic Larynx
T1N0M0
N
N
Y
2A
16
13
Rt. Pharyngeal Wall/Pharnyx
T3N2bM0
N
Y
Y
1
17
13.1
Epiglottis/Aryepiglottic Fold
T2N0M0
N
N
Y
2A
18
13.1
Anterior Surface of Epiglottis
T2N0M0
N
N
Y
2A
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Chemo/Radiosensitizer Radiation NCCN Category of Evidence
Standard 4.6
nine of those 10 received chemoradiation, while the other patient received surgery followed by radiation. Eight patients received definitive radiation. All 18 treatment plans adhered to national standards as recommended and outlined by the NCCN.
4.6 Clinical Review Clinical Setting
Clinical Scenario
Treatment Course/Recommendations
Cancer of the Supraglottic Larynx
cT4a, N0-3, Not resected, Patients who decline surgery
IMRT - 7020 cGy with Erbitux
Cancer of the Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
3D XRT - 7200 cGy
Cancer of the Glottic Larynx
cT3, N0-1, No surgery
IMRT - 7020 cGy with Erbitux
Cancer of the Supraglottic Larynx
cT4a, N0-3, Not resected, Patients who decline surgery
IMRT - 7020 cGy with Erbitux
Cancer of Glottic Larynx
cT3, N0-3, Surgical resection, Other adverse features (pT4, pN2-3, nodal disease in level 4 or 5, LVI, perinerual invasion
IMRT - 7020 cGy with Cisplatin
Cancer of Glottic Larynx
cT3, N0-1, No surgery
3D XRT - 7900 cGy, BID (120 cGy)
Cancer of Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
3D XRT - 6600 cGy
Cancer of Glottic Larynx
cT3, N0-3, Surgical resection, Other adverse features (pT4, pN2-3, nodal disease in level 4 or 5, LVI, perinerual invasion
IMRT - 7020 cGy and Carboplatin
Cancer of Glottic Larynx
cT1-T2 or select cT3, Partial laryngectomy & neck dissection, Adverse features - Extranodal extension
Laryngectomy and IMRT - 6000 cGy
Cancer of Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
3D XRT - 6600 cGy
Cancer of Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
3D XRT - 6600 cGy
Cancer of Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
Paclitaxel & 3D XRT - 6840 cGy
Cancer of Glottic Larynx
Carcinoma-in-situ, No surgery, cT1-T2 or select cT3, amenable to larynx-preserving sx.
3D XRT - 6600 cGy
Cancer of Supraglottic Larynx
cT1-3, N+, cT4a, N0-3 patients who decline surgery, CR or PR to introduction chemotherapy
Cisplatin & IMRT - 6800 cGy
Cancer of Supraglottic Larynx
cT1-T2, N0, Not resected
IMRT - 6600 cGy
Cancer of Hypopharnyx
cT2-3, Any N, cT1, N+, Induction chemotherapy with CR in primary and stable or improved disease in neck, Not resected
Cisplatin & IMRT - 6600 cGy
Cancer of Hypopharnyx
cT1-2, N0, No resection
IMRT - 6900 cGy
Cancer of Hypopharnyx
cT1-2, N0, No resection
IMRT - 6900 cGy
Regional West| |rwhs.org rwhs.org | 13 Regional West Medical Center | 13
Colon Cancer Screening Kits 2018 Dates, Distribution Sites, and Ve Regional West Cancer Services Standard 4.2 review for 2018 – Screening Programs In recognition of Colorectal Cancer Awareness Month, Regional West Community Health, in partnership with the Scotts Bluff County Health Department, gave away free colon cancer screening kits in March through June 2018. A total of 294 FOBT kits were given out with a return rate of 60 percent. Two of the returned kits were positive.
Sept. 19, 2017
Legacy of the Plains Fall Festival
Dec. 3, 2017
Bomgaars Ladies Night Out
Feb. 5, 2018
Panhandle Public Health flyer distribution mailing
Feb. 9/10, 2018
KNEB Farm and Ranch Show
Feb. 21, 2018
Scottsbluff Public Schools Wellness
Feb. 22, 2018
Western Nebraska Community College Employee Wellness
March 2018
Newspaper articles marketing free CCP screening kids (this is facilitated by Regional West’s Marketing and Public Relations department and includes approximately eight area newspapers)
March 2018
Regional West Physicians Clinic handed out coupons for each patient 50 through 74 years of age for a free CCP screening kit
March 7, 2018 March 9, 2018
NBC Nebraska TV Town Talk interview
March 10, 2018
Regional West Intranet to all staff for CCP screening kits
March 14, 2018
Platte Valley National Bank employee wellness
The screening test is performed in the privacy of one’s own home. By following instructions included in the kits, individuals obtain a stool sample and then return the sample to the lab where it is checked for blood.
March 23, 2018
Mitchell Berean Church colon cancer awareness
April 7, 2018
KNEB Spring Show
May 24, 2018
Western Sugar Company
Regional West Community Health advertised the FOBT kits in 69 places in the 10 communities located in Scotts Bluff County, including the venues and activities listed in the yellow box to the right. Posters, displays, or venues were utilized.
June 24, 2018
SWBC employee wellness
The fecal occult blood test (FOBT) kits were available at no cost to Nebraska residents ages 50 to 74. Those who receive the kits were required to have a health care provider. “Finding cancer early, when it’s small and hasn’t spread, often allows for more treatment options,” said Regional West internal medicine physician A. J. Magana, MD. “A colonoscopy is the best screening test available for colorectal cancer and should be done at age 50. During the years in between recommended colonoscopy exams, the fecal occult blood test is a good option.” Fecal occult screening can reveal the presence of microscopic or invisible blood in the stool, or feces. The blood can be a sign of a problem in the digestive system, such as a growth, polyp, or cancer in the colon or rectum. Early detection may prevent polyps from becoming cancerous and may jumpstart early treatment, when it is most effective. When it is found early and treated, the five-year survival rate for colorectal cancer is 85 to 90 percent.
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KCMI radio Coffee Break show
enues Scotts Bluff County Health Department Fecal Occult Blood Test (FOBT)
Kit distribution and return rate by venue Jan. 1, 2018 through July 10, 2018 Return rate denoted at top of each bar Total kits distributed: 285
50
69%
60 Kits
16 47%
40
9 59%
30 78% 20
35
# Not Returned #Returned
31
79% 3
10
0
55%
5
40% 11 3 100% 2 2
47%
0% 1
17
80% 1 4
8
50% 11 3 3
15
64%
9 9
18
35%
12
5
9
64% 55% 73% 3 4 5 7
6
8
8
50% 1 1
KNEB WNCC KNEB NBC SB NewsChurch- Comm Deb Farm and Spring and Nebraska papers PPHD Western Employee YMCA PVNB SBPS Radio RWHS RWPC County Bomgaars Pharm Sugar MBC Keener Ranch Garden TV Wellness 3 0 3
1 16
2 2 11 0 35
5
1 9 9 3 9 12 5 4 5 3 15 1
18
4 31 8 3 11 17 9 7 6 8
8 1
Avenue of Distribution
“Colorectal cancer is the second leading cancer killer in the United States. That’s a scary statistic and it’s one of the reasons why we offer free colon cancer screening kits during Colorectal Cancer Awareness Month.”
Deb Keener, RN | Regional West Community Health Nurse
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For Additional Information Call:
308.630.1574
Write:
Regional West Medical Center Cancer Treatment Center 3911 Avenue B, Suite G100 Scottsbluff, NE 69361 Attention: Jeff Kriewald, MBA, B.S.RT (R) (T) Director, Cancer Servicves
Email: Jeff.Kriewald@rwhs.org Web:
Access the report at www.rwhs.org
2018 annual report published October 2019 Teresa Clark, Editor
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Annual 18 | 2014 Cancer Services Annual Report