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We make tough decisions that lead to great outcomes.

2011 Oncology Annual Report With a special report on genital, urinary and gynecological cancers

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TABLE OF CONTENTS A Message From Our Chair...................................................................................... 3. Oncology Committee..................................................................................................4 In Memory: Harvey Bender, PhD............................................................................ 5 Services & Locations.................................................................................................. 6 Treatment Modalities: Radiation Therapy.................................................................................................... 8 Chemotherapy........................................................................................................... 8 Genetics & Risk Assessment............................................................................... 9 Research & Clinical Trials..................................................................................... 9 Clinical Nutrition....................................................................................................... 9 Support: Nurse Navigation....................................................................................................10 Spiritual Care...........................................................................................................10 Women’s Task Force..............................................................................................11 Outreach Services..................................................................................................12 RiverBend Cancer Services.................................................................................13 American Cancer Society....................................................................................13 Cancer Registry Report...........................................................................................14 Plymouth Cancer Institute......................................................................................17 Patient Care Conferences.......................................................................................19 Special Report: Genital, Urinary & Gynecological Cancers.......................22 Affiliates, Approvals & Accreditations..............................................................29 Colors of Cancer Awareness................................................................................ 30 Phone Directory..........................................................................................................31

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A MESSAGE FROM OUR CHAIR We set the standard for care. Then we share it. Each cancer patient has a story. From detection and diagnosis to treatment and recovery, the experience is very personal one. The care provided to each patient should not be any different. At Saint Joseph Regional Medical Center, patients receive individualized treatment from talented and compassionate physicians, nurses and staff who are dedicated to their work. Our continuum of care begins with Patient Navigation. Provided free of charge, this outpatient nursing support system guides cancer patients and their families through the complex health care system. Together with Memorial Hospital, SJRMC sponsors weekly cancer forums with area oncology experts to discuss individual patient cases. This board-certified team includes family physicians, radiation oncologists, medical oncologists, clinical psychologists, surgeons, pathologists, hematologists and radiation therapists. Our multi-disciplinary approach ensures our patients have confidence in the abilities and knowledge of those who provide care. Decisions are made using best and most current data available – evidence-based therapy. And our significant investments in technology ensure we are providing advanced treatment that is setting the standard for cancer care. We are committed to doing everything we can give our patients and the entire community access to leading healthcare – and the peace of mind that comes from that experience.

Bilal Ansari, MD Oncology Committee Chairman Saint Joseph Regional Medical Center Cancer Program

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2011 ONCOLOGY COMMITTEE This is a place of healing. Where every individual is cared for in body, mind and spirit. Where quality, dignity and respect are not just words, but actions. A common purpose unites us: caring for the community that we’re a part of. We know that the health of every individual affects us all. So we’ve created a system to deliver exceptional care, close to home, from people who know what living here means. This is our calling.

Bilal Ansari, MD

Marian Brown, CTR

Louis Pace, RN

Committee Chair

Cancer Registrar

Pain Control Specialist

Michael Rotkis, MD

Erica Borys, RD

Vanessa Perkins

Cancer Liaison Physician/Surgeon

Nutrition Specialist

Recorder

Michael Method, MD

Roberto Carbonell

Corrine Reno, Pharm

Medical Oncologist

Pastoral Care Representative

Pharmacy

Robert Tomec, MD

Kathy Deka

Camilla Shaw, RN

Pathologist

American Cancer Society

Patient Nurse Navigator

Roger Klauer, MD

Bernadette Dolezal

Gretchen Skurla, MS

Rehabilitative Services Representative/Physiatrist

Center for Women’s Health

Cancer Genetic Counselor

Linda Tuthill, MD

Gwen Ehlers, RD

Amelia Taggart, RN, OCN

Nutrition Specialist

Oncology Nurse

David Hofstra

Susan Whitehead, RN

Performance Improvement Professional

Case Manager

Radiation Oncologist

Ameri Kazi, MD

Christopher Karam, COO

Pain Control Physician

Cancer Program Administrator

Facility-based Community Outreach Employee

Lisa Barnaby, CCRP

Joan Lennon

Kate Voelker

Clinical Research Representative

Public Member of the Community Served

RiverBend Cancer Services

Diagnostic Radiologist

Binh Tran, MD

Harvey Bender, PhD

Cari Wilson

Cancer Genetics Program Director*

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IN MEMORY Harvey A. Bender, PhD, FACMG 1933-2011

In 2011, the community lost a dedicated scientist, treasured teacher, well respected colleague and compassionate man. Harvey A. Bender, PhD, was a Professor of Biological Sciences and Director of the Human Genetics Program at the University of Notre Dame for more than 50 years. He also served as an Adjunct Professor of Medical Genetics at the Indiana University School of Medicine. From 2004 until his passing, Dr. Bender served as Director of the Cancer Genetics and Risk Assessment Center at Saint Joseph Regional Medical Center. Dr. Bender received his undergraduate training at Case Western Reserve University, majoring in Chemistry and English. His graduate studies in Developmental Genetics were undertaken at Northwestern University, where he received both his M.S. and Ph.D. degrees. He also served as a U.S. Public Health Fellow in Genetics at the University of California (Berkeley) and has held postdoctoral positions as a Gosney Fellow at the California Institute of Technology and as a Visiting Professor at the Yale University Schools of Medicine and Law. Dr. Bender was a Fellow of the American Association for the Advancement of Science and a Founding Fellow of the American College of Medical Genetics. He also authored and reviewed numerous publications on genetics and teaching throughout his career. He was elected a Carnegie Scholar by the Carnegie Foundation in 2001 and a Kaneb Teaching Fellow at the University of Notre Dame in 2003. During and after his achievement of all of the above, Dr. Bender served as the founding Director of the Regional Genetics Center at the South Bend Memorial Hospital before accepting his position at Saint Joseph Regional Medical Center. During the course of his extraordinary career, Dr. Bender created, implemented and maintained two Clinical Genetics programs, all while pursing his love of teaching and his passion for Notre Dame. He was part of many committees and educational venues and was instrumental in implementing and creating Newborn Screening in the State of Indiana. Dr. Bender was well respected both in the field of genetics and especially in our community. When genetics were involved, physicians, educators and other colleagues would seek him out for advice and guidance. We are saddened by the loss of the “face of Genetics� in Michiana. Saint Joseph Regional Medical Center celebrates and honors Dr. Harvey Bender and his zest for life, his remarkable accomplishments, and his dedication to improving the health of all.

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SERVICES AND LOCATIONS Center for Women’s Health 611 East Douglas Road, Suite 123 Mishawaka, IN 46545 574.335.6216

Saint Joseph Regional Medical Center provides access to cutting-edge cancer services and care for patients across Michiana. Mishawaka & South Bend

The Center for Women’s Health, located in the Medical Office Building connected to the hospital, offers a unique and convenient experience for Michiana women. The Center is committed to the importance of early detection and promotion of breast health with leading edge technology and a highly trained staff. All the resources and technology our staff needs to effectively and efficiently care for patients are in one convenient location.

Mishawaka Campus

5215 Holy Cross Parkway Mishawaka, IN 46545 574.335.5000 Garcia Family Foundation Oncology Unit The Garcia Family Foundation Oncology Unit, located on the sixth floor of the Mishawaka Campus, is specially designed to create a soothing environment for patients with cancer. Our goal is to provide excellent care effectively manage cancer, its treatments and its side effects to allow the patient the highest quality of life All of our providers are specially trained to care for cancer patients. Our nurses attend Oncology Nursing Society chemotherapy/biotherapy provider courses in order to administer these medications to our patients. The Unit also includes a large Hospice Room to accommodate patients with special needs or a longer length of stay. Team of Experts • Nurses & Oncology Clinical Nurse Specialist • Oncologists & Physicians who specialize in cancer treatment • Case Manager • Chaplain • Clinical Dietician • Oncology Pharmacist • Physical, Occupational & Speech Therapists

Services • Two digital mammography units • Digital state-of-the-art biopsy room • Ultrasound • Bone Density Screening Lymphedema Treatment Clinic 611 East Douglas Road, Suite 140 Mishawaka, IN 46545 574.252.3616 The Lymphedema Treatment Clinic, located in the Medical Office Building connected to the hospital, offers a comprehensive approach to help patients manage lymphedema. The program is a collaboration between Roger Klauer, MD, Acupuncturist, of Saint Joseph Family Medicine at Elm Road and Outpatient Rehabilitation. Our staff works closely with Michiana Hematology Oncology and is specially trained to provide treatment sensitive to the needs of oncology patients. Team of Experts • Physiatrist • Nurse Navigator • Physical Therapists • Appointment Scheduler

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Saint Joseph Medical Imaging 53940 Carmichael Dr. South Bend, IN 46635 574.243.0100

Services • Gynecologic Oncologists • Medical & Radiation Oncologists • Imaging Services • Genetics & Risk Assessment • Financial Assistance • Complementary Medicine • Master Nutritional Therapist • Nurse Navigator • Oncology Rehabilitation • On-Site Laboratory • Pain Management Consultations • Second Opinion Clinic • Support Groups • 24-Hour Nursing Assistance • Personal Appearance & Image Boutique

Saint Joseph Medical Imaging services are available at the Mishawaka Campus and a freestanding location on Carmichael Drive in South Bend. Our state-of-the-art equipment ensures the best possible detection and diagnosis of a variety of conditions. Technology has substantially improved the quality of exams, and our facilities offer many of the newest and best devices on the market. Our expert staff of radiologists and technicians is dedicated to quality care and treating every patient with dignity, respect, and compassion. All of our images are digitally acquired and graphically stored for future reference and quick access. Services • Bone Density • CT Scan • Mammography • MRI

Plymouth Plymouth Cancer Institute

• X-Ray & Fluoroscopy • Ultrasound • PET/CT Imaging

Michiana Hematology Oncology

1915 Lake Avenue Plymouth, IN 46563 574.936.3181 5340 Holy Cross Parkway Mishawaka, IN 46545 574.237.1328 All the cutting-edge cancer services and care that a patient may need can be found under one roof at Michiana Hematology Oncology’s Regional Cancer Center, a joint venture located directly across the street from the Mishawaka Campus. This state-of-the-art freestanding facility was designed by highly skilled experts in cancer care who asked for input from real patients to ensure that it was designed as a welcoming place. Technically advanced and completely integrated, this Regional Cancer Center treats the whole person.

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The Plymouth Cancer Institute offers patients who live in Marshall County and surrounding communities access to the latest treatments conveniently close to home. Our medical oncologists, radiation oncologists and specially trained nurses provide expert cancer care in a soothing and healing environment. Services • Radiation Therapy • Outpatient Infusion Center • Laboratory & Imaging • Nutritional Counseling • Oncology Patient Navigator • Spiritual Care


TREATMENT MODALITIES Radiation Therapy & Chemotherapy Radiation Oncology services at SJRMC offer advanced comprehensive radiation therapy programs, with individualized treatments for each patient. The oncology team consists of a specially trained oncology nurse, radiation therapist, dosimetrist and physicist, who each work with the patient to ensure the highest quality, safety and best possible outcomes. SJRMC has partnered with Michiana Hematology Oncology in the delivery of state-of-the-art Radiation Therapy at the new cancer center, including the region’s first and only Linear Accelerator with “rapid arc” technology and respiratory gaiting. The Linear Accelerator speeds up treatment for patients and delivers more targeted radiation, minimizing exposure to surrounding healthy tissues. The 120-leaf MCL provides custom blocking around critical structures while optimizing radiation dose to the target area, creating precise treatment custom to each patient. Cone beam CT helps to obtain diagnostic CT-like quality images with the Linear Accelerator. This technology delivers more precise treatments much faster than other technologies, and allows for pinpoint accuracy of radiation directly at the tumor site. RT vision is able to obtain 3D images of patients in real time such that breathing may be tracked during treatment. In addition, our staff uses Oncovision, a computer software program that allows diagnostic imaging to be integrated into treatment planning. We now offer MammoSite®, a unique therapy option that provides targeted radiation and a shorter treatment time for breast cancer patients. The therapy concentrates just on the cancerous area of the breast, minimizing exposure to surrounding healthy tissues. For many women, the 5-day treatment plan is a preferred alternative to multi-week, daily radiation treatments. Radiation Oncologist Binh Tran, MD, administers the tumor-specific therapy. Not all patients are eligible. SJRMC uses national guidelines in recommending appropriate treatment. Outpatient Infusion Patients receiving treatment can do so conveniently at one of our three Outpatient Treatment & Infusion Centers, located in Mishawaka and Plymouth. Services provided include, but are not limited to: • Chemotherapy administration • Catheterizations • Blood & blood product transfusions • Injections • IV medication administration • IV fluids for hydration • Dressing changes Genetics & Risk Assessment Center Our Genetics & Risk Assessment Center is the only one of its kind in the area. Our certified genetics counselor on staff works with recently diagnosed patients to help provide them information on their diagnosis, determine the likelihood that the cancer is inherited, coordinate genetic testing and provide accurate interpretations of the results according to the recommended AHRQ and the NCCN guidelines.

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Access to genetic testing for a variety of cancers continues to increase. Our goal at the Genetics & Risk Assessment Center is to give patients the information they need to make the best decision for them. Services available include: • Genetic Counseling & Testing • Risk assessment for individuals and their families • Cancer screening recommendations for individuals and their families Self-referrals are accepted. Many insurance companies will cover all or a portion of the cost of genetic counseling and testing. There is a process of pre-certification available, so that a patient can know the amount of coverage ahead of time. Northern Indiana Cancer Research Consortium The Northern Indiana Cancer Research Consortium (NICRC) is a team of hospital systems that has joined together to support and advance cancer research in Indiana and Southwest Michigan. The NICRC provides access to nationwide cancer clinical trials that provide our patients with the most up-to-date care in our community. NICRC is a member of the Community Clinical Oncology Program, which is supported by the National Cancer Institute. SJRMC supports the NICRC by providing experienced research professionals for the Cancer Institute & Plymouth Campuses. Our certified Oncology Nurses and Certified Clinical Research Professionals assist the physicians in presenting clinical trials, treatment medications and provide risk and benefits associated with each trial. In year 2010, 12.1% of the analytic cases accrued to a clinical trial, thus exceeding national standards. According to the American College of Surgeons, in order to receive commendation, a community hospital cancer program needs to accrue to clinical trials 4% of the number of analytical cases. The NICRC has been awarded the National Cancer Institute’s Platinum Certificate of Excellence for Exceptional Achievement in clinical trial patient enrollment for the period of June 1, 2010 to May 31, 2011. The following staff and Investigators were commended, and include Drs. Rafat Ansari, Michael Rodriguez, Binh Tran and Robin Zon. Congratulations to the entire staff and all of our dedicated, enrolling investigators on continuing their efforts to benefit our patients and community. Clinical Nutrition Our Clinical Nutrition Services are available to provide a continuum of nutritional care for the patient diagnosed with cancer, starting with initial diagnosis and continuing through treatment. “Nutrition is an important part of cancer treatment. Eating the right kinds of food before, during and after treatment can help you feel better and stay stronger. Surgical treatment, aggressive chemotherapy and radiation treatment may lead to altered taste, anorexia, dysphasia, or dehydration, which can result in malnutrition, treatment interruption or morbidity.” (1) Aggressive oral or enteral nutritional support may improve outcome in selected cancer patients. Reference: Nutrition for the Person with Cancer during Treatment (Pamphlet) p. 3

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SUPPORT Oncology Patient Navigator Discovering that you are about to battle cancer can be frightening, confusing and overwhelming. To assist our patients and families through the treatment process, SJRMC offers the support of an Oncology Patient Navigator, free of charge, at the Mishawaka Campus and the Plymouth Campus. Our patient navigators are registered nurses who provide education, emotional support and anticipatory guidance to patients and their families. They serve as advocates and educators to ensure cancer patients receive the support and knowledge they need to navigate through the health care system. Role of the Navigator • Help patient understand diagnosis • Explain procedures, treatments, side effects, roles of physicians and other aspects of care • Assist with questions to ask your doctors • Help patients locate support groups • Provide patient with more detailed educational material pertaining to specific types of cancer and treatment options. • Offer resource information about financial assistance, home health needs, insurance issues, medication assistance, transportation and other concerns • Coordinate physician and diagnostic appointments, if needed • Function as a hospital “go to” person for staff when need be • Provide patients with a primary point of contact Spiritual Care SJRMC is committed to body, mind and spirit. Our professional chaplains are available to visit with patients and their families at all of our inpatient facilities. They provide spiritual and emotional support for all patients and families, regardless of whether or not they have a religious affiliation. Our Chaplains are available to speak with patients about the following: • Anxiety about a medical procedure • End-of-life care decisions • Difficult diagnosis • Difficulties with a significant relationship • Trouble sleeping • When a patient or family needs support • Exploring spirituality or faith • When a patient wishes to talk or pray • Ethical issues For our Catholic patients, a priest is available for sacramental needs and may be reached through the on call chaplain. Eucharistic ministers bring communion daily to patients who list themselves as Catholic.

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SUPPORT Women’s Task Force Founded in 2001 as an all-volunteer group of women cancer survivors, the Women’s Task Force of SJRMC promotes prevention, awareness and the importance of early detection of cancer. Secret Sisters Society Mammogram Program For ten years the Secret Sisters Society has raised funds to provide mammograms to Secret Sisters participants who qualify for the Indiana Breast and Cervical Cancer Program (BCCP) due to income, but do not become eligible for cancer screenings until they reach the age of 50. Since March of 2003, the Secret Sisters Fund has scheduled more than 4,000 mammograms for women age 4049. By donating $50 or more, anyone can become a Secret Sister. The Secret Sisters program is managed through the BCCP, which is administered locally by United Health Services (UHS). Women can access the program by calling UHS directly to inquire about financial qualifications, or their physicians will refer them. In 2010, the Women’s Task Force was pleased to announce that the Secret Sisters program would expand its services to provide cervical cancer screenings in addition to mammograms for women in need. The 10th Annual Secret Sisters Society Luncheon & Style Show in September 2011 at the University of Notre Dame Joyce Center raised $109,000 to provide breast and cervical cancer screenings. GynaGirls The GynaGirls promote community awareness through the annual University of Notre Dame Domer Run/Walk on campus, an event that raises money for charity including the GynaGirls. The group spearheads an awareness campaign about Gynecological Cancer during the month of September and throughout the year. The GynaGirls continue to present a highly successful educational program in area nursing schools, with members visiting students at Saint Mary’s College, Bethel College and Indiana University South Bend to share their experiences relating to diagnosis and treatment for cancer. Additionally, the group prepares and distributes “Hope Packets” to newly diagnosed patients in the community. Young Survivors of Breast Cancer The Young Survivors breast cancer support group established and funds the Young Survivors Mammogram Program through United Health Services, in partnership with the University of Notre Dame Women’s Basketball Program. This fund helps women under 40 years of age, who would otherwise be financially unable, gain access to life-saving mammograms and diagnostic services. The group also continues to fund a cardio and strength training fitness program for cancer survivors, Young Survivors Boot Camp. The Boot Camp program is free, providing an opportunity for women who have been through cancer obtain optimal fitness. In addition, the Young Survivors prepare and deliver care packages, each tailored to the needs of newly diagnosed patients.

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SUPPORT Outreach Services SJRMC Outreach Services plays a very active and critical role in cancer prevention and awareness through community outreach. • In May 2011, approximately 400 women received free cervical cancer screenings through an event called Pap-a-Thon.® This was the 7th event in 8 years. This year’s event was a partnership with the Women’s Task Force, American Cancer Society, South Bend Medical Foundation and Michiana Hematology Oncology. • In October 2011, Betty Greene, RN, was named by they Alliance for Clinical Trials in Oncology as an Associate Director of Advocacy. On a local level she gives educational seminars and on a national level she advocates for dollars for cancer research. • Jill Sabo, MSW, is the St. Joseph County Tobacco Coordinator through SJRMC. She is the only Trained Tobacco Specialist (TTS) in Indiana and is trained by the Mayo Clinic. Jill monitors and implements programs that are evidence-based, cost effective for patients and taxpayers and proven to increase the overall health of our community. Many of the initiatives may also affect Meaningful Use through CMS. • The Mobile Medical Unit (MMU) provides approximately 80-100 mammograms a month depending on time of year and location. • Community Outreach received two Valscope machines in 2011. One machine is housed at Sister Maura Brannick Health Center and one at the Outreach Services office for use at screening events. • One of the screenings done at nearly all health fairs and screening events is a glucose screening. New glucose machines were purchased in the fall of 2011 to meet updating requirements. Operators must be trained and verified with SJRMC database to offer screenings. Such screening can help detect diabetes and as a result, if managed properly, can prevent liver cancer. In addition, postmenopausal women with the “high” blood glucose levels were nearly twice as likely to develop colorectal cancer over 12 years than those who had low levels, a study showed. Researchers examined 4,500 women ages 50 to 70 and found that 35 patients in the “high” group - not quite high enough to be diabetic - developed colorectal cancer by the end of the study period, compared with only 18 in the “low” group. The findings appear in the British Journal of Cancer.

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SUPPORT RiverBend Cancer Services SJRMC works closely with RiverBend Cancer Services, a local agency whose primary goal is to assist people with cancer and their caregivers by providing financial assistance, advocacy services and emotional support. The staff at RiverBend is dedicated to helping those battling cancer, and their families, by providing much needed supplies and services, free of charge. These can includes medical equipment loans for at-home recovery, nutritional products, prostheses or items from a wig salon and counseling services. RiverBend is the lead agency for Touch Base at the Cove, an annual community event that focuses on prostate screenings and other health screenings. SJRMC is a proud partner of this event. American Cancer Society The American Cancer Society (ACS) is an active partner with SJRMC. In addition to being a partner with Pap-a-Thon, a local representative is a member of the Tobacco-free St. Joseph County Coalition, housed at SJRMC. Together, ACS and tobaccofunded counties throughout Indiana, including St. Joseph County, are working to achieve a comprehensive smoke free law to protect all workers in Indiana. The ACS also supports the following programs and support groups locally: • Surgeons refer patients recovering from Breast Cancer surgery to receive a “Reach to Recovery” visit from a Breast Cancer Survivor who is matched by type of surgery, adjuvant treatment, age, etc. • Volunteers trained as “Road to Recovery” drivers provide SJRMC cancer patients with rides to appointments and treatments. • Man-to-Man, a support group for Prostate Cancer survivors. This group meets on the first Thursday of each month (except July and December) at 5:30 pm at Michiana Hematology Oncology. • Woman-to-Woman, a Breast Cancer support group meets on the second Wednesday in March, April, May, June, August, September and October at 6 pm at the American Cancer Society, 130 Red Coach Drive in Mishawaka. The Breast Center nurses from SJRMC and Memorial Hospital facilitate this group. • Cancer patients receive a free Personal Health Manager kit to help learn about their cancer and organize their health care information by calling 1.800.227.2345. No matter what you need the American Cancer Society may be contacted 24 hours a day, 365 days a year by calling 1.800.227.2345 or going to www.cancer.org.

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CANCER REGISTRY REPORT A Cancer Registry is essential for cancer programs within a hospital setting. The Cancer Registry at SJRMC collects, manages, analyzes and reports information on patients who have been treated and/or newly diagnosed with a cancer diagnosis. The cancer cases collected by our certified cancer registrars are reported to the Indiana State Cancer registry as required by law. As an accredited cancer program through the Commission on Cancer each year, complete data for all requested analytic cases are submitted to the National Cancer Data Base (NCDB) in accordance with the annual Call for Data. This statistical information is used for a number of reasons to include analyzing the need for screening programs within our local community to investigating environmental contaminants that show an isolated cancer cluster. The overall goal of cancer registries is to provide high quality data that helps to understand and address the nation’s cancer burden. Staffing at SJRMC consist of three full–time certified cancer registrars, one full-time cancer conference coordinator, one full-time follow-up coordinator, and two very special volunteers. Summary of New Cases In 2010, our Certified Cancer Registrars collected a comprehensive total of 791 new cancer cases. The top five sites reported collectively at SJRMC are digestive, respiratory system, breast, female genital system, and the urinary system as shown in the Primary Site Table. Distribution of All Patients Diagnosed with a New Cancer at SJRMC in 2010 BONES & JOINTS MESOTHELIOMA SOFT TISSUE MYELOMA HODGKIN LYMPHOMA ORAL CAVITY & PHARYNX LEUKEMIA SKIN EXCLUDING BASAL & SQUAMOUS MISCELLANEOUS BRAIN & OTHER NERVOUS SYSTEM ENDOCRINE SYSTEM NON-HODGKIN LYMPHOMA MALE GENITAL SYSTEM URINARY SYSTEM FEMALE GENITAL SYSTEM BREAST RESPIRATORY SYSTEM DIGESTIVE SYSTEM

0

20

40

60

14

80

100

120

140

160

180

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CANCER REGISTRY REPORT The top five male sites collected are lung, prostate, colon & rectum, pancreas and urinary bladder. For female sites collected; breast, lung, colon & rectum, uterine corpus, and ovary as shown below.

2010 Summary of Cancers Diagnosed by Male and Female at Saint Joseph Regional Medical Center Female

Male

Thyroid................................................ 17 (4%) Lung & Bronchus..........................76 (16%) Breast.............................................146 (30%) Kidney & Renal Pelvis....................11 (2%) Ovary.................................................... 18 (4%) Uterine Corpus................................. 33 (7%) Colon & Rectum.............................. 35 (7%) Non Hodgkin Lymphoma.............. 14 (3%) Melanoma of the Skin...................... 7 (1%) Leukemia...............................................4 (1%) All Other Sites............................. 120 (25%)

Oral Cavity & Pharynx......................5 (2%) Lung & Bronchus..........................64 (21%) Pancreas............................................. 19 (6%) Kidney & Renal Pelvis................... 15 (5%) Urinary Bladder............................... 18 (6%) Colon & Rectum............................39 (13%) Prostate............................................41 (13%) Non Hodgkin Lymphoma.............. 15 (5%) Melanoma of the Skin......................7 (2%) Leukemia...............................................9 (3%) All Other Sites................................78 (25%)

2011 Estimates According to the American Cancer Society, in 2011, the U.S. population is estimated to have 1.6 million new cancer cases with male representing 51.5% and female 48.5%.* The top five male new cancer cases. .The top five female new cancer cases estimated for 2011 are: estimated for 2011 are: Prostate............................................... 29% Breast .....................................................30% Lung & Bronchus ............................ 14% Lung & Bronchus ............................... 14% Colon & Rectum .................................9% Colon & Rectum ....................................9% Urinary Bladder ..................................6% Uterine Corpus .......................................6% Melanoma .............................................5% Thyroid ......................................................5%

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CANCER REGISTRY REPORT Cases by County Seventy percent (70%) of new cancer cases collected at SJRMC are from St. Joseph County, as shown in the county of distribution map. Berrien, Michigan represents 9% and Marshall County is represented at 8%.

Berrien 9%

Quality Control & Follow-Up To ensure that the patients who are diagnosed and/or treated at SJRMC obtain the best possible outcomes, the FollowUp Coordinator routinely track lifetime survivorship on our patients. Since our reference year of 1999 we have collected over 12,000 patients in the registry’s database and have a successful follow-up on 95.89% of these patients. From the fiveyear reference date we have a successful follow-up rate of 97.43%.

LaPorte 1%

Starke 1%

Cass 3%

St. Joseph 70%

Elkhart 5%

Marshall 8%

Other IN Counties 2%

To ensure the quality of cancer data Fulton collected in the registry, cancer committee 1% physicians and registry associates participate in quality control review of 10% of registry data and pathology review annually. All registry staff participates in ongoing educational activities to keep abreast of the latest standard changes. We also participate in community outreach programs such as national cancer survivor’s day and the annual relay for life walk. Yearly goals for the registry include identifying opportunities for improvement that will impact patient care and continuous data quality, participate in the rapid quality reporting system (RQRS), implement in-house electronic casefinding, and build on College American Pathology (CAP) new pathology checklists for cancer pathology reports. *Rounded to the nearest 10; estimated new cases exclude basal cell skin cancers and in situ carcinomas except urinary bladder. About 57,650 carcinoma in site female breast and 53,360 melanoma in site will be newly diagnosed in 2011. ©2011, American Cancer society, Inc. Surveillance Research.

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PLYMOUTH CANCER INSTITUTE Cancer patients have enough on their minds. The Plymouth Cancer Institute offers advanced treatments and quality care conveniently close to home for our patients who live in Marshall County and surrounding communities. Advanced Treatment & Technology Our Wide-Bore CT Simulator helps physicians plan the course of radiation therapy before treatment begins. This advanced equipment is designed to be more comfortable for patients and reduce any feeling of claustrophobia. The Linear Accelerator speeds up treatment for patients and delivers more targeted radiation, minimizing exposure to surrounding healthy tissues. The 120-leaf MCL provides custom blocking around critical structures while optimizing radiation dose to the target area, creating precise treatment custom to each patient. A Laboratory is located inside the medical oncology department, providing added convenience for patients, physicians and staff. Radiology services are located next door, and diagnostic tests and screenings can be scheduled before or after treatments, minimizing a patient’s time driving back and forth to the hospital. The Outpatient Treatment & Infusion Center at the Plymouth Campus provides: • Chemotherapy administration • Blood & blood product transfusions • IV medication administration • Dressing changes • Catheterizations • Injections • IV fluids for hydration

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PLYMOUTH CANCER INSTITUTE Multi-Disciplinary Team Radiation treatment is directed by radiation oncologist Guy Kedziora, MD. Dr. Kedziora has practiced in the Michiana area since 1991 and is active on the medical staffs at the SJRMC Plymouth and Mishawaka hospitals. Medical oncology care at the Cancer Institute is provided by Ronald H. Kawauchi, MD, board certified medical oncologist and hematologist. Dr. Kawauchi offers inpatient and outpatient consultations and medical oncology services to better meet the needs of patients in Plymouth and surrounding communities. To assist our patients and families through the treatment process, the Plymouth Cancer Institute also offers the support of an Oncology Patient Navigator, whose services are free of charge. Turn to page 10 to learn more. Cancer patients also have access to the services and resources offered by: • Nutritional Counselors • Genetic Risk & Assessment • Spiritual Care • Clinical Research • Wound Healing Center Cancer Conferences The Cancer Conferences at the Plymouth Cancer Institute are supported by the Cancer Registry. These monthly tumor board meetings are held every third Monday of each month from 7 am – 8 am and are located in the Education Center. General case discussions occur and include a multi-disciplinary team of physicians and support staff that is prepared to share their knowledge and expertise with one another. Data collection in 2010 reports a total of 171 analytic cancer cases. The top five primary sites reported are: lung & bronchus at 16.4%, breast at 14.6%, colon excluding rectum at 11.7 %, kidney & renal pelvis and non-Hodgkin lymphoma both at 6.4%. Of the 171 analytic cases diagnosed in 2010, 88% were over the age of 50 years old. Sixty percent of the patients diagnosed are Marshall County residence. 15% are St. Joseph County residence, with 12% from Fulton County, 9% traveling from Starke County, and 4% from other outlying counties in Indiana.

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PATIENT CARE CONFERENCES Cancer Conferences The goal of cancer conferences is to promote a multidisciplinary team approach to the whole care of a patient who has been diagnosed with cancer. During these weekly conferences, key specialist and managing physicians review and explore treatment options for all types of cancer cases. These conferences allow each specialist an opportunity to pool their expertise to create the most effective individualized treatment plan for each patient. The conferences are also forums to discuss new treatments related to cancer. One exciting improvement to the cancer conferences this year was to add remote attendance to those physicians who are unable to physically attend our weekly cancer conferences. The WebEx session is targeted towards physicians whose schedules do not allow them to attend the on-site cancer conferences, but would still like to participate during the live event. Continuing Education credits will be available for remote participants. There will be no charge for these events, but you must pre-register for each event via a link that will be emailed to interested parties before each conference. Each week notification is sent to all staff physicians inviting them to participate in this wonderful event. Total number of conferences scheduled in 2010: Breast: 51 Head & Neck: 12 Neurosurgical: 12 Lung: 12 Hematology: 6 Urology: 6

Gynecological: 4 Gastrointestinal: 12

Saint Joseph Regional Medical Center 2010 Total Numbers By Physicians

900 800 700 600 500 400 300 200 100 0

856

310

235 50 57 27 52 40 Med Onc

101 26 24 14 23 14 Rad Onc

45 22 21 29 29 Surgeons

BCF

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ENT

51

12 12 6 12 11 Pathology

LUNG

19

UROL

51

108 11 12 6 13 11

3 15 1 3 2

Radiology

Other Drs

GI

NEURO

147142 132 75 107 Total Phy


Standard 2.8 Total number of SJRMC cases presented: 202 Total number of SJRMC prospective cases presented: 157 Percent of prospective cases (Target 75%): 78% Saint Joseph Regional Medical Center 2010 Cancer Conferences

250 200 150 100 50 0

202 157 95

77 8

BCF

6

GYN

24

14

ENT

21

17

19

LUNG

16 GI

Cases Presented

10

8

UROL

5

3

HEMA

20

16

NEURO

TOTAL

Pros. Cases Presented

Annual Cancer Educational Updates Annually, the Cancer Committee offers continued medical education that focuses on the use of AJCC staging, prognostic indicators and evidence – based national guidelines used in treatment planning. On Wednesday, April 20, 2011 we focused on a lecture for primary care physicians. An Oncology Update was presented and featured local physicians who discussed the management of lung cancer, the management of rectal cancer, the use of PET in cancer diagnosis and management and the future of oncology as relating to genetics and targeted therapy. The objective of this conference was to education primary care physicians so that they are able to discuss with their patients the diagnosis, treatment strategies, side effects, and use of state of the art technologies available for cancer patients in 2011. On October 21, 2011, SJRMC held our fourth annual northern Indiana oncology symposium in conjunction with other health care facilities in the Michiana community. The focus this year included breast and ovarian cancers. With all of this wealth of information we completed our day in time to take advantage of the many activities of the Notre Dame Football weekend.

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Featured Speakers: Jose Montero, MD Mammaprint in Clinical Practice

Peter Rose, MD Surgical Treatment of Ovarian Cancer

Kathy Miller, MD Chemotherapy and Targeted Therapy for Breast Cancer

Julian Schink, MD Early Detection, Screening, and Prevention of Ovarian Cancers

Malcolm Pike, MD Estrogens, Progestins and the Risk of Breast and Ovarian Cancers

Gail Vance, MD Genetic Services for Hereditary Breast Cancers

Frank Vicini, MD Partial Breast Irradiation Pat Whitworth, MD The Evolving Concepts of Managing the Axillary Nodes in Treatment of Breast Cancer

Save the Date Next year, we look forward to another informative cancer care update on Saturday, October 13, 2012, the morning of the Notre Dame vs. Stanford College football game. We look forward to your visit.

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SPECIAL REPORT SJRMC: Data Analysis and US Comparison of Genital, Urinary and Gynecological Cancers Each year cancer registrars across the country delve into the cancer statistics they have collected in their registries over the past years and prepare a subset of their cancer data to what is happening in the nation. We are looking to see if there are any abnormal, stable, or declining trends in the types of cancers we treat in our facilities based on the national guidelines that are followed here and throughout the nation. This year, SJRMC will focus on Male and Female genitourinary cancers and female gynecological cancers. According to the American Cancer Society’s cancer facts & figures for 2011 it is estimated that approximately 11.7 million Americans with a history of cancer were alive in January 2007. While some are considered cancer-free, others had evidence of cancer and are possibly still undergoing some form of treatment. It is expected that about 1,596,670 new cancer cases are expected to be diagnosed in the US in year 2011. This estimate excludes non-invasive cancers (carcinoma in situ) of all sites with the exception of urinary bladder. Also excluded are basal and squamous cell skin cancers because cancer registries are not required to report these cases. The mortality of Americans in 2011 from cancer which is the second most common cause of death in the US exceeded by heart disease is about 571,950. With these quoted statistics, cancer accounts for nearly 1 of 4 deaths in the United States. In 2011, 471,520 new male and female genitourinary and gynecological cancer cases are estimated in the US of the total new cancer cases diagnosed. Male urinary bladder cancers are estimated to represent 90,750 of the total new cancer cases and female urinary bladder cancers are estimated to represent 42,150 of the total new cancer cases diagnosed. The male genital system will represent an estimate 250,540 new cancer cases in 2011. The female genital system/gynecological are estimating new cancer cases that include uterine cervix 12,710, uterine corpus 46,470, ovary 21,990, vulva 4,340, and vagina & other female genital areas 2,570. Indiana residences are estimated to represent 34,050 new cancer cases in 2011. 1,440 of the new cancers diagnosed will be urinary bladder cancers. Prostate cancers will represent 4,580 new cases. Uterine cervix is estimating 260 new cases and uterine corpus is estimating 1,010 new cases in 2011. With these alarming estimated numbers of new cancer cases we will look at what percentage of these people are estimated to survive cancer. The American Cancer Society quotes that the 5-year relative survival rate for all cancers diagnosed between 1999 and 2006 is 68%, up from the 50% rate in 1975 – 1977. Therefore if we can diagnose cancer at an earlier stage with the improvements in treatment, people can live longer and possibly free from cancer.

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SPECIAL REPORT This retrospective review of data will show the incidence and mortality statistics for years 2000 - 2009.

Male Genital Cancers Saint Joseph Regional Medical Center and NCDB-All Types of Hospitals in All States Comparison of Male Genital Cancers by Stage Cases Diagnosed 2000 - 2009 80.0% SJRMC

NCDB

68.7%

70.0%

65.1%

60.0%

50.0%

40.0%

30.0% 19.8%

20.0%

0.0%

11.0%

10.4%

10.0%

6.8%

4.9%

4.6%

4.3%

3.6%

0.2%

0.3%

0.1%

0.1%

0

I

II

III

IV

NA

UNKNOWN

Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in All States Comparison of Male Genital System Cancers By Age Group Diagnosed 2000 - 2009 40.0% SJRMC

NCDB

35.0%

37.0%

32.7%

30.0% 27.1%27.5%

25.0% 20.7%

21.3%

20.0%

15.0% 11.1%

10.0% 6.7% 3.8%

5.0% 2.0%

1.5%

1.7%

4.0%

1.5%

1.0% 0.6%

0.0% Under 30

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30-39

40-49

50-59

23

60-69

70-79

80-89

90 and over


SPECIAL REPORT Male Genital Cancers Saint Joseph Regional Medical Center and NCDB - All Types of hospitals in All States Comparison of Male Genital System Cancers By First Course of Treatment Cases Diagnosed 2000-2009 60.0% SJRMC

NCDB

50.1%

50.0%

40.8%

40.0%

30.0% 20.1%

20.0%

16.1% 15.8% 12.9%

10.4% 4.8%

cifi pe

No

1s tC

ed

ou

Th

rs

e

On n tio ia

ra py he ot em Ch

Rx

ly

ly On

ly On er ap y Th e on

Ot

n Ra d

ia

tio

rm

&

y er rg Su

Ho

&

Ho

rm

Ch

on

em

e

ot

Th

he

ia Ra d & y er rg Su

er ap y

ra py

n tio

ly On y er rg Su

er ap y

0.0% 0.1%

0.0%

7.4%

2.5%

rS

3.4%

1.3% 1.0%

1.2%

Ra d

3.4%

he

10.0%

8.7%

24

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SPECIAL REPORT Female Genital Cancers Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in all States Comparison of Female Genital System Cancers By Age Group Cases Diagnosed 2000-2009 30.0% SJRMC

25.0%

24.2%

NCDB

23.4% 22.9%

22.1%

20.0%

19.2% 17.9%

14.7% 14.1%

15.0%

11.0% 9.6%

10.0% 6.1%

6.7%

5.0% 2.5% 2.2%

2.1%

1.3%

0.0% Under 30

30-39

40-49

50-59

60-69

70-79

80-89

90 and over

Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in all States Comparison of Female Genital System Cancers By Stage Cases Diagnosed 2000-2009 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 0

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I

II

III

25

IV

NA

UNKNOWN


SPECIAL REPORT Female Genital Cancers Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in All States Comparison of Female Genital Systems By First Course Treatment Cases Diagnosed 2000-2009 60.0% SJRMC

47.9%

50.0%

NCDB

46.8%

40.0%

30.0%

16.7%

20.0% 16.0% 9.1%

10.0%

10.0%

7.3% 5.5% 4.7%

4.6% 4.7%

2.3%

7.1%

6.6% 5.9%

2.5%

1.1% 1.4%

er ap y

Rx cifi pe rS he Ot

No

1s tC

ed

ou

Th

rs

e

On n tio ia Ra d

he ot em Ch

er rg Su

ly

ly ra py

Ch ,& y,R ad

em Ch & n tio

Ra d

ia

On

em

o

ra oy he ot

he ot em Ch y er rg

Su

Su

rg

&

er

y

Su

&

rg

er

Ra d

y

ia

On

tio

ly

n

ra py

0.0%

26

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SPECIAL REPORT Urinary Cancers Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in All States Comparison of Male and Female Urinary Cancers By Age Diagnosed 2000-2009 45.0% 41.5%

40.0%

35.0% 31.0%

30.0%

28.9%

SJRMC

NCDB

25.0%

23.8% 22.1%

20.0% 17.4%

16.7%

15.0% 10.6%

10.0%

8.0%

7.0%

5.0%

3.2% 0.6%0.93%

0.9%

1.8%

2.4%

0.0% Under 30

30-39

40-49

50-59

60-69

70-79

80-89

90 and over

Saint Joseph Regional Medical Center and NCDB - All Types of Hospitals in All States Comparison of Male and Female Cancers By Stage Diagnosed 2000-2009 35.0% SJRMC

30.8% 30.0%

NCDB

28.9%

25.2% 25.0%

23.3% 21.3%

20.0%

15.0%

14.5%

13.9%

9.1%

10.0%

10.2%

9.6%

7.4% 4.8%

5.0% 0.6% 0.4% 0.0% 0

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I

II

III

27

IV

NA

UNKNOWN


SPECIAL REPORT Urinary Cancers

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Affiliates, Approvals & Accreditations Affiliations American Academy of Family Physicians American Board of Family Practice American Hospital Association American Medical Rehabilitation Providers Association Association of Community Cancer Centers Catholic Health Association (Consolidated Catholic Health Care) Indiana Hospital Association Indiana University Rehabilitation Institute of Chicago Riley Hospital for Children Riley Trauma Life Center South Bend Medical Foundation Approvals Indiana Board of Health Indiana State Nurses Association Indiana State Emergency Medical Services Commission Medicare & Medicaid Programs Accreditations American College of Radiology American College of Surgeons’ Commission on Cancer American Council on Graduate Medical Education American Registry of Radiologic Technology Association for Clinical Pastoral Education College of American Pathologists Joint Commission on Accreditation of Healthcare Organization National Accreditation Program For Breast Centers

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Breast Pink

Ovarian Teal

Leukemia Orange

Melanoma Black

Liver Emerald Green

Cervical Teal/White

Colon Dark Blue

Childhood Gold

Kidney Kelly Green

Pancreatic Purple

Leiomyosarcoma Purple

Lymphoma Lime

Lung Pearl

Uterine Peach

Brain Gray

Prostate Blue

Bladder Yellow

Sarcoma/Bone Yellow

Esophageal Periwinkle Blue

Stomach Periwinkle Blue

Thyroid Teal/Pink/Blue

Head & Neck Multiple Myeloma Burgundy/Ivory Burgundy

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General Lavender

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PHONE DIRECTORY Saint Joseph Regional Medical Center – Mishawaka 5215 Holy Cross Parkway Mishawaka, IN 46545 574.335.5000

Care Management............................. 574.335.3100

Saint Joseph Regional Medical Center – Plymouth 1915 Lake Avenue Plymouth, IN 46563 574.936.3181

Center for Spiritual Care..................574.335.5139

Michiana Hematology Oncology 5340 Holy Cross Parkway Mishawaka, IN 46545 574.237.1328

Medical Imaging Center................... 574.247.5400

Center for Women’s Health – Mishawaka.............................................574.335.6216 Center for Women’s Health – Plymouth............................................... 574.935.2310 Clinical Nutrition..................................574.335.2431 Garcia Family Foundation Oncology Unit.......................................574.335.6110 Lymphedema Clinic............................574.252.3616 Oncology Patient Navigator............574.231.6474 Oncology Research........................... 574.231.6484 Outpatient Treatment & Infusion Center.....................................574.335.6115

Community/National Agencies American Cancer Society................574.257.9789

Radiation Therapy Mishawaka......574.204.7860

American Cancer Society Response System.............................800.ACS.2345

Radiation Therapy Plymouth......... 574.935.2353 Saint Joseph VNA Home Care......574.335.8600

Cancer Information Services....... 800.4CANCER

Women’s Task Force......................... 574.231.6465

Center for Hospice & Palliative Care, Inc................................................. 574.243.3100

Online

Marshall County American Cancer Society.....................................866.522.2111

Saint Joseph Regional Medical Center www.sjmed.com

RiverBend Cancer Services at United Health Services.................... 574.234.3136

American Cancer Society www.cancer.org Center for Hospice & Palliative Care, Inc www.centerforhospice.org

Saint Joseph Regional Medical Center Mishawaka Campus..........................574.335.5000

Women’s Task Force www.womenstaskforce.org

Plymouth Campus..............................574.936.3181 Michiana Hematology Oncology.... 574.237.1328 Cancer Institute – Plymouth.......... 574.935.2353

RiverBend Cancer Services www.uhs.in.org

Cancer Genetics & Risk Assessment Center............................574.231.6477

Northern Indiana Cancer Research Consortium www.nicrc.org

Cancer Registry...................................574.237.6857

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Mission Statement We serve together in Trinity Health, In the spirit of the Gospel, To heal mind, body and spirit, To improve the health of our communities, And to steward the resources entrusted to us.

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2011 Oncology Annual Report