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Quality seems to be the buzz word for the 2007 Cancer Committee activities in Commission on Cancer Approved Programs. Cancer Program leaders are facing an era of change as increasing pressure is placed on providers to engage in performance measurement and reporting. Public accountability is becoming the rule rather than the exception. With information so easily obtained over the Internet, patients have more responsibility and control over their care and where they receive it than at any other time. Insurers and payers are demanding more information to improve the quality of data across several disease sites and to improve clinical management and coordination of patient care in the multidisciplinary setting. There are numerous efforts currently underway to establish consensus on performance measures for colorectal cancer care. Among the leaders has been the public/private partnership led by the National Quality Forum (NQF) that has brought together payers, consumers, researchers, and clinicians to promulgate performance measures for breast and colorectal cancer. The 80-year history of the Approvals Program places the Commission on Cancer in an enviable leadership role and CoC-Approved Programs at the forefront of these changes. The National Quality Forum’s endorsement of measures for breast and colorectal cancer care in April 2007 leaves the Commission on Cancer (CoC) well positioned to assist CoC-Approved cancer programs in preparing for the implementation of these quality-focused measures and to benchmark those practices with other CoC Approved Programs across our nation. CHRISTUS ST. Michael Health System and Wadley Regional Medical Center ranked high in compliance with CoC Programs across the nation in comparing 1998-2005 data Stage III Colon Cancer with CSMHS ranking 92.6% and WRMC ranking 91.4%. The ranking of all CoC Approved Programs across the country was 76%. The mission of the CSMHS & WHS Cancer Programs is to provide quality comprehensive care including state-ofthe-art services and equipment, a multidisciplinary team approach to coordinate the best treatment options available, access to cancer-related education and support services, and ongoing monitoring and improvements in cancer care to provide quality care close to home for our patients.

It takes

Ron Hekier, M.D. CSMHS & WHS Cancer Committee Chairman


2007 Cancer Committee Physician Members (from left to right): Ranga Balasekaran, M.D.; Mike Finley, M.D.; Roger Good, M.D.; Bryan Griffin, M.D.; Howard Morris, M.D.; George English, M.D.; Jack H. McCubbin, M.D.; J. Alan Solomon, M.D.; J.D. Patel, M.D; Anthony Tran, M.D.

CANCER SITE Prostate

# CASES 296

PERCENT 25%

# NATIONAL CASES FOR 218,890

PERCENT 20%

PH Y SIC IAN

Ron Hekier, MD Chair

M E M B ER

NON-PHYSICIAN MEMBERS Kim Lewis, RN

Lung

251

21%

213,380

20%

Breast

193

16%

180,510

17%

Colorectal

129

11%

153,760

14%

Melanoma

91

8%

59,940

6%

Kristen Lower, MD

Bladder

72

6%

67,160

6%

Alan Solomon, MD

Tracy Wade, RHIT

Kidney

64

5%

51,190

5%

Bryan J Griffin, MD

Donna Marlar, CTR

Oral Cavity & Pharynx

Howard Morris, MD

46

4%

34,360

3%

Robert Parham, MD

Dianne Greenhaw, RN

Lymphoma

36

3%

71,380

7%

Chris McMillian, MD

Pancreas

28

2%

37,170

3%

H. Anthony Tran, MD

100%

Total 1,087,740

100%

TOTAL CASES

Total 1,206

*American Cancer Society, Cancer Facts and Figures 2007 Estimated New Cancer Cases CY: 2007 This table represents cases diagnosed or treated in CSMHS, WHS and physician offices or private practice institutions during 2007. Only the cases submitted to the UAMS AHEC-SW Cancer Registry are reflected in this table. Cases were researched against the Cancer Registry database to eliminate duplicates.

Mike Finley, MD J. D. Patel, M.D. Roger Good, MD Joe Robbins, MD.

Ranga Balasekaran, MD George W. English, III, MD

Jena Teer, LSW Debra Wright, RN Susan Paxton Mike Jones, BS PHA

Mary Miller, LMSW-ACP Jodie Martindale, RHIA Dianne Ketchum, CTR Alan Anderson, PharmD Tammy McKamie, RN, OCN


Howard Morris, M.D. Radiation Oncologist of CHRISTUS St. Michael Health System, serves as moderator of the CSMHS Tumor Board meetings and educational conferences as well as CSMHS Liaison to the Commission on Cancer Liaison Program. Dr. Morris is an active member of the Joint Cancer Committee and has served as Chairman in the past. He is the medical advisor for the Texarkana Unit American Cancer Society and participates in CoC initiatives at CSMHS. Dr. Morris recently trained at the Seattle Prostate Seed Institute in Seattle, Washington and initiated the local prostate seed program at CSMHS in 2007. His leadership in providing a less invasive therapy for prostate patients who qualify and in providing newly purchased state-of-the-art equipment to offer the best treatment available is greatly appreciated.

CSMHS SCREENINGS AND EDUCATIONAL EVENTS CSMHS Prostate Screening for the Black Community

CSMHS Cancer Survivor’s Day

CSMHS Colorectal Screening for the Community

CSMHS Weight Watchers International

CSMHS & ACS Coping with Breast Cancer Support Group

Texarkana Susan G. Komen Race for the Cure

CSMHS Breast Cancer and Cervical Care Outreach Program,

American Cancer Society Great American Smoke Out

Funded by grants from Susan G. Komen RFC and Texas Breast & Cervical Care Services, Underwritten by CSMHS.

American Cancer Society Relay For Life

CSMHS & ACS Man to Man Support Group

American Cancer Society Reach to Recovery

CSMHS Life & ACS After Loss Support Group

ACS Days at the W. Temple Weber Cancer Center

Prostate Cancer by County  Y2003‐2007

CSMHS Prostate Cancer Distribution by Race, Y2007

Bowie Other Miller Hempstead

26% 74%

26%

Little River Cass Howard

Caucasian

African‐Am


CANCER SITE

ORAL CAVITY & PHARYNX

# of CASES

29

PERCENT

NATIONAL PERCENT

3.6

2.4

CANCER SITE

SOFT TISSUE/CONNECTIVE TISSUE

# of

CSMHS

NATIONAL

CASES

PERCENT

PERCENT

.1

.6

1

TONGUE

9

1.1

.7

BREAST

121

15

12.5

MOUTH

3

.4

.7

CERVIX

10

1.3

.8

PAROTID GLAND

2

.3

-

UTERUS

12

1.5

2.7

TONSIL

5

.6

-

OVARY

6

.8

1.6

PHARYNX

8

1

.8

PROSTATE

13.3

15

OTHER

2

.3

.2

TESTES/OTHER MALE GENITAL

8

1

.6

11

1.4

1.1

KIDNEY

26

3.6

3.4

STOMACH

8

1

1.5

BLADDER

35

4.4

4.7

SMALL INTESTINE

3

.4

.4

OTHER URINARY ORGS

2

.3

.1

COLON

80

10

7.8

MENINGES

2

.3

-

RECTUM

13

1.6

2.9

BRAIN

24

3

1.4

ANUS

4

.5

.3

ADRENAL

1

1

.1

LIVER

3

.4

1.3

THYROID GLAND

5

.6

2.3

19

2.4

2.6

LYMPHOMA

29

3.6

4.9

2

.3

.3

LEUKEMIA/ANEMIA

5

.6

1.4

191

23.9

14.8

10

1.3

3.1

9

1.1

2.2

ESOPHAGUS

PANCREAS OTHER ILL DEFINED DIGESTIVE LUNG/BRONCHUS TOTAL

106

MULTIPLE MYELOMA

LUNG -SMALL CELL

7

-

-

OTHER & UNSPECIFIED SITES

LUNG-NON SMALL

184

-

-

TOTAL CASES ACCESSIONED

911

.5

.8

** ANALYTICAL CASES

800

2.6

4.2

LARYNX MELANOMA

4 21

*** NON-ANALYTICAL

CASES

111

1,444,920


Prostate cancer affects one in six men in their lifetime and is estimated that there were 218,890 prostate cancer cases diagnosed in 2007 in the U. S. The estimated number of prostate deaths for that year is 27,050 which makes this site of cancer the second leading cause of cancer deaths in men. Historically, prostate cancer was considered a disease of old age but its prevalence is increasing in younger men and is the second most commonly diagnosed cancer affecting men after middle age as depicted in our local data shown in the graphs provided.( Fg.1 & 2). The optimal treatment of prostate cancer is determined due to several factors, age, stage of disease and grade of differentiation. Substantial changes have occurred in the treatment of prostate cancer prior to the widespread use of PSA. NCI SEER data demonstrates a substantial shift toward more aggressive therapy for clinically localized prostate cancer, most notably toward radical prostatectomy. Rates of aggressive therapy have increased in both black and white men. However, there are racial differences in treatment patterns. On a national and local level localized and regional stages of prostate cancer in white men are more likely than black men to receive radical prostatectomy while black men are more likely to receive radiation therapy. (Fig 3)

CSMHS & WHS Prostate Cancer Distribution by Age & AJCC Stage Y2003-2007

CSMHS & WHS Frequency of Cancer in Men

BLADDER 9%

COLON 12% PROSTATE 36%

90+

KIDNEY 5%

80-89 70-79 BRON LUNG 38%

60-69 50-59 40-49 30-39 0-29 0

50 Stage 2

100 Stage 3

150

200

Stage 4

Unk Stage

250


Treatment patterns are strongly influenced by age with

CSMHS & WH S Prostate Distribution by Age and Treatment Type

younger men tending to have radical prostatectomy, middleaged men tending to have radiation therapy and older men tending to have conservative approaches (no treatment or hormone therapy).

The distribution of treatments for ad-

vanced stage disease has remained stable. (Fig.3)

100% 80% 60% 40% 20% 0% Surg

Most men diagnosed with prostate cancer will die from other disease.

Over 90% of prostate cancer cases are diagnosed

with local or regional disease.

Rad 20-49

Horm Comb None 5 0-69

70-99

The national 5 year relative

overall survival rate is about 99%.

CSM HS & WHS Pr os tate Dis tr ibution by Race and Tr e atm e nt Type

When this data is further subdivided into stage, local or regional prostate cancer patients have a nearly 100% 5 year sur-

vival, while only 34% of metastatic prostate cancer patients

70% 60%

survive 5 years.

50%

These national figures compare favorably to our local data

30%

(Fig 5) which also show a significant difference in survival

based on stage. It is clear that early detection leads to better survival at 5 years. Routine screening with yearly combined PSA and digital rectal exam (DRE) is recommended for middle aged men.

Respectfully submitted,

C. Todd Payne, M.D. Urologist Collom & Carney Urology Center

40%

C auc as ian A fric an-A m

20% 10% 0%

Surg

Rad

Ho rm Co mb

No ne


Dr. George English, III is an active member of the Joint Cancer Committee and has accepted the responsibility of Wadley Health System Liaison to the Commission on Cancer. He was appointed by the CoC based on his knowledge, skill and dedication to the cancer program in Texarkana and is the moderator of the WHS Tumor Board Conferences. In 2007 Dr. English participated in the HER2 NEU targeted therapy for early stage breast cancer patients study by the American College of Pathology (CAP) in order to monitor the proficiency of his department studies and to reduce the substantial risks associated with false positive and false negative results. Dr. English’s efforts to provide quality and precise diagnosis of cancer make him a valuable member of the WHS cancer team.

WHS SCREENINGS AND EDUCATIONAL EVENTS Wadley/Susan G. Komen for the Cure Health Education Program, Free mammograms, ultrasounds, biopsies, wigs and prostheses

Wadley Genetics Educator- Genetics Testing Program

Wadley Bringing Hope Home Breast Cancer Education & Awareness Event

American Cancer Society Great American Smoke Out

Wadley & ACS Dialogue Support Group

American Cancer Society Reach to Recovery

Wadley & ACS Breast Cancer Support Group

Wadley & Weight Watchers International

Wadley Prostate Screening & Education Program

ACS Days in the Cancer Center

WRMC FREQUENCY OF CANCER IN WOMEN

KIDNEY COLON

PANCREAS

ALL OTHER

American Cancer Society Relay For Life

Endometrial Distribution by General Summary,  Y 2003‐2007

Unknown BREAST

BRON LUNG

Texarkana Susan G. Komen Race for the Cure

Distant Regional Localized 0

10

20

30


CANCER SITE

ORAL CAVITY & PHARYNX

# of CASES

9

PERCENT

NATIONAL PERCENT

7.7

2.4

CANCER SITE

MELANOMA

# of

WHS

NATIONAL

CASES

PERCENT

PERCENT

2

.6

4.2

TONGUE

5

1.5

.7

BREAST

95

29.1

12.5

TONSIL

1

.3

-

CERVIX

3

.9

.8

OROPHARYNX

2

.6

.8

OTHER ORAL CAVITY

1

.3

.2

PROSTATE

3

.9

1.1

TESTES/PENIS

6

1.8

1.5

COLON

22

6.7

RECTUM

2

ANUS

2

.6

2.7

40

12.3

11.5

2

.6

.6

KIDNEY/RENAL PELVIS

16

4.9

3.4

7.8

BLADDER

16

4.9

4.7

.6

2.9

BRAIN

5

1.5

1.4

1

.3

.3

THYROID GLAND

3

.9

2.3

LIVER

3

.9

1.3

LYMPHOMA

5

1.5

4.9

GALLBLADDER

3

.9

.6

LEUKEMIA/ANEMIA

3

1

3.1

PANCREAS

7

2.1

2.6

MULTIPLE MYELOMA

3

1

1.4

4

1.2

.8

OTHER & UNSPECIFIED SITES

3

.9

2.2

20.6

14.8

9

-

-

** ANALYTICAL CASES

58

-

-

*** NON-ANALYTICAL

1

.3

.2

ESOPHAGUS STOMACH

LARYNX LUNG/BRONCHUS

67

LUNG -SMALL CELL LUNG-NON SMALL BONES

UTERUS

326 CASES

TOTAL CASES ACCESSIONED

American Cancer Society, Cancer Facts and Figures 2007. ** Diagnosed and all of the first course of treatment was preformed at reporting facility. *** Diagnosis and all of the first course of treatment was preformed elsewhere, recurrence or progression of disease cases at the reporting facility.

64 390


Endometrial carcinoma is the most common gynecologic maE ndo m e t ria l C a nc e r D is t ribut io n by A ge a nd S t a ge Y 2 0 0 3- 2 0 0 7

lignancy in the United States. Slightly more than 40,000 cases are diagnosed each year. It accounts for 6 percent of all cancers in women. (FN1.)

5 4

Two types of endometrial cancer exist. Type 1 (endometrioid

3

tumors) accounts for 80 percent of cases and is estrogen-related.

2

Type II (papillary serous or clear cell tumors) accounts for 20 percent of cases and is unrelated to estrogen stimulation. (FN 2). Endometrial cancer usually occurs in postmenopausal women (mean age early 60s).

1 0 0-29

30-39 40-49 50-59 60-69 70-79 80-89

Stage 1

Stage 2

Stage 3

Stage 4

90+

Unk Stage

Twenty-five percent of cases are diag-

nosed in pre-menopausal women and 5 to 10 percent of these

CSMHS & WRMC Endometrial Cancer  Distribution by Race Y2003‐2007

women are under the age of 40. (FN 46). This disease can occur in women under age 30. (FN 47) Distribution by age and stage of our 55 cases is depicted graphically

African  American 11%

Caucasian 89%

For years 2003-2007, we had 55 reported cases of endometrial cancer. Incidence rates are always higher in white women than in African American, Hispanic, or Asian/Pacific women. FN 1. 89 percent of our cases occurred in Caucasian women; 11 percent in African American women.

(FIGO) American Joint Committee on Cancer (AJCC) classification

15

system.

10 5

and adjuvant radiation therapy or chemotherapy and prognosis

0

of differentiation and histologic subtype).

No  Tr

stratification is determined by disease stage and histology (grade

Su rg er y

Individualized treatment (surgery; radiation therapy; surgery

Ra di aio n

20

Co m bin ed

to the Joint International Federation of Gynecology and Obstetrics

ea tm en t

Endometrial carcinoma should be surgically staged according

Su r/R ad

CSMHS & WHS Endometrial Cancer by Treatment, Y2003‐2007


Nationally, Five year survival rates for localized, regional and me-

CSMHS & WHS ENDOMETRIAL SURVIVAL DISTRIBUTION BY AJCC STAGE

tastatic disease are 95, 67 and 23 percent respectively (FN 1). The cardinal symptom of endometrial carcinoma is abnormal uterine

G 100 IN90 IV V80 R U S70 T60 N E50 C R40 E P30

bleeding, which occurs in 90 percent of cases (FN 98). Even one drop of blood in a postmenopausal woman not on hormone replacement is an indication for diagnostic testing to excluded endo-

20 10

metrial cancer.

0

0

3

6

9

12

15

18

21

24

27

30

33

36

39

42

45

48

51

54

57

60

NU MBER OF MONTHS 1 3

2 4

FN #1. Jemal, A. Siegel, R, Ward, E, et al. Cancer Statistics,2008. CA Cancer j Clin 2008 FN # 2. Bokhman, JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10. FN # 3. Gallup, DG, Stock, RJ. Adenocarcinoma of the endometrium in women 40 years of age or younger, OBstet Gynecol 1984; 64:417

Of great interest, in the past year, we had two

cases of early endometrial cancer diagnosed by endometrial biopsy even though the sonographic measurement was reassuring (less than 4 millimeters).

Respectfully submitted, Jack H.McCubbin,MD,FACOG,FACS

FN #4. Azim, A. Oktay, K. Letrozole for ovulation induction and fertility preservation by embryo cryopreservation in younger women with endometrial carcinoma. Fertil Steril 2007; 88:657. FN # 5 ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005; 106:413.

As healthcare evolves…as standards evolve…as technology lected while striving to also maintain the timeliness of abstracting evolves…the role of the cancer registry is evolving as well. Today the data. an effective cancer registry produces clinical and market reports The Cancer Registry accessioned 1037 analytical cases in the that can promote the growth and success of a cancer program. year 2007. We have collected data over the past 19 years for a The entire interdisciplinary team involved with treating cancer at total of 19,801 patients. Of this number, we have a follow up rate CHRISTUS St. Michael Health System and Wadley Health System of 97 % for CSMHS and WRMC. utilize the resources found in the cancer registry. Physicians and All of the functions of a registry are equally important in the other healthcare professionals use the registry as a resource for management of a successful database that allows for the analysis detection of trends in recurrent or metastatic disease and tracking of data in a meaningful manner. While it has been shown the pathe efficacy of different treatment protocols affecting patient care tients of today may benefit from a yearly reminder to have a check decisions. The American Cancer Society Texarkana Unit and the up, the patients of tomorrow will benefit from the evaluation of Susan G. Komen for the Cure-Texarkana Affiliate utilize the regislong-term results of today’s treatment to identify treatments that try data for early detection and community needs assessments projects. The value of our database is measured by the quality of are more effective. Thank you to all of the Cancer Committee the data we collect. Susan Paxton, Becky Mahone, CTR, Donna members, tumor board moderators and to the Cancer Registry Marla, CTR all work diligently to maintain the quality of data col- staff for all your hard work.


c

CHRISTUS St. Michael Health System and Wadley Health System received a ThreeThree-Year Approval by the Commission on Cancer (COC) of the American College of Surgeons as a Community Hospital Comprehensive Cancer Program in 2007.

The two facilities received commendations in several areas for exceeding the standards for Approval by the CoC. That approval is given only to those facilities that have voluntarily committed to provide the best in cancer diagnosis and treatment and reaffirms a facility’s ongoing commitment to providing highhigh-quality, multidisciplinary cancer care. Approval by the CoC encourages selfselfassessment and continuous evaluation of the cancer program. Only one in four hospitals that treat cancer receive this special approval. More than one million cases per year are added to the over 18 million cases already in the National Cancer Data Base (NCDB) by approved cancer programs. This report is produced and published by the UAMS AHECAHEC-SW Cancer Registry and is supported by the Cancer Committee. Special thanks to Gary D. Miller, UAMS AHECAHEC-SW Community Outreach & Education Director for his assistance with the layout and cover design.

UAMS AHEC AHEC-SW CANCER REGISTRY 300 E. 6th Street x Texarkana, AR CHRISTUS ST. MICHAEL HEALTH SYSTEM 2600 St. Michael Drive x Texarkana, TX WADLEY HEALTH SYSTEM 1000 Pine x Texarkana, TX

www.ahectxk.uams.edu


2007 Cancer Program Annual Report  

2007 Cancer Program Annual Report

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