joint cancer committee
chairman’s report he Texarkana Medical Community should take great
active cancer case management? The presentations of cases
pride in reaching the 20 year milestone as a Com-
at these conferences ensure that treatment plans follow na-
mittee on Cancer of the American College of Surgeons Approved Community Hospital Comprehensive Cancer Program. In this annual report, Dr. Herbert Wren
tional guidelines. This will be increasingly important as “pay for performance” policies are implemented. In addition to Dr. Wren’s reflection column, Dr. George
has presented a historical perspective of how we have pro-
Hunter and Dr. J.D. Patel have prepared articles on bladder
gressed to this point. The uncertainty of the future of medical
cancer and lymphoma. On behalf on the cancer committee, I
practice climate presents many challenges for the cancer pro-
would like to extend my thanks to the physicians who have
gram as well as for individual physicians. Participation in the
contributed to this annual report and to Dianne Ketchum and
cancer program activities may offer some solutions. For our
her staff at UAMS AHEC-SW for all they have done to make
patients, there are several programs facilitated by the cancer
the cancer program a success. I would also like to thank the
program which offer screenings, funding for diagnostic tests,
medical community for their participation and ask for their
financial assistance for surgery as well as chemotherapy.
continued support for years to come.
These programs included the Texarkana Komen Grant program, the Texas Breast and Cervical Cancer Program, the
Indigent Drug program at CHRISTUS St. Michael Health Care System and the American Cancer Society education and prevention programs. For physicians, the Friday tumor board
J. Alan Solomon, M.D.
conference is one of the few multidisciplinary activities in our
Joint Cancer Committee Chair Wadley Regional Medical Center
community. Where else would one find interaction of a treat- CHRISTUS St. Michael Health System ing physician, pathologist, and radiologist giving input on an
j. alan solomon, m.d.
Chairman’s Report– J. Alan Solomon, MD…………...page 2 WRMC Facts on Cancer Report…………………………….page 9 CSMHS Liaison Report—Howard Morris, MD..…….page 4 Reflections by Herbert Wren, MD…………………page 10-11 CSMHS Facts on Cancer……………………………………….page 5 Lymphoma Report—J.D. Patel, MD……………….page 12-13 Bladder Cancer Report—George Hunter, MD……page 6-7 Highlights: 20 Years of Cancer Reporting………page 14-15 WRMC Liaison Report—George English, III, MD…..page 8 By Dianne Ketchum, CTR WRMC Genetics Testing—Tammy McKamie, BSN, RN, ONC
Joint Cancer Committee Members…………………….page 16
christus st. michael health system
oward Morris, M.D. Radiation Oncologist of CHRISTUST St. Michael Health System has continued his support of the CSMHS Cancer Program by moderating the CSMHS cancer conferences and educational conferences as well as assuming the responsibility of CSMHS Liaison to the Commission on Cancer Liaison Program. Dr. Morris is an active member of the Joint Cancer Committee and has served this committee as Chairman in 1995-1996. He is the medical
advisor for the Texarkana Unit American Cancer Society and participates in CoC initiatives at CSMHS. Dr. Morris began his career at CSMHS and is one of the founding members of the Cancer Committee formed in 1989. In reflecting upon the past 20 years at CSMHS, his perspective of the single most advancement in cancer care in Texarkana was the advent of 3D radiation treatment planning from CT scans-CT treatment simulators.
howard morris, m.d.
screening & education programs CSMHS Colorectal Screening for the Community
CSMHS Life & ACS After Loss Support Group
CSMHS & ACS Coping with Breast Cancer Support Group
CSMHS Weight Watchers International
CSMHS Breast Cancer and Cervical Care Outreach Program (Funded by grants from Susan G. Komen for the Cure and Texas Breast & Cervical Care Services, Underwritten by CSMHS) High Tea Breast Cancer Survivor Celebration
Texarkana Susan G. Komen Race for the Cure American Cancer Society Great American Smoke Out American Cancer Society Relay For Life American Cancer Society Reach to Recovery ACS Days at the W. Temple Webber Cancer Center
CSMHS facts on cancer CANCER SITE
OTHER ORAL CAVITY
PANCREAS OTHER ILL DEFINED DIGESTIVE LUNG/BRONCHUS (TOTAL)
LUNG -SMALL CELL LUNG-NON SMALL
LARYNX ACCESSORY SINUSES/NASAL CAVITY MELANOMA
OTHER FEMALE PROSTATE
MENINGES THYROID GLAND LYMPHOMA LEUKEMIA/ANEMIA MULTIPLE MYELOMA OTHER & UNSPECIFIED SITES
*** NON-ANALYTICAL CASES
814 83 897
American Cancer Society, Cancer Facts and Figures 2008 ** 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.
fo c u s o n
bladder cancer george r. hunter, m.d.
here are approximately 63,000 new cases of bladder cancer (BC) in the United States each year. It is the second most common urinary tract cancer. In this country there has been a 50% increase in the occurrence of BC over the past 25 years.
are the most commonly identified abnormalities in human cancers. Absence of this gene is an important finding in invasive BC. Some normal genes are overexposed in BC and they may facilitate tumor development.
Bladder cancer is rarely diagnosed incidentally at autopsy. The
Greater than 90% of BCs arise from the urothelium. The World
age of onset is generally over 50, with a median onset at age 70. In the
Health Organization has deemed urothelial cancer (UC) the more appro-
U.S. the disease is most common in white males. There is a 3:1 male to
priate term than transitional cell carcinoma (TCC). The latter is still
female occurrence ratio. The disease occurs one-half as often in African widely used. Squamous cell carcinoma and adenocarcinoma are the -Americans, Hispanic-Americans and Asian
next most common BCs. They are commonly
Americans as in Anglo-Americans. On the
muscle invasive when diagnosed. Other
other hand, African-Americans have twice
cancers occurring are bladder pheochromo-
the death rate as do Anglo-Americans. Both
cytoma, metastatic cancer, sarcoma and
Asian-Americans and Hispanic-Americans
neurofibroma (benign). Unless specified the
have a lower death rate from BC as Anglo-
following discussion refers to UC/TCC.
Pathologic grading has changed from Jew-
Heredity has not been demonstrated
ettâ€™s 1-3 grading to well differentiated and
to be a significant factor in BC. Cigarette
poorly differentiated. The system of staging
smokers have twice the occurrence as life
is currently used in the American Joint Com-
long non-smokers. Exposures to certain chemicals are associated with a higher inci-
mittee on Cancer TNM system. Spread of BC is by direct dissemination, lymphatic,
dence of tumor development. Workers in chemical, dye, rubber, petro- vascular or direct implantation. The most common symptom is hemaleum, leather and printing industries are also more likely to develop BC
turia. Less common are bladder irritation, flank pain (secondary to
than the general population. Those with prior cyclophosphamide
obstruction), lower extremity edema, pelvic mass and weight loss. The
(Cytoxan) or pelvic radiation therapies face increased risk. In laboratory diagnosis is most commonly made by cystoscopy with bimanual pelvic animals artificial sweetener use has long been identified as a risk factor, exam and biopsy. Excretory urography is used to rule out upper tract but his risk has not been demonstrated in humans. The genetic factors
obstruction and/or upper tract disease. Computerized tomography,
that lead to tumor development in the bladder are likely to be multifac- magnetic resonance imaging, ultrasonagraphy and positron emission eted. It probably involves the activation of oncogenes (genes that en-
tomography are more useful in follow up than in diagnosis. Micro-
hance carcinogenisis) and the inactivation of tumor suppressor genes.
scopic cytology and flow cytometry may be useful to diagnosis and/or
The oncogene most closely associated with BC is RAS and it occurs on
follow up. Screening tests include BTA stat, NMP22, ImmunoCYT and
chromosome 11p. Absence of Chromosome 9 is commonly seen in BC.
UroVision DNA FISH, these are used more in follow up than tumor diag-
The gene p53 is found on chromosome 17p and alterations of this gene
facts on bladder cancer Non-invasive BC is defined as carcinoma-in-situ, Ta and T1 lesions. They may be low or high grade pathologically. They are treated primarily with TURBT and post operative intravesical chemotherapy given within six hours of resection. The agents used for post TURBT intravesical chemotherapy are Mitomycin C, Thiotepa, Doxorubicin and epirubicin. High grade or CIS non-invasive lesions that are four to six weeks post TURBT should be treated with Bacillus Camette-Guerin (BCG). The BCG is administered intravesically. It is the immunotherapy of choice for non-invasive BC. As with diagnosis, follow up is primarily cystoscopy, cytology and/or flow cytometry. Timely cystectomy may be done in
cancer free survival. The changes in management of BC that have occurred since the first Cancer Program annual report was published in 1989 are a mixed bag. The local hospitals were making preparation for acquiring the first local CT simulator equipment. Cobalt, linear accelerator, CT and MRI machines were in place. Local PET technology was ten plus years in the future. As far as treatment, TURBT and radical cystectomy with urinary diversion were done. Intravesical therapy was done with thiotepa. MVAC and intravesical BCG therapies were just beginning to be done in Texarkana. The knowledge we now have of genetic changes was in its infancy.
the case of a non responsive CIS or
Continent urinary diversions were
high grade non invasive BC. Non-
only done in big cancer centers.
muscle invasive low grade tumors
Orthotropic diversions were only
progress in 20% of diagnosed and
occasionally done in males and
treated cases. Less than 5% pro-
rarely in females. The newer che-
gress to death from BC. However,
motherapy drugs have made treat-
the same figures for high grade non
ment less toxic in some instances
muscle invasive BC and CIS are 15-
and have offered new treatment in
40% and 10-25% respectively.
other cases. New immunotherapy
Muscle invasive tumors that are
agents eg., interferon-a are used.
confined to the pelvis but do not involve the pelvic wall are treated with radical cystectomy and pelvic lymphadenectomy with or without neo-adjuvant chemotherapy. Pre-operative radiation has been done but has not been found to significantly effect survival. Adjuvant chemotherapy is used in cases found to have metastatic disease. Alternatives to radical cystectomy include radiation therapy, chemotherapy and/or TURBT with partial cystectomy. Salvage cystectomy can be done in failed bladder sparing regimens. Muscle invasive disease
Discussing this subject seems to be an appropriate time to recognize a modern Texarkana medical pioneer. Texarkana native, Dr. C.P. Yarbrough (1916-2002) was the first Texarkana urologist to complete a modern urology residency program. While he served as chief resident at St. Louis City Hospital, he was Dr. Brickerâ€™s first assistant when the first Bricker Pouch was done. The Bricker Pouch greatly increased long term radical cystectomy survival.
progresses in 30-50% of treated cases and is fatal in 33%. Systemic chemotherapy is used to manage metastatic BC. The MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) combination has been commonly used. More recently gemcitabine has been used in combination with cisplatin. This combination has comparable effectiveness and less toxicity. Metastatic BC has rare long term
George R. Hunter, M.D. Retired Yarbrough-Floyd-Hunter Urology Association Diplomat American Board of Urology American Board of Urology
george r. hunter, m.d. page seven
r. English is AP/CP board certified and sub
entation to cancer conferences two years prior to its require-
board certified in both Hematopathology and ment, standardized Her-2/neu receptor reporting and may Coagulation Medicine, completing an American introduce qRT-PCR, microarray Comparative Genomic HybridiCancer Society fellowship at IU and is an Ad-
zation (aCGH) and/or oligonucleotide technology testing for
junct Assistant Professor of Pathology, UAMS, therapeutic and prognostic benefit to Stage I/II, node negaan active member of the Joint Cancer Committee tive, ER/PR positive breast cancer, Dukes B colon caner pa-
and participates in CoC initiatives at WRMC. He served as a
tients and eventually others for sub select adju-
GOG Pathologist for a number of years after completing an
vant chemotherapy. WRMC remains commit-
Arthur Purdy Stout fellowship in OB/Gyn and Perinatal pathol- ted to the highest degree of excellence in canogy at Magee Womenâ€™s Hospital of the University of Pitts-
cer patient treatment care and strives to con-
burgh, School of Medicine.
tinue to be a leader in the community.
Dr. English introduced NCCN guidelines as standard pres-
george english, III, m.d.
screening & education programs Wadley Bringing Hope Home Breast Cancer Awareness Texarkana Susan G. Komen Race for the Cure Event American Cancer Society Great American Smoke Out Wadley & ACS Dialogue Support Group American Cancer Society Reach to Recovery Wadley Prostate Screening & Education Program Wadley & Weight Watchers International Wadley Genetics Educator- Genetics Testing Program ACS Days in the Cancer Center
is cancer in c your genes? ancer has become a common disease, however, some people
have a greater chance of developing cancer. This could be due
Having a mutation can increase your risk by as much as 50%-90%.
Wadley offers HCRA and testing for Breast, Ovarian, Colorectal, Endo-
to a gene mutation that can be passed from one generation to an-
metrial (Uterine), and Melanoma cancers. Of the 228 patients coun-
other. Since October of 2003, Wadley has provided Hereditary Can-
seled since 2003, 97 have pursued testing and 15 were found to have
cer Risk Assessment (HCRA) and testing to patients at a risk for possi-
a mutation. Knowledge is power and early detection is the key to
ble inherited gene mutation on Hereditary Cancer Syndrome (HCS).
improved survival on any type of cancer.
Identifying a mutation for HCS is essential in order to provide the appropriate medical management.
Tammy McKamie, RN, BSN, OCN
Wadley Regional Medical Center Cancer Center
WRMC facts on cancer CANCER SITE
# of CASES
PERCENT of Total Cases
# of CASES
PERCENT of Total Cases
OTHER ORAL CAVITY
OTHER & UNSPECIFIED SITES
** ANALYTICAL CASES
LARYNX LUNG/BRONCHUS LUNG -SMALL CELL LUNG-NON SMALL MELANOMA
TOTAL CASES ACCESSIONED
American Cancer Society, Cancer Facts and Figures 2008; ** 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.
ref l e c t i o n s b y
herbert wren, m.d.
hysicians in Texarkana have treated patients with cancer for many years. In the early 1940s a group of doctors began treating cancer patients in what was called the Tumor Clinic. This was done primarily
for those patients who were unable to pay for treatment.
Gloria Mugno, Director of Nursing Education at UAMS AHECSW remembers the first patient who received chemotherapy in Texarkana. The patient had cancer of the colon and received FluroUracil. According to the first annual report of the Tumor Program, it began as a St. Michael activity. Wadley became an equal partner and
The clinic, located in St. Michael Hospital, was open one day of the
ten area hospitals agreed to become part of the program. Activities
week and patients unable to pay were treated by physicians who
of the Tumor Program were directed toward bringing the surround-
alternated covering the clinic.
ing area hospitals into the program and preparing for a survey by the
Over the years the Tumor Clinic used several sites in the hospital. A small area in the basement of the nurses' quarters was used followed by a room on the 5th floor of the hospital. And finally the Emergency Rooms served as the Tumor Clinic one day a week. An outgrowth of the Tumor Clinic was the Tumor Registry where all the records of tumor diagnosed
American College of Surgeons. UAMS AHECâ€“ SW began area hospital abstraction in early 1990. The data of these hospitals was beneficial to follow-up since many of the patients seen in Texarkana were first diagnosed in the outlying hospitals. Their hospital database could also be updated with current treatment information performed at St. Michael or Wadley so their data
patients were kept. The first cancer registrar in Texar-
was a valuable asset to the Cancer Program. The Joint
kana was Patsy Wade. She did a wonderful job for
Program was the first Regional Cancer Registry in Ar-
many years. Follow-Up files were placed on 3x5 cards and were in very accurate order. Volunteer doctors for the clinic included Dr. John Walter Jones, Dr. Walter Barnes, Dr. Dr. Eugene Ellison, Dr. Henry Carney, Dr. Herbert Wren, Dr. Don Thorton, Dr. Bob Bransford, Dr. Lloyd
kansas and second Regional Cancer Registry in Texas. The first physician members of the Cancer Committee were Walter Barnes, Ed Eichler, M.W. Wright, I.C. Cummins, Alan Solomon, Howard Morris, Cordell Klein, Ronald Woody, R.F. Carlton, F. E. Joyce, G.H. Druff, J.R. Robbins, and Herbert Wren as Chairman. The first tumor regis-
Gary, Dr. R.K. Harrison and Dr.
trars were Deleta Miller, St. Michael-
William Harrell. Dr. William
1989 and Joanne Allen, Wadley-1989.
Harrell was given a Meritorious
Dianne Ketchum came as an abstractor
Service Award from the Arkan-
in 1990. New physician members of
sas General Assembly in 1945
the Cancer Committee in 1990 were
for his voluntary professional
Drs. John Dodge, J. D. Patel, and Rock-
service to the cancer control
ridge Hannah, PharmD.
program in Arkansas.
Dr. Howard Morris took the position of Chairman of the Joint
began as a Wednesday morning 7a.m. meeting and later were
Cancer Program from 1995-1996 and in 1997-1999 Joe Robbins, M.D. changed to Friday conferences held at noon on a rotation basis at took the leadership of this committee. Gary Engstrom, M.D. provided guidance for the Joint Cancer
each hospital. We have enjoyed many successes in our 20 years of service and
Program from 2000-2004 with Ron
we are still committed to the continued development of our Cancer
Hekier, M.D. assuming the role from
Program for the benefit of this community. Challenges before us are
2004-2007. Alan J. Solomon, one of
significant. Still, the efforts and successes of our past accomplish-
the founding physicians in the Joint
ments have brought us closer to the goals we had in the beginningâ€“
Cancer Program in 1989, assumed
stamping out cancer in our community and treating all cancer pa-
leadership of this program in 2008
tients with the best cancer care available.
through the present. The year 1991 was a special year for our Joint Tumor Program with Approval given for a three-year period Herbert B. Wren, M.D. geons. Emphasis in 1991 was given Founding Joint Cancer Committee Chair to AJCC Staging of the hospital cases by the attending physicians. The CHRISTUS ST. Michael Health System Wadley Regional Medical Center number of cases in those days were almost completely divided beby the American College of Sur-
tween SMH (502)and WRMC (481). Tumor Board conferences first
herbert b. wren, m.d.
founding cancer committee members, 19891989-1990 First Row: J. Alan Solomon, MD, Hebert B. Wren, MD, John Dodge, MD, Second Row: Cordell L. Klein, MD, Rockridge Hannah, Pharm.D, J.D. Patel, MD, Howard G. Morris, MD; Not pictured: F. E. Joyce, MD, Joseph R. Robbins, MD, Edward A. Eichler, MD, M. W. Wright, MD
page eleven page eleven
fo c u s o n
j.d. patel, m.d.
he lymphomas are a diverse group of malignant disorders
mediate types of lymphoma are: Diffuse large Cell lymphoma, Pri-
that vary with respect to their molecular features, genet-
mary mediastinal large cell lymphoma and Anaplastic large cell lym-
ics, clinical presentation, treatment approaches, and out-
phoma. High Grade Lymphomas grow very fast and have many dif-
come. Lymphoma is a general term for cancers that de-
ferent symptoms that can be associated with this type of cancer.
velop in the lymphatic system and can be classified as ei-
High-grade NHL is Burkitt’s Lymphoma and Lymphoblastic lymphoma.
ther Hodgkin’s disease or non-Hodgkin’s lymphoma or (NHL).
Treatment for NHL depends on stage of disease, the patient’s
They develop in other parts of the
general health and other factors:
lymphatic system, including the
Treatment may consist of chemo-
bone marrow, spleen, thymus and
therapy, radiation therapy, bone
lymph nodes and then can spread to
marrow or stem cell transplantation
or a combination of these treat-
NHL is the fifth most common
type of cancer (not including skin
Chemotherapy is the most
cancer) in the United States today.
common type of treatment for NHL.
Over 66,000 adults and children will
A single drug may be prescribed but
be diagnosed with NHL this year.
combination drugs are most often
Over 95% of those cases will be
used. Giving several drugs in combi-
adults around 60 years of age. Men
nation may increase their effective-
have a slightly higher risk than
ness but also may increase side ef-
women, although the numbers of women is increasing. NHL is more
fects. Radiation therapy is most often used for low stage NHL (Stage I
common in whites than African-Americans or Asian Americans.
& II) and may be used in higher stage to reduce tumor mass or bulky
Low-grade or indolent, NHL progresses slowly and is associated disease. with painless swelling of the nodes, but patients are otherwise
New therapies are now available with the potential to improve
healthy. If a low-grade NHL has spread outside the lymph nodes,
patient outcome. Most notably, the antiCD20 monoclonal antibody
they may be discomfort in the affected areas. Types of low grade
rituximab has altered our therapeutic paradigms for B-cell disorders.
lymphoma are: Marginal Zone Lymphoma, Malt Lymphoma, Follicular Rituximab (Rituxan) is an antibody that recognizes and attaches to a Lymphoma and Mantle Cell Lymphoma. Intermediate Grade NHL grows more rapidly and is associated
substance called CD20 found on the surface of some types of lymphoma cells. Newer forms of monoclonal antibodies are similar to
with more symptoms than low-grade lymphoma. Fever, night sweats rituximab but have radioactive molecules attached to them which and unexplained weight loss may also occur. Examples of the Inter-
may help them work better.
facts on lymphoma cancer Zevalin is another antibody directed at CD20 and also Tositu-
Clinical trials are available and may also be an option for some
momab (Bexxar), although this one has radioactive iodine attached
NHL patients. The challenge of clinical research is to optimize the use
to it. Alemtuzumab (Campath) is an antibody directed at the CD52
of these agents, select patients most likely to respond, and develop
antigen. It is useful in some cases of chronic lymphocytic leukemia
multi-targeted strategies based on sound scientific rational, with the
(CLL) and also some types of peripheral T-cell lymphomas.
potential to increase the cure rate of patients with lymphomas.
New chemotherapy regimens such as bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and pred-
nisone (BEACOPP), agents such as gemcitabine, and monoclonal anti- Ca Cancer J Clin 2004:54:260-272;Title: What is New In Lymphoma, Bruce D. bodies directed against CD30 are also being studied in Hodgkin Lymphoma. Autologous or allogeneic bone marrow transplantation (BMT)
Cheson, MD. www.mdanderson.org;Cancer Information: Non-Hodgkins Lymphoma, Basics and Treatment of Lymphoma
and peripheral blood stem cell transplantation restore the supply of normal cells that have been destroyed by high-dose chemotherapy and /or radiation therapy. Peripheral blood stem cell transplantation is the most common procedure of bone marrow transplantation. Interferon is a hormone-like protein made by white blood cells to help the immune system fight infections. Some studies have suggested that giving man-made interferon can cause some types of non -Hodgkin lymphomas to shrink or stop growing.
J. D. Patel, M.D. American Board of Internal Medicine ABIM-Hematology; ABIM-Medical Oncology Collom & Carney Clinic
j.d. patel, m.d.
twenty years of
cancer reporting dianne ketchum, ctr
n 1956 the Commission on Cancer approved requirements were revised to include the Cancer Registry as a mandatory
Gary Engstrom, M. D., served as Medical Director for the grant and Dianne Ketchum, CTR, served as Project Coordinator.
component of the Approval process. Since that time Ap-
The study findings were presented to physicians and hospital
proved Cancer programs are maintained by a cancer regis- administrators. With the combined efforts of the cancer committee try and cancer registrars. These groups of professionals are
members, cancer registry staff, and the UAMS AHEC-SW Family Prac-
trained in the collection of cases by age, sex, county, site and histol-
tice Residents, an intense year of data analysis and education on
ogy. In earlier years data elements were counted by hand, graphs
treatment options for breast surgery was given to the community.
were drawn by hand and annual reports were typed manually. Sur-
The graphs below trend 10 years of BCS and Mastectomy rates in our
vival statistics were kept on a manual sheet with rows and columns
community by age group.
for tracking. All living cases were filed together by site and by acces-
placed on a 3x5 card by month. These files, called tickler files, were used to decease the patients in early years by simply moving one 3x5 card to another file. Although there were few data elements collected, they were accurate in registering the number of cases seen in
sion year until they were pulled for follow-up. Follow-up files were
practice model entitled â€œA Training Model in Treatment Options for
Early Stage Breast Cancerâ€? for continuing medical education in breast
breast cancer treatment disparities. Local data was compared to a regional cancer registry and a nationally-recognized cancer treatment center in the northeast U.S. to determine treatment patterns of lumpectomy and mastectomy procedures in our region.
49 or Younger Age Group
at UAMS AHEC-SW, developed and implemented a replicable, best
cer Foundation to support this project and to determine Stage I & II
Breast Conserving Surgery /Mastectomy
Rebecca Hyatt, former Director of Research and Development
grant from the Arkansas Chapter of the Susan G. Komen Breast Can-
changed with over 200 data fields now being collected.
In 1999 the UAMS AHEC-SW Cancer Registry was awarded a
were surgery, radiation and the condition of the patient. Times have
cancer treatment in the region.
our community. A total of 27 fields were collected initially, which
60 40 20
Breast Conserving Surgery /Mastectomy 50+ Age Group
In the 2003 Annual Report, an article by Ranga Balasekaran,
and were interested in the CoC survey requirements. The documen-
M.D. revealed our community had an increased proportion of late
tary featuring the Minister of Health in Japan was aired in April 2005.
stage colorectal cancers when compared to national statistics. Ad-
The Cancer Registry segment was aired on “Good Morning Japan” in
vanced cases of colorectal cancer are especially regrettable as it is
a later segment.
estimated that 90% of all cases of colorectal cases could be pre-
After a year-long effort of Japan’s cancer survivors petitioning
vented if the public followed recommended screening guidelines. As
their government legislators in 2005, a National Cancer Program law
an improvement to this study, the cancer committee requested 400
was finally passed in Japan. The legislators agreed to start a cancer
American Cancer Society pamphlets with guidelines for screening and program with clinical trials, provide education for oncologists and surveillance for early detection of colorectal cancer be sent to all
create education and prevention programs. Toshi contacted the
physicians in the Southwestern Arkansas and Northeast Texas area.
Cancer Registry again in February 2006 and stated the government
By increasing awareness efforts to the community, the committee
had left off a very important aspect of the program—the funding for
members hopes were to increase screenings to find and remove co-
a national cancer registry. Toshi had learned without a cancer regis-
lon polyps before
try to track the outcomes of cancer patients and treatment, there
they developed into
could not be a national program. He stated the work done by the
cancer, and to find
Cancer Registry for CSMHS is a model for the cancer registry program
colorectal cancer at
an early stage, when
Japenese Film Crew with Dr. Howard Morris, CSM Cancer Center
Toshi published a book on his experience in Texarkana in 2006.
it can be treated
He has produced four documentaries on Japan’s public broadcasting
network to complete his "mission.” The NHK Crew was presented
In 2005 CHRISTUS St.
with a key to the city of Texarkana while in our community. This visit
Michael Health Sys-
and experience will always be cherished as one of the highlights of
tem & the UAMS
the cancer registry’s twenty years cancer program.
The abstractor supervisor for the cancer registry is Donna Mar-
Registry were visited by a Japanese Film Crew from (NHK) National
lar, BAAS, LPN, CTR. Donna is
Broadcasting Network of Japan. The Producer of the Japanese Film
accurate in obtaining quality
Crew (Toshi) had contacted the CoC to find a hospital in the U.S.
data and is a valuable mem-
which had scored high on their survey. Toshi chose CSMHS because
ber of the staff. Christy Dabbs
of their “Approval with Commendation” status and the number of
joined the Cancer Registry
cancer cases seen each year at their facility. They also wanted a can-
staff in 2008 and is Adminis-
cer center in which multi-disciplinary care was provided to the pa-
trative Secretary for the Can-
cer Registry. Christy has an
The CSMHS Cancer Center staff, Drs. Morris and Patel and the
Associate of Arts and is re-
Dianne Ketchum, Donna Marlar, & Christy Dabbs
UAMS AHEC-SW Cancer Registry assisted the crew for three weeks to sponsible for follow-up, tumor board, abstracting radiation and cheprovide information on how physicians collaborate on patient care, to assist with the filming of tumor boards and a mock cancer commit-
motherapy charts. The dedication of these staff members is evident by the collec-
tee meeting. The film crew interviewed the UAMS AHEC-SW Cancer
tion of quality data. This has contributed to the success of the cancer
Registry staff. They filmed the staff while performing their duties
program in the year of 2008.
he UAMS AHEC-SW Cancer Registry is proud to have reached 20-year milestone as an Approved Cancer Program for
CHRISTUS St. Michael Health System and Wadley Regional Medical Center by the American College of Surgeons as a Community Hospital Comprehensive Cancer Program. It is through the continued support and contributions of the two approved hospitals, physicians, nurses, cancer center staff and other
accomplishment. The cancer registry submits data to the National Cancer Data Base (NCDB), which is a joint program of the Commission on Cancer and the American Cancer Society.
NCDB is a
nationwide oncology outcomes data-base in the United States and Puerto Rico. Some 75% of all newly diagnosed cases of cancer in the United States are captured at the institutional level and reported to the NCDB. The NCDB, which began in 1989, now contains approximately 20 million records from hospital cancer registries across the US. These data are used to explore trends in cancer care, create regional and state benchmarks for participating hospitals, and to serve as the basis for quality
2008 joint cancer committee members PHYISICAN MEMBERS J. Alan Solomon, MD Chair Mike Finley, MD J. D. Patel, M.D Roger Good, MD Joe Robbins, MD Bryan J Griffin, MD Howard Morris, MD Robert Parham, MD Chris McMillian, MD H. Anthony Tran, MD Ranga Balasekaran, MD Jack H. McCubbin, MD George W. English, III, MD
NON-PHYSICIAN MEMBERS Kim Lewis, RN Christy Dabbs Jena Teer, LSW Tracy Wade, RHIA Mike Jones, BS PHA Dianne Greenhaw, RN Jodie Martindale, RHIT Dianne Ketchum, CTR Alan Anderson, PharmD Mary Miller, LMSW-ACP Donna Marlar, BAAS, LPN, CTR Tammy McKamie, RN, BSN, OCN
improvement. Special thanks to Gary D. Miller, UAMS AHEC-SW Community Outreach & Education Director for his assistance with the layout and cover design. This report is produced and published by the UAMS AHECSW Cancer Registry and is supported by the Joint Cancer Committee.
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