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joint cancer committee

t

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

Sincerely,

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.

page two


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

h

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

page four

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

ORAL CAVITY

# of

PERCENT of

CASES

Total Cases

NATIONAL

CANCER SITE

PERCENT

PERCENT of

CSMHS

NATIONAL

Total Cases

PERCENT

PERCENT

14

2

3

BREAST

129

16.0

12.8

MOUTH

4

.5

.8

UTERUS

5

.6

2.8

PHARYNX

4

.5

.9

CERVIX

4

.5

.8

4

.5

-

OVARY

10

1.2

1.5

OTHER ORAL CAVITY

2

.2

.1

1

.1

.2

ESOPHAGUS

6

.7

1.1

100

12.3

13

STOMACH

9

1

2

TESTES/PENIS

7

1

1

SMALL INTESTINE

3

.4

.4

KIDNEY

26

3.2

4.8

COLON

79

10

7.5

BLADDER

39

4.8

.2

RECTUM

18

2.2

2.8

BRAIN

8

1

1.5

ANUS

4

.5

.4

12

2

-

LIVER

6

.7

1.5

3

.4

2.6

23

.1

2.6

30

3.6

5.2

4

.5

.3

6

.6

3

216

27

15

13

1.4

1.4

39

4.7

-

14

2

2

177

21.8

-

8

1

.9

3

.4

.2

14

1.7

1.4

TONSIL

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

** ANALYTICAL

CASES

*** NON-ANALYTICAL CASES

TOTAL CASES

814 83 897

1,437,180

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.

page five


fo c u s o n

t

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.

Americans.

Pathologic grading has changed from Jew-

Heredity has not been demonstrated

ett’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-

Bladder tumors

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

nosis.

page six


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. Bricker’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


wadley regional

d

medical center

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 Women’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.

page eight

Tammy McKamie, RN, BSN, OCN

Wadley Regional Medical Center Cancer Center


WRMC facts on cancer CANCER SITE

WRMC

# of CASES

PERCENT of Total Cases

NATIONAL

CANCER SITE

PERCENT

WRMC

# of CASES

PERCENT of Total Cases

NATIONAL PERCENT

7

2

3

BREAST

85

28

13

LIP

1

.3

-

CERVIX

2

.7

.8

TONGUE

1

.3

.7

UTERUS

8

3

3

TONSIL

1

.3

-

OVARY

1

.3

2

HYPOPHARYNX

1

.3

.9

PROSTATE

35

12

13

PAROTID GLAND

1

.3

-

TESTES/ OTHER

2

.7

.6

OTHER ORAL CAVITY

2

.7

.1

KIDNEY

15

5

4

1

.3

1

URETER

1

.3

.2

STOMACH

1

.3

2

BLADDER

8

3

5

SMALL INTESTINE

1

.3

.4

BRAIN/MENINGES

7

2

2

33

11

8

THYROID GLAND

1

.3

3

RECTUM

4

1

3

LYMPHOMA

4

1

5

LIVER

1

.3

2

LEUKEMIA/ANEMIA

4

1

3

PANCREAS

7

2

3

MULTIPLE MYELOMA

3

1

1

2

.7

1

OTHER & UNSPECIFIED SITES

8

3

2

58

19

15

8

3

-

** ANALYTICAL CASES

50

17

-

*** NON-ANALYTICAL

5

2

4

ORAL CAVITY

ESOPHAGUS

COLON

LARYNX LUNG/BRONCHUS LUNG -SMALL CELL LUNG-NON SMALL MELANOMA

304 CASES

TOTAL CASES ACCESSIONED

24 328

1,437,180

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.

page nine


p

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 AHEC– 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.

page ten


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 beginning–

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

lymphoma cancer

t

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

other organs.

or a combination of these treat-

NHL is the fifth most common

ments.

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-

page twelve

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-

*References

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.

page thirteen


highlights:

twenty years of

i

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-

100

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

Percentages

sion year until they were pulled for follow-up. Follow-up files were

89

80

66

60

60

40

40

20

1994

1995

1996

1997

1998

practice model entitled “A Training Model in Treatment Options for

100 86

Early Stage Breast Cancer� 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.

page fourteen

2000 2001

2002 2003

2004

BCS Mastectomy

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

1999

Breast Conserving Surgery /Mastectomy

Rebecca Hyatt, former Director of Research and Development

90

84

83

80

Percentages

grant from the Arkansas Chapter of the Susan G. Komen Breast Can-

29

Year

changed with over 200 data fields now being collected.

In 1999 the UAMS AHEC-SW Cancer Registry was awarded a

40

15

were surgery, radiation and the condition of the patient. Times have

cancer treatment in the region.

36

35

16

11

60

33 33

71

64

66

58

53 47

0

our community. A total of 27 fields were collected initially, which

85

79

75 72

71

60 40 20

28

0 1994

1995

43

46

43

2002

2003

52 48

22

17

1996

51

23

14 10

57

52

15

1997

1998

1999

2000

2001

Year

Breast Conserving Surgery /Mastectomy 50+ Age Group

2004

BCS Mastectomy


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

in Japan.

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

more effectively.

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.

AHEC-SW Cancer

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-

tients.

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.

page fifteen


t

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

numerous

persons

we

have

achieved

this

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.

UAMS AHEC-SW Cancer Registry 300 E. 6th Street | Texarkana, AR CHRISTUS St. Michael Health System 2600 St. Michael Drive | Texarkana, TX Wadley Regional Medical Center 1000 Pine | Texarkana, TX

www.ahectxk.uams.edu


2008 Cancer Program Annual Report