(REV. 12.20.13)

To Comfort. To Cure.

cancercarechampions.org | Findlay, Ohio |419.423.5522

Cancer Annual Report2012

(Published September 2013)

Joce Abbott, RN, BSN, OCNOncology Nursing

American Cancer Society

Kimberly Benson, RNDirector of Outpatient Specialty Services

Eric Browning, MD Cancer Committee ChairCancer Physician LiaisonGeneral Surgery

Kendra Brooks, MSW, LSWSocial Worker

Heidi Budke, MDQuality Control CoordinatorPathology

Tim Burkart, PharmD Pharmacy

Cancer Patient Services

Sharon Cole, MDMedical Oncology

Jill Jaynes, RT(R)Director of Imaging Services, Cath/Vascular Labs

Elizabeth Kelly, MDivChaplain

Bill Kose, MDSenior VP Medical Affairs

Jennifer R. Lammers, RNClinical Resource Surgery/Peds; Medical/Oncology; Ortho/Neurology

Chaoyang Li, MDMedical Oncology

Stephen Lutz, MD Quality Improvement Coord. Radiation Oncology

Carolyn Maurer, RN, BSNPalliative Care

Miki McClain, RN, BSN, OCNOncology Outreach and Clinical Services Manager

Christine Montgomery, RNClinical Research

Cindy Ohms, RNDirector, Bridge Home Health & Hospice

Barbara J Pasztor, MHSA RN, BSN, V.P. Patient Care Services, CNO

Renee Santin, CTRTumor Registry and Cancer Conference Coordinators

Natalie Phoenix, RN, BSNDirector of Inpatient Nursing Services

M. I. “Rene” Shelly, DOFamily Practice

Julie Calvin Quality and Patient Safety

Lauren Thorington, DORadiology

Bonnie VanSchoik, MT (ASCP), MT (HEW), MLT (ASCP), CLA (ASCP)Director of Laboratory Services

Chris WebbDirector of Rehabilitation Services

Daniel Dawley, MDMedical Director, Hospice

Nancy George, RDLDDietary

Abigail Hartman Public Relations

2012 Cancer Committee

1900 South Main Street | Findlay, Ohio 45840cancercarechampions.org | 419.423.5522

2013 Blanchard Valley Health System

On this day we served 19 patients, four of which were first-time baseline mammo-grams. Through this grant were able to serve patients not just in Hancock County, but all surrounding counties.

Below you’ll see our three year trend for screening and diagnostic mammograms performed at EasternWoods Outpatient Center as well as our Positive Predictive Value for biopsies and can-cers found. Breast imaging statistics for Blanchard Valley Hospital in 2012 have exceeded national standards. In comparison, National Positive Predictive Value of biopsies (percent of biop-sies that show cancer) in the US is 10-20 percent, while Blanchard Valley Hospital’s Positive Predictive Value of biopsies for 2012 was an astonishing 33 percent.

In addition to the BICOE award, the Nuclear Medicine department received accreditation through the

ACR. The Nuclear Medi-cine Accreditation Program involves the acquisition of clinical and phantom images and corresponding data for each unit. The acquisition of the phantom images involves the use of a designated SPECT phantom. Adding Nuclear Medicine to our long list of accredited programs speaks to our overall vision, “Extraordinary people, Exceptional care.”

In October of 2012 BVH invested in a new 1.5 Tesla magnet for Magnetic Resonance Imaging, which is the most open high-field MRI scanner available in Hancock County. We’re able to perform all aspects of MRI imaging; from head to toe

2012 Cancer Report for Imaging/Woman WiseThe Imaging Department at Blanchard Valley Hospital and EasternWoods Outpatient Center continues to focus on quality in order to better serve our community and surrounding areas. In 2012, Woman Wise (our outpatient Mammography Department), located at our EasternWoods Outpatient Center campus, continued to hold the honor of BICOE, Breast Imaging Center of Excellence through the ACR (American College of Radiology) as well as the mandatory mammography accreditation program.

In April 2012, for the third time, BVH received a grant to conduct the Hancock County Mammography Screening Initiative (HCMSI). The grant was approved for $31,355 from the Northwest Ohio Affiliate of Susan G. Komen for the Cure. This is also funded by a grant from the Findlay-Hancock County Community Foundation. On July 10, 2012 we provided a day of free mammograms through the HCMSI grant.

with a 70cm bore opening. This opening is much larger than the traditional MRI. In addition, the unit has a shorter design which may allow your head to be outside the system for many exams. With colorectal cancer being the third most com-mon cancer worldwide, this high-end magnet allows us to perform imaging in order to determine the stage of col-orectal cancer. MRI is the most widely used staging modality in patients with rectal tumors in that it visualizes not only the intestinal wall but also the surrounding pelvic anatomy. With Blanchard Valley Health System investing in this type of technology it provides our community excellent care close to home.

1.5 Tesla magnet for Magnetic Resonance Imaging, which is the most open high-field MRI scanner available in Hancock County.

Positive Predictive Value Mammograms

Positive Predictive Value is the percent of biopsies that show cancer.

Skin Cancer Screening99 participatesJune 19, 2012Physicians performing screen:Drs. Cairns, Rower & Patel

Prostate Cancer Screening54 participatesSeptember, 2012Physician performing screen: Dr. Gilbert

All Day Oncology Clinical Education (CE) Event41 participantsAugust, 2012

BVH hosted Cancer Prevention Study (CPS3)August, 2012Goal was 288 participantsGoal exceeded!427 participants enrolled!

BVHS awarded American Cancer Society (ACS) Platinum Mission Impact Award. Award given for BVHS’ outstanding cancer connection, collaboration, prevention and research with ASC.

Platinum Mission Impact Award

(l. to r.)Christy Montgomery, Miki McClain & Shannon Kohls holding the American Cancer Society plaque for support of the CPS3 study.

BVHS Associates involved in the BVHS cancer program attended 26 outreach events to educate the community on cancer services & prevention!

Clinical trials are the key to “finding the cure.” Standard cancer treatments used today are the direct result of clinical trials of the past. Enrollment in a clinical trial can provide access to newer drugs or treatment procedures that might not otherwise be available. Enrollment may also provide information for the prevention and control of cancer. The goals of clinical trials are to answer specific questions about cancer, find better ways to prevent or detect it, and find better ways to treat or improve patient care.

The clinical research department is staffed by award winning nurses and physicians. BVH nurses have received awards from the Dayton Clinical Oncology Program (DCOP) for top accrual in 2008, 2009, 2010 & 2011. Dr. Sharon Cole was named the Top Accruing Physician by DCOP in 2008, 2009, 2010 & 2011.

Growth of Clinical Research 2012

Clinical Research: Our Contribution to the Future of Cancer Care

The Blanchard Valley Health System Cancer Registry has been collecting data in accordance with state and national guidelines since our cancer program reference date of January 1, 2003. The data collected includes demograph-ic, cancer identification (primary site, histology, stage of disease, treatment), follow-up and survival data. Our data is routinely reported to the Ohio Cancer Incidence Surveillance System (OCISS), Ohio’s Central Registry. Our data includes both our hospital and cancer center patients and is reported to the National Cancer Data Base (NCDB).

Cancer RegistryIn addition to being utilized at cancer conferences and in our annual report, the medical staff, administration, other departments, and other cancer registries also utilize the data. The data is used as a clinical surveillance mechanism to re-view patterns of care and outcomes and in long-range planning for services.

Lifetime follow-up is performed on our patients on at least an annual basis. Ongoing follow-up benefits patients by reminding them that routine medical examinations are recommended to ensure early detection of recurrence or

new primary malignancies. This also benefits physicians by potentially bringing lost patients back under medical supervision. In addition, the follow-up information is used to compare outcome results with regional, state, and national standards.

We would like to express our appreciation to the cancer committee, administration, medical staff, hospital and cancer center staff, and the community for the continued support throughout the year.

BVHS OHIO U.S.TOTAL 423 100.0% 66,560 100.0% 1,638,910 100.0%BREAST 104 24.6% 8,990 13.5% 276,870 16.9%LUNG 73 17.3% 10,270 15.4% 226,160 13.8%PROSTATE 37 8.7% 8,560 12.9% 241,740 14.8%COLON 27 6.4% 6,020 9.0% 143,460 8.8%BLADDER 22 5.2% 3,160 4.7% 73,510 4.5%

TOP SITESThe top sites accessioned at Blanchard Valley Health System in 2012 are displayed below. Comparison of our incidence rate to Ohio and the U.S. is demonstrated.

DIAGNOSIS # OF PERCENTCOUNTY CASES HANCOCK 231 54.6%WOOD 53 12.5%WYANDOT 39 9.2%PUTNAM 31 7.3%SENECA 21 5.0%HARDIN 20 4.7%ALLEN 13 3.1%HENRY 7 1.7%UNKNOWN 2 0.5%DEFIANCE 1 0.2%VAN WERT 1 0.2%SANDUSKY 1 0.2%ERIE 1 0.2%AUGLAIZE 1 0.2%JEFFERSON 1 0.2%TOTAL CASES 423 100.0%

COUNTY OF RESIDENCE AT DIAGNOSISAnalysis of county of residence at diagnosis reveals that the majority reside in Hancock County. The breakdown is demonstrated below.

Age Range Male Female20 - 29 0 130 - 39 1 1140 - 49 11 2650 - 59 32 4060 - 69 58 6470 - 79 70 5680 - 89 21 3190 - 99 1 0TOTALS 194 229

AGE AND SEXOf the analytic primaries, 194 (45.9%) were males and 229 (54.1%) were females. The majority of males were diagnosed between the ages of 70-79 and females between the ages of 60-69.

STAGE # OF PERCENTGROUP CASES0 23 5.4%I 119 28.1%II 112 26.5%III 54 12.8%IV 89 21.0%UNK 1 0.2%N/A 25 5.9%TOTAL CASES 423 100.0%

STAGE AT DIAGNOSISAnalysis of the 2012 analytic primaries reveals that the majority were diagnosed at AJCC Stage I (28.1%), 5.4% at Stage 0, 26.5% at Stage II, 12.8% at Stage III, 21.0% at Stage IV, and 0.2% at Unknown Stage. 5.9% of the primaries were not eligible for AJCC staging.

2012 ANALYTIC CASES

Breast104

RespiratorySystem

79

Digestive System

67

Male Genital

40

Urinary System

29

Female Genital

24

Lymphatic System

22

Oral Cavity17

Unknown Primary

11

Skin9

All Sites Total423

Blood & Bone Marrow....8Endocrine....7

Brain & CNS....3Bone & Soft Tissue....3

TREATMENT # OF CASES PERCENTNONE 44 10.4%SINGLE MODALITY THERAPY 166 39.2% SURGERY ONLY 86 20.3% RADIATION ONLY(RAD) 40 9.5% CHEMOTHERAPY ONLY(CHEM) 37 8.7% HORMONE THERAPY(HOR) 3 0.7%

MULTIMODALITY THERAPY 213 50.4% SURG/CHEM 36 8.5% SURG/RAD 35 8.3% CHEM/HOR 1 0.2% CHEM/RAD 42 9.9% RAD/BRM 1 0.2% SURG/HOR 11 2.6% SURG/RAD/HOR 25 5.9% SURG/CHEM/HOR 4 0.9% SURG/CHEM/RAD 44 10.4% CHEM/RAD/HOR 1 0.2% SURG/CHEM/RAD/HOR 13 3.1%

TOTAL CASES 423 100.0%

TREATMENTAnalysis of the 2012 analytic cases reveals that, 10.4% of the patients had no treatment documented, 39.2% received single modality treatment, and 50.4% received multi-modality treatment.

Cancer Registry

SIGNS AND SYMPTOMSSymptoms may include a sore in the throat or mouth that bleeds easily and does not heal, a red or white patch that persists, a lump or thicken-ing, ear pain, a neck mass, or coughing up blood. Difficul-ties in chewing, swallowing, or moving the tongue or jaws are often late symptoms.

RISK FACTORSKnown risk factors include all forms of smoked and smokeless tobacco products and excessive consumption of alcohol. Many studies have

HEAD & NECK CARCINOMA DIAGNOSED 1/1/2012 – 12/31/2012SITE SPECIFIC ANALYSIS

reported a synergism between smoking and alcohol use, resulting in a more than 30-fold increased risk for indi-viduals who both smoke and drink heavily. HPV infection is associated with cancers of the tonsil, base of tongue, and some other sites within the oropharynx and is believed to be transmitted through sexual contact.

EARLY DETECTIONCancer can affect any part of the oral cavity, includ-ing the lip, tongue, mouth, and throat. Through visual

inspection, dentists and primary care physicians can often detect premalignant abnormalities and cancer at an early stage, when treatment is both less extensive and more successful.

INCIDENCENew cases: An estimated 40,250 new cases of cancer of the oral cavity and pharynx (throat) are expected in 2012. Incidence rates are more than twice as high in men as in women. From 2004 to 2008, incidence rates declined by 1.0% per year in women and

were stable in men. However, recent studies have shown that incidence is increasing for cancers of the oropharynx that are associated with human papillomavirus (HPV) infec-tion among white men and women.

Deaths: An estimated 7,850 deaths from oral cavity and pharynx cancer are expected in 2012. Death rates have been decreasing over the past three decades; from 2004 to 2008, rates decreased by 1.2% per year in men and by 2.2% per year in women.

TREATMENT # OF CASES PERCENTNONE 44 10.4%SINGLE MODALITY THERAPY 166 39.2% SURGERY ONLY 86 20.3% RADIATION ONLY(RAD) 40 9.5% CHEMOTHERAPY ONLY(CHEM) 37 8.7% HORMONE THERAPY(HOR) 3 0.7%

MULTIMODALITY THERAPY 213 50.4% SURG/CHEM 36 8.5% SURG/RAD 35 8.3% CHEM/HOR 1 0.2% CHEM/RAD 42 9.9% RAD/BRM 1 0.2% SURG/HOR 11 2.6% SURG/RAD/HOR 25 5.9% SURG/CHEM/HOR 4 0.9% SURG/CHEM/RAD 44 10.4% CHEM/RAD/HOR 1 0.2% SURG/CHEM/RAD/HOR 13 3.1%

TOTAL CASES 423 100.0%

Estimated New Cancer Cases and Deaths by Sex, US, 2012* Estimated New Cases Estimated Deaths Both Sexes Male Female Both Sexes Male FemaleAll Sites 1,638,910 848,170 790,740 577,190 301,820 275,370Oral cavity & pharynx 40,250 28,540 11,710 7,850 5,440 2,410Tongue 12,770 9,040 3,730 2,050 1,360 690Mouth 11,620 7,030 4,590 1,790 1,070 720Pharynx 13,510 10,790 2,720 2,330 1,730 600Other oral cavity 2,350 1,680 670 1,680 1,280 400

SITE NAME NBR-CASES MALE FEMALE BASE OF TONGUE 2 12.5% 1 6.3% 1 6.3%OTHER PARTS OF TONGUE 5 31.3% 3 18.8% 2 12.5%FLOOR OF MOUTH 1 6.3% 1 6.3% 0 0.0%PAROTID GLAND 1 6.3% 1 6.3% 0 0.0%TONSIL 6 37.5% 6 37.5% 0 0.0%HYPOPHARYNX 1 6.3% 1 6.3% 0 0.0%TOTAL CASES 16 100.0% 13 81.3% 3 18.8%

Analytic primaries from BVHS diagnosed from January 1, 2012 through December 31, 2012 reveal sixteen primaries. A breakdown of primary site by sex is demonstrated below.

AGE AT DIAGNOSIS BY SEXAnalysis of the BVHS primaries age at diagnosis by sex reveals that the majority of the males were diagnosed at age 50-59. Females were evenly distributed between the age ranges of 50-59, 70-79, and 80-89.

Age Range Male Female30 - 39 1 040 - 49 1 050 - 59 7 160 - 69 4 070 - 79 0 180 - 89 0 1TOTALS 13 3

75% of patients

diagnosised are between 50-69 years

Cancer Registry

SITE BY STAGE AT DIAGNOSISAnalysis of the BVHS data reveals that the majority of primaries were located in the tonsil. The most common AJCC stage at diagnosis was Stage IV (distant disease). A breakdown of the remainder of the sites by stage are demonstrated below.

TREATMENTRadiation therapy and surgery, separately or in combination, are standard treatments; chemotherapy is added for advanced disease. Targeted therapy with cetuximab (Erbitux) may be combined with radiation in initial treatment or used alone to treat recurrent cancer.

Analysis of the BVHS primaries reveals that the majority (75%) were treated with multi-modality therapy.

SURVIVALFor all stages combined, about 84% of persons with oral cavity and pharynx cancer survive one year after diagnosis. The 5-year and 10-year relative survival rates are 61% and 50%, respectively. A comparison of the analytic primaries diag-nosed 2003-2006 of NCDB (all programs) and BVHS is demonstrated below.

References:National Cancer Data Base Survival (Diagnosed 2003-2006, all programs)American Cancer Society Cancer Facts & Figures 2012Blanchard Valley Health Systems Cancer Registry Database

SITE NAME NBR CASES STAGE 0 STAGE II STAGE II STAGE III STAGE IV

BASE OF TONGUE 2 12.5% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 12.5%

OTHER PARTS OF TONGUE 5 31.3% 0 0.0% 1 6.3% 2 12.5% 0 0.0% 2 12.5%

FLOOR OF MOUTH 1 6.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 6.3%

PAROTID GLAND 1 6.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 6.3%

TONSIL 6 37.5% 0 0.0% 0 0.0% 1 6.3% 0 0.0% 5 31.3%

HYPOPHARYNX 1 6.3% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 6.3%

OVERALL TOTALS 16 100.0% 0 0.0% 1 6.3% 3 18.8% 0 0.0% 12 75.0%

TREATMENT TYPE NBR CASE PERCENT SINGLE MODALITY THERAPY 4 25.0% SURGERY 3 18.8% RADIATION 1 6.3% MULTI-MODALITY THERAPY 12 75.0% SURG/RAD 4 25.0% CHEM/RAD 4 25.0% SURG/CHEM/RAD 4 25.0% TOTAL CASES 16 100.0%

HEAD & NECK CARCINOMA

2012 BVHS Cancer Annual Report | Findlay, Ohio | 419.423.55222013 Blanchard Valley Health System(Published September 2013)