2013 - Sentara Healthcare · since 1996. In October 2009, the cancer program received ... 2 2013...

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Based on 2012 – 2013 statistics

Annual Report20132014

The Sentara Northern Virginia Medical Center cancer program maintains a strong emphasis on evidence-based medicine and therapeutic options for the community. We offer an array of educational programs on healthy living, disease prevention and early diagnosis as well as frequent screening programs for colon, prostate, skin and breast cancer.

We have support groups and regular meetings in place to reach out to cancer patients and families in an attempt to get them through this most difficult time and to improve the quality of their lives while living with cancer. A patient navigator was added to our staff in August 2012 to further coordinate and facilitate this process. The role of a patient navigator is to ensure that the comprehensive and varied cancer care treatments offered through Sentara Northern Virginia Medical Center are accessible to all patients, especially those who may not have a strong support system throughout

Our cancer program has been approved and accredited by the American College of Surgeons Commission on Cancer since 1996. In October 2009, the cancer program received the American College of Surgeons’ highest commendation by achieving the American College of Surgeons Commission on Cancer Outstanding Achievement Award. Based on our last survey in October 2012, the program once again received a Commission on Cancer three-year Accreditation with Commendation. In addition, since 2012 the Sentara Northern Virginia Comprehensive Breast Center received a three-year accreditation by the National Accreditation Program for Breast Centers (NAPBC).

The cancer registry program at Sentara Northern Virginia Medical Center has been very active collecting data and maintaining a complete database of information for cancer cases diagnosed and/or treated at our facility, which is then made available for comparison to major Virginia hospitals and the national database. Sentara Northern Virginia Medical Center cancer data are also available for use by the medical staff and administration for special studies, medical planning, education and research. Some of the impressive statistics pertaining to 2012 and 2013 data that describe our patients and programs are highlighted in this report.

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May 2015

The information contained in this report is based on 2012 and 2013 statistics.

The report can be viewed online at Sentara.com/cancer.

Information about Sentara Northern Virginia Medical Center’s Cancer Program can also be found at www.cancer.org/asp/search/ftc/ftc_global.asp.

Shirlana Gabriel, CTR, Cancer Registrar compiled this report. For questions, please contact 703-523-1941.

On Behalf of Sentara Northern Virginia Medical Center Cancer Committee, it is with pleasure that I present to you the following report on our cancer program.

2012 and 2013 were years of success for Sentara Northern Virginia Medical Center’s cancer program: providing excellence in comprehensive cancer care for our community, including prevention, detection, state-of-the-art treatment modalities, and recovery and support groups. As you will note, we have made significant strides and met key milestones.

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their treatment. In 2013, we added meditation and yoga classes to further supplement our support program; they have been very well received and attended. Cancer information is available on the Sentara website and in hospital publications to keep our community aware and up-to-date on the broad range of resources and literature available. This

information is also available to our patients.

The Cancer Committee provides leadership for the hospital’s cancer program and meets quarterly. To help ensure that all patients receive the highest quality and coordinated comprehensive care, our Cancer Committee is made up of a multidisciplinary panel, from diagnostic and therapeutic specialties as well as allied health professionals who provide care to patients with cancer. The dedication and commitment of these individuals, and that of our entire

hospital community, are major reasons for the continuing success of our cancer program. We are all very appreciative of their hard work and dedication to this program, and I wish to personally thank everyone involved that helps make the cancer program at Sentara Northern Virginia Medical Center a success.

In June 2012, the Sentara Northern Virginia Comprehensive Breast Center was accredited by the National Accreditation Program for Breast Centers (NAPBC). This accomplishment was achieved by the hard work of our multidisciplinary team in meeting the highest standards; it also promises to bring state-of-the-art care for breast cancer patients closer to home for the residents of Northern Virginia. In addition, the mobile mammography unit, funded by a grant from the Potomac Health Foundation, continues to serve the women of Prince William County.

C O N T E N T S

SENTARA NORTHERN VIRGINIA MEDICAL CENTER CANCER PROGRAM CHAIRMAN REPORT

CANCER LIAISON

PHYSICIAN CANCER COMMITTEE

CANCER REGISTRY

CANCER CONFERENCES

CARE COORDINATION

COMMUNITY OUTREACH PROGRAMS

INFORMATION RESOURCES

HEMATOLOGY ONCOLOGY UNIT

PATHOLOGY AND LABORATORY MEDICINE

RADIATION ONCOLOGY

CLINICAL STUDY: INTRAOPERATIVE RADIATION THERAPY (IORT)

CHAPLAINCY SERVICES

RADIOLOGY AND IMAGING SERVICES

SURGICAL ORTHOPEDICBARIATRIC UNIT

STATISTICAL REVIEW

ANALYSIS OF CANCER DATA

CLINICAL STUDY:SITE SPECIFIC ANALYSIS

PRIMARY SITE TABLE - 2012

PRIMARY SITE TABLE - 2013

GLOSSARY OF TERMS

REFERENCES

ACKNOWLEDGEMENTS

LOOKING AHEAD

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The Cancer Program at Sentara Northern Virginia Medical Center 3

We offer an array of educational programs on healthy living, disease pre-vention and early diagnosis as well as frequent screening programs for colon, prostate, skin and breast cancer.

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blood products, chemotherapy, antibiotic and other infusion therapies. This center is open Monday through Friday.

Interventional radiology services have expanded to offer local therapies, such as chemoembolization for metastatic and primary liver lesions, radiofrequency ablation and a new clinical trial open for ablation of lung metastasis at the Alexandria location.

Da Vinci robotics has been in use since 2009 and has revolutionized urological and gynecological procedures.

Our multidisciplinary site specific tumor boards, including prostate and breast cancer conferences, continue to be productive settings to prospectively discuss patient care and are well attended by our cancer team. Medical and radiation oncology, surgery, pathology and radiology are regularly represented. Our breast program meets every month, and prostate and general cancer conferences meet every other month. We hope that you find this report useful and informative. Further information on any of the data presented or components of our cancer program can be obtained by calling the Cancer Registry at 703-523-1941. We thank you for your continued support of the cancer program at Sentara Northern Virginia Medical Center.

Sincerely,

Hamed Khosravi, M.D. Chairman, Cancer CommitteeSentara Northern Virginia Medical Center

Radiology and Imaging Services available at Sentara Northern Virginia Medical Center include magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine, ultrasound, digital mammography with computer aided detection (CAD), as well as stereotactic, ultrasound-guided and MRI-guided breast biopsy.

The Department of Radiology and Imaging Services is accredited by the American College of Radiology, ACR Accreditation for US Breast & Breast Biopsies as well as the American College of Radiology Breast Imaging Center of Excellence (ACR BICOE) designation. The MRI Department is accredited by the American College of Radiology.

Sentara Northern Virginia Medical Center is one of the few hospitals in the Northern Virginia area that offers intraoperative radiation therapy (IORT), which is offered to patients with early stage breast cancer. IORT is a type of radiation therapy in which radiation is delivered at the time of surgery. During IORT, the entire dose of radiation may be delivered during a single, intraoperative fraction. A typical IORT treatment can be delivered in as little as 8 minutes, compared to the five to seven-week course of external beam therapy. This program has been very active at our hospital and has enrolled more than 50 patients into the clinical study since its inception in May 2013.

The cancer program at Sentara Northern Virginia Medical Center provides specialized care for our cancer and hospice patients. The Hematology/Oncology Hospice Unit consists of 10 private patient rooms with dedicated oncology beds as well as 4 hospice beds in a private suite. Nurses deliver primary, patient-focused, personalized care and many of our nurses are Certified Oncology Nurses (OCN).

Additionally, our six-bay outpatient Infusion Center provides a quiet, setting for outpatient oncology infusions. Patients can be treated with a variety of outpatient infusions including

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Important

MilestonesCancer Liaison Physician’s Annual Report

Sentara Northern Virginia Medical Center has shared its contact, resource and service information with the Commission on Cancer Facility Information Profile System (FIPS), which also sends the information to the American Cancer Society (ACS). Sentara Northern Virginia’s information can be found online at the Commission on Cancer’s hospital locator at http://www.facs.org/cancerprogram/index.html.

Sentara Northern Virginia Medical Center’s Cancer Program is an American College of Surgeons approved cancer program. In October 2009, the cancer program received the ACoS highest accolade by achieving the ACoS Commission on Cancer Outstanding Achievement Award, and in October 2012, the program received a Commission on Cancer three-year Accreditation with Commendation. In addition, the Sentara Northern Virginia Comprehensive Breast Center received a three-year accreditation through the National Accreditation Program for Breast Centers, in 2012 (NAPBC).

Sentara Northern Virginia Medical Center continues to maintain our close working relationship with the local ACS chapter in Vienna, Virginia, and promotes education for the community, physicians and allied health personnel. The ACS website is www.cancer.org, and the local chapter telephone number is 703-938-5550. The Patient Resource Center (Reach to Recovery, Transportation, etc.) is available at 1-888-227-6333. Our local cancer control specialist is JoAnn Murchison.

Sentara Northern Virginia Medical Center offers an array of cancer prevention and management programs on the hospital campus that include free cancer screenings, nutritional therapy, and several cancer support groups. More information can be obtained by visiting Sentara.com and selecting the Northern Virginia region (Prince William County).

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Potomac Hospital opens in Woodbridge, Virginia.

Potomac Hospital and Inova Health System partner to open Potomac Radiation Oncology Center (PROC).

Potomac Hospital Cancer Center obtains initial program accreditation from the Commission on Cancer.

New patient bed tower opens, including dedicated oncology and hospice beds and a conference center, to host support programs.

Potomac Radiation Oncology Center adds Intensity-Modulated Radiation Therapy (IMRT) technology.

Outpatient Infusion Center opens.

Potomac Hospital merges with Sentara Healthcare, becoming Sentara Potomac Hospital.

Sentara Potomac Hospital is renamed Sentara Northern Virginia Medical Center.

Sentara Northern Virginia Comprehensive Breast Center receives accreditation by the National Accreditation Program for Breast Centers (NAPBC).

PROC opens new location and unveils Trilogy™ linear accelerator and imaging system from Varian Medical Systems.

Sentara Northern Virginia Comprehensive Breast Center is first in state to offer iCAD Xoft Intraoperative Radiation Therapy (IORT)for the treatment of early breast cancers.


The Cancer Committee

Providing leadership for the hospital’s cancer program.

The Cancer Committee includes multidisciplinary members, from diagnostic and therapeutic specialties as well as allied health professionals who provide care to patients with cancer. Interested members of the medical staff may serve on the Cancer Committee. Committee members are appointed by the medical staff president and are selected on the basis of willingness to participate and medical subspecialty. While the Cancer Committee meets quarterly to evaluate the management and administration of the program, its members provide guidance and expertise on a daily basis to hospital staff, the Cancer Registry, and community physicians while demonstrating excellence in the care of the cancer patient.

The Cancer Committee provides management and administration of the cancer program, in addition to supervising the registry. The committee is also required to demonstrate its ability to acquire, display and analyze data related to cancer care with the goal of improving cancer care and survival rates.

The Cancer Committee reports to the Chairman of the Performance Evaluation Committee who updates the Medical Executive Committee on the Cancer Committee’s activities. Listed at right are the 2012-2013 committee members.

Hamed Khosravi, M.D.ChairmanMedical Oncology

Dayo Akinbi, RPHDirector, Pharmacy

Alice Austiff, RN, MSN, CCMCare Coordination

Stephen Bane, M.D.Otorhinolaryngology

Norbertina Banson, M.D.Diagnostic Radiology

Barbara Beverage, RNQuality Improvement

Julie Billingsley, MSEdPhysician Liaison

Marlene Bolster, MBAVice President, Operations

Susan Boylan, M.D.Cancer Liaison PhysicianRadiation Oncology

Michael Brown, M.D.Gastroenterology

Joanne ChoeNutrition

Robert Cohen, M.D.Surgery

Pratik Desai, M.D.Urology

John Dockins, M.D.Surgery

Ken Erickson, RPHAssistant Director, Pharmacy

Beverly Foreman, RHIAHealth Information

Tina Gillispie, RHIA, CTRCancer Registry

Masoom Kandahari, M.D.Hematology & Oncology

Nancy Keithley, RNNursing

Judy Merring, RN, MSNCommunity Education and Health Promotion

Geoffrey Moorer, M.D.Medical Oncology

Debra MungerRadiation Oncology

JoAnn MurchisonAmerican Cancer Society

A.H. Nagia, M.D.Pain Management

Jerome O’Connell, M.D.Chair, Pathology

Ronnie Owen, RNClinical Educator

Julie Pierce, RN, BSN, OCNPatient Navigator

Lynda Reha, RPT Rehabilitative Services

Carol WilleHospital Chaplain

Maureen WilliamsHospice


Cancer Committee 2012-2013 members:

Cancer Registry

The Complete Database – An Important Tool in Patient Care

The Cancer Registry maintains a complete database

of information on all cancer cases diagnosed and/or

treated at Sentara Northern Virginia Medical Center.

The Tumor Registry database contains 8,592 abstracts

of cases from 1991 to 2012. In 2012, 527 new cases

were added. Of these new cases, 433 were analytic

cases. This database is an important patient care and

quality assessment tool.

The purpose of the Cancer Registry is to develop and

maintain a statistical database to include those patients

who meet specific criteria and who were either diagnosed

with and/or treated for cancer or other select reportable

diagnoses at Sentara Northern Virginia Medical Center.

All necessary records, manuals and statistics, as required

by the American College of Surgeons Commission on

Cancer, are maintained in order to be an approved

community hospital cancer program.

Data on newly diagnosed cancers are reported to the

Virginia Cancer Registry, a statewide central database.

Other data are submitted annually to the National

Cancer Data Base (NCDB), which requests cases for

special studies. Data submitted to the NCDB are shared

with and included in reports published by the American

Cancer Society, the National American Association of

Central Cancer Registries and the International Union

Against Cancer. Sentara Northern Virginia Medical Center

cancer data are also available for use by the medical staff

and administration for special studies, medical planning,

education and research. Reports generated from state and

national sources are useful when comparing quality of care

and assist the Cancer Committee in monitoring patient

care and recognizing opportunities for improvement.

Life-long follow-up activities are conducted annually to

confirm the accuracy of the survival data for statistics,

as well as to remind patients and their physicians of

the importance of continued cancer surveillance. Core

follow-up data include the dates and types of treatment

for persistent or recurrent disease, the site of distant

metastases, the site and histology of subsequent primaries,

the date of the last contact and the status of the patient.

As of November 2013, there are 3,660 analytic cases under

active follow-up with a follow-up rate that consistently

exceeds the 90% required rate set by the American College

of Surgeons Commission on Cancer for approved cancer

centers. In addition to the certified cancer registrars and

other registry staff, the Cancer Committee is thankful for

the follow-up efforts provided by the members of the

Sentara Northern Virginia Medical Center Auxiliary.

Reports generated from state and national sources are useful in monitoring patient care and recognizing opportunities for improvement.

As of November 2013

there are

analytic cases under

active follow-up with

a follow-up rate that

consistently exceeds the

90% required rate set by

the American College of

Surgeons Commission

on Cancer for approved

cancer centers.

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Cancer Conferences

Education is Key

Sentara Northern Virginia Medical Center offers three cancer conferences as educational sessions for the benefit of the medical staff and other health professionals within the hospital. Surgical and medical oncology, radiation therapy, and pathology are present at each session. The physicians involved with cancer from related specialties conduct discussions regarding diagnosis and current management in cancer care.

The Tumor Board is an educational conference held at 7 a.m. on the fourth Thursday of each month. Cases in the major cancer sites treated at Sentara Northern Virginia Medical Center are presented. Current cases are discussed, including the patient’s history, clinical course and stage, with radiological and pathological review. Treatment modalities are discussed employing the expertise of the participants.

The Prostate Cancer Conference is a site specific conference held at 12:30 p.m. on the third Wednesday of every other month. This conference brings together surgery, medical oncology, radiation oncology, pathology, radiology and other disciplines to discuss the latest state-of-the-art treatment approaches for prostate cancer.

The Breast Cancer Conference is a site specific conference held at 12:30 p.m. on the first Friday of the month. This conference brings together surgery, medical oncology, radiation oncology, pathology, radiology, and other disciplines to discuss the latest state-of-the-art treatment approaches for breast cancer based on nationally recognized standards of care.

Sentara Northern Virginia Medical Center is accredited by the Medical Society of Virginia to sponsor continuing medical education for physicians. Sentara Northern Virginia Medical Center designates these continuing medical education activities for one credit hour in Category I of the Physician’s Recognition Award of the American Medical Association.


JANUARYNon-invasive Papillary Transitional Cell

Carcinoma/BladderSeminoma/TesticularB-Cell Lymphoma

FEBRUARYHigh Grade Urothelial Carcinoma/

BladderRenal Cell Carcinoma/KidneyBladder CancerAdenocarcinoma/Esophagus

MARCHInvasive Adenocarcinoma/Sigmoid

ColonAdenocarcinoma, Signet Ring Type/

ColonAdenocarcinoma/ Unknown PrimaryInvasive Squamous Cell Carcinoma/

Right Tonsil

APRIL Metastatic Carcinoma/EsophagusEmbryonal Carcinoma/Testicular

MAYInvasive Ductal Carcinoma/Left BreastDCIS with Papillary Features/Left BreastSquamous Cell Carcinoma/UrethraRenal Cell Carcinoma/Kidney

JUNEAdenocarcinoma/Gastric AntrumAdenocarcinoma/Right ColonMalignant Spindle Cell Myoepithelial/

Parotid GlandInvasive Ductal Carcinoma/Left Breast

JULYRenal Cell Carcinoma/Right KidneyAdenocarcinoma/Stomach

AUGUSTAdenocarcinoma/ProstateInvasive Lobular Carcinoma/Right

Breast x2Ductal Carcinoma InSitu/Right BreastInvasive Ductal Carcinoma/Left Breast

SEPTEMBERInvasive Ductal Carcinoma/Left BreastInvasive Adenocarcinoma/Sigmoid

Colon

OCTOBERMucoepidermoid Carcinoma/ Right Parotid GlandSquamous Cell Carcinoma/EpiglottisEndometrioid Adenocarcinoma/UterusMetastatic Renal Cell Carcinoma/Kidney

NOVEMBERSquamous Cell Carcinoma/Right LungNeuroendocrine Tumor/Unknown

PrimaryClear Cell Carcinoma/Right KidneyInvasive Papillary Transitional Cell

Carcinoma/BladderMultilocular Clear Cell Carcinoma/ Right Kidney

DECEMBERMerkel Cell Carcinoma/Right ElbowInvasive Ductal Carcinoma/ Right Breast

Site Specific Conference Topics in 2012:

Care Coordination

The Care Coordination Department at Sentara Northern Virginia Medical Center is staffed by Social Work Care Coordinators, Registered Nurse (RN) Care Coordinators and a Prince William County Eligibility Worker. The Care Coordinators provide a wide range of services to patients and their families, whether they are from the inpatient or outpatient setting. Counseling services are directed toward helping the patient and family identify and address emotional and practical issues that may impact their ability to respond constructively to the changes brought about by the diagnosis of cancer. Special care is taken to be aware of and responsive to the variety of cultural backgrounds presented by our hospital’s patients.

Facilitating open dialogue on end-of-life decision making, including Advance Directives, Hospice involvement and grief counseling, is frequently requested. Concrete patient services include planning for discharge, which may include Hospice involvement, Palliative Care and referrals to include community resources for such needs as support groups, home health, financial aid/disability and medical equipment.

JANUARYDuctal Carcinoma in Situ/R Breast

Adenocarcinoma/Prostate

Renal Cell Carcinoma/R Kidney

Pleomorphic Malignant Neoplasm/Bladder

FEBRUARYInvasive Adenocarcinoma/Colon

Clear Cell Carcinoma/Kidney

Classical Hodgkin Lymphoma

MARCHSquamous Cell Carcinoma/Anus

Immature Teratuma/Testis

APRIL Clear Cell Renal Carcinoma/L Kidney

Hodgkin Lymphoma/Lung

MAYEmbryonal Carcinoma/Testicular

High Grade Urothelial Carcinoma/Bladder

JUNEChromophobe Renal Cell Carcinoma/R

Kidney

Squamous Cell Carcinoma/R Lung

Invasive Squamous Cell Carcinoma/Pharynx

JULYAdenocarcinoma /Prostate

Left Renal Mass

AUGUSTAdenocarcinoma/Prostate with

Incidental Bladder Cancer

Invasive Ductal Carcinoma/Left Breast

Metastatic Adenocarcinoma /Rectum

SEPTEMBERAdenocarcinoma/Prostate

Invasive Adenocarcinoma/Ascending Colon

Invasive Urothelial Carcinoma/Urinary Bladder

Hepatocellular Carcinoma/ Liver

OCTOBERMetastatic Invasive Ductal Carcinoma/

Left Breast

Nodular Sclerosing Hodgkin Disease

NOVEMBERAdenocarcinoma with Signet Ring Cell

Morphology/ Bladder

Metastatic Squamous Cell Carcinoma/Base of Tongue

Invasive Papillary Urothelial Carcinoma/Bladder

DECEMBERAdenocarcinoma/Prostate

Invasive Ductal Carcinoma/L Breast

Site Specific Conference Topics in 2013


Community Outreach Programs

Screenings: Each year, Sentara Northern Virginia Medical Center offers a free skin cancer screening to the community and low cost mammograms to all women who meet ACS guidelines. Cancer prevention, screening, and other educational materials are available at all health fairs. Sentara provides free mammograms to the area’s free clinic and health department.

Health Education: In addition to programs offered at the hospital, community health educators also present

programs on cancer prevention, nutrition and breast health to women’s and senior citizens’ groups and civic organizations. Topics addressing the risks of smoking

to youth, adolescents and non-smokers and smoking cessation for those who individuals who currently smoke

are just a sampling of topics presented at schools, local businesses, churches and senior centers.

Community Education: The American Cancer Society “Great American Smokeout” campaign is conducted for hospital employees. In addition, a self-guided smoking cessation program is offered to individuals who want to stop smoking, through 1- 800 SENTARA.

Support Groups: Monthly meetings are offered for cancer patients and their families. A general support group meets once a month and features guest speakers on issues selected by the group. Look Good, Feel Better, cosponsored with the American Cancer Society and local cosmetologists, is offered several times a year for those patients undergoing radiation or chemotherapy treatments. Sentara Northern Virginia Medical Center also partners with Westminster at Lake Ridge to sponsor a chapter of US TOO International Prostate Cancer Support Group.

Annual Programs: Support group participants form teams every year to join in the American Cancer Society’s annual Relay for Life. An annual employee health fair includes a cancer display and free cancer prevention information.

We have several community outreach initiatives designed to prevent to reduce a woman’s risk of being diagnosed with breast cancer. Educational classes and supporting materials and health screenings, for example, empower individuals with the knowledge to manage their health. We understand that an investment in wellness is the best investment for our community’s future.



Our mission is “We improve health

every day,” and we are committed to improving the

health of the many communities that

we serve.

Sentara is a proven leader in breast health. From education and prevention to cutting-edge treatments, patients benefit from a wealth of resources across Sentara, including the Sentara Northern Virginia Comprehensive Breast Center and our network of imaging centers.

Radiation oncologist Susan Boylan, M.D. and team review patient treatment plan. Sentara Northern Virginia Medical Center and its partners are proud to offer advanced treatment options.

Information Resources

• PubMed (MEDLINE via the Internet)

• National Cancer Institute’s PDQ (Physician Data Query)

• National Cancer Institute’s website at www.cancer.gov

• MedlinePlus

The Richard Immerman Memorial Library has an experienced, trained medical librarian who is fully versed in information retrieval techniques and computer operations. Several databases that are routinely available and accessed at the library include the following:

Computer printouts of material are usually available within one day. All of the cancer databases are also available via the library’s public access computer for those individuals wishing to perform their own literature searches. The librarian also has access to resources on the Internet and provides information via fax, pdf attachments to email, surface mail or pick up. Numerous journals (both electronic and print formats) and standard textbooks (both electronic and print) on cancer and related subjects are available. In addition, several Point of Care resources are available through the hospital’s web portal.

In its convenient location near the medical staff offices and physicians’ lounge, the library represents a universe of information available not only to physicians on staff, but patients and families as well. Providing information and resources to our physicians and the community is a very critical part of expanding the knowledge base related to cancer and its subsequent management.

All patients admitted to the Oncology Unit for initial chemotherapy treatments also receive information on cancer therapies, their specific chemotherapy regime, nutrition, community resources and coping mechanisms. Educational programs are also available through the TIGR Education Systems on the closed circuit TV in patient rooms.


Hematology Oncology Unit

The Cancer Program at Sentara Northern Virginia Medical Center provides specialized care for our cancer and hospice patients. The Hematology/Oncology Hospice Unit consists of 10 private patient rooms.

Nurses deliver primary, patient-focused, personalized care and work with state-of-the-art equipment. They are encouraged to become certified in Oncology Nursing by the Oncology Nursing Certification Corporation (ONCC). In 2014, we had nine Certified Oncology Nurses (OCN) on staff.

The Division Director of Medicine and Oncology Services is a master’s-prepared oncology nurse who is certified by the ONCC. She and the Assistant Director of Oncology Services, who is also certified, oversee the unit and all aspects of nursing care provided by the specially trained staff. Certified nurses provide the coordination of care for patients with cancer and consistently utilize the Oncology Nursing Society (ONS) standards in providing care.

Pain management is an important aspect of care on this unit and is provided according to the patient’s individual needs. Staff undergoes annual continuing education, oncology competency training, pain management, chemotherapy administration and other oncology aspects of care.

The care provided is multidisciplinary, bringing together rehabilitative services, dietary, pharmacy, social work and all other disciplines necessary for high quality, current cancer care. The nursing staff participates in the American Cancer Society’s community education for colon, breast and lung cancer. Several of the certified nurses participate in the cancer support group. Many belong to the Oncology Nursing Society.

Sentara Northern Virginia Medical Center works in conjunction with Hospice of Northern Virginia and Community Hospice to provide four contract hospice inpatient rooms. These beds are utilized when the focus of care may no longer be deemed curative and the ultimate goal is palliative, providing comfort, pain management and support to the patient in the final stages of terminal illness and his or her family. The rooms are designed to afford the patient and family comfort and privacy. Staff receives annual training on end of life care and special training in working with families at the end of life.

Our six-bay Outpatient Infusion Center provides a calm, quiet setting for outpatient oncology infusions.

Patients can be treated with a variety of outpatient infusions including blood products, chemotherapy, antibiotic and other infusion therapies. Patients can relax in comfortable recliner chairs and listen to music or watch individual DVD players.


Pathology & Laboratory Medicine

The Laboratory offers a wide variety of diagnostic services in both clinical and anatomic pathology and plays an important role in assisting the physician in diagnosing, treating and managing the cancer patient.

Second opinions from respected consultants at academic centers are obtained on challenging cases seen at Sentara Northern Virginia Medical Center. In addition, if the patient or a family member requests a second opinion or is referred to another treatment center, patient-related material is forwarded for outside review.

Fine needle aspirations are available at Sentara Northern Virginia Medical Center; all fine needle aspirations are image guided and performed with local anesthesia. A radiologist will obtain the sample, and a pathologist will evaluate the material during the procedure. A pathologist will attend all fine needle aspirations to ensure the specimen is adequate. These efforts will minimize the need for a repeat procedure.

The Pathology Department assists in selecting interesting and instructive cases for the monthly Tumor Board conferences. Photomicrographs are prepared, and the pathologic features of each case are discussed. Other educational presentations on cancer-related topics are given at department meetings upon request.

A close working relationship exists between the departments of pathology, surgery, oncology, radiation oncology and radiology. These relationships will help determine the best course of treatment for each patient. We are committed to providing superior diagnostic clinical laboratory and anatomic pathology services for patients with cancer.

The clinical laboratory performs blood and body fluid testing that can provide effective screening and monitoring and assess the effectiveness of therapy. These test results can help the treating physician individualize therapy to the patient.

The Anatomic Pathology Department provides essential diagnostic services and supports each element of the cancer program at Sentara Northern Virginia Medical Center. Daily microscopic examination of tissue and fluids allows for identification of both benign and malignant processes. Prognostic information is provided on malignant cases and consists of diagnosis, tumor staging and the performance of ancillary testing. For example, routine ancillary testing for breast cancer patients includes: assessment of estrogen, progesterone receptor status and Her-2/neu expression. These tests are performed on all new cases of invasive breast carcinomas. At the physician’s request, additional ancillary testing, such as fluorescent in situ hybridization (FISH) assays, Mammoprint, Oncotype Dx and a wide variety of molecular based testing, is available through our reference laboratories.

Intraoperative consultation is available for immediate assessment of suspected malignancies and can provide the surgeon with information that may be essential for the operative management of the patient.


The Varian Eclipse 3D conformal treatment-planning software has continued to enhance the precision with which tumors can be treated. These technologies allow shaping of the tumor volume for maximum coverage while at the same time decreasing the amount of normal tissue receiving radiation within the field. They also allow maximum dose to the tumor, which aims at improved tumor control while at the same time decreasing the dose to normal tissues, thereby reducing the complications of treatment.

The PROC team continues to work closely with the physicians and services at Sentara Northern Virginia Medical Center. In 2012, there were 404 patients seen in consultation at the center along with 18 Prostate Seed Implant cases performed at Sentara Northern Virginia Medical Center. In 2013, there were 406 patients seen in consultation at the center along with 8 Prostate Seed Implant cases performed at Sentara Northern Virginia Medical Center. Other services that are available at the center for all patients include dietary and care coordination support. Members of the team are also involved with the American Cancer Society to establish and facilitate other patient support programs such as “Look Good, Feel Better.” The center organized the celebration of National Cancer Survivors’ Day for our local community.

PROC is accredited by the American College of Radiology for the achievement of high practice standards. PROC’s commitment to bringing new services to the community will continue as the needs of the community grow.


Potomac Radiation Oncology Center (PROC) at Sentara Northern Virginia Medical Center continues to serve the growing population of Prince William County and the surrounding areas. It is located in The Century Building on the hospital campus. PROC is affiliated with the Inova Health System and is staffed by board-certified personnel who have a broad range of experience in radiation oncology.

The facility continues to be equipped with an array of sophisticated technology. This includes a Varian Trilogy® linear accelerator with dual energy photons and multiple energy electrons, as well as a multi-leaf collimation system that can deliver Intensity Modulated Radiation Therapy (IMRT). Also inherent to the machine is an onboard imager, known as IGRT. There is a GE CT that is used during simulation to collect 3-dimensional images to plan the patient’s treatment. All of this equipment helps in the ongoing effort to improve accuracy of patient positioning and dose delivery.

Radiation Oncology

Advanced radiation technology, including the Varian Trilogy®

linear accelerator, are key to improved patient outcomes.

Sentara Northern Virginia Medical Center Clinical Study

A Safety and Efficacy Study of Intraoperative

Radiation Therapy (IORT) Using the Xoft®

Axxent® eBx® System at the Time of

Breast Conservation Surgery for Early Stage

Breast Cancer

The study began enrollment in May 2012, with an anticipated enrollment of 1,000 women throughout the United States and an expected end date of 2024. Sentara Northern Virginia Medical Center began its participation in this clinical study in May of 2013 and to date has enrolled 56 participants with 50 women treated. The purpose of the trial is to assess the safety and efficacy of the Xoft Axxent eBx System when used for single-fraction IORT in early stage breast cancer. The primary objective of the study is to compare IORT using the Xoft Axxent eBx System to the current standard of whole breast irradiation (WBI) when used in women with early stage breast cancer. Study inclusion criteria include women age 40 and older with biopsy-proven invasive ductal carcinoma or ductal carcinoma in situ of the breast. The tumor(s) must be Stage 1 and less or equal to 3.0 cm in greatest diameter by peroperative assessment. Tumors also must meet AJCC Tumor Classification: Tis, T1 or T2 (< 3 cm), N0, M0. Women who are pregnant or nursing, have significant auto-immune disease, have biopsy-proven multi-focal, multi-centric or invasive lobular breast cancer, or have undergone neo-adjuvant chemotherapy or neo-adjuvant endocrine therapy for the current breast cancer diagnosis are not eligible to participate in the clinical study.The clinical study will assess the objectives at right.


Primary Objective:

• To assess the rate of ipsilateral breast tumor recurrence in subjects treated with the Xoft Axxent Electronic Brachytherapy System when used for single-fraction, intraoperative radiation therapy treatment of early stage breast cancer when compared to whole breast irradiation (WBI) at five years of follow-up.

IBTR is defined as biopsy-proven reappearance of cancer in the treated breast. IBTR will be assessed at Month 6, Month 12, Month 18, Year 2, and then annually through 10-year follow-up. A comparison to whole breast irradiation will be made at five years.

Secondary Objectives:

• Rates of IBTR reported at 10 years.

• Rates of regional recurrence reported at 5 and 10 years.

Regional breast tumor recurrence is defined as biopsy-proven reappearance of cancer in the axilla. Regional recurrence will be assessed at Month 6, Month 12, Month 18, Year 2, and then annually through 10-year follow-up. Regional recurrence rates will be compared to WBI.

• Disease Free Survival (DFS) and Overall Survival (OS), reported at 5 and 10 years.

Disease free survival (DFS) is defined as the length of time from IORT to any first recurrence. The incidence of disease free survival will be assessed at Month 1, Month 6, Month 12, Month 18, Year 2, and then annually through 10-year follow-up. DFS will be compared to the historical control at 5 and 10 years.

• Cosmetic Outcome reported at 5 and 10 years.

Cosmetic outcome will be recorded at baseline, Month 12, Month 18, Year 2, and then annually through 10-year follow-up. Physician evaluation will be done using the Harvard Scale, and Cosmesis photographs will be taken.

• Quality of Life (QOL) reported at 5 and 10 years.

Quality of Life will be assessed at baseline and at each follow-up visit: Month 1, Month 6, Month 12, Month 18, Year 2, and then annually through 10-year follow-up. QOL will be measured using the FACT-B self-reporting questionnaire.

• Assess the safety of single fraction IORT at the time of breast conserving surgery for early stage breast cancer; on-going monitoring, report at 5 and 10 years.

The rates and severity of Adverse Events (AEs), Adverse Device Effects (ADEs), and Unanticipated Adverse Device Effects (UADEs) during and following IORT will be assessed at each follow-up visit. Safety events will be compared to the historical control of WBI at 5 and 10 years. Each event will be classified according to the following: Device Related, Procedure Related or Radiation Related.

Source: https://clinicaltrials.gov/ct2/show/NCT01644669

Chaplaincy Services

Sentara Northern Virginia Medical Center recognizes that being in a hospital can be an emotional and stressful time. Chaplaincy Services provides religious and spiritual care during a patient’s hospital stay. The hospital chaplain is a member of the Cancer Committee.

Working with the Prince William Ministerial Association, Chaplaincy Services can include:

• Providing information about community religious groups and/or resources.

• Prayer and spiritual guidance for our patients and their families.

• Providing sacramental and spiritual counseling ministries.

• Offering devotional materials.

• Interfaith Worship Room open 24 hours a day.

• Channel 18, our closed circuit channel, transmits live services from the Worship Room to the patient’s room.

Spiritual services can be accessed by dialing ext. 30680 from bedside telephones, dialing 703-523-0680 from outside the hospital, or asking a staff member to page the hospital chaplain.


Radiology and Imaging Services

Meeting a growing demand to better serve our patients

Radiology and Imaging Services available at Sentara Northern Virginia Medical Center include magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine, nuclear cardiology, whole body bone scans, ultrasound, digital mammography with computer aided detection (CAD), stereotactic breast biopsy, bone densitometry, diagnostic X-ray, interventional radiology, non-invasive vascular lab procedures and a picture archiving communication system (PACS) with remote access for referring physicians.

The digital mammography suite includes a private waiting area with spacious dressing rooms. It is equipped to perform digital screening, diagnostic, computer aided detection (CAD), needle localizations, breast ultrasounds and US breast biopsies, and stereotactic biopsies. The department successfully passed the MQSA standards in July 2012 and is accredited by the American College of Radiology, ACR Accreditation for US Breast and Breast Biopsies as well as achieving the American College of Radiology Breast Imaging Center of Excellence (ACR BICOE) designation.

To meet a growing demand for services and to better serve our patients and referring physicians, Radiology and Imaging Services expanded hours of service in ultrasound, MRI, and CT. The department now houses two ACR accredited multi-slice CT scanners, including a 64-slice CT

scanner. The CT scanner acquires images rapidly, thereby enabling the department to accommodate more patients and to significantly reduce the waiting period for outpatient procedures. In 2012, Radiology and Imaging Services performed 102,938 procedures. In 2013, Radiology and Imaging Services performed 117,601 procedures including an array of less invasive diagnostics that benefit patients who otherwise might require more invasive surgical procedures. These procedures include image-guided biopsies and nuclear medicine sentinel node studies for breast cancer and melanoma patients who might otherwise undergo more invasive, wide resections of axillary lymph nodes.

The MRI Department is

accredited by the American

College of Radiology and

performs Breast MRI and

MRI Breast Biopsies.

In 2012, Sentara Northern Virginia Medical Center performed

In 2013, Sentara Northern Virginia Medical Center performed

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proc

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5,423


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Surgical Orthopedic Bariatric Unit

Support Every Step of the Way

The Surgical Unit provides educational packets to all inpatient mastectomy and lumpectomy patients. Included are American Cancer Society educational brochures/booklets, a survey form, information about the Cancer Registry and support groups, and After Your Mastectomy, a DVD about incision care, exercises and support groups. Patients have indicated that they found the materials helpful in their decision-making process.

In addition to educational materials, Surgical Unit staff nurses provide teaching and referrals to other hospital departments and staff to meet patients’ assessed needs. Staff members work closely with the Medical Oncology nurses to provide support for patients who have been treated surgically for any cancer diagnoses.


Sentara Northern Virginia Comprehensive Breast Center was first to market with the Xoft ® Axxent® Electronic Brachytherapy System® to treat certain qualified patients with early stage breast cancer. For certain qualified breast cancer patients, the Xoft® Intraoperative Radiation Therapy (IORT) system can reduce radiation therapy treatment to a single, prescribed, targeted dose of isotope-free radiation, delivered directly to the tumor cavity during surgery. This process minimizes radiation to healthy tissue and organs and eliminates the need for a shielded treatment environment. The medical team can stay in the same room with the patient during treatment. Typical radiation therapy methods for breast cancer include whole breast radiation, which involves daily treatments for five to seven weeks, and partial breast irradiation where 10 treatments are delivered over a period of five days. While not all breast cancer patients will qualify for this treatment approach, the availability of Xoft® at the Sentara Northern Virginia Comprehensive Breast Center represents advancement in the era of personalized medicine and demonstrates our com-mitment to providing a patient-centered approach to treating breast cancer.

Intraoperative Radiation Therapy

3D Mammography

3D mammography is a revolutionary state-of- the-art technology that gives radiologists the ability to view inside the breast layer by layer, helping to see the fine details more clearly by minimizing overlapping tissue. During a 3D mammogram, multiple low-dose images known as “slices” of the breast are acquired at different angles. With 3D technology, the radiologist can view a mammogram in a way never before possible.

3D mammography results in superior clinical performance through:

EARLIER DETECTION – By minimizing the impact of overlapping breast tissue, 3D mammography can help improve breast cancer screening and detection.

FEWER CALLBACKS – 3D mammography helps distinguish harmless abnormalities from real cancers, leading to fewer callbacks and less anxiety for women.

BETTER VISUALIZATION – Radiologists can better see the size, shape and location of an abnormality.

90%continues to meet the CoC requirements of

Follow-up

The registry does not abstract cases diagnosed and treated only on an outpatient basis in the physician’s office.

Analysis of 2012 Cancer Data

20 1 2

43 3 new

cases in

20 1 1

3 9 5new

cases in

82%total analytic cases in 2012

SNVMC ACSBreast (100 cases) 23% 15%Lung (34 cases) 8% 13%Prostate (73 cases) 17% 17%Colon (32 cases) 7% 8%

Primary Site The following table compares this data to estimated new cases for all sites, 2012, from the American Cancer Society (ACS).

Sentara Northern Virginia Medical Center’s lung caseload is less than the national average. Comparisons with this database continue to be useful to detect significant trends.

Compared to All Analytic Cases


Site Specific Analysis: Breast

Adjuvant Endocrine Therapy in Breast Cancer Patients

By: Geoffrey Moorer, M.D.

Adjuvant endocrine therapy (ET) is the use of hormone-therapy medications to block the production or utilization of estrogen by cancer cells, thus decreasing the risk of breast cancer recurrence. National Comprehensive Cancer Network (NCCN) guidelines recommend patients with invasive breast cancer receive ET in addition to surgical and chemotherapy interventions. In premenopausal breast cancer patients, the treatment of choice is tamoxifen; the recommendation for postmenopausal women is tamoxifen combined with aromatase inhibitors. Randomized studies also support the use of ET, stating that for “women with Estrogen Receptor (ER) positive disease, continuing tamoxifen to 10 years rather than stopping at 5 produces a further reduction in recurrence and mortality, particularly after year 10.” See Graph at right. The following data and analysis addresses the 31 analytic breast cancer patients whom Sentara Northern Virginia Medical Center physicians treated in 2011 with comparison of data to the National Cancer Data Base (NCDB).

Analysis of Sentara Northern Virginia Medical Center Data (Analytic Cases)

• 31 total cases were reviewed.

• 25/31 (80.6%) cases Estrogen Receptor/Progesterone Receptor (ER/PR) positive.

– The national average is 70-80%.

• 21/31 (68%) STAGE 1

• 5/31 (16%) STAGE 2

• 5/31 (16%) STAGE 3

• 24/25 (96%) cases received or recommended adjuvant ET. 1 case unknown (post-surgical treatment at another facility).

• All pathology results confirmed by negative and positive controls.

Source: Davies, C; Pan, H; Godwin, J, et al. (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of estrogen receptor-positive breast cancer: ATLAS, a randomized trial. Lancet; 381: 805-16.

90%continues to meet the CoC requirements of

Follow-up

The registry does not abstract cases diagnosed and treated only on an outpatient basis in the physician’s office.

Analysis of 2013 Cancer Data

20 1 3

46 3 new

cases in

20 1 2

43 3new

cases in

8 6%total analytic cases in 2013

SNVMC ACSBreast (124 cases) 27% 15%Lung (39 cases) 8% 13%Prostate (46 cases) 10% 17%Colon (33 cases) 7% 8%

Primary Site The following table compares this data to estimated new cases for all sites, 2013, from the American Cancer Society (ACS).

Sentara Northern Virginia Medical Center’s lung caseload is less than the national average. Comparisons with this database continue to be useful to detect significant trends.

Compared to All Analytic Cases


30%

20%

10%

0%5

Years10

Years15

Years0

Diagnosis

Continue Tamoxifen to 10 Years

25.1%21.4%

14.5%

13.1%

Stop Tamoxifen at 5 Years

Summary by Body System, Sex, Class, Status and Best AJCC Stage Report: 1St Contact Year 20122012 Primary Site Table


Primary Site Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv

Sex Class of Case Status Stage Distribution - Analytic Cases Only

ORAL CAVITY & PHARYNX 15 (2.8%) 12 3 15 0 14 1 0 3 1 0 11 0 0 0 Tongue 4 (0.8%) 2 2 4 0 4 0 0 1 0 0 3 0 0 0 Salivary Glands 2 (0.4%) 2 0 2 0 2 0 0 0 0 0 2 0 0 0 Floor of Mouth 1 (0.2%) 1 0 1 0 1 0 0 0 1 0 0 0 0 0 Tonsil 7 (1.3%) 6 1 7 0 6 1 0 1 0 0 6 0 0 0 Hypopharynx 1 (0.2%) 1 0 1 0 1 0 0 1 0 0 0 0 0 0 DIGESTIVE SYSTEM 86 (16.2%) 48 38 67 19 60 26 1 18 7 13 27 0 1 0 Esophagus 2 (0.4%) 0 2 2 0 1 1 0 1 1 0 0 0 0 0 Stomach 11 (2.1%) 6 5 6 5 6 5 0 2 1 1 2 0 0 0 Small Intestine 1 (0.2%) 1 0 1 0 1 0 0 0 0 1 0 0 0 0 Colon Excluding Rectum 36 (6.8%) 18 18 33 3 29 7 1 9 3 8 11 0 1 0 Cecum 6 2 4 6 0 6 0 0 1 0 2 2 0 1 0 Appendix 2 1 1 2 0 1 1 0 1 0 1 0 0 0 0 Ascending Colon 3 1 2 3 0 3 0 0 0 1 1 1 0 0 0 Hepatic Flexure 1 0 1 1 0 0 1 0 0 0 1 0 0 0 0 Transverse Colon 5 4 1 5 0 5 0 0 1 1 1 2 0 0 0 Splenic Flexure 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 Descending Colon 4 2 2 4 0 3 1 1 1 1 0 1 0 0 0 Sigmoid Colon 11 7 4 11 0 8 3 0 5 0 2 4 0 0 0 Large Intestine, NOS 3 1 2 0 3 2 1 0 0 0 0 0 0 0 0 Rectum & Rectosigmoid 9 (1.7%) 6 3 8 1 8 1 0 4 1 0 3 0 0 0 Rectosigmoid Junction 2 1 1 2 0 2 0 0 1 0 0 1 0 0 0 Rectum 7 5 2 6 1 6 1 0 3 1 0 2 0 0 0 Anus, Anal Canal & Anorectum 1 (0.2%) 0 1 0 1 1 0 0 0 0 0 0 0 0 0 Liver & Intrahepatic Bile Duct 5 (0.9%) 4 1 1 4 2 3 0 0 1 0 0 0 0 0 Other Biliary 1 (0.2%) 0 1 1 0 1 0 0 0 0 0 1 0 0 0 Pancreas 18 (3.4%) 12 6 14 4 9 9 0 1 0 3 10 0 0 0 Retroperitoneum 1 (0.2%) 1 0 1 0 1 0 0 1 0 0 0 0 0 0 Peritoneum, Omentum & Mesentery 1 (0.2%) 0 1 0 1 1 0 0 0 0 0 0 0 0 0 RESPIRATORY SYSTEM 57 (10.8%) 27 30 37 20 32 25 1 13 3 4 15 0 1 0 Larynx 4 (0.8%) 2 2 4 0 4 0 1 1 0 2 0 0 0 0 Lung & Bronchus 53 (10.0%) 25 28 33 20 28 25 0 12 3 2 15 0 1 0 BONES & JOINTS 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 1 0 0 0 Bones & Joints 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 1 0 0 0 SOFT TISSUE 3 (0.6%) 1 2 3 0 3 0 0 2 1 0 0 0 0 0 Soft Tissue (including Heart) 3 (0.6%) 1 2 3 0 3 0 0 2 1 0 0 0 0 0 SKIN EXCLUDING BASAL & SQUAMOUS 11 (2.1%) 9 2 8 3 10 1 1 2 3 1 0 0 1 0 Melanoma – Skin 8 (1.5%) 6 2 6 2 8 0 1 2 1 1 0 0 1 0 Other Non-Epithelial Skin 3 (0.6%) 3 0 2 1 2 1 0 0 2 0 0 0 0 0 BREAST 116 (21.9%) 2 114 100 16 107 9 26 43 16 9 5 0 1 0 Breast 116 (21.9%) 2 114 100 16 107 9 26 43 16 9 5 0 1 0


2012



FEMALE GENITAL SYSTEM 19 (3.6%) 0 19 16 3 17 2 0 9 3 0 2 0 2 0 Cervix Uteri 3 (0.6%) 0 3 2 1 3 0 0 2 0 0 0 0 0 0 Corpus & Uterus, NOS 12 (2.3%) 0 12 12 0 11 1 0 6 3 0 1 0 2 0 Corpus Uteri 11 0 11 11 0 11 0 0 6 3 0 0 0 2 0 Uterus, NOS 1 0 1 1 0 0 1 0 0 0 0 1 0 0 0 Ovary 4 (0.8%) 0 4 2 2 3 1 0 1 0 0 1 0 0 0 MALE GENITAL SYSTEM 89 (16.8%) 89 0 80 9 88 1 0 57 15 4 4 0 0 0 Prostate 82 (15.5%) 82 0 74 8 81 1 0 51 15 4 4 0 0 0 Testis 7 (1.3%) 7 0 6 1 7 0 0 6 0 0 0 0 0 0 URINARY SYSTEM 49 (9.2%) 33 16 46 3 41 8 14 16 6 5 4 0 1 0 Urinary Bladder 30 (5.7%) 19 11 27 3 25 5 14 6 2 3 2 0 0 0 Kidney & Renal Pelvis 19 (3.6%) 14 5 19 0 16 3 0 10 4 2 2 0 1 0 BRAIN & OTHER NERVOUS SYSTEM 9 (1.7%) 2 7 6 3 8 1 0 0 0 0 0 6 0 0 Brain 2 (0.4%) 0 2 1 1 2 0 0 0 0 0 0 1 0 0 Cranial Nerves Other Nervous System 7 (1.3%) 2 5 5 2 6 1 0 0 0 0 0 5 0 0 ENDOCRINE SYSTEM 12 (2.3%) 4 8 12 0 11 1 0 7 2 0 0 1 2 0 Thyroid 11 (2.1%) 3 8 11 0 10 1 0 7 2 0 0 0 2 0 Other Endocrine including Thymus 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 0 1 0 0 LYMPHOMA 26 (4.9%) 16 10 22 4 21 5 0 5 4 4 9 0 0 0 Hodgkin Lymphoma 5 (0.9%) 3 2 3 2 4 1 0 0 0 1 2 0 0 0 Hodgkin - Nodal 4 3 1 2 2 3 1 0 0 0 0 2 0 0 0 Hodgkin - Extranodal 1 0 1 1 0 1 0 0 0 0 1 0 0 0 0 Non-Hodgkin Lymphoma 21 (4.0%) 13 8 19 2 17 4 0 5 4 3 7 0 0 0 NHL - Nodal 18 11 7 17 1 15 3 0 5 3 3 6 0 0 0 NHL - Extranodal 3 2 1 2 1 2 1 0 0 1 0 1 0 0 0 MYELOMA 9 (1.7%) 6 3 6 3 4 5 0 0 0 0 0 6 0 0 Myeloma 9 (1.7%) 6 3 6 3 4 5 0 0 0 0 0 6 0 0 LEUKEMIA 10 (1.9%) 6 4 5 5 7 3 0 0 0 0 0 5 0 0 Lymphocytic Leukemia 6 (1.1%) 5 1 2 4 5 1 0 0 0 0 0 2 0 0 Chronic Lymphocytic Leukemia 5 4 1 1 4 4 1 0 0 0 0 0 1 0 0 Other Lymphocytic Leukemia 1 1 0 1 0 1 0 0 0 0 0 0 1 0 0 Myeloid & Monocytic Leukemia 3 (0.6%) 1 2 2 1 2 1 0 0 0 0 0 2 0 0 Acute Myeloid Leukemia 1 0 1 1 0 0 1 0 0 0 0 0 1 0 0 Chronic Myeloid Leukemia 2 1 1 1 1 2 0 0 0 0 0 0 1 0 0 Other Leukemia 1 (0.2%) 0 1 1 0 0 1 0 0 0 0 0 1 0 0 KAPOSI SARCOMA 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 0 1 0 0 Kaposi Sarcoma 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 0 1 0 0 MISCELLANEOUS 17 (3.2%) 9 8 11 6 10 7 0 0 0 0 0 11 0 0 Miscellaneous 17 (3.2%) 9 8 11 6 10 7 0 0 0 0 0 11 0 0

Total 530 266 264 436 94 433 97 43 175 61 40 78 30 9 0





ORAL CAVITY & PHARYNX 12 (2.6%) 10 2 12 0 12 0 1 5 1 2 1 1 1 0 Lip 1 (0.2%) 1 0 1 0 1 0 0 1 0 0 0 0 0 0 Tongue 3 (0.6%) 3 0 3 0 3 0 0 2 0 1 0 0 0 0 Salivary Glands 1 (0.2%) 1 0 1 0 1 0 0 0 0 1 0 0 0 0 Floor of Mouth 1 (0.2%) 1 0 1 0 1 0 1 0 0 0 0 0 0 0 Gum & Other Mouth 1 (0.2%) 0 1 1 0 1 0 0 1 0 0 0 0 0 0 Nasopharynx 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 0 0 1 0 Tonsil 2 (0.4%) 1 1 2 0 2 0 0 1 1 0 0 0 0 0 Oropharynx 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 1 0 0 0 Other Oral Cavity & Pharynx 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 0 1 0 0 DIGESTIVE SYSTEM 71 (15.3%) 40 31 63 8 58 13 2 12 10 14 16 0 9 0 Esophagus 3 (0.6%) 1 2 2 1 2 1 0 0 0 0 2 0 0 0 Stomach 12 (2.6%) 7 5 11 1 9 3 0 1 1 2 4 0 3 0 Colon Excluding Rectum 33 (7.1%) 17 16 30 3 30 3 1 6 7 7 5 0 4 0 Cecum 7 3 4 7 0 6 1 0 1 3 0 1 0 2 0 Ascending Colon 9 6 3 9 0 8 1 1 3 1 2 2 0 0 0 Hepatic Flexure 1 1 0 1 0 1 0 0 1 0 0 0 0 0 0 Transverse Colon 2 0 2 2 0 2 0 0 1 0 1 0 0 0 0 Descending Colon 2 1 1 2 0 2 0 0 0 1 1 0 0 0 0 Sigmoid Colon 8 4 4 7 1 8 0 0 0 2 3 1 0 1 0 Large Intestine, NOS 4 2 2 2 2 3 1 0 0 0 0 1 0 1 0 Rectum & Rectosigmoid 8 (1.7%) 7 1 8 0 8 0 0 4 1 2 0 0 1 0 Rectosigmoid Junction 2 2 0 2 0 2 0 0 1 0 1 0 0 0 0 Rectum 6 5 1 6 0 6 0 0 3 1 1 0 0 1 0 Anus, Anal Canal & Anorectum 2 (0.4%) 1 1 2 0 2 0 1 0 0 1 0 0 0 0 Liver & Intrahepatic Bile Duct 4 (0.9%) 2 2 4 0 3 1 0 1 0 2 0 0 1 0 Pancreas 9 (1.9%) 5 4 6 3 4 5 0 0 1 0 5 0 0 0 RESPIRATORY SYSTEM 44 (9.5%) 27 17 38 6 34 10 1 8 4 6 18 0 1 0 Nose, Nasal Cavity & Middle Ear 1 (0.2%) 0 1 1 0 1 0 0 0 0 1 0 0 0 0 Larynx 4 (0.9%) 3 1 4 0 4 0 0 0 0 1 3 0 0 0 Lung & Bronchus 39 (8.4%) 24 15 33 6 29 10 1 8 4 4 15 0 1 0 BONES & JOINTS 1 (0.2%) 0 1 0 1 0 1 0 0 0 0 0 0 0 0 Bones & Joints 1 (0.2%) 0 1 0 1 0 1 0 0 0 0 0 0 0 0 SOFT TISSUE 3 (0.6%) 1 2 2 1 2 1 0 0 0 0 0 0 2 0 Soft Tissue (including Heart) 3 (0.6%) 1 2 2 1 2 1 0 0 0 0 0 0 2 0 SKIN EXCLUDING BASAL & SQUAMOUS 14 (3.0%) 12 2 13 1 13 1 3 2 1 1 1 0 5 0 Melanoma – Skin 14 (3.0%) 12 2 13 1 13 1 3 2 1 1 1 0 5 0 BREAST 124 (26.8%) 5 119 110 14 123 1 26 54 16 4 3 0 7 0 Breast 124 (26.8%) 5 119 110 14 123 1 26 54 16 4 3 0 7 0

2013 Primary Site Table Summary by Body System, Sex, Class, Status and Best AJCC Stage Report: 1St Contact Year 2013



FEMALE GENITAL SYSTEM 20 (4.3%) 0 20 17 3 19 1 0 5 0 2 3 0 7 0 Cervix Uteri 1 (0.2%) 0 1 1 0 1 0 0 0 0 1 0 0 0 0 Corpus & Uterus, NOS 10 (2.2%) 0 10 8 2 9 1 0 4 0 0 1 0 3 0 Corpus Uteri 8 0 8 8 0 8 0 0 4 0 0 1 0 3 0 Uterus, NOS 2 0 2 0 2 1 1 0 0 0 0 0 0 0 0 Ovary 7 (1.5%) 0 7 6 1 7 0 0 1 0 1 2 0 2 0 Vagina 1 (0.2%) 0 1 1 0 1 0 0 0 0 0 0 0 1 0 Other Female Genital Organs 1 (0.2%) 0 1 1 0 1 0 0 0 0 0 0 0 1 0 MALE GENITAL SYSTEM 51 (11.0%) 51 0 41 10 49 2 0 15 13 1 5 0 7 0 Prostate 46 (9.9%) 46 0 38 8 44 2 0 15 13 1 4 0 5 0 Testis 4 (0.9%) 4 0 2 2 4 0 0 0 0 0 0 0 2 0 Penis 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 1 0 0 0 URINARY SYSTEM 62 (13.4%) 40 22 56 6 58 4 16 16 4 5 3 0 12 0 Urinary Bladder 39 (8.4%) 28 11 35 4 37 2 15 7 3 1 2 0 7 0 Kidney & Renal Pelvis 23 (5.0%) 12 11 21 2 21 2 1 9 1 4 1 0 5 0 EYE & ORBIT 1 (0.2%) 0 1 0 1 0 1 0 0 0 0 0 0 0 0 Eye & Orbit 1 (0.2%) 0 1 0 1 0 1 0 0 0 0 0 0 0 0 BRAIN & OTHER NERVOUS SYSTEM 4 (0.9%) 1 3 3 1 4 0 0 0 0 0 0 3 0 0 Brain 1 (0.2%) 1 0 0 1 1 0 0 0 0 0 0 0 0 0 Cranial Nerves Other Nervous System 3 (0.6%) 0 3 3 0 3 0 0 0 0 0 0 3 0 0 ENDOCRINE SYSTEM 11 (2.4%) 4 7 10 1 11 0 0 4 0 2 0 0 4 0 Thyroid 11 (2.4%) 4 7 10 1 11 0 0 4 0 2 0 0 4 0 LYMPHOMA 17 (3.7%) 12 5 12 5 16 1 0 0 2 3 6 0 1 0 Hodgkin Lymphoma 2 (0.4%) 1 1 2 0 2 0 0 0 1 0 1 0 0 0 Non-Hodgkin Lymphoma 15 (3.2%) 11 4 10 5 14 1 0 0 1 3 5 0 1 0 NHL - Nodal 13 10 3 8 5 13 0 0 0 1 2 4 0 1 0 NHL - Extranodal 2 1 1 2 0 1 1 0 0 0 1 1 0 0 0 MYELOMA 8 (1.7%) 3 5 5 3 7 1 0 0 0 0 0 5 0 0 Myeloma 8 (1.7%) 3 5 5 3 7 1 0 0 0 0 0 5 0 0 LEUKEMIA 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 0 1 0 0 Lymphocytic Leukemia 1 (0.2%) 1 0 1 0 1 0 0 0 0 0 0 1 0 0 MESOTHELIOMA 3 (0.6%) 2 1 1 2 2 1 0 1 0 0 0 0 0 0 Mesothelioma 3 (0.6%) 2 1 1 2 2 1 0 1 0 0 0 0 0 0 KAPOSI SARCOMA 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 0 1 0 0 Kaposi Sarcoma 1 (0.2%) 1 0 1 0 0 1 0 0 0 0 0 1 0 0 MISCELLANEOUS 15 (3.2%) 8 7 14 1 9 6 0 0 0 0 0 14 0 0 Miscellaneous 15 (3.2%) 8 7 14 1 9 6 0 0 0 0 0 14 0 0

Total 463 218 245 399 64 418 45 49 122 51 40 56 25 56 0


2013


Glossary of Terms

ANALYTIC CASES: Cases first diagnosed and/or received all or part of their first course of therapy at Sentara Northern Virginia Medical Center since 1991.

FIRST COURSE OF TREATMENT: Tumor-directed therapy planned and administered by the physician, which may include multiple modalities of therapy and encompass intervals of a year or more.

NON-ANALYTIC: Cases not seen at Sentara Northern Virginia Medical Center for first course of therapy since 1991 following diagnosis; cases diagnosed and treated elsewhere; cases discovered at autopsy; and benign brain, recurrence and other cases required to be reported to the Virginia Cancer Registry.

TNM STAGE: American Joint Committee on Cancer Staging System (AJCC), Sixth Edition.

T - Size and extent of tumor.

N - Involvement of regional lymph nodes.

M - Distant metastasis.

CLASS OF CASE: Class assigned to analytic cases to indicate where diagnosis and treatment took place.

Class 0: Diagnosed at Sentara Northern Virginia Medical Center since 1991 and all of first course of therapy elsewhere.

Class 1: Diagnosed at Sentara Northern Virginia Medical Center and all or part of first course of therapy at SPH and staff physicians’ offices.

Class 2: Diagnosed elsewhere and all or part of first course of therapy at Sentara Northern Virginia Medical Center and staff physicians’ offices.

References

AJCC Cancer Staging Manual, American Joint Committee on Cancer, sixth edition

Cancer Facts and Figures, 2010 American Cancer Society, Inc., Atlanta, Georgia

Commission on Cancer Program Standards 2004

National Cancer Data Base - 1998, 2000, Commission on Cancer Benchmark Summary of Cancer Care and Survival United States National Cancer Data Base Benchmark Reports, Breast Cancer Statistics, www.web.facs.org/ncdbbmr

Acknowledgements The Cancer Committee would like to recognize the following physicians for their participation in cancer prevention screenings and educational programs during 2013:

Kathleen Cleland, M.D.Negar Golesorkhi, M.D.Richard J. Hwang, M.D.Raman Kumar, M.D.Steven Nakao, M.D.Carol Shapiro, M.D.Rebecca Zuurbier, M.D.

A special thanks to all the nurses and ancillary personnel who gave generously of their time to help with the cancer screening programs and to the American Cancer Society for their patient education materials.


Looking Ahead

Future-focused

While this report shares 2012 – 2013 data, our focus is already far into the future. As a transformation of care happens throughout all of health care, Sentara Northern Virginia Medical Center will be at the leading edge of cancer care, delivering the right care at the right place and time. We will build upon the skills, technology and experience that have formed the network to find more ways to customize treatment for individuals, to be accessible to our at-risk populations, to translate more clinical research into our care and to continue the mission of improving health every day.

A relentless pursuit of

better, faster, more

effective cancer treatment

inspires us to do more,

to make a difference for

our patients today and

to improve the future of

cancer care.

Sentara Northern Virginia Medical Center

2300 Opitz BoulevardWoodbridge, Virginia 22191

703-523-1000www.sentara.com

CANC-314-05-15-JMB

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