Cancer Annual Report 2012

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St. Anthony’s Memorial Hospital, in conjunction with Crossroads Cancer Center, continues to provide the highest quality of care to our patients with cancer. Several exciting developments deserve notice.

We are grateful to have developed a strong relationship with the Cancer Care Specialists of Central Illinois at the Crossroads Cancer Center, where exceptional medical and radiation oncology services are provided to patients of this region. Dr. Philip Dy, as the Cancer Liaison Physician for St. Anthony’s, offers important direction to the hospital’s oncology program, and has been awarded a Platinum Certificate of Excellence from the National Cancer Institute for exceptional achievement in patient enrollment in national clinical trials. Dr. Hanna Saba received the Gold Certificate of Excellence from the same organization. Dr. Philip Dy, Dr. Hanna Saba, Dr. Irene Dy, Dr. Michael Bruin, Dr. James Wade and the other physicians at the Cancer Care Specialists of Central Illinois were recently recognized for being the top accruing member of the Cancer Control Clinical Trials. This means that our cancer patients can participate in 75-100 of the most current clinical trials in the nation; and in collaboration with MD Anderson, University of Chicago, and other prestigious cancer research centers, have access to leading national research programs right here in Effingham, without having to drive hundreds of miles to participate.

We have been pleased to welcome Dr. Bassam Maalouf as a medical oncologist/hematologist at Crossroads

Cancer Center. Dr. Maalouf said “I am excited to relocate to Illinois. I am already enjoying getting to know my colleagues and am looking forward to working with patients and families in this area. I believe in providing compassionate care and treating patients like family, and I will always be ready to run the extra mile for my patients.”

The members of the Medical Staff at St. Anthony’s Memorial Hospital continue to offer superb medical, diagnostic, and surgical care to the oncology patients in this region. The Medical Staff have brought a wealth of expertise and perspective to a variety of the hospital’s programs, committees, and cancer-related activities. As just one example, Dr. Ruben Boyajian recently achieved membership in the prestigious American Society of Surgical Oncology and American Society of Clinical Oncology.

Under the medical direction of Dr. Philip Dy and Dr. Irene Dy, a new Hospice program for patients and families facing life-threatening illnesses has been organized. Hospice provides a comprehensive program of care for terminal illnesses and end-of-life issues. This life-affirming program neither hastens nor postpones death, but emphasizes palliative help while realizing that death is a natural part of life. Shawna O’Dell is the nursing manager who will help organize the program’s high-quality medical care, sophisticated symptom relief, and personalized services to patients and caregivers. Patients and their families are included in the care plans; and emotional, spiritual and practical support are given based on the patient’s wishes and family’s needs.

A new Nurse Navigator, Ashley Davis, has joined the Women’s Wellness Center, which itself has now achieved Joint Commission Accreditation for mastectomy products available in their Boutique. Thousands of people have benefitted from the Women’s Wellness

Center this year. Services include full-field Digital Mammography (the most technologically advanced and accurate form of mammography available in this region), minimally invasive stereotactic breast biopsies, Dexa scans for bone density testing, a Boutique which features prosthetics for breast cancer patients along with bras and free fittings for all women of the region. The fittings are performed by certified mastectomy fitters. Educational programs are available for local organizations and clubs of our community.

During the past year, the Community Relations department hosted many community programs, including cancer awareness education at the Effingham County Fair and area health fairs, Caregivers’ Symposium (providing help to caregivers as they care for their loved ones), Cancer Survivor’s Day (organized by Crossroads Cancer Center), and Women’s Wellness Event. Educational articles were provided to the community. Dr. George Saliba volunteered his time to provide prostate cancer screenings. A hugely successful “Real Men Wear Pink” including the “St. Anthony High School Pink-Out Game,” and Effingham High School’s “Playing tonight for a cure tomorrow” game was done to promote breast cancer awareness and encourage women to have annual mammograms.

St. Anthony’s Memorial Hospital Center for Advanced Imaging continues to offer excellent service, with a 64-slice CT Scanner, 16-channel MRI Unit, and Nuclear Medicine Suite. Two new Toshiba ultrasound machines are now also available, providing increased resolution and the ability to assist the interventional radiologist in obtaining tumor biopsies.

We have been very fortunate to have such a capable medical and nursing staff, with excellent radiological diagnostic care, exceptional surgical services, and outstanding medical and radiation oncology providers. In addition, our certified tumor registrar, Jill Navarro,

Cancer Committee Chairperson Reportby Dr. Steven Jones, Committee Chair 2012

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Cancer Committee Chairperson Reportby Dr. Steven Jones, Committee Chair 2012

Coordinators

Cancer Conference Steven Jones, MD, Pathology

Quality Control/Cancer Registry Jill Navarro, CTR

Quality Improvement Mary Finley, RN

Community Outreach Marilyn Boone

Psychosocial Services Janet Strange, LCSW

Clinical Research Kimberly Siemer, RN, CRA

Palliative Care Shawna, O’Dell, RN

Cancer Committee Members2012

Steven Jones, MD Pathology Chairperson

Phillip Dy, MD Medical Oncology, Cancer Liaison Physician

Omer Aker, MD Radiology

Marilyn Boone Women’s Wellness Manager

Ruben Boyajian, MD General Surgery

Michael Bruin, MD Radiation Oncology

Mary Finley, RN Director of Medical Staff & Quality Services

Carol Gapsis, RN Pastoral Care Manager

Denise Hahn, RN Physical Rehabilitation Manager

Lisa Hoelscher Community Relations

Ashley Davis, RN Nurse Navigator

Angela Kelly, RN Surgical Services Manager

Jill Navarro, CTR Cancer Registrar

Shawna, O’Dell Acute Care Manager

Teri Phillips, RHIA Health Information Manager

Annette Schnabel, DPT Executive Director of Strategy and Administration

Kelly Sager, RN Chief Nursing Officer

Kim Siemer, RN Clinical Research Specialist

Donna Smith, RN ONS Medical Care

Kristi Smith, RN Clinical Educator

Janet Strange, RN Social Services

Lawrence Underwood American Cancer Society

has worked closely with the Medical Staff to provide quality data about our cancer patients and has administered many aspects of our cancer program. Her contributions have been invaluable.

In 2012, the Commission of Cancer gave St. Anthony’s Memorial Hospital and Crossroads Cancer Center an Outstanding Achievement Award for our collaborative cancer care program. This is a very prestigious award that places our Cancer Program in the top 5% of the accredited programs in the United States.

We wish to thank all of the individuals who strived so diligently this year, as always, to provide outstanding and compassionate care to our patients.

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Cancer Registry Report Jill Navarro, Cancer Registrar

The Cancer Registry at St. Anthony’s Memorial Hospital is charged with collecting data about every cancer case diagnosed or treated at our hospital. The cancer registrar’s job is to report information to state and national databases, as well as our own Cancer Committee, about what types of cancer we are seeing, how we are treating them, and how patients are doing afterwards.

In 2012, St. Anthony’s Memorial Hospital entered 324 new cancer patients into the database (156 males and 168 females). The best data comes from the 309 patients who were diagnosed or treated at St. Anthony’s Memorial Hospital. Breast cancer was our top primary site for 2012 (for three years running), followed by prostate cancer, then lung cancer. Sixty new breast cancer patients were diagnosed in 2012 and fifty new prostate cancers.

One very important aspect of the cancer registry is annual followup of every living patient in our database. Physicians whose patients are seen or treated at St. Anthony’s Memorial Hospital will receive letters annually asking for information about that patient. If none of their physicians have seen them in a year or longer, then the patient will get a letter from the hospital asking about how they are doing.

Why is this followup information important? This is how we calculate survival rates for our patients. We can even calculate disease-free survival rates or see how many patients stayed disease-free and for how long. Because we are a Commission on Cancer-approved facility, we are able to compare our survival rates to other hospitals, to Illinois survival rates, or to National survival rates. This helps us to see how well our patients are doing after they leave our facility.

Source: Illinois Behavorial Risk Factor Surveillance System survey data, 2006-2010

Top Five Primary Sites of Effingham County

Prostate .......................................... 162

Breast ............................................... 168

Lung ..................................................157

Colorectal ......................................106

Bladder ..............................................54

Source: Illinois Department of Public Health, 2004-2008

2012 Data from the Illinois Behavioral Risk Factor Surveillance System

64% of Illinois adults (50+) had colonoscopy/sigmoidoscopy for screening.

35.4% of Illinois adults are overweight.

18.6% of Illinois adults currently smoke.

Interesting Statistics - Effingham County

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2012 Annual Report Site Table

Non Stage Stage Stage Stage Stage Stage UnstgPrimary Site Cases Analytic Analytic M F 0 1 2 3 4 88 Unk

Oral Cavity & Pharynx 2 2 0 1 1 0 1 0 0 1 0 0 Tonsil 2 2 0 1 1 0 1 0 0 1 0 0

Digestive System 55 54 1 27 28 0 9 14 15 12 2 2 Esophagus 1 1 0 1 0 0 0 0 0 1 0 0 Stomach 6 6 0 6 0 0 0 2 0 3 0 1 Small Intestine 1 1 0 1 0 0 0 0 0 1 0 0 Colon Excluding Rectum 32 31 1 12 20 0 7 8 11 4 0 1 Rectum & Rectosigmoid 6 6 0 4 2 0 1 2 2 1 0 0 Anus, Anal Canal & Anorectum 1 1 0 0 1 0 0 1 0 0 0 0 Liver & Intrahepatic Bile Duct 1 1 0 1 0 0 0 0 1 0 0 0 Gallbladder 2 2 0 0 2 0 0 0 1 1 0 0 Other Biliary 1 1 0 1 0 0 0 0 0 0 1 0 Pancreas 3 3 0 1 2 0 1 1 0 1 0 0 Other Digestive Organs 1 1 0 0 1 0 0 0 0 0 1 0

Respiratory System 50 47 3 26 24 0 11 5 6 24 0 1 Nose, Nasal Cavity & Middle Ear 1 1 0 0 1 0 0 0 0 1 0 0 Larynx 1 1 0 0 1 0 0 0 1 0 0 0 Lung & Bronchus 48 45 3 26 22 0 11 5 5 23 0 1

Soft Tissue 2 2 0 0 2 0 0 1 0 1 0 0

Skin Excluding Basal & Squamous (Melonoma) 13 13 0 5 8 2 8 2 0 0 0 1 Malanoma - Skin 12 12 0 5 7 2 8 2 0 0 0 0 Other Non-Epithelial Skin 1 1 0 0 1 0 0 0 0 0 0 1

Breast 60 60 0 0 60 10 23 17 2 3 2 3

Female Genital System 16 7 9 0 16 0 1 1 2 3 0 0 Cervix Uteri 1 1 0 0 1 0 0 1 0 0 0 0 Corpus & Uterus (NOS) 9 1 8 0 9 0 1 0 0 0 0 0 Ovary 4 4 0 0 4 0 0 0 2 2 0 0 Vulva 2 1 1 0 2 0 0 0 0 1 0 0

Male Genital System 51 50 1 51 0 0 8 35 3 3 0 1 Prostate 50 49 1 50 0 0 8 35 2 3 0 1 Testis 1 1 0 1 0 0 0 0 1 0 0 0

Urinary System 29 29 0 22 7 9 11 3 2 4 0 0 Urinary Bladder 22 22 0 19 3 9 8 3 1 1 0 0 Kidney & Renal Pelvis 5 5 0 2 3 0 3 0 0 2 0 0 Ureter 2 2 0 1 1 0 0 0 1 1 0 0Brain & Other Nervous System (Cranial Nerves) 8 8 0 2 6 0 0 0 0 0 8 0 Brain 1 1 0 1 0 0 0 0 0 0 1 0 Cranial Nerves Other Nervous System 7 7 0 1 6 0 0 0 0 0 7 0

Endocrine System 7 7 0 2 5 0 4 0 0 0 2 1 Thyroid 5 5 0 1 4 0 4 0 0 0 0 1 Other Endocrine including Thymus 2 2 0 1 1 0 0 0 0 0 2 0

Lymphoma 12 11 1 7 5 0 0 3 6 2 0 0 Hodgkin Lymphoma 2 1 1 1 1 0 0 1 0 0 0 0 Non-Hodgkin Lymphoma 10 10 0 6 4 0 0 2 6 2 0 0

Myeloma 5 5 0 4 1 0 0 0 0 0 5 0

Leukemia 3 3 0 0 3 0 0 0 0 0 3 0 Lymphocytic Leukemia 2 2 0 0 2 0 0 0 0 0 2 0 Myeloid & Monocytic Leukemia 1 1 0 0 1 0 0 0 0 0 1 0

Mesothelioma 2 2 0 2 0 0 0 0 0 1 1 0

Miscellaneous 9 9 0 7 2 0 0 0 0 0 9 0

TOTAL 324 309 15 156 168 21 76 81 36 54 32 9

Class of Case Sex AJCC Stage at DX (Analytic Cases Only)

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County of Residence at Diagnosis(Analytic Cases Only 2012 cases/SAMH)

COUNTY: #CASES:

Effingham 146Fayette 35 Jasper 34Clay 26Shelby 17Cumberland 16Marion 11Richland 11Wayne 5Bond 4Crawford 3Coles 3Montgomery 2 Clark 1Edwards 1Christian 1Madison 1Sangamon 1Clinton 1

2012 CANCER INCIDENCE BY SITE & SEXAnalytic Cases

MALE St. Anthony’s National Memorial Hospital

Prostate 28% 32%Lung & Bronchus 14% 17%Urinary Bladder 6% 12% Colorectal 9% 10%Non-Hodgkin Lymphoma 4% 4% Stomach 1% 4%Melanoma of Skin 5% 3% Myeloma 1% 3% Kidney & Renal Pelvis 5% 1% Brain & CNS 1% 1%

FEMALE St. Anthony’s National Memorial Hospital Breast 29% 36%Lung & Bronchus 14% 13%Colorectal 9% 13%Uterine corpus 6% 5%Melanoma of Skin 4% 4%Brain & CNS 1% 4%Thyroid 6% 2%Non-Hodgkin Lymphoma 4% 2%Ovary 3% 2%Bladder 2% 2%

REFERENCE NOTE: National figures are estimates and exclude basal and squamous cell skin cancers and in situ carcinomas except for the urinary bladder. The predicted National incidence figures were taken from the “Cancer Statistics 2012”, published by the American Cancer Society. St. Anthony’s Memorial Hospital figures represent analytic cases only (diagnosed and/or received at least part of their first course of therapy at our facility) during 2012.

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Top 5 Primary Sitesat SAMH

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2012 CANCER INCIDENCE BY SITE & SEXAnalytic Cases

2012 STATISTICS (ALL SITES)/SAMHAnalytic Cases Only

STAGE AT DIAGNOSIS

STAGE Male Female TOTAL

Stage 0 9 12 21

Stage 1 31 53 84

Stage 2 49 34 83

Stage 3 14 23 37

Stage 4 32 22 54

88 16 16 32

99 5 8 13_____________________________________TOTAL 156 168 324

AGE AT DIAGNOSIS

Number of % ofAGE: Cancer Patients TOTAL

0-29 6 1.79%

30-39 6 1.79%

40-49 21 6.25%

50-59 51 15.18%

60-69 90 26.79%

70-79 88 26.19%

80-89 51 15.18%

90+ 11 3.27%____________________TOTAL 324

Youngest 10 months

Oldest 95

60-69 26.79%

70-79 26.19%

80-89 15.18%

50-59 15.18%

90+ 3.27%

40-49 6.25%

0-29 1.79% 30-39

1.79%

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St. Anthony’s

Illinois

CoC Programs

Every year, our cancer registry submits data to the National Cancer Database (NCDB). This data is then analyzed for national statistics, which can then be used for a variety of reports and publications, as well as treatment guidelines and survival statistics. St. Anthony’s Memorial Hospital actively participates in this type of data collection and has recently received very favorable reports on compliance with national treatment guidelines. The Commission on Cancer (CoC) encourages the use of these reports to monitor the quality of data being reported and to monitor the use of national treatment guidelines. Due to the dedication of the Medical Staff and the Cancer Committee, SAMH with Crossroads Cancer Center has 100% compliance with all five of the applicable quality treatment guidelines. This is a much higher, and more favorable, quality score than the State and National scores.

This graph shows how St. Anthony’s Memorial Hospital compares with all State and National CoC-approved cancer programs for each of the measured quality performance rates.

BCS/RT MAC HT ACT 12RLN

BREAST COLON

NATIONAL TREATMENT GUIDELINES:

BCS/RT: Radiation therapy is administered within one year of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer.

MAC:C ombination chemotherapy is considered or administered within four months of diagnosis for women under age 70 with AJCC T1cN0M0, or Stage II or III, ERA and PRA negative breast cancer.

HT: Tamoxifen or third generation aromatase inhibitor is considered or administered within one year of diagnosis for women with AJCC T1cN0M0, or Stage II or III ERA and/or PRA positive breast cancer.

ACT: Adjuvant chemotherapy is considered or administered within four months of diagnosis for patients under the age of 80 with AJCC Stage III colon cancer.

12RLN: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer.

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Figure 1

Cancer Program Practice Profile Reports (CP3R) Best Practice Quality Guidelines for Breast and Colon Cancers

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Primary Site – Colon CancerDr. Ruben Boyajian / Dr. Steven Jones

Figure 2

Colon cancer is the second leading cause of cancer death in both men and women in the United States.

It is estimated by the American Cancer Society (ACS) that 103,170 new cases of colon cancer were diagnosed in

2012. The good news is that colon cancer deaths have been decreasing during the last decade, in large part due to increased

colon cancer screening.

Colon cancer develops slowly over time and usually starts as a noncancerous polyp in the lining of the colon, which is why screening for colon cancer is so important for our community. Screening tests include colonoscopies and fecal occult blood testing. Colonoscopies identify polyps within the colon so that they can be removed before cancer cells have time to develop. According to the Centers for Disease Control and Prevention (CDC), the vast majority of colon cancers are totally preventable, through appropriate screening. Once colon cancer develops, it can be effectively treated with surgery alone when detected in its earliest stages. Additional new targeted chemotherapies are also available for some tumors. According to the ACS, 74% of patients diagnosed with colon cancer at its earliest stage will survive for at least five years after diagnosis.

Some of the main risk factors for colon cancer are diets high in red meat and fried foods, lack of exercise and obesity, smoking, alcohol consumption, and diabetes. Another important risk factor is age, which is why screening colonoscopies are highly recommended for men and women over the age of 50. Genetic factors are also important, and individuals with a family history of colon cancer should talk to their physicians about having screening tests sooner and at more regular intervals.

In 2012, the Cancer Committee did a quality study to determine if St. Anthony’s Memorial Hospital (SAMH) patients with colon cancer were receiving adequate treatment. A total of eight stage 3 colon cancers were diagnosed or treated at SAMH in 2012. Each case was compared against current NCCN guidelines, according to stage at diagnosis, and discussed at the quarterly cancer committee meetings. The study showed that all colon cancer patients diagnosed or treated at SAMH did indeed receive the treatment appropriate to their particular case and stage at diagnosis. Once completing their surgery or diagnosis at SAMH, all patients

were referred to an appropriate physician for followup or further treatment.

With regard to the overall performance of St. Anthony’s Cancer Program, the National Cancer Data Base has compiled information on Best Practice Quality Guidelines for Cancer Care (CP3R). St. Anthony’s Memorial Hospital (SAMH) scored 100% in every applicable quality measure for cancer treatment, which is a much better score than State and National scores, and places St. Anthony’s Memorial Hospital in the top 5% of the nation for these scores (see Figure 1).

The Cancer Committee compared SAMH to other hospitals regarding the stage at which colon cancer cases are being detected, using data from the NCDB Hospital Benchmark Reports (Figure 2).

The data showed that 50% of the cases at SAMH were diagnosed at an early stage (at stage 2 or below). This is nearly identical to the state and national averages.

The Cancer Committee also examined the five-year colon cancer survival rates for patients at SAMH as calculated by the National Cancer Database (Figure 3), and compared the survival rates to those of patients in Illinois and across the nation. The figure shows that 98% of SAMH patients with “early” colon cancer survived

Cancer Program Practice Profile Reports (CP3R) Best Practice Quality Guidelines for Breast and Colon Cancers

Stage at Diagnosis - Colon Cancer Patients

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Stage 0 1 2 3 4 Unk

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Observed survival rates (death may be due to causes other than patient’s cancer, such as age and/or co-morbidities.)

National Cancer Database Report 5-year observed survival rates are quoted per latest available data (1/13); Filters for observed survival of colon cancer from 1318 national programs and 73 state programs.

Commission on Cancer, American College of Surgeons, NCDB Reports, Chicago, Il, 2012. The contents reproduced from the applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based on the original Text, Tables, or Figures.

Figure 3

their colon cancer for at least five years. When all cases of death are included (motor vehicle accidents, heart attacks, and so forth), the five-year survival rate for SAMH patients is very similar to national averages, given the small number of cases involved.

The Cancer Committee’s colon cancer studies have shown that St. Anthony’s Memorial Hospital Cancer Program continues to offer NCCN-based quality treatments to all colon cancer patients. In particular, our hospital scored in the top 5% of the nation on the National Cancer Data Base Best Practice Quality Guidelines for Colon Cancer (CP3R).

In conclusion, St. Anthony’s is always striving to diagnose cancer at the earliest possible stages. As such, our Cancer Program will continue to emphasize the importance of appropriate colon cancer screening, to offer quality fecal occult blood testing and biopsy options, to make available state-of-the-art surgical care, and to collaborate with Crossroads Cancer Center to provide the best quality medical and radiation oncological treatments.

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St. Anthony’s

Illinois

NCDB

5 Year Survival Rate - Colon Cancer Patients (All Causes of Death)

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503 North Maple StreetEffingham, Illinois 62401

217-342-2121www.stanthonyshospital.org