Oncology Services 2010

OncologyServices

a t K D M C

a n n u a l r e p o r t

Terry Kidd says he owes his life to a piece of rusty metal. It was a minor cut he received while mowing grass in September 2009 that led him to KDMC’s Cedar Knoll Family Care Center for a tetanus shot. During his appointment, a physician assistant asked the 59-year-old if he’d ever had a screening colonoscopy. He was fit, very active with no health concerns, but well past the recommended screening age of 50. He made an appoint-ment with gastroenterologist Arthur Gaing, M.D. – a physician specializing in digestive issues –soon after.

After the screening, Dr. Gaing delivered very unexpected news. “Dr. Gaing told me I had colon cancer,” he said. “I was stunned.” That was on a Monday. Immediately, Kidd and Dr. Gaing made an appointment with surgeon William Dunlop, M.D. Four days later, Kidd underwent a minimally invasive operation in which Dr. Dunlop removed three inches of his colon.

“Dr. Dunlop gave me very good news after the surgery. The cancer had not spread past the intestinal walls, and I was cured.”

With no family history for the disease, Kidd still says he was astounded to have had cancer with no symptoms. “Since my

experience, every member of my family over age 50 has had a screening colonoscopy. All of them thankfully with no more unexpected results like mine.”

Digestive health nurse navigator Eva Joseph counseled Kidd after his operation, helping educate him about the disease and how to stay vigilant with screenings. She says that’s one of her biggest roles as a nurse navigator—helping patients with their next steps during and after treatment. Cancer can strike anyone at any age, and the best defense against it is following guidelines for screenings.

With no family history for the disease, Kidd still says he was astounded to have had cancer with no symptoms.

Screeningssave lives.can

Digestive health nurse navigator Eva Joseph and gastroenterologist Arthur Gaing, M.D.

On the cover (clockwise from front): Breast cancer survivor Robin Vanhorn; breast health nurse navigator Debbie Alexander; radiologist Robert Penkava, M.D.; radiation oncologist Jeffrey Lopez, M.D.; and general surgeon Mary Legenza, M.D.

2 | KING’S DAUGHTERS MEDICAL CENTER

“One of the best things patients can do is take a proactive approach to their health. Getting screenings is a great way to do that.”

- David Goebel, M.D.Oncologist/hematologist

Mary Legenza, M.D., removed the cancerous tissue, which was followed by 28 radiation treatments with radiation oncologist Jeffrey Lopez, M.D.

Today, she is cancer-free while staying vigilant against a possible return. From beginning to end, Vanhorn said she received exceptional care.

“After this experience I am so surprised when I hear a woman say ‘I just get a mamogram when I think I need one’ or ‘I get a mammogram every couple of years or so’ or ‘I don’t get those.’ In my opinion, this is playing with fire. Every woman should take a few minutes to educate themselves about the different stages of breast cancer and the treatments for each stage, and they will see that early detection is the key!”

Robin Vanhorn says her breast cancer story is a success, thanks to early detection. “I’ve always been diligent about having mammograms,” she says. “I previously had calcifications and two biopsies and I thought, ‘This is the way it’s going to be for me.’ Never in my mind did I think I would have anything cancerous. Both of my biopsies had been benign. I had gotten into a comfort zone that I wouldn’t have breast cancer.”

In November 2009, Vanhorn’s comfort zone was gone when her yearly mammogram and a follow-up biopsy showed her the results she never thought she would see. Radiologist Robert Penkava, M.D., showed her where the calcifications had grown.” Even though I knew the possiblity of cancer was there, I was in total shock. During the next few days I experienced many emotions – shock, fear, anger and then happiness – my cancer had been discovered at its earliest stage,” Vanhorn said.

KDMC breast health nurse navigator Debbie Alexander contacted Vanhorn soon after, to offer support and explain the game plan for treatment. Two weeks later, general surgeon

Cancer Liaison

Stayingcan detect

breast cancer

Get a mammogram every year after 40.

early. vigilant

2010 ONCOLOGY SERVICES ANNUAL REPORT | 3

Breast cancer survivor Robin Vanhorn and breast health nurse navigator Debbie Alexander

The cancer liaison program is a network of physician volunteers who help coordinate and manage cancer-related activities in local hospitals and surrounding communities. All hospitals that have an approved cancer program must have a cancer liaison physician for accreditation. The Commission on Cancer uses cancer liaisons to assist in providing leadership and direction to hospital and statewide cancer programs.

Since 1996, Mary Legenza, M.D., has served as King’s Daughters’ cancer liaison. She collaborates with our Cancer Committee to ensure quality cancer care is given and accurate cancer data are submitted to the National Cancer Data Bank. She also promotes participation in clinical trials and works to improve the health of our community.

Dr. Legenza regularly attends Kentucky’s Physicians’ Task Force to share ideas and work toward improving

cancer care throughout Kentucky and the nation. As state chairman of Kentucky Cancer Liaisons, she

is responsible for communicating information throughout the state from the Commission on Cancer—information such as staging changes and changes in requirements for accreditation. Also, she serves as chairperson of the biannual state meeting and represents Kentucky at annual national meetings.

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I Can Cope Everyone needs help when facing cancer – whether personally, or as a friend, family member or caregiver. These monthly groups can equip patients with the knowledge and tools to live life while fighting cancer.

Breast Cancer Support GroupFor women battling breast cancer, as well as their family and friends. Share support, encouragement and hear from a variety of guest speakers. This group meets quarterly.

Look Good, Feel Better A monthly support group that teaches beauty techniques to cancer patients to help them combat the appearance-related side effects of cancer treatment.

Quitting tobacco for good Our tobacco cessation program can be your best opportunity to leave tobacco addiction behind for good. Weekly classes offer support, tips on sticking with the plan and medical supervision with an oncologist. Classes are available at two different times weekly, and you can join at any time.

To find out more about our support groups, call us at 1.888.377.KDMC.

“Our patient care rounds have really changed the way we deliver care,” says Oncology Specialty Unit nurse manager Kim Dillon. On the 25-bed unit, nurses, case managers and social workers perform care rounds each morning to plan patients’ care – with their involvement. “When you include the patient and family in planning their care for the day, it really has an impact on their recovery.”

The daily visits cover upcoming tests and procedures, lab results, pain control and what’s working best for each patient. The teams also emphasize diet and exercise whenever possible for each patient.

“Our goal is to proactively take care of a patient’s needs before they happen,” Dillon says. “If we can inspire communication between all the caregivers, and the patient and family, that makes for a better, more healing environment for everyone.”

Support Groups in the hospital

Teamwork

Daily team rounds help involve patients in their

care. From left: case manager Andrea Lewis;

social worker April Broun; nurses Linda

Conley, Mallory Brown and Tammy Doyle.


The Center for Pulmonary Health specializes in testing, treatment and education for patients receiving follow-up care for lung nodules, those with pulmonary hyper-tension and those needing pulmonary function testing.

Like other conditions, lung diseases can be better managed when caught in the early stages. Every chest X-ray or chest CT performed at King’s Daughters is reviewed by a cross-sectional committee. Abnormal results (where spots or lung nodules are found) are referred to the lung health nurse navigator for follow up. A nurse practitioner is at the center full-time to assess patients and, together with a pulmonologist, treat each patient.

While most lung nodules are benign, the American Cancer Society recommends patients be seen within three months of finding the abnormality, and regularly for a two-year period afterward.

“The Center for Pulmonary Health provides a fast diagnosis and treatment plan when a nodule is discovered,” said Mary Adams, the KDMC lung health nurse navigator. “If a nodule is growing and is cancerous, it can be treated immediately in the earliest stages when outcomes are best. If it’s benign, the patient is informed and spared needless worry.”

To contact the center, call 606.408.4414.

Center forAdvocates & educatorsOur nurse navigators help patients choose their treatment and supportOne of the most unique and effective parts of our oncology program is absolutely free. A team of nurse navigators specialize in guiding patients through the many physician appointments, tests, treatments and options available to them. Need information on a new procedure? Want to find a support group that’s right for you? Our navigators can help.

Three nurse navigators specialize in helping patients with the most frequently diagnosed cancers at King’s Daughters. Palliative carePalliative care focuses on improving the quality of life for patients and families facing a life-threatening illness. A team of nurses, social workers, pastoral care staff and physicians can provide support through pain management, spiritual and emotional support, and more. Oncology navigators• Breast health – Debbie Alexander, R.N. 606.408.4067 | [email protected] • Lung health – Mary Adams, R.N. 606.408.6110 | [email protected] • Digestive health (stomach and bowels) – Eva Joseph, R.N. 606.408.3741 | [email protected]

Palliative care coordinator• Crystal Vance, R.N. 606.408.3863 | [email protected]

Center for Pulmonary Health nurse practitioner Anna Bayes

PulmonaryHealth


Lung cancer accounts for the most cancer-related deaths in both men and women in the United States For 2010, 157,300 deaths were estimated to occur. Kentucky has the highest death rate, ranking 25 to 30 percent greater than the rest of the country.

Kentucky also has the second highest prevalence rate for adult cigarette smokers at 25.2 percent, ranking at 49th among the states, second only to West Virginia. Kentucky’s mortality rate of adult cigarette smokers ranks highest, among all states in the nation. Because there is high tobacco use, Kentucky will continue to see higher incidence of lung cancer (as seen in Table B).

At KDMC, 25 percent of lung cancer cases were diagnosed at stage 1, which is slightly higher than both the state and national statistics. For cases staged as 2 and 3, KDMC is comparable to both state and national data. Stage 4 cases are comparable to state, but slightly higher than national statistics, which is reflective of the excessive tobacco use in our state.

The one-year survival rate for lung cancer has increased during the past 30 years to 50 percent nationally, with KDMC at 46 percent. This is largely due to improved surgical techniques and combined therapies. However, the overall five-year survival rate at KDMC is comparable to the state and national rate at 16 percent (as seen in Table C).

Unfortunately, there is no generally accepted screening test for lung cancer at this time, which contributes to the high rate of patients presenting with advanced stages of lung cancer at diagnosis. Several methods of detecting lung cancer are being

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Lung cancer critiqueAmerican Joint Commission on Lung (Non-Small

Cell & Small Cell) Cancer Stage at Diagnosis

Table B

Table A

Table C

Lung cancer is the most prevalent cancer diagnosed at KDMC and nationwide. Of our total cancer cases, 26 percent of men and 19 percent of women were diagnosed with lung cancer in 2009. An estimated 222,520 new cases of lung cancer were expected nationwide for 2010. Kentucky has the highest incidence of lung cancer in the nation.

1

2

3

4

Stag

e

0 10% 20% 30% 40% 50%

Percent of Patients

21%20%

25%

6%5%

4%

23%28%

25%

36%42%

44% 17%

16%

18%

19%

22%

23%

30%

31%

46%

50%1

2

3

4

5

Year

s

0 10 20 30 40 50

Percent Alive

1

2

3

4

Stag

e

0 10% 20% 30% 40% 50%

Percent of Patients

21%20%

25%

6%5%

4%

23%28%

25%

36%42%

44% 17%

16%

18%

19%

22%

23%

30%

31%

46%

50%1

2

3

4

5

Year

s0 10 20 30 40 50

Percent Alive

2001-2005 Lung Cancer (Non-Small Cell & Small Cell) Five Year Survival

KDMC*

KDMC*

Kentucky**

National**

National***

*KDMC 2009; **Data from KCR (State) 2009; ***National Survival Data - American College of Surgeons Survival NCBD 2007

*KDMC (2001-2005)** 2005 National Survival Data - American College of Surgeons Survival NCDB

Lung Cancer Treatments(Non-Small Cell and Small Cell)

Treatments KDMC* Ky.** National***

Surgery 22% 17% 16%

Surgery & chemo 2% 4% 4%

Radiation only 21% 12% 9%

Surgery & radiation 2% 1% N/A

Surgery, chemo & radiation

2% 3% 2%

Chemo 5% 15% 16%

Chemo & radiation 23% 23% 23%

No 1st course prescription

23% 24% 16%

Other specified therapy

N/A N/A 14%

*KDMC 2009; **Data from KCR (State) 2009, ***American College of Surgeons Survival NCBD 2007


tested as possible screening exams to see if lung cancer can be found earlier when tumors are at their smallest and most curable stage. However, none of these studies have proven effective overall for reducing late-stage disease at diagnosis.

In the early stages of this disease there are often no symptoms. But, as the cancer grows, common symptoms include persistent cough, shortness of breath, constant chest pain, bloody sputum, voice change, unplanned weight loss, and recurrent pneumonia or bronchitis.

Cigarette smoking is by far the most important risk factor for lung cancer. The risk increases with quantity and duration of cigarette consumption. Cigarette smoking is the primary cause of 90 percent of lung cancer in men and almost 80 percent in women. Other risk factors include exposure to secondhand smoke, radon, asbestos, certain metals (such as chromium and nickel), radiation and air pollution. A family history of lung cancer may pose a slight increased risk, especially in those who developed the disease at a young age.

You can reduce your risk of developing cancer in several ways. Don’t smoke, if you do – quit now. Avoid secondhand smoke; there is no risk-free level of secondhand smoke exposure. Have your home tested for radon and take corrective action if high levels are found. Follow health and safety guidelines in the workplace and avoid exposure to substances known to cause lung cancer.

Lung cancer is classified clinically as small cell or non-small cell for the purposes of treatment. Treatment options are determined by the type and stage of lung cancer and include surgery, radiation therapy, chemotherapy and targeted thera-pies. For localized cancers, surgery is usually the treatment of choice. Because the disease has usually spread by the time of diagnosis, both radiation therapy and chemotherapy are used either consecutively or as a combined therapy (as seen in Table A).

Our Thoracic Cancer Conference is comprised of dedicated specialty physicians and surgeons who meet weekly to review and develop a plan of care for lung cancer patients. The committee follows the recommendations of the National Comprehensive Cancer Network (NCCN) guidelines to ensure the best outcome for each patient. NCCN guidelines are

considered the “gold standard” nationwide for cancer treatment using the most current and effective medical evidence to support treatment recommendations. All services necessary to provide the special care and treatment needs of our lung cancer patients are provided here at KDMC.

Our lung cancer program is also supported by Lung Health Services and the Center for Pulmonary Health. Lung Health Services provides tobacco cessation educa-tion and support, lung nodule radiology review with follow-up, and a lung health navigator who provides assistance to newly diagnosed lung cancer patients. The Center for Pulmonary Health provides timely follow-up care, education and support for patients identified with lung nodules.

Jeffrey Lopez, Cancer Committee Chair

Boyd235 cases27.94%

Lawrence124 cases14.74%

Scioto51 cases6.06%

Lewis12 cases1.43%

Greenup110 cases13.08%

Carter87 cases10.34%

Lawrence63 cases7.49%

Elliott11 cases1.31%

Johnson42 cases4.99%

Floyd22 cases2.62%

Martin20 cases2.38%

Pike7 cases0.83%

Wayne7 cases0.83%

Rowan4 cases0.48%

2009 KDMC Cancer Cases by County at Diagnosis

Total Cases - 841

Counties not listed on map:Cabell County, W.Va. 9 cases, 1.07%

Magoffin County, Ky. 8 cases, 0.95%

Mingo County, W.Va. 5 cases, 0.59%

Morgan County, Ky. 5 cases, 0.59%

Jackson County, Ohio 4 cases, 0.48%

Other counties outside Ky. 3 cases, 0.36%

Unknown counties outside Ky. 2 cases, 0.24%

Counties with 1 case (0.12%): Adams (Ohio), Fairfield (Ohio), Gallia (Ohio), Hamilton (Ohio), Lorain (Ohio), Knott (Ky.), Logan (W.Va.), Mason (W.Va.), Mason (Ky.), Nicholas (W.Va.)

KDMC* Ky.* National**

MaleLung 26% 12% 15%

Prostate 16% 18% 25%

Colorectal 15% 12% 10%

Bladder 6% 6% 7%

Kidney 5% 5% 5%

FemaleBreast 33% 30% 27%

Lung 19% 16% 14%

Colorectal 10% 11% 10%

Thyroid 10% 4% 4%

Malignant melanoma 3% 3% 4%

2009 Local, State & National Cancer Cases by Type

*KDMC and Kentucky percentages from the Kentucky Cancer Registry (2009); **American Cancer Society Facts and Figures 2009 Estimates

Table D

Oncology/HematologyMary Edgecomb, D.O.David Goebel, M.D.Tri-State Hematology/ OncologyMedical Plaza A617 23rd St., Suite 19Ashland, KY 41101606.325.2221

Cristina Alencar, M.D.Vinay Vermani, M.D.Tri-State Cancer and Blood Specialists2301 Lexington Ave., Suite 135Ashland, KY 41101606.324.3333

Radiation OncologyTerry Justice, M.D.Jeffrey Lopez, M.D.Tri-State Regional Cancer Center706 23rd St. Ashland, KY 41101606.329.0060

Cardiothoracic SurgeryRobert Fried, M.D.Juan MacHannaford, M.D.Marcos Nores, M.D.Cardiothoracic Surgeons of KentuckyMedical Plaza B613 23rd St., Suite 210Ashland, KY 41101606.326.9847

Colorectal SurgeryMariano Faresi, M.D.King’s Daughters Medical Specialties - Colorectal Surgery336 29th Street, Suite 301Ashland, KY 41101606.329.1256

GastroenterologyCheryl Bascom, M.D.Michael Canty, M.D.Tri-State Digestive Disease AssociatesMedical Plaza A617 23rd St., Suite 11Ashland, KY 41101606.324.3188

Morris Beebe, M.D. Arthur Gaing, M.D.King’s Daughters Medical Specialties - Gastroenterology1200 Central Ave., Suite 3Ashland, KY 41101606.327.1760

Houssam E. Mardini, M.D.Medical Plaza B613 23rd St., Suite 120Ashland, KY 41101606.329.1049

Rajkumar Warrier, M.D.Ashland Gastroenterology1101 St. Christopher Dr., Suite 200Ashland, KY 41101606.836.9644

General SurgeryWilliam Dunlop, M.D.Medical Plaza B613 23rd St., Suite 310Ashland, KY 41101606.327.5628

Mary Legenza, M.D.Northeastern Kentucky SurgeonsMedical Plaza A617 23rd St., Suite 13Ashland, KY 41101606.325.1151

Eric Smith, D.O.Roderick Tompkins, M.D.Timothy Wheeler, M.D.Medical Plaza B613 23rd St., Suite 440Ashland, KY 41101606.329.2888

PathologyLinda Eskew, M.D.Shamsa Haroon, M.D.Malisha Johnson, D.O.Katalin Kovacs, M.D.Diane Marie Pierson, D.O.Valerie White, M.D.Professional Pathology2201 Lexington Ave.Ashland, KY 41101606.408.4603

Otolaryngology(Ear, Nose & Throat)Gregory Baker, M.D.Alfred M. Sassler, D.O.King’s Daughters Medical Specialties - OtolaryngologyMedical Plaza B613 23rd St., Suite 420Ashland, KY 41101606.326.0271606.324.2600

Jon A. Brinkman, D.O.William Van Beneden, D.O.2550 Carter Ave.Ashland, KY 41101606.325.8561

Charles Watson, M.D.2301 Lexington Ave., Suite 315Ashland, KY 41101606.324.1188

PulmonologyMohamad Abul-Khoudoud, M.D.Mehdi Khosravi, M.D.Diego Maldonado, M.D.Mahmoud Moammar, M.D.Ashland Medical Group1061 Kenwood DriveRussell, KY 41169606.833.5864

Scott Nelson, M.D.Gregory Stark, M.D.Bjorn Thorarinsson, M.DTri-State Pulmonary AssociatesMedical Plaza B613 23rd St., Suite G30Ashland, KY 41101606.329.1185

RadiologyHunter Boshell, M.D.Mayola Boykin, M.D.Erik Fraley, M.D.Candy Howard, M.D., PhDPaul Wesley Lewis, M.D.Mukesh Kumar Madupur, M.D.Scott Moore, M,D,Ash Motimaya, M.D.Pho Nguyen, M.D.Robert Penkava, M.D.Stella Powell, M.D.Alvin Schwarz, M.D.Amina Tariq, M.D.Charl Van Wyk, M.D.Jay Wigboldy, M.D.Tri-State Radiology2201 Lexington Ave.Ashland, KY 41101606.408.4627 UrologyWilliam Boykin, M.D.

Timothy Dixon, M.D.James Krick, D.O.Charles Thorndyke, M.D.King’s Daughters Medical Specialties - Urology336 29th St., Suite 101Ashland, KY 41101606.324.4404

E.W. Unnikrishnan, M.D.900 St. Christopher Dr., Suite 201Ashland, KY 41101606.836.2311

For a complete list of all our physicians, visit kdmc.com.

Physicians

Physicians of the KDMC Thoracic Tumor Board (clockwise from front): pathologist Shamsa Haroon, M.D., oncologist Vinay Vermani, M.D., pulmonologist Bjorn Thorarinsson, M.D., radiation oncologist Jeffrey Lopez, M.D., cardiothoracic surgeon Robert Fried, M.D., and radiologist Erik Fraley, M.D.

Oncology Services 2010

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