Quality seems to be the buzz word for the 2007 Cancer Committee activities in Commis-

sion on Cancer Approved Programs. Cancer Program leaders are facing an era of change as in-

creasing pressure is placed on providers to engage in performance measurement and report-

ing. Public accountability is becoming the rule rather than the exception. With information so

easily obtained over the Internet, patients have more responsibility and control over their care

and where they receive it than at any other time. Insurers and payers are demanding more in-

formation to improve the quality of data across several disease sites and to improve clinical

management and coordination of patient care in the multidisciplinary setting.

There are numerous efforts currently underway to establish consensus on performance measures for colorectal

cancer care. Among the leaders has been the public/private partnership led by the National Quality Forum (NQF) that

has brought together payers, consumers, researchers, and clinicians to promulgate performance measures for breast

and colorectal cancer. The 80-year history of the Approvals Program places the Commission on Cancer in an enviable

leadership role and CoC-Approved Programs at the forefront of these changes.

The National Quality Forum’s endorsement of measures for breast and colorectal cancer care in April 2007 leaves

the Commission on Cancer (CoC) well positioned to assist CoC-Approved cancer programs in preparing for the im-

plementation of these quality-focused measures and to benchmark those practices with other CoC Approved Pro-

grams across our nation. CHRISTUS ST. Michael Health System and Wadley Regional Medical Center ranked high in

compliance with CoC Programs across the nation in comparing 1998-2005 data Stage III Colon Cancer with CSMHS

ranking 92.6% and WRMC ranking 91.4%. The ranking of all CoC Approved Programs across the country was 76%.

The mission of the CSMHS & WHS Cancer Programs is to provide quality comprehensive care including state-of-

the-art services and equipment, a multidisciplinary team approach to coordinate the best treatment options available,

access to cancer-related education and support services, and ongoing monitoring and improvements in cancer care

to provide quality care close to home for our patients. It takes

Ron Hekier, M.D.

CSMHS & WHS Cancer Committee Chairman

P H Y S I C I A N M E M B E R P H Y S I C I A N M E M B E R P H Y S I C I A N M E M B E R Ron Hekier, MD Chair Mike Finley, MD J. D. Patel, M.D. Roger Good, MD Joe Robbins, MD.

Kristen Lower, MD Alan Solomon, MD Bryan J Griffin, MD Howard Morris, MD Robert Parham, MD Chris McMillian, MD H. Anthony Tran, MD Ranga Balasekaran, MD George W. English, III, MD

N O NN O NN O N---P H Y S I C I A N M E M B E RP H Y S I C I A N M E M B E RP H Y S I C I A N M E M B E RSSS

Kim Lewis, RN

Jena Teer, LSW

Debra Wright, RN

Susan Paxton

Mike Jones, BS PHA

Tracy Wade, RHIT

Donna Marlar, CTR

Dianne Greenhaw, RN

Mary Miller, LMSW-ACP

Jodie Martindale, RHIA

Dianne Ketchum, CTR

Alan Anderson, PharmD

Tammy McKamie, RN, OCN

CANCER SITE #

CASES PERCENT

# NATIONAL

CASES FOR PERCENT

Prostate 296 25% 218,890 20%

Lung 251 21% 213,380 20%

Breast 193 16% 180,510 17%

Colorectal 129 11% 153,760 14%

Melanoma 91 8% 59,940 6%

Bladder 72 6% 67,160 6%

Kidney 64 5% 51,190 5%

Oral Cavity & Pharynx 46 4% 34,360 3%

Lymphoma 36 3% 71,380 7%

Pancreas 28 2% 37,170 3%

TOTAL CASES Total

1,206 100% Total

1,087,740 100%

*American Cancer Society, Cancer Facts and Figures 2007 Estimated New Cancer Cases CY: 2007 This table represents cases diagnosed or treated in CSMHS, WHS and physician offices or private practice institutions during 2007. Only the cases submitted to the UAMS AHEC-SW Cancer Registry are reflected in this table. Cases were researched against the Cancer Registry database to eliminate duplicates.

2007 Cancer Committee Physician Members (from left to right): Ranga Balasekaran, M.D.; Mike Finley, M.D.; Roger Good, M.D.; Bryan Griffin, M.D.; Howard Morris, M.D.; George English, M.D.; Jack H. McCubbin, M.D.; J. Alan Solomon, M.D.; J.D. Patel, M.D; Anthony Tran, M.D.

C S M H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T SC S M H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T SC S M H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T S

Howard Morris, M.D. Radiation Oncologist of CHRISTUS St. Michael Health System, serves as moderator of the CSMHS Tumor Board meetings and educational conferences as well as CSMHS Liaison to the Commission on Cancer Liaison Program. Dr. Morris is an active member of the Joint Cancer Committee and has served as Chairman in the past. He is the medical advisor for the Texarkana Unit American Cancer Society and participates in CoC initiatives at CSMHS.

Dr. Morris recently trained at the Seattle Prostate Seed Institute in Seattle, Washington and initiated the local prostate seed program at CSMHS in 2007. His leadership in providing a less invasive therapy for prostate patients who qualify and in providing newly purchased state-of-the-art equipment to offer the best treatment available is greatly appreciated.

CSMHS Prostate Screening for the Black Community

CSMHS Colorectal Screening for the Community

CSMHS & ACS Coping with Breast Cancer Support Group

CSMHS Breast Cancer and Cervical Care Outreach Program, Funded by grants from Susan G. Komen RFC and Texas Breast & Cervical Care Services, Underwritten by CSMHS.

CSMHS & ACS Man to Man Support Group

CSMHS Life & ACS After Loss Support Group

CSMHS Cancer Survivor’s Day

CSMHS Weight Watchers International

Texarkana Susan G. Komen Race for the Cure

American Cancer Society Great American Smoke Out

American Cancer Society Relay For Life

American Cancer Society Reach to Recovery

ACS Days at the W. Temple Weber Cancer Center

Prostate Cancer by County Y2003‐2007

Bowie

Other

Miller

Hempstead

Little River

Cass

Howard

74%26%

26%

CSMHS Prostate CancerDistribution by Race, Y2007

Caucasian African‐Am

CANCER SITE # of CASES PERCENT NATIONAL PERCENT CANCER SITE # of

CASES

CSMHS

PERCENT

NATIONAL

PERCENT

ORAL CAVITY & PHARYNX 29 3.6 2.4 SOFT TISSUE/CONNECTIVE TISSUE 1 .1 .6

TONGUE 9 1.1 .7 BREAST 121 15 12.5

MOUTH 3 .4 .7 CERVIX 10 1.3 .8

PAROTID GLAND 2 .3 - UTERUS 12 1.5 2.7

TONSIL 5 .6 - OVARY 6 .8 1.6

PHARYNX 8 1 .8 PROSTATE 106 13.3 15

OTHER 2 .3 .2 TESTES/OTHER MALE GENITAL 8 1 .6

ESOPHAGUS 11 1.4 1.1 KIDNEY 26 3.6 3.4

STOMACH 8 1 1.5 BLADDER 35 4.4 4.7

SMALL INTESTINE 3 .4 .4 OTHER URINARY ORGS 2 .3 .1

COLON 80 10 7.8 MENINGES 2 .3 -

RECTUM 13 1.6 2.9 BRAIN 24 3 1.4

ANUS 4 .5 .3 ADRENAL 1 1 .1

PANCREAS 19 2.4 2.6 LYMPHOMA 29 3.6 4.9

OTHER ILL DEFINED DIGESTIVE 2 .3 .3 LEUKEMIA/ANEMIA 5 .6 1.4

LUNG/BRONCHUS TOTAL 191 23.9 14.8 MULTIPLE MYELOMA 10 1.3 3.1

LUNG -SMALL CELL 7 - - OTHER & UNSPECIFIED SITES 9 1.1 2.2

LUNG-NON SMALL 184 - - TOTAL CASES ACCESSIONED 911 1,444,920

LARYNX 4 .5 .8 ** ANALYTICAL CASES 800

MELANOMA 21 2.6 4.2 *** NON-ANALYTICAL CASES 111

LIVER 3 .4 1.3 THYROID GLAND 5 .6 2.3

Prostate cancer affects one in six men in their lifetime and is estimated that there were 218,890 prostate cancer

cases diagnosed in 2007 in the U. S. The estimated number of prostate deaths for that year is 27,050 which makes

this site of cancer the second leading cause of cancer deaths in men. Historically, prostate cancer was considered a

disease of old age but its prevalence is increasing in younger men and is the second most commonly diagnosed can-

cer affecting men after middle age as depicted in our local data shown in the graphs provided.( Fg.1 & 2).

The optimal treatment of prostate cancer is determined due to several factors, age, stage of disease and grade of

differentiation. Substantial changes have occurred in the treatment of prostate cancer prior to the widespread use of

PSA. NCI SEER data demonstrates a substantial shift toward more aggressive therapy for clinically localized prostate

cancer, most notably toward radical prostatectomy. Rates of aggressive therapy have increased in both black and

white men.

However, there are racial differences in treatment patterns. On a national and local level localized and regional

stages of prostate cancer in white men are more likely than black men to receive radical prostatectomy while black

men are more likely to receive radiation therapy. (Fig 3)

0 50 100 150 200 250

0-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

CSMHS & WHS Prostate Cancer Distribution by Age & AJCC Stage Y2003-2007

Stage 2 Stage 3 Stage 4 Unk Stage

BRON LUNG38%

PROSTATE36%

COLON12%

BLADDER9%

KIDNEY5%

CSMHS & WHS Frequency of Cancer in Men

Treatment patterns are strongly influenced by age with

younger men tending to have radical prostatectomy, middle-

aged men tending to have radiation therapy and older men

tending to have conservative approaches (no treatment or

hormone therapy). The distribution of treatments for ad-

vanced stage disease has remained stable. (Fig.3)

Most men diagnosed with prostate cancer will die from other disease. Over 90% of prostate cancer cases are diagnosed with local or regional disease. The national 5 year relative overall survival rate is about 99%.

When this data is further subdivided into stage, local or re-gional prostate cancer patients have a nearly 100% 5 year sur-vival, while only 34% of metastatic prostate cancer patients survive 5 years.

These national figures compare favorably to our local data (Fig 5) which also show a significant difference in survival based on stage. It is clear that early detection leads to better survival at 5 years. Routine screening with yearly combined PSA and digital rectal exam (DRE) is recommended for middle aged men.

Respectfully submitted,

C. Todd Payne, M.D.

Urologist Collom & Carney Urology Center

0%20%40%60%80%

100%

Surg Rad Horm Comb None

CSMHS & WHS Prostate Distribution by Age and Treatment Type

20-49 5 0-69 70-99

0%10%20%30%40%50%60%70%

Surg Rad Horm Comb None

CSM HS & WHS Pros tate Dis tr ibution by Race and Treatm ent Type

Caucasian

A frican-A m

Wadley/Susan G. Komen for the Cure Health Education Program, Free mammograms, ultra-sounds, biopsies, wigs and prostheses

Wadley Bringing Hope Home Breast Cancer Education & Aware-ness Event

Wadley & ACS Dialogue Support Group

Wadley & ACS Breast Cancer Support Group

Wadley Prostate Screening & Education Program

Wadley Genetics Educator- Genetics Testing Program

Texarkana Susan G. Komen Race for the Cure

American Cancer Society Great American Smoke Out

American Cancer Society Relay For Life

American Cancer Society Reach to Recovery

Wadley & Weight Watchers International

ACS Days in the Cancer Center

W H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T SW H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T SW H S S C R E E N I N G S A N D E D U C A T I O N A L E V E N T S

Dr. George English, III is an active member of the Joint Cancer Committee and has accepted the responsibility of Wadley Health System Liaison to the Commission on Cancer. He was ap-pointed by the CoC based on his knowledge, skill and dedication to the cancer program in Texar-kana and is the moderator of the WHS Tumor Board Conferences.

In 2007 Dr. English participated in the HER2 NEU targeted therapy for early stage breast can-cer patients study by the American College of Pathology (CAP) in order to monitor the proficiency of his department studies and to reduce the substantial risks associated with false positive and false negative results. Dr. English’s efforts to provide quality and precise diagnosis of cancer make him a valuable member of the WHS cancer team.

WRMC FREQUENCY OF CANCER IN WOMEN

BREAST

ALL OTHER

BRON LUNG

COLONPANCREAS

KIDNEY

0 10 20 30

Localized

Regional

Distant

Unknown

Endometrial Distribution by General Summary, Y 2003‐2007

American Cancer Society, Cancer Facts and Figures 2007. ** Diagnosed and all of the first course of treatment was preformed at reporting facility. *** Diagnosis and all of the first course of treatment was preformed elsewhere, recurrence or progression of disease cases at the reporting facility.

CANCER SITE # of

CASES PERCENT

NATIONAL

PERCENT CANCER SITE

# of

CASES

WHS

PERCENT

NATIONAL

PERCENT

ORAL CAVITY & PHARYNX 9 7.7 2.4 MELANOMA 2 .6 4.2

TONGUE 5 1.5 .7 BREAST 95 29.1 12.5

STOMACH 6 1.8 1.5 KIDNEY/RENAL PELVIS 16 4.9 3.4

COLON 22 6.7 7.8 BLADDER 16 4.9 4.7

RECTUM 2 .6 2.9 BRAIN 5 1.5 1.4

ANUS 1 .3 .3 THYROID GLAND 3 .9 2.3

LIVER 3 .9 1.3 LYMPHOMA 5 1.5 4.9

GALLBLADDER 3 .9 .6 LEUKEMIA/ANEMIA 3 1 3.1

PANCREAS 7 2.1 2.6 MULTIPLE MYELOMA 3 1 1.4

LARYNX 4 1.2 .8 OTHER & UNSPECIFIED SITES 3 .9 2.2

LUNG/BRONCHUS 67 20.6 14.8

LUNG -SMALL CELL 9 - - ** ANALYTICAL CASES 326

LUNG-NON SMALL 58 - - *** NON-ANALYTICAL CASES 64

BONES 1 .3 .2 TOTAL CASES ACCESSIONED 390

ESOPHAGUS 3 .9 1.1 TESTES/PENIS 2 .6 .6

TONSIL 1 .3 - CERVIX 3 .9 .8

OROPHARYNX 2 .6 .8 UTERUS 2 .6 2.7

OTHER ORAL CAVITY 1 .3 .2 PROSTATE 40 12.3 11.5

Endometrial carcinoma is the most common gynecologic ma-

lignancy in the United States. Slightly more than 40,000 cases

are diagnosed each year. It accounts for 6 percent of all cancers

in women. (FN1.)

Two types of endometrial cancer exist. Type 1 (endometrioid

tumors) accounts for 80 percent of cases and is estrogen-related.

Type II (papillary serous or clear cell tumors) accounts for 20 per-

cent of cases and is unrelated to estrogen stimulation. (FN 2).

Endometrial cancer usually occurs in postmenopausal women

(mean age early 60s). Twenty-five percent of cases are diag-

nosed in pre-menopausal women and 5 to 10 percent of these

women are under the age of 40. (FN 46). This disease can occur

in women under age 30. (FN 47) Distribution by age and stage of

our 55 cases is depicted graphically

For years 2003-2007, we had 55 reported cases of endo-

metrial cancer. Incidence rates are always higher in white women

than in African American, Hispanic, or Asian/Pacific women. FN 1.

89 percent of our cases occurred in Caucasian women; 11 percent

in African American women.

Endometrial carcinoma should be surgically staged according

to the Joint International Federation of Gynecology and Obstetrics

(FIGO) American Joint Committee on Cancer (AJCC) classification

system.

Individualized treatment (surgery; radiation therapy; surgery

and adjuvant radiation therapy or chemotherapy and prognosis

stratification is determined by disease stage and histology (grade

of differentiation and histologic subtype).

CSMHS & WRMC Endometrial Cancer Distribution by Race Y2003‐2007

Caucasian89%

African American

11%

0

1

2

3

4

5

0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

Endo metrial C ancer D istribut io n by A ge and Stage Y 2003-2007

Stage 1 Stage 2 Stage 3 Stage 4 Unk Stage

0

5

10

15

20

Surgery

No Treatment

Sur/Rad

Combined

Radiaion

CSMHS & WHSEndometrial Cancer by Treatment,

Y2003‐2007

As healthcare evolves…as standards evolve…as technology evolves…the role of the cancer registry is evolving as well. Today an effective cancer registry produces clinical and market reports that can promote the growth and success of a cancer program.

The entire interdisciplinary team involved with treating cancer at CHRISTUS St. Michael Health System and Wadley Health System utilize the resources found in the cancer registry. Physicians and other healthcare professionals use the registry as a resource for detection of trends in recurrent or metastatic disease and tracking the efficacy of different treatment protocols affecting patient care decisions. The American Cancer Society Texarkana Unit and the Susan G. Komen for the Cure-Texarkana Affiliate utilize the regis-try data for early detection and community needs assessments projects. The value of our database is measured by the quality of the data we collect. Susan Paxton, Becky Mahone, CTR, Donna Marla, CTR all work diligently to maintain the quality of data col-

lected while striving to also maintain the timeliness of abstracting the data.

The Cancer Registry accessioned 1037 analytical cases in the year 2007. We have collected data over the past 19 years for a total of 19,801 patients. Of this number, we have a follow up rate of 97 % for CSMHS and WRMC.

All of the functions of a registry are equally important in the management of a successful database that allows for the analysis of data in a meaningful manner. While it has been shown the pa-tients of today may benefit from a yearly reminder to have a check up, the patients of tomorrow will benefit from the evaluation of long-term results of today’s treatment to identify treatments that are more effective. Thank you to all of the Cancer Committee members, tumor board moderators and to the Cancer Registry staff for all your hard work.

Nationally, Five year survival rates for localized, regional and me-

tastatic disease are 95, 67 and 23 percent respectively (FN 1). The

cardinal symptom of endometrial carcinoma is abnormal uterine

bleeding, which occurs in 90 percent of cases (FN 98). Even one

drop of blood in a postmenopausal woman not on hormone re-

placement is an indication for diagnostic testing to excluded endo-

metrial cancer. Of great interest, in the past year, we had two

cases of early endometrial cancer diagnosed by endometrial biopsy

even though the sonographic measurement was reassuring (less

than 4 millimeters). Respectfully submitted,

Jack H.McCubbin,MD,FACOG,FACS

FN #1. Jemal, A. Siegel, R, Ward, E, et al. Cancer Statistics,2008. CA Cancer j Clin 2008

FN # 2. Bokhman, JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10.

FN # 3. Gallup, DG, Stock, RJ. Adenocarcinoma of the endometrium in women 40 years of age or younger, OBstet Gynecol 1984; 64:417

FN #4. Azim, A. Oktay, K. Letrozole for ovulation induction and fertility preservation by embryo cryopreservation in younger women with endometrial carcinoma. Fertil Steril 2007; 88:657.

FN # 5 ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005; 106:413.

0

10

20

30

40

50

60

70

80

90

100

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

PERCENT SURVIVING

NU MBER OF MONTHS

CSMHS & WHS ENDOMETRIAL SURVIVAL DISTRIBUTION BY AJCC STAGE

1 23 4

UAMS AHECUAMS AHECUAMS AHEC---SW SW SW CANCERCANCERCANCER REGISTRYREGISTRYREGISTRY

300 E. 6th Street Texarkana, AR

CHRISTUS ST. MICHAEL HEALTH SYSTEMCHRISTUS ST. MICHAEL HEALTH SYSTEMCHRISTUS ST. MICHAEL HEALTH SYSTEM

2600 St. Michael Drive Texarkana, TX

WADLEY HEALTH SYSTEMWADLEY HEALTH SYSTEMWADLEY HEALTH SYSTEM

1000 Pine Texarkana, TX

c CHRISTUS St. Michael Health System and Wadley CHRISTUS St. Michael Health System and Wadley Health System received a ThreeHealth System received a Three--Year Approval by the Year Approval by the Commission on Cancer (COC) of the American College of Commission on Cancer (COC) of the American College of Surgeons as a Community Hospital Comprehensive Surgeons as a Community Hospital Comprehensive Cancer Program in 2007.Cancer Program in 2007.

The two facilities received commendations in several The two facilities received commendations in several areas for exceeding the standards for Approval by the areas for exceeding the standards for Approval by the CoC. That approval is given only to those facilities that CoC. That approval is given only to those facilities that have voluntarily committed to provide the best in cancer have voluntarily committed to provide the best in cancer diagnosis and treatment and reaffirms a facility’s ongoing diagnosis and treatment and reaffirms a facility’s ongoing commitment to providing highcommitment to providing high--quality, multidisciplinary quality, multidisciplinary cancer care. Approval by the CoC encourages selfcancer care. Approval by the CoC encourages self--assessment and continuous evaluation of the cancer assessment and continuous evaluation of the cancer program. Only one in four hospitals that treat cancer program. Only one in four hospitals that treat cancer receive this special approval. More than one million cases receive this special approval. More than one million cases per year are added to the over 18 million cases already in per year are added to the over 18 million cases already in the National Cancer Data Base (NCDB) by approved cancer the National Cancer Data Base (NCDB) by approved cancer programs.programs.

This report is produced and published by the UAMS This report is produced and published by the UAMS AHECAHEC--SW Cancer Registry and is supported by the Cancer SW Cancer Registry and is supported by the Cancer Committee.Committee.

Special thanks to Gary D. Miller, UAMS AHECSpecial thanks to Gary D. Miller, UAMS AHEC--SW SW Community Outreach & Education Director for his Community Outreach & Education Director for his assistance with the layout and cover design. assistance with the layout and cover design.

www.ahectxk.uams.edu