Heal. Help.Hope.

2014 Cancer ProgramAnnual Report

Based on 2013 Activities at

Direct inquiries about this report to:Wise Regional Health System Cancer Program609 Medical Center Drive, Decatur, Texas 76234Telephone: 940-626-2300 | Fax: 940-626-1281www.WiseRegional.com

For additional services, contact:Wise Regional Health System 940-627-5921Wise Regional Health Foundation 940-626-1384Customer Service 940-626-1240NCI Cancer Information Service 1-800-4-CANCERAmerican Cancer Society 1-800-227-2345 www.cancer.org

The 2014 Annual Report of the Cancer Program was published by Wise Regional Health System for patients, donors, and friends of Wise Regional Health System. All contents ©2014 Wise Regional Health System. Contents may be reproduced by permission from the editor and if appropriate credit is given.

TABLE OF CONTENTS

Dr. Arshad YousufDr. Neelima Maddukuri Medical Oncology, Medical Director and ChairDr. Guy Garrett Radiation OncologyDr. Joe Barns PathologyAngela Christian RN, OCN Director of OncologyCarol Poehl, CTR Cancer RegistrarJohn Neal, RT(R), CRA, CAAMA Director of RadiologyLynn Sherman, LVN Quality Management, AdministrationLaura Tanner, LBSW Social WorkerDawn Byrd, RHIA Health Information ServicesAmy Fields, MS, BSMT (ASCP) Director of LaboratoryMartin McQuaid, RN, BSN, CCRN NursingMelinda Henry, LVN Radiation NurseMcKenzie Lanier, LVN Oncology Office NurseTravis Fulton Admininstrative Director, Therapy ServicesStacey Case Physical Therapy

2013 Cancer Committee Members

3 2013 CANCER COMMITTEE MEMBERS

4 FOCUSED LUNG CANCER FINDINGS REPORT

7 CP3R-CANCER PROGRAM PRACTICE PROFILE REPORT

FOCUSED LUNG CANCER FINDINGS REPORT

Lung CancerIn the United States, there are approximately 224000 new cases diagnosed with lung cancer and about 159000 deaths. Lung cancer is the leading cause of cancer-related mortality in the United States. Lung carcinomas are placed into two distinct groups: Non-small cell lung carcinomas (NSCLC) which arise from the epithelial cells which line the lung and Small cell carcinoma (SCLC) which originate from neuroendocrine cells surrounding the bronchi. Treatment for the two groups is vastly different. The three main subtypes of NSCLC include adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Clinical Presentation:The most common symptoms at presentation include: cough, shortness of breathe, chest pain, coughing up mucous and/or blood, loss of appetite, weight loss and fatigue. At times, the patient may be asymptomatic and a lesion is noted on either a routine chest x-ray or CT scan.

If the lung cancer invades adjacent structures in the thorax, patients may present with hoarseness, difficultly with swallowing, or facial swelling when the Superior Vena Cava is compressed. Some symptoms from distant spread include neurological deficits with brain metastasis or pain with bone metastasis.

Risk Factors:The leading and most important risk factor contributing to lung cancer is smoking cigarettes, pipe or cigars. This risk increases with quantity of cigarettes, duration of smoking and the starting age of smoking. Other risk factors include exposure to second hand smoke, asbestos, radon, chromates, nickel and other agents. Radiation to the chest and breast is also a risk factor.

Diagnosis:Treatment options are determined by cell type (histology), stage and the patient’s current state of health and their comorbidities. The procedures recommended in diagnosis often include: history and physical exam, lab evaluations, radiological tests (chest-x-ray, CT scan of the chest and abdomen) and obtaining tissue for pathological review. Biopsies can be done via bronchoscopy by a pulmonologist or CT guided needle biopsy by a radiologist. On rare occasions a thoracic surgeon will perform a mediastinoscopy in order to obtain nodal tissue for diagnosis. Other radiological tests may be performed in order to evaluate for distant spread and they include PET scan, bone scan and CT scan or MRI scan of the brain.

Before a patient begins treatment, the histological diagnosis must be determined. SCLC is treated generally with chemotherapy and not surgically. NCLCA may be treated with surgical resection or with chemotherapy and radiation.

Treatment:Once again treatment selection is influenced by stage of the lung cancer, histological subtype and the patient’s state of health.

For NSCLC, surgical resection is preferable for stage I, II and select stage III patients. Surgery provides the most curative option for patients with early stage disease. If the patient is not surgical candidate due to medical contraindications then definitive radiation is recommended. The radiation treatment xcourse can delivered daily for approximately 6 to 7 weeks. In recent years, stereotactic body radiation (SBRT) has proven to be very effective for non-surgical candidate with focal small lesions in the lung with no evidence of nodal or distant disease. SBRT is the delivery of 5-6 high doses of radiation to the tumor over a 2-week course. If the tumor is locally advanced then a combination of chemotherapy and radiation are recommended. If the patient presents with distant disease, then palliative chemotherapy and/or radiation can be delivered to alleviate symptoms.

For SCLC, the patients have either limited disease (LD) or extensive disease (ED). LD is confined to thorax or in the supraclavicular nodes, which can then be encompassed in a radiation treatment portal. ED is where the cancer is widespread to other organs such are the liver, brain or bone. Chemotherapy is the primary treatment for SCLA, which are primarily Cisplatin and Etoposide. Radiation to the thorax is sometimes delivered for LC and prophylactic brain radiation is delivered to those patients who respond well to chemotherapy.

Prognosis and Survival:For SCLCA, the 5 year survival rates based on stage are as follows:

IA: 49 percentIB: 45 percentIIA: 30 percentIIB: 31 percentIIIA: 14 percentIIIB: 5 percentIV: 1 percent

For SCLC, patients with LD have a better prognosis butthe median survival is 16- 24 months with a 5-year survival of 14%. The medial survival for patients with ED is 6 to 12 months.

4 2014 ANNUAL REPORT OF THE CANCER PROGRAM AT WISE REGIONAL HEALTH SYSTEM

2014 ANNUAL REPORT OF THE CANCER PROGRAM AT WISE REGIONAL HEALTH SYSTEM 5

FOCUSED LUNG CANCER FINDINGS REPORT

Non-small and small cell Carcinoma

WRHS

NCDB

<30

0

21

50-59

26

624

80-89

13

565

40-49

8

157

70-79

47

1257

60-69

40

1206

90+

1

37

WRHS

NCDB

30-39

1

3

50-59

7

147

80-89

2

91

40-49

5

30

70-79

9

216

60-69

16

273

90+

n/a

n/a

Age Group of Lung, Non-Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

At Wise Regional Health System, the majority of patients with non-small cell carcinoma were diagnosed at age 70-79, consistent with the NCDB data.

At Wise Regional Health System, the majority of patients with small cell carcinoma were diagnosed at age 60-69, consistent with the NCDB data.

Age Group of Lung, Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

Age

WRHS

NCDB

0

0

7

II

10

336

UNK

19

331

I

20

862

IV

57

1480

III

29

849

na

0

2

WRHS

NCDB

0

0

1

II

1

26

UNK

15

95

I

5

38

IV

13

440

III

6

160

na

Stage of Lung, Non-Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

At Wise Regional Health System, the majority of patients with non-small cell carcinoma were diagnosed at stage IV, consistent with the NCDB data.

Stage of Lung, Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

Stage

Year

2007

2008

2009

2010

2011

2012

Small

2

11

8

7

4

8

Non-Small

22

21

24

22

18

28

At Wise Regional Health System, the number of lung cases diagnosed and/or treated dropped significantly in 2011 and then trended upward again in 2012. This could be attributed to the fact that many of the members of the community are at high risk for lung diseases.

2007 - 2012 Analytical

6

FOCUSED LUNG CANCER FINDINGS REPORT

WRHS

NCDB

53

773

17

392

14

179

20

502

15

687

0

103

0

178

16

1053

SurgerySurgery Chemo

OtherChemoRadiationSurgery

Radiation Chemo

Radiation Chemo

None

WRHS

NCDB

19

234

3

34

0

27

17

275

1

190

OtherChemoRadiationRadiation

ChemoNone

Stage of Lung, Non-Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

At Wise Regional Health System, the majority of patients with non-small cell carcinoma were treated with radiation and chemotherapy, consistent with the NCDB data.

Stage of Lung, Small cell Carcinoma, Diagnosed 2007-2012Analytical Approved Community Cancer Program Hospitals in Texas

Treatment

Survival

Non-Small cell Carcinoma, Diagnosed 2007-2012

Small cell Carcinoma, Diagnosed 2007-2012

2014 ANNUAL REPORT OF THE CANCER PROGRAM AT WISE REGIONAL HEALTH SYSTEM

72014 ANNUAL REPORT OF THE CANCER PROGRAM AT WISE REGIONAL HEALTH SYSTEM

Cancer registry data elements are nationally standardized and considered open source. Each of these measures was developed by the Commission on Cancer with the expectation that cancer registries would be used to collect the necessary data to assess and monitor concordance with the measures. Extensive assessment and validation of the measures was performed using cancer registry data reported to the National Cancer Data Base (NCDB).

All measures are designed to assess performance at the hospital or systems-level, and are not intended for application to individual physician performance. This reporting tool has demonstrated that improvements in data quality can demonstrate the quality of patient care when the entire cancer committee supports system-level enhancements to ensure complete and precise documentation.

CP3R currently reports estimated performance rates within six breast, two colon and one rectal measure.

Breast Cancer Measures - Estimated Performance RatesRadiation (BCSRT)Radiation is administered within 1 year (365 days) of diagnosis for women under the age of 70 receiving breast conservation surgery for breast cancer (Accountability) 2010 2011 2012 100% 100% 80%

Chemotherapy (MAC)Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage IB - III hormone receptor negative breast cancer (Accountability) 2010 2011 2012 100% 100% 100%

Hormone (HT)Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1c or stage IB-III hormone receptor positive breast cancer (Accountability) 2010 2011 2012 93% 100% 80%

Colon Cancer Measures - Estimated Performance RatesAdjuvant chemotherapy (ACT)Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC stage III (lymph node positive) colon cancer (Accountability) 2010 2011 2012 100% 100% 100%

Rectum Cancer Measures - Estimated Performance RatesRadiation (RECRT)Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or stage III receiving surgical resection for rectal cancer. 2010 2011 2012 100% 0% 100%

2012 Comparison

Wise Regional State

MAC

100% 82% 91%

100% 89% 91%

100% 81% 89%HT

RadiationBCSRT

National

Breast Cancer Measures - Estimated Performance Rates

Wise Regional State

100% 83% 88%ACT

National

Colon Cancer Measures - Estimated Performance Rates

Wise Regional State

100% 90% 89%RECRT

National

Rectum Cancer Measures - Estimated Performance Rates

CP3R-CANCER PROGRAM PRACTICE PROFILE REPORT

The North Texas Cancer Center at Wise Regional Health System provides our communities with the latest technologies in cancer

treatment. Cancer patients who live in this area now have an opportunity to seek treatment close to home rather than

traveling to a facility in the Metroplex.

The radiation oncology program offers intensity modulated radiation therapy (IMRT), which enhances radiation treatment

planning for the patient and allows delivery of high doses of radiation to a tumor while minimizing the amount

of radiation to normal tissues.

The medical oncology program has medical oncologists and oncology-trained staff which offers state of the art chemotherapy,

immunotherapy, and targeted therapies for various types of cancers.

The oncology groups of both programs play a major role in cancer care to include management of treatment plans,

therapies, and evaluations of the patient’s progress.

Cancer Care and Treatmentin Wise and Surrounding Counties

609 Medical Center Drive • Decatur, TX • 76234940.627.5921 • WiseRegional.com

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