2010

CANCER CONTROLANNUAL REPORT

TEACHING HOSPITALCANCER PROGRAMACCREDITED BY THE AMERICAN COLLEGE

OF SURGEONS WITH COMMENDATION

COMMUNITY OUTREACH 2009

Provided Sun Safety Program, Jenny Quade,Nevada Cancer Institute, and entertainment

from Mark O'Toole, Lymphoma Cancer Survivor

Provided a Survivorship talk from a lymphomasurvivor, Mindy Krasner, Freedom Dance Company, and

American Native Flutes, Tim Ramel from The Caring Place

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TEACHING HOSPITAL CANCER PROGRAMUMC TREATMENT AND DIAGNOSTIC PROGRAMS

The American College of Surgeons has designated University Medical Center as a Teaching Hospital Cancer Center. This designation indicates that the hospital program has met very stringent requirements for the care of cancer patients. UMC Medical Staff Cancer Control Committee supervises the program.

The UMC Teaching Hospital Cancer Center offers a full range of diagnostic and treatment capabilities for the patients who have been found to have one of the many forms of cancer.

The staff of the Teaching Hospital Cancer Center includes physicians with special interest, training, and abilities in the care of the cancer patient. Members of the UMC medical staff with special interests in oncology include internal medicine, obstetrics/gynecology, thoracic and cardiovascular surgery, general surgery, colorectal surgery, genitourinary surgery, neurosurgery, pediatrics, plastic surgery, radiology, and pathology.

The specially trained and experienced nursing staff is of vital importance in the management of the patient. The separate oncology nursing unit assure continuity of care for our patients to include rehabilitation, home health care and hospice care.

Treatment may require surgical care, radiation or chemotherapy/biotherapy either as an inpatient on the oncology inpatient unit for adults and pediatrics or as an outpatient in the pediatric outpatient clinic for pediatric patients.

stRadiation treatment is provided by an affiliation with the 21 Century Radiation Center. The Nevada Cancer Research Foundation – Community Clinical Oncology Program provides cancer patients with participation in clinical trials and supports the physicians in their care of the patient.

The Pharmacy Department plays an active role in the preparation of chemotherapy/biotherapy, pain control and assistance with research protocols. With their expertise, the pharmaceutical services ensure safe and accurate distribution of medications. Pharmacists are responsible for compliance with the American Society of Hospital Pharmacists and OSHA guidelines for chemotherapy/biotherapy preparation, handling, and dispensing of chemotherapeutic and biological agents.

Rehabilitation of patients is done with the assistance of the UMC Rehabilitation Center, the HOPE Chaplains and counseling programs at UMC and the American Cancer Society. University Medical Center partners with the American Cancer Society (ACS) in providing the Look Good Feel Better (LGFB) Program. The LGFB program is free and teaches beauty techniques to women in active treatment to help them with appearance-related side effects of cancer treatment. An enterostomal therapist is available to provide specialized care and treatment for patients with ostomies, skin problems, decubitus ulcers and draining wounds. Patients receive pre-and-post operative counseling, treatment and education.

Nutritionists are available to provide adequate nutritional support to patients receiving supplements, such as TPN or tube feedings, and to assist with planning special menus.

The Cancer Control Committee supervises the Teaching Hospital Cancer Center. Their educational programs include the UMC Tumor Board, which reviews cases and furnishes an annual review of cancer diagnosis and therapy. The committee is responsible for supervision of the cancer registry, participation in studies of the American College of Surgeons and the publishing of the Cancer Control Annual Report.

UMC 2005 Cervical MalignanciesBy Ethnicity

UMC 2005 Cervical MalignanciesBy Age Range

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UMC 2005 Cervical MalignanciesBy Treatment

UMC 2005 Cervical MalignanciesUMC Vs NCDB By AJCC Stage

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UMC 2005 Cervical MalignanciesBy Patient Status

Cervical Cancer Graphs

UMC 2005 Cervical MalignanciesBy Pay Source

Professional Education

Program Activities

Health Fairs

Screening Activities

Community Activities

2009 Cancer Control Committee Members:

John Ellerton, M.D., C.M., Medical Oncology/Hematology, Chairperson

Wydell Willilams, M.D., Surgery, Liaison Physician

Craig Voss, M.D., Pathologist

Susan Reisinger, M.D., Radiation Oncologist

Harvey Riceberg, PharmD, Hematology/Oncology

Joshua Mark, PharmD, Hematology/Oncology

Jonathan Gerber, PharmD, Hematology/Oncology

Vicki Huber, RN, Chief Nursing Officer

Kim Voss, RN, Performance Improvement

Marivella G. Abad, RN, Oncology Clinical Manager

Fina Wardle, RN, BSN, Director of Medical-Surgical Services

Marjaana Mehta-Krieger, MSN, RN, NP-C, AOCNP Adult Advanced Oncology Certified Nurse Practitioner

Doris Cowell, RN, BSN, OCN, Oncology Program Coordinator

Amy Smithson, RN, Research Nurse

Evelyn McGuckin, RN, Nursing Administration

Jeanette Aguilera, RN, Pediatrics

Wendy Voight, RN, PICU

Karen Sartell, RN, M.A., Nevada Cancer Research Foundation Program Coordinator

Jaya Kamath, Study Coordinator, Nevada Cancer Research Foundation

Robyn Simon, CTR, Cancer Registrar

Cynthia Hull, CSW, Social Services

January 2009 - December 2009

Acronym GlossaryACSAJCCCCOPLGFBONSOSHAUMC

American Cancer SocietyAmerican Joint Commission on CancerCommunity Clinical Oncology ProgramLook Better, Feel BetterOncology Nursing SocietyOccupational Safety and Health AssociationUniversity Medical Center

ONS Chemotherapy and Biotherapy Course – June 09, November 09Greater Las Vegas Chapter ONS Oncology Nursing Symposium – March 09

Nursing Home Studies to include the following: Labs & Tests Pertinent to Cancer Patients; Oncology Nursing Overview; Oncologic Emergencies; Pain Management in the Cancer Patient

Walking With Weekly 2009 Health Fair – Dr. William U. Pearson Community Center May 09UMC Employee Health & Wellness Fair – May 09Doolittle Senior Center – October 09

Medical Grand Rounds – Pain Management Update presented by Warren Wheeler, M.D., Director of Nathan Adelson Hospice Center July 09

Annual Nursing Chemotherapy/Biotherapy Certification Competency – November 09

Melanoma at Family Resource Center – Senior Celebrations program – May 09UMC Community Outreach Prostate Cancer Screening – September 09

American Cancer Society Look Good Feel Better Program – April 09, June 09, September 09

Las Vegas High School – Education on Effects of Cigarette Smoke and Smoking Cessation – May 09

UMC Cancer Survivor Picnic – May 09

UMC Cancer Survivor Holiday Party – December 09

UMC Cancer Survivor Support Group – 1st & 3rd Tuesday of the Month

Support Groups

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UMC 2005 Cervical MalignanciesMonths Of Survival - All Stages

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The advent of the Papanicolaou smear as well as human papilloma virus (HPV) testing in the United States has led to a dramatic reduction in the incidence and death rate of cervical cancer. Despite these advances, there remain populations who are not screened or are underscreened and women who remain at higher risk than the average population such as those affected by human immunoodeficiency virus. In addition, survival rates vary among racial groups with 74% survival in Caucasian women and 66% in African-American women. This may very well reflect access to screening and other risk factors.

The University Medical Center of Southern Nevada (UMC) serves as the county hospital in Clark County, Nevada and traditionally serves an underserved and minority population, unfortunately a great many who are financially disadvantaged. In a 5 year long-term survival analysis of patients diagnosed with cervical cancer and treated at UMC, 61% of patients were either self pay or receiving government insurance. This reflects the overall population served by UMC. UMC continues to provide care for minority population which is represented by 38% of the diagnosed population being Hispanic.

For the most part, minority and underserved populations do not receive adequate screening for cervical cancer and thus are in a high risk population. Early stage cervical cancers (stage I) were significantly less common in the treated UMC patients that the national average, 26% versus 39% respectively. Additionally, twice as many women were diagnosed with metastatic disease than the national average which ultimately represented one-fifth of those diagnosed in 2005 at UMC. More advanced stage at diagnosis decreases the role of surgical only intervention and increases the need for combined and sometimes concurrent cancer therapies including chemotherapy and radiation. This ultimately is reflected in the survival rates. At 5 years, 62% were alive in the treated population versus the national average of 70 to 74% survival.

Emphasis on prevention and screening is paramount in the Clark County population as witnessed by the above 2005 data. Cervical cancer remains a highly preventable and avoidable disease if vaccinations which are currently readily available and annual screening occur. UMC has made it a primary goal to provide treatment services to those ultimately diagnosed by a multi-disciplinary approach to cancer care. Surgical gynecologic oncology services are combined with medical oncology and radiation oncology to provide total care at the newly opened Nevada Cancer Institute (NVCI) at UMC Clinic. This clinical service was developed to address and meet the significant needs of the economically disadvantaged population of Clark County suffering from all types of malignancies. This combined effort is hoped to make a positive impact on survival of those diagnosed and reduce the burden of cancer in Nevada.

IN-DEPTH STUDY OF CERVICAL CANCERKaren S. Jacks, M.D.Medical Director, Oncology Services at UMC

The American Cancer Society estimates that over 1.5 million new cases of cancer will be diagnosed and approximately 569,000 people will die of cancer in the United States during 2010. Of these, a small proportion will be diagnosed and succumb to cervical malignancies. Currently the projected numbers for cervical cancer in 2010 are as follows: 12,200 new cases and 4,210 deaths. The state of Nevada will see 130 of those new diagnoses. In contrast, uterine cancer and ovarian cancer are much more common with 43,470 and 21,880 annual diagnoses, respectively. Cervical cancer is the 3rd leading gynecologic malignancy in the United States.

Despite the low incidence of cervical cancer in the United States compared to breast, lung, prostate and colon cancers, cervical cancer remains a significant global concern. Developing countries are afflicted with the disease with over 470,000 cases diagnosed annually and it remains the leading cause of cancer related deaths in the developing world.

Review of Statistics for Melanoma

Daniel M. Kirgan, M.D., F.A.C.S.Associate Professor

In reviewing the data for our institution on melanoma for the year 2009, it is noteworthy to mention that UMC sees a significant number of early melanomas. Our patients present at an earlier stage than the National Cancer Data Base, patients which represent a national perspective, 39% compared to 32%. We, however, see a reasonable number of unknown primaries at 23%. This is still in line with the National Cancer Data Base of approximately 30%. In general, however, our numbers per stage, such as stage 0 and stage 1 thru 4, are relatively in line with National Cancer Data base, although we have a tendency to see slightly earlier stages than national.

The distribution of male and females is a slightly higher female rate for the UMC patients, which is a change from historical trends of melanomas being more commonly seen in males. However, per site, melanomas of the trunk greatly outweigh all other sites. We see equal rates of upper limb vs lower limbs, and a reasonable number of face, but by and large the largest is melanoma trunk.

With regards to treatment, our overall survivor data is good. The exception is stage 0, which is slightly lower than stage 1. This is more of a function of the denominator, where there are twice as many stage 1 patients being evaluated than stage 0 which I believe explains the changes in the survival graph.

Overall, I believe our survival data is in line with the National Cancer Data Base, and therefore national rates suggest that our treatment of melanoma remains exemplary.

University of Nevada

School of MedicineDepartment of Surgery

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DIETICIAN'S CANCER REPORTLisa Ledo, R.D.Food and Nutrition ServicesUniversity Medical Center ofSouthern Nevada

As a Dietitian on the Oncology unit at UMC, I encounter all different types of patients. Some patients are eating by mouth and require a structured meal plan for optimal nutrition, while other patients are fed by a tube in the stomach or intestine, and also require a nutrition regimen so that they may obtain the proper amounts of calories, protein, fluids and nutrients. Nutrition plays an important role in the prevention and treatment of all types of cancer. A rounded well-balanced diet that is rich in fruits, vegetables, healthy protein sources (such as chicken, fish or beans) and whole grains is important in both patients that may need to gain or lose weight. The RD plays an important role in tailoring the diet to meet these needs.

Patients undergoing chemotherapy may be losing weight, feeling nauseated and having a complete loss of appetite. Changes in taste sensation may also accompany chemotherapy treatment.

Some tips for nutrition with chemotherapy include:

Therefore some weight loss tips include:

Overall nutrition plays an important role for all individuals. However cancer patients present unique challenges for maintaining optimal health.

Sit in a well lit room or by your favorite window to allow for plenty of light and a pleasant dining experience

Make food look attractive on your plate

Try lemon in water for added flavor, as plain water can taste undesirable

Avoid very hot or spicy foods, or food with strong odors

Make every bite count—try to consume high calorie high protein foods such as fortified milk shakes, casseroles and peanut butter added to snacks

Choose food with a lower calorie content, such as fruits, vegetables and whole grains. These foods can also help make an individual feel “fuller.”

Avoid high calorie beverages sweetened with sugar. Water or light beverages are the better choice.

Increase your amount of physical activity; aim for 30-60 minutes of moderate exercise most days. Of course, make sure your physician approves any exercise regimen.

THE NEVADA CANCER RESEARCHFOUNDATION CLINICAL ONCOLOGYPROGRAMKaren Sartell, M.A., CCRPProgram Administrator

The Nevada Cancer Research Foundation – Community Clinical Oncology Program (NCRF-CCOP) is a non-profit, clinical trials oncology program that has been funded since 1983 by a grant from the Division of Cancer Prevention, National Cancer Institute (NCI). The mission of the NCI-supported Community Clinical Oncology Program Network is to develop and conduct state-of-the-art cancer prevention, control, and treatment clinical trials with significant involvement of community oncologists and populations they serve. The CCOP Network mission includes: (1) accelerating development of interventions to prevent and treat cancer and its symptoms by increasing accrual to trials; (2) fostering quality care in the community through adoption of results from clinical trials; and (3) increasing the involvement of minority and underserved patient/participant populations in cancer clinical trails.

The NCRF-CCOP is fortunate that the University Medical Center of Southern Nevada (UMCSN) has been affiliated with the NCRF-CCOP since 1983. To assist the NCRF-CCOP, UMCSN provides a regulatory umbrella so that studies are reviewed and approved by its Institutional Review Board so that these studies are available for patients being treated at the hospital and in local oncologists’ and radiation oncologists’ offices. This affiliation has allowed patients in the Las Vegas area to participate in national clinical trials that would otherwise not have been available to them.

These clinical trials are available to the patients because UMCSN is a member of national cooperative oncology groups through its affiliation with the NCRF-CCOP. These cooperative oncology groups serve as ‘research bases’ for the NCRF-CCOP and provide a portfolio of clinical trials from which the NCRF-CCOP and UMCSN are able to choose studies that best fit the patient population. The Cooperative Groups which UMCSN is affiliated with via the NCRF-CCOP include: the Cancer and Leukemia Group B (CALGB), Eastern Cooperative Oncology Group (ECOG), Southwest Oncology Group (SWOG), National Surgical Adjuvant Breast and Bowel Program (NSABP), and the Radiation Therapy Oncology Group (RTOG). There are approximately 75 studies that are active currently and many more studies that are closed to new patient enrollment but the NCRF-CCOP and UMCSN continue to collect data on these patients. This collaboration will continue for many years as each study has a unique period of time where the patient is followed after active treatment. This may range from a few months to the lifetime of the patient.

In 2008, UMCSN became a member of the Children’s Oncology Group. The UMCSN now has about 65 pediatric oncology studies available for children with leukemia and renal cancers as well as correlative science and quality of life studies.

UMCSN has been instrumental in the success of the NCRF-CCOP program due to the support and commitment of the UMC administration, as well as the medical and nursing staff of the Pediatric and Oncology Units.

For more information on the Nevada Cancer Research FoundationCommunity Clinical Oncology Program, phone (702) 384-0013.

UMC 2009 Melanoma By AJCC Stage 2007 Melanoma, UMC Vs NCDB By AJCC Stage

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Melanoma Graphs

UMC 2005 Melanoma, Survival By AJCC Stage

UMC 2009 Melanoma By Subsite

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UMC 2009 Melanoma By Age Range

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UMC 2009 Melanoma By GenderPe

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The Cancer Registry at UMC is just one of the important parts of an American College of Surgeons approved Teaching Hospital Cancer Program. The registry collects, manages, and analyzes data on patients who are diagnosed with a malignancy or treated for a malignancy at UMC. In 2010, the registry performed a Long Term Survival PCE study on Analytic CERVICAL Malignancies diagnosed in 2005. The Cancer Registry at UMC was established in 1979 and its’ reference year is 1995. There are approximately 12,296 cases in its database with 942 new cases accessioned into the registry in 2009 and approximately 4,526 patients followed annually.

The registry’s primary goal is to assist the hospital in providing optimal care to the cancer patients. To ensure a credible database, the registry performs ongoing quality control checks through IOP (Improving Organizational Performance) improvement procedures on case finding for both pathology andDisease Index List sources of cases and also maintains the quality of registry data with a review of ten percent of analytical cases by Cancer Control Committee Member. These findings are reported to the Cancer Control Committee quarterly.

2009 All Sites By Systems

2009 Cases By Ethnicity

2009 By Pay Source2009 Age At Diagnosis

UMC CANCER REGISTRYRobyn Simon, CTR

Cases By Gender

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