Cover of the program from the groundbreaking event.

2

Since its inception 25 years ago, the Merle M. Mahr Cancer Center has strived to offer the best care possible in Western Kentucky. At the Merle M. Mahr Cancer Center, we’ve found that the best approach to cancer care is based on a team approach. Our medical oncology, radiology oncology and surgical departments are united in patient care. We also have a vast network of professional contacts at hospitals such as the University of Louisville and Vanderbilt that support our efforts. Our caregivers know the healing process is as much an emotional journey as a physical one. By putting patients’ needs first, the Merle M. Mahr Cancer Center averages 96 percent in patient satisfaction. We hope that neither you, nor anyone in your family, is ever faced with the need to seek cancer treatment. However, if you ever are, we are confident that if you come to the Merle M. Mahr Cancer Center, we will not only work to fight the disease, we also will offer you the knowledge and compassion you need to heal.

– E. Berton WhitakerPresident and CEO

3

A Remarkable HistoryThis year, the Merle M. Mahr Cancer Center celebrates its 25 year anniversary. Since 1985, the center has been providing quality cancer care, enabling Western Kentucky residents to stay close to home. With the influence of Dr. Merle Mahr’s vision, today the Merle M. Mahr Cancer Center diagnosis more than 435 cancer patients each year. Last year, the center had more than 19,000 patient visits and performed more than 35,000 cancer treatments. We stand strong in our history of meeting our patients’ needs.

Dr. Mahr, a nationally-known surgeon and pioneer in cancer treatment in Western Kentucky, came to Madisonville in 1953 with his wife, Glema. He became one of the five Trover Clinic founding partners with Doctors Loman Trover, Faull Trover, Fred Scott and John Haynes. His surgery practice at Trover Health System (then Trover Clinic Foundation) spanned 35 years until his retirement in 1987. During his career, Dr. Mahr was a major force in the growth of both Trover Clinic and Regional Medical Center. He was a member of the Board of Directors of Trover Clinic Foundation and was instrumental in the development of the first core curriculum in surgery for junior medical students outside the University of Louisville. Additionally, Mahr served as a clinical professor of surgery at the University of Louisville School of Medicine, was a fellow of the American College of Surgeons, a member of the American and Kentucky Medical Associations, a Cancer Liaison Fellow, a national surveyor for Outpatient Facilities and Ambulatory Health Care and a Senior Member of the Kentucky Surgical Society.

Merle M. Mahr at the groundbreaking for the Merle M. Mahr Cancer Center

on May 23, 1984.

4

Being a dedicated and diligent practitioner of his profession, Mahr was instrumental in the initiation of the American College of Surgeons Certified Cancer Registry Program at Hopkins County Hospital in 1972. He also served on the Board of Directors of the McDowell Cancer Network Board in Lexington.

Dr. Merle M. Mahr passed away at Regional Medical Center on December 22, 1991. He left a lasting legacy of quality medical care. Dr. Mahr touched many lives, saved many lives and will continue to do so through the cancer center named in his honor.

Remembering a Generous SpiritIn 2010, the community lost Glema Mahr, the widow of Dr. Mahr. Mrs. Mahr was born in Nebraska and married Dr. Mahr, her high school sweetheart, in 1941. The couple moved to Madisonville in 1953, and made many great contributions to the community, giving of their time, their talents, and their money. Upon her death, we learned that Mrs. Mahr established a generous grant for the Merle M. Mahr Center to be used for equipment, education and research, and improvement and expansion of the building. This year, the center has already begun to put these funds to good use. Mrs. Mahr’s gift has been used to purchase a new linear accelerator, a vital piece of equipment to any cancer center. The linear accelerator is used in radiology treatment. Additionally, funds will be used to remodel the center in phases.

Construction of the Merle M. Mahr Cancer Center in March 1985.

5

About Our FacilityTrover Health System’s Merle M. Mahr Cancer Center provides a comfortable, caring atmosphere for patients to visit their physicians through office appointments and receive chemotherapy or radiation treatments. State-of-the-art treatment is provided through a highly qualified, specially trained clinicians and support staff. Patients are our focus, and we strive to meet each patient’s individual needs. At the Merle M. Mahr Cancer Center, we attribute our above-average outcomes to the fact that our medical oncology, radiation oncology and surgical departments are united in patient care.

The Merle M. Mahr Cancer Center is Kentucky’s oldest Community Hospital Cancer Program to consistently hold accreditation with the American College of Surgeons. The Approvals Program sets standards for cancer care and reviews those programs to ensure they conform to the high standards set by the American College of Surgeons. Approval by the Commission on Cancer is earned only by those facilities that have committed to provide the best in diagnosis, treatment, and prevention of cancer and have successfully completed a rigorous evaluation process. Approved cancer programs are required to undergo an onsite re-evaluation every three years. Only slightly more than one-fifth of the country’s hospitals have approved cancer programs, and more than 80 percent of patients who are newly diagnosed with cancer are treated in these facilities.

Dr. William Jernigan, Dr. Jack L. Hamman, and Dr. Merle Mahr with the Tree of Life.

6

Clinical ServicesRadiation Therapy – The Merle M. Mahr Cancer Center includes an experienced and dedicated team trained in providing radiation treatment to cancer patients with compassionate care. Before a patient’s first treatment, the Radiation Oncologist meets with the patient to determine what kind of radiation will be most effective.

The Radiation Therapy team includes a Certified Medical Physicist, Certified Medical Dosimetrist, Registered Radiation Therapists and Radiation Nurses. A Continuing Quality Improvement Program is in place to meet the high standards of the American College of Surgeons accreditation. Program members coordinate efforts to ensure continuous improvements of patient care and clinical outcomes. All members of the Radiation Therapy team at Trover are dedicated to continuing medical education in order to eliminate treatment errors and ensure patient safety.

Radiation therapy treatments are delivered in our facility using state-of-the-art equipment:

Linear Accelerator – Currently, the center has a Seimens Oncor and is in the process of installing a Varian 21EX linear accelerator. Linear accelerators are used to deliver high intensity X-Ray treatments or high energy electron treatments to the tumor. This treatment utilizes a set of

The center’s first linear accelerator being installed in August 1985.

7

sliding strips of metal called a Multileaf Collimnator to protect healthy, non-cancerous tissue while maximizing the radiation dose delivered to the tumor.

Dedicated CT Simulator – A dedicated CT scanner located within our department allows the physician to accurately direct the radiation treatments. Because the dedicated CT simulator is located in our department, we are able to reduce patient wait times.

Intensity Modulated Radiation Therapy – This noninvasive procedure allows for pinpoint delivery of radiation therapy, resulting in better tumor control and spares the healthy tissue from the radiation dose. Better control results in less damage to healthy tissues and organs surrounding the tumor, increasing a patient’s chance of a better quality of life.

Image Guided Radiation Therapy – This procedure utilizes radiographic or ultrasonic imaging devices to accurately position the patient to within millimeter tolerances.

Low Dose Brachytherapy – Radioactive sources are inserted in or around the cancerous tissues. This treatment option is used to treat gynecological cancers as well as some lung cancers. The sources are left in place for the amount of time determined as needed by the Radiation Oncologist and Physicist. This invasive procedure

allows for treating the tumor from the inside-out as opposed to the external radiation produced by linear accelerator treatments.

Medical Oncology – The Merle M. Mahr Cancer Center Medical Oncology department is comprised of physician practice, and chemotherapy infusion. Patients receive their needed lab and X-Rays, see the physician and receive their chemotherapy treatments most of the time on the same day.

Chemotherapy – Our registered nurses are specially trained in the most current chemotherapy agents and regimens. They act as patient advocates by providing information regarding the disease and educating on the chemo process. Certified RNs, and some with the National Certification by the Oncology Nursing Society, provide treatment follow-up to assess the patient’s chemo process. These nurses also act as a patient liaison to the physicians.

Infusion Services – The Outpatient Infusion Center at the Merle M. Mahr Cancer Center is dedicated to meeting the needs of patients from a variety of medical settings who require infusion services, including:• Injections • IV fluid administration • IV antibiotic administration • Blood and blood product transfusions

8

• Blood draws from implanted venous access devices and PICC lines.Nurses are available Monday through Friday starting at 8 a.m., to help patients.

State of the Art Imaging• Pet/CT• MRI/Breast MRI• Digital Mammography• Stereotactic Breast Biopsy• Ultrasound Biopsy

Nutritional Care – Nutrition plays a very important role in the fight against cancer. For this reason, a registered dietitian is available to all Merle M. Mahr Cancer Center patients.

Spiritual Care – Regional Medical Center employs a full-time chaplain who oversees the spiritual care of our patients. The Merle M. Mahr Cancer Center also is fortunate enough to have dedicated volunteer chaplains and spiritual counselors who provide services to our patients exclusively.

Clinical Trials – The Merle M. Mahr Cancer Center currently follows approximately 60 patients who are enrolled in a clinical trial through the Eastern Cooperative Oncology Group, or Radiation Therapy Oncology Group. A dedicated research associate follows all patients

entered on clinical trials to ensure that all requirements are met.

Cancer Registry – The Cancer Registry is a computerized database that is connected to the Kentucky Cancer Registry system, a statewide system for collection of cancer data. All cancer cases diagnosed at Regional Medical Center are entered into the database.Cancer Conferences are scheduled every Wednesday at noon. This provides the opportunity for a multidisciplinary team of physicians, nurses and other cancer care providers to assemble and hear the physician discuss treatment options that are then presented to the patient by their physician.

Supportive CareA diagnosis of cancer can be devastating for both the patient and family. Family roles may suddenly change. Underlying problems may come to the forefront. Support groups can offer an outlet for these worries and can help aid in treatment.

American Cancer Society – Trained information specialists assist cancer patients, their families and the public 24 hours a day, seven days a week at the American Cancer Society’s toll-free number, 800.227.2345. Specialists provide current information on transportation, housing, financial assistance, support groups, American Cancer Society programs and other local resources. Cancer information also is available online at www.cancer.org.

9

Look Good…Feel Better – The American Cancer Society’s Look Good…Feel Better is a beauty program for women going through or recently completing treatment. ACS-trained volunteer cosmetologists teach makeup techniques, skincare and options related to hair loss, such as wigs, turbans and scarves. Each participant receives a free cosmetics kit.

Reach to Recovery – The American Cancer Society volunteer visitation program matches breast cancer survivors with those concerned about breast cancer. Whether the person has been diagnosed with breast cancer, had surgery or found a suspicious lump, a Reach volunteer lends an ear, shares resources and offers emotional support.

Road to Recovery – Road to Recovery is an American Cancer Society program that provides cancer patients with transportation to and from medical facilities for treatment. Volunteer drivers help keep them on their regular treatment schedule.

Also offered is the General Cancer Support Group and the Becky West Breast Cancer Support Group, as well as Grief Camps for children who have lost parents to Cancer.

National Cancer National Cancer InstitutesCancer Information Center – NCI’s central Web site,

www.cancer.gov, has extensive information on cancer prevention, diagnosis, treatment, statistics, research, clinical trials and news, as well as links to other NCI Web sites. Trained cancer control specialists are available at the toll free hotline, 800.4.CANCER, to answer questions and provide cancer education materials.

Local Cancer Resource Guide – The Kentucky Cancer Program publishes the PATHFINDER, a local cancer resource guide for cancer patients and their families. The guide is available at the Merle M. Mahr Cancer Center or by phoning the Kentucky Cancer Program at 270.821.4398.

The Shelly Coffman Patient Library – The Shelly Coffman Patient Library at the center was donated in the memory of patient Shelly Coffman, and provides patients access to computer use, the Internet and multiple Web sites related to cancer care. Also available are books, educational brochures, treatment information and more.

Additionally, the Merle M. Mahr Cancer Center offers the use of wigs, free of cost to patients. The wigs are supplied to the Merle M. Mahr Cancer Center from various donors. Students from the local beauty college volunteer their time to wash and style the wigs.

Financial Advocacy – All patients have access to a Financial Counselor, who guides them through the financial aspect of their care.

10

This gives patients peace of mind before their treatments begin.

Social Services/Case Management and Home Health/Hospice are available by referral.

Relay For Life of Hopkins County – Each year, the Merle M. Mahr Cancer Center, along with other departments throughout Trover Health System plays a huge part in the Relay for Life. Trover Health System is a sponsor every year, and a top fund raiser for the event. The Merle M. Mahr Cancer Center hosts fundraisers year-round to support Relay for Life, the Survivors Dinner and other Relay events.

Prevention and Awareness ProgramsColon Cancer Screening – Each March, the Merle M. Mahr Cancer Center, in coordination with the Kentucky Cancer Program, hosts a Colon Cancer Screening. This consists of participant education, and a take-home kit to check for blood in the stool.

Prostate Cancer Screening – Although screening for Prostate Cancer Screening is controversial, we follow the guidelines from the American Cancer Society, and offer a screening each September in coordination with the Kentucky Cancer Program and the American Cancer Society. We feel this is a community service for men who may

have need and are not able to see a regular doctor for prostate health.

Think Pink! A Breast Health Education – Sponsored by a grant from the State of Kentucky, Dr. Darren Chapman, general surgeon and Cancer Program Clinical Liaison, as well as various other members of the Cancer Team, provided education to women of Hopkins, Webster and Muhlenberg Counties about breast cancer and breast health.

Smoking Cessation – The West Area Health Education Center offers the Cooper Clayton Smoking Cessation Program to help people break the habit through free classes for individuals, businesses and organizations. The program is co-sponsored by Trover Health System and the Kentucky Cancer Program.

Health Fairs – Staff members participate in numerous health fairs throughout the year to promote wellness and preventive education to the community. Friday Night Live, Carhartt, church groups, and various other organizations ask the Merle M. Mahr Cancer Center to participate in these events. Our participation is just another way to reach the community members of Hopkins County, and educate them on the importance of preventive health and awareness.

11

900 Hospital Drive l Madisonville, KY 42431 l 800.295.6247 l www.troverhealth.org

2009 Data

Cancer Program

2010

ANNUAL REPORT

Muhammad Siddique, MD – Chairman 2010Hematology/Oncology

Sarah E. Snell, MD – Chairman 2009General Surgery/Surgical Oncology

Darren Chapman, MD- ACoS Liaison 2010General Surgery

William A. Logan, MD – ACoS Liaison 2009Otolaryngology – Head & Neck Surgery

Suresh Devineni, MDHematology Oncology

Satish Shah, MDRadiation Oncology

Justin Sedlak, MD Pathology

T. Mark Stanfield, MDCardiothoracic Surgery

Craig Lundquist, MDDiagnostic Radiology

Richard Bauer, MDPathology

Harry Debandi, MDUrology

Diana Jackson, RN, BSN, OCNDirector of Oncology ServicesCancer Program Coordinator

Jenifer Miller, RN, OCNClinical Trial Research Associate

Shari Walker, RT(T)Radiation Lead Therapist

Sarah Lynch, RNInpatient Oncology Services

Sheila Baker, RDFood & Nutrition

Rev. Bill McCannChaplain

Heather BlairACS Community Program Representative

Margo Ashby, Pharm DDirector of Pharmacy

Judy Blue, CSWClinical Social Worker/Patient Representative

Joan Lang, MBARegional Coordinator, KY Cancer Program

Teresa Ford, CTRCancer Registry

Stacy Littlepage, CTRCancer Registry Coordinator

AD-Hoc members:William Crump, MDFamily Practice Residency Faculty

Mary Ellington, RNAssistant Director

Gerald Dysert, MD Obstetrics & Gynecology

Timothy DukesVice President of Operations

2009-2010 Cancer Committee

New Cancer Cases 2009 – Major Sites

Site RMC Kentucky National

Lung – (SC & NSC) 21.9% 17.9% 14.8%

Breast, female & male 15.8% 15.7% 13.0%

Colorectal 15.1% 11.2% 9.9%

Malignant Melanoma 5.5% 4.0% 4.6%

Prostate 3.7% 9.2% 13.0%

• National estimated new cancer sites by American Cancer Society “Facts & Figures” 2009

• 2009 Regional Medical Center and Kentucky figures are actual to date• Kentucky information obtained from the Kentucky Cancer Registry

2009 Case Frequency Report

Site Total Cases

RMC Percent

State Percent

Trachea,bronchus,lung-NSC/SC 96 21.92% 17.89%

Breast, female & male 69 15.75% 15.66%

Colorectal 66 15.07% 11.23%

Malignant melanoma 24 5.48% 4.01%

Prostate 16 3.65% 9.23%

Kidney 15 3.42% 3.56%

Bladder 15 3.42% 3.89%

Non-Hodgkin’s Lymphomas 15 3.42% 3.51%

Esophagus 14 3.20% 1.07%

Endometrium (corpus uteri) 12 2.74% 2.57%

Plasma cell tumors 11 2.51% 0.93%

Myeloprolif. & myelodysplas. 10 2.28% 0.98%

Other female genital organs 8 1.83% 1.52%

Larynx 7 1.60% 1.31%

Thyroid 5 1.14% 2.61%

Pancreas 5 1.14% 2.04%

Unknown primary 4 0.91% 1.67%

Cervix 4 0.91% 0.89%

Lymphocytic leukemias 4 0.91% 0.85%

Tongue 4 0.91% 0.71%

Brain 3 0.68% 1.17%

Stomach 3 0.68% 0.97%

Other skin 3 0.68% 0.24%

Other urinary organs 3 0.68% 0.42%

Connective & soft tissue 3 0.68% 0.56%

Other oral cavity 2 0.46% 0.03%

Gallbladder 2 0.46% 0.51%

Myeloid leukemias 1 0.23% 0.83%

Oropharynx 1 0.23% 0.75%

Small Intestine 1 0.23% 0.45%

Other leukemias 1 0.23% 0.15%

Hypopharynx 1 0.23% 0.20%

Other hematopoietic diseases 1 0.23% 0.05%

Floor of mouth 1 0.23% 0.22%

Liver 1 0.23% 0.83%

Gum & hard palate 1 0.23% 0.15%

Other respiratory 1 0.23% 0.16%

Testis 1 0.23% 0.40%

Other digestive tract 1 0.23% 0.28%

Ovary 1 0.23% 1.18%

Lip 1 0.23% 0.16%

Hodgkin's 1 0.23% 0.46%

Total 438

Case Counts by Year 2004-2009Site 2004 2005 2006 2007 2008 2009

Lip 3 1 1 2 2 1

Tongue 4 2 0 1 1 4

Salivary glands 1 2 0 1 0 0

Gum & hard palate 3 1 0 1 0 1

Floor of mouth 1 3 2 0 0 1

Buccal mucosa 0 1 0 0 1 0

Oropharynx 1 1 4 3 10 1

Nasopharynx 0 0 2 0 2 0

Hypopharynx 2 4 1 0 1 1

Other oral cavity 0 0 0 1 0 2

Esophagus 5 6 8 10 8 14

Stomach 3 8 6 4 3 3

Small Intestine 4 4 1 2 1 1

Colon 31 30 34 37 42 47

Rectum/Anus 18 19 18 18 10 19

Liver 3 0 0 2 5 1

Gallbladder 3 5 2 1 0 2

Pancreas 7 14 7 8 11 5

Other digestive tract 2 3 0 1 0 1

Nasal cavities,sinuses,ear 2 2 0 1 0 0

Larynx 4 7 7 9 3 7

Trachea,bronchus,lung-small 13 15 11 20 13 23

Trachea,bronchus,lung-NSC 60 59 75 97 72 73

Other respiratory 1 0 1 3 1 1

Bone 0 0 1 0 0 0

Connective & soft tissue 1 1 1 2 2 3

Malignant melanoma 17 14 12 19 13 24

Other skin 4 1 1 2 0 3

Breast, female & male 59 47 55 75 61 69

Cervix 5 4 4 7 6 4

Endometrium (corpus uteri) 6 2 10 11 12 12

Ovary 5 5 9 3 3 1

Other female genital organs 6 5 9 8 8 8

Prostate 61 39 36 36 34 16

Testis 0 0 0 2 1 1

Other male genital organs 1 0 0 0 1 0

Bladder 22 15 15 18 17 15

Kidney 11 7 9 14 18 15

Other urinary organs 2 3 8 4 3 3

Brain 5 2 7 4 1 3

Thyroid 11 1 6 3 3 5

Other endocrine 0 0 1 0 0 0

Hodgkin's 2 3 2 1 3 1

Non-Hodgkin's Lymphomas 20 15 19 25 20 15

Plasma cell tumors 9 12 7 6 7 11

Lymphocytic leukemias 6 9 14 7 5 4

Myeloid leukemias 2 3 5 4 4 1

Other leukemias 1 0 1 0 0 1

Myeloprolif. & myelodysplas. 9 21 16 19 15 10

Other hematopoietic diseases 0 0 0 0 0 1

Other & ill-defined sites 0 1 0 0 0 0

Unknown primary 9 8 9 6 8 4

Benign/borderline brain,cns 4 4 4 0 1 0

Total 449 409 441 498 432 438

CHAIRMAN’S REPORTThe Cancer Committee would like to sincerely thank Dr. Sarah E. Snell for her service as cancer committee chairman. Her guidance, leadership and service was an integral part of the success of our Cancer Program.

As incoming chairman, I am pleased to introduce the Merle M. Mahr Cancer Center’s 2010 Annual Report. The Trover Health System Cancer Program continues to provide high quality care to residents of Western Kentucky. From early detection programs, advanced diagnostic testing, multidisciplinary surgical, medical and radiation therapy treatment options to support programs, the cancer program truly provides comprehensive care close to home.

Our cancer program is deeply committed to preventing cancer and educating the public about the disease. This includes improving access to medical care, creating education and screening programs, and establishing partnerships with communities. Screening and prevention programs offered during past year included breast, prostate and colorectal cancers.

The cancer program has been continuously accredited by the American College of Surgeon’s Commission on Cancer since 1976. Since 80 percent of all cancer patients are diagnosed and treated at ACoS accredited programs, this participation allows our cancer program to compare our facilities experiences and trends with that of the nations through the data submissions to the National Cancer Data Base and participation in the Cancer Program Practice Profile Reports (CP3R). Our facility has continued to perform comparatively above the benchmark of 95 percent in both breast and colorectal cancer treatment. Survival outcomes have continuously benchmarked above state and national averages. The cancer committee recognizes that this is greatly in part due to the prospective multidisciplinary approach to cancer care. Oncology tumor board conferences are held weekly at Regional Medical Center. 154 prospective cases were presented in 40 tumor board conferences in 2009. The conferences are attended by members of the medical staff, residents, medical students and other ancillary personnel. Radiographic studies, pathological slides and case information are presented to allow for an open discussion forum including TNM staging and adherence to national treatment guidelines.

The cancer registry has accessioned more than 13,480 cases since it’s inception in 1973. In 2009, approximately 440 new cancer cases were accessioned into the cancer registry database. The cancer registry staff is continually following an average of 6,300 patients on an annual basis with a success rate of 92 percent. The cancer registry is part of the Kentucky Cancer Registry’s Cancer Patient Data Management System using a modern data encryption system with patient confidentiality and data security a top priority. Our cancer registry continually exceeds all expectations of data quality as evidenced by audits performed by the state, SEER and NCDB.

The 2010 Annual Report provides a multidisciplinary review of the current state of lung cancer care, comparing our local experience to state and national standards. If any further data or graphics are required, please contact Stacy Littlepage, CTR, at the Cancer Registry at 270.825.5820 or by e-mail at slittlep@trover.org.

Muhammad Siddique, MDOncology Advisory Board Chairman

Stacy Littlepage, CTRCancer Registry Coordinator

2010 Cancer Program Annual Report 3

4 2010 Cancer Program Annual Report

Note from the Cancer Program LiaisonDarren Chapman, MDThe Cancer Committee would like to sincerely thank Dr. William A. Logan for his efforts over the past 10 years as cancer liaison physician. He has made numerous contributions to the success of the Cancer Program.

As a new general surgeon at Trover Health System Regional Medical Center, it is with great pleasure that I was asked to serve as the American College of Surgeon’s (ACoS) Cancer Program Liaison. I was pleased to become a participant in such an active and vibrant multidisciplinary Tumor Board Conference that has been in place for more than 30 years. I feel such a Tumor Board Conference is critical to increase appropriate and timely care of our cancer patients. Comprehensive staging and discussion of the latest nationally recognized treatment guidelines are an essential part of each patient presentation.

I recently attended the Commission on Cancer sponsored sessions at the ACoS 96th Annual Clinical Congress in Washington, DC including the Cancer Liaison meeting. With the numerous new initiatives and standards of the Commission on Cancer, at both the national and state levels, cancer programs are challenged to ensure an exchange of quality information. Specifically, I have accepted the challenge of monitoring and interpreting our facility’s National Cancer Data Base submissions and employing this information to evaluate and improve the quality of care for our cancer patients at Trover Health System. I look forward to working with other Cancer Committee Members to ensure that the cancer program adheres to the Commission on Cancer Standards that are evaluated every three years. I am committed to maintaining the accreditation by the ACoS and to assure the highest level of care for all our cancer patients.

The American Cancer Society in Madisonville, KY ACS Activities Supporting CoC StandardsCoC Standard 6.1 – Supportive Services fiscal year 09 Results:n 737 Patients Served (126 underserved) in Market

Area FY 08-09 Total served in Hopkins – 224/41 (Last FY – 599 total patients served in Market

Area, 167/32 for Hopkins)

n Look Good…Feel Better – Sessions held bi-monthly at Mahr, next session October 12th

l 16 women served through this program this FY in Hopkins

n Reach to Recovery – ongoing breast support program, offers early support and post surgery

l 7 volunteer recruited/trained to visit with breast patients in market area

l 40 Reach visits made in Hopkins County area (140 for market area)

n Transportation Grant – funding to Mahr for 08/09 year - $2,000

l 26 patients served

n Road To Recovery – new volunteer program began March 09, provides rides for patients to treatment

l 3 patients assisted, 65 rides provided

n Direct Fax Referrals – since beginning last October, ACS has sent out 119 information packets and provided other resources to newly diagnosed patients referred by Mahr.

CoC Standard 6.2 – Prevention & Early Detection Programsn Provided materials, information, and volunteers for

local Screeningsn Partnership for Think Pink! Event last Octobern Added local Screening Information to ACS

National Resource Database

Contact InformationAmerican Cancer Society Staff Contact: Heather Blair, heather.blair@cancer.org, or 270.685.8702

Lung CancerT. Mark Stanfield, MDLung cancer is divided into two major types: non-small cell lung carcinoma and small cell lung carcinoma. Non-small cell lung carcinoma can be further subdivided into squamous cell carcinoma, adenocarcinoma, and other less common types. However, therapy for all types except small cell carcinoma is similar, and so they are often considered as a group. The primary risk factor for all types of lung carcinoma is cigarette smoking. Smoking rates in men increased during the twentieth century, and lung cancer rates increased accordingly. Similarly, rates of lung cancer in women increased after more women began to smoke. Lung Cancer is now the leading cause of cancer death in both men and women in the United States, and has been for several years. Approximately 215,000 new cases are diagnosed annually, and 160,000 people die of lung cancer each year. Less than 20 percent of those diagnosed will survive for 5 or more years. In the past few years, the incidence of lung cancer in United States males is decreasing, following a decrease in the rate of smoking. Unfortunately, Hopkins County, like the rest of Kentucky, continues to have high rates of both smoking and lung carcinoma.

Diagnosis and StagingDiagnosis of lung cancer is established by obtaining lung tissue samples (biopsy) or cell samples (cytology). Samples may be obtained through various procedures, including

bronchoscopy, CT guided transthoracic needle biopsy, mediastinoscopy, endoscopic ultrasound, thoracentesis, and video-assisted thoracoscopy.

Once the diagnosis has been made, the next step is staging; treatment and prognosis is different for each stage. Tools that are used for staging include CT scan, PET-CT fusion scan, bone scan, and mediastinoscopy.

TreatmentMultiple treatment approaches are employed for the treatment of lung cancer. The disciplines involved in management include thoracic surgery, medical oncology, radiation oncology, pulmonology, radiology, pathology, and clinical trials program.

Surgery remains the mainstay of treatment for early stage non-small cell lung cancers. Due to new minimally invasive surgical techniques, recovery time is much faster. After surgery, chemotherapy with or without radiation therapy may be recommended to decrease the risk of

2010 Cancer Program Annual Report 5

0

20

40

60

80

100

2004

Non-SC

2005 2006

Diagnosis Year

2007 2008 2009

Sm Cell

Lung Cancer Incidence at RMC

relapse. Combined chemotherapy and radiation therapy may be used for locally advanced non-small cell lung cancer. Metastatic cancer is usually not curable and may be treated with chemotherapy and/or radiation, which can improve quality of life and survival.

Most early stage small cell lung cancers are treated with combined chemotherapy and radiation. Surgery is useful only for a small number of highly selected early stage small cell lung cancers. Chemotherapy is used to treat metastatic small cell lung cancer, and can result in dramatic improvements in the patient’s health and survival. Total disappearance of the cancer is sometimes achieved, although the cancer almost always recurs; metastatic small cell carcinoma is not considered curable.

Prevention, Outreach, SupportThe most effective lung cancer prevention strategy is smoking cessation. RMC offers smoking cessation programs to the public, as well as its employees, on a regular basis. Support groups are also offered for those with cancer, as well as professional spiritual, physical, and dietary support.

ScreeningNo screening techniques have proven to be effective for lung cancer. Studies have evaluated annual chest x-ray or CT scanning as a screening tool. Chest x-ray screening is not useful, although studies of CT screening are ongoing.

More than half of lung cancer cases present at an advanced stage when cure is not realistically possible.

Our ExperienceThe Cancer Committee at Trover has reviewed all lung cancer cases dating 2000 through 2008, and compared our data with the National Cancer Center Database and the Community Hospital Cancer Programs of the American College of Surgeons Commission on Cancer. Each year, Trover physicians cared for an average of 75 new cases of non-small cell lung cancer and an average of 16 cases of small cell lung cancer. In 2009, 73 cases of non-small cell lung cancer and 23 cases of small cell lung cancer were diagnosed and treated.

As the following tables show, our experience and success with lung cancer treatment is similar to the national experience. Survival rates for both small and non-small lung cancers at our center are comparable to CHCP and NCDB (figures 5 & 10). Although the numbers are small, there does appear to be a trend toward treatment at RMC, as opposed to no treatment, compared to national figures. Abbreviations used in the following tables include Regional Medical Center, NSC Lung Cancer (non-small cell lung cancer), SC Lung Cancer (small cell lung cancer), NCDB (National Cancer Data Base), and CHCP (Community Hospital Cancer Programs)

6 2010 Cancer Program Annual Report

0

3

6

9

12

15

Figure 1: NSC Lung cancer incidence RMC vs NCDB

Diagnosis Year of Lung, Bronchus - Non-Small Cell Carcinoma Cancer Diagnosed in 2000-2008

2000 2001 2002 2003 2004 2005 2006 2007 2008

9%

11% 11% 11% 11% 11%

12% 12% 12%

11% 11% 11%

12% 12%

14%

10%

9% 9%

0

5

10

15

20

25

30

35

40

Under 20 30-39 40-49 50-59 60-69 70-79 80-89 90 and over20-29

0% 0%1%

5%

16%

30%

32%

28%

25%

39%

15%

1%2%

7%

Figure 2: Age at Diagnosis (RMC vs NCDB)

Age Group of Lung, Bronchus - Non-Small Cell Carcinoma Cancer Diagnosed in 2008

NCDBrmc

7

0

5

10

15

20

25

30

35

40

25%

19%

0%

7%6%

26%

23%

33%

36%

14%

9%

0%

0 I II III IV OC UNK

Figure 3: American Joint Committee on Cancer Stage at Diagnosis (RMC vs NCDB)

Stage of Lung, Bronchus - Non-Small Cell Carcinoma Cancer Diagnosed in 2008

0

5

10

15

20

25 Figure 4: First Course Therapy (RMC vs NCDB)

First Course Treatment of Lung, Bronchus - Non-Small Cell Carcinoma Cancer Diagnosed in 2008

Surgery Only Radiation Only Surgery & Chemotherapy

Radiation & Chemotherapy

Chemotheraphy Only

Surgery, Radiation &

Chemotherapy

Other Specified Therapy No 1st Course Rx

21%

14%

18%19%

5%

9%

21%

12%

14%

5%

9%

14%13%

3%2%

22%

NCDBrmc

8

Sample size too small for stage comparisons for RMC

Overall survival comparison for NSLC at RMC was 12.8% compared to CHCP Category at 12.2% and all NCDB Programs at 15.7%.

9

${meta.name}

0

10

20

30

40

50

60

70

80

90

100

Years From Diagnosis

Cum

mul

ativ

e Su

rviv

al R

ate

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

0

10

20

30

40

50

60

70

80

90

100

Years From Diagnosis

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Cum

mul

ativ

e Su

rviv

al R

ate

Figure 5: First year survival rate (RMC vs NCDB)

Observed Survival of Lung, Bronchus - Non-Small Cell Carcinoma Cancer Diagnosed in 2003Data from 1 Program (RMC)

Occult Stage 0Stage I Stage II

Stage III Stage IV OVERALL

Data from 1313 Programs (National)

0

10

20

30

40

50

60 Figure 7: Age at Diagnosis (RMC vs NCDB)

Age Group of Lung, Bronchus - Small Cell Carcinoma Cancer Diagnosed in 2008

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90 and over

0% 0% 5%

19%

34%

30%

11%

1%

8% 8%

58%

17%

8%

NCDBrmc

10

0

3

6

9

12

15

Figure 6: SC Lung Cancer Incidence RMC vs NCDB 2000-2008

Diagnosis Year of Lung, Bronchus - Small Cell Carcinoma Cancer Diagnosed 2000-2008

11% 11% 11% 11% 11% 11% 11% 11% 11%

9%

15%

8%

10%

9%

10%

12%

14%

12%

2000 2001 2002 2003 2004 2005 2006 2007 2008

0

10

20

30

40

50

Radiation Only

5%

38%

42%

4%

22%

50%

42%

8%

Radiation & Chemotherapy

Chemotherapy Only

Other Specified Therapy No 1st Course Rx

Figure 9: First Course Therapy (RMC vs NCDB)

First Course Treatment of Lung, Bronchus - Small Cell Carcinoma Cancer Diagnosed in 2008

NCDBrmc

11

0

10

20

30

40

50

60

0 I II

Figure 8: AJCC Stage at Diagnosis (RMC vs NCDB)

Stage of Lung, Bronchus - Small Cell Carcinoma Cancer Diagnosed in 2008

III IV OC UNK

0% 0%6%

3%

27%

55%

10%

17%

50%

33%

12

Cancer Related Educational Opportunities for StaffWeekly tumor board conferences are open to all physicians, students and ancillary staff. 1 Category I CME is offered for each conference.

Total Attendance

Total MD Attendance

1/15/2009 Treating Tobacco Use and Dependence Effectively in Hospitalized Patients 60 41

3/5/2009 Increasing Colorectal Cancer Screening in Primary Care 80 46

5/14/2009 New Advances in Breast Cancer Treatment 55 37

5/21/2009 PET Images: Questions and Answers 60 40

6/17/2009 Standard 4.3: Staging and Treatment Planning ( CoC Webinar) 4 2

8/18/2009 Module I: Nicotine Dependence (Hopkinsville) 3 3

9/3/2009 The Kidney in Plasma Cell Dyscrasias 50 33

9/9/2009 Tobacco Dependence: An Academic Detailing Project (Powderly) 4 4

9/22/2009 Tobacco Dependence: An Academic Detailing Project (Hopkinsville) 3 3

9/23/2009 Using Motivational Interviewing to Help Your Patient Quit Smoking 18 0

9/24/2009 An Evidence Based Approach to Treating Tobacco Dependence 63 40

11/12/2009 Hematuria and Evaluation 59 40

12/16/2009 Debunking Urban Legends in Staging (CoC Webinar) 5 3

3/29/2010 AJCC 7th Edition Staging Series: The New Staging System for Lung Ca (CoC Webinar) 10 5

4/1/2010 Appendiceal Tumors 56 39

4/14/2010 Lung Cancer: The New Staging System 46 35

Figure 10: Five Year Survival Rate (RMC vs NCDB)

Observed Survival of Lung, Bronchus - Small Cell Carcinoma Cancer Diagnosed in 2003Data from 1281 Programs (National)

RMC SCLC sample size too small for survival comparison graph

Overall survival comparison for SCLC at RMC was 4.8% compared to CHCP Category at 5.0% and all NCDB Programs at 5.6%.

0

10

20

30

40

50

60

70

80

90

100

Years From Diagnosis

Cum

mul

ativ

e Su

rviv

al R

ate

0.50.0 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0

Stage I Stage II Stage III Stage IV OVERALL