!"#$ Oncology Outcomes Report

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1 !"#$ Oncology Outcomes Report The Cleveland Clinic Florida Cancer Institute is dedicated to the comprehensive care of patients with cancer. Oncologists collaborate with a variety of physicians across multiple specialties to provide patients with access to comprehensive and compassionate care. Support services are provided to patients and their families to assist them during and after treatment. Extensive clinical research, including participation in trials sponsored by the National Cancer Institute (NCI) as well as Pharmaceutical sponsored trials, is performed. The goal of the program is to provide cancer patients with access to NCI- sponsored cancer treatment trials and up- to- date cancer management.

2 Diagnosis Groups Breast Colon & Rectum Prostate Lung & Bronchus Other 8. Bronchus & Lung 8.8% 15.2% 13.7% Colon & Rectum 12.6% 8.7% 9. CCF Florida Breast 16.8% 13.3% 29. USA Prostate 12.4% 14.6% 28. This graph compares Cleveland Clinic Florida s percentage of cases to the rest of Florida, as well as the United States. These figures were obtained from the 2013 Cancer Facts and Figures, published by the American Cancer Society and may represent estimates.

3 The Cancer Registry of Cleveland Clinic Florida operates under the direction of the Cancer Committee, providing data management services to meet mandatory state cancer reporting requirements, as well as those of the American College of Surgeons Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC). Cleveland Clinic Florida became accredited by the CoC in 2008, and was accredited by the NAPBC in Cancer registrars collect and analyze all reportable cancer cases, making data available for multiple uses including research, education and evaluating quality of care. The Cancer Registry database contains data including patient demographics, cancer diagnosis and treatment information, staging, and outcomes on cancer cases since The Cleveland Clinic Florida Cancer Registry was awarded the Jean Byers award for Excellence in Cancer Registration, in 2012, for completeness, timeliness, and quality of the data. Total Cases by Year In 2013, 1,440 new cases, diagnosed and/or treated in our hospital, were added to the Cancer Registry database. The top five primary sites include breast, prostate, lung & bronchus, colon and rectum. This table represents all new cases diagnosed and/or receiving initial treatment at Cleveland Clinic Florida.

4 Age Distribu:on Female Top Sites Breast Colon & Rectum Bronchus & Lung Thyroid Kidney Male Top Sites Prostate Colon & Rectum Bronchus & Lung 50 Kidney 37 Bladder

5 Breast Cancer Cleveland Clinic Florida s Breast Center is one of a few centers in Broward County to be accredited by the National Accreditation Program for Breast Centers (NAPBC). The program provides multidisciplinary care through a team of dedicated breast surgeons, breast medical oncologists, radiation oncologists, breast radiologists, breast pathologists, and plastic surgeons. Treatment of both benign and malignant breast disease is provided. Cases are presented in a multidisciplinary conference in which all members participate in developing a comprehensive care plan for the patient. Patients are encouraged to participate in a variety of support groups including the 4 th Angel Mentoring Program, the Breast Cancer Book Club, and The American Cancer Society s Look Good Feel Better program. Percentage of Screening Mammograms Resul:ng in Callback % 13.9% 12.9% Cleveland Clinic Florida offers a diagnostic callback program for patients with abnormal screening mammograms. The National Comprehensive Cancer Network (NCCN) benchmark is 5% to 15%.

6 Breast Surgery Mastectomy Lumpectomy The breast conservation rate is above 54% for all breast cancer surgeries. This exceeds the NAPBC ideal benchmark of 5 for breast conservation surgery in patients with stage 0, 1 or 2 breast cancer. Breast Cancer Stage Distribu:on 2013 Stage III 8% Stage IV 2% Unknown 1% Stage II Stage 0 3 Stage I 39%

7 Breast Cancer Quality Measures Radia:on ager Lumpectomy % Administered 97.7% Not administered Breast cancer patients <70 years of age who had a lumpectomy also had radiation therapy within 1 year. The American College of Surgeons Commission on Cancer s Cancer Program Practice Profile Report (ACoS/CoC CP3R) benchmark is 9. Tamoxifen or third generation aromatase inhibitors were administered within 1 year of diagnosis for >7 of women with American Joint Committee on Cancer (AJCC) stage T1c, or stage 2 or 3 hormone receptor positive breast cancer. ACoS/CoC CP3R benchmark is 9. Tamoxifen or Third Genera:on AI within 1 Year % 81.5% Considered or Adminsitered Not Administered Combina:on Chemotherapy within 4 months Administered Not Administered Combination chemotherapy was administered within 4 months for women <70 years of age with AJCC stage T1c, or stage 2 or 3 hormone receptor negative breast cancer. ACoS/CoC CP3R benchmark is 9.

8 Colon and Rectal Cancer Cleveland Clinic Florida's Department of Colorectal Surgery diagnoses and treats a broad array of diseases including colon cancer, inflammatory bowel disease, and functional disorders such as fecal incontinence. The Department of Colorectal Surgery is the largest colorectal surgery center in Florida and has the largest colorectal residency- training program in North America. Colorectal surgeons use a collaborative team approach with other specialties to provide high- quality patient care. One of the factors that set us apart is the number of treatment options available to save the sphincter and avoid the need for colostomy. These options include transanal excision and radical surgery with anastomosis of the colon to the anus, and more recently, incorporating a colonic J pouch reconstruction or coloplasty procedure. Using these techniques, our surgeons can avoid the need for a permanent colostomy in over the majority of cases while still achieving some of the lowest recurrence rates in the world. Regional Lymph Node Removal Colon Cancer % 90.7% 12 or more regional lymph nodes removed <12 regional lymph nodes removed Cleveland Clinic Florida s performance rate was 90.7% for the standard of care quality measure, at least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. The American College of Surgeons Commission on Cancer s Cancer Program Practice Profile Report (ACoS/CoC CP3R) benchmark is 85%.

9 Adjuvant Chemotherapy Colon Cancer Adjuvant chemotherapy not administered Adjuvant chemotherapy considered or adminsiterd Cleveland Clinic Florida s performance rate was 9 for the standard of care quality measure, adjuvant chemotherapy is administered within 4 months of diagnosis for patients under the age of 80 with AJCC stage III colon cancer. The American College of Surgeons Commission on Cancer s Cancer Program Practice Profile Report (ACoS/CoC CP3R) benchmark is 9. Colon Cancer Stage Distribu:on 2013 Stage IV 9% Stage III Unknown 2% Stage I 11% Stage II 58%

10 Radia:on Therapy Rectal Cancer % 88.5% Radiajon considered or administered Radiajon not administered Cleveland Clinic Florida s performance rate was 88.5% for the standard of care quality measure, radiation therapy is considered or administered within 6 months of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or stage III receiving surgical resection for rectal cancer. Rectal Cancer Stage Distribu:on 2013 Unknown 2% Stage IV 9% Stage I 11% Stage III Stage II 58%

11 Lung Cancer A highly specialized team of physicians cooperates to provide lung cancer patients with coordinated diagnosis and innovative treatment plans. Employing a multidisciplinary approach to manage and treat patients with lung cancer, pulmonologists (lung specialists), pathologists (tissue diagnostic specialists), medical and radiation oncologists (cancer treatment specialists), thoracic (chest) surgeons, and pain management experts collaborate to offer a full spectrum of diagnostic and therapeutic services. The complexity of lung cancer treatment requires input from various experts skilled in different medical specialties. Through the multidisciplinary clinic, number of specialists from a variety of disciplines, collaborate with each other to ensure that patients receive the best possible treatment. Lung cancer is the second most common form of cancer in the United States and the leading cause of cancer deaths. More women die of lung cancer than of breast cancer. While the rate of lung cancer cases appears to be dropping among Caucasian and African- American men, it continues to rise among both Caucasian and African- American women. Ninety percent of lung cancer cases are caused by cigarette, pipe or cigar smoking. Lung Cancer Stage Distribu:on 2013 Unknown 1% Stage I 23% Stage IV 43% Stage II 5% Stage III 28%

12 Lung Treatment Combina:ons % 21% Chemotherapy alone Radiajon alone Surgery alone 3 Combinajon treatment modality Regional Lymph Node Removal Lung Cancer % 68.7% 10 or more regional lymph nodes removed <10 regional lymph nodes removed Cleveland Clinic Florida s performance rate was 68.7% for the performance measure, at least 10 regional lymph nodes are removed and pathologically examined for AJCC stage IA, IB, IIA, and IIB resected non- small cell lung carcinoma. Cleveland Clinic Florida s performance rate was for the performance measure, systemic chemotherapy is administered within 4 months to day preoperatively or day of surgery to 6 months postoperatively, or it is considered for surgically resected cases with pathologic lymph node- positive (pn1) and (pn2) non- small cell lung carcinoma. Chemotherapy Administered Lung Cancer 2013 Chemotherapy adminsitered within jmeframe

13 Prostate Cancer Each year, approximately 200,000 U.S. men are diagnosed with prostate cancer and about 30,000 will die from the disease. Prostate cancer is the second most common malignancy in men. However, if found early, prostate cancer is one of the most treatable cancers. Prostate Cancer Stage Distribu:on 2013 Stage IV 9% Unknown 2% Stage I 11% Stage III Stage II 58% Prostate cancer is best managed in a multidisciplinary, integrated, and patient- centered format. Recurrence rates, survival, functional results, and patient satisfaction are optimized. Patients with early clinical stage at diagnosis have cancer confined to the prostate gland and are amenable to localized ablative treatment. At Cleveland Clinic in Florida, treatment is personalized and the patient s age, comorbid illnesses, clinical stage of disease, and personal expectations are considered. Treatment includes surgery, radioactive prostatic seed implantation, high dose radiotherapy (HDRT), or conformal beam therapy. Multi- modality therapy may be indicated based on individual cases and represented 5.6% of the patients. Prostate Cancer Treatment Combina:ons % 5% Hormone Therapy alone Radiajon alone 77% Surgery alone Combinajon treatment modality