04 Genomics and research

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1 Annual Report 04 Genomics and research Cutting-edge approaches in genomic medicine match targeted therapies to specific genetic changes at the cellular level. 01 Medical expertise A full range of cancer specialists provide excellent care, using the latest evidencebased practices and most current protocols Supportive services CANCER CARE DONE DIFFERENTLY Care for the whole person is offered through patient navigation, integrative medicine, spiritual care, social workers, patient advocates, support groups and more. 02 Latest technology State-of-the-art imaging, radiation therapy and cancer care technology ensures accurate diagnosis and precise treatment.

2 Message from the Cancer Committee It is an honor to serve with a team of professionals who provide cancer care services on the level of nationally-known cancer centers. As a result of this team effort, patients living within our region have the opportunity to receive a high level of care near home, family and loved ones. Michael Peterson, MD, Cancer Committee Chairman The Seventh Annual Simply D Vine fundraiser was another huge success this year. More than 400 people attended the event and over $80,000 was raised to help support cancer patients. The event helps provide care and transportation to qualified patients. It also funds education and wellness opportunities for both patients and caregivers. Our health care professionals participate in continuing education to stay abreast of the latest developments in the prevention, early detection, diagnosis and treatment of cancer. They provide patients with access to a variety of community resources such as a monthly cancer support group and a breast cancer support group. Cancer Committee has a close relationship with the local American Cancer Society (ACS). The ACS participates in our Cancer Committee meetings, and some of our Cancer Committee members serve on the state Cancer Control Committee and the local unit of the American Cancer Society. Our community participates in the American Cancer Society Relay for Life event and fundraiser. Avera Sacred Heart Hospital s cancer program has been accredited with the Commission on Cancer (COC) for over 50 years. In the past year our cancer program received the full three-year CoC accreditation with silver level commendation. Accreditation ensures that comprehensive care (including a complete range of state-of-the-art equipment and services) is available, that data analysis is ongoing and that clinical trials, cancer registry and prevention/early detection programs are in place. The CoC s recognition validates that is on par with the best community cancer centers in the country. Looking ahead to 2015, some of the goals our Cancer Committee plans to achieve are: 1) To ensure the cancer program continues to provide comprehensive cancer care services. 2) To provide and improve cancer screening programs. 3) To improve and expand educational programs for a wide range of medical professionals. Rhonda Mines, CTR Tumor Registry CANCER REGISTRY REPORT The Cancer Registry is a vital component of. Its primary purpose is to collect, analyze and disseminate cancer incidence data to ultimately assist in preventing and controlling cancer. There have been 2,440 cases entered into the Cancer Registry database, with a successful follow-up rate of 96 percent. In 2013, 258 cases were abstracted into the registry. Breast is our top site, representing 30 percent of our cases. We continue to submit our data to the National Cancer Data Base (NCDB) and South Dakota Cancer Data Collection System (SDCDCS) in Pierre, S.D., on an annual basis. This makes it possible for researchers to track trends in diagnosing and treating cancer. Twelve cancer conferences were held averaging 10 medical staff in attendance at each conference. Out of the 62 cases presented, 95 percent of the cases were prospective. The Cancer Committee has put great effort into our Cancer Conferences with presenting current cases. We really count on our medical oncologist, radiation oncologist, surgeons, and pathologist to bring prospective cases. Tumor Conference runs smoothly with this format and much is accomplished. The Cancer Registrar would like to thank the medical staff for their continued support in Tumor Conference. As Cancer Committee Chairman, I would like to acknowledge and thank the members of our Cancer Committee and all of the members of our cancer diagnosis and treatment teams for the high quality medical care they provide to our patients at Annual Report Annual Report 3

3 MOST COMMON CANCER SITES FOR 2013 Avera Cancer Insitute Yankton vs. American Cancer Society 30% 6% National Breast Prostate Colorectal Lung Bladder The most prevalent age at diagnosis was % 8% 70 10% 8% 4% AGE/SEX DISTRIBUTION 2013 ANALYTIC CASES Male 119 Cases (46%) Female 139 Cases (54%) The five most common sites at Avera Cancer Institute Yankton, were in this order, breast, colorectal, lung, urinary bladder and prostate. Cancer Facts and Figures-2013 predicted the most common sites would be in this order: prostate, breast, lung, colorectal and bladder. was slightly above national trends for breast, colorectal and urinary bladder. Prostate and lung were slightly below national trends. Male Female COUNTY OF RESIDENCE AT DIAGNOSIS 2013 CHARLES MIX 17 (10%) BOYD 6 (7%) HOLT 13 (15%) *All counts less than 3 are suppressed Data indicating less than three cancer cases in one county are suppressed as they may lead to identification of the person(s) and instability in interpretation. HUTCHINSON 10 (6%) BON HOMME 15 (9%) KNOX 29 (34%) PIERCE 12 () MADISON 6 (7%) YANKTON 101 (59%) CEDAR 16 () CLAY 19 (11%) South Dakota Counties, 170 cases *Douglas, Gregory, Hamlin, Hughes, and Turner 8 cases 5% Nebraska Counties, 86 cases Antelope, Boone and Dixon 4 cases 4% Geography: 258 cases were abstracted into the Avera Cancer Institute Yankton Tumor Registry in 2013, 65 percent were from South Dakota, 34 percent from Nebraska and 1 percent from Iowa. Overall, the majority of our cases diagnosed are from Yankton County, 39 percent Annual Report 5

4 2013 SITE/GENDER DISTRIBUTION Site CANCER BY STAGE Oral Cavity & Pharynx 1 1 Digestive System 4 na Colon/Rectum Larynx 2 na Lung & Bronchus Breast 2 75 Melanoma 6 3 Female Genital System na 7 Prostate 17 na Male Genital System 3 na Rectum 4 5 Urinary Bladder 20 1 Kidney & Renal Pelvis 6 1 V 1% 13% BREAST - 77 CASES 24% Stage 0 13% 49% V 32% LUNG - 28 CASES Stage Unkown 25% 25% 4% 29% PROSTATE - 17 CASES COLORECTAL - 31 CASES BLADDER - 21 CASES Stage I 6% 65% Stage Unknown 7% V 36% 24% Stage 0 57% Thyroid 1 11 Myeloma 3 na Leukemia 5 1 Lymphoma 11 4 Other percent of breast cases were diagnosed at an early stage (stage 0, I, II). 57 percent of lung cases were diagnosed at stage III or IV. 71 percent of prostate cases were diagnosed at stage I or II. 38 percent of colorectal cases were diagnosed at stage I or II. 100 percent of bladder cases were diagnosed at stage 0, I, or II. Total Analytic Cases Male 46%-119 Cases Female 54%-139 Cases The Cancer Registry welcomes any questions or requests for information and can be reached at or you can Rmines@avera.org. As Tumor Registrar, I am pleased to work with such a devoted Cancer Committee and look forward to the years to come Annual Report 7

5 Mom, wife and teacher learns and teaches throughout her cancer experience Jennifer Pritchett has learned a lot from her battle with triple-positive breast cancer, but she has also used the experience to teach others. The 34-year-old Lynch, Neb., woman is a social studies instructor in Niobrara, Neb., and has been very open about the experience with her classes. In fact, a group of six juniors, several of whom are considering health care as a career option, accompanied her during a recent trip to for radiation treatment. The staff at walked the students through every step of the treatment process with Pritchett, answered questions and shared why they find health care a fulfilling profession. Pritchett s journey began in January 2014, when she discovered a lump in her breast. She visited with her OB/GYN specialist, Kevin Bray, MD, who arranged for her to get a mammogram and biopsy. He also referred her to other physicians. After exploring her options, Pritchett received initial treatment at the Avera Cancer Institute Sioux Falls but was able to do her radiation treatments at. Throughout the treatment process, Pritchett didn t want her students or her own children to be scared. She and her husband, Brent, have four children: Chase, 10; Billie Rose, 8; Wade, 5; and Colton, 1. Instead of trying to hide her illness, Pritchett chose to be open about it and share information about her treatment process. In turn, her family, students and the communities where she lives and works have given her tremendous assistance. I ve had a great support system, she said. Pritchett has tried to set an example for her students, many of whom come from challenging conditions at home. She strives to demonstrate that, if bad things do occur, individuals can choose to handle them with grace and dignity, and attempt to turn them into positive experiences. Services and assistance from provided through the financial support of the Avera Sacred Heart Foundation have played a role in that support system, according to Pritchett. It has supplied things such as gas cards and counseling. It has eased the financial burden and alleviated the stress, Pritchett said. I consider myself lucky for as easy as everything has gone, she added. But I was determined not to let this illness kick me in the gut. The care in Yankton has been great, Pritchett said. The staff here is always very comforting, and so the treatments have gone fast. Dr. (Michael) Peterson has done an excellent job of explaining things to me. - Jennifer Pritchett Annual Report Annual Report 9

6 DISTRESS STUDY FINDINGS Megan Gleich, MSW AVERA CANCER INSTITUTE YANKTON 2013 CANCER COMMITTEE A study was conducted from Feb. 10, 2014 to Sept. 10, 2014 that measured patient distress ratings between their first and third week of cancer radiation treatments. Of the 31 patients who completed both the initial and three-week National Comprehensive Cancer Network (NCCN) Distress Screening Tool assessments, 42 percent experienced an increase in their overall distress score, 35 percent experienced a decrease in their overall distress score, and 23 percent experienced no change between the initial and three week distress screening scores. See Table 1, Chart 1. A review of the findings indicated that as patients progressed through their treatments they are more likely to experience an increase in overall distress. TABLE 1 Increased 42% Decreased 35% Stayed the Same 23% As a result of these findings, Avera Cancer Institute Yankton has implemented a new policy to better serve the psychosocial needs of its patients. This policy states that patients will be assessed using the NCCN Distress Screening Tool within five days of their initial treatment. If the patient has an overall distress rating of four or above on this initial assessment, they will be flagged for an additional assessment at the midpoint of their treatment. If at this midpoint assessment their distress is still at four or above, they will be flagged for a verbal assessment to be given upon their followup appointments. Should they continue to rate their distress above a four at their follow-up appointments, a referral will be made back to the social worker for assessment and referral of services. Cancer Committee members, pictured from left to right, front row: Dr. Michael Peterson, Dr. Max Farver, Dr. Gregory Taylor, Dr. Mary Lee Villanueva, Dr. Mary Milroy, Second Row: Rhonda Mines, CTR, Dr. Richard Strom, Darla Gullikson RN, OCN, Megan Gleich, MSW, Steph Reinhardt, RN, Dr. Jesse Kampshoff, Mary Pistulka RN, Robert Nicholas CHART 1 Overall Distress Responses Between Week 1 And Week 3 Increased Decreased Stayed the Same 23% 35% 42% This policy takes into consideration NCCN Distress Screening Tool guidelines, which classify an overall distress score of four or higher as a moderate-high response, indicating a need for service referrals and/ or continued contact with the social worker/mental health professional. An overall distress score of three or less indicates a low overall distress score, requiring no further intervention. In making these changes Avera Cancer Institute Yankton hopes to offer continuous psychosocial support to patients with high distress throughout the course of their treatment and into survivorship. Mary Milroy, MD, Surgeon Cancer Liaison Physician Michael Peterson, MD, Radiation Oncologist Committee Chairman Cancer Registry Quality Coordinator Richard Strom, MD, Pathologist Gregory Taylor, MD, Radiologist Ralph Tullo, MD, Radiologist Mary Lee Villanueva, MD, Medical Oncologist, Clinical Research Coordinator Darla Gullikson, RN, OCN Community Outreach Coordinator Christen Rennich, American Cancer Society Representative Lori McKee, BSN, MSHCA Administration Rhonda Mines, CTR, Cancer Registry Cancer Conference Coordinator Mary Pistulka, RN Palliative Care Stephanie Reinhardt, RN Quality Control Coordinator Megan Gleich, MSW Psychosocial Services Coordinator Annual Report Annual Report 11

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