Cancer Program ANNUAL REPORT

Transcription

1 Cancer Program ANNUAL REPORT

2 2015 Chairperson s Report HCGH Cancer Program Annual Report Reflecting back on what we have accomplished in HCGH s cancer program in 2015, we certainly have much to be proud of. Our sights are always set on high quality care, patient safety and bringing innovations in cancer care to our program, and 2015 was a year of growth for our program in several areas. Sally Cheston, M.D. This year, HCGH s cancer program received a three-year accreditation with silver level commendation as a Comprehensive Community Cancer Program (CCCP) from the American College of Surgeons (ACoS) Commission on Cancer (CoC), an accomplishment of which we are most proud. This recognition is another sign that HCGH s cancer program continues to deliver high-level care to those who turn to our oncology specialists. Central Maryland Radiation Oncology is a partnership between Howard County General Hospital, Johns Hopkins Medicine and the University of Maryland Medical System. With this relationship, we are able to adopt and implement new treatment modalities ahead of the curve of communitybased radiation oncology facilities which do not have an academic affiliation. For instance, the overwhelming majority of our breast cancer patients are now treated with hypo-fractionated radiation therapy, delivering the course of therapy with one half to one third fewer treatments than conventional therapy, while providing equal effectiveness and less toxicity. Cancer care in Howard County is significantly enhanced by this partnership. Our commitment to serving patients and our surrounding community also continued in The Central Maryland Oncology Practice recently introduced a new resource support program for patients to address some of their quality of life issues. The support program assists oncology patients with medical and non-medical issues that arise so that they can focus on their treatments. Comprehensive support services include prescription assistance, transportation to medical treatments, utility services, meal delivery, medical assistance and counseling services. Finally, HCGH, in partnership with Central Maryland Radiation Oncology, medical oncology and Johns Hopkins Community Physicians (JHCP), has been working to provide select patients with a survivorship visit at the culmination of cancer treatment. As our survivorship program continues to be developed in the coming year, we look forward to offering more patients with this visit, which provides a documented summary of their cancer treatment as well as recommendations for followup, ensuring that our cancer survivors thrive in their lives after cancer. As we continue to grow the HCGH cancer program and our services, we are providing our community with the highest level of cancer care as well as a future full of new possibilities. Sally Cheston, M.D. Radiation Oncology, Cancer Committee Chair 2

3 Cancer Conference Report Cancer conferences improve the care of patients with cancer by providing multidisciplinary treatment planning and contribute to physician and allied medical staff education. The HCGH Cancer Program currently offers four cancer conferences. Cases are presented at a point when patient care management can be directly influenced by the discussion. Each discussion includes the patients medical history; physical findings; diagnostic, pathologic and operative findings; staging; and treatment options. Discussions also include national evidence-based guidelines, protocol updates, literature reviews and presentation of cancer registry data General Conference Breast Conference Thoracic Conference Genito-Urinary Conference Day 2nd & 4th Friday Every Tuesday 3rd Friday 1st Tuesday Time 12:15 p.m. 7:30 a.m. 7:30 a.m. 12:00 p.m. Location: (Medical Pavilion) Suite G010 Suite G010 Suite G010 Suite G030 All Conferences Combined # of Meetings Attendance by Surgeon 5 (11%) 50 (98%) 7 (70%) 12 () 74 (80%) Attendance by Diag. Radiology 10 (44%) 51 () 4 (40%) N/A* 65 (81%)* Attendance by Pathology 17 (78%) 51 () 10 () N/A* 78 (98%)* Attendance by Med. Oncology 19() 51 () 10 () 12 () 92 () Attendance by Rad. Oncology 18 (89%) 50 (98%) 10 () 12 () 90 (98%) Total Attendance Average Attendance Total # of Patients Discussed Average # of Cases Per Mtg *Radiologists and Pathologists are not required to attend the GU conferences. Average attendance based on 80 total meetings. CASE DISTRIBUTION BY CONFERENCE General Breast Thoracic Genitourinary Site Cases Site Cases Site Cases Site Cases Lung 17 Breast 287 Lung 31 Prostate 48 Colorectal 9 Dx. Unk. 7 Bladder 8 NHL/Hodgkin 8 Mets. 6 Kidney 1 Breast 4 Benign 2 Met. Melanoma 1 Unk. Primary 4 NHL 1 Epididymis 1 Other Digestive 4 Thymoma 1 Testis 2 Female Genital 3 Pancreas 3 Skin-Melanoma 3 Liver 2 Urinary 2 Other 4 TOTAL All conferences are coordinated through the Oncology Data Office. For additional information, contact Sheryl Daugherty at sdaugherty@jhmi.edu or or Sharon Tunney at stunney1@jhmi.edu or

4 Cancer Registry Report Hospital-based cancer registries serve as the nation s primary source of oncology statistics. This comprehensive collection of patient data facilitates comparisons between individual facilities and the state, or the nation as a whole. As with all cancer registries, the role of the Oncology Data Office at HCGH continues to grow and evolve. With advances in cancer related research, technology and treatments, the registry collects more detailed information than ever before. Information collected and analyzed includes demographic, personal and family histories, risk factors, diagnostic procedures, site and histology, tumor markers, prognostic indicators, staging, treatment, follow-up and survival data for each case. The Oncology Data Office at Howard County General Hospital, a part of the Health Information Management Department, collects data on all cancer patients diagnosed and/or treated at this facility. In 2014, 623 analytic cases were accessioned to the registry s database (Table 1, page 5). This is a 5.75% decrease from Over the past year, the number of new breast cancer cases decreased 8.52% from 176 in 2013 to 161 in Breast cancer remained the most frequently seen primary site at Howard County General, making up 25.84% of the entire analytic case load. The second most frequently seen primary site in 2014 was colorectal with 77 cases (12.40% of the total caseload). This represents an increase of 26.23% over the 61 colorectal cancer cases accessioned in The other top primary sites seen at the hospital were lung, prostate, urinary bladder and non- Hodgkin lymphoma. The number of lung cancer cases decreased by 29.67% from 91 cases in 2013 to 64 in Prostate cases decreased from 35 to 29 over the past year. This is a decrease of 17.14%. Bladder cases decreased from 38 cases in 2013 to 29 in This is a decrease of 23.68%. Non-Hodgkin lymphoma cases increased by 3.57% from 28 cases in 2013 to 29 cases in For 2014, lung cancer cases made up 10.27% of the total analytic caseload. Prostate, bladder and non-hodgkin lymphoma cases were tied at 4.65% of the total analytic caseload. When compared to state and national statistics, HCGH continued to see breast and colorectal cancer cases as a significantly higher percentage of its total caseload. The incidences of bladder cancer cases were slightly higher at HCGH than for the state of Maryland and equal to that of the national data. The incidence of prostate and lung cancer cases were significantly lower than those of the state and nation (Table 2, page 6). Individual registries help hospital physicians and administrators track quality of care and treatment by monitoring compliance with national evidence-based guidelines. Registry data is also used by the hospital for cancer conference presentations, administrative reports, to evaluate staffing and equipment needs, and guide the development of educational and screening programs for both patients and the community. The Oncology Data Office staff also compiles the required documentation to insure the HCGH oncology program s compliance with all standards established by the American College of Surgeons (ACoS) Commission on Cancer (CoC) to maintain its accreditation as a Comprehensive Community Cancer Program (CCCP). For more information about the HCGH Cancer Registry, please call

5 TABLE 1 HCGH 2014 SITE DISTRIBUTION TABLE ANALYTIC CASES Sex AJCC Stage at Dx Primary Site Cases M F 0 I II III IV N/A UNK Oral Cavity, Pharynx Salivary Gland Floor of Mouth Tonsil Digestive Organs Esophagus Stomach Small Intestine Colon Rectosigmoid / Rectum Anus & Anal Canal Liver & Intrahep Bile Ducts Gallbladder Other Biliary Pancreas Other Digestive Organs Respiratory System Nose, Nasal Cavity & Middle Ear Larynx Lung & Bronchus Trachea, Mediastinum, Other Resp Skin (Excludes Squamous & Basal Cell) Melanoma Other Non-Epithelial Skin Soft Tissue Including Heart Breast Female Genital Organs Cervix Uterus Ovary Other Female Genital Organs Male Genital Organs Prostate Testis Other Male Genital Organs Urinary Tract Urinary Bladder Kidney & Renal Pelvis Brain / Other Nervous System Meninges/Brain/CNS Benign & Borderline Brain, Malignant Endocrine System Thyroid Other Endocrine including Thymus Lymphoma Hodgkin Lymphoma Non-Hodgkin Lymphoma Myeloma Leukemia Lymphocytic Myeloid & Monocytic Kaposi Sarcoma Unknown & Other Primary Site ALL SITES Abbreviations: M=male, F=female, UNK=unknown or unstageable, N/A=not applicable. Carcinoma in-situ/cin III of the cervix is not included. 5

6 TABLE 2 HCGH Top 5 Site Comparison: 2014 Analytic Cases Bladder US MD Prostate HCGH Site Lung Colorectal Breast US and MD statistics from ACS Facts and Figures Percent of Total Caseload TABLE 3 HCGH 2014 Analytic Cases Age by Sex Distribution Female Male Age at Diagnosis Number of Cases 6

7 TABLE 4 HCGH 2014 Analytic Cases Race Distribution 4% 3% 2% Caucasian 19% African American Oriental Asian Indian/Pakistani Other 72% Cancer Program Practice Profile Report (CP3R) Breast, Cervix, Colon, Endometrium, Gastric, Lung, Ovary and Rectal Cases Diagnosed Ongoing quality reviews monitor HCGH s compliance with nationally established evidence-based treatment guidelines for the management of care for cancer patients. This review includes 20 measures and compares our performance rate with those from our American Cancer Society (ACS) division, our census region, all CoC (Commission on Cancer)programs accredited at the same level as we are (CCCP Comprehensive Community Cancer Program), all CoC accredited hospitals in the state of Maryland and all CoC accredited programs in the entire U.S. This data is compiled by the National Cancer Data Base (NCDB) using information submitted by cancer registries at all CoC accredited hospitals. An accountability measure is the standard of care based on clinical trial evidence. They are used for public reporting, payment incentive programs, and the selection of providers by consumers, health plans, or purchasers. A quality improvement measure is one that demonstrates good practice but is not based on clinical trial evidence. They are intended for internal monitoring of performance within an organization. Surveillance measures are used to monitor patterns and trends of care in order to guide decision-making and resource allocation. Performance Rate (%) Title Measure Definition Breast Cancer Measures BCS Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer.(surveillance) 75.5% (71/94 cases) 70.2% (80/114 cases) 75.5% (77/102 cases) nbx Image or palpation-guided needle biopsy (core or FNA) of the primary site is performed to establish diagnosis of breast cancer. (Quality Improvement) 91.8% (89/97 cases) 95.5% (84/88 cases) 85.1% (97/114 cases) Table continued on page 8 7

8 Performance Rate (%) Title Measure Definition HT MASTRT BCSRT MAC CERRT CERCT CBRRT Breast Cancer Measures 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) Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >= 4 positive regional lymph nodes. (Accountability) 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) Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0, or stage II or III hormone receptor negative breast cancer. (Accountability) Cervical Cancer Measures Radiation therapy completed within 60 days of initiation of radiation among women diagnosed with any stage of cervical cancer (Surveillance) Chemotherapy administered to cervical cancer patients who received radiation for stages IB2-IV cancer (Group 1) or with positive pelvic nodes, positive surgical margin, and/or positive parametrium (Group 2) (Surveillance) Use of brachytherapy in patients treated with primary radiation with curative intent in any stage of cervical cancer (Surveillance) Colon Cancer Measures 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) 12RLN ENDCTRT ENDLRC G15RLN 10RLN LNoSurg LCT OVSAL OVCT RECRTCT At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. (Quality Improvement) Endometrial Cancer Measures Chemotherapy and/or radiation administered to patients with Stage IIIC or IV Endometrial cancer (Surveillance) Endoscopic, laparoscopic, or robotic performed for all Endometrial cancer (excluding sarcoma and lymphoma), for all stages except stage IV (Surveillance) Gastric Cancer Measure At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer. (Quality Improvement) Lung Cancer Measures At least 10 regional lymph nodes are removed and pathologically examined for AJCC Stage IA, IB, IIA, and IIB resected NSCLC. (Surveillance) Surgery is not the first course of treatment for cn2, M0 lung cases (Quality Improvement) 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) NSCLC. (Quality Improvement) Ovarian Cancer Measures Salpingo-oophorectomy with omentectomy, debulking/cytoreductive surgery, or pelvic exenteration in Stages I-IIIC Ovarian cancer (Surveillance) Chemotherapy started within 42 days (before or after) the Date of Most Definitive Surgery in Stages IA-IV Ovarian, Fallopian Tube, or Peritoneal cancers (Surveillance) Rectal Cancer Measure Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered; for patients under the age of 80 receiving resection for rectal cancer (Quality Improvement) (41/41 cases) (4/4 cases) 97.6% (40/41 cases) (11/11 cases) (1/1 cases) (1/1 cases) (1/1 cases) (2/2 cases) 94.4% (17/18 cases) 33.3% (2/6 cases) 0% (0/3 cases) (6/6 cases) 20% (1/5 cases) 40% (2/5 cases) (1/1 cases) 96.3% (52/54 cases) (6/6 cases) 93.2% (41/44 cases) 87.5% (7/8 cases) (7/7 cases) 96.9% (31/32 cases) (1/1 case) (4/4 cases) 66.7% (2/3 cases) 0% (0/4 cases) 50% (1/2 cases) (5/5 cases) 0% (0/1 cases) (10/10 cases) 92.3% (60/65 cases) (3/3 cases) 92.7% (51/55 cases) (6/6 cases) 87.5% (7/8 cases) (29/29 cases) 85.7% (6/7 cases) 50% (1/2 cases) 0% (0/1 cases) (4/4 cases) 0% (0/1 cases) 83.3% (5/6 cases) 8

9 TABLE 5 Comparison of 2013 CoC CP3R Accountability Measures (Std. 4.4) % Performance Rate 80.00% 60.00% 40.00% 20.00% HCGH ACS Division Census Region CoC Prgm Type Maryland US 0.00% HT MASTRT BCSRT MAC ACT MEASURE TABLE 6 Comparison of 2013 CoC CP3R Quality Improvement Measures (Std. 4.5) % Performance Rate 80.00% 60.00% 40.00% 20.00% HCGH ACS Division Census Region CoC Prgm Type Maryland US 0.00% nbx 12RLN G15RLN LNoSurg LCT RECRTCT MEASURE TABLE 7 Comparison of 2013 CoC CP3R Surveillance Measures Performance Rate % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% BCS CERRT CERCT CBRRT ENDCTRT ENDLRC 10RLN OVSAL OVCT MEASURE HCGH ACS Division Census Region CoC Prgm Type Maryland US 9

10 Focus On Melanoma The American Cancer Society estimates that over 73,000 cases of melanoma will be diagnosed in Melanoma most commonly starts in the skin, but it can start in other parts of the body. If diagnosed early, melanoma is almost always curable. Risk factors for melanoma include excessive exposure to ultraviolet radiation, pale skin, multiple or unusual moles, history of severe sunburns, old age and a weakened immune system. Melanoma is more than 20 times more common in Caucasians than in African Americans [Table 4, page 7]. Symptoms include change in the color or size of a mole, a new growth, or a sore that doesn t heal. Treatment for earlier stages of melanoma is usually surgical resection. More advanced stages may receive other/additional treatments. This can include chemotherapy, radiation therapy, immunotherapy or targeted therapy. At HCGH, there were 61 new cases of melanoma in This includes 22 In Situ, or Stage 0 cases, 24 stage I, 7 Stage II, 3 Stage III, and 5 Stage IV cases [Table 8, below]. The site distribution shows 22.41% of the cases were of the head and neck. Cases involving the skin of the torso made up 29.31% % were from the upper extremity and 22.41% from the lower extremity [Table 9, page 11]. The specific histology s included melanoma NOS, superficial spreading melanoma, nodular, lentigo maligna, acral lentiginous and spindle cell melanomas [Table 10, page 11]. Review of Analytic Cutaneous Melanoma Cases A retrospective review of all patients diagnosed and/or treated at HCGH for newly diagnosed melanoma between January 1, 2013 and December 31, This review included 61 cases and was done to evaluate compliance with national evidence-based treatment guidelines. TABLE 8 Stage 0 Stage I Stage II Stage III Stage IV Total Number of Cases Documented Breslow s Thickness N/A Documented Ulceration Status Documented Clinical N Stage Documented Mitotic Rate N/A Documented Regression Status Documented Vertical Growth Status N/A Pathologic Exam of Lymph Nodes Positive Lymph Nodes Surgical Resection Clear Margins

11 TABLE 9 HCGH Analytic Cutaneous Melanoma Site Distribution 6.90% 22.41% Head and Neck 22.41% Trunk Upper Limb/Shoulder Lower Limb/Hip Skin, NOS 18.97% 29.31% TABLE 10 HCGH Analytic Melanoma by Histology In Situ Spindle Cell, NOS Acral Lentginous Histology Lentigo Maligna Nodular Superficial Spreading Melanoma, NOS 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% Percent Caseload 11

12 The Year in Review Co-sponsored the Cancer Survivors Reception at the American Cancer Society s Relay for Life. HCGH was a corporate sponsor and sponsored a team, which raised over $14,000. Free monthly meeting space was provided for the American Cancer Society Leadership Council and the prostate cancer support group. The hospital provided space for Nicotine Anonymous meetings every Sunday evening. Oral cancer awareness education is provided during our Smoke Free Lungs class as well as at health fairs in the community. The Great American Smokeout, which provided tobacco prevention information to more than 100 staff and visitors, was held in November in the HCGH main lobby. Pulmonary function tests were also provided to 30 attendees. Through the Let Go of Tobacco program, HCGH provided patients in Labor & Delivery with brochures listing local resources and websites available for smoking cessation. Another phase provided anti-tobacco resources in local faith communities through the hospital s Community Cardiovascular Project. Parish-based volunteer nurses were provided with posters and brochures on smoking cessation to share while screening for hypertension. Tobacco prevention information was distributed to Maternal Child Health classes. Over 1,600 packets of information were distributed through this program. Twenty-six prostate cancer screenings were performed by urologists at the HCGH Wellness Center in April at the annual Topic of Cancer event. Distributed free colorectal cancer screening kits to the community at the Topic of Cancer event. In May, 49 skin cancer screenings were performed at the HCGH Wellness Center. Provided information on cancer risk reduction and the importance of early detection at health fairs throughout the year. The hospital s Speakers Bureau filled numerous requests for presentations on cancer risk reduction and the dangers of tobacco use. The Howard County Cancer and Smoke Free Tobacco Coalition was represented by a member of HCGH s Wellness Center Staff. The Howard Hospital Foundation raised over $217,000 for the Claudia Mayer/Tina Broccolino Cancer Resource Center (CMTBCRC), including nearly $150,000 from fundraisers including Blossoms of Hope events, the signature Autumn Extravaganza event, and many smaller events hosted by community members and local organizations. Participated in the Latino Health Fair. Free screenings, information booths and physician experts provided health information to over 300 attendees. Breast health, cancer prevention and BMI screenings were provided by HCGH staff. HCGH was a sponsor of Get Active Howard County, an annual healthy lifestyle program. Co-sponsored the 50+ Expo for thousands of seniors. Breast health information, blood pressures, BMI, pulmonary function tests, and other wellness programs were offered at Wilde Lake High School in October. 12

13 Approximately 1,700 BMI (Body Mass Index) screenings were performed in the community, due to the relationship between obesity and increased cancer risk. The Cancer Resource Center continued to offer programs to cancer patients such as yoga, quilting, knitting and crocheting, and acupuncture. Other support programs offered at CMTBCRC were Qi Gong, the Caregivers Support Group, Together We Thrive, and Living with Cancer. Smoke Free Lungs, a free quarterly program for those who want to quit using tobacco, provided support and education to those in any stage of the quitting process. The annual Healthy Howard Day highlighted healthy lifestyles, physical activity and wellness. HCGH provided more than 70 BMI measurements. In May, over 2,000 people attended the Howard County Public School System s Employee/ Family Wellness Day. HCGH staffed this 3rd annual event and provided over 300 BMI calculations. In June, the Howard County Men s Health Fair featured health awareness programs specific to men. BMI screenings were provided to 70 participants. Ten online video presentations were available to our community on YouTube. Breast cancer, prostate cancer, bladder cancer and kidney cancer were discussed. Wellness Center seminars on obesity in children were featured. The Claudia Mayer/Tina Broccolino Cancer Resource Center co-sponsored the 2nd annual Surviving Survivorship: Living with Cancer event in October. Cervical cancer education and information on HPV was provided along with breast health education sessions. 13

14 Programs and Support Groups for Patients and Their Families Claudia Mayer/Tina Broccolino Cancer Resource Center (CMTBCRC) Provides educational, aesthetic, emotional, and psychosocial support services through center resources, which include a lending library, ongoing classes and support programs for patients, families and caregivers, full service salon, prosthesis specialist, Oncology Social Worker, navigation, acupuncture and therapeutic massage. For more information, call Volunteer Wig Salon Appointment required Breast Cancer Support Group Meets the third Wednesday of the month from 7-8:30 p.m. Free, but registration is required. For more information, call Caregivers Support Group Meets the first Tuesday of each month from 3:30-4:30 p.m. or the second Saturday of each month from 10:00-11:00 a.m. Free, but registration is required. Call for more information. Living with Cancer Designed to meet the needs of men and women diagnosed with stage 4 or metastatic disease. Meets the 4 th Thursday of each month from 7-8:30 p.m. Free, but registration is required. For more information call Together We Thrive Support group for men and women diagnosed with cancer. Meets the first Saturday of each month from 10:00-11:30 a.m. Free, but registration is required. Call for more information. The Red Devils Financial support for breast cancer patients, coordinated through the CMTBCRC The Little Things 4 Cancer Financial support for all cancer patients, coordinated through the CMTBCRC Advance Directives A quarterly class to educate patients, families and members of the community about advance directives. Sponsored by CMTBCRC and the Wellness Center. Free, but registration is required. For additional information call Yoga for Patients, Caregivers and Survivors Offered Tuesdays from 10-11:00 a.m. under the leadership of an experienced and clinically trained instructor. For information or to register, call Knitting and Crocheting Group For patients and survivors, meets weekly on Wednesdays from 10:00 a.m.-noon. Free Quilting Group For patients and survivors. Meeting the 2 nd and 4 th Tuesdays of each month, 1-3:00 p.m. Free Healing Point Provides acupuncture, therapeutic massage, and family counseling Comfort Care Specializing in lymphedema, compression and mastectomy products. Call Kristin Hassed, orthotic fitter, at Wigs and Hair Solutions Specializing in custom fitted synthetic and human hair wigs

15 Programs through ACS at Cancer Resource Center Look Good Feel Better This American Cancer Society program provides a free workshop led by a licensed cosmetologist. Women undergoing cancer treatment learn to manage the appearance-related side effects of cancer treatment and receive a complimentary bag of cosmetics. Meets monthly. To register call the American Cancer Society at Road to Recovery Sponsored by the American Cancer Society, volunteer drivers will provide transportation for cancer patients undergoing treatment. Call Reach to Recovery Sponsored by the American Cancer Society, this service matches patients with a volunteer who will talk about coping with breast cancer diagnosis and treatment. Other Community Resources Colorectal Cancer Program (CRCP) Offered through the Howard County Health Department, provides free colonoscopies to residents over 50, or over 21 who have an increased risk and lack health insurance or are underinsured. Diagnosis and treatment services available if needed Breast and Cervical Cancer Diagnosis and Treatment Program (BCCP) Offered through the Howard County Health Department, provides clinical breast exams, mammograms and pap tests for women aged 40 and over who have a limited income, lack insurance, or are underinsured. Diagnosis and treatment services are also provided if needed American Cancer Society Offering information and community resources Gilchrist Hospice Care Services for the terminally ill, their families, and the bereaved. Call HCGH Wellness Center Programs include screenings, health fairs, support groups and smoking cessation classes. For information call Bolduc Family Outpatient Center Physical and occupational therapies for cancer patients, including breast cancer specific rehabilitation, including lymphedema therapy Moveable Feast A non-profit agency that provides food and nutritional support counseling for cancer patients and their families. Free

16 2015 Cancer Committee Sally Cheston, M.D., Radiation Oncology, Cancer Conference Coordinator, Chairperson Carolina Collison, CRNP, Palliative Care Sheryl Daugherty, RHIT, CTR, Oncology Program Coordinator Sandra Dawson, RHIA, Director, Health Information Management Suzi Ford, American Cancer Society Leslie Hack, PA-C, Quality Review Coordinator Martha Koch, M.D., Colorectal Surgery Kelly Marasco, PT, Outpatient Rehab Michelle Morgan, Clinical Research Andrew Morton, M.D., Diagnostic Imaging Stanley Podlasek, M.D., Pathology Sandy Roemer, RN, Community Education Adrienne Shepardson, PharmD, Pharmacy Teji Sastry, M.D., Medical Oncology, Cancer Liaison Physician Judy Siegelman, RN, OCN, Nurse Manager, 4 South Amy Tissiere, LCSW-C, OSW-C, Oncology Social Worker / CMTBCRC Jim Young, Administration Lisa Jacobs, M.D., Medical Director, Breast Center