COMMITTEE. Cancer. Physician Members: Kevin Bond, M.D., Chairman & Liaison Physician, Urology. Raymond Orgler, M.D., Vice Chairman, Surgery

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2 Cancer COMMITTEE Cancer Committee Activities The North Mississippi Medical Center Cancer Committee, which is comprised of a multidisciplinary panel of specialists and ancillary personnel, continues to be a very active and progressive component of the overall cancer program at NMMC. During 2004, 181 prospective cases were reviewed at our weekly cancer conference. These conferences allow treating physicians to obtain a very diverse review of their case by the physicians in attendance. They also enable attending clinicians to obtain CME credits. The last conference of each month is devoted to one of NMMC s top five primary cancer sites. These specialty conferences allow even further review of our most common cancers and our treatment options for patients with these diseases. The Cancer Committee also strives to improve the care of cancer patients in our region. Our goals for 2004 include: Maintain a three-year approval by the American College of Surgeons as a Community Hospital Cancer Program and the American College of Radiology. Improve the cancer survival rate of people in our region. Participate in clinical trials with a minimum of 2 percent annual caseload entered into clinical trials annually. Continue promoting awareness and screening standards at the primary care physician level for the following types of cancer: breast, colon, cervix, prostate, lung and skin. Promote a higher quality of life for cancer patients by increasing awareness of support groups, the Cancer Center Library and the North Mississippi Pain Management Center. Continue to increase the utilization of the Cancer Registry for cancer data incidence and survival reporting compared to national statistics. Assess patient satisfaction with the management of cancer pain in the outpatient population. Compare our compliance to nationally approved guidelines for breast conservation. Continue Multidisciplinary Specialty Conferences that report the top five primary sites seen by NMMC. These cancer sites are urological, breast, lung, GI and lymphoma. Maintain the College of American Pathologists Protocol Guidelines. Implement the new Collaborative Staging and Coding Guidelines. The accomplishment of these goals is the result of continued hard work of not only the physicians, but also an excellent group of support personnel at NMMC. During 2004, our Cancer Registry accessioned 1,400 new analytical cancer cases. We plan to continue to make improvements and advancements in the care of our cancer patients in the coming year. Kevin Bond, M.D. Chairman Cancer Committee Physician Members: Kevin Bond, M.D., Chairman & Liaison Physician, Urology Raymond Orgler, M.D., Vice Chairman, Surgery James Shirley, M.D., Liaison Physician Chris Bergmann, M.D., Diagnostic Radiology Carl Bevering, M.D., Neurosurgery Curt Collins, M.D., Pathology Bert Duncan, M.D., Radiation Oncology Eric Emig, M.D., Diagnostic Radiology Jeff Houin, M.D., Dermatology William Kahlstorf, M.D., Ob/Gyn Andrew Kellum, M.D., Hematology/Oncology Robert McAuley, M.D., Surgery Charles Montgomery, M.D., Hematology/Oncology John Phillips, M.D., Gastroenterology Ray Reed, M.D., Radiation Oncology Jim Rish, M.D., Pulmonology Vishal Sachdev, M.D., Cardiothoracic Surgery Staff Members: Laura Brower, RN, MSN, Administration Cindy Edwards, LMSW, Social Work Shelia Jinkins, CTR, Cancer Registry Mois Johnson, RN, BSN Joellen Murphree, RN, Clinical Quality Jeannine Peters, Pharm.D., Pharmacy Linda Roof, RN, Clinical Trials Rev. Dick Stevens, Chaplain Paula Turner, MSHA, Director, NMMC Cancer Center

3 Cancer REGISTRY Mission Why we exist: To help increase survival rates of the people in our region with cancer. Vision What we want to be: The provider of the most consistent and accurate cancer data available to the North Mississippi Medical Center cancer program. The Cancer Registry, which includes three specialized medical professionals who collect information on every patient diagnosed and/or treated for cancer, is an essential component of the multidisciplinary cancer program at NMMC and functions within the guidelines of the American College of Surgeons Commission on Cancer approvals program. The registry participates in the National Cancer DataBase (NCDB) call for data and reports cases to the Central Registry in Jackson, as well as the Commission on Cancer Facility Information Profile System (FIPS) and the American Cancer Society (ACS). This information is used by researchers to determine cancer trends, treatment patterns, education and screening guidelines. Annual follow-up is one of the many functions performed by the Cancer Registry. This directly benefits patients by reminding physicians and patients that routine medical examinations are encouraged. Continued surveillance ensures early detection of a possible recurrence or a new primary malignancy. The statistical worth of survival is supported when successful followup rate exceeds 90 percent. Our current follow-up rate is 94 percent. The registry s goals are to: Assemble and report measurements of cancer incidence, survival and mortality. Provide information on changes over time in the extent of disease at diagnosis, therapy and patient survival. Promote and conduct studies designed to identify factors relating to cancer etiology, prevention and control. Provide data for cancer research activities and educational opportunities. Exceed 90 percent follow-up rate. The statistical analysis of data in the annual report reflects fiscal year Year of Diagnosis C ANCER R EGISTRY C ASES ANALYTICAL CASES 1,089 1,181 1,171 1,168 1,240 1,210 1,215 1,267 1,299 1,341 1,515 1,300 1,412 1,299 1,259 1, ,000 1,200 1,400 1, = Number of Cases NMMC CANCER Shelia Jinkins, CTR Jewell Johnson, CTR Sandra Oliver, CTR R EGISTRARS

4 Data ANALYSIS The North Mississippi Medical Center Cancer Registry for calendar year 2004 accrued 1,569 cases. Of these, 169 cases were non-analytical. These patients were of an equal proportion of male cases (697) to female cases (703). As in previous years, lung cancer was the most prevalent type of malignancy with 270 cases. The other top four sites continue to reflect previous, as well as national statistics, as the following cases were identified: breast, 202 cases; prostate, 155 cases; colon, 119 cases; and melanoma, 67 cases. The NMMC Cancer Center continues to serve a large geographic area. The registry includes patients from 32 Mississippi counties, as well as 59 patients from Alabama and eight patients from Tennessee. NMMC continues to provide all aspects of cancer care registry including work-up, diagnosis, counseling, surgical intervention, radiation treatment, oncology, pain control and palliative care. In addition, transportation to the NMMC Cancer Center is provided for patients who are receiving treatment and need assistance with travel. This year, a second van was added to help meet this need. The Cancer Committee actively reviews the registry to best utilize resources for screening and treatment programs for patients and area communities. In addition, prevention continues to be a top priority for committee members. We are committed to state-of-the-art cancer care for the NMMC service area. Raymond Orgler, M.D. Vice Chairman, Cancer Committee All Patients T OP F IVE P RIMARY S ITES ANALYTICAL CASES Lung Breast Prostate Colon Melanoma...67 Liaison REPORT The North Mississippi Medical Center cancer program is accredited by the Commission on Cancer, which is a multidisciplinary program of the American College of Surgeons and the American College of Radiology. National guidelines established by these organizations assure that the NMMC cancer program adheres to the highest standards and allows comparison of treatment and outcomes across the nation. Cancer patients in this area are thus assured of receiving the best and most up-to-date treatment available. The NMMC cancer program also participates in several cooperative studies with other institutions throughout the nation to evaluate new treatment options. A weekly cancer conference is held to discuss a variety of current and prospective cancer cases, including diagnosis, staging and treatment options. Specialists involved in the care of cancer patients provide a broad range of knowledge and experience, which allows our patients to receive the best treatment for their particular cancer. Several times a year leading national cancer experts are invited to speak on topics related to cancer and its management. The Cancer Committee is comprised of specialists from medical oncology, radiation oncology, diagnostic radiology, pathology, numerous surgical subspecialties, cancer liaison physicians, a representative from the American Cancer Society and other health care professionals. The committee meets quarterly to establish policies and goals, ensuring that NMMC s cancer program is one of the best in the nation. NMMC maintains a Cancer Registry of all cancer patients treated and reports this data to the National Cancer DataBase annually. In 2004, 1,569 cases were added to the Registry, bringing the total to 21,549 since January As Liaison physician, I would like to recognize and express my appreciation to all those who enable us to maintain an approved comprehensive cancer program, which leads to improved care for cancer patients in our region. James Shirley, M.D. Liaison Physician

5 Primary Site INCIDENCE PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV BUCCAL CAVITY & PHARYNX Tongue Salivary Glands Floor of Mouth Gums & Other Mouth Nasopharynx Tonsil Oropharynx Hypopharynx DIGESTIVE SYSTEM Esophagus Stomach Small Intestine Colon Rectum & Rectosigmoid Junction Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas RESPIRATORY SYSTEM Nasal Cavity, Middle Ear & Accessory Sinuses Larynx Lung & Bronchus Trachea, Mediastinum & Other Respiratory Organs SOFT TISSUE Soft Tissue (Including Heart) SKIN (Excluding Basal & Squamous) Melanomas - Skin BREAST Breast FEMALE GENITAL SYSTEM Cervix Uteri Corpus & Uterus, NOS Ovary Vagina Vulva Other Female Genital Organs

6 PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV MALE GENITAL SYSTEM Prostate Testis Penis URINARY SYSTEM Bladder Kidney & Renal Pelvis Ureter BRAIN & OTHER NERVOUS SYSTEM Brain Other Nervous System Benign/Borderline Primary Intracranial & CNS ENDOCRINE SYSTEM Thyroid Other Endocrine (including Thymus) LYMPHOMAS Hodgkin Lymphoma Non-Hodgkin Lymphoma MYELOMA Myeloma LEUKEMIAS Lymphocytic Myeloid & Monocytic Other MESOTHELIOMA Mesothelioma OTHER Ill-Defined & Unspecified Sites Invalid Site* TOTALS 1,569 1, Headings: A=Analytic N/A=Non-Analytic M=Male F=Female * Invalid Site group includes: 1. Any site or histology code not within valid range or site code not found in primary site table. 2. Cases with unusual primary site/histology codes that have been over-ridden in an edit. 3. Sites with a primary site code of C44 with histology codes Invalid Site group does NOT include cases where the Behavior code is 0 or 1. (NAACCR Volume III, Data Analysis and Reporting, Process Standards Chapter III.B.1)

7 All Patients S Demographic DATA R T EX Male % Female % Total 1,400 ACE Caucasian 1,166 83% African American % Other 5 1% Total 1,400 OP F IVE P RIMARY S ITES Female: Male: Breast Lung Lung Prostate Colon...61 Colon...58 Cervix...38 Bladder...53 Melanoma...34 Melanoma & Younger AGE AT DIAGNOSIS 1,400 Analytic Cases & Older All statistics are based on analytic case numbers Number of Cases

8 Geographic LOCATION TENNESSEE Marshall 7 Benton 7 Tippah 46 Alcorn 53 Prentiss 83 Tishomingo 75 ALABAMA Colbert 2 Lafayette 7 Union 53 Pontotoc 92 Lee 406 Itawamba 103 Marion 41 Franklin 3 Yalobusha 3 Calhoun 38 Chickasaw 91 Monroe 136 MISSISSIPPI Webster 39 Clay 28 Lamar 12 Choctaw 8 Oktibbeha 14 Lowndes 19 Attala...2 Desoto...2 Grenada...5 Leflore...1 Montgomery...3 Other Mississippi Counties Noxubee...2 Panola...5 Tallahatchie...1 Washington...1 Winston...2 Other Alabama...1 Tennessee...8 Texas...1 Total...1,400 All statistics are based on analytic case numbers

9 Analysis of PROSTATE CANCER C OMPARISON OF T REATMENT R ECEIVED FOR E ARLY S TAGE P ROSTATE C ANCER This retrospective review was done to compare the treatment patients with Stage I & II carcinoma of the prostate were given in 1995 to similar cases in The national trend during this period has been toward patients receiving more conservative treatments (i.e. radiation, hormones, observation) and fewer patients undergoing radical surgery. This review was completed to determine if this trend is the same at NMMC. A total of 131 patients with Stage I & II carcinoma of the prostate were treated at NMMC in 1995 compared to 129 patients in The racial breakdown of these patients was essentially the same in both years. Caucasians made up 75 percent of patients, with African Americans accounting for only 25 percent. No racial differences appeared in the treatments received. The median age of patients was 69 years of age in 1995 compared to 65 years of age in This difference is attributed to the increased use of PSA as a screening tool for prostate cancer during these nine years. During 1995, 50 patients (29 percent) received Radical Prostatectomy as their primary treatment. This compares to 42 patients (29 percent) in This difference is statistically insignificant. Sixty-four patients (37 percent) received external beam radiation as primary therapy in In 2003, 59 patients (41 percent) received external beam radiation as their primary treatment. This represents a slight increase in the number of patients receiving radiation therapy. The most significant change in treatment patterns has been the large increase of patients that received neoadjuvant hormone therapy prior to radiation therapy. Only eight of 64 patients received neoadjuvant therapy in 1995, compared to 22 of 59 patients in This change in treatment has resulted in improved cancer free survival for patients receiving external beam radiation as primary therapy. In conclusion, no significant difference exists in the number of patients receiving surgery versus external beam radiation therapy for low stage carcinoma of the prostate from 1995 to This is consistent with nationwide data trends. However, the increased use of neoadjuvant hormone therapy and improved surgical techniques have improved both cancer free survival and quality of life in patients treated for low stage carcinoma of the prostate at NMMC. P P R ROSTATE D ATA 1995 & 2003 ROSTATE D ATA 1995 & 2003 ELATIVE 5 YEAR S URVIVAL Kevin Bond, M.D. Chairman Cancer Committee