Oncology. Cancer Committee Chairman Report Annual Report

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1 Oncology Annual Report Cancer Committee Chairman Report 2012 At Gwinnett Medical Center (GMC), 2012 was an exciting year for the oncology program. Many important program developments were initiated that will improve access to cancer care and support for patients and families living with cancer in our region. Several goals were accomplished in 2012 including ensuring that our breast cancer treatment performance measures are consistent with or better than national data; attendance by our breast health nurse at community events to help increase awareness and education; and initial development of a high risk program for patients who may be genetically at risk for cancer. Several patient care improvements were implemented in 2012, including the formation of the Office of Research at GMC which will include oncology clinical trials oversight. This is a significant step forward in establishing a strong infrastructure for research within the organization. Clinical trials continued to be available for cancer patients at GMC in 2012 with a total of 46 patient enrollments to studies, including a mix of government sponsored and pharmaceutical industry sponsored cutting-edge treatment trials. We increased our cancer committee membership this year by adding hospitalists to the committee. These physicians provide care to inpatients at GMC including palliative care services. They are an important part of the care continuum for many patients with cancer who require a stay in our hospitals. Our weekly breast tumor conference, a forum for the multidisciplinary team to come together to discuss cases and provide input into treatment options, is now available remotely to broaden the participation to more physician specialists and other members of the care team. To further develop and expand our program, a Director of Oncology position was created and a director was hired in November to help continue to build our oncology program working with the members of the cancer committee. In addition, as of December 3, 2012, Gwinnett Medical Center established a formal relationship with Suburban Hematology-Oncology, a private physician practice, whereby their infusion centers in Lawrenceville, Duluth and Snellville are now known as the Center for Cancer Care, a service of Gwinnett Medical Center. We believe this relationship represents a major breakthrough in the way residents of Gwinnett and the surrounding communities receive cancer treatment. The goal is to provide cancer patients with a continuum of care, so they can receive a growing range of oncology and hematology-related services through GMC. In short, we want to make it as convenient as possible for patients to get the high quality care they need and desire close to home. It was a year of important steps for the GMC oncology program and we know that there are many patients and family members in our region who are counting on us to continue to innovate, collaborate and ensure good continuity and quality of care. It is our intent to provide them with an ever growing and improving system of care now and into the future. Alexander Saker, Jr. MD Medical Oncologist/Hematologist Chairman, Cancer Committee In addition to offering high quality treatment options in the region, there are a significant amount of outreach, navigation, screening and prevention offerings accessible locally. The breast health navigator (in place since 2005) made 3,024 patient contacts in 2012 The American Cancer Society Navigator made 391 patient contacts 23,305 total contacts/ offerings were provided in 2012 on topics related to cancer prevention and support through the GMC Faith Community Nursing program 44 individuals attended the Look Good Feel Better Classes 261 people attended the Women s Cancer Support Group 1,547 mammograms were provided through the mobile mammography unit, Care-a-Van, in patients enrolled in Fresh Start Smoking Cessation

2 Breast Cancer Quality Report Comparison of GMC 2007 and 2011 Analytic Breast Data By Age, Stage and First Course of Treatment Kimberly Hutcherson, MD Breast Interventional Radiologist There were 301 analytic breast cases in 2007 and 325 analytic breast cases in This is an 8 percent increase in 5 years. Analytic cases are those cases that were diagnosed and/or received all of their first course of treatment at GMC or were diagnosed elsewhere and received all or part of first course of therapy at GMC. Graph 1 shows the age range for 2007 and 2011 analytic breast cases. More patients were diagnosed in the age range for 2007 (n=85) and 2011 is (n=91). The second highest age range for 2007 was (n=82), and second highest for 2011 was (n=86). Graph 2 shows the stage at diagnosis. More patients were diagnosed at Stage IA and Stage 0 in 2007 (Stage IA n=110; Stage 0 n=68) and 2011 (Stage IA n=135; Stage 0 n=77). Primary first course of treatment for 2007 was biopsy, surgery radiation therapy and hormone. Primary first course of treatment for 2011 was biopsy, surgery, radiation therapy and hormone. Graph 1 - Breast Cancer Graph 2 - Breast Cancer Age at Diagnosis Breast Cancer Stages at Diagnosis GMC and National Cancer Database (U.S.) 5 year survival rate comparison The survival data for GMC and the NCDB are similar. GMC 5 Year Survival NCDB (U.S.) 5 Year Survival

3 GMC Hepatobiliary Quality Report Graph 1 - Liver Comparison of GMC 2007 and 2011 Analytic Hepatobiliary Data By Age, Stage and First Course of Treatment (Graphs and information broken down by Liver, Gallbladder and Pancreas) Ken Dixon, MD General and Oncologic Surgeon Liver There were 25 liver cases in 2011 and 10 liver cases in This is a 150 percent increase in 5 years. Graph 1 shows the age range for 2007 and 2011 analytic liver cases. More patients were diagnosed in the age ranges and for 2007 (n=4) and the highest age range in 2011 was (n=9). The second highest for 2007 was (n=2) and the second highest for 2011 was (n=5). Graph 2 shows the stage at diagnosis. More patients were staged at Stage 4 in 2007 (n=4) and Stage 1 in 2011 (n=8). Primary first course of treatment for 2007 was biopsy as was biopsy in For 2007 biopsy and chemotherapy was second first course of treatment and for 2011 biopsy and chemotherapy was the second first course of treatment. Pancreas There were 20 pancreas cases in 2007 and 21 pancreas cases in This is an increase of 5 percent in 5 years. Graph 3 shows the age range for 2007 and 2011 analytic pancreatic cases. More patients were diagnosed in the age ranges of (n=5) and (n=5). In 2011 more patients were diagnosed in the age range(n=4). Graph 4 shows the stage for 2007 and 2011 analytic pancreatic cancers. In 2007 more patients were diagnosed at Stage 4 (n=9) as well as Stage 4 for 2011 (n=9). The second highest stage in 2007 was Stage 3 (n=3) and for 2011 it was Stage 3 (n=6). Primary first course of treatment for 2007 was biopsy followed by biopsy and chemotherapy. Primary first course of treatment for 2011 was biopsy and chemotherapy. Gallbladder There were 4 gallbladder cases in 2007 and 10 in This is a 150 percent increase in 5 years. Age at Diagnosis Graph 2 - Liver Stage at Diagnosis Graph 3 - Pancreas Age at Diagnosis Graph 4 - Pancreas Graph 5 shows the age range for 2007 and 2011 analytic gallbladder cases. More patients were diagnosed in the age range of for 2007 (n=4) and 2011 is also 60-69(n=4). The second highest age range was 70-79(n=1) and (n=1), and the second highest for 2011 was (n=3) and (n=3). GMC 5 Year Survival NCDB (U.S.) 5 Year Survival Stage at Diagnosis Graph 5 - Gallbladder Age at Diagnosis

4 Oncology Data Center Report Debra Fortier, CTR Oncology Data Center Coordinator The Oncology Data Center (ODC) information system is designed for the collection, management and analysis of data of persons with the diagnosis of malignant (or neoplastic disease) and benign tumors. The information maintained in the GMC tumor registry includes demographic information, medical history, diagnostic findings, cancer findings (including primary site, histology cell type and extent of disease and/or stage), cancer therapy (including surgery, radiation therapy, chemotherapy and/or immunotherapy to name a few) and follow-up (annual information concerning additional treatment, recurrences and patient status). In 2011, the ODC processed 1,387 analytic cases. These cases represent patients who were diagnosed and/or received all of the first course of treatment at GMC or were diagnosed elsewhere and received all or part of the first course of therapy at GMC. Additionally there were 225 non-analytic cases, representing patients diagnosed elsewhere and receiving all of the first course of treatment elsewhere and seen at GMC now with active disease. The top five cancers for women were breast, lung, thyroid, colon and lymph node cancer. The top five cancers for men were prostate, lung, colon, bladder and hematopoietic. Three out of the four abstractors in the registry are certified tumor registrars and the fourth plans to take the exam later this year. The ODC collects the required data items mandated by the American College of Surgeons, Commission on Cancer, Georgia Comprehensive Cancer Registry and SEER (Surveillance Epidemiology and End Results), while maintaining strict patient confidentiality. The ODC reports monthly to the Georgia Center for Cancer Statistics and the American College of Surgeons Rapid Quality Reporting System (RQRS) and yearly to the National Cancer Data Base. GMC 2011 Analytic Cancer Cases Males Females Oral Cavity & Pharynx - 21 (4%) Thyroid - 61 (7%) Lung & Bronchus - 75 (13%) Lung & Bronchus - 92 (11%) Pancreas - 11 (2%) Breast (39%) Kidney & Renal Pelvis - 31 (6%) Kidney & Renal Pelvis - 20 (2%) Urinary Bladder - 39 (7%) Ovary - 32 (4%) Colon & Rectum - 59 (11%) Uterine Corpus - 36 (4%) Prostate (25%) Colon & Rectum - 70 (8%) Non-Hodgkin Lymphoma - 21 (4%) Non-Hodgkin Lymphoma - 26 (3%) Melanoma of the Skin - 19 (3%) Melanoma of the Skin - 6 (1%) Leukemia - 8 (1%) Leukemia - 9 (1%) All Other Sites (24%) All Other Sites (18%) Images reprinted by the permission of the American Cancer Society, Inc. from cancer.org. All rights reserved.

5 Summary by Body System and Sex Report GMC 2011 Analytic Cancer Cases Primary Site Total % Male % Female % ORAL CAVITY & PHARYNX % % 7 0.8% Lip 1 0.1% 1 0.2% 0 0.0% Tongue % 8 1.4% 2 0.2% Salivary Glands 2 0.1% 1 0.2% 1 0.1% Gum & Other Mouth 2 0.1% 1 0.2% 1 0.1% Nasopharynx 2 0.1% 1 0.2% 1 0.1% Tonsil 5 0.4% 5 0.9% 0 0.0% Oropharynx 2 0.1% 1 0.2% 1 0.1% Hypopharynx 2 0.1% 1 0.2% 1 0.1% Other Oral Cavity & Pharynx 2 0.1% 2 0.4% 0 0.0% DIGESTIVE SYSTEM % % % Esophagus % 7 1.3% 4 0.5% Stomach % % 7 0.8% Small Intestine 7 0.5% 0 0.0% 7 0.8% Colon Excluding Rectum % % % Cecum Appendix Ascending Colon Hepatic Flexure Transverse Colon Splenic Flexure Descending Colon Sigmoid Colon Large Intestine, NOS Rectum & Rectosigmoid % % % Rectosigmoid Junction Rectum Anus, Anal Canal & Anorectum 2 0.1% 0 0.0% 2 0.2% Liver & Intrahepatic Bile Duct % % 8 1.0% Liver Intrahepatic Bile Duct Gallbladder % 3 0.5% 7 0.8% Other Biliary 3 0.2% 0 0.0% 3 0.4% Pancreas % % % Peritoneum, Omentum & Mesentery 2 0.1% 0 0.0% 2 0.2% RESPIRATORY SYSTEM % % % Larynx 8 0.6% 6 1.1% 2 0.2% Lung & Bronchus % % % BONES & JOINTS 1 0.1% 1 0.2% 0 0.0% Bones & Joints 1 0.1% 1 0.2% 0 0.0% SOFT TISSUE 5 0.4% 3 0.5% 2 0.2% Soft Tissue (including Heart) 5 0.4% 3 0.5% 2 0.2% SKIN EXCLUDING BASAL & SQUAMOUS % % 7 0.8% Melanoma - Skin % % 6 0.7% Other Non-Epithelial Skin 1 0.1% 0 0.0% 1 0.1% BREAST % 2 0.4% % Breast % 2 0.4% % FEMALE GENITAL SYSTEM % 0 0.0% % Cervix Uteri % 0 0.0% % Corpus & Uterus, NOS % 0 0.0% % Corpus Uteri Uterus, NOS Ovary % 0 0.0% % Vagina 2 0.1% 0 0.0% 2 0.2% Vulva 4 0.3% 0 0.0% 4 0.5%

6 MALE GENITAL SYSTEM % % 0 0.0% Prostate % % 0 0.0% Testis 9 0.6% 9 1.6% 0 0.0% Other Male Genital Organs 1 0.1% 1 0.2% 0 0.0% URINARY SYSTEM % % % Urinary Bladder % % % Kidney & Renal Pelvis % % % Ureter 3 0.2% 0 0.0% 3 0.4% EYE & ORBIT 1 0.1% 0 0.0% 1 0.1% Eye & Orbit 1 0.1% 0 0.0% 1 0.1% BRAIN & OTHER NERVOUS SYSTEM % % % Brain 9 0.6% 7 1.3% 2 0.2% Cranial Nerves Other Nervous System % 8 1.4% % ENDOCRINE SYSTEM % % % Thyroid % % % Other Endocrine including Thymus 9 0.6% 4 0.7% 5 0.6% LYMPHOMA % % % Hodgkin Lymphoma 4 0.3% 1 0.2% 3 0.4% Non-Hodgkin Lymphoma % % % NHL - Nodal NHL - Extranodal MYELOMA % % 7 0.8% Myeloma % % 7 0.8% LEUKEMIA % 8 1.4% 9 1.1% Lymphocytic Leukemia 6 0.4% 4 0.7% 2 0.2% Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia % 4 0.7% 7 0.8% Acute Myeloid Leukemia Chronic Myeloid Leukemia MISCELLANEOUS % % % Miscellaneous % % % Total 1,

7 2012 Cancer Committee Alexander Saker, Jr. MD James York, MD Murtaza Cassoobhoy, MD Ken Dixon, MD Kimberley Hutcherson, MD Miles Mason III, MD, FACS Leela Maxa, MD Julie McGill, MD Philip Shrake, MD Robert Siegel, MD Cathie Brazell, RN, MHA, CPHQ Jamila Brown, CHES Samantha Cannon, MSOT/L-CLT Chuck Christie, M.Div., BCC Mary Fender, RN, OCN Sheila Forman, RN Debra Fortier, CTR Judy Godfrey Jennifer Griffin Amy McEachin, RN, OCN Rita Michael, RN, BS, CPHQ Mark Mullin Mary Beth Salin, BASW, BS Sharon Smallwood Tina Smith, RN, BSN, TNCC Cindy Snyder, APNG, FNP-C CBCN Donna Stoudenmire, RN, CBPN-IC Amy Tella, RD Cancer Committee Chair Medical Oncologist/Hematologist Vice Chair Cancer Committee Chair Cancer Conference Coordinator Vascular Interventional Radiologist Hospitalist/Palliative Care General and Oncologic Surgeon Breast Interventional Radiologist Cancer Liaison Physician Surgeon Community Outreach Coordinator Radiation Oncologist Cancer Registry Quality Coordinator General Surgery Radiation Oncologist Pathologist Cancer Program Administrator Health Education Specialist Lymphodema Therapist Chaplain, Psychosocial Services Coordinator Clinical Research Oncology Nurse Palliative Care Certified Tumor Registrar American Cancer Society American Cancer Society Patient Resource Navigator Outpatient Treatment Center Supervisor Performance Improvement Representative Director of Planning Social Worker Clinical Manager, Oncology Clinician Genetics Professional Quality Improvement Coordinator Breast Health Nurse Navigator Clinical Nutrition Manager

8 2012 Cancer Community Events Mobile Mammography Van Fight Like a Girl Photobooth Paint the Mall Pink was a community, grass-roots program embracing breast cancer and women s health awareness. Activities included: Girls Night Out, live entertainment, consults with Gwinnett Medical Center s Women s Health Navigator, mammograms on GMC s Mobile Mammography Van and breast education and women s health booths. Women s Health Navigator Girls Night Out Educational Booths Know Your Stats About Prostate Cancer was a community event targeting men to learn and know their stats when it comes to prostate cancer. The program featured a prostate health presentation by Ronald Anglade, MD, a Gwinnett Medical Center affiliated and board-certified urologist and covered topics such as: What is the prostate? What is prostate cancer? How common is it? Risks & symptoms Who should be screened, and why? Diagnosis & treatment options