Comprehensive Oncology Program

Transcription

1 Comprehensive Oncology Program

2 01 Radiation Oncology 02 Thoracic Surgery and Surgical Oncology 03 Comprehensive Breast Care 04 Plastic Surgery Thoracic Surgery and Lung Center of Excellence Genitourinary Oncology Cancer Committee Community Outreach Additional Cancer Facilities Robotic Surgery Cutaneous Oncology Support Services Cancer Registry Gynecologic Oncology Oncology Research and Clinical Trials The Comprehensive Cancer Prgoram is accredited, with commendation, by the Commission on Cancer as a Comprehensive Community Cancer Program. Only 30 percent of cancer programs in the United States hold this accreditation. As a patient you can be assured that we have met the highest quality standards established Dear Friends, Jupiter Medical Center s Ella Milbank Foshay Cancer Center mission has always been about providing the best available treatments with paramount cutting-edge technology from expert physicians with the utmost compassion for our patients. With a great sense of pride, I reflect on 2015 and 2016 and all the amazing accomplishments that have lead to world-class care for every cancer patient that walks through our doors. I am encouraged at our recent transformations, having modeled ourselves after top academic medical centers, and confident that we have evolved into a comprehensive cancer care program, recruiting world-renowned oncology physician specialists who provide unparalleled cancer care to our community. The implementation of multidisciplinary clinics represents a highly academic and collaborative approach to cancer treatment in which an entire team of specialists discuss a patient s individualized treatment needs. Another aspect to this academic approach in oncology care is the multidisciplinary cancer conferences that we hold each week to review the treatment of specific patients. In 2015, the opening of the Margaret W. Niedland Breast Center was monumental and changed the way women in our community receive care. Fully operational, the new center provides women with peace of mind in knowing they will receive their screening mammogram results on the same day, alleviating many from the anxiety of testing and the possible diagnosis of cancer. In the result of a breast cancer diagnosis, women in our community can be confident in the care they receive through the Niedland Breast Center, directed by two of the region s leading fellowship-trained breast surgeons. We also transformed how we deliver cancer care, expanding use of the breakthrough intraoperative radiation therapy method, e-iort, and enhancing our portfolio of advanced technology. The addition of bluelight cystoscopy for detecting bladder cancer allows for quicker diagnosis. Our nationally recognized Thoracic Surgery and Lung Center of Excellence continues to diversify with a second da Vinci robot system for minimally invasive surgeries allowing for enhanced precision and quicker recovery. Plus, the breakthrough technology of the CyberKnife M6 allows our radiation oncologists to target and eliminate many types of tumors without making an incision, offering pain-free cancer treatment to qualified patients. Additionally, we increased the availability of clinical trials in oncology and plans are underway to expand our clinical research with a prominent partner, The Icahn School of Medicine at Mount Sinai, known for groundbreaking medical and scientific inquiry, discovery and development. The future of our innovative cancer treatment lies first and foremost with the patient. I find it more important than ever that we surround each patient with complete cancer care from expert physicians and health care specialists, and through prevention education, early diagnosis and treatment provided with the most advanced technology available all integrated with supportive services thereby treating the whole person, with the goal of bringing our patients back to wellness. The following pages will narrate the story of our dedicated and accomplished physicians and staff, the great transformation in the field of oncology and how the Foshay Cancer Center will continue to bring together a higher tier of sub-specialty to our clinical oncology team, blended with the best tools and technology. Our story will continue with dedication to cancer research, treatment and wholly integrated care with our new innovative Comprehensive Cancer Institute designed to deliver undeniable world-class cancer care to our patients. It is our patients and their families that drive us to want to do our best. Continually, I ask how can we take the foundation of this world-class cancer center and make it better. Abraham Schwarzberg, MD Hematology Oncology Chief of Oncology by the Commission on Cancer. Radiation Oncology is accredited by the American College of Radiology and the Comprehensive Breast Care Program is accredited by the National Accreditation Program for Breast Centers, the first facility in Palm Beach and Martin counties to achieve this prestigious accreditation.

3 Radiation Oncology Thoracic Surgery and Surgical Oncology We utilize an academic approach through the multidisciplinary clinics and conferences, providing cancer patients the very latest surgical and nonsurgical treatment options delivered by teams with unique expertise in using these technologies. Anthony E. Addesa, MD Radiation Oncology Radiation Oncology The growth in the Foshay Cancer Center s Radiation Oncology department has been significant with an increase in new patients of more than 87 percent in the past two years. Highly effective for certain appropriate patients, the use of Electron Beam IntraOperative Radiation Therapy, or e-iort, has transformed the way we deliver radiation. The method of delivering radiation immediately after a tumor is removed can reduce weeks of radiation to a single dose. Initially used to treat breast cancer patients, e-iort proves to be successful in treating gynecological conditions as well as colorectal, lung and gastrointestinal cancer. Plans are underway to expand our e-iort treatment protocols to include these diseases. In March 2015, we added the revolutionary non-invasive technology of the CyberKnife M6 System which enables our radiation oncologists to deliver targeted radiation therapy with the highest precision destroying tumor tissue while sparing the surrounding healthy tissue. It can be used anywhere in the body, including the head, spine, lung, prostate, liver and pancreas. The Ella Milbank Foshay Cancer Center at Jupiter Medical Center was the first in Florida to offer this pain-free, treatment alternative to certain patients with complex or inoperable tumors. In fact, we are the busiest facility with CyberKnife M6 on Florida s east coast with the most experienced physicians in the state. In 2016, Foshay Cancer Center s Radiation Oncology received a threeyear reaccreditation from the American College of Radiology (ACR). One of only 14 centers in Florida to achieve reaccreditation, the voluntary process invites external reviewers to evaluate our performance standards, patient care and safety, quality control activities, and treatment planning and services. The ACR designation assures patients of our consistent high-level quality care. As we look to the future, we continue to combine the latest in imaging technology with the most current innovations in oncology. With the expertise of our interventional radiologists, we now offer radiofrequency embolization, an aggressive treatment proven to effectively treat primary and metastatic tumors of the liver. This FDA-approved outpatient procedure sends tiny radioactive beads to tumors through the blood stream, focusing high doses of radiation directly inside tumors, minimally affecting nearby healthy tissue. Patients experience fewer side effects, less pain, and a shorter recovery period. Adding to our state-of-the-art equipment, the newest TrueBeam linear accelerator will be available at the Center in the near future. This latest model is capable of delivering radiation at a faster dose rate than most conventional linear accelerators. TrueBeam s on-board imaging system captures CT scans and fluoroscopy, or movie-like X-ray images to help doctors ensure that the patient s tumor and normal organs are positioned with millimeter accuracy, and that motion is properly controlled. This advance translates into even greater precision for physicians and shorter treatment times for patients. Lastly, outreach to educate the community about the most modern imaging technology available continues. Our goal is to ensure community members know the best imaging capabilities are right here in their own community. Additionally, our physicians remain dedicated to their patients, learning cutting-edge techniques and treatment through continuing medical education opportunities, ensuring patients continue to receive world-class cancer care. Our goal is to provide every patient the highest level of evaluation, treatment and individual support for the best opportunity to achieve the superior outcomes our patients deserve. The Foshay Cancer Center consistently offers the world s best physician specialists and expert surgical oncologists for patients with benign and malignant tumors. In 2015, we focused on making positive differences in the lives of our patients and their families every day. Educating our community on the latest screening options that detect cancers at the earliest stages continued. We increased the number of highly skilled oncology specialists and obtained the most advanced equipment to provide patients diagnosed with cancer the latest treatments and world-class cancer care. Quality in all aspects of cancer care is always at the forefront of what we do. Continual assessment of treatment through cancer committees and conferences resulted in the implementation of several new protocols for melanoma, thoracic pulmonology, and more, based on national guidelines, and ensuring standards of the highest quality care. We expanded treatments and technologies that may not have been available in the past, but are now routine. For example, the use of minimally invasive robotic surgery has broadened the scope of surgical oncology, offering a safer and quicker path to getting the patient back to good health. The addition of a second surgical robot and one of the first in the nation to offer the da Vinci Xi System has provided our physicians greater surgical precision and mobility to gain successful outcomes for their patients allowing them to experience fewer complications, less pain and scarring, and to heal faster. Our physicians are dedicated to learning the latest treatments and technologies securing knowledge through continuing medical education on a national level. Additionally, as a teaching site for navigational bronchoscopy and da Vinci robotic surgery, we solidified our position of excellence in program modeling and teaching of specialty surgical techniques to physicians throughout the world. In 2016, we took steps to build an academic partnership with The Icahn School of Medicine at Mount Sinai, known for revolutionary medical practices and innovative research, furthering our mission to bring the best specialists in the country to our patients. This partnership is evolutionary to cancer surgery and is another way of bringing the most advanced technologies and treatments to our patients. Our academic model and multidisciplinary approach has revolutionized and transformed the way we deliver cancer care. K. Adam Lee, MD General and Cardiothoracic Surgery Thoracic Surgery and Lung Center of Excellence 1 2

4 Comprehensive Breast Care Plastic Surgery We are dedicated to working together to create a tailored treatment plan for every patient, leveraging all areas of expertise in breast care, including leading-edge clinical therapies that include comprehensive diagnostics and staging to identify relevant breast cancer biology. Nancy J. Taft, MD, FACS General and Breast Surgery Comprehensive Breast Care Jupiter Medical Center s Comprehensive Breast Care program is committed to providing the best possible care to patients with diseases of the breast. Our recent three-year reaccreditation from the National Accreditation Program for Breast Centers (NAPBC) demonstrates our ability to sustain world-class performance and reaffirms the excellence of our program. From diagnostics at the Margaret W. Niedland Breast Center, to treatment through the Kristin Hoke Breast Health Program, Jupiter Medical Center s Comprehensive Breast Care program provides leading-edge technology and treatment options, delivered by a team of highly skilled, compassionate physicians, specialized nurses, technologists and support staff. High-risk patients diagnosed with breast cancer meet with various healthcare specialists and physicians in the same location, all at one time. Our academic model of this multidisciplinary approach helps facilitate optimal comprehensive individualized treatment for our patients. Expanding our talented and dedicated team of physicians with the addition of two fellowship-trained breast surgeons has added depth and expertise to our world-class team and elevated the level of care we provide both individually and collectively. Performing two of the latest technological surgical advancements - hidden scar surgery and nipple-sparing mastectomy - Jupiter Medical Center breast surgeons are able to remove most of the breast tissue through one small incision while sparing the breast envelope and nipple allowing a plastic surgeon to reconstruct the breast in a way that is aesthetically more similar to the patient s original state. These newest technologies can be the most important step in getting a woman back to whole wellness. Jupiter Medical Center was the first in the state of Florida to offer electron beam IntraOperative Radiation Therapy, or e-iort. This advancement allows patients to undergo a lumpectomy and have targeted radiation during the same surgery, eliminating the need for weeks of outpatient radiation treatment after surgery. Research to cure breast cancer continues to dominate the research field around the world in hopes of one day finding a cure for breast cancer. In the meantime, our program will continue to secure the latest in clinical trials exploring ways to diagnose cancer earlier, and develop innovative breast cancer treatments using advanced technologies, as well as the latest in evidence-based medicine to provide superior outcomes for our patients. National Accreditation Program for Breast Centers In 2016, The Comprehensive Breast Care Program at Jupiter Medical Center was reaccredited by the National Accreditation Program for Breast Centers (NAPBC). This prestigious designation attests to our commitment to breast health and wellness, and is granted only to those centers that are voluntarily committed to providing the best possible care to patients with diseases of the breast. Each breast program must undergo rigorous evaluation and review of its performance and compliance with the NAPBC standards, which include evaluation of leadership, clinical management, research, community outreach, professional education and quality improvement. To maintain accreditation, programs must monitor compliance with these standards to ensure quality care, and must have an onsite review every three years. Plastic surgery is a critical component to comprehensive care of cancer patients. Our primary role is to extend the ability of other surgeons and specialists to more radically treat cancer. Data continually shows improved psychosocial wellbeing and quality of life in patients who undergo major reconstruction to minimize deformity from cancer therapy. Jupiter Medical Center plastic surgeons are integral to the multidisciplinary conferences and clinics where cancer patients receive personalized individual treatment plans. Advances in plastic surgery are in surgical treatment of head and neck cancer, sarcoma and tumors of the breast and chest wall; however, plastic surgeons also affect surgical oncology, providing medical oncologists with well-vascularized tissue coverage for management of complex tumors and areas affected by radiation. In 2015 and 2016, we developed uniform standards of care in adhering to National Comprehensive Cancer Network (NCCN) guidelines, and specific to radiation patients. The plastic surgeons on staff at Jupiter Medical Center remain committed to provide the highest level of care to obtain the best treatment options for all oncology patients. Skilled plastic and reconstructive surgeons play an integral role in the treatment and recovery of cancer patients by restoring normal form and function. David A. Lickstein, MD Plastic Surgery Plastic Surgery 3 4

5 Thoracic Surgery and Lung Center of Excellence Robotic Surgery The nationally progressive use of technology and innovative treatments available to Jupiter Medical Center s Thoracic Surgery and Lung Center of Excellence patients translates to world-class care. K. Adam Lee, MD General and Cardiothoracic Surgery Thoracic Surgery and Lung Center of Excellence The Thoracic Surgery and Lung Center of Excellence is comprised of a team of highly skilled specialists and thoracic leaders in the region, treating patients referred to us from throughout the country. With lung cancer being the leading cause of cancer deaths in men and women nationwide, Jupiter Medical Center has made it a mission to fight against diseases of the chest and lungs with prevention, education and screenings, and with acquiring the most advanced equipment and technologies available for treatment. This is an exciting time in medicine as we lead the charge in groundbreaking advances and strengthen our fight against lung cancer. Our comprehensive Thoracic Surgery and Lung Center of Excellence offers treatment options for all stages of disease, including surgery, chemotherapy and radiation therapy, in addition to some of the most revolutionary techniques such as radiofrequency ablation, targeted therapy and minimally invasive robotic surgery. We expanded as a training site in navigational bronchoscopy and the da Vinci robotic surgery technologies. Our expertly trained thoracic surgeons set the bar for physicians around the world who visit our program to build their own successful thoracic and lung programs, emulating our procedures and protocols. Additionally, we acquired a second surgical robot, making us one of the first in the world to offer the new da Vinci Xi System - a natural progression as our surgical team was the first in the nation to perform a four-arm robotic lobectomy for lung cancer more than a decade ago. In June 2016, we presented a paper at the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) World Conference held in Rome, Italy on the topic of labeling of small deep pulmonary nodules for those patients undergoing sublobar minimally invasive lung surgery. We were one of the first thoracic and lung programs in South Florida to implement weekly thoracic multidisciplinary cancer conferences. Patients diagnosed with cancer can be confident their health team recommends the best treatment options, having considered best practices along with evidence-based and national treatment guidelines. In 2015 and 2016, a total of 825 cases were examined at the weekly conferences. Each patient case received input from a variety of specialties, including medical and radiation oncologists, surgeons, radiologists, pathologists and more. The future of the Jupiter Medical Center Thoracic Surgery and Lung Center of Excellence looks to the expansion of incorporating worldwide data through IBM Watson technology into the multidisciplinary conferences furthering personalized treatment capabilities to lead to even better patient outcomes. The Frank E. & Mary D. Walsh Robotic Surgery Program at Jupiter Medical Center is a leader in minimally invasive robotic surgery. Our program was one of the first ten facilities in the world to install the da Vinci Xi Surgical System, the most advanced robotic system available. Since 2010, we have added more than 20 physicians to the roster of robotictrained physicians skilled to perform delicate and complex operations through a few tiny incisions with increased vision, precision, dexterity and control. Now with two robotic systems, surgeons from a variety of specialties including thoracic, urologic, colorectal, gynecologic, single site and general surgery are performing these cutting-edge robotic procedures to treat their patients. The patient experience results in a less invasive surgery with less pain, blood loss, and scarring, fewer complications and quicker recovery times. Lower risk of infection and shorter hospital stays are also a benefit to the patient. We have enhanced our robotic surgery program with the use of Firefly fluorescence imaging capability that provides real-time, image-guided identification of key anatomical landmarks using near-infrared technology. Firefly technology is especially effective during surgery to treat cancers of the colon, kidney and uterus. Firefly uses a dye that highlights the difference between cancerous tissue and healthy tissue, thus enhancing the surgeon s ability to avoid removing healthy tissue and capturing all of the cancerous tissue more precisely. In the past, the entire organ was removed. However, with Firefly technology, surgeons can often remove just the tumor. Jupiter Medical Center is the first hospital in the state of Florida to implement the da Vinci Si and Xi Surgical System Stapler. Physicians use surgical staplers to close skin wounds and connect or remove parts of the bowel or lung. The da Vinci Si and Xi Surgical System Stapler is the first and only fully wristed and articulating stapler that contains Smart Clamp technology, which gives our surgeons advanced tools with more control during complex procedures. Combined with 3D vision, the stapler enables doctors to work with precision deep inside the body. Overall, patients require a shorter length of stay in the hospital and recover more quickly with less pain when surgeries are performed with laparoscopic and robotic technology. Together our team of physicians, nurses and physical therapists consistently strive to improve patient outcomes. Our technology, including robotics and advanced laparoscopic surgery, allows us to perform more complex surgeries with less pain and faster recovery. Donna Pinelli, MD Obstetrics and Gynecology/ Gynecologic Oncology Gynecologic Oncology and Robotic Surgery The development of a lung nodule clinic utilizes CT lung cancer screenings to look for lung nodules. The Clinic is designed to help diagnose and monitor patients with previously identified or suspected lung nodules, and allows for prompt treatment to cure the cancer. 5 6

6 Gynecologic Oncology Genitourinary Oncology We remain devoted to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to cancer care for women. Donna Pinelli, MD Obstetrics and Gynecology/ Gynecologic Oncology Gynecologic Oncology and Robotic Surgery The Gynecologic Oncology Program at Jupiter Medical Center is a leader in South Florida providing innovative treatments for women with gynecologic cancers, including cervical, endometrial, ovarian, uterine and vulvar cancers. Our multidisciplinary team consists of board-certified gynecologic oncologists, a nutritionist and geneticist to guide patients through each aspect of treatment with personalized care. We are inspired to provide our community a gynecologic oncology program that meets each woman s individual needs through custom treatment plans coordinated through a team approach. A personal navigator to guide patients each step of the way further demonstrates our commitment to personalized care. In 2015 and 2016 we remained steadfast in our commitment to the prevention of gynecologic cancer not just diagnosing and treating it. Jupiter Medical Center is persistent in its pursuit of the most advanced leadingedge surgical technologies, the latest updates in equipment and software to allow us to perform the latest procedures like hysterectomies, myomectomies and others to achieve optimal results for our patients. Advanced minimally invasive laparoscopic and robotic surgical treatments continue to revolutionize the way we treat gynecologic cancers offering physicians greater accuracy and surgical precision providing shorter hospital stays, less pain and shorter recoveries. The genetics risk and testing department is integral in the care of our patients. Our dedicated Genetic Clinical Nurse maps a woman s family cancer history and determines their risk through BRCA genetic testing. We remain on the forefront of genetic testing capabilities an area that has seen exponential growth in recent years making it a key in providing prevention plans and cancer risk assessments for patients. Education also was a highlight of activity, which included a variety of seminars, lectures, and screenings to community members. We targeted awareness efforts of risks of HPV specifically to high school students with a goal of prevention, risk assessment, treatment and early detection of HPV. In addition to treating gynecologic oncology disease in patients, Jupiter Medical Center will continue its focus on lifestyle and health and wellness, concentrate on restoring patients to wellness, and will provide education and activities directed to maintaining wellness in our population. The Genitourinary Oncology Program at Jupiter Medical Center brings together leading urologists, medical oncologists, radiation oncologists, radiologists and pathologists to provide state-of-the-art diagnosis and management of prostate, bladder, kidney and testicular cancer. We offer routine as well as complex surgical and nonsurgical treatments, as we strive for optimal outcomes in our patients with genitourinary malignancies. Robotic, organ preserving and enhanced imaging techniques are all available in our community hospital setting. Monthly multidisciplinary conferences are designed to provide our cancer patients with personalized treatment plans. Through our research program, we can offer patients access to emerging therapies including immunotherapy and investigational protocols. In essence, world-class care is now available locally at Jupiter Medical Center! In the GU Oncology Program, we remain committed to community outreach. As is the case for other malignancies, it is critical to educate the public about the risks, prevention and treatment options for genitourinary cancers. As an institution, we are committed to the latest technology for both the diagnosis and treatment options in all areas of cancer management. Multidisciplinary coordinated care is the key to best treating urologic cancer. R. Neill Borland, MD Urology Genitourinary 7 8

7 Cutaneous Oncology Oncology Research and Clinical Trials 9 We are committed to elevate our services to provide our community the best in world-class care. Michael Borenstein, MD, PhD Dermatology Co- Cutaneous Oncology Providing the best care to complex skin cancer and melanoma patients is a true team effort with a coordinated integration of every specialty. Alissa O Brien, MD Dermatology Co- Cutaneous Oncology Skin cancer is the most commonly diagnosed cancer in the United States. In fact, one in five Americans will develop a skin cancer during their lifetime, and the number of skin cancers is rising rapidly. The good news for people who live in Palm Beach and Martin counties is they can find world-class skin cancer care through the Cutaneous Oncology Program at Jupiter Medical Center. For patients with locally advanced or metastatic disease, the widest variety of conventional and experimental treatments is available including chemotherapy, immunotherapy, biochemotherapy, radiation therapy, and vaccines in the treatment of melanoma. Our goal in 2015 and 2016 was to build the Cutaneous Oncology Program. We developed melanoma multidisciplinary conferences where individual patient cases are discussed among physicians of different specialties. Our patients have access to various specialists including oncologists, dermatologic oncologists, surgical oncologists, radiation oncologists and plastic surgeons all in one location. The weekly high risk Melanoma Screening Clinic at Jupiter Medical Center s Foshay Cancer Center is designed to detect cancer at its earliest stages, crucial to improving a patient s survival of a melanoma diagnosis. Patients at high risk for developing melanoma also are monitored using advanced imaging techniques to attempt to reduce unnecessary biopsies. Advanced technologies include FotoFinder Mole Mapping, a high-resolution imaging system that scans the entire skin surface for areas that could potentially develop into melanoma, and Confocal Scanning Laser Microscopy 3-D imaging technology that provides in vivo images of the epidermis and papillary dermis in realtime. Genetic testing also is an option for patients at high risk for melanoma. Another example of our coordinated cancer services is the addition of monthly complex cutaneous oncology conferences in 2016, further strengthening the Cutaneous Oncology Program. The tumor board process gathers dermatologists, pathologists, radiologists and radiation oncologists, surgeons and medical oncologists to assess complex cases to determine the best options for treatment. Our medical directors attended continuing medical education (CME) programs to stay abreast of the most advanced treatments available. In October 2016, Keynote Speaker Desiree Ratner, MD, of Mount Sinai New York joined Jupiter Medical Center physicians to host a CME lecture and panel discussion on non-melanoma skin cancer at the Raso Education Center. Radiation oncologist, Nathan Tennyson, MD, served as lecturer for the radiation portion. In December 2016, Jupiter Medical Center s Cutaneous Oncology Program hosted another CME lecture and panel discussion in Palm Beach Gardens on melanoma. More than 45 physicians from specialties including primary care, dermatology, plastic surgery, and oncologic surgery attended the event with Keynote Speaker Vernon Sondak, MD, Chair of the Department of Cutaneous Oncology and Director of Surgical Education at Moffitt Cancer Center in Tampa. Drs. Abraham Schwarzberg and Alissa O Brien served as lecturers for the oncology dermatologic portion. Additionally, physicians and dermatologic oncology specialists participated in several educational outreach programs, educating the community through lectures and skin cancer screenings, particularly in locations where individuals may not otherwise have access to our services. We will continue to promote prevention through collaborations with local organizations such as Richard David Kann Melanoma Foundation and high school student melanoma clubs to raise the awareness of skin cancer protection and the importance of early diagnosis. Researchers across the nation work every day to find new and better ways to treat and cure disease and improve the health of patients. The Clinical Research Program at Jupiter Medical Center is under the medical direction of S. Raymond Golish, MD, Chair of the Jupiter Medical Center Institutional Review Board. Clinical trials offered at Jupiter Medical Center include oncology related trials. Clinical trials focused on new cancer drugs or drug combinations, new approaches to radiation therapy, surgical techniques, quality of life and genomic tissue are some of the trials available to cancer patients. Our research department achieved commendation status with the Commission of Cancer (CoC) for clinical trial accrual. Collaborations with major pharmaceutical companies offer cutting-edge diagnostic and treatment trials to better serve our community. Prevention trials test new approaches with medicines, vitamins, minerals or other supplements that may lower the risk of specific cancers. These trials may discover ways to prevent cancer in people who have never had cancer or to prevent the return of cancer in patients who have already had cancer. Screening trials test the best way to find cancer in its early stages and quality of life trials explore ways to improve comfort and daily living for cancer patients. In 2016, we established a new research team, including the addition of Dr. Smitha Gubbi, CCRC who serves as Director of Clinical Research. Under this new direction, the focus has intensified through a collaboration with Mount Sinai New York, local research institution Scripps Florida and Max Planck, and other pharmaceutical companies, to bring more treatment focused trials to oncology and our Comprehensive Cancer Program. These collaborations will further increase the availability of drugs and novel therapies for patients in our local community. In late 2016, Jupiter Medical Center announced the signing of a formal agreement with Mount Sinai New York and the Icahn School of Medicine for research, which includes oncology. We are privileged to have the opportunity to affiliate with the Icahn School of Medicine, an institute world-renowned for ground breaking medical and scientific inquiry, discovery and development. The new partnership has real implications for people facing illness and disease in Palm Beach and Martin counties. Investigators at both institutions will work together to conduct basic, clinical, epidemiologic, and translational research, striving to rapidly transform scientific advances into improved patient care and outcomes. Highlights of Oncology Research Amgen Pharmaceutical Chemotherapy Induced Anemia trial for patients receiving blood transfusions This study looks at patient s symptoms and treatment related to anemia while on chemotherapy. Xeno 01/Scripps Florida This trial is the study of surgical tissue specimens of the breast and the lung to learn more about cancer mutations affecting DNA, RNA and protein expression in tumors. Oncology Bio-specimens Trials: Collection of tumor tissue samples Jupiter Medical Center has over 15 bio-specimens trials open in breast, lung, and gynecology. Enrollment has doubled since previous years. IOERT B2 Radiation Breast Oncology Trial Managed by the radiation oncology team under the supervision of Principal Investigator Anthony Addesa, MD, trial enrollment continues to grow. Clinical research at Jupiter Medical Center remains committed to ensure we are on the forefront of the future of medicine. Clinical research offers great potential for future cancer treatments. Results from these trials will help the medical community better understand how therapies work and how to most effectively manage and treat cancers changing cancer patient care. Clinical trials play an integral role in cancer treatment, they are where treatments are discovered, tested and made available to patients. Today s trials will produce the drugs that are future cancer treatment. Lucy De La Cruz, MD General and Breast Surgery 10

8 Cancer Committee We are extremely proud that Jupiter Medical Center is accredited by the Commission on Cancer and as we continue our commitment to excellence, we will search for new and better ways of providing cancer care, new treatments and new technologies that exceed national standards. Antonella Leary, MD Chair, Cancer Committee Obstetrics and Gynecology and Gynecologic Oncology The Cancer Committee is a multidisciplinary standing committee composed of physicians, allied health professionals, quality services and administrative staff representing all specialty and service areas of oncology. We meet compliance with the American College of Surgeons (ACoS) Commission on Cancer standards for superior quality and comprehensive care through bimonthly meetings. The mission of the Committee is to provide the Medical Staff with leadership in planning and assessing all cancer related activities at Jupiter Medical Center. We are fully committed to putting our expert knowledge, experience and energy forward striving each day to provide the best cancer care and supportive services to patients, their families and the community and to exceed national benchmarks. The Commission on Cancer (CoC) of the American College of Surgeons (ACoS) once again granted full accreditation to the cancer program at Jupiter Medical Center. To earn voluntary CoC accreditation, a cancer program must meet 34 CoC quality standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patientcentered care. CoC-accredited cancer centers take a multidisciplinary approach to treating cancer as a complex group of diseases that requires consultation among surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialists. This accreditation demonstrates that the Jupiter Medical Center Comprehensive Cancer Care Program is home to uniquely skilled physicians who utilize state-of-the-art technology to bring high-quality cancer care to the community, resulting in improved patient care. Applying for and maintaining accreditation from the Commission on Cancer (CoC) is a voluntary commitment by Jupiter Medical Center s Comprehensive Cancer Care Program to ensure we serve our patients at the highest level providing access to the full scope of services required to diagnose, treat, rehabilitate and support cancer patients and their families. As the Cancer Liaison Physician (CLP), I am responsible for the collaboration with the Cancer Committee to meet and exceed cancer program standards and improve clinical practice by evaluating, interpreting and reporting the program s performance using National Cancer Data Base (NCDB) data to the Cancer Committee at least four times annually. The CoC has developed quality measures that offer providers comparative information to assess adherence to and consideration of standard of care therapies for major cancers. This reporting tool provides a platform from which to promote continuous improvement of patient care at the local level and also permits hospitals to compare their care for these patients relative to that of other providers. The aim is to empower clinicians, administrators, and other staff to work collaboratively to identify problems in practice and delivery and to implement best practices that will diminish disparities in care across CoC-accredited cancer programs. Cancer registry data elements are nationally standardized and considered open source. Each of these measures was developed by the CoC with the expectation that cancer registries would be used to collect the necessary data to assess and monitor concordance with the measures. Extensive validation and assessment of the measures were performed using cancer registry data reported to the NCDB. Below are examples of prevention and screening programs in that are part of the numerous CoC related activities offered to the community. COC Standard 4.1 Prevention Programs An education program about Human Papillomavirus (HPV) and Cervical Cancer, driven by national evidencebased guidelines for vaccine and the importance of healthy lifestyles, was presented to Jupiter High School students and their parents. Centers for Disease Control and Prevention (CDC) guidelines for HPV vaccine and The American Congress of Obstetricians and Gynecologists (ACOG) HPV vaccine and screening guidelines were addressed at the event held on October 21, COC Standard 4.1 Prevention Programs Donna Pinelli, MD, Gynecology/Oncology presented as keynote speaker at The Teal Tea event held on September 22, 2016 at Wyndham Grand Jupiter at Harbourside Place. Jupiter Medical Center, in partnership with Hearing the Ovarian Cancer Whisper (H.O.W.), also led a panel discussion at the event. The panel of experts discussed prevention and wellness for women, how to improve gynecologic health, the role genes play in cancer, and best strategies for detecting gynecologic disease at its earliest stage. COC Standard 4.2 Screening Programs Lung cancer is the leading cause of cancer deaths in the United States. More people die of lung cancer each year than colon, breast, pancreas and prostate cancers combined. Low-dose computed tomography (LDCT) scans allow lung cancer to be detected when the disease is in its earliest, most curable stages. There is evidence that demonstrates lung cancer screening of high-risk Medicare beneficiaries is not only life-saving but more cost-effective than other cancer screening protocols currently covered by Medicare. An analysis from the landmark National Lung Cancer Screening Trial (NLST), a nearly decade-long study involving more than 50,000 current and former heavy smokers ages 55 to 74, found that lung cancer mortality was 20 percent lower after only three rounds of LDCT scans, and researchers expect much greater reductions with additional rounds. Following two years of evidence review, United States Preventive Services Task Force recommended the use of annual LDCT scans for individuals years of age with a history of heavy smoking in December An educational seminar on lung cancer care was offered on November 13, 2015, that included lung cancer screening, nodule clinics, and new treatments for lung cancer. Those patients who met criteria for lung screening were registered for follow-up screening at Jupiter Medical Center. The ability as a cancer program to continually evaluate our performance and take proactive, corrective actions when necessary reaffirms our commitment of the program to provide advanced world-class cancer care. K. Adam Lee, MD General and Cardiothoracic Surgery Thoracic Surgery and Lung Center of Excellence Cancer Liaison Physician, Cancer Committee 11 12

9 Support Services Navigation Jupiter Medical Center is dedicated to our oncology patients from the moment an abnormality is identified to diagnosis, through treatment, and ultimately to survivorship. A highly specialized and compassionate team of disease-specific registered nurse navigators engages and supports our oncology patients from the start of their care with our providers within the institution. Our goal is to guide patients seamlessly through our system of care and wellness continuum to ensure timely access to world-class services. The Navigation Program is an essential component of cancer patient care. A cancer diagnosis comes with many challenges. The nurse navigator guides the patient through the entire continuum of care, identifying potential barriers to care financial, transportation, insurance, and or psychosocial and providing resources to address those barriers. Additionally, navigators help with scheduling appointments and provide education as needed. Cancer patients are introduced to our tumor board and the multidisciplinary clinic concept of Jupiter Medical Center s academic model of care to provide personalized treatment plans including needs regarding surgery, chemotherapy, and radiation services. Our oncology nurse navigators also acquaint patients with supportive oncology services and integrative medicine, including our survivorship program, provided as part of the multidisciplinary clinic within the hospital. Multidisciplinary Cancer Conferences Our strength lies in our academic model of care through multidisciplinary cancer conferences, also known as tumor boards. Multidisciplinary cancer conferences follow standards set by the Commission on Cancer and the American College of Surgeons. Breast and thoracic multidisciplinary conferences were the first implemented at Jupiter Medical Center. Their success prompted the implementation of cutaneous, genitourinary and gynecologic cancer conferences in recent years. The cancer conferences are attended by medical oncologists, radiation oncologists, surgeons, radiologists, pathologists and other specialists who share ideas and knowledge, and work together to determine the best treatment for each patient. Cancer conference discussions include an analysis of the disease stage, including prognostic indicators, options for clinical research trials, genetic testing, and palliative care and a treatment plan is developed using evidence-based and national treatment guidelines. Psychosocial care, nutrition and rehabilitation services also may be discussed. Nurses, genetic counselors, social workers, psychologists, chaplains and dieticians often attend the conference to provide consultative service for their patients. In 2015, 766 cases were presented at cancer conferences. In 2016, 787 patient cases were presented. The collaboration of the cancer conferences are a positive influence in determining the optimal treatment plan for a cancer patient unique to the individual. The monitoring of cancer conference activity may also identify opportunities to improve the patient care process. Chemotherapy and Infusion The Jupiter Medical Center Outpatient Oncology & Infusion Unit provides cancer patients with chemotherapy and medical infusion services in a calm, comfortable setting. Certified oncology nurses focus on patient safety during treatment and provide education and support on all aspects of their care and treatment. Ongoing evaluation of our patients progress is key to successful treatment. Nutritional support, an important aspect of care during chemotherapy treatment, is available to assist patients as well. Patients and families have access to our patient resource room where they can learn more about their diagnosis, treatment, and cancer coping mechanisms. Outpatient Oncology & Infusion Unit amenities include comfortable recliners, each with a television to help pass the time when not visiting with family members or friends, blanket warmers, and complimentary lunch and snacks for patients receiving treatment. Cancer Genetics Jupiter Medical Center now screens 100 percent of newly diagnosed breast and gynecological cancer patients for genetic predisposition syndromes. When appropriate, these patients are referred for genetic counseling and subsequent testing. Plans to expand our risk assessment programs next year include the high-risk cutaneous and GI cancer patients. In the future, genetic services at Jupiter Medical Center plans to integrate these patients and their risk assessments with the IBM Watson artificial intelligence analytical software program

10 Rehabilitation Psychosocial Support Palliative Care Survivorship The Oncology Rehabilitation Program, available at Jupiter Medical Center s Cary Grossman Health and Wellness Center meets the unique rehabilitative needs and interests of cancer patients and survivors. Licensed physical, occupational, and speech therapists, a dietician, oncology counselor, massage therapist, exercise specialists, and oncology nurses integrate a variety of therapeutic techniques individualized for each patient. All aspects of rehabilitation are coordinated with the approval and guidance of the patient s physician. Patients who participate in oncology rehabilitation experience enhanced self-image and sense of control, improved endurance and increased muscular strength resulting in improved functional mobility. A decreased incidence of anxiety and depression and reduction of fatigue and pain also are among the benefits to patients. Oncology rehabilitation helps many cancer patients manage lymphedema and treatment side effects, improve tolerance to chemotherapy, shorten recovery time after surgery and treatment, strengthen the immune system, decrease risk of infection, and improve quality of life. Jupiter Medical Center psychosocial support to patients and their families is a key component of comprehensive care. An enhanced distress screening tool developed to more accurately identify each patient s distress level and psychosocial needs assists us to determine on-campus and community resources that may be of benefit. The oncology social worker also collaborates with the multidisciplinary team, to ensure a seamless coordination of care in a plan unique to each individual patient. Over the past two years, four support groups were created to provide patients and their families with support, education and the opportunity to talk to others with similar experiences. Individual, couples and family counseling are available. Cancer support groups facilitated by the oncology social worker include: Living with Cancer Support Group This bi-weekly group benefits all those living with ANY cancer and cancer survivors. Young Women with Cancer Support Group Women, age 45 and under, who are managing a cancer diagnoses and treatment will benefit from this monthly group. Caregiver Support Group This group meets monthly for education and support while caring for a family member or friend with cancer. Living with Breast Cancer Support Group From diagnosis to survivorship, any person who has had a breast cancer diagnosis is encouraged to attend this monthly group. Palliative care is an approach that improves the quality of life for patients and their families facing challenges associated with life-threatening illness. Jupiter Medical Center is a partner with Trustbridge Palliative Services to provide inpatient consultative services. Board-certified palliative care physicians and nurse practitioners strive to provide excellent symptom management to assist the oncology patient to find relief from symptoms. These expert consultants help the patient and their family determine patient care goals and make recommendations to the attending physician regarding medication adjustments, treatment interventions and advanced planning. Hospital pharmacists, social workers, a chaplain, and the patient s physicians complete the palliative care team. Hospice Care When a medical provider estimates a patient has six months or less to live, hospice care may be recommended. Committed to assisting patients and their families to live as fully and comfortably as possible, hospice professionals can care for patients in their own homes, assisted living facilities or nursing homes. When patients have uncontrolled symptoms or are very near the end of life and need comfort interventions, Hospice of Palm Beach County, a division of Trustbridge, also provides 24-hour care in a thirteen bed inpatient unit located in the Jupiter Medical Center Skilled Nursing and Rehabilitation Center. There, board-certified hospice physicians, nurses, social workers and chaplains provide compassionate, skillful care to allow patients to have peace, dignity and comfort. Our comprehensive cancer program includes assistance with the transition to survivorship, once treatment is completed. Our goal is to ensure that all cancer patients at Jupiter Medical Center receive a survivorship care plan. This past year we began giving all eligible breast, lung, and gynecological cancer patients treated at Jupiter Medical Center, a survivorship care plan. We continue to host the annual Celebration of Life event for cancer survivors and their families an event that has been hosted at Jupiter Medical Center for more than 25 years. Future plans for the Survivorship Program include offering a Cancer Survivorship Lecture Series to cover topics pertinent to survivorship

11 Community Outreach 2015 Community Outreach 2016 Man Up: Straight Talk About Prostate Cancer Community members gathered to get the facts about risk factors for prostate cancer, when to get tested, how to reduce risk and what to do if you are diagnosed with prostate cancer. Targeting Cancer In Five Days With Cyberknife An informative discussion on the newest technology in the fight against cancer, The CyberKnife M6 System, was presented to community members. Participants learned of the system s ability to treat patients in just five days using intense, highly focused beams of radiation in a pain-free, non-surgical procedure. HPV 101 A panel of physicians discussed gynecologic health, HPV virus and vaccinations to Jupiter High School students. Skin Cancer Screening at Martin County School District Employee Health Fair Living with Breast Cancer Support Group 20th Anniversary Breast cancer survivors and their loved ones were invited to join a celebration and to meet the current team and those who started the living with Breast Cancer Support Group 20 years ago. National Cancer Survivors Day Hats Off To Survivors Celebration of Life event hosted speakers and survivors, highlighting the Survivor s Quilt Project. : It s Not Just Punctuation! Take Care of Your Colon Get Screened event was hosted in recognition of National Colorectal Cancer Awareness Month. Community members learned about the importance of colonoscopy screening in the prevention of colorectal cancer. Do You or Someone You Care About Suffer from Heartburn? Held in recognition of National Esophageal Cancer Awareness Month, attendees learned when heartburn can be a more serious issue. The Teal Tea event In recognition of National Gynecologic Cancer Awareness Month, the informative discussion focused on the role of a healthy lifestyle in preventing gynecologic cancers, information on genetics, nutrition and screenings. Real Men Wear Pink This Breast Cancer Awareness Event was held in conjunction with the Food Truck Invasion at Abacoa Town Center and included a concert, pink ribbon giveaways and breast health information. Skin Cancer Screening at Scripps Research Institute Employee Health Fair Jonathan s Landing 5th Annual Health Fair Jupiter Inlet Colony Health & Wellness Fair Frankly Speaking About Lung Cancer: A Lung Cancer Awareness Talk in recognition of National Lung Cancer Awareness Month Physicians discussed the benefits of CT lung screenings, smoking cessation, and the comprehensive thoracic program available to community members at Jupiter Medical Center

12 Cancer Registry The Cancer Registry is the department designated to collect, manage, analyze and report information on every cancer patient diagnosed and/or treated at our center. The information collected for each patient includes routine personal and demographic data, diagnosis, stage of disease at diagnosis, medical history, laboratory data, tissue diagnosis and course of treatment. To protect the privacy of each patient, each case is de-identified and coded by number rather than name, and personal/demographic information is removed before it is reported to the Florida Cancer Registry and the National Cancer Database to help health officials to better monitor and advance cancer treatments, conduct research and improve cancer prevention and screening programs. 9% 10% 4% 2% 1% 2% 7% 13% 2015 BODY SYSTEMS 12% 6% 8% 10% 1% 2% 4% 1% 7% 10% 2016 BODY SYSTEMS 13% 3% The Cancer Committee uses the cancer registry data to measure compliance with evidence-based clinical practice guidelines endorsed by the American College of Surgeons Commission on Cancer through quality improvement studies. The integrity of the data is closely monitored through dedicated quality control measures while strict confidentiality is maintained to protect patient privacy. 11% 23% 12% 29% 2015 Primary Site Groups Total Digestive System 195 Respiratory System 189 Skin Excluding Basal & Squamous Cell 98 Breast 355 Female Genital System 178 Male Genital System 151 Urinary System 144 Brain & Other Nervous System 32 Lymphoma 61 Leukemia 34 Endocrine System 20 Miscellaneous % Digestive System 10% 12% Respiratory System 13% 6% Skin Excluding Basal & Squamous Cell 3% 23% Breast 29% 11% Female Genital System 12% 10% Male Genital System 10% 9% Urinary System 8% 2% Brain & Other Nervous System 1% 4% Lymphoma 4% 2% Leukemia 2% 1% Endocrine System 1% 7% Miscellaneous 7% 2016 Primary Site Groups Total Digestive System 123 Respiratory System 156 Skin Excluding Basal & Squamous Cell 37 Breast 343 Female Genital System 146 Male Genital System 113 Urinary System 98 Brain & Other Nervous System 7 Lymphoma 49 Leukemia 23 Endocrine System 13 Miscellaneous

13 2015 Summary Site Breakdown 2016 Summary Site Breakdown SEX CLASS OF CASE STATUS STAGE DISTRIBUTION - Analytic Cases Only SEX CLASS OF CASE STATUS STAGE DISTRIBUTION - Analytic Cases Only PRIMARY SITE Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv BREAST 355 (22.7%) Breast 355 (22.7%) FEMALE GENITAL SYSTEM 178 (11.4%) Cervix Uteri 21 (1.3%) Corpus & Uterus, NOS 91 (5.8%) Corpus Uteri Uterus, NOS Ovary 36 (2.3%) Vagina 2 (0.1%) Vulva 17 (1.1%) Other Female Genital Organs 11 (0.7%) MALE GENITAL SYSTEM 151 (9.7%) Prostate 145 (9.3%) Testis 6 (0.4%) URINARY SYSTEM 144 (9.2%) Urinary Bladder 93 (5.9%) Kidney & Renal Pelvis 47 (3.0%) Ureter 4 (0.3%) EYE & ORBIT 4 (0.3%) Eye & Orbit 4 (0.3%) BRAIN & OTHER NERVOUS SYSTEM 32 (2.0%) Brain 10 (0.6%) Cranial Nerves Other Nervous System 22 (1.4%) ENDOCRINE SYSTEM 20 (1.3%) Thyroid 18 (1.2%) Other Endocrine including Thymus 2 (0.1%) LYMPHOMA 61 (3.9%) Hodgkin Lymphoma 4 (0.3%) Non-Hodgkin Lymphoma 57 (3.6%) NHL - Nodal NHL - Extranodal MYELOMA 22 (1.4%) Myeloma 22 (1.4%) LEUKEMIA 34 (2.2%) Lymphocytic Leukemia 10 (0.6%) Acute Lymphocytic Leukemia Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia 23 (1.5%) Acute Myeloid Leukemia Chronic Myeloid Leukemia Other Leukemia 1 (0.1%) MESOTHELIOMA 5 (0.3%) Mesothelioma 5 (0.3%) MISCELLANEOUS 41 (2.6%) Miscellaneous 41 (2.6%) TOTAL 1, , , SEX CLASS OF CASE STATUS STAGE DISTRIBUTION - Analytic Cases Only SEX CLASS OF CASE STATUS STAGE DISTRIBUTION - Analytic Cases Only PRIMARY SITE Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv FEMALE GENITAL SYSTEM 146 (12.3%) Cervix Uteri 10 (0.8%) Corpus & Uterus, NOS 90 (7.6%) Corpus Uteri Uterus, NOS Ovary 26 (2.2%) Vagina 3 (0.3%) Vulva 9 (0.8%) Other Female Genital Organs 8 (0.7%) MALE GENITAL SYSTEM 113 (9.5%) Prostate 112 (9.4%) Testis 1 (0.1%) URINARY SYSTEM 98 (8.2%) Urinary Bladder 58 (4.9%) Kidney & Renal Pelvis 32 (2.7%) Ureter 6 (0.5%) Other Urinary Organs 2 (0.2%) BRAIN & OTHER NERVOUS SYSTEM 7 (0.6%) Brain 1 (0.1%) Cranial Nerves Other Nervous System 6 (0.5%) ENDOCRINE SYSTEM 13 (1.1%) Thyroid 12 (1.0%) Other Endocrine including Thymus 3 (0.2%) LYMPHOMA 49 (4.1%) Hodgkin Lymphoma 4 (0.3%) Non-Hodgkin Lymphoma 45 (3.8%) NHL - Nodal NHL - Extranodal MYELOMA 16 (1.3%) Myeloma 16 (1.3%) LEUKEMIA 23 (1.9%) Lymphocytic Leukemia 6 (0.5%) Chronic Lymphocytic Leukemia Other Lymphocytic Leukemia Myeloid & Monocytic Leukemia 16 (1.3%) Acute Myeloid Leukemia Chronic Myeloid Leukemia Other Leukemia 1 (0.1%) MESOTHELIOMA 2 (0.2%) Mesothelioma 2 (0.2%) MISCELLANEOUS 47 (4.0%) Miscellaneous 47 (4.0%) TOTAL 1, , , PRIMARY SITE Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv PRIMARY SITE Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv ORAL CAVITY & PHARYNX 28 (1.8%) ORAL CAVITY & PHARYNX 12 (1.0%) Lip 1 (0.1%) Lip 1 (0.1%) Tongue 6 (0.4%) Tongue 3 (0.3%) Salivary Glands 2 (0.1%) Salivary Glands 3 (0.3%) Floor of Mouth 2 (0.1%) Floor of Mouth 1 (0.1%) Gum & Other Mouth 1 (0.1%) Tonsil 3 (0.2%) Nasopharynx 1 (0.1%) Other Oral Cavity & Pharynx 1 (0.1%) Tonsil 12 (0.8%) DIGESTIVE SYSTEM 123 (10.3%) Oropharynx 1 (0.1%) Esophagus 13 (1.1%) Hypopharynx 2 (0.1%) Stomach 4 (0.3%) DIGESTIVE SYSTEM 195 (12.5%) Small Intestine 3 (0.3%) Esophagus 16 (1.0%) Colon Excluding Rectum 50 (4.2%) Stomach 13 (0.8%) Cecum Small Intestine 6 (0.4%) Appendix Colon Excluding Rectum 72 (4.6%) Ascending Colon Cecum Hepatic Flexure Appendix Transverse Colon Ascending Colon Splenic Flexure Hepatic Flexure Sigmoid Colon Transverse Colon Large Intestine, NOS Splenic Flexure Rectum & Rectosigmoid 14 (1.2%) Descending Colon Rectosigmoid Junction Sigmoid Colon Rectum Large Intestine, NOS Anus, Anal Canal & Anorectum 5 (0.4%) Rectum & Rectosigmoid 22 (1.4%) Liver & Intrahepatic Bile Duct 7 (0.6%) Rectosigmoid Junction Liver Rectum Intrahepatic Bile Duct Anus, Anal Canal & Anorectum 10 (0.6%) Other Biliary 1 (0.1%) Liver & Intrahepatic Bile Duct 12 (0.8%) Pancreas 18 (1.5%) Liver Other Digestive Organs 8 (0.7%) Intrahepatic Bile Duct RESPIRATORY SYSTEM 156 (13.1%) Gallbladder 3 (0.2%) Larynx 3 (0.3%) Other Biliary 1 (0.1%) Lung & Bronchus 152 (12.8%) Pancreas 32 (2.0%) Trachea, Mediastinum & Other Respiratory 1 (0.1%) SOFT TISSUE 4 (0.3%) Soft Tissue (including Heart) 4 (0.3%) SKIN EXCLUDING BASAL & SQUAMOUS 37 (3.1%) Melanoma - Skin 33 (2.8%) Other Non-Epithelial Skin 4 (0.3%) BREAST 343 (28.8%) Breast 343 (28.8%) Peritoneum, Omentum & Mesentery 2 (0.1%) Other Digestive Organs 6 (0.4%) RESPIRATORY SYSTEM 189 (12.1%) Larynx 8 (0.5%) Lung & Bronchus 181 (11.6%) BONES & JOINTS 1 (0.1%) Bones & Joints 1 (0.1%) SOFT TISSUE 6 (0.4%) Soft Tissue (including Heart) 6 (0.4%) SKIN EXCLUDING BASAL & SQUAMOUS 98 (6.3%) Melanoma -- Skin 89 (5.7%) Other Non-Epithelial Skin 9 (0.6%)

14 The Anderson Family Cancer Institute Renderings (also featured on the cover) of the Anderson Family Cancer Institute on the Peter and Missy Crisp Cancer Campus. Patients at the Anderson Family Cancer Institute will have direct access to the science-driven diagnostic and therapies found at the nation s most renowned health care institutions all in one state-of-the-art facility. The Margaret W. Niedland Breast Center The Margaret W. Niedland Breast Center is a state-of-the-art facility housing the most advanced and sophisticated imaging and diagnostic equipment, it is like no Breast Center you have probably ever seen. When you walk in the doors, harmonious feng shui design elements combine with engaging artwork and natural light to enhance each individual s experience of wellness. Outside, there is a beautiful meditation garden that is the perfect space to relax the body and mind