Call to Action. Core Values. Enabling Strengths. Healthcare That Works Healthcare That Is Safe Healthcare That Leaves No One Behind for Life

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2 Call to Action Healthcare That Works Healthcare That Is Safe Healthcare That Leaves No One Behind for Life Core Values We are called to: Service of the Poor Reverence Integrity Wisdom Creativity Dedication Enabling Strengths Inspired People Trusted Partnerships Empowering Knowledge Vital Presence Stewardship

3 St. Vincent s Cancer Center Chairperson s Annual Report Susan Salter, M.D. St. Vincent s Bruno Cancer Center experienced another year of growth in patient care and implementation of new cancer therapies. We diagnosed and managed 16 cancers. As expected, these were predominantly prostate, breast, colorectal, lung, lymphomas, oral cavity, and a variety of hematologic conditions. Most of the patients were primarily treated with surgery, but more than half received radiation therapy, chemotherapy, or antibody therapy as their primary or adjuvant treatments in the Bruno Cancer Center. The Radiation Oncology Center continued to expand state-of-the-art radiation therapy procedures. Introduced in 4, the High Dose Rate unit allows breast cancer radiation to be delivered in five days rather than the seven weeks required for traditional external beam radiation therapy. The IMRT (Intensity Modulated Radiation Therapy) program, enhanced by the Acculoc component, allows for sub millimeter localization of the radiation therapy target thus avoiding toxicity to adjacent tissues. The TomoTherapy unit was fully implemented in 7 for treatment of prostate, head and neck, and brain cancers. TomoTherapy is a new revolutionary way to treat cancer with radiation therapy. The system allows the physician to check the location of the patient s tumor before each treatment and then deliver precise radiation therapy based on a carefully customized plan. The TomoTherapy unit combines precise -D imaging from computerized tomography with a highly targeted radiation beam. This cutting-edge technology, which is currently available in two locations in the Birmingham area, allows the Bruno Cancer Center to offer our patients optimum treatment for a variety of cancers. Another radiation oncology program, BEXXAR radio immunotherapy, is a complex modality that combines monoclonal antibody therapy with radiation. Tositumomab, combined with CD- antigen iodine(1 11), is used for the treatment of patients with CD- antigenexpressing relapsed or refractory, low-grade follicular or transformed non-hodgkin s lymphoma, including patients who have failed prior monoclonal antibody therapy. The recent clinical trials have established that this treatment is effective and offers patients a relatively short and non-toxic treatment program that is capable of suppressing certain lymphomas for many years without the need to maintain the patient on continuous treatment, as is the case with most other chronic therapies for low-grade lymphoma. The Bruno Cancer Center, the only community hospital with BEXXAR therapy in the Birmingham area, is serving a vital role in offering patients a unique treatment option. Radiation Oncology continues to provide Partial Breast Irradiation treatment with MammoSite and Contura devices. This allows us to treat selected breast cancer patients in a shorter time frame from seven weeks to one week. In 7 we treated 7 patients. Other vital services that continue to enhance our program include the Breast Cancer Support Group, the General Cancer Support Group, Camp Bluebird, and cancer screenings. The Medical Oncology Center Census continued to grow and new treatment programs and key personnel were added. There were more than 14, patient visits and 7, treatments (primarily chemotherapy) administered in the Bruno Cancer Center facility. Medical oncology clinical trials involved a variety of cancer types and therapies including new agents in late phase trials for FDA approval. By virtue of these trials, breast cancer patients were able to receive Avastin as adjuvant therapy for breast cancer, Herceptin with a newer better tolerated chemotherapy regimen consisting of Doxil and Carboplatin, adjuvant Herceptin in early stage breast cancer and Avastin in combination with various chemotherapy regimens in patients with previously treated metastatic breast cancer. Chronic lymphocytic leukemia patients were placed on a trial that compared a standard therapy with the addition of Pentostatin, an agent that previously showed superior single agent activity as compared to standard treatment with Fludarabine; an indolent lymphoma trial using Velcade (a major new chemotherapy agent developed for the treatment of myeloma) in patients with relapsed or refractory non-hodgkin s lymphoma. Two Phase III randomized trials testing the efficacy of new agents included the study drug E789 (a synthetic analog of Halichondrin B, a substance isolated from the rare marine sponge Halicondria okadai that could have clinical effectiveness in breast cancer patients refractory to other agents, particularly taxanes. Prostate cancer patients were given access to DN-11 in combination with

4 St. Vincent s Cancer Center Chairperson s Annual Report (cont.) weekly Taxotere. DN-11(Calcitriol) interacts with vitamin D receptor which messages activation or suppression of gene transcription. A prior Phase II trial showed activity in measurable disease and survival outcome superior to the standard therapy of Taxotere alone. Both the E789 and DN-11 trials remain active at the time of this publication. Finally, the medical oncology service continues it long standing policy of aggressively pursuing state of the art standard therapies and investigational therapies for our patients at top tier cancer centers, including MD Anderson, Duke University and Mayo Clinic, along with numerous others. We have established collaborative efforts with these institutions and others along with our in house clinical research program in order to provide the Bruno Center cancer patients with state of the art treatment options. Kathy Jackson, Cancer Center Program Director, organized and executed two very successful cancer screening clinics. The skin screening had 164 participants and 4 possible skin cancers were detected. The participating physicians were Robert Pritchett, MD, Matthew Abele, MD, and Janet Cash, MD. The prostate screening clinic had 67 participants, which 17 had abnormal findings. The participating physicians were Leon Hamrick, MD, Eddie Bugg, MD, Jason Moellinger, MD, and A. Scott Tully, MD. We continue to operate all of the various cancer center program components that underpin our Commission on Cancer rating as a Community Hospital Comprehensive Cancer Center. This designation is awarded to comprehensive programs that meet the highest standards of practice in all components essential to provide high quality comprehensive cancer care. Everyone involved in these complex treatments, especially the patients, appreciate how fortunate we are to have our diagnostic modalities and cancer treatments conveniently housed in the same building complex. We are especially grateful to our Cancer Registry Specialist, Sheila Grant, for managing the cancer registry and continuously mapping our program activities. We would like to thank the St Vincent s Foundation for graciously continuing to provide funds for patients needs, particularly the patient drug assistance program. Cancer Committee 7-8 Susan Salter, MD Cancer Committee Chairperson Matthew Abele, MD Dermatology Mack Barnes, MD Gynecologic Oncology Sheldon Black, MD Otolaryngology John Blalock, MD General Surgery Cara Bondly, MD Medical Oncology Tom Brown, MD Internal Medicine Gray Buck, III, MD General Surgery Charles Bugg, Jr., MD Urology Philip Fischer, MD General Surgery Jon David Holmes, MD Oral/Maxillofacial Surgery Carolyn McCall, MD Pathology Jason Moellinger, MD Urology Robert Pritchett, MD Dermatology Jill Rutherford, MD Diagnostic Radiology Sally Salter, MD General Surgery James Strickland, MD Pulmonary Disease Diane Cherry, RN Patient Care Services Andy Davis Administration Sheila Grant, RHIA, CTR Cancer Registry Coordinator Sarah Anne Higgins, MSW Social Worker Kathy Jackson, RT Cancer Center Manager Rosalind Patterson, RHIT, CTR Cancer Registry Kimberly Rider Wellness Services Christen Ridley American Cancer Society

5 St. Vincent s Cancer Program St. Vincent s Cancer Program is accredited by the Commission on Cancer (CoC) approval program as a Community Hospital Comprehensive Cancer Program (COMP). The cancer program has five key elements that make it a successful program: Cancer Committee leads the program through setting annual goals, monitoring activity and evaluating patient outcomes, and improving patient care. The Committee also hosts community outreach screenings for Prostate Cancer, Head/Neck Cancer, and Skin Cancer. Clinical Services provide state-of-the-art pre-treatment evaluation, staging, treatment, and clinical follow-up for cancer patients seen at the facility for primary, secondary, tertiary or quaternary care. Cancer Conferences provide a forum for patient consultation through discussion of state-of-the-art techniques and treatment options for cancer patients as well as formal education for medical staff and ancillary personnel. Quality Improvement program is the mechanism for evaluating and improving patient outcomes. Annually, the Cancer Committee discusses clinical areas or cancer sites to be reviewed throughout the year. As a COMP Cancer Program, annually the program is responsible for collecting data for two Quality Studies and two Quality Improvements. Cancer Registrar and Database is the basis for monitoring the quality of care. The Cancer Registry is staffed by. FTE s, both Certified Tumor Registrars. In 7, the Registry collected 1,686 new cases in which 1,599 cases were diagnosed and treated at St. Vincent s Hospital. The top five treated sites are Prostate, Breast, Lung, Colon and Oral Cavity. The registry continues to exceed the standard survival rate with ninety-one percent. This is done by collecting follow-up data on 1, cases in their database on an annual basis. In efforts to maintain quality data, the cancer registry data is submitted and reviewed monthly by the Alabama Statewide Cancer Registry and annually by the National Cancer Database s Call for Data.

6 Charts and Graphs St. Vincent s Birmingham Top Ten Cancer Sites by Sex FEMALES 1. Breast. Lung. Colon 4. Oral Cavity 5. Ovary 6. Leukemia 7. Corpus Uteri 8. Cervix Uteri 9. Pancreas 1. Brain MALES 1. Prostate. Lung. Oral Cavity 4. Colon & Rectum 5. Leukemia 6. Bladder 7. Kidney 8. Lymphona 9. Skin 1. Brain REFERENCES: Cancer Facts & Figures 7 - American Cancer Society American Joint Committee on Cancer (AJCC) Staging Manual, 6th Ed. - J.B. Lippincott Co.-Philadelphia, PA 1997 International Classification of Disease for Oncology rd Ed - World Health Organization-Geneva, Switzerland, Commission on Cancer, NCDB Benchmarking

7 Breast Cancer and Molecular Genetics James R. Hackney, M.D. Oncologists have known for some time that genes play an important role in determining an individual s susceptibility to breast cancer. Many genes are known to be involved, some with powerful promoting effects and others with more subtle effects that are difficult to measure when viewed in an isolated manner. Recently, researchers have developed a way of measuring the activity of multiple genes in breast cancer cells that affect the aggressiveness of breast cancer. This test measures the activity of sixteen genes in an individual s breast cancer cells. The results are compared to those in a large cohort of breast cancer patients that have been carefully followed over many years. In this way, accurate predictions of outcomes for individual patients can be obtained, expressed as the probability of distant metastasis at ten years. This result is based on the patient s own sixteen gene profile, and is therefore highly individualized. At the present time, this test is used in a particular class of breast cancer patient, those who have no tumor metastases in their axillary lymph nodes, and whose tumor cells express the estrogen receptor. These particular patients have long presented a treatment dilemma for Recently, researchers have developed a way of measuring the activity of multiple genes in breast cancer cells that affect the aggressiveness of breast cancer. oncologists. Should one recommend no therapy, therapy with an estrogen receptor blocker alone, or cytotoxic chemotherapy? The availability of the Oncotype DX multigene breast cancer assay allows Oncologists to classify patients tumors into low risk, intermediate risk, and high risk for recurrence within ten years. Patients at low risk can generally be spared chemotherapy and treated with estrogen receptor blockers alone. Patients at intermediate or high risk can be offered chemotherapy in the confident expectation that this more rigorous treatment plan will offer real benefit to the patient. Oncologists at the Bruno Cancer Center have been using this test since it first became available in 4. From 4 through the end of 7, 95 patients tumors have been studied in this way. Only 19 of these patients had an unfavorable report and thus received cytotoxic chemotherapy. This means that 76 patients in this normally good prognosis group could safely avoid the difficulties and expense of chemotherapy without compromising a favorable outcome. In this way, patients and their Oncologist can together make informed, individualized decisions about the desirability of chemotherapy. In the future, it is likely that additional genes will be identified that are relevant to the prognosis and treatment of breast caner. It is also likely that similar multigene assays will be developed for other cancers. Whatever the future holds, the Oncologists and technical personnel of the Bruno Cancer Center will be at the forefront of cancer diagnosis and treatment.

8 Breast Cancer Survivial Graphs 1 9 St. Vincent s Birmingham Observed Breast Cancer Survival BY AJCC Stage Percentage of Patients Surviving STAGE ONE STAGE TWO STAGE THREE STAGE FOUR 1Year Years Years 4 Years 5 Years 1 NCBD Observed Breast Cancer Survival BY AJCC Stage Percentage of Patients Surviving STAGE ONE STAGE TWO STAGE THREE STAGE FOUR 1Year Years Years 4 Years 5 Years

9 Cancer Summary by County The top five counties served were Jefferson, Shelby, Walker, Talladega and St. Clair. Of the 1599 cases treated, 1 were patients referred to St. Vincent s Hospital from outside the state of Alabama. LAUDERDALE COLBERT FRANKLIN LAWRENCE LIMESTONE MORGAN MARION WINSTON CULLMAN LAMAR PICKENS SUMTER 1 CHOCTAW 1 GREENE WASHINGTON 14 MOBILE FAYETTE TUSCALOOSA HALE MARENGO 6 CLARKE BALDWIN WALKER PERRY WILCOX MONROE ESCAMBIA BIBB DALLAS JEFFERSON 4 CONECUH MADISON BLOUNT SHELBY 1 4 CHILTON 7 AUTAUGA LOWNDES 4 BUTLER MARSHALL ST. CLAIR 4 JACKSON ETOWAH TALLADEGA COOSA DEKALB CALHOUN CLAY CHEROKEE CLEBURN RANDOLPH CHAMBERS TALLAPOSSA 8 LEE 9 ELMORE MONTGOMERY CRENSHAW PIKE COFFEE MACON BULLOCK DALE RUSSELL BARBOUR HENRY COVINGTON HOUSTON GENEVA

10 Primary Site Tabulation For 8 Analytic Cases Prostate Gland Breast Bronchus and Lung Oral Cavity Colon and Rectum Hematopoietic/Reticuloen Kidney Lymph Nodes Bladder Ovary Brain Corpus Uteri Pancreas Skin Larynx Cervix Uteri Meninges Thyroid Gland Stomach Unknown Primary Site Esophagus Small Intestine Testis Tonsil Rectosigmoid Jct. Con., Subq. & other Soft Tissue Liver-Intrahep Bile Ducts Vulva Anus and Anal Canal Gallbladder Other Female Genital Organs Other Endocrine Glands/REL S Parotid Gland Oropharynx Nasal Cavity/Middle Ear Renal Pelvis Other Central Nervous System Other Parts/Major Salivary Glands Nasopharynx Heart, Mediastinum and P Bones, Joints, Art. Cart. Li. Bones, Joints, Art. Cart. Ot. Retroperitoneum and Peri. Other Male Genital Organs Ureter Eye and Adnexa TOTAL ANALYTICAL ALL 7 CASES TOTAL MALE FEMALE ALIVE EXPIRED

11 x Sarah, Ron Poppy Morrison, and Victoria Giving Hope With Knitted Scarves Colorful hand-made scarves created by the loving hands of the Circle of Life knitting group fill a basket in the Radiation Therapy Department at St. Vincent s Birmingham, awaiting patients undergoing treatment for cancer. Knitting these scarves is a labor of love for Ilse Nathan. Nathan has volunteered in the St. Vincent s Birmingham Gift Shop for twenty years. She got involved with the Circle of Life project when her daughter was fighting cancer. Although her daughter passed away last year, Nathan continues to make the scarves for others. I feel lucky to be here; I just want to give something back. A Holocaust survivor, Nathan was born in Germany and lived in Holland before spending several years in concentration camps. She arrived in the United States in My life is faith, she said. God let me live. I have always felt that I have to give back. I am so grateful to be in this country. According to Nathan, the Circle of Life Society has a two-fold purpose: to teach knitting to others and to create scarves and wraps for those in our community whose lives have been touched by cancer. Starting three years ago with a dozen individuals, the Circle of Life has grown to nearly 5 people. Although her daughter passed away last year, Nathan continues to make scarves for others. I feel lucky to be here; I just want to give something back.

12 Bruno Cancer Center 81 St. Vincent s Drive Birmingham, Alabama