2012 Cancer Program Report Statistics

Transcription

1 2012 Cancer Program Report 2011 Statistics

2 Dear Colleagues: Methodist and the Methodist Cancer Committee present our 2012 Annual Report. Our program has undergone recent review and we are proud to say that we have been accredited by the American College of Surgeons Commission on Cancer for three years with eight areas of commondations. We feel that we continue to provide a high level of quality care for patients in the Peoria area. This year we have focused on lung cancer. Comparatively, patients at Methodist are similar to those nationally both in occurrence and outcomes. However, we have found that there are higher numbers of Stage IV patients being diagnosed nationally. As part of our focused efforts with The Methodist Cancer Institute, we have developed a lung cancer screening program to better identify patients at earlier stages. We will also continue to push for tobacco cessation and further awareness in our community. We continue to receive strong support from all of our providers, including radiology, pathology, pulmonology, radiation oncology, medical oncology, and thoracic surgery. In addition, we have further developed our cancer navigator roles and hope to see further improvements with patient awareness and outcomes. Our support services such as Hospice and Palliative Care are also heavily utilized, in addition to coordinated efforts with the American Cancer Society. As always, the efforts of all of our staff and providers are greatly appreciated and our achievements would not be possible without such a excellent team and their collaborative efforts. My many thanks to everyone involved. Sincerely, Gregory J. Gerstner, M.D. Hematology-Oncology Chair, Methodist Cancer Committee 1

3 2012 Cancer Committee Members Gregory Gerstner, MD, Cancer Committee Chairman Medical Oncology Roby Lal, DO, Radiation Oncology Revathi Swaminathan, MD, Radiation Oncology Asim Jaffer, MD, Family Medicine/Palliative Care Lynne Jalovec, MD, Surgery/Cancer Liaison Carter Young, DO, Diagnostic Radiology Michael Spears, MD, Pathology Barbara Svendsen, RN, MS Manager of Radiation Oncology Kathy Lusher, RN, Performance Improvement Stephanie Brooks, RN, Nurse Manager, Oncology Courtney Slack, American Cancer Society Florence Doye, CTR, Cancer Registrar Gail Smith, Cancer Registrar Jean Ward, RHIA, Director, Health Information Services Jill Prosser, MS, LSW, Hospice Anita Priester, RN, Patient Navigator Marsha Kutter, Research, Illinois Cancer Care Matt George, Cancer Center for Healthy Living Mike Stinson, RN, Oncology, Clinical Nurse Specialist Sue Copp, RN, Manager Clinical Research Mike Namanny, PharmD, MBA, Director of Growth & Innovation Methodist Medical Center Methodist Medical Center is a 330-bed regional tertiary care hospital offering comprehensive cancer care. A full range of diagnostic and therapeutic services are available including Positron Emission Tomography (PET), wide-bore and traditional MRI, 3-D Conformal Radiotherapy (3-D CRT), bone marrow transplant, transperineal intraprostatic and seed implantation. In 2008, Methodist introduced advanced TomoTherapy radiation treatment to Central Illinois, and in 2009 added a second TomoTherapy location, the Methodist Radiation Oncology Center in north Peoria. Methodist was selected as a Community Clinical Oncology Program (CCOP) a consortium of the medical oncology group, radiation oncology group and the Medical Center, with the Mayo Clinic serving as the primary research base. Together, the oncologists and Methodist serve as a comprehensive affiliated referral service for the central Illinois region. In 2012, the Commission on Cancer of the American College of Surgeons granted three-year approval with commendation to the Methodist cancer program. Methodist has also been designated a Breast Imaging Center of Excellence by the American College of Radiology. The Methodist Breast Health Center offers all-digital mammography, bilateral breast MRI, ultrasound imaging, and needle core biopsy. A breast health navigator ensures coordinated care and the Comprehensive Breast Day approach brings a team of specialists together to expedite patient care. Friends at Five is Methodist s unique spa-based support group for breast cancer survivors. The Methodist autologous bone marrow transplant program, the only one in downstate Illinois, is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT). Methodist also has an oncology unit providing specialized care for patients receiving cancer treatments including surgery, chemotherapy, radiation therapy, and bone marrow transplant. The Medical Center s cancer program provides a number of education and support services. Methodist is proud to be a Magnet hospital, recognizing excellence in nursing services, and has earned the Joint Commission s Gold Seal of Approval. Methodist outpatient services have received national recognition for consistently scoring above the 95th percentile in patient satisfaction. Amenities at Methodist include 100% private rooms in the acute care units, free parking, and the Methodist Inn Methodist s free hotel within a hospital for out-of-town loved ones or for patients who would like a place to stay the night before an early-morning procedure. Clinical Trials Offer State of the Art Care Methodist is committed to delivering leading-edge cancer care to patients through ongoing involvement in national clinical trials. Since 1983, Methodist Medical Center has participated in the federally sponsored Community Clinical Oncology Program. This program offers state-of-the-art therapies in cancer prevention and treatment to patients in the Peoria area and its surrounding communities. At Methodist, we know that today s standard therapies were yesterday s experimental treatments, so the only path toward continued improvement in cancer care is through participation in human subject clinical trials. The availability of these trials to patients and their physicians improves the quality of care for all patients, whether they participate in the studies or not. Due to availability of clinical trials, 6.1 percent of Methodist cancer patients were accrued on clinical trials in

4 The Cancer Committee: The Cancer Committee is a multidisciplinary committee consisting of members from all medical staff departments and from ancillary departments involved in the care and treatment of cancer patients. The Committee formulates policies and procedure in regard to cancer detection and management. The Committee is responsible for the organized cancer program, such as the Cancer Registry and Working Tumor Conference and for maintaining the requirements of the American College of Surgeons for hospital Cancer Program Approval. In 2012 Methodist received a three year accreditation of our Cancer Program by the American College of Surgeons, Commission on Cancer with commendations in 8 areas. Working Tumor Conference The Working Tumor Conference is a multidisciplinary conference open to all members of the medical staff and ancillary staff interested in diagnosis and treatment of cancer patients at the Methodist Medical Center. These conferences are held every Wednesday at 7:00 a.m. in the G303. The topics of discussion include review of cases undergoing current work-up and treatment planning, retrospective review of cases and presentations regarding published reports, lectures and workshops attended by physicians, which are related to the diagnosis and treatment of cancer patients. A physician wishing to present a case should contact the Radiation Oncology Department at and arrangements will be made for the appropriate pathology slides and x-rays to be presented as part of the discussion. In 2011, a total of 135 patients were discussed prospectively at the Working Tumor Conference and represented 16% of the analytic cases. This conference is approved for 1 hour Category I Continuing Education for physicians CANCER REGISTRY DATA Class of case # of Patients Class 00: Diagnosis here, treatment elsewhere* 121 Class 10-14: Diagnosis here, treatment here 410 Class 20-22: Diagnosis elsewhere, treatment here 320 Class 30-49: Diagnosis and treatment elsewhere 175 Total Accessions 1026 The Cancer Registry The Cancer Registry is a data system designed for the collection, management and analysis of data on persons with the diagnosis of malignant neoplasm. The Cancer Registry is staffed by a Certified Tumor Registrar and Cancer Registry Assistant. The Cancer Registry contains demographic, diagnostic, treatment, follow-up and survival information on all analytic patients. We added 851 analytic cases in 2011 and 175 non-analytic cases for a total of 1026 new cases. The current follow-up rate is 85% for all patients and 92% for the last 5 years. The Cancer Registry continues to report all required information to the Illinois State Cancer Registry and the National Cancer Data Base for the American College of Surgeons, Commission on Cancer. The Facility Information Profile Systems, FIPS, is updated annually for the American Cancer Society. The information from the FIPS is used as part of the hospital locator program to aid patients in finding cancer care close to their home. Class of Case definitions changed for *Class 00 includes patients treated in physician office only, previously these were in class 10 category. Analytic Cases are Class Non-analytic Cases are Class

5 2011 INCIDENCE OF CANCER - ANALYTIC CASES - METHODIST MEDICAL CENTER Total Male Female Breast Respiratory Lung, Bronchus, Trachea Larynx Nose, Nasal Cavity & Middle Ear Male Genital Prostate Testis Digestive Colon Rectum, Rectosigmoid, Anus Pancreas Stomach Liver/Intrahepatic Bile Ducts Esophagus Other Biliary Small Intestine Gallbladder Female Genital Corpus Uteri Cervix Ovary Vulva Urinary Tract Bladder Kidney/Renal Pelvis/Ureter Other Urinary Tract Oral Cavity/Pharynx Tongue Salivary Gland Tonsil Nasopharynx Oropharynx Hypopharynx Lip Gum and Other Non-Hodgkin Lymphoma - Nodal Non-Hodgkin Lymphoma - Extranodal Hodgkin Lymphoma - Nodal Leukemia Multiple Myeloma Mesothelioma Melanoma Other Skin Thyroid and other Endocrine Brain and other CNS, Malignant Brain and other CNS, Benign Eye Soft Tissue Unknown Primary/other Totals Figure 1 displays the incidence of cancer by primary site and gender. 4

6 2011 Comparison of Top Ten Primary Sites MMCI # MMCI % *% Estimated of Patients of Patients for United States Breast % 20% 18% Lung % 18% 14% Prostate % 6% 15% Colon % 5% 6% Kidney/Renal Pelvis % 5% 4% Thyroid % 5% 3% Non-Hodgkin Lymphoma % 4% 4% Corpus Uteri % 4% 3% Melanoma % 4% 8% Bladder % 3% 4% Figure 2 shows a comparison of the top ten primary sites for 2011 MMCI cases versus 2006 MMCI and percent of estimated cases for United States in Breast, Lung, Prostate, Colon and Kidney/Renal Pelvis remained the top 5 sites for Our top site remains to be Breast with 20% of the cases compared to 18% estimated for the United States. Thyroid moved up to the 6th top primary site from 10th in 2010 and Non-Hodgkin Lympoma to 7th and back in the top ten. The primary site study this year is on lung cancer. *2011 percent of estimated new cases by site for the United States per Cancer Facts and Figures 2011, provided by the American Cancer Society. Breast and melanoma estimates include in-situ cases added to invasive cases First Course Treatment % of Patients % 279 Surg 3% 29 Rad 9% 73 6% Chemo 2% 13 Hormone 9% 6% 75 7% % 45 S & R S + R + H S + R + C +/-H S + C +/-H R + C +/-H 8% 66 12% 105 Other comb None/unknown Treatment Figure 3 displays the first course of treatment summary for all cancer patients. Surgery as a single modality was used for 33% of patients an increase of 3% from Radiation was 3% same as Chemotherapy increased 1% from Single modality treatment is at 47% an increase of 5% from Multimodality treatment is at 41% a decrease of 3% from None and unknown which includes palliative treatment is at 12% a decrease of 2%. S = Surgery R = Radiation C = Chemotherapy H = Hormone 5

7 2011 Age At Diagnosis and Gender Methodist Medical Center Male 150 Female # of Cases Age Range (years) Figure 4 displays patient age at diagnosis compared with gender. There were 357 male patients and 494 female patients for Eight percent of the male patients were under age 50 a decrease of 1% from 2010, and 16% of the female patients were under age 50 which is a decrease of 1% from The age range consisted of 47% of the male patients which is a decrease of 1% from 2010 versus 46% of the female patients which is an increase of 3% from The 70 plus age range showed 45% of the male an increase of 2% versus 38% of female patients, a decrease of 1% from Best CS/AJCC Stage Grouping 2011 Analytic Cases Comparison of Stage Grouping by Gender % 184 Male Female # of Cases % 13 8% 38 Stage 0 24% 87 Stage I 21% 15% 76 13% % 45 Stage II Stage III 25% 88 17% 84 Stage IV 1% 4 2% 11 Unknown 12% 44 *N/A 8% 38 Stage Figure 5 displays a comparison of Best CS/AJCC Stage by Gender. Forty-nine percent of the male patients, were staged 0, I, II the same as 2010, versus 58% of the female patients which is a decrease of 4% from cases were staged according to the guidelines of the 7th edition AJCC staging system and Collaborative Stage. The 7th edition of AJCC Staging went into effect for all applicable cases in *N/A = Not applicable, there are some primary sites and histologies that do not have an AJCC staging system. 6

8 2011 County of Residence at Time of Diagnosis 2011 Analytic Cases County # of Patients Peoria 357 Tazewell 221 Fulton 50 Woodford 35 Knox 32 Marshall 30 LaSalle 18 Mason 17 Bureau 12 Stark 11 McDonough 10 Henry 9 McLean 9 Putnam 6 Warren 6 Henry Bureau LaSalle Putnam Warren Knox Stark Peoria Marshall Woodford Livingston McDonough Fulton Tazewell McLean Mason Figure 6 displays the county of residence at time of diagnosis for the analytic cases. Seventy-four percent of the patients were from the top 3 counties. These are Peoria with 357 cases, Tazewell with 221 cases and Fulton with 50 cases. Twenty-three percent of the cases were from surrounding counties. Three percent were from 13 additional counties and out of state patients with less than 5 patients each in

9 2011 Site Specific Studies for Lung Cancer By Gregory J. Gerstner, MD The American Cancer Society estimated 221,130 new cases of lung cancer diagnosed in the United States during 2011, accounting for 14% of cancer diagnoses. The estimate of Illinois patients are 9,210 new cases. Lung cancer was the second most common site at Methodist during 2011 at 14% of the total patient, this is the same as the national estimates. In this section of the report the results of the 2011 Site Specific Studies for Lung Cancer is presented. Diagnostic Evaluation Typical diagnostic evaluation consists of imaging and biopsy of suspicious lesions. CT and PET/CT are utilized as standard evaluation tools to assess local disease as well as to evaluate for nodal involvement and distant metastases. MRI of the brain is also frequently used in patients deemed at risk of for distant metastases. We then utilized image-guidance biopsies with our interventional radiologist or bronchoscopy (and/or endobronchial ultrasound (EBUS) where needed) for obtaining tissue diagnosis. Also, when indicated, patients are evaluated by our thoracic surgeons with mediastinascopy. Treatment Treatment of lung cancer varies depending on the stage. Early stage cancers (Stage I and Stage II) are typically treated with surgery. In older patients or those with significant comorbid illness or inadequate pulmonary function, radiation with stereotactic body radiotherapy (SBRT) may also be appropriate. The radiation oncologists at Methodist recently upgraded their equipment to be able to perform SBRT in Peoria. Patients with small cell lung cancer are more commonly treated with chemoradiation (CRT). In patients with more advanced NSCLC disease, combined modality therapy with concurrent CRT is also frequently utilized, either as definitive therapy or in some cases as neoadjuvant therapy. For patients with Stage II or III disease who undergo surgery, adjuvant chemotherapy is offered. For patients with Stage IV disease, treatment primarily consists of chemotherapy. Tissue samples are routinely tested for molecular abnormalities that would predict response to targeted therapies. Multiple clinical trials are also available for Stage IV patients, in addition to some trials for earlier stage patients. Palliative therapy with radiation for painful bone metastases or brain metastases is also available. Patients may receive either whole-brain radiotherapy (WBRT) or more targeted approaches with SBRT for their brain lesions, again, depending on the nature of their disease. Prognosis Prognosis varies by stage and histology. Patients with small cell lung cancer perform less favorably. Those with non-squamous nonsmall cell lung cancers also typically have a better prognosis than squamous histologies, which in turn are better than small cell. These differences apply in both Stage IV as well as earlier stage cancers. Survival Data and Comparison Data The expected rate of lung cancer by gender is 52% for male and 48% for female patients per ACS Cancer Facts and Figures, The 2009 NCDB data also showed 52% for male and 48% for female patients. At Methodist in 2011, 54% of patients were male and 46% were females. This is 4% higher for male patients and 4% lower for females when compared to ACS and NCDB data. See figure 3 in the report. At Methodist during 2011, the age comparison of lung cancer 8 patients was 16% under the age of 60 a decrease of 8% from 2009 when it was 24% and was 20% less than the NCDB data for The age group was 26% in 2009, increased to 29% in 2011 for Methodist, with NCDB 30% for The age group was 29% in 2009, increased to 31% in 2011 and was 33% for NCDB for See Figure 5. The primary location of the lung cancers were 50% in right lung and 49% in left lung with 1% unknown laterality. The upper lobe was the most common location for both the right and left lung with 51% of right lung cancers and 64% for left lung cancers. See figure 6. In lung cancer, the histology of the cancer and staging is used in determining the appropriate treatment. You will find in the studies the cases are separated as non-small cell lung carcinoma or small cell lung carcinoma. Nationally non-small carcinoma is present in 85% of the cases versus 88% at Methodist and small cell carcinoma is present in 14% of the cases versus 12% at Methodist. See figure 7. In 2010, the AJCC staging system changed from the 6th edition to the 7th edition and this has affected the ability to compare 2009 data with the 2011 data. In the 2009 NCDB data and the 2009 Methodist data, the stage-by-stage group matches closely for non-small cell carcinoma. In 2011, we saw an increase to 35% of the patients being stage I and an increase of stage IV to 43% for non-small cell carcinoma. In 2011, small cell carcinoma patients stage IV went from 61% in 2009 up to 78% in See figures 8 and 9. Based on these findings of higher numbers than average of Stage IV patients, Methodist has developed an active lung cancer screening program this past year in an effort to detect cancers at earlier stages. See guidelines for the lung screening program on page 2 of this report. The treatment of non-small cell carcinoma of the lung consists of surgery, radiation and chemotherapy depending on the stage at diagnosis. The single modality treatment of surgery was used for 70% of the stage I cases, 22% of stage II, and 13% of Stage III. The single modality treatment of radiation was used for 20% of stage I, 11% of stage II, 7% for stage III, and 5% for Stage IV. Chemotherapy only was used for 37% of stage IV cases. Multimodality therapy was used for 6% of stage I, 67% of stage II, 53% of stage III, and 14% of stage IV cases. Small cell carcinoma is mainly treated with chemotherapy, radiation or combination of both modalities. See figures 10 and 12. A summary of the surgical treatment is listed under Figure 10. Comparison data between Methodist 2009 and 2011 patients and NCDB 2009 patients is depicted in figures 11 and 13. The five year observed survival data for non-small cell lung cancer patients treated at Methodist is also reported along with comparison with NCDB data and American Cancer Society estimates. The overall survival for Methodist NCDB data was 13%. Updated data by the registry for Methodist was 15%. The NCDB survival rate for 1481 cancer programs was 17%. The five-year survival rate for all stages by the American Cancer Society Facts and Figures is 17% for non-small cell carcinomas. The overall observed survival rate for small cell carcinoma for Methodist NCDB was 5% and Methodist updated cases was the same at 5%. The overall survival rate for NCDB was 6%, which is the same as reported by the American Cancer. See Figures *The National Cancer Database (NCDB) comparison data is from COC programs in our category of Community Hospital Comprehensive Cancer Programs from all states. The American Cancer Society data is from the Cancer Facts and Figures 2011.

10 2011 Site Specific Report Lung Cancer The American Cancer Society estimated 221,130 new cases of lung cancer diagnosed in the United State during 2011 accounting for 14% of cancer diagnoses. The estimate of Illinois patients are 9,210 new cases. Lung cancer was the second most common site at MMCI during 2011 at 14% of the total patients and is the same as the national estimates. *Estimates are from Cancer Facts & Figures 2011, published by the American Cancer Society 23% 22% 2011 Class of Case Lung Cancer Class 00: Diagnosed here, treatment elsewhere Class 10-14: Diagnosed here, treatment here 55% Class 20-22: Diagnosed elsewhere, treatment here Figure 1 displays fifety-five percent of the lung cancer patients were diagnosed and treated at Methodist during An additional twenty-three percent of the patients were referred to Methodist for treatment. The new definitions for class of case 00 includes patients diagnosed at Methodist and had all treatment at the Medical Oncologist Clinics. Previously these were coded to Class of Case 13. Methodist 2011 NCDB 2009 Non-Small Cell Race # Patients (Percent) and Small Cell Carcinoma % of Patients White 135 (90%) 87% Black 14 (9%) 8% Other 1 (1%) 5% Total 150 Figure 2 displays the distribution of patients by Race. Comparison with NCDB reveals similar results. Methodist 2011 NCDB 2009 Non-Small Cell Gender # Patients (Percent) and Small Cell Carcinoma % of Patients Male 81 (54%) 52% Female 69 (46%) 48% Total 150 Figure 3 displays comparison of Gender between Methodist 2011 and NCDB for Estimated new lung cancer cases to 2011 included 52% male and 48% female patients per Cancer Facts and Figures. 9

11 2011 Age at Diagnosis Comparison by Gender Gender # Patients (Percent) Age Ranges Male Female Total (4%) 2 (3%) (9%) 12 (17%) (28%) 21 (30%) (36%) 18 (26%) (21%) 15 (22%) (2%) 1 (1%) % 46% Figure 4 displays 54% of the lung cancer patients were male and 46% were female. The comparison reveals the and under age groups consisted of 20% for female versus 13% for male patients. The age group was 30% for female versus 28% for male, was 26% female versus 36% male, and 80 and over was the same. Age Comparison between Methodist 2009, 2011 and NCDB 2009 # of Patients % 3% % 16% 15% 13% % 26% % 33% 31% 29% % 19% 17% MMCI 2009 MMCI 2011 NCDB 2009* 2% 2% 1% 90+ Age Ranges Figure 5 displays the comparison of percent of patients by age groups for Methodist 2009 and 2011 with 2009 NCDB data. *NCDB data from National Cancer Data Base, Commission on Cancer, August 27, 2012 reports. 10

12 2011 Location of Lung Primaries * Right Lung Left Lung Main Bronchus 1 Main Bronchus 2 Upper Lobe 38 Upper Lobe 47 Middle Lobe 5 Lower Lobe 23 Lower Lobe 19 Overlapping 0 Overlapping 0 Lung, Nos 8 Lung, Nos 6 Laterality unknown 1 *Illustration from 5th Edition AJCC Staging Manual Figure 6 depicts the locations of the cancer in the anatomical portions of the lungs. The upper lobe was the most common location for both the right and left lung. Histology of Lung Cancer 2011 Non-Small Cell Carcinoma Small Cell Carcinoma 132 Patients 18 Patients Figure 7 displays the main histologic groupings of lung cancer seen in Treatment decisions are made based on the grouping of lung cancer into non-small cell versus small cell cancer. 11

13 2011 Best Stage for Non-Small Cell Carcinoma of lung Comparison of MMCI 2009 and MMCI 2011 with NCDB 2009 Data Stage # Patients 2009 % MMCI 2009 # Patients 2011 % MMCI 2011 % NCDB 2009 Stage 0 0 0% 0 0% <1% Stage I 27 27% 46 35% 26% Stage II 6 6% 9 7% 6% Stage III 25 25% 15 11% 23% Stage IV 35 35% 57 43% 36% Unk/N/A 7 7% 5 4% 8% Total Figure 8 displays a comparison of the stage at diagnosis between MMCI 2009 and MMCI 2011 with NCDB 2009 data for non-small cell lung cancer cases cases were staged according to the 6th edition of AJCC staging and the 2011 cases were staged according to the 7th edition of AJCC staging which went into effect in The T classfications and M classfications were redefined and cause a change in the overall stage for cases staged in 2011, such as malignant pleural effusion now makes it stage IV. Unk/na includes carcinoids not stageable by AJCC The 2009 Methodist and NCDB staging data are comparable as they are staged with the 6th edition AJCC. Stage I for 2009 Methodist was 27% and increased to 35% for Stage IV was 35% for Methodist in 2009 and increased to 43% in The staging percentages are reflective of the changes in the staging from 6th edition to 7th edition Best Stage for Small Cell Carcinoma of lung Comparison of MMCI 2009 and MMCI 2011 with NCDB 2009 Data Stage # Patients 2009 % MMCI 2009 # Patients 2011 % MMCI 2011 % NCDB 2009 Stage 0 0 0% 0 0% 0% Stage I 2 9% 1 6% 5% Stage II 0 0% 0 0% 3% Stage III 6 26% 2 11% 29% Stage IV 14 61% 14 78% 55% Unk/N/A 1 4% 1 6% 8% Total Figure 9 displays a comparison of the stage at diagnosis between MMCI 2009 and MMCI 2011 with NCDB 2009 data for small cell cancer cases cases staged according to the 6th edition of AJCC staging and the 2011 cases were staging according to the 7th edition of AJCC staging which went into effect in The 2009 data for Methodist and NCDB are very similar but the changes in the stage IV categories show a rise in the number of Stage IV cases in 2011 by 17% at Methodist and 23% when compared to 2009 NCDB. 12

14 2011 Lung Cancer First Course of Treatment Best CS/AJCC Stage Non-Small Cell Carcinoma Stage I Stage II Stage III Stage IV Unk/NA Total Surg (70%) 32 (22%) 2 (13%) 2 (27%) 36 Chemo (37%) 21 (16%) 21 Rad only (20%) 9 (11%) 1 (7%) 1 (5%) 3 (20%) 1 (11%) 15 S+R (20%) 1 (1%) 1 S+R+C (11%) 1 (7%) 1 (2%) 2 S+C (2%) 1 (33%) 3 (7%) 1 (4%) 5 R+C (4%) 2 (22%) 2 (40%) 6 (14%) 8 (14%) 18 None/Palliative (4%) 2 (27%) 4 (44%) 25 (60%) 3 (26%) 34 Total Patients Figure 10 summarizes the treament of non-small cell cancer by stage. Surgical treatment of these patients consisted of 52% lobectomy with lymph nodes, 11% lobectomy without nodes, 20% wedge resection, 7% pneumonectomy of one lung, 5% segmentectomy, 5% ablation procedures. Thirty-seven patients had their surgery at Methodist and 7 patients had the surgery done elsewhere. S = Surgery R = Radiation H = Hormone 2011 First Course Treatment Comparison of All Stages Non-Small Cell Lung Cancer Methodist Methodist Methodist Methodist NCDB # of Patients % of Patients # of Patients % of Patients % of Patients Surg 16 16% 36 27% 20% Rad 9 9% 15 11% 13% Chemo 12 12% 21 16% 14% S&C 8 8% 5 4% 5% R&C 22 22% 18 14% 21% S&R&C 4 4% 2 2% 3% Other Comb 6 6% 1 1% 2% None/Palliative 27 27% 34 26% 23% Total Figure 11 displays the comparison of first course treatment for 2009 and 2011 Methodist patients with 2009 NDCB patients. 13

15 2011 Lung Cancer First Course of Treatment Best CS/AJCC Stage Small Cell Carcinoma Stage I Stage II Stage III Stage IV Unk/NA Total Surg (100%) 1 (6%) 1 Chemo (43%) 6 (100%) 1 (39%) 7 Rad only (50%) 1 (6%) 1 R+C (50%) 1 (14%) 2 (17%) 3 None/palliative (43%) 6 (33%) 6 Total Patients Figure 12 summarizes the treatment of small cell lung cancer by stage. The Stage I surgery patient was treated with lobectomy and lymph node dissection First Course Treatment Comparison of All Stages Small-Cell Lung Cancer MMCI 2009 MMCI 2011 NCDB 2009 % of Survival % 6% 0% 6% 4% 5% 39% 39% 30% 35% 17% 40% 4% 0% 4% 17% 33% 22% Surg Rad Chemo R & C Other Comb None/Unkown Figure 13 displays the comparison of first course treatment with 2009 and 2011 Methodist patients compared to 2009 NCDB patients. 14

16 2011 Non-Small Cell Lung Cancer Observed Survival by Stage Non-Small Cell Lung Cancer Best AJCC Stage Years Years Years Years Years Years Total Stage # patients Stage 0 100% 100% 100% 100% 100% 100% 1 Stage I 100% 74% 56% 50% 45% 38% 89 Stage II 100% 60% 40% 33% 27% 16% 30 Stage III 100% 52% 31% 20% 14% 8% 93 Stage IV 100% 24% 10% 6% 4% 4% 137 Overall 100% 48% 30% 23% 19% 15% 350 Figure 14 displays the observed survival by Best AJCC Stage for the years of Comparison Five Year Observed Survival Comparison of NCDB and Methodist Observed Survival % MMCI MMCI NCDB % of Survival % 46% 38% 23% 16% n/a * 27% 8% NCDB % 11% 15% 13% 17% 4% 4% 3% Stage 0 Stage I Stage II Stage III Stage IV Overall * insufficient number of cases to display per NCDB reporting Figure 15 displays the Methodist five year observed survival compared with NCDB data. The 6th edition AJCC staging was in use during Per American Cancer Society Facts and Figures for 2011 overall survival for non-small lung cancer is 16%. The Overall survival depicted above for NCDB was 17% and for Methodist was 15%, which is consistent with American Cancer Society survival rates. **Source: NCDB, COC, ACoS, Survival Reports, 2012 Included data from 1481 Cancer Programs. 15

17 2011 Small-Cell Lung Cancer Observed Survival by Stage Non-Small Cell Lung Cancer Best AJCC Stage Years Years Years Years Years Years Total Stage # patients Stage 0 0 Stage I 0 Stage II 100% 100% 50% 0% 0% 0% 2 Stage III 100% 71% 41% 35% 18% 18% 17 Stage IV 100% 30% 7% 2% 0% 0% 44 Overall 100% 41% 15% 12% 5% 5% 63 Figure 16 displays the observed survival by Best AJCC Stage for the years of Comparison Five Year Observed Survival Comparison of NCDB and Methodist Observed Survival % 22% 17% 18% 10% 2% n/a * n/a * 0% * * 0% 0% MMCI MMCI NCDB NCDB % 5% 6% Stage 0 Stage I Stage II Stage III Stage IV Overall * insufficient number of cases to display per NCDB reporting Figure 17 displays the Methodist five year observed survival compared with NCDB data. The 6th edition AJCC staging was in use during Per American Cancer Society Facts and Figures for 2011 overall survival for small cell lung cancer is 6%. The overall survival depicted above for NCDB was 6% and Methodist was 5%, which is consistent with survival data from the American Cancer Society. **Source: NCDB, COC, ACoS, Survival Reports, 2012 Included data from 1460 Cancer Programs. 16

18 Cancer Referral Resources: Methodist Medical Center Resources: Phone: Methodist PET/CT Imaging Center... Methodist Diagnostic Center 112 Crescent Ave. (Lower Level) Peoria, IL (309) Autologous Peripheral Stem Cell Transplants... (309) Breast Health Navigator... Methodist Breast Health Center 112 Crescent Avenue Peoria, IL (309) Oncology Patient Navigator (309) Methodist Hospice Services NE Glen Oak Ave, Suite 200 Peoria, IL (309) Community Resources: Cancer Center for Healthy Living N. Knoxville Ave Peoria, IL (309) Reach to Recovery... (309) Kids Konnected... (309) The American Cancer Society... (800) Peoria, IL (309)

19 An affiliate of Iowa Health System.