C ANCER C OMMITTEE. Cancer Committee Activities. Physician Members: Staff Members:

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1 C ANCER C OMMITTEE Cancer Committee Activities The North Mississippi Medical Center Cancer Committee remained very busy in The Cancer Committee continues to oversee weekly Cancer Conferences. This year, 189 prospective cases were presented during 49 conference meetings. Physicians, as well as other health care professionals, attend these conferences, which promote a multidisciplinary approach to cancer treatment. The conferences also provide continuing education hours approved by the Mississippi State Medical Association to physicians who attend. In addition to our regular Cancer Conferences, we had the privilege of hosting Dr. Henry Friedman, head of Medical/Pediatric Neuro-Oncology from Duke University, who discussed different treatment options for brain tumors. Videoconferencing capabilities at the NMMC Education Center enabled us to participate in the videoconference, Changing Strategies of TNM Staging: Introduction to the AJCC 6th Edition, and allowed us to broadcast our weekly cancer conference for physicians and other health care professionals at the NMMC Cancer Center. Our Cancer Committee actively participates in clinical trials, and the number of active protocols continues to increase. The Cancer Committee set the following goals for 2002: Continue to follow approved guidelines for American College of Radiology and maintain a three-year approval by the American College of Surgeons as a Community Hospital Cancer Program. Improve the cancer survival rate of people in our region. Participate in clinical trials with a minimum of 2 percent annual caseload entered into clinical trials annually. Continue promoting awareness and screening standards at the primary care physician level for breast, colon, cervix, prostate, lung and skin cancers. Promote a higher quality of life for cancer patients. Increase awareness of support groups. Continue to promote the Joyce B. Atwell Cancer Resource Library. Continue to increase the utilization of Cancer Registry for cancer date incidences and survival reporting compared to national statistics. Maintain survival status reports for each specialty group meeting. Continue multidisciplinary specialty conferences that report the top five primary sites diagnosed and treated at NMMC. These sites include urologic, breast, lung, gastrointestinal and lymphoma. As the year progresses from 2002 to 2003, we continue our interest in oncology care, including screening programs, diagnostic and therapeutic procedures, clinical trials and end-of-life care. It is our hope that you will continue to support us and participate when possible in the coming years. Sincerely, Andrew H. Kellum, M.D., F.A.C.P. Chairman, Cancer Committee Physician Members: Andrew Kellum, M.D., Chairman, Hematology/Oncology Phil Mathis, M.D., Vice Chairman, Surgery Kevin Bond, M.D., Liaison Physician, Urology James Shirley, M.D., Liaison Physician, Surgery Emeritus Chris Bergmann, M.D., Diagnostic Radiology Dominic Cannella, M.D., Neurosurgery Bert Duncan, M.D., Radiation Oncology Eric Emig, M.D., Diagnostic Radiology Richard Griswold, M.D., Pathology Jeff Houin, M.D., Dermatology William Kahlstorf, M.D., OB/GYN Roger Lowery, M.D., Otolaryngology Robert McAuley, M.D., Surgery Charles Montgomery, M.D., Hematology/Oncology John Phillips, M.D., Gastroenterology Ray Reed, M.D., Radiation Oncology Jim Rish, M.D., Pulmonology Vishal Sachdev, M.D., Cardiothoracic Surgery Staff Members: Laura Brower, RN, MSN, Administration Cindy Edwards, LMSW, Social Work Shelia Jinkins, CTR, Cancer Registry Joellen Murphree, RN, Clinical Quality Jeannine Peters, Pharm.D., Pharmacy Rev. Dick Stevens, Chaplain Marthe Thomas, RN, Clinical Data Manager Paula Turner, M.Ed., Director, Cancer Center Tommie Wood, RN, Oncology

2 C ANCER R EGISTRY The Cancer Registry is an essential component of the multidisciplinary cancer program at North Mississippi Medical Center and functions within the guidelines of the American College of Surgeons-Commission on Cancer approvals program. One of our goals is to maintain data that provides results of diagnostic and therapeutic efforts, as well as information that enhances the overall care of patients with cancer. Last year, the registry completed 31 data requests from NMMC physicians, administrators and departments. The registry participates in the National Cancer Data Base (NCDB) call for data and reports cancer cases to the Central Cancer Registry in Jackson, Miss., as well as the Commission on Cancer Facility Information Profile System (FIPS) and the American Cancer Society (ACS). This information is used by researchers to determine cancer trends, treatment patterns, education and screening guidelines. Under the supervision of the Cancer Committee, the Cancer Registry maintains a complete database of all cancer cases diagnosed and/or treated at NMMC. This data now includes more than 18,500 cases identified since January Annual follow-up is one of the many functions performed by the Cancer Registry. This directly benefits patients by reminding Year of Diagnosis physicians and patients that routine medical examinations are encouraged. Continued surveillance ensures early detection of a possible recurrence or a new primary malignancy. The statistical worth of survival is supported when successful follow-up exceeds 90 percent. Our current follow-up rate is 95 percent. During 2002, 1,432 cases were accessioned into the registry. Of those, 1,299 were analytic (newly diagnosed and/or treated at NMMC) and 133 were nonanalytic (diagnosed and treated elsewhere or diagnosed prior to reference date). Located on the first floor of the NMMC Cancer Center, the registry is available Monday through Friday from 7:30 a.m. to 4:30 p.m. For Cancer Registry information and statistics, call Shelia Jinkins, CTR; Jewell Johnson, CTR; Sandra Oliver, CTR; or Christy West, RHIT; at (662) C ANCER R EGISTRY C ASES ANALYTICAL CASES ,000 1,200 1,400 1, = Number of Cases 1,089 1,181 1,171 1,168 1,240 1,210 1,215 1,267 1,299 1,341 1,515 1,300 1,412 1,299

3 D ATA A NALYSIS The following data is from North Mississippi Medical Center s Cancer Registry for calendar year A total of 1,432 cases were added to the registry. Of the 1,432 cases, 133 cases were non-analytical. The American College of Surgeons no longer requires non-analytical (physician office, class 6 cases) to be abstracted; however, the Cancer Committee and Cancer Registry choose to continue to abstract these cases. These figures are not included in our analytical statistics. Cancer of the lung is again the most prevalent site with 248 new cases during Breast cancer is the second most prevalent site with 202, and prostate cancer is third with 159 cases. In fourth and fifth place were colon/rectal with 141 and lymphoma with 48. The Cancer Committee will continue to use the Cancer Registry s data to provide effective screening programs that will increase early detection and diagnosis among residents of our communities. The registry will continue to monitor the incidence of cancer as well as the survival data for cancer patients in our region. This data will be used to further enhance our multidisciplinary team approach to treating cancer. Early detection in the war against cancer is extremely important for long-term survival. It is the goal of the Cancer Committee to support all efforts to increase the early diagnosis of cancers and to take the lead in this endeavor. As always, NMMC s team of physicians and other health care professionals commit to provide state-of-theart cancer treatment in a compassionate and cost effective manner. Phil Mathis, M.D. Vice Chairman, Cancer Committee All Patients T OP F IVE P RIMARY S ITES ANALYTICAL CASES Lung Breast Prostate Colon/Rectum Lymphoma...48 L IAISON R EPORT Last year, 1,432 new patients with cancer were added to the Cancer Registry, bringing the total number of cases to almost 19,000 in the 14 years since the registry s reference date in The NMMC Cancer Program is accredited by the Commission on Cancer, which is a multidisciplinary program of the American College of Surgeons, and the American College of Radiology. These organizations establish guidelines to assure that our program adheres to the highest standards. This allows comparison of treatment modalities and outcomes with programs across the United States, thus assuring that cancer patients in this area receive the best and most up-to-date treatment. This also allows our participation in various cooperative studies that assess new treatment regimens. All physicians and other health care professionals involved in the care of cancer patients at NMMC participate in weekly conferences to discuss specific cancer cases, including diagnosis, staging and treatment options. Leading cancer experts present programs several times a year at NMMC on topics related to cancer and its management. The Cancer Committee is comprised of physicians from medical oncology, radiation oncology, diagnostic radiology, pathology, various surgical specialties and the liaison physicians. Also represented are other health care professionals who participate in the care of cancer patients. This committee meets quarterly and establishes policies and goals for the comprehensive NMMC cancer program. As Liaison Physicians, we express our appreciation to those who enable us to maintain an approved, comprehensive cancer program. Kevin Bond, M.D., F.A.C.S. Liaison Physician James Shirley, M.D. Liaison Physician

4 P RIMARY S ITE I NCIDENCE PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV BUCCAL CAVITY & PHARYNX Lip Tongue Salivary Glands Floor of Mouth Gum & Other Mouth Nasopharynx Tonsil Hypopharynx Other Buccal Cavity & Pharynx DIGESTIVE ORGANS Esophagus Stomach Small Intestine Colon Rectum & Rectosigmoid Anus, Anal Canal & Anorectum Liver & Intrahepatic Bile Duct Gallbladder Other Biliary Pancreas Peritoneum, Omentum & Mesentery RESPIRATORY SYSTEM Nasal Cavity/Middle Ear & Accessory Sinuses Larynx Lung & Bronchus Trachea, Mediastinum & Other Respiratory Organs SOFT TISSUE Soft Tissue (Including Heart) SKIN (Excluding Basal & Squamous) Melanomas - Skin Other Nonepithelial Skin BREAST Breast FEMALE GENITAL SYSTEM Cervix Uteri Corpus Uteri Uterus, NOS Ovary

5 PRIMARY SITE CLASS OF CASE SEX MIXED AJCC STAGE AT DX CASES A N/A M F 0 I II III IV 88 UNK INV FEMALE GENITAL SYSTEM (Continued) Vagina Vulva Other Female Genital Organs MALE GENITAL SYSTEM Prostate Testis Penis Other Male Genital URINARY SYSTEM Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs EYE & ORBIT Eye & Orbit BRAIN & OTHER NERVOUS SYSTEM Brain Other Nervous System ENDOCRINE SYSTEM Thyroid LYMPHOMAS Hodgkin Lymphoma Non-Hodgkins Lymphoma MULTIPLE MYELOMA Multiple Myeloma LEUKEMIAS Lymphocytic Myeloid & Monocytic Other OTHER Ill-defined & Unspecified Sites Invalid Site TOTALS 1,432 1, Headings: A=Analytic N/A=Non-Analytic M=Male F=Female Nonpatient or physician office cases are no longer required by ACOS; therefore, these cases are considered non-analytic and are excluded from the sex and stage statistics on this table. Localized basal and squamous cell carcinoma of the skin are not included.

6 D EMOGRAPHIC All Patients D ATA S EX Male % Female % Total 1,299 R ACE Caucasian 1, % African American % Other % Total 1,299 T OP F IVE P RIMARY S ITES Female: Male: Breast Prostate Lung...83 Lung Colon/Rectum...70 Colon/Rectum...71 Cervix...52 Bladder...32 Endometrium...24 Lymphoma & Younger AGE AT DIAGNOSIS 1,299 Analytic Cases & Older Number of Cases **All statistics are based on analytic case numbers

7 G EOGRAPHIC L OCATION TENNESSEE Marshall 3 Benton 11 Alcorn 51 ALABAMA Tippah 37 Prentiss 75 Tishomingo 82 Colbert 1 Lafayette 23 Union 58 Pontotoc 88 Lee 390 Itawamba 85 Marion 32 Franklin 5 Yalobusha 6 Calhoun 30 Chickasaw 64 Monroe 113 MISSISSIPPI Webster 28 Clay 35 Lamar 17 Choctaw 8 Oktibbeha 22 Lowndes 9 Other Mississippi Counties Grenada...1 Leflore...1 Montgomery...4 Noxubee...1 Panola...2 Winston...5 Total...1,232 Other Alabama Counties Marengo...2 Mobile...1 Walker...1 Winston...1 Total...60 Other Tennessee...6 Texas...1 Total...7 Total...1,299 *All statistics are based on analytic case numbers

8 A NALYSIS OF N ON-SMALL C ELL L UNG C ARCINOMA During 2001, chart reviews were conducted on all analytical cases of Non-Small Cell Lung Carcinoma (NSCLC) made available to the NMMC Cancer Registry. Demographics and specific risk factors were analyzed. According to data from the NMMC Cancer Registry, 192 patients were diagnosed with NSCLC in The vast majority of these cases were male (135 males versus 57 females), and the majority of cases occurred in Caucasians (164) versus other ethnic groups (28). The age of patients at the time of initial diagnosis included four patients between 30-39; six patients between 40-49; 31 patients between 50-59; 71 patients between 60-69; 54 patients between 70-79; and 26 patients between Either a past history of smoking or a current smoking history was identified as a risk factor in all but a small percentage of the cases. Only six cases involved patients who had never smoked. Squamous cell carcinoma was the predominant histologic type noted in the series, followed closely by adenocarcinoma. As is typical with this disease, the majority of the cases presented at an advanced stage. The breakdown is as follows: Stage 0, 1; Stage I, 37; Stage II, 22; Stage III, 34; and Stage IV, 94. The stage was not known in four cases. Treatment involved chemotherapy exclusively in 23 cases and radiation therapy exclusively in 23 cases. Surgery alone was utilized in 31 cases. The majority of cases (70) were treated with combined chemotherapy and radiation therapy. Surgery combined with chemotherapy, radiation therapy or both was utilized in 15 cases. Treatment was not appropriate in 23 cases, and seven patients refused treatment. Five-year survival rates for this disease have been disappointing. The national five-year survival rate ranges from 35 percent for Stage I disease to 1.4 percent for Stage IV disease. Our local experience closely parallels the national statistics. James Rish, M.D. Pulmonology H ISTOLOGY Large cell Sarcomatoid 1 carcinoma Non-small cell Papillary 1 squamous cell Squamous cell Bronchioloalveolar carcinoma 4 Papillary adenocarcinoma 2 Mucin-producing adenocarcinoma 1 Adenosquamous carcinoma 3 Adenocarcinoma Adenocystic carcinoma 1 Neuroendocrine 1 Other G ENDER R ATIO Female - 57 Male R ACE R ATIO Other African American Caucasian S TAGE OF DISEASE Unknown - 4 IV - 94 III - 34 II - 22 I R ELATIVE 5 YEAR S URVIVAL Stage IV 1% 3% Stage III 5% 7% NMMC Stage II 19% NCDM 19% 35% Stage I 38% 0% 10% 20% 30% 40%