2015 CANCER ANNUAL REPORT

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Alexandrina Hester Baker
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1 2015 CANCER ANNUAL REPORT

2 A WORD FROM OUR LEADERSHIP We are pleased to bring you this 2015 Annual Report, highlighting some of the accomplishments of our team at Roper St. Francis Cancer Care. Every day we are inspired by the courage of those we serve, and we express our deepest gratitude to our colleagues whose hard work and caring attention continually makes our Cancer Center environment one that embodies healing with compassion, faith and excellence. In 2015 we celebrated the fifth anniversary of our flagship Cancer Center on the campus of Bon Secours St. Francis Hospital. Through the generous support of our community and colleagues, the RSF Cancer Center was able to expand our on-site shared clinical and community space. The enhanced shared clinic space is utilized by our lung nodule clinic, neuro-oncology and supportive care clinics. In addition, we now have a dedicated space for the Donna Fielding Cancer Wellness Institute. The Wellness Institute is an unparalleled resource that helps coordinate services available for cancer patients throughout Roper St. Francis and the community, including therapeutic massage, disease specific support groups, legal clinic services, survivorship education, exercise and nutritional classes. Roper St. Francis Cancer Care is recognized by the American College of Surgeons Commission on Cancer. We are accredited with Gold-level Commendation the highest level of accreditation, with only seven percent of nationally accredited programs achieving this level. The National Accreditation Program for Breast Centers (NAPBC) is a national coalition of professional organizations dedicated to the improvement of the quality of care and the monitoring of outcomes for patients with diseases of the breast. NAPBC accreditation is a voluntary program administered by the American College of Surgeons. In 2015 our breast cancer program was awarded a full three-year accreditation by the NAPBC. This reflects our commitment to excellence and is a testament to our efforts to continually improve our levels of care. RSF Cancer Care is affiliated as a Charter Member of the Levine Cancer Institute (LCI). The LCI is a network of cancer programs at 12 hospitals across the Carolinas Healthcare System (CHS) network. System-wide, the LCI treats approximately 14,000 newly diagnosed cancer patients each year, placing it among the largest cancer care networks in the US. Our priorities for development of the collaboration include: a significant focus on clinical trials and research, resulting in access for Lowcountry residents to new cancer-fighting drugs well before they become commercially available;

3 clinical linkages to centers of specific clinical expertise throughout the LCI system that offer Lowcountry cancer patients advanced treatment options, e.g., radical cystectomy with ileal loop or neo-bladder reconstruction for patients with muscle invasive bladder cancer; co-enhancement with LCI of our navigation, supportive care and survivorship programs. The focus of this 2015 Cancer Care Annual Report includes outcomes from our community outreach. Our outreach programs reflect our commitment to improving public access to cancer prevention, early detection screening and education programs. Our comprehensive and multidisciplinary Cancer Care programs span the continuum of cancer care from outreach and screening programs, state of the art diagnostics and treatment, access to clinical trials and supportive care. In addition, RSF Cancer Care remains committed to providing the most advanced evidence-based medicine within a framework of multidisciplinary coordinated care. As such this year we would like to highlight the care provided to patients with breast cancer. Our breast cancer program is delivered by a multidisciplinary team that includes board certified surgeons, medical and radiation oncologists, breast radiologists, pathologists, a geneticist, pharmacist and nurse navigators. We hope that this report provides helpful information to the community we serve. While we recognize that no one would hope to require our services, we will continue to endeavor to provide the compassionate, individualized care to all who entrust us with their care. Steven A. Akman, MD Medical Director, Roper St. Francis Cancer Care

4 Program Outcomes: Prevention and Screening 2015 Community Outreach In 2015, Roper St. Francis Cancer Care participated in over 45 community events reaching more than 16,074 participants from Charleston, Dorchester, Berkeley, Hampton and Colleton counties. Community members participating in events received education on cancer prevention and early detection for many disease sites, such as breast, skin, colorectal and lung cancers. In addition, RSF Cancer Care provided monthly wellness activities such as nutrition, exercise, yoga (Relax and Restore) and survivorship classes. Patients and caregivers also had access to massage and music therapy, selfexploration writing workshops; breast, bladder and general cancer support groups; and legal clinics offered in collaboration with the Charleston School of Law. In 2015, RSF Cancer Care offered cancer screening events throughout the year with the assistance of physicians and clinical volunteers. Screenings included skin, lung, and breast for a total of 547 participants. All abnormal finding results found during the screening events were referred to physicians for further follow-up or intervention. Results 2015 Screenings: BREAST SCREENING 39 Participants 35 Normal Exams 10% (4 participants) warranted referrals to appropriate physicians for follow-up care. Based on follow-up diagnostic procedures 1 breast cancer was diagnosed. 512 Charity Care Breast Procedures SKIN SCREENING LUNG SCREENING 421 Participants 329 Negative 92 Indeterminate All indeterminates are reviewed by the Multidisciplinary Thoracic Oncology Program (MTOP) cancer conference and additional diagnostic evaluations are recommended. Based on follow-up diagnostic procedures 3 lung cancers were diagnosed. 87 Participants 48 Normal Exams 39% (34 participants) warranted referrals to appropriate physicians for follow-up care

We are privileged to treat more patients with breast cancer than any other institution in the Tri-County area.

5 Multidisciplinary Breast Cancer Program Megan Baker, MD and Paul Baron, MD The Roper St. Francis Multidisciplinary Breast Cancer Program continues to be Charleston s leader in the diagnosis and treatment of breast cancer. We are privileged to treat more patients with breast cancer than any other institution in the Tri-County area. As stewards of this trust, we continue to offer our patients cuttingedge prevention, diagnostic screening and cancer treatment with the convenience and peace of mind of being able to do so as close to home as possible. These efforts were recently recognized by the National Accreditation Program for Breast Centers as exemplary and far exceeding national standards during our reaccreditation, as well as demonstrated by our Commission on Cancer Quality measures. Patients seen by a member of the Roper St. Francis breast team not only benefit from the experience of their treating providers, but also leverage the collective knowledge of over 30 breast cancer specialists. Patient s cases are reviewed and discussed weekly among the RSF Breast Cancer Team to ensure that all diagnostic measures are optimal, treatment options are personalized and holistic, and clinical trial candidacy is evaluated. While this is taking place, patients continue to be supported and educated by our recently expanded breast cancer nurse navigator team. These experienced nurses are essential to patients successful way-finding through complex cancer care. Together with the treating physician, the navigators evaluate every patient for participation in our Wellness Program, which offers nutritional counseling, psychological and social support, exercise intervention and smoking cessation counseling. In order to better serve our patients closer to their home, we have expanded services at all of our locations. This includes the introduction of 3D tomosynthesis breast mammography at Bon Secours St. Francis Hospital, Roper Hospital and Mount Pleasant Hospital, expanded breast cancer surgery services at Mount Pleasant hospital to include autologous breast cancer reconstruction and lymphedema care, and the scheduled expansion of breast cancer surgical services to Summerville in the first quarter of As a comprehensive community cancer center, an integral part of our mission includes the prevention of breast cancer and treatment of all women. To this end, the High Risk breast cancer program continues to grow both in volume as well as accessibility. Patients have local access to high risk assessment to include genetic counseling, genetic testing, high risk breast imaging screening and medical and surgical prevention strategies. Similarly, while fulfilling our mission to heal all people,

6 we offer community outreach efforts throughout the year targeting women who have barriers to breast cancer screening and treatment so that no woman is left behind. Delivering the highest quality breast cancer care to our patients is our first priority. As illustrated in the accompanying table, Roper St. Francis consistently exceeds national breast cancer care delivery standards set by the Commission on Cancer of the American College of Surgeons. We make this effort in the belief that delivering high quality care is the best way to enable the best possible treatment outcome for every patient. As 2015 closes, we are proud of our RSF breast cancer team as it is through their collective strength that we best serve our patients. We also are humbled by our patients who bravely navigate their treatment and for those who participate in clinical trials helping not only themselves but women who face the diagnosis in the future. Cancer Program Practice Profile Reports (CP³R) Roper Hospital Select Breast Measure CoC Std 2013 Radiation therapy is administered within 1 year of diagnosis < age 70 receiving breast conserving surgery 90% 95.6% Radiation therapy is considered after mastectomy within 1 year of diagnosis for 4 nodes 90% 100.0% Combination chemotherapy is considered or administered within 4 months of diagnosis < age 70 with AJCC T1cN0M0, or Stage IB-III hormone receptor negative breast cancer 90% 95.0% Tamoxifen or 3rd generation aromatase inhibitor is considered or administered within 1 year of diagnosis for AJCC T1c or IB-III hormone receptor positive breast cancer 90% 93.5%

Breast Tomosynthesis/3D Mammography Amy Deaton, MD Regular mammographic screening in accordance with national guidelines is the best way to insure early detection of breast cancer.

7 Breast Tomosynthesis/3D Mammography Amy Deaton, MD Regular mammographic screening in accordance with national guidelines is the best way to insure early detection of breast cancer. New imaging technology has improved mammographic screening by enabling better detection of cancers in the breast and helping to distinguish potentially malignant lesions from benign lesions or normal structures. Recognizing these benefits, Roper St. Francis has invested in state-of- the-art breast imaging technology known as breast tomosynthesis/3d mammography. Breast tomosynthesis differs from the standard 2D mammographic image by performing a radiographic sweep of each breast in two projections. Multiple images are acquired, which can be paged through for evaluation of the breast parenchyma. Masses, previously often obscured by overlying structures, are more easily detectable with this technology, and thus the finding of early breast cancers is improved by up to 40 percent. Additionally, patients are called back for follow up imaging less often, reducing inconvenience, cost and worry. With 2D imaging, recalls for asymmetry or questionable masses are common due to superimposed normal structures. 3D imaging allows the radiologist to see through that tissue and discern whether a true abnormality is present. The exam, as far is the patient is concerned, is virtually unchanged from traditional 2D mammography. It takes minimally longer and the radiation dose is only slightly increased, but well within acceptable range. 2D images are reconstructed from the 3D data set, so additional 2D imaging is not required. This imaging modality is particularly helpful in patients with dense to extremely dense breasts, which make up about half of the population. Those patients whose breast density falls in between fatty and dense are also well served with 3D mammograms. Currently, Medicare is paying for 3D mammography, whereas coverage by other payers is variable. It is likely that over the next year or two, 3D mammograms will become the standard screening mammogram and will be covered by insurance. Roper St. Francis has added three new 3D mammography units, one each at St. Francis MOB, Roper Hospital and Mount Pleasant Hospital. An additional unit is available at St. Francis MOB, which has been upgraded and combines the capability of 3D and stereotactic biopsies.

CANCER ANNUAL REPORT

2016 CANCER ANNUAL REPORT A WORD FROM OUR LEADERSHIP We are pleased to present our 2016 Annual Report highlighting advances in state of the art cancer care at the Roper St. Francis Cancer Program. Our