ALTRU CANCER PROGRAM ANNUAL R E P O RT

ALTRU CANCER PROGRAM ANNUAL R E P O RT 208

ALTRU HEALTH SYSTEM 208 ALTRU CANCER PROGRAM ANNUAL REPORT TABLE OF CONTENTS CANCER COMMITTEE MEMBERSHIP 208... ADMINISTRATIVE MESSAGE...2 CANCER LIAISON PHYSICIAN MESSAGE...3 QUALITY OF CARE MEASURES...4 CANCER CENTER PATIENT NAVIGATION SERVICES...5-6 ALTRU CANCER PROGRAM DATA 207...7-0 207 PATIENT DEMOGRAPHICS... CANCER CENTER PROVIDERS...2 ALTRU S PROMISE EVERY MOMENT OF EVERY DAY WE PROMISE TO PROVIDE AN EXCELLENT HEALTH CARE EXPERIENCE. WE WILL BE RESPECTFUL, COMPASSIONATE AND THOROUGH. WE KNOW THAT YOUR FAMILY AND FRIENDS ARE AN IMPORTANT PART OF YOUR CARE; WE WILL INVOLVE THEM AS YOU WISH AND EXTEND THE SAME PROMISE OF EXCELLENCE TO THEM.

CANCER COMMITTEE 208 The Cancer Committee is composed of representatives of primary and specialty care physicians, as well as team members involved in the care of our cancer patients. The multidisciplinary Committee meets at least quarterly to review and evaluate the quality and direction of the overall cancer program, and makes recommendations for improvement. Daniel Walsh, MD, Committee Chair, Medical Oncology Stefan Johnson, MD, Surgery Grant Seeger, MD, Radiation Oncology Kevin Panico, MD, Medical Oncology Marshall Winchester, MD, Radiation Oncology Muhammad Siddique, MD, Medical Oncology Mark Rodacker, MD, Pathology David Chou, MD, Radiology Laura Lizakowski, MD, Internal Medicine, Palliative Care Todar Dentchev, MD, Medical Oncology Tana Setness Hoefs, MD, Obsterics & Gynecology Henry Caoili, MD, Physiatrist Jill Wilson, MBA, OTR/L, Administrator Clinic Operations Beth Nelson, RN, OCN, Cancer Services Manager LeAnne Kilzer, RN, OCN, Oncology Resource Nurse Jodi Savat, RN, OCN, Inpatient Medical Oncology Shelly Evenson, RN, Quality/Utilization Review Rachel Salberg, NP, Palliative Care Denise Becker, RN, OCN, Medical Oncology Wanda DeKrey, RN, OCN, Oncology Research Aaron Kempenich, MS, Physicist Vickie Misialek, LSW, Oncology Social Services/Case Manager Anne Nygaard, MS, FNP-C, Medical Oncology Jackie Roberts, AOCNP, DNP, FNP-BC, Medical Oncology Emily Schmiedeberg, RN, Patient Referral Coordinator Annie Berginski, RN, Outpatient Medical Oncology Cassidy Rhondeau, RN, Outpatient Medical Oncology Julie Sundby, RN, Hospice Case Manager Nicole Hylden, RN, Breast Center Danielle Conrad, LISCW, Grief Center Kim Sheldon, CTR, Cancer Registry Pam Vigen, CHUC, CTR, Cancer Registry Lindsay Carpenter, CTR, Cancer Registry Sara Anderson, American Cancer Society Kaitlyn Dufault, Recorder CANCER COMMITTEE COORDINATORS FOR 208 Kevin Panico, MD - Cancer Conference Coordinator Lindsay Carpenter, CTR - Cancer Registry Quality Control Coordinator Shelly Evenson, RN, - Quality Improvement Coordinator LeAnne Kilzer, RN, OCN - Education/Community Outreach Coordinator Wanda DeKrey, RN, OCN - Research Coordinator Vickie Misialek, LSW - Psychosocial Services Coordinator CANCER LIAISON PHYSICIAN FOR 208 Stefan Johnson, MD General Surgery 208 Cancer Program Annual Report Altru Health System

ADMINISTRATIVE MESSAGE Dear Friends and Colleagues, Our goal at Altru Cancer Center is to provide the highest quality of oncology healthcare in the region. We offer cancer services in support of this goal through a multidisciplinary team of physicians, researchers, genetic educators, nurses, navigators, administrators and other healthcare professionals. Together we provide excellent care addressing everything from cancer prevention and screening to diagnostic work-up, from cutting edge treatment to palliative care. With our focus ever on this goal, we are pleased to present the 208 Cancer Program Annual Report recognizing our continued hard work and many achievements. Altru Cancer Center is accredited by the American College of Surgeons, which assures that cancer programs meet the highest national standards for comprehensive and patient-centered cancer care. We are proud to have been awarded three-year Accreditation by the Commission on Cancer (CoC) of the American College of Surgeons a consortium of 56 professional organizations that reflect the full spectrum of cancer care. To earn continued accreditation for over 30 years, Altru Cancer Center has continued to successfully complete thorough on-site evaluations to demonstrate compliance with all established CoC Standards. Our next accreditation evaluation survey will take place in November 208. This year s annual report highlights some of the key accomplishments achieved in 208 and features the exciting new equipment and facilities made available this year. On behalf of the entire cancer program team, we sincerely hope you find this year s annual report informative. Thank you for allowing us to continue to advance the Altru Health System mission of Improving Health, Enriching Life and the vision to deliver world-class healthcare to the residents of our region. Kevin Panico, MD Beth Nelson, RN, OCN Daniel Walsh, MD Cancer Services Practice Manager Altru Cancer Program Department Chair Altru Cancer Center Cancer Committee Chair 2 208 Cancer Program Annual Report Altru Health System

CANCER LIAISON PHYSICIAN MESSAGE As the Altru Cancer Liaison Physician, one of my responsibilities is to have a strong commitment to the success of the cancer program. To this end, I am pleased to announce we now proudly offer our patients some of the most advanced, minimally invasive surgical systems, skillfully operated by our expert surgeons. In 208 we will begin to offer robotic surgery in some practices. Stefan Johnson, MD Surgery Robotic surgery offers a magnified vision system, giving our surgeons a 3-D, high definition view inside the body. Wristed instruments bend and rotate far greater than the human hand, enabling the robot to maneuver more easily in tight spaces. The surgeon sits nearby at a console manipulating the instruments and performing the operation. This allows the surgeon s hand movements to be translated into smaller, precise movements of tiny instruments inside the body. Altru uses the latest Intuitive davinci Xi robotic surgical system. The system offers 3-D high definition visualization and allows for enhanced dexterity and greater control for surgeons. Altru Health System is the only system in North Dakota to have dual operating consoles, allowing two surgeons to operate together. The davinci system allows Altru surgeons to perform minimally invasive procedures in the following departments: General Surgery, Gynecology and Urology. 3 208 Cancer Program Annual Report Altru Health System

QUALITY OF CARE MEASURES Another responsibility as Cancer Liaison Physician is to evaluate, interpret, and report the cancer program s performance using data from the National Cancer Data Base (NCDB). The American College of Surgeons Commission on Cancer 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 practice improvement to improve quality of patient care at the local level and permits hospitals to compare their care for these patients relative to that of other providers. The following data is excerpted from Altru s 206 (the latest information available) CQIP report, which Altru uses to assess its program s compliance with evidence-based standards of care. BREAST CANCER Estimated Performance Rate (EPR) Radiation therapy considered or administered following Altru Cancer Center 00% mastectomy within year of All COC-Approved Compressive Cancer Programs 84.5% diagnosis for women with 4 or more positive regional lymph All COC-Approved Programs in the country 85.6% nodes CCO Benchmark-Expected Performance Rate 90% Radiation therapy considered or administered within year of Altru Cancer Center 93.3% diagnosis for women under age All COC-Approved Compressive Cancer Programs 90.7% 70 receiving breast conservation surgery All COC-Approved Programs in the country 90.8% CCO Benchmark-Expected Performance Rate 90% Tamoxifen or 3rd generation aromatase inhibitor is considered or administered within year of diagnosis for women with stage T2c of 2B-3 hormone receptor positive breast cancer. Combination chemotherapy is considered or administered within 4 months of diagnosis for women under age 70 with stage Tc of 2B-3 hormone receptor negative breast cancer. Altru Cancer Center 00% All COC-Approved Compressive Cancer Programs 9.% All COC-Approved Programs in the country 9.3% CCO Benchmark-Expected Performance Rate 90% Altru Cancer Center 00% All COC-Approved Compressive Cancer Programs 92.9% All COC-Approved Programs in the country 92.9% CCO Benchmark-Expected Performance Rate 90% 4 208 Cancer Program Annual Report Altru Health System

PATIENT NAVIGATORS services that may be of interest and assistance to patients, particularly those who will be receiving any type of cancer treatment. They can also help arrange care that can be provided closer to the patient s home and primary provider. If the treatments are to be administered at Altru Cancer Center, they can assist patients with lodging and transportation, if needed. Left to right: Vicki Misialek, LSW, Robbie Narlock, RN, Doreen Langlois, RN, LeAnne Kilzer, RN, OCN. We recognize that coming to a cancer center can be overwhelming. Altru Cancer Center Patient Navigators are available to assist patients and families to find their way through this process. The patient navigators work closely with the consulting physicians in radiation and medical oncology areas. As part of the patient s physician visit, one of our patient navigators will meet with the patient and family, and help coordinate further tests, appointment and treatment dates. They will help answer questions patients might have about treatment plan physicians recommend. The patient navigators will complete an assessment of potential needs and review New in 208, we are excited to announce the opening of Sunshine Hospitality Home. This is a place of comfort, compassion and convenience for patients and their families who must travel for healthcare needs. Comfortable and homelike, the home allows individuals to stay close to their loved ones to assist with care, rehabilitation, home care teaching and support. It is conveniently situated west of Altru s Columbia Road campus across from Sertoma Park (933 Duke Drive, Grand Forks, ND). The patient navigators will be offering accommodations at the Sunshine Hospitality Home as an option within the Filling the Gap (FTG) program, and recommending it as an affordable option for patients who do not qualify for FTG. The Hospitality Home day rooms will be a great no-cost option for our patients to rest while having multiple appointments during the day. It is a beautiful inviting facility where they can interact with others or have private areas to rest. HOSPITALITY HOME 5 208 Cancer Program Annual Report Altru Health System

FINANCIAL NAVIGATOR Eileen Marti is the financial navigator for the Altru Cancer Center. Her extensive background in the insurance industry and astute organizational skills have contributed to the success of the financial program. She has worked to secure funding to assist patients, as well as to reimburse Altru for funds that would otherwise be lost. The Association of Community Cancer Centers describes Oncology Financial Navigators as an integral member of the multidisciplinary cancer care team, but notes that the oncology community has done Eileen Marti, Financial Navigator an inadequate job of addressing the financial burden of the patient population. Understanding this burden, the Altru Cancer Center has shown initiative in creating Eileen s position and staffing it full-time. While Eileen s position has been in place since 202, it wasn t until 207 that her title was changed to Financial Navigator to better describe the services she offers. With the ever-changing world of healthcare becoming increasingly complex, it is imperative that patients and staff to whom they can turn, to help them navigate the rules and regulation. The financial navigator serves this role and assists patients with financial barriers. Oncology drugs, specifically some oral drugs, are one of the fastest growing industries in healthcare with most coming on the market at a price of over $00,000 a year. The role for the financial navigator is essential in decreasing out of pocket cost to the consumer and reducing the financial toxicity of their treatment. To better assess the impact that her position is making we initiated a method to track some of the assistance that is provided by Eileen. The following are totals for 207:» 4 patients enrolled in a program that offers replacement of infused/injection therapies» 32 patients receiving free oral therapies» 54 patients enrolled into co-pay assistance foundations, grant programs» 4 patients enrolled in the Altru Foundation funding program for Lovenox/Xeloda» The total dollar amount in patient assistance for the year of the year totaled $977,705 Continued growth of this financial program and further streamlining is expected to increase which may increase the need for more financial navigators in the future. 6 208 Cancer Program Annual Report Altru Health System

CANCER REGISTRY REPORT The cancer registry is part of the cancer program and is located within the Altru Cancer Center. The purpose of the cancer registry is to maintain timely, accurate and complete data on all types of cancer diagnosed and/or treated at Altru Health System. We maintain records in our database starting with diagnosis dates of January, 2006. We currently have 0,405 records in the database. The table below highlights cancer incidence in Altru Health System patient population per year since 2006. In 207, 938 new cancer diagnoses were added to the cancer registry database. The following pages show the site distribution for these cancers and the patient demographics. Altru Health System s cancer data are part of national statistics for incidence reporting and research. Our data are submitted to the National Cancer Data Base (NCDB), the Minnesota Cancer Surveillance System (MCSS) and the North Dakota Central Registry Data Base (NDCR). Guidelines are in place so that submission of data to the entities complies with Health Insurance Portability and Accountability Act (HIPAA). The most current NCDB annual submission (Call for Data) was completed in January 208. We also submit data to the NCDB as part of the Rapid Quality Reporting System (RQRS). If you have any questions or would like to request data from the cancer registry, please contact registry staff at 70.780.5395, 70.780.5396 or 70.780.547. 200 000 800 600 878 838 834 890 9 969 938 400 748 796 88 78 757 200 0 2006 2007 2008 2009 200 20 202 203 204 205 206 207 In the cancer registry, we are very focused on data, reporting, and statistics. But we never lose sight of patients and their stories; the people and lives behind the data we collect. Pictured here are Sharon Olson and Ryan Fish, two patients who met and formed a friendship while receiving cancer treatment. 7 208 Cancer Program Annual Report Altru Health System

CLASS of CASE Class of Case Description #207 Cases % 207 Cases 00 3 4 2 22 Diagnosis at Altru, Treatment elsewhere Diagnosis at Altru, Partial Treatment at Altru Diagnosis at Altru, All Treatment at Altru Diagnosis elsewhere, Partial Treatment at Altru Diagnosis elsewhere, All Treatment at Altru 68 8.8% 69 8.9% 56 67.0% 77 9.2% 48 6.2% 00 Diagnosis at Altru, Treatment elsewhere 3 Diagnosis at Altru, Partial Treatment at Altru 4 Diagnosis at Altru, All Treatment at Altru 2 Diagnosis elsewhere, Partial Treatment at Altru 22 Diagnosis elsewhere, All Treatment at Altru 8 208 Cancer Program Annual Report Altru Health System

TOP FIVE CANCER SITES Analytic (class of case 00-22) January, 207 - December 3, 207 30 04 24 3 6.4% 4.95% 78 52 7 9.39% 62 60 8.2% 7.67% 26 0 Breast Bronchus and Lung Prostate Gland Blood and Bone Marrow Colon The following page details the primary site of cancers seen here at Altru Health System in 207; it highlights cancer staging for male and female patients, analytic and non-analytic cases, as well as general staging. According to the American Joint Committee on Cancer (AJCC) staging is the process of determining how much cancer is in the body and where it is located. Staging describes the severity of an individual's cancer based on the magnitude of the original (primary) tumor as well as on the extent cancer has spread in the body. Understanding the stage of the cancer helps doctors to develop a prognosis and design a treatment plan for individual patients. Staging provides a common language for doctors to effectively communicate about a patient s cancer and collaborate on the best courses of treatment. To further describe the table on page 0; the general stage is listed as:» INS = in situ stage is early cancer that has not spread to neighboring tissue» LOC = localized stage is usually found only in the tissue or organ where it began, and has not spread to nearby lymph nodes or to other parts of the body» REG = regional stage is a malignancy that has spread beyond the confines of the original primary tumor to nearby lymph nodes and/or organs and tissues» DIST = distant stage refers to cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes» BEN = benign tumor is not malignant. It does not invade nearby tissue or spread to other parts of the body the way cancer can. But benign tumors can be serious if they press on vital structures such as blood vessels or nerves.» UNK = unknown stage, this indicates there either is not a staging system for the primary or the degree of stage is unknown. 9 208 Cancer Program Annual Report Altru Health System

SITE DISTRIBUTION Primary Site Total Class Sex General Stage A N/A M F INS LOC REG DIST BEN Unk All Sites 938 772 66 478 460 59 307 220 222 2 8 Oral Cavity 25 23 2 7 8 0 9 2 3 0 Tongue 7 7 0 4 3 0 5 0 0 Hypopharynx 0 0 0 0 0 0 0 Other 7 5 2 2 5 0 8 7 0 Digestive System 64 40 24 87 77 4 25 78 42 4 Esophagus 23 8 5 7 6 0 5 6 0 Stomach 7 6 5 2 0 2 2 Colon 66 60 6 30 36 3 36 3 0 3 Rectum 2 7 4 2 9 4 0 4 0 2 Anus/Anal Canal 7 6 0 7 0 2 4 0 0 Liver 0 9 2 0 6 0 3 Pancreas 20 7 3 0 0 0 3 6 8 0 3 Other 3 0 3 8 5 0 2 8 2 0 Respiratory System 88 22 66 85 03 0 3 38 56 0 63 Larynx 4 3 4 0 0 0 2 0 Other 2 2 0 2 0 0 0 0 0 Lung/Bronc-Small Cell 24 20 4 8 6 0 2 3 7 0 2 Lung/Bronc-Non Small Cell 97 88 9 46 5 0 27 32 32 0 6 Other Bronchus & Lung 6 9 52 25 36 0 2 0 5 0 54 Blood & Bone Marrow 78 64 4 55 23 0 0 0 78 0 0 44 36 8 30 4 0 0 0 44 0 0 8 6 2 5 3 0 0 0 8 0 0 6 2 4 0 6 0 0 0 6 0 0 Bone 2 0 2 0 2 0 0 0 0 Connect/Soft Tissue 6 4 2 3 3 0 3 2 0 0 Skin 4 36 5 23 8 25 5 0 0 0 Melanoma 38 33 5 2 7 23 4 0 0 0 Other 3 3 0 2 0 2 0 0 0 Breast 32 23 9 3 4 86 23 6 0 3 Female Genital 30 24 6 0 30 0 6 7 4 0 3 Cervix Uteri 3 2 0 3 0 2 0 0 0 Corpus Uteri 7 5 2 0 7 0 2 4 0 0 Ovary 6 4 2 0 6 0 2 0 2 Vulva 4 3 0 4 0 2 0 0 Male Genital 97 80 7 97 0 0 55 25 0 0 7 Prostate 93 76 7 93 0 0 52 25 9 0 7 Testis 4 4 0 4 0 0 3 0 0 0 Urinary System 85 75 0 6 24 30 3 4 0 9 Bladder 49 44 5 36 3 28 0 7 0 3 Kidney/Renal 36 3 5 25 2 2 4 3 0 6 Brain & Cns 2 7 4 0 0 6 0 9 5 Brain (Benign) 0 0 0 0 0 0 0 0 0 0 0 Brain (Malignant) 9 7 2 7 2 0 5 0 0 3 Other 2 0 2 3 9 0 0 0 9 2 Endocrine 4 2 2 7 7 0 4 6 2 2 0 Thyroid 2 0 2 7 5 0 4 6 2 0 0 Other 2 2 0 0 2 0 0 0 0 2 0 Lymphatic System 39 35 4 22 7 0 4 7 4 0 4 Unknown Primary 2 2 0 6 6 0 0 2 0 9 Leukemia Multiple Other 0 208 Cancer Program Annual Report Altru Health System

CASES PER DEMOGRAPHICS GOLDEN VALLEY DIVIDE BURKE WILLIAMS 2 MCKENZIE BILLINGS SLOPE DUNN STARK BOWMAN ADAMS MOUNTRAIL HETTINGER RENVILLE MERCER GRANT WARD 2 MCLEAN OLIVER MORTON SIOUX BOTTNEAU ROLETTE 0 PIERCE 4 MCHENRY SHERIDAN BURLEIGH EMMONDS BENSON 7 WELLS KIDDER TOWNER 6 LOGAN MCINTOSH CAVALIER 8 RAMSEY 57 EDDY - 3 FOSTER STUTSMAN PEMBINA 47 WALSH 68 GRAND FORKS NELSON 286 6 LAMOURE GRIGGS 2 DICKEY BARNES STEELE RANSOM SARGENT TRAILL 6 CASS 3 KITTSON 9 RICHLAND The demographics shown on map reflect that 63% of our cancer patients in 207 North Dakota residents. 34% were from Minnesota and 2% were from out of state. ROSEAU 57 MARSHALL 4 PENNINGTON - 28 RED LAKE - 5 POLK 23 NORMAN CLAY WILKIN CLEARWATER 2 MAHNOMEN 3 HUBBARD BECKER LAKE OF THE WOODS 0 BELTRAMI 5 WADENA KOOCHICHING CASS CROW WING ITASCA 2 AITKIN CARLTON MCLEOD CARVER RENVILLE YELLOW MEDICINE SCOTT DAKOTA SIBLEY LA LYON REDWOOD NICOLLETE SUEUR RICE LINCOLN BROWN BLUE PIPESTONE COTTON- WATON- EARTH MURRAY WOOD WAN ROCK OTTER TAIL GRANT NOBLES DOUGLAS JACKSON TODD MORRISON MARTIN MILLE LACS KANNABEC PINE TRAVERSE STEVENS POPE STEARNS BENTON ISANTI SHERBURNE CHISAGO BIG STONE ANOKA WASH- SWIFT KANDIYOHI WRIGHT INGTON CHIPPEWA MEEKER HENNEPIN RAMSEY LAC QUI PARLE GOODHUE WABASHA STEELE DODGE WASECA OLMSTED FAIRBAULT FREEBORN SAINT LOUIS MOWER LAKE WINONA FILLMORE HOUSTON COOKE Many of our patients travel a great distance to receive care at Altru Cancer Center. Our goal through Patient Navigation and various programs is to ease the burden of that distance and to provide excellent quality of care for our patients and their families. North Dakota (594 Cases 63%) 286 Grand Forks 68 Walsh 57 Ramsey 47 Pembina 8 Cavalier 7 Benson 6 Nelson 0 Rolette 6 Traill 6 Towner 4 Pierce 3 Cass 3 Eddy 2 Ward 2 Williams 2 Griggs Bottineau Stark Burleigh Richland Minnesota (323 cases 34%) 23 Polk 57 Roseau 4 Marshall 28 Pennington 9 Kittson 5 Red Lake 0 Lake of the Woods 5 Beltrami 3 Mahnomen 2 Clearwater 2 Itasca Crow Wing - Saint Louis Norman Becker Clay Out of State (4 cases 2%) 208 Cancer Program Annual Report Altru Health System

PROVIDERS Todor Dentchev, MD, is board certified in hematology, medical oncology and internal medicine by the American Board of Internal Medicine and has additional ECG certification by the American College of Cardiology. Dr. Dentchev received his medical degree from Higher Medical Institute, Medical Academy in Bulgaria and has completed an internal medicine residency and hematology/oncology fellowship at the Brooklyn Hospital Center in New York. Laura Lizakowski, MD, received her nursing degree and medical degree from the University of North Dakota. She completed her residency and fellowship at Marshfield Clinic in Marshfield, Wisconsin. She is board certified in internal medicine, hospice and palliative medicine. Ngozi Okoro, MD, is board certified in internal medicine and medical oncology. Dr. Okoro earned her medical degree from the University of Maiduguri, Maiduguri, Nigeria and completed her internal medicine residency and medical oncology fellowship from Howard University, Washingto, D.C. Kevin Panico, MD, received his medical degree from the University of Texas Southwestern Medical Center, and completed an internal medicine residency at SUNY Health Science Center and hematology/oncology fellowship at Ohio State University. Dr. Panico is board certified in internal medicine, hematology, medical oncology and palliative medicine by the American Board of Internal Medicine. Grant Seeger, MD, received his medical degree from the University of North Dakota School of Medicine, and completed his residency internship at the University of Minnesota Internal Medicine program. He completed a four-year radiation oncology residency at the University of Texas Medical Branch. He is board certified in radiation oncology by the American Board of Radiology. Muhammad N. Siddique, MD, received his medical degree from Punjab Medical College in Pakistan. He completed his residency in internal medicine. He completed his residency at Staten Island University in New York, where he also completed his fellowship in hematology and oncology. Dr. Siddique is board certified in internal medicine, hematology and oncology by the American Board of Internal Medicine. Daniel Walsh, MD, received his medical degree from University of Illinois in Chicago. He completed an internal medicine residency and hematology/ oncology fellowship at University of Minnesota Hospitals and Clinics in Minneapolis, MN. Dr. Walsh is board certified in medical oncology by the American Board of Internal Medicine. Marshall Winchester, MD, received his medical degree from Wayne State University in Detroit, Michigan and completed his radiation oncology residency and was chief resident at Henry Ford Hospital in Michigan. He has more than 25 years of radiation oncology experience. Jackie Devine Roberts, DNP, FNP-C, AOCNP, received her master's degree as a family nurse practitioner from the University of North Dakota College of Nursing in 998 and her Doctorate of Nursing Practice from the University of Minnesota in 202. She is certified by the American Nurses Credentialing Center and completed the Advanced Oncology Certification for Nurse Practitioners in 2007. Anne Nygaard, FNP-C, AOCNP, received her master's degree from the University of North Dakota College of Nursing in 2006. She is certified as a family nurse practitioner by the American Association of Nurse Practitioners and completed the Advanced Oncology Certification for Nurse Practitioners in 203. 2 208 Cancer Program Annual Report Altru Health System

Improving Health, Enriching Life 960 South Columbia Road Grand Forks, ND 5820 altru.org