CANCER REGISTRY Annual Report

CANCER REGISTRY Annual Report 2017 Cancer Treatment Centers of America at Southwestern Regional Medical Center Tulsa, Oklahoma Philadelphia, Pennsylvania Chicago, Illinois Atlanta, Georgia Phoenix, Arizona

2016 CANCER COMMITTEE Chairman s Report From program changes to clinical studies, 2016 was a year of change and growth for Cancer Treatment Centers of America (CTCA) at Southwestern Regional Medical Center (Southwestern). This report outlines the 2016 activities and achievements of the Cancer Committee at Southwestern. The membership of our Cancer Committee is made up of a multidisciplinary team of physicians from the diagnostic and treatment specialties, as well as non-physicians from administrative and supportive care services. The Cancer Committee holds multidisciplinary cancer conferences, in which our care providers discuss treatment options for patients. In addition to the general cancer conferences, specialty conferences are held for head and neck, thoracic and breast cancer. Additionally, we began holding a molecular tumor board to present cases of patients who had received therapy for genetic mutations. Collectively, more than 400 patients benefited from our cancer conferences this year. Bradley Mons, DO Otolaryngology Head and Neck Surgeon Cancer Committee Chairman In 2016, Southwestern provided 20 open clinical trials to patients. In addition to these trials, we conducted quality studies throughout the year and looked at ways to increase our compliance for venous thromboembolism (VTE) assessment and treatment within the first 24 hours of all patient admissions. By the end of the year, we achieved 89 percent compliance, and we will continue to make improvements until we reach our goal of 100 percent. Our committee also looked at the assessment of female breast cancer survivors sexual quality-of-life needs. By the end of a three-month pilot, we implemented an evidence-informed Brief Sexual Symptoms Checklist for women and a sexual function measurement tool for female breast cancer survivors. Proper cancer care requires highly-qualified staff, therefore, only oncology-certified nurses provide systemic therapy to patients at Southwestern. Additionally, our patients meet regularly with one of five registered clinical oncology nutritionists. Our Physician Cancer Liaison, Dr. Peter Baik, attended the Commission on Cancer Clinical Congress and brought back updates for policies. As a surgeon, Dr. Baik began offering hyperthermic intrathoracic chemotherapy as a treatment modality. We strive to work as a team to provide the most inclusive cancer care possible, and as a result, our cancer registrars attended the annual National Cancer Registrars Association meeting as well as the state workshop. This year, Southwestern was awarded the Joint Commission s Gold Seal of Approval for Hospital Accreditation along with a Gold Seal 2 Cancer Treatment Centers of America at Southwestern Regional Medical Center

of Approval for Lung Cancer Certification and we earned a 5-Star Patient Survey Summary Score from the Centers for Medicare & Medicaid Services. Additionally, our radiation department continues to be accredited by the American College of Radiology (ACR). In 2016, the genetic counseling program at Southwestern continued to grow through the use of patient cancer risk assessments. During an assessment, our genetics professional educates patients who are at risk for hereditary cancer syndromes, empowering them to make informed decisions about genetic testing, cancer screening and cancer prevention. The Supportive Care/Quality of Life team at Southwestern adopted new practices designed to help more patients this year as well. This team now introduces a number of services, including quality of life care available at CTCA and hospice services available in the community, to inpatients at the time of diagnosis. The multidisciplinary team is comprised of a certified hospice and palliative care physician and two registered nurses, also certified in hospice and palliative care. Patients in our Supportive Care/Quality of Life program are also supported by a variety of specialty teams, including Social Work, Nutrition, Pastoral Care and Mind-Body. CONTENTS 4 2016 Primary Sites 6 Southwestern Cancer Prevention and Screening Programs 8 Accreditations and Certifications 10 Awards Every year, the Cancer Committee sets one programmatic and one clinical goal designed to improve patient care at Southwestern. In 2016, our programmatic goal was to achieve certification for our lung program, which was accomplished. Our clinical goal was to enhance the recovery of surgery patients. To that end, we launched the Advanced Surgical Recovery Program (ASURE ), which is designed to help patients recover from surgery more quickly and with fewer complications. Delivered by a multidisciplinary team working collaboratively to implement evidence-informed protocols, ASURE is intended to decrease the length of hospital stays and manage pain levels with non-narcotic pain relievers. The team combines post-surgical rehabilitation with pre-habilitation and addresses patient nutrition and physical activity within the first 24 hours after surgery. Additionally, Southwestern continued its commitment to increasing mortality rates of skin cancer patients (Oklahoma has one of the lowest survival rates for skin cancer) and improve survival rates of breast cancer patients by providing breast and skin cancer screenings as well as lung cancer screenings. At Southwestern, we offer our patients cancer care at every stage and vow to provide the Mother Standard of care, by delivering both compassion and clinical excellence every day. Sincerely, The information presented throughout the 2017 Cancer Registry Annual Report reflects the data collected from January 1 to December 31, 2016 unless otherwise noted. Bradley Mons, DO Cancer Committee Chairman 2017 CANCER REGISTRY ANNUAL REPORT 3

Primary Sites Summary by Body System, Sex, Class and Best CS/AJCC Stage Report Sex Class of Case Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank ORAL CAVITY & PHARYNX 30 (4.1%) 23 7 19 11 0 3 1 3 12 0 0 0 Lip 1 (0.1%) 1 0 1 0 0 1 0 0 0 0 0 0 Tongue 10 (1.4%) 8 2 6 4 0 1 0 2 3 0 0 0 Salivary Glands 4 (0.5%) 2 2 2 2 0 0 1 0 1 0 0 0 Floor of Mouth 2 (0.3%) 2 0 1 1 0 1 0 0 0 0 0 0 Gum & Other Mouth 4 (0.5%) 2 2 3 1 0 0 0 0 3 0 0 0 Tonsil 6 (0.8%) 6 0 4 2 0 0 0 0 4 0 0 0 Oropharynx 3 (0.4%) 2 1 2 1 0 0 0 1 1 0 0 0 DIGESTIVE SYSTEM 178 (24.4%) 114 64 105 73 2 7 11 17 59 8 1 0 Esophagus 10 (1.4%) 10 0 6 4 0 0 0 1 5 0 0 0 Stomach 18 (2.5%) 10 8 13 5 1 1 3 2 5 1 0 5 Small Intestine 5 (0.7%) 2 3 4 1 0 0 0 0 1 2 1 0 Colon Excluding Rectum 60 (8.2%) 37 23 26 34 1 1 3 4 17 0 0 0 Cecum 13 11 2 5 8 0 0 1 0 4 0 0 0 Appendix 5 4 1 4 1 0 0 0 0 4 0 0 0 Ascending Colon 6 2 4 2 4 0 0 1 0 1 0 0 0 Hepatic Flexure 2 1 1 0 2 0 0 0 0 0 0 0 0 Transverse Colon 3 1 2 2 1 0 0 0 1 1 0 0 0 Descending Colon 7 3 4 3 4 0 0 0 2 1 0 0 0 Sigmoid Colon 21 12 9 8 13 0 1 1 1 5 0 0 0 Large Intestine, NOS 3 3 0 2 1 1 0 0 0 1 0 0 0 Rectum & Rectosigmoid 34 (4.7%) 23 11 17 17 0 3 2 7 5 0 0 0 Rectosigmoid Junction 8 5 3 3 5 0 2 0 1 0 0 0 0 Rectum 26 18 8 14 12 0 1 2 6 5 0 0 1 Anus, Anal Canal & Anorectum 3 (0.4%) 1 2 2 1 0 0 0 1 1 0 0 0 Liver & Intrahepatic Bile Duct 10 (1.4%) 8 2 8 2 0 1 0 1 4 2 0 1 Liver 6 5 1 4 2 0 1 0 1 1 1 0 0 Intrahepatic Bile Duct 4 3 1 4 0 0 0 0 0 3 1 0 3 Gallbladder 2 (0.3%) 1 1 1 1 0 0 0 0 1 0 0 2 Other Biliary 3 (0.4%) 2 1 3 0 0 0 0 0 3 0 0 1 Pancreas 29 (4.0%) 17 12 21 8 0 1 3 1 16 0 0 0 Retroperitoneum 2 (0.3%) 2 0 2 0 0 0 0 0 0 2 0 0 Peritoneum, Omentum & Mesentery 1 (0.1%) 0 1 1 0 0 0 0 0 1 0 0 0 Other Digestive Organs 1 (0.1%) 1 0 1 0 0 0 0 0 0 1 0 1 RESPIRATORY SYSTEM 98 (13.4%) 54 44 58 40 0 8 6 14 30 0 0 4 Nose, Nasal Cavity & Middle Ear 2 (0.3%) 1 1 1 1 0 0 1 0 0 0 0 1 Larynx 8 (1.1%) 8 0 3 5 0 0 0 2 1 0 0 0 Lung & Bronchus 88 (12.1%) 45 43 54 34 0 8 5 12 29 0 0 3 BONES & JOINTS 1 (0.1%) 1 0 0 1 0 0 0 0 0 0 0 0 SOFT TISSUE (Including heart) 8 (1.1%) 5 3 4 4 0 0 1 0 2 1 0 1 4 Cancer Treatment Centers of America at Southwestern Regional Medical Center

Sex Class of Case Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank SKIN EXCLUDING BASAL & SQUAMOUS 16 (2.2%) 9 7 14 2 0 9 0 3 2 0 0 0 Melanoma -- Skin 13 (1.8%) 7 6 12 1 0 7 0 3 2 0 0 0 Other Non-Epithelial Skin 3 (0.4%) 2 1 2 1 0 2 0 0 0 0 0 0 BREAST 151 (20.7%) 1 150 85 66 8 25 31 11 10 0 0 0 FEMALE GENITAL SYSTEM 53 (7.3%) 0 53 31 22 0 12 4 5 7 3 0 0 Cervix Uteri 12 (1.6%) 0 12 7 5 0 1 3 0 2 1 0 0 Corpus & Uterus, NOS 18 (2.5%) 0 18 10 8 0 7 0 0 1 2 0 0 Corpus Uteri 17 0 17 10 7 0 7 0 0 1 2 0 2 Uterus, NOS 1 0 1 0 1 0 0 0 0 0 0 0 0 Ovary 19 (2.6%) 0 19 11 8 0 2 1 4 4 0 0 1 Vulva 4 (0.5%) 0 4 3 1 0 2 0 1 0 0 0 1 MALE GENITAL SYSTEM 59 (8.1%) 59 0 43 16 0 7 23 6 7 0 0 0 Prostate 57 (7.8%) 57 0 42 15 0 7 23 5 7 0 0 1 Testis 2 (0.3%) 2 0 1 1 0 0 0 1 0 0 0 0 URINARY SYSTEM 34 (4.7%) 26 8 16 18 0 6 1 2 7 0 0 0 Urinary Bladder 10 (1.4%) 9 1 5 5 0 0 1 1 3 0 0 0 Kidney & Renal Pelvis 23 (3.2%) 16 7 10 13 0 6 0 0 4 0 0 0 Ureter 1 (0.1%) 1 0 1 0 0 0 0 1 0 0 0 0 BRAIN & OTHER NERVOUS SYSTEM 15 (2.1%) 9 6 10 5 0 0 0 0 0 10 0 0 Brain 11 (1.5%) 6 5 8 3 0 0 0 0 0 8 0 0 Cranial Nerves Other Nervous System 4 (0.5%) 3 1 2 2 0 0 0 0 0 2 0 0 ENDOCRINE SYSTEM 24 (3.3%) 9 15 17 7 0 11 1 0 4 1 0 0 Thyroid 22 (3.0%) 7 15 16 6 0 11 1 0 4 0 0 4 Other Endocrine including Thymus 2 (0.3%) 2 0 1 1 0 0 0 0 0 1 0 3 LYMPHOMA 30 (4.1%) 17 13 20 10 0 3 4 4 8 0 1 1 Hodgkin Lymphoma 13 (1.8%) 7 6 6 7 0 0 3 1 1 0 1 1 Non-Hodgkin Lymphoma 17 (2.3%) 10 7 14 3 0 3 1 3 7 0 0 0 NHL - Nodal 15 8 7 12 3 0 3 1 3 5 0 0 1 NHL - Extranodal 2 2 0 2 0 0 0 0 0 2 0 0 0 MYELOMA 5 (0.7%) 2 3 5 0 0 0 0 0 0 5 0 0 LEUKEMIA 9 (1.2%) 5 4 4 5 0 0 0 0 0 4 0 0 Lymphocytic Leukemia 5 (0.7%) 3 2 3 2 0 0 0 0 0 3 0 0 Myeloid & Monocytic Leukemia 3 (0.4%) 2 1 1 2 0 0 0 0 0 1 0 0 Acute Myeloid Leukemia 1 1 0 1 0 0 0 0 0 0 1 0 2 Acute Monocytic Leukemia 1 1 0 0 1 0 0 0 0 0 0 0 2 Chronic Myeloid Leukemia 1 0 1 0 1 0 0 0 0 0 0 0 2 Other Leukemia 1 (0.1%) 0 1 0 1 0 0 0 0 0 0 0 2 MISCELLANEOUS 19 (2.6%) 11 8 16 3 0 0 0 0 0 16 0 0 Total 730 345 385 447 283 10 91 83 65 148 48 2 0 Analytic patients are those who are diagnosed and/or receive all or part of their first course of cancer treatment at CTCA. Non-analytic patients are those who receive subsequent cancer treatment at CTCA due to progressive or recurrent disease. 2017 CANCER REGISTRY ANNUAL REPORT 5

Cancer Prevention and Screening Programs AT SOUTHWESTERN 30 prevention events hosted in 2016 6 Lung Watch events Prevention Programs In 2016, Southwestern executed 30 community events that featured cancer prevention educational speakers and provided information; six Lung Watch events were also held. Lung Watch events assessed 596 individuals for lung cancer risk and provided a detailed report to share with their physician for follow-up care. One hundred percent of participants polled committed to making a healthy lifestyle change, such as incorporating a healthy diet, exercising daily or wearing sunscreen. Eighty nine percent of Lung Watch participants requested more information and resources on smoking cessation programs. 2 skin cancer screening events 62 skin cancer screenings Skin Cancer Screening and Prevention Southwestern conducted two skin cancer screenings, one at Nabholz Construction and the other at Tulsa Public Schools. During these two events, a total of 62 individuals participated, including 24 males and 38 females. Risk factors were addressed with the participants, including smoking history, use of sunscreen and whether or not the participant has a primary care physician. Routine follow-up was recommended for 39 participants and immediate follow-up was recommended for 23 participants whose cases may have otherwise gone undetected. All immediate follow-up participants were called and notified to contact their health care provider. Of the individuals screened, 41 percent indicated that they either currently smoke or had a history of smoking, 10 percent had a personal history of cancer and 65 percent used sunscreen regularly. Employer Partnership Program The Employer Partnership Program at Southwestern provides organizations with necessary resource information, educational speakers and cancer screenings to promote early detection and educate their employee populations about cancer prevention through simple lifestyle changes. 6 Cancer Treatment Centers of America at Southwestern Regional Medical Center

Oklahoma Project Woman Breast Cancer Screenings Oklahoma Project Woman provides access to breast health care to facilitate the early diagnosis of breast cancer and to decrease the mortality rate for uninsured women with limited financial resources. They provide free mammograms, diagnostic procedures and surgical services for Oklahomans of any age without health insurance and/or limited financial resources. Since the beginning of the program in 1998, they have provided breast health care to more than 39,000 uninsured Oklahomans, more than 600 of whom have been diagnosed with breast cancer. Southwestern partnered with Oklahoma Project Woman to offer diagnostic and screening mammograms and ultrasounds. We also made a concentrated effort to reach more of the population of high-risk individuals who work outdoors and were able to successfully hold skin cancer screenings for 107 participants. 13 diagnostic mammograms 12 screening mammograms 10 ultrasounds Community Outreach Our Community Outreach Program adds value to existing community programs through educational speakers, informational materials and activities that contribute toward the overall goal of empowering a healthy lifestyle and reducing cancer incidence through prevention. Partner organizations continue to express value in the resources that we offer to help them better serve those affected by cancer. We continue to receive positive feedback from event attendees on educational learnings through speakers and activities that increase cancer awareness and promote cancer-preventing lifestyles to help reduce cancer incidence in our region. 117 community outreach events 190,000 individuals reached At Southwestern, we pride ourselves in educating the community about cancer and cancer care. In 2016, Southwestern hosted or participated in a total of 117 community outreach activities or events, providing expert speakers at 102 speaking events, and reaching more than 190,000 individuals through our efforts. Of those polled, 100 percent of participants committed to making a healthy lifestyle change such as eating a healthy diet, exercising daily or wearing sunscreen. Six of the events included lung cancer screenings where we assessed approximately 600 individuals for lung cancer risk factors and provided a detailed report for them to take to their personal physician for follow up. Of these participants, 89 percent requested more information and resources on smoking cessation programs. 2017 CANCER REGISTRY ANNUAL REPORT 7

Accreditations AND CERTIFICATIONS The Joint Commission Southwestern holds the Joint Commission s Gold Seal of Approval for Hospital Accreditation. This accreditation decision is awarded to a health care organization that demonstrates satisfactory compliance with applicable Joint Commission standards in all performance areas. Lung Program Certification by The Joint Commission Southwestern has earned The Joint Commission s Gold Seal of Approval for Lung Cancer Certification (issued in January 2017 for up to two years). The Gold Seal of Approval is a symbol of quality that reflects an organization s commitment to providing safe and effective patient care. The Joint Commission s Disease-Specific Care Certification evaluates clinical programs across the continuum of care and addresses three core areas: compliance with consensus-based national standards, effective use of evidence-based clinical practice guidelines to manage and optimize care, and an organized approach to performance measurements and improvement activities. National Accreditation Program for Breast Center In 2012, Southwestern earned a three-year full accreditation for our breast program from the National Accreditation Program for Breast Centers (NAPBC) and was re-accredited in 2015. Southwestern is the only NAPBC-approved hospital in Tulsa, and only one of two in the state of Oklahoma. The American College of Surgeons Commission on Cancer Southwestern has been accredited by the Commission on Cancer (CoC), a quality program of the American College of Surgeons (ACS), since 1994. Each accreditation is for three years. Quality Oncology Practice Initiative Certification In 2014, Southwestern was recognized as meeting the highest standards for quality cancer care by the Quality Oncology Practice Initiative (QOPI ) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI Certification Program provides a three-year certification for outpatient hematology-oncology practices. The QCP seal designates those practices that not only score high on the key QOPI quality measures, but also meet rigorous chemotherapy safety standards established by ASCO and the Oncology Nursing Society (ONS). 8 Cancer Treatment Centers of America at Southwestern Regional Medical Center

Southwestern is also accredited or certified by the following health care organizations: American Association for Respiratory Care Quality Respiratory Care Recognition American College of Radiology Radiation Oncology Accredited Facility Clinical Laboratory Improvement Act American Association of Blood Banks College of American Pathologists American College of Radiology CT Accreditation American College of Radiology Mammography Accreditation American College of Radiology MRI Accreditation American College of Radiology Nuclear Medicine Accreditation American College of Radiology PET/CT Accreditation American College of Radiology Ultrasound Accreditation American Diabetes Association Diabetes Self- Management Education Program Center for Medicare and Medicaid Services The Joint Commission Disease-Specific Certification for Lung Cancer 2017 CANCER REGISTRY ANNUAL REPORT 9

AWARDS Guardian of Excellence Award SM in Patient Experience, Press Ganey, 2017, 2016, 2015 Since 2015, Southwestern has been recognized by Press Ganey as a Guardian of Excellence Award winner in the category of Patient Experience. This award recognizes outstanding hospitals that have consistently achieved the 95th percentile or above of performance in the realm of patient experience as gauged by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey through the US Department of Health and Human Services. Oklahoma Certified Healthy Business Award In 2012, 2014, 2015 and 2016, Southwestern was awarded the Oklahoma Certified Healthy Business Award by the Oklahoma State Department of Health. The Oklahoma Certified Healthy Business Program recognizes businesses that make a positive impact on employee health by providing programs such as health screenings, opportunities for physical activities, health and nutrition education, as well as community involvement in health and wellness. 10 Cancer Treatment Centers of America at Southwestern Regional Medical Center

Becker s Review Top Hospital, 2017 With a national average of 72 percent, Southwestern is honored to announce that our hospital had 94 percent of patients report that they would definitely recommend our hospital. This information was collected from July 2015 through June 2016 and published by Becker s Hospital Review in May 2017 with Southwestern featured as number 16 on the Top 44 Hospitals Patients Would Definitely Recommend list. Five-Star Patient Survey Summary Score from Centers for Medicare & Medicaid Services, 2017 Southwestern was awarded a Five-Star Patient Survey Summary Score - the highest possible rating - by the Centers for Medicare & Medicaid Services (CMS). The rating, published by CMS and designed to help consumers compare hospitals, evaluated inpatient experiences at 3,504 hospitals nationwide from October 1, 2015 through September 30, 2016. The five-star rating was awarded to just 215, or six percent, of the eligible hospitals. The hospital rating system from CMS assigns hospitals a rating of one to five stars based on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The rating is based on a cumulative score from 11 survey measures that measure inpatient experiences and satisfaction. Southwestern has also received awards or recognition from the following organizations: The Top Doctors, US News and World Report, 2017: Daniel Nader, DO, FCCP; Timothy Holder, MD, FAAFP; Sagun Shrestha, MD; James Flynn, MD, FACR, FACRO Great 100 Nurses of Oklahoma, Great 100 Nurses Foundation, 2017, 2016, 2015, 2014 A-List Readers Choice Winner for Hospital, Tulsa People, 2017, 2016, 2015, 2013 Best of the Best List Winner for Best Cancer Center, Oklahoma Magazine, 2017 2017 CANCER REGISTRY ANNUAL REPORT 11

Cancer Treatment Centers of America at Southwestern Regional Medical Center 10109 E. 79th Street Tulsa, OK 74133 cancercenter.com 800-333-CTCA 2017 Rising Tide