ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival

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1 ST JOSEPH REGIONAL HEALTH CENTER LUNG CANCER ANALYSIS Incidence, Diagnosis, Treatment and Survival It is logical that the Cancer Program Committee choose to review the Lung Site, as Lung is the second most common site for cancer after Breast. Therefore, the following is a reporting based on the Cancer Registry Databank and the National Cancer Databank of the Incidence of Lung Cancer, the Diagnostic Procedures used at, the treatment provided in the first course and the Rates of Survival. The data includes only cases that were either diagnosed and/or treated at during the first course of treatment. Lung cancer incidence has been one of the Top Five Sites since the Cancer Registry started in For the past four years, Lung cancer has held steady in the second position with 120 cases of 790 total cases or 15% in 2006, 122/767 total cases or 16% in 2007; 141/843 total cases or 17% in 2008 and 118/803 total cases or 15% in Lung cancer diagnosed and treated at is a disease of age. The age at diagnosis has not changed significantly over the last four years with a range from years to Lung cancer is considered an inaccessible site because the disease is not readily palpable. For that reason, it is acceptable for lung cancer to be diagnosed by imaging only. However, since the treatment of non-small lung cancer versus small cell lung cancer is so different, the need for a tissue biopsy for a histologic confirmation is always recommended. The data found in Attachment #1 demonstrates the types of diagnostic procedures by Stage and Type of Lung Cancer. Biopsy-proven histology from either the primary lung site or from a regional lymph node was obtained 58% of the time for nonsmall cell lung cancer during the years ; and 61% of the time for small cell lung cancer. It is not surprising, since lung cancer frequently has metastasized at time of diagnosis, that 26% of all nonsmall cell and 25% of small cell cancers are from biopsyproven histology of a metastatic site rather than from the primary site. Attachments 2a and 2b reflect the treatment that was provided at from The most obvious difference between treatment options for nonsmall cell versus small cell cancer is surgery. Surgery is not provided for small cell lung cancer. Other options include Radiation only, Radiation/Chemo, Chemo only, and No treatment. There are basically three reasons why patients do not receive therapy: 1) the patient or family members refuse treatment; 2) the patient s comorbid conditions would place the patient at too high a risk; or 3) the patient is too ill or too frail to withstand the treatment. In comparing the treatment provided at to that offered by other Comprehensive Cancer facilities (tables on 2a and 2B), treats a significantly larger percent of their small cell lung cancers with Radiation/Chemo than the national average. However,

2 since we are discussing only 69 total cases, this is likely more a function of statistical variation than a difference in treatment choice. In reviewing the comparison between St Joseph and other Comprehensive Cancer facilities, there seems no significant difference between the use of treatment choices. It would make sense that similar treatment choices should mean similar results. Attachment 3, Comparative Observed Survival for Nonsmall Lung Cancers, reflects that this statement is true. survival rates compare favorably to the other CoC Comprehensive facilities and to the National CoC facilities. The actuarial tables reflect that that the average survival for Stage 1 is 24 months, for Stage 2 it is 26 months, for Stage 3 it is 13 months and Stage 4 is 6 months. Summary Regional Health Center provides a full continuum of services from diagnostic procedures, surgery and chemotherapy and radiation therapy. It is evident that our Medical Oncologists and Radiation Oncologists work together well in providing the best treatment match for our patients. Our treatment and survival rates are comparable to the national average, and should be proud of our standing. As seen nationally,there is a large percent of patients being diagnosed at at Stage 4, and those persons are frequently diagnosed by biopsies of other than the primary site. Since Lung cancer does not always present with obvious symptoms and in some cases, metastatic disease is evident without measureable disease in the lungs, this trend will continue. The ray of hope in treating this prolific disease is that new drug therapies are being developed to fight metastatic and relapsed lung cancer. It is hoped that within the next few years the survival rates of Stage 3 and Stage 4 Lung Cancers will increase nationally, and will be reflected in our survival rates at. Prepared by: Scott Goble, MD, Chair, Cancer Program Committee. This report will be placed on the Cancer Center website under Cancer Committee Reports.

3 St. Joseph Regional Health Center Non Small Cell Lung Cancer Combined Years Diagnostic Methods (Data from ERS-supported Registry) Diagnostic Procedure Stage 1 Stage 2 Stage 3 Stage 4 Refused Imaging only Bx lung or LN Wedge bx Mediastinoscopy Biopsy Other TOTAL: 54 Bone 11 Brain 13 Liver 5 Thoracentesis 16 Other mets 9 Total St. Joseph Regional Health Center Small Cell Lung Cancer Combined Years Diagnostic Methods (Data from ERS-supported Registry) Diagnostic Procedure Stage 1 Stage 2 Stage 3 Stage 4 Refused Imaging only Bx lung or LN Other Biopsy TOTAL: 10 Bone 1 Brain 2 Liver 5 Pleura 2 Total It is evident that the diagnostic work-up usually includes a biopsy of either lung tissue or of an associated lymph node for all stages, but over one-third of the diagnostic procedures for Stage 4 Non-small cell lung cancer, and one-fourth for Small cell lung cancer is based on pathology from other than the primary site.

4 NonSmall Cell Lung Cancer Treatment Treatment Cases Percent Comp Hosp Surgery Only 45 12% 21% Surgery/Chemo 14 4% 5% Radiation Only 61 16% 13% Surg/Rads/Chemo 5 1% 3% Radiation/Chemo 96 25% 22% Surg/Radiation 4 1% 0% Chemo Only 46 12% 13% Other 6 2% 4% None % 19% Total Cases % 100% NONSMALL CELL LUNG CANCER TREATMENT SURG/RADIATIO N 1% CHEMO ONLY 12% OTHER 2% RADIATIO N/CHEMO 25% NO NE 27% SURG/RADS/CHEMO 1% RADIATIO N O NLY 16% SURGERY/CHEMO 4% SURGERY O NLY 12%

5 Small Cell Lung Cancer Treatment Treatment CASES PERCENT HOSP Radiation Only 0 0 5% Radiation/Chemo 40 58% 40% Chemo Only 16 23% 30% Other Specified Therapy 1 1% 5% None 12 17% 20% Total Cases % 100% SMALL CELL LUNG CANCER TREATMENT CHEMO ONLY 23% O THER SPECIFIED THERAPY 1% NONE 17% RADIATION/CHEMO 59%

6 Comparative Observed Survival for Non Small Lung Cancers Based on NCDB data from years Best Stage 1.0 yr 2.00 yr 3.0 yr 4.0 yr 5.0 yr Stage Stage Stage Stage Overall = insufficient data to calculate the Survival Rate for Stage 2. The comparison is made between non-small cell lung cancer, since we have too few small cell lung cancers for a survival comparison.

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