2011 ANNUAL REPORT C.H. Chub O Reilly Cancer Center. The cancer journey

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1 2011 ANNUAL REPORT C.H. Chub O Reilly Cancer Center The cancer journey

2 The C.H. Chub O Reilly Cancer Center is home to the latest technology and treatments, including davinci surgery, the region s only TomoTherapy and Cyberknife options, a dedicated breast center, the Jane Pitt Pediatric Cancer Center and promising clinical trials and research. Put simply, we ve had another eventful year in Gary L. Hoos, MD It s been another year of big developments for oncology services at Mercy. Within the last year, we ve put particular emphasis on the development of women s oncology services and welcomed Dr. Jay Carlson, who is board certified in both obstetric gynecology and gynecology oncology. We ve also seen growth in our pediatric oncology services and watched with great anticipation as construction progressed on our new Mercy Children s Hospital building. We also continue to develop our radiation oncology capabilities and welcomed Dr. Steven Braun to our team this past year. We continue to recruit new, well trained physicians to enhance the care we provide to our patients. As we look to the future, we ll continue to enhance our radiation capabilities. Ministrywide, Mercy is convening an oncology task force to ensure our cancer services are world class. We re committed to continuing developments on both our Springfield campus and in outlying areas to bring cancer services to our patients and their families. Even as we work to improve care through advanced treatments and technologies, we stay focused on finding new and meaningful ways to support our patients, their families and survivors through our Cancer Resource Center. In 2011, we offered a number of new programs and services in keeping with our mission of providing compassionate care and exceptional service. Gary L. Hoos, MD Medical Director

3 Ovarian Cancer: The Toughest of Gynecologic Cancers by Jay W. Carlson, DO journey To get through the toughest journey we need to take only one flight at a time, but we must keep on flying. Gynecologic cancers include uterine cancer, the most common gynecologic cancer, as well as cervical, vaginal, vulvar, fallopian tube and ovarian cancer. Ovarian cancer is the seventh most common cancer among women but the second most common gynecologic cancer. It also causes more deaths than any other gynecologic cancer. There are three general types of ovarian cancer with epithelial ovarian cancer being the most common. It accounts for 85 to 89 percent of all ovarian cancers. It forms on the surface of the ovary in the epithelial cells. Historically, epithelial ovarian cancer has been known as the silent killer because most patients had few early symptoms, presented in advanced stages and believed the chance of cure was poor. Recent studies, and current treatment, however, have proved this term to be inaccurate. Most patients with this disease are much more likely to have a cluster of symptoms. (See table on page 4.) The most common are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms such as urgency or frequency. Women with ovarian cancer say these symptoms were persistent, being present for more than half the days in any month, and were a clearly out of the norm for their bodies.

4 Ovarian Cancer Cumulative Survival Rate Jay W. Carlson, DO An individual has cancer, but it affects the whole family. My passion is to fight cancer and make a difference one mom, one wife, one daughter one woman at a time. Women who regularly have these symptoms should see their doctor or gynecologist. Even early-stage ovarian cancer can produce these symptoms and prompt evaluation may lead to detection and treatment at the earliest possible stage. Symptoms commonly reported with ovarian cancer: Bloating Pelvic or abdominal pain Early satiety (feeling full) Urinary urgency or frequency Fatigue Indigestion Back pain Constipation Menstrual irregularities The clinical challenge for physicians is that many of these symptoms are present in women who don t have ovarian cancer and are often due to other causes. However, if these symptoms are new and occur almost daily, they should be medically evaluated to confirm whether or not they are associated with a gynecologic cancer. If a cancer is found, treatment typically begins with surgery to determine if it has spread beyond the ovaries and to remove as much of the cancer as possible. Ideally, this type of surgery is performed by a gynecologic oncologist who has received specialized training in the management of gynecologic cancers. Although surgery has been shown to significantly improve survival in ovarian cancer patients, most patients still require chemotherapy. Radiation therapy, which is commonly used for uterine or cervical cancer, is rarely used for ovarian cancer. What is a Gynecologic Oncologist? Gynecologic oncologists are experts in the surgical and nonsurgical treatment of women with gynecologic cancers such as cervical, endometrial, uterine, and ovarian cancer. They play a crucial role in all phases of patient care, from pre-operative through operative and post-operative management, and prescribe chemotherapy and radiation treatments. These physicians have received years of specialized training and are skilled in both more traditional surgical and laparoscopic procedures including newer technologies such as da Vinci robotically-assisted surgery. Studies confirm patient outcomes are better if gynecologic cancer surgery is performed by a gynecologic oncologist. What is a Gynecologic Oncology Nurse Practitioner? A gynecologic oncology nurse practitioner is an advanced practice registered nurse with a master s degree in nursing who is trained to monitor disease and collaborates with the physician on treatment decisions. He or she works closely with patients to answer questions about disease improvement or progression, treatment options, lab results and/or radiologic tests, and can prescribe medications when indicated. At Mercy Clinic Women s Oncology, the gynecologic oncology nurse practitioner is available for office appointments and to speak with patients by phone if there s an urgent issue or concern. He or she also functions as first assistant to the physician in surgery and is involved in post-operative patient care. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% YEARS FROM DIAGNOSIS Dx 1 year 2 years 3 years 4 years 5 years STAGE 1 STAGE 2 STAGE 3 STAGE 4 Many of the current chemotherapy treatments for ovarian cancer include the option of being involved in a clinical trial. Clinical trials study new and diverse ways of treating ovarian cancer and offer patients conventional chemotherapy while adding new investigational, biologic agents to target cancer cell death through different tumorigenic pathways. Over the years, tremendous progress has been made in improving ovarian cancer survival due to research trials and the courageous women who have agreed to participate in them. First Course Treatment of Ovary Cancer Diagnosed in 2009 St. John s Hospital, Springfield, MO vs. All Types of Hospitals in All States All Diagnosed Cases # First Course Treatment My (N) Oth. (N) My(%) Oth. (%) 1. Surgery Only % 23.87% 2. Surgery & Chemotherapy % 55.25% 3. Chemotherapy Only % 9.14% 4. Other Specified Therapy % 2.22% 5. No 1st Course Rx % Col. TOTAL % 100% 2012 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Developer: Florin Petrescu, Thursday, April 26, 2012 Stage of Ovary Cancer Diagnosed in 2009 St. John s Hospital, Springfield, MO vs. All Types of Hospitals in All States All Diagnosed Cases # Stage My (N) Oth. (N) My(%) Oth. (%) 1. I % 21.50% 2. II % 7.76% 3. III % 35.51% 4. IV % 24.06% 5. NA % 6. UNK % Col. TOTAL % 100% 2012 National Cancer Data Base (NCDB) / Commission on Cancer (CoC) / Developer: Florin Petrescu, Thursday, April 26, 2012

5 2010 Analytic Site Distribution Analytic cases are those that are first diagnosed and/or received all or part of their first course of treatment at St. John s. Alan Burns, BS, RT The delivery of radiation therapy takes a dedicated team of professionals to insure that our patients receive safe and quality treatment. My team is here to serve our patients and community. Advances in Radiation Therapy at Mercy by R. Alan Burns, BS, RT (R)(T) Mercy is committed to providing our patients with the newest, most-advanced radiation therapies. We continue to add to the tools, technologies and resources we offer our patients to fight and cure complex cancers. In 2011, we made several enhancements to our radiation therapy program. Among them, we: Doubled our TomoTherapy capacity for Volumetric Modulated Arc Therapy Intensity Modulated Radiation Therapy (IMRT)/Image Guided Radiation Therapy (IGRT). - Ideal for cancers of the prostate, head and neck, brain, pediatric, gynecological, thorax, and abdomen which lie near critical healthy tissue and organs. - Benefits: increased treatment precision with minimized exposure to healthy tissue. Made advances in the way we deliver Brachytherapy so patients can now receive therapy as outpatients, allowing better quality of life during treatment. - Often utilized for cancers of the prostate, breast, cervix, uterus and vagina, and to alleviate symptoms caused by esophageal and lung cancers. - Examples include prostate seed implant, mammosite HDR brachytherapy and vaginal HDR brachytherapy. - Benefits: fewer treatments, less radiation to surrounding healthy tissue, shortened treatment course, and enhanced patient convenience. Enhanced Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiotherapy (SBRT). Hardware programs and software upgrades streamlined treatment delivery and patient throughput. - Ideal for cancers and benign tumors of the brain, spine, lung, liver, head and neck, pancreas and prostate. - Benefits: precisely-focused high-dose radiation effectively targets tumor cells while sparing nearby normal tissue; requires few treatments. Acquired Velocity Software, a sophisticated tool that assists the radiation oncologist, medical dosimetrist and others in treatment planning and allows our patients to begin treatment sooner. - Allows previous treatment plans to be combined with new plans so a total treatment dosage composite plan can be created. - Enables quick, accurate retrieval of data and images. Additional enhancements made during the last year include streamlining our record keeping to help us improve continuity of patient care. Mercy s Electronic Health Record (EHR) puts vital Information at our physicians and patients fingertips so better decisions can be made more quickly. Health history, previous treatments, test results, medicines taken, allergies. - All are readily accessible to Mercy caregivers. Benefits include: - Patients can easily access test results and other health information via computer or internet-enabled phone, day or night. - Physicians can quickly access medical records such as diagnostic tests and health history. - Mercy physicians who coordinate care can see procedures which have already been completed and review results. - In case of emergency, authorized caregivers can access comprehensive health information even if the patient is unable to speak. Patient safety is always a primary concern. To further improve patient safety, we ve adopted a rigorous system of steps that must be completed prior to each radiation therapy session. Known as the time out process, it includes a very specific series of checks and sign-offs to ensure our patients receive the right dose at the right time. PRIMARY SITE TOTAL % OF TOTAL Lung and Bronchus % Breast % Prostate % Colon Excluding Rectum % Melanoma - Skin % Urinary Bladder % Non-Hodgkin Lymphoma % Brain & Other Nervous System % Rectal & Rectosigmoid % Corpus & Uterus, NOS % Unknown/Ill defined % Kidney & Renal Pelvis % Leukemia % Endocrine System % Ovary % Pancreas % Stomach % Esophagus % Liver & Intrahepatic Bile Duct % Larynx % Cervix Uteri % Anus, Anal Canal & Anorectum % Small Intestine % Myeloma % Tonsil % Testis % Mesothelioma % Soft Tissue (including Heart) % Other Biliary % Tongue % Vulva % Hodgkin Lymphoma % Bones & Joints % Other Non-Epithelial Skin % Gallbladder % Peritoneum, Omentum, Mesentery % Salivary Glands % Floor of Mouth % Nasopharynx % Hypopharynx % Other Digestive Organs % Gum & Other Mouth % Oropharynx % Retroperitoneum % Vagina % Ureter % Other Oral Cavity & Pharynx % Nose, Nasal Cavity & Middle Ear % Other Urinary Organs % TOTAL 1763

6 Mercy Cancer Resource Center by Sharon Davis, RN, MHA Sharon Davis, RN, MHA The Cancer Resource Center team is committed to using our individual skills and gifts in a combined way to support patients, family members, caregivers and community members touched by cancer. Mercy s Cancer Resource Center goal is to meet the emotional and educational needs of our cancer patients. During 2011, we introduced many new programs and activities for survivors and their families. Additionally, we continued to offer many of the programs, services and support groups our patients, survivors and their families have found beneficial. Highlights of new programs we began in 2011 include: Hosting our first High Tea for cancer patients in April. The event, which we now hold quarterly, provides a relaxing and healing break for cancer patients and their families. The 68 participants at our first tea had an opportunity to celebrate the moment and enjoy what our Mercy foundress, Catherine McCauley, described as a comfortable cup of tea. Nutrition classes. To address the needs of patients experiencing poor appetite, inability to eat or swallowing difficulties, a new nutrition class was started in Led by our dieticians, each class provides nutritional information, food demonstrations, recipes and encouragement. The class averaged 10 participants each session. Music classes and music therapy. Leslie Jones, a trained music therapist, began music classes utilizing methods designed to address the physical, emotional, cognitive and social needs of cancer patients. Additionally, Leslie also regularly interacts with patients and family members during chemotherapy treatments. Yoga classes. In June, Sherry McCubbins, a yoga instructor, began yoga classes for our cancer patients. These classes allow cancer patients to discover the calming and restorative power of yoga. Art therapy classes. Cathy Kristek, certified art therapist, started offering art therapy classes to cancer patients in November. Art therapy provides a creative outlet which helps individuals reframe, externalize emotions and deepen their understanding of their experiences. While we added new programs in 2011, we continued to provide many regular programs, services and support groups for patients, survivors, family members and the community. The Cancer Resource Center, in collaboration with AT&T Pioneers, coordinated two camping experiences for cancer patients and survivors in 2011: 41 campers went in April and the September camp hosted 49 cancer survivors. The Epic Colon event had nearly 300 attendees. Of those, 82 participated in a nutrition self-assessment conducted by one of the dieticians. In May, we conducted a free skin cancer screening with almost 100 in attendance. We hosted our annual National Cancer Survivor s Day event in June. There were 170 attendees who united at the event to show that life after a cancer diagnosis can be meaningful and productive. Wellness Wednesday, a monthly group led by one of our dieticians, continued to be well-attended, averaging attendees. Super Wellness Wednesday held in April, was attended by 158 community members who learned healthy nutrition tips and tasted healthy recipes. Other ongoing groups and services include: The weekly Journey Group for all cancer survivors; a monthly prostate cancer group, a monthly caregiver group, a quarterly breast cancer network group; the meditation/relaxation group held twice a week; and Tai-Chi-Chih, a weekly class to enhance balance, relaxation, breath control and stress management. We continue to provide practical support to our cancer patients who require assistance with food, transportation, lodging and other needs. A psychologist is available for individuals who need help dealing with their cancer diagnosis and the stress it creates. A chaplain is readily available to address spiritual needs. Throughout 2011, the Mercy Cancer Resource Center team collaborated with community organizations, such as the American Cancer Society, Breast Cancer Foundation of the Ozarks and GYN Cancers Alliance, to better serve our patients and the cancer community. In 2012, we look forward to reaching out to more cancer survivors through our ongoing programs, events, support groups and continued collaboration with community members and organizations. Tumor Registry Report 2010 The Tumor Registry is a required component of the Cancer Program to collect, abstract, and functions include identifying reportable cancer cases, collecting and abstracting an extensive items for the indentified cases and performing lifetime followup on each case. In 2010, 1,763 new cases were identified and abstracted. The registry has been in operation since January 1, 1987 and now contains over 42,800 cases. There are approximately 15,000 active cases that are followed on an annual basis. The registry data is submitted to the Missouri Cancer Registry and the National Cancer Data Base. Special studies are also processed by the registry staff as requested by physicians and other various entities.

7 C.H. Chub O Reilly Cancer Center