Cancer Center Annual Report. Troy & Dollie Smith Cancer Center INTEGRIS Baptist Medical Center

Transcription

1 2007 Cancer Center Annual Report with statistical data from 2006 Troy & Dollie Smith Cancer Center Medical Center

2 Medical Center 2007 Cancer Committee Physician Members CO-CHAIRMAN James W. Hampton, M.D., Hematology/Oncology CO-CHAIRMAN Teresa G. Craig, M.D., Radiation Oncology * Karl K. Boatman, M.D., General Surgery * Christopher Bozarth, M.D., Radiation Oncology* Chris Davis, M.D., Colo/Rectal Surgery * Romeo A. Mandanas, M.D., Hematology/Oncology * Johnny R. McMinn, M.D., Hematology/Oncology Jennifer J. McNeil, M.D., Colo/Rectal Surgery, Liaison Physician Maria Ochoa, M. D., Pathology * Gregory A. Parker, M.D., Hematology/Oncology * Kenneth A. Rogers Jr., M.D., Otolaryngology * Fenton M. Sanger, M.D., Obstetrics-Gynecology * Kenneth R. Stokes, M.D., Radiology Allied Health Members Denise Baker, Cancer Registrar Glenda Bell, RN, ARNP, Research Andi Berry, MHR, ATR-BC, LPC, NCC, Cancer Education and Support Specialist Cathy Christian, Administrative Secretary Sylvia Dillard, Special Programs Assoc. Jim Edge, M. Div., Pastoral Care Kimberly Frank, RN, B.S.N., Clinical Director Cancer Unit Kimberly Garbutt, RHIA, Quality Management Robert Geis, R.Ph., Oncology Staff Pharmacy Terry Gonsoulin, RN, B.S.N., Hospice Jackie Grams, LCSW, Clinical Social Worker Letha Grellner, RN, B.S.N., Admin. Director Nancy L. Hane, RN, M.S., AOCN, Oncology Clinical Nurse Specialist Susan Ingham, ACSW, LSW, Clinical Social Worker Julie Krywicki, RN, Admin. Director Anna McIntosh, RHIA, CTR, Cancer Registrar Pat Lynn Moses, MHR, MA, ATR-BC, LPC, Cancer Education and Support Clinician Stacy Robberson, RN, B.S.N. Lynda Vanhorn, BSRT (T) Sharon Williams, RN, Enterostomal Therapy * Board Certified

3 2006 INTEGRIS Baptist Medical Center 2006 Site Group by Sex Male Female Total % Anus and Anal Canal % Base of Tongue % B l a d d e r % Bones and Cartilage % Brain % Breast % Bronchus and Lung % Cervix Uteri % Colon % Connective and Other Soft Tissue % Corpus Uteri % E s o p h a g u s % Floor of Mouth % Gallbladder % G u m % H e a r t / M e d i a s t i n u m / P l e u r a % Hematopoietic and Reticuloendothelial System % Hypopharynx % Kidney % Larynx % Lip % Liver and Intrahepatic Bile Duct % Lymph Nodes % Meninges % Nasopharynx % Other Endocrine Glands % Other Major Salivary Glands % Other Male Genital Organs % Other Mouth % Other Parts Of Biliary Tract % Other Sites % Other Tongue % O v a r y % Pancreas % Parotid Gland % Prostate Gland % Rectosigmoid Junction % Rectum % Retroperitoneum and Peritoneum % Skin % Small Intestine % Spinal Cord and Other CNS % S t o m a c h % Te s t i s % Thyroid Gland % Tonsil % Tr a c h e a % Unknown Primary Site % Ureter % Vulva % TOTAL , % Medical Center Summary of 2006 Cancer Cases INCIDENCE In 2006, 1054 new cases were added to the Cancer Registry. The most common malignancy diagnosed at Medical Center for the year was lung cancer at 22 percent. Breast cancer, 19 percent, was second, and colorectal cancer was third at 16 percent. Prostate cancer was ranked fourth at 5 percent and liver/intrahepatic bile duct was fifth, accounting for 4 percent of the cases reported in SEX An analysis of cancer cases by sex showed that males accounted for 47 percent of all new cases, while females accounted for 53 percent. AGE Cancer incidence increases with age. The majority of cases, 75 percent, were diagnosed between ages 50 to 79 years. The seventh decade accounted for 27 percent of the cases, followed by the sixth decade at 25 percent, and the fifth decade with 23 percent. The mean age was 64. STAGE AT DIAGNOSIS A comparison of all analytic cases added to the registry in 2006 was done using the American Joint Committee on Cancer (AJCC) TNM Cancer Staging System. Seven percent of the cases were stage 0 disease, 24.4 percent stage I disease, 16.9 percent stage II disease, 15.1 percent stage III disease, and 17 percent stage IV disease at the time of diagnosis. RACE Review of registry data revealed that of the 1054 analytic cases, 89 percent were Caucasian, 7 percent African American, 2 percent American Indian and 2 percent other. (2006 summary continued on next page)

4 Medical Center Summary of 2006 Cancer Cases (continued) Genetic Testing COLON BREAST Patients Seen Tests Performed # Positive 4 2 % Positive 40% 10% 2006 Incidence Top 5 Sites Troy & Dollie Smith Cancer Center Compared to State and Bronchus and Lung * Breast Colorectal TREATMENT Sixty percent of cases had surgery alone or in combination with other treatment modalities for first course of therapy in 2006 cases. Radiation alone or in combination with other treatment modalities was utilized in 24 percent of the cases. Chemotherapy alone or in combination with other treatment modalities was utilized in 32 percent of the cases. Hormonal therapy in combination with other treatment modalities was used in 6 percent of the cases. Another 3 percent of the cases either were unsuitable candidates for any of the above modalities or had no record in the registry of having received treatment. SURVIVAL Review of registry data revealed that of the 1054 analytic cases accessioned for the year, 75 percent are living. REQUEST LOG Three data requests were received by the registry in Data was sent to the Cancer Data Base (NCDB) and Central Cancer Registry (OCCR). The Cancer Committee performed several patient care/performance improvement studies for the year. Prostate Liver & Intrahepatic Bile Duct 4.1% Additionally, the Commission on Cancer (CoC) requested that our cancer program participate in a study entitled Chemoradiation and Treatment of Nasopharyngeal (NP) Cancer. Participation in this study was required, as outlined in Standard 3.8. Also in 2006, our cancer program was selected to participate in a quality assurance and outcomes study of breast cancer conducted by the State Department of Health s Central Cancer Registry. Excludes in situ carcinomas. State comparision data is unavailable for Liver and Intrahepatic Bile Duct. * Female breast cancer only.

5 Lung Cancer A Major Public Health Problem 2006 Report from the Troy & Dollie Smith Cancer Center at Medical Center James W. Hampton, M.D. Lung cancer is the leading cause of deaths due to cancer in. ranks fifth in the nation in consumption of tobacco use. The elephant in every room of a patient dying of lung cancer is Big Tobacco a product of corporate America. We cannot persuade the legislators to curtail Big Tobacco because their pockets are too deep and the multi-billion dollar industry can buy any elected official. Passive smoke inhalation is a threat to all Americans. An estimated 174,470 new cases of lung cancer were expected in 2006, which account for about 12 percent of cancer diagnoses. An estimated 162,400 deaths due to lung cancer were expected to occur in Since 1987 more women have died each year of lung cancer than of breast cancer. Death rates have continued to decline significantly in men, from 1991 to 2002, by about 2 percent per year. Female lung cancer rates are approaching a plateau after continuously increasing for several years. These trends in lung cancer mortality reflect decreased smoking rates during the past 20 years. USE OF TOBACCO Lung cancer is the leading cause of cancer deaths in the United States for both men and women. Lung cancer is the most preventable form of cancer death in our society. Eighty seven percent of cancer deaths can be attributed to tobacco use. Besides lung cancer, tobacco use also causes increased risk for cancer of the mouth, nasal cavities, larynx, pharynx, esophagus, stomach, liver, pancreas, bladder, uterine cervix and myeloid leukemia (Source: Cancer Prevention and Early Detection, 2005). Tobacco use accounts for at least 30 percent of all cancer deaths. Per capita cigarette consumption is currently lower than at any point since the start of World War II. Nonetheless, an estimated 25 percent of men and 20 percent of women still smoke cigarettes with approximately 82 percent of these individuals smoking daily. An estimated 45 million Americans are currently smokers. Each year about 3,000 nonsmoking adults die of lung cancer as a result of breathing secondhand smoke. This also causes an estimated 35,000 deaths from heart disease in non-smokers. Cigars contain many of the same carcinogens as cigarettes. Cigar smoking increased 146 percent from 1993 to Cigar smoking causes cancer of the lung, oral cavity, larynx, esophagus, and the pancreas (Cancer Facts & Figures 2006, 2007). Among adults 18 years and older, national data shows 6 percent of men and 1 percent of women are current users of chewing tobacco or snuff. In 2005 nationwide, 14 percent of U.S. male high school students and 2 percent of female high school students were currently using chewing tobacco or dipping snuff. The use of oral tobacco increases the risk for developing cancer of the oral cavity. HISTOPATHOLOGY OF LUNG CANCER Lung cancer is classified clinically as small cell and non-small cell for the purpose of treatment. The WHO classification of Epithelial Bronchogenic Carcinoma-malignant includes small cell carcinoma (oat cell, intermediate cell and combined oat cell) and non-small cell carcinoma such as squamous cell (epidermoid and spindle cell), adenocarcinoma (acinar, papillary, bronchoalveolar, mucous secreting) and large cell carcinoma (giant cell, clear cell). Figures 1a and 1b represent the distribution of lung cancer histologies for 2006 at the Troy & Dollie Smith Cancer Center. It appears that squamous cell carcinoma and small cell carcinoma have a distinct dose-response relationship with increasing exposure to tobacco smoke. In North America, adenocarcinoma is the most frequent malignant tumor, which accounts for 40 percent of all cases of lung cancer. Although PET scans have been used to detect the spread of most lung cancers, bronchoalveolar may be overlooked by a PET scan. EARLY DETEcTION OF LUNG CANCER Efforts at early detection have not yet been demonstrated to reduce mortality. Chest X-ray, sputum cytology and bronchoscopy have shown limited effectiveness in improving

6 Lung Cancer A Major Public Health Problem 2006 Report from the Troy & Dollie Smith Cancer Center at Medical Center (continued) FIGURE 1a Lung Cancer Histology 2006 Cases Small Cell Carcinoma 12% survival. Newer tests, such as low dose spiral computed tomography (CT) scans, have produced promising results in detecting lung cancer at earlier stages with better survival statistics FIGURE 1b Non-Small Cell Histologies 2006 Cases Squamous Cell Carcinoma 25% Large Cell Carcinoma 3% Non-Small Cell Carcinoma, NOS 27% FIGURE 2 Lung Cancer Age at Diagnosis 2006 and 2001 Cases Non-Small Cell Carcinoma 88% Adenocarcinoma 45% SIGNS AND SYMPTOMS Lung tumors arising in the larger airways produce symptoms related to the growth of the tumor. Frequently, patients present with a persistent cough or a wheeze with partial airway obstruction. Atelectasis (partial collapse of the lung) and pneumonia may develop. Depending on the location of the primary tumor, adjacent structures such as the chest wall or mediastinum (central chest structures) may become involved by direct spread. Coughing up blood may be an early sign. Figure 2 compares the age at diagnosis of the 2006 lung cancer cases at the Troy & Dollie Smith Cancer Center with the 2001 lung cancer cases. STAGING Four stages of lung cancer have been identified with significant differences in five-year survival depending on the stage at diagnosis. The TNM staging includes clinical, surgical and pathological assessment. Using pretreatment minimally invasive techniques only, a significant number of patients are clinically understaged compared to the ultimate stage identified by surgical and pathological staging. MRI offers no benefit over CT scan. PET (positron emission tomography) scan has proven to be very useful in staging lung cancer especially for the detection of distant metastases. Bronchoscopy, mediastonoscopy and thoracotomy (surgery) continue to be the methods of staging. Percutaneous fine needle aspiration biopsy using CT-guided techniques are especially useful for small cell lung carcinoma. This technique makes it difficult to stage lung cancer. TREATMENT Chemotherapy combined with radiation therapy is the treatment of choice for small cell lung cancer; on this regimen a large percentage of patients experience remission, which

7 120 FIGURE 3 Lung Cancer First Course of Treatment 2006 and 2001 Cases may be long lasting in some cases. Localized non-small cell lung carcinoma surgery is usually the treatment of choice. Recent studies indicate that survival with early stage non-small cell lung cancer is improved by chemotherapy following surgery. Early clinical trials of adjuvant chemo therapy and post operative radiation therapy were plagued by small samples, inadequate staging, and ineffective treatment. Newer phase III trials have reported a benefit with chemotherapy, especially cisplatinum, which has emerged as the new standard. The Neoadjuvant Taxol/Carboplatin Hope (NATCH) trial results should be available soon. Other new agents such as Avastin and other chemotherapy drugs such as vinorelbine, taxotere and tarceva, an EGFR tyrosine kinase inhibitor, are in clinical trials. Figure 3 shows the first course of treatment for all lung cancers at the Troy & Dollie Smith Cancer Center in 2006, as compared to 2001 registry data. SURVIVAL The one year relative survival for lung cancer has increased from 37 percent in 1975 to 42 percent in largely due to improvement in surgical techniques and combined therapies. However, the five year survival for all stages combined is only 15 percent. Only 16 percent of lung cancers are diagnosed at an early stage but if so, the survival rate is increased to 50 percent. The graphs in Figures 4a and 4b compare the five-year survival figures based on stages I to IV non-small cell carcinoma and small cell carcinoma at the Troy & Dollie Smith Cancer Center at Medical Center, with the five year survival rates for the United States (NCDB, Commission on Cancer, ACoS). Survival rates are shown on the ordinate in percentage and the five years on the abscissa. The two rates appear to compare favorable stage for stage for non-small cell carcinoma. However, due to the small number of patients (two) diagnosed with stage I small cell carcinoma, the Troy & Dollie Smith Cancer Center figures clearly contrast the national statistics FIGURE 4a Chemotherapy Surgery Alone Surgery & RT Surgery/RT/Chemo At Dx 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs FIGURE 4b NCDB and NCDB AJCC 5-Year Observed Survival Non-Small Cell Lung Carcinoma I I and NCDB AJCC 5-Year Observed Survival Small Cell Lung Carcinoma At Dx 1 Yr 2 Yrs 3 Yrs 4 Yrs 5 Yrs I II II II III III III IV IV IV NCDB I II III IV

8 Troy & Dollie Smith Cancer Center Medical Center 3300 N.W. Expressway City, OK (405) integrisok.com