EXCELLENT AWESOME. They felt like family. First class!! WONDERFUL The level of care is the best GREAT BEST. caring and compassionate

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1 CANCER PROGRAM ANNUAL REPORT /// My doctor was fantastic! GREAT caring and compassionate AWESOME BEST WONDERFUL The level of care is the best Nursing staff was absolutely fantastic Very pleasant and courteous First class!! They felt like family EXCELLENT

2 When you choose Cheyenne Regional, you choose more than just a health system. You choose our more than 2,000 employees working to improve healthcare in our region. You choose an $80 million expansion into our downtown Cheyenne campus, including a new Cancer Center and new emergency department, as well as the beautification of our neighborhood. When you choose Cheyenne Regional, you make a choice to invest in our community and the quality of healthcare for our entire region. 214 East 23rd Street u Cheyenne, WY u (307) u crmcwy.org

3 TABLE OF CONTENTS/// Together with the patient, this team develops a unique and comprehensive treatment plan. Message from the Chair... 2 Cancer Committee... 3 In Memory of Dr. Robert L. Lanier... 4 Community Participation/Race for the Cure... 5 Cancer Center Cancer Center Program Colon Cancer Outcome Study Cheyenne Regional Cancer Cases...16 Distribution by Residence/ Breakdown by Site Incidence Distribution...18 Breast Cancer Cases...19 Prostate Cancer Cases Lung Cancer Cases...21 Colon Cancer Cases Hematopoietic Cancer Cases Glossary Jeffrey C. Carlton, MD, and Don R. Dickerson, MD On the walls of our cancer treatment areas there are painted quotes about perseverance, hope and finding the best in life. For those fighting the battle against cancer, words can serve as inspiration. As medical providers of cancer treatment, words are inspiration for us as well. But often, those words are the ones spoken to us by our patients and their families. Throughout this Cancer Annual Report, you will find quotes that came directly from our patients via recent patient satisfaction surveys. They help inspire us in our work, and we hope they help inspire you. 1

4 Jeffrey C. Carlton, MD Message from the Chair The members of Cheyenne Regional Medical Center Cancer Committee, the Cheyenne Regional Cancer Registry staff and I are delighted to present the Cancer Program Annual Report for As an extended organization, we continue our efforts to provide the highest quality collaborative care for our cancer patients as we strive for enhanced services, quality improvement and visioning for the future. Much of our structure, goals and initiatives are guided by the accreditation standards provided by the American College of Surgeons Commission on Cancer (ACoS CoC), the primary organization responsible for accrediting cancer programs around the country. We continue to be the only accredited cancer program within our state, and we are convinced that pursuing and maintaining this accreditation has had a very positive impact on our direct patient care and programmatic focus. The Cancer Committee membership is structured to represent a broad cross section of the many disciplines responsible for oncologic care in our medical center. The members include physicians, administrators, physical therapists, social workers, nursing staff, nutritionists, chaplains, American Cancer Society representatives and hospice and palliative care providers. Our focus is to provide leadership and oversight for the many processes that ensure the highest quality care for our patients. Subcommittees and coordinator positions are defined to address the accreditation standards, a proven template for structured success. The monthly Cancer Conference functions as both an educational opportunity and a clinical conference to collaborate on direct patient management recommendations. At least 10 percent of our newly diagnosed patients are presented in a prospective fashion with clinical information, projected pathology slides, radiographic studies, staging information and online clinical guidelines. Attendance at this conference remains excellent, and the level of discussion frequently provides treatment recommendations for complicated oncologic patients. Two years ago we formed a subcommittee to compare the cancer management of patients within our system to national guidelines as published by the National Comprehensive Cancer Network (NCCN). The subcommittee has reviewed the care of 122 patients, representing a random 10 percent selection from our newly diagnosed cancer population. This review has demonstrated 100 percent compliance with the care recommended by the NCCN. The worldwide oncology community is recognizing the need to support patients beyond treatment during the remainder of their lives. These survivorship issues require new strategies for assessment and management. Through our Comprehensive Oncology Patient Experience (COPE) assessment program, we are identifying the emotional, financial and social impacts of cancer diagnosis and care in our patients and are providing early support and intervention. Our continued thanks go to Denise Sartz, RN, MS, AOCNP, FNP-C, for directing this initiative, and we look forward to the expansion of our Survivorship Program. Jennifer Van Horn, RN, MSN, AOCNS, was recruited this year as Clinical Trials Program coordinator, and she has been hard at work developing policies and procedures for the implementation of therapeutic clinical trials at our institution through the national organization ACORN (Accelerated Community Oncology Research Network). We have completed our approval process and anticipate enrolling our first patient during the third quarter of I greatly appreciate the hard work of the many individuals involved in the direct care of our patients and the many who provide administrative support for that mission. Tamela Thiede, RTR, CCS, CCS-P, has proved herself wise and capable in her first year as Oncology Service Line Director. Her extensive institutional and community knowledge have complemented her skills as we move forward with exciting endeavors not the least of which is the construction of the new cancer center, slated to open during the fall of Shawn Bonner, CTR, and Barb Weiss, CCA, continue to do an outstanding job of collecting, reviewing and submitting our Cancer Registry data. A large part of their time is spent coordinating the activities of the Cancer Committee, organizing the Cancer Conference and ensuring that we are in compliance with the ever-changing ACoS CoC accreditation standards. Jeffrey C. Carlton, MD 2

5 CANCER COMMITTEE/// Jeffrey C. Carlton, MD...Radiation Oncology, Chair Maristela Batezini, MD... Medical Oncology, Cancer Liaison Physician Stine-Katherine Kraeft, MD... Pathology, Cancer Conference Coordinator Mohamed El-Tarabily, MD... Medical Oncology, Cancer Registry Coordinator Richard Fermelia, MD... General Surgery Eric Hoyer, MD.... Diagnostic Radiology Don Dickerson, MD.... Radiation Oncology Phillip Haberman, MD... Pathology Jakub Stefka, MD... Pathology Ron Waeckerlin, MD.... Pathology Amy Gruber, MD... Hospice, Family Practice B. Douglas Harris, DO... Urology Tamela Thiede, RTR, CCS, CCS-P... Director of Oncology Services Constance Schmidt, RN, BSN, MHA, CBN... Chief Nursing Officer Barbara Lawyer, RN... Oncology Program Manager / Outreach, Community Outreach Coordinator Denise Sartz, RN, MS, AOCNP, FNP-C... Oncology Nurse Practitioner, Quality Improvement Coordinator Catherine Hoff, RN, BSN... Oncology Case Manager Danette Best, RN, BSN, OCN.... Breast Health Navigator Pat Bradley, MA, BCC... Director of Pastoral Care Paul Panico, PhD, MBA, FACHE.... Executive Vice President, Chief Operations Officer Shawn Bonner, CTR... Certified Tumor Registrar Barb Weiss, CCA.... Cancer Registry Staff Elizabeth Nyce, RD.... Nutrition Services Cheryl Walker, PT... Physical Therapy Patricia Wagner, RN, OCN... Ambulatory Infusion Center Charge Nurse Bonnie Bath, RN, BSN, MSN.... Oncology Nurse Educator Leonard Geringer, RTT, RTR.... Radiation Oncology Manager Kimberly Johnson, RN, BSN.... Ambulatory Infusion Center Nurse Manager Beverly Gross...American Cancer Society Tara Leinart, RN... Oncology Inpatient Unit Nurse Manager Kristen Truman, MS,MA,PCC... Administrator of Inpatient Services Tamara Cottam, MD... Palliative Care Margie Turner, RN HACP.... Quality Manager Linda Akers, MSW, LSW... Oncology Social Worker 3

6 IN MEMORY OF DR. ROBERT L. LANIER Rob was a delightful colleague and friend who was intensely devoted to doing the right thing for his patients. - Dr. Jeffrey Carlton A highly respected oncologist and hematologist in Cheyenne, Dr. Robert L. Lanier passed away earlier this year after a long battle with cancer. Dr. Lanier had been a resident of Cheyenne for 30 years. Dr. Lanier received his medical degree from the University of Colorado Medical School and furthered his studies at the University of Kentucky and the University of Kansas. He practiced medicine for many years at the Internal Medicine Group in Cheyenne before opening his own successful practice, Cheyenne Hematology-Oncology. He also worked briefly before retirement for the Cheyenne Regional Physicians Group. Dr. Lanier was very devoted to his medical practice, patients and family. I had the pleasure of working closely with Dr. Lanier these past 18 years, said Dr. Jeffrey Carlton, Radiation Oncologist at Cheyenne Regional Medical Center. Rob was a delightful colleague and friend and was intensely devoted to doing the right thing for his patients. Even after his diagnosis and during his difficult therapy, he continued to take care of cancer patients in this community out of his love for the specialty and his compassion for those who came to him for care. He is indeed missed. Dr. Lanier was very devoted to his medical practice, patients and family. - Dr.Jeffrey Carlton Dr. Lanier was committed to providing his patients with the very best care available. He will be remembered for that commitment as well as his determination that people in this region have access to high quality cancer treatment close to home, said Tamela Thiede, Director of Oncology Services at Cheyenne Regional. 4

7 COMMUNITY PARTICIPATION RACE FOR THE CURE/// Breast cancer was the second most diagnosed cancer in 2010 with 363 women and six men being diagnosed. Cheyenne Regional has been an active sponsor of many cancer functions in the community and surrounding region, including the American Cancer Society s Relay for Life; Susan G. Komen s Art for the Cure, Race for the Cure and Tough Enough to Wear Pink Day at Cheyenne Frontier Days; and the Sunrise Lion s Ride for Sight. - Wyoming Department of Health Cheyenne Regional Medical Center was proud to have a team for the 2012 Susan G. Komen Race for the Cure, which provides funding for breast cancer education, support and research. Hospital employees and family members turned out in force to lend their support to this worthwhile effort. The theme for this year's Cheyenne Regional team was "Hooked on Finding a Cure." 5

8 CANCER CENTER/// Cheyenne Regional Medical Center broke ground for its new comprehensive cancer center in August. Once completed, the center will provide oncology treatment and care in a stateof-the art facility designed specifically to meet the needs of cancer patients and their family members. This new center will meet this critical need - Dr. Mohamed El-Tarabily for our community. Our cancer patients and their families need a home a functional caring place to be treated and empowered to take some control of their treatment plan, said Dr. Mohamed El-Tarabily, oncologist/hematologist with the Cheyenne Regional Physicians Group. This new center will meet this critical need for our community. By building a new facility to house all cancer care services, Cheyenne Regional is taking strides to ensure that high quality care remains here in the region, said Tamela Thiede, Cheyenne Regional s Oncology Services Director. Scheduled to open in late 2013, the 40,432 square foot center will allow Cheyenne Regional to expand its already wide array of cancer care. The Radiation Oncology program will include a new stateof-the-art linear accelerator for treatment and a CT scanner for treatment planning. The TomoTherapy machine will also be moved from the hospital s main building to the new center. Cheyenne Regional was the first Wyoming hospital to offer the unique treatment benefits of a TomoTherapy machine and is still one of only a handful of hospitals in the Rocky Mountain region to provide this service. The Ambulatory Infusion Center (AIC) will grow from its current capacity of 15 treatment chairs and one bed to 23 treatment chairs and two private rooms, each including a treatment bed and chair. The current infusion area is often at capacity and the added seating will be beneficial. The new A IC h a s a l so b e e n de s i g ne d to of fe r a wa r m a nd com for t able environment and will ensure more timely treatment by having staff pharmacists on site who can mix infusions as soon as a patient arrives. 6

9 Another improvement will be the close proximity of all cancer-related services. Currently, cancer patients must travel back and forth across town to receive care. The constant travel can be exhausting not to mention difficult for patients and family members to coordinate. In the new center, all cancerrelated care including physician appointments, lab work, radiation oncology treatments, chemotherapy and infusions will take place under one roof. A bridge will connect Cheyenne Regional to the new center for hospital patients who also require cancer treatment. There is no need to travel to a larger city for care when Cheyenne has excellent physicians and state-of-the-art equipment, said Thiede. Having a comprehensive cancer center in this community will allow patients to receive advanced care in a warm and caring environment. A healing garden and historic square have been included in the center s landscaping to enhance the look and feel of the center for patients, family members and the surrounding neighborhood. The new center will also have areas designated for massage and lymphedema therapy, meditation/yoga and support groups as well as nutrition, social work and chaplain consultations. A boutique including wig and hat-fitting stations and private dressing rooms for breast prosthesis fittings will be included, in addition to a library with computerized and bound educational materials for the use of patients and families. In 2010, there were 2,767 Wyoming residents diagnosed with cancer. - Wyoming Department of Health Cancer Center There is no need to travel to a larger city for care when Cheyenne has excellent physicians & state-of-the-art equipment. -Tamela Thiede Main Entrance as viewed from 24 th Street Rendering of new cancer center 7

10 CANCER CARE PROGRAM/// The Cancer Care Program at Cheyenne Regional Medical Center focuses on providing state-of-the-art diagnostic technologies and treatments reducing the symptoms and side effects of cancer treatment positively impacting survival rates and improving the overall quality of life for our patients and their families. Our multidisciplinary cancer team meets regularly in a Cancer Conference to discuss patient cases that are diagnosed and/or treated at the hospital. Physicians and other health professionals involved in the care of cancer patients present and discuss the cases, including a review of the patient s history, pathology and imaging studies. Together with the patient, this team develops a unique and comprehensive treatment plan which may include conservative monitoring, surgery, chemotherapy, radiation or a combination of treatment. We believe providing patients with knowledge about their diagnosis and treatment options gives them some control and empowers them to participate in their cancer treatment. Together with specially trained oncology nurses and support services staff, we provide patient-centered, family-oriented care in an atmosphere of compassion, commitment, hope and healing. Cheyenne Regional Medical Center strives to identify and meet the needs of the cancer patients in the region. Cheyenne Regional s Cancer Committee establishes goals for quality improvement and directs the oncology program s growth by evaluating new technologies, programs and services that would enhance patient care. Our Cancer Committee includes board-certified physicians from medical specialties that diagnose or treat cancer, including: Surgery, Medical Oncology, Hematology, Diagnostic Radiology, Radiation Oncology, Pathology, Internal Medicine, Family Medicine, Palliative Care and Urology as well as members from Cheyenne Regional s Administration, Social Work, Patient Navigation, Cancer Registry, Rehabilitation, Nursing and Nutritional Services. Clinical and demographic data are collected from diagnosis through treatment and continuing to end of life by Cheyenne Regional s Cancer Registry staff. This data plays a vital role in improving prevention, detection and treatment of cancer, including survival rates, treatment efficacy and incidence trends. It also improves overall patient care and allows us to offer services that enhance quality of life for cancer patients in our region. The staff was caring, knowledgeable and encouraging. 8

11 Inpatient Oncology Unit Infusion Center Staff O u r se ve n -b e d i np at ie nt u n it i s a n i mp or t a nt p a r t of comprehe n s i ve c a nce r c a re at C he ye n ne R e g ion a l Me d ic a l C e nt e r. We offer a multidisciplinary, holistic approach to cancer care which considers the medical, functional, psychosocial and spiritual needs of our patients. Physicians, specialists and highly trained oncology nurses coordinate patient care with social workers, case managers, patient navigators, dietitians and pharmacists who are specially trained in cancer care. Oncology Diagnostic & Medical Imaging Our dedicated, experienced staff consists of board-certified radiologists, nationally and state-certified technologists, sonographers, mammographers and registered nurses. Our Medical Imaging Department is equipped with technology and services that include: MRI (Magnetic Resonance Imaging) Digital Mammography, Breast MRI and Stereotactic Breast Biopsies Ultrafast CT Scanners and CT Coronary Angiography Dual Head Nuclear Medicine Scanner Angiographic Suite for Interventional Radiology Ultrasound with 3-D and 4-D imagery Bone Densitometry CAD (Computer Aided Detection) image reading capability Fluoroscopy PET/CT Scanner Nuclear Medicine SPECT/CT scanner Oncology Patient Navigation & Breast Health Navigator Our patient navigators offer continuum of care to cancer patients, their families, caregivers and survivors throughout the healthcare system. They help patients find information about diagnosis, treatment and recovery, enabling patients to make informed decisions about their care. The navigators coordinate services by collaborating with medical providers, nutritionists, counselors, community resources and support groups in order to identify patient needs and assist in finding financial, psycho-social and other resources to meet these needs. Cheyenne Regional was the first hospital in Wyoming to offer the services of a breast health navigator, an oncology registered nurse who guides and supports breast cancer patients throughout the treatment and recovery process. Patients find that working with the navigator helps reduce the anxiety experienced during cancer treatment. Lung cancer was the leading cause of cancer death in Wyoming in 2010 with 229 deaths. Colorectal cancer was second with 97 deaths. - Wyoming Department of Health 9

12 CANCER CARE PROGRAM/// Cheyenne Regional has two treatment systems for External Beam Radiation therapy. These systems can provide both IMRT (Intensity Modulated Radiation Therapy) and IGRT (Image Guided Radiation Therapy) treatments. The TomoTherapy Hi Art system uses an on-board CT imaging system for IGRT, to precisely align the patient for the specialized delivery of an IMRT treatment. Cheyenne Regional was the first facility in the region to utilize the TomoTherapy system. This technology is used for all IMRT treatments and for Stereotactic Radiosurgery and Stereotactic Body Radiation treatments and enables the delivery of high doses of radiation to the treatment area while sparing sensitive areas that are near to the affected area. Multi-leaf collimation allows the tumor to be treated with the necessary radiation while minimizing side effects in the surrounding healthy tissue. High Dose Rate and Low Dose Rate Brachytherapy systems at Cheyenne Regional use a radioactive source that is either implanted directly into tissues or introduced into catheters that have been place into the area to be treated. Radiation Oncology Staff Radiation Oncology The Radiation Oncology Department at Cheyenne Regional Medical Center uses the newest technologies to provide the safest treatments consistent with nationally recognized best practices. Treatment options include External Beam Radiation and High Dose Rate and Low Dose Rate Brachytherapy. Two board-certified radiation oncologists, a medical physicist, certified medical dosimetrists, registered radiation therapists, registered nurses and clinical specialists provide a compassionate state-of-the-art experience for patients undergoing cancer treatments. Medical Oncology & Hematology Cheyenne Oncology and Hematology Associates offers consultation and follow-up of patients in the clinics new location at 800 East 20th Street, Suite 350. The physicians work with an experienced office support staff to provide individualized care. Our on-site laboratory, staffed by a medical laboratory technician, permits faster reporting to the hematologists/oncologists. Our registered nursing staff offers IV hydration, injections, Central Venous Access maintenance, port flushing, therapeutic phlebotomies and patient education. An American Cancer Society volunteer is available in the clinic two mornings a week to offer our patients additional support, including informational pamphlets and service such as free wigs and hats. 10

13 Palliative Care Palliative care specializes in the relief of the pain, symptoms, and stress of serious illness. This service is appropriate at any point in an illness and can be provided at the same time as treatment that is meant to cure. The goal is to improve quality of life for patients and their families. Palliative Care patients have a range of diseases and respond differently to treatment options so palliative care customizes treatment to meet the needs of each individual person. This service aims to relieve symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. Palliative care benefits both patients and their families. The team of physicians, nurse practitioners, social workers and chaplains help patients and families make medical decisions, choose treatments, provide support and provide resource assistance. A patient can receive palliative care when at home or in an assisted living facility, nursing facility or hospital. Working in partnership with a primary care physician, the palliative care team provides expert treatment of pain and other symptoms and help navigating the healthcare system. The team also guides patients and family members through difficult and complex choices and offers emotional and spiritual support. From 2001 to 2010 the highest Five-Year survival rates where found for prostate cancer (99.00 percent), thyroid cancer (95.10 percent), melanoma (88.40 percent) and breast cancer (86.80 percent). - Wyoming Department of Health Surgical Specialties Cheyenne Regional Medical Center Perioperative Services provides many services to our oncology and surgical patients. Care Clinic is a pre-operative testing and teaching unit that prepares surgical patients with information regarding their elective and planned surgical procedures. Patients are admitted to Same Day Surgery the morning of their surgery/procedure and are discharged home or to a nursing unit following their surgical or invasive procedure. The Post Anesthetic Care Unit (PACU) provides intensive nursing care to surgical inpatients and outpatients of all ages who require intensive observation and monitoring following an operative procedure or other specialized procedures in which an anesthetic agent has been administered. PACU also has a pre-operative area where patients having epidurals and regional blocks are closely monitored. Our Operating Rooms (OR) provide surgical services to patients of all ages on an elective and emergency basis. Services are available on a scheduled basis or on a 24-hour basis for emergency cases. Everyone is always friendly and if I had a question they d find the answer. Jeffrey C. Carlton,MD; Don R. Dickerson, MD; Maristela Batezini, MD; Mohamed E. El-Tarabily 11

14 CANCER CARE PROGRAM/// Ambulatory Infusion Center The Ambulatory Infusion Center (AIC) provides infusion and injection services to patients with a wide variety of diagnoses. The AIC offers a specialized environment in which patients may have their laboratory tests, chemotherapy administration and specialty infusions, transfusions and injections. The AIC has experienced and caring registered nurses who are Oncology Nursing Society certified in chemotherapy administration. An on-site nurse practitioner/ advanced practice nurse is available for chemotherapy education and symptom management. All patients are treated utilizing evidence - based standards of care and best practice patterns to ensure that they receive highly skilled care centered on their comfort, safety and well-being. The AIC offers patients and families the services they need in a stress-free environment close to home. Laboratory The Laboratory at Cheyenne Regional Medical Center is a key component of the detection, diagnosis and treatment of cancer. Our on-site laboratory provides quick results for many routine laboratory tests, enabling physicians to prescribe or adjust patients treatment plans as needed without unnecessary delays. Nutritional Services Inpatient Oncology patients who are at nutritional risk receive a complete nutritional assessment by our oncology dietitian. A nutritional plan of care is tailored to the patient s current medical needs and to personal preferences. Patient education, nutritional supplements, personalized highprotein or nutrition-dense diets and enteral/parenteral nutrition are provided by highly trained dietitians to assist the patients in maintaining healthy diets and eating habits during treatment for cancer. The oncology dietitian is available to visit patients in the outpatient setting of Radiation Oncology and the Ambulatory Infusion Clinic upon the request of the patient, a staff member or their physician. The dietitian visits with patients to discuss unwanted weight loss, side effects from treatment, healthy eating principles needed to maintain nutrition during treatment and nutritional interventions such as enteral nutrition via feeding tubes if required. Radiation Therapists Pathology Our Pathology Department has the expertise to diagnose and classify all types of cancer, which helps surgeons and oncologists to choose the most effective treatment method for their patients. The pathologists at Cheyenne Regional have examined hundreds of breast, cervical, prostate, gastric and colorectal cancers, lymphomas, melanomas and other skin cancers. Each pathologist is board certified by the American Board of Pathology in Clinical Pathology. They offer 24- to 48-hour turnaround time for most tests. Cancer Resource Center The Cancer Resource Center s primary goal is to deliver professional, compassionate assistance to cancer patients, their families and their caregivers from the moment of diagnosis. Working in collaboration with the American Cancer Society, the Cancer Resource Center has created a library and boutique with computer access to online information, a conference area for patients and families and information for community members who are interested in cancer detection, treatment, clinical trials and prevention. An extensive library of books, magazines, pamphlets, videos and DVDs are offered to patients and families wishing to learn more about their cancer diagnosis. Free wigs, scarves, turbans and hats are available as well as breast prostheses and mastectomy bras for uninsured patients. Support groups are available in partnership with the American Cancer Society. 12

15 Hospice Davis Hospice Center Hospice assists patients and families in working towards end of-life goals. Hospice strives to nurture and enhance quality of life. The patient, caregiver and family are involved in the care and decision-making process. Our Hospice team provides comfort, expert medical care, pain and symptom management as well as emotional and spiritual support tailored to the patient s needs and wishes. Hospice offers both outpatient and inpatient (at Davis Hospice Center) services, allowing patients to remain at home as long as possible and offering a dignified and comfortable inpatient atmosphere when their needs can be better met on an inpatient basis. Hospice bereavement programs and services offer support and guidance to those in the grieving process. Outreach Services With a grant from Wyoming Cancer Resource Services, Cheyenne Regional Medical Center s Cancer Resource staff provides community cancer awareness programs and promotes two state cancer screening programs for low income and/or underinsured patients. The Wyoming Breast and Cervical Cancer Early Detection Program and Wyoming Colorectal Cancer Screening Program are available resources for patients needing assistance. Mammogram assistance is also available through the Cancer Resource Center through partnership with Wyoming Women First-Komen/GE and The Caring for Program. Dr. Mohamed El-Tarabily, MD, medical oncologist/ hematologist, travels to Laramie, Wyoming, two days per week to provide consultative services and care at the Meredith & Jeannie Ray Cancer Center. Further outreach clinics are planned in the near future. For children (0-19 years), the overall five-year relative survival rate from 2001 to 2010 was percent. - Wyoming Department of Health Rehabilitation Rehabilitation for cancer patients helps them achieve the best physical, social, psychological and work-related functioning possible during and after cancer treatment. The goal of rehabilitation is to help patients regain control over many aspects of their lives and remain as independent and productive as possible. The staff has made me feel so comfortable it was almost like being at a spa! These ladies are quick, courteous and expert at their jobs. 13

16 COLON CANCER OUTCOME STUDY/// In 2008, when the Cheyenne Regional Medical Center Cancer Committee began the rigorous process of obtaining accreditation for the cancer program through the American College of Surgeons Commission on Cancer (ACoS CoC), we reorganized the cancer data registry and placed a major emphasis on strengthening and updating our cancer statistics. We now have accurately registered the statistics for our regional cancer patients for years 2008 through This data is submitted yearly to the National Cancer Database (NCDB) for comparison to other institutions around the country and is available for public review. The comparison process allows the Cancer Committee to measure patient outcomes against the national experience and determine areas for possible improvement. For this annual report, the committee has selected colon cancer management for focused review. This report compares the data for the 108 patients diagnosed with colon cancer during the years 2008 through 2011 at Cheyenne Regional Medical Center with the data for 9,561 patients from similar institutions in the NCDB from around the country during Tables 1 and 2 indicate that age of patients and stage of cancer at diagnosis are very similar for our institution and the national experience. There is a suggestion from the data that we may diagnose more patients at later stages (III and IV) than the NCDB experience. This may indicate a need for increased public education and screening efforts in our region. These are two areas that have been addressed by our state government through the Wyoming Cancer Resource Services and the Colorectal Early Detection program. The Cheyenne Regional Medical Center Cancer Resource Center staff has been working with these programs to promote early detection. We will continue to monitor this trend to determine the impact of these programs. Table 3 illustrates the course of therapy that patients received after initial diagnosis. The data suggest that a higher percentage of patients at Cheyenne Regional Medical Center received chemotherapy in addition to surgical resection than the patients in the NCDB data set. Postoperative chemotherapy is the recommended standard of care for patients with stage II and higher colon cancer. This difference in data sets supports that our clinicians are rigorous in following these standard of care recommendations, as the percentage of patients with stage II or higher colon cancer is similar for the Cheyenne Regional Medical Center data and the NCDB data (72 percent and 66 percent respectively). The ACoS CoC has established Oncology Core Measures to help institutions monitor quality of care. Two of these measures relate to the management of colon cancer and are reported in Table 4. To insure that colon cancer patients have been staged thoroughly at the time of surgery, the college recommends that an adequate number of lymph nodes be removed with the surgical specimen. Studies have demonstrated this adequate minimum sampling number to be 12 lymph nodes. Table 4 shows that in 2009 only 50 percent of colon cancer resections produced at least 12 nodes. The Cancer Committee, surgeons and pathologists have worked diligently since then to reach this goal, and the data from 2011 shows a 90 percent compliance with the target number. The second core measure relates to the use of postoperative chemotherapy as discussed above. Our data from the past three years show a 100 percent compliance with this goal. Jeffrey C. Carlton, MD As Chair of the Cancer Committee, I am pleased with the findings of this review. Our data demonstrate a high level of care for Cheyenne Regional Medical Center colon cancer patients, consistent with the national data. It appears that screening efforts and public education need to be emphasized to improve the rate of early detection, and programs are in place to pursue this goal. We have shown incremental improvement in the adequacy of surgical staging since we became aware of the data on this core measure. I am proud to see that our cancer program is successful in pursuing effective improvement to the direct benefit of our patients. 14

17 Age at Diagnosis (Table 1) Stage at Diagnosis (Table 2) 40 34% Percentage % 14% 26% 22% 29% 20% 22% Percentage % 13% 20% 20% 26% 33% 23% 19% 17% 9% 5 0 5% 3% 4% 2% 2% 1% 1% 0.4% Age CRMC NCDB 5 0 5% 0 (DCIS) Stage 1 Stage 2 Stage 3 Stage 4 Stage CRMC NCDB 2% Unknown First Course of Therapy (Table 3) Core Measures (Table 4) % 56.0% % 100% 90% 100% % Percentage % Percentage 50 50% 66% 10 10% 10% 0 Surgery only Surgery and Chemo CRMC Theraphy NCDB Other or none Removal of 12 Lymph Nodes 2010 Year 2011 Adjuvant Chemo of Colon From 2001 to 2010, the Five-Year relative survival rates for all forms of cancer in Wyoming was percent. Relative Survival is a net survival measure representing cancer survival in the absence of other causes of death. It is defined as the ratio of the proportion of observed survivors in a cohort of cancer patients to the proportion of expected survivors in a comparable set of cancer-free individuals for a specific time period. - Wyoming Department of Health 15

18 CHEYENNE REGIONAL CANCER CASES/// YEARLY BREAKDOWN BY YEAR OF DIAGNOSIS PRIMARY SITE ALL YEARS LIP TONGUE MOUTH PAROTID & MAJOR SALIVARY GLANDS PHARYNX ESOPHAGUS STOMACH SMALL INTESTINE COLON RECTUM/ANUS/RECTOSIGMOID LIVER GALLBLADDER & BILIARY TRACT PANCREAS OTHER DIGESTIVE ORGANS NASAL CAVITY & MIDDLE EAR ACCESSORY SINUSES LARYNX LUNG 1, OTHER, INCLUDING TRACHEA, HEART, MEDIASTINUM & PLEURA BONE & JOINTS OTHER NERVES, PERITONEUM & CONNECTIVE TISSUE MULTIPLE MYELOMA LEUKEMIA OTHER HEMATOPOIETIC DISEASES SKIN - REPORTABLE MELANOMA OF SKIN BREAST 1, INVASIVE CERV UTERI CORPUS UTERI & UTERUS OVARY VULVA, VAGINA & OTHER FEMALE GENITAL ORGANS PROSTATE 1, TESTIS PENIS & OTHER MALE GENITAL ORGANS KIDNEY BLADDER OTHER URINARY ORGANS -including renal pelvis, ureter, urethra BRAIN / CNS THYROID THYMUS & OTHER ENDOCRINE HODGKIN LYMPHOMA NON-HODGKIN LYMPHOMA UNKNOWN/MISC TOTAL 8, Counts do not include cervix in-situ cases or basal cell and squamous cell carcinomas of the skin. 16

19 DISTRIBUTION BY RESIDENCE/// Cheyenne Regional Cases From 1992 to 2011 Total Wyoming.... 7,662 Out-of-state and unknown residence Total...8,042 Albany Campbell...6 Carbon Converse Crook Fremont Goshen Hot Springs...3 Johnson... 1 Laramie...6,342 Natrona Niobrara Park...3 Platte Sheridan...4 Sublette...3 Sweetwater Teton Uinta... 2 Washakie... 2 Weston... 3 Arizona Colorado Nebraska Other states Unknown BREAKDOWN BY SITE/// All Primary-Site Cases Entered from Breast... 1,521 Prostate... 1,346 Lung... 1,003 Colon Bladder Non-Hodgkin s Lymphoma Thyroid Brain/CNS Rectum/Anus/Rectosigmoid Corpus Uteri & Uterus Kidney Unknown Pancreas Ovary Leukemia Melanoma of Skin Invasive Cervix Uteri...88 Multiple Myeloma Larynx Stomach Esophagus...69 Liver Testis...65 Gallbladder & Biliary Tract Pharynx Thymus & Other Endocrine Tongue...49 Other Nerves, Peritoneium & Connective Tissue Other Hematopoietic Diseases...44 Mouth...44 Hodgkin s Lymphoma...44 Vulva, Vagina & Other Female Genital Organs Other Urinary Organs including Renal Pelvis, Ureter, Urethra Other including Trachea, Heart, Mediastinum & Pleura Small Intestine Parotid & Major Salivary Glands Bone & Joints Lip Skin Reportable Other Digestive Organs... 6 Nasal Cavity & Middle Ear... 5 Penis & Other Male Genital Organs.. 4 Accessory Sinuses... 2 Misc Total...8,042 17

20 INCIDENCE DISTRIBUTION/// All Cases Entered from Males Females Prostate... 1,346 Lung/Bronchus Urinary Bladder Colon Non-Hodgkin Lymphoma Kidney Rectum/Rectosigmoid Brain / CNS Leukemia Pancreas...72 Testis...65 Melanoma...56 Stomach Thyroid Esophagus...45 Multiple Myeloma...42 Gallbladder / Other Biliary Hodgkin Lymphoma...25 All Other Sites Breast....1,514 Lung / Bronchus Colon Thyroid Corpus Uteri Non-Hodgkin Lymphoma Ovary Brain / CNS Urinary Bladder Rectum / Rectosigmoid Cervix Pancreas...87 Kidney...76 Melanoma Leukemia...47 Multiple Myeloma...37 Stomach...25 Gallbladder / Other Biliary Hodgkin Lymphoma All Other Sites Total Cases... 3,839 Total Cases...4,203 18

21 BREAST CANCER/// 1,521 Cases from SEER Summary Stage at Diagnosis AJCC Stage at Diagnosis In Situ 15% 70 Local 52% Regional 25% Distant 5% Unknown 3% Percentage % 14% Stage 0 56% 37% Stage I 29% 21% Stage II 9% 10% Stage III 4% 2% Stage IV 6% 0% Unknown All Years 2011 SEER Summary Stage at Diagnosis 2011 Treatments Provided in In Situ 13% Local 64% Regional 20% Distant 2% Number of Cases Unknown 0% 10 0 Chemotherapy 1 Hormone 9 Multi-modality 3 Other 7 No Treatment AGE AT DIAGNOSIS ALL YEARS 2011 MOST FREQUENT HISTOLOGY ALL YEARS 2011 DUCTAL CARCINOMA IN SITU 16% 11% INFILTRATING DUCTAL 56% 63% INFLITRATING & LOBULAR 14% 14% ADENOCARCINOMA 9% 0% OTHER SPEC TYPES 7% 12% TOTAL

22 PROSTATE CANCER/// 1,416 Cases from SEER Summary Stage at Diagnosis AJCC Stage at Diagnosis 90 Local 75% % 63% Regional 14% Distant 3% Percentage Unknown 8% % 8% Stage I Stage II 13% 10% Stage III 6% 4% Stage IV 12% 0% Unknown All Years 2011 SEER Summary Stage at Diagnosis 2011 Treatments Provided in Local 81% Regional 19% Distant 0% Unkown 0% Number of Cases Hormone Radiation Radiation & Hormone Surgery 5 Surgery & Hormone 6 Surgery & Radiation 4 Surgery, Radiation & Hormone 0 No Treatment AGE AT DIAGNOSIS ALL YEARS 2011 MOST FREQUENT HISTOLOGY ALL YEARS 2011 ADENOCARCINOMA 97% 98% CARCINOMA NOS 2.90% 2% TOTAL

23 LUNG CANCER/// 1,001 Cases from SEER Summary Stage at Diagnosis AJCC Stage at Diagnosis 90 Local 17% Regional 27% Distant 46% Percentage % 44% Unknown 9% % 15% 24% 28% 15% 10 0 Stage I 9% 7% Stage II Stage III Stage IV 3% Unknown All Years 2011 SEER Summary Stage at Diagnosis 2011 Treatments Provided in Local 18% Regional 22% Distant 60% Unknown 0% Number of Cases Chemo 2 Palliative Radiation Radiation & Chemo 7 Surgery 1 Surgery & Chemo 1 Surgery, Radiation & Chemo 9 No Treatment AGE AT DIAGNOSIS ALL YEARS 2011 MOST FREQUENT HISTOLOGY ALL YEARS 2011 ADENOCARCINOMA 33% 38% SQUAMOUS CELL CARCINOMA 24% 16% SMALL CELL CARCINOMA 24% 23% CARCINOMA NOS 19% 23% TOTAL

24 COLON CANCER/// 552 Cases from SEER Summary Stage at Diagnosis AJCC Stage at Diagnosis 90 In Situ 7% Local 30% Regional 41% Percentage Distant 18% Unknown 4% % 7% Stage 0 16% 14% Stage I 25% 25% Stage II 28% 24% Stage III 17% 11% Stage IV 10% 4% Unknown All Years 2011 SEER Summary Stage at Diagnosis 2011 Treatments Provided in In Situ 18% Local 39% Regional 29% Distant 11% Unknown 4% Number of Cases Surgery 10 Surgery & Chemotherapy 1 No Treatment AGE AT DIAGNOSIS ALL YEARS 2011 MOST FREQUENT HISTOLOGY ALL YEARS 2011 ADENOCARCINOMA 68% 71% ADENOCARCINOMA IN POLYPS 9% 3% MUCINOUS ADENOCARCINOMA 11% 7% SIGNET RING 0% 0% OTHER 11% 18% TOTAL

25 HEMATOPOIETIC CANCER/// 502 Cases from SEER Summary Stage at Diagnosis Local 9% Regional 11% Treatments Provided in 2011 Distant 73% Unknown 8% 80 Number of Cases SEER Summary Stage at Diagnosis Chemotherapy 1 Hormone 9 Multi-modality 3 Other 7 No Treatment Local 6% Regional 0% Distant 94% Unknown 0% AGE AT DIAGNOSIS ALL YEARS 2011 MOST FREQUENT HISTOLOGY ALL YEARS 2011 NON-HODGKIN LYMPHOMA 37% 6% MYELOMA 24% 24% LEUKEMIA 26% 47% OTHER 11% 24% TOTAL

26 GLOSSARY/// Biological Response Modifier (BRM) or Immunotherapy BRM is a generic term which covers all chemical or biological agents that alter the immune system or change the host s response (defense mechanism) to the cancer. First Course Treatment Generally the initial tumor-directed treatment or series of treatments, usually initiated within the first four months after diagnosis. Observed Survival Rate The literal survival rate from counting each case in the registry. Relative Survival Rate Survival rate that takes the normal life expectancy into account. This avoids the bias that the figures may convey with the majority of patients being older but having expired due to causes other than cancer. Stage of Disease Determined at first course of treatment. SEER Summary Staging Guide is used except where indicated. In Situ Neoplasm which fulfills all microscopic criteria for malignancy except invasion. Localized Neoplasm that appears entirely confined to the organ of origin. Regional Neoplasm has spread by direct extension to immediate adjacent organs or tissues and/or has metastasized to regional lymph nodes or organs and appears not to have spread any further. Distant Neoplasm has spread beyond immediate adjacent organs or tissues by direct extension and/or has either developed secondary or metastatic tumors, metastasized to distant lymph nodes or has been determined to be systemic in origin. Unknown or Not Recorded Tumor is said to be unknown when the stage cannot be determined from the medical record or a medical authority. Every member of the staff did an outstanding job. Many thanks! 24

27 Cancer services at Cheyenne Regional are supported in part through generous gifts from our community. Please contact the Foundation for information on how you can contribute to this important program. u (307)

28 214 East 23rd Street, Cheyenne, WY u (307) u crmcwy.org