MERCY REGIONAL MEDICAL CENTER CANCER PROGRAM ANNUAL REPORT 2014

MERCY REGIONAL MEDICAL CENTER CANCER PROGRAM ANNUAL REPORT 2014

MERCY CANCER CENTER When you have cancer, you might think first of treatments chemotherapy and radiation. You want and need both of these to be at the highest level, with the most advanced technologies and techniques, with cancer doctors who are not only experts in their field, but compassionate and caring. You will find all of that and more at Mercy Cancer Center in Lorain County. We serve the needs of people with cancer throughout northeastern Ohio. Guided by a holistic philosophy, our multidisciplinary team of board certified radiation oncologists, medical oncologists and hematologists devise individualized, targeted treatment plans based on the latest clinical guidelines. The Mercy Cancer Center in Lorain County has full accreditation from: The American College of Surgeons Commission on Cancer The Joint Commission on Accreditation of Healthcare Organizations American College of Radiology (ACR) Breast Excellence Joint Commission Accreditation recognizes health care organizations and programs with focus on patient safety and quality of care. Accreditation from The Joint Commission is recognized nationwide as a symbol of quality. Mercy Cancer Center is one of many facilities and services of Mercy which are accredited by the Joint Commission.

Cancer Committee Members 2014 PROGRAM ADMINISTRATOR SYLVIA RADZISZEWSKI Cancer Liaison Physicians 2014 Dr. Kurt H. Dinchman, MD Dr. Christopher A. Haas, MD CANCER COMMITTEE CHAIR BELAGODU KANTHARAJ MD RADIATION ONCOLOGY M. RIBOVICH, MD ALBIN GONZALEZ, PHYSICIST PATHOLOGY FAIZI ALI, MD GENERAL SURGERY WILLIAM LARCHIAN, MD ONCOLOGY NURSING DARLENE BROWN, RN WOMEN S CENTER NURSING CATHY FIOR, RN DIAGNOSTIC RADIOLOGY CHAD COHEN MD Cancer Committee Coordinators 2014 Psychosocial Services C Cancer Conference Coordinator Deanna Petruchik Quality Improvement Coordinator Kathy Grueschow, RN Community Outreach Coordinator Beth Finnegan Cancer Registry Quality Coordinator Lori Adams, RHIT CTR Psychosocial Coordinator Vikki Howard, LSW Clinical Trials Coordinator Barbara Hanigosky Coordinator QUALITY MANAGEMENT KATHY GRUESCHOW, RN SOCIAL SERVICES VIKKI HOWARD, LSW CLINICAL RESEARCH BARBARA HANIGOSKY COMMUNITY OUTREACH BETH FINNEGAN REHABILITATION DEANNA SCHREIBER, LPT DIETARY SHERRY VAN GILDER, RD PHARMACY MICHELE CARDENAS HOSPICE DR ZAWORSKI CANCER REGISTRY LORI ADAMS, RHIT CTR

MERCY REGIONAL CANCER CENTER REGISTRY REPORT: The primary goal of the Cancer Registry is to collect and maintain complete and accurate data on cancer patients diagnosed and/or treated at Mercy Regional Medical Center. Data collected by the cancer registry is an invaluable tool in the fight against cancer. As an accredited CoC facility the registry collects demographic and disease specific data elements on each cancer patient presenting for diagnosis or treatment. The information collected is utilized by physicians, administration, and other healthcare professionals. Among the many uses are: measuring quality outcomes tracking community outreach initiatives supporting clinical, diagnostic, and treatment research evaluating the effectiveness of current treatment modalities presenting data for individualized patient treatment planning submitting to local and national databases for incidence and outcome comparison 2013 DATA SUMMARY MRMC cancer registry accessioned 381 new analytical cancer cases for 2013. BREAST 25% LUNG 23% PROSTATE 8% BLADDER COLON 5% 5% 0% 5% 10% 15% 20% 25% 30% TOP FIVE SITES MRMC 2013 The top 5 sites for all patients are breast, lung, prostate, bladder and colon. 218 FEMALE 163 MALE MAJORITY OF PATIENTS AGE AT DIAGNOSIS: 60 69 YEARS OF AGE

. FEMALE SITE DISTRIBUTION BREAST 43% LUNG 17% COLON NON HODGKINS LYMPHOMA RECTUM 5% 4% 3% 0% 10% 20% 30% 40% 50% TOP FIVE SITES FEMALES 2013 Breast was the most frequent primary to be accessioned in the registry for female patients seen at MRMC for 2013 followed by lung, colon, Non Hodgkin s Lymphoma and rectal carcinoma MALE SITE DISTRIBUTION LUNG 29% PROSTATE 19% NON HODGKINS LYMPHOMA BLADDER 9% 9% COLON 6% 0% 5% 10% 15% 20% 25% 30% 35% TOP FIVE SITES MALES FOR 2013 Lung was the most frequent primary to be accessioned into the registry for male patients seen at MRMC for 2013 followed by prostate, non Hodgkin s lymphoma, bladder and colon.

MERCY CANCER CENTER SITE DISTRIBUTION PRIMARY SITE TABULATION FOR 2013 PRIMARY SITE TOTAL SEX AJCC STAGE GROUP M F 0 I II III IV UNK N/A ALL SITES 381 163 218 21 95 75 48 89 25 28 TONGUE 3 2 1 0 1 0 0 2 0 0 OROPHARYNX 1 0 1 0 0 0 0 1 0 0 OTHER ORAL 6 2 4 0 1 0 1 3 0 1 ESOPHAGUS 7 5 2 0 0 0 2 1 4 0 STOMACH 6 4 2 0 0 0 0 2 3 1 COLON 20 9 11 0 2 5 6 5 2 0 RECTUM 16 10 6 0 3 5 1 3 4 0 ANUS/ANAL CANAL 7 1 6 0 0 2 1 1 2 1 LIVER 2 1 1 0 0 0 1 1 0 0 PANCREAS 3 0 3 0 0 0 0 3 0 0 OTHER DIGESTIVE 3 1 2 0 0 0 0 1 2 0 NASAL/SINUS 1 1 0 0 0 0 0 0 0 1 LARYNX 4 4 0 0 2 1 1 0 0 0 LUNG/BRONCHUS 86 48 38 0 11 9 12 54 0 0 LEUKEMIA 1 1 0 0 0 0 0 0 0 1 MULTIPLE MYELOMA 2 0 2 0 0 0 0 0 0 2 OTHER BLOOD 1 0 1 0 0 0 0 0 0 1 CONNECT/SOFT TISSUE 1 0 1 0 0 0 0 0 1 0 MELANOMA 2 1 1 0 0 0 0 0 2 0 BREAST 94 1 93 11 43 25 12 1 2 0 CERVIX UTERI 4 0 4 0 0 1 2 1 0 0 CORPUS UTERI 3 0 3 0 1 0 2 0 0 0 OVARY 3 0 3 0 0 0 0 2 1 0 VULVA 2 0 2 1 1 0 0 0 0 0 PROSTATE 31 31 0 0 6 22 1 2 0 0 TESTIS 1 1 0 0 1 0 0 0 0 0 OTHER MALE 1 1 0 0 0 0 0 0 0 1 BLADDER 18 14 4 9 5 3 0 1 0 0 KIDNEY/RENAL 7 3 4 0 3 0 1 3 0 0 BRAIN (MALIGNANT) 3 0 3 0 0 0 0 0 0 3 OTHER BRAIN AND CNS 3 0 3 0 0 0 0 0 0 3 THYROID 5 3 2 0 2 0 2 0 1 0 OTHER ENDOCRINE 3 2 1 0 0 0 0 0 0 3 HODGKIN'S DISEASE 3 3 0 0 1 2 0 0 0 0 NON HODGKIN'S 18 9 9 0 12 0 3 2 1 0 UNKNOWN PRIMARY 10 5 5 0 0 0 0 0 0 10

COMMUNITY CANCER PROGRAM PRACTICE PROFILE REPORTS (CP3R) FOR BREAST Standard 4.4 Accountability Measures 100% 95% 100% 90% 85% 93% 91% 2009 2010 2011 80% 75% RADIATION THERAPY (BCS) Radiation therapy is administered within 1 year (365) days of diagnosis for women < 70 receiving breast conserving surgery. 2011 42*/46 patients.

Standard 4.4 Accountability Measures 100% 90% 100% 100% 80% 70% 60% 50% 40% 75% 2009 2010 2011 30% 20% 10% 0% CHEMOTHERAPY (MAC) Combination Chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women < 70 with AJCC T1c N0 M0, or Stage II or III, ER / PR negative breast cancer. 2011 6/6 patients.

Standard 4.4 Accountability Measures 100% 95% 90% 85% 89% 93% 2009 2010 2011 80% 83% 75% HORMONE THERAPY (HT) Tamoxifen or third generation aromatase inhibitor is considered or administered with 1 year (365 days) of diagnosis for women with AJCC T1c N0 M0, or Stage II or III ER/ PR positive breast cancer. 2011 43*/52 pati (*indicates patients refusal of treatment or patients going elsewhere for completion of treatment)

MERCY REGIONAL MEDICAL CENTER CANCER PROGRAM SITE STUDY PROSTATE Prostate Cancer makes up 8% of MRMC s total cases for 2013 and is the second most common cancer seen in males at MRMC. Prostate Cancer is the most common cancer in men and second leading cause of cancer deaths among men in the US. American Cancer Society Facts and Figures 2008 For patients seen at MRMC with prostate cancer in 2013 the age ranged from 50 90 years of age, with the majority of cases diagnosed between the ages of 70 79. 2013 Patients with prostate cancer seen at MRMC: 87% Lorain County.. 11% Huron County.. 1% Geauga County.. 1% Medina County.. 1% Coshocton County Prostate Cancer Diagnosed at MRMC in 2013: Stage I 60% Stage II 0% Stage III 10% Stage IV 30%

MERCY REGIONAL MEDICAL CENTER CANCER PROSTATE COMPARISON DATA 2000 2012 PROSTATE COMPARISON DATA AGE AT DIAGNOSIS AGE RANGE MRMC OHIO NATIONAL 40 49 0% 1% 3% 50 59 14% 16% 23% 60 69 34% 35% 40% 70 79 42% 34% 27% 80 89 9% 12% 6% 90 (+) 0% 1% 1% Age of Prostate Cancer diagnosed in 2000 2012 2014 National Cancer Data Base (NCDB) Prostate cancer for Mercy Regional Medical Center is higher than the state and national average for prostate cancer in the 70 79 age groups. Mercy Regional Medical Center (for years 2000 2012) experienced 42% of men presenting with prostate cancer, while the state averaged 34% and the national average was 27% overall. PROSTATE COMPARISON DATA STAGE AT DIAGNOSIS STAGE MRMC OHIO NATIONAL I 5% 6% 6% II 85% 78% 74% III 3% 6% 9% IV 4% 7% 5% UNK 3% 4% 6% Stage of Prostate Cancer Diagnosed in 2000 2012 2014 National Cancer Data Base (NCDB) Mercy Regional Medical Center diagnoses prostate cancer most often in Stage II, which is slightly higher than state and national averages.

STANDARD 4.6 COMPLIANCE WITH NCCN GUIDELINES PROSTATE CANCER REVIEW Each year, a physician member of the cancer committee performs a study to assess whether patients within the program are evaluated and treated according to evidence based national treatment guidelines. The study must determine that the diagnostic evaluation is adequate and the treatment plan is concordant with a recognized guideline. Source: Review of a single treatment (radiation) for a specific cancer site (prostate) Conducted by Dr. Dinchman, Cancer Committee Chair Urology Study Data: 2012 2013 prostate cases Stage II receiving radiation therapy @ MRMC (37 total cases). Exempt: 1 Case low risk group PSA 3.7 Gleason Score 6 Stage Group 2A. These 36 patients comprise two recurrence risk groups as follows: Intermediate risk of recurrence: 25 patients and High risk of recurrence: 11 patients Elements reviewed included: prognostic factors PSA and Gleason Score, treatment recommendations, hormones if applicable, radiation treatment modalities delivered, and clinical staging. Assessment: The treatment plans developed by MRMC Radiation Oncologists for each case were reviewed and all treatment recommendations were found to be concordant with the NCCN Clinical Practice Guidelines in Oncology. Evaluation of these patients included all prognostic work up and treatments.

2014 PROSTATE SCREENINGS PROSTATE CANCER SCREENING Needs assessment: Higher than state and national average in the 70 79 age group for prostate cancer Lorain County Incidence of Cancer, 2007 Prostate: 232 cases (15%) DATE ATTENDANCE PROGRAM EVENT COLLABORATION January 2014 10 PSA Screening February 2014 32 PSA Screening March 2014 47 PSA Screening April 2014 22 PSA Screening May 2014 31 PSA Screening June 2014 17 PSA Screening July 2014 11 PSA Screening August 2014 20 PSA Screening September 2014 70 PSA Screening October 2014 29 PSA Screening November 2014 20 PSA Screening December 2014 22 PSA Screening

THE CENTER FOR BODY, MIND & SPIRIT The Center helps patients and their family members learn new skills to refocus their lives as they cope with a cancer diagnosis. All of these services are free to anyone touched by cancer. Complementary and expressive therapy techniques can work in conjunction with conventional treatments to boost the immune system, decrease stress and provide spiritual nurturance and inner healing. We offer advice and support on addressing the challenges that arise for you and your family when you are being treated for cancer. We offer programs; support groups and classes that can help you reduce stress. We also offer gentle exercise classes that help boost your energy level and promote a sense of well being. Social workers: Our social workers are licensed through the State of Ohio. These health care professionals are available to help patients cope with the stress of the diagnosis and treatment of cancer. They provide supportive services to both you and your and family, assist you in finding support groups and/or other cancer related services. MERCY CANCER CENTER RADIATION ONCOLOGY Our radiation oncologists are certified by the American Board of Radiology. A radiation oncologist is a physician who specializes in treating cancer using radiation therapy, including high energy radiation and/or radioactive substances. A radiation oncologist will determine the precise type, dose and placement of radiation; administer the radiation; and monitor the number and length of treatments. Radiation therapy may come from a machine outside the body (external radiation) or from radioactive material placed directly into or near a tumor (internal radiation). Martin L Ribovich, MD, PhD is a board certified radiation oncologist. He received his medical degree from The Ohio State University and a doctorate in chemistry from the University of Wisconsin, at Madison. He is an Assistant Clinical Professor in the Department of Radiation Oncology at University Hospitals Case Medical Center, Cleveland, and previously worked at the Ireland Cancer Center at Firelands Regional Medical Center, Sandusky, Ohio. His post graduate education included residencies and fellowships in Columbus, Ohio. He has been treating patients at our facility since July, 2002.

Mehran Saboori, MD is a board certified radiation oncologist. He has worked at Mercy Cancer Center since April, 2013 and previously worked at the center in 2007. He is also employed at Chagrin Highlands UH Seidman Cancer Center, Beachwood. He is Assistant Clinical Professor, Radiation Oncology at Case Western Reserve University School of Medicine, Cleveland. He received his medical degree from New York Medical College, Valhalla, New York. He interned at Westchester Medical Center, Valhalla, New York and served residencies in Radiation Oncology at Westchester and at New York University Langone Medical Center and School of Medicine, New York. Areas of special interest Head & Neck Cancer and Prostate Cancer. David Mansur, MD is a board certified radiation oncologist. He received his medical degree from the University of Kansas School of Medicine, Wichita. He is an Associate Professor, in both the Radiation Oncology and Pediatrics departments of Case Western Reserve University School of Medicine, Cleveland. He is the Division Chief, Radiation Oncology at University Hospitals Rainbow Babies and Children s Hospital. He interned at the University of Kansas Medical Center and School of Medicine and served his residency at the University of Chicago Medical Center. Areas of special interest Brain Tumor Management, Gamma Knife Radiosurgery, Leukemia, Lymphoma and Pediatric Radiation Oncology. Albin Gonzalez, PhD DABR, chief medical physicist, implements the radiation safety protocols. He also provides oversight to staff members who calculate and deliver the correct dosage provided by the radiation oncologists. Dr. Gonzalez received his doctoral degree in Medical Physics from Vanderbilt University and is board certified to practice Therapeutic Radiologic Physics by the American Board of Radiology. HEMATOLOGY ONCOLOGY INC. Belagodu N. Kantharaj, MD who serves as the Medical Director of the Cancer Program, is board certified in internal medicine and medical oncology. He has practiced medicine in Lorain County since 1982. He is a graduate of Mysore Medical College, Mysore, Karnataka, India, and served residencies in Trenton, New Jersey, and Detroit, Michigan, before establishing his medical practice locally. Ruben S. Escuro, MD is board certified in internal medicine, hematology and medical oncology. He has practiced medicine in Lorain County since 1989. He earned his medical degree from the University of the Philippines and served internships and residencies in the Philippines and Buffalo, New York. He completed a fellowship at Case Western Reserve University, Cleveland, Ohio, before joining the Hematology Oncology Center, Inc.

Patrick P. Litam, MD is board certified in internal medicine, hematology and medical oncology. He has practiced medicine in Lorain County since 1997. He received his medical degree from the University of the East, Ramon Magsaysay Memorial Medical Center, Philippines. His postgraduate education included residencies and fellowships in the Philippines, M.D. Anderson Cancer Center, Houston, Texas; Sayre, Pennsylvania; Youngstown, Ohio; and Syracuse, New York. Before joining this practice, he also worked in Temple, Texas. Jay E. Sidloski, DO is board certified in internal medicine, hematology and medical oncology. He came to the cancer center in 2004 after completion of a fellowship program at The University of Iowa. He received his medical degree from the University of Osteopathic Medicine & Health Sciences, Des Moines, IO, and served internships and residencies in Sandusky and Cleveland. MERCY CANCER CENTER RESOURCES American Cancer Society (ACS) www.cancer.org American College of Surgeons (ACoS) http://www.facs.org/cancer/index.html College of American Pathologists www.cap.org American Joint Committee on Cancer (AJCC) www.cancerstaging.org National Cancer Institute (NCI) www.nci.nih.gov For information about the Mercy Cancer Center, please call 440 324 0400.