THE CANCER PROGRAM AT SOUTHERN OCEAN COUNTY HOSPITAL

THE CANCER PROGRAM AT SOUTHERN OCEAN COUNTY HOSPITAL 2008 ANNUAL REPORT 1

Table of Contents Section Title Page 1. Mission 3 2. Letter from the President 4 3. Letter from the Medical Director 5 4. Cancer Program Components 6 5. Cancer Committee Membership 9 6. Cancer Program Support Services 10 7. Summary of Cancer Registry Activities 12 8. Patient Care Study 16 9. Glossary of Terms 22 10. Bibliography 23 Tables 1. Demographic Information for Year 2008 12 2. 2008 Site Frequency Summary Analytic Cases 13 3. 2008 Top Cancer Sites 15 4. Wellness Programs Offered 20 2

The Cancer Program at Southern Ocean County Hospital Our Mission The Cancer Program at Southern Ocean County Hospital serves our community through prevention, detection, diagnosis and treatment. The Cancer Committee ensures that care is appropriate, patient and family centered, holistic and caring through a variety of quality focused activities. Approval by the American College of Surgeons (ACS) The cancer program at Southern Ocean County Hospital has been designated by The Commission on Cancer (COC) of the ACS, as a Community Hospital Cancer Program. This honor reflects Southern Ocean County Hospital s commitment to provide the highest standards of care through a multidisciplinary approach for individuals with cancer. The goal of the COC is to ensure cancer care that will improve the chances for cure and increased survival and quality of life for cancer patients, as well as promotion of programs to decrease the incidence of cancer. Affiliation with The Cancer Institute of New Jersey Southern Ocean County Hospital is proud of its status as a Clinical Research Affiliate of The Cancer Institute of New Jersey. The Cancer Institute of New Jersey is one of only 41 National Cancer Institute (NCI)-designated Comprehensive Cancer Centers in the nation the only one in New Jersey. The NCI awards this designation to organizations that have demonstrated a strong research base with the potential for transforming laboratory results into clinical application to reduce cancer incidence, morbidity and mortality. The Cancer Institute of New Jersey focuses on basic and clinical research, the newest treatments available only through clinical trials, as well as prevention and early detection programs. Through its affiliation with The Cancer Institute of New Jersey, Southern Ocean County Hospital can offer its patients the same state-of-the-art treatment they could receive at an NCIdesignated cancer center in New York or Philadelphia, right in their own neighborhood. This affiliation also assist Southern Ocean County Hospital with greater availability of clinical drug trials and research protocols that area patients can take advantage of without traveling outside of the Southern Ocean County Hospital community. 3

Letter from the President We are extremely proud of The Cancer Center at SOCH and the significant impact it has on the quality of life for cancer patients in our community and their families. The corner stones of our Cancer Center are innovation, expertise, compassion and hope. We offer our patients innovative treatment protocols designed to destroy cancerous tumors and ground breaking new medications that help patients cope with the side effects of chemotherapy. We offer sophisticated radiation therapies including Intensity Modulated Radiation Therapy and Image Guided Radiation Therapy which when combined provide the most precise and effective dose of radiation treatment. We offer Radiofrequency Ablation in our interventional center, which in some cases precludes the need for surgery. And our prestigious affiliation with The Cancer Institute of New Jersey assures that our have access to a large network of internationally renowned oncologists for consultations. Our impressive, multi-disciplinary team of expert medical and radiation oncologists, interventional radiologists, surgeons, certified oncology nurses, radiation therapists, nutritionists and support staff come together to provide our patients the highest quality, comprehensive compassionate care. Our surgical team includes experts in oncologic surgery, colorectal surgery and breast surgery. The Cancer Center at SOCH offers a wide array of diagnostic imaging capabilities designed to detect cancer at its earliest stage, when there is the best chance for successful treatment. From PET scanning and digital mammography to a Multi-Slice CT Scanner, MRI and a high resolution SPECT Camera our imaging technology give physicians excellent ability to view detailed images of the inside of the body. We also take a proactive approach to prevent cancers through many educational offerings at our Family Resource Center around lifestyle and nutrition that can actually help prevent certain types of cancers. And we offer a number of free or low-cost detection screenings throughout the year. Hope exists in new technologies, new drugs, successful treatments and the expertise of our medical staff. Hope exists in the exciting research that holds promise for new treatments on the horizon and through our affiliation with the Cancer Institute of New Jersey, SOCH brings the promise of clinical research close to home. And hope comes from the unrivaled caring and support provided by our staff and through special cancer support days and ongoing cancer support groups. It is with heartfelt pride that I present the 2008 Annual Report for The Cancer Center at SOCH. Sincerely, Joseph P. Coyle President and CEO, Southern Ocean County Hospital 4

Letter from the Medical Director The Cancer Center at SOCH is committed to maintaining the highest standard of care while providing a comprehensive and multidisciplinary approach to cancer treatment and prevention. From diagnosis, treatment both chemotherapy and radiation oncology, to surgery and cancer support services our program focuses on the comprehensive needs of our patients and their families. We our proud of our continued affiliation with The Cancer Institute of New Jersey (CINJ). Our alliance with New Jersey s only National Cancer Institute designated cancer center provides Southern Ocean County Hospital medical staff and patients access to the latest clinical trials and symposiums. Cancer prevention and early detection and community education continue to be a major focus of our program with emphasis in Breast, Colorectal and Lung Cancer. Wellness programs, Pastoral Care, Dietary Services, Social Services and Physical Therapy Services are several of the other important components of our program. I am proud to present this 2008 Annual Report on behalf of the Cancer Team at SOCH. It reflects the multidisciplinary efforts of the many physicians, hospital staff, administration and members of our community that made our program possible and ensures our ability to provide the highest quality, comprehensive cancer care to the residents of southern Ocean County. I want to thank the SOCH Medical Staff, nurses and all the others at SOCH including our volunteers who are dedicated to providing the highest level of care, support and comfort to our patients each and every day. And, on behalf of our entire Hospital family, I want to express our gratitude to our cancer patients and their families for their trust and support. I look forward to a future that continues to bring the best care, comfort and hope to our community. Sincerely, Paul K. Chung, MD 5

The Cancer Program at Southern Ocean County Hospital The Cancer Program at Southern Ocean County Hospital features state-of-the-art medical, surgical and radiation oncology along with customized chemotherapy services that blend the most advanced treatments with compassionate care and medical excellence. Oncologists, radiation oncologists and surgeons affiliated with the Hospital are board certified. Chemotherapy at Southern Ocean County Hospital is guided by oncology-and-chemotherapy certified nurses. In addition to treatment plans tailored to the patient's needs, the Cancer Program at Southern Ocean County Hospital also utilizes a multidisciplinary team approach to patient care as well as cancer survivor support groups, health screenings and community education programs based on our communities top cancer sites. The goal of the Cancer Program at Southern Ocean County Hospital is to provide the community with programs for prevention, early detection, and diagnosis and to offer the most up to date treatment, research, supportive care, education, and rehabilitation care modalities available. This mission is achieved by providing personalized treatment plans individually developed with the patient and their physician. Cancer Program Components Cancer Care Team The cancer program multidisciplinary team is comprised of physicians who specialize in diagnosis and treatment of cancer and professional staff including dieticians, social workers, nurses, pharmacists and a representative from the clergy. Under the leadership of staff Medical Oncologists Dr. Ruiz and Dr. Chung and Radiation Oncologists Dr. Coia, Dr. Lattanzi and Dr. D Ambrosio this team plans, executes and evaluates the effectiveness of the cancer care services at the hospital. Cancer Committee This is a multidisciplinary team of physicians and health professionals who meet four times per year to plan, implement and evaluate the effectiveness of the Cancer Program, Cancer program goals and Cancer related services provided by the Hospital. The Cancer Program Goals and Annual Report are developed and reviewed by the members of the Cancer Committee. Cancer Treatment Administration Patient specific chemotherapy, hydration, antibiotic therapy, blood and blood products are administered by chemotherapy and oncology certified nurses under the direction of the cancer program medical director in a dedicated outpatient oncology unit. The team also implements therapies and plans of care. The unit is under the direction of Dr. Ruiz a board certified in oncology, hematology, internal medicine and geriatrics. Inpatient cancer treatment is provided in patient rooms by registered nurses under the direction of oncology and chemotherapy certified nurses, with specialized education and training in the care of cancer patients. The Cancer treatments are family centered and a designated oncology education space supports the patient and family. 6

Cancer Support Groups The cancer support groups at Southern Ocean County Hospital are free of charge. The cancer patient, their family members and significant others are a very important part of the patient care team and are welcome to attend the support groups. Support groups include the cancer support days, which occur quarterly and two types of support system for breast cancer patients. The breast cancer survivor group meets the 2 nd Tuesday of each month and individual support by phone is provided for those patients who can t travel to the meeting place. Patient needs are being met through discussions and education provided at the group meetings. The participants choose the topics of discussion for education sessions. Community Education Programs and Health Screenings - Screenings, seminars and workshops are planned, designed and conducted through the Family Resource Center at the Ocean Club, Southern Ocean County Hospital and various locations throughout the community and year. The goals of the programs presented are to educate the community about the risks of cancer and provide information for cancer prevention and early detection. Presented programs focus on known high cancer volumes in SOCH s community such as breast, lung, prostate and colon cancers. Institutional Review Board - A multidisciplinary team of physicians and health professionals, as well as a community member, are available to review for approval research protocols presented by members of the medical staff. Medical Interventions Board certified physicians provide both inpatient and outpatient care in designated areas. Radiation Oncology- The department of Radiation Oncology continues to expand services to provide the highest quality of care to the patients of Southern Ocean County. The focus continues to be to expand the availability of clinical research trials both through the individual efforts of our physicians as well as through cooperative efforts with CINJ. Our initial success has been quite encouraging and we plan to continue to move forward promoting a multi-specialty approach to cancer care. Radiology The Diagnostic Imaging Department plays a vital role in caring for patients with cancer. All of the modalities provided by Board certified Radiologist. In addition, our Nuclear Medicine Department plays an important role not only in diagnosing but also in treating patients with thyroid cancer. We provide I -131 therapy, which is a treatment for this disease. Our Samarium program provides cancer patients with palliative treatment for cancer pain. State-of-the-Art Diagnostics The Radiology Department offers the most advanced mammography services, which are nationally accredited by the American College of Radiology. In addition, SOCH s Radiology Department features an array of advanced diagnostic imaging technology, including the following, which assist the referring physicians in assessing their patients for malignancies and the effect of treatments that the patients receive. High Resolution SPECT Camera: Provides 3-D images of the body. The super computer connected to the camera is capable of 64 million instructions per second, 7

allowing it to display the patient s internal organs as 3-D graphic images which can be rotated to any desired angle. Positron Emission Tomography (PET): A PET Scan creates images reflecting differences in glucose (or sugar) uptake between cancer cells and normal cells. By reflecting small changes at the cellular level, PET can detect disease earlier and provide information on whether the cancer has spread. Magnetic Resonance Imaging (MRI) Produces high-quality images of the brain, spine, joints and other organs to determine severity of patient injuries and conditions. Spiral CT Scanning: During a spiral CT, the x-ray machine rotates continuously around the body, following a spiral path to make cross-sectional pictures of the body. Surgical interventions Board certified surgeons and anesthesiologists provide inpatient and outpatient services in fully equipped operating suites. Tumor Board Conferences- These conferences are organized by the Medical Staff, Cancer Conference Chairperson and the Oncology Registrar; they provide a venue for learning, presentation and discussion of case studies. There were 12 conferences held in 2008 with a total of 42 cases presented, 100% were prospective cases, allowing for review of diagnostic work-up, staging and discussion of treatment options with specialist from CINJ. All patient care staff is encouraged to attend these educational meetings. Oncology Registry - A data base is maintained which compiles the diagnosis and treatment information of cancer patients treated at Southern Ocean County Hospital and is electronically transmitted to the NJ State Cancer Registry for tracking and trending of cancer occurrences. The data obtained through the tumor registrar assist in determining the top cancer sites diagnosed in SOCH s community. This information is then used in planning our education, prevention and early detection programs around these top sites. This database assists us to once again use education and early detection as the best protection/ammunition in the fight against cancer. 8

2008 Cancer Committee Physician Membership: Joseph P. Lattanzi, MD Victor G. Ruiz, MD Paul K Chung, MD Samuel Epstein, DO Thomas Feneran, MD Joseph Miller, MD Sergey Grachev, MD Edward Niewiadomski, MD Toby Tracy, MD Thomas Yu, MD Carlos Ricart, MD Chairman - Radiation Oncology Medical Oncologist Medical Oncologist (Liaison to The Commission on Cancer) Orthopedics Urology OB/GYN Surgery VP Medical Affairs Family Practice Radiology Pathology Non-Physician Membership: Catherine Korn RN,MSN VP Acute Care Services Barbara O Connor, RN Director of Oncology Services Jackie Scheffer Oncology Registrar Jane Masick RN,OCN OCN/Clinical Research Nurse Donna Reinbeck, RN Nurse Manager of Med-Surg 2 Michele DeNoia, RN Director of Performance Improvement Rev. James Occhipinti Pastoral Services Scott Sattan, PT Manager of Physical Therapy Carol Schoenberger RN Director of Community Education John Wolf, MSW Social Services Jason Plaia American Cancer Society Glen V. Bianchini, MHA, RPh. Director of Pharmacy Services A Representative from the Cancer Institute of New Jersey 9

Cancer Program Support Services Family Resource Center - The Family Resource Center at Southern Ocean County Hospital provides a wide variety of services for cancer patients and their families. The Family Resource Center is the core of Southern Ocean County Hospital s community wellness initiative. The Family resource center provides a wide variety of educational workshops, support groups and health screenings that reach more than 30,000 people each year. The Family Resource Center offers easy access to information on cancer and cancer prevention through a free lending library of books and videos as well as Internet access. The resource center is available whether it is helping someone learn more about prevention and screening, treatment options for prostate cancer or assisting a cancer survivor to join a support group. In addition, the Hospital s Oncology department and Oncology physicians continue to play a leadership role working with other healthcare professionals to host numerous educational lectures and workshops. The Oncology Department and Family Resource Center also continue to take part in numerous health fairs within southern Ocean County and serve as a reliable source of information on cancer prevention and the latest treatment options. Nursing Services - The nursing care of our oncology patient reflects the philosophy, standards and practice guidelines of the Oncology Nursing Society. The nursing care of both our inpatients and outpatients is guided by chemotherapy and oncology certified registered nurses. The nursing staff at Southern Ocean County Hospital maintains current knowledge and expertise through educational seminars and lectures on cancer prevention, treatment and care. The oncology nurses at Southern Ocean County Hospital work closely with the cancer patient and their family to assist them through this very challenging time. The practice of oncology nursing includes the roles of the direct caregiver, educator, coordinator, supervisor and researcher. Nutrition and Diet - The Southern Ocean County Hospital dietary department is part of the cancer treatment team. The Dietary Department is available to assist our patients through referral by our Oncology nurses. The Dietitians work with patients and their families to develop an individualized meal plan to help reach the optimal nutrition necessary to combat cancer and minimize the side effects of treatment. Spiritual Care - Spiritual care is a vital component of the cancer services provided by Southern Ocean County Hospital to cancer patients and their families. This program provides an opportunity for patients and families to call on the support of local clergy at any time during their course of inpatient and outpatient care. The goal is to reach out and touch those in need with love and compassion. Pharmacy - The professional goal of every staff pharmacist is to provide safe and therapeutically effective medications. Every chemotherapeutic preparation has been customized for each patient and is based on his or her own special and individual characteristics. Each chemotherapeutic medication order is reviewed by the pharmacist for correct dosing, adverse reactions, drug interactions, and appropriateness. Each order is double checked by another staff pharmacist prior to the compounding of the medications. All injectable medications are prepared in a sterile environment. To achieve these goals, the pharmacist works in concert with the oncology nurse and physician to insure patient safety. 10

Rehabilitative Services / Physical Therapy - The physical therapy department provides services for patients at Southern Ocean County Hospital. By providing both inpatient and outpatient care for these patients, we create an excellent continuum of care and smooth transition from hospital to home with emphasis on maximal functioning. Social Services - The Southern Ocean County Hospital Social Services Department is always available to assist our patients through referral by our Oncology nurses. All new patients are assessed during their first visit and throughout treatment for social services need. Referrals can include providing information concerning community resources that are available as well as referrals to assist patients and their families who need help coping with psychological aspects of their diagnosis. If indicated patients may be referred for home health or hospice services. Patients may be referred to the social service department through self-referral, physician, family or hospital staff. The department can be reached at 609-978-8900 ext. 2130. Southern Ocean Home Health and Hospice SOCH strives to extend the continuum of the health system by providing high quality, comprehensive services to the community. Over the past year Southern Ocean Home Health and Hospice has cared for patients with a diagnosis of cancer in nursing homes, assisted living facilities and the hospital, as well as in the comfort of their own homes. In hospice, the greatest challenge has been one of education. We have participated in the journey through grief program and have counseled families whose lives have been touched with this disease. SOCH s Hospice mission is for each patient to determine how he or she wants to live when faced with a terminal diagnosis. SOCH attempts to enable those who are being cared for to control all aspects of their life for as long as possible. Hospice works collaboratively with the physician to manage all symptoms as they occur. Many cards and letters from families expressing thanks us for all Hospice has done attests that the program meets our goals consistently. 11

Summary of Cancer Registry Activities All new cases of cancer, patients with a history of cancer and selected benign reportable tumors are electronically forwarded to the New Jersey State Registry on a monthly basis as required by law. In 2008 the registry accessioned and abstracted 508 cases into the registry: 352 Analytic and 156 Non-Analytic. Collected data includes patient demographics, diagnostic and/or treatment information. This component of the cancer program provides data to carefully monitor the cancer trends within the community. Physicians utilize this information in planning of community and professional education. It is also used as assessment for planning new or expanding services to ensure quality treatment and care is provided to our community. The Cancer Registry follows patients for a lifetime. In 2008 the follow-up rate for patients in the Cancer Registry was 98%. Cancer Registry Statistical Report The following graphical presentations are based on 508 cases accessioned in 2008: 1. Age at Diagnosis The mean age at diagnosis at this facility is 69 years old. 2. Gender Distribution 48% of the cases diagnosed here were male and 52 % were female. 3. Race Distribution 98% of the 508 cases diagnosed at Southern Ocean County Hospitals in 2008 were white. 2% of the cases were of other races. Table # 1: Demographic Information for Year 2008 Age at Diagnosis # Patients % 0-29 1.20 30-39 5.98 40-49 26 5.12 50-59 71 13.98 60-69 137 26.97 70-79 173 34.06 80-89 88 17.32 90+ 7 1.38 TOTAL 508 100 % Race/Ethnicity White 496 97.64 Black 4.79 Filipino 2.39 Other Asian 2.39 Other 1.20 Unknown 3.59 TOTAL 508 100% Gender Male 243 47.83 Female 265 52.17 TOTAL 508 100% 12

Table # 2: 2008 Site Frequency Summary Summary by Body System, Sex, Best CS/AJCC Stage Sex 13 Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Stg 0 Stg I Stg II Stg III Stg IV 88 Unk ORAL CAVITY & PHARYNX 7 (1.4%) 4 3 0 0 1 0 0 0 3 Tongue 2 (0.4%) 1 1 0 0 1 0 0 0 1 Salivary Glands 2 (0.4%) 1 1 0 0 0 0 0 0 0 Gum & Other Mouth 3 (0.6%) 2 1 0 0 0 0 0 0 2 DIGESTIVE SYSTEM 107 (21.1%) 53 54 4 11 19 14 26 1 13 Esophagus 13 (2.6%) 8 5 0 3 6 0 2 0 1 Stomach 8 (1.6%) 4 4 0 1 0 0 7 0 0 Colon Excluding Rectum 38 (7.5%) 18 20 2 4 4 7 9 1 6 Cecum 7 1 6 0 1 0 1 1 0 3 Appendix 2 1 1 0 0 0 1 0 0 0 Ascending Colon 10 5 5 1 1 3 1 2 1 1 Hepatic Flexure 1 1 0 0 0 0 1 0 0 0 Transverse Colon 4 3 1 0 1 1 1 0 0 1 Splenic Flexure 2 2 0 0 0 0 1 1 0 0 Sigmoid Colon 8 4 4 0 1 0 1 4 0 1 Large Intestine, NOS 4 1 3 1 0 0 0 1 0 0 Rectum & Rectosigmoid 20 (3.9%) 8 12 2 1 2 5 2 0 1 Rectosigmoid Junction 3 1 2 0 0 0 1 0 0 1 Rectum 17 7 10 2 1 2 4 2 0 0 Anus, Anal Canal & Anorectum 4 (0.8%) 2 2 0 0 2 1 0 0 1 Liver & Intrahepatic Bile Duct 4 (0.8%) 3 1 0 0 0 0 1 0 2 Gallbladder 2 (0.4%) 1 1 0 1 1 0 0 0 0 Other Biliary 1 (0.2%) 1 0 0 0 0 0 0 0 1 Pancreas 17 (3.3%) 8 9 0 1 4 1 5 0 1 RESPIRATORY SYSTEM 84 (16.5%) 48 36 0 10 3 13 30 1 3 Larynx 8 (1.6%) 5 3 0 1 1 1 1 0 0 Lung & Bronchus 76 (15.0%) 43 33 0 9 2 12 29 1 3 BONES & JOINTS 1 (0.2%) 1 0 0 0 0 0 0 0 0 Bones & Joints 1 (0.2%) 1 0 0 0 0 0 0 0 0 SOFT TISSUE 3 (0.6%) 2 1 0 0 0 0 1 0 1 Soft Tissue (including Heart) 3 (0.6%) 2 1 0 0 0 0 1 0 1 SKIN EXCLUDING BASAL & SQUAMOUS 17 (3.3%) 12 5 4 2 2 2 0 0 5 Melanoma -- Skin 16 (3.1%) 11 5 4 1 2 2 0 0 5 Other Nonepithelial Skin 1 (0.2%) 1 0 0 1 0 0 0 0 0 BASAL & SQUAMOUS SKIN 3 (0.6%) 2 1 0 0 0 0 0 0 0 Basal/Squamous cell carcinomas of Skin 3 (0.6%) 2 1 0 0 0 0 0 0 0 BREAST 111 (21.9%) 0 111 16 24 11 6 6 0 12 Breast 111 (21.9%) 0 111 16 24 11 6 6 0 12

Sex Stage Distribution - Analytic Cases Only Primary Site Total (%) M F Stg 0 Stg I Stg II Stg III Stg IV 88 Unk FEMALE GENITAL SYSTEM 17 (3.3%) 0 17 0 0 0 2 2 0 5 Cervix Uteri 1 (0.2%) 0 1 0 0 0 0 0 0 0 Corpus & Uterus, NOS 7 (1.4%) 0 7 0 0 0 0 1 0 3 Ovary 3 (0.6%) 0 3 0 0 0 1 1 0 1 Vagina 2 (0.4%) 0 2 0 0 0 1 0 0 0 Vulva 4 (0.8%) 0 4 0 0 0 0 0 0 1 MALE GENITAL SYSTEM 58 (11.4%) 58 0 0 1 10 0 0 0 1 Prostate 58 (11.4%) 58 0 0 1 10 0 0 0 1 URINARY SYSTEM 32 (6.3%) 25 7 11 9 0 2 4 0 1 Urinary Bladder 23 (4.5%) 20 3 10 7 0 0 3 0 1 Kidney & Renal Pelvis 7 (1.4%) 4 3 1 1 0 2 0 0 0 Ureter 2 (0.4%) 1 1 0 1 0 0 1 0 0 BRAIN & OTHER NERVOUS SYSTEM 4 (0.8%) 2 2 0 0 0 0 0 1 0 Brain 4 (0.8%) 2 2 0 0 0 0 0 1 0 ENDOCRINE SYSTEM 11 (2.2%) 6 5 0 1 3 3 1 0 1 Thyroid 9 (1.8%) 4 5 0 1 3 3 1 0 1 Other Endocrine (including Thymus) 2 (0.4%) 2 0 0 0 0 0 0 0 0 LYMPHOMAS 22 (4.3%) 12 10 0 6 0 4 4 0 2 Hodgkin Lymphoma 1 (0.2%) 0 1 0 1 0 0 0 0 0 Non-Hodgkin Lymphoma 21 (4.1%) 12 9 0 5 0 4 4 0 2 NHL - Nodal 18 11 7 0 3 0 3 4 0 2 NHL - Extranodal 3 1 2 0 2 0 1 0 0 0 MULTIPLE MYELOMA 7 (1.4%) 2 5 0 0 0 0 0 5 0 Multiple Myeloma 7 (1.4%) 2 5 0 0 0 0 0 5 0 LEUKEMIAS 6 (1.2%) 5 1 0 0 0 0 0 4 0 Lymphocytic Leukemia 4 (0.8%) 4 0 0 0 0 0 0 2 0 Myeloid & Monocytic Leukemia 2 (0.4%) 1 1 0 0 0 0 0 2 0 MISCELLANEOUS 18 (3.5%) 11 7 0 0 0 0 0 18 0 Miscellaneous Sites 18 (3.5%) 11 7 0 0 0 0 0 18 0 Total 508 243 265 35 64 49 46 74 30 47 14

Table # 3: 2008 Top 5 Cancer Sites at Southern Ocean County Hospital Compared to New Jersey and National Trends Site S.O.C.H. % New Jersey* % National* % Breast 111 21.9 6,310 13.74 184,450 12.8 Lung 76 15 6,210 13.52 215,020 14.96 Colon/Rectum 58 11.4 4,600 10.02 148,810 10.35 Prostate 58 11.4 5,090 11.08 186,320 12.96 Urinary Bladder 23 4.5 2,620 5.70 68,810 4.78 Lymphoma 22 4.3 2,210 4.81 74,340 5.17 *Estimated numbers gathered from Cancer Facts and Figures 2008 The above chart reflects a comparison of the top cancer sites at Southern Ocean County Hospital to the New Jersey and National trends of the same sites. The registry data was queried to determine our top five cancer sites listed in the table above. One is limited in establishing definitive conclusions about incidence in comparison with state and national trends given the small number of cases in the Hospital registry. The information obtained in the above chart shows the hospital staff and physicians where we should continue to focus our efforts on early detection and prevention. Using this data Southern Ocean County Hospital can plan Community Education Programs about early detection, prevention, treatment and screenings of its top cancer sites. 15

Patient Care Study: Cancer of the Colon and Rectum: A Five Year Survival Study as Compared to the National Cancer Data Base By: Dr. Paul K.Chung and Linnette Frey, CTR A Patient Care Study is the review of the risk factors, prevention, possible symptoms, diagnosis and treatment techniques of a common cancer site at SOCH. The site to be reviewed is discussed at and selected by the Cancer Committee. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society's most recent estimates for the number of colorectal cancer cases in the United States are for 2009: 106,100 new cases of colon cancer (52,010 in men and 54,090 in women) 40,870 new cases of rectal cancer (23,580 in men and 17,290 in women) The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping for more than 20 years. There are a number of likely reasons for this. One is that polyps are being found by screening and removed before they can develop into cancers. Screening is also allowing more colorectal cancers to be found earlier when the disease is easier to cure. In addition, treatment for colorectal cancer has improved over the last several years. As a result, there are now more than 1 million survivors of colorectal cancer in the United States. The main risk factors for the development of colorectal cancer include: 1. Older age 2. A personal or family history of colorectal cancer or polyps.. 3. History of inflammatory bowel disease 4. High fat and/or low fiber diet 5. Inherited Syndromes such as Familial Adenomatous Polyposis (FAP) Signs and Symptoms: change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days feeling that you need to have a bowel movement that is not relieved by doing so rectal bleeding, dark stools, or blood in the stool (often, though, the stool will look normal) cramping or abdominal (stomach area) pain weakness and fatigue 16

Early Detection is the Best Protection The incidence of survival in colorectal cancer, like all other cancers, shows a strong relationship with the stage of the cancer at the time of detection the more advanced the stage, the lower the survival rate. The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps keeps some people from getting colorectal cancer. Tests that have the best chance of finding both polyps and cancer are preferred if these tests are available to you and you are willing to have them. Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below: flexible sigmoidoscopy every 5 years* colonoscopy every 10 years double-contrast barium enema every 5 years* CT colonography (virtual colonoscopy) every 5 years* fecal occult blood test (FOBT) every year* *Colonoscopy should be done if test results are positive. Making treatment decisions The main types of treatment for colon cancer and rectal cancer are: surgery - removal of the tumor and nearby tissues, usually including lymph nodes. radiation therapy - use of high energy rays to kill cancer cells. Radiation may come from outside the body (external radiation therapy) or from putting material that contains radiation directly into the intestinal area (internal radiation therapy). chemotherapy - use of drugs that kill cancer cells throughout the body. targeted therapies - targeted drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. At this time, they are most often used either along with chemotherapy or by themselves if chemotherapy is no longer working. Depending on the stage of the cancer, 2 or more of these types of treatment may be combined at the same time or used after one another. Surgery is the primary treatment used in colorectal cancer. Neoadjuvent therapies (drugs or radiation used prior to surgery to shrink the tumor) and adjuvant therapies (drugs or radiation used after surgery to destroy minute cancer cells that may be left behind) are often used in conjunction with surgery. 17

Follow-up after Treatment for Colorectal Cancer A plan of regular follow-up exams after the diagnosis and treatment of colorectal cancer is recommended. Physicians discuss individual needs with each patient and a plan for his/her recommendation for follow-up after a diagnosis of and treatment for colorectal cancer. The following graphs reflect the survival rates of the SOCH Community (N=164) vs. that of the National Cancer Data Base (NCDB) (N=211,071) A review of the information found in the charts below, was done to analyze the survival rates in patients diagnosed with colorectal cancer at this hospital as compared to the survival rates of the NCDB. This is an all cause mortality study. Due to our high geriatric population and low N number this may not be a true representation of treatment outcomes. SOCH Survival 1998-2001 100 90 80 Percentage 70 60 50 40 30 20 10 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 0 Year 1 Year 2 Year 3 Year 4 Year 5 Survival Years 18

NCDB 5 Year Survival 1998-2001 Percentage 100 90 80 70 60 50 40 30 20 10 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 0 Year 1 Year 2 Year 3 Year 4 Year 5 Survival Years Overall 5 Year Survival by AJCC Stage SOCH vs. NCDB 1998-2001 90 80 70 78.5 74.9 60 64.9 63.9 Survival Rate 50 40 30 57.1 50 57.1 49.9 SOCH NCDB 20 10 0 5.9 6.6 Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage of Disease 19

The following graph reflects the first course of treatment provided to the SOCH Community (N=164) vs. that of the National Cancer Data Base (NCDB) (N=211,071) In a review of the patient charts, registry data and the graph below we found that 26 of the 164 patients were diagnosed at SOCH but treated elsewhere due to patient preference or family recommendation. Many of our patients have family out of the area that prefer they receive treatment closer to family. There were 138 remaining patients who were both diagnosed and treated at SOCH. In a review of these patient charts the first course of treatment provided by SOCH is in concordance with the NCCN guidelines. First Course of Treatment by AJCC Stage 1998-2001 30 25 Number of Patients 20 15 10 5 0 D D, C D, R, C D, S D, S, C D, S, C, H Stg 0 8 0 0 4 0 0 0 0 0 2 0 0 Stg I 11 0 0 24 0 0 0 0 0 11 0 0 Stg II 0 0 0 26 3 1 0 0 1 3 3 0 Stg III 0 0 0 13 7 0 1 1 2 6 2 1 Stg IV 7 2 1 5 9 0 0 0 0 4 5 1 D, S, C, I Treatment D, S, R D, S, R, C S S, C S, R, C Stg 0 Stg I Stg II Stg III Stg IV Treatment Legend: D = Diagnosis R = Radiation C = Chemotherapy H = Hormone S = Surgery I = Immunotherapy 20

Table # 5: Southern Ocean County Hospital Wellness Programs The following programs were offered by the Family Resource Center in 2008 Program Date Place Participants Tobbacco Program 2-Jan Mates School 25 Breast Health 14-Jan Brighton at Barnegat 32 Stop Smoking with Hypnosis 16-Jan FRC 26 Breast Health 17-Jan Crestwood 10 Colon Rectal Screening 24-Jan FRC 5 Tobacco Program 1-Feb Pinelands Middle School 319 Breast Health 5-Mar St Francis Nutrition Site 16 Breast Health 13-Mar Lanoka Harbor Nutrition Site 33 Colon Rectal 13-Mar Men's health Night 52 Tobbocco Health 18-Mar SRHS 252 Skin Cancer Awareness 18-Mar SRHS 252 Breast Health 19-Mar West Creek Nutrition Site 22 Colon Rectal Screening 26-Mar FRC 15 Choose to Be Tobacco Free 2-Apr CAT Coalition 1042 Tobbaco Health 4-Apr Pinelands Middle School 156 Skin Cancer Awaness 4-Apr Pinelands Middle School 156 Cancer Support Day 9-Apr SOCH 31 Head and Neck Cancer Screening 24-Apr FRC 10 Colon Rectal 15-May FRC 9 Breast Health 28-May Park Plaza 22 Breast Health 9-Jun Stafford by the Bay 9 Breast Health 11-Jun Crestwood 17 SOCH Cancer Outreach 19-Jun NJ Cancer Institute 10 Choose Your Cover (Skin Cancer Screening) 2-Aug Ship Bottom 180 Breast Health 19-Aug Tuckerton Church 29 Colon Rectal Screening 27-Aug FRC 14 Breast Health 2-Sep Perry lakes 35 Skin Cancer Screening 6-Sep St. Francis Health Fair 38 Stop Smoking with Hypnosis 17-Sep FRC 12 Breast Health 1-Oct Pheasant Run 2 19 Breast Health 8-Oct Soropitimist 22 Breast Health 14-Oct Atlantic Hills 35 Breast Health 17-Oct Mystic Shores 6 Breast Health 21-Oct Heritage Bay 12 Colon Rectal 22-Oct Women's Health Night 145 Pap Smears 22-Oct Women's Health Night 56 Breast Health 22-Oct Women's Health Night 55 Tabacco Progrqam 19-Nov SRMS 450 Tabacco Progrqam 28-Nov McKinley School 358 Breast Health Luncheon 24-Oct SOCH 48 Prostate Health 30-Oct FRC 25 Cancer Update 14-Nov SOCH 12 Stop Smoking with Hypnosis 19-Nov FRC 7 Breast Health 10-Nov Brighton at Barnegat 26 Breast Health 11-Nov Pheasant Run 1 43 21

Support Groups Breast Cancer Cancer Support Day Ostomy Support Members of Southern Ocean County Hospital Staff participate in: American Cancer Society Board Communities Against Tobacco Relay For Life Ocean County Cancer Coalition NJ CEED Komen Grant 22

Glossary of Terms: 1. Accessioned - All information regarding demographics, follow-up contacts, employment, presenting symptoms, diagnosis, first course of treatment and following physicians are obtained from the medical record and entered into an abstract on that patient. 2. AJCC Staging (American Joint Committee on Cancer) A method of grouping patients based on tumor growth, lymph node involvement, and presence or absence of distant metastasis to determine treatment and prognosis. 3. CA 19-9 is another general tumor marker found in many cancers of the GI tract including pancreatic and stomach cancers. The CA 19-9 tumor marker is best used to track response to treatment in pancreatic cancer. 4. CEA (carcinoembryonic antigen) is a tumor marker found in many cancers of the GI tract. It is not specific to any one type of cancer so it cannot be used to screen people for a particular type of cancer. People with colorectal cancer whose CEA levels are high at the time of diagnosis may have an increased chance of the cancer returning after surgery. Serial testing of CEA can help a doctor track how well treatment is working. After treatment ends, follow up CEA test can help detect a cancer recurrence. A high CEA level can be a sign that the cancer has spread to the liver. 5. Class of Case: A determination of the patient s diagnostic and treatment status upon first being seen at the facility. Analytic A case, which is diagnosed, and all or part of the first course of treatment is administered at the facility. Non-Analytic A case which is diagnosed and treated elsewhere before coming to the facility and/or diagnosed prior to the facility s reference date. 6. Metastasized - Means the cancer has spread beyond the original site to other parts of the body. 7. Stage of disease The AJCC stages I, II, III, or IV of cancer corresponds to the tumor size and/or depth of invasion, nodal involvement and distant metastasis. 8. Unknown/ Unstageable Tumor is said to be unknown when a stage cannot be determined from the medical record or a medical authority or primary site does not apply to AJCC stage criteria. 23

Bibliography: Cancer Facts and Figures 2009 American Cancer Society- Atlanta, GA. American Cancer Society Website (www.cancer.org) National Cancer Data Base (NCDB) 1998 2001 Copyright by the American College of Surgeons, Chicago Ill.(internet source) Manual for the Staging of Cancer 6 th Edition Standards of the Commission on Cancer Volumes I & II SEER Summary Stage 24