2010 joint cancer program annual report

Chairman Report………………………………………..………….……………………………………page 3

Breast Cancer Report……………………………………………………………...…...............page 4-5

CHRISTUS St. Michael Health System Report……..……….………..…………………..page 6-7

Pancreatic Cancer Report……………..............................................................page 8-9

A Survivor’s Story……………..…………………..…………………………………………………..page 10

Wadley Regional Medical Center Report……………….………………….……………….page 11

Joint Cancer Program Moderators……………………………………………………………..page 12

Community Breast Cancer Education………………………………………………………….page 13

Joint Cancer Committee……………….…………………………………………………………….page 14

Cancer Registry Report……………………………………………………………………………..page 15

t is my pleasure to introduce the 2010 Cancer

Program Report. The Cancer Registry is the

workhorse of the Joint Cancer Program of CHRISTUS

St. Michael Health System and Wadley Regional Medical

Center and has maintained Accreditation of the

Commission on Cancer (CoC) as an Approved Community

Comprehensive Cancer Program since 1989.

In 2010, the survey by the CoC was the primary focus

of the registry. Much hard work and preparation were

rewarded by a CoC Three-Year Accreditation Award.

Both CHRISTUS St. Michael and Wadley Regional Medical

Center received multiple areas of commendation. In the

Performance Report for each hospital, Dr. Marvin Lopez,

the CoC surveyor, was very complimentary of the cancer

registry staff and our Joint Cancer Program.

Please take time to review the cancer statistics and

analysis for our community. Pancreatic and breast

cancer are featured in the 2010 report. I extend my

thanks to Dr. Ranga Balasekaran and Dr. J.D. Patel for

their accompanying articles.

On behalf of the Joint Cancer Committee, I wish to

express appreciation to Mrs. Dianne Ketchum and her

cancer registry staff for all the hard work resulting in the

production of this report.

reast cancer is the most common site of cancer

seen in women in Texarkana in 2010. This cancer

totals 37% of the total cancers seen at CHRISTUS

St. Michael and Wadley Regional Medical Center. Exclud-

ing cancers of the skin, breast cancer, accounting for

nearly 1 in 4 cancers in women, is the most common

cancer among women in the U.S.

Local statistics on breast cancer have revealed 1,014

female breast cancer cases in the last five years, with

14 cases being males. There were 83% early stage

and 14% late stage cancers, and 3% unknown/not

applicable stage. Distribution of cases by race were

79% Caucasian, 20% African-American women and

1% other in 2010.

Breast cancer incidence and death rates gen-

erally increase with age. According to the Ameri-

can Cancer Society (ACS), 95% of new cases and

97% of breast cancer deaths occurred in women

aged 40 and older. White women have a higher inci-

dence of breast cancer than African American women

beginning at age 45. In contrast, African American

women have a higher incidence rate before age 45 and

are more likely to die from breast cancer at every age.

Besides being female, age is the most important risk fac-

tor for breast cancer. Figure 1 shows a woman’s risk of

being diagnosed with breast cancer at different ages.

Figure 2 represents local incidence trends by race and

stage at diagnosis in the years 2006-2010. This graph

suggests 84% of our cases are local-regional stage and

15% are Stage 3 and 4 cancers.

Many of the known breast cancer risk factors, such as

age, family history, age at first full-term pregnancy, early

menarche, late menopause, and breast density, are not

easily modifiable. However, other factors associated with

increased breast cancer risk (postmenopausal obesity,

use of combined estrogen and progestin menopausal

hormones, alcohol consumption, and physical inactivity)

are modifiable.

Gene expression analysis has led to the identifi-

cation of molecularly defined subtypes of breast

cancer that are distinct biological features, clinical

outcomes, and responses to chemotherapy.

Treatment strategies are now being developed

based on an individual’s tumor characteristics .

A patient’s response to chemotherapy is influ-

enced not only by the tumor’s genetic charac-

teristics but also by inherited genetic variations

that affect a person’s ability to absorb, metabo-

lize, and eliminate drugs. This new information has as-

sisted in the development of more effective and less

toxic chemotherapeutic agents.

For postmenopausal women with hormone receptor-

positive breast cancer, an aromatase inhibitor therapy

should be incorporated at some point during adjuvant

treatment. This treatment strategy reduces the risk of

breast cancer recurrence compared to five years of

tamoxifen alone. Figure 3 indicates when breast cancer is

diagnosed at its earliest stage, survival is excellent. Early

diagnosis is the key.

TABLE 1 1 Yr-Texarkana 1 Yr- NCDB 3 Yr-Texarkana 3 Yr- NCDB 5 Yr-Texarkana 5 Yr- NCDB

Stage I 98% 99% 93% 96% 88% 92%

Stage II 96% 98% 86% 91% 79% 85%

Stage III 92% 94% 76% 77% 49% 65%

Stage IV 67% 64% 38% 36% 23% 21%

>Approximately 207,090 new cases of in-vasive breast cancer in U.S. women were estimated in 2010 and 54,010 new cases of carcinoma in situ (CIS). >The American Cancer Society (ACS) esti-mated 39,840 breast cancer deaths in women in 2010. >ACS estimated 1,970 new cases of breast cancer in men in 2010. >Breast cancer is the most common form of cancer among women in the U.S., ex-cept for skin cancer. >Breast cancer ranks second among can-cer deaths in women, exceeded only by the number of lung cancer deaths in women, were expected to be 71,080 in 2010. >Inflammatory breast cancer (IBC) ac-counts for about 1% of all breast cancers diagnosed in the U.S. Sources: American Cancer Society Breast Cancer Facts and Figures,

2010. The American Society of Clinical Oncology Clinical Practice

Guideline; UAMS AHEC Southwest Cancer Registry database for CHRIS-

TUS St. Michael Health System and Wadley Regional Medical Center;

National Cancer Database, Commission on Cancer.

0%

10%

20%

30%

40%

Stage 0 Stage 1 Stage 2Stage 3

Stage 4

18% 26%

18%

6%

2%

4%

10%12%

1%0%

CSMHS & WRMC Breast Cancer by Race and AJCC Stage, Y2006-2010

Whites African-Am

0%

5%

10%

15%

20%

25%

30%

30-39 40-49 50-59 60-69 70-79 80-89 90+

5%

16%

22%

27%

18%

11%

2%

CSMHS & WRMC Breast Cancer by Age Distribution, Y2006-2010

Figure 1

Figure 2

ur mission, “To Extend the Healing Ministry of

Jesus Christ” means that each and every person

at the W. Temple Webber Cancer Center at

CHRISTUS St. Michael Health System takes great pride in

assuring that all of the needs of our patients are being

met – physically, emotionally and spiritually. We continu-

ally evaluate our services to enhance and innovate the

services provided to our patients and their families.

For three years in a row, we have maintained one

of the top patient satisfaction scores possible rank-

ing in the top 99th percentile of Cancer Centers in

the U.S. in the Press Ganey database. Even with

satisfaction scores such as these, we are still striving

to improve. Maintaining a vision of how our

services look from our customer’s view-

point, we realize there are always opportu-

nities for improvement. In 2010, three ar-

eas were targeted for improvements: ser-

vices, technology and facilities.

Our efforts are paying off. In the area of service, the

idea of providing our patients with one person who

would help “walk” through and navigate cancer care ser-

vices from diagnosis to survivorship is now a reality. Our

first Clinical Patient Navigator joined the Cancer Center

in July 2011. For well over 10 years, our social workers

have provided Diagnostic Patient Navigation and help

connect patients to diagnostic services in the area of

breast cancer. Working with the Texarkana Affiliate of

the Susan G. Komen for the Cure and the Texas Breast &

Cervical Cancer Services programs, we link underserved

and uninsured patients to resources for obtaining breast

and cervical cancer diagnostic services. Over the past

year, 647 screening mammograms were provided under

this service and 656 other diagnostic procedures were

performed.

Technology changes and innovations in the area of can-

cer treatment are constantly evolving in order to provide

the types of services our patients and their physicians

seek. High-dose rate radiation therapy was added in No-

vember 2010 at the Cancer Center at CHRISTUS St. Mi-

chael. Used for specific kinds of cancer, this specialized

therapy targets lung, gynecologic, and breast can-

cers.

In August 2011, our Chemotherapy and Radiation

received a much-needed expansion. This included

eight additional chemotherapy chairs and

specialized changing rooms for patients

undergoing radiation therapy. The Cancer

Center at CHRISTUS St. Michael is the first

and only cancer treatment center in our

service area with both an in-house Medical Oncologist

and Radiation Oncologist. This assures a higher level of

care for patients being served by both physicians and

provides direct and personal supervision by the Medical

Oncologist to patients receiving infusion services.

As we continue to plan for the future, our hopes are

that by 2012 we will be providing clinical research trials

to patients in our community. There will then be no need

to go to larger cancer centers away from home for these

services. Helping our patient stay close to home with

their loved ones and receive the type of health care

needed and guided by Our Mission drives us to seek ex-

cellence each and every day.

ancreatic cancer is a devastating disease that is

the fourth leading cause of cancer-related death

in the U.S. It is an insidious disease that is often

only discovered at advanced stages. Surgical re-

section is the only potentially curative treatment, but

unfortunately only 15 to 20 percent of patients are can-

didates for pancreatectomy due to the late presentation

of the disease.

More than 40,000 cases of pancreatic cancer are diag-

nosed annually in the U.S. It is rare before age 45 and

the mortality rates follow incidence rates because of

the poor prognosis. The national incidence is higher

in men and higher in blacks compared to whites and

other races. Figure 1 illustrates our local distribu-

tion of pancreatic cancer diagnosed at both

local hospitals based on race and stage.

There were a total of 103 cases diagnosed

locally for the five-year period of 2006 to

2010. The majority were unresectable with

advanced stage at the time of diagnosis.

Figure 2 illustrates the local distribution of

pancreatic cancer based on age and gender. Locally,

there were slightly more women than men diagnosed

with pancreatic cancer for this time period.

The major risk factors include smoking, hereditary pre-

disposition to pancreatic cancer, chronic pancreatitis and

diabetes. Most patients present with pain, weight loss or

jaundice. The majority of patients have unresectable

disease by the time symptoms occur and the diagnosis is

made. The most common sites of distant metastases

include the liver, peritoneum, lungs and also bone. CA 19

-9 is a serum tumor marker that is frequently elevated in

pancreatic cancer and can be useful in monitoring for

recurrence after potentially curative surgery. Patients

are considered resectable if they demonstrate no distant

metastases, no radiographic evidence of superior mesen-

teric vein and portal vein abutment, distortion, tumor

thrombus or venous encasement, and clear fat planes

around the celiac axis, hepatic artery and superior mes-

enteric artery. Endoscopic ultrasound (EUS), which is not

available in our community, is the most accurate modal-

ity for local T and N staging and predicting vascular inva-

sion. EUS guided fine needle aspiration biopsy is the best

modality for obtaining tissue diagnosis. CT scanning will

evaluate for distant metastasis and complement EUS for

determining resectability. Those rare patients that

qualify for surgery are referred to tertiary centers

with pancreatic surgeons for their surgery. Adjuvant

concurrent chemoradiotherapy is recommended for

all patients with resected pancreatic cancer.

Neoadjuvant chemoradiotherapy can be

considered in the setting of clinical trials.

For those patients that are unresectable

and have a good performance status, sys-

temic chemotherapy provides benefit

with improving disease-related symptoms

and up to a 4 month survival benefit when

compared to best supportive care alone. ERCP is avail-

able in our community for those that require relief of

biliary obstruction for palliation. Table 1 illustrates the 1-

year, 3-year and 5-year survival rates for patients locally

and nationally with pancreatic cancer by stage. The local

survival rate is less than national rate for all stages of

disease for 3-year and 5-year survival, but the number of

patients in these groups is too small to make any infer-

ences.

Pancreatic cancer is an insidious devastating cancer

that is often discovered at advanced stages. Long term

prognosis is dismal even after potentially curative resec-

tion and chemoradiotherapy.

TABLE 1 1 YR-Texarkana 1 YR- NCDB 3 YR-Texarkana 3 YR- NCDB 5 YR- Texarkana 5 YR- NCDB

Stage I 60% 46.6% 20% 21.2% 20% 15.7%

Stage II 44.4% 50.3% 11.1% 16.3% 11.1% 9.2%

Stage III 50% 33% 0% 4.9% 0% 2.5%

Stage IV 9.4% 12.1% 3.1% 2.2% .3.1% 1.3%

*Data Sources: National Cancer Database by [email protected]; UAMS AHEC-SW Cancer Registry Y2003-2007; CHRISTUS St. Michael Health System & Wadley Regional Medical Center

Figure 1

Figure 2

>An estimated 44,030 Americans will be diag-

nosed with pancreatic cancer in the U.S. and

over 37,660 will die from the disease.

>Pancreatic cancer is one of the few cancers

for which survival has not improved substan-

tially over nearly 40 years.

>Pancreatic cancer has the highest mortality

rate of all major cancers.

>74% of patients die within the first year of

diagnosis.

>94% of pancreatic cancer patients will die

within five years of diagnosis. Only 6% will

survive more than five years.

Average life expectancy after diagnosis with

metastatic disease is just three to six months.

There are no detection tools to diagnose pan-

creatic cancer in its early stages when surgical

removal of the tumor is still possible. The Na-

tional Cancer Institute (NCI) spent an esti-

mated $97.1 million on pancreatic cancer

research in 2010. This represents a mere 2%

of the NCI’s $5billion cancer research budget

for that year.

Source for statistics: American Cancer Society

eanette Akin, RN, MS, Chief Nursing Officer at

Wadley Regional Medical Center, knows first hand

what it feels like to hear that scary phrase, “you’ve

got cancer.” On Friday, January 29, 2011, Jeanette

began to have severe chest pain and was suspi-

cious of either a gallbladder attack or heart attack. Either

way, she knew that she needed to get to the Emergency

Room at Wadley. After initial treatment in the ER, she

was admitted to the Telemetry Unit for further testing.

By Saturday morning, the cardiologist had assured

her that it was not her heart. “I was feeling much

better until the routine gallbladder test showed an

unexpected finding of a mass on my right kidney,”

Jeanette recalls. “Within minutes of having the test

performed, my physician came in to tell me while I

did have a problem with my gallbladder, the bigger

problem was that I had kidney cancer.”

As a trained nurse, Jeanette knew her

symptoms pointed toward a gallbladder

problem since heart issues had been ruled

out and she was expecting surgery. The

mass on her right kidney, however, was a total surprise.

“My twin sister, Jennifer, was sitting by my bed when I

was told and she immediately grabbed my hand. I could

see the shock on her face and the tears in her eyes. Al-

though I was shocked, I moved quickly from shock to

acceptance because having worked with the involved

radiologists and physicians for years, I had absolute con-

fidence in their diagnosis and treatment plan.”

Being a person of faith, Jeanette’s first response was to

pray. As it always had before and still does every day,

this provided her with a sense of peace and comfort and

helped her to move on to the next thing….telling family

and close friends. Having a large extended family in the

Texarkana area, Jeanette knew this news would spread

rapidly once it was shared. “I knew I had to call my son,

Chris, in New York before a “tweet” went out from one

of my extended family or my church’s prayer chain. I

needed Jennifer to tell my mother and brother in person.

I needed to call my boss. It was all coming so fast, all the

things I needed to do.”

Having worked with physicians in the community for

almost 39 years, Jeanette knew that she would be in

good hands right here in Texarkana at Wadley. By the

middle of Saturday afternoon, the plan was com-

ing together. Dr. Sorenson and Dr. Parham had

coordinated their schedules to remove her gall-

bladder and kidney on the following Tuesday. “My

son and his family had a plane trip booked so they

could be here. As my daughter-in-law, Megan, put

it, ‘we want unfiltered information!’” she said.

By Tuesday evening, the surgery was

over and the wait began for the pathology

report. When the report came back, it was

good news – no evidence the cancer had

spread beyond the kidney. The follow-up

radiology studies were also negative.

Jeanette’s philosophy on her cancer journey, “We all

face difficult times in our lives. Having faith in God and

being surrounded by people who love and care for us

makes those difficult times much easier to get through.

Today, I can say that I truly understand when someone

tells me they have been diagnosed with cancer, but be-

fore January 30, 2011, I could only imagine what they

were going through. I also have a better understanding

of the importance of support and resources that help

patients cope with cancer related illness and treatment.

Each day is a gift and I don’t take my good health for

granted. So for now, I continue my life’s journey, now as

a survivor.”

oward Morris, M.D. has been the Medical

Director of the Radiation Oncology depart-

ment at CHRISTUS St. Michael Health

System since May 1988. Dr. Morris has moder-

ated the cancer conferences and educational

conferences held at CHRISTUS St. Michael

on the second and fourth Friday of each

month since 1990. He is an Assistant

Professor at UAMS in Little Rock, Ark.,

and his specialty training is head & neck

and GYN . Dr. Morris is an active mem-

ber of the Joint Cancer Committee and has

served as Chairman in the past. He is the

Medical Advisor for the Texarkana Unit Ameri-

can Cancer Society and participates in the

annual Relay for Life activities. He is the

Commission on Cancer Liaison for

CHRISTUS St. Michael and promotes

the CoC initiatives at this facility.

Douglas Trippe, M.D., Radiologist

with Advanced Imaging, is the moderator of the

Wadley Cancer Conferences on the third Friday of

each month. Dr. Trippe is Medical Director of Wad-

ley Radiology and P.E.T. Imaging Center. His exper-

tise in the area of breast cancer diagnosis has en-

hanced the tumor board discussions at Wadley Re-

gional Medical Center.

George W. English, III, M.D., is a native of Philadel-

phia, Penn., where he completed his residencies

at the University of Pennsylvania and Thomas Jef-

ferson University Hospital. He is an AP/CP board

certified pathologist with fellowships in OB/GYN

and Perinatal Pathology as well as in Hematopa-

thology with Molecular Diagnostics and is

sub board certified in Hematology as

well as Coagulation Medicine. He is

President of Pathology Services of Tex-

arkana and Medical Director of Labora-

tories and Cancer Liaison Physician for

Wadley Regional Medical Center. Dr. English

gave the tumor board physicians a presenta-

tion on "Update on Molecular Diagnostics in

Breast Cancer with Prediction of Benefit from

Endocrine Therapy" in 2010. His presenta-

tion included explanations of the mo-

lecular classification and grading of

breast cancer and to explain Protei-

nomic and Genomic expressions of

breast cancer. Dr. English helped the participants to

understand the determination of a Recurrence Score

and its application and how to appreciate its influ-

ence on chemoendocrine predictive factors in treat-

ment of breast cancer.

We appreciate Dr. Morris, Dr. Trippe and Dr. Eng-

lish for their support in the Cancer Program and the

Joint Cancer Committee.

or the past four years, UAMS AHEC

Southwest and Texarkana College have co-

hosted the Texarkana Breast Health

Symposium to bring more breast cancer-

related education to area health care professions.

The one-day conference brings in local and

reg ional profess iona l

speakers who share their

knowledge and experience

with breast cancer.

Additionally, a breast cancer

survivor is invited to speak,

sharing personal experience

with the audience from the

patient perspective.

The symposium is

supported by a community

grant from the Susan G.

Komen for the Cure-

Texarkana Affiliate awarded

to UAMS AHEC Southwest for breast health

outreach, education and clinical services.

In addition to the symposium, other breast cancer

educations efforts are occurring in the Texarkana

area. The annual Susan G. Komen Race for the

Cure—the largest series of 5K runs/fitness walks in

the world—raises significant funds and awareness

for the fight against breast cancer, celebrates

breast cancer survivorship and honors those who

have lost their battle with the disease. Since its

inception in 1999, the Komen Texarkana Race for

the Cure has raised more the $4 million. Up to 75

percent of the funds raised at the Komen Race for

the Cure remain in the Komen Texarkana service

area to provide breast health screening, and

education for uninsured or underinsured women.

The remaining 25% goes to

fund national research to

discover the causes of breast

cancer and, ultimately, its

cures. For information about

Komen Texarkana Race for

the Cure, please call Terrie

Arnold, Executive Director, at

903-791-9585 or visit

www.komentexarkana.org.

The American Cancer

Society—Texarkana Unit staff

and volunteers are saving

lives and creating more

birthdays by helping people stay well, through

education and prevention messaging; by helping

people get well through programs and services such

as Reach to Recovery, a one-on-one support service

for breast cancer patients; free wigs and gas cards

and other services, by finding cures through

research; and by fighting back through advocacy

efforts at the local, state, and national level.

Contact us 24/7 at 1-800-227-2345 or visit us on-

line at www.cancer.org.

Mike Finley, MD, speaks during the 2011 Breast

Health Symposium held at Texarkana College.

J. Alan Solomon, MD, Chair

Collom & Carney Clinic

George W. English, III, MD

Pathology Services of Texarkana, LLP

Jack H. McCubbin, MD


Mike Finley, MD

CHRISTUS. St. Michael Health System

J. D. Patel, MD


Joe Robbins, MD

CHRISTUS St. Michael Health System

Bryan J. Griffin, MD


Howard Morris, MD


Robert Parham, MD


Chris McMillian, MD

Wadley Regional Medical Center

H. Anthony Tran, MD

New Hope Cancer Institute

Ranga Balasekaran, MD

Texarkana Gastroenterology

Dianne Ketchum, CTR

UAMS AHEC SW Cancer Registry

Donna Marlar, BAAS, LPN, CTR


Christy Dabbs


Tammy McKamie, MSN, RN, OCN


Kim Lewis, RN


Jena Teer, LSW


Jodie Martindale, RHIT


Gary Upp, MHSA


Tracy Wade, RHIA


Mike Jones, BS PHA


Dianne Greenhaw, RN


Turner Bratton, PharmD


Mary Miller, MSSW, LCSW


John Phillips, COO


he Joint Cancer Committee is composed of

medical oncologist, radiation oncologist,

diagnostic radiologist, pathologist,

pharmacy, social workers, administration,

quality improvement and oncology nurses. The

committee is multi-disciplinary and governs the

components of the cancer program to include the

cancer registry, patient care evaluations, clinical

oncology research and performance improvements.

The Joint Cancer Committee meets quarterly and

subcommittee members meet as needed to

accomplish the duties and responsibilities of this

committee. The UAMS AHEC Southwest Cancer

Registry staff would like to thank all the cancer

committee members for their support and

guidance during 2010.

he cancer registry, under the umbrella of

UAMS AHEC Southwest, has collected and

reported data for the past 21 years totaling

25,044 patients with a follow-up rate of

93% for both facilities. The cancer registry staff

accessioned 1,003 newly diagnosed cancer cases in

2010 for both facilities.

Our staff coordinated 37 tumor

board meetings and educational

conferences in 2010, with a total

of 116 case presentations at

CHRISTUS St. Michael Health

System (CSMHS) and Wadley

Regional Medical Center (WRMC).

One of the responsibilities of the

UAMS AHEC Southwest Cancer

Registry is to provide accurate and complete

information to cancer committee members,

physicians, administrators, the state registries and

the National Call for Data. The goal of the collection

of this data is to show improvements in patient

care and in patient outcomes.

Preparation for the Commission on Cancer survey

was the major focus for the cancer registry staff in

2010. Documentation of the components of the

cancer programs for WRMC and CSMHS to meet

the requirements set forth by the CoC resulted in

our seventh successful survey with commendations

for these institutions.

Education was another major focus for the cancer

registry staff in 2010 with revisions in the manuals

of the standard setters across the nation. Manuals

which were recently updated were the AJCC Cancer

Staging Manual, Collaborative Staging Manual, a

new Hematopoietic Database

Manual and Multiple Primary

Calculator.

All of the functions of a registry

are equally important in the

management of a successful

database that allows for the

analysis of data in a meaningful

manner. Current follow-up of

cancer patients is essential to the

survival analysis outcome data. The evaluation of

long-term studies identifies treatments which are

more effective to allow improved patient

outcomes.

I would like to add a “Big Thank You” to the tumor

board moderators, pathologists, radiologist and

physicians who present cases to the Cancer

Conferences held at WRMC and CSMHS each

week. Also appreciation is given to Donna Marlar

and Christy Dabbs for their excellent data collection

and dedication to the cancer program in Texarkana.

w w w . r u r a l h e a l t h . u a m s . e d u / a h e c s w

2010 joint cancer program annual report

Documents