2011 Cancer Program - Augusta Health


2011 Cancer Program - Augusta Health



Based on 2010 Statistics

Surgeons Providing Excellence in Breast Cancer Care

Donald C. Carmichael, MD, FACS

Specialty: General Surgery


Medical School Georgetown University

Residency Medical College of Georgia

Special Procedures & Interests:

Treatment of breast surgery and surgical oncology. Treatment of general, thoracic, and

laparoscopic surgery and endoscopy.

David W. Caulkins, MD

Specialty: General Surgery


Undergraduate School University of Richmond, BS Biology

Medical School Medical College of Virginia

Residency Medical College of Virginia

Certification(s) Board Certified General Surgery

Fellow American College of Surgeons

Special Procedures & Interests:

General and Laparoscopic Surgery, Surgical Treatment of Breast Cancer,

Thyroid Surgery

William L. Faulkenberry, II, MD, FACS

Specialty: General Surgery


Undergraduate School Virginia Polytechnic Institute

Medical School Eastern Virginia Medical School

Residency Eastern Virginia Medical School

Special Procedures & Interests:

Treatment of general and laparoscopic surgery and endoscopy.

William Blake McKibbin, MD

Specialty: General Surgery


Undergraduate School Auburn University

Medical School University of Alabama at Birmingham

Residency The Medical College of Georgia

Certification(s) Board certified by the American Board of Surgery

Fellow American College of Surgeons

Special Procedures & Interests:

General and Laproscopic Surgery Endoscopy

Colonoscopies Breast and Colon Cancer

Laparoscopic Antirefux procedures, laparoscopic hernia repairs, and laparscopic

gastrointestinal procedures

Single Incision Laparoscopic Surgery (SILS)

2011 Cancer Program


CANCER PROGRAM .................................................................................................................... ....


Message from the Chairman

Administrative Message

2011Cancer Committee Members

Tumor Board Activity

Augusta Health Cancer Center and Duke Medicine

Breast Center of Excellence

CLINICAL AND PATIENT SUPPORT SERVICES .................................................................. 8

Inpatient Medical Oncology

Outpatient Medical Oncology

Radiation Oncology

Pathology and Clinical Laboratory

Diagnostic Radiology/Imaging

Pharmacy Oncology Services

Rehabilitation Services

Lymphedema Clinic

Medical Nutrition Services

Nursing Treatment Center

Wound Healing Clinic

Augusta Community Care

The Shenandoah House

Hospice of Shenandoah

Home Health

Care Home Medical

Oncology Social Services

The Bridge Fund at Augusta Health Cancer Center

Breast Health Navigation Program

Patient and Family Education

Volunteer Services

Chaplaincy Program

PATIENT AND COMMUNITY OUTREACH ..........................................................................17

Community Wellness and Screenings

Waynesboro Extravaganza 5K/10K Race/Walk

Healthy Lifestyle Program at the Lifetime Fitness Center


American Cancer Society Report

Camp Dragonfl y

STATISTICS .....................................................................................................................................22

Cancer Registry

2010 Statistical Review

Kidney Study

Approved by the Augusta Health Cancer Committee on October 13, 2011.


This has been a

very active and

productive year

for the Cancer

Program at

Augusta Health.



Message from the Chairman

Robert Kyler, M.D.

Radiation Oncologist

This has been a very active and productive

year for the Cancer Program at Augusta

Health. First, we were accredited by the

National Accreditation Program for Breast

Centers (NAPBC) for our Breast Health Program.

This accomplishment is a tribute to

the hard work of those who serve on the

Breast Health Center of Excellence Committee

under the leadership of Dr. William

Thompson, its chairman, and Meg Shrader,

the Breast Navigator. The second milestone

was the establishment of our new relationship

with Duke Medicine, also discussed in

more detail in the Administrative Message.

The benefi ts of this affi liation will include

access to new cancer treatments and research,

a wider array of clinical trials, assurance

of high-quality care through the use of

protocols and standards of care developed

by Duke Medicine, and continuing education

and special training opportunities for

our physicians, nurses, technical staff and

pharmacists to ensure that Augusta Health’s

services remain among the best for a community

hospital. We are very excited about

the opportunities that this will bring for our

patients and providers.

Several new technologies have also become

available at Augusta Health, including radiofrequency

ablation (RFA) for treatment of

cancers in the liver, lung and bone in selected

cases, and “4D” CT scanning that allows

us to take the movement of some tumors

that occur with respiration into account

when planning radiation therapy.

Additionally, we continue to carry out the

activities mandated by the American College

of Surgeons Commission on Cancer for

ongoing approval of our Cancer Program,

including accurate registration of all new

cancer diagnoses, tracking and benchmarking

of our results, cancer screenings, and

ongoing education of those involved in delivering

care to patients and the community.

The addition of a new tumor registrar to our

team will help ensure that cancer cases continue

to be abstracted and data submitted

in a timely fashion.

The following pages describe the activities

of the Cancer Program and the Cancer

Committee over the past year. There is also

a report that provides a review of the incidence

of the cancers that were diagnosed

and treated at Augusta Health in 2010, as

well as a special report by Dr. Julie Plumbley

that reviews our experience with cancers of

the kidney.

Our Cancer Program continues to grow and

mature. The steps taken over the past year

will help to ensure its ongoing viability, and

improve our ability to provide the highest

possible level of cancer care to those who

live in this area.

Robert M. Kyler, M.D.

Chairman, Cancer Committee



Brad Johnson


Cancer Center

Augusta Health’s Cancer Program is on the move, with its eye on

taking services to the next level for the community. Cancer cases

continue to grow at Augusta Health—close to 900 new patients

a year now receive all or part of their oncology care at Augusta

Health. Because one in two men and one in three women are at

risk for developing cancer in their lifetime, Augusta Health has a

vision of patient-centered care that is comprehensive, compassionate

and coordinated.

In January, 2011, the Augusta Health Cancer Program—which

was already accredited by the American College of Surgeons

Commission on Cancer—became the fi rst hospital in the region

to receive accreditation from the National Accreditation Program

for Breast Centers (NAPBC). This accreditation is granted

only to those centers that undergo a rigorous evaluation and review

of performance and compliance with 27 evidence-based

standards of care. The closest accredited programs are in Winchester

and Richmond.

NAPBC accreditation is only awarded to centers who take a multidisciplinary,

team-oriented approach to breast cancer care that

is primarily achieved through breast cancer care conferences

and Breast Health Nurse Navigator. Instead of providing care in a

fragmented way, all of our medical specialties—pathology, radiology,

surgery, medical oncology and radiation oncology—are

involved in treating the patient. They review the cases together

and create a customized plan for each patient.

Augusta Health’s Breast Navigator is Meg Shrader. As Navigator,

Meg helps simplify the complex healthcare maze for each patient,

and lets them know they are not going through this alone.

She is a guide who is with them every step of the way.

In April, we began working with Duke Medicine as a Research

Affi liate, and then in September, Augusta Health became a full

Program Development Affi liate within the Duke Oncology Network.

The expanded affi liation will strengthen the clinical relationships

between the care providers in Augusta County and

the faculty and staff at Duke. The Duke Cancer Institute was one

of the original eight cancer centers funded by the National Cancer

Act in 1971, and received National Cancer Institute (NCI) des-

ignation as a Comprehensive Cancer Center in 1973. There are

no NCI designated Comprehensive Cancer Centers in Virginia.

Augusta Health was inspired by their vision to bring state-ofthe-art,

nationally ranked cancer care into local communities

and the infrastructure that supports 23 affi liate sites in six states.

Duke Oncology Network’s specialized knowledge in research,

quality clinical practice, program development and continuing

medical education leads to improved cancer care in communities

all over the Southeast. Additional benefi ts that Duke

Medicine brings to the table are innovative cancer education

initiatives for patients and families, patients access to clinical research

in the community and state-of-the-art cancer treatment

protocols close to home.

Another rapidly expanding and evolving area at our Cancer

Center is Survivorship and Supportive Care. National statistics

demonstrate that 66% of all cancer patients survive fi ve years

or more, and that number increases to 90% for those cancers

discovered at an earlier stage. To provide support to these survivors,

Augusta Health focuses on treating not just the disease,

but the whole person—with a team of dietitians, social workers,

recreational therapists, chaplains and fi tness regimens tailored

to cancer patients. Additionally, we have strengthened our

working relationship with the American Cancer Society over the

last year by re-starting some programs like Look Good, Feel Better

and Man-to-Man, as well as providing new off erings like Cancer

Resource Days. All enhancements have been received well

by patients, families and friends.

Augusta Health feels fortunate and humbled to be the preferred

choice in cancer care for so many referring physicians

and patients. And we are committed to providing comprehensive

quality oncology services for years to come. We encourage

you to take a few minutes to get to know us better by reading

the following pages, visiting our website and taking advantage

of our community outreach programs off ered throughout the


Brad Johnson

Director, Cancer Center

Janet P. Mangun, MSA


Medical Administration


Karen Clark, MT, MBA


Professional Services


2011 Cancer

Committee Members

Robert Kyler, M.D., Cancer Committee Chairman

William Thompson, M.D., ACoS Liaison, General Surgery

Julie Plumbley, M.D., Pathology, Registry Physician Advisor

Christopher Zazakos, Jr., M.D., Medical Oncology

Todd Wolf, M.D., Medical Oncology

Matthew Shapiro, M.D., Radiology

William Jones, M.D., Urology


Thomas Patterson, M.D., Family Practice and Palliative Care

Margaret Flather, M.D., Gynecology

Dr. Justina Ju, M.D., Gastroenterology

Kathleen Haden, RN, Oncology Nurse Practitioner

Leigh Anderson, LCSW, Oncology Social Services

Janet Mangun, MSA, VP Medical Administration

Kim Nelson, RN, Director, Inpatient Oncology Services

Karen Clark, MT, MBA, VP Professional Services

Brad Johnson, Director, Outpatient Oncology Services

Mary Beth Landes, MS, RD, CSO, Nutrition Services

Tammy Irby, RN, Director, Post Acute Care

Linda Gail Johnson, RN, Director, Community Wellness

Meg Shrader, RN, CBCN, Breast Health Navigator

Janet Reynolds, Community Manager, American Cancer Society

Clay Wilson, PharmD, BCOP, Pharmacy Oncology Services

Lee Phillips, Chaplaincy Program

Rader Dod, Director, Radiology Services

Erica Sabatini, BS, Cancer Registrar

Jessie Washington, CTR, Cancer Program Coordinator

Becky Cutlip, RN, BSN, OCN, CHPN, Research Coordinator


Tumor Board

Patient-focused Tumor Conference luncheons are held twice a

month for discussion of the most appropriate management of

current cancer patients. A multidisciplinary team of physicians

provides an open forum for participation and continuing medical

education. Didactic lectures presented by specialty physicians

cover a wide range of cancer sites and address current issues in

cancer care. One hundred fi fty one (151) cases were presented in

2010. Attendance at Tumor Conference averaged 29 total attendees,

with an average attendance by physicians of 19.

2 0 11 T U M O R B O A R D














Case Presentations

Case Presentations

Case Presentations

Case Presentations

Advances in Molecular

Diagnosis of Cancer

Case Presentations

Case Presentations

Case Presentations

Case Presentations

Fraction for whole breast irradiation:

ASTRO evidence based guidelines.

Case Presentations

Case Presentations

Augusta Health Cancer Center

and Duke Medicine –

A Collaborative Relationship –Working Together for Quality Care

The patient. That is at the heart of the Augusta

Health Cancer Center. The theme of

patient-centered care is a core value that

underlies all the care provided at the Augusta

Health Cancer Center. While quality and

professionalism are always emphasized, the

approach guiding every treatment plan developed,

every therapy provided and every

encounter with a patient or family is this:

What is best for the patient?

This patient-centered focus led to not one,

but two affi liations between the Augusta

Health Cancer Center and Duke Medicine in

2011. First, in April, Augusta Health Cancer

Center became a Research Affi liate of Duke

Medicine—providing patients with access

to oncology clinical trials, a key component

of the most advanced comprehensive care.

Then, in September, the relationship expanded

when Augusta Health Cancer Center

became a full Program Development Affi liate within the

Duke Oncology Network.

“Our relationship with Augusta Health is collaborative and

collegial, as we build toward cancer care for tomorrow,” says

Linda Sutton, MD, Medical Director of the Duke Oncology

Network. “Duke and Augusta Health share common values

in our approach to cancer care: we both want to ensure that

patients receive the best care possible, and that they receive

it in their local communities where they are surrounded by

family, friends and all things familiar and comforting at times

of stress.”

Together, the Augusta Health Cancer Center and Duke

Medicine focus on three areas—Patient Care, Quality Improvement

and Education-and take a comprehensive, multidisciplinary

approach to care. Benefi ts to Augusta Health’s

patients are access to new treatments and research; expert

care, close to home; access to national cooperative group

clinical trials and Duke-investigator initiated trials; and the

assurance of high quality care that includes protocols and

standards of care developed by Duke Medicine.

“Duke’s selection of Augusta Health as an affi liate is based

in part on the high quality of care patients were already receiving

at Augusta Health. We now hope to work in partnership

with the Augusta Health staff to identify opportunities


to expand cancer services and meet the challenges for improvement

and quality that will defi ne the care of patients in

the future. We do that by helping the physicians identify the

best resources for their patients, providing opportunities for

education at Duke, and helping to build the clinical resources

and research structure needed to support a top Oncology

program,” adds Dr. Sutton.

Karen Clark, Vice President of Professional Services of Augusta

Health concludes, “We began working with Duke

Medicine in April, and have been impressed with the progress

we’ve made to bring the expertise of the Duke Cancer

Institute’s clinical research and cancer treatment protocols

to our community. We are inspired by their vision to bring

state-of-the-art, nationally ranked cancer care into local

communities—including ours—through the Duke Oncology

Network. Their specialized knowledge in research, clinical

practice, program development and continuing medical

education lead to improved cancer care all over the Southeast,

but specifi cally here in Augusta County. This successful

relationship allows Augusta Health to provide our cancer

patients with the highest quality care while remaining a

community-owned hospital.”


National l Accredit Accreditation

Program gram for Bre Breast

Centers (NAPBC)

Dr. William Thompson,


ACoS S Physician


Chairman, man, Br Breast Center

of Excellence ellenc Committee

Accreditation by the National Accreditation

Program for Breast Centers (NAPBC)

for our breast health care at Augusta

Health was the culmination of several

years of planning and organization involving

all of the members of the clinical

team. At Augusta Health, we were fortunate

to already have a multi-disciplinary

approach and dedication to breast care

involving Radiology, Surgery, Pathology,

Radiation Oncology and Medical Oncology.

When the NAPBC certifi cation was

announced and the criteria to become a

designated program became available,

we found we were already doing nearly

everything listed. All that was needed

was a Navigator to help put it all together.

Meg Shrader RN came on board, the

Breast Center of Excellence Committee

was formed, and thanks to the hard work

of all involved we were successful in our

application for certifi cation. This certifi cation

provides the women in the community

the confi dence that if they are treated

here for breast cancer, they can be assured

that they are receiving the most up

to date care available anywhere. Augusta

Health’s multidisciplinary Breast Conference

meets twice a month and continues

to improve care by reviewing many cases

prospectively. This has already resulted in

changes in treatment that may not have

been considered if this forum were not

already in place. Going forward, Augusta

Health will continue to be dedicated to

caring for breast cancer, working on maintaining

our accreditation and improving

the entire process from screening to biopsy

to treatment.


Breast Center of Excellence

The Breast Center of Excellence Committee, chaired by Dr. William G.

Thompson, is a subcommittee of the Cancer Committee and provides the

breast program leadership for Augusta Health. The committee is comprised

of Medical Oncologists, Radiation Oncologists, Pathologists, Radiologists,

Surgeons, Plastic Surgeons, and Gynecologists, as well as our

Tumor Registrar, Breast Navigator, Cancer Center Director and representatives

from Hospital administration.

A major emphasis for 2010 was the pursuit of the National Accreditation

Program for Breast Centers Accreditation. Augusta Health was surveyed

on December 6, 2010 and received a Three-Year Full Accreditation. Dr. Terry

Sarantou, surveyor, had many positive comments about the program,


■ Regarding the Multidisciplinary Breast Conference: “Very good conference.

Engaged and cooperative discussion regarding prospective

care. The treating physicians have a good understanding of each others

expectations for optimal patient care.”

■ Regarding the Breast Program Leadership: “Dedicated physician and

ancillary support for breast program leadership.”

■ Regarding the Patient Navigator: “Navigator does an outstanding job

of organizing program, she is passionate about her program, I was

very impressed.”

■ Regarding the overall survey and the breast program at Augusta

Health: “I was very impressed with the survey. The staff was prepared

and professional. They do an outstanding job regarding patient care”.


Multidisciplinary breast conference:

Goal: Present 75% of the Stage 0, 1, and 2 breast cancers in a prospective


Augusta Health: 75% of all stage 0, 1, 2 breast cancers were

presented at multidisciplinary breast conference.

Breast conserving surgery:

National benchmark goal: At least 50% of all patients diagnosed with

early breast cancer (Stage 0, 1, 2) are off ered and/or treated with breast

conserving surgery.

Augusta Health: 97 % of patients were off ered breast conserving

surgery and 91% received breast conserving surgery.

Axillary sentinel lymph node biopsy:

Goal: Axillary sentinel lymph node biopsy is considered or performed for patients

with early stage breast cancer (Stage 1, 2) and compliance is evaluated

annually by the breast program leadership.

Augusta Health: 97% of patients had documented discussions

about axillary sentinel lymph node biopsies. 98% had axillary

sentinel lymph node biopsied performed.

Palpation-guided or image guided needle biopsy is the initial diagnostic

approach rather than open biopsy:

Augusta Health: 87% had palpation or image guided biopsy as

initial approach. 100% of those undergoing excisional biopsy

had the reason for open biopsy documented in the History and




1) Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving

breast conserving surgery for breast cancer:

Performance rate – Augusta Health 100%

Virginia 93.1%

American Cancer Society Division (South Atlantic) 90.2%

My Census Region (Southeast) 87.9%

My CoC Program Type (Comp) 88.3%

All CoC Approved Programs (All) 86.2%

2) Combined Chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women

under 70 with AJCC T1cN0M0, or Stage II or III hormone receptor negative breast cancer:

Performance rate – Augusta Health 100%

Virginia 90.7%

American Cancer Society Division (South Atlantic) 89.2%

My Census Region (Southeast) 87.4%

My CoC Program Type (Comp) 88.7%

All CoC Approved Programs (All) 87.1%

3) Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of

diagnosis for women with AJCC T1cN0M0, or Stage II or III hormone receptor positive breast cancer:

Performance rate – Augusta Health 97.7%

Virginia 87.4%

American Cancer Society Division (South Atlantic) 86.2%

My Census Region (Southeast) 82.3%

My CoC Program Type (Comp) 82.9%

All CoC Approved Programs (All) 81.0%



Clinical and Patient Support Services


The Inpatient Oncology Care Unit at August Health is an integral part of the cancer care provided to the community. This care

is provided to patients on the 3East Medical Unit. The nursing team includes registered nurses trained in the administration

of chemotherapy and the recognition and management of side eff ects, and provides patient and family education to meet

patient needs during the disease process and treatment.

In order to address the patients’ and families’ stress during hospitalization, there

is an interdisciplinary team approach to planning care for treatment and education.

The team includes social workers, case managers, dietitians, respiratory

therapists, physical therapists and other discipline in addition to the registered

nurses and nursing support.

On this unit, registered nurses complete chemotherapy courses and a competency

for quality standard of care management of patients receiving treatment

for cancer or care for associated complications of treatment or disease. This year

the unit sent Becky Cutlip to the 2011 Oncology Congress where she gained

re-certifi cation in the Biotherapy/Chemotherapy Course. The unit revised the Michelle Davis, RN – Terri Perkinson, RN

chemotherapy safe handling and administration training and then completed

competency training of all 32 registered nurses on the revision. The unit will continue to off er the Biotherapy/Chemotherapy

course twice a year to maintain staff competency in addition to other unit based education.


The Outpatient Medical Oncology Department at the Augusta Health Cancer Center provides multidisciplinary oncology/

hematology care—including a full spectrum of preventive, diagnostic, therapeutic and rehabilitative services required for

the care of cancer patients. In 2010, the department saw slightly more than eight hundred new oncology and hematology

patients and administered nearly eight thousand patient treatments.

The chemotherapy treatment area is comprised of 24-bays with views of the healing garden from many of the rooms. There is

a self-serve nutrition area with drinks and snacks adjacent to the treatment area. Lunch is served for those infusions that last

longer than a couple hours. A massage therapist is also available and off ers multiple techniques to decrease stress and anxiety

during this diffi cult time. The majority of the registered nurses in the outpatient unit are certifi ed through the Oncology Nursing

Society, and have completed the ONS Chemotherapy and Biotherapy course.

Medical decision-making for the Augusta Health medical oncology clinic is provided by board-certifi ed Hematologist-Oncologists

working in tandem with subspecialty-trained nurse practitioners. The clinical team has access to research trials

through Cancer and Leukemia Group B (CALGB), a national cooperative

of oncologists engaged in research and in trials in the pursuit of new

cancer treatments. Through Augusta Health’s affi liation with Duke Medicine

and the Duke Oncology Network (DON), there is access to the most

current clinical trials so Augusta Health can provide treatment options in

immunotherapy, hormonal therapy, monoclonal antibody therapy, conventional

chemotherapy, as well as many other exciting new modalities.


The Augusta Health Cancer Center also provides education to patients

about hereditary risk for developing disease, counsel about the benefi ts

and risks associated with genetic testing, and help in assessing and managing

disease risk based on genetic information. Testing for susceptibility

genes in breast and ovarian cancer syndrome and colon cancer are

available at Augusta Health, while genetic testing for other sites is coordinated

with major teaching facilities.


The Radiation Oncologists and staff at Augusta Health Cancer Center work as a team to ensure that patients are provided

with the information, care and support that is unique to their needs. During treatment, patients may be dealing with a great

deal of physical and emotional stress, and the staff realizes their responsibility to help patients understand and cope with the

illness by providing quality medical support services. The goal is to provide patients and those who care about them with a

complete and thorough understanding of the diagnosis and the treatment options available.

The highly trained team of diverse cancer specialists in this unit focuses on the full spectrum of oncology and its problems,

and includes board-certifi ed Radiation Oncologists, ONS certifi ed registered nurses, licensed radiation therapists, a certifi ed

medical dosimetrist, and a board certifi ed medical physicist.

In 2010, the totally digital department saw approximately three hundred-sixty new starts and administered over nine thousand

patient treatments in a calming environment with state-of-the-art technology. Around 60 percent of all cancer patients

will require radiation therapy during some phase of

their cancer care. Radiation treatments may be just one

part of an integrated (or a combined) cancer treatment

strategy involving other modalities of treatment including

surgery and chemotherapy.

The Augusta Health Radiation Therapy department utilizes

both IMRT (Intensity Modulated Radiation Therapy)

and IGRT (Image Guided Radiation Therapy).

IGRT technology is the most advanced therapy available,

allowing the treatment team to localize and view

the treatment target every day, while IMRT allows the

team to conform the dose of radiation more closely to

the target. Because tumors are three-dimensional, it is

important to map the radiation dose to the shape of the

tumor. IMRT enables the team to do this by modulating

or controlling the intensity of the radiation beam. More

accurate targeting allows us to decrease the radiation

dose to sensitive normal tissue, thus decreasing side effects

and improving outcomes, while making sure the

cancer gets the full treatment.

A state-of-the-art electronic medical record is used to

link all aspects of the medical history, diagnostic testing, treatment details, and follow-up information in a way that ensures a

seamless fl ow of information, and signifi cantly reduces the risk of medical errors. In fact, if any one treatment parameter out

of the hundred that play a part in the delivery of the treatment is not as it should be, the machine cannot be beamed-on. The

duration of treatment can vary by patient and type of cancer. However, the average patient receives radiation therapy treatments

daily over a period of two to eight weeks.


At the Augusta Health Cancer Center, the companion services of the Blue Ridge Pathology Department and the Augusta

Health Clinical Laboratories have essential roles in the diagnosis and treatment of cancer. The pathology department uses

state-of-the-art technology such as immunoperoxidase studies, fl ow cytometry and molecular testing to assure accuracy in

diagnosis and to provide vital prognostic information for the treating oncologists.

The pathologists are actively involved in Tumor Board discussions, where patients with malignancy are discussed in a multidisciplinary

fashion, to arrive at the best treatment plan for their cancers. All pathologists are skilled in the technique of fi ne

needle aspiration cytology and are readily available to perform these procedures when requested. The Blue Ridge Pathology

department off ers additional specialty expertise in the diagnosis of lymphomas and leukemia (hematopathology).



The fully accredited Augusta Health Clinical Laboratory off ers a comprehensive array of tests to patients and their physicians.

Virtually all routine hematology, blood chemistry, serology and microbiology tests are continuously available. For outpatient

convenience, specimen collection sites are located in Staunton, Waynesboro and across the street from the main hospital on

Goose Creek Road, as well as at the Augusta Health main lab. Commonly employed cancer screening and monitoring tests

such as PSA and CEA are performed daily. Less frequently utilized cancer markers are also available through a network of accredited

reference laboratories. The transfusion service (Blood Bank) maintains an inventory of red blood cells, platelets and

fresh frozen plasma suffi cient for routine and emergency needs. Special blood products such as irradiated components and

CMV negative units (which Oncology patients may require) can be obtained from our suppliers.

The Pathologists and the Clinical Laboratory staff are a team that works with oncologists, surgeons and others who treat

patients with malignancies. The duty of this lab “team” is to facilitate and maximize the diagnostic and healing process for



The Department of Radiology at Augusta Health provides state

of the art imaging tools for the diagnosis, staging and follow up

of cancer patients.

The Women’s Imaging Center provides excellent imaging in

the fi eld of Mammography with state-of-the-art digital Hologic

Selena imaging equipment. In September, the Women’s Imaging

Center brought Bone Density imaging to the leading edge by replacing

its system with the new “Hologic Discovery” system. The

Women’s Imaging Center continues to uphold the highest standards

from the Department of Health and Human Services Food

and Drug Administration through yearly inspection in accordance

with the Mammography Quality Standards Act (MQSA).

Augusta Health off ers convenient digital mammography screening at both Augusta Health and its Staunton Outpatient location.

This provides two convenient options for those in Augusta Health’s community to make timely

appointments for screening mammograms.

Rader Dod,BA,RTR

Director of Radiology

The Radiology Department off ers a wide range of noninvasive testing that includes CT, MRI, SPECT/

CT and PET/CT scanning. These tests off er valuable information for the diagnosis and staging of

disease. In September 2011, Augusta Health installed a new Siemens Aspree Ultra Short/Ultra Wide

Open Bore MRI magnet. This unit’s Bore width is 70cm wide which provides more comfort for larger

patients as well as those patients who tend to be claustrophobic.

The Radiology Department and the Women’s Imaging Center also provide a wide range of minimally

invasive techniques for diagnosis, biopsy and staging of tumors. Non-surgical breast biopsies

as well as image guided biopsies are off ered. Most of these biopsies can be done on an outpatient

basis for convenience to patients and minimal recovery time. In 2011, the Radiology Special Procedures

Department added a minimally invasive procedure called “Radio Frequency Ablation” (RFA).

RFA is used in treating certain small cell lung, liver, kidney

and bone tumors.

The Augusta Health Radiologists actively participate in the bi-monthly Tumor

Board and the monthly Multidisciplinary Breast Conferences and are readily available

to the medical staff for consultation.

Pharmacy Oncology Services

Pharmacy Oncology Services is dedicated to counseling, education, and communication

with all health care providers, and to oncology patients and their families.

Providing prompt, precise pharmaceutical products to patients is a top priority.


Nancy Williams, LPh and Clay Wilson, Pharm D

Inpatient, outpatient, and community prescriptions are provided through Augusta Health’s Pharmacy Oncology Services. An

automated computer data system provides the latest technology. The drug inventory is continuously reviewed. There is an

extensive oncology inventory approved by the Medical Staff to meet the needs of Oncology Services.


Augusta Health uses a multidisciplinary team approach when providing a continuum of care to patients with cancer. It is the

team’s goal to maximize the patient’s functional independence. The Therapies team consists of Occupational Therapy, Physical

Therapy, Recreation Therapy, and Speech/Language Pathology. Outpatient and Home Health Therapy services are also

provided. Some of the services off ered by therapists that are particularly appropriate for the cancer patient include, but are

not limited to, lymphedema therapy, energy conservation techniques, independent living skills, non-pharmaceutical pain

control, strengthening exercises and patient and family education.


Augusta Health off ers Outpatient Lymphedema Management to the oncology

population of Augusta County and its surrounding areas. In addition, limited lymphedema

services are now available to the in-patient oncology population as needed.

Lymphedema is a condition characterized by the development of protein rich fl uid

that causes swelling of one or more limbs, the hand and neck or the trunk. Primary

lymphedema may develop in infancy, childhood or as an early adult and is the result

of malformed lymph vessels. Secondary lymphedema may develop as the result of

damage to the lymphatic system following surgery, radiation or injury. In both cases,

the goal of the Augusta Health Lymphedema Clinic is to teach individuals and their

families how to successfully manage their lymphedema.

Augusta Health employs two certifi ed lymphedema therapists (Pam Vandevander,

OT, CLT and Heather MacDanel, OT, CLT) who utilize the Complete Decongestive

Therapy (CDT) approach to lymphedema management. This approach includes

two phases of treatment: Phase I is clinic–based and may include patient education,

compression bandaging, Manual Lymph drainage (MLD) and exercise. Phase II

is home-based where individuals continue with a home exercise program, compression

garments for day and compression bandaging at night along with ongoing skin

care. Pam Vandevander also completed an advanced training course in CDT through

the Norton School of Lymphatic Therapy in March, 2011.

Shawna Camden

Clinic hours are Monday- Friday from 8:00 – 5:00. The outpatient Lymphedema Clinic is located at Augusta Health’s Therapy @

the Lifetime Center along with other Physical, Occupational, and Speech Therapy services.

Mary Beth Landes, MS, Registered Dietitian


Early nutrition intervention is one of the most cost-eff ective cancer treatments

available. Nausea and vomiting, loss of appetite and mouth sores are

some of the many side eff ects to oncology treatment. Metabolism alterations

and competition for nutrients by the tumor add to the complexity of

a cancer patient’s nutritional needs.

All oncology patients are considered to be at risk for malnutrition and are

assessed by the oncology staff . The Augusta Health registered dietitian assesses

all in-patient oncology patients. The dietitian provides both outpatient

and inpatient nutritional support for patients through the use of diet,

medical nutritional supplements, tube feeding, and/or parental nutrition.



Registered Dietitians present several community and staff education sessions on cancer prevention and recommendations.

Augusta Health’s oncology dietitian is a Board Certifi ed Specialist in Oncology Nutrition, a member of the Cancer Committee,

and a member of the oncology multidisciplinary team.


The Nursing Treatment Center provides care to patients who need a nursing service but do not qualify for home health or inpatient

admission. Patients from the Augusta Health Cancer Center are able to receive such services as IV fl uid administration,

blood transfusions and injections in the Nursing Treatment Center.


The Augusta Health Wound Healing Clinic provides a team approach to the wound healing process, where the team treats not

only the wound, but also provides the specialists, education and support necessary to treat the underlying disease process.

The Wound Healing Clinic is a partnership with the patient’s primary care physician, and updates are provided to the physician

after each visit.

The Wound Healing Clinic

helps heal chronic, non-healing

wounds faster by treating

the cause and applying

evidence-based, medical and

surgical techniques that are

outcome focused and costeff

ective. Treatment methods


■ Advanced wound


■ Vacuum Assisted


■ Bioengineered Tissue

■ Debridement

■ Wraps to decrease

lower leg swelling

A physician on staff in the clinic

evaluates every patient, coordinating

with other medical

specialists as needed.

The team consists of wound care certifi ed nurses, nutritionists, physical therapists, diabetic educators and other resources for

a full continuum of care. Teamwork, coordinated care, advanced technologies and excellent outcomes are all found in one

convenient location.


Augusta Community Care is a division of Augusta Health and encompasses a wide range of services that includes Augusta

Health Hospice of the Shenandoah, Augusta Home Health and Care Home Medical. Augusta Community Care’s goal is to be

the provider of choice for any health-related services. Augusta Community Care works in partnership with Augusta Health

and its physicians and other health care professionals to provide community-based services of high quality, value and satisfaction.



The Shenandoah House is a home-like facility where care is

provided for patients who are at the end of life. The House was

a collaborative eff ort between the community and Augusta

Health. Home cooked meals, a warm fi replace, the smell of

fresh baked cookies and the opportunity to look out of a window

to see nature are all of the things the Shenandoah House

provides. The residence has four bedrooms that all have a cozy

appearance, like that of a bedroom in a private home. This year,

through October, 65 residents have been cared for at Shenandoah

House. The Hospice of the Shenandoah Community Advisory

Board provides for those who cannot aff ord to stay in the

home though a Gifted Care program funded by donations and

fund-raising events. Through October 2011, 64% of the care

given at the Shenandoah House was paid for by the Gifted Care




Augusta Health’s Hospice of the Shenandoah’s services are provided

to patients who choose comfort care and support at the

end of life. In order to qualify for these services, a doctor has to

state that the patient has a prognosis of 6 months or less. Hospice

of the Shenandoah provides care to both patients and their

families. The bereavement program provides support to patient

families for 13 months after the death of their loved ones. The

Hospice of the Shenandoah staff and the 150 volunteers, who give time and talents to the program, reside in the community.

In 2011, three new services were added to Hospice of the Shenandoah’s programs: Pet Visitation, Massage Therapy and a

special program for Veterans.


Augusta Home Health Care emphasizes family involvement to help designated care givers fi nd ways to manage the care of

the patient. Many therapies once provided in a hospital setting can be eff ectively managed at home.

Nurses in Home Care have completed extra training with the cooperation of the Oncology Department in the administration

of chemotherapy, providing better continuity of care between the hospital and home. Physical, Occupational and Speech

therapies are available through Augusta Home Health if the patient requires rehabilitation related to a decrease in functional

abilities. Social Services off ers help in resource management, support and problem solving. Home Health aides provide

per¬sonal care assistance for patients.

The patient’s nurse or on-call designee can be reached seven days a week, 24 hours a day for referrals or patient concerns.

Palliative care is now available for those patients who are not eligible for hospice. The patient is admitted as a home health

patient for symptom and pain management using the expertise of a hospice nurse as the care manager. Other hospice counseling

services are also available for these patients when identifi ed through the care planning process.


Augusta Health Care Home Medical provides respiratory and home medical equipment support by professional respiratory

therapists and skilled equipment technicians. Inventory includes a wide range of technologically advanced equipment and

supplies that meet virtually every home health care need. Quality products and services are fundamental to Care Home Medical—products

and services meet stringent quality medical standards established by regulatory and governmental agencies

such as The Joint Commission, Medicare and the Federal Drug Administration.



The Augusta Health Care Home Medical Retail Store off ers items for sale that are often prescribed by healthcare practitioners

or are available over the counter to handle a wide variety of healthcare needs such as convalescent aids and wound care and

ostomy products. Care Home Medical Retail Store also carries a full line of Mastectomy products for breast cancer patients.

Bras, prostheses and accessories are presented and fi tted in a private setting by certifi ed fi tters on staff . Fittings are done by



Augusta Health’s Social Services Department recognizes that

the needs of the cancer patient are multiple and complex, often

involving social, emotional, and fi nancial issues. To address

these needs along the continuum of care, a full-time social

worker is available weekdays during clinic hours. Counseling

and support groups are included among the services off ered to

cancer center patients and their immediate family members.

At this time, the following support groups are off ered:

■ Friends Listening to Friends (for newly diagnosed cancer

patients learning to live life during and after cancer


■ Lean on Me (cancer caregiver support group)

An on-call social worker is also available evenings and




Leigh Anderson, LCSW

Oncology Social Services

Cancer patients need excellent clinical care…and more. They need compassion, understanding and caring. But they also need

personalized help and assistance with those things that serve as barriers and obstacles to care. The Bridge Fund at Augusta

Health Cancer Center off ers a reassuring hand during this stressful and overwhelming time.

The purpose of the Bridge Fund is to lower anxieties and help ease burdens from the moment the patient enters the doors

of the Augusta Health Cancer Center. Many off erings were implemented directly from patient and family comments, suggestions

concerns and observations.

Patients benefi t from a combination of high quality, compassionate and coordinated healthcare services and services to help

“Bridge the Gap” to healing. The services provided by the Bridge Fund include:

■ Financial counseling, support and medication assistance

■ Wigs, Turbans, Scarves, and Skin care

■ Help and assistance with transportation: gas vouchers, taxi rides, and volunteer rides

■ Help and assistance with short-term housing

■ Help and assistance with getting aff ordable home medical equipment; wheelchair, walker, commode, or hospital bed

■ Dental needs as it relates to treatment; exams, extractions, and dentures

Cancer Resource Center and Lending Library



Meg Shrader, RN, BSN, CBCN is the Breast Navigator for Augusta Health. She is a

dedicated oncology nurse who coordinates all aspects of care and serves as a support

system for breast cancer patients from diagnosis through treatment. She acts

as a resource for patients, family, and the community on breast health issues and

treatment options. Meg also coordinates the multidisciplinary breast conference as

well as the NAPBC program.

Meg was awarded the inaugural Karin Decker Noss scholarship from the Virginia

Breast Cancer Foundation in May, 2010. The scholarship provides funds for breast

cancer advocates to attend breast cancer scientifi c meetings. Meg attended the

American Society of Clinical Oncology (ASCO) Breast Symposium in October, 2010,

Meg Shrader, RN, CBCN – Breast Health Navigator

and the ASCO annual meeting in 2011. She was chosen to review breast cancer

research grant proposals for the Congressionally Directed Medical Research Program in 2010.


The Augusta Health Cancer Center team realizes the diffi cult situation that people experience when given a cancer diagnosis,

so the team does do everything within its power to make patients and their loved ones feel as comfortable and at ease as

possible. The team’s duty is not to provide just the treatment necessary to win the battle, but to help remove the fear and

uncertainty that can accompany a cancer diagnosis, and replace fear with knowledge, compassion and hope. The educational

services provided to patients and support persons enable them to learn more about cancer care, chemotherapy and/or radiation

therapy and all the supportive care options that aid healing.

Augusta Health’s Cancer Center staff provides very individualized information and support to the patient and family members

based on patient needs, type and location of the cancer, and the therapy recommended. Through such eff orts, patients and

families are able to make more informed decisions and assume responsibility for their care.

In 2010, Augusta Health and the American Cancer Society joined forces to off er Cancer Resource Days. Cancer Resources Days

are scheduled two or three days each week in the Augusta Health Cancer Center’s waiting area. The space is dedicated to

providing people with information of all types and has a computer installed to do Web searches. An American Cancer Society

volunteer is available to off er personal assistance to help patients get the information they seek, connect with complementary

services available in the community, and support services to help them to cope and assist their loved ones.

Additionally, there are resources available in the Augusta Health Cancer Center that include books, pamphlets and videos/

dvds for patients and support persons to borrow or keep. Cancer Center staff is available to search for and obtain current

literature and other resource materials for patients and family members upon request.


The Offi ce of Volunteer Services coordinates volunteers and members of the Auxiliary of Augusta Health services on a weekly

basis in Medical Oncology and Radiation Oncology. Several volunteers also assist with periodic cancer screenings off ered by

the staff and physicians of the Augusta Health Cancer Center. The ongoing presence, compassion and eff orts of our Augusta

Health volunteers enhance the patient care and education off ered by this facility.


Augusta Health Volunteer Chaplains are experienced clergy and members of the hospital team. They are trained listeners,

ready to provide confi dential assistance to people of all faiths and backgrounds without judgment or pressure. Volunteer

chaplains provide a range of services to Augusta Health Cancer Center patients including presence, prayer, consultation

about specifi c religious practices and grief and loss support.

A Volunteer Chaplain is on call 24/7 for emergency needs (pager is available to staff only; search ‘chaplains’ in the web portal).

Each day they also respond to referrals and non-emergency telephone requests from patients (anyone may dial 4744).

Volunteer chaplains also provide ‘daily rounds’ when they walk through the waiting and patient care areas where many rich

and meaningful encounters occur. They stand ready to support patients, family and staff and are honored to be part of the

Cancer Center team.



Forty-four-year-old Sandy Bazan sat across from Augusta health

Surgeon William Thompson, M.D., FACS waiting for the response

that could change her life.

“You think I have breast cancer?” she asked the doctor.

“I’m too young for that,” the mother of two teenage boys


That was October 2009, just a few short months after she fi rst

found a lump in her right breast. Though her breast tissue had

always been a little lumpy, she knew deep down that this time

was diff erent.

Results from her biopsy confi rmed Dr. Thompson’s suspicions, and

he called her a few days after their meeting to give her the news.

He also said, “There’s someone I want you to meet. She’s been

in your shoes.” That someone was breast health navigator Meg

Shrader, RN., BSN. A breast cancer survivor herself, Shrader helps

Augusta Health patients work through an overwhelming number

of cancer resources and coordinates care among the physicians

who treat the disease.

“It was the beginning of a beautiful relationship on a not-sobeautiful

journey,” Bazan says.

Bazan would undergo additional testing, including an MRI, a

second biopsy and a diagnostic mammogram, to confi rm her

diagnosis and help physicians determine exactly what they were

dealing with. Her cancer was stage I, grade 3—an aggressive

form of cancer that was caught early on.

As she began to come to grips with what she was facing, she

often turned to Shrader. “I can’t begin to describe the impact that

Meg has had,” she says. “It was amazing to have someone to talk

with, someone who’s been where I was headed. She could relate

to everything I was telling her.” The two women discussed treatment

options, as well as physical and emotional issues surrounding

breast cancer.

Because testing revealed that Bazan was at high risk for a

recurrence of breast cancer, chemotherapy became part of her

treatment plan. After a lumpectomy in November 2009, she

began the fi rst of four rounds of chemo in December of that year.

Her fi rst chemotherapy treatment was given in a private room at

the hospital’s infusion center to help her adjust to the new treatment.

Subsequent treatments were given in an area alongside

other patients. “I met so many wonderful people there,” she says.

In preparation for the likelihood of losing her hair, she had her

hairdresser cut her long locks into a short style. “I cried like a

baby when she cut my hair off ,” she says. In January 2010, her

hair started to fall out. That’s when she shaved her head and

covered it with hats.

Fighting the Good Fight……How

Augusta Health is helping defeat

breast cancer

“It was hard,” admits Bazan. “Society looks at women based on their hair, makeup and breasts. I felt that everything that made me a woman was being attacked.”

Six weeks of radiation followed the chemotherapy, with treatment offi cially wrapping up on April 30, 2010. Bazan was amazed at how supportive everyone at Augusta Health

was. That included her medical oncologist, her surgeon, the oncology nurses, and, of course, Shrader. “My healthcare providers treated not only the body, but the spirit as

well,” Bazan says, noting that the Augusta Health Cancer Center staff also provided support to her husband, John, and family.

Now cancer-free, Bazan is currently enrolled in a three-year clinical trial. It aims to fi nd out if taking bone-building medications can reduce the risk of cancer spreading to the

bones, a common site of recurrence in breast-cancer patients. She says the study is helping her do her part to help other women.

Some women might question why breast cancer had to happen to them, but it’s something that never crossed Bazan’s mind. “Why not me?” she says. “I’m being led down this

path for a reason.” She says the experience has given her a new lease on life. She fell in love all over again with her husband, who’s stood by her throughout this diffi cult journey.

She notices things she may not have before, such as birds singing during a rainstorm. She’s curbed the hours she puts in at her job as a supervisor in the health information

department at a local psychiatric center.

“This experience changes your perspective,” Bazan says. “Things that I thought were important before I realize aren’t. I’m not the person I was before, and I hope I never will be.”


Patient and Community Outreach

Augusta Health, through the Community Wellness Department and in collaboration with oncology service representatives,

provides cancer education to all segments of the population within the greater Augusta County region. Risk

reduction information, early detection screenings, cancer information and activities are off ered to the community in

various settings.

Children and youth are encouraged to make positive lifestyle choices through programs that address the risk of tobacco

use, poor dietary habits and inactivity. Through the “Working on Wellness” initiative, children and teens benefi t from

positive changes in school nutrition and physical education programs. Work site health fairs provide an ideal opportunity

for adults to obtain information on breast, testicular, prostate, colon and skin cancer detection, as well as education

related to cancer prevention and high risk health behaviors. Many local employers partner with Community Wellness

to off er PSA screenings to men at risk during annual health fairs. Special events sponsored by local civic organizations

and faith groups throughout the area provide another prime setting for reaching the community with risk reduction/

cancer prevention education. Regularly scheduled courses in tobacco cessation are off ered to the public throughout

the year and individual consultation is available at any time to interested persons attempting to make life style changes.

The health educators of Community Wellness are also trained to serve as consultants to the in-patient who seeks assistance

with tobacco cessation while hospitalized or who wishes to pursue a course of action after discharge. In addition,

the staff s of Community Wellness and Oncology plan and implement the following annual screenings for the


May Skin Cancer Free Screening/Education

September Prostate Cancer Free Screening/Education

Year-round All Cancers Public Education

This year 6,396 citizens were reached with cancer education, cancer risk reduction information, early detection screenings,

and related services, encompassing children and youth, working populations and seniors.

The staff of Community Wellness continues to touch the community each year with

public education, prevention/risk reduction programs, and screenings/early detection projects to further the mission of

the Cancer Program at Augusta Health.

The Every Woman’s Life program helps uninsured, underinsured, and low income women that meet

eligibility requirements gain access to free breast and cervical cancer screening services. Women

must be between the ages of 40 and 64 and have an income at or below 200% of the federal poverty

level (FPL).

Women who are screened through this program and diagnosed with breast and/or cervical cancer

may be eligible for treatment through Medicaid. This program is very fortunate to have multiple providers

in this area.

For more information, please contact the Virginia Breast and Cervical Cancer Early Detection Program

at (866) 395-4968 or visit their website http://www.vahealth.org/breastcancer/.









In 2011, the City of Waynesboro once again chose The Augusta

Health Cancer Center’s Bridge Fund as the recipient

of the proceeds from its Extravaganza 5K/10K Race/Walk.

Augusta Health Cancer Center appreciates the generosity

of the City and was honored to be the selected charity.

Donations totaling $7240.00 were raised and given to the

“Bridge Fund”, then used to help patients at the Augusta

Health Cancer

Center cope

with the fi nancial

diffi culties

that can come

with a cancer


The awards ceremony

for the

race was held

at The Serenity

Garden, a

cancer memorial

garden at

Ben Lancaster – City of Waynesboro

Karen Robertson – Radiation Oncology

Ridgeview Park in Waynesboro. Brad Johnson, Director of

the Augusta Health Cancer Center, thanked everyone for

their participation, gave a brief overview of the “Bridge

Fund” and explained some of the possible uses for the

money that was raised. Awards were then presented by

gender to each age group.

The 5K/10K (3.1/6.2 miles) Race/Walk had 227 participants

this year. Next year, plans are to encourage more families,

friends and co-workers of current cancer patients, cancer

survivors or those who have lost their fi ght to see the

event as a way to honor or remember those who have

bravely fought this disease.

The event is possible through the generosity of volunteers,

especially those who support the event as Title

Sponsors. Many local businesses and individuals also

contributed to the event at the Silver and Bronze levels by

donating door prizes, refreshments and monetary contri-

butions. Additionally more than 30 hospital employees and community members volunteered their time to make this

event a success.


Augusta Health’s Lifetime Fitness Center off ers a

wide variety of classes for people who suff er from

chronic ailments or diseases. One specifi c to cancer

patients is the Tai Chi Class for Cancer Recovery. This

class meets at 6:45pm on Tuesday evenings in the

Lifetime Center. The Augusta Health Cancer Center

sponsors this free class.

There are also several Monitored Medical Programs

to aid in overcoming obstacles and helping patients

reach their goals:

• Personal water and land exercise programs are offered

to help reduce symptoms of chronic ailments

or conditions like cancer. This program is perfect for

anyone who needs a small progression through supervised

exercise. These programs include four oneon-one

sessions with an Exercise Physiologist. These

programs encourage clients to workout at their own


• Client Training Plus is a one-on-one supervised exercise

program for individuals with medical conditions

or individuals who may not be able to exercise

on their own. This program off ers a “helping hand” to

assist with set up of equipment, transporting, or any

other tasks the client may need assistance with.


Massage has been shown to reduce anxiety, pain, nausea and fatigue in patients undergoing cancer treatment. It can

be a simple, yet eff ective way to alleviate discomfort while allowing the patient to experience a sense of physical and

emotional wellbeing. Massage therapists are available at the Augusta Health Cancer Center Monday through Friday

from 9:30am-3:00pm. Hand, foot, shoulder and chair massages can be done before, during and after treatment.


Look Good…Feel Better was re-started at Augusta Health in 2011 and is now held on a monthly basis. This program for

radiation therapy and chemotherapy patients includes a skin care and make-up consult as well as a demonstration on

how to use wigs, turbans and hats. The program has been received with enthusiasm by the participants who appreciate

help with restoring the challenges from side-eff ects and issues with self-image.

Man-to-Man also began anew in 2011 and is off ered on a quarterly basis. This program for prostate patients and their

families gives opportunities to hear topics and trends related to screening, diagnostics, treatment and survivorship.

American Cancer Society Resource Days is a brand new program that is co-sponsored with Augusta Health. This is an

information resource area located within the Cancer Center comprised of books, brochures and CDs along with access to

computer web content. Six volunteers were trained with assistance coverage Wednesday and Thursday mornings. More

than fi fty patients have been served through October 2011. The material and internet web access are available Monday

through Friday, from 8 am-5 pm. For 2012, the goal is to increase volunteer assistance coverage to a full fi ve days.




Grieving children and teenagers often feel alone in their grief. Most of their

friends do not understand how it feels when someone special dies. Camp Dragonfl

y, held annually at Camp Horizons Camp in Harrisonburg, is a place where

children and teens from throughout the region can gather with peers to share

the experience of grieving the death of someone they love.

Fun is the top priority at Camp Dragonfl y. Campers learn that it is okay to laugh

and play—that it is not disrespectful to the memory of the person who died.

Activities include arts and crafts, canoeing, singing, swimming, team building

exercises, and fi shing. Many of the activities are designed to gently guide each

camper through some of the pain of grief. Activities include making a memory

collage, a question/answer period with a physician, workbook sessions, a candlelight

ceremony, and a special camp closing ceremony. The closing ceremony

includes the entire family. It symbolically allows the campers and participants to

release some of the pain associated with losing a loved one while holding onto

the special memory.

At Camp Dragonfl y, campers have the opportunity to meet others who have lost

someone special. They feel supported in a healing environment and can openly

express their feelings without fear of being criticized.

Camp Dragonfl y is held each fall, soon after school begins. Camp Horizon provides

a beautiful, youth-friendly and fun location. In 2011, camp was held September

17 and 18. There were 64 campers ranging from age 6 to 18 years from

the counties of Augusta, Rockbridge and Rockingham, Virginia. The weekend

was a success with the help and support of 101 volunteers, including James

Madison University nursing students.




The Cancer Registry is a vital component of the Augusta

Health Cancer Program.

All patients newly diagnosed and/or treated (analytic) at Augusta

Health have an “abstract” prepared and stored in a database.

This abstract includes cancer identifi cation information

and data to determine the extent of the cancer, as well

as information on the treatment the patient received at Augusta

Health and/or other facilities. Pertinent data from the

abstracts are reported to the Virginia Cancer Registry (VCR)

and the National Cancer Data Base (NCDB). Cancer Registry

data are used in data quality studies, treatment analysis

studies, cancer reports, as well as needs assessment studies.

To capture the full scope of the cancer care at Augusta

Health, the Cancer Registry also collects and reports abbreviated

information on incidence cases and previously diag-


Report of Cancer Registry Activity

Erica Sabatini, BS and Jessica Washington, CTR

nosed (non-analytic) cases. Since January 1, 1991 a total of

11,509 cases have been entered into the database. Annual

follow-up is conducted on analytic cases until death. Currently

there are 4,489 patients under active follow-up. The

America College of Surgeons (ACoS) requires that at least a

90% follow-up rate be maintained on active patients. The

Augusta Health Cancer Registry exceeds this requirement

with a follow-up rate of 93%.

The Cancer Registry is also responsible for coordinating and

monitoring the Tumor Board luncheons and Cancer Committee

meetings set forth by the American College of Surgeons

Cancer Program Standards.

The Augusta Health Cancer Registry is staff ed by two fulltime

Registrars, Jessica Washington, CTR and Erica Sabatini, BS.

Statistical Review 2010

Review of the data abstracted from the Tumor Registry for the year 2010

reveals very few major surprises. The number of cancer cases went up

slightly compared to 2009, with 884 analytic cased abstracted into the


Robert Kyler, M.D.

Chairman, Cancer Committee

It is well known that the incidence of cancer rises with age though the 70’s, but then declines thereafter, a pattern that

is confi rmed by fi gure 2.

The fi ve most commonly-diagnosed cancers are shown in fi gure 3, as are the percentages of all cancers that each comprises.

Very minor diff erence is seen between the Augusta Health and state and national statistics.



Source: 2010 American Cancer Society (fi gure 3)

Augusta Health Cancer Registry

Excludes Insitu Carcinomas Except Urinary Bladder

For the fi rst time ever, breast and prostate cancer were tied for fi rst in overall cases diagnosed, with 147 cases of each, although

there were slightly more analytic breast cancer cases than prostate. Lung cancer was next, with 104 patients diagnosed;

since this is a far more lethal malignancy than either breast or prostate cancer, lung cancer remains the leading

cause of cancer death in our community and nationally. Ironically, it is one of the few cancers that is preventable, since

most cases are caused by smoking. Fortunately, the overall incidence of lung cancer has been declining over the past

few years. Most of this decline has been among men, with incidence and mortality having remained level in women.

The 5-year survival statistics for the four most prevalent cancers diagnosed at Augusta Health in 2010 are shown in

fi gure 4, and our results are compared with national statistics obtained from the American Cancer Society. These show

that there are insignifi cant diff erences between our outcomes and those seen nationally, a fi nding that should be reassuring

to those who chose to seek their cancer care locally. Interestingly, the three cancers for which screening is available

(breast, colorectal and prostate) have excellent 5-year survival for those diagnosed with local disease, well above

90% for breast and prostate cancers, and nearing 90% for colorectal cancer. This underscores the extreme importance

of regular cancer screenings that include colonoscopy, breast examination and mammography for women, and digital

rectal examination and PSA testing for men. Of course, screening does not prevent cancer, but it does increase the likelihood

of early detection, which improves dramatically the likelihood of cure.


Taken as a whole, the statistics compiled in this report

provide ample evidence that the goals of our

Cancer Program are being achieved through the

diligent eff orts of the dedicated healthcare team

at Augusta Health.

2010 Primary Site Table Class of Case SEX AJCC STAGE (Analytic Cases Only)

Total Analytic Other Male Female O I II III IV UNK N/A

ALL SITES 884 716 168 466 418 72 198 146 84 108 42 66

Oral Cavity 13 13 0 7 6 0 6 2 2 2 1 0

Lip 2 2 0 1 1 0 2 0 0 0 0 0

Tongue 3 3 0 2 1 0 2 1 0 0 0 0

Other 8 8 0 4 4 0 2 1 2 2 1 0

Digestive System 117 112 5 69 48 2 21 22 25 28 12 2

Esophagus 6 6 0 6 0 0 1 1 0 4 0 0

Stomach 8 8 0 4 4 0 1 1 4 0 2 0

Colon 46 44 2 26 20 2 11 5 13 9 4 0

Rectum 21 20 1 11 10 0 7 3 5 4 1 0

Anus/Anal Canal 6 5 1 4 2 0 1 4 0 0 0 0

Liver 4 4 0 3 1 0 0 1 0 3 0 0

Pancreas 18 17 1 9 9 0 0 6 1 6 4 0

Other 8 8 0 6 2 0 0 1 2 2 1 2

Respiratory System 112 110 2 56 56 0 22 9 26 46 7 0

Nasal/Sinus 1 1 0 1 0 0 0 0 0 0 1 0

Larynx 5 4 1 3 2 0 2 1 0 1 0 0

Lung/Bronchus 104 103 1 50 54 0 20 8 26 43 6 0

Other 2 2 0 2 0 0 0 0 0 2 0 0

Blood/Bone Marrow 44 42 2 23 21 0 0 0 0 0 0 42

Leukemia 19 18 1 11 8 0 0 0 0 0 0 18

Multiple Myeloma 11 10 1 4 7 0 0 0 0 0 0 10

Other 14 14 0 8 6 0 0 0 0 0 0 14

Conn/Soft Tissue 3 3 0 2 1 0 0 2 0 0 1 0

Skin 124 31 93 76 48 9 10 6 2 0 1 3

Melanoma 118 27 91 73 45 9 9 5 1 0 1 2

Other 6 4 2 3 3 0 1 1 1 0 0 1

Breast 147 138 9 4 143 27 64 26 10 7 4 0

Female Genital 37 30 7 0 37 0 17 1 5 4 3 0

Cervix Uteri 3 2 1 0 3 0 1 1 0 0 0 0

Corpus Uteri 25 19 6 0 25 0 16 0 2 0 1 0

Ovary 5 5 0 0 5 0 0 0 2 3 0 0

Vulva 2 2 0 0 2 0 0 0 1 0 1 0

Other 2 2 0 0 2 0 0 0 0 1 1 0

Male Genital 150 115 35 150 0 2 37 61 5 4 6 0

Prostate 147 112 35 147 0 0 36 61 5 4 6 0

Testis 1 1 0 1 0 0 1 0 0 0 0 0

Other 2 2 0 2 0 2 0 0 0 0 0 0

Urinary System 71 64 7 45 26 32 13 8 4 3 3 1

Bladder 55 50 5 37 18 32 4 8 2 1 3 0

Kidney/Renal 15 13 2 7 8 0 9 0 2 2 0 0

Other 1 1 0 1 0 0 0 0 0 0 0 1

Brain & CNS 12 9 3 8 4 0 0 0 0 0 0 9

Brain(Malignant) 8 6 2 6 2 0 0 0 0 0 0 6

Other 4 3 1 2 2 0 0 0 0 0 0 3

Endocrine 6 6 0 0 6 0 3 1 0 1 1 0

Thyroid 6 6 0 0 6 0 3 1 0 1 1 0

Lymphatic System 39 34 5 22 17 0 5 8 5 13 3 0

Non-Hodgkin’s 39 34 5 22 17 0 5 8 5 13 3 0

Unknown Primary 8 8 0 4 4 0 0 0 0 0 0 8

Other/Ill-Defi ned 1 1 0 0 1 0 0 0 0 0 0 1

Number of cases excluded from Analytic Total: 7

This report EXCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases.



Conformance of Kidney Cancer Treatment

to NCCN Guidelines The Augusta Health Cancer

Julie Plumbley, MD

Registry Physician Advisor

and/or regional lymph nodes or have extended

beyond Gerota’s fascia, a membrane

that surrounds the kidney’s surrounding fat



American Joint

Committee on Cancer * 2010

This year a review of cases of primary kidney cancer (renal cell carcinoma and variants) diagnosed

between 2004 and 2009 was undertaken for the purpose of assessing degree of

conformance at Augusta Health with National Comprehensive Cancer Network (NCCN®)

guidelines for initial treatment. The NCCN is a not-for profi t alliance of 21 of the world’s

leading cancer centers dedicated to improving the quality and eff ectiveness of care provided

to cancer patients.

Recommended treatments are predicated on the stage of the cancer. NCCN recommendations

for primary treatment of kidney cancer are NCCN category 2A, that is, based on

a low level of evidence but uniform consensus among kidney cancer panel members.

Stage refers to the size and extent of spread of cancer. Each type of primary cancer has

its own staging scheme. At Augusta Health the American Joint Commission on Cancer

(AJCC) staging system is employed. In the AJCC system stage I kidney cancer consists

of a tumor that measures 7 cm or less that is confi ned to the kidney. Stage II is a tumor

greater than 7 cm but less than 10 cm and confi ned to the kidney. Stages III and IV are

more complicated to explain. Tumors of these higher stages may involve the renal vein

Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois.

The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010)

published by Springer Science and Business Media LLC, www.springer.com.

Staging fi rst occurs through the use of physical examination and imaging. This is called clinical staging. If the tumor

is resected, a pathologic stage can also be determined. Resection and pathologic staging can result in upstaging or

downstaging of a tumor, but most of the time clinical and pathologic assessments result in the same stage assignment.

Registry recorded 72 cases

of kidney cancer among its

analytic cases for the years

2004-2009. Sixty-seven

of these were eligible for

this review. Five were of

unknown stage and ineligible

for review. Thirtysix

stage I kidney cancers

were diagnosed and 34

were treated at this institution.

Initial treatment

consisted of radical or partial

nephrectomy, in accordance

with NCCN treatment recommendations.

Radical nephrectomy is recommended for stage

II and III kidney cancer unless medically or surgically

contraindicated. There were 12 stage II and III

cases. Eleven were eligible for surgery and radical

nephrectomy was performed in all of these cases.

In the 12th case, surgery was medically contraindicated

and the patient refused chemotherapy. Recommended

treatment for stage IV kidney cancer

potentially includes primary site surgery, metastatectomy

and systemic therapy, depending on the

details of that patient’s disease involvement and

attendant medical issues. Of the 18 stage IV cases,

nine were able to be treated both surgically and

with systemic therapies. Of the other nine, six received

systemic therapies and three received no

therapy due to refusal or inability to tolerate any of

the available therapies.

Care of kidney cancer at this institution occurs in conformance with NCCN fi rst-line treatment guidelines.

Julie Plumbley, MD

Physician Advisor, Cancer Registry

References: AJCC Cancer Staging Manual 7th Edition

AJCC Stage by Sex



All Stages


Beating the Odds…Augusta

Health helps one woman

battle breast cancer

Myers was referred to a medical oncologist and to the hospital’s breast health navigator.

Providing this invaluable service at Augusta Health is Meg Shrader, R.N., B.S.N.,

who helps patients navigate an overwhelming number of resources and assists in coordinating

care among the numerous physicians involved in cancer treatment. She accompanies

patients to their physician appointments and takes notes, so the patients

can focus on listening carefully. Plus, she soothes the fears of those in remission, who

may be afraid that any twinge of pain could signal a return of the disease.

Shrader herself is a triple-negative breast cancer survivor, so she identifi ed with Myers.

In fact, it’s part of the reason why she became a breast health navigator. “After I

was diagnosed, a friend told me, ‘You’re going to do something with your experience,’

” says Shrader, who sees women on both a physician- and self-referral basis. Luckily

for Augusta Health patients, this prediction proved true.

“After you’re diagnosed, you’re ready for someone to hold your hand,” Myers says.

“Meg’s g been by y my y side the entire time. She’s also been there for my y husband and my y

Certain dates likely stand out in your memory because of how they impacted the rest

of your life. For Tammy Myers, October 15, 2009 is that date—the day she was diagnosed

with breast cancer.

Lumps in her breasts weren’t uncommon for Myers, who suff ered from fi brocystic

breast changes, a noncancerous condition that makes breast tissue more bumpy

than normal. But when one of her growths grew larger and eventually made its way

under her arm, she knew something was wrong. Her surgeon, David Caulkins, M.D.,

confi rmed her fear: breast cancer.

It was, in fact, Stage III triple-negative breast cancer, a less common and typically

more aggressive form of the disease that doesn’t respond to targeted therapies such

as hormonal therapy and Herceptin (a drug which targets cells with the HER-2/neu

gene). Still, it’s much more sensitive to chemotherapy than other forms of breast cancer.

The diagnosis was a blow to the then-47-year-old Staunton resident. “I considered

myself the poster child of good health,” she says. She was even an organ donor, donating

a kidney to a co-worker’s wife who was in renal failure. But Myers faced the

reality and, thinking of her family—especially her young grandchildren—declared

war on the disease.

two girls. She’s my angel.” Shrader was there to accompany Myers to her tests and answer any questions as she endured 16 weeks of chemotherapy before having a double

mastectomy in February. Following that, there was another three months of chemotherapy, which ended in early July. Within a week of completing treatment, she had a recurrence

of the cancer and is currently undergoing another round of chemotherapy, which is rapidly shrinking her tumors.

The battle continues, but Myers knows she’s in good hands.

Myers actually looks forward to her chemotherapy treatments. Coming to see the Augusta Health physicians, nurses and fellow patients is like visiting family, she says.

“The team at Augusta Health is amazing,” Shrader says. “The medical, hospital and Cancer Center staff are dedicated to providing the best care for our patients. We want to give

them a wonderful quality of life.” She loves seeing patients’ hair growing back and hearing patients ring the bell to celebrate personal victories and completion of treatment.

Myers has been so inspired by her journey that she foresees being able to volunteer her time to help cancer patients in the near future—even if it’s only to sit with them and

off er a comforting presence. As a patient herself, she feels lucky for the treatment she has received.

Myers says, “It’s such a blessing not to have to travel to get great cancer care.”



Douglas W. McKibbin, MD

Specialty: General Surgery


Undergraduate School Purdue University

Medical School John Hopkins

Residency Mary Imogene Bassett / Columbia University

Certification(s) Certified American Board of Surgery

Fellow American College of Surgeons

Special Procedures & Interests:

General and Laparoscopic Surgery, Endoscopy, Breast and Colon Cancer, Thyroid and

Parathyroid Surgery

Joseph L. Ranzini, MD

Specialty: General Surgery


Undergraduate School Dartmouth, BA

Medical School University of Virginia

Residency Bassett Hospital

Special Procedures & Interests:

Breast Cancer and Breast Health, Hernia Surgery, Gallbladder, GI Surgery, Thyroid and

Parathyroid Surgery, Endoscopy and Colonoscopy

William G. Thompson, MD, FACS

Specialty: General Surgery


Undergraduate School University of Pittsburg, BS Chemistry

Medical School University of Pittsburg School of Medicine

Residency Bethesda Naval Hospital/Eastern Virginia School of Medicine

Honors / Awards American College of Surgeons Liaison Physician

Special Procedures & Interests:

Treatment of breast surgery, surgical oncology, surgery of the thyroid and parathyroid.

Treatment of general and laparoscopic surgery and endoscopy.

Laura K. Knox, MD

Assistant Professor of Plastic Surgery

M.D. Degree: University of Oklahoma, 1988

Residency: General Surgery, University of Oklahoma Plastic Surgery,

University of Virginia

Fellowship: Microsurgery, St. Vincent’s Hospital, Australia

Certification: General Surgery

Plastic Surgery: Breast surgery, reconstructive surgery, liposuction, laser surgery,

and aesthetic surgery Same as Clinical Interests

Research Interests: Wound healing

Specialty: Plastic Surgery

Surgeons Providing Excellence in Breast Cancer Care

Augusta Health’s Cancer Program has

been designated a “Community Hospital

Comprehensive Cancer Program” by the

American College of Surgeons.

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