2011 Cancer Program - Augusta Health

2011 CANCER PROGRAM 

ANNUAL REPORT 

Based on 2010 Statistics

Surgeons Providing Excellence in Breast Cancer Care 

Donald C. Carmichael, MD, FACS 

Specialty: General Surgery 

Education: 

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 


Education: 

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 


General and Laparoscopic Surgery, Surgical Treatment of Breast Cancer, 

Thyroid Surgery 

William L. Faulkenberry, II, MD, FACS 


Education: 

Undergraduate School Virginia Polytechnic Institute 

Medical School Eastern Virginia Medical School 

Residency Eastern Virginia Medical School 


Treatment of general and laparoscopic surgery and endoscopy. 

William Blake McKibbin, MD 


Education: 

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 



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 

TABLE OF CONTENTS 

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

2 

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 

Massage 

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. 

www.augustahealth.com

This has been a 

very active and 

productive year 

for the Cancer 

Program at 

Augusta Health. 

2 

CANCER PROGRAM 

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 

Administrative 

Message 

Brad Johnson 

Director 

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 

year. 

Brad Johnson 

Director, Cancer Center 

Janet P. Mangun, MSA 

Vice-President 

Medical Administration 

AUGUSTA HEALTH • CANCER PROGRAM ANNUAL REPORT AUGUSTA HEALTH • CANCER PROGRAM ANNUAL REPORT 

Karen Clark, MT, MBA 

Vice-President 

Professional Services 

3

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 

w.augustahealth.com 

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 

4 

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 

A C T I V I T Y 

JANUARY 

FEBRUARY 

MARCH 

APRIL 

MAY 

JUNE 

JULY 

AUGUST 

SEPTEMBER 

OCTOBER 

NOVEMBER 

DECEMBER 

Case Presentations 




Advances in Molecular 

Diagnosis of Cancer 





Fraction for whole breast irradiation: 

ASTRO evidence based guidelines. 



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.” 

5

National l Accredit Accreditation 

Program gram for Bre Breast 

Centers (NAPBC) 

Dr. William Thompson, 

Thom 

ACoS S Physician 

Liaison, 

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. 

6 

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, 

including: 

■ 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”. 

QUALITY MEASURES FOR 2010 

Multidisciplinary breast conference: 

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

manner. 

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 

Physical. 

NATIONAL CANCER DATA BASE (NCDB) CANCER PROGRAM PRACTICE PROFILE 

REPORTS FOR BREAST CANCERS DIAGNOSED 2004-2008 

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% 






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% 







7

Clinical and Patient Support Services 

INPATIENT MEDICAL ONCOLOGY 

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. 

OUTPATIENT MEDICAL ONCOLOGY 

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. 

8 

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. 

RADIATION ONCOLOGY 

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. 

PATHOLOGY AND CLINICAL LABORATORY 

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). 


9

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 

patients. 

DIAGNOSTIC RADIOLOGY /IMAGING 

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. 

10 

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. 

REHABILITATION 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. 

LYMPHEDEMA CLINIC 

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 

MEDICAL NUTRITION THERAPY 

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. 


11

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. 

NURSING TREATMENT CENTER 

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. 

WOUND HEALING CLINIC 

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 

include: 

■ Advanced wound 

dressings 

■ Vacuum Assisted 

Closure 

■ 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 

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. 

12 

THE SHENANDOAH HOUSE 

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 

program. 

AUGUSTA HEALTH HOSPICE 

OF THE SHENANDOAH 

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 

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. 

CARE HOME MEDICAL 

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. 


13

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 

appointment. 

ONCOLOGY SOCIAL SERVICES 

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 

treatment) 

■ Lean on Me (cancer caregiver support group) 

An on-call social worker is also available evenings and 

weekends. 

THE BRIDGE FUND AT AUGUSTA HEALTH 

CANCER CENTER 

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 

14 

BREAST HEALTH NAVIGATION PROGRAM 

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. 

PATIENT AND FAMILY EDUCATION 

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. 

VOLUNTEER SERVICES 

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. 

CHAPLAINCY PROGRAM 

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. 


15

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 

thought. 

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.” 

16 

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 

community. 

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/. 


Every Woman’s Life COMMUNITY WELLNESS AND SCREENINGS 

17

WAYNESBORO 

EXTRAVAGANZA 

5K/10K RACE/WALK 

w.augustahealth.com 

18 

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 

diagnosis. 

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. 

HEALTHY LIFESTYLES PROGRAM AT THE LIFETIME FITNESS CENTER 

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 

paces. 

• 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 

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. 

AMERICAN CANCER SOCIETY ACTIVITIES 

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. 


19

CAMP DRAGONFLY 

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. 

20 


21

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- 

22 

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 

Registry. 

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. 


23

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. 

24 

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. 


25

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 

capsule. 

26 

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 


Treatment 

All Stages 

27

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.” 

28 

AUGUSTA HEALTH • CANCER PROGRAM ANNUAL REPORT

Douglas W. McKibbin, MD 


Education 

Undergraduate School Purdue University 

Medical School John Hopkins 

Residency Mary Imogene Bassett / Columbia University 

Certification(s) Certified American Board of Surgery 



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

Parathyroid Surgery 

Joseph L. Ranzini, MD 


Education: 

Undergraduate School Dartmouth, BA 

Medical School University of Virginia 

Residency Bassett Hospital 


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

Parathyroid Surgery, Endoscopy and Colonoscopy 

William G. Thompson, MD, FACS 


Education: 

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 


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.

2011 Cancer Program - Augusta Health

Create successful ePaper yourself

Delete template?

Save as template?