Cancer Program Annual Report 2011 - St. Vincent's Health System

St. Vincent’s Medical Center Riverside
Cancer Committee
Cancer Program
Annual Report 2011
(statistics from 2010)

Dear Friends
As another year comes to a close, we reflect on St. Vincent’s accredited
cancer program improvements, growth and accomplishments.
Again, I have the honor and privilege of highlighting the significant
accomplishments of St. Vincent’s Cancer Committee Program.
This past year we have had several major accomplishments. The
most significant accomplishment of the Cancer Committee was the
accreditation awarded from the National Accreditation Program
for Breast Centers (NAPBC). This was only possible due to the hard
work of the cancer committee and the tumor registry. St. Vincent’s
was the first hospital in Northeast Florida to receive this recognition
and it again proves how committed the hospital is in providing the highest quality of care for
women with disease of the breast.
The Lung Cancer Institute was also initiated as a comprehensive approach, from screening to
treatment and support. Now referring doctors or patients have a direct line to a multidisciplinary
physician thoracic panel through the lung cancer nurse navigator. Throughout the year,
the program has been a success as patients from Fernandina to St. Augustine have been treated
in a team approach, as each patient’s specific needs and concerns are tailored specifically for
them.
Our skin cancer screening program made a very large impact on the Jacksonville community,
with over 275 people registered for a skin exam in 2010. We continue to evaluate our patient
care and success at St. Vincent’s, as this year we received our data for corpus uteri (endometrial)
cancer. A detailed report can be found in this year’s annual report.
Support Services for cancer patients remain an important aspect of caring for our patients at
St. Vincent’s, including patient and nurse navigators and a nutritionist. The navigator’s role
has become a great asset for our patients and continues to grow. We now have added a second
breast navigator.
The Cancer Committee continues to meet every other month to review quality improvement,
promote cancer conferences, educational programs, clinical research, and community outreach
and support services. The committee also regularly stays abreast of Cancer Committee changes
and updates and monitors compliance with national guidelines.
St. Vincent’s cancer program continues to strive to be the best in delivering cancer care in
Jacksonville while maintaining Ascension Health’s core values of service of the poor, reverence,
integrity, wisdom, creativity and dedication.
Paul Ossi, M.D.
Cancer Committee Chairman
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More than 50 years of success
St. Vincent’s Medical Center Riverside (SVMCR) operates one of the nation’s oldest cancer
care programs, with more than 50 years of continual accreditation by the American College
of Surgeons as a “Community Hospital Comprehensive Cancer Program.”
St. Vincent’s Mary Virginia Terry Cancer Center’s participation in ongoing clinical trials
allows many patients to receive tomorrow’s gold standard of care years before it becomes
widely available elsewhere.
Mary Virginia Terry Cancer Center
Bill Yates / CYPIX
St. Vincent’s Mary Virginia Terry Cancer
Center serves as the centerpiece for the
excellent cancer care at SVMC. Located at
Shircliff Way and Riverside Avenue, the
site houses the consolidation of cancer
services at St. Vincent’s Medical Center
and the Walk of Hope, an attractive
walkway that connects Radiation Oncology
to the DePaul Medical Building and houses care
giving and educational resources,
including a salon, boutique, and an
American Cancer Society office.
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Professionals Working Together
Collaboration is the hallmark of the SVHC cancer program. Dedicated specialists work together to diagnose
and plan treatments for patients through a unique prospective clinical process that provides patients with the
benefit of a thorough, thoughtful therapy recommendation. Information regarding patients diagnosed and
treated at SVHC is entered into the Cancer Registry database and followed throughout the patient’s lifetime.
Physicians and administrators use this information to monitor our cancer care and to ensure continued quality
of care.
Cancer Services
2010-2012 Cancer Committee
Physician Membership
Paul B. Ossi, MD, Chair
William Sumner, MD, Cancer Committee Physician Liaison
Steven Siegel, MD, Cancer Conference Coordinator
Ryan Perkins, MD
Leann Fox, MD
Brett Cantrell, MD
Anne Bernstein, MD
Daniel Wyzan, MD
Ricardo Izurieta, MD
Paul Crum, Sr., MD
Brian McKibben, MD
Michael Donohue, MD
Paul Nowicki, MD
Donald Smitha, DDS
James E. Hardy, III, MD
Timothy Sternberg, DMD, MD
St. Vincent’s HealthCare offers the most technologically advanced methods and equipment to provide
comprehensive cancer treatment.
Major components include:
• Breast Health Centers and the Multidisciplinary Breast Clinic
• Oncology Services: Medical and Radiation Onclology
• Surgical Services
• The Walk Of Hope
• Support Services and Resources
• Rehabilitative Services
Mission Focused
Non-Physician Membership
Ann Berry, RN, OCN...................................................................Nurse Manager, Oncology
Robin Bettman, RPH, BCOP........................................................ Oncology Pharmacist
Kelly Brockmeier.......................................................................... Director, Marketing
Tanya Brown, RN, OCN............................................................. Breast Cancer Nurse Navigator
Jamie Buller, LCSW...................................................................... Manager, Care Managment
Barbara Dearmon, BS, CTR.........................................................Manager, Oncology Data Services
Alanna Eubanks, RD................................................................... Cancer Dietitian
Cynthia Farah, RT........................................................................Director, Cancer Services
Suzanne Greer...............................................................................ACS Representative
Wendy Holt, RN, BSN, OCN.......................................................Clinical Research Nurse/Lung Cancer Nurse Navigator
Cathy Lane, RN, BSN, OCN....................................................... Radiation Oncology
Eric Lisitano, PT...........................................................................Manager, Physical Therapy
David Meyer, VP...........................................................................Strategic Planning and Marketing
Elaine Murtha, MBA/HCM, RT(R), (M), CRA............................Medical Imaging, Radiation Oncology, Rehab Services
Jill Nelson, RT..............................................................................Manager, Medical Imaging
Marlynn Townsend, RT................................................................Patient Navigator
Carol Trudel, RN, BSN, MS.........................................................Performance Improvement
Sister Andrea Zbiegien, D.Min.....................................................Pastoral Care
Program Coordinators
QI Coordinator: Carol Trudel (Leann Fox, MD, to serve as co-coordinator)
Education/Outreach Coordinator: Cynthia Farah (with support from Dr. Siegel)
Cancer Conference Coordinator: Steven Siegel, MD
Cancer Registry Coordinator: Barbara Dearmon, BS, CTR
“Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons, with
special attention to those who are poor and vulnerable...” so begins our mission statement and such is
the foundation for the cancer services we offer. Whether “poor and vulnerable” refers to a financial,
spiritual, or emotional need, St. Vincent’s is there to help. Some of our mission-focused cancer services
include:
• Mobile Mammography: screening mammography services provided in the community for
ease of access
• Family Practice Medicine Center, primary care services for those in need
• Financial counseling and financial aid
• Pastoral care and spiritual support
• Social work services
• Free and discounted services based upon need
• A licensed Dietitian committed solely to the care of cancer patients
• Patient Advocate helping patients navigate from a screening mammogram through diagnostic
testing and diagnosis
• Nurse Navigator helping patients navigate the system once a breast cancer diagnosis has
been made
• Cancer Patient Navigator helping patients with any type of cancer navigate the system throughout
the cancer journey
All of our Patient Navigators provide education and emotional support to patients in need. They are
available to be with patients during procedures and assist as needed with any questions the patient or
family may have.
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Breast Health
St. Vincent’s HealthCare (SVHC) is one of the pioneers when it
comes to breast health and breast cancer care. Early detection of
breast cancer is the strongest weapon in fighting the disease.
St. Vincent’s Medical Center Riverside
The Josephine H. Bryan Breast Health Center has long been a hallmark
of coordinated, compassionate care at St. Vincent’s Medical
Center. St. Vincent’s has provided breast imaging services for over
40 years. Components of the Center include digital mammography,
breast ultrasound, minimally invasive biopsy, breast MRI, and bone
densitometry. A library with Internet access is also available
on site. In addition to the St. Vincent’s location, we have a mobile
mammography unit that delivers services to women where it is
most convenient. Whether it is in a shopping mall or at a place of
work, women can take advantage of the mobile unit being near
them. That means less time to drive to an appointment and more
time to spend on you.
St. Vincent’s Medical Center Southside
The Breast Health Center at St. Vincent’s Southside also provides a
comprehensive array of services to support screening and diagnostic
services. Digital mammography, breast ultrasound, minimally
invasive biopsy, breast MRI, and bone densitometry services are
available. With renovation, the area is warm and inviting. In addition
to the clinical services provided, the staff of the center also
participates in education and outreach efforts to increase awareness of these potentially life-saving procedures.
Mobile Mammography
As an additional point of early detection, St. Vincent’s
Mobile Mammography program offers convenient access
for screening mammograms to residents throughout
Northeast Florida. Each year more than 3,000 women
receive their screening mammograms through the mobile
mammography unit, which also offers assistance to those
who cannot afford this service.
Multidisciplinary Breast Clinic
Breast cancer patients
For many women facing a breast cancer diagnosis,
the roughest period is the initial, anxiety-ridden, notknowing-for-sure
period, which can sometimes stretch
out for six weeks or even more. That’s why our
multidisciplinary breast clinic brings together all the
various breast cancer related specialties in one location.
When a woman suspects or learns she has breast cancer,
she can come to our clinic and see a number of specialists
in a matter of hours, rather than weeks or months. This
allows patients to get answers to all their questions in one
day and go home with both a diagnosis and a definitive
treatment plan.
One team at work for you
Radiation and medical oncologists, general and
reconstructive plastic surgeons, a dietitian, and a nurse
navigator are all here to move the process along.
This group also has a “fast-track arrangement” with
pathologists and radiologists, for patients seen in the
clinic.
This multidisciplinary approach is ideal for busy women
juggling work, family, and other commitments. It is also
extremely comforting to those who, understandably,
would like a second, third, or even fourth opinion. This
approach to breast cancer treatment should also lead to
better outcomes by shaving off time between the
diagnosis and the onset of treatment.
We feel that all this, combined with some of the most
sophisticated technology, will help us not only treat
women with cancer more efficiently, but also allow us to
provide them and their loved ones with peace of mind.
The program is accredited by the American College of
Radiology and certified by the Food and Drug
Administration. Every mammogram is read by radiologists
using the same state-of-the-art technology found
at SVHC hospital locations.
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The Walk
of Hope
Providing hope for a
bright future
There is special place at St. Vincent’s HealthCare
that offers an extra dose of support for cancer
patients and their loved ones. The Walk of Hope,
located on the second floor entrance of the Mary
Virginia Terry Cancer Center, connects cancer
patients with products, services, and support
needed most during their journey with cancer and
beyond.
• Walk of Hope Boutique
• American Cancer Society (Satellite Office)
Walk of Hope Boutique
For those hard-to-find, necessary items, the Walk of Hope Boutique offers a multitude of options for the cancer
patient, survivor, and loved ones, including:
• Prostheses for use after a mastectomy or other
surgery, fitted by a certified fitter (call for
appointment)
• Fashionable swimwear designed specifically
for mastectomy support
• Sleepwear
• Lingerie, including bras and camisoles
• Wigs, turbans, and scarves
• Cosmetics, creams, and lotions
• Jewelry
• Cards and other inspirational gifts
• Cancer awareness products
• In-house wig salon with a licensed professional
to offer fitting and solutions to common
problems facing hair loss
• Gift certificates
Open: 9 a.m. to 4 p.m., Monday through Friday. For information call: 904-308-HOPE (4673)
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Support Services And Resources
Candid Conversations About Breast Cancer
Join us for an informal program where women facing breast cancer can talk with our experts about
their experience and concerns. This is not a lecture or an educational forum… it’s simply conversations:
intimate, personal, interesting, and helpful conversations. Our breast health experts know
how stressful a diagnosis of breast cancer is. Working as a team, our cancer specialists are available
for this night of informal conversations. Sessions are held every month from 6 to 7 p.m. in the
Mary Virginia Terry Cancer Center (St. Vincent’s Medical Center Riverside campus). To reserve
your place in one or more of these conversations, call (904) 308-5490.
Resources
We offer a variety of patient and community education materials, physician referrals and support
services. Some of these resources include:
• Deliver The Dream Foundation Retreat
• Oncology-Certified Dietitian
• Support Groups
• Patient and Nurse Navigators
MAN TO MAN PROSTATE CANCER
EDUCATION AND SUPPORT GROUP
In collaboration with the American Cancer Society,
SVHC provides a support group for men who have
been diagnosed with Prostate Cancer.
Man To Man is a free Prostate Cancer Support Group
run by volunteers of the American Cancer Society. The
group provides an educational opportunity for men
diagnosed with prostate cancer and is open to wives,
significant others and caregivers. Physicians and other
cancer specialists will provide information on prostate
cancer and issues related to the cancer journey.
No registration is required. The group meets at the
Mary Virginia Terry Cancer Center, 2 Shircliff Way,
on the 1st Tuesday of each month from 6 - 7 p.m.
A light dinner is served.
Free parking for this event is available in the DePaul Garage 2nd floor, near the entrance to
Radiation Oncology. For more information, call Marlynn Townsend at 308-7877.
PATIENT NAVIGATORS
SVHC is proud to have a complement of four associates who serve as patient navigators.
Working as a team, these navigators identify any potential needs patients may have and try to
help them in advance of a problem occurring. They serve as liaisons between the patient and
the healthcare providers to make sure there are no unanswered questions. The navigators live
the mission of St. Vincent’s every day by being there for the patient, offering a warm,
compassionate person to listen and hold your hand when times are tough. Sometimes, the
small things make all the difference during a patient’s cancer journey.
DIETITIAN
SVHC is the only program in this geographic area with a licensed Dietitian committed solely
to the care of cancer patients. Our Dietitian works with patients to make sure they are
maintaining good nutrition and weight during treatments and gives them options if they are
having difficulties. The Dietitian also serves as a liaison between the patients and the healthcare
providers to make sure the patient receives seamless care.
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Kids Together Against Cancer (KTAC)
KTAC provides families with the helping hands they
need during a parent’s cancer experience. The program
is offered quarterly at Riverside Presbyterian Day
School of Jacksonville. Each week, children will
attend a session led by a clinical social worker and art
therapist that will focus on a specific topic. Adults will
meet separately in a group. They will learn how to
effectively communicate with their children regarding
their cancer diagnosis. Monthly sessions and one-onone
counseling are also available.
This community-based program was developed
through the generous support of the Rice Family
Foundation. Other partners in the project are Riverside
Presbyterian Day School and the Cummer Museum of
Art and Gardens. There is no cost to participate in the
program but space is limited. The program is designed
for children ages 5 to 17.
2010 Accomplishments for the Year Included:
• Awarded 3 year accreditation from NAPBC
• Offered skin cancer screening to the community in conjunction with the American Academy of
Dermatology
345 participants screened
41 Basal cell cancers were identified
32 Squamous cell cancers were identified
1 male breast cancer
105 biopsies recommended
• Implemented the Lung Cancer Institute
• Continued to offer Kids Together Against Cancer – a cancer support group for families who have
a parent with cancer
• Offered ACS Man to Man prostate cancer support group
• Awarded Jean Byers Memorial Award for Excellence in Cancer Registration from FCDS
• Purchased da Vinci Robotics Surgical Technology
• Implemented and promoted use of AJCC Cancer Staging Manual 7th Edition
• Continued to offer Cancer Treatment Panel, a treatment planning conference for physicians
representing multiple disciplines; continues to meet twice weekly to discuss prospective treatment
plans for cancer patients
• Improved effectiveness of Thoracic Panel
• Implemented new 2010 coding guidelines (FORDS, CSv2, AJCC Cancer Staging 7th Edition,
revised Multiple Primary & Histology coding and new Hematopoietic Database & Manual)
• Promoted monthly didactic Cancer Conferences with expert speakers on the topics of:
Surgical Management of Malignant Melanoma
Breast Cancer: One Surgeon’s Perspective
Metastatic Renal Cell Carcinoma
Addressing Non Small Cell Lung Cancer
• Participated in national cooperative group research trials including medical oncology, gynecologic
oncology and surgical oncology
• Hosted Candid Conversations about Breast Cancer – quarterly informational sessions for newly
diagnosed patients
• Continued membership and participation in Association of Community Cancer Centers (ACCC)
• Hosted Lunch and Learn lectures on various topics for all cancer patients and caregivers
Uterine Cancer and Treatment Options
Lung Cancer: What You Need to Know
What You Need to Know About Breast Cancer
Colon Cancer: From Prevention to Cure
• Promoted and provided membership to American Cancer Society Board Committee and
programs such as Road to Recovery
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• Conducted patient care evaluation studies that measure quality and outcomes; one study using
registry data:
Reviewed management of Lung Cancer (non small cell carcinoma) compared to national trends
Reviewed referral patterns for chemotherapy for Stage 1 & 2 lung cancer
Reviewed erythropoiesis-stimulating agents for treatment of anemia and evaluated increases in
blood transfusion in oncology patients
• Conducted two improvements directly related to cancer patient care
• Continued physician review of cancer registry abstracting for timeliness, accuracy and quality
• Promoted physicians use of the AJCC TNM Staging and clinical documentation in pretreatment
planning
• Continued to monitor the NQF estimated performance rate for breast and colorectal cancers
• Continued to participate in NCDB Annual Call for Data
• Continued to participate in ACS National Call Center
• Promoted smoking cessation with Quit Smart program
• Offered community education programs on breast cancer
• Promoted Patient Navigators and Dietitian
• Participated in community outreach programs
Cancer Registry Data Summary (2010 Statistics)
Oncology Data Services is a hospital-based cancer registry designed to collect, analyze, and manage data on
malignant (cancer) diagnosis and other reportable diseases. A wide range of demographics and medical
treatment is collected to provide quality outcome data in the registry. For 2010, Oncology Data Services
accessioned (added) 1,317 cases; 1,117 of which were analytic cases (diagnosed and/or received first course
of therapy at our facility). The number of cases excluded from data comparison were 21 with diagnosis of in situ
of cervix, squamous and basal cell skin cancers and intraepithelial neoplasia cases. In addition, there were a total
of 72 historical cases captured which accounted for incidence reporting to the state (not included in incidence
comparison reports). The case load for 2010 increased by 2% compared to previous year.
Oncology Data Services coordinates St. Vincent’s weekly Cancer Treatment Panel, bi-monthly Thoracic Panel
and follows all analytic cases through each patient’s lifetime. A total of 512 cases were presented at the weekly
cancer panels during 2010 and 96% were prospective. Cancer Conferences provide multidisciplinary consultative
services for patients and physicians to develop a plan of care. The current follow-up rate is 93% for all
living patients which exceeds the Commission on Cancer requirements and a 94% rate for patients diagnosed
within the last 5 years. Oncology Data Services is vital to the success of St. Vincent’s cancer program and is
staffed by 2 certified cancer registrars, 2 staff members eligible for certification and the Manager, who is certified.
Staff participated in numerous educational activities to prepare for release of new coding guidelines. The department
successfully implemented the following 2010 changes for collecting incidence data:
• AJCC Cancer Staging Manual 7th edition
• Collaborative Staging version 2
• FORDS 2010
• Hematopoietic Database and Manual
• Revised Multiple Primary and Histology Rules
Oncology Data Services complies with Florida Cancer Data Systems state reporting guidelines regulated by the
Florida Department of Health. The department continues to capture high quality data and maintains compliance
with the American College of Surgeons Commission on Cancer standards for St. Vincent’s Riverside’s approved
program and data reporting to the State for St. Vincent’s Southside.
Annual Review of Cancer Panel 2010
Total number of cases presented 512
Total number of cases prospective 491 (96%)
AJCC Staging discussed 356 (69%)
Breast Presentations 298 (58%)
National Guidelines discussed 93 (19%)
% of analytic cases presented 47%
Multidisciplinary representation 99% - 100%
Physician attendance (average) 8-10
Top Sites discussed (breast, colorectal, lung, melanoma)
Frequency of meetings
Cancer Panel
Bi-weekly – Tues. - Fri.
Breast Panel (7-7:30 a.m.) Bi-weekly – Tues. - Fri.
Thoracic
2nd and 4th Thurs
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St. Vincent’s Medical Center Riverside
Cases Diagnosed 2010
National Comparison of the Ten Most Prevalent Cancer Sites
Estimated Cancer Cases from: The American Cancer Society Cancer Fact & Figures 2010
*national comparison excludes basal and squamous cell skin cancers and in situ carcinomas except
urinary bladder
St. Vincent’s Florida National
Sex Distribution
The ACS 2010 estimated new cancer cases by sex for Male is 789,620 (52%) and Female
739,940 (48%) compared to sex distribution St. Vincent’s Riverside Male 527 (40%) and Female
790 (60%). Our data reveals a higher incidence in female gender compared to national trends.
PRIMARY SITE CASES PERCENT CASES PERCENT CASES PERCENT
BREAST 243 22% 14,080 13% 207,090 13%
COLORECTAL 109 10% 10,500 10% 142,570 9%
LUNG 154 14% 18,390 17% 222,520 14%
CORPUS UTERI 72 6% 2,710 3% 43,470 3%
PROSTATE 47 4% 14,610 14% 217,730 14%
BLADDER 41 4% 5,600 5% 70,530 5%
NH LYMPHOMA 34 3% 4,660 4% 65,540 4%
MELANOMA 26 2% 4,980 5% 68,130 4%
LEUKEMIA 10 1% 3,330 3% 43,050 3%
CERVIX 15 1% 940 1% 12,200 1%
ALL OTHERS 342 33% 27,200 25% 436,730 28%
TOTAL CASES 1093 100% 107,000 100.0% 1,529,560 100.0%
Age Distribution by Sex (all cases)
Age Range Male Female
10 - 19 1 3
20 - 29 4 15
30 - 39 11 32
40 - 49 40 112
50 - 59 112 157
60 - 69 156 213
70 - 79 133 153
80 - 89 66 86
90 - 99 3 11
100 - 109 0 1
Race Distribution
White 1009 (80%)
Black 256 (18%)
Other 52 (2%)
TOTALS 526 783
St. Vincent’s Medical Center Riverside
2010 Cases by County of Diagnosis
Florida County of Diagnosis Number of cases Percent
DUVAL 710 63%
CLAY 139 12.5%
NASSAU 65 6%
BAKER 54 5%
ST. JOHNS 36 3%
PUTNAM 15 1%
FLAGLER 12 1%
GEORGIA 8 1%
ALL OTHER 78 7%
TOTAL CASES 1117 100%
A total of 63% of patients diagnosed and/or treated at St. Vincent’s Riverside reside in
Duval County.
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Colorectal Cancer
St. Vincent’s Medical Center Riverside
2010 Major Sites by AJCC TNM Staging Distribution
(Analytic cases only)
Breast Cancer
Breast Cancer was the most common cancer treated at our facility for 2010 and comprised 22% (247 cases)
of all cancers diagnosed and/or treated at St. Vincent’s Riverside. An 3% increase was noted in the breast
incidence compared to prior year. A total of 50% of cases were diagnosed at an early stage (Stage 0,I) noninvasive
and localized at the time of diagnosis. An 3% increase is noted in early stage compared to last year’s
figures which reveals that patients are being diagnosed at earlier stages which may be related to increased use
of screening digital mammography. Locally advanced Stage II, III comprised 43% of cases which decreased
from last year, 3% were distant Stage 4 at time of diagnosis and only 4% stage was unknown at diagnosis.
Breast cancer cases along with other cancer sites are discussed prospectively at our multi-disciplinary treatment
panel weekly. Cases are accessioned into our Registry’s database and monitored for estimated performance
rate on the national breast cancer measures by National Quality Forum listed below (2008 data):
• St. Vincent’s estimated performance rate is 89% for breast cancer patients receiving conserving surgery
diagnosed under the age of 70 administered radiation therapy within 1 year (365 days) of diagnosis
compared to 86% for all COC programs
• St. Vincent’s estimated performance rate is 86% for breast cancer patients who were considered or
administered combination chemotherapy within 4 months (120 days) of diagnosis for women under
70 with AJCC T1c N0M0, or Stage II or III ERA and PRA negative breast cancer compared to 87% for
all COC programs.
• St. Vincent’s estimated performance rate is 84% for breast cancer patients who were considered or
administered Tamoxifen or third generation aromatase inhibitor within 1 year (365 days) of diagnosis for
women with AJCC T1c N0 M0, or Stage II or III ERA and/or PRA positive breast cancer compared to
80% for all COC programs
Our data revealed a decline in the estimated performance rates for breast cancer compared to previous year
and national trends. The decline may be due to lack of access to treatment information or patients being
treated elsewhere.
Colorectal Cancer is the third most common cancer incidence for 2010 at St. Vincent’s and
represents 10% of cases. Non-invasive and local stage represented 26% of cases. A total of 54%
of cases were diagnosed at Stage II or greater with tumor spread outside of the colon and 15%
of the cases were diagnosed advanced stage (Stage IV). Cases presented at Treatment Panel and
accessioned into the Registry’s database are monitored for compliance with the national colon
measures listed below:
• Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for
patients under the age of 80 with AJCC Stage III colon cancer is at 83% (compared to 88% for
all COC programs)
• At least 12 regional lymph nodes are removed pathologically examined for resection of colon
cancer is at 80% (compared to 82% for all COC programs)
• Radiation therapy is considered or administered within 6 months of diagnosis for Stage II rectal
cases is at 83% (compared to 89% for all COC programs)
Endometrial Cancer
Endometrial cancer is the fourth most common cancer seen at St. Vincent’s Riverside for 2010.
Review of data reveals that the majority (69%) of endometrial cancers were diagnosed at an early
stage. An increase was noted in early detection of endometrial cancer. Stage II & III (17%) revealed
invasion into the cervix and/or regional extension and 10% were Stage IV distant at time
of diagnosis.
Prostate Cancer
Prostate cancer is the fifth most common cancer seen at St. Vincent’s Riverside for 2010 which
represents 4% of the new cancer cases. The incidence remained stable compared to 2009 data.
Prostate cancer is the most frequently diagnosed cancer in men (ACS, Cancer Facts & Figures,
2011). A large majority of cases (92%) were diagnosed while still localized or confined to the
prostate. A small number (4%) had extra prostatic extension at diagnosis and 4% had distant
metastasis.
Lung Cancer
Lung Cancer was the second most common site diagnosed at our
facility for 2010 and comprised 14% of all cases diagnosed and/or
treated at St. Vincent’s. Comparison against 2009 data revealed
a slight decrease in incidence from prior year. Stage I and II
comprised 37% of cases diagnosed which is cancer still confined
to lung and 16% were Stage III at diagnosis. Stage IV represented
42% of cases diagnosed at advanced or distant stage which
declined from least year.
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St. Vincent’s Medical Center Southside
For 2010, Oncology Data Services accessioned a total of 316 cases; 191 of which cases
analytic diagnosed and/or treated at St. Vincent’s Southside. The most common primary
sites seen in 2010 were breast, colorectal, lung, melanoma of the skin and pancreas which
is consistent with national trends. A total of 63% of patients reside in Duval County and
37% are from surrounding communities. In addition, there were a total of 29 historical
cases captured which accounted for incidence reporting to the state (not included in incidence
comparison reports).
Sex Distribution
St. Vincent’s Medical Center Southside
2010 Cases by County of Diagnosis
Florida County Number Percent
of Diagnosis
of Cases
DUVAL 121 63%
CLAY 22 12%
NASSAU 6 3%
ST. JOHNS 12 6%
ALL OTHER 30 16
TOTAL CASES 191 100%
Sex distribution for St. Vincent’s Southside is male 124 (39%) and female 192 (60%). Our
data reveals a higher incidence in female gender compared to national trends.
St. Vincent’s Medical Center Riverside
Corpus Uteri (Endometrium Study)
By Paul Nowicki, MD
Uterine Corpus (body of the uterus) cancer is the seventh most common
malignancy diagnosed at St. Vincent’s Medical Center Riverside and nationally
represents 6% of cases seen in 2010. This report will analyze management of
corpus uteri adenocarcinoma endometrioid type by incidence at age, gender, race
AJCC stage, first course of treatment and outcome, compared to national trends.
The ACS Facts & Figures estimated new cancer case for uterine corpus (endometrium)
in the United States were 43,470 with 7,950 deaths in 2010 for females.
Uterine Corpus cancer usually occurs in the endometrium (lining of the uterus).
The most common symptom includes abnormal bleeding or spotting (especially in
postmenopausal women) is a frequent early sign. Estrogren is a strong risk factor
for endometrium cancer (American Cancer Society). Other risk factors include:
menopausal estrogen therapy (without use of progestin), obesity, late menopause,
never having children and history of polycycstic ovary syndrome.
2010 Endometrium Cases By Combination Treatment
Treatment Type Number of Cases Percent
Surgery 60 84.51%
Surgery/Chemo 3 4.23%
None 3 4.23%
Surgery/Radiation 3 4.23%
Chemo 1 1.41%
Radiation 1 1.41%
TOTAL CASES 71 100%
St. Vincent’s Southside
Review of Tumor Board (Jan-Dec) 2010
Review of 2010 cases reveals cancer directed surgery were performed on 92% of
St. Vincent’s endometrium cases.
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Total number of cases presented 96
Total number of cases prospective 62 (64%)
AJCC Staging discussed 43 (45%)
National Guidelines discussed 15 (16%)
Multidisciplinary representation 99% - 100%
Physician attendance (average) 8-10
Top Sites discussed
Frequency of Tumor Board meetings
1st and 3rd Wed.
Treatment Hospital Number of Cases Percent
Surgical Approach 2010
Open Approach or Unspecified 42 59.15%
Robotic Assisted 16 22.54%
Endoscopic Converted to Open 5 7.04%
Robotic Converted to Open 5 7.04%
No Surgical Procedure of 2 2.82%
Primary Site at This Facility;
Diagnosed at Autopsy
Endoscopic or Laprascopic 1 1.41%
TOTAL CASES 71 100%
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Age Group of Corpus Uteri Cancer Diagnosed in 2000 to 2008
St. Vincent’s Medical Center Riverside, Jacksonville, Florida
vs. Comprehensive Hospitals in ACS Division of Florida
All Diagnosed Cases
# Age Group SVMCR (N) NCDB (N) SVMCR (%) NCDB (%)
1 Under 20 0 4 0% 0.03%
2 20 - 29 0 59 0% 0.46%
3 30 - 39 11 349 1.89% 2.75%
4 40 - 49 60 1102 10.31% 8.68%
5 50 - 59 161 2926 27.66% 23.05%
6 60 - 69 162 3690 27.84% 29.07%
7 70 - 79 127 2973 21.82% 23.42%
8 80 - 89 57 1446 9.79% 11.39%
9 90 and over 4 143 0.69% 1.13%
Total 582 12,692 100% 100%
St. Vincent’s Corpus Uteri Histology comparison for endometriod adenocarcinoma was
lower than national trends. A random sample review of Registry’s data from 2005 – 2010
revealed a discrepancy in coding morphology cell type. Cases will be recoded accordingly
based on review of pathology reports.
Histology of Corpus Uteri Cancer Diagnosed in 2000 to 2008
St. Vincent’s Medical Center Riverside, Jacksonville, Florida
vs. Comprehensive Hospitals in ACS Division of Florida
All Diagnosed Cases
# Histology SVMCR (N) NCDB (N) SVMCR (%) NCDB (%)
1 Adenocarcinoma, NOS 373 2708 64.09% 21.34%
2 Endometrioid 104 6789 17.87% 53.49%
Adenocarcinoma
3 Other Specified Types 105 3195 18.04% 25.17%
Total 582 12,692 100% 100%
Stage of Corpus Uteri Cancer Diagnosed in 2000 to 2008
St. Vincent’s Medical Center Riverside, Jacksonville, Florida
vs. Comprehensive Hospitals in ACS Division of Florida
All Diagnosed Cases
# Stage SVMCR (N) NCDB (N) SVMCR (%) NCDB (%)
1 0 0 203 0% 1.60%
2 I 319 6329 54.81% 49.87%
3 II 33 1187 5.67% 9.35%
4 III 76 1609 13.06% 12.68%
5 IV 50 751 8.59% 5.92%
6 NA 19 433 3.26% 3.41%
7 UNK 85 2180 14.60% 17.18%
Total 582 12,692 100% 100%
First Course of Treatment of Corpus Uteri Cancer Diagnosed in 2000 to 2008
St. Vincent’s Medical Center Riverside, Jacksonville, Florida
vs. Comprehensive Hospitals in ACS Division of Florida
All Diagnosed Cases
# First Course of Treatment SVMCR (N) NCDB (N) SVMCR (%) NCDB (%)
1 Surgery Only 410 8215 70.45% 64.73%
2 Surgery and Radiation 63 1889 10.82% 14.88%
3 Surgery and Chemotherapy 59 839 10.14% 6.61%
4 Surgery, Radiation and 22 590 3.78% 4.65%
Chemotherapy
5 Other Specified Therapy 13 703 2.23% 5.54%
6 No 1st Course Rx 15 456 2.58% 3.59%
Total 582 12,692 100% 100%
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The overall 5-year Observed Survival Rate is 91% for Stage I Cases from 1998-2002. There was an insufficient
number of cases to display survival information for all other stages.
ACS Facts & Figures 2011
The 1- and 5-year relative survival rates for uterine corpus cancer are 92% and 83%, respectively. The
5-year survival rate is 96%, 68% or 17% if the cancer is diagnosed at local, regional or distant stage,
respectively.
St. Vincent’s Riverside Observed 5-Year Survival for Corpus Uteri (Endometrium)
Diagnosed 1998-2002
Summary
Review of St. Vincent’s Endometrial Cancer from 2000 through 2008 compared to the National Cancer Database
reveals patient are being treated consistent with national trends. St. Vincent’s unknown stage at diagnosis
should decrease with required staging documentation on the interim operative report. The histology varied on
adenocarcinoma versus adenocarcinoma endometrioid type compared to national data trends. Majority of the
cases should be coded to adenocarcinoma endometrioid sub classification. The Registry staff will review
endometrial cases and recode sub-classification if appropriate and resubmit to NCDB. With increased use of
the robotic surgical system, we should see a decrease in the number of open surgical cases. St. Vincent’s 5-year
observed survival for Stage 1 cases from 1998-2002 was 91% compared to 87% for national trends. There
was insufficient number of cases to display survival information for all other stages. Nationally, the overall
survival for all stages was 90%. According to American Cancer Society Facts & Figures 2011 the 1-and
5-year relative survival rates for uterine corpus cancer are 92% and 83%, respectively. The 5-year survival
rate is 96%, 68%, or 17%, if the cancer is diagnosed at a local, regional, or distant stage, respectively.
Stage of Disease ENTER 0.0 yr 1.0 yr 2.0 yr 3.0 yr 4.0 yr 5.0 yr 95% Confidence Interval
Stage I 88 100.0 97.7 97.7 95.3 91.8 90.7 84.4 - 96.9
References
St. Vincent’s Cancer Registry data
National Cancer Data Base – benchmark reports
National Cancer Institute
St. Vincent’s Riverside Observed 5-Year Survival for Corpus Uteri (Endometrium)
Cases Diagnosed 2003-2004
COC Comprehensive Community Cancer Centers
Stage of Disease Number 0.0 yr 1.0 yr 2.0 yr 3.0 yr 4.0 yr 5.0 yr 95% Confidence Interval
of Cases
Stage 0 175 100.0 100.0 96.4 95.8 93.8 92.3 87.9 - 96.6
Stage I 5383 100.0 98.1 96.1 94.3 92.2 90.0 89.2 - 90.9
Stage II 822 100.0 93.3 86.4 80.2 75.4 70.8 67.5 - 74.1
Stage III 1132 100.0 83.6 67.1 58.1 53.4 48.4 45.4 - 51.5
Stage IV 554 100.0 48.7 27.1 19.5 15.6 13.2 10.4 - 16.1
2011 National Cancer Data Base/Commission on Cancer
National Cancer Database (NCDB), Commission on Cancer. Benchmark reports
www.facs.org
American Cancer Society, Cancer Facts & Figures 2010 & 2011
http://www.cancer.org
National Comprehensive Cancer Network Clinical Guidelines
www.nccn.org
St. Vincent’s Oncology Data Services
Definition of Terms:
ACS – American Cancer Society
AJCC – American Joint Committee on Cancer
Analytic (A) – patients initially diagnosed and or treated at St. Vincent’s Medical Center
Non-Analytic (NA) – patients diagnosed and treated elsewhere prior to being seen at St. Vincent’s Medical Center.
NCDB – National Cancer Database
COC – Commission on Cancer
Contact Information:
1 Shircliff Way
Jacksonville, FL 32204
904 308-8222
www.jaxhealth.com
MARY VIRGINIA TERRY
CANCER CENTER
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1 Shircliff Way
Jacksonville, Florida 32204
(904) 308-8222
www.jaxhealth.com
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