ANNUAL REPORT - Saint Joseph Mercy Health System

2010 

Annual Report 

Data Represented 2009

Table of Contents 

INTRODUCTION (2 - 3) 

2 Letter from the Medical Director 

3 Letter from Cancer Committee Chair 

EXECUTIVE SUMMARY (4 - 5) 

FOUNDATIONS OF CANCER CARE (6 -15) 

6 American College of Surgeons’ Commission on Cancer: 

Accreditation as a Teaching Hospital Cancer Program 

6 Cancer Program Overview 

7 Facilities 

8 Oncology Physician Specialists 

8 Medical Oncology 

9 Radiation Oncology 

10 Surgical Oncology 

10 Multidisciplinary Clinics 

11 Multidisciplinary Programs 

11 Breast Cancer Program 

12 Gastrointestinal Cancer Program 

(Colorectal, Hepatobiliary) 

13 Genitourinary Cancer Program 

(Renal, Prostate) 

13 Lung Cancer Program 

14 Gynecologic Oncology Program 

14 Neurologic Cancer Program 

(Brain, Spinal Cord) 

14 Head & Neck Cancer Program 

14 Endocrine Cancers (Thyroid) 

14 Skin Cancers (Melanoma) 

CANCER RESEARCH (16) 

16 MICHIGAN CANCER RESEARCH CONSORTIUM 

COMMUNITY CLINICAL ONCOLOGY PROGRAM 

(MCRC-CCOP) 

CARE ACROSS THE CONTINUUM (17) 

17 NATIONAL CANCER INSTITUTE COMMUNITY 

CANCER CENTERS PROGRAM GRANT (NCCCP) 

17 Program Overview 

17 Nurse Navigators 

18 Community Partnerships 

18 Health Disparities 

19 Biospecimen Research Initiatives 

19 Cancer Survivorship and Palliative Care Services 

PATIENT CENTEREDNESS (20) 

20 Oncology Patient Advocates Team 

20 Patient Satisfaction 

20 A Patient Speaks 

QUALITY INITIATIVES AND OUTCOMES (22 -27) 

22 Oncology & Infusion Collaborative Practice 

Team: Review of Chemotherapy Safety 

23 Chemotherapy Infusion Clinic: Streamlining 

Systems - Chemotherapy Order Process 

23 Department of Radiation Oncology: 

Streamlining Systems 

23 Cardiothoracic Surgeons: Benchmarking Utilizing 

the Society of Thoracic Surgeons Database 

24 Medical Oncologists: Quality Oncology 

Practice Initiative (QOPI) 

24 Medical Oncologists: Michigan Oncology 

Clinical Treatment Pathways Program 

24 Breast Program Quality Initiatives 

25 Cancer Research Audits (2009-2010) 

26 American College of Surgeons’ Commission 

on Cancer: Outcomes Comparison 

APPENDICES (28-34) 

28 Appendix A: Tumor Registry Analytical Cases 

(2009) by Diagnostic Site 

30 2009 Best General Summary Stages 

31 2009 Tumor Boards & Registry 

32 2009-2010: Highlights of Scholarly Activities 

34 2009-2010: Publications & Resident Awards 

SJMHS Dermatology 

2010 Annual Cancer Report • 1

Letter from the 

Medical Director 

Philip J. Stella, MD, Medical Director 

St. Joseph Mercy Cancer Program 

Principal Investigator, Michigan Cancer Research Consortium 

I am pleased to present the 2009-10 annual report of the St. Joseph Mercy Cancer Program. This 

past year truly has been eventful, highlighted by the awarding of a National Cancer Institute (NCI) 

Community Cancer Centers Program (NCCCP) contract. This prestigious award from the NCI signifies 

our program as one of a select group of community cancer programs in the country. It recognizes 

excellence in research and supports our efforts toward high-quality multidisciplinary care; in addition, 

it supports resources for a genetics counselor and nurse navigators, and provides resources for the 

underserved populations. The NCCCP contract also assists in the development of a tissue repository 

to help advance translational research. 

We are excited about the long-awaited expansion of our multidisciplinary clinics this coming fall. In 

addition to a lung cancer clinic, we will now be able to see patients with breast, gastrointestinal (GI), 

prostate, head and neck cancer, and neuro-oncologic malignancies in a multidisciplinary fashion 

supported by nurse navigators to help facilitate timely access to state-of-the-art care for patients and 

providers. 

Speaking of access, we have expanded the oncology program with new satellites in Canton and Chelsea 

as well as the established sites in Brighton and Livonia. We look forward to adding a fellowship-trained 

breast surgeon to head a superb team of specialists and staff providing optimal breast care. 

I am particularly pleased with the work of our patient advocate committee. Under the leadership of Pastor 

Dave McNeil and Beth LaVasseur, RN, MSN, we have developed partnerships with American Cancer 

Society (ACS) and the Wellness Community to expand the services we provide to cancer patients. 

With patient representation on our program committees, we are fulfilling our mission to truly be patientcentered. 

Our work with Blue Cross Blue Shield of Michigan (BCBSM) to support quality initiatives such as Michigan 

Breast Oncology Quality Initiative (MiBOQI), Quality Oncology Practice Initiative (QOPI) and the Pathway 

Project is putting us on the cutting edge of measuring and implementing cost effective quality programs 

that are models of care garnering national recognition. 

Finally, we are promoting early detection and screening through an all-digital mammography network, 

a robust screening colonoscopy program and annual prostate and skin cancer screening events. 

In what promises to be a paradigm shifting approach, our Smoking Cessation Collaborative Practice 

Team has developed a program to train a champion in physician offices to identify and provide 

evidence-based intervention to our patients who are tobacco dependent. 

With 10 million dollars in grants and contracts over the next four or five years, a faculty committed to 

research and access to the latest technologic advancements such as robotic surgery and Cyberknife ® , 

we are confident that we can provide the best cancer care for our patients. 

2 • 2010 Annual Cancer Report

Letter from the 

Cancer Committee Chair 

Timothy McHugh, MD, Chairperson 

St. Joseph Mercy Cancer Committee 

The Cancer Committee is a multidisciplinary committee charged with oversight of the quality of 

care delivered to patients as they traverse the health care system. As Chair of the SJMHS Cancer 

Committee, I am proud to report that we continue to exceed the standards for American College of 

Surgeons’ Commission on Cancer Hospital Teaching Programs. Accreditation by the American College 

of Surgeons’ Commission on Cancer is a very rigorous process that documents our compliance with 

multiple quality and process improvement initiatives set to define cancer programs of excellence. 

Through our accreditation by the American College of Surgeons our committee follows a comprehensive 

structure for the ongoing measurement of the quality of our program for all cancer related services. 

Only 25% of community cancer programs in the country are accredited. The standards measured 

represent care across the continuum: prevention, early-diagnosis, pre-treatment evaluation, staging, 

optimal treatment, rehabilitation, and surveillance for recurrent disease, support services and end of life 

care. We were particularly pleased this past year with the increasing amount of quality measurement 

data made available to the Committee and the increased focus on multidisciplinary care to improve the 

patient experience. A representative from the American Cancer Society has also joined our committee, 

which provides us with an excellent community partnership and expanded resources for our patients. 

At each Cancer Committee meeting we review the eight categories of ACOS standards, which provides 

us the opportunity to organize and manage the cancer program to assure multidisciplinary, integrated 

and comprehensive oncology services. Each of our twenty-five members is actively engaged in 

discussing and accepting the challenge to accomplish the newly identified goals the Committee sets 

for the program. 

Throughout this report you will see examples of the quality of care and process improvements that we 

review and oversee on a regular basis to assure the cancer program is not only meeting but exceeding 

the needs of our patients. 


EXECUTIVE SUMMARY 

The opening of the Robert H. and Judy Dow Alexander Cancer Care Center 

at St. Joseph Mercy Hospital in Ann Arbor in 1993 was the beginning of an 

extraordinary time in the evolution of cancer care in our community. In a 

short 16 years, SJMHS has developed an all-expansive oncology program 

that is recognized for its leadership and innovation in developing cancer 

services that continually look to the future for the newest technology, 

advanced treatment options, breakthrough medications, and programs 

that improve the cancer experience for individuals and families. 

The following highlights provide a historical context and illustrate the 

accomplishments and growth of the SJMHS cancer program. 


° The Robert H. and Judy Dow Alexander Cancer 

Care Center on the SJMHS campus in Ann 

Arbor began as a new 30,000 square foot facility 

housing chemotherapy infusion services, medical 

oncology, laboratory services, and program 

offices. As the first dedicated cancer center in 

our service area, it became the model for care. 

Today, SJMHS cancer centers include additional 

state-of-the-art facilities in Brighton and Canton, 

with a fourth being planned for Chelsea. Services 

in all centers include both chemotherapy and 

radiation therapy as well as multidisciplinary clinic 

space and all ancillary services. 

° When the oncology program was being formalized 

in the early 1990’s, a total of four patients were 

enrolled in clinical trials through our affiliation with 

the Toledo Community Clinical Oncology Program. 

In 2009, SJMHS enrolled over 200 patients on both 

treatment and cancer control protocols. 

° The establishment of SJMHS leadership in cancer 

clinical trials research has been extraordinary 

under the leadership of Philip J. Stella, MD, Medical 

Director. With the vision to develop a leadingedge 

program, Dr. Stella and staff put in place the 

elements needed to become a National Cancer 

Institute funded Community Clinical Oncology 

Program. The Ann Arbor Regional CCOP was 

formed, receiving NCI support commencing in 

1994. Since that time, a total of 11 other Michigan 

health systems and one Connecticut hospital have 

joined what is now the Michigan Cancer Research 

Consortium CCOP (MCRC CCOP) -- renamed to 

better reflect its membership. SJMHS has been the 

fiscal agent for the CCOP since its inception; Dr. 

Stella has been the Principal Investigator this entire 

time. In 2009, over 600 patients were enrolled 

in research studies, and 2,000+ individuals on 

studies are being followed each year. The MCRC 

CCOP has achieved a national reputation for 

quality research and has been funded by the NCI 

continuously since 1994. It is one of the largest 

CCOPs in the country. 

° The original vision for the Robert H. and Judy Dow 

Alexander Cancer Care Center was to provide all 

oncology services in one location and to establish 

“clinics” where physicians of many disciplines 

would come to the patient to coordinate the 

diagnostic and treatment processes. Our original 

hope was to develop multidisciplinary clinics 

for the several major cancer diagnoses: breast, 

colon, lung and prostate malignancies. Not only 

do we have multidisciplinary physician groups 

for each of these disease sites, but we have them 

for gastrointestinal, genitourinary, gynecologic, 

neurologic, endocrine, head and neck, and 

cutaneous malignancies. This has become our 

model of care. 

° In 1993, our measurements related to the quality 

of care we were providing utilized data from 

our Tumor Registry and compared our data with 

that of other hospital tumor registries. We were 

able to review such things as stage of disease 

at diagnosis, numbers of patients enrolling in 

clinical trials, and morbidity and mortality data. 

Over the years we chose to participate in the 

multiple cancer quality databases as they 

became available so as to develop one of the 

most comprehensive and far-reaching quality 

programs in existence today. These databases 

include the National Comprehensive Cancer 

Network (NCCN) Breast Cancer Database, the 

Quality Oncology Physician Initiative (QOPI) 

sponsored by the American Society of Clinical 

Oncology (ASCO), the Society of Thoracic 

Surgeons Database, the Blue Cross & Blue 

Shield of Michigan Pathways Project, and the 

American College of Surgeons Tumor Registry. 

We clearly want to know how our care compares 

with that around the country and “continuous 

improvement” is a framework which we embrace. 

° One of our most recent and most exciting 

accomplishments occurred in April 2010 when 

the SJMHS cancer program was awarded a 

$2.5 million NCI Community Cancer Centers 

Program (NCCCP) grant. This grant program is 

competitive and SJMHS was among 

only 14 sites selected from applications across 

the country. Funding for this program comes 

from the American Recovery and Reinvestment 

Act; and the funds will support eleven oncology 

program positions including genetics coordinator, 

continuum of care coordinator, and additional 

nurse navigators among others. It supports 

methods to reduce healthcare disparities and 

improve access to clinical trials. It is discussed 

in more detail later in this report. 

° In mid-2009, SJMHS was notified that the 

oncology program was awarded $199,000 

to be utilized through August 2011 to fund 

two Nurse Navigator positions that focus on 

education related to clinical trials as well as 

actual recruitment to research studies. This 

funding, too, comes via the National Institutes 

of Health and the American Recovery and 

Reinvestment Act and is designed to both 

accelerate and promote scientific research 

and allow for job creation and retention. 


FOUNDATIONS OF CANCER CARE 

American College of Surgeons’ 

Commission on Cancer: Teaching 

Hospital Cancer Program 

Originating in 1922 by the American College 

of Surgeons’ (ACoS), the Commission on 

Cancer establishes standards to ensure quality, 

multidisciplinary, and comprehensive cancer care 

delivery. Accreditation by the Commission on 

Cancer (CoC) is granted only to those organizations 

that have voluntarily committed to provide the best 

in cancer diagnosis and treatment and are able 

to comply with established CoC standards. These 

standards ensure that a full range of state-of-the-art 

diagnostic, treatment, and supportive services are 

offered at accredited facilities. 

St. Joseph Mercy Hospital and the SJMH Cancer 

Program have been accredited by the Commission 

on Cancer since 1986, receiving accreditation 

with commendation in 2007 as a Teaching Hospital 

Cancer Program. A rigorous evaluation and review 

of our performance and compliance with CoC 

standards will again be conducted in 2010. 

Cancer Program Overview 

Saint Joseph Mercy Health System (SJMHS) is one 

of the most advanced providers of comprehensive 

cancer care in Michigan with three patient-centered, 

dedicated cancer centers and a fourth one soon to 

open. Our multidisciplinary approach provides highquality 

patient outcomes that are based on leadingedge 

research and clinically proven therapies. 

Newly-diagnosed cancer patients average 2,400 

each year (see Appendix A, Tumor Registry 2009 

Analytic Cases by Diagnostic Site). 

Integral to the SJMHS oncology program is a full 

spectrum of interdisciplinary caregivers who are 

highly experienced and passionate about their 

work. Chemotherapy certified nurses in Ann Arbor 

provide infusion services to an average of 65 patients 

per day. Oncology social workers are available for 

individual and family counseling at all phases of the 

cancer experience; they also lead numerous support 

groups which have been a mainstay of our program 

for 25+ years. The Palliative Care Team works across 

all settings, developing and implementing plans for 

care when comfort is the goal. Nurse navigators, 

home care case managers, dieticians, pastoral 

care chaplains and hospice staff are key members 

of the oncology team to ensure we address the 

comprehensive needs of our patient population. 

2009 Program Statistics 

Topic 

Data Point 

Newly Diagnosed Cancer Patients 2,448 

Radiation Treatments Delivered 24,85 

CyberKnife ® Fractions Delivered 614 

Chemotherapy & Infusion Treatments 18,847 

Mammograms Performed 54,000 

GI Endoscopies Performed 16,000 

Lung Cancer Surgical Cases 477 

# of Patients Enrolled in Clinical Trials since 2005 1,300 


Additional Cancer 

Centers Opened 

November 2009 

St. Joesph Mercy Canton 

Cancer Center 

May 2006 

St. Joesph Mercy Brighton 

Cancer Center 

Facilities 

Opened in 1993, the Robert H. and Judy Dow 

Alexander Cancer Care Center (also known as 

St. Joseph Mercy Cancer Care Center) at St. Joseph 

Mercy Hospital in Ann Arbor was a leader in cancer 

center design, focusing on the inclusion of all 

outpatient services under one roof. It is a 45,000+ 

square foot outpatient facility housing radiation 

oncology, a large chemotherapy/infusion clinic, 

laboratory, medical and gynecologic oncology 

physician offices, the Michigan Cancer Research 

Consortium CCOP operations office, and oncology 

program administration. Multidisciplinary clinic 

space affords patients the opportunity to be evaluated 

by all oncology physician specialists in one 

setting. The Radiation Oncology Department houses 

Michigan’s first Cyberknife ® Radiosurgery Center 

and a dedicated brachytherapy surgical suite. 

This outpatient cancer center links to the new St. 

Joseph Mercy Hospital with a 60,000 square-foot 

Surgery Pavilion, incorporating 17 surgical suites 

equipped for the latest minimally invasive procedures. 

A beautiful 30-bed inpatient oncology unit 

located on the eleventh floor offers a panoramic 

view of the surrounding countryside. 

Two additional cancer centers provide comprehensive 

care to patients in the SJMHS service area. In May 

2006, SJMHS opened the $13.6 million Warren R. & 

Lauraine A. Hoenshield Cancer Center (also known 

as St. Joseph Mercy Brighton Cancer Center), 

20 miles north of Ann Arbor. This is one of the 

fastest growing communities in the state, and this 

Center houses the only linear accelerator in 

Livingston County. Prior to its opening, patients undergoing 

radiation therapy drove an average of 40 

minutes to a treatment facility. The chemotherapy 

treatment area includes 15 treatment bays. Each bay 

overlooks a healing garden with bright, modern-looking 

sculptures. The first bay is considered a retreat 

area where patients can play cards, games or work 

on computers. The design team consulted with both 

patients and employees throughout the project 

which has resulted in a cancer center with a healing 

environment of soothing colors, water fountains, 

murals and original artworks. 

The new St. Joseph Mercy Canton Cancer Center 

in Canton, Michigan opened in late November 2009. 

This facility duplicates the St. Joseph Mercy Brighton 

Cancer Center described above, offering both chemotherapy 

and radiation oncology services. Plans 

are underway to open a fourth cancer treatment 

center in Chelsea, Michigan within the next year. 


FOUNDATIONS OF CANCER CARE (con’t) 

Oncology Physician Specialists 

Medical Oncology 

Medical oncologists/hematologists are the 

mainstay for cancer treatment and most often are 

the coordinators of the comprehensive care required 

by oncology patients. At SJMH, two new physicians 

came on board in 2009 for a total of 11 medical 

oncologists in three physician practices. All 

participate in clinical trials through the Michigan 

Cancer Research Consortium and are the lead 

accruers to study protocols. In addition, they provide 

leadership to the multiple tumor boards where 

patient cases are presented for input and direction 

from a group of multispecialty physicians. 

2009 Critical Review Cases 

Tumor Board 

Cases 

Ann Arbor 

General (Includes Lung, GI) 155 

Breast Cancer 272 

Genitourinary Cancers 28 

Head & Neck Tumors 80 

Livingston 59 

The medical oncologists at SJMHS participate in all 

multidisciplinary clinics and interdisciplinary advisory 

groups. In the past year they presented a total of 

seven grand rounds for the Department of Medicine. 

They provide program leadership in multiple areas 

including membership on the SJMHS Oncology 

Institutional Review Board and various quality 

improvement initiatives. 

Medical oncologists oversee the chemotherapy 

infusion clinics in all cancer centers. They worked 

closely with nursing staff this year to evaluate the 

safety of chemotherapy ordering and administration 

at SJMHS and undertook steps to develop/refine the 

chemotherapy physician order entry system. Over 

16,000 chemotherapy doses were analyzed with 

only 17 errors (0.1%) that reached the patient; none 

of these had negative outcomes for the patient. The 

Oncology & Infusion Services Collaborative Practice 

Team is currently working on standardized chemotherapy 

order forms, with 17 presently in place. 

During 2009, the following guidelines were 

created/revised and implemented: 

° Management of Tumor Lysis Syndrome 

° Guidelines for Use of Antiemetics in the Adult 

Patient Receiving Chemotherapy 

° Guidelines for the Administration of Immune 

Globulin (Intravenous) 

2009 Chemotherapy and Infusion Volumes 

Ann Arbor 

Brighton 

Chemotherapy 7631 2234 

Blood Transfusions 239 158 

Other Infusions 5698 2920 


Radiation Oncology 

Radiation oncology services are available in the St. Joseph Mercy Cancer Care Center (Ann Arbor) and 

both the Brighton and Canton facilities. Walter Sahijdak, MD, Medical Director, and five radiation oncologists 

provide expertise in the full spectrum of radiation therapy services. 

In 2007, SJMHS unveiled the first CyberKnife ® in Michigan. CyberKnife ® represents the latest generation of 

radiosurgery systems, combining image guidance technology with a compact linear accelerator. It has the 

flexibility to move in three dimensions to focus on the targeted area for treatment practically anywhere in the 

body. It has demonstrated success with a wide spectrum of cancers including brain, lung, prostate, pancreas, 

liver, and head/neck. The very precise radiation treatment can pinpoint and destroy tumors deep inside the 

body with no incisions, minimal side effects, no pain, and immediate return to normal activity. 

SJMHS has one of the few dedicated brachytherapy surgical suites in North America, offering both highdose-rate 

(HDR) and low-dose-rate (LDR) brachytherapy treatments for prostate, gynecologic, head/neck 

and breast cancers.k and breast ca 

2009 Radiation Oncology Patient 

Volumes & Services 

Ann Arbor 

Brighton 

New Patient Consults 958 251 

Radiation Treatments 17,876 6,975 

CyberKnife ® Consults 87 N/A 

CyberKnife ® Fractions 614 N/A 

High-Dose-Rate Brachytherapy 157 N/A 



The daVinci ® Robotic Surgical System is designed 

to enable complex surgery using a very precise, 

minimally invasive approach. We were the first 

Michigan hospital to routinely utilize the system for 

complex thoracic and cardiac surgery. 

Surgical Oncology 

The American College of Surgeons ranks SJMHS 

among the best cancer care providers in the United 

States. We have an expert team of respected and 

experienced oncologic surgeons, with each 

specialty trained to treat specific malignancies: 

° Thoracic/Esophageal Tumors 

° Breast Cancer 

° Neurological Cancers (Brain, Spinal Cord) 

° Genitourinary Cancers (Renal, Prostate) 

° Cutaneous Cancers (Skin) 

° Hepatobiliary Malignancies (Liver, Pancreas) 

° Colorectal Cancer 

° Gynecologic Malignancies 

In 2007, SJMHS opened one of the most sophisticated 

surgery pavilions in the country at St. Joseph Mercy 

Hospital, Ann Arbor. The all-new, 60,000 square-foot 

facility features 17 suites designed for minimally 

invasive procedures and equipped with the latest 

computer, image-driven technology, including the 

daVinci ® Robotic Surgical System. This robotic 

platform is designed to enable complex surgery 

using a very precise, minimally invasive approach. 

We were the first Michigan hospital to routinely utilize 

the daVinci ® system for complex thoracic and 

cardiac surgery. 

Multidisciplinary Clinics 

The St. Joseph Mercy cancer program has dedicated 

clinic space on the second floor of the Cancer 

Center in Ann Arbor. This spacious suite incorporates 

patient exam rooms as well as well as patient/family 

meeting rooms and large conference spaces. Multidisciplinary 

clinics are in place for the following areas: 

° Lung cancer 

° Breast cancer 

° Head and neck malignancies 

° Neuro-oncology diagnoses 

° Gastrointestinal cancers 

° All diagnoses requiring CyberKnife ® treatment 

(both intracranial and extra-cranial malignancies) 

The lung cancer multidisciplinary clinic is our most 

experienced and long-standing clinic which serves 

as the model for all other multidisciplinary clinics. 


Multidisciplinary Care 

The overriding model for cancer care at St. Joseph 

Mercy Cancer Center is the interdisciplinary Advisory 

Committees that have been established for breast 

cancer, lung cancer, gastrointestinal malignancies, 

genitourinary tumors, neurologic malignancies, 

gynecologic oncology, and head/neck cancers. 

Advisory Committees are charged with the 

development and oversight of the overall program 

and service delivery for their diagnostic sites. National 

Comprehensive Cancer Network Guidelines 

(NCCN) provide the framework for care. Committee 

membership is comprised of key physicians, nurse 

navigators, research nurses, administrators, and social 

workers. The Advisory Committees are responsible 

for the ongoing evaluation of their programs and the 

implementation of quality initiatives. Each committee 

includes a Nurse Navigator, which is discussed in 

greater detail in this report in the section “Coordination 

of Care.” 

Breast Cancer Program 

Breast care at SJMH is delivered in a comprehensive 

multidisciplinary program including all sectors of care 

from screening through breast cancer survivorship. 

Screening is performed through an all digital network 

with diagnostics performed at the Women’s Health 

Center at SJMH-Ann Arbor and our outpatient centers 

in Chelsea and Brighton. Over 50,000 mammograms 

are performed yearly and read the same day by 

radiologists specializing in breast diagnostics. 

In addition to digital mammography the centers 

are equipped with breast MRI capability for screening 

high-risk women and performing MRI-guided biopsies. 

A training program has been developed and implemented 

following American College of Radiology 

guidelines to ensure expert interpretation of MRI 

exams. New state-of-the-art ultrasound equipment 

for core biopsies and diagnostic studies has been 

acquired and is currently being utilized in both the 

Ann Arbor and Brighton centers. 

Breast Health Specialists and a Breast Cancer Nurse 

Navigator ensure the seamless delivery of care and 

provide patient education and support. Navigators 

meet patients at the time of breast biopsy to assess 

patient needs if the biopsy is positive. They provide 

education related to surveillance of high-risk 

conditions noted by Pathology. 

Radiation oncology offers the most technologically 

advanced planning and treatment systems, 

including partial breast irradiation. Nationally 

accepted guidelines are followed for cancer care. 

A database through the Michigan Breast Oncology 

Quality Initiative, the National Comprehensive 

Cancer Network, and Quality Oncology Physician 

Initiative funded through Blue Cross Blue Shield of 

Michigan provide nearly real-time quality data to 

help with benchmarking and ensure compliance 

with guidelines. 

An Image Recovery Center was recently 

opened in the beautiful Inspirit Salon & Spa 

located in the retail space of the new St. 

Joseph Mercy Hospital in Ann Arbor. Full-time 

image recovery services and products are 

offered including prosthesis fittings, skin care 

and clothing items specific to the needs of 

breast cancer patients, head shaving, wigs 

and head scarves. The certified specialist 

working in this center personally visits all 

patients hospitalized after breast cancer 

surgery to provide assistance and assure 

the patient is aware of available resources. 



Gastrointestinal (GI) Cancer Program 

The Gastrointestinal Cancer Program has evolved 

to become one of the premiere cancer care 

programs at SJMHS, encompassing multiple 

physician specialists who are recognized experts in 

their fields and cutting edge technology offered by 

only a few centers in the state. The following 

provides a brief overview of some of the important 

work being done by this outstanding team. 

Over 16,000 endoscopies are performed each year. 

Our managed care colorectal screening rate is 68% 

compared with 59% for southeast Michigan. 

The Department of Colorectal Surgery comprised of 

three colorectal surgeons pioneered the technique 

of laparoscopic colectomy and are currently at the 

forefront of minimally invasive surgery using the 

daVinci ® robotic surgical system. Robert Cleary, MD, 

has achieved the distinction of becoming the 

leading robotic colorectal surgeon in the Midwest. 

Another new area of expertise utilized by the 

colorectal surgeons is transendoscopic microsurgery 

or TEM. TEM allows the minimally invasive local 

excision of rectal tumors with the aid of a special 

operative rectoscope and magnified view. This 

technique is not widely available due to the necessary 

special instrumentation, unusual technical aspects 

of the approach, and stringent patient selection. 

Dr. Cleary has led the effort at SJMH to establish a 

colorectal surgery fellowship program, 

and our first fellow is expected in 

July 2011. 

The scholarly work of Naresh Gunaratnam, MD, has 

focused on two new minimally invasive techniques 

to combat the potentially progressive disease of 

Barrett’s Esophagus with or without high-grade 

dysplasia. Radiofrequency ablation (BARRX) utilizes 

energy to allow a limited depth of injury to destroy 

the Barrett’s cells without destroying the normal tissue 

in the deeper layers. Endoscopic Mucosal 

Resection (EMR) is a procedure that is available 

for removal of small nodules within the Barrett’s 

segment. EMR enables physicians to take a much 

larger biopsy specimen and offers the advantages 

of outpatient treatment. Both Dr. Gunaratnam and 

his colleague, Dr. Andrew Catanzaro, have 

successfully performed the BARRX and/or EMR 

procedures on over 45 patients with Barrett’s 

related dysplasia and adenocarcinoma. To date, 

five patients have completed treatment and 

show no residual dysplasia or cancer with up 

to three-year follow-up. 

Edward Kreske, MD, specializes in surgery of liver, 

pancreas and gallbladder. Minimally invasive 

techniques include laparoscopic pancreatic 

surgical resections, radiofrequency ablation for 

treatment of hepatocellular carcinoma and 

embolization in conjunction with the expertise 

of the interventional radiologists. 

The GI Cancer Program was one of the first workgroups 

at SJMH to embrace multidisciplinary care, 

which is evident in their progress and the fact that 

they are in the forefront of their field. 

Robert Cleary, MD and the 

daVinci Robotic Surgical System 


Lung Cancer Program 

Genitourinary Cancer Program 

Although the Genitourinary Cancer Advisory 

Committee oversees care of patients with 

tumors of the entire genitourinary system, a 

major focus of their work is in the field of prostate 

cancer. The Committee includes specialists in 

urology, radiation oncology, medical oncology, 

radiology and pathology. 

Over the past year, this group has 

accomplished the following: 

° Adoption of the National Comprehensive 

Cancer Network (NCCN) prostate cancer 

treatment guidelines that assures patients are 

educated about all recommended treatment 

options and are afforded the opportunity to 

consult with all appropriate specialists; 

° Prostate biopsy protocols were reviewed and 

standardized so that core biopsies performed 

in both the Urology and Radiology 

Departments include twelve core samples 

done with local anesthesia; 

° Educational resources for prostate cancer 

patients were developed and made available 

throughout urology offices as well as radiation 

and medical oncology areas. 

The multidisciplinary team offers a full range of 

treatment options that include robotic-assisted 

surgeries, brachytherapy (high dose rate [HDR]; 

low dose rate [LDR]); intensity modulated 

radiation therapy (IMRT), and hormonal therapy. 

Additionally, SJMHS is currently participating 

in a “Prospective Evaluation of CyberKnife ® 

Stereotactic Radiosurgery for Low and 

Intermediate Prostate Cancer: Homogenous 

Dose Distribution.” 

The SJMH Pathology Department added its 

first fellowship-trained genitourinary pathologist, 

Matthew Wasco, MD, who had the opportunity 

to spend some time at the University of Indiana 

studying testicular pathology. 

In addition, the SJMH Pathology Department 

now offers a relatively new laboratory test, 

Fluorescence in situ hybridization (FISH), to 

detect bladder cancer through analysis of 

chromosomal abnormalities in urine. 

Over the last few years, lung cancer treatment has 

transitioned toward minimally invasive techniques and 

expanding the role of robotic surgery. Additionally, the 

field of video-assisted thoracoscopic surgery (VATS) 

has evolved from experience with laparo-scopic 

procedures. Advanced video technology, computers 

and high-tech electronics are utilized to perform many 

operations that formerly required large, open incision 

thoracotomy. 

Other technologic advances are also changing the 

scope of lung cancer treatment. With the addition of 

the new Cyberknife ® , we are now able to offer curative 

therapy to those patients who are not good surgical 

candidates due to pulmonary function or other medical 

comorbidities. We have obtained the superDimension ® 

Electromagnetic Navigation Bronchoscopy system 

designed to extend the reach of the conventional 

bronchoscope, providing minimally invasive access to 

lesions deep in the lungs as well as mediastinal lymph 

nodes. Using GPS-like navigation, this system enables 

physicians to make early diagnoses of benign and 

malignant lung lesions. 

SJMHS is participating in an International Randomized 

Study to Compare CyberKnife® Stereotactic Radiotherapy 

with Surgical Resection in Stage I Non-Small 

Cell Lung Cancer (STARS). Sites from around the world 

are participating in this 1,200-patient study, with 

coordination and oversight by the MD Anderson 

Cancer Center team. In addition, we have developed 

a cryotherapy program that facilitates treatment 

of endobronchial tumors and maintenance of 

airway patency. 

The above describes cutting-edge approaches to lung 

cancer treatment. However, as we view the continuum 

of care, we are working diligently to develop initiatives 

that address the area of prevention. We are especially 

proud of a smoking cessation program that we are 

implementing in offices of primary care physicians 

called “Tackle Tobacco.” This program is based 

on the U.S. Department of Health and Human Services 

Clinical Practice Guidelines: Treating Tobacco Use 

and Dependence (2008), which provides an evidencebased 

framework. “Tackle Tobacco” is a system-wide 

“train the trainer” program in which an office 

“champion” is educated regarding tobacco addiction, 

“quit” products, motivational interviewing, methods/ 

tools to assess smoking behaviors, and counseling 

strategies to assist patients to discontinue smoking. 

Office “champions” are also charged with the 

development of a plan to ensure compliance with 

this program in their office practices. 

Vita Sullivan, MD has been the Medical Director of Thoracic 

Oncology since 2006. Dr. Sullivan completed her medical 

education at the University of Chicago. She did her General 

Surgery Residency at St. Joseph Mercy Hospital, Ann Arbor, 

MI and her Fellowship in Cardiothoracic Surgery at the 

University of Minnesota, Minneapolis, MN. 



Gynecologic Oncology Program 

Gynecologic oncology practice is joining with 

scientific experts to deliver minimally invasive surgery 

for staging of endometrial cancer. Robot-assisted 

surgery with the da Vinci ® Surgical System is 

accomplished by our surgeons through tiny, 1-2 

centimeter incisions; this provides greater precision 

and control, minimizing the pain and risk associated 

with large incisions while increasing the likelihood of 

a fast recovery and excellent clinical outcomes. 

Head & Neck Malignancies 

Head and neck tumors include those that arise in 

the nasal cavity, sinuses, lips, oral cavity, salivary 

glands, throat, or larynx. They comprise 3-5% of all 

cancers nationally, and average about 2% of all new 

cancer diagnoses at SJMH. The multidisciplinary 

team working with this patient population includes 

otolaryngologists, radiation oncologists, medical 

oncologists, plastic surgeons, pathologists, and 

speech therapists. 

Although not a new practice, intraperitoneal (IP) 

chemotherapy has become a standard of care 

for women fighting gynecologic cancers within the 

peritoneal cavity. Collaboration with our interventional 

radiologist for the insertion of abdominal ports for 

IP chemotherapy has eliminated the need for 

patients to return to the operating room following 

a diagnosis of cancer. This alliance has saved 

patients a surgical procedure and improved 

recovery time while allowing for an expedited 

initiation of IP chemotherapy. 

The gynecologic oncologists at SJMHS participate in 

national Gynecologic Oncology Group clinical trials 

through the Michigan Cancer Research Consortium 

CCOP. In addition, investigator-initiated studies are 

implemented when they are deemed appropriate 

for the SJMHS population. One such study currently 

underway surveys gynecologic oncology patients 

to measure distress during cancer treatment; results 

will be shared with oncology program physicians 

and staff. 

Neurologic Cancers (Brain, Spinal Cord) 

The advent of the CyberKnife ® has had a tremendous 

impact on the treatment of brain and spinal cord 

tumors. SJMH neurosurgeon Georffrey M. Thomas, MD, 

was the first neurosurgeon in Michigan to perform 

pain-free CyberKnife ® radiosurgery. Using this 

revolutionary technology, he is able to “target” 

benign and malignant tumors of the brain and spine 

with extreme accuracy. Having just completed our 

third year of treating patients with the CyberKnife ® , 

data show that for brain and spine cases we have 

treated 13 malignant and 36 non-malignant tumors. 

The head and neck surgeons at St. Joseph Mercy 

Hospital in Ann Arbor are among the first in the 

country to offer Trans-Oral Robotic Surgery (TORS) 

for their patients. TORS is a minimally invasive 

surgical treatment for diseases of the head and 

neck. The robotic instruments provide the surgeon 

with unsurpassed visualization, precision, dexterity 

and control. For head and neck cancer surgery, 

the advantages are much faster recovery, decreased 

need for feeding tubes, and no scar. TORS is FDA 

approved for excision of tumors of the tongue, 

tonsils and larynx (voice box). Potential benefits 

of TORS include the avoidance of disfiguring surgery, 

minimizing or eliminating the need for chemotherapy 

or radiation therapy, avoiding tracheotomy, quicker 

return to normal speech and swallowing, less pain, 

shorter recovery time, and minimal scarring. 

Endocrine Cancers (Thyroid) 

The major focus of the Endocrine Cancers Advisory 

Committee has been in the area of the diagnosis 

and treatment of thyroid cancer. The Committee 

has standardized treatment guidelines for thyroid 

cancers. Of importance has been their work to 

correlate the fine needle aspiration biopsy results 

with the subsequent surgical outcomes, ensuring 

that the pre-surgical biopsy results correlate with 

the surgical pathology; results have been excellent, 

with no false positive results. 

Of note is the increased utilization of Thyrogen 

scanning (and treatment as applicable) in patients 

with certain types of thyroid cancer. The use of 

Thyrogen is an alternative to thyroid hormone 

withdrawal and is more convenient for patients. 


Skin Cancers (Melanoma) 

The Academic Dermatology Residency is in its fifth 

year. We currently have 11 residents in our three-year 

program. All have presented at national meetings 

including the American Academy of Dermatology. 

SJMH medical staff dermatologists and dermatology 

residency dermatologists remove hundreds of skin 

cancers per year including both melanoma and 

non-melanoma lesions (squamous cell carcinomas 

and basal cell carcinomas). 

Cutaneous T Cell lymphoma patients are cared for 

by Dr. David Fivenson. 

Areas of research over the past two years include 

new TMN (tumor-metastases-node) and pathologic 

classification of malignant melanoma as well as new 

protocols for treatment of melanoma and Merkel 

cell carcinoma. 

The focus of the cutaneous malignancy program 

has been on establishing state-of-the-art care 

for individuals with various skin cancers. Key 

accomplishments in this area include implementation 

of a Mohs Micrographic Surgery clinic at SJMH 

and the development of sentinel node testing for 

malignant melanoma. Close collaboration between 

the dermatopathologists and plastic surgeons 

has resulted in excellent cure rates and minimum 

disfiguration for non-melanoma skin cancers 

using frozen section control to treat the malignancies. 

Mohs surgery for non-melanoma skin cancers is 

performed by three Mohs surgeons on the SJMH 

staff: Drs. Craig Cattell, Montgomery Gillard and 

Kent Krach. The sentinel lymph node biopsy program 

for advanced melanomas is expanding at SJMH 

with the addition of Dr. Ian Lytle, plastic surgeon; 

he is performing sentinel lymph node biopsies 

on deeper melanoma cases. 

Our second annual free skin cancer 

screening at SJMH was held in 

May 2010, with screening of over 

100 individuals. Both melanoma 

and non-melanoma skin cancers 

were detected in participants.} 


CANCER RESEARCH 

Michigan Cancer Research Consortium 

Community Clinical Oncology Program 

Since its inception in 1983, the Community Clinical 

Oncology Program (CCOP) of the National Cancer 

Institute has linked community cancer specialists to 

NCI-supported research to conduct approved 

cancer treatment, prevention, and control clinical 

trials. Types of studies carried out have broadened 

from treatment to chemoprevention, symptom 

management, continuing care, and quality of life. 

By far, the majority of cancer care is provided in the 

community setting; therefore, it is imperative that 

those patients and families have access to the most 

current and innovative treatment that is available 

through clinical trials programs. To this end, the 

oncology program at SJMHS initiated its research 

program in 1988. 

St. Joseph Mercy Health System first received 

funding for its clinical trials program from the 

National Cancer Institute in 1994 and has been 

funded continuously since that time. Originally 

established as the Ann Arbor Regional CCOP, its 

growth has been phenomenal under the steadfast 

leadership of Philip J. Stella, MD, principal 

investigator since the program’s inception. A name 

change better reflected its expansion to include its 

current 12 Michigan hospitals and one Connecticut 

hospital as well as over 100 medical oncologists, 

radiation oncologists, surgeons and other specialists. 

The MCRC CCOP received over $1.5 million in 

funding support in 2009 to maintain the infrastructure 

necessary to implement one of the country’slargest 

and most respected community research programs. 

The dollars support over 20 research staff of nurses, 

regulatory specialists, data managers, laboratory 

coordinators, a research pharmacist and program 

accountant. 

As one of 47 CCOP research programs currently 

sponsored by the NCI, the MCRC-CCOP has 

established a stellar reputation for quality research 

practices and patient accrual. 

The following highlights key accomplishments: 

° The MCRC-CCOP has received over $15 million in 

grant support from the NCI since 1994; 

° At any given time, over 120 treatment and cancer 

control studies are open and available for patient 

accrual; 

° Over 600 patients are placed on clinical trials 

each year, with SJMH patients comprising half of 

that total; 

° At any given time over 2,000 patients are being 

followed on protocols to which they were enrolled 

in previous years (e.g., long-term follow-up); 

° The MCRC CCOP received the prestigious 

American Society of Clinical Oncology Clinical 

Trials Participation Award (2006) for its demonstrated 

outstanding “commitment to improving the care 

of people with cancer through increased 

participation in clinical trials.” 


CARE ACROSS 

THE CONTINUUM 

National Cancer Institute Community 

Cancer Centers Grant (NCCCP) 

In 2009, SJMHS applied for and received the 

prestigious NCI Community Cancer Centers 

Program (NCCCP) grant with funding of $2.5 million 

over two years. This grant program is competitive, 

and SJMHS was among only 14 sites selected from 

applications across the country. This program is a 

strategic partnership of the NCI and participating 

hospitals designed to create a community-based 

cancer center network to support cancer research 

and enhance access to quality care at community 

hospitals. It began as a pilot program in 2007 as a 

network of community hospital cancer centers 

working to provide the most current, researchbased 

cancer care spanning the full cancer 

continuum with an emphasis on minority and 

underserved populations. 

Funding for this program comes from the American 

Recovery and Reinvestment Act and, therefore, will 

support the hiring of individuals to address the 

seven major focus areas designed to: 

° Reduce cancer health disparities 

° Improve quality of care at community hospitals 

° Increase participation in clinical trials 

° Enhance cancer survivorship and palliative 

care services 

° Participate in biospecimen research initiatives to 

support personalized medicine 

Nurse Navigators 

The Nurse Navigator role has existed at St. Joseph 

Mercy Cancer Care Center for over ten years. 

Initial collaboration with the Women’s Health 

Program supported the hiring of a nurse navigator 

for our breast cancer population. Being at 

the forefront of this concept, we needed to 

demonstrate the value of this role to physicians 

who believed their office staff provided all of the 

assistance required by women with breast cancer. 

However, patients readily embraced the direction, 

information and support offered by the nurse 

navigator as they traversed the health care system. 

Today there is no question as to the invaluable 

role nurse navigators play in the oncology field. 

In spring 2009, the Michigan Cancer Research 

Consortium CCOP applied for and received 

Administrative Supplement funding under the 

American Recovery and Reinvestment Act (2009) 

for the hiring of an Oncology Research Nurse 

Navigator (ORNN). The ORNN links with 

all newly-diagnosed patients to facilitate their 

transition to treatment with an important focus 

on considering a treatment plan that incorporates 

clinical trials. 

With the NCCCP award, the Office of Nurse 

Navigators was formalized in fall 2009 and is now 

comprised of four full-time and one part-time 

nurse navigator who work with all of the surgeons, 

medical oncologists and radiation oncologists so 

that all patients are contacted shortly after they 

are notified by their physician of their cancer 

diagnoses. 

° Expand use of electronic health records and 

connect to cancer research data network 

° Enhance cancer advocacy 

Saint Joseph Mercy Health System 

clinical nurse navigators that assist 

our patients through oncology 

services: left to right – Lara Blair, 

Pam Ceo, Sharon Petri, Colleen 

Sweetland and Jennifer Bailey. 


CARE ACROSS THE CONTINUUM (con’t) 

Community Partnerships 

Both the American Cancer Society (ACS) and The 

Wellness Community have a major presence in our 

community. Our 25-year relationship with the 

American Cancer Society covers a broad spectrum 

of involvement including ACS community and state 

Board representation by SJMHS oncologists, Cancer 

Center administrators, and social workers; long-term 

(20+ years) collaboration in the presentation of 

patient support programs including “Look Good . . . 

Feel Better;” co-sponsoring of survivor events such 

as “Making Strides Against Breast Cancer;” and 

participation in fundraising activities. 

Our current partnership with ACS extends to 

implementation of the ACS Cancer Resource 

Centers at both the Ann Arbor and Brighton cancer 

centers. ACS volunteers work with patients at these 

facilities to assess needs that can be met through 

ACS resources. This has resulted in over 518 referrals 

for ACS services in 2009. SJMHS is the most involved 

and active health system in partnership with the ACS 

in southeastern Michigan. 

SJMHS is committed to “walk the talk” when it 

comes to working with community agencies for the 

benefit of oncology patients and families. To that 

end, SJMHS has made the commitment to donate 

land on its 341-acre campus for the construction 

of an American Cancer Society Hope Lodge. 

Hope Lodge offers free lodging for patients and 

caregivers who live outside the area and are 

receiving treatments or undergoing clinical trials 

at SJMHS. ACS is currently developing its timeline 

for this important project. 

Over the past three years, The Wellness Community 

of Southeast Michigan has become the major 

provider in our service area of support and 

educational services for cancer patients, families, 

and friends. All services are free for participants. 

Located in Ann Arbor, MI, it began as a grass roots 

organization that was started locally by a group of 

committed community volunteers who were each 

personally touched by cancer. Linda Langmore, 

MSW, oncology social worker in the St. Joseph 

Mercy Cancer Center, was one of the organization’s 

founding members. 

The Wellness Community offers a comprehensive 

array of educational programs and workshops which 

are often provided by SJMHS oncologists, nurses, and 

other health care providers. For example, a class 

entitled “Frankly Speaking About Advanced Breast 

Cancer” was presented in October 2009 by Elaine 

Chottiner, MD, medical oncologist at SJMHS. Wellness 

Community brochures and events calendars are 

placed in the waiting rooms of all cancer center 

departments as well as physician offices. 

Health Disparities 

We will have no difficulty directing almost 40% of 

NCCCP project funding to disparities initiatives. 

An NCCCP award allows us to build on the successes 

we have had by: 

° Hiring a Manager of the Healthcare Disparities 

Program whose sole focus is the planning, 

implementation and evaluation of a cancerfocused 

program addressing the myriad of needs 

of patients and families who comprise minority, 

underserved, and uninsured persons. 

° Expanding our social services programs and 

staff to focus on the needs of minority and socioeconomically 

disadvantaged patients and 

families; 

° Enlisting a dedicated oncology patient financial 

services counselor to work with our 

socioeconomically disadvantaged population; 

° Expanding our network of African-American 

churches in the SJMH service area; 

° Initiating linkages with area churches that are 

building their Hispanic congregations (e.g., First 

United Methodist Church, Ypsilanti, MI; St. Mary’s 

Student Chapel, Ann Arbor, MI); 

° Establishing linkages with the ever-growing Asian 

populations in Washtenaw and Wayne Counties; 

° Expanding the MCRC CCOP’s minority-directed 

community education programs related to the 

NCI clinical trials program. 


Biospecimen Research Initiatives 

The NCCCP award allows us to make significant 

progress toward the implementation of the NCI Best 

Practices for Biospecimen Resources program. We 

have the full support of Samuel Hirsch, MD, Chief 

of Pathology, and Drs. Paul Valenstein and Joseph 

Tworek who have assumed responsibility for this 

project. Our experience in the collection and 

submission of both blood and tissue samples is 

significant through our clinical trials program. Many 

NCI clinical trials require specimen collection; other 

studies offer pharmacodynamic and pharmacokinetic 

testing as optional. The Michigan Cancer 

Research Consortium CCOP’s participation in these 

optional studies approaches 98%, establishing the 

framework for SJMHS leadership in the Biospecimen 

Research Initiative. 

Our work in the area of biospecimen research is 

a component of the National Cancer Institute’s 

Translational Research Program. The mission of 

the Translational Research Program is to integrate 

scientific advancements in the understanding of the 

biology of human cancer with the development of 

new interventions for the prevention, diagnosis, and 

treatment of cancer patients or populations at risk 

for cancer – and to speed up the process in order 

that promising new cancer discoveries can be 

translated into new interventions for patients faster. 

This is a particularly critical element for the future 

of oncology care and one to which we are 

strongly committed. 

Cancer Survivorship and 

Palliative Care Services 

Palliative Care is an approach to health care 

that focuses on relief of suffering and symptom 

management rather than on curing disease. It is 

designed to help provide the highest quality of 

life possible for people with illnesses that cannot be 

cured or conditions that are life-limiting. The Palliative 

Care Program at SJMH is staffed by a team of 

physicians, nurses, social workers, and pastoral care 

professionals, all skilled in symptom management 

and end-of-life care. They assist in the design and 

implementation of comprehensive care plans that 

include all aspects of patients’ and families’ 

needs at this very critical time. 

The SJMHS oncology program developed a 

role which spans the entire continuum from the 

outpatient infusion area and inpatient units to the 

patients’ homes. Chaplain David McNeil has defined 

the continuum of care to mean any and all places 

where patients and families exist. He goes wherever 

needed. Home visits are common. He is often at 

the bedside when a patient dies. Chaplain McNeil 

performed numerous funeral services in the past 

year for those patients without a church home. 

We are fortunate to have this role and a remarkable 

man to fill it who embodies the word “continuum” 

as no other has done. 

Chaplain David McNeil has defined the 

continuum of care to mean any and all 

places where patients and families exist. 

He goes wherever needed. 


PATIENT CENTEREDNESS 

Oncology Patient Advocates Team 

Initiated in June 2008, the Oncology Patient Advocates 

Team links with cancer center patients and families 

to develop and implement plans to enhance the 

patient experience at SJMHS. Membership on this 

important workgroup includes staff from most 

disciplines, representatives from community 

organizations, and oncology patients and 

families. Key projects over the past year include: 

Implementation of patient support, advocacy and 

information symposia during both Cancer Survivors’ 

Month and Lung Cancer Awareness Month. These 

events were jointly sponsored by SJMHS, Wellness 

Community, and American Cancer Society. 

Patient Satisfaction 

A critical component of our quality management 

plan is the measurement of how satisfied patients 

are with the care we provide. Quarterly surveys are 

undertaken for SJMH inpatient areas. One of the 

most revealing questions asked relates to whether 

the individual patient would recommend the hospital 

to family. Results from the most recent survey 

conducted during the last quarter of 2009 were 

extremely positive for the inpatient oncology unit 

at SJMH. Patients rated the hospital in general in the 

top decile of the survey respondents. As to whether 

oncology patients would recommend the hospital 

to family, 83% responded in the affirmative, which, 

again, was in the top decile of those responding. 

Development of an atmosphere of camaraderie 

and sharing in our cancer treatment centers through 

activities such as barbeques, musical performances, 

and holiday events. 

Expansion of the American Cancer Society’s 

Resource Center volunteers who align with cancer 

program staff to provide patients with information 

regarding available resources. 

In addition, the Oncology Patient Advocates 

Committee appointed a Survivorship Support Team. 

The Survivorship Support Team is in the process of 

obtaining patient feedback regarding survivorship 

issues and is charged with the task of developing 

survivorship care plans. A representative from the 

Wellness Community is a member of this workgroup 

and will provide leadership for this process. 

Radiation Oncology has an ongoing patient 

satisfaction survey program which includes specifics 

to their department (e.g., satisfaction with radiation 

schedule, courtesy of staff, etc.). Other components 

of the oncology program survey patients and family 

members periodically as well as solicit feedback at 

all points in their care. 

A Patient Speaks 

Following is a letter received from a patient written 

to Phil Stella, MD, Medical Director of the SJMHS cancer 

program. The perspective of this gentlemen is unique, 

as he is also a retired physician who was on the SJMHS 

staff for more than 35 years. As an internist, he was 

particularly interested in and aware of many aspects 

of care not evident to most patients entering our doors. 

His experience is what we strive for . . . and why the 

hundreds of our cancer program physicians and 

team members come to work every day. 


Dear Phil: 

Imagine my surprise when what originally was thought to be a rather large 

hematoma over my sternum turned out to be a malignancy, hurling me over 

to a most uncomfortable position of being a patient -- and a cancer patient 

at that! I never thought about “needing” you and your colleagues, being 

only desirous of a collegial and social relationship. However, I wanted to 

share a few thoughts about my experience, particularly as it relates to what 

we all speak so casually about as the “continuum of care.” 

First, the diagnostic process was relatively easy. A quick ultrasound and 

then an appointment with the surgeon who set me up for a C-T the same 

afternoon. Outpatient surgery was readily scheduled to accommodate my 

calendar. Then things got interesting. The frozen section was reported to 

be a sarcoma. 

Over the following week, extraordinary efforts were made on my behalf. The 

surgeon arranged for me to see the oncologic surgeon at the University of 

Michigan. The pathologists collaborated with their colleagues at U of M to 

determine the definitive diagnosis for a somewhat unusual tumor specimen. 

To our amazement and relief, a final diagnosis of T-cell lymphoma was 

made – a totally curable malignancy which required tried and true 

CHOP chemotherapy. I then moved into the medical oncology realm and 

appreciated the care and thoughtfulness of Andy Eisenberg, MD, who even 

provided me with a thorough literature review of T-cell lymphomas! 

Care in the oncology infusion clinic was extraordinary – there’s no other 

way to describe it. The expertise and competency of the nursing staff was 

apparent. Follow-up required PET scans at 3- and 6-month intervals, 

which were scheduled at the time of my visits with Andy. 

As I moved through the cancer experience, interacting with multiple 

departments (radiology, surgery, pathology, laboratory, medical oncology, 

chemotherapy infusion, pharmacy) and cancer center staff, your years 

of work to develop a cohesive approach to cancer care was evident – 

and I am one grateful patient. 

With best regards, 

Gerry 


QUALITY INITIATIVES AND OUTCOMES 

The SJMHS cancer program is accredited by the 

American College of Surgeons’ Commission on 

Cancer as a Teaching Hospital Cancer Program. 

As such, it is held to the standards of this organization 

and must undergo rigorous on-site reviews every 

three years. 

In 1993, our measurements related to the quality of 

care we were providing utilized data from our Tumor 

Registry and compared our data with that of other hospital 

tumor registries. We were able to review such 

things as stage of disease at diagnosis, numbers of patients 

enrolling in clinical trials, and morbidity and mortality 

data. Over the years we have chosen to participate 

in the multiple cancer quality databases available 

so as to develop one of the most comprehensive 

and far-reaching quality programs in existence today. 

These databases include the National Comprehensive 

Cancer Network (NCCN) Breast Cancer Database, the 

Quality Oncology Physician Initiative (QOPI) sponsored 

by the American Society of Clinical Oncology (ASCO), 

the Society of Thoracic Surgeons (STS) Database, the 

Blue Cross & Blue Shield of Michigan Pathways Project, 

and the American College of Surgeons Tumor Registry. 

We clearly want to know how our care compares with 

that around the country, and “continuous improvement” 

is a framework which we embrace. 

We are pleased to provide an overview of some of the 

quality initiatives that have been accomplished as well 

as those that are ongoing. 

Oncology & Infusion Collaborative Practice 

Team: Review of Chemotherapy Safety 

Chemotherapy ordering has been identified as one 

of the most complex and potentially dangerous areas 

of medicine. Oncology practices and departments 

must employ strategies to ensure safety. To this end, 

the chemotherapy infusion staff initiated an ongoing 

review of “near misses” and chemotherapy errors in 

2009, reported via the PEERS (Potential Error/Event 

Reporting System) process. An Oncology & Infusion 

Collaborative Practice Team was established to 

oversee this project, and the Hematology/Oncology 

Section of the Department of Internal Medicine also 

reviewed the data; these two groups worked together 

to identify potential for improvement through process 

change, staff education and communication. The 

table illustrates an outstanding record of chemotherapy 

safety at SJMHS. 

Although the results are excellent, the Oncology & 

Infusion Collaborative Practice Team has developed 

standardized chemotherapy order forms as a process 

improvement project which will prevent any errors 

related to illegible orders. 

In addition, the Oncology & Infusion Collaborative 

Practice Team reviewed the 2009 Standards for 

Excellence in Chemotherapy Administration released 

by the American Society of Clinical Oncology and 

the Oncology Nursing Society and will be monitoring 

their practices to ensure compliance. 

2009 Data: Oncology 

Error / Near Miss 

Number (n) 

% of Doses 

Number of Errors/Near Misses/Events Reported 33 0.2% 

Number of chemotherapy doses given 16,000 

• Errors reached patient 17 0.1% 

• Unavoidable Events 2 0.0% 

• Near Misses 13 0.1% 

• Other (non-patient) 1 0.0% 

Error/Near Miss Resulted in Treatment Delay 3 0.02% 

Error/Near Miss Resulted in Significant Patient Harm 0 0.0% 

Extravasation (non-vesicant)/IV dislodgement 2 0.01% 

Extravasation (vesicant) 0 0.0% 

Avoidable Errors with Computerized Physician Order Entry 12 36.4% 

Related to Pump Programming/Pump Double Check 5 15.2% 


Streamlining Systems: Chemotherapy 

Order Processes 

Six Sigma originated as a set of quality management 

methods designed to improve manufacturing 

processes and eliminate defects, but its application 

was subsequently extended to other types of business 

processes as well. In Six Sigma, a defect is defined 

as any process output that does not meet customer 

specifications or that could lead to an output that 

does not meet customer specifications. Each Six 

Sigma project carried out within an organization 

follows a defined sequence of steps and has 

quantified targets. 

The staff in the Chemotherapy Infusion Clinic 

applied the Six Sigma Lean Process to streamline 

the chemotherapy order process so that orders were 

complete and available to both the pharmacist and 

charge nurse for review prior to a patient’s arrival, 

thereby ensuring that patients would have their 

chemotherapy initiated at their scheduled appointment 

time. Assessment of the “defects” or processes 

interfering with the desired “output” or goal determined 

two critical areas: (1) timing of patient’s laboratory 

studies, and (2) processing of chemotherapy orders. 

Findings showed that most patients were having their 

blood drawn immediately before treatment which 

delayed the initiation of chemotherapy and that 10% 

of chemotherapy orders required modifications. 

New processes were designed which required patients 

to have their blood work done at least two hours (and 

up to two days) prior to treatment. Chemotherapy 

orders are now written 2-5 days before treatment 

and submitted to the pharmacy and infusion clinic 

by mid-afternoon the day before treatment to allow 

the pharmacist and charge nurse to perform a 

preliminary review. These changes have resulted 

in significant improvements in the efficiency of 

chemotherapy schedules and administration. 

Streamlining Systems: Radiation Oncology 

The Department of Radiation Oncology utilized the 

Six Sigma process to accomplish five goals: 

(1) Redesign of the registration process for better 

utilization of clerical staff and improved accuracy 

of information; 

(2) Redesign of the scheduling process to improve 

integration of staff and standardization of 

patient-centered care; 

(3) Redesign of the RN and Clerk roles to better 

utilize skills and improve time management of 

staff; 

(4) Redesign the DosSimulation planning process to 

allow more timely and efficient completion of 

treatment planning; and 

(5) Become a paperless department through 

implementation of the electronic medical record. 

Although a major undertaking, these quality 

improvement efforts were all accomplished over 

the course of four months with an added outcome 

of going entirely “paperless” when the new SJMHS 

Canton Cancer Center opened in November 2009. 

Cardiothoracic Surgery: Benchmarking 

Through the Society of Thoracic Surgeons 

Database 

The Society of Thoracic Surgeons began data 

collections for cardiac procedures in 1992 and 

for thoracic surgery in 2002. SJMHS cardiothoracic 

surgeons began contributing to the STS database 

in July 2006 when approximately 50 sites were 

participating; as of October 2009 there were 142 

sites collecting thoracic surgery data and 985 sites 

contributing cardiac surgery data. 

Utilizing the STS data for 2006-2009 as a benchmark, 

the Cardiovascular & Thoracic Surgeons of Ann 

Arbor completed a comprehensive study of thoracic 

surgery outcomes for that timeframe. They reviewed 

data from both open thoracotomies and video-assisted 

thoracic surgeries (VATS) with specific interest 

in lobectomy and pneumonectomy procedures. 

From that they developed/refined length-of-stay 

risk models. Patient profiles were consistent with 

STS data, and mortality was somewhat better 

(1.2% versus 1.6%). 


QUALITY INITIATIVES AND OUTCOMES (con’t) 

Medical Oncology: Quality Oncology 

Practice Initiative (QOPI) 

Ann Arbor Hematology Oncology Associates, the 

largest medical oncology private practice at SJMHS, 

is participating in the American Society of Clinical 

Oncology’s (ASCO) Quality Oncology Practice 

Initiative (QOPI). QOPI is one of a series of quality 

improvement initiatives underway between Blue 

Cross Blue Shield of Michigan, hospitals, and/or 

physician groups. QOPI is a physician-led voluntary 

program for measuring practice quality whose goal 

is to promote excellence in cancer care by assisting 

practices in creating a culture of self-examination 

and improvement. The oncologists at SJMHS submit 

information to ASCO’s national database on 

chemotherapy planning, chemotherapy-related 

side effects, pain assessment and control, and 

specific measures related to the management of 

oncology patients and end-of-life care. Blue Cross 

Blue Shield of Michigan (BCBSM) is providing funding 

to defray data collection costs and to encourage 

physician participation. Dr. Stella and Beth 

LaVasseur, RN, MSN were instrumental in working 

with BCBSM to implement this statewide. 

Medical Oncology: Michigan Oncology 

Clinical Treatment Pathways Program 

The SJMHS medical oncologists are also participating 

in the Michigan Oncology Clinical Treatment Pathways 

Program, a partnership between Blue Cross Blue 

Shield of Michigan, the Michigan oncology community 

and P4 Healthcare, an oncology benefit management 

company. Participating oncologists utilize oncology 

clinical pathways guidelines created by a steering 

committee of Michigan oncologists representing the 

most up-to-date and effective treatments for cancer 

patients. Objectives of the program include: 

° Establish evidence-based oncology treatment 

pathways for a variety of cancers, specifically 

with regard to the use of chemotherapy and 

supportive care 

° Define optimal quality care and treatment with 

the least toxicity while being most cost effective 

for the patient, provider, and payer – without 

compromising integrity or delivery of treatment 

° Decrease variability in treatment regimens between 

providers in order to utilize a consistent 

treatment regimen based upon a balance between 

outcomes, toxicity, and cost 

° Improve quality of health care delivery 

Initial results have demonstrated less variability 

in regimens, reduced misuse of chemotherapy, 

better managed toxicity, and more defined 

treatment milestones. 

Breast Program Quality Initiatives 

Nationally accepted guidelines are utilized to evaluate 

breast cancer care. A database through the 

Blue Cross funded Michigan Breast Oncology Quality 

Initiative (MiBOQI) and Quality Oncology Physician 

Initiative (QOPI) provides nearly real-time quality 

data to assist with benchmarking and ensure compliance 

with national guidelines. 

Breast program quality metrics for 2009 include: 

° The Breast Cancer Multidisciplinary Committee 

reviewed all MiBOQI data and chose to investigate 

two elements of patient cases that were considered 

non-concordant with NCCN Guidelines; these 

areas were: 

– Stage II, Node Positive Breast Cancer receiving 

chemotherapy; 67% of 57 evaluable patients 

received chemotherapy; 

– Sentinel Node Positive patients receiving axillary 

lymph node dissection; 71% of 66 evaluable 

patients were concordant. 

Each non-concordant patient case was reviewed 

and found to have well-documented rationale for 

non-compliance. 

° Thirteen key Breast Cancer Quality Measures were 

reviewed in the most recently diagnosed patients 

through the QOPI project at two sampling periods 

in 2009. Care measures were consistent with or 

demonstrated higher compliance in 12 of the 13 

measures. Cases that were non-concordant with 

standards were assessed and measures identified 

to correct non-compliance where applicable. 


° The Breast Center undertook a quality improvement 

project to decrease the time from request for 

screening mammogram appointment to actual 

date of screening. In early 2009 the wait time was 

14 weeks; this was decreased to same week 

scheduling at the time of this report. 

° The number of positive biopsies as compared to 

number of biopsies completed is continuously 

monitored. Our rate of positive biopsies consistently 

measures ± 40% which is in keeping with 

national standards. 

Of key importance is the dedication of SJMH physicians 

to ongoing quality improvement. Tari Stull, MD, 

member of the Breast Cancer Advisory Committee, 

participated in the American Society of Breast 

Surgeons’ Mastery of Breast Surgery Pilot Program, 

a continuing quality improvement initiative. The 

program required a self-reporting process related 

to breast surgical procedures for both benign and 

malignant disease as a fundamental first step in 

improving quality. Ongoing continuing medical 

education criteria must be met over the ensuing 

five years to continue to meet the requirements of 

this program. In addition, Dr. Stull is presently 

completing a breast surgery fellowship at Bryn 

Mawr Hospital in Bryn Mawr, PA. 

Cancer Research Audits (2009-2010) 

The Michigan Cancer Research Consortium CCOP 

is affiliated with ten National Cancer Institute sponsored 

research bases (including the NCI Cancer Trials 

Support Unit). Each of these organizations conducts 

regularly-scheduled audits of data submitted for 

patients on clinical trials. Compliance with the 

exacting data requirements of clinical research is a 

strength of the MCRC. Over our 17-year history, the 

MCRC has established an excellent record for data 

quality and timeliness of submissions. 

The volume and detail of data submission is truly 

phenomenal. Over 120 studies were open for 

recruitment in 2009, and more than 1,300 patients 

have been enrolled in clinical trials in the past five 

years. On-site audits were conducted by the North 

Central Cancer Treatment Group (at Mayo Clinic), 

the Southwest Oncology Group, and the M.D. 

Anderson Cancer Center with excellent results. 

American College of Surgeons’ Commission 

on Cancer: Outcomes Comparison 

The SJMH Cancer Program is accredited by the 

American College of Surgeons’ Commission on 

Cancer as a Teaching Hospital Cancer Program. 

The standards “ensure that cancer services, care, 

and patient outcomes are evaluated and improved 

so that patients receive care that meets or exceeds 

patient expectations and standards distributed by 

local, state, regional, and national standard-setting 

organizations.” This requires an annual evaluation 

of services and care which provides a baseline to 

measure quality and an opportunity to correct or 

enhance patient outcomes. We continuously review 

the outcomes of patients at SJMH, and the following 

presents our patient care evaluation for those 

individuals with lung cancer including both 

non-small cell and small cell lung cancers. 

An estimated 222,520 new cases of lung cancer are 

expected in the United States for 2010, accounting 

for about 15% of cancer diagnoses. The incidence 

rate is declining significantly in men, from a high of 

102.1 cases per 100,000 in 1984 to 71.3 cases in 2006. 

In women, the rate is approaching a plateau after a 

long period of increase. Lung cancer is classified 

clinically as small cell (14%) or non-small cell (85%) 

for purposes of treatment. 

According to the National Cancer Institute, lung cancer 

is the leading cause of cancer-related mortality in the 

United States. An estimated 157,300 deaths, accounting 

for about 28% of all cancer deaths, are expected to 

occur in 2010. Since 1987, more women have died 

each year from lung cancer than from breast cancer. 

Since 1990, death rates among men have continued to 

decrease while female lung cancer death rates have 

been stable since 2003 after continuously increasing for 

several decades. 

Cigarette smoking is by far the most important risk 

factor for lung cancer. Cigar and pipe smoking also 

increase risk. Other risk factors include occupational 

or environmental exposure to secondhand smoke, 

radon, asbestos, certain metals, some organic 

chemicals, radiation, air pollution, and a history 

of tuberculosis. Genetic susceptibility plays a 

contributing role in the development of lung 

cancer, especially in those who develop the 

disease at a younger age. 


QUALITY INITIATIVES AND OUTCOMES (con’t) 

American College of Surgeons’ Commission on Cancer: 

Outcomes Comparison (con’t) 

A total of 252 new analytic lung cancer cases (267 including non-analytic) 

were diagnosed at SJMH in 2009, accounting for 11.5% of all new cancer cases. 

Incidence was divided equally between the sexes, with males accounting for 

136 and females totaling 131. 

Survival Statistics 

TABLE 1: Distribution by Age at Diagnosis 

Lung Cancer (Analytic Cases) 

Age at Diagnosis % & # New Diagnoses # New Diagnoses 

SJMH 

National Cancer Data 

Base (Ncdb)* 

0 - 29 0.4% (1) 0.2% 

30 - 39 0% (0) 0.8% 

40 - 49 3.2% (8) 4.5% 

50 - 59 19.1% (48) 18.1% 

60 - 69 27.4% (69) 29.4% 

70 - 79 33.3% (84) 34.8% 

80 - 89 15.9% (40) 11.5% 

90+ 0.8% (2) 0.8% 

*Clearly demonstrates that the age of patients diagnosed with lung cancer at SJMH is 

consistent with national norms. 

TABLE 2: Distribution by Stage 

Lung Cancer (Analytic Cases) 

Stage at Diagnosis SJMH (2009) National Cancer Data 

Base (Ncdb)* 

Stage I 24.6% (62) 5.4% 

Stage II 3.6% (9) 3.3% 

Stage III 21.0% (53) 25.5% 

Stage IV 38.5% (97) 52.6% 

Unknown/Unstaged 12.3% (31) 12.8% 

It is of interest to note that almost 25% of SJMH patients are diagnosed with Stage I 

local disease as compared with 5.4% of patients nationally. The reasons for this are 

not obvious; however, the NCDB data is from earlier years (2000-2007) which might 

contribute to the difference as improvements in diagnostic technology have been 

made over the years. 

*Please note that NCDB Data is from years 2000-2007, which is the most current national 

information available. 


TABLE 3: Initial Therapy 

Lung Cancer 

Treatment of Modality SJMH (%) National Cancer Data 

Base (Ncdb)* 

Surgery Only 14.3% (36) 25.6% 

Chemotherapy Only 13.1% (33) 7.0% 

Radiation Therapy Only 13.9% (35) 10.6% 

Radiation + Chemotherapy 17.8% (45) 17.5% 

Palliative Treatment* 19.8% (50) Not Specified 

Other/Unknown 16.7% (41) 19.4% 

Diagnosis Only 13.1% (33) 16.3% 

*Palliative treatment incorporates any care provided in an effort to alleviate symptoms. It may 

include surgery, radiation, therapy, chemotherapy, and/or other pain management therapy. 

Data from the SJMH Tumor Registry compares SJMH lung cancer five-year 

survival with the National Cancer Database. 

Relative Survival 

by Summary at Diagnosis 

Stage at Diagnosis 

% Five Year Survival % Five Year Survival 

SJMH 

National Cancer Data 

Base (Ncdb) 

I 44.9% 46.5% 

II 28.0% 26.9% 

III 12.8% 11.2% 

IV 2.3% 2.4% 

Five-year survival information includes patients diagnosed in years 1998 – 2002. 

Note that the SJMH data clearly mimics national survival rates. 


APPENDICES 

2009 Primary Site: Body System, Sex, Class, Status and Best AJCC Stage 

Primary Site 

ORAL CAVITY & PHARYNX 

Sex 

Class of Case 

Status 

Stage Distribution - Analytic Cases Only 

Total (%) M F Analy NA Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv 

34 (1.4%) 22 12 32 2 29 5 1 5 6 4 11 0 4 1 

1 (0.0%) 0 1 0 1 0 1 0 0 0 0 0 0 

9 (0.4%) 7 2 8 1 0 0 1 2 5 0 1 0 

9 (0.4%) 5 4 9 0 0 2 2 1 1 0 1 0 

5 (0.2%) 2 3 3 2 1 2 2 0 0 0 0 0 

1 (0.0%) 1 0 1 0 0 0 0 0 1 0 0 0 

6 (0.2%) 5 1 6 0 0 0 1 1 3 0 1 0 

1 (0.0%) 1 0 1 0 0 0 0 0 1 0 0 0 

1 (0.0%) 1 0 0 1 0 0 0 0 0 0 1 0 

1 (0.0%) 0 1 1 0 0 0 0 0 0 0 0 1 

Lip 1 0 

Tongue 9 0 

Salivary Glands 7 2 

Gum & Other Mouth 5 0 

Nasopharynx 1 0 

Tonsil 6 0 

Oropharynx 1 0 

Hypopharynx 1 0 

Other Oral Cavity & Pharynx 1 0 

DIGESTIVE SYSTEM 

349 (14.2%) 

187 162 329 20 273 76 3 68 49 68 60 11 70 0 

Esophagus 29 (1.2%) 26 3 28 1 22 7 0 5 2 5 7 1 8 0 

Stomach 16 (0.7%) 9 7 15 1 9 7 0 5 0 2 3 1 4 0 

Small Intestine 10 (0.4%) 6 4 10 0 9 1 0 2 0 1 0 4 3 0 

Colon Excluding Rectum 142 (5.8%) 79 63 133 9 130 12 0 33 20 40 20 2 18 0 

Cecum 

23 11 12 21 2 21 2 0 7 2 6 2 1 3 0 

Appendix 

6 5 1 4 2 5 1 0 0 0 0 2 0 2 0 

Ascending Colon 

44 27 17 44 0 42 2 0 10 9 18 4 0 3 0 

Hepatic Flexure 

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

Transverse Colon 

13 6 7 13 0 12 1 0 2 3 1 3 0 4 0 

Splenic Flexure 

3 3 0 3 0 3 0 0 3 0 0 0 0 0 0 

Descending Colon 

7 3 4 7 0 5 2 0 0 1 5 0 0 1 0 

Sigmoid Colon 

35 17 18 34 1 35 0 0 10 5 9 5 1 4 0 

Large Intestine, NOS 

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

Rectum & Rectosigmoid 68 (2.8%) 35 33 63 5 64 4 1 16 10 12 10 3 11 0 

Rectosigmoid Junction 

7 2 5 7 0 7 0 0 0 3 1 1 0 2 0 

Rectum 

61 33 28 56 5 57 4 1 16 7 11 9 3 9 0 

Anus, Anal Canal & Anorectum 4 (0.2%) 1 3 4 0 4 0 2 0 1 0 0 0 1 0 

Liver & Intrahepatic Bile Duct 8 (0.3%) 4 4 8 0 1 7 0 1 1 1 2 0 3 0 

Gallbladder 5 (0.2%) 1 4 5 0 2 3 0 0 2 1 0 0 2 0 

Other Biliary 9 (0.4%) 4 5 9 0 6 3 0 1 1 0 1 0 6 0 

Pancreas 54 (2.2%) 21 33 52 2 23 31 0 4 12 5 17 0 14 0 

Retroperitoneum 4 (0.2%) 1 3 2 2 3 1 0 1 0 1 0 0 0 0 

RESPIRATORY SYSTEM 

283 (11.5%) 151 132 268 15 205 78 3 67 12 56 99 2 29 0 

Larynx 16 (0.7%) 15 1 16 0 16 0 3 5 3 3 2 0 0 0 

Lung & Bronchus 267 (10.9%) 136 131 252 15 189 78 0 62 9 53 97 2 29 0 

BONES & JOINTS 

1 (0.0%) 0 1 1 0 1 0 0 1 0 0 0 0 0 0 

Bones & Joints 1 (0.0%) 0 1 1 0 1 0 0 1 0 0 0 0 0 0 

SOFT TISSUE 

6 (0.2%) Sex 5 1 Class 5 of Case 1 Status 5 1 0 0 Stage Distribution 1 - Analytic 1 Cases 1 Only 1 1 0 

Soft Primary Tissue Site(including Heart) 6 Total (0.2%) (%) M5 F1 Analy 5 NA 1 Alive 5 Exp 1 Stg 0 0 Stg 0 I Stg 1 II Stg 1 III Stg 1 IV 88 1 Unk 1 Blank/Inv 0 

SKIN EXCLUDING BASAL & SQ 216 (8.8%) 110 106 102 114 211 5 47 39 3 0 2 0 11 0 

Melanoma -- Skin 209 (8.5%) 108 101 98 111 204 5 47 37 2 0 2 0 10 0 

Other Non-Epithelial Skin 7 (0.3%) 2 5 4 3 7 0 0 2 1 0 0 0 1 0 

BASAL & SQUAMOUS SKIN 

3 (0.1%) 2 1 0 3 3 0 0 0 0 0 0 0 0 0 

Basal/Squamous cell carcinoma 3 (0.1%) 2 1 0 3 3 0 0 0 0 0 0 0 0 0 

BREAST 

523 (21.3%) 12 511 504 19 514 9 118 222 86 13 9 0 56 0 

Breast 523 (21.3%) 12 511 504 19 514 9 118 222 86 13 9 0 56 0 

FEMALE GENITAL SYSTEM 

175 (7.1%) 0 175 147 28 165 10 6 75 7 20 14 4 21 0 

Cervix Uteri 38 (1.5%) 0 38 15 23 38 0 0 8 1 2 2 0 2 – continued 0 

28 • 2010 Annual Cancer Report 

Corpus & Uterus, NOS 85 (3.5%) 0 85 83 2 82 3 0 57 3 8 3 3 9 0 

Corpus Uteri 

84 0 84 82 2 81 3 0 57 3 8 3 2 9 0 

Uterus, NOS 

1 0 1 1 0 1 0 0 0 0 0 0 1 0 0

SKIN EXCLUDING BASAL & SQ 216 (8.8%) 110 106 102 114 211 5 47 39 3 0 2 0 11 0 

Melanoma -- Skin 209 (8.5%) 108 101 98 111 204 5 47 37 2 0 2 0 10 0 

Other Non-Epithelial Skin 7 (0.3%) 2 5 4 3 7 0 0 2 1 0 0 0 1 0 

BASAL & SQUAMOUS SKIN 

3 (0.1%) 2 1 0 3 3 0 0 0 0 0 0 0 0 0 

Basal/Squamous cell carcinoma 3 (0.1%) 2 1 0 3 3 0 0 0 0 0 0 0 0 0 

BREAST 

523 (21.3%) 12 511 504 19 514 9 118 222 86 13 9 0 56 0 

Breast 523 (21.3%) 12 511 504 19 514 9 118 222 86 13 9 0 56 0 

ORAL FEMALE CAVITY GENITAL & PHARYNX SYSTEM 

34 175 (1.4%) (7.1%) 22 0 12 175 32 147 228 

29 165 510 

16 575 67 420 11 14 04 421 10 

Lip Cervix Uteri 138 (0.0%) (1.5%) 

0 138 115 023 

038 10 

0 18 01 02 02 0 02 0 

Tongue Corpus & Uterus, NOS 985 (0.4%) (3.5%) 70 285 983 02 

882 13 

0 057 13 28 53 03 19 0 

Salivary Corpus Glands Uteri 

984 (0.4%) 50 484 782 2 981 03 

0 257 23 18 13 02 19 0 

Gum Uterus, & Other NOSMouth 51 (0.2%) 20 31 51 0 31 20 

10 20 20 0 0 01 0 0 

Nasopharynx Ovary 137 (0.0%) (1.5%) 10 037 136 01 

132 05 

0 09 01 09 19 0 08 0 

Tonsil Vagina 61 (0.2%) (0.0%) 50 1 61 0 61 0 01 0 10 10 30 0 10 0 

Oropharynx Vulva 112 (0.0%) (0.5%) 10 012 110 02 

111 01 

05 01 02 0 10 0 02 0 

Hypopharynx Other Female Genital Organs 12 (0.0%) (0.1%) 10 02 12 0 01 1 

0 0 0 01 0 01 10 0 

Other MALE Oral GENITAL Cavity SYSTEM & Pharynx 1326 (0.0%) (13.3%) 0326 10 1316 010 

1322 04 

0 08 0217 027 09 0 054 1 

DIGESTIVE Prostate SYSTEM 

349 317 (14.2%) (12.9%) 187 317 162 0 329 307 20 10 273 313 76 4 30 68 1 49 215 68 27 60 9 11 0 70 54 01 

Esophagus Testis 29 8 (0.3%) (1.2%) 26 8 30 28 8 10 

22 8 70 

0 57 21 50 70 10 80 0 

Stomach Other Male Genital Organs 16 1 (0.0%) (0.7%) 91 70 15 1 10 

91 70 

0 50 01 20 30 10 40 0 

Small URINARY Intestine SYSTEM 

10 187 (0.4%) (7.6%) 6133 454 10 174 013 

9178 19 

079 247 010 16 08 41 323 0 

Colon Urinary Excluding Bladder Rectum 142 125 (5.8%) (5.1%) 79 89 63 36 133 116 9 130 119 12 6 075 33 17 20 10 40 0 20 5 20 18 9 0 

Kidney Cecum& Renal Pelvis 58 23 (2.4%) 11 41 12 17 21 55 23 

21 55 23 

03 729 20 6 23 1 313 0 

Ureter Appendix 

36 (0.1%) 52 1 43 20 

53 10 

01 01 0 0 20 0 21 0 

Other Ascending Urinary Colon Organs 144 (0.0%) 27 1 17 0 44 0 01 

42 1 20 

0 10 0 90 18 0 40 0 30 0 

EYE Hepatic & ORBIT Flexure 

25 (0.1%) 41 1 40 12 

32 20 

0 10 0 10 20 0 0 0 

Transverse Colon 

Eye & Orbit 2 

13 

(0.1%) 

6 7 13 0 12 1 

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

Splenic Flexure 

3 3 0 3 0 3 0 

3 0 BRAIN & OTHER NERVOUS SY 81 (3.3%) 29 52 77 4 72 9 0 0 0 0 0 77 0 0 

Descending Colon 

7 3 4 7 0 5 2 

1 5 0 1 Brain 33 (1.3%) 19 14 31 2 26 7 0 0 0 0 0 31 0 0 

Sigmoid Colon 

35 17 18 34 1 35 0 

10 5 9 5 1 4 Cranial Nerves Other Nervous S 48 (2.0%) 

Large Intestine, NOS 

10 38 46 2 46 2 0 0 0 0 0 46 0 0 

6 3 3 3 3 4 2 0 1 Rectum ENDOCRINE & Rectosigmoid SYSTEM 

68 65 (2.8%) (2.6%) 

35 18 33 47 63 61 54 

64 60 45 

10 16 24 10 5 12 8 10 5 314 11 5 0 

Thyroid Rectosigmoid Junction 

48 

7 

(2.0%) 

211 537 747 01 

744 04 

0 024 35 18 15 0 25 0 

Other Rectum Endocrine including Thymu 17 61 (0.7%) 33 7 28 10 56 14 53 

57 16 41 

10 16 0 70 11 0 90 314 90 0 

Anus, LYMPHOMA Anal Canal & Anorectum 4101 (0.2%) (4.1%) 159 342 488 013 

494 07 

20 031 114 010 028 03 12 0 

Liver Hodgkin & Intrahepatic Lymphoma Bile Duct 810 (0.3%) (0.4%) 47 43 810 0 110 70 

0 14 14 12 20 0 30 0 

Gallbladder Hodgkin - Nodal 

59 (0.2%) 16 43 59 0 29 30 

0 03 24 12 0 0 20 0 

Other Hodgkin Biliary - Extranodal 

91 (0.4%) 41 50 91 0 61 30 

0 1 10 0 10 0 60 0 

Pancreas Non-Hodgkin Lymphoma 54 91 (2.2%) (3.7%) 

21 52 33 39 52 78 213 

23 84 31 7 

0 427 12 10 58 17 28 03 14 2 0 

Retroperitoneum NHL - Nodal 

436 (0.2%) 121 315 233 23 

332 14 

0 18 04 17 013 01 0 0 

NHL - Extranodal 

RESPIRATORY SYSTEM 

283 

55 

(11.5%) 

31 24 45 10 52 3 0 19 6 1 15 2 2 0 

151 132 268 15 205 78 3 67 12 56 99 29 MYELOMA 

28 (1.1%) 17 11 27 1 25 3 0 0 0 0 0 27 0 0 

Larynx 16 (0.7%) 15 1 16 0 16 0 3 5 3 3 2 0 Myeloma 28 (1.1%) 17 11 27 1 25 3 0 0 0 0 0 27 0 0 

Lung & Bronchus 267 (10.9%) 136 131 252 15 189 78 

62 9 53 97 2 29 LEUKEMIA 

33 (1.3%) 14 19 29 4 26 7 0 0 0 0 0 29 0 0 

BONES & JOINTS 

1 (0.0%) 0 1 1 0 1 0 

1 0 Lymphocytic Leukemia 8 (0.3%) 2 6 5 3 8 0 0 0 0 0 0 5 0 0 

Bones & Joints 1 (0.0%) 0 1 1 0 1 1 0 Acute Lymphocytic Leukemia 1 0 1 1 0 1 0 0 0 0 0 0 1 0 0 

SOFT TISSUE 

6 (0.2%) 5 5 1 5 1 

1 1 1 1 Chronic Lymphocytic Leukemia 7 2 5 4 3 7 0 0 0 0 0 0 4 0 0 

Soft Tissue (including Heart) 6 (0.2%) 

Myeloid & Monocytic Leukemia 23 (0.9%) 

5 1 5 1 5 1 

1 1 1 1 1 11 12 23 0 16 7 0 0 0 0 0 23 0 0 

Acute Myeloid Leukemia 

15 7 8 15 0 8 7 0 0 0 0 0 15 0 0 

Chronic Myeloid Leukemia 

7 3 4 7 0 7 0 0 0 0 0 0 7 0 0 

Other Myeloid/Monocytic Leuke 1 1 0 1 0 1 0 0 0 0 0 0 1 0 0 

Other Leukemia 2 (0.1%) 1 1 1 1 2 0 0 0 0 0 0 1 0 0 

MESOTHELIOMA 

4 (0.2%) 3 1 3 1 4 0 0 2 0 1 0 0 0 0 

Mesothelioma 4 (0.2%) 3 1 3 1 4 0 0 2 0 1 0 0 0 0 

MISCELLANEOUS 

39 (1.6%) 19 20 38 1 27 12 0 0 0 0 0 38 0 0 

Miscellaneous 39 (1.6%) 19 20 38 1 27 12 0 0 0 0 0 38 0 0 

Primary Site 

Primary Site 

Sex Class of Case Status 


Total (%) M F Analy NA 

Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv 

Sex Class of Case Status 


Total (%) M F Analy NA 

Alive Exp Stg 0 Stg I Stg II Stg III Stg IV 88 Unk Blank/Inv 

Total 2,456 1,108 1,348 2,201 255 2,216 240 257 589 410 214 246 207 276 2 

Exclusions: Not Male and Not Female 0 


2009 BEST 

GENERAL SUMMARY STAGES 

Breast 

Analytic Breast Cases 

Total Number of Patients 

PROSTATE 

Analytic Prostate Cases 


250 

200 

150 

100 

50 

0 

In-situ Local Regional Distant Unknown 

250 

200 

150 

100 

The four most commonly occurring 

malignancies both nationally and 

St. Joseph Mercy Cancer Center 

are breast, prostate, lung and colon. 

BREAST CANCER 

We have seen a 20 percent increase 

in the number of new breast cancer 

cases. The distribution of the stage 

of disease at diagnosis virtually 

replicates that of the past few years 

with approximately 67 percent of 

our analytic case diagnosed with 

in situ or local disease. 

50 

0 

LUNG 

50 

45 

40 

Local Regional Distant Unknown 

Analytic Lung Cases 

Male 

Female 

PROSTATE CANCER 

There was a slight decrease in the 

number of our prostate cancer cases 

over the past year. Of the 305 analytic 

cases, 70% were diagnosed with 

local disease. 


COLON 


35 

30 

25 

20 

15 

10 

5 

0 

35 

30 

25 

20 

15 

10 


Analytic Colon Cases 

Male 

Female 

LUNG CANCER 

New lung cancer cases remained 

virtually the same as last year 

(2009 = 251 cases versus 2008 = 264). 

This number has remained fairly 

consistent over the years. 

COLON CANCER 

There was a 13% increase in the 

number of new colon cancer cases 

in 2009, attributable to outreach and 

screening activities. 

5 

0 



2009 TUMOR BOARDS / REGISTRY 

Tumor Boards 

Total Meetings 

Central Tumor Board 43 

(all cancer types) 

Breast Cancer 22 

Genitourinary Cancers 8 

Head and Neck 20 

Tumor Registry 

Statistics 

Total Records in Database 31,322 

Living Patients 15,147 

Cases Abstracted 2,454 

Data Requests From: 

• Physicians 3 

• Administration or Research 3 

• Other Hospitals/Tumor Registries 75 


APPENDICES 

2009-2010 Highlights of Scholarly Activities 

Beekman KW, Hussain M. Hormonal 

Approaches in Prostate Cancer: Application in 

the Contemporary Prostate Cancer Patient. 

Urol Oncol. 2008 Jul-Aug;26(4):415-9. Review. 

Hines SL, Mincey BA, Sloan JA, Thomas SP, 

Chottiner E, Loprinzi CL, Carlson MD, Atherton 

PJ, Salim M, Perez EA. Phase III Randomized, 

Placebo-Controlled, Double-Blind Trial of 

Riedronate for the Prevention of Bone Loss 

in Premenopausal Women Undergoing 

Chemotherapy for Primary Breast Cancer. 

J Clin Oncol. 2009 Mar 1;27(7):1047-53. 

Epub 2008 Dec 15. 

Byker G, Dinh MT, Gunaratnam NT, Robinson 

EA, Shehab TM, Malani, AN. Management 

of Clostridium Difficile Infection: Survey of 

Practices and Compliance with national 

Guidelines among Primary Care Physicians. 

Infect Control and Hosp Epidemiol. 2009 

Apr;(4):397-9. 

Grewal JS, Brar PK, Sahijdak WM, Tworek JA, 

Chottiner EG. Bing-Neel syndrome: a case report 

and systematic Review of Clinical Manifestations, 

diagnosis and treatment Options. Clin 

Lymphoma Myeloma. 2009 Dec;9(6):462-6. 

Grewal JS, Smith LB, Winegarden JD 3 rd , Krauss 

JC, Tworek JA, Schnitzer B. Highly Aggressive 

ALK-positive Anaplastic Large Cell Lymphoma 

with a Leukemic Phase and Multi-organ Involvement: 

A Report of Three Cases and a Review of 

the Literature. Ann Hematol. 2007 Jul;86(7)499- 

508. Epub 2007 Mar 30. Review. 

Jatoi A, Schild SE, Foster N, Henning GT, 

Dornfeld KJ, Flynn PJ, Fitch TR, Dakhil SR, 

Rowland KM, Stella PJ, Soori GS, Adjei AA. A 

Phase II Study of Cetuximab and Radiation in 

Elderly and/or Poor Performance Status 

Patients with Locally Advanced Non-Small 

Lung Cancer (N0422). Ann Oncol. 2010 Jun 21. 

Loprinzi CL, Dueck AC, Khoyratty BS, Barton DL, 

Jafar S, Rowland KM Jr, Atherton PJ, Marsa GW, 

Knutson WH, Bearden JD 3rd, Kottschade L, 

Fitch TR. A Phase III Randomized, double-blind, 

placebo-controlled trial of gabapentin in the 

management of hot flashes in men (N00CB). 

Ann Oncol. 2009 Mar;20(3):542-9. Epub Jan 6. 

Greil S, Robinson EA, Singal B, Kleer E. Efficacy 

over time of LHRH Analogs in the Treatment 

of Pca—a Prospective Analysis Using Serum 

Testosterone to Determine Doing Intervals. 

Urology. 2009 Mar;73(3):631-4. Epub 2008 

Dec 24. 

Hayes MJ, Carey JL, Krauss JC, Hedstrom DL, 

Gulbranson RL, Keren DF. Low IgE Monoclonal 

Gammopathy Level in Serum Highlights 20-yr 

Survival in a Case of IgE Multiple Myeloma. 

Eur J Haematol. 2007 Apr;78(4):353-7. 

Pulaski HL, Spahlinger G, Silva IA, McLean K, 

Kueck AS, Reynolds RK, Coukos G. Conejo- 

Garcia JR, Buckanovich RJ. Identifying 

Alemtuzumab as an Anti-Myeloid Cell 

Antiangiogenic Therapy for the Treatment of 

Ovarian Cancer. J Transl Med. 2009 Jun 

19;7:49. 

Kueck A, Opipari AW Jr, Griffith KA, Tan L, 

Choi M, Huang J, Wahl H, Liu JR. Resveratrol 

Inhibits Glucose Metabolism in Human 

Ovarian Cancer Cells. Gynecol Oncol. 2007 

Dec;107(3):450-7. Epub 2007 Sep 10. 

Uhm JH, Ballman KV, WU W, Giannini C, Krauss 

JC, Buckner, JC, James CD, Scheithauer BW, 

Behrens RJ, Flynn PJ, Schaefer PL, Dakhill SR, 

Jaeckle KA. Phase II Evaluation of Gefitinib 

in Patients with Newly Diagnosed Grade 4 

Astrocytoma: Mayo/ North Central Cancer 

Treatment Group Study N0074. Int J Radiat 

Oncol Biol Phys. 2010 May 24. 


Barton DL, LaVasseur BI, Sloan JA, Stawis AN, 

Flynn KA, Dyar M, Johnson DB, Atherton PJ, 

Diekmann B, Loprinzi CL. Phase III, Placebo- 

Controlled Trial of Three Doses of Citalopram 

for the Treatment of Hot Flashes: NCCTG Trial 

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APPENDICES 

2009-2010 Publications & Resident Awards SJMHS Dermatology 

JAAD Publications 

° Jason Mazzurco: Phaeohyphomycosis Caused by 

Phaeoacremonium Species in a Patient Taking 

Infliximab (Accepted for publication 4/2010) 

° Amy Basile: Disseminated Strongyloides stercoralis: 

Hyperinfection during medical immunosuppression. 

(Accepted for publication 2/22/2010) 

International Journal of Dermatology 

Publications 

° Jason Mazzurco: Localized Mycosis Fungoides of the 

Bilateral Thumbs and Nail Units Treated with Orthovoltage 

Radiation Accepted for publication (3/10) 

° Jason Mazzurco: Eruptive Disseminated Spitz Nevi in 

a 26-Year-Old African American Woman (6/10) 

AOCD Publications 

° Amy Basile: Plexiform Firohistiocytoma in a 13-yearold 

female: Case report and brief review. April 2010, 

Volume 16, Number 1. 

Journal of Drugs in Dermatology Publications 

° Brooke Bair: Lenalidomide manuscript (6/10) 

Other Publications 

° Jeni Stead: Palmoplantar erythrodysesthesia 

syndrome induced by capecitabine (Xeloda(r)) - 

Dermatology Clinics (6/10) 

Michigan Dermatology Society 

° 5 Honorable mentions: D. Cleaver, J. Mazzurco, J. 

Stead, A. Basile, C. Messana 

° Winter MDS Meeting: Residency program hosted the 

meeting at SJMHS in February 2010 comprised of 36 

patient presentations of interesting & difficult 

dermatological cases. 

•Resident PowerPoint Presentations: 

6/10 residents presented interesting cases 

Resident PowerPoint Presentations 

° AOCD New Orleans, Nov. 2009: 7/10 residents 

presented 15-minute PowerPoint presentations 

° Cosmetic Surgery Forum, Las Vegas Dec. 2009: 

David Cleaver Presented a surgical case 

° AAD Miami FL, March 2010: 5 Residents presented 

at Gross & Microscopic Symposium 

• Brooke Bair, Nichole Edwards, Emily Fibeger, 

Jennifer Stead, Christopher Messana 

° Dominican Republic: Interesting cases from Michigan 

Presented by J.Mazzurco, D.Cleaver, B.Bair 

° AOCD midyear meeting, Sedona, Az, April 2010: 

Two residents presented 

Resident Awards 

° Jason Mazzurco: Australia Surgical Paper Competition 

Winner, Nov. 2009 

° David Cleaver: ASDS Surgical Scholarship Recipient 

Dec. 2009 

° Brooke Bair: Caribbean Dermatology Recipient 

Jan. 2010 - Triax Resident Research Award 

° ARTE Scholarship to attend Orlando Dermatology 

meeting, Jan. 2010: Jason, David, Brooke 

° Brooke Bair: ASLM Resident Research competition 

for oral presentation 

° Brooke Bair: 2008-2009 Michigan Dermatological 

Society Residents’ Research Paper Award 

Ongoing Research 

° Cutera laser research: Four active abstracts in 

development (1st/2nd year residents) 

° Teledermatology Study 

Resident Poster Presentations 

° ASDS Meeting Phoenix, Az, Sept. 2009: David Cleaver 

presented surgical poster 

° ASDP Meeting Chicago, IL, Oct. 2009: 3 Residents 

presented pathology posters 

• Brooke Bair, Sarah Maggio, Jennifer Stead 

° MDS Winter Meeting, SJMHS February 2010: 

5 Residents presented posters 

° SJMHS Resident research poster session, April, 2010: 

9/10 Residents presented posters 

° ASDS Meeting Chicago 2010: Amy Basil presenting 

a poster on Mohs surgery for Merkel Cell CA 


St. Joseph Mercy 

Cancer Centers 

st. joseph mercy 

ann arbor 

5301 McAuley Drive 

Ypsilanti, MI 48197 


brighton 

7575 Grand River 

Brighton, MI 48114 


canton 

1600 S. Canton Center Road 

Canton, MI 48188 

St. Joseph Mercy Cancer Program 

888-474-HOPE / 888-474-4673 

stjoeshealth.org

ANNUAL REPORT - Saint Joseph Mercy Health System

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