2007 Cancer Annual_prod5 - St. Joseph Medical Center

2007 Annual Report | 2006 Statistics
The Cancer Institute
at St. Joseph Medical Center
To create a coordinated team of dedicated specialists and staff who will
provide the highest quality, compassionate care to cancer patients, in an
efficient and patient-centered manner.

A New Day In Cancer Treatment
at St. Joseph Medical Center
One team. One location.
One comprehensive treatment plan.
Building the Vision
The vision of creating a state-of-the-art, patient-centered cancer
care program is quickly becoming reality as the new Cancer
Institute at St. Joseph Medical Center approaches completion
in early 2008.
Although other cancer
programs may claim to
provide patient-centered care,
few can match the meticulous
planning, level of expertise
and investment that have gone into creating the patient’s
optimum experience when facing this formidable disease.
At The Cancer Institute at St. Joseph Medical Center, the world
revolves around the patient. The patient experience begins with
warm, inviting spaces and welcoming, supportive staff. “Our
vision for The Cancer Institute centers around the patients’
needs,” Dr. Mark Krasna, medical director of The Cancer
Institute says, “and it begins with the architectural design.
From the open reception area to the spacious clinical facilities,
the Center creates a welcoming, reassuring first impression.
Even our chemotherapy infusion area – with its own garden
and two-story glass atrium – has an open, pleasant feeling.”
“Not only are the surroundings of the chemotherapy infusion
center beautiful, but the center features infusion chairs
designed specifically for patient comfort. We spent six
months looking at chairs that were available,” Dr. Krasna
says. “None met our needs, so we designed our own. We
hope that our unique St. Joseph’s chair will someday be
in use throughout cancer programs of Catholic Health
Initiatives, our parent organization.”
However, the physical attributes of the new facility are
just the beginning of the patient experience at The Cancer
Institute. Treating cancer successfully requires the very highest
level of expert diagnosis, staging, and treatment planning that
brings all the experts together in consultation, supported
by state-of-the-art technology. The Cancer Institute is where
renowned cancer experts and cutting-edge technologies
meet old-fashioned personal attention under one roof.
Multidisciplinary Treatment Planning
The multidisciplinary care team includes specialists
for each cancer type, experts in radiation, surgery and
chemotherapy, support services, genetics counseling and
a nurse coordinator who plays a crucial and supportive
role in the patient’s experience.
The team approach is implemented through the weekly
multidisciplinary disease site-specific conference. “When
patients leave at the end of this visit to The Cancer Institute,
they will have seen all the specialists at one time,” Dr. Krasna
explains. “The doctors revolve around the patient. The patient
receives a single, customized, comprehensive treatment plan
agreed to by all our experts.
The Cancer Institute at St. Joseph Medical Center uses a
multi-modality approach, customized to each patient, to
deliver state-of-the-art cancer care and to provide patients
with unprecedented access to clinical research.
The Breast Center
The Colorectal Oncology Center
The Gynecologic Oncology Center
The Hodes Comprehensive Liver & Pancreas Center
The Radiation Oncology Center
The Thoracic Oncology Center
The Urologic Oncology Center
2 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

“This way, the patient is assured of getting the care that is
best for him or her,” Dr. Krasna says. “We are fortunate
that St. Joseph Medical Center recognizes the value of this
approach for cancer patients and was willing to invest in the
resources required to make The Cancer Institute a leader in
this unique mission of care.”
No resources have been spared when it comes to providing
and developing the latest treatments either. “Advanced
treatment often involves multi-modality therapies, combining
surgery, radiation and/or chemotherapy,” according to
Dr. Krasna. “This is the case with advanced lung cancer that
involves not only the lung but also the lymph nodes in the
middle of the chest.” Physicians are using an exciting, new
triple modality approach – a hard-hitting combination of
radiation therapy, chemotherapy and surgery – to remove
the tumor. Clinical evidence supports that this combination
can have a big impact on survival.
“By using chemotherapy together with radiation in a certain
timeframe, we can actually downstage the cancer and eradicate
it from the lymph nodes of the center of the chest for many,
though not all, patients,” says Dr. Ziv Gamliel, chief of Thoracic
Surgery at The Cancer Institute. “The chemotherapy makes
the tumor more sensitive to the radiation. It is now possible
to treat stage III-A lung cancer patients and have a very high
chance of success by combining the best practices at The
Cancer Institute for all three modalities together.”
At The Breast Center, patient care also follows the multidisciplinary
model approach for every case. “We sit down with
two to four pathologists in addition to medical oncologists,
radiation oncologists, surgeons, reconstructive surgeons and
other members of the team to discuss the subtleties of each
diagnosis and to make sure the specific cell type or extent
of the disease is accurately reflected before surgery takes
place,” emphasizes Dr. Michael J. Schultz, medical director
of The Breast Center at The Cancer Institute.
Clinical Trials Reaching the Community
The Cancer Institute at St. Joseph is honored to be the only
Maryland hospital chosen for an unprecedented pilot program
to extend the reach of NCI research and state-of-the-art
treatment into community hospitals across the country. This
exciting initiative expands the offerings of advanced clinical
cancer trials, giving even more treatment options to cancer
patients who come to St. Joseph Medical Center.
“Studies indicate that patients treated in major cancer centers
with access to clinical research may live longer with a greater
chance of cancer cure,” Dr. Krasna says. “The three-year NCI
Community Cancer Centers Program (NCCCP) expands
clinical trial availability and will increase cancer survival for
parts of our community who do not presently have access to
this type of care. This is our dream: to see multidisciplinary
care in the community and to see clinical trials and research
also done in a community setting.”
The Cancer Institute is making that dream a reality by not
only providing advanced, patient-centered cancer care, but
also by offering loving compassionate support for each
patient’s journey through the battle with cancer.
For more information about The Cancer Institute at
St. Joseph Medical Center and the multidisciplinary approach
to cancer care or about the NCI Community Cancer Centers
Program, call St. Joseph Medical Center, 410-427-2551.
“
A patient may come from three to four hours
away but when they leave at the end of their visit,
they will have seen all the specialists at one time.
The doctors revolve around the patient.
Mark Krasna, M.D.
“
2007 THE CANCER INSTITUTE ANNUAL REPORT | 3

The Cancer Institute
Message from the Medical Director & Vice President
Mark Krasna, M.D.
Medical Director
The Cancer Institute
This has been an exciting year for the
St. Joseph Cancer Institute. Since my
arrival here in September of 2006, we
have seen many changes to the face
and mission of The Cancer Institute.
The new Cancer Institute building has
been completed and now occupies
over 36,000 square feet of Medical
Building A. This brand new, state-ofthe-art
facility is the first structure one
sees when entering the St. Joseph campus from Osler Drive.
The magnificent atrium on the building’s facade is comprised
of a two-level glass space which encloses the chemotherapy
infusion areas and the waiting room for our comprehensive
Breast Center. The ground floor houses Radiation Oncology
and a dedicated PET/CT scanner for The Cancer Institute, as
well as cancer support services. It also includes all of Cancer
Research, as well as the Tumor Registry. Genetic counseling,
psychosocial services, nurse navigators and a patient
education area are located here as well. A Cancer Boutique
and a cafe are scheduled to open in early 2008. The first floor
features the Multidisciplinary Clinics, Medical Oncology,
physician offices and Cancer Institute executive offices,
in addition to the stunning infusion area. The second floor
is mainly devoted to The Breast Center and dedicated Breast
Imaging Center.
As exciting as the new construction is, we are just as proud
of the new recruits who have joined us. We are delighted
with our new medical oncologists, Drs. Richard Schraeder and
Rima Couzi, who are working hand-in-hand with the radiation
oncologists and surgeons in The Cancer Institute. To add to
the energy, our new cancer surgeons, Drs. Richard Mackey,
Robert Akbari and Linda Martin, have all hit the ground
running and are demonstrating themselves to be excellent
clinicians and cancer team players. Operationalizing our
new Multidisciplinary Clinics, PET/CT and Breast Imaging has
been an exciting undertaking for our new director of Cancer
Services, Monica Fulton, who brought with her experience
in managing a community cancer center in the Dana Farber
system in Boston. She has met the challenge with vigor and
a sense of mission.
The Multidisciplinary Clinics and prospective case conferences
are the centerpieces of The Cancer Institute. These programs
embody the spirit of coordinated care and single out St. Joseph
as an institution where collaboration and team planning are
focused on what is best for our patients. The synergy of the
building and the dedicated staff who work here have come
together to ease cancer patients’ journeys from diagnosis
through treatment during one of the most difficult times in
their lives.
Finally, our Tumor Registry and Research staffs have worked
tirelessly to open more opportunities for our patients to enter
clinical trials. This commitment and dedication have been
recognized by our parent organization, CHI – Catholic Health
Initiatives – who has established a Catholic Health Oncology
Network (CHON) with St. Joseph at the helm. This work has
also been recognized by Dr. John Niederhuber and the National
Cancer Institute (NCI) who have chosen St. Joseph and four
other hospitals in the CHI system as National Community
Cancer Center Network Pilot Program participants (NCCCP).
This exciting, new initiative will bring research opportunities
and new research staff to St. Joseph Cancer Institute patients
through the NCI grant.
We hope that this coming year is as successful as the
past one, and that, as our numbers of patients grow,
so will our successful mission of delivering the best,
compassionate multidisciplinary care available in our
Maryland regional community.
Mark Krasna, M.D,
Medical Director,
The Cancer Institute
Lucy Shamash,
Vice President, Operations
and The Cancer Institute
4 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

The Cancer Institute
Cancer Liason Physician Annual Report
Maen Farha, M.D.
Cancer Liasion Physician
The Cancer Institute
In some ways, Cancer Liaison
Physicians (CLPs) are the guardians
of their medical center’s cancer
program. Each cancer program in
the U.S. that is accredited by the
Commission on Cancer is required to
have a CLP. It is my honor to be the CLP
at St. Joseph Medical Center during
the creation of The Cancer Institute.
has been implemented for breast cancer, thoracic malignancies
and gastrointestinal tumors.
The Cancer Liaison Program is a grass-root network of 1,600
physicians volunteers (CLPs) whose primary roles are to:
• Serve as the physician champion within the cancer program
• Serve as the liaison between CoC and the cancer program
• Serve as an agent of change within the community
The CoC was founded by the American College of Surgeons
in 1922 and has been inspecting hospital cancer programs and
approving those that meet its stringent standards. The CoC
reviews cancer programs every three years to determine their
compliance with its standards. Twenty-five percent of U.S.
hospitals are CoC approved, but they collectively care for
80 percent of new cancer patients.
MISSION STATEMENT
“The Commission on Cancer (CoC) is a consortium
of professional organizations dedicated to improving
survival and quality of life for cancer patients through
standard-setting, prevention, research, education
and the monitoring of quality care.”
St. Joseph Medical Center’s cancer program was reapproved
in 2005 and the CoC will be back next spring to evaluate our
program. We look forward to that with anticipation because
the recent expansion of our cancer program has already
begun to bear fruit and is making a difference in cancer
patients’ care. One of the most impressive initiatives is the
implementation of multidisciplinary prospective Tumor Board.
Specialists from multiple disciplines, including many types of
non-physician providers, confer to plan the treatment of our
cancer patients. The result is always superior to what we can
individually accomplish, since many minds come together to
share expertise and create a treatment plan that is always
rich, intelligent and abundantly detailed for each patient. This
This role has been an enriching and positive experience for
me. In this capacity during the past year, accomplishments
have included:
• Reporting regularly to the Cancer Committee including
sharing our NCDB data and comparison to national
benchmarks
• Working closely with tumor registrars and registry to improve
the quality and completeness of our reporting
• Establishing initial relations with the American Cancer
Society and inviting our ACS Liaison to our Cancer
Committee meetings
• Establishing initial connection with the State Cancer Control
program and inviting them to present an overview of the
program at our cancer conference
• Attending the annual meeting of the CoC at the clinical
Congress of the American College of Surgeons
What is the value of all that data entry to the NCDB and
the SEER database?
Tumor registrars from the 1,500 or more approved institutions
enter extensive data into that database about each patient
treated at an institution. To date, 20 million patients are in
the database with good solid data on demographics, stage,
treatment and survival. This is a massive amount of data that
can be “farmed” to answer questions that may otherwise be
impossible to answer in a scientific manner. Recent examples
are data analysis that showed that having colon resections
with larger number of lymph nodes in the specimen confers
higher survival rates and that resecting primary tumors in
patients with metastatic breast cancer is associated with
increased survival. Plus, there have been similarly difficult
2007 THE CANCER INSTITUTE ANNUAL REPORT | 5

The Cancer Institute
Cancer Liason Physician Annual Report (continued)
questions that we have argued about without clear data other
than a few series involving a handful of patients before the
database was created. I believe that this orchard is definitely
ripe for the picking and that the data should be accessed by
all who are interested.
On an institutional level, our data is very useful in that we
can measure our performance against others and we can
measure our compliance with standards set by the CoC. Four
standards are being scrutinized (three for breast cancer and
one for colon) through eQuIPs (Electronic Quality Improvement
Packets). An example is a standard that calls for administering
radiation therapy to patients under 70 years of age after breastconserving
therapy for breast cancer. The challenge is that,
in addition to offering the treatment, the documentation has to
be available to our tumor registrars and that information has to
be entered into the NCDB. I encourage everyone to cooperate
with our registry staff by providing complete information. There
is a strong push in Washington to tie physician and hospital
reimbursement into meeting these standards (P4P).
A year ago, I was asked to perform the CLP role and I accepted
it because, with limited knowledge of its details, I thought it
was a “good” thing to do. As the year passed and I became
more familiar with the role’s details, I began to appreciate
what a worthwhile endeavor this is, and I have found it a very
fulfilling experience. I want to acknowledge the dedication of
the many physicians who, in addition to providing high quality
care, supply the registry with stage and survival data on their
patients; the tumor registry staff who work collecting and
entering the data and the hospital leadership that continues
their strong commitment to our Cancer Institute.
What are the CLP and CoC objectives for next year?
The areas of interest for CLPs as determined at the last
meeting of the CoC are: quality improvement, advocacy, ACS
partnership, clinical trials and comprehensive cancer control.
The CoC defined an objective for next year around each focus
area, and here are the objectives:
• Facilitate the utilization of eQuIP to promote quality care
for breast and colorectal cancer
• Work with the American Cancer Society Cancer Action
Network (ACS-CAN) in the area of legislative and
regulatory advocacy
• Bring ACS staff to the Cancer Committee table and facilitate
ACS interaction with the cancer program staff
• Increase enrollment of patients into clinical trials by
championing implementation and recruitment
• Present the state cancer plan to the Cancer Committee
and define ways to become involved
6 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

Cancer Institute Registry Activity
Data Analysis
2006 Five Most Frequent Cancer Sites
The most frequently diagnosed cancer at St. Joseph in 2006
was Breast, which represented 19.0% of our cases. Prostate was
the second most often diagnosed cancer at St. Joseph during
this same time period, accounting for 16.1% of our 2006
caseload. Colorectal diagnosis represented 11.8%, followed by
Lung/Bronchus, which comprised 11.0% of the annual cases.
Skin was the fifth most diagnosed cancer at 7.6%.
Breast
Prostate
Colorectal
Lung/Bronchus
11.8%
11.0%
16.1%
19.0%
Skin
7.6%
0 5 10 15 20
Source: St. Joseph Cancer Institute Registry
Follow-Up
Follow-up activity affords the opportunity to collect information
about additional treatment and aids in the identification of those
patients with cancer who have had local recurrence, metastases
or who have been diagnosed with an additional primary cancer.
Follow-up letters to physicians also serve as a reminder to contact
patients they may not have seen in the past year. The St. Joseph
Cancer Institute Registry currently has 9,039 cases under active
follow-up, with an average follow-up rate of 94.3%.
St. Joseph Follow-Up Rate 2006
Total number of cases under active follow-up:
9,039
Total number of cases with current follow-up data:
8,521 (94.3%)
Staging
The American College of Surgeons Commission on Cancer
mandates that all newly diagnosed cancer cases be American
Joint Committee on Cancer (AJCC) TNM-staged at initial
diagnosis by the managing physician. The AJCC TNM staging
system is a classification scheme used to assess the extension
and growth of a tumor, involvement of lymph nodes and
metastasis to any distant site at the time of diagnosis. This
staging system was developed to provide consistency in cancer
care and give physicians important information necessary to
choose the most appropriate treatment interventions.
AJCC Stage at
Diagnosis
ST. JOSEPH
MEDICAL CENTER
2006 FIVE MOST
FREQUENT SITES
Source: St. Joseph Cancer
Institute Registry
Stage 0
Stage I
Stage II
Stage III
Stage IV
Unknown
Lung/
Breast Prostate Colorectal Bronchus Skin
17.6% 0% 14.8% 0% 37.8%
42.9% 0% 27.3% 32.6% 46.7%
23.9% 80.6% 22.7% 7.1% 6.7%
7.8% 12.9% 25.8% 19.0% 5.5%
3.4% 3.2% 6.3% 27.0% 0%
4.4% 3.2% 3.1% 14.3% 3.3%
Stage 0 – Carcinoma in situ –
an early form of carcinoma.
Stage I – Localized to one
part of the body.
Stage II – Involves regional
lymph nodes.
Stage III – Locally advanced.
Stage IV – Metastasized
or spread to other organs
throughout the body.
2007 THE CANCER INSTITUTE ANNUAL REPORT | 7

10 Most Frequent Cancer
Sites by Gender
2006 NATIONAL* AND ST. JOSEPH
COMPARATIVE INCIDENCE
*Source: American Cancer Society
Female
National*
St. Joseph
Breast 31% 19.0%
Lung 12% 6.6%
Colorectal 11% 6.6%
Corpus Uteri 6% 5.1%
Ovary 3% 1.6%
Non-Hodgkins
Lymphoma 4% 1.0%
Skin 4% 3.5%
Thyroid 3% 0.4%
Pancreas 2% 1.5%
Bladder 2% 2.0%
Male
National*
St. Joseph
Prostate 33% 16.1%
Lung 13% 6.0%
Colorectal 10% 6.9%
Bladder 6% 3.3%
Skin 5% 5.2%
Non-Hodgkins
Lymphoma 4% 0.6%
Kidney 3% 2.4%
Pancreas 2% 1.9%
Leukemia 3% 0.5%
Oral 3% 0.3%
St. Joseph Medical Center 2006 Primary Site Table
Non-
Total
Primary Site Analytic* Analytic** Male Female Cases
Breast 205 29 1 233 234
Prostate 155 19 174 N/A 174
Colorectal 128 17 74 71 145
Lung/Bronchus 124 12 65 71 136
Skin 90 4 56 38 94
Cervix Uteri 55 2 N/A 57 57
Urinary Bladder 46 12 36 22 58
Kidney/Renal/Pelvis &
Other Urinary Organs 33 7 26 14 40
Pancreas 32 4 20 16 36
Corpus Uteri 32 5 N/A 37 37
Unknown/III Defined Sites 28 9 14 23 37
Lymphomas 21 1 8 14 22
Ovary 17 4 N/A 21 21
Brain/Meninges/CNS 14 1 6 9 15
Esophagus 11 5 11 5 16
Liver/Intrahepatic Bile Duct 11 1 9 3 12
Gallbladder/Other Biliary 11 1 5 7 12
Stomach 10 1 7 4 11
Small Intestine 8 1 4 5 9
Thyroid & Oth. Endocrine 8 1 5 4 9
Hematopoietic/Reticuloendo 6 2 5 3 8
Penis/Testis 6 1 7 N/A 7
Oral Cavity 5 0 3 2 5
Myeloma 5 3 6 2 8
Anus 4 0 2 2 4
Vulva/Vagina 3 1 N/A 4 4
Other Female Genital Site 3 1 N/A 4 4
Larynx/Nasal/Sinuses 2 3 5 0 5
Mesothelioma 2 0 1 1 2
Soft Tissue 2 2 2 2 4
Other Male Genital Site 1 0 1 N/A 1
Retroperitoneum/Peritoneum 0 0 0 0 0
Other Digestive Organs 0 1 0 1 1
Eye & Orbit 0 4 3 1 4
Totals 1078 154 556 676 1232
*ANALYTIC – Any or all of the first course of therapy completed at the reporting facility.
*NON-ANALYTIC – Cases not receiving any first course of therapy at the reporting facility.
8 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

Focus on Non-Small Cell Lung Cancer
In-Depth Site Study
Ziv Gamliel, M.D., F.A.C.S.
Chief, Thoracic Surgery
With over 185,000 new cases annually,
non-small cell lung cancer remains
the number one cancer killer in the
United States, claiming more than
150,000 lives each year. While the great
majority of lung cancer patients are
males in their 70s who are current or
former smokers, there is a disturbing
trend of increasing numbers of women
and nonsmokers who are being diagnosed with lung cancer
at younger ages, often in their 40s or 50s.
Survival rates and optimal treatment regimens vary according
to disease stage. Historically, overall cure rates have averaged
roughly 13 percent. However, exciting recent developments
in early detection methods, accurate pretreatment staging,
minimally invasive surgical techniques and aggressive
multi-modality treatment regimens have brought with
them renewed optimism in the fight against lung cancer.
The Thoracic Oncology Center
Recognizing the importance of providing the community
with the most advanced lung cancer care available, The
Cancer Institute at St. Joseph Medical Center established
an outstanding Thoracic Oncology Center in 2006.
Dr. Mark J. Krasna, a nationally recognized expert in
Thoracic Oncology, was recruited to serve as The Cancer
Institute’s medical director. Dr. Ziv Gamliel was recruited
to serve as chief of Thoracic Surgery. They were joined
by Dr. Lope T. Villa, a longstanding member of the
St. Joseph Medical Center staff, to form the surgical
faculty of The Thoracic Oncology Center. An additional
thoracic surgeon, Dr. Linda Martin, was recruited in 2007.
The Radiation Oncology department, under the direction of
Dr. Jason Citron, offers state-of-the-art radiotherapy techniques
to patients with lung cancer. Medical Oncology services are
provided by Dr. Richard Schraeder, Jr., and Dr. Rima Couzi,
both recruited in 2007, as well as Dr. Hecter Silva and
colleagues. Comprehensive Pathology services are provided
by Dr. James Eagan and colleagues. Using state-of-the-art
equipment, expertise in Diagnostic Radiology is provided
by Dr. Fred Yeganeh and in Interventional Radiology by
Dr. Margaret A. Lynch-Nyhan.
Participants in The Thoracic Oncology Center from the
division of Pulmonary and Critical Care Medicine include
Dr. Hassan M. Makhzoumi, as well as Dr. John H. Eppler, Jr.,
and colleagues. Participants from the division of
Gastroenterology include Dr. Steven A. Fleisher, as well as
Dr. Neil D. Goldberg and colleagues. Support is also provided by
Dr. Neal Naff and colleagues from the division of Neurosurgery,
as well as by Dr. Mark H. Fraiman and colleagues from the
division of Hepatobiliary Surgery. Counseling on smoking
cessation is provided by Christine Schutzman.
Multidisciplinary Thoracic Oncology Clinic and
Tumor Conference
Increasingly, the management of thoracic malignancies in
general, and lung cancer in particular, involves the use of
multiple treatment modalities in various combinations. In
the last few years, clinical trials have demonstrated that
patients undergoing surgery for most early stages of lung
2007 THE CANCER INSTITUTE ANNUAL REPORT | 9

Focus on Non-Small Cell Lung Cancer
In-Depth Site Study (continued)
cancer can benefit from postoperative adjuvant chemotherapy.
For locally advanced lung cancers, curative surgical resection
has been made possible by pretreatment with neoadjuvant
concurrent chemotherapy and radiation. More than ever
before, the safe and effective delivery of modern lung cancer
care is dependent upon close cooperation and constant
communication between health care providers with many
different areas of expertise. At St. Joseph Medical Center,
coordination of multidisciplinary lung cancer care in
The Thoracic Oncology Center is accomplished in several
different ways.
Table 1
Number and gender distribution of patients
with non-small cell lung cancer evaluated
and/or treated at St. Joseph Medical Center,
by year.
Year Patients Females
2001 67 52.2%
2002 69 59.4%
2003 71 50.7%
2004 77 40.3%
2005 77 55.3%
2006 64 54.7%
New patients seeking lung cancer care at St. Joseph
Medical Center are encouraged to undergo initial evaluation
in the multidisciplinary Thoracic Oncology Clinic. During a
single clinic visit, the multidisciplinary team revolves around the
patient both figuratively and literally. Lung cancer patients are
evaluated by a thoracic surgeon, medical oncologist, radiation
oncologist, smoking cessation counselor and nurse coordinator.
Patients, together with their loved ones, meet with all the above
health care professionals without even having to move from one
room to another. Not only for local patients, but especially for
patients traveling long distances in order to obtain their care
at St. Joseph Medical Center, eliminating the need for multiple
trips to different offices on different days both facilitates and
expedites multidisciplinary evaluation and treatment.
Later on the same day of the multidisciplinary evaluation,
cases are discussed in a multidisciplinary conference during
which biopsy slides are reviewed by participating pathologists,
and radiological imaging studies are reviewed by participating
radiologists. Within hours of a multidisciplinary evaluation,
based upon group consensus at the Tumor Conference, a
comprehensive evaluation and treatment plan is formulated
for each lung cancer patient with input from surgeons, medical
oncologists, radiation oncologists and pulmonologists. The
close cooperation and streamlined communication between all
of the above specialists makes it possible to provide complex,
comprehensive care that is individually tailored to each patient’s
specific circumstances.
Communication between patients and their physicians is of
utmost importance. Such communication can be particularly
confusing and complicated when multiple treating physicians
are involved. The Thoracic Oncology Center at St. Joseph
utilizes nurse coordinators to oversee scheduling of tests,
10 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

Table 2
Geographic distribution of patients evaluated and/or treated
at St. Joseph Medical Center between 2001 and 2006.
Baltimore County
Baltimore City
Harford County
Carroll County
Other
2.4%
6.1%
9.6%
13.4%
appointments, treatments and surgery for each patient
undergoing multidisciplinary evaluation and treatment.
The nurse coordinators meet the patients at their
multidisciplinary clinic appointment and participate in
the multidisciplinary Thoracic Oncology conference.
After a patient’s case is discussed at the multidisciplinary
conference, their nurse coordinator reinforces the
management plan to them on behalf of all of the physicians
involved. Having a nurse coordinator involved in their care
greatly alleviates patients’ anxiety and increases patients’
confidence as well as their knowledge about their care.
Aggressive Pretreatment Staging
68.5%
0 5 10 15 ... 60 65
The optimal management of non-small cell lung cancer is
highly dependent upon the stage of the disease. A serious
consequence of incorrect staging is that it can lead to incorrect
treatment. In some cases, standard radiological imaging studies
may fail to identify the true extent of a patient’s disease, which
is how incorrect staging can occur. In our efforts to maintain
an unsurpassed standard of excellence in radiological imaging,
The Cancer Institute at St. Joseph Medical Center has
recently acquired a state-of-the-art PET/CT scanner with
which high-speed/high-resolution CT images of a patient
can be obtained simultaneously with PET images. In order
to enhance the diagnostic usefulness of this imaging and in
order to avoid performing a separate contrast-enhanced CT
scan, intravenous contrast is administered during the PET/CT
scan, allowing both scans to be accomplished at once. The
high-quality imaging that results allows detection of very subtle
but critically important metastatic disease that might otherwise
go unrecognized.
In non-small cell lung cancer, involvement of lymph nodes in
the mediastinum has a major negative impact on the likelihood
of accomplishing curative surgery. While CT scans and PET
scans can often identify metastatic involvement of mediastinal
lymph nodes, microscopic involvement of these nodes with
tumor can easily be missed. Mediastinoscopy is a minimally
invasive outpatient surgical technique in which mediastinal
lymph nodes are sampled and microscopic metastatic
disease can be identified. At St. Joseph Medical Center,
mediastinoscopy is used routinely in non-small cell lung
cancer patients in order to rule out mediastinal lymph node
involvement before surgical resection is undertaken. Often,
patients whose CT scans and PET scans failed to reveal any
metastatic cancer in their mediastinal lymph nodes are
found to have microscopic lymph node involvement using
mediastinoscopy. Knowing about this type of microscopic
metastatic disease is vital before treatment is undertaken,
Never Smoked
10.4%
Table 3
Smoking status of patients with
non-small cell lung cancer evaluated
and/or treated at St. Joseph Medical
Center between 2001 and 2006.
Previous Smokers
Current Smokers
Unknown 3.1%
30.1%
56.5%
0 10 20 30 40 50
2007 THE CANCER INSTITUTE ANNUAL REPORT | 11

Focus on Non-Small Cell Lung Cancer
In-Depth Site Study
(continued)
in order to ensure that the best treatment strategy is applied.
Patients with unrecognized mediastinal lymph node metastases
who undergo major operations to remove their cancer are
unlikely to be cured by their surgery. By identifying microscopic
mediastinal lymph node involvement, mediastinoscopy can
ensure that patients do not undergo major surgery that is
unlikely to result in a cure. Instead, more appropriate treatment
methods with a higher likelihood of success can be offered.
Expanded Minimally Invasive Surgery Capabilities
Patients with non-small cell lung cancer whose tumor has
not yet spread beyond the lung have a significant chance to
be cured by surgical removal of the tumor. While limited
operations such as “wedge” resections can be curative, the
likelihood of remaining free of disease is greater in patients
who undergo complete removal of the entire lobe in which
the cancer is located, using formal anatomic dissection.
Increasingly, during the last 10 years, surgeons have used
minimally invasive surgical techniques aided by slender
telescopes and instruments in order to perform lung operations
through very small incisions. These smaller incisions decrease
the extent and duration of postoperative disability and allow
an earlier return to normal functioning. In contrast, the
standard surgical approach has involved making large incisions
and spreading the ribs apart in order to gain access to the lung.
Due to the added complexity of minimally invasive surgery
techniques, surgeons who lack experience with these techniques
are often restricted in the extent of surgical procedure they
are capable of performing and may be limited to performing
thoracoscopic “wedge” resections for lung cancer. However,
at St. Joseph Medical Center, minimally invasive surgery
techniques are now regularly used to perform procedures that
most other centers are only able to offer using large incisions.
The same anatomic dissection and surgical principles that
would be used in open surgical procedures are always applied
to minimally invasive procedures as well. Thoracoscopic
lobectomy is routinely performed at St. Joseph Medical Center
using meticulous individual dissection and ligation of anatomic
structures through three, small thoracoscopy port sites, the
largest of which typically measures less than two inches.
Tri-Modality Therapy for Locally
Advanced Lung Cancer
The optimal treatment of lung cancer that has not spread to
distant organ sites is surgical removal. Sometimes, however,
the cancer has advanced locally to the point that complete
surgical removal is not technically feasible. This is the case
in stage III lung cancer.
Recently, there has been increasing evidence that “triple
modality” treatment with chemotherapy, radiation therapy
and surgery results in greatly improved cure rates for locally
advanced lung cancer. Due to the logistical complexity of
coordinating patient care between three different specialists,
and due to the technical challenges of performing surgery on
such patients, most hospitals in the United States do not offer
such sophisticated treatment. Tri-modality treatment of locally
advanced lung cancer has been performed mainly in a limited
number of large university centers. In a warm and caring
Table 4
Comparative stage distribution
of patients with non-small cell
lung cancer
Cancer St. Joseph Medical Center National
Stage 2001– 2006 1996 – 2003
Localized 41% 16%
Regional 17% 35%
Distant 31% 42%
Unstaged 11% 7%
12 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

community setting, The Thoracic Oncology Center at
St. Joseph Medical Center now has the necessary tools and
expertise to provide even the most challenging locally
advanced lung cancer cases with tri-modality treatment that
is second-to-none.
One example of stage III lung cancer that can benefit from
triple modality treatment is disease that has spread locally to
regional lymph nodes in the mediastinum. Another example
of locally advanced lung cancer involves cancer arising at the
top of the lung that has invaded the nerves and/or blood
vessels of the arm. In these situations, surgical removal without
any other treatment is very unlikely to be curative and the
cancer usually recurs. Combined treatment with chemotherapy
and radiation therapy is effective at decreasing the extent of the
cancer and is better than surgery alone. Even with combined
chemotherapy and radiation therapy, cure rates have remained
rather low.
However, locally advanced lung cancer that responds well
to combined chemotherapy and radiation therapy can often
be completely removed. The response of lung cancer to
combined chemotherapy and radiation therapy is better in
patients receiving relatively high doses of radiation therapy.
Because radiation therapy results in inflammation and scar
tissue formation, performing lung surgery on patients who have
undergone such treatment is much more difficult than usual.
The risk of complications can also be higher. For well over ten
years, Drs. Krasna, Gamliel and Martin have been operating
on lung cancer patients who have undergone combined
chemotherapy and high-dose radiation therapy with enviably
low complication rates, thus making it possible to implement the
high standard of tri-modality treatment offered at The Thoracic
Oncology Center.
Improved Palliation Capabilities
The goal of lung cancer treatment must not be limited
to achieving a cure. For many patients whose lung cancer is
not curable, relief of symptoms is essential. These patients
may become short of breath for a variety of reasons. Most
commonly, their shortness of breath is due to buildup of
fluid in the chest cavity or due to airway obstruction by
tumor. Obtaining rapid relief of their shortness of breath
using minimally invasive methods can allow these patients
to stay out of the hospital and regain quality of life.
When advanced lung cancer results in fluid buildup in the
chest cavity, the lung has less space for inflation. One-time
drainage of the fluid provides only temporary relief, since the
fluid will rapidly reaccumulate. One method for preventing
fluid reaccumulation is to instill sterile powdered talc onto
the lung using minimally invasive thoracoscopy through a tiny
incision. The resulting inflammation causes the formation of
adhesions between the lung and the rib cage, called pleurodesis,
effectively obliterating the space where fluid might accumulate.
In certain cases where the lung cannot reexpand due to a
restricting rind of tumor, convenient long-term drainage can
be achieved using an indwelling tunneled catheter. Patients
are able to drain the fluid from their chest cavity at home by
themselves as often as necessary, using convenient prepackaged
sterile supplies. Often, after a couple of months of intermittent
drainage at home, the fluid stops reaccumulating.
Table 5
Number of patients with
non-small cell lung cancer
undergoing mediastinoscopy,
surgical resection, neoadjuvant
(preoperative) therapy and
adjuvant (postoperative) therapy
at St. Joseph Medical Center,
by year.
Year Mediastinoscopy Neoadjuvant Surgical Resection Adjuvant
2001 0 1 23 1
2002 5 0 24 4
2003 2 0 31 1
2004 1 1 32 0
2005 9 1 28 3
2006 7 2 28 2
2007 THE CANCER INSTITUTE ANNUAL REPORT | 13

Focus on Non-Small Cell Lung Cancer
In-Depth Site Study
(continued)
Table 6
Comparative overall three-year survival rates for patients
with non-small cell lung cancer, by stage.
Cancer St. Joseph Medical Center National
Stage 2001– 2006 1988 – 2003
Localized 62.1% 58.0%
Regional 18.6% 20.8%
Distant 3.8% 4.5%
Unstaged 11.6% 14.3%
Patients with advanced lung cancer may develop airway
obstruction due to their tumor. Such airway obstruction
can often be relieved with conventional radiation therapy,
but this treatment method may require several weeks to
produce results and not all patients are suitable candidates.
St. Joseph Medical Center now offers bronchoscopic tumor
ablation and airway stenting. Using the Nd:YAG laser through
a fiberoptic video bronchoscope, thoracic surgeons are able
to essentially vaporize a tumor blocking a patient’s airway.
In cases where a tumor is causing external compression of
the airway, an expandable stent can be deployed into the
airway in order to keep it open. These interventions typically
produce instantaneous results and can usually be performed
on an outpatient basis.
Availability of Clinical Trials
The nature of cancer treatment is continually evolving.
Rather than follow others, The Thoracic Oncology Center at
St. Joseph Medical Center is striving to lead the fight against
lung cancer. As an accredited center with the South West
Oncology Group (SWOG) and with the Radiation Therapy
Oncology Group (RTOG), we can now offer many of our
patients the opportunity to participate in exciting clinical trials
that will help to establish the standard of care for tomorrow.
Future Directions
The future of lung cancer care is exciting. The Thoracic
Oncology Center at St. Joseph is poised to achieve prominence
as a leader in many aspects of lung cancer care. Already in
2007, aggressive pretreatment staging including routine use
of mediastinoscopy has improved our ability to make optimal
treatment decisions for our patients. Our patients with early
stages of lung cancer have been undergoing thoracoscopic
lobectomy and enjoying faster than ever recuperation. Patients
with regionally advanced lung cancer have been undergoing
tri-modality therapy, including high-dose radiotherapy and
surgery, with low complication rates and excellent results.
Aggressive management of obstructing airway tumors using
lasers and stents has helped patients to regain quality of life.
As The Thoracic Oncology Center establishes itself as a local
and regional leader in lung cancer care, we will need to share
and compare our results with other centers. Toward this end,
we are planning to undertake full participation in the Society
of Thoracic Surgeons clinical database. We are expecting to
14 | ST. JOSEPH MEDICAL CENTER sjmcmd.org

treat ever increasing numbers of patients from outside
Baltimore City, Baltimore County and Harford County
and have already seen a dramatic increase in the number
of patients traveling to our center from over two hours away.
In order to allow these patients to receive all of their care
at St. Joseph Medical Center, we are seeking a commitment
from the American Cancer Society to establish a Hope Lodge
that will provide nearby free accommodations for patients
undergoing treatment and/or their family members. We
are also exploring new treatment strategies to offer patients
with malignant pleural effusions, including intrapleural
hyperthermic chemotherapy.
As our Thoracic Oncology Center evolves and expands, striving
for ever increasing excellence, we must never lose sight of our
other core values: reverence, integrity and compassion. For
while our patients will always continue to seek us out for our
excellence, it is our adherence to these other core values that
truly sets St. Joseph Medical Center apart from the rest.
2007 Cancer Committee Members
Arthur Serpick, M.D.
Chairman
Lucy Shamash, R.N., M.A.
V. P. Cancer Institute
Howard Berg, M.D.
Colon and Rectal Surgery
Elaine Que Lim, M.D.
Obstetrics and Gynecology
Richard Schraeder, M.D.
Medical Oncology
Michael Schultz, M.D.
Breast Surgery
Sue Currence, R.N.,
B.S.N., C.E.T.N.
Wound Ostomy
Continence Nursing
Monica Fulton, R.N.,
B.S.N., M.B.A.
The Cancer Institute
Danielle McQuigg, R.N., O.C.N.
Cancer Navigator
Marcia Medina
Performance Improvement
Carol Smith
Cancer Institute Registry
Paul Chang, M.D.
Medical Oncology
Hector Silva, M.D.
Medical Oncology
Pat Johnson, R.N., O.C.N.
Research
Pam Trombero
Clinical Research Associate
Jason Citron, M.D.
Radiation Oncology
Rima Couzi, M.D.
Medical Oncology
Mark Fraiman, M.D.
Hepatobiliary Surgery
Maen Farha, M.D.
General Surgery
Mark Krasna, M.D.
Thoracic Surgery/Medical
Director of The Cancer
Institute
Nassif Soueid, M.D.
Plastic and Reconstructive
Surgery
Alma Nyhan, M.D.
Diagnostic Radiology
Fowzia Taqi, M.D.
Pathology
Nancy Conner, R.N.,
NACC Certified
Spiritual Care
Brian Cornblatt, Ph.D.
Research
Sharon Katrinak, M.B.A., R.C.H.
Inpatient Pharmacy
Coordinator
Kathleen Kelly
Cancer Institute Registry
Ann Kennedy, R.N., B.S.N.
Supportive Care Coordinator
Sherry McCarter, L.S.C.W.
Social Services
Pat Wallace
Cancer Institute Registry
Gloria Webster, R.N.
Community Outreach
Bernadette White, R.N., M.S.
Community Outreach
2007 THE CANCER INSTITUTE ANNUAL REPORT | 15

The Cancer Institute Services
Oncologic Surgery
• General
• Abdominal
• Thoracic
• Head and Neck
• Neurologic
• Urologic
• Gynecologic
• Liver and Pancreas
•Breast
• Colorectal
Medical Oncology
• Serpick Infusion
Center
• Inpatient Unit 5 East
• Biotherapy
• Management of Red
Cell, Leukocyte and
Platelet Disorders
• Clinical Research
• Ostomy/Wound Care
• Pain Management
• Nurse Navigator:
Comprehensive
Support for Patients
with Cancer
• Supportive Care:
Comprehensive
Support for Patients
with a Life-Threatening
Illness
• Nutrition Counseling
7601 Osler Drive
Towson, MD 21204-7582
sjmcmd.org
• Psychosocial Support
for Patients and
Families
• Chemotherapy Class
• Lymphedema Services
• Genetic Counseling
Services
Radiation Oncology
• Clinac IX & Varian
2100 Accelerators
• CT Simulator
• Prostate Brachytherapy
• High Dose Rate
Brachytherapy
• IMRT
• IGRT
• Mammosite HDR
• Respiratory Gating
• Cone-Beam CT
Spiritual Care
• Spiritual Counseling
• Advanced Directives
Counseling
• Caregivers Support
Group
Community Outreach
• Screenings for
Prostate, Skin, Breast
and Head/Neck/Oral
Cancers
sjmcmd.org
• Ostomy Support
Group
• Community Cancer
Education: Lectures
and Health Fairs
• Smoking Cessation:
Inpatient, Outpatient
and Community
• Bereavement Support
Group
Community
Participation
• Susan G. Komen
Race for the Cure
• SOS (Survivors
Offering Support)
• Making Strides Against
Prostate Cancer
• Hopewell Run
• Relay for Life:
American Cancer
Society
• Cancer Coalition:
Baltimore County
Health Department
• Smoke Free Maryland
• Look Good, Feel
Better ©
• Cancer Survivor
Celebration
Non-Profit Org.
US Postage
PAID
Baltimore, MD
Permit #4944
Important Phone Numbers
Hospital Information
410-337-1000
Advanced Directives Counseling
410-337-1109
Clinical Research
410-337-4543
Community Outreach
410-337-1479
Customer Service–Billing
410-337-1020
Doctors Directory
410-337-1337
Home Care/Hospice
410-931-0990
Inpatient Oncology (5 East)
410-337-1390
Serpick Infusion Center
410-337-1841
Nuclear Medicine
410-337-1328
Nurse Navigator
410-427-2319
Nutrition Counseling/Education
410-337-1246
Cancer Institute Registry
410-337-1968
Ostomy/Wound Care
410-337-1845
Pain Management Coordinator
410-337-1185
Palliative Care
410-337-1535
Pathology
410-337-1717
Physical/Occupational Therapy
410-337-1330
Radiation Oncology
410-427-2525
Radiology
410-337-1441
Smoking Cessation
410-337-1555
Social Work and Integrated
Care Management
410-337-1550
Spiritual Counseling
410-337-1109
Surgical Services
410-337-1066
TDD Access
410-337-1671
© 2007 St. Joseph Medical Center