2011 Annual Cancer Program Report SAFH - Sutter Health ...

Sutter Auburn Faith Hospital Cancer Services
2011 Annual Cancer Program
Report on Bladder Cancer
2011 Annual Cancer Program Report 3

A Note from the Chairman of the Oncology Committee
Bart Bradshaw, M.D., Sutter Auburn Faith Hospital
Cancer Committee Chair
Dear Colleagues and Friends,
As a program that has been approved by the American College of Surgeons (ACoS),
we are pleased to present the Sutter Auburn Faith Hospital 2011 Annual Report. This
report features a statistical overview of SAFH’s 2010 Cancer Registry data for Sutter
Health institution. Our cancer registry is responsible for collecting comprehensive data
on all patients, providing demographic, diagnostic, treatment, and long-term follow-up
information. The most common cancers are described in more detail and their prevalence
compared with trends seen across California and nationally.
We are proud of the continual efforts made to provide comprehensive care to our cancer
patients. Our center emphasizes state-of-the-art diagnostic and therapeutic services provided
conveniently in the patient’s local community. On behalf of our cancer committee, we extend
our thanks to our outstanding communities, medical staff, employees, administration and
volunteers for the continued support of our cancer program.
We hope you enjoy and learn from our presentation of the SAFH 2011 Annual Cancer
Program Report on Bladder Cancer and appreciate the extent of services available here at
Sutter Auburn Faith Hospital.
For more information, please visit our website at suttercancer.org.
2011 Annual Cancer Program Report 1

Sutter Auburn Faith Oncology Committee
The Sutter Auburn Faith Hospital Oncology Committee is a multidisciplinary team that represents physicians
from diagnostic and treatment specialties and non-physicians from administrative and supportive services.
They meet quarterly to provide leadership in the cancer activities at SAFH. The Oncology Committee is
involved in evaluating new technologies, establishing new programs, and improving all cancer-related
activities in the area.
2 Sutter Health Sacramento Sierra Region Cancer Services

Barton Bradshaw, M.D.
Surgeon, Chair
D. Linstadt, M.D.
Radiation Oncologist, Clinical
Physician Liaison
Michael Antonini, M.D.
Surgeon
Jeffery Jenkins, M.D.
Surgeon
Mary Keohane, M.D.
Pathologist, Quality Improvement
Coordinator
William Kirby, M.D.
Urologist, Cancer Conf.
Coordinator
James McGregor, M.D.
Palliative Care and
Pain Management
Michael Hecimovich, M.D.
Diagnostic Radiologist
Thomas Roschak, M.D.
Medical Oncologist, Quality of
Registry Coordinator
Gurvinder Shaheed, M.D.
Medical Oncologist
Vijay Suhag, M.D.
Medical Oncologist
Virgie Galindo, R.N.
Nursing Administration
Dana Ittner, P.T.
Rehabilitation Services
Nita Robinson, R.N.
Infusion Center
Mindy Danovaro
Community Outreach
Coordinator
Colleen Kuelper
Administration &
Quality Management
Mary Swimley
Service Line Program
Manager, SMCS
Dayna Lawrence
Cancer Center Quality
Management Specialist, SMCS
Maryann Sacks, CTR
Cancer Registry, Quality of the
Cancer Registry Coordinator
Linda Marks
Medical Research Director,
Clinical Research Coordinator
Terry Wright, LCSW
Psychosocial Services Coordinator
Michelle Day, R.N.
Inpatient
Catherine Nishikawa
Nutritionist
Molly Bolognini
American Cancer Society
Representative
Sutter Auburn Faith Hospital
11815 Education Street
Auburn, CA 95602
(530) 888-4500
2011 Annual Cancer Program Report 3

Clinical and Patient Support Services
This table displays the broad range of services available at the SAFH Cancer Program accredited by the
American College of Surgeons (ACoS). Although this table is not reflective of the actual physical location
of the service, all resources are available for referrals for patients within our region.
Services
ACOS Accredited Cancer Center
Y
Blood and Marrow Transplants N*
Brachytherapy
Y
Cancer Surgery
Y
Cancer Clinical Trials and Prevention Trials
Y
Cancer Education Programs
Y
Cancer Support Groups
Y
Community Screenings for Cancer
Y
Indoor Pool for Patient/Rehabilitation N*
Core Needle Biopsy – Ultrasound
Y
Core Needle Biopsy – Stereotactic
Y
Stereotactic Radiosurgery & Radiotherapy on Site N*
Ablation Surgery N*
Gamma Knife N*
Infusion Therapy
Y
Outpatient Services
Valet Parking N*
Comprehensive Breast Center N*
Cancer Treatment Center N*
Chemotherapy Treatment
Y
Home Care & Hospice
Y
Nutrition Services
Y
Interventional Radiology
Y
Mammography
Y
Minimally Invasive Surgery
Y
Nurse Navigator
Y
Oncology Social Worker
Y
Pediatric Cancer and Surgery N*
PET – Position Emission Tomography on Site
Y
Image – Guided Prostate Radiation Therapy
Y
Radiation Oncology Service
Y
Thermo Ablation on Site N*
IMRT
Y
SPECT
Y
Tumor Board
Y
Tumor Registry (In-House)
Y
Palliative Care
Y
Pain Management
Y
Dance Movement N*
Music Therapy
Y
Massage Therapy N*
Pet Therapy N*
*service available within Sutter Health Sacramento Sierra Region
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Sutter Health Sacramento Sierra Region Cancer Services

Annual Summary of Auburn’s Activities
Sutter Auburn Faith Hospital
Barton G. Bradshaw, M.D., FACS.
Chairman of the Cancer Committee
The Cancer Committee at Sutter Auburn Faith Hospital continues to
work to improve the quality of care for all of our cancer patients. These
efforts were highlighted in November of 2010 when we were visited
by surveyors from the American College of Surgeons Commission on
Cancer. We were pleased to see those efforts acknowledged in December
2010 when our cancer program was awarded a full three-year approval
with commendation.
In 2011 the Cancer Committee directed ongoing endeavors in the
following areas:
Community Outreach – We have strengthened our long-standing
relationship with the American Cancer Society with efforts to
facilitate referrals to the ACS and to publicize and encourage patient
participation in ACS programs like Look Good, Feel Better, and Reach
to Recovery. We also have continued our participation in the ACS
fundraiser Relay for Life.
We also have continued our anti-smoking program directed at junior
high students with physicians speaking to local middle school students
to discourage teen smoking.
Dr. Jenkins, our local bariatric surgeon, has spearheaded our programs
encouraging weight loss and cancer prevention in patients with his
bariatric program and support group.
2011 Annual Cancer Program Report 5

Annual Summary of Auburn’s Activities, continued
Quality Improvement – This year we have focused on improving
screening for colon cancer. We sponsored several education programs
for physicians through formal medical staff lectures, as well as letters
to every local practitioner encouraging adherence to colon cancer
screening guidelines.
Programmatic – We established a breast cancer navigator program
to assist patients newly diagnosed with the disease. We have been
fortunate to be able to share a navigator with Sutter Roseville Medical
Center in Amy Beazizo, R.N., BSN OCN, who has been a fantastic
resource for our patients.
Clinical – We directed improvements in our women’s imaging center by
updating pamphlets for breast care, breast cancer diagnosis, and general
health. We also made improvements in our Pathology Department
procedures to comply with new recommendations for breast specimen
processing made by the American College of Pathology.
Sutter Auburn Faith Hospital has also continued a large renovation
of the physical facilities, and we expect to start soon with a major
renovation of the operating rooms. We expect that these changes will
improve the experience of our cancer patients with state-of-the-art
equipment and facilities.
The cancer conferences at Sutter Auburn Faith Hospital continue to be
very successful and facilitate communication between our physicians
and staff to provide the very best care for each cancer patient. These
conferences meet twice a month and have reviewed close to 30 percent
of the cancer patients in our community.
In summary, the physicians, nurses and staff of the cancer committee at
Sutter Auburn Faith Hospital are committed to providing the best care
available for all of our cancer patients. By maintaining our accreditation
by the Commission on Cancer of the American College of Surgeons, we
continue to demonstrate this commitment to provide comprehensive,
multidisciplinary, state-of-the-art care, close to home.
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Sutter Health Sacramento Sierra Region Cancer Services

Bladder Cancer (2001-2010)
Focus on Bladder Cancer
Sutter Auburn Faith Hospital’s (SAFH) cancer center is fully accredited by the American College of Surgeons
Commission on Cancer (ACoS). As part of the process required by ACoS, we annually review our experience
with one specific cancer site. This year for our annual report, the SAFH Cancer Committee decided to review
our experience with bladder cancer.
2011 Annual Cancer Program Report 7

Incidence
Since 2004, bladder cancer has
been the fifth most common cancer
treated at SAFH, behind breast, lung,
colon and prostate cancer.
Top 10 sites 2004-2010
29 Ovary
31 Kidney & Renal Pelvis
47 Melanoma of Skin
52 Pancreas
64 Lymphoma
350
All Other Sites
372 Breast
200 Lung
204
Colon & Rectum
79 Bladder
83 Prostate
Over the past seven years, we have
treated 79 patients with bladder cancer
(58 men and 21 women). The volume of
bladder cancer patients has remained
relatively consistent with an average
of 11 patients per year; a high of 14
in 2005 and a low of eight in 2004.
Bladder cases treated at
sutter auburn faith hospital
Number of Patients
15
10
5
0
2004 2005 2006 2007 2008 2009 2010
8 Sutter Health Sacramento Sierra Region Cancer Services

Age at Diagnosis
Bladder cancer tends to affect older people. Mean age at diagnosis for bladder cancer
in the United States is 73 years according to the National Institute of Health SEER data
(http://seer.cancer.gov/statfacts/html/urinb.html).
Eleven percent our patients were in their 50s, 25 percent were in their 60s, 32 percent
were in their 70s and 25 percent were in their 80s. The age at diagnosis of our patients
reflects both state and national trends as illustrated in the following graph.
comparison of age at diagnosis
35
30
25
20
15
10
5
0
Under 20 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 90 +
SAFH (%)
State Community Hospitals (%)
National (%)
“The cancer committee at Sutter Auburn Faith Hospital is committed
to providing excellent multidisciplinary care of our patients with
bladder cancer. We are working to improve education of both the medical
community and the public to improve early detection and treatment.”
— Bart Bradshaw, M.D.,
Sutter Auburn Faith Hospital
Cancer Committee Chair
2011 Annual Cancer Program Report 9

Stage at Diagnosis
The following table shows the stage at diagnosis of SAFH patients compared with state and national patients.
SAFH (%) State Community Hospitals (%) National (%)
STAGE 0 41.5 39.6 47.3
STAGE 1 13.2 25.3 22.3
STAGE 2 26.4 15.9 11.2
STAGE 3 1.9 4.1 3.6
STAGE 4 5.7 5 4.8
NA 1.9 0.1 0.2
STAGE UNKNOWN 9.4 10 10.6
Forty-one percent of our patients were diagnosed at stage 0, (noninvasive carcinoma in situ).
Thirteen percent were diagnosed at stage 1 (tumor invading subepithelial connective tissue without nodal or distant metastases).
Twenty-six percent were diagnosed at stage 2 (tumor invading superficial or deep muscle without nodal or distant metastases).
Two percent were diagnosed at stage 3 (tumor invading perivesical tissue or adjacent organs without nodal or distant metastases).
Six percent were diagnosed at stage 4 (tumor invading the abdominal or pelvic wall or with nodal or distant metastases).
Compared to national and state data, we had fewer stage 1 patients and more stage 2 patients.
Percentages of stage 0, 3 and 4 patients were comparable to state and national rates.
It is unclear why we have seen more
stage 2 patients. This may represent
a sampling error as our numbers are
relatively low with 20 patients in stage
2. However, this could also be due to a
delay in diagnosis and treatment. This
is a potential area for improvement in
education for our medical community.
Most bladder cancer patients present
with hematuria and timely referral to a
urologist for cystoscopy—particularly in
older patients—is important. We plan
to make this an area of focus in our
cancer committee’s ongoing efforts.
comparison of stage at diagnosis
50
40
30
20
10
0
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage
Unknown
SAFH (%)
State Community Hospitals (%)
National (%)
10 Sutter Health Sacramento Sierra Region Cancer Services

Survival
Nationally bladder cancer has an excellent prognosis for stage 0 patients and relatively good prognosis for localized disease
(stage 1 and 2). Patients with metastatic disease have a poor prognosis. The following chart is from national SEER data
(http://seer.cancer.gov/statfacts/html/urinb.html#incidence-mortality).
Stage at Diagnosis Stage Distribution (%) Five-year Relative Survival (%)
In situ (only in the layer of cells in which it began) 51 96.6
Localized (confined to primary site) 35 70.7
Regional (spread to regional lymph nodes) 7 34.6
Distant (cancer has metastasized) 4 5.4
The following graph shows survival for SAFH bladder cancer patients by stage.
Survival report —Actuarial Method
Cumulative Survival Rate
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
All Stages
Stage 0
Stage 1
Stage 2
Stage 3
Stage 4
0
1.0000
1.0000
1.0000
1.0000
1.0000
1.0000
1
0.7580
0.9692
0.9000
0.5000
1.0000
0.2500
2
0.6991
0.9346
0.9000
0.4412
1.0000
0.0000
3
0.6991
0.9346
0.9000
0.4412
1.0000
0.0000
4
0.6010
0.8780
0.6000
0.3431
1.0000
0.0000
5
0.4596
0.7253
0.1200
0.3431
1.0000
0.0000
Years
Database: SHSSR
Facility: AFC
Filter: SAFH 2011 Annual Report (Bladder)
2011 Annual Cancer Program Report 11

Conclusion
Survival for stage 4 patients was poor with no survivors after two years. Stage 3 patients were all alive at
five years. Stage 1 and 2 patients had an unexpectedly poor survival of 12 percent at five years for stage
1 and 34 percent at five years for stage 2. Stage 0 patients had slightly worse survival than national
patients at 73 percent at five years.
It appears that the relatively low numbers of patients in each stage affects the data here. We had only
three stage 3 patients who had an excellent survival rate where our earlier stage patients had a worse
outcome. The data are not disease-specific; that is, the deaths are from all causes, not necessarily
bladder cancer, which could certainly skew the data with small numbers of patients. It is difficult to
draw meaningful conclusion at this time. As we accumulate more data over time we expect that the
numbers for early stage patients will improve.
12 Sutter Health Sacramento Sierra Region Cancer Services

A759812P 9/12
Sutter Auburn Faith Hospital
11815 Education Street
Auburn, CA 95602
(530) 888-4500
suttercancer.org
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Sutter Health Sacramento Sierra Region Cancer Services
T Printed on recycled paper with soy-based inks.