CANCER INCIDENCE BY SITE

A Message from the President and CEOBack to the Future: Several years ago, one of our new cancer physicians was having his hair cut inCumberland County when the barber asked him what his specialty was. When the physician answeredthat he was a cancer physician, the barber shared that most folks in the area go to Philadelphia for theircancer care. The cancer physician was taken aback and asked the barber why. The barber responded,"Well, isn’t Philadelphia where everyone goes for their quality cancer services?"Today, state-of-the-art cancer care is available close to home at the Frank and Edith Scarpa RegionalCancer Pavilion. Here our community has access to cancer experts of all types, including medicaloncologists, radiation oncologists, surgical oncologists, breast surgeon, urologist and GYN oncologists toname a few. These physicians are co-located with an assortment of diagnostic and therapeutictreatment modalities under one roof at the South Jersey Healthcare Regional Medical Center. We alsohave patient navigators for breast, ovarian and prostate cancer who act as patient advocates for ourcancer patients.Additionally, the capture of relevant cancer data, as well as the pursuit of research in the name ofimproving outcomes for our cancer patients provides the glue that brings together our comprehensivecancer program. What follows in this Annual Report is a catalog of all of our cancer activities.Enjoy a good perusal of the report. It demonstrates South Jersey Healthcare’s commitment to meetingthe expectations of our neighbors and offering a quality cancer program in our community. Come tothink of it, we will distribute a copy of this report to that very same barber in town. He may be takenaback by what he didn’t know was so available in his back yard.Chester B. Kaletkowski

Report from the Assistant Vice President of Oncologic and Women’s Health Service LinesThe mission of the SJH Cancer Program is to provide comprehensive cancer services that lessen theburden of cancer on our community. This mission was the driving force behind the recent developmentof our three-year Oncology strategic plan. This plan serves as a roadmap for the growth anddevelopment of the Cancer Program, ensuring that we remain focused on our core values as we balancethe acquisition of innovative technology, new treatment options, and clinical research with increasedregulatory oversight, decreased reimbursement, and most importantly—the needs of our patients.SJH recognizes the value that the Cancer Program brings to the organization as a whole, as well as thevalue it provides to the community—enabling patients to receive quality cancer care, complete withaccess to the latest technology and clinical research, close to home.Specifically, the Oncology Strategic Plan outlines systemic advances along five fronts—overall programdevelopment, advancements that touch multiple types of patients, and four tumor sites that create thegreatest burden for our community in terms of their overall prevalence. Targeted advancement in eachof these areas is critical to achieving the mission of the SJH Cancer Program. The following is a briefsummary of initiatives included in each target area.Overall Program Development – Acquire new equipment to expand the treatment options available topatients. Develop long term plan for continuation of patient support services. Recruit sub-specialtyphysicians to strengthen the surgical oncology program.Breast Center- Enhance patient navigation process. Pursue national accreditation as a breast center.Continue to expand diagnostic/screening technology.Colorectal Cancer – Explore enhanced access to screening and diagnostic technology. Organizeawareness campaign in collaboration with primary care physicians.Lung Cancer – Revitalize smoking cessation program. Develop coordinated, multi-disciplinary programincluding support services.Genito-Urinary – Enhance patient navigation process. Explore expanded treatment offerings, includingholistic approaches to supplement traditional treatment.The 2010 opening of the expanded Frank and Edith Scarpa Regional Cancer Pavilion represents asignificant strategic investment for South Jersey Healthcare and provides us with an optimal foundationfrom which we can continue building our program and further our goal of changing medicine andchanging lives.Michelle Marshall, MBA

Report from the Director of Cancer ServicesTwo thousand ten was a very rewarding year for all involved in the planning of the expansion of theFrank and Edith Scarpa Regional Cancer Pavilion. The new building was completed ahead of scheduleand ready for patient care in April. The new Center has been favorably received by patients andfamilies, oncologists and surgeons located there, nurses, and research and cancer registry staff. Theclose proximity of these cancer care professionals means easier care coordination and communication.Patients have the convenience of most services and specialists being located in one building.We have added several very fine physician specialists to our medical staff this year, and they are quitepleased with their offices and with South Jersey Healthcare (SJH) overall.The SJH Cancer Program continues to tackle the tough problem of cancer in Cumberland County andsurrounding areas by spearheading the Cumberland County Cancer Coalition and the New Jersey CancerEducation and Early Detection program.Through increased cancer screening in Cumberland County, we have achieved a significant reduction ina disparity that existed 5-10 years ago. African American women in our area were diagnosed withbreast cancer in later stages and had a higher death rate from breast cancer than other groups. Thatdisparity is trending toward elimination as many African American women are practicing annual breastcancer screening.Our partnership with Fox Chase Cancer Center continues in its 15th year. Our cancer research programis growing and branching out. Oncology nursing studies are underway as well as an economics of caredecision-making study in collaboration with a medical oncologist at Fox Chase Cancer Center.We look forward to many years of high quality cancer care in our new center. If we can help you in anyway, please contact us at 856-641-8670.Melanie Pirollo, MS, RN, AOCN

A Message from the Chairman of the Cancer CommitteeOn behalf of all the members of the cancer committee, I am very pleased to inform you that the newcancer center was opened earlier this year and is fully operational. This facility has brought a newdimension to cancer care in South Jersey. Patients as well as the public are thrilled about having accessto state of art cancer care in their own community.Additionally, the American College of Surgeons Commission on Cancer (COC) survey last year brought usour second consecutive outstanding achievement award. Obviously, the aim of the cancer committee isto continue to work hard toward receiving another outstanding achievement award after our nextsurvey.We have also acquired various subspecialty surgeons who have enhanced our ability to provide bettercare with less inconvenience to our patients.All of the cancer committee’s programs are progressing well. Tumor boards are well attended and wenow hold two breast cancer tumor boards each month to set the stage for accreditation from theNational Accreditation Program for Breast Centers. Recently we also launched a GU dedicated tumorboard and we plan to hold these every quarter. GU tumor boards are teleconferenced with Fox Chaseto provide a broad level of opinion and education.In conclusion, the SJH Cancer Program is marching forward in the right direction and continues toprovide cutting-edge cancer care in our community.Rama Sudhindra, M.D.

Report from the Cancer Liaison PhysicianThe main event of the year was attending the American College of Surgeons’ (ACOS)Commission on Cancer (COC) meetings in Washington DC. Several discussions centered on theproposed healthcare reform. The presenters focused on the changing landscape of oncologycare. Dr. Webb Brawley, Chief Medical and Scientific Officer of the American Cancer Societypresented “Cancer in the US: The Impact of Changes in Health Care Access and Delivery,” whichI shared with our Cancer Committee.There was also much discussion of changes in cancer program standards and new codingmethods for cancer registrars. I shared this information with our coding team, who are doing aremarkable job for South Jersey Healthcare. I believe our NCDB data is among the best in thecountry.I have presented a variety of information from the COC at our Cancer Committee meetings,which are very informative. There is an excellent cross‐section of disciplines represented,including a representative from the American Cancer Society and the Fox Chase Cancer Center.Representation from our senior management team allows us to implement any new policieseasily, and we have a strong relationship with the regional Cancer Coalition, which is alsorepresented on the committee.This year, we found the physician attendance increased at our tumor boards, particularlyamong surgeons. The discussions have become more lively and informative with all disciplinesrepresented. Teleconferencing with Fox Chase during our tumor boards assists us in maintain ahigh level of care in our institution. Our annual Cancer Symposium was also well attended, withpresentations equally as valuable as those presented by the ACOS.Jarrod Kaufman, MD, FACS from CentraState Medical Center has been elected as the newchairman of the State Cancer Liaison Physicians. I have been in constant contact with him and Iexpect that cancer advocacy at the state level will continue to increase in the coming years.We will be continuing our oncology continuing education program and I am working to preparemore comprehensive presentations for our physicians. Our goal is to provide the highest qualitycancer services in our region, and the entire cancer team has worked exceptionally hard tomake this a reality.Condapuram Pasupathy, MD

Report from the SJH Cancer Program Medical Director2010 was another year of continued growth for our program. A number of projects that have been inthe planning stages for several years have now come to fruition. The expansion of our cancer center iscomplete, nearly tripling its size. The additional space has allowed Southern Oncology-HematologyAssociates, a community practice specializing in cancer care, to provide its services inside the center.There are also multiple oncologic surgical sub-specialists now housed in the center’s second floorsurgical suite. This gives our patients access to medical, radiation, gynecologic and surgical oncology, aswell as a dedicated breast surgeon, all under one roof. They can be seen by multiple specialists, ifnecessary, without leaving the building.Our affiliation with Fox Chase Cancer Center remains strong and through this partnership, our researchprogram has added many new trials. For some of these studies, our program is the only site in theregion making that research available to patients. We currently have joint research projects under waywith Fox Chase, with several new programs expected to be implemented in the near future.Overall the future looks bright for patients in our community who need cancer care. No longer will theyneed to travel out of the county to receive sophisticated surgical procedures or to participate in anational cooperative oncology trial. 2010 was an exciting year for growth and expansion and we lookforward to seeing the maturation of these programs in the coming years.David Blom, M.D.

Report from the Medical Director of Radiation OncologyThe Department of Radiation Oncology of South Jersey Healthcare remains an integral part of SJHCancer Services and the SJH Frank and Edith Scarpa Regional Cancer Pavilion. We continue to respondto the unique needs of Cumberland County residents and the surrounding communities.In 2010 we performed a retrospective patient care evaluation of our top five cancer sites (breast,bladder, colon, lung, prostate) treated in our institution from 1996 until 2008. This represented almost6,000 patients from our Tumor Registry database. We compared outcomes of the top five cancer sitesby type of patients’ insurance coverage. We were able to determine the patients who are coveredunder our New Jersey Cancer Early Detection and Education (NJCEED) program appeared to have similaroutcomes to the patients who are otherwise covered with Medicare or commercial insurance. We wereagain reminded that those who have no insurance or Medicaid coverage present with higher stagedisease and have worse outcomes. Our Cancer Committee continues to review these issues and makesuggestions on how to improve the care that we deliver to these populations.The Department of Radiation Oncology continues to add technology to its armamentarium for cancertreatment. In 2010 we were approved for our Nucletron high dose rate (HDR) unit and will be using theHDR technology to launch our partial breast irradiation program in conjunction with our new breastsurgeon in 2011. We will also initiate HDR treatments for our gynecological patients, lung patients andskin cancer patients. We will be completing our American College of Surgeons review in 2010 andexpect to extend our ACR accreditation.We remain determined and committed to improve the cancer services we deliver as part of acomprehensive regional cancer program. In 2011 we will be looking to add stereotactic radiosurgery tothe services offered in the Department of Radiation Oncology.Joseph W. Fanelle, MD

Oncology Data Services Activity ReportThrough the efforts of the Oncology Data Services Department, South Jersey Healthcare has access todemographic and disease related information on nearly 22,000 cancer patients. This data is utilized tomonitor trends in cancer incidence, identify areas of concern in disease management, and developprograms to address the needs of our community.Information contained in our detailed database undergoes intense physician review to ensure thecollection of precise, accurate information. Our de-identified data is subjected to a second reviewprocess when it is submitted to the New Jersey State Department of Health Cancer Registry, and a thirdreview when submitted to the National Cancer Database (NCDB). In 2009 we electronically uploadedmore than 3,700 cases to the NCDB and all cases were deemed to be error free on submission.The data submitted to the NCDB is used to measure performance rates, which promote awareness ofthe importance of compliance with evidence-based practice guidelines. These measures wereestablished when the National Quality Forum brought together payers, consumers, researchers andclinicians to broaden the consensus on treatment of breast and colorectal cancer. South JerseyHealthcare consistently performs above state and national averages in all six available measures.Evelyn CorwonskiSupervisor, Oncology Data Services

2009CANCER INCIDENCE BY SITESITESouth JerseyHealthcareNJUSALung/Bronchus 17% 13% 15%Prostate 14% 13% 13%Breast 12% 13% 13%Colorectal 9% 10% 11%Urinary Bladder 6% 6% 5%Non HodgkinLymphoma3% 5% 4%Uterus 3% 3% 3%Melanoma Skin 1% 5% 5%South Jersey Healthcare saw a larger percentage of lung and prostate cancer than the State of NJ andthe United States.*United States and NJ statistics are estimates published in The American Cancer Society Facts andFigures 2009

A Report from the SJH Research Program Medical DirectorApril 2010 marked the opening of John F. Scarpa Cancer Research Institute at the SJH Frank and EdithScarpa Regional Cancer Pavilion. Our active research team is new located all under one roof, workingtogether closely with physicians and surgeons involved in clinical cancer research.The cancer research program at SJH began in 1995 in partnership with Fox Chase Cancer Center andcurrently has 25 cancer clinical trials open for recruitment. This year our program opened six newstudies and twelve studies closed to accrual.We have a robust research program and since its inception, approximately 450 patients have enteredclinical research trials at SJH. Through National Cancer Institute (NCI) approved clinical research trials,our patients have access to newer treatment before they are approved. In the last fifteen years we havecontributed many articles and abstracts for publication in scientific medical journals and have assisted inthe approval process for new treatments.We expect to have enrolled approximately 80 patients in clinical trials this year, the highest number inthe history of our research program. We also have 223 patients in active follow up.In addition, SJH is collaborating with Fox Chase Cancer Center on a study titled “Understanding HowPatients Choose Cancer Treatments.” This research aims to determine how patients choose amongcancer treatments with varying efficacy, toxicity and cost. Patients will be recruited to this study at bothSJH and Fox Chase Cancer Center at the time of their appointments. Our goal is to recruit 400 totalpatients, with 200 at each site.South Jersey Healthcare will continue to provide cutting-edge, evidence-based, and high-quality cancercare to South Jersey patients, closer to home.Kush Sachdeva, M.D.

Outcome Study: Patient Care Evaluation of Breast Cancer Cases by InsurancePATTERNS OF CARE: LONG-TERM OUTCOME OF BREAST CANCER SEEN IN SOUTH JERSEY HEALTHCARE1996-2008South Jersey Healthcare is approved by the American College of Surgeons' Commission on Cancer as acommunity hospital comprehensive cancer program. The Tumor Registry of South Jersey Healthcare hasbeen accessioning information on all cancer cases since January 1, 1982.The Cancer Committee of South Jersey Healthcare initiated a patient care evaluation of breast cancerwith a focus on outcome disparities as they relate to insurance coverage. A total of 1,626 breast cancercases were accessioned in study from 1996 to 2008. Distribution by year of diagnosis is seen in Graph#1.Graph #2 shows decade of life versus type of insurance showing a bell curve for distribution of age. Thehighest number of patients are in the 40-69 year range.

Graph #3 shows the distribution of the 1,626 patients by type of insurance with commercial insuranceand Medicare representing approximately three-quarters of all the patients in the study.Graph #4 shows the distribution by race as reported for black, Hispanic, other, unknown and whiteHispanic. Approximately three-quarters of all the patients in the study identified themselves as whiteand non-Hispanic.

The patient’s best pathological stage is represented in chart #5.The majority of the patients presented with Stage 0 - III with the greatest number of patients in Stage I,the trend however shows a greater percentage of uninsured which are stage III and IV. Graph #6 showsfour stages of breast cancer with relative five year survival, showing South Jersey Healthcare versusNCDB.

Graph #7 shows comparative data from South Jersey Healthcare versus NCDB.South Jersey Healthcare has a higher proportion of Medicare and a lower proportion of commercialinsurance. Graph #8 shows NCDB data comparing cases diagnosed as South Jersey Healthcare between2000 and 2008 versus NCDB data. South Jersey Healthcare has a smaller proportion of Stage O, Stage 1patients.

Graph #9 shows a portion of patients treated with lumpectomy and radiation versus mastectomy versuslumpectomy alone. Although two-thirds of patients underwent lumpectomy, almost 11% of the patientswere not given radiation therapy in conjunction with the lumpectomy. Most of these representedpatients who either refused treatment or had other medical contraindications for having radiationtherapy.Graph #10 shows proportionality of mastectomy versus lumpectomy by insurance. For the most part,two-thirds of the patients seem to have undergone conservative therapy versus one-third mastectomyalthough the proportion is closer to 50% in the Medicaid population.

Graph #11 shows NCDB data surgical treatment versus NCDB data comparing 1085 of the patientsbetween 2000 and 2008 were South Jersey Hospital System has a higher proportion of patientsundergoing lumpectomy versus mastectomy in the study.The Tumor Registry of South Jersey Healthcare is a valuable tool in studying long-term outcome ofpatients diagnosed with breast cancer who receive their treatment at South Jersey Health System.

South Jersey Healthcare Institutional Review Board and Clinical TrialsThe South Jersey Healthcare Institutional Review Board (IRB) is an independent committee, comprisingindividuals with diverse medical and non-medical backgrounds, that reviews and approves all clinicalstudy related documents. The IRB approves protocols, informed consent forms, physician credentialsand eligibility, and patient recruitment materials, such as print advertisements and public serviceannouncements.The mission of the South Jersey Healthcare IRB is to facilitate quality research, with quality in thiscontext emphasizing balancing risks and benefits for human subjects. Every month the SJH IRBmembers continue their ongoing education regarding the protection of participants in research trials byreading and reviewing recently published articles.This year, the SJH IRB added new members to the board. Carl Minniti Jr. MD, a Medical Oncologist fromThe Minniti Center in Mickleton, NJ, joined as an additional Primary Reviewer. Marge Pollock, MSN,WHNP, BC, is the Administrative Director of Women and Children’s Services at SJH. Bruce Boxer, PhD,MBA, RN, CPHQ, is the Director of Quality/Magnet Coordinator at SJH.In 2010, the South Jersey Healthcare IRB approved eight new clinical trials. Of the eight, six were cancertrials, and two were nursing studies. The new cancer studies treat breast, colon, cervical and ovariancancers. The following oncologists participated in the recruitment of patients and the opening of newcancer clinical trials during 2010: Tami Bach, MD; David Blom, DO; Joseph Fanelle, MD; Carl Minniti, Jr.,MD; Benjamin Negin, MD; Shailja Roy, MD; Kush Sachdeva, MD; Glenda Smith, MD; and RamaSudhindra, MD.Through our partnership with Fox Chase Cancer Center (FCCC), our site was able to open apharmaceutical industry sponsored research trial. FER-BR-033 A Randomized Trial of Ixempra vs Taxol inAdjuvant Therapy of Triple-Negative Breast Cancer (TITAN) is sponsored through the Sarah CannonResearch Institute (SCRI). The study’s primary endpoint compares Disease Free Survival (DFS). OverallSurvival (OS) and Safety Assessments are the secondary endpoints. To date, two SJH patients have beenaccrued to this study. Through this successful opening, SJH plans to open more FCCC ExtramuralResearch studies in 2011.South Jersey Healthcare participates in the Central IRB (CIRB) Initiative. CIRB is designed to help reducethe administrative burden on local IRBs and investigators while maintaining a high level of protection forhuman research participants. The CIRB Initiative is sponsored by National Cancer Institute (NCI) inconsultation with the Department of Health and Human Services Office for Human Research Protections(OHRP). Currently, SJH has three NCI CIRB approved trials open.The South Jersey Healthcare IRB continued mentoring the SJH Nursing Research Council in 2010. Thisrelationship has opened a positive pathway for nursing research studies at SJH. The SJH IRB is impressedby the SJH nurses’ constant enthusiasm to create new and valid nursing studies in their desire toimprove SJH patient care.

2010 South Jersey Healthcare Cancer Committee MembersPhysician RepresentativesRama Sudhindra, MDCancer Committee Chair, Medical OncologistJoseph Fanelle, MDRadiation OncologistMedical Director, Dept. of Radiation OncologyRobert Frelick, MD, FACPMedical OncologistAndrew S. Heller, MDSurgeon (General, Thoracic, Critical Care, Vascular)Robert Lazarus, MDRadiologistLarry Mapow, MDPathologistCarl J. Minniti, Jr. MDMedical OncologistCondapuram Pasupathy, MDSurgeonKush Sachdeva, MDMedical OncologistRaghuraj S. Tomar, MDInternal MedicineNon-Physician RepresentativesElizabeth Sheridan, FACHE, MA, RN, NEA-BC, Chief Operating Officer, Chief Nurse Executive,AdministrationJeanine Aussenberg, PharmD, PharmacyMaria Basche, MS, RD, NutritionRuth Ann Bishop-Sotak, RN, MA, CBCNBreast Cancer Care CoordinatorColleen M. BodhuinAdministrative Assistant, Cancer ServicesEvelyn Corwonski, RHIT, CTR, SupervisorOncology Data ServicesJackie Craig, Community Executive

American Cancer SocietyJill Darminio, RDNutritionLisa Dickson, SupervisorPathologyRev. Ray Elberson, Oncology ChaplainDebbie Franceschini, MS, PTRehabilitationPatricia Keeley, MSN, RN, OCNFox Chase Cancer Center Partnership LiaisonMichelle Marshall, AVPOncology & Women’s Health ServicesDoris Moore, RNBreast Cancer Bridge CoordinatorChristie O’Connell, DirectorHospiceCare of South JerseyMelanie R. Pirollo, MS, RN, AOCNAdministrative Director of Cancer ServicesGreg Potter, DirectorMarketing and Public RelationsJoe ProfettoMen’s Cancer CoordinatorRobert Robinson, MSW, CSWOncology Social Worker/Case ManagementMario Sergi, Jr., RT (R) (T) CTR, DirectorRadiation Oncology, Radiology and ODSKaren Swenson, RN, OCN, CCRPResearch Nurse