Regional West Cancer Services 2012 Annual Report

CANCER SERVICES

2012 Annual Report

INTRODUCTION

Carol Willis, MD

05

A SURVIVOR’S STORY

Barb Lebruska

06

CANCER CONFERENCE/CANCER PROGRAM

08

CANCER REGISTRY

09

THYROID CANCER

10

CANCER COMMITTEE

14

PHYSICIAN LIAISON

15

COMPARISON OF DATA

16

PRIMARY SITE TABLE

17

THYROID CANCER GRAPHS

18

TEAM APPROACH TO CARE

20

GLOSSARY

22

Regional West Medical Center | rwhs.org 3

If I were a flower. I would be a sunflower, to always

follow the sun, turn my back to darkness, stand proud, tall and straight even with my head full of seeds.

—Pam Stewart

Thyroid cancer is the focus of this year’s annual report. Thyroid cancer forms in the thyroid gland, which is an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight. The four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic. The four types are determined based on how the cancer cells look under a microscope.

In 2013, there will be an estimated 60,220 new cases of thyroid cancer in the United States and 1,850 deaths from the disease. In this annual report, a surgeon, oncologist, and an endocrinologist share their perspective and years of experience in treating and managing thyroid cancer.

Because cancer diagnosis and treatment often involves multiple physicians and cancer care services, navigating the process as a patient

can be overwhelming. At Regional West Medical Center, providing individualized cancer care is a team effort. From the dedicated physicians and nurses to a coordinated network of support staff, Regional West involves seasoned professionals in every facet of cancer diagnosis and treatment. Together they collaborate to develop the best treatment plan for each individual. Regional West’s cancer program offers compassionate care with the latest in screening, diagnosis, treatment, and support services working together to ensure the best possible outcome for our patients.

Sincerely,

Carol Willis, MD, MBA, FCAPChairman, Cancer Committee

INTRODUCTION

Carol Willis, MD, MBA, FCAP ChairmanCancer Committee


Shortly after waking up one morning in December 2011, Barb Lebruska noticed something on her neck that wasn’t there the night before—a lump. As an LPN at Regional West Physicians Clinic–Family Medicine, Morrill, she was concerned enough to immediately schedule an appointment with her family physician, Dr. Alan Johnson, at Regional West Physicians Clinic–Family Medicine, Gering. After an ultrasound proved suspicious, Barb underwent a biopsy, which showed the presence of malignant cells.

“My first thought was, “I have cancer??” says Barb. “Then I immediately wondered what was going to happen next—it’s such a jumble of emotions at that moment that it’s hard to focus on what you’re hearing.”

Although no one wants a diagnosis of cancer, the good news is that thyroid cancer is one of the most treatable types. According to the National Cancer Institute, from 2003-2009, the overall five-year relative survival was 97.7 percent.

Soon after her diagnosis, Barb had surgery at Regional West to remove the right side of her thyroid gland and

THYROID CANCER SURVIVOR’S STORY

Barb Lebruska

Cancer Treatment Center Annual Report | rwhs.org6

the attached lump. She was startled when test results revealed unclear margins, which meant another surgery to remove the left side of her thyroid. Surgeons had hoped to preserve part of the gland with partial removal, but “That wasn’t in the cards,” says Barb.

Each surgery meant just one night in the hospital, and she soon faced what she calls the most challenging part of her cancer journey.

In order to receive the radioactive iodine necessary for Barb’s recovery, physicians first had to get her TSH levels to a point between 40 and 60 and then sustain that level for the radioactive iodine treatment. The process wreaked havoc with both her system and her emotions.

“It was awful—I literally couldn’t do anything; even lifting my head made me want to cry,” she says. “My levels would climb then drop, climb then drop. I felt so incredibly horrible.”

Her TSH levels were tested twice a week, and when they were close to the acceptable level, Dr. Clint Merrill, Barb’s oncologist at Regional West Physicians Clinic-Oncology, decided to proceed with the radioactive iodine process.

According to Barb, that part was a ‘piece of cake.’ After taking the pill, she was effectively radioactive, so had to be isolated from friends, loved ones, and pets for 72 hours. Her isolation took place at home and she admits to somewhat enjoying the peace and quiet after the hectic few months of diagnosis, surgery, and recovery. She suffered no side effects and is now cancer-free.

“I get an ultrasound of my neck every six months for now but that will soon change to just once a year,” says Barb. “My blood work is more frequent—that’s checked every six weeks.”

Barb lauds the care she received throughout the process. “Everyone was so

encouraging—I had wonderful care from beginning to end,” she says. “My family and significant other were so supportive—I absolutely couldn’t have done this without them. I feel very lucky.”

Barb’s advice to others who have been recently diagnosed with thyroid cancer? “Stay strong. It’s human nature to automatically imagine the worst-case scenario, but there have been so many recent advances in cancer diagnosis and treatment.”

She also stresses the importance of listening to your intuition. “If you think something is wrong, don’t wait. Get it checked out.”

How to perform a thyroid self-examAn estimated 15 million Americans have undiagnosed thyroid problems. The thyroid gland is a small, butterfly-shaped gland located in the lower front of the neck, above the collarbone, and below the voice box (larynx). The thyroid gland makes hormones that help control the function of many of our body’s organs, including the heart, brain, liver, kidneys, and skin. Making sure that the thyroid gland is healthy is important to our body’s overall well being.

In order to recognize an enlarged thyroid or a nodule, the American Association of Clinical Endocrinologists (AACE) recommends periodically performing a thyroid neck check:

1. Stand in front of a mirror and focus on the lower front area of your neck, above the collarbones, and below

the voice box (larynx). Your thyroid gland is located in this area of your neck.

2. While focusing on this area, stretch your neck back.

3. Take a drink of water and swallow.

4. As you swallow, look at your neck, checking for any bulges or protrusions in this area. Look for enlargement in neck (below the Adam’s Apple, above the collar bone). When swallowing, do not confuse the natural movement of your Adam’s apple with your thyroid. You may want to repeat the drink and swallow process several times.

5. Feel area to confirm any enlargements or bumps.

6. If a problem is detected, see your health care provider.Note: The self-check is not conclusive. A thorough examination by a physician is needed to diagnose or rule out thyroid cancer.


CANCER PROGRAM2013 Goals

• Improvement of colorectal screening.

• Coordination of Initial Cancer Care Access.

2012 Accomplishments• Organized a Head and Neck Case Management team

(Discussed current algorithm and areas for improve-ment with all providers, then implemented process). The team continues to meet on a regular basis.

• A Breast Cancer Task Force committee was devel-oped as part of a programmatic goal toward improv-ing breast cancer care and potentially creating a Breast Cancer Center of Excellence. The Task Force committee meets on the third Thursday of each month and reviews standards as well as current breast cancer patient care processes and barriers to treatment (i.e. cost) at each meeting.

2012 Cancer Conference

In 2012, Regional West Medical Center held 20 twice-monthly multidisciplinary Cancer Conferences to review and discuss current trends in the treatment of cancer. Coordinators for 2012 were Pathologists Peter Schilke, MD and Randall Williams, MD.

Physician representatives from all appropriate disciplines, as well as other cancer health care providers, attend and participate in these conferences. On an average, eight physicians who actively participate in cancer care attended Cancer Conference. The multidisciplinary average attendance was nine.

In 2012, 183 cases were cases were presented. Sites discussed included: breast, colon, rectum, lung, esophagus, prostate, renal/pelvis, liver, appendix, kidney, endometrium, bladder, thyroid, melanoma, lymphoma, head/neck carcinoma, vocal cord, base of the tongue, and gastrointestinal.

In November, Dr. Charles E. Leonard, a radiation oncologist at Rocky Mountain Cancer Centers in Littleton Colo., presented “New Genomic Testing in the Management of DCIS and Invasive ER+ Node- Breast Cancer.”

To arrange for case presentation at Cancer Conference or for further information regarding the Cancer Registry, please call 308.630.2421.


CANCER REGISTRYCindy Keller, CTR Cancer Registry Coordinator

The Cancer Registry is the component of the cancer program responsible for the accurate and timely collection of cancer patient data, which is used for the evaluation of patient outcomes.

The Cancer Registry is responsible for monitoring and coordinating many of the activities of the Regional West Medical Center Cancer Program and our participation in the American College of Surgeons (ACoS) Commission on Cancer (CoC) as an accredited program. The program has been accredited since 1985.

The Cancer Registry is responsible for the data collection and follow-up of all cancer patients diagnosed and/or treated at Regional West. These cases are part of the computerized database

utilizing Rocky Mountain Cancer Data Systems in Salt Lake City, Utah. The updated registry computer system allows instant retrieval capabilities. The database includes information on demographics, anatomic site, extent of disease at the time of diagnosis, history, staging of the cancer, and treatment summary. There were 381 total analytic cases added to the registry in 2012. See primary site table on page 17.

In October, the Data Specialist and Cancer Registrar attended the 35th Annual Tumor Registrars Association of Nebraska TRAN workshop at Mahoney State Park in Ashland, Neb.


It is estimated that in 2013, 60,220 people in the United States will be diagnosed with thyroid cancer and there will be 1,850 deaths. The female to male ratio is 3:1 for thyroid cancer. Data from 1935 to 2008 has shown a dramatic increase in the incidence of thyroid cancer, especially in women. In 1935 the incidence was 1.3/100,000 and in 2008 it had increased to 16.3/100,000. From 1992 to 2001 the 4.3 percent per year increase in thyroid cancer among women showed the highest rate of increasing incidence among all malignancies tracked by SEER (Surveillance, Epidemiology and End Results) data. Regional West Medical Center’s data on thyroid cancer is comparable to the national average.

The use of external beam radiation from 1910 to 1960 for benign childhood conditions led to the increased incidence of thyroid cancer in the last half of the 20th century. Many things like acne and other skin conditions were treated with radiation. The incidence has increased over the last 10 to 15 years, not due to radiation but more likely due to the greater use of imaging techniques. SEER data confirms that from

1980 to 2005, 87 percent of newly diagnosed thyroid cancers were < 2 cm. It appears that the rise in thyroid cancer incidence is due to increased medical surveillance and improved detection, although one can not conclude this with absolute certainty.

Risk factors for thyroid cancer include:

1. Gender. There is a 3:1 female predominance.

2. Radiation exposure, treatment of benign conditions and childhood malignancies, releases from nuclear power plants, and excessive imaging.

3. Familial. Probably accounts for approximately six percent of thyroid cancers.

Mutations or rearrangements in the genes coding for proteins in the MAPK pathway play a critical role in the development and progression of differentiated thyroid cancer. The BRAF V600 E mutation is the most common mutation found in papillary thyroid cancer.

Jaroslaw Aniszewski, MD Regional West Physicians Clinic Endocrinology

Vince Bjorling, MD Regional West Physicians Clinic Internal Medicine

Melissa Stade, MD, FACS Regional West Physicians Clinic Surgery, Vascular Diagnostics

THYROID CANCER


Thyroid cancer usually presents as a palpable thyroid abnormality or is detected on an imaging study done for another reason.

The pathology of thyroid cancer includes several different types. They are separated based on their histology:

1. Papillary–85 percent, generally the type referred to when discussing thyroid cancer.

2. Follicular–10 percent, approached very similarly to papillary.

3. Medullary–Two percent, associated with 14 percent of thyroid cancer deaths, RET mutations.

4. Lymphoma–Two percent, treated as a lymphoma.

5. Anaplastic–One percent, generally in older patients with worse prognosis.

The overall prognosis of thyroid cancer is very good, with the death rate being very low overall. Forty to 60 percent of adults and 90 percent of children will have positive lymph nodes. Nodal disease tends to have minimal impact on survival unless it is bilateral. The most important prognostic factors tend to be local extension of disease (into other organs), distant

metastatic disease, and age > 45 years.

Five-year survival data according to SEER:

• Localized disease 99.9 percent

• Regional disease 97.4 percent

• Distant disease 55 percent• Unknown stage 87.5 percent

DiagnosisMost patients with thyroid cancer are initially seen with a palpable thyroid nodule but are otherwise asymptomatic. Less commonly, patients are first seen for compressive symptoms that include difficulty or pain with swallowing, shortness of breath, hoarseness, or coughing and choking spells. Enlarged neck lymph nodes may be the initial manifestation of thyroid cancer in some patients.

Although thyroid nodules are common, only five percent are malignant. The workup of a thyroid nodule includes a routine serum thyrotropin (TSH) level to evaluate the function of the thyroid and a routine ultrasound examination of the neck to characterize the nodule and to evaluate the rest of the thyroid gland. Thyroid nodules concerning for malignancy have certain ultrasound characteristics regarding

their shape, vascular pattern, and presence of microcalcifications.

Ultrasound-guided fine needle aspiration biopsy (FNAB) is performed for nodules 1 cm or larger and nodules less than 1 cm with concerning ultrasound features. FNAB is accurate in identifying papillary thyroid cancer and medullary thyroid cancer. The limitation of FNAB is in follicular carcinoma and Hurthle cell cancer, which requires more tissue to determine the diagnosis.

Surgical ManagementThe details of surgical intervention of thyroid cancer depend on the pathologic type of thyroid cancer that is found on FNAB. The specific recommendations for surgical intervention follow the National Comprehensive Cancer Network and American Thyroid Association guidelines.

In general, thyroid lobectomy or total thyroidectomy will be recommended. If lymph node metastasis is present, a lymph node dissection will also be required and central neck or modified radical neck dissection will be recommended, based on the pathologic type of thyroid cancer. Intraoperative frozen section analysis may be


utilized by the surgeon if pre-operative FNAB diagnosis is uncertain.

Thyroidectomy is performed under general anesthesia and is considered an outpatient operation. The thyroid gland is located in the lower anterior neck and removed through a small incision. Several approaches to minimally invasive thyroidectomy, such as video-assisted thyroidectomy and endoscopic thyroidectomy via axillary incisions have been proposed. These methods are feasible but clear benefits over the traditional approach have not been established.

The risk of complication from thyroidectomy is rare and dependent on size of the thyroid nodule and involvement of the recurrent laryngeal nerve, which innervates the vocal cord. Complications can include bleeding, neck hematoma, hoarseness after surgery, and injury to the parathyroid glands.

Radioactive IodineRadioactive iodine I-131 plays a very important role in treatment and management of the most common types of thyroid cancer papillary and follicular, frequently referred to as differentiated thyroid cancer (DTC).

While surgery is the most important intervention and its quality often determines long-term outcome, radioiodine plays an important adjunct role and probably improves long term outcomes. Multiple controversial issues are difficult to resolve, due to slow course of disease progression and predominantly favorable outcomes with surgical-only approach.

The rationale for treatment of residual thyroid tissue with 131-I is to destroy any remnant normal thyroid tissue remaining after total thyroidectomy (remnant ablation). This will, in turn:

• Destroy subclinical, microscopic foci of disease remaining after surgery (adjuvant therapy).

• Prevent new cancer development in residual thyroid tissue in high risk patients, especially those exposed to radiation or with genetic predisposition.

• Improves surveillance with thyroglobulin measurements and whole body scans as there is no normal thyroid tissue interfering with the test.

There is considerable disagreement about the efficacy of radioactive iodine

compounded by lack of any prospective trials. Some retrospective studies show nearly 50 percent reduction in recurrence rate when postoperative I-131 is used, while others show no benefit of such approach.

It is a fairly well accepted approach to forgo remnant ablation in patients with small tumors (less than 10 mm) without high-risk features like particular types of histology or lymph node involvement.Remnant ablation doses ranging from 30 to 200mCi are given to higher risk patients with differentiated thyroid cancer.

Patients receiving remnant ablation usually include:

• All patients with known distant metastases, gross extrathyroidal extension of the tumor regardless of tumor size, or primary tumor size >4 cm even in the absence of other high-risk features.

• Select patients with tumor size 1 to 4 cm confined to the thyroid, who have documented lymph node metastases or other higher-risk features (eg, vascular invasion, more aggressive histologic subtypes, such as tall cell, columnar


cell, insular, or poorly differentiated histologies) when the combination of age, tumor size, or multifocality; lymph node status; and individual histology predicts an intermediate to high risk of recurrence or death from thyroid cancer. In the absence of evidence supporting survival benefit for all of the factors listed, the ATA recognizes the importance of clinical judgment and an individualized approach to care.

Guidelines regarding dose selection take into account estimated risk of recurrence with low risk patients receiving a small dose and the highest doses reserved for large primary tumors with lymph node and extrathyroidal extension.

Recombinant human TSH has been recently introduced into management of DTC in order to minimize burden of hypothyroidism required to perform remnant ablation. Multiple studies confirmed its effectiveness in destroying the remnant as effectively as thyroid hormone withdrawal, however no long term studies are available assessing its effectiveness in preventing

recurrences. For this reason some centers reserve this approach only to the lowest risk patients and those considered at high risk of complications ensuing from thyroid hormone withdrawal and subsequent profound hypothyroidism.

Radioiodine is also widely utilized in long-term follow and surveillance. Radioiodine diagnostic scans with 123-I or 131-I are usually performed six to 12 months after treatment with 131-I in moderate to high-risk patients and in lower risk patients who have detectable thyroglobulin levels during follow-up that are not declining. If significant uptake is seen within the thyroid bed (>1 percent), one more treatment with 100 to 150 mCi (3.7 to 5.550 GBq) of 131-I may be given to complete the ablation.

If residual or recurrent disease is detected higher doses of I-131 are given:

• 150 mCi (5.550 GBq) 131-I to treat uptake in lymph nodes in the neck and mediastinum.

• 150 to 200 mCi dose (5.550 to 7.5 GBq) for patients with pulmonary metastases.

• 200 mCi (7.5 GBq) for patients with skeletal or other distant metastatic disease.

Higher activities may be given to patients who have recurrent disease after previous therapy, but should be based on dosimetry to ascertain their safety. Novel approaches utilizing various sensitizers are under study but there is not enough data to recommend such an approach. The benefits of I-131 in management of thyroid cancer should be weighed against risks predominantly related to secondary cancers. Sodium iodine symporters are present in salivary glands and estrogenized breast tissue, and the gastrointestinal and urinary routes of excretion of radioiodine thus salivary gland, breast, bladder, and gastrointestinal cancers can be plausibly hypothesized to occur more frequently in thyroid cancer patients treated with radioiodine. The risk of acute myeloid leukemia is also increased.


Medical OncologyVincent Bjorling, MD Regine Leconte, MDClinton Merrill, MD

Radiation OncologyMark Hartman, MD

Pathology Carol Willis, MD, MBA, FCAP Chairman, Cancer CommitteePeter Schilke, MD, FCAP Randall Williams, MD, FASCP

Diagnostic RadiologyStephen Johnson, MD, PhD Gitesh Chheda, MD

SurgeryJason Walsh, MD, FACS Melissa Stade, MD, FACS

Cancer Liaison Physician through November 13, 2012Jason Walsh, MD, FACS

Cancer Liaison Physician November 13, 2012 to presentMelissa Stade, MD, FACS Cancer Services Jeff Kriewald, B.S. RT(R)(T) Director, Cancer Services Cindy Keller, CTR Cancer Registry Coordinator Carol Diffendaffer, PMHP, PMSW, OSW-C Social Worker

Quality Resource Margo Ferguson Oncology NursingSue Schoeneman, APRN-C, OCN

Palliative Care ServicesLinda Rock, BA

Adhoc MembershipTodd Sorensen, MD, MS President/CEO Regional West Health Services

Jan Taylor, MT (ASCP) Vice President Ancillary Services

Shirley Knodel, RN, MS Chief Nursing Officer/Vice President Patient Services

John Kabalin, MD Urology

Kim Croft, RN, BSN Cancer Patient Navigator

Becci Bowman, DNP, APRN-C, AOCNP, ACHPN Internal Medicine

Nancy Sloan, PharmD Clinical Pharmacist

Martha Stricker, RN, BSN Nurse Manager

Karen Johnson, RD, CSO, LMNT Dietician

Julie Glover American Cancer Society Representative

Sharon McKinney Director, Imaging Services Department

Amy Potts Medical Staff Office

2012 CANCER COMMITTEE MEMBERSHIP


Melissa Stade, MD, FACS, a general surgeon at Regional West Physicians Clinic-Surgery, Vascular Diagnostics, began her term as Cancer Physician Liaison in 2012. In this capacity, Dr. Stade promotes communication and collaboration between the American College of Surgeons, the Heartland Division of the American Cancer Society, Regional West Medical Center Cancer Committee, and local community agencies.

Dr. Stade attended Chadron State College in Chadron, Neb. and earned her medical degree from the University of Nebraska

College of Medicine in Omaha. She completed her residency in general surgery at the University of Nebraska Medical Center, Department of Surgery. Dr. Stade is a fellow in the American College of Surgeons and a member of the American Society of Breast Surgeons. She recently attended the World Congress on Thyroid Cancer in Toronto, Canada.

Along with Dr. Stade's role as Physician Liaison, she serves on Surgery Committee and vice-chairman of the Pharmacy and Therapeutics Committee at Regional West Medical Center.

Melissa Stade, MD, FACS Regional West Physicians Clinic Surgery, Vascular Diagnostics

PHYSICIAN LIAISON REPORT


SOURCE: American College of Surgeons, National Cancer Data Base (NCDB), Benchmark report, 2005 National Data,

2005 Nebraska Health & Human Service System - Nebraska Cancer Registry, Regional West Medical Center.

There were 409 cases of cancer and reportable tumors in the Regional West Medical Center Cancer Registry for 2012. Of these, 28 cases were non-analytic, with a total of 381 cases qualifying for analysis (See Primary Site Table on page 17). Breast cancer is the most frequently diagnosed and treated primary site at Regional West. All graphs shown include analytic cases only.

2012 COMPARISON OF CANCER DATA

COMPARISON CHARTS

Regional West

Nebraska

National

CASE COUNTS BY COUNTY OF RESIDENCE

Total equals 381 casesfor 2012

Out of state: 48

TOP FIVE INCIDENCE SITES-MEN

TOP FIVE INCIDENCE SITES-WOMEN

Lung | 35

Prostate | 32 Bladder | 19

Colon | 15 Non-Hodgkin’s Disease | 12

Other | 71

Other| 69

Lung| 22 Colon | 12

Corpus Uteri | 19 Brain and Other Nervous System | 13

Breast | 62


Primary Site All

Cases (includes non-

analytic)

AnalyticCasesOnly

Sex Best AJCC Stage

M F Stage 0

Stage I

Stage II

Stage III

Stage IV

Not Staged

Buccal Cavity/Pharynx 8 7 7 0 0 2 0 1 4 0Tongue 3 3 3 0 0 1 0 0 2 0Tonsil/Pharynx/Other Buccal 4 4 4 0 0 1 0 1 2 0Lip 1 0 0 0 0 0 0 0 0 0

Digestive System 61 60 38 22 1 5 11 21 16 6Anus/Anal Canal 1 1 0 1 0 0 0 1 0 0Esophagus 3 3 3 0 0 1 0 1 1 0Stomach 4 4 4 0 0 0 0 2 0 2Retroperitoneum 1 1 1 0 0 0 0 1 0 0Colon, Excluding Rectum 27 27 15 12 1 3 7 10 5 1Rectum and Rectosigmoid 11 10 7 3 0 0 1 4 4 1Liver 7 7 4 3 0 1 1 1 2 2Pancreas 6 6 3 3 0 0 2 1 3 0Other Biliary 1 1 1 0 0 0 0 0 1 0

Respiratory System 63 60 38 22 0 11 4 13 31 1Nasal Cavity Sinuses and Larynx 3 3 3 0 0 1 0 2 0 0Lung, Bronchus 60 57 35 22 0 10 4 11 31 1

Bones and Joints 1 1 1 0 0 1 0 0 0 0Soft Tissue 6 6 2 4 0 0 1 3 1 1Skin (Exc. Basal & Sq. Ca) 19 9 4 5 0 3 2 2 1 1

Melanoma of the Skin 17 7 2 5 0 3 2 1 0 1Other Skin Cancer 2 2 2 0 0 0 0 1 1 0

Breast 70 65 0 65 9 26 23 4 2 1Female Genital 28 28 0 28 1 14 3 8 2 0

Cervix Uteri 2 1 0 1 0 0 1 0 0 0 Corpus Uteri 18 19 0 19 1 12 0 5 1 0 Ovary 3 3 0 3 0 0 1 2 0 0 Uterus 1 1 0 1 0 0 0 0 1 0 Vulva 3 3 0 3 0 2 0 1 0 0 Other Female Genital 1 1 0 1 0 0 1 0 0 0

Male Genital 50 33 33 0 0 9 16 2 5 1 Prostate 49 32 32 0 0 8 16 2 5 1 Testis 1 1 1 0 0 1 0 0 0 0

Urinary System 42 40 28 12 12 21 2 2 2 1 Urinary Bladder 29 27 19 8 12 10 2 1 1 1 Kidney and Renal Pelvis 12 12 8 4 0 10 0 1 1 0 Ureter 1 1 1 0 0 1 0 0 0 0Brain and Other Nervous System 19 19 6 13 N/A N/A N/A N/A N/A 19Endocrine System 12 12 4 8 0 6 1 1 3 1Thyroid Gland 11 11 3 8 0 6 1 1 3 0Other Endocrine 1 1 1 0 0 0 0 0 0 1Lymphatic System 27 26 13 13 0 7 2 8 8 1 Hodgkin’s Disease 2 2 1 1 0 1 0 1 0 0 Non-Hodgkin’s Disease 25 24 12 12 0 6 2 7 8 1Multiple Myeloma 5 4 3 1 N/A N/A N/A N/A N/A 4Blood/Leukemia 4 3 1 2 N/A N/A N/A N/A N/A 3Other, Ill-defined and Unknown 9 8 3 5 0 0 0 0 1 7

All Sites Combined 424 381 181 200 23 105 65 65 76 47

M=male, F=female, AJCC stage grouping T, N, and M categories describe the anatomic extent of disease. Stage groupings gather cases into homogeneous categories to facilitate analysis. See glossary.

Cancer Incidence by Primary Site 2012 Cancer Treatment Center and Dorwart Cancer Care Center


0

5

10

15

20

25

50

60

0

10

20

30

40

Age at Diagnosis

AJCC Stage

01020304050607080

Gender

Regional West Medical Center

Nebraska All States


Nebraska All States


Nebraska All States

THYROID CANCER DIAGNOSED 2000-2010 National Cancer Data Base: Benchmark Reports Community hospitals in all states – 448 hospitals (28,477 cases), hospitals in Nebraska – five hospitals (343 cases), and Regional West Medical Center (69 cases).

Stage 0 Stage I

Stage II Stage III

Stage IVUnkown

Under 2020-29

30-3940-49

50-5960-69

70-7980-89

90+

Female Male Cancer Treatment Center Annual Report | rwhs.org18

Age at Diagnosis


Combining personalized care with the most technologically advanced cancer treatment in the region, the physicians and staff or Regional West's Cancer Services are committed to offering best practices and compassionate care to cancer patients in western Nebraska, eastern Wyoming, and northeastern Colorado.

Our integrated, multidisciplinary approach for patients and their families has earned the Cancer Treatment Center accreditation by the American College of Surgeons Commission on Cancer as well as the Commission on Cancer's Outstanding Achievement Award. The award is presented only to those facilities that voluntarily commit to provide the best in diagnosis and treatment of cancer and undergo a rigorous evaluation process and performance review every three years.

Because cancer diagnosis and treatment often involve several physicians and cancer care services, navigating the process can be overwhelming. That’s where Regional West’s team approach to cancer shines, says Carol Willis, MD, a Pathologist and Chairman of Regional West’s Cancer Committee.

“Having the very latest in screening, diagnosis, treatment, and support services all on one campus is a huge plus for our patients,” she says. “Because all of the experts connected with a patient’s care are all right here, they can easily collaborate to develop the best treatment plan for each individual.”

“We truly have specialists in every facet of the cancer diagnosis/treatment spectrum,” says Dr. Willis. “To find the depth of services and specialization that we offer in a relatively rural facility is amazing and comes as a surprise to most people—I would say that Regional West’s cancer program really is a hidden gem.”

She adds that Regional West has a good relationship with other facilities, so if a patient’s condition and type of cancer warrant receiving treatment elsewhere, then a seamless care transition is made. Likewise, if a patient receives an out-of-town cancer diagnosis, he or she can work with Regional West to receive treatment right here at home.

Diagnosis and TreatmentFrom the moment patients first enter the Cancer Treatment Center, Regional West's staff and physicians help them face their disease with confidence and determination, providing support every step of the way.The first step to diagnosing cancer includes a comprehensive clinical evaluation using a wide range of diagnostic tools, which may include laboratory tests, X-ray exams and a biopsy of the suspected abnormality. The clinical evaluation may also require the use of advanced diagnostic tools such as nuclear medicine scans, endoscopy, stereotactic breast biopsy or sentinel node biopsy.

After reviewing the diagnostic results, the center's cancer specialists can pinpoint the extent of the cancer and suggest appropriate treatment options.

REGIONAL WEST’S TEAM APPROACH TO CANCER CARE


• Radiation Therapy The Radiation Oncology Department at Regional West Medical Center offers the most current treatment options for breast cancer. We offer 3D conformal external beam radiation therapy along with Intensity Modulated Radiation Therapy and Partial Breast Brachytherapy. The Radiation Oncology department provides outstanding individualized care from a highly trained and specialized multidisciplinary treatment team, with one goal: “To treat the whole person, personally.”

• Intensity-Modulated Radiation Therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.

• Partial Breast Brachytherapy We offer Partial Breast Brachytherapy for breast cancer treatment. Brachytherapy is an advance radiation cancer treatment that involves placing a source of radiation directly into a tumor or surrounding tissues. It allows a physician to use a higher dose of radiation and treat a smaller area (tumor) in a shorter amount of time than external radiation.

• Surgery is frequently used in combination with other forms of cancer treatment. For optimum results, our surgeons use a team approach and actively work with radiologists, pathologists, medical oncologists and radiation oncologists while utilizing the latest surgical techniques.

• Chemotherapy treatment utilizes anti-cancer drugs designed to interfere withcancer cell growth and reproduction. It is often used in conjunction with surgery and/or radiation treatment. Administered in the offices of Scottsbluff Internal Medicine or on an inpatient basis, chemotherapy treatments are supervised by highly trained oncology nurses and supported by physicians and staff.

Thyroid cancer statistics and facts• In 2013, an estimated 60,220 new

cases of thyroid cancer will be diagnosed (45,310 in women and 14,910 in men).

• There will be approximately 1,850 deaths from thyroid cancer in 2013 (1,040 women and 810 men).

• Thyroid cancer is commonly diagnosed at a younger age than most other adult cancers. Nearly two out of three cases are diagnosed in people younger than 55 years of age.

• Thyroid cancer is the fifth most common cancer in women.

• Just two percent of thyroid cancers occur in children and teens.

• The chance of being diagnosed with thyroid cancer has doubled since 1990.

• Thyroid cancers (like almost all diseases of the thyroid) occur about three times more often in women than in men.

• Thyroid cancer is considered one of the least deadly and most survivable cancers; the five-year survival rates for thyroid cancer is 97 percent.

• Many patients, especially in the early stages of thyroid cancer, do not experience symptoms. As the cancer develops, symptoms can include a lump or nodule in the front of the neck, hoarseness or difficulty speaking, swollen lymph nodes, difficulty swallowing or breathing, and pain in the throat or neck.

Source: American Cancer Society cancer.org


GLOSSARY OF TERMSAJCC STAGEAmerican Joint Committee on Cancer Staging Scheme using tumor size, node involvement and metastases to distant sites, T=primary tumor size; N=regional lymph node involvement; M=metastasis or distant spread.

AJCC STAGE GROUPINGS (FOR MOST SITES)Stage 0: Carcinoma in-situStage I: Localized carcinomaStage II: Limited local extension and/or limited regional lymph node involvementStage III: More extensive local extension or regional lymph node involvementStage IV: Involvement of distant sites

ANALYTICCancer cases initially diagnosed and /or having received all or part of the first course of treatment at Regional West Medical Center.

FIRST COURSE OF TREATMENTPlanned definitive therapy initiated within four months following initial diagnosis.

NCDBNational Cancer Data Base.

OBSERVED SURVIVAL RATEThe literal survival rate from counting each case in the Registry

STAGE GROUPING PURPOSET, N, and M categories describe the anatomic extent of the disease. Stage grouping gathers cases into homogenous categories to facilitate analysis.

UNKNOWNTumor is said to be unknown when the stage cannot be determined from the medical record or a medical authority.


For additional copies

Call308.630.2421

WriteRegional West Medical CenterCancer Treatment CenterAttention: Cindy Keller, CTR Cancer Registry Coordinator3911 Avenue B, Suite G100Scottsbluff, NE 69361

Email [email protected]

Web Access the report at RegionalWestCTC.org

2012 annual report published October 2013Teresa Clark, Editor


Documents

Regional West Cancer Services 2012 Annual Report