2007 Annual Report
ESOPHAGEAL CANCER
The Cancer Program of Our Lady of the Lake and Mary Bird Perkins 1
Chairman’s Letter On behalf of the Cancer Committee of the Cancer Program of Our Lady of the Lake (OLOL) and Mary Bird Perkins (MBP), I am pleased to present the 2006 Cancer Annual Report. On the pages that follow, you will read about recent highlights of the Cancer Program, as well as a ten-year study on esophageal cancer. During 2006, the Cancer Program accomplished many clinical, programmatic, quality improvement and community outreach goals focused on the needs of cancer patients and the community at large. The Cancer Program of Our Lady of the Lake and Mary Bird Perkins is an approved program of the American College of Surgeons (ACoS) Commission on Cancer (CoC). The CoC is dedicated to improving survival and quality of life for cancer patients through best practice standards, prevention, research, education and quality of care initiatives. Only facilities that have voluntarily committed to provide the best in cancer care and comply with CoC established standards receive approval. Meeting patients’ needs is the primary focal point of the Cancer Committee as it works to ensure a seamless approach to comprehensive cancer care. For many years, the Cancer Program of Our Lady of the Lake and Mary Bird Perkins has recruited top-notch medical professionals, instituted quality clinical pathways and acquired leading-edge technology so Louisianians can stay close to home and receive state-ofthe-art cancer treatment. In addition, under the direction of the Cancer Committee, the Cancer Program continued to increase public awareness for prevention and early detection by providing free cancer screenings to the medically underserved. The Cancer Program increased its quantity of breast, colorectal, prostate and skin cancer screenings during nationallyrecognized cancer awareness months. Overall, the Cancer Program screened over 4,500 people at 122 free cancer screenings. Last, but certainly not least, I am pleased to report that the Cancer Program of Our Lady of the Lake and Mary Bird Perkins was one of 14 community-based cancer programs in the country selected to participate in the National Cancer Institute Community Cancer Centers Program (NCCCP) pilot. The aims of the pilot are profound and include bringing more Americans in contact with high-quality, community-based cancer care, increasing participation in clinical trials, reducing cancer healthcare disparities and improving information sharing among community cancer programs. We look forward to participating in the important NCCCP initiative and are honored to join the elite group of hospitals and centers dedicated to improving the delivery of community-based cancer care in the United States.
Sincerely,
David S. Hanson, MD
1
2006 Cancer Committee The Cancer Committee is a multidisciplinary organization responsible for planning, initiating, implementing, evaluating and improving all cancer-related activities. The Cancer Committee maintains an exemplary cancer program to benefit all patients. The committee consists of physicians from specialties involved in cancer treatment and representatives from MBPCC and OLOL. PHYSICIANS
HEALTHCARE PROFESSIONALS
David S. Hanson, MD Hematology/Oncology Cancer Committee Chairman
Reverend Mark Adams OLOL Chaplain
David A. Boudreaux, MD Pathology Annual Report Committee Chairman PCE Subcommittee Chairman Tumor Registry Advisor ACoS Cancer Liaison Physician
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Kathy Babin, CTR OLOL Cancer Registry Tandra Davison, BSIE, CPHQ OLOL Performance Improvement Jennifer Blackman, MS, CCRP OLOL Manager of Clinical Research
M. Giles Fort III, MD Gynecological Oncology
Susan Finley, RN, OCN MBPCC Clinical Research Coordinator
Sheldon A. Johnson, MD Radiation Oncology
Kevin Guidry, MHA OLOL Cancer Center, Administrator
Jeffrey Littleton, MD General Surgery
Nicole Magee, CTR MBPCC Cancer Registry Director
Ryan Majoria, MD Radiology
Lori McCallum, MEd, CTR MBPCC Executive Director, C.A.R.E. Network
Gerald P. Miletello, MD Hematology/Oncology
Charmaine Mosby, RHIA OLOL Cancer Registry Manager
Susan E. Nelson, MD Gerontology
Charles W. Mouton, RD, LDN OLOL Dietitian
Stanley Peters, MD Otolaryngology
Jacqueline O’Neill, LCSW OLOL Cancer Liaison
Ronald Radzikowski, MD Internal Medicine OLOL Vice President of Medical Affairs Ex-Officio Member
Salli Phillips, LCSW, OSW-C MBPCC Social Worker
Brian W. Webb, MD Pathology
Brenda Truxillo, RN, LRT MBPCC Vice President, Radiation Oncology
Gena Skelton, RN, BSN OLOL Cancer Center Nurse Manager
Cancer Liaison physician’s Report The Cancer Liaison Physician Program was established in 1963 by the Commission on Cancer (CoC) of the American College of Surgeons. As an ACoS multidisciplinary program, the CoC is dedicated to decreasing morbidity and mortality from cancer through education, standard setting and monitoring of the quality of care. Cancer Liaison Physicians (CLP) serve as links between the CoC and the hospitals they represent, manage clinically-related cancer activities within their local institutions and partner with local community agencies, such as the American Cancer Society (ACS), to accomplish community outreach goals regarding education, early detection and prevention of cancer. This year marks my first year as CLP for the Cancer Program, taking over for my capable colleague David A. Boudreaux, MD, who has done such an admirable job for the last several years. To better understand the responsibilities of a CLP, I have participated in two CoCsponsored web conferences titled The Role of the Cancer Liaison Physician and American Cancer Society: Resources and Services. I have also attended the CoC Annual Meeting and the Cancer Liaison Program Breakfast Meeting, both held in New Orleans. With regard to my responsibilities specific to the Cancer Program, I participate in quarterly meetings of the Cancer Committee by reporting upcoming activities and initiatives of the ACS. I also report on the quality assurance studies I personally perform regarding the use of College of American Pathologists (CAP) checklists on all pathology reports with a cancer diagnosis. This has led to the initial steps in standardizing pathology reports and cancer diagnoses across different institutions within the community to ensure completeness and accuracy. Other activities I have been involved with include reviewing our Patient Care Evaluation (PCE) study regarding esophageal cancer as well as attending preliminary meetings on developing a biospecimen repository (“tissue bank�), one of the initiatives from the National Cancer Institute Community Cancer Centers Program (NCCCP) pilot. I look forward to working with local and national organizations to facilitate communication and collaboration in the years ahead.
Sincerely,
Brian Webb, MD
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Cancer-related Services
OLOL
MBPCC
TREATMENT Medical Oncology Chemotherapy l Hormonal/Antihormonal Therapy l Immunotherapy l Infusion Therapy l Peripheral Stem Cell Transplantation l Radiation Oncology Radiation Therapy External Beam Radiotherapy l High Dose Rate Brachytherapy (HDR) l Image Guided Radiation Therapy (IGRT) l Intensity Modulated Radiation Therapy (IMRT) l Prostate Seed Implants l l SirSpheres l l Stereotactic Radiosurgery l Treatment Planning Computerized Axial Tomography (CT) l l Image Fusion (CT, MRI, PET) l l Medical Physics/Dosimetry l Positron Emission Tomography (PET) l l Virtual Simulation l Dental Oncology l l Surgical Oncology l Support Services CancerFit l Enterostomal Therapy l Nutritional Support l l Occupational, Physical and Speech Therapies l Pastoral Care l Respiratory Therapy l Social Services l l Other Services Lymphedema Prevention Clinics l Pain Management l l Patient Transportation l EDUCATION Professional Education Allied Health Cancer Grand Rounds l Continuing Education (CE) l l Continuing Medical Education (CME) l l Graduate Medical Education (GME) l l Medical Library l l Community Education Cancer Resource Call Center l l Cancer Screenings l l Community Library l l Community Outreach l l Elderly Services l Speakers Bureau l l CASE MANAGEMENT Tumor Conferences RESEARCH Clinical Research Tumor Registry
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l
l
l
l
l
l
Tumor Conferences Multidisciplinary treatment planning conferences are
held weekly to improve the care of patients with cancer. The cases of patients from the Cancer Program are selected for presentation and discussion based on the case complexity, unusual presentation of disease or special interest. Physician representatives from appropriate disciplines attend and participate in the conference. In March 2006, the Cancer Committee presented a facility-wide didactic CME conference titled Incorporating Genomics in the Management of Early Stage Breast Cancer by Virginia Kaklamani, MD, DSc. During 2006, 162 cases were presented at the standard weekly tumor conference. The cases reviewed included neoplasms of the following types and sites.
Blood/Bone Marrow 7 Brain/Nervous System 2 Breast
21
Digestive System
50
Endocrine 2 Lymphatic System
11
Male Genital 8 Oral Cavity/Pharynx 2 Respiratory/Intrathoracic
25
Skin 7 Soft Tissue
11
Unknown Primary 9 Urinary Tract 7
To schedule cases for presentation, physicians may call Dianne Griffin at (225) 215-1238.
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An Overview: Esophageal Cancer Esophageal cancer is a disease in which a
malignant tumor arises from the tissues lining the esophagus. Located behind the trachea, the esophagus is a 10inch-long, hollow, muscular tube that carries food and liquids from the mouth/pharynx to the stomach; it is divided into upper (cervical), middle (thoracic) and lower (abdominal) segments. The inner lining of the esophagus (the mucosa) is normally comprised of flattened squamous epithelium. Between the mucosa and the muscular wall, there are submucosal glands that keep the passageway moist and make swallowing easier. A rich network of blood vessels and lymphatics runs the length of the esophagus with extensive interconnections, making the course of metastatic spread from esophageal cancer somewhat unpredictable. Tumors from the upper esophagus typically spread to the cervical and superior mediastinal lymph nodes. Tumors from the lower esophagus often spread to the lower mediastinal and abdominal lymph nodes. The most common extranodal sites of metastasis are the liver and lung. Unlike the rest of the gastrointestinal tract, the outer surface of the esophagus is not surrounded by a serosa (a thin layer of mesothelial cells); so the adjacent mediastinum is susceptible to direct involvement by a tumor invading through the esophageal wall. Esophageal cancer is divided into two major histologic types. Squamous cell carcinomas usually arise from the cells that line the upper and middle parts of the esophagus. Adenocarcinomas typically involve the lower esophagus and arise within mucosa that has been damaged, usually by gastroesophageal reflux disease (GERD) and has undergone metaplastic change to a more intestinal type glandular epithelium (Barrett’s esophagus). Adenocarcinomas may also arise from the submucosal glands within the esophagus. Other types of tumors such as melanomas, sarcomas and lymphomas comprise only a very small fraction of esophageal malignancies. The incidence of esophageal cancer fluctuates dramatically throughout the world and has the largest variability of any known malignancy. Esophageal cancer is the third most common tumor of the digestive tract and the seventh leading cause of cancer death worldwide. Incidence of esophageal carcinoma can be as high as 30 to 800 cases per 100,000 persons in particular areas of northern Iran, areas of southern Russia and northern China. Unlike the United States, squamous cell carcinoma is responsible for 95 percent of all esophageal cancer worldwide. The epidemiology of esophageal cancer has changed markedly over the past several decades in the United
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States. Until the 1970s, squamous cell carcinoma accounted for more than 90 percent of esophageal cancer, which was lodged in the mid esophagus and commonly affected mostly African-American men with a long history of smoking and alcohol consumption. Over the last two decades, adenocarcinoma of the lower esophagus related to Barrett’s esophagus has the fastest growing incidence rate of all cancers. Currently, it accounts for over half of the 15,000 new cases of esophageal cancer diagnosed each year (approximately three to six cases per 100,000 persons). RISK FACTORS Both types of esophageal carcinoma are more common in adults over age 60 and develop more often in men than in women. Tobacco use, whether by smoking or using smokeless tobacco, also increases the risk of both types of carcinoma–particularly squamous cell carcinoma. Chronic and/or heavy use of alcohol is a major risk factor for squamous cell esophageal cancer, and people who use both alcohol and tobacco have an especially high risk. Other risks for squamous cell carcinoma include low intake of fruits and vegetables, infection with human papilloma virus, achalasia (a benign esophageal muscular disease) and chronic scarring of the esophagus due to swallowing lye or other caustic substances. The most significant risk factor for esophageal adenocarcinoma is the development of Barrett’s esophagus secondary to chronic GERD. Tobacco use, obesity and poor diet may also play a role by contributing to the development or persistence of GERD. A genetic predisposition for esophageal carcinoma has been suggested since these cancers have been found to cluster within some families; however, this observation may be related to common environmental factors. Studies investigating the molecular biology of esophageal carcinoma have yielded several potential molecular alterations involved in its pathogenesis that soon may be applied to the diagnosis, prognosis and treatment of this devastating disease. CLINICAL FINDINGS Dysphagia (difficulty swallowing), which progresses from solids to liquids, is the most common presenting symptom. Weight loss is the second most common symptom and occurs in more than 50 percent of people with esophageal carcinoma. Pain can be felt in the epigastric or retrosternal area and over bony structures, representing a sign of metastatic disease. Hoarseness caused by invasion of the recurrent laryngeal nerve and respiratory symptoms related to invasion of the tracheobronchial tree by the tumor are both signs of unresectability. SCREENING There are no early detection tests used in the United States to screen the general population for esophageal cancer. However, people with Barrett’s esophagus
or other risk factors are followed closely with esophagogastroduodenoscopy (EGD, upper endoscopy); this involves passing a flexible tube down the esophagus and visualizing the wall. Then, the biopsies are examined histologically for abnormal changes. Dysplasia in Barrett’s esophagus represents an early pre-malignant alteration of the columnar epithelium that may progress to invasive adenocarcinoma. While patients with low-grade dysplasia may be followed by endoscopic surveillance, the detection of high-grade dysplasia often prompts definitive treatment to prevent the progression to carcinoma. Dysplastic epithelium in Barrett’s esophagus often has no distinguishing endoscopic features, and numerous random biopsy specimens are taken for histologic examination. Several new techniques have been proposed to highlight dysplastic areas for targeted sampling during endoscopy, including chromoendoscopy, endosonography, optical coherence topography and fluorescence detection techniques; however, these remain in an investigational stage. DIAGNOSIS/STAGING Occlusive tumors or strictures may be suspected by chest X-ray or with barium swallow. However, a definitive diagnosis is best made by endoscopic examination with biopsies of suspicious lesions, which are then evaluated by a pathologist for malignancy. Additional testing estimates the extent of the disease (tumor stage). Computed tomography (CT) of the chest, abdomen and pelvis detect whether the cancer has spread to adjacent tissues or distant organs (especially liver and lymph nodes). CT scan sensitivity is limited by its ability to detect masses generally larger than one centimeter. Positron emission tomography (PET) scans estimate whether enlarged masses are metabolically active, indicating faster-growing cells characteristic of cancer. Esophageal endoscopic ultrasound (EUS) provides staging information regarding the level of tumor invasion and possible spread to regional lymph nodes. TREATMENT Esophageal resection (esophagectomy) remains a crucial part of esophageal cancer treatment. It is used in the 20 to 30 percent of patients with high-grade dysplasia or small, less advanced (lower stage) cancers that are localized. If the tumor is larger but still localized, chemotherapy and/or radiotherapy may occasionally shrink the tumor to an operable size. An esophagectomy can be performed by using either an abdominal/cervical approach (i.e., transhiatal esophagectomy, THE) or a thoracic approach (i.e., transthoracic esophagectomy, TTE). THE offers the advantage of avoiding a chest incision, which can prolong discomfort and further aggravate the condition of patients with compromised respiratory function. Some authors question the validity of THE as a cancer operation because part of the surgery is not
performed under direct vision and fewer lymph nodes are removed compared to TTE. Yet, many retrospective and two prospective studies have shown no difference in survival between the operations, suggesting cancer stage at the time of surgery–not the type of operation– influences survival. The use of laparoscopic or thoracoscopic techniques has revolutionized the treatment of benign esophageal disorders such as achalasia and GERD. When compared to open surgery, the hospital stay is shorter; the postoperative discomfort is reduced; and, the recovery time is much faster. Since these techniques reduce morbidity due to cardiac and respiratory complications, they soon may become standard in the treatment of esophageal cancer. Laser therapy is the use of high-intensity light to destroy tumor cells; it affects only the treated area. This therapy is recommended if the cancer cannot be removed surgically. The relief of a blockage can help reduce dysphagia and pain. Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells. When exposed to a special light, the drugs become active and destroy the cancer cells. Both laser therapy and photodynamic therapy can provide effective palliation for superficial tumors and are not currently considered curative modalities. Chemotherapy depends on the tumor type but tends to be cisplatin-based (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In recent studies, the addition of epirubicin (ECF) was better than other comparable regimens in advanced nonresectable cancer. Chemotherapy may be given after surgery (adjuvant, i.e., to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy. For example, the Phase II/III REAL-2 trial compares four regimens containing ECF and either cisplatin or oxaliplatin and either continuously infused 5-FU or capecitabine. Radiotherapy is given before, during or after chemotherapy or surgery and, sometimes, alone to control symptoms. In patients with localized disease with contra-indications to surgery, radical radiotherapy may be used with curative intent. PROGNOSIS Esophageal cancer is a treatable disease and can be cured–if discovered in an early stage. In patients amenable to definitive treatment, the overall five-year survival rate ranges from five to 30 percent. Patients with severe dysplasia in distal esophageal Barrett’s mucosa often have in situ or even invasive cancer within the dysplastic area. Following resection, these patients usually have excellent prognoses.
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Figure 1: Year of Diagnosis Figure 1: Esophageal Cancer–Year of Diagnosis 18
During the past 10 years (1997 to 2006), there were 123 cases of esophageal carcinoma that were diagnosed and/or received initial therapy at OLOL or MBPCC.
Number of Cases Per Year
16 14 12
Although relatively few cases of esophageal carcinoma are diagnosed each year, there does appear to be a slight decline over this period that most likely reflects a local patient demographic shift rather than a decreasing incidence of esophageal carcinoma.
10 8 6 4 2 0 1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
n OLOL/MBPCC
Year of Diagnosis
Figure 2: Age at Diagnosis and Comparison with National Statistics Age
Number of cases
Percentage
0-29
1
0.8%
0.1%
30-39
1
0.8%
1.0%
40-49
10
8.1%
6.7%
50-59
28
22.8%
20.1%
60-69
32
26.0%
27.8%
70-79
37
30.1%
29.0%
80-89
13
10.6%
14.0%
90+
1
0.8%
1.3%
n OLOL/MBPCC 1997-2006 n NCDB 2000-2004
While esophageal carcinoma is typically diagnosed in patients between the fifth and seventh decades, our data revealed a broad age range. While the youngest patient was diagnosed at age 27, the oldest was age 93. Both had squamous cell carcinomas. Overall, our data closely parallel that of NCDB.
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Figure 3: Gender, Race and Comparison with National Statistics All Races Gender
Number
Percentage
Caucasian
African American
Other
Percentage
Percentage
Percentage
Male
96
78.0%
78.9%
54.5%
64.5%
22%
8.3%
1.6%
5.2%
Female
27
22.0%
21.1%
15.5%
17.3%
6.5%
3.3%
0.0%
1.5%
123
100.0%
100.0%
70.0%
81.8%
28.4%
11.6%
1.6%
6.6%
Total
n OLOL/MBPCC 1997-2006
n NCDB 2000-2004
Esophageal carcinoma is typically more common in men than in women with a reported male to female ratio of more than 3:1. Our local data show a similar ratio and closely parallel those of the NCBD. When looking at race, our local data show a greater percentage of esophageal carcinomas arising in African Americans (more than twice that seen in the national statistics), while other races appear underrepresented. This no doubt reflects the makeup of our local population.
Figure 4: Histopathologic Patterns
16 14
Number of Cases Per Year
12 10 n OLOL/MBPCC Squamous cell carcinoma Squamous cell carcinoma
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Adenocarcinoma
n OLOL/MBPCC Adenocarcinoma
6 4 2 0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year of Diagnosis
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Figure 5: Histologic Patterns and Comparison with National Statistics Histologic type
Number of Cases
Carcinoma, NOS*
Percentage
0
0.0%
4.3%
Squamous Cell Carcinoma
68
55.3%
31.7%
Adenocarcinoma
52
42.3%
53.0%
All other types**
3
2.4%
11.0%
123
100.0%
100.0%
Total
n OLOL/MBPCC 1997-2006 n NCDB 2000-2004
* NOS~ not otherwise specified **Other histologic types include adenosquamous carcinoma and small cell carcinoma
Figure 6: Histologic Patterns, Race and Comparison with National Statistics
Histologic type
Caucasian
African American
Other
Percentage
Percentage
Percentage
Squamous cell carcinoma
39.5%
24.6%
91.4%
73.9%
100%
43.5%
Adenocarcinoma
59.3%
60.2%
2.9%
10.4%
0.0%
39.7%
Carcinoma, NOS
0.0%
4.4%
0.0%
3.9%
0.0%
5.2%
All other types
1.2%
10.8%
5.7%
11.8%
0.0%
11.6%
100.0%
100.0%
100.0%
100.0%
Total
100.0%
100.0%
n OLOL/MBPCC 1997-2006
n NCDB 2000-2004
As shown in Figures 4, 5 and 6, esophageal carcinoma is divided into two major histologic types—squamous cell carcinoma and adenocarcinoma. Despite the national trend of an increasing incidence of adenocarcinoma, our data reveal a higher percentage of squamous cell carcinoma, which may reflect a higher than average African American population at greater risk for squamous cell carcinoma. Another possibility is the presence of a higher incidence of known risk factors for squamous cell carcinoma (i.e., smoking and alcohol use) compared to the incidence of gastroesophageal reflux disease (GERD) and development of Barrett’s esophagus typically associated with adenocarcinoma.
Figure 7: American Joint Committee on Cancer (AJCC) Stage at Diagnosis and Comparison with National Statistics Stage
10
Number of cases
Percentage
Stage 0
2
1.6%
2.4%
Stage I
16
13.0%
9.7%
Stage II
23
18.7%
19.8%
Stage III
15
12.2%
18.8%
Stage IV
28
22.8%
27.6%
Unknown
39
31.7%
21.7%
Total
123
100.0%
100.0%
Over the past 10 years (1997-2006), our local data for the distribution of esophageal carcinoma by the American Joint Committee on Cancer (AJCC) stage at diagnosis parallel the national statistics. n OLOL/MBPCC 1997-2006 n NCDB 2000-2004
Figure 9: Relative Five-Year Survival Rates and Comparison w 70%
Figure 8: Relative Five-Year Survival Rates and Comparison with National Statistics
60%
n OLOL/MBPCC 1997-2006
50%
Survival Rates
Esophageal carcinoma is one of the most lethal malignancies with an overall five-year survival rate of only 15 percent according to national statistics from the NCDB. While early detection significantly improves survival rates, it is notable that approximately one out of three patients diagnosed with even the lowest stage lesion (carcinoma in-situ or Stage 0) succumb to the disease within five years. Our local data reflect survival rates that closely parallel those of NCBD.
40%
OLOL/M NCDB 19
30% 20% 10% 0%
n NCDB 1996-2000
Stage 0
Stage I
Stage II
Stage III
Stage IV
Overall
Stage at Diagnosis
Figure 5: Treatment Modalities: First Course and Comparis on with National Statistics 40%
35%
Percentage of Cases
30%
25%
n OLOL/MBPCC 1997-2006
OLOL/MBPCC 1997-2006 NCDB 2000-2004 n NCDB 2000-2004
20%
15%
10%
5%
0%
Chem/Rad
Surg/Rad/Chem
Surg only
Rad only
Chem only
None
Treatment Modalities
Figure 9: Treatment Modalities: Entire First Course and Comparison with National Statistics Treatment for esophageal cancer depends greatly on the extent of the disease, i.e., clinical stage. Lower stage tumors usually only require some form of surgical resection, while more advanced tumors usually necessitate multiple treatment modalities including surgery, chemotherapy and/or radiation therapy. Our local data reveal 59 percent of our patients initially received a combination of at least two treatment modalities compared to the national average of 44 percent. Single modality therapy was used less often compared to national averages, suggesting our patients may present with higher stage tumors at the time of initial treatment and thus require more aggressive treatment. The percentage of our local patient population opting for no treatment is comparable to that seen in the national statistics.
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OLOL Cancer Registry The Cancer Registry is a specialized data system designed
for the collection, management and analysis of demographic, diagnostic, treatment and staging data on cancer patients treated at OLOL. The Cancer Registry reference date is 1987, and it contains data on 36,965 cancer cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry (LTR). High importance is placed on data quality using these guidelines, and a physician member of the Cancer Committee reviews a sample of the cases for quality assurance. Once part of the registry database, these cases are followed throughout the patient’s life. The OLOL Cancer Registry maintains a follow-up rate averaging 95 percent, which exceeds the ACoS minimum standard of 90 percent. Of the 1,284 newly accessioned cases in 2006, 1,132 were analytic and 152 were non-analytic*. The top five sites treated were lung, prostate, colon, breast and Non-Hodgkin’s lymphoma. The OLOL cancer registry maintains cancer data that are available for use by clinical and administrative staff at OLOL. All information collected is kept completely confidential. During 2006, the registry received requests for statistical reports including analytic studies, annual statistics, research activities, healthcare delivery and quality management studies. The registry also reported to the state cancer registry and the National Cancer Data Base (NCDB) and participated in the Facility Information Profile System (FIPS) on the American Cancer Society’s website www.cancer.org. *Analytic cases are those receiving all or part of the first course of therapy at OLOL within the first four months of diagnosis. Non-analytic cases are those not seen within the first four months following diagnosis.
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OLOL 2006 Site Distribution Table Site Group All Sites Blood/Bone Marrow Leukemia Myeloma Other Hematopoietic Bone Brain Breast Digestive System Anus, Anal Canal, Anorectum Bile Duct Colon Esophagus Gallbladder Liver Pancreas Rectum & Rectosigmoid Small Intestine Stomach Digestive, Other Endocrine Thyroid Other Endocrine Female Genital Cervix Uteri Corpus Uteri Fallopian Tube Ovary Vagina Vulva Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma Male Genital Penis Prostate Testis Oral Cavity/Pharynx Gum Hypopharynx Lip Mouth, Floor of Mouth, Other & NOS Nasopharynx Nasal Cavity, Sinus, Ear Oropharynx Salivary Glands, Major Tongue Tonsil Other Nervous System Respiratory/Intrathoracic Larynx Lung/Bronchus, Non-Small Cell Lung/Bronchus, Small Cell Pleura Skin Melanoma of Skin Other Skin Cancer Soft Tissue Unknown or Ill-Defined Urinary Tract Bladder Kidney and Renal Pelvis Ureter Urethra
Total Cases 1284 72 37 27 8 3 55 81 282 1 2 132 12 6 8 35 52 11 22 1 20 18 2 22 2 4 1 11 1 3 83 11 72 154 3 147 4 37 1 2 1 5 3 6 2 1 11 5 15 262 26 200 34 2 29 27 2 11 26 132 58 69 3 2
Class A N/A 1132 152 51 21 29 8 17 10 5 3 3 0 52 3 55 26 253 29 1 0 2 0 119 13 10 2 5 1 8 0 32 3 46 6 11 0 18 4 1 0 18 2 17 1 1 1 17 5 2 0 2 2 1 0 8 3 1 0 3 0 71 12 9 2 62 10 144 10 3 0 138 9 3 1 32 5 1 0 1 1 1 0 5 0 2 1 5 1 1 1 1 0 10 1 5 0 14 1 238 24 18 8 186 14 32 2 2 0 26 3 24 3 2 0 11 0 23 3 124 8 53 5 66 3 3 0 2 0
Sex M 750 44 24 18 2 3 26 3 146 0 1 66 12 3 3 15 24 6 15 1 7 5 2 1 0 0 0 0 1 0 42 8 34 153 3 146 4 25 1 1 1 4 1 4 2 1 7 3 4 166 24 120 20 2 20 18 2 6 14 90 46 41 1 2
F 534 28 13 9 6 0 29 78 136 1 1 66 0 3 5 20 28 5 7 0 13 13 0 21 2 4 1 11 0 3 41 3 38 1 0 1 0 12 0 1 0 1 2 2 0 0 4 2 11 96 2 80 14 0 9 9 0 5 12 42 12 28 2 0
0 39 0 0 0 0 0 0 6 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 2 0 1 1 0 0 0 0 0 0 26 24 0 1 1
I 229 0 0 0 0 1 0 24 53 0 0 29 4 3 1 0 14 0 2 0 11 11 0 1 0 0 0 0 0 1 17 1 16 5 1 1 3 6 0 0 1 1 0 0 0 0 4 0 0 51 6 42 2 1 12 12 0 6 0 43 7 36 0 0
Stage II III 252 150 0 0 0 0 0 0 0 0 0 0 0 0 15 2 56 37 0 1 1 0 32 21 3 0 0 0 0 1 5 2 11 9 2 1 2 2 0 0 1 2 1 2 0 0 2 6 1 1 0 0 0 1 1 3 0 0 0 1 17 6 4 0 13 6 116 19 0 0 116 18 0 1 8 2 1 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 4 0 1 1 0 0 13 57 2 4 10 42 1 10 0 1 5 4 5 3 0 1 0 1 0 0 18 15 11 4 6 10 0 1 1 0
IV 250 0 0 0 0 1 0 7 73 0 0 27 2 1 2 22 9 2 8 0 3 3 0 4 0 0 0 3 1 0 29 4 25 1 0 1 0 13 0 1 0 2 2 2 1 1 1 3 0 101 6 77 18 0 1 1 0 1 0 16 4 11 1 0
Not App. 160 51 29 17 5 1 52 0 8 0 0 1 0 0 0 1 0 4 1 1 1 0 1 2 0 2 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 14 2 0 2 0 0 1 0 1 1 23 3 1 2 0 0
Unk. 52 0 0 0 0 0 0 1 23 0 1 6 1 1 4 2 3 2 3 0 0 0 0 2 0 0 0 1 0 1 2 0 2 3 1 2 0 2 0 0 0 0 0 1 0 0 1 0 0 12 0 12 0 0 3 3 0 1 0 3 2 1 0 0
NOS = Not Otherwise Specified A = Analytic N/A = Non-Analytic M = Male F = Female Not App. = Not Applicable Unk. = Unknown or unstaged
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MBPCC Cancer Registry In March of 2007, the cancer registry departments of OLOL
and MBPCC integrated services and became the Integrated Cancer Registry (ICR) of MBPCC. The ICR will streamline many of the existing functions such as the Cancer Annual Report, patient care studies, follow-up on shared cases, tumor conferences, quality improvement initiatives and case abstracting. In addition, the ICR will benefit from a consolidated database allowing shared cases of the two institutions to have the most complete and accurate data regarding diagnosis and treatment. The Cancer Registry is an integral component of the Commission on Cancer (CoC) approved program and plays a vital role in the success of the program. The registry collects and analyzes demographic, diagnostic, treatment and staging data on cancer patients treated at MBPCC in Baton Rouge. The MBPCC Cancer Registry reference date is 1989, and it contains data on 10,058 cancer cases. All new cases identified are abstracted, coded and staged in accordance with guidelines set by the American College of Surgeons (ACoS), the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program and the Louisiana Tumor Registry (LTR). High importance is placed on data quality using these guidelines and a radiation oncologist reviews a sample of the cases for quality assurance. Once part of the registry database, these cases are followed throughout the patient’s life. MBPCC Cancer Registry maintains a follow-up rate averaging 95 percent, exceeding the ACoS minimum standard of 90 percent. Of the newly accessioned cases in 2006, 672 were analytic and 117 were non-analytic*. The top five sites treated were breast, lung, prostate, brain and colorectal. The registry maintains cancer data that is available for use by clinical and administrative staff at MBPCC. All information collected is kept confidential in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations. During 2006, the registry received requests for statistical reports including analytic studies, annual statistics, research activities and quality management studies. The registry participated in the National Cancer Data Base (NCDB) Annual Call for Data and participated in the Facility Information Profile System (FIPS) initiative on the American Cancer Society’s website www.cancer.org. *Analytic cases are those receiving all or part of the first course of therapy at MBPCC within the first four months of diagnosis. Non-analytic cases are those not seen within the first four months following diagnosis.
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MBPCC 2006 Site Distribution Table Class Site Group All Sites Blood/Bone Marrow Leukemia Myeloma Brain Breast Digestive System Anus, Anal Canal, Anorectum Bile Duct Colon Esophagus Liver Pancreas Rectum & Rectosigmoid Small Intestine Stomach Endocrine Thyroid Other Endocrine Female Genital Cervix Uteri Corpus Uteri Ovary Vagina Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Lymphoma Male Genital Prostate Testis Oral Cavity/Pharynx Gum Hypopharynx Lip Mouth, Floor of Mouth, Other & NOS Nasopharynx Nasal Cavity, Sinus, Ear Oropharynx Salivary Glands, Major Tongue Tonsil Respiratory/Intrathoracic Larynx Lung/Bronchus, Non-Small Cell Lung/Bronchus, Small Cell Pleura Skin Melanoma of Skin Other Skin Cancer Soft Tissue Unknown or Ill-Defined Urinary Tract Bladder Kidney and Renal Pelvis
Sex
Stage
Total Cases
A
N/A
M
F
0
I
II
III
IV
Not App.
Unk.
789 11 2 9 35 171 73 4 1 7 7 1 13 29 2 9 4 1 3 37 22 13 1 1 21 3 18 134 128 6 46 2 4 1 5 6 5 2 2 11 8 210 25 150 33 2 11 6 5 3 13 20 12 8
672 8 0 8 31 157 58 3 1 1 7 0 12 23 2 9 2 1 1 34 20 12 1 1 13 2 11 108 102 6 46 2 4 1 5 6 5 2 2 11 8 183 25 131 26 1 5 1 4 2 13 12 8 4
117 3 2 1 4 14 15 1 0 6 0 1 1 6 0 0 2 0 2 3 2 1 0 0 8 1 7 26 26 0 0 0 0 0 0 0 0 0 0 0 0 27 0 19 7 1 6 5 1 1 0 8 4 4
412 4 2 2 16 0 45 2 1 4 6 0 7 18 2 5 2 1 1 0 0 0 0 0 12 0 12 134 128 6 33 1 4 0 3 5 3 1 2 10 4 135 23 92 18 2 8 6 2 2 8 13 9 4
377 7 0 7 19 171 28 2 0 3 1 1 6 11 0 4 2 0 2 37 22 13 1 1 9 3 6 0 0 0 13 1 0 1 2 1 2 1 0 1 4 75 2 58 15 0 3 0 3 1 5 7 3 4
20 0 0 0 0 18 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0
109 0 0 0 0 63 3 0 0 0 0 0 2 0 0 1 0 0 0 9 3 6 0 0 3 0 3 5 0 5 2 0 0 0 1 1 0 0 0 0 0 20 6 11 3 0 2 1 1 2 0 0 0 0
183 0 0 0 0 46 18 1 0 0 3 0 2 11 0 1 0 0 0 7 4 3 0 0 4 1 3 85 85 0 8 1 2 0 1 1 0 0 0 3 0 11 2 8 1 0 1 0 1 0 0 3 3 0
131 0 0 0 0 19 19 2 0 0 3 0 4 6 1 3 0 0 0 11 9 2 0 0 2 1 1 14 13 1 6 0 0 1 0 1 1 0 0 2 1 56 3 43 9 1 1 0 1 0 0 3 3 0
158 0 0 0 0 10 11 0 0 1 1 0 1 4 1 3 1 1 0 4 3 0 1 0 4 0 4 4 4 0 28 1 2 0 3 3 3 2 2 6 6 91 13 65 13 0 0 0 0 0 0 5 1 4
56 8 0 8 31 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 13 0 0 0
15 0 0 0 0 1 7 0 1 0 0 0 3 2 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 4 0 4 0 0 0 0 0 0 0 1 1 0
NOS = Not Otherwise Specified A = Analytic N/A = Non-Analytic M = Male F = Female Not App. = Not Applicable Unk. = Unknown or unstaged
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The Cancer Program of Our Lady of the Lake and Mary Bird Perkins The Cancer Program of OLOL and MBP coordinates the entire continuum of cancer care. Surgical and medical oncology are available at OLOL and radiation oncology is available at MBP. The Cancer Program is the most comprehensive cancer program in the Baton Rouge area offering patients the convenience of receiving high-quality, advanced cancer care in one location close to home. The Cancer Program has been accredited since 1992 by the American College of Surgeons (ACoS)–the goldstandard for community-based cancer care. For over a century combined, the Cancer Program has delivered–with compassion and excellence–the most advanced cancer care available to Louisiana’s citizens. The Cancer Program provides nearly 42,000 cancer treatments and accessions over 2,200 new cancer cases annually, which is approximately 11 percent of new cases in the state each year. The Cancer Program addresses care for a broad variety of primary sites, with the most common seen being lung, breast, digestive system, prostate and urinary cancers. Approximately 15 percent of newly accessioned cases are indigent patients. The gender distribution of new cases is 55 percent male and 45 percent female. Almost 20 percent of cases present at late stages, which is consistent with Louisiana’s high cancer mortality rates and fuels the commitment for outreach and improvement found within the Cancer Program and its medical staff. Of the 41,986 treatments delivered, 16 percent of those treatments were to indigent patients. The Cancer Program is the largest and most advanced cancer program in Louisiana with a steadfast dedication to finding cancer and fighting it with our extensive resources and unique clinical expertise. Our program proves daily that area residents do not have to leave family and friends behind to find innovative, world-class treatment. The Cancer Program has been recognized nationally for its excellence in cancer care. It has been selected by the National Cancer Institute (NCI) as one of only 14 sites in the country, and the only one in the Gulf South, to participate in its new and prestigious National Community Cancer Centers Program (NCCCP) pilot. The Cancer Program of OLOL and MBP was chosen based on its ability and experience in conducting clinical trials and providing leadership and healthcare outreach in the communities it serves. A successful pilot will lead to the nationwide launch of the NCCCP in 2010.
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17
5000 Hennessy Boulevard
4950 Essen Lane
Baton Rouge, LA 70808-4398
Baton Rouge, LA 70809-3432
(225) 765-8879
(225) 767-0847 or (225) 215-1100
ololrmc.com
marybird.org