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Rex Cancer Center Annual Report
2008 Annual Cancer Center Report on 2007 Cancer Data
Rex Cancer Center Program—A Year in Review
By Vickie Byler, Director, Rex Cancer Center
2008 has proven to be another phenomenal year for the Rex Cancer Center program as we continue to strive to provide superior quality care with compassion. This year witnessed the addition of physicians and staff to our center as both our program and our services for our patients continue to grow. Dr JoEllen Speca joined Rex Hematology Oncology at the Rex site in June. In September, Dr Robert Wehbie also joined Rex Hematology Oncology as medical oncologist for our new Rex Cancer Center of Wakefield satellite office. The radiation oncologists, formerly Triangle Radiation Oncology Services, joined the UNC Department of Radiation Oncology on July 1, 2008, and Dr Justin Wu joined the Rex/UNC Department of Radiation here at the Rex site in October. Building upon the success of our patient navigator program we added a second breast cancer navigator and then a navigator for prostate cancer patients. Our prostate cancer navigator position is funded through our grant from the V Foundation to develop a model program as a Prostate Cancer Center of Excellence.
In support of our patients, Rex recently created the Cancer CARE program with CARE being an acronym for cancer assessment, rehabilitation, and education. In collaboration with our physical/speech therapy department a program has been designed to address the treatment-related side effects such as fatigue, pain, and mobility through therapy and education. Our fulltime nutritionist recently received her certification in oncology nutrition. This is the first time this certification had been offered in the nation, and she is one of two people in North Carolina to hold this specialized certification in oncology. The staff at Rex and Rex Cancer Center focused on chemotherapy safety and implemented several processes to increase patient safety in the administration of chemotherapy. The inpatient oncology unit has a full time pharmacist on the floor assisting with chemotherapy orders, counseling patients, and working with the staff nurses to provide a safe environment for the administration of chemotherapy. With the implementation of our EMR, many processes needed to be developed to ensure accurate chemotherapy ordering. At the Rex Cancer Center we instituted an “oral chemo nurse” who follows the patient on oral chemotherapy to ensure adherence to the treatment regimen and all follow up that is required for the safe administration of oral chemotherapy.
Through an endowment with the Rex Foundation created by Andy Weber, Radiologist, and his sister in memory of their father, the first Annual Weber Lymphoma Education event was held. The Cancer Center was able to bring Dr Andrew Zelenetz from Memorial Sloan Kettering Cancer Center to speak on the latest information on the diagnosis and treatment of lymphoma. It was a very successful event with many physicians acknowledging the great learning opportunity. Dr Zelenetz also provided an educational session for the community.
2008 was a year of recognition for our program. In September we were surveyed by the American College of Surgeons, Commission on Cancer, and continue our accreditation as a comprehensive cancer center by achieving an almost perfect score. PRC, a national firm measuring patient satisfaction, awarded Rex Hematology Oncology with the Top Performer and 5-Star Award for our high patient satisfaction scores. Rex Hospital also recognized the achievement of 12 months of sustained 100% satisfaction scores by this group of physicians and staff. The Triangle Business Journal, through their Health Heroes Award, recognized Jeanne Poole, our Breast Cancer Navigator, for her work in assisting breast cancer patients as they move from diagnosis to treatment to survivorship. They also recognized the support group kidscan! for their work with children who have a parent with cancer.
As I started out, 2008 has been a phenomenal year and that has been through the dedication of our physicians and staff of the Cancer Center. The Cancer Center would not be able to achieve our goals without the support of our physician colleagues, community organizations, ancillary departments at Rex, and our patients and families who continue to help us improve.
Listing of Services and Resources
Medical Oncology Therapy
Radiation Oncology Therapy
Diagnostic Imaging Services
Day Treatment Unit
Oncology Social Worker
Counseling and Support Services
Certified Oncology Dietician Services
Cancer Registry
Breast, GI and Lung, and Prostate Cancer Nurse Navigators
Cancer Resource Center
Multidisciplinary Cancer Case Conferences
Community Outreach and Screening Events
Hospice and Home Care Services
Oncology Clinical Trials
Inpatient Oncology and Hospice Unit
Valet Service
Educational Conferences
kidscan! Program
Lab Services
Oncology Infusion
Cancer Outreach and Support Services 2008
Support Services `
Rex Cancer Center offers a variety of services, programs, and classes to help patients and their families cope with diagnosis, treatment, and recovery from cancer. All services, programs, and classes are available at no charge or for a nominal fee.
Cancer Care Navigation
Rex Cancer Care Navigators function in a variety of ways to ensure the highest quality of care for patients including serving as an: advocate and team member, coordinator of patient care, liaison between patients, providers, and family members, educator, problem solver, and resource coordinator. Cancer Care Navigation includes breast, lung, prostate, and GI cancers. The number of patients provided navigation this year are: 
Breast Cancer Navigation - 1380
Lung Cancer Navigation - 115
GI Cancers Navigation – 260
Prostate Cancer Navigation – 178 (initiated May 2008)
Social Work
The Rex Cancer Center social worker is available to assist patients and their families with needs related to cancer diagnosis and treatment. The social worker assists with financial resources, Advance Directives, transportation, home care needs, coping and adjustment, support groups and other related issues. Social work services were provided to 1080 patients and caregivers this year.
Patient and Family Counseling
Individual and family counseling is offered to assist in coping with a cancer diagnosis. The opportunity to explore the challenges and changes that diagnosis can bring leads to patients to learning techniques for coping and communicating through the experience. 2048 counseling service hours were provided to patients and caregivers this year.
Nutrition
During and following cancer treatment, good nutrition is an important component of healing and maintained health. The Rex Cancer Center nutritionist offers individual consults and workshops to assist in learning about good nutritional choices.
Individual - 1449 consults
Workshops - 38 participants
Wellness Programs
Rex Cancer Center offers integrative programs to support healing, reduce stress, and assist with side effect management. The following services and programs were offered at Rex Cancer Center this year:
Creative Writing - 31 participants 
Art Cart - 114 participants
Yoga - 105 participants
Massage - 1051 participants
Breast Surgery Class
This class provides an overview of surgery options, pre- and post-operative care, resources and special support and guidance for newly diagnosed women. 91 women participated in the class this year.
Support Groups
Monthly support groups offer the education, support, and understanding needed to cope with a cancer diagnosis. The following support groups were offered at Rex Cancer Center.
Blood Cancer Support Group
Breast Friends
Triangle Breast Cancer Support Group
Sisters Supporting Sisters
Prostate Cancer Support Group
Thyroid Cancer Support Group
kidscan!
Community ScreeningsRex offers free cancer screenings to the community and often in partnership with other health care agencies. Screenings provided in 2008 were the following:
Cervical Cancer - January - 87 participants
Colorectal Cancer - March - 137 participants
Skin Cancer - May - 203 participants
Prostate Cancer - September - 376 participants
Breast Cancer - October - 82 participants
Rex is also offers free breast cancer screening through Healthy Women, Healthy Wake a collaborative grant program with Wake County Human Services. The mobile mammography unit serves women in the community and diagnostic imaging, if necessary, is performed at the Breast Care Center.
Screening Mammograms - 62 participants
Diagnostic Imaging - 53 participants
Community Health Fairs & Talks
Rex Cancer Center participants in numerous health fairs throughout the year to provide information to the community and increase awareness of cancer prevention, detection, and treatment. Interactive workshops and presentations are held to educate adults about the early detection of cancer. Breast related requests are staffed by Save Our Sisters of Rex, a group of specially-trained lay health volunteers. Save Our Sisters, Health Instructors, and the Outreach team customize the information and workshops to fit the needs of the community request.
Health Fairs 8768 participants
Health Talks 1568 participants
Community Events 
Cancer Survivor’s Day - 650 participants
Each year Rex Cancer Center continues to reach a large number of survivor’s and their loved ones throughout and beyond Wake County. A nationally recognized day, this survivorship program educates the community that cancer is a survivable disease and offers the opportunity for survivors to celebrate life together.
Living With Breast Cancer & Beyond - 99 participants
LBBC has served a unique educational and psychosocial need for newly diagnosed / breast cancer survivors throughout this community since 1993. This survivor retreat provided the most recent information via medical panel, an inspirational speaker, and healing arts activities.
Sponsored Community Events
| Event | Beneficiary | |
The Cancer Challenge |
The Rex Healthcare Foundation Cancer Center Angel Fund |
|
Le tour de femme |
The Rex Healthcare Foundation Cancer Center Angel Fund |
|
Hoops for Hope |
Kay Yow/WBCA Cancer Foundation |
|
Race for the Cure |
Susan G. Komen for the Cure |
|
Relay for Life |
American Cancer Society |
|
Raleigh Round Up |
American Cancer Society |
|
City of Oaks Marathon |
American Cancer Society |
|
Light the Night |
The Leukemia & Lymphoma Society |
|
Bowling for Hope |
Pancreatic Cancer Action Network |
|
Boot Camp to Beat Cancer |
National Students of AMP Support Network |
|
Devil’s Ridge Charity Golf Classic |
Prostate Cancer Coalition |
|
Devil’s Ridge Pretty in Pink Golf Rally |
Pretty In Pink Foundation |
|
Free to Breathe Lung Cancer 5K |
National Lung Cancer Partnership |
|
Pay-It-Forward Party |
The Caring Community Foundation |
Welcome from the Chairman of the Cancer Care Committee
By Kenneth Zeitler, MD
The Rex Cancer Care Committee has continued aggressive and comprehensive oversight of cancer-related services at Rex Healthcare throughout the year. We understand that quality matters, and, thus, commitment to patient-centered care is at the core of our mission. We are, therefore, committed to continuous assessment of quality measures and believe in the transparent reporting of our outcomes and patient volume data.
In this year’s report we specifically focus on prostate cancer, as well as providing our standard volumetric data. We continue to support and expand our fundamental mission to provide the most modern and comprehensive oncologic care while also creatively exploring ancillary services such as our navigator programs established for breast, prostate, lung and gastrointestinal malignancies.
We have successfully renewed our Comprehensive Community Oncology Center certification from the American College of Surgeons, expanded our preventive screening services, expanded oncologic pharmacy services to minimize the potential for medication errors, maintained frequent physician-oriented continuing education, provided new and continued community education resources, and expanded our cooperative group clinical trials programs.
In the coming year we are prepared to establish multidisciplinary disease-specific treatment programs, to expand cancer services to the Wakefield area, to grow our relationship with the Lineberger Comprehensive Cancer Center of the University of North Carolina, to invite the American Cancer Society to report annually and as needed to our cancer care committee, and to pursue application for the newly established certification by the American College of Surgeons as a breast cancer care center.
The achievements of our committee and of the Rex Cancer Center in general are too numerous to completely list, but I would like to personally extend my thanks to the entire cancer committee for their tireless efforts on behalf of our patients, their families, and the entire community we serve.
2008 Cancer Care Committee Members
Roger Adkins, R.N., Infection Control |
Sheri Breitenbach, Coordinator, Cancer Registry
|
Thomas Bucheit, M.D., Pain Center / Palliative Care |
Steve Burriss, Vice President, Ambulatory Care Services |
Vickie Byler, R.N.,M.S.N., Director, Cancer Center (Quality Improvement Coordinator) |
David Blanchard, RPh, Pharmacy |
Patty Cepull, R.D., C.S.O., L.D.N., Oncology Certified Dietitian |
Stephen Chiavetta, M.D., Pathology |
Charles Eisenbeis, M.D., Medical Oncology |
| Nunzio Esposto, R.T.T., Manager Radiation Oncology |
Douglas Hammer, M.D., Family Practice |
Pete Hoffman, M.D., Medical Director Radiation Oncology |
Meena Mohan, M.D., Hospitalist/Hospice/ Medical-Oncology |
Robert Ornitz, M.D., Radiation Oncology |
George Pascal, M.D., General Surgery (Cancer Conderence Coordinator) |
Yale Podnos, M.D. , Surgery |
Nancy Reifsteck, O.T.R./ L.,C.L.T., Outpatient Rehabilitation |
Donna Quinn, Pharm. D., Oncology Pharmacy |
Riley, John, M.D., Radiation Oncology |
Stacey Shaw, M.S.W., Access Management |
Suzanne Smith, R.D., L.D.N., Food & Nutrition |
Laura Thomas, M.D., Radiology |
Jennifer Van Vickle, M.D., Radiology |
| Kathy Von St. Paul, R.N., O.C.N., Inpatient Oncology |
Mona Watters, R.N., O.C.N., Manager, Day Treatment |
Emmeline Weber, M.P.H., Manager of Community Outreach and Support Services (Community Outreach Coordinator) |
Seth Weinreb, M.D., General Surgery (ACoS Liaison Physician) |
Sherry Whitt, R.N., M.S., Director of Nursing |
| Dietra, Williams-Toone, M.D., Anesthesia |
Ken Zeitler, M.D., Medical Oncology (Chair, Cancer Care Committee) |
REX HEALTHCARE PROSTATE CANCER STUDY
OVERVIEW OF PROSTATE CANCER AT REX
By Dr. Leroy Hoffman, MD
The 2007 Rex Cancer Center Annual Report shows that our patients with prostate cancer have an overall survival at or above the national average, and that the vast majority is diagnosed in the earliest stage giving a better chance for cure. This also reflects the community’s acceptance of early detection with annual PSA screening and reemphasizes the importance of the community screening programs promoted by Rex Healthcare, especially for those patients at higher risk and with less access to screening.
The overall five-year survival results do not reflect the actual risk of death from prostate cancer during this period, which is very low. Many studies have emphasized the increased risk of dying from cardiovascular disease, from second cancers of GI and lung, or from other chronic health care problems in the first five to ten years after diagnosis of prostate cancer.
Improved health through smoking cessation, weight reduction, exercise, control of blood pressure, and screening colonoscopy is important for improving overall survival and quality of life in this population. Through participation in investigational trials, we will be able to determine the most beneficial treatment for those with advanced stage or more aggressive cancer and improve their chances for long-term survival.
Rex Healthcare, through education and outreach programs, has tried to raise awareness and knowledge about prostate cancer in the community, while providing state of the art diagnosis and treatment for those with cancer, and support for patients and families while dealing with their cancer
PROSTATE CANCER SYMPTOMSIf the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms that might indicate the presence of prostate cancer, including: - A need to urinate frequently, especially at night; - Difficulty starting urination or holding back urine; - Weak or interrupted flow of urine; Painful or burning urination; - Difficulty in having an erection; - Painful ejaculation; - Blood in urine or semen; or - Frequent pain or stiffness in the lower back, hips, or upper thighs. Because these symptoms can also indicate the presence of other diseases or disorders, such as BPH or prostatitis men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms |
REX Prostate Cancer Statistics
Prepared by Sheri Breitenbach, RN, CTR
Prostate cancer is the most common cancer, other than skin cancers, in American men. The American Cancer Society estimates that during 2008 about 186,320 new cases of prostate cancer will be diagnosed in the United States. About 1 man in 6 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 35 will die of it. More than 2 million men in the United States who have been diagnosed with prostate cancer in the past are still alive today.
Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. The American Cancer Society estimates that 28,660 men in the United States will die of prostate cancer in 2008. Prostate cancer accounts for about 10% of cancer-related deaths in men.
The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. These rates are used to create a standard way of discussing prognosis (outlook). Of course, many of these patients live much longer than 5 years after diagnosis. Five-year survival rates are based on patients diagnosed and first treated more than 5 years ago. Improvements in treatment since then may result in a better outlook for recently diagnosed patients. Five-year relative survival rates compare the observed survival with that expected for people without the cancer. That means that relative survival only talks about deaths from the cancer in question. This is a more accurate way to describe the outlook for patients with a certain cancer.
According to the most recent data for all men with prostate cancer, the relative 5-year survival rate is 100% and the relative 10-year survival rate is 91%. The 15-year relative survival rate is 76%. Keep in mind that 5-year survival rates are based on patients diagnosed and first treated more than 5 years ago, and 10-year survival rates are based on patients diagnosed more than 10 years ago.
How do Rex patients compare with the national averages? Let’s take a look and see.
5-YEAR OBSERVED SURVIVAL -- PROSTATE CANCER (Analytic Cases)
.
Rex Prostate Cancer by Age at Diagnosis
The average age at diagnosis was 65.8 years of age; the median age at diagnosis was almost identical at 66.0 years of age. The range of ages of prostate cancer patients treated at Rex in 2003-2007 was 35-93 years of age.
At Rex the age group most likely to be diagnosed with prostate cancer was 60-69 (41%). The most common stage group at diagnosis was Stage II (88.5%). The good news is that while incidence of prostate cancer has remained level among all races since 1995, the mortality rate has decreased significantly by 4.1% among all men in general, and by 6.0% among African-American men only.1
AGE AT DIAGNOSIS BY STAGE |
||||||
2007 Prostate Cancer - Analytic Cases |
||||||
Rex Healthcare |
||||||
n=321 |
||||||
Age at Diagnosis |
Stage at Diagnosis |
Age at Dx |
||||
II |
III |
IV |
|
|||
|
n=284 |
n=29 |
n=8 |
|
|
|
40-49 |
11 (4%) |
1 (3%) |
0 |
12 (4%) |
||
50-59 |
59 (21%) |
7 (24%) |
2 (25%) |
68 (21%) |
||
60-69 |
114 (40%) |
15 (52%) |
3 (38%) |
132 (41%) |
||
70-79 |
87 (31%) |
6 (21%) |
2 (25%) |
95 (30%) |
||
80+ |
13 (5%) |
0 |
1 (13%) |
14 (4%) |
||
1Statistics from Centers for Disease Control and Prevention.
In the USA, blacks comprise 15.5% of the population. At Rex in 2007, 15% of the analytic prostate cancer cases were African-American; 81% were Caucasian (including Hispanic); and 2% were Asian.
RACE BY STAGE |
||||||
2007 Prostate Cancer - Analytic Cases |
||||||
Rex Healthcare |
||||||
n=321 |
||||||
Race |
Race by Stage at Diagnosis |
Race |
||||
II |
III |
IV |
|
|||
n=284 |
n=29 |
n=8 |
|
|||
Black |
42 (15%) |
5 (17%) |
0 |
47 (15%) |
||
White |
238 (84%) |
22 (76%) |
8 |
260 (81%) |
||
Other |
4 (1%) |
2 (7%) |
0 |
6 (2%) |
||
Treatment for Prostate Cancer at Rex
There are many surgical options for prostate cancer. One of the most common is transurethral resection prostate (TURP). This procedure is primarily used to relieve bladder outlet obstruction symptoms and evaluate the urethral passage. Because prostate cancer usually develops deep in the parenchyma of the gland, complete resection of tumor is not possible through a transurethral approach, which simply cores out or scrapes away the tissue adjacent to the urethra. It is generally not considered to be adequate cancer-directed therapy except in very low stage disease; it is usually considered a diagnostic procedure.
Another common surgical option is radical prostatectomy, which includes removal of the prostate, ejaculatory ducts and seminal vesicles.
Radiation therapy is commonly used for high grade, large, or extracapsular tumors. It is also effective in treating symptoms of metastatic disease.
Interstitial brachytherapy is a procedure that delivers a radioactive treatment dose locally to the tumor.
Systemic therapy is typically not recommended for early prostate cancer but is effective for regionalized or metastatic disease. Occasionally, anti-androgens (such as lupron, casodex, or flutamide) are given for early stage prostate cancer.
A variety of chemotherapeutic agents may be used in cases of recurrent or advanced stage prostate cancer that has not responded to hormone treatment. However, chemotherapy has not been proven to be useful to treat early stage prostate cancer.1
| FIRST COURSE TREATMENT SUMMARY BY STAGE | ||||||
| 2007 Analytic Prostate Cancer Cases | ||||||
| Study Group: 321 Cases | ||||||
| TREATMENT | Stage Group | |||||
| II | III | IV | Total | |||
| Surgery ( S ) | 161 | 21 | 2 | 184 | ||
| Radiation ( R ) | 58 | 0 | 0 | 58 | ||
| Hormone ( H ) | 3 | 0 | 2 | 5 | ||
| Chemotherapy ( C ) | 0 | 0 | 0 | 0 | ||
| S + R | 2 | 2 | 0 | 4 | ||
| S + H | 0 | 1 | 0 | 1 | ||
| R + H | 51 | 1 | 2 | 54 | ||
| S + R + H | 1 | 3 | 0 | 4 | ||
| R + C + H | 1 | 1 | 0 | 2 | ||
| S + R + C + H | 0 | 1 | 0 | 1 | ||
| Other Combo | 0 | 0 | 1 | 1 | ||
| Treated | 277 | 30 | 7 | 314 | ||
2007 Cancer Conference Report
Prepared by Sheri Breitenbach, RN, CTR
Weekly multidisciplinary case conferences are held in the Rex auditorium every Friday morning, Breast Cancer Conference at 7:00 am and General Cancer Conference at 7:45 am. Every third Friday, the General Conference has an emphasis on pulmonary cancer cases. These educational conferences provide an opportunity for physicians representing oncology, general, surgery, pulmonary, thoracic, urologic, gastroenterology, reconstructive surgery, radiology, and pathology to come together in discussing diagnosis, staging and treatment. Also included are representatives from oncology nursing, patient navigators, nutrition and pharmacy.
Cases for discussion can be scheduled by filling out the form on Rexweb. Just go to Forms (at the top of the page), then Global Forms, and then to the last entry which says Tumor Conference.
Each week cases of various types of malignant disease are selected for presentation on the basis of complexity, unusual manifestations of the disease, clinical course or special interest. Each presentation begins with a synopsis of pertinent patient medical history, physical findings, clinical course, and radiological and pathological findings. Open discussion follows regarding treatment options, available clinical trials, and published literature or research pertinent to the case.
Dr. George W. Paschal, III, is the Cancer Conference coordinator for the years 2007 and 2008. In 2007 a total of 88 conferences were held with 320 cases presented. About 30 different primary sites were discussed at Cancer Conferences in 2007.
The overall goal of the conference is to offer patients the very best and most current therapy that medicine has to offer through the sharing of information and ideas in a confidential setting. It has been encouraging to see our conference grow each year, and we anticipate continued growth and expansion for the future. We send a special thank you to all who participate in our conference.
The following chart shows the sites presented at the weekly cancer conferences and how often the sites were discussed. Half the cases presented were breast cancer (51%) followed by lung cancer (17%).
| *Other Sites Discussed: | ||||||
| (n = 64) | ||||||
| Adrenal cortico | 1 | Leiomyosarcoma | 2 | |||
| Adrenal gland | 1 | Liver | 2 | |||
| Appendix | 2 | Maltoma | 1 | |||
| Bladder | 4 | Melanoma | 4 | |||
| Brain | 3 | Ovary | 1 | |||
| Esophagus | 6 | Pancreas | 4 | |||
| Eye (periorbital) | 1 | Pyriform Sinus | 1 | |||
| Gastric | 3 | Skin, Other | 1 | |||
| H&N | 1 | Small intestine | 3 | |||
| Hematopoetic disorder | 5 | Testes | 1 | |||
| Hodgkin lymphoma | 4 | Thymoma | 1 | |||
| Kaposi sarcoma | 1 | Thyroid | 2 | |||
| Kidney | 7 | Ureter | 2 | |||
THE REX CANCER REGISTRY
By Sheri Breitenbach, RN, CTR
The Rex Cancer Registry is a data system whose purpose is the collection, management, and analysis of data on patients who have been diagnosed and/or treated for cancer at Rex Healthcare. Rex is required by state law to report cancer cases to the North Carolina Central Cancer Registry.
Registry data is used to make important public health decisions that maximize the effectiveness of limited public health funds, such as the placement of screening programs. It is a valuable research tool for those interested in the etiology, diagnosis and treatment of cancer. Fundamental research on the epidemiology of cancer is initiated using the accumulated data. Lifetime follow-up is important for obtaining accurate survival rate statistics and, also serves as a reminder to physicians and patients to schedule regular clinical examinations.
What information is maintained in the cancer registry?
- Demographic Information: Age, gender, race/ethnicity and residence.
- Medical History: Physical findings, screening information and history of previous cancer.
- Diagnostic Findings: Types, dates and results of procedures used to diagnose cancer.
- Cancer information: Primary site, cell type and extent of disease.
- Cancer Therapy: Surgery, radiation therapy, chemotherapy, hormone or immunotherapy.
- Follow-up: Annual information concerning treatment, recurrence, and patient status is updated to maintain accurate surveillance information.
Rex’s first full-time cancer registrar was hired in 1987, and currently the registry employs five full-time and two casual-time employees. All but one have attained CTR certification.
In addition to casefinding, abstracting and follow-up, the registry coordinates case presentations at the weekly cancer conferences, physician quality review of registry data, and pathology review of CAP protocol compliance. Also, statistical and focus studies are prepared to review care provided to our cancer patients and compare the results to national standards.
Incidence of Cancer at Rex in 2007
The prostate is the most common site for cancer in both NC (15.7%)and the USA (15.2%); however, at Rex female breast cancer is the most common site (30.8%) and the prostate is the second most common (16.5%). Over half (55.1%) of the women seen at Rex for cancer were seen for breast cancer while the national average for female breast cancer is 26.3% of all cancers.
Rex Cancer Center, North Carolina and USA |
|||||||||||||||
Primary Site |
BOTH SEXES |
MALE |
FEMALE |
||||||||||||
REX |
*NC |
**USA |
REX |
*NC |
**USA |
REX |
*NC |
**USA |
|||||||
n = 1816 |
n = 40,860 |
n = 1,444,920 |
n = 802 |
n = 20,980 |
n=766,860 |
n = 1,014 |
n = 19,880 |
n = 678,060 |
|||||||
Percentages (%) |
Percentages (%) |
Percentages (%) |
|||||||||||||
Breast, Female |
30.8 |
15.1 |
12.4 |
55.1 |
31.0 |
26.3 |
|||||||||
Ovary |
0.3 |
1.6 |
1.6 |
0.6 |
3.3 |
3.3 |
|||||||||
Uterus/Cervix |
1.5 |
3.7 |
3.5 |
2.6 |
7.7 |
7.4 |
|||||||||
Prostate |
16.5 |
15.7 |
15.2 |
37.3 |
30.6 |
28.5 |
|||||||||
Stomach |
0.9 |
1.7 |
1.5 |
1.4 |
2.0 |
1.7 |
0.5 |
1.4 |
1.2 |
||||||
Melanoma |
1.9 |
4.0 |
4.2 |
2.5 |
4.4 |
4.4 |
1.5 |
3.5 |
3.8 |
||||||
Oral |
1.3 |
2.3 |
2.4 |
2.1 |
3.0 |
3.2 |
0.6 |
1.5 |
1.5 |
||||||
Lung |
10.7 |
13.6 |
14.8 |
12.8 |
14.8 |
15.0 |
9.0 |
12.9 |
14.5 |
||||||
Pancreas |
1.4 |
2.4 |
2.6 |
1.4 |
2.3 |
2.5 |
1.4 |
2.5 |
2.7 |
||||||
Colon & Rectum |
6.8 |
10.8 |
10.6 |
7.0 |
10.6 |
10.3 |
6.6 |
11.1 |
11.0 |
||||||
Urinary |
7.5 |
7.3 |
8.3 |
12.7 |
9.8 |
10.8 |
2.6 |
4.6 |
5.5 |
||||||
Leukemia & Lymphoma |
6.0 |
7.3 |
8.0 |
6.0 |
7.7 |
8.3 |
6.0 |
6.8 |
7.7 |
||||||
All Other Sites |
15.0 |
14.6 |
15.2 |
16.8 |
15.4 |
15.4 |
13.6 |
13.8 |
15.0 |
||||||
*Projected NC data from Cancer Facts and Figures North Carolina 2007 |
|||||||||||||||
**Projected USA data from American Cancer Society's Cancer Facts and Figures 2007 |
|||||||||||||||
TOP 5 PRIMARY SITES BY AGE AT DIAGNOSIS AT REX IN 2007
In 2007 the five most common sites of cancer were breast (30.8%), prostate (16.5%), lung (10.7%), colorectal (6.8%) and urinary bladder (7.5%). Breast cancer occurred most often between the ages of 50 and 59, colon and prostate cancer between the ages of 60 and 69, and lung and urinary
bladder cancer between the ages of 70 and 79.
INPATIENT ADMISSIONS AND LENGTH OF STAY
During 2007 there were 26,602 inpatient admissions to Rex Healthcare. Cancer patients represented 3,016 (11.3%) of these admissions. The average length of stay (LOS) for all patients was 3.7 days, whereas cancer patient admissions averaged 5.7 days. The chart below shows the LOS trends over the past ten years.
LOS for the most common malignancies averaged: Breast 4.0 days; Lung 6.3 days; Prostate 3.4 days; Colorectal 6.8 days; and Leukemia 6.6 days.
ERA & PRA DATA -- Prepared by John Sorge, MD, Pathologist |
||||||||||||||
|
2004 |
2006 |
2007 |
|||||||||||
Total Cases Evaluated: |
n=302 |
% |
n=310 |
% |
n=323 |
% |
||||||||
ERA Positive Cases: |
235 |
77.8 |
222 |
71.6 |
245 |
76.0 |
||||||||
PRA Positive Cases: |
207 |
68.5 |
187 |
60.3 |
204 |
63.0 |
||||||||
ERA (+) PRA (+): |
206 |
68.2 |
187 |
60.3 |
204 |
63.0 |
||||||||
ERA (+) PRA (-): |
29 |
9.6 |
35 |
11.3 |
41 |
13.0 |
||||||||
ERA (-) PRA (+): |
1 |
0.3 |
0 |
0.0 |
0 |
0.0 |
||||||||
ERA (1) PRA (-): |
66 |
21.9 |
88 |
28.4 |
78 |
24.0 |
||||||||
HERCEPT TESTING 2005-2007 |
||||||||||||||
Score |
National Average |
2005 Totals |
2005% |
2006 Totals |
2006% |
2007 Totals |
2007% |
|||||||
0 |
60% |
179 |
53% |
216 |
65% |
150 |
50% |
|||||||
1+ |
10% |
84 |
25% |
67 |
20% |
88 |
29% |
|||||||
2+ |
5-10% |
31 |
9% |
14 |
4% |
23 |
8% |
|||||||
3+ |
15-20% |
45 |
13% |
38 |
11% |
39 |
13% |
|||||||
Total |
100% |
339 |
100% |
335 |
100% |
300 |
100% |
|||||||
ASCO/CAP Guidelines
- Adequate fixation of breast cancer specimens: Specimen processors have been programmed and a system is in place to assure adequate formalin fixation (i.e. 6-48 hours) of breast specimens.
- Standardization of immunohistochemical stains: The laboratory uses the immunohistochemistry method (IHC) as the initial testing for Her 2 status that is FDA approved, distributed by DAKO under the trademark Hercept test and is the IHC test used in the Herceptin clinical trials.
- Standards for interpretation and participation in proficiency testing surveys: The interpretive guidelines recommended by the ASCO/CAP expert panel are followed by the Rex Pathologists and participation in CAP proficiency testing for Her 2 is ongoing. The results of the last CAP proficiency testing demonstrated agreement in 32 out of 33 samples. The one minor discordance involved the referee scoring of a sample as 1+ and the Rex Pathologists scoring as 2+.
- Validation of 2+ and 3+ Hercept staining reactions: In 2008, all 2 and 3+ cases were sent to Mayo Medical Laboratories for FISH confirmation testing. All 3+ cases (33) amplified and only 19% of the twenty one 2+ cases amplified. The national average for her 2 gene amplification in the 2+ category is 25-35%. Interestingly, 20% of the 2+ group demonstrated either gene duplication or gene amplification in minor tumor populations.
- Small vs large biopsy bias: Based on tumor heterogeneity issues, all 0-1+ Hercept tests on small core biopsy specimens are repeated on the subsequent larger biopsy specimen. Of 51 cases subjected to repeat testing, only 3 cases (6%) demonstrated a 2-3+ staining reaction in the subsequent larger biopsy specimen. Of these 3 cases, only one case gene amplified by the FISH method.
- Validation of 0 and 1+ Hercept staining reactions: Twenty five 0-1+ cases in a retrospective review were sent for FISH confirmation testing and none of the cases amplified.
- An assessment of four image analysis systems is currently underway in an attempt to further standardize the IHC stain interpretive process.
External Links
- American Cancer Society
- National Institutes of Health
- American Society of Clinical Oncology / ASCO
- Susan G. Komen for the Cure
- Pancreatic Cancer Action Network
- Leukemia & Lymphoma Society
- Myeloma Foundation
- National Kidney Foundation
- The V Foundation
- Cooley’s Anemia Foundation
- Sickle Cell Disease Association of America, Inc.
- Association of Cancer Online Resources / ACOR
- National Cancer Institute
- Sisters Network, Inc.
- Y-Me National Breast Cancer Organization
- National Breast Cancer Coalition (NBCC)
- Cancer Care, Inc.
- Physicians Data Query
