ADENA ONCOLOGY ANNUAL REPORT2013 | Adena Health System

Department of: Adena Regional Medical Center

ADENA ONCOLOGY ANNUAL REPORT PAGE - 3

TABLE OF CONTENTS

Chairman’s Letter

Cancer Committee Members

Lung Report

Free Lung Screening Program

Patient Navigators

Medical Oncology

Radiation Oncology

Adena’s Cancer Experience

Clinical Research Trials

Pharmacy

Social Work

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The Cancer Committee of Adena Health System is pleased to present our 21st Annual Report of the Cancer Committee of

Adena Health System. This report includes our cancer treatment data and updates from 2013.

In this report, you will find information about the many services and initiatives at the Adena Cancer Center, including a new

initiative that Adena Regional Medical Center has undertaken to address the high rates of tobacco abuse and lung cancer

in our community. Our new free lung cancer screening program incorporates a tobacco cessation program and is meant

to help in the early detection of lung cancers as well as to offer assistance to patients who are contemplating leading a

tobacco-free lifestyle.

At the Adena Cancer Center, we are proud that our care is coordinated among many oncology specialists, including surgeons,

pathologists, pulmonologists, radiologists, gastroenterologists, and medical and radiation oncologists. We continually strive to

give our patients the best, most up-to-date care. Our specialists meet up to four times weekly in a multidisciplinary tumor

board to discuss new treatment updates and collectively review patient information and craft individualized patient care plans.

The Adena Cancer Center is an active participant in the Columbus Community Oncology Program, giving patients the added

opportunity to participate in clinical trials with newer therapies and treatment options.

As part of our ongoing efforts to maintain the most up-to-date care possible, we were pleased to welcome Dr. Gordana

Vlahovic from the Duke Cancer Institute, who gave an update on lung cancer and new discoveries in the realm of cancer

genetics and treatments. We are also active with our graduate medical education program and the Adena Continuing Medical

Education Committee to help provide accredited programs in conjunction with the PACCAR Medical Education Center.

At the heart of our treatment plans are our patient navigators and physician nurses who help coordinate cancer care for our

patients. They are a lifeline for our patients and help them navigate the health system and make sure our patients understand

their treatments.

In addition to the support from our nursing team, we have a truly state-of-the-art infusion and radiation center staffed with

experienced, well-trained nurses who help provide care for our patients. Additionally, we provide many ancillary services,

including social work, a new outpatient pharmacy, nutrition counseling, physical therapy, pastoral services, and hospice and

palliative care that create an added layer of support for our cancer patients and their families. These services are further

supported by generous contributions from the Adena Health Foundation and many community partners, including many

volunteers from the community as well as the American Cancer Society, Southern Ohio Cancer Survivors, and many more

year-round initiatives and donations that support the patients and efforts of the Adena Cancer Center to provide the best care

possible for our community. Our world-class center is recognized and accredited by the American College of Surgeons’

Commission on Cancer (CoC). I hope you find the enclosed report helpful and informative!

Sincerely,

Jeffrey VanDeusen, MD, PHD

Cancer Committee Chairman, 2013

ADENA CANCER COMMITTEE 2013 REPORT —CHAIRMAN’S LETTER

2013 CANCER COMMITTEE MEMBERS

Jeffrey Vandeusen, MD, PHD

Medical Director of Oncology Services

Thomas Lewis, MD

Dermatology

Michael Levey, MD Radiology

Ralph Roach, MD Medical Oncology

Ganapathy Krishnan, MD Medical Oncology

Jeyanthi Ramanarayanan, MD Medical Oncology

David Adam Jones, MD Radiation Oncology

Carl Szczesniak, MD Pathology

Byron Smith, MD Pathology

W. Bill Sever, DO Surgery

William Mitchell, MD Radiology

Michael Fealk, MD Surgery

Lana Uhrig, RN, MS, MBA Director Of Oncology Services

Brenna Eldridge, BSN, OCN, RN Medical Oncology Manager

Carolyn Hice Excecutive Assistant

Erin Trapp, RN Radiation Oncology Manager

Debbie Bihl, MSN, AOCN, CNP Medical Oncology

Doug Smith, MA, MS, CNS, CNP Medical Oncology

Tammy McManus, RN, BSN, OCN Patient Navigator, Lung

Ray Seitz, RN Medical Oncology RN

Linda Kight RN, BSN, OCN Clinical Trials Nurse

Stacie Daugherty, CTR Cancer Registrar

Mike Pugh, RPH, BCOP Pharmacy

Kristin Williamson, RPH Pharmacy

Lindsey Kemper, RN Patient Navigator, Breast

Cathy Costillow, RD, LD Dietician

Karen Jenkins, MA, CCC-SLP Rehab

Rev. Paul Ray Pastoral Services

Sharon Wills, RN Hospice

Becky Emerine, LSW Social Worker

Beth Krouse American Cancer Society

Lynne Ayers, MBA American Cancer Society

Robin Primer Navigator Support

Jana Eldridge, RN Colorectal Patient Navigator

Ruth Mcroberts Radiation Oncology

Tonya Mckee, RN, BSN, OCN Patient Navigator, Head and Neck

Elizabeth Whitt, BSN,RN Physician Nurse

Candice Kennedy, RN, BSN System Director for Cardiothoracic,

Pulmonary and Oncology Service

Kate Shane, MS, LGC OSU Genetic Counselor

Heather Hampill, MS, LGC OSU Genetic Counselor

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LUNG REPORT

There have been many changes in the past two years in the manner in which we diagnose and treat lung cancer. As a result of

these changes, patients can now be diagnosed at earlier stages in their diseases, leading to potentially curative treatment

options. The Adena Cancer Center is at the forefront of these changes. We use a multidisciplinary team approach that

coordinates the expertise of all our cancer specialists. Our patients receive the best care possible from screening and diagnosis

through treatment.

In November 2013 Adena was one of the first hospitals in the area to implement a successful low-dose CT lung screening

program that has been recognized as a screening center of excellence by the National Lung Cancer Alliance. Adena’s lung

cancer screening CT is free and is recommended for individuals 55 – 74 years old who have a history of smoking at least one

pack a day for 30 years or at least two packs a day for 15 years and are either a current smoker or have quit within the past 15

years. Those who are currently smoking are also offered smoking cessation intervention and counseling. In the first year of the

highly successful program, we have screened over 600 individuals and identified 12 cases of lung cancer.

The Adena Cancer Center staff works very closely in collaboration with our pulmonologists Drs. Haval Saadlla, Vishal Patel and

Emilia Anigbo. Adena uses state-of-the-art diagnostic tools, including bronchoscopy with endobronchial ultrasound and

superDimension navigational bronchoscopy to help diagnose lung cancer accurately and quickly with minimally invasive

diagnostic biopsies. In addition to our team of pulmonologists, we also rely heavily on Adena’s Interventional Radiology

Department staff and physicians. They are able to offer not only CT and ultrasound-guided biopsies for diagnostic purposes,

but also for various cancer treatment measures as well. These minimally invasive procedures include cryotherapy and

radiofrequency ablation, which can destroy smaller tumors without the need for surgery.

Our Radiation Oncology Department and physicians are also on the cutting-edge of cancer treatment with their spacious

9,000-square-foot unit housing two linear accelerators. This state-of-the-art equipment allows the radiation oncologists to

precisely target tumors while sparing healthy tissue. The radiation oncologists here are highly skilled at using intensity-

modulated radiation therapy (IMRT), which is a very sophisticated approach to the planning and delivery of radiation therapy.

Unlike conventional techniques, IMRT utilizes computerized programs to generate treatment plans that highly conform the

prescription dose to the shape of the tumor in three dimensions, thereby decreasing the amount of normal tissues irradiated.

Another newer radiation treatment available at the Adena Cancer Center is stereotactic body radiotherapy (SBRT). This

procedure is performed utilizing our Trilogy Linear Accelerator

and is similar to cyberknife therapy in that it is a method of

targeting tumors very precisely. The result of this method is that

the cancer receives a lethal dose of radiation while the

surrounding healthy tissue is spared. This method of treatment

usually requires only one to five total treatments.

We have also kept pace with new scientific developments in the

arena of lung cancer. New evidence demonstrates that

treatments for lung cancer are more effective when treatment is

personalized based on the individual genetics of the cancer.

Understanding what genetic changes have occurred inside a

tumor can help physicians identify and utilize new treatments that target these specific changes. These newer therapies are

not only less toxic, but also more effective in the fight against lung cancer. At Adena, we utilize next-generation sequencing to

profile our lung cancer patients and then utilize this information to pick from many new therapeutic options available for

patients with lung cancer. These new “targeted therapies” are all being utilized successfully at the Adena Cancer Center.

In summary, all of the Adena Cancer Center staff, including physicians, patient navigators, office nurses, infusion nurses,

radiation staff, technicians and clerical personnel are here to provide compassionate, comprehensive care to our patients and

their families. We coordinate our efforts in a team-based approach that provides state-of-the-art cancer care close to home at

the Adena Cancer Center.

OUR RADIATION ONCOLOGY DEPARTMENT AND PHYSICIANS ARE ALSO ON THE

CUTTING-EDGE OF CANCER TREATMENT WITH THEIR SPACIOUS 9,000-SQUARE-FOOT

UNIT HOUSING TWO LINEAR ACCELERATORS. THIS STATE-OF-THE-ART EQUIPMENT

ALLOWS THE RADIATION ONCOLOGISTS TO PRECISELY TARGET TUMORS WHILE

SPARING HEALTHY TISSUE.

Tammy E. McManus BSN, RN, OCN

Lung Cancer Patient Navigator

IN NOVEMBER 2013 ADENA WAS

ONE OF THE FIRST HOSPITALS

IN THE AREA TO IMPLEMENT A

SUCCESSFUL LOW-DOSE CT LUNG

SCREENING PROGRAM THAT HAS BEEN

RECOGNIZED AS A SCREENING CENTER

OF EXCELLENCE BY THE NATIONAL

LUNG CANCER ALLIANCE.

ADENA ONCOLOGY ANNUAL REPORT PAGE - 9

PATIENT NAVIGATORS

JANA ELDRIDGE, RNColorectal/GI Navigator

TONYA MCKEE, RN, BSN, OCNHead and Neck Navigator

ROBIN PRIMERPatient Navigator Support

TAMMY MCMANUS, RN, BSN, OCNLung Navigator

LINDSAY KEMPER, RNBreast Navigator

FREE LUNG SCREENING PROGRAM

In its first year, Adena Health System’s free lung cancer screening program has saved lives, while becoming a national model

for excellence. In the past year, 595 people have been screened. Of those, a dozen have been diagnosed with lung cancer,

one was diagnosed with breast cancer, and other patients have been found to have heart aneurysms, tumors and other

conditions they may not have known about until it was too late, thanks to the free CT scan.

Adena’s free lung cancer screening program provides CT scans for people at high risk for lung cancer at no cost. The program

began last November, and was initially meant to last just one month. However, due to overwhelming response, and Health

System and physician leader’s recognition of the benefits of free lung cancer screening, it was extended indefinitely.

In just one year, Adena’s free lung screening program has gained a reputation in the industry as one of the nation’s best. The

program has been designated a “Screening Center of Excellence” by The Lung Cancer Alliance, the nation’s leading lung

cancer advocacy group. The Alliance recently invited Adena Cancer Center’s Medical Director Dr. Jeffrey VanDeusen to be one

of its featured speakers at its recent national conference.

“FOR CENTERS LOOKING TO OFFER FREE LUNG CANCER SCREENINGS, ADENA IS

BEING HELD UP AS THE NATIONAL MODEL ON HOW TO ACCOMPLISH THAT,” SAID

DR. VANDEUSEN, “WE’VE DONE IT BETTER THAN ANYONE ELSE. WE’RE PROBABLY THE

NEWEST KID ON THE BLOCK, AND THE MOST SUCCESSFUL. WE ARE PRETTY PROUD

OF THAT.”

The program’s one-year anniversary marks the next big step in the program, and one of the most important – the annual

follow-up. While a patient’s first screening may not identify cancer, it serves as a powerful tool with which to compare

subsequent screens, and to determine if there have been any changes. People who were screened last year are encouraged

to schedule a follow up screening by calling (740) 542-LUNG (5864).

Additionally, new patients at high risk for lung cancer are also encouraged to have a lung cancer screen. The test is a non-

invasive, CT scan which easily identifies tumors or lesions that may need medical attention. Those eligible for the free

screening are: between 55-74 years old; have 30 or more “pack years” of smoking in their past (a pack year=1 pack a day for 30

years, 2 packs a day for 15 years, 3 packs a day for 10 years, etc.); a current smoker or someone who has quit smoking in the

past 15 years. Patients meeting the criteria should schedule a free lung cancer screening by calling (740) 542-LUNG (5864).

ADENA ONCOLOGY ANNUAL REPORT PAGE - 11

RADIATION THERAPY

Radiation therapy is one of the most common cancer treatments for cancer. It uses special equipment to aim high doses of

radiation at cancer cells. This damages the cancer cells and causes them to die. It can be given alone or used with other

treatments, such as surgery or chemotherapy.

Unlike chemotherapy, which exposes the whole body to cancer-fighting drugs, radiation therapy is usually a local treatment. It

targets only the part of the body being treated. The goal of radiation treatment is to damage as many cancer cells as possible,

with little harm to nearby healthy tissue.

There are two basic types of radiation therapy: external beam radiation therapy (EBRT) and internal radiation therapy, also

called brachytherapy. With EBRT, the radiation is delivered from outside of the body using one of several different types of

radiation systems. For patients undergoing brachytherapy, a radioactive source is temporarily or permanently implanted inside

the body, either in the tumor site or in a cavity left by a tumor that has been surgically removed.

The Adena Cancer Center has expanded the radiation treatment options available to patients. These new radiotherapy

techniques include partial breast irradiation and stereotactic body radiotherapy.

Partial breast irradiation (PBI) is performed utilizing brachytherapy targeted specifically for breast cancer treatment. This

treatment technique involves the placement of radioactive iridium using a multi-lumen catheter directly to the area where a

breast tumor has been surgically removed via lumpectomy.

Stereotactic body radiotherapy (SBRT) is a technique that utilizes precisely targeted radiation to a tumor while minimizing

radiation to adjacent normal tissue. This targeting allows treatment of small- or moderate-sized tumors in either a single or

limited number of fractions.

FOR QUESTIONS REGARDING CANCER TREATMENT OPTIONS, CONTACT THE ADENA CANCER CENTER.

DAVID ADAM JONES, MDRadiation Oncology

MEDICAL ONCOLOGY

The Medical Oncology program at the Adena Cancer Center is made up of a

well-integrated multidisciplinary care team of professionals, including physicians,

nurse practitioners, nurses, patient navigators, a clinical trials nurse, tumor registrar,

pharmacists, social workers, dieticians, a financial counselor, and clinical and

administrative staff.

The vision of the Adena Cancer Center is to provide compassionate, quality,

comprehensive cancer care for patients, families and our communities. Our staff

of highly qualified and board-certified physicians has completed training and

fellowships in some of the most prestigious cancer programs in the United States.

Their skill and expertise allow our patients to receive cutting-edge treatment close

to home in our new freestanding state-of-the-art cancer center.

Our priority is to meet the needs of our patients during each step of their cancer

journeys. Besides availability to the most advanced chemotherapy and radiation

regimens, we have a tightly woven care delivery model that includes regular

face-to-face care conferences with our oncologists, interventional radiologists,

pharmacists, pathologists, surgeons and patient navigators, who collaboratively

tailor individualized treatment plans for our patients. Additional services include

chemotherapy education, breast health clinics and advanced care planning clinics

led by our nurse practitioners, diet counseling by licensed dieticians, and a palliative

and hospice care program. We are also dedicated to providing daily availability on

our schedule for walk-in appointments for our patients’ urgent needs so trips to the

emergency room can be avoided when possible.

To address the long-term needs of our patients, we offer a variety of survivorship

programs, including American Cancer Society’s “I Can Cope” and “Look Good Feel

Better” programs led by trained facilitators from our staff as well as a breast cancer

support group. We also host a Survivor Celebration with the Paints and a Breast

Cancer Tree Lighting ceremony. Our Cancer Center social work team provides a wide

variety of services to our patients, including help with medication assistance

programs, access to community resources, transportation and psychosocial support.

The comprehensive cancer care team at the Adena Cancer Center takes pride in the

compassionate and quality care we provide, and we find it a privilege to serve our

community with the best cancer care right here at home.

ADENA ONCOLOGY ANNUAL REPORT PAGE - 13

AGE AND SEX

(60 > yrs. of age account for 65% of all cancer diagnosed)

AGE MALE FEMALE TOTAL

10-19 0 0 0

20-29 1 2 3

30-39 2 12 14

40-49 14 46 60

50-59 64 69 133

60-69 89 90 179

70-79 70 68 138

80-89 31 34 65

90+ 2 5 7

COUNTY AT DIAGNOSIS

ROSS 268

PIKE 87

JACKSON 53

PICKAWAY 41

FAYETTE 38

HIGHLAND 36

VINTON 25

OTHER 51

CLASS OF CASE

00-Diagnosed at Adena and all first course of therapy elsewhere10-14-Diagnosed at Adena and all or part of first course of therapy here

20-22-Diagnosed elsewhere and all or part of first course of therapy at Adena

CLASS OF CASE 00 34 5.7%

CLASS OF CASE 10-14 453 75.6%

CLASS OF CASE 20-22 112 18.6%

CITY AT DIAGNOSIS

CHILLICOTHE 195

WAVERLY 46

WASHINGTON CH 36

JACKSON 34

CIRCLEVILLE 28

PIKETON 26

GREENFIELD 22

FRANKFORT 21

BAINBRIDGE 18

KINGSTON 10

WELLSTON 14

OTHER 149

Adena Cancer Center Information from 2013599 Analytic Cases 610 Accessioned Cases

All of the Analytic statistics are based from the analytic cases, unless otherwise specified. Analytic cases are those cases that are either diagnosed at Adena Health System or receive their first treatment at Adena.

SEX

FEMALE 326 54%

MALE 273 46%

TOP 5 SITESTop 5 sites account for 63% of all cancers seen at Adena

SITE # OF CASES %

LUNG 132 22%

BREAST 124 21%

HEAD & NECK 49 8%

COLORECTAL 48 8%

LYMPHOMA 26 4%

TOP 5 SITES BY SEX

Adena Medical Center remained steady in the number of analytical cases for 2013. Compared to 2012 statistics of 599 breast cancer continues to hold the highest

incidence among women. Lung cancer remains the highest type of cancer for males.

FEMALE MALE

SITE # OF CASES SITE # OF CASES

BREAST 124 LUNG 70

LUNG 62 PROSTATE 37

COLON/RECTUM 25 HEAD & NECK 35

HEAD & NECK 14 COLORECTAL 23

LYMPHOMA 13 LYMPHOMA 13

ADENA’S CANCER EXPERIENCE

ADENA ONCOLOGY ANNUAL REPORT PAGE - 15

CLINICAL STUDIES REPORT

In 2013 we accrued to both cancer treatment studies and cancer control studies and biorepository. Patients were accrued to

both phase II and phase III studies. We accrued to study groups National Surgical Adjuvant Breast and Bowel Project, Southwest

Oncology Group, Ohio Colorectal Cancer Prevention Initiative and the American College of Surgeons Oncology Group. We

accrued to breast, renal, quality of life and biorepository studies, with a total of 11 patients with eight substudies.

The types of studies patients have been accrued to include a stage II new drug for progression of stage IV breast cancer, mTor

inhibitor versus placebo for high risk renal cancer, removing a drug from a group of three drugs given for breast cancer, text

messaging for medication compliance, and tumor and blood samples for Lynch syndrome.

We continue to work with Columbus Community Clinical Oncology Program, which provides the studies we have available to

offer, clinical support services and the internal review board.

ALL ANALYTIC CASES FOR 2013

LUNG 132

BREAST 124

COLON/RECTUM 48

HEAD & NECK 49

LYMPHOMA 26

BLADDER 32

PROSTATE 37

GYN 17

THYROID 8

KIDNEY 15

PANCREAS 12

MELANOMA 7

OTHER 92

ADENA CANCER EXPERIENCE CONTINUED

ADENA ONCOLOGY ANNUAL REPORT PAGE - 17

People diagnosed with cancer encounter a wide range of concerns related to finances, medical worries and emotional

issues. When someone is diagnosed with cancer, the focus is on the person’s physical well being, treatments, side effects,

doctor visits, tests, etc. We also know there are other parts of a patient’s life that are affected by cancer, such as self-image,

work, family and the approach to living.

The American College of Surgeons and NCCN have set standards of care for distress management with standard 3.2,

Psychosocial Distress Screening, which will be phased in by 2015. The Adena Cancer Center’s social workers are currently

working with other staff on this tool for screening and referrals to community resources for provision of services.

The licensed social worker is there to help patients and significant others navigate through the complexities of the

treatment process by serving as a knowledgeable, objective and unbiased resource. The licensed social worker assists

patients and significant others with a wide array of problems and issues, including but not limited to:

– Understanding insurance coverage and following up on insurance statements and rulings.

– Help finding assistance with the rising cost of medications, especially costs that aren’t covered by insurance, and seeking foundations for co-pay assistance and pharmaceutical programs providing free medication.

– Adjusting to and coping with a cancer diagnosis as well as the social, emotional, financial and professional issues that arise from such a diagnosis.

– Linking cancer patients and their significant others to helpful community resources.

– Advance directives information and completion.

– Serving as a sounding board, helping patients and significant others sort through confusion, myths and misconceptions so they can make reasonable, informed decisions about their care.

– Referral to support groups and other organizations that can help cancer patients and their significant others.

Social work services are a highly valued component of the Adena Cancer Center program. The licensed social worker

provides input and insight into the Adena Cancer Center program through involvement in the Cancer Committee and

is available to assist patients and their significant others when needed.

The Adena Foundation Cancer Center Fund continues to be a resource for many of the patients and their families, from

assistance with gas vouchers and medication to the wig fund.

SOCIAL WORK SERVICESPHARMACY

The Adena Cancer Center Pharmacy, located within the Adena Cancer Center, provides all cytotoxic and immunobiological

products required by our patients as well as any adjuvant and supportive therapies that may be prescribed. In 2013 the Adena

Cancer Center Pharmacy prepared and dispensed 6,695 chemotherapy doses and 18,296 doses of adjuvant and supportive

medications, with patient safety first and foremost in consideration.

Additional services provided by the oncology pharmacists include maintaining patient profiles for all chemotherapy patients,

clinical monitoring and intervention, patient education materials regarding medication side effects and proper use and care,

and pharmacokinetic consultation. In addition, the Adena Cancer Center Pharmacy serves as a clinical pharmacy teaching site

for Ohio Northern University, University of Findlay, Ohio State University and University of Charleston.

The Adena Cancer Center Pharmacy will be opening its retail pharmacy in the beginning of 2014. This dispensing pharmacy

will serve Adena Cancer Center patients by filling prescriptions for oral chemotherapy drugs as well as prescriptions for support

medications needed by those patients. The pharmacy will be able to fill most prescriptions in a fraction of the time other

pharmacies require.

THE ADENA CANCER CENTER PHARMACY STAFF CONSISTS OF THE FOLLOWING:

Mike Pugh, RPh, BCOP, Lead Oncology Pharmacist

Kristen Williamson, RPh, Oncology Pharmacist

Jackie Huiss, CPhT, Pharmacy Technician

Nikki Elkins, CPhT, Pharmacy Technician

Sarah Robinette, CPhT, Pharmacy Technician

ADENA CANCER CENTER4435 St. Rte. 159

Chillicothe, Ohio 45601740-542-3030

WWW.ADENA.ORG