DOYLESTOWN HOSPITAL

CANCER INSTITUTE

ANNUAL REPORT

2009

2

Special thanks to Elsie White, Peter Fernandez, and the

Arboretum Committee for their dedication, hard work and

passionate belief in the mission of Doylestown Hospital. Your

healing gardens and most especially the “Dancing Cranes” have created an atmosphere of serenity and hope for our patients.

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Letter from the Cancer Committee Chair… This year 2009 marks the fifth year of my tenure as Medical Chair of

the Doylestown Hospital Cancer Program. I would like to begin by

thanking you for entrusting us with the cancer care of your patients. I

am proud to report nearly 4 of 5 patients diagnosed at the hospital choose to follow up with oncology services locally. I believe that our

efforts to provide comprehensive care close to home provides better

quality of life, continuity of care, and favorable outcomes for our

patients.

This year also marks the end of an era of wanting to provide the

complete spectrum oncology services on site. The ground breaking

ceremony for the Cancer Institute at Pavilion II occurred on October

28th. This venture will place University of Pennsylvania Radiation Oncology services under the same roof as Medical Oncology. The

design of the physical space has been meticulously reviewed and

includes space for adjunct support services and an express elevator

connecting the two departments directly. The affiliation with the University of Pennsylvania will also allow our patients preferential

access to Proton Therapy.

We continue to enjoy excellent complimentary service from the department of surgery and interventional radiology. Surgery has

continued to expand the use of the da Vinci robot in oncologic

applications. The Interventional Radiologists have had extensive

experience performing radiofrequency ablation and chemoembolization of both metastatic and primary tumors. At your leisure take the time

to review the outcomes data and summery articles that follow in this annual report. Mitchel l Alden, D.O.

Medical Director, Cancer Services/Cancer Committee Chair

Doylestown Hospital is a member of

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Cancer Committee The Cancer Committee is a multidisciplinary team organized to provide leadership, responsibility and accountability for all the activities of the

Doylestown Hospital Cancer Program. This leadership body is

responsible for goal setting, planning, initiating, implementing,

evaluating, and improving all cancer-related activities of the facility to ensure that the highest quality of care is provided to our patients.

Physician Education Programs Sponsored by

Cancer Committee

July 2, 2009 “Staging Education for Physicians” Joseph Curci, MD, Cancer Liaison Physician

September 22, 2009 Annual Cancer Symposium

“Medical Ethics and Palliative Care/Pain”

Art Caplan, MD, Director of the Center for Bioethics, Univ of PA David Howell, MD, Univ of Michigan

Veronica Coyne, MD, Hospice Director, Doylestown Hospital

Cancer Conferences/Tumor Board Cancer Conferences are a bimonthly forum for multidisciplinary review

of newly diagnosed cancer cases. Physicians representing medical

oncology, radiation oncology, surgery, radiology, and pathology convene to share information about challenging cases, review

standards of care such as the National Comprehensive Cancer Network

Guidelines, or discuss rare tumor types for educational purposes and

multidisciplinary input. For patients at Doylestown Hospital, these collaborative efforts are integral to the quality care and excellent

outcomes for which we are known.

In 2009, 70 cases were presented, representing 10% of our

accessioned cases.

Cancer Conference Physician Education ! June 4, 2009 – “ASCO Breast Cancer Update”

Kevin Fox, MD, Univ of PA

! October 1, 2009 – “Treatment of NSCLC” James Stevenson, MD, Univ of PA

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Community Outreach/Support Programs Skin Cancer Screening

Drs. Adler, Santoro, Spiers, Toporcer and Willard

! 130 Screened

! 47 Referred for suspicious lesions

Prostate Cancer Screening

Drs Izes and Flashner

! 41 Screened

! 4 Referred for suspicious DRE or PSA

Smoking Cessation Classes

! 6 classes

! 73 participants attended

Cancer Survivor Day – A Celebration of Life

! “ Laugh for the Health of It”

! Keynote Speaker: Hedda Matza-Haughton, a dynamic

speaker whose presentation highlighted the benefits of laughter in your life

! 80 Patients/Family members attended

Cancer Survivor Day: ‘Laugh for the Health of It”

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Central Bucks Relay for Life ! Doylestown Hospital Cancer Center Team ! $2000 donated to American Cancer Society

Coaches vs. Cancer

! Collaboration between Doylestown Hospital and CB South High School to support the American Cancer Society

! Breast Cancer Awareness/Education Program for CB South High School Students and Community

Other Support Services

! Breast Cancer Support Group

! Man to Man Prostate Cancer Support Group

! Cancer Fit

! Reach to Recovery ! I Can Cope

! Look Good Feel Better

! Lymphedema Management & Support Group

! Nutrition classes ! Music Therapy

! Pet Therapy

Cancer Risk Evaluation Program The University of Pennsylvania’s Cancer Risk Evaluation Program

(CREP) at Doylestown Hospital completed its second year in October 2009. This comprehensive program, developed at the University of

Pennsylvania’s Abramson Cancer Center, provides our community

access to information, evaluation and genetic counseling to assess a

woman’s personal susceptibility for breast and ovarian cancer.

Since its inception, the Cancer Risk Evaluation Program has generated

great interest among the women in our community. To date 89 women

have entered the program, 53 were tested (3 positive for a BRCA 1 or

2 genetic mutation) and 16 women chose to enlist in genetic research studies at the University of Pennsylvania.

For more information or to refer your patients to this free risk

assessment program contact:

Kathy Nellett, RN, OCN, CBCN Breast Care Coordinator, at

215-345-2200 ext. 4871 or 215-918-5872.

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Breast Care Coordinator The Breast Care Coordinator Program is designed to ensure that all breast cancer patients at Doylestown Hospital receive the best possible

services and highest quality care. “I serve as a resource for patients

who have seen alterations in their breast health or a breast cancer

diagnosis,” says Kathy Nellett. “Whenever a woman has a biopsy performed in the Women’s Diagnostic Center (WDC), I support her

through the procedure, answer questions, and provide information,

even if the result is not positive for cancer.”

Our Breast Care Coordinator works closely with Family Physicians,

Radiologist, Surgeons, Medical Oncologist, and Radiation Oncologists

to help coordinate all aspects of care as well as assistance with

referrals for second opinions, if requested. “It’s hard at the beginning to know where to turn…I’m here to help our patients navigate the

system to get the best possible care,” says Nellett.

The response to the Breast Care Coordinator program has been

overwhelmingly positive. Year to date 2009, 323 women were seen in WDC; 89 (28%) were diagnosed with cancer; and of those 65 (73%)

were treated by DH physicians.

CBCN Certification

! In 2009, the Oncology Nursing Society offered the very first “Breast Care Certification (CBCN) Exam” to test the knowledge and tasks that are important to the competent performance of registered

nurses who provide breast care. Kathy Nellett successfully

completed the examination and was awarded the “CBCN” credential

attesting to her advanced knowledge in caring for women diagnosed

with breast cancer.

Hospice The Hospice Program at Doylestown hospital is a specialized part of

the Visiting Nurse/Home Care Department. It is not a place. Rather,

it is a coordinated program of home care and support services for the

terminally ill and their families, and a way for patients to remain comfortably in the familiar surroundings of their homes with people

who love them.

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The Hospice support team members, including nurses, home health

aides, a social worker, chaplain, physician, and volunteers work

together to provide emotional, physical, and spiritual support to the patient and the family.

These services are generally covered by health insurance, but

generous donations and memorials help to ensure hospice care for those who need it. Specially trained volunteers provide

companionship, personal care, letter writing, etc. Since becoming

Medicare certified in the late 1980’s Hospice has provided services to

more than 4000 patients and families.

Hospice also offers bereavement services to family and friends of

Hospice patients for up to 13 months following the death of a loved

one. For more information or to refer a patient please call 215-345-2201

Cancer Center Volunteers: In 2009, our wonderful volunteers logged more than 2200

hours to help ensure smooth operations and, most importantly,

to provide for the comfort and care of our patients.

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Clinical Trial News

Clinical Trials are the way we make progress against disease. Doylestown Hospital Cancer Center offers clinical trials to the patients

in our community allowing them to receive the best quality of care

close to home. Each year patients enter clinical trials and have the

chance to help others and improve health care. Clinical trials have

recently discovered a mutation of the KRAS Oncogene in colon cancer tumors (see Howard Zipin, MD report), giving medical oncologists the

opportunity to choose a more specific treatment for these patients.

Since January 2007 the Cancer Center has enrolled a total of 31 patients in clinical trials. The Cancer Program has again met National

Cooperative Group accrual goals. The following clinical trials are currently open to enrollment at

Doylestown Hospital Cancer Center.

Breast - Adjuvant:

PACCT-1: Program for Assessment of Clinical Trials Tests – Trial

Assigning Individualized Options for Treatment - TAILORx Trial

SWOG s0307: Phase III trial of Bisphosphonates as adjuvant therapy

for primary breast cancer. (Stage I,II,III)

Breast - Metastatic:

CALGB 40503: Endocrine therapy in combination with anti-VEGF therapy; randomized double-blind, placebo-controled phase III trial of

endocrine therapy alone or endocrine therapy plus Bevacizumab for

women with hormone receptor-positive advanced breast cancer. Colon - Adjuvant:

E5202 : A Randomized Phase III Study Comparing 5-FU, Leucovorin and Oxaliplatin versus 5-FU, Leucovorin, Oxaliplatin and Bevacizumab

in Patients with Stage II Colon Cancer at High Risk for Recurrence to

Determine Prospectively the Prognostic Value of Molecular Markers

N0147: A Randomized Phase III Trial of Oxaliplatin (OXAL) Plus 5-

Fluorouracil (5-FU)/ Leucovorin (CF) with or without Cetuximab (C225) after Curative Resection for Patients with Stage III Colon Cancer

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Colon or Rectal – Metastatic:

CALGB 80405: A Phase III Clinical Trial of Irinotecan/5-FU/Leucovorin or Oxaliplatin/5-FU/Leucovorin with Bevacizumab, or Cetuximab

(C225), or with the Combination of Bevacizumab and Cetuximab for

Patients with Untreated Metastatic Adenocarcinoma of the Colon of

Rectum. (Combination Arm closed)

Genitourinary:

E2805: A Randomized, Double-Blind Phase III Trial of Adjuvant Sunitinib versus Sorafenib versus Placebo in Patients with Resected

Renal Carcinoma

U of PA - 703123: Inherited genetic variation and predisposition to

testicular germ cell tumor.

Lung – Adjuvant: ECOG 1505: Phase III randomized study of adjuvant chemotherapy with or without Bevacizumab in patients with completely resected

Stage IB – IIIA NSCLC

Lung – Advanced:

SWOG S0819: A randomized, phase III study comparing

Carboplatin/Paclitaxel or Carboplatin/Paclitaxel/Bevacizumab with or

without concurrent Cetuximab in patients with advanced NSCLC

Myeloma:

ECOG 1A05: A Randomized Phase III trial of consolidation therapy with Velcade-Revlimid-Dexamethasone vs Velcade-Dexamethasone for

patients with multiple myeloma who have completed a dexamethasone

based induction regimen.

Prostate, Breast, Multiple Myeloma – Metastatic:

CALGB C70604: Randomomized phase III study of standard dosing vs.

longer dosing interval of zoledronic acid in metastatic cancer.

For more information on oncology research contact:

Laura B. Heacock, RN, BSN, OCN 215-345-2378, fax 215-345-2031

Clinical Research Nurse lheacock@dh.org

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What’s New in Cancer Care…

Tumor Directed Treatments

Cancer therapies have been evolving at a rapid pace and a particular

area of active growth is in minimally invasive tumor directed therapies.

At Doylestown Hospital we have very active and experienced Interventional Radiologists who specialize in minimally invasive cancer

therapy. We offer expertise in several tumor directed treatments such

as chemoembolization, radiofrequency ablation, and radioembolization,

procedures previously available only at academic teaching centers. Our

interventionalists perform numerous embolization and ablation procedures on routine basis at Doylestown Hospital as well as a other

locations. Interventional radiologists are experts in endovascular and

image-guided treatments. When treating cancer patients,

interventional radiologists use sophisticated imaging guidance to precisely target and attack tumors locally without surgery or systemic

side effects.

Chemoembolization

Chemoembolization is a minimally invasive procedure designed for the

treatment of primary or metastatic cancer to the liver. The procedure

is designed to deliver a high dose of chemotherapy intra-arterially into the feeding vessels of the tumor and subsequently embolizing these

vessels using embolic beads. Hence, we are attacking the tumor in

two ways; one is the effect of the intra-arterial chemotherapy resulting

in high concentrations of drug within the tumor, and the second is effect of embolization to prevent drug washout and also deprive the

tumor of nutrients and oxygen. In this procedure, the interventional

radiologist uses angiography to identify the vascular supply to the liver

and tumors. Microcatheter techniques are used to select the arterial supply to the tumors and allow for precise directed therapy. Usually

one lobe of the liver can be treated during a procedure and the second

lobe treated 1 month later. This procedure can be repeated over time.

Patients are admitted overnight for observation of post-embolization

syndrome which includes pain, nausea, vomiting, fever, and loss of appetite. This is a self-limited process that can occur after tumor

embolization related to a cytokine release. This procedure is useful to

help obtain local tumor control in patients who have primary cancer in

the liver (HCC, cholangiocarcinoma) or those with liver metastases (colon, neuroendocrine, etc.). Chemoembolization is useful in patients

who do not respond to standard therapy, cannot tolerate systemic

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effects of chemotherapy, or who have progressive disease within the

liver.

Radiofrequency Ablation

Radiofrequency ablation (RFA) is a minimally invasive, image-guided

therapy used to treat primary or metastatic cancer in a variety of organs including; the liver, kidney, lung, adrenal gland, and bone. RFA

is a form of thermal ablation that uses heat to destroy tumors via a

percutaneous approach. RFA is locally directed therapy designed for

those patients who are not candidates for surgical resection of their

tumor. We know that many patients are not surgical candidates for resection due to tumor location, patient condition, or extent of disease.

Thermal ablation is based on the principle that if you heat a cell,

cancer cell or normal cell, to above 50ºC the proteins denature, cell

membrane falls apart, and the result is cell death. RFA is a procedure in which an interventional radiologist guides a 17g electrode through

the skin and into a tumor in the body using imaging guidance such as

CT or ultrasound. Radiofrequency energy is applied to the electrode

and the tumor heats to near 100ºC, resulting in coagulative necrosis of the tumor. This can be performed with a high degree of precision to

spare the adjacent normal tissues. We have extensive experience in

RFA of a wide variety of tumor types and organs. RFA of RCC has

extensive literature with excellent long term results in tumors up to

3.5 cm and good results in even larger tumors. RFA of liver tumors, primary or isolated metastases, has excellent results in tumors up to 5

cm. We are also one of few locations that can offer RFA of lung masses

including inoperable NSCLC or isolated metastases. Lung RFA has also

shown synergistic effects when combined with conventional radiation therapy for larger lesions. In the bone, RFA can provide significant

pain relief for those patients with painful bone metastases. RFA can

help to control both primary and metastatic tumors in a variety of

settings.

Radioembolization

Radioembolization is the latest technology being developed and

available at only few cancer centers nationwide. The interventional radiologists at Doylestown currently perform this procedure at a

regional cancer center and this could become available locally at

Doylestown Hospital in the future. This technology is a progression

from chemoembolization. Instead of using intra-arterial chemotherapy and blocking off the blood supply to tumors, radioembolization is a

similar procedure that uses tiny glass beads coated with a radioactive

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ß-emitter(Yttrium-90). This is performed through the arteries in the

liver just like chemoembolization, but uses internal radiation emitted

by the tiny beads that lodge in the fine arteries within the liver tumors. The internal radiation provides another means of cancer cell death by

the radiation effect. This is currently under investigation at several

sites although may be beneficial in those patients with primary liver

cancer and metastatic colon cancer. Use in other cancer types is currently under investigation.

This year alone at Doylestown Hospital we have performed 9 RFA

procedures, 4 chemoembolization procedures, and 1 combined RFA/chemoembolization. These procedures have been successful and

helped a variety of patients including those with; renal cell carcinoma,

cholangiocarcinoma, neuroendocrine tumors, and metastatic colon

cancer to the liver.

The above is a summary of highly technical and at times complex

procedures. These procedures are typically very well tolerated and

require only an overnight hospital stay. Depending on the tumor

location and type, one or more treatments may be required. The specific procedural risks and side effects vary according to the patient

and specific procedure. All patients are seen in consultation with an

interventional radiologist and we will help determine which procedure

is most appropriate and work with the referring physician to aid in patient management and follow-up.

The above treatments provide cancer patients additional options that

can be used in conjunction with standard treatments or can help to provide local control if other therapies fail. The goal of tumor directed

treatments is to destroy cancer cells using a minimally-invasive,

locally-directed, and image-guided procedure to help cancer patients

extend and improve quality of life.

Steven C. Wagner, M.D.

Interventional Radiologist

Chemoembolization: representation of intra-arterial tumor directed therapy.

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Angiogram during chemoembolization of a liver tumor, metastatic colon cancer.

15

CT image shows RFA electrode placement into a primary renal cell cancer.

Advances in Chemotherapy for Colon Cancer: The use of

Molecular Markers

Colon cancer remains the second most common cause of cancer

death in the United States. Until recently, the palliative treatment of

metastatic colon cancer solely employed the empiric use of cytotoxic chemotherapy agents either alone or in combination and was guided

based on the results of controlled clinical trials. As we have entered

the 21st Century, there have been remarkable advances in the

understanding of cancer biology especially on a molecular level. These advances have begun to dramatically improve outcomes in patients

with colon cancer based on discovery of new biologic “targeted” agents

that specifically inhibit or target proteins that play a role in

carcinogenesis. Some specific examples that demonstrate this “targeted” approach in colon cancer are agents in the Anti-VEGF

antibody and Anti-EGFR antibody classes. What we are also finding

out is that these same approaches are showing great promise in many

other tumor types in addition to colon cancer which was the prototype for these agents.

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Vascular Endothelial Growth Factor Blocker: Avastin

In Febuary 2004, bevacizumab (Avastin®), a humanized monoclonal antibody that recognizes and blocks vascular endothelial

growth factor (VEGF), was approved by the FDA for use in combination

with cytotoxic chemotherapy based on data promising data

improvements in outcomes. VEGF is a chemical signal that stimulates the growth of new blood vessels also know as Angiogenesis. Its initial

approval came following studies which used the drug in combination

with intravenous, fluorouracil (5-FU)-based chemotherapy.

Bevacizumab’s toxicity profile is quite atypical when compared to side-

effects of standard chemotherapy. Side effects such as are bleeding/hemorrhage, headache, hypertension, rhinitis, proteinuria,

taste alteration, dry skin are some the more commons ones seen. It

also can effect post operative wound healing which combined with a

long half life makes elective and unexpected surgery more challenging; serum half-life is approximately 20 days (range, 11–50

days). Nevertheless, these differences allows for synergistic use more

easily because toxicities are not additive as they typically are with

many other combination chemotherapy regimens. In addition to its effectiveness in colon cancer, bevacizumab now has formal FDA

approvals for use in a variety of malignancies. In October 2006, it was

approved to treat unresectable locally advanced or metastatic

nonsquamous, non-small-cell lung cancer (NSCLC) in combination with

carboplatin and paclitaxel, and in February 2008, it was approved for use with paclitaxel for patients who have not received chemotherapy

for metastatic HER2-negative breast cancer. Just this year, it was also

approved for use in metastatic renal cell carcinoma and glioblastoma.

In addition, it continues to be studied in a variety of other tumor types.

Epidermal Growth Factor Receptor Blockers: Erbitux and

Vectibix Even more recently, the monoclonal antibodies cetixumab

(Erbitux®) first, followed by panitubimab (Vectibix®) have been

approved. These monoclonal antibodies inhibit a slightly different

target, the epidermal growth factor receptor (EGFR), which also has

been implicated cancer growth and metastasis. They function by binding to the EGFR protein and thus inhibit its cell-signaling function.

Unlike bevacizumab, they have been shown to have activity on their

own, in addition to enhancing the activity of standard forms of

chemotherapy when used together. One recent and very important

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finding was that the benefits of these agents are predominately seen

in colon cancers that specially carry unmutated copies of the well

described K-ras oncogene, so-called K-ras wild type cancer. K-ras is a GTP-binding protein that acts as a critical off-on switch for cellular

growth and survival pathways. In cancers with mutated K-ras, there

were little to no benefits from these agents seen. Based on these

findings, the FDA amended its approval for this class of anti-EGFR monoclonal antibodies. This is one of the earliest examples of the

approval of a drug therapy for solid tumors that is based on a genetic

test.

VEGF and EGFR are just two of hopefully many molecular targets that we as oncologists can use to customize our therapy and improve

the prognosis of patients with all stages of colon cancer, and for that

matter, other types of cancers. The relatively new drugs

bevacizumab, cetixumab, and panitubimab have been newly approved for treatment in colon cancer over the past five years as antibodies

against these specific targets. Their use both alone in some instances

and in combination with cytotoxic chemotherapy has improved patient

outcomes in oncology in general and specifically in colon cancer. As

we move forward, these technologies will continue to be an integral part of cancer therapeutics.

Howard S. Zipin, MD

Bux-Mont Oncology Hematology Medical Associates, P.C.

Robotics in Surgical Oncology At Doylestown Hospital

In 2008, Doylestown Hospital made a major investment in its

Oncology program with the acquisition of Intuitive Surgical’s da Vinci

Surgical System. This innovative system has enabled Doylestown Hospital surgeons to greatly expand the number of minimally-invasive

procedures that can be provided to our cancer patients. The robotic

surgical platform represents a significant advancement beyond

standard laparoscopic surgery. Compared to traditional, open surgery

and standard laparoscopic surgery, the da Vinci robotic system offers vastly superior visualization with its high-definition, three-dimensional,

ten-fold magnified field of view. The robotic, wristed instrumentation

provides the surgeon with unparalleled ability to precisely dissect

cancerous tissues away from healthy tissues and subsequently reconstruct the patient’s healthy anatomy. Post-operative pain and

scarring are substantially reduced. Blood loss and post-surgical

infections are greatly diminished. Hospital stays are shorter and

resumption of normal activities faster.

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Doylestown Hospital surgeons have eagerly embraced the da Vinci

system for prostate, kidney, ureteral and bladder cancers with terrific

results. The robotic system is also used by the cardiothoracic surgery team during mitral valve repairs and by our gynecologists for

hysterectomies, oophorectomies and fallopian tube reanastamoses.

The oncologic surgeons of Doylestown Hospital are proud to be able to

provide our patients with university-caliber care in the community setting. The da Vinci Surgical System demonstrates the Hospital’s and

its surgeons’ commitment to remaining at the cutting edge of Surgical

Oncology.

Kevin Fitzgerald, MD

Central Bucks Urology

Cancer Program Quality Improvement Annually, the Cancer Committee evaluates the care and outcomes of cancer patients treated at Doylestown Hospital to measure quality and

to provide an opportunity to enhance patient outcomes. The National

Cancer Data Base (NCDB) serves as a benchmark against which the

Cancer Committee can compare its caseload in an effort to evaluate trends that are unique to our community.

Doylestown Hospital Cancer Program is an American College of

Surgeons, Commission on Cancer, designated Community Hospital Cancer Program. The following comparison includes data from all

Pennsylvania Community Hospital Cancer Programs (PA CHCP),

Doylestown Hospital (DH), and the National Cancer Data Base (NCDB)

The following statistical analysis was performed using registry data to

evaluate breast and colon cancer diagnosed at Doylestown Hospital

and includes age and stage at diagnosis. Overall 5-year survival is

included for the top 5 sites diagnosed at Doylestown Hospital. Age

and stage comparison is based on the year 2008 caseload and 5 year and overall survival is based on the year 2001 registry accessions and

follow-up data.

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Breast Cancer

Breast Cancer Age at Diagnosis

0

5

10

15

20

25

30

16-2

9

30-3

9

40-4

9

50-5

9

60-6

9

70-7

9

80-8

9

90+

0

5

10

15

20

25

30

35

PA Centers %

DH %

DH 2008

Breast Cancer Stage at Diagnosis

0

10

20

30

40

50

0 1 2 3 4

unknow

n

0

10

20

30

40

50

PA Centers %

DH %

DH 2008

Age at Diagnosis: Historical data reveals a younger age distribution at diagnosis at DH when

compared to the National Cancer Data Base (NCDB). Between the years

2000 –2006, 19% of patients were diagnosed before 50 years of age as

compared to 15% reported by the NCDB. In 2008, 23% of patients were diagnosed before the age of 50 likely reflecting continued aggressive

community screening. The majority of patients (29%) were diagnosed between

age 60 to 69.

Stage at Diagnosis: The stage distribution of breast cancer has not changed over previous years

and corresponds almost exactly with that reported from the NCDB from

2000 – 2006. New cases follow this trend with 19% of patients presenting

with stage 0 disease; 41% with stage I disease; and 26% with stage II disease.

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Colon Cancer

Colon Cancer Age at Diagnosis

0

5

10

15

20

25

30

35

<40 40-49 50-59 60-69 70-79 80-89 90+

PA CHCP%

DH%

DH 2008

Colon Cancer Stage at Diagnosis

0

5

10

15

20

25

30

0 1 2 3 4

unknow

n

0

5

10

15

20

25

30

PA Centers%

DH%

DH 2008

Age at Diagnosis:

Historically, the distribution by age at DH has been very similar to that

reported by the NCDB with the incidence increasing each decade. However, in 2008, there is an increase in patients being diagnosed between age 50 to

59 reflecting the increase of community education and screening. There is a

downward trend in those patients diagnosed between the ages of 70 to 79.

Seven percent of patients were diagnosed in their 90’s which is consistent with national and regional trends.

Stage at Diagnosis:

The distribution of stage of colon cancer at DH compares favorably with historical data from the NCDB. In 2008, 51% of patients at DH presented with

stage II or less disease giving them a 75% chance of cure with surgery alone.

Twenty-seven percent (27%) of patients presented with stage III disease and

treated aggressively with adjuvant chemotherapy which significantly improves

the 5-year disease free survival rate.

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Doylestown Hospital Cancer Registry

Site Specific Cancer Cases Diagnosed at Doylestown

Hospital 2005 - 2008

0

20

40

60

80

100

120

140

160

180

Breast Lung Colon Prostate Bladder

# o

f P

ath

olo

gic

Ac

ce

ss

ion

s

2005

2006

2007

2008

These figures represent the Cancer Program’s four-year caseload for the

5 most frequently occurring site-specific cancers: breast, colorectal, lung,

prostate and bladder.

Total Cancer Cases Diagnosed at Doylestown

Hosptial

0

100

200

300

400

500

600

700

800

2005 2006 2007 2008

Total

Cancer cases accessioned by Doylestown Hospital’s Cancer Registry reflect

the continued growth of cancer services.

22

The following graph represents Doylestown Hospital’s five-year

survival rates for the five most common cancers we treat compared to

the National Cancer Data Base (NCDB) and Pennsylvania Community

Hospital Cancer Programs (CHCP). The cancer patients we treat have

superior or equivalent survival rates when compared to national and

regional averages.

Overall 5 Year Survival for Top 5 Sites

0

10

20

30

40

50

60

70

80

90

100

Breast Colon Prostate Lung Bladder

NCDB

PA CHCP

DH

Cancer Program Recognized for Quality

Doylestown Hospital Cancer Program was surveyed in 2009 by the American College of Surgeons, Commission on Cancer

(CoC) and received a 3-Year Approval with Commendation as a

Community Hospital Cancer Program. This Commendation

rating means that Doylestown Hospital Cancer Program exceeded the standards required by the CoC.

Only 40% of institutions surveyed receive this rating!

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All Cancers by Site

Primary Site 2008 2007 2006

ORAL CAVITY & PHARYNX 6 15 9

DIGESTIVE SYSTEM

Esophagus 12 4 10

Stomach 6 5 5

Small Intestine 4 5 1

Colon (excluding rectum) 50 66 49

Rectum/Rectosigmoid 17 20 16

Anal 1 1 2

Liver 3 4 2

Gallbladder 3 2 1

Other Biliary 0 2 1

Pancreas 18 11 9

Peritoneum 0 0 1

RESPIRATORY SYSTEM

Nasal Cavity/Middle Ear 2 1 0

Larynx 6 3 4

Lung & Bronchus 98 92 73

Trachea/Mediastinum 1 0 0

BONES & JOINTS 0 1 0

SOFT TISSUE (including Heart) 3 1 2

SKIN (excluding basal & squamous)

Melanoma 38 25 22

Other nonepithelial skin 1 1 1

BREAST 141 154 124

FEMALE GENITAL SYSTEM

Cervix Uteri 3 2 2

Corpus & Uterus 18 12 10

Ovary 8 6 5

Vulva 0 1 2

Other 0 0 1

MALE GENITAL SYSTEM

Prostate 59 68 66

Testis 10 4 3

Other 0 0 1

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URINARY SYSTEM

Urinary Bladder 65 49 37

Kidney & Renal Pelvis 18 29 24

Ureter 2 2 2

Other 0 1 2

EYE & ORBIT 1 0 1

BRAIN & NERVOUS SYSTEM

Brain 8 5 5

Other Nervous System 14 8 3

ENDOCRINE SYSTEM

Thyroid 16 17 15

Other (including Thymus) 2 0 1

LYMPHOMAS

Hodgkin Lymphoma 4 2 4

Non-Hodgkin Lymphoma 35 26 38

MULTIPLE MYELOMA 7 4 7

LEUKEMIAS

Lymphocytic 9 5 8

Myeloid & Monocytic 8 4 10

Other Leukemia 1 0 0

MESOTHELIOMA 3 0 3

KOPOSI SARCOMA 0 1 0

MISCELLANEOUS 23 22 22

TOTAL 724 681 604

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Exceptional Cancer Care in the Heart of Our

Community The Doylestown Hospital Cancer Center is located on the third floor of

The Pavilion, suite #302. Our patients receive the quality care they

expect from a leader in cancer diagnosis and treatment close to home.

The hospital’s membership in the Penn Cancer Network further serves to bring the very latest knowledge of cancer and its treatment to the

very heart of our community.

Infusion Services – Much More Than Chemotherapy The spacious and comfortable Outpatient Infusion unit in the Cancer

Center provides services for patients being treated for cancer as well

as a wide range of medical conditions. An onsite clinical pharmacist works closely with the patient’s physician and infusion nurses to

coordinate care and ensure the best possible outcomes. Therapies

include:

• Antibiotics, Antivirals and Antifungals

• Biologic Response Modifiers

• Bisphosphonates

• Blood Products

• Chemotherapy

• Corticosteriods

• Endocrine Testing

• Immune Globulin

• IV Iron

• Phlebotomy

• Remicade

• Rituxan

• Targeted therapies

• Therapeutic Injections

• Xolair

Expert Clinicians Provide the Latest in Cancer Care

• Board Certified Medical Oncologists

• Oncology Certified Nurses (OCN)

• Clinical Research Nurse

• Certified Breast Care Coordinator/Genetics Nurse • Onsite Oncology Pharmacist

• Onsite Lab/Certified Medical Lab Technician

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2009 Cancer Committee Members

Mitchell Alden, D.O.

Medical Director, Cancer Services

Cancer Committee Chair

Eleanor Wilson, RN MSN, MHA………………………..Vice President, Patient Services

Robert J. Trotta, MD, PhD………………………………….……….Department of Pathology

Joseph J. Curci, MD, FACS…………………….…….………..……..Department of Surgery

Brett M. Harrison, MD………...………….….………………………….Department of Surgery

William R. Rate, MD, PhD………………...….…….Department of Radiation Oncology

Eileen Engle, MD……………………………………………………….Department of Gynecology

Veronica Coyne, MD………………………………………………………………...Director, Hospice

Michele Kopach, MD………………………….….………………..…..Department of Radiology

Albert Ruenes, MD………………………….….…………….…………….Department of Urology

Joanne Spiegle, MD……………………………………………………..Department of Radiology

Elizabeth Mathew, Pharm D ……….………...……………..….Department of Pharmacy

Jean Chubb, RN, MSN…………………..…Coordinator, Doylestown Hospital Hospice

Grace Schellinger, RNC…….…….…..…………… ………………………...Case Management

Ruth Doyle………………………………...……..VIA Representative, Doylestown Hospital

Margaret George…………………..….…… ……… ………………Community Cancer Advisor

Jeanne Rogers, RN, MEd…………….……….………………………..Administrative Director,

University of Pennsylvania Cancer Network

Karen Quinlan, RN, MSN, OCN……….…………..……………..Director, Cancer Services

Laura Heacock, RN, BSN, OCN….…….………..… ……………...Clinical Research Nurse

Jacqueline Ridge, BS, CTR……………….…… ..…………………………….Cancer Registrar

Karen McCurdy……………………………….….……..……..……………….Community Relations

Lisa Strouse ………………………………….….……..……………..Sr. Administrative Assistant

Cancer Program Coordinators

Robert Trotta, MD – Cancer Conference

Joseph Curci, MD – Community Outreach

Brett Harrison, MD – Quality Control of Registry William Rate, MD – Quality Improvement

To schedule an appointment in the Doylestown

Hospital Cancer Center call 215-345-2489.

To schedule an appointment with a Medical Oncologist

affiliated with Doylestown Hospital call:

Barry Tonkonow, MD: 215-348-1595

Bux-Mont Oncology Hematology: 215-345-8444