2011 annual summary of 2010 memorial hermann cancer ... · 2011 annual summary of 2010 . memorial...

2011 Annual Summary of 2010 Memorial Hermann Cancer Program Activities

TOP CANCER SITES AT MEMORIAL HERMANN

The most prevalent cancers seen in 2010 at Memorial Hermann are breast, lung, prostate and colorectal cases, which

have not changed for the past 20 years. Female breast cancers (23%) diagnosed and/or treated at our accredited

institutions continue to have higher incidence than state and national data. Lung (12%) and prostate (9%) low

incidence data is likely due to community referral patterns to outpatient treatment centers; colorectal data (9%) is

consistent with state and national data.

Table 1: Top 4 Analytic Cancer Sites Comparison of Incidence with State and National Data

23

13 1412

14 15

9

14 14.5

9 10 9

0

5

10

15

20

25

Perc

ent

Breast Lung Prostate Colorectal

Site

MHHS* Texas** National**

*MHHS is comprised of the following accredited cancer hospitals: Memorial Hermann Memorial City, Memorial

Hermann Northeast, Memorial Hermann Northwest, Memorial Hermann Southeast, Memorial Hermann Southwest,

Memorial Hermann-Texas Medical Center and Memorial Hermann The Woodlands. The total number of analytic

cancer cases in 2010 was 5,311.

**American Cancer Society Fact and Figures 2010. Total cancer cases for Texas: 101,130. Total cases for National:

1,529,560.

2010 INCIDENCE OF TOP 5 SITES BY GENDER

MHHS analytic and non-analytic cases total = 6,432

MALE Male Genital System 641 (10%) Respiratory System 459 (7.1%) Colorectal 329 (5.1%) Urinary System 301 (4.7%) Brain & CNS 156 (2.4%) FEMALE Breast 1,143 (17.7%) Respiratory System 400 (6.2%) Gynecologic System 370 (5.7%) Colorectal 256 (4%) Brain & CNS 218 (3.4%)

MEMORIAL HERMANN MEMORIAL CITY MEDICAL CENTER

Muffaddal Morkas, MD, MD

Chairman, MH-MC Cancer Committee

Memorial Hermann Memorial City Medical Center has been accredited as a Comprehensive Community Cancer Program

through the American College of Surgeons Commission on Cancer since 1994. We have established the highest level of

quality oncology care for west Houston and surrounding communities with a comprehensive range of cancer-related

services, including medical, radiation and surgical oncology, and support services through various internal and external

resources. The Memorial City Cancer Program functions under the direction of its multidisciplinary Cancer committee,

including physicians, nurses, administrators, social workers, and registrars, who provide direct guidance and leadership.

The Cancer Program at Memorial City continues to evolve, setting goals and milestones intended to enhance services and

prove that exceptional care is available close to home.

2010 Cancer Committee

Physician Members

Muffaddal Morkas, M.D. Chairman Medical Oncology

Joel Abramowitz, M.D., Ph.D. Medical Oncology/Hematology

Jeffery Charnov, M.D. Pain Management

Vivek Kavadi, M.D. Radiation Oncology

Bonnie Kemp, M.D. Pathology

Rick Ngo, M.D. ACoS Liaison General Surgery

Alex Nguyen, M.D. Medical Oncology

Samuel Pak, M.D. Radiology

James Salter, Jr., M.D. Physician Advisor Pathology

Neil Sherman, M.D. Radiation Oncology

Non-Physician Members

Mary Brimer, RN, OCN Nurse Navigator

Diana Burkett American Cancer Society

Grace Conroy, CTR Cancer Registry

Daren Davin, RN Nurse Navigator (Breast Center)

Peggy Determeyer Chaplaincy

Amy Deutsch, RN, MSN, CNS, OCN APN System

Minerva Franco LMSW Oncology Social Services

Rhonda Kitchen, RN QI Coordinator

Maryellen McGlothlin, RN Nursing Administration

Shelley Mosley, RN, OCN Manager Oncology Floor

Merilyn Oliveros, RN Community Outreach

Maria Tran, MPH, CTR Director, System Wide Cancer Registry

Alla Vargo Cancer Program Administration

Theresa Vela Cancer Registry

Ella Vernon, CTR Manager, Cancer Registry

2010 Cancer Program Goals and Accomplishments

Programmatic: Implemented a palliative care program as a service to include a palliative care physician to be called on

as a consultant.

Clinical: XRT GI Toxicity Assessment/Dietician support was implemented

Community outreach: New Nurse Navigator added to the Cancer Services Department

Great Cancer Seminar & Brunch, The lifestyle-Cancer Connection

Ovarian Cancer Awareness-Paint the Town Teal- An educational Breakfast Seminar

Great American smoke out

Look Good Feel Better Program

Eagle Trace Healthy Living Expo at Eagle’s Trace Senior Living Community

Annual Survivors Day Celebration

Skin Screening and Prostate Screening

General Cancer Support Group

Breast Cancer Support Group

Cancer Conference

A total of 141 cases were presented at cancer conference in 2010 with 91% prospective presentations. The overall

attendance by required physicians was 100%.

Site Cases presented

Head and Neck 9

Digestive Tract 16

Respiratory 20

Bone 2

Breast 49

Retroperitoneum 3

Gynecologic Sites 2

Genitourinary Sites 7

Urinary Tract 7

Brain & CNS 8

Endocrine 2

Lymphatics 9

Unknown Primary 5

TOTAL 141

Community Early Detection Programs

Skin Cancer Screening 47 participants

Prostate Cancer Screening 67 participants

Quality Improvements in Patient Care

• New Cancer Center with state of the art equipment

• Multiple Myeloma: Tailoring Treatment to Optomize Patient Outcomes

• GI Toxicities in the Radiation Oncology Cancer patient population

• Spanning the Continuum of Care: Optimizing Patient Outcomes in NHL

• Nursing Concepts in the Identification and Care of Patients with Peripheral T-Cell Lymphoma

• Obtained new radiation oncology group

• Radiation Oncology department added a cesium I31 isotope seed implant for prostate cancer patients, equally

effective, shorter recovery time

MHMC Sex Class of

Case Stage Distribution

Analytic Cases Only

Primary Site Total (%) M F Analy NA Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Total 1,856 732 1,124 1,327 530 109 363 294 149 148 162 100 ORAL CAVITY & PHARYNX 31 (1.7%) 16 15 22 9 1 2 4 4 6 1 4 Tongue 10 4 6 7 3 1 0 2 0 3 0 1 Salivary Glands 6 4 2 4 2 0 1 1 2 0 0 0 Floor of Mouth 1 1 0 1 0 0 0 0 0 0 0 1 Gum & Other Mouth 4 2 2 3 1 0 1 0 1 0 0 1 Tonsil 3 1 2 3 0 0 0 1 0 2 0 0 Oropharynx 3 1 2 2 1 0 0 0 1 1 0 0 Hypopharynx 2 1 1 1 1 0 0 0 0 0 0 1 Other Oral Cavity & Pharynx 2 2 0 1 1 0 0 0 0 0 1 0 DIGESTIVE SYSTEM 333 (17.9%) 176 157 207 126 6 44 41 46 36 9 25 Esophagus 12 11 1 3 9 0 2 0 0 0 0 1

MHMC Sex Class of


Analytic Cases Only


Stg II

Stg III

Stg IV 88 Unk

Stomach 24 13 11 17 7 0 3 3 3 4 1 3 Small Intestine 3 1 2 3 0 0 1 1 0 0 0 1 Colon Excluding Rectum 134 74 60 95 39 5 23 27 24 15 0 1 Rectum & Rectosigmoid 61 37 24 33 28 1 6 8 10 4 0 4 Anus, Anal Canal & Anorectum 8 3 5 3 5 0 0 0 0 0 0 3 Liver & Intrahepatic Bile Duct 23 13 10 14 9 0 5 0 1 1 4 3 Gallbladder 7 3 4 4 3 0 0 1 2 1 0 0 Other Biliary 9 5 4 7 2 0 1 0 0 0 2 4 Pancreas 44 14 30 22 22 0 3 1 4 9 0 5 Retroperitoneum 1 1 0 0 1 0 0 0 0 0 0 0 Peritoneum, Omentum & Mesentery 5 0 5 4 1 0 0 0 2 2 0 0 Other Digestive Organs 2 1 1 2 0 0 0 0 0 0 2 0 RESPIRATORY SYSTEM 225 (12.1%) 112 113 163 62 0 31 20 21 60 2 28 Larynx 9 6 3 8 1 0 4 1 1 0 0 2 Lung & Bronchus 213 103 110 154 59 0 26 19 20 60 2 26 Mesothelioma 3 3 0 1 2 0 1 0 0 0 0 0 BONES & JOINTS 2 (0.1%) 0 2 2 0 0 1 0 0 0 0 1 SOFT TISSUE 6 (0.3%) 2 4 5 1 0 2 1 0 1 0 1 SKIN excluding basal & squamous 17 (0.9%) 10 7 8 9 2 3 0 0 1 1 1 Melanoma -- Skin 16 10 6 7 9 2 3 0 0 1 0 1 Other Skin 3 2 1 2 1 0 0 0 0 0 2 0 BREAST 446 (24.0%) 0 446 337 109 64 128 97 20 12 0 16 FEMALE GENITAL SYSTEM 137 (7.4%) 0 137 98 39 12 37 7 20 6 11 4 Cervix Uteri 17 0 17 11 6 0 7 1 2 1 0 0 Corpus Uteri 54 0 54 43 11 0 22 3 6 1 8 2 Ovary 43 0 43 22 21 0 5 2 10 3 0 2 Vagina 3 0 3 3 0 3 0 0 0 0 0 0 Vulva 15 0 15 14 1 9 3 1 1 0 0 0

MHMC Sex Class of


Analytic Cases Only


Stg II

Stg III

Stg IV 88 Unk

Other Female Genital Organs 5 0 5 5 0 0 0 0 1 1 3 0 MALE GENITAL SYSTEM 181 (9.7%) 181 0 135 46 0 19 96 13 4 0 3 Prostate 168 168 0 123 45 0 12 94 11 4 0 2 Testis 10 10 0 9 1 0 6 1 2 0 0 0 Penis 2 2 0 2 0 0 1 1 0 0 0 0 Other Male Genital Organs 1 1 0 1 0 0 0 0 0 0 0 1 URINARY SYSTEM 100 (5.4%) 77 23 88 12 24 33 12 11 5 0 3 Urinary Bladder 50 41 9 43 7 22 9 6 3 2 0 1 Kidney & Renal Pelvis 48 34 14 43 5 2 23 5 8 3 0 2 Ureter 1 1 0 1 0 0 1 0 0 0 0 0 Other Urinary Organs 1 1 0 1 0 0 0 1 0 0 0 0 EYE & ORBIT 1 (0.1%) 1 0 1 0 0 0 0 0 0 0 1 BRAIN & other nervous system 55 (3.0%) 20 35 39 16 0 0 0 0 0 39 0 Brain 26 14 12 15 11 0 0 0 0 0 15 0 CNS 29 6 23 24 5 0 0 0 0 0 24 0 ENDOCRINE SYSTEM 90 (4.8%) 22 68 85 5 0 43 6 7 1 18 10 Thyroid 68 9 59 66 2 0 43 5 7 1 0 10 Other Endocrine including Thymus 22 13 9 19 3 0 0 1 0 0 18 0 LYMPHOMA 91 (4.9%) 47 44 57 34 0 20 10 7 16 1 3 Hodgkin Lymphoma 11 3 8 7 4 0 2 3 0 1 0 1 Non-Hodgkin Lymphoma 80 44 36 50 30 0 18 7 7 15 1 2 MYELOMA 28 (1.5%) 16 12 14 14 0 0 0 0 0 14 0 LEUKEMIA 36 (1.9%) 18 18 20 16 0 0 0 0 0 20 0 Lymphocytic Leukemia 10 6 4 6 4 0 0 0 0 0 6 0 Myeloid & Monocytic Leukemia 24 12 12 14 10 0 0 0 0 0 14 0 Other Leukemia 2 0 2 0 2 0 0 0 0 0 0 0 HEMATAPOETIC DISEASE 23 (1.2%) 8 15 23 0 0 0 0 0 0 23 0 UNKNOWN PRIMARY 52 (2.8%) 24 28 52 0 0 0 0 0 0 52 0

MEMORIAL HERMANN NORTHEAST

Memorial Hermann Northeast Hospital is an approved Community Hospital Cancer Program through the American College of

Surgeons Commission on Cancer. The Cancer Program has maintained approval status since 1993. Through the effective

leadership of the Cancer Committee, MH-NE continues the commitment to provide high-quality, compassionate cancer care to

the community we serve. Memorial Hermann Northeast continues to strive to maintain achievements through the

development, collaboration and evaluation of annual goals and objectives for the hospital. In 2010, the Memorial Hermann

Northeast Hospital cancer program received three year reaccreditation with commendation from the Commission on Cancer.

Cancer Committee

Physician Members

Richard P. Baltz, M.D. - Medical Oncology - Chairman & Tumor Board Coordinator

Walid Adham, M.D. – Diagnostic Radiology

Neelofur Ahmad, M.D. – Radiation Oncology

Giuseppe Fraschini, M.D. – Medical Oncology

Kathy Lamprecht, M.D. – Pathology – Quality Control of Registry Data

Majid Mohiuddin, M.D. – Radiation Oncology

Jose Ortega, M.D. – General Surgery – CoC Physician Liaison

Sally Shu, M.D. – Otolaryngology


Gayle Bratsakis, C.T.R. – Senior Cancer Registry Coordinator

Tom Broad – Marketing – Community Outreach Coordinator

Carol Cartwright, L.M.S.W. – Social Worker

Charlotte Daigle – American Cancer Society

Lisa Daniel – Clinical Manager Breast Center

Janet Duncan, R.N. – Clinical Manager 5 Tower

Amy Deutsch, D.N.P.(c), R.N.,C.N.S., O.C.N. – System Advanced Practice Nurse

Cassie McClain, R.N. – Clinical Manger Hospice

Raelynn Munsinger, R.N. – Breast Center Nurse Navigator

Susan Noe – Manager Rehab

Toni Schau, R.N.- Community Educator

Kathy Tenczynski, C.T.R., Manager Cancer Registry

Maria Tran, M.P.H., C.T.R. – Director System Cancer Registry

Joyce White, R.N. – Community Educator

Lynn Whitehair, M.B.A. – Cancer Program Administrator

Linda Wuest, R.N., B.S.N.,O.C.N. – Oncology Nurse Navigator – Quality Improvement Coordinator

2010 Cancer Committee Goals and Accomplishments

• Clinical: Pursue a social worker position one day a week for outpatient oncology

• Community Outreach: Increase annual number of women receiving services from Project Mammogram by 15%

• Quality Improvement: 1) Malnutrition screening program for Radiation Oncology patients. 2) Implement tracking

of education/certifications of 5 Tower staff assuring System requirements for port competency and chemotherapy

courses have been completed.

• Programmatic Goals: 1) Implementation infusion suite. 2) Successful Commission on Cancer Survey


EVENT Number of Participants

Skin Cancer Screening 122

Prostate Cancer Screening 110

Oral Cancer Screening 35

Project Mammogram 582 diagnostic and/or screening procedures

Colorectal Seminar 40

Tumor Board Summary

Facility-wide, bi-weekly conferences were held. 48 cases presented or 12% of analytic caseload with 83% staging discussion,

95% national treatment guidelines discussion and 100% attendance of required physicians. In 2010, the following sites were

presented.

Head and Neck 6

Digestive System 2

Respiratory System 8

Breast 18

Gynecologic Sites 1


Endocrine 2

Lymphoma 4

Skin 2

Unknown Primary 4

Total Prospective Cases 39 (81%)

TOTAL PRESENTED 48


• New software & hardware for treatment planning in Radiation Oncology

• Genetic Counseling

• American Cancer Society’s Gift Closet (Bras and prosthesis for no cost for low income patient)

• Cancer pain management in-services for 5 Tower nursing staff

• Radiation Oncology Toxicity Assessment Tool for dietician

• In-service of 5 Tower nursing staff on “Oncologic Emergencies” by Majid Mohiuddin, M.D., Radiation Oncologist

• Chemotherapy Desensitization Protocol

Cancer-Related Professional Education

• Inclusive Her-2 Testing

• Infertility Preservation Options for the Oncology Patient

• The Advisory Board Oncology Round Table

• Multiple Myeloma: Tailoring Treatment to Optimize Patient Outcomes


MHNE 2010 Stage Distribution - Analytic Cases OnlyPrimary Site Total (%) M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 UnkTotals 617 272 345 395 222 25 81 80 66 73 42 28ORAL CAVITY & PHARYNX 18 (2.9%) 14 4 12 6 0 0 1 3 8 0 0Tongue 6 4 2 4 2 0 0 1 1 2 0 0Salivary Glands 1 1 0 0 1 0 0 0 0 0 0 0Gum & Other Mouth 1 0 1 1 0 0 0 0 0 1 0 0Pharynx 10 9 1 7 3 0 0 0 2 5 0 0DIGESTIVE SYSTEM 110 (17.8%) 65 45 63 47 0 11 10 9 21 0 12Esophagus 7 7 0 3 4 0 0 0 0 0 0 3Stomach 13 7 6 8 5 0 0 2 1 3 0 2Small Intestine 2 1 1 2 0 0 0 0 1 1 0 0Colon Excluding Rectum 38 19 19 21 17 0 5 5 4 4 0 3Rectum & Rectosigmoid 22 15 7 16 6 0 3 3 2 7 0 1Anus, Anal Canal & Anorectum 2 1 1 2 0 0 0 0 0 0 0 2Liver & Intrahepatic Bile Duct 10 8 2 2 8 0 1 0 0 0 0 1Gallbladder 3 0 3 3 0 0 1 0 0 2 0 0Other Biliary 2 1 1 1 1 0 0 0 0 1 0 0Pancreas 11 6 5 5 6 0 1 0 1 3 0 0RESPIRATORY SYSTEM 112 (18.2%) 54 58 71 41 0 7 9 22 31 0 2Nose, Nasal Cavity & Middle Ear 1 1 0 0 1 0 0 0 0 0 0 0Lung & Bronchus 111 53 58 71 40 0 7 9 22 31 0 2BONES & JOINTS 1 (0.2%) 0 1 0 1 0 0 0 0 0 0 0SOFT TISSUE 4 (0.6%) 3 1 1 3 0 1 0 0 0 0 0SKIN EXCLUDING BASAL & SQUAMOUS 7 (1.1%) 3 4 4 3 3 0 0 1 0 0 0Melanoma -- Skin 5 2 3 4 1 3 0 0 1 0 0 0Other Skin 2 1 1 0 2 0 0 0 0 0 0 0BREAST 153 (24.8%) 0 153 119 34 17 50 29 18 4 0 1FEMALE GENITAL SYSTEM 19 (3.1%) 0 19 10 9 0 2 1 3 2 0 2Cervix Uteri 4 0 4 3 1 0 1 1 1 0 0 0Corpus Uteri 5 0 5 2 3 0 1 0 0 1 0 0Ovary 9 0 9 4 5 0 0 0 2 1 0 1Vulva 1 0 1 1 0 0 0 0 0 0 0 1MALE GENITAL SYSTEM 60 (9.7%) 60 0 33 27 0 3 22 3 2 0 3Prostate 56 56 0 30 26 0 1 22 2 2 0 3Testis 3 3 0 2 1 0 1 0 1 0 0 0Penis 1 1 0 1 0 0 1 0 0 0 0 0URINARY SYSTEM 35 (5.7%) 27 8 20 15 5 5 2 4 2 0 2Urinary Bladder 18 16 2 12 6 5 3 2 0 1 0 1Kidney & Renal Pelvis 16 10 6 7 9 0 2 0 4 1 0 0Ureter 1 1 0 1 0 0 0 0 0 0 0 1BRAIN & OTHER NERVOUS SYSTEM 11 (1.8%) 5 6 10 1 0 0 0 0 0 10 0Brain 4 2 2 4 0 0 0 0 0 0 4 0CNS 7 3 4 6 1 0 0 0 0 0 6 0ENDOCRINE SYSTEM 7 (1.1%) 2 5 7 0 0 1 1 3 0 2 0Thyroid 5 0 5 5 0 0 1 1 3 0 0 0Other Endocrine including Thymus 2 2 0 2 0 0 0 0 0 0 2 0LYMPHOMA 26 (4.2%) 13 13 15 11 0 1 5 0 3 0 6Hodgkin Lymphoma 1 0 1 1 0 0 0 1 0 0 0 0Non-Hodgkin Lymphoma 25 13 12 14 11 0 1 4 0 3 0 6NHL - Nodal 17 10 7 8 9 0 0 2 0 2 0 4NHL - Extranodal 8 3 5 6 2 0 1 2 0 1 0 2MYELOMA 10 (1.6%) 4 6 5 5 0 0 0 0 0 5 0LEUKEMIA 21 (3.4%) 8 13 12 9 0 0 0 0 0 12 0Acute Lymphocytic Leukemia 1 0 1 1 0 0 0 0 0 0 1 0Chronic Lymphocytic Leukemia 10 3 7 4 6 0 0 0 0 0 4 0Acute Myeloid Leukemia 4 1 3 4 0 0 0 0 0 0 4 0Chronic Myeloid Leukemia 4 3 1 2 2 0 0 0 0 0 2 0Other Leukemia 2 1 1 1 1 0 0 0 0 0 1 0HEMATOPOIETIC DISEASE 12 (1.9%) 8 4 5 7 0 0 0 0 0 5 0UNKNOWN PRIMARY 11 (1.8%) 6 5 8 3 0 0 0 0 0 8 0

Sex Class of Case

MEMORIAL HERMANN NORTHWEST

Memorial Hermann Northwest Hospital is a 216 bed Community Hospital Cancer Program that has been providing

quality cancer care to patients since it was first accredited by the Commission on Cancer in 2000. Our program utilizes

the efforts of surgeons, medical oncologists, radiation oncologists, interventional radiologists, pathologists, nurses, social

workers, chaplains, cancer registrars, administrators and many other qualified and highly committed individuals to deliver

quality cancer care in the community. We pride ourselves on our weekly Cancer Conferences, where prospective cases

are discussed, and multidisciplinary care plans are formulated. We sponsor prostate, skin, and oral cancer screenings on a

regular basis for the community, and host a number of seminars for the public involving breast and colon cancer. Our

Imaging Department has been classified as a Breast Imaging Center of Excellence, affording cutting-edge digital

mammography, ultrasound, and on-the-spot biopsy capabilities to facilitate rapid diagnosis of breast lesions. We strive to

offer our patients the absolute best in comprehensive and compassionate cancer care in their own community.

Cancer Committee

Physicians

T. F. Tenczynski, MD – Medical Oncology, Chairman

W. Michael Ratliff, MD – General Surgery, Cancer Liaison Physician, Cancer Conference Coordinator

Vinod Bhuchar, MD – Medical Oncology

Luke Burke, MD – Otolaryngology

Jennifer Cunningham, MD – Pulmonary Medicine

Peter Farha, MD – Medical Oncology

Arthur Hamberger, MD – Radiation Oncology

Daniel Howell, MD – Colorectal Surgery

Shahab Khan, MD - Medical Oncology

Robert E. McDonald, MD – Urology

Robert Montoya, MD – Plastic Surgery

Samuel Smiley, MD – Diagnostic Radiology

Sergio Soroka, MD – Pathology


Shelita Anderson, RN, OCN – Oncology Unit, Oncology Nurse

Jeremy Brynes – Director of Business Development, Cancer Program Administrator

Diana Burkett – American Cancer Society

John Champagne – Pastoral Services

Sonja Cothran, RN – Quality Management

Jean Dorosh, LMSW – Social Services

Reyna Hernandez, CTR – Cancer Registrar

Gary Kerr – Administration

Diana Schauer-Tran – Community Outreach

Nancy Stamos, RRT – Radiation Therapy

Ad-hoc Members

Linda Arfele, RN – Rehab Services

Aziz Benamar, RRT – Radiology

Amy Deutsch, DNP, RN, CNS, OCN – System Services

Diana Howard, RN, OCN – Radiation Therapy

Tanika Lee – Registry Office Assistant

Angela Sisk, MSN, RN, OCN – Nurse Navigator

Kathy Tenczynski, CTR – Cancer Registrar

Maria Tran, MPH, CTR – System Services, Cancer Registry

Cancer Committee Goals and Accomplishments

Clinical – Increase the number of oncology certified nurses and increase the number of chemotherapy certified nurses.

Community Outreach – Hold 4 screening for the community and a smoking cessation event. Increase survivor support.

Programmatic – A clinical staging rate of 60% set for the top three sites: breast, lung and prostate cancers.

Quality Improvement – Clinical staging pilot study created to obtain clinical stage from the physician’s office prior to

the patient’s surgery.

Community Early Detection Program

EVENT PARTICIPANTS

Breast Seminar 22

Colorectal Seminar 23



Cancer Conference

Facility-wide cancer conferences are held weekly every Wednesday at 12:00 pm. In 2010, a total of 140 cases were

presented or 31% of the analytic caseload. The conference continues to meet the requirements of the Commission on

Cancer for physician attendance (100%), prospective case presentations (94%), and discussion of cancer stage and patient

treatment planning (>80%).

Head and Neck 37

Digestive System 34


Breast 29

Gynecologic Sites 7


Lymphoma 6

Hematopoietic 1

Skin 3

Unknown Primary 4

TOTAL 140


• A task force was created to re-educate all nurses on central line placement. Two central line experts will be

available during each shift to assist physicians

• Speech Therapist available to head and neck patients during and after radiation therapy treatment

• The Imaging Department has been designated as a Breast Imaging Center of Excellence by the American College

of Radiology.

• Breast patient support services provided by the Oncology Nurse Navigator, before, during, and after procedures to

improve patient experiences

• Chemotherapy order templates developed and approved

• Nurse Navigator provides education, support and appointment assistance

• American Cancer Society representative relocated to the Cancer Center for easier patient access

• American Cancer Society personal health manager kits available through the ACS volunteer or Nurse Navigator

• Pain management physician




• Advances in the Treatment of Multiple Myeloma

MHNW Sex Class of


Analytic Cases Only

Primary Site Total (%) M F Analy NA

Stg 0

Stg I

Stg II

Stg III

Stg IV 88 Unk

Total 666 299 367 451 215 21 89 83 78 112 39 29

ORAL CAVITY & PHARYNX 19 (2.8%) 14 5 13 6 0 0 0 5 7 1 0

Tongue 9 7 2 6 3 0 0 0 3 3 0 0 Gum & Other Mouth 3 2 1 2 1 0 0 0 0 2 0 0 Pharynx 5 3 2 4 1 0 0 0 2 2 0 0 Other Oral Cavity & Pharynx 2 2 0 1 1 0 0 0 0 0 1 0

DIGESTIVE SYSTEM 164 (24.6%) 90 74 126 38 1 22 24 25 38 4 12

Esophagus 9 7 2 8 1 0 0 0 2 5 0 1 Stomach 16 10 6 12 4 0 1 2 4 5 0 0 Small Intestine 1 0 1 1 0 0 0 0 0 1 0 0 Colon Excluding Rectum 64 31 33 48 16 1 11 14 10 11 0 1 Rectum & Rectosigmoid 29 18 11 23 6 0 5 6 6 3 1 2 Anus, Anal Canal & Anorectum 2 2 0 2 0 0 0 1 1 0 0 0 Liver & Intrahepatic Bile Duct 14 10 4 9 5 0 0 0 0 3 1 5 Gallbladder 6 1 5 6 0 0 1 0 1 3 0 1 Other Biliary 4 3 1 4 0 0 2 0 0 0 1 1 Pancreas 16 8 8 10 6 0 2 1 0 6 0 1 Retroperitoneum 1 0 1 1 0 0 0 0 1 0 0 0 Peritoneum, Omentum & Mesentery 1 0 1 1 0 0 0 0 0 1 0 0 Other Digestive Organs 1 0 1 1 0 0 0 0 0 0 1 0

RESPIRATORY SYSTEM 110 (16.5%) 67 43 78 32 0 12 10 17 35 0 4

Larynx 7 5 2 5 2 0 1 1 1 2 0 0 Lung & Bronchus 101 61 40 73 28 0 11 9 16 33 0 4 Mesothelioma 2 1 1 0 2 0 0 0 0 0 0 0 BONES & JOINTS 1 (0.2%) 1 0 0 1 0 0 0 0 0 0 0 SOFT TISSUE 4 (0.6%) 0 4 3 1 0 0 0 0 2 1 0 SKIN excluding basal & squamous 5 (0.7%) 3 2 1 4 0 0 1 0 0 0 0 Skin - Melanoma 4 2 2 1 3 0 0 1 0 0 0 0 Kaposi Sarcoma 1 1 0 0 1 0 0 0 0 0 0 0

BREAST 123 (18.5%) 0 123 92 31 12 22 32 11 9 0 6

FEMALE GENITAL SYSTEM 33 (5.0%) 0 33 21 12 0 7 2 5 2 2 3

Cervix Uteri 12 0 12 12 0 0 4 2 3 0 1 2 Corpus Uteri 13 0 13 6 7 0 3 0 0 1 1 1 Ovary 6 0 6 2 4 0 0 0 1 1 0 0 Vulva 2 0 2 1 1 0 0 0 1 0 0 0

MHNW Sex Class of


Analytic Cases Only


Stg 0

Stg I

Stg II

Stg III

Stg IV 88 Unk

MALE GENITAL SYSTEM 57 (8.6%) 57 0 23 34 0 3 9 4 5 0 2

Prostate 54 54 0 22 32 0 2 9 4 5 0 2 Testis 3 3 0 1 2 0 1 0 0 0 0 0

URINARY SYSTEM 35 (5.3%) 20 15 29 6 8 13 0 2 5 0 1

Urinary Bladder 18 13 5 13 5 8 3 0 0 1 0 1 Kidney & Renal Pelvis 17 7 10 16 1 0 10 0 2 4 0 0 BRAIN & OTHER NERVOUS SYSTEM

12 (1.8%) 5 7 5 7 0 0 0 0 0 5 0

Brain 1 1 0 1 0 0 0 0 0 0 1 0 CNS 11 4 7 4 7 0 0 0 0 0 4 0

ENDOCRINE SYSTEM 18 (2.7%) 4 14 15 3 0 6 0 3 1 4 1

Thyroid 12 1 11 11 1 0 6 0 3 1 0 1 Other Endocrine including Thymus 6 3 3 4 2 0 0 0 0 0 4 0

LYMPHOMA 35 (5.3%) 16 19 23 12 0 4 5 6 8 0 0

Hodgkin Lymphoma 4 3 1 3 1 0 1 1 0 1 0 0 Non-Hodgkin Lymphoma 31 13 18 20 11 0 3 4 6 7 0 0 NHL - Nodal 25 11 14 15 10 0 0 3 6 6 0 0 NHL - Extranodal 6 2 4 5 1 0 3 1 0 1 0 0

MYELOMA 13 (2.0%) 8 5 5 8 0 0 0 0 0 5 0

LEUKEMIA 5 (0.8%) 2 3 2 3 0 0 0 0 0 2 0 Lymphocytic Leukemia 2 1 1 0 2 0 0 0 0 0 0 0 Myeloid & Monocytic Leukemia 1 0 1 1 0 0 0 0 0 0 1 0 Other Leukemia 2 1 1 1 1 0 0 0 0 0 1 0

HEMATOPOIETIC DISEASE 10 (1.5%) 2 8 3 7 0 0 0 0 0 3 0

UNKNOWN PRIMARY 22 (3.3%) 10 12 12 10 0 0 0 0 0 12 0

MEMORIAL HERMANN SOUTHEAST

The Cancer Program at Memorial Hermann Southeast is accredited as a Community Hospital Cancer Program by the

American College of Surgeons Commission on Cancer (CoC) and earned its cancer accreditation with nine

commendations, the highest possible level of accreditation. Additionally, the CoC awarded Memorial

Hermann Southeast Hospital with its 2008 Commission on Cancer Outstanding Achievement Award. This additional

award recognizes cancer programs that exceed the standards in seven areas of compliance: cancer committee

leadership, cancer data management, clinical services, research, community outreach, and quality improvement. In

2010, Memorial Hermann Southeast enhanced its Imaging Services to by implementing the use of MRI imaging and

MRI-guided biopsies of the breast. We introduced the use of iLogic Electomagnetic Navigation Bronchoscopy

technology to reach lung lesions deep within the small airways in a minimally invasive way and also

enhanced our surgical services by implementing the single-incision surgery for colon cancer patients. The Cancer

Program at Memorial Hermann Southeast is committed to providing quality, state-of-the-art care close to home.

Cancer Committee

Physicians

Farzaneh Banki, MD, Surgery

Mary Cross, MD, General Practice

Craig Floyd, MD, Pathology

Mohamed Haq, MD, Oncology

Nadya Hasham-Jiwa, MD, Oncology (Chairman)

Aaron Joseph, MD, Dermatology

Mohammad Khan, MD, Oncology

David Lawrence, Jr., MD, Radiology

Alex Lechin, MD, Pulmonology

Sahba Nadeem, MD, Oncology

Suresh Rajendran, MD, Gastroenterology

Joseph Roosth, MD, Palliative Medicine

Ted Voloyiannis, MD, Colorectal Surgery

Theodore Yang, MD, Radiation Oncology

Non-Physicians

Kyle Price, Administration

Shane Crisp, Healthcare Improvement

Coleen White, Radiation Oncology

Margaret Cryer, Medical Oncology Nursing

Keith Cypert, Social Services

Carol Dippel, Nutritional Services

Ami Gates, Cancer Registry

Diana Burkett, American Cancer Society

Julieanne Levine, Marketing

Gayle Hatch, Nurse Navigator

Marci Holub, Medical Oncology Nursing


Clinical Goal- Institute a bowel regimen for oncology patients on pain medication on the oncology unit

Community Outreach Goal- Provide cancer-related educational and screening events for teachers in local school

districts

Programmatic Goal- Increase clinical staging for bladder cases by 50%

Quality Improvement Goal- Increase the availability of AJCC 7th Edition Staging in Care4


EVENT PARTICIPANTS



Tumor Board Summary

Digestive 14

Respiratory 17

Breast 16

Gynecologic Sites 2


Lymphoid Neoplasms 3

Unknown Primary 1

Total Cases Presented 57

Total Prospective 57


• Implemented Single-incision Surgery for select colon cancer patients

• Implemented use of MRI Imaging for breast and MRI guided biopsies

• Implemented the use of iLogic Electomagnetic Navigation Bronchoscopy technology to reach lung lesions

deep within the small airways in a minimally invasive way

Professional Education

• Preserving Fertility for the Patient Undergoing Cancer Treatment

• ALK Mutation: A Recently Recognized Molecular Subtype of NSCLC with Significant Theraputic

Implications

• Electomagnetic Navigation Bronchoscopy- Minimally Invasive Access to Deep Lesions


• Spanning the Continuum of Care: Optimizing Patient Outcomes in NHL


MHSE Sex Class of Case

Stage Distribution Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Totals 790 380 410 540 250 30 132 95 74 83 71 55

ORAL CAVITY & PHARYNX

17 (2.2%) 12 5 9 8 0 1 1 1 4 1 1

Tongue 5 4 1 3 2 0 1 0 0 2 0 0

Salivary Glands 1 0 1 0 1 0 0 0 0 0 0 0

Gum & Other Mouth 2 1 1 2 0 0 0 0 0 1 0 1

Pharynx 6 5 1 3 3 0 0 1 1 1 0 0

Other Oral Cavity & Pharynx 3 2 1 1 2 0 0 0 0 0 1 0


Esophagus 12 7 5 5 7 0 0 1 0 2 0 2

Stomach 20 11 9 7 13 0 2 1 1 2 0 1

Small Intestine 4 2 2 4 0 0 1 0 2 0 0 1

Colon Excluding Rectum 55 25 30 47 8 1 9 12 13 9 0 3

Rectum & Rectosigmoid 34 27 7 26 8 0 8 9 6 1 0 2

Anus, Anal Canal & Anorectum 4 2 2 2 2 0 0 1 0 0 1 0

Liver & Intrahepatic Bile Duct 18 14 4 11 7 0 4 0 2 1 2 2

Gallbladder 3 1 2 3 0 0 0 2 0 0 0 1

Other Biliary 4 4 0 4 0 1 1 1 1 0 0 0

Pancreas 19 12 7 15 4 0 4 3 0 5 0 3


Larynx 6 5 1 4 2 0 2 0 0 1 0 1

Lung & Bronchus 147 82 65 101 46 0 18 12 23 37 0 11

Mesothelioma 2 2 0 1 1 0 0 0 0 0 0 1

Other Respiratory Organs 3 2 1 3 0 0 0 0 0 0 3 0

MHSE Sex Class of Case Stage Distribution

Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

BONES & JOINTS 1 (0.1%) 1 0 1 0 0 1 0 0 0 0 0

SOFT TISSUE 5 (0.6%) 2 3 5 0 0 4 0 0 0 0 1

SKIN excluding basal & squamous

12 (1.5%) 6 6 6 6 1 0 1 1 2 0 1

Melanoma -- Skin 11 6 5 6 5 1 0 1 1 2 0 1

Other Non-Epithelial Skin 1 0 1 0 1 0 0 0 0 0 0 0

BREAST 153 (19.4%) 1 152 116 37 18 46 26 13 4 0 9

FEMALE GENITAL SYSTEM

24 (3.0%) 0 24 18 6 0 5 3 3 3 1 3

Cervix Uteri 6 (0.8%) 0 6 4 2 0 0 3 1 0 0 0

Corpus Uteri 9 (1.1%) 0 9 8 1 0 5 0 0 0 1 2

Ovary 9 (1.1%) 0 9 6 3 0 0 0 2 3 0 1


Prostate 48 (6.1%) 48 0 20 28 0 0 11 0 5 0 4

Testis 6 (0.8%) 6 0 6 0 0 4 1 1 0 0 0

Penis 1 (0.1%) 1 0 1 0 0 0 0 0 0 0 1

URINARY SYSTEM 57 (7.2%) 43 14 40 17 9 16 6 2 3 0 4

Urinary Bladder 28 (3.5%) 24 4 21 7 8 5 5 1 1 0 1

Kidney & Renal Pelvis 28 (3.5%) 18 10 18 10 1 11 1 1 2 0 2

Ureter 1 (0.1%) 1 0 1 0 0 0 0 0 0 0 1

BRAIN & CNS 27 (3.4%) 13 14 19 8 0 0 0 0 0 19 0

Brain 11 (1.4%) 8 3 6 5 0 0 0 0 0 6 0

CNS 16 (2.0%) 5 11 13 3 0 0 0 0 0 13 0


Thyroid 3 (0.4%) 1 2 2 1 0 2 0 0 0 0 0

Other Endocrine including Thymus 6 (0.8%) 0 6 4 2 0 0 0 0 0 4 0

LYMPHOMA 33 (4.2%) 18 15 20 13 0 4 4 5 4 0 3

Hodgkin - Nodal 4 2 2 2 2 0 0 1 1 0 0 0

Hodgkin - Extranodal 1 1 0 1 0 0 0 0 0 1 0 0

NHL - Nodal 19 8 11 9 10 0 3 2 3 0 0 1

NHL - Extranodal 9 7 2 8 1 0 1 1 1 3 0 2

MHSE Sex Class of Case Stage Distribution

Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

MYELOMA 10 (1.3%) 4 6 6 4 0 0 0 0 0 6 0

LEUKEMIA 23 (2.9%) 12 11 14 9 0 0 0 0 0 14 0

ALL 1 1 0 1 0 0 0 0 0 0 1 0

CLL 6 4 2 3 3 0 0 0 0 0 3 0

AML 10 4 6 7 3 0 0 0 0 0 7 0

CML 1 0 1 1 0 0 0 0 0 0 1 0

Other Leukemia 5 3 2 2 3 0 0 0 0 0 2 0

HEMATOPOIETIC DISEASE 8 4 4 2 6 0 0 0 0 0 2 0

UNKNOWN PRIMARY 25 12 13 18 7 0 0 0 0 0 18 0

MEMORIAL HERMANN SOUTHWEST

Memorial Hermann Southwest Hospital, accredited by the Commission on Cancer since 1993, is a Comprehensive

Community Cancer Program. The program is comprised of many different departments and services including, but not

limited to, diagnostic imaging services, a full-service breast center, clinical research services, surgical oncology services,

an inpatient medical oncology unit, and a Radiation Oncology department with a linear accelerator.


Physician Members

Arlene Ricardo, MD – Breast Surgeon (Cancer Chairman)

Mark Bonnen, MD – Radiation Oncology

Richard Brown, MD – Pathology (Quality Coordinator of Cancer Registry Data)

Robert Furse, MD – Medical Oncology

Anne Kushwaha, MD – Breast Radiology

Kay Lee, MD – Family Practice

Patricia Mitchell, MD – Gynecology

Darren Pollock, MD – Colon and Rectal Surgeon (Cancer Liaison Physician)

Nabeel Shalan, MD – Medical Oncology

William Velasquez, MD – Medical Oncology (Cancer Conference Coord.)


Marcela Arauz – Cancer Nurse Navigator

Leila Asnaashari – Cancer Registry

Esther Batarseh – Radiology

Kristin Chandler – Research

Amy Deutsch – Advanced Practice Nurse

Fawnya Doiron – Breast Center

Vivian Dunlop – Rehab services

Cindy Garza – Oncology (Quality Improvement Coord.)

David Leos – Nurse Educator

Sherry Nelson – Healthcare Improvement

Toke Ogundiya – Oncology

Julia Powers – Research

Kyle Stanzel – Marketing

Felicia Warren – Cancer Registry

Patricia Watson – Social Worker

Gina Yokley – Palliative Nurse

2010 CANCER CONFERENCE SUMMARY

Memorial Hermann Southwest hosts weekly tumor board meetings and site-focused breast conferences. These

conferences allow for prospective review of cancer cases and encourage multidisciplinary involvement in the care process.

Cancer conferences are integral to improving the care of cancer patients by contributing to the patient management

process and outcomes as well as providing education to physicians and other hospital staff in attendance. These meetings

are designated a maximum of 1 AMA PRA Category 1 Credits(s)TM.

In 2010, 107 cancer cases were presented, representing 11 % of the annual analytic caseload. The conference continually

meets the Commission on Cancer requirements for physician attendance (>90%), prospective case presentations (>80%),

and discussion of cancer stage and patient treatment planning (>80%).

2010 CANCER EDUCATION

• Preserving Fertility for the Patient Undergoing Cancer Treatment

• Multiple Myeloma: Tailoring Treatments to Optimize Patient Outcomes

• Microwave Ablation

• Nursing Concepts in the Identification and Care of Patients with Peripheral T-cell Lymphoma

2010 CANCER SCREENINGS

• Colorectal awareness (March)

• Skin screening

• Participated in Asian Community fairs

• Survivors Day and Resource Fair

2010 QUALITY IMPROVEMENTS IN PATIENT CARE

• Anti-emetic pocket cards

• superDimension Navigational Bronchoscopy

• American Cancer Society personal health manager kits in the Breast Center

• Updated Cancer Services folder with fact sheets about services offered at MH-SW

• Updated CAP Protocols on surgical pathology reports

• Breast Nurse Navigator was hired

• American Cancer Society visits in radiation therapy department

• Chemotherapy order templates developed and approved

• Third Eye Retroscope

• Faxitron machine in the OR for breast cases

• Accuboost in Radiation Therapy

• Child Life Specialist

• Re-modeled Breast Center

2010 GOALS/ACCOMPLISHMENTS

• Clinical Goals -Improved documentation of patient response to PRN medications from 79% to over 90%;

Improved patient satisfaction scores for nursing response time to call lights; Number of Oncology Certified

Nurses increased

• Community Outreach Goals – Provide 3 or more cancer-related educational and screening events for the

community

• Programmatic Goals - Cancer Committee by-laws were updated for membership and cancer staging

requirement; Radiation Oncologist was hired; Breast center sign on building

• Quality Improvement Goal -Electronic cancer treatment letters in Care4

MHSW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Total 1,336 561 775 984 352 102 249 179 112 119 129 94

ORAL CAVITY & PHARYNX 15 (1.2%) 10 5 9 6 0 2 2 1 3 0 1 Tongue 4 2 2 2 2 0 1 1 0 0 0 0

Salivary Glands 3 3 0 3 0 0 0 0 1 2 0 0

Gum & Other Mouth 1 0 1 0 1 0 0 0 0 0 0 0

Nasopharynx 3 3 0 2 1 0 0 1 0 0 0 1

Tonsil 1 1 0 1 0 0 0 0 0 1 0 0

Oropharynx 1 0 1 1 0 0 1 0 0 0 0 0

Hypopharynx 1 1 0 0 1 0 0 0 0 0 0 0

Other Oral Cavity & Pharynx 1 0 1 0 1 0 0 0 0 0 0 0

DIGESTIVE SYSTEM

196

(14.7%) 108 88 149 47 2 27 24 36 32 7 21

Esophagus 12 7 5 7 5 1 2 0 3 0 0 1

Stomach 21 15 6 19 2 0 5 5 3 2 0 4

Small Intestine 3 2 1 3 0 0 1 0 0 2 0 0



Anus, Anal Canal &

Anorectum 5 2 3 4 1 0 0 0 1 2 0 1


Gallbladder 4 1 3 3 1 0 0 0 1 0 0 2

Other Biliary 1 1 0 1 0 0 1 0 0 0 0 0

Pancreas 36 15 21 26 10 0 2 4 2 15 0 3

MHSW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Retroperitoneum 1 0 1 1 0 0 1 0 0 0 0 0

Other Digestive Organs 2 1 1 2 0 0 0 0 0 0 2 0


Larynx 11 10 1 5 6 0 3 0 0 1 0 1

Lung & Bronchus 154 79 75 110 44 0 17 10 23 46 2 12

Mesothelioma 2 2 0 1 1 0 0 0 0 0 1 0

Other Respiratory Organs 1 0 1 1 0 0 0 0 0 0 1 0

BONES & JOINTS 2 (0.1%) 2 0 1 1 0 0 0 0 1 0 0

SOFT TISSUE 8 (0.6%) 2 6 6 2 0 2 1 1 1 1 0

SKIN excluding basal & squamous 12 (0.9%) 7 5 2 10 1 0 0 0 0 0 1 Melanoma -- Skin 11 6 5 2 9 1 0 0 0 0 0 1

Other Skin 1 1 0 0 1 0 0 0 0 0 0 0

BREAST 347 (25.9%) 2 345 298 49 78 110 68 16 7 0 19

FEMALE GENITAL SYSTEM 51 (3.8%) 0 51 30 21 1 15 3 2 2 0 7 Cervix Uteri 14 0 14 8 6 1 2 0 1 0 0 4

Corpus Uteri 18 0 18 12 6 0 10 1 1 0 0 0

Ovary 16 0 16 9 7 0 2 2 0 2 0 3

Vulva 3 0 3 1 2 0 1 0 0 0 0 0


Prostate 141 141 0 82 59 0 5 59 9 3 0 6

Testis 8 8 0 5 3 0 2 0 2 0 0 1

Penis 1 1 0 1 0 0 1 0 0 0 0 0

URINARY SYSTEM 76 (5.7%) 49 27 68 8 20 28 6 5 4 0 5

Urinary Bladder 28 21 7 25 3 17 3 2 1 1 0 1

Kidney & Renal Pelvis 45 26 19 40 5 2 25 4 2 3 0 4

Ureter 3 2 1 3 0 1 0 0 2 0 0 0

BRAIN & other nervous system 60 (4.5%) 20 40 40 20 0 0 0 0 0 40 0 Brain 11 7 4 6 5 0 0 0 0 0 6 0

CNS 49 13 36 34 15 0 0 0 0 0 34 0

MHSW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk


Thyroid 62 14 48 58 4 0 32 3 9 2 0 12

Other Endocrine including

Thymus 7 3 4 6 1 0 0 0 0 0 6 0

LYMPHOMA 58 (4.3%) 27 31 41 17 0 5 3 8 17 1 8

Hodgkin Lymphoma 1 0 1 0 1 0 0 0 0 0 0 0

Non-Hodgkin Lymphoma 57 27 30 41 16 0 5 3 8 17 1 8

MYELOMA 21 (1.6%) 11 10 8 13 0 0 0 0 0 8 0

LEUKEMIA 32 (2.4%) 20 12 20 12 0 0 0 0 0 20 0

Lymphocytic Leukemia 16 12 4 10 6 0 0 0 0 0 10 0

Myeloid & Monocytic

Leukemia 12 6 6 7 5 0 0 0 0 0 7 0

Other Leukemia 4 2 2 3 1 0 0 0 0 0 3 0

HEMATAPOETIC DISEASE 24 (1.8%) 18 6 6 18 0 0 0 0 0 24 0

UNKNOWN PRIMARY 47 (3.5%) 27 20 0 0 0 0 0 0 0 47 0

MEMORIAL HERMANN-TEXAS MEDICAL CENTER

The Memorial Hermann TMC Cancer Program is an approved Teaching Hospital Cancer Program through the American

College of Surgeons Commission on Cancer and has been providing exceptional cancer care since 1994. The MH-TMC

Cancer Program earned accreditation with all possible commendations at the most recent ACoS survey in June of 2009.

The MH-TMC Cancer Program is the result of a combined effort of a group of dedicated physicians, nursing staff and

hospital administrators who strive to improve cancer services for patients. The Cancer Program at MH-TMC focuses on

compassionate, timely and technologically advanced cancer treatments and achieves these goals through its association

with the University of Texas Medical School at Houston.

MEMBERSHIP

Physicians:

Emily Robinson, MD (chair) (General Surgery)

Angel Blanco, MD (Radiation Oncology)

Robert E. Brown, MD (Pathology)

Joan M. Bull, MD (Medical Oncology) (Cancer

Conference Coordinator)

Putao, Cen, MD (Medical Oncology)

Michael Covinsky, MD (Pathology)

Michael Frumovitz, MD (Gynecological Oncology)

Ron Kami, MD

Kamal Khalil, MD

Mohammad Y. Khan, MD (Medical Oncology)

Larry Kramer, MD (Radiology)

Donald Lesslie, MD (General Surgery)

Erik Maus, MD (Hyperbaric Medicine)

Luis Mieles, MD

Sozos Papasozomenos, MD (Pathology)

Jorge Quesada, MD (Medical Oncology) (Cancer

Liaison Physician and Cancer Registry Data Quality

Control Coordinator)

Adan Rios, MD (Medical Oncology)

Tung Shu, MD (Urological Surgery)

Grace Varas, MD (General Internal Medicine)

Non-Physicians

Lisa Taylor, RHIA, CTR (Cancer Registry)

Mary Brimer, RN, OCN (Cancer Center)

Amy Deutsch DNP, RN, CNS, AOCNS (Advanced

Practice Nurse)

Patty Harrison, RN, CTR (Cancer Registry)

Wendy Enciso, CTR (Cancer Registry)

Charisse Adams, RN

Linda Brown, PhD (Research)

Courtney Rieniets (Medical Staff)

Ryan Schniederjan, PA (Pathology)

D’Ann Guidry, RN (Cancer Center)

Nikki Roux, RN (Cancer Program Administrator)

Michelle Thomas, RN (Nurse Navigator)

2010 TUMOR BOARD SUMMARY

Tumor boards are conducted as a joint activity between Memorial Hermann Hospital and the University of Texas

Medical School at Houston and were initiated in 2003. The combined modality oncology conferences are held weekly

and provide a multidisciplinary approach for discussion of diagnostic and treatment options for our patients.

Educational programs regarding unusual or rare tumors are provided as part of the CMOC activity. The meetings also

provide for ongoing fellow, resident and attending physician education. Cancer conferences for liver and breast cases

are held at the Texas Liver Center and the Memorial Hermann Cancer Center respectively. In 2010, a total of 310 cases

were discussed, representing 66 percent of the analytic case load for the year. The most commonly discussed sites

were lung, brain, lymphoma, bone marrow, breast and colon.

Attendance by Specialty Conference Name

Conference Type Frequency

Rad Onc Pathology

Med Onc Surgery Radiology

Combined Modality

Facility Wide

Weekly: Every Tuesday @ 5:00 pm 80% 80% 80% 50% 80%

Breast Site Specific

Monthly: Every 1st Wednesday @ 7:30 am 80% 80% 80% 80% 80%

Thoracic Site Specific

Monthly: Every 2nd Tuesday @ 7:30 am 80% 80% 80% 80% 80%

GU Site Specific

Monthly: Every 2nd Wednesday @ 7:30 am 80% 80% 80% 80% 80%

Hepatobiliary Site Specific

Weekly: Every Wednesday @ 4:00 pm N/A N/A 80% 80% 80%

GI Site Specific

Monthly: Every 3rd Tuesday @ 7:30 am 80% 80% 80% 80% 80%

Head & Neck Site Specific

Monthly: Every 3rd Wednesday @ 7:30 am 80% 80% 80% 80% 80%

Leukemia/ Lymphoma

Site Specific

Monthly: Every 3rd Wednesday at 12:00 pm N/A 80% 80% N/A N/A

CNS Site Specific

Monthly: Every 4th Tuesday @ 7:30 am 80% 80% 80% 80% 80%

2010 CANCER RELATED CONFERENCES/PRESENTATIONS

• Patient and Caregiver Seminar

• Oncology Conference


• Nursing Concepts in the Identification and Care of Patients with Peripheral T-cell Lymphoma

2010 CANCER SCREENINGS

• Prostate screening

• Skin screening

• Survivorship classes in conjunction with CanCare

2010 QUALITY IMPROVEMENTS IN PATIENT CARE

Studies of quality and outcomes:

• Breast Specimen TAT (turn around time) project

• Lung Cancer Treatment Study

• CP3R for Breast, Colon and Rectal Cancer

Improvements that directly affect patient care:

• Cancer Center move to new clinic area with improvements in infusion area

• Implementation of HER2Neu score reporting on Care4 Pathology Reports

• Chemotherapy patient education DVD for Spanish-speaking patients

• Opening of a second PET CT scanner for improved imaging

• Methotrexate Toxicity Rescue Algorithm

• Expansion of palliative care services to outpatient setting along with support group meetings

• Chemotherapy order templates

• Outpatient dietician will be available to provide nutritional management for cancer survivors

2010 GOALS/ACCOMPLISHMENTS

• Improved breast specimen turnaround time with creation of flowchart process.

• Colectomy lymph node project

• CAP synoptic protocols included on all surgical pathology specimen

• Prostate and skin screenings were held for the community and hospital employees

• Cancer Center in new location allows for on-site laboratory staff and increased number of infusion chairs for

patients

• Oncology Nurse Navigator was hired for the Cancer Center

• Expansion of palliative care services to outpatient setting

MHTMC Sex Class of Case Stage Distribution

Analytic Cases Only

Primary Site Total (%) M F Analy NA Stg 0

Stg I

Stg II

Stg III

Stg IV

88 Unk

Total 1,296 722 574 957 339 21 117 189 108 191 280 51

ORAL CAVITY & PHARYNX

41 (3.2%) 25 16 34 7 0 4 3 6 17 1 3

Lip 2 1 1 1 1 0 0 0 0 1 0 0

Tongue 11 7 4 9 2 0 1 0 3 5 0 0


Analytic Cases Only


Stg I

Stg II

Stg III

Stg IV

88 Unk

Salivary Glands 7 1 6 7 0 0 0 1 2 2 0 2

Floor of Mouth 2 2 0 2 0 0 1 0 0 1 0 0

Gum & Other Mouth 7 3 4 5 2 0 1 2 0 1 0 1

Pharynx 10 9 1 9 1 0 1 0 1 6 0 0

Other Oral Cavity & Pharynx

2 2 0 1 1 0 0 0 0 0 1 0

DIGESTIVE SYSTEM 212 (16.4%)

126 86 157 55 3 31 21 37 39 3 23

Esophagus 5 4 1 5 0 0 0 2 2 1 0 0

Stomach 17 10 7 12 5 0 2 1 2 4 0 3

Small Intestine 7 3 4 7 0 0 0 1 3 1 0 2

Colon Excluding Rectum

48 28 20 33 15 0 9 3 8 10 0 3


Anus, Anal Canal & Anorectum

5 2 3 3 2 1 0 0 1 0 0 1

Liver & Intrahepatic Bile Duct

55 39 16 48 7 0 14 4 11 10 2 7

Gallbladder 3 2 1 2 1 0 0 1 1 0 0 0

Other Biliary 8 4 4 5 3 0 1 1 1 2 0 0

Pancreas 26 16 10 20 6 0 1 8 2 7 0 2


Peritoneum, Omentum & Mesentery

3 0 3 3 0 0 1 0 0 1 0 1

Other Digestive Organs 1 0 1 1 0 0 0 0 0 0 1 0

RESPIRATORY SYSTEM

172 (13.3%)

100 72 117 55 0 10 9 24 63 6 5

Nose, Nasal Cavity & Middle Ear

9 7 2 8 1 0 0 0 1 1 6 0

Larynx 16 14 2 10 6 0 1 2 3 4 0 0

Lung & Bronchus 142 75 67 97 45 0 9 7 20 56 0 5

Trachea, Mediastinum & Other Respiratory Organs

2 2 0 1 1 0 0 0 0 1 0 0

Mesothelioma 3 2 1 1 2 0 0 0 0 1 0 0

BONES & JOINTS 7 (0.5%) 4 3 3 4 0 1 1 0 1 0 0


Analytic Cases Only


Stg I

Stg II

Stg III

Stg IV

88 Unk

SOFT TISSUE (including heart)

5 (0.4%) 1 4 4 1 0 1 1 2 0 0 0

SKIN (excluding basal & squamous)

12 (0.9%) 6 6 6 6 1 2 0 0 2 0 1

Melanoma -- Skin 11 5 6 6 5 1 2 0 0 2 0 1

Other Non-Epithelial Skin

1 1 0 0 1 0 0 0 0 0 0 0

BREAST 105 (8.1%) 1 104 71 34 10 19 26 1 7 0 8

FEMALE GENITAL SYSTEM

47 (3.6%) 0 47 31 16 2 10 2 6 3 4 4

Cervix Uteri 10 0 10 6 4 0 1 0 1 1 1 2

Corpus & Uterus, NOS 20 0 20 14 6 1 7 2 0 0 2 2

Ovary 12 0 12 7 5 0 2 0 3 2 0 0

Vulva 2 0 2 1 1 1 0 0 0 0 0 0

Other Female Genital Organs

3 0 3 3 0 0 0 0 2 0 1 0

MALE GENITAL SYSTEM

196 (15.1%)

196 0 153 43 0 2 111 16 22 0 2

Prostate 192 192 0 149 43 0 0 111 14 22 0 2

Testis 4 4 0 4 0 0 2 0 2 0 0 0

URINARY SYSTEM 73 (5.6%) 57 16 50 23 5 16 6 6 16 0 1

Urinary Bladder 18 14 4 14 4 5 3 1 2 2 0 1


Other Urinary Organs 1 1 0 1 0 0 1 0 0 0 0 0

EYE & ORBIT 1 (0.1%) 0 1 0 1 0 0 0 0 0 0 0

BRAIN & OTHER NERVOUS SYSTEM

218 (16.8%)

96 122 173 45 0 0 0 0 0 173 0

Brain 86 51 35 71 15 0 0 0 0 0 71 0

Cranial Nerves Other Nervous System

132 45 87 102 30 0 0 0 0 0 102 0


Thyroid 28 11 17 24 4 0 14 3 2 4 0 1

Other Endocrine including Thymus

32 10 22 27 5 0 0 0 0 0 27 0


Analytic Cases Only


Stg I

Stg II

Stg III

Stg IV

88 Unk

LYMPHOMA 54 (4.2%) 32 22 41 13 0 7 6 8 17 0 3


NHL - Nodal 37 19 18 29 8 0 3 4 6 13 0 3

NHL - Extranodal 11 9 2 8 3 0 4 1 1 2 0 0

MYELOMA 12 (0.9%) 10 2 6 6 0 0 0 0 0 6 0

LEUKEMIA 43 (3.3%) 27 16 28 15 0 0 0 0 0 28 0


Myeloid & Monocytic Leukemia

22 11 11 17 5 0 0 0 0 0 17 0

Other Leukemia 5 2 3 2 3 0 0 0 0 0 2 0

Hematopoietic Disease 8 6 2 6 2 0 0 0 0 0 6 0

Unknown Primary 30 14 16 26 4 0 0 0 0 0 26 0

MEMORIAL HERMANN THE WOODLANDS HOSPITAL

At Memorial Hermann The Woodlands, our cancer services team is committed to providing patients with the information

and support needed to make informed decisions that increase chances of living a long, productive life. Physician and

clinical specialists work together to design individual treatment plans based on the type, stage and aggressiveness of the

cancer. With our extensive knowledge and experience and our access to leading-edge technologies, we can take care of all

cancer needs close to home. Memorial Hermann The Woodlands Hospital is Montgomery County’s only accredited Cancer

Program by the American College of Surgeons Commission on Cancer.


Physicians

Richard Brown, MD (Quality Data Coordinator) -Pathology

Sandra Gomez, MD - Palliative Care

Christopher Herman, MD (Tumor Board Coordinator) -Pathology

Alan Hubbard, MD - General Surgery

Pierre Khoury, MD - Medical Oncology

Christine Lee, MD (Chair) - Gynecologic Oncology

Krishna Pachipala, MD - Medical Oncology

William Parks, MD - Administration

Mark Pidala, MD - Colorectal Surgery

M. Elizabeth Sands, MD (Cancer Liaison Physician) - Radiation Therapy

Huy Tran, MD - Diagnostic Radiology

Non-Physicians

Tom Bollinger, LMSW - Social Services

Sue Koller, RN - Patient Care

Carol Lewis, RN, OCN (Quality Improvement Coordinator) - Nurse Navigator

Linda Nelson (Community Outreach Coordinator) - Marketing

George Philipose - Chaplain

Kathy Tenczynski, CTR - Cancer Registrar

Lynn Whitehair, MBA - Cancer Program Administrator

Ad Hoc Members

Bernadette Brown, RN, BSN - Palliative Care Nursing

Charlotte Daigle - American Cancer Society

Amy Deutsch, RN, DNP, CNS, AOCNS - APN System

Mabel Dzakuma, RN, OCN - Radiation Oncology

Laura Ellis, MS, CGC - Genetic Counselor

Brett McCormick - Rehab

Cuong Nguyen, PharmD - Pharmacy

Virginia Pettry, RHIT, CTR - Cancer Registry

Paul Polansky, RTT - Radiation Therapy

Kathleen Resnick, RN - Patient Care

Steve Sanders - CEO

Maria Tran, MPH, CTR - Cancer Registry

Josh Urban - COO

Nancy Wyatt, PharmD - Pharmacy


Clinical – Open an outpatient infusion suite.

Community Outreach – Increase number of annual mammograms for indigent women in the community.

Programmatic Endeavors – Hold oncology related CME programs on MHTW campus.

Quality Improvement – Establish malnutrition screening program for radiation therapy patients.


Colorectal Seminar 40 participants

Skin Cancer Screening 51 participants

Prostate Cancer Screening 214 participants

Tumor Board Summary

44 facility-wide weekly conferences held. 130 cases presented or 17% of analytic caseload with 96% staging discussion,

96% national guidelines discussion, 100% attendance of required physician representatives

Head and Neck 1

Digestive System 9


Breast 87

Gynecologic Sites 11


CNS 1

Endocrine 2

Lymphoma 5

Hematopoietic 1

Skin 3

Soft Tissue 2

Unknown Primary 3

TOTAL 130


• Genetic Counseling

• Chemotherapy Desensitization Protocol

• Upgrade radiation therapy equipment to include CT multi-slice, stereotactic radio-surgery and new treatment

planning software.

• Malnutrition screening program for radiation therapy patients.

• Outpatient chemotherapy infusion suite.

• American Cancer Society’s Gift Closet (Bras and prosthesis at no cost for low income patients)


• Brain Tumors from a Neurological Perspective

• The Advisory Board Oncology Round Table


• Oncologic Emergencies: How to Prevent, Reverse and Minimize Life-Threatening Complications


MHTW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Total 1,377 518 859 797 580 71 256 148 86 102 65 69

ORAL CAVITY & PHARYNX 22 (1.6%) 16 6 9 13 0 0 2 1 5 0 1

Tongue 6 3 3 3 3 0 0 1 1 0 0 1

Salivary Glands 1 1 0 1 0 0 0 1 0 0 0 0

Gum & Other Mouth 2 1 1 0 2 0 0 0 0 0 0 0

Pharynx 13 11 2 5 8 0 0 0 0 5 0 0


Esophagus 11 10 1 5 6 0 2 0 1 2 0 0

Stomach 12 11 1 8 4 0 1 2 0 2 0 3

Small Intestine 4 1 3 4 0 0 1 1 1 0 0 1

MHTW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk



Anus, Anal Canal & Anorectum 6 3 3 4 2 0 0 1 0 0 1 2


Gallbladder 2 2 0 2 0 0 0 0 2 0 0 0

Other Biliary 4 3 1 4 0 0 0 0 2 0 1 1

Pancreas 25 16 9 10 15 0 0 1 0 8 0 1


Peritoneum, Omentum & Mesentery 2 0 2 1 1 0 0 0 0 0 1 0

RESPIRATORY SYSTEM 162 83 79 75 87 0 10 6 10 37 0 12

Nose, Nasal Cavity & Middle Ear 2 2 0 0 2 0 0 0 0 0 0 0

Larynx 5 3 2 2 3 0 1 0 0 1 0 0

Lung & Bronchus 149 72 77 70 79 0 9 6 10 35 0 10

Mesothelioma 4 4 0 1 3 0 0 0 0 0 0 1

Other Respiratory 2 2 0 2 0 0 0 0 0 1 0 1

BONES & JOINTS 2 (0.1%) 1 1 2 0 0 0 0 0 0 1 1

SOFT TISSUE 8 (0.6%) 5 3 5 3 0 0 0 0 3 1 1

SKIN excluding basal & squamous

17 (1.2%) 11 6 7 10 1 2 0 2 0 0 2

Melanoma -- Skin 16 11 5 7 9 1 2 0 2 0 0 2

Other Skin 1 0 1 0 1 0 0 0 0 0 0 0

BREAST 375 (27.2%) 1 374 222 153 48 100 45 10 3 0 16

FEMALE GENITAL SYSTEM 148 (10.7%) 0 148 105 43 4 59 6 14 13 4 5

Cervix Uteri 26 0 26 18 8 0 11 1 3 3 0 0

Corpus Uteri 78 0 78 65 13 0 44 3 7 5 4 2

Ovary 24 0 24 10 14 0 0 2 4 2 0 2

Vagina 4 0 4 3 1 1 1 0 0 0 0 1

Vulva 10 0 10 7 3 3 2 0 0 2 0 0

Other Female Genital Organs 6 0 6 2 4 0 1 0 0 1 0 0


Prostate 107 107 0 69 38 0 3 51 11 2 0 2

Testis 2 2 0 2 0 0 1 0 0 0 0 1

MHTW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk

Penis 1 1 0 1 0 0 0 1 0 0 0 0

URINARY SYSTEM 105 (7.6%) 66 39 76 29 17 31 6 8 9 0 5

Urinary Bladder 44 35 9 31 13 13 7 3 3 4 0 1


Ureter 4 3 1 4 0 3 0 1 0 0 0 0

EYE & ORBIT 2 (0.1%) 1 1 0 2 0 0 0 0 0 0 0

BRAIN & OTHER NERVOUS SYSTEM

51 (3.7%) 18 33 26 25 0 0 0 0 0 26 0

Brain 23 12 11 15 8 0 0 0 0 0 15 0

CNS 28 6 22 11 17 0 0 0 0 0 11 0


Thyroid 26 5 21 25 1 0 19 2 2 1 0 1

Other Endocrine including Thymus 16 9 7 8 8 0 0 0 0 0 8 0

LYMPHOMA 71 (5.2%) 41 30 36 35 0 14 8 1 5 0 8


NHL - Nodal 44 27 17 20 24 0 6 5 0 4 0 5

NHL - Extranodal 20 12 8 12 8 0 8 1 0 1 0 2

MYELOMA 14 (1.0%) 7 7 2 12 0 0 0 0 0 2 0

LEUKEMIA 30 (2.2%) 14 16 11 19 0 0 0 0 0 11 0


Myeloid & Monocytic Leukemia 11 6 5 6 5 0 0 0 0 0 6 0

Other Leukemia 3 1 2 1 2 0 0 0 0 0 1 0


UNKNOWN PRIMARY 13 (0.9%) 7 5 5 7 0 0 0 0 0 5 0

MHTW Sex Class of


Analytic Cases Only


Stg 0 Stg I

Stg II

Stg III

Stg IV 88 Unk


Thyroid 26 (1.9%) 5 21 25 1 0 19 2 2 1 0 1

Other Endocrine including Thymus

16 (1.2%) 9 7 8 8 0 0 0 0 0 8 0

LYMPHOMA 71 (5.2%) 41 30 36 35 0 14 8 1 5 0 8

Hodgkin Lymphoma 7 (0.5%) 2 5 4 3 0 0 2 1 0 0 1

Non-Hodgkin Lymphoma 64 (4.6%) 39 25 32 32 0 14 6 0 5 0 7

NHL - Nodal 44 27 17 20 24 0 6 5 0 4 0 5 NHL - Extranodal 20 12 8 12 8 0 8 1 0 1 0 2

MYELOMA 14 (1.0%) 7 7 2 12 0 0 0 0 0 2 0

Myeloma 14 (1.0%) 7 7 2 12 0 0 0 0 0 2 0

LEUKEMIA 30 (2.2%) 14 16 11 19 0 0 0 0 0 11 0

Lymphocytic Leukemia 16 (1.2%) 7 9 4 12 0 0 0 0 0 4 0

Myeloid & Monocytic Leukemia 11 (0.8%) 6 5 6 5 0 0 0 0 0 6 0

Other Leukemia 3 (0.2%) 1 2 1 2 0 0 0 0 0 1 0


UNKNOWN PRIMARY 11 (0.8%) 6 5 5 6 0 0 0 0 0 5 0

Total 1,377 518 859 797 580 71 256 148 86 102 65 69

1

MEMORIAL HERMANN OVERVIEW OF LUNG CANCER SMALL CELL AND NON-SMALL CELL CARCINOMA INTRODUCTION Memorial Hermann Healthcare System (MHHS) diagnosed 601 new lung cancers in 2010 which

accounted for 5% of all new lung cancer cases diagnosed throughout Texas.1 Lung Cancer is the 2nd

most common cancer among men and women in this country today only to follow prostate in men and breast

in women. The American Cancer Society estimated that 222,520 new lung cancers would be diagnosed in

2010 which accounted for 15% of all cancers.

Lung cancers are thought to form as pre-cancerous changes in the lung. Many times, these changes cannot

be seen on x-ray. Over time, changes in cells may develop into cancer. Chemicals from cancer cause new

blood vessels to form that feed the cancer cells and cause a tumor to form. As a tumor becomes larger, it

may be more easily detected or a patient may experience symptoms related to the tumor.

SYMPTOMS AND DETECTION

Screening for early lung cancer has not yet been proven to reduce mortality so most patients with lung cancer

present for medical care when they have symptoms. These symptoms may include persistent cough, blood

streaked sputum, voice change, chest pain and recurrent pneumonia or bronchitis. Other symptoms such as

bone pain, numbness/weakness of the limbs, seizure, etc. may indicate a lung cancer related syndrome or a

cancer that has spread. Individuals with these symptoms should be evaluated by a doctor. Sometimes these

symptoms are caused by something other than cancer. A diagnostic work-up will help determine whether a

patient has lung cancer. Evaluation may include a chest X-ray. The chest X-ray is limited so many times

other diagnostics such as computed tomography (CT) scan and MRI (magnetic resonance imaging) are used.

PET (positron emission tomography) or CT combined with PET are also used. The PET diagnostic uses a

form of radioactive contrast in the blood that sensitizes to cancer cells to show images of radioactivity or

active cancer. Once lung cancer is suspected on imaging studies, tissue and cell evaluation will be conducted

to confirm a diagnosis of lung cancer. Tissue can be collected from sputum samples, fine needle biopsy

(FNA), core biopsy, bronchoscopy, endobronchial ultrasound, thoracentesis, and other lung specific tests.

These tests provide tissue samples that are examined by a pathologist who help identify the type of lung

1 MHHS belongs to Texas Health Service Region (HSR) 6. Based on state data from 2004-2008, the average annual number of new lung cancer cases was 12,709 cases for Texas. The estimated number of new cancer cases for HSR 6 for 2011 is 23,812 and 8413 cancer deaths. This information can be located at http://www.dshs.state.tx.us/tcr/ in the article 2011 Texas Fact Sheets.

http://www.dshs.state.tx.us/tcr/

2

cancer. This process involves an evaluation of the tissue cells and many times special tissue analysis to

pinpoint the cell type of cancer. This information is critical to physicians that are developing a cancer

patient’s treatment plan.

There is a National Lung Screening Trial (NLST) comparing two ways of detecting lung cancer: low-dose

helical computed tomography (CT) and standard chest X-ray. Both of these imaging studies have been used

to find lung cancer early, but the effects of these screening techniques on lung cancer mortality rates have not

been determined. Initial findings from this study in 2010, revealed that participants who received low-dose

CT scans had a 20% lower risk of dying from lung cancer than participants who received standard chest X-

rays. This is published in the New England Journal of Medicine, June 29, 2011. Many other clinical trials

and research endeavors are being conducted to validate lung cancer screening and prevention.

RISK FACTORS

The major risk factor for lung cancer is cigarette smoking. Risk increases with quantity and duration of

cigarette consumption. Cigar and pipe smoking also increase risk. Other risk factors include occupational or

environmental exposure to secondhand smoke, radon, asbestos (particularly among smokers), certain metals

(chromium, cadmium, arsenic) some organic chemicals, radiation, air pollution, and a history of tuberculosis.

Individuals with lung cancer have a higher risk of getting another lung cancer. People who have family

members (brothers, sisters, parents) with lung cancer may have a slightly higher risk of getting lung cancer

themselves. Genetic susceptibility plays a contributing role in the development of lung cancer, especially in

those who develop the disease at a younger age. Avoiding controllable risk factors and increasing protective

factors such as regular exercise, maintaining a healthy weight and eating healthy may lower one’s risk for

getting cancer.

STAGING & TREATMENT

Lung cancer treatments are formulated by determining the tumor type and stage of cancer. Staging is the

process of correlating the extent a cancer has spread. Cancer staging can be divided into clinical and

pathologic. Clinical stage is based on results of physical exam, radiology and biopsy. Pathologic stage is

based on clinical staging factors plus information from surgery. Because most patients with lung cancer do

not have surgery, the clinical stage is most often used when describing the cancer. Staging for NSCLC is

different from small cell lung cancer and those differences will be explained in each respective section

below. Once a case is staged, physicians will correlate the stage to develop a treatment plan by utilizing their

knowledge, experience, and evidence based treatment guidelines. Treatments for lung cancer include

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surgery, radiation therapy, chemotherapy, targeted therapies and clinical trials. For localized cancers,

surgery is usually the treatment of choice. Because lung cancer has usually spread by the time it is

diagnosed, radiation therapy and chemotherapy are often used, sometimes in combination with surgery.

Clinical trials, which are special studies to determine treatment outcomes for new therapies, are used on a

case by case basis when survival advantage and or improved quality of life benefit the patient. Lung cancer

is classified clinically as non-small cell (85%) or small cell (14%). This classification is imperative for

staging and treatment.

NON-SMALL CELL LUNG CANCER (NSCLC)

Non-small cell lung cancer (NSCLC) accounts for the majority of the lung cancer classifications which can

be further caterorized into squamous cell carcinoma, adenocarcinoma and large cell (undifferentiated)

carcinoma. Chacterisitics of squamous cell carcinoma are that they are linked to smoking and tend to

originate in the middle lungs near the bronchus. Squamous cell carcinoma accounts for about 25-30% of all

lung cancers. Adenocarcinoma is another type of lung cancer which accounts for 40% of lung cancers and it

usually arises in the outer part of the lung. This type is most common in non-smokers however; smokers and

people with history of smoking are known to have this type of lung cancer as well. Adenocarcinoma of the

lung is typically more common in women than men and it is likely to occur in younger people. Large-cell

carcinoma is the other NSCLC which accounts for about 10-15% of lung cancers. This type can start

anywhere in the lung and tends to grow and spread quickly, which it more challenging to treat. At

Memorial Hermann, we diagnosed over 3,000 cases of NSCLC from 2006 to 2010 (see table 1).

Table 1: Analytic Volume by Memorial Hermann facility from 2006-2010 Facility 2006 2007 2008 2009 2010 Grand Total

Southwest 138 114 121 131 95 599 Memorial City 104 99 141 127 131 602 Northwest 67 68 73 69 63 340 Medical Center 51 66 74 84 87 362 Katy 20 13 19 35 17 104 The Woodlands 48 73 79 73 54 327 Southeast 61 95 81 50 90 377 Sugar Land 1 11 13 10 11 46 Northeast 54 61 54 55 56 280 Grand Total 544 600 655 634 601 3037

An analysis of our data revealed that the majority (63%) of NSCLC were diagnosed among patients in

their 60s and 70s. Sixteen percent of the patients were diagnosed in their 80s and 14% were diagnosed

in their 50s. Only 4% of the patients were diagnosed in their 40% (see table 2). These figures are

compatible with data from the National Cancer Database (NCDB) for Texas and the US.

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Table 2: Age Group (years) at Diagnosis by Memorial Hermann facility from 2006-2010 Facility 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90+ Grand Total

Southwest 2 5 23 77 175 209 101 7 599Memorial City 1 2 15 78 174 205 120 7 602Northwest 3 10 49 94 120 58 6 340Medical Center 4 21 80 119 95 41 2 362Katy 1 3 12 33 32 22 1 104The Woodlands 1 3 13 45 97 107 53 8 327Southeast 2 21 47 132 120 51 4 377Sugar Land 3 5 12 14 10 2 46Northeast 1 13 40 97 89 38 2 280Grand Total 4 21 122 433 933 991 494 39 3037

MHHS cancer staging data for NSCLC reveals that the majority of our patients are diagnosed at a

late stage meaning patients are not presenting for medical care until they have advanced lung cancer.

This trend is seen across Texas and the United States as well. Some of our comprehensive cancer

programs have a higher percentage of cases diagnosed at an earlier stage than others (see table 3).

Table 3: AJCC Cancer Stage at Diagnosis by Memorial Hermann facility from 2006-2010 Facility Stage I Stage II Stage III Stage IV NA Unknown Grand Total

Southwest 129 33 160 186 11 80 599Memorial City 131 47 101 239 7 77 602Northwest 43 20 77 152 48 340Medical Center 45 13 60 202 4 38 362Katy 16 4 30 35 0 19 104The Woodlands 49 14 60 144 2 58 327Southeast 80 24 82 129 7 55 377Sugar Land 0 3 19 19 0 5 46Northeast 61 18 60 108 0 33 280Grand Total 554 176 649 1214 79 365 3037

Patients with NSCLC are typically staged with the AJCC (American Joint Committee on Cancer) system

which consists of four stages. MHHS reported 18% of NSCLC with stage I disease between 2006 and

2010. Stage one is localized to the lung. Stage II is generally regional to lymph nodes, and MHHS

reported 6% in this category. This percentage is compatible with NCDB data for Texas and the US.

Stage III exhibits spread to regional lymph nodes and tissue and stage IV has spread outside the lung

to other organs or to the opposite lung. MHHS reported 21% and 40% respectively for stage 3 and 4

NSCLC. Research has shown improved survival for early stage non-small cell lung cancer patients that

receive chemotherapy after surgery. When disease has spread, data has proved that combined treatment with

radiation, chemotherapy and sometimes surgery improve overall survival for advanced NSCLC. A recent

5

clinical trial showed a survival advantage for advanced-stage non-small cell lung cancer patients when

cetuximab (Erbitux, a monocloncal antibody) was combined with the traditional chemotherapeutic regimen.

SMALL CELL LUNG CANCER

MHHS reported 100 small cell lung cancers in 2010 and 486 from 2006 through 2010 (see table 4).

Table 4: Analytic Volume by Memorial Hermann facility from 2006-2010 Facility 2006 2007 2008 2009 2010 Grand

Total Southwest 17 24 14 15 15 85 Memorial City 11 21 19 21 21 93 Northwest 8 7 11 12 9 47 Medical Center 10 9 11 9 9 48 Katy 2 1 3 5 3 14 The Woodlands 8 12 11 13 16 60 Southeast 17 15 14 18 11 75 Sugar Land 1 2 1 4 Northeast 11 13 14 7 15 60 Grand Total 84 102 98 102 100 486

This type of cancer is also referred to as oat cell carcinoma and small cell undifferentiated carcinoma. Many

times, this cancer starts in the bronchi near the center of the chest. Since the cells are small, they divide

quickly which causes this disease to spread faster. This aspect of the cancer type makes it more challenging

to treat because surgery is rarely a treatment option due to the size of tumor and extent of disease spread.

Diagnosing small cell lung cancer is similar to NSCLC; however, cancer staging is different. The (AJCC)

TNM staging system is generally not used for this type of cancer because the treatment options don’t vary

much between detailed stages. Because this type of cancer grows fast, a two-stage system is more

commonly used to separate patients that can benefit from treatment and those with advanced disease that will

not benefit from a curative approach. This system is divided into limited and extensive stage. Limited stage

refers to cancer that is localized in the lung or around the lung in local lymph nodes. Extensive stage refers

to lung cancer that has spread outside of the lung to other organs or the opposite lung. The majority of

small cell lung cancer cases (81%) at MHHS presented with extensive disease at the time of diagnosis

while only 7% presented with limited disease (see table 5).

6

Table 5: AJCC Cancer Stage at Diagnosis by Memorial Hermann facility from 2006-2010 Facility Stage I Stage II Stage III Stage IV Unknown Grand Total

Southwest 5 2 20 49 9 85 Memorial City 5 3 23 48 14 93 Northwest 3 1 8 32 3 47 Medical Center 1 0 8 33 6 48 Katy 0 0 7 5 2 14 The Woodlands 4 1 10 35 10 60 Southeast 6 1 12 46 10 75 Sugar Land 0 0 1 3 0 4 Northeast 3 0 21 33 3 60 Grand Total 27 8 110 284 57 486

NCDB data for the US is similar with 83% of patients diagnosed with extensive disease and only 8%

with limited disease. Texas data reveals a slightly better trend with only 78% of patients diagnosed

with extensive disease. This makes chemotherapy with or without radiation therapy a top choice for treating

small cell lung cancer. Although a large number of patient’s experience remission, sometimes the cancer

recurs. Our experience showed that the majority of patients (35%) were diagnosed in their 60s and

31% were diagnosed in their 70s (see table 6). These outcomes are similar to NCDB data for Texas and

the US. Texas reports 36% of patients diagnosed in their 60’s and 28% diagnosed in their 70’s. The

US reports 34% for the 60 age group and 30% for the 70 age group.

Table 6: Age Group (years) at Diagnosis by Memorial Hermann facility from 2006-2010 Facility 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79 80 to 89 90+ Grand TotalSouthwest 4 16 29 25 11 85Memorial City 2 13 29 34 14 1 93Northwest 1 2 9 16 14 5 47Medical Center 4 9 22 10 2 1 48Katy 4 4 5 1 14The Woodlands 3 9 25 16 6 1 60Southeast 4 11 21 28 11 75Sugar Land 1 1 1 1 4Northeast 1 13 24 19 3 60Grand Total 1 20 85 171 152 54 3 486The age factor sometimes poses another obstacle for treating small cell lung cancer. Generally, with

advanced age the probability that a patient has co-morbidities increases which may prevent a patient from

undergoing a treatment of choice and because some co-morbidities may increase risks of associated

complications.

SURVIVAL

Lung cancer is the leading cause of cancer death among men and women in the U.S. and causes more deaths

than any other cancer. The American Cancer Society projected that 157,300 people would die from lung

cancer in 2010. Of those, 86,220 (29%) were men and 71,080 (26%) were women. One year relative

survival for lung cancer increased from 35% in 1975-1070 to 42% in 2002-2005. This is mostly due to

improvements in surgical techniques and combined treatment modalities. However, the 5-year survival rate

for all stages combined is only 16%. The 5-year survival is 53% for cases detected when the disease is still

localized, but only 15% of lung cancers are diagnosed at this early stage. Patients with NSCLC may have an

overall better prognosis as compared to patients with small cell lung cancer. National data shows that 6% of

patients with small cell cancer of the lung are still living after five years while 17% of patients with NSCLC

survived five years. Lung cancer survival statistics for MHHS is similar for non-small cell lung cancer

when compared to the National Cancer Data Base (see figure 1 & 2, table 7 and 8), but differs

significantly for small cell lung cancer (stage II). 2 Patients diagnosed with stage I small cell lung

cancer at MHHS have a better survival than national data.

Figure 1: Non-small Cell Lung Cancer Observed Survival for MHHS by Best AJCC Stage3

2 National Cancer Data Base looked at 1313 accredited cancer programs in 2003 for non-small cell carcinoma.

73 Data was generated for patients seen at MHHS in 2003 and compared to the National Cancer Data Base

Table 7: Survival Data Comparison of NCDB and MHHS for Non-Small Cell Lung Cancer Diagnosed in 2003 NCDB Data MHHS Dx 1 Year 2 Years 3 Years 4 Years 5 Years 5 Years Occult n=39 100 46.2 25.6 17.9 12.8 12.8 - Stage 0 n=181 100 45.4 31.2 23.6 18.3 16.5 0 Stage I n=16235 100 80.5 66.9 57.4 50.8 44.9 45 Stage II n=5537 100 67.1 47.1 36.7 30.5 26 25 Stage III n=20799 100 45.3 24.8 17.3 12.8 10.3 10.7 Stage IV n=30935 100 21.7 8.6 4.8 3.2 2.4 0

Figure 2: Small Cell Lung Cancer Observed Survival for MHHS by Best AJCC Stage

Table 8: Survival Data Comparison of NCDB and MHHS for Small Cell Lung Cancer Diagnosed in

2003

NCDB Data MHHS

Dx 1 Year

2 Years

3 Years

4 Years

5 Years

5 Years

Stage I n=836 100 66.1 39.6 30.3 26 21.3 50.0Stage II n=528 100 65.6 33.7 23.5 16.6 14.7 0.0Stage III n=4242 100 49.5 23.9 14.9 11.6 9.6 11.1Stage IV n=8696 100 21.9 5.5 2.8 2 1.7 0.0Source: National Cancer Database by [email protected]

8

9

Memorial Hermann Healthcare System (MHHS) Cancer Services

MHHS provides comprehensive cancer services at seven facilities which are accredited by the American

College of Surgeons Commission on Cancer. Despite low national lung cancer survival data, we see an

opportunity to prevent, educate, research and support. MHHS diagnoses over 5,200 cancer cases each year

all over the greater Houston area which gives us an advantage at improving the overall health within our

communities. MHHS is conducting ongoing research with various clinical trials. We are developing lung

nodule clinics to advocate early lung cancer detection and to promote curative approaches to lung cancer

treatment. We host lung specific case conferences in which a multi-specialty group of physicians meet to

formulate treatment plans for optimizing lung cancer patient outcomes. We provide an array of support

services and lung cancer prevention programs. Of these, smoking prevention endeavors and smoking

cessation programs are among the most important to decreasing the incidence of lung cancer and overall

better health within our community. These are just a few of our programs; go to www.memorialhermann.org

for more information.

CONCLUSION

Lung cancer is one of the most prevalent cancers throughout the United States. It is also a leading cause of

cancer death. Ongoing research is underway at MHHS and around the world looking at prevention, better

lung cancer detection and treatment modalities. This brings hope to those diagnosed with the disease.

National statistics also show a declining incidence rate in men and a plateau after a long period of increased

incidence for women. Many researchers believe that prevention offers the greatest promise to fighting lung

cancer. Because smoking still accounts for almost 9 out of 10 lung cancer related deaths, many times the

disease is preventable. There are ongoing studies about how to help people stop smoking and to convince

young people not to start smoking. Other researchers are concentrated on gene changes that predispose some

people to getting lung cancer opposed to others who smoke.

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