Place you r m essag e h ere. Fo r m axim um i mpact , use two or t hre e se ntenc es.

He

ad

ing

2005 Chairman ’ s Report Ron Hekier, M.D.

Committee Chairman

As a member of the Cancer Committee and its newly designated chairman, I am pleased

to introduce the 2005 Annual Report. The highlights and accomplishments of the Cancer

Programs of CHRISTUS ST. Michael Health System and Wadley Health System are

included in this report. As is typical of cancer programs nationwide, the summary of the

major cases diagnosed at these facilities are lung cancer, breast cancer, colorectal cancer

and prostate cancer. These four major sites of cancer comprise 80% of all cancers seen

in our community.

As healthcare evolves, as standards evolve, as technology evolves, the role of the cancer program in Texarkana is

evolving as well. An effective cancer program produces clinical results and measurable outcomes. The cancer

program ’ s patient-centered approach gives patients direct access to the latest diagnostic and treatment services in

an environment that stresses compassion and caring. It's a combination that has proven to be one of the most

effective in cancer recovery for our patients.

Primary cancer prevention means taking the necessary precautions to prevent the occurrence of cancer. The Joint

Cancer Committee of CSMHS & WHS focuses on patient early detection programs and screenings to increase

community awareness and provide early detection guidelines to health professionals.

In 2005, a two-fold project to the community for education for colon cancer screening and ACS guidelines for early

detection was implemented. A study provided by NCDB to our facilities shows our hospitals concordance with the

standard of care for stage III colon cancer patients. Findings from clinical trials clearly demonstrate the survival

benefit associated with surgical resection of the primary tumor followed by the administration of a 5-FU based

chemotherapy regimen.

The current management of lung cancer, the most common malignancy in this country, is expertly reviewed by

Christopher Bailey, M.D. What was once a male predominant disease is now being diagnosed with increased

frequency in women. In the USA more women die form lung cancer than from breast cancer. Three times more

men die from lung cancer than from prostate cancer.

In closing, great appreciation is due to the dedicated staff of physicians, nurses, therapists, cancer registry staff and

other health care professionals who involved in the diagnosing, treatment and tracking of cancer.

Facts on Cancer

Community Top Ten Sites

*American Cancer Society, Cancer Facts and Figures 2005 Estimated New Cancer Cases CY: 2005 PERCENTPERCENT

This table represents cases diagnosed or treated in CSMHS, WHS and physician offices or

private practice institutions during 2005. Only the cases submitted to the UAMS AHEC-SW

CANCER SITE NUMBER CASES PERCENT NUMBER NATIONAL

CASES* FOR TOP TEN SITES

PERCENT

LUNG 220 28% 172,570

17%

BREAST 164 21% 212,930

21%

COLORECTAL 159 20% 145,290

14%

PROSTATE 104 13% 232,090

23%

BLADDER 51 6% 63,210

6%

KIDNEY/RENAL

PELVIS 44 6% 38,670

4%

LYMPHOMA 24 3% 63,740

6%

HEMATOPPIETIC

DISEASE 16 2% 50,790

5%

PANCREAS 10 1% 32,180

3%

BRAIN 8 1% 18,500

2%

TOTAL CASES Total 800 100% Total

1,029,970 100 %

Community Program

2005 Cancer Committee

PHYSICIAN MEMBER Ron Hekier, MD Chair J. D. Patel, MD Mike Finley, MD Joe Robbins, MD Kristin Lower, MD Steven Kyser, MD Bryan J Griffin, MD Howard Morris, MD Robert Parham, MD Gary Engstrom, MD Chris McMillian, MD H. Anthony Tran, MD Ranga Balasekaran, MD George W. English, III, MD

NON-PHYSICIAN MEMBERS Debra Wright, RN Kim Lewis, RN Susan Paxton Patti Shaffer, RN Ellen Smith, RPh Jena Teer, LSW Sandi Griffin, RN-OCN Dianne Greenhaw, RN Mike Jones, BS PHA Mary Miller, LMSW-ACP Darlene Williams, RN,OCN Rose Anne Watkins, RN Dianne Ketchum, CTR Tammy McKamie, RN-OCN

Cancer Committee 2005 The Cancer Committee is composed of medical oncologist, radiation oncologist, radiologist, surgery,

pathologist, pharmacy, social workers, administration, quality improvement and oncology nurses. The committee is multi-disciplinary and governs the components of the cancer program to include the cancer registry, patient care evaluations, clinical oncology research and performance improvements. The Joint Committee meets quarterly and subcommittee members met as needed to accomplish the duties and responsibilities of the Joint Committee.

The Cancer Registry staff would like to thank all the Cancer Committee members for their support and guidance during 2005.

CSMHS SCREENINGS AND EDUCATIONAL EVENTS

CSMHS Prostate Screening for the Black Community CSMHS Skin Cancer Screening Program CSMHS Colorectal Screening for the Community CSMHS/Susan Komen Foundation Breast

Cancer Health Education Program, free mammograms, ultrasounds, biopsies, wigs and prostheses

CSMHS Dialogue Support Group CSMHS Breast Cancer Support Group CSMHS Look Good Feel Better Program

CSMHS Life After Loss Support Group CSMHS Cancer Survivor’s Day CSMHS Genetic Counseling CSMHS Road to Recovery Texarkana Susan G. Komen Breast Cancer Foundation Race for the Cure American Cancer Society Great American Smoke Out American Cancer Society Relay For Life Signature

Event American Cancer Society Reach to Recovery

CHRISTUS St. Michael Health System

CoC Liaison Howard Morris, M.D. began his career at CSMHS in 1989 as a Radiation Oncolo-gist. He has been a continuous supporter of the Cancer Program since that time. He serves as moderator of the CSMHS Tumor Board meetings and educational conferences as well as CSMHS Liaison to the Commission on Cancer Liaison Pro-gram. Dr. Morris assists the Cancer Registry in studies and physician guidance on staging discrepancies. He is the medical advisor for the Texarkana Unit American Cancer Society and spearheads CoC initiatives at CSMHS.

Japanese Film Crew Visits Texarkana In January of 2005 National Broadcasting film crew of Japan traveled to Texarkana

to learn more about cancer treatment and cancer registration. The CSMHS Cancer

Center Manager, Sandi Griffith, Dr. Howard Morris, Dr. J.D. Patel and the Dianne

Ketchum, CTR, UAMS AHEC-SW Director of the cancer registry assisted the crew

for three weeks to provide information on the CoC approval requirements, filming

tumor boards, a mock cancer committee meeting and several medical oncologist

giving the cancer diagnosis to their patients.

Many physicians and cancer center staff assisted the JFC during their visit. The cri-

teria for the NHK visit was to locate a facility with the cancer caseload of CSMHS, and a cancer center which provided multi-

disciplinary care to the patients. The JFC contacted the Commission on Cancer in Chicago to obtain the names of facilities in

the nation which had scored high on their CoC survey and in which met the mentioned criteria.

Toshiki Ishikawa, the producer for the Japanese NHK broadcasting network, who is assisting survivors in Japan by petitioning

their government to change cancer treatment in his country, has published a book on his experience in Texarkana. Toshi said

the work done by the CSMHS staff and the UAMS AHEC-SW Cancer Registry is a model for a cancer program in Japan.

CANCER SITE # of

CASES PERCENT

NATIONAL

PERCENT CANCER SITE

# of

CASES PERCENT

NATIONAL

PERCENT

Oral Cavity/ Pharynx 6 1.7% 2.2% Breast 113 16.5% 15.8%

2 - - Vulva 1 .2% .3%

Tonsil 4 - - Cervix 3 .4% .8%

Esophagus 13 1.9% 1.1% Uterus 8 1.8% 3%

Stomach 11 1.6% 1.6% Ovary 3 .6% 1.6%

Small Intestine 2 .3% .4 Prostate 75 11% 17.2%

Colon 90 13.2% 7.8% Testes/Penis 7 1.0% .6%

Rectum 17 2.5% - Bladder/Ureter 39 5.7% 4.9%

Anus 5 .7% 3.0% Kidney/ Renal Pelvis 28 4.1% 2.7%

Liver 9 1.3% 1.3% Brain 7 1.0% 1.4%

Gallbladder 1 .2% .6% Thyroid Gland 6 .9% 2%

Pancreas 9 1.3% 2.9% Adrenal/Other 2 .3% .1%

Other 2 .3% .4% Lymphoma 16 2.3% 4.7%

Lung 167 24.4% 12.8% Hematopoietic 10 1.5% 3.8%

Lung/Bronchus

Small Cell 33 4.8% - Other Unspecified 13 1.9% 2.1%

Lung/Bronchus

Non Small Cell 134 19.6% -

Larynx 8 1.2% .7% ** Analytical cases 684

Connective /Soft

Tissue 1 .2% .7%

*** Non-Analytical

Cases 106

Melanoma 6 .9% 4.4% Total Cases

Accessioned 2005 790

Facts on Cancer AT CHRISTUS ST. MICHAEL

Tongue

* American Cancer Society, Cancer Facts and Figures 2005. ** Diagnosed and all of the first course of treatment was preformed at reporting facility.

*** Diagnosis and all of the first course of treatment was preformed elsewhere, recurrence or progression of disease cases at the reporting facility.

2005 Lung Cancer Report

Christopher A. Bailey, M.D. Advanced Pulmonary & Sleep Solutions

Lung cancer is the second most commonly occurring cancer, excluding skin cancer, and is the leading cause of cancer deaths in the United States, An estimated 175,000 new cases are diagnosed yearly, with the national distribution of 54% male and 46% female. Our local distribution by sex reveals 60% male and 40% female (Fig.1 ). Death rates have continued to decline significantly in men and the death rates have recently reached a plateau after continuously increasing for several decades.

Cigarette smoking is by far the most important risk factor for lung cancers. Environmental or second-hand smoke is also implicated in causing lung cancer due to the carcinogenic component in tobacco (Fig 2). Non-small cell lung cancer (NSCLC) is often the classification of several histologies, squamous cell carcinoma, adenocarcinoma and large cell carcinoma. These histologies are often classified together because diagnosis, staging, prognosis and treatment is similar. Patients with resectable disease often may be cured by surgery or surgery with adjuvant chemotherapy. The CSMHS & WHS data reveal 82% lung cancer patients histologies are NSCLC, with only 18% being small cell lung cancer. Studies reveal patients with NSCLC at diagnosis can be divided into three groups. The first group are patients with surgically resectable disease, stage I, stage II, and selected stage III patients. Patients with medical contraindications and are not surgical candidates may receive curative radiation therapy. Cisplatin-based combination chemotherapy may provide a survival advantage to patients with early stage disease. The second

group of patients are patients with locally advanced tumors or unresectable N2-N3 disease and can be treated effectively with surgical resection and/or either preoperative or postoperative chemotherapy or chemoradiation therapy.

The final group are patients with distant metastases (M1) found at the time of diagnosis. This group can be treated with radiation therapy or chemotherapy for palliation of symptoms from their disease. The graphs (Fig 3 & Fig 4 ) compare our local NSCLC survival rates to national comparisons by AJCC stage.

CSMHS & WHS Lung Cancer

Distribution by Sex

M ale

6 0 %

Female

4 0 %

CSMHS & WHS 2005 Smoking

History

S mok e r

6 4 %

Unk HX

3 2 %

Non

S mok e r

4 %

Fig I

CSMHS & WHS 2005 Smoking

History

S mok e r

6 4 %

Unk HX

3 2 %

Non

S mok e r

4 %

Fig 2

Facts on Cancer NATIONAL TRENDS

Small Cell Lung Cancer (SCLC) tends to be widely disseminated at diagnosis when compared to other cancers, but is much more responsive to chemotherapy and radiation. Small cell cancer accounts for 15-20% of all lung cancers nationally. CSMHS & WHS had 18% SCLC in 2005. SCLC is divided into limited stage (19%) and extensive stage (81%) locally. Patients with limited disease are usually treated with up-front combined chemotherapy and radiation therapy. In patients with complete or good partial response, prophylactic cranial irradiation has been proven to significantly reduce brain recurrence and improve over-all survival. Patients with tumors that have spread to the supraclavicular areas are said to have extensive disease. These patients should be treated with systemic chemotherapy and the prognosis remains poor as is shown in the graphs below (Fig 5 &6).

Dr. Bailey’s signature goes here

Fig 3 Fig 4

Fig 5 Fig 6

Gary Engstrom, M.D. serves as Wadley Health System Liaison to the Commission on Cancer. Dr. Engstrom’s contribution to the cancer program in Texarkana has been to serve as Cancer Committee Chairman for the past six years and a member of this committee since 1998. His role on the committee is in research, clinical trials and other initiatives in the community. Dr. Engstrom is involved in CoC special studies as a medical advisor for the cancer registry staff. His interest in patient care and expertise in the field of oncology have enhanced the effectiveness of the cancer committee. We would like to take this opportunity to thank him for his leadership of this committee.

WHS SCREENINGS AND EDUCATIONAL EVENTS

Wadley/Susan G Komen Foundation Breast Cancer Health Education Program, Free mammograms, ultrasounds, biopsies, wigs and prostheses Wadley Bringing Hope Home Breast Cancer Fundraiser and Awareness Event Wadley Dialogue Support Group Wadley Pain Management Program Wadley Genetics Educator- Genetics Testing Program “Is Cancer in your Genes? “

Texarkana Affiliate of the Susan G. Komen Breast Cancer Foundation Race for the Cure American Cancer Society Great American Smoke Out American Cancer Society Relay For Life Signature Event American Cancer Society Reach to Recovery Prostate Screening Program

Lung Cancer Distribution for CSMH & WHS

Wadley Health System

CoC Liaison

C SM HS & W HS LU N G C A N C ER

IN IT IA L T HER A PY

NO TREATMENT

28.4%

RAD CHEMO

18.4%

RAD

18.2%

SURGERY

17.0%

CHEMO

10.4%

ALL OTHER

7.7%

CANCER SITE # of

CASES PERCENT

NATIONAL

PERCENT CANCER SITE

# of

CASES PERCENT

NATIONAL

PERCENT

Lip/ Other Oral 2 .7% 2.2% Cervix 2 .7% .8%

Pharynx 1 .3% .7% Uterus 8 2.6% 3.1%

Esophagus 5 1.6% 1.1% Ovary 6 2.0% 1.7%

Stomach 7 2.3% 1.7% Prostate 32 10.5% 17.7%

Small Intestine 5 1.6% .4% Testes 1 .3% .6%

Colon 43 14.1% 8.0% Bladder/Ureter 16 5.3% .5%

Rectum 12 4.0% 3.1% Kidney 14 4.6% 2.8%

Liver 5 1.6% 1.3% Brain/CNS 1 .3% 1.4%

Lung 57 18.8% 13.2% Thyroid Gland 4 1.35 2.0%

Lung -Small

Cell 8 2.6% - Lymphoma 5 1.6% 4.9%

Lung-Non

Small Cell 49 16.1% -

Leukemia/

Anemias 4 1.3% 2.7%

Larynx 2 .7% .8% Multiple Myeloma 3 1.0% 1.2%

Bones 1 .3% .2% Other Unspecified 7 2.3% 2.2%

Melanoma 1 .3% 4.5% ** Analytical cases 304 100% 100%

Soft Connective

Tissue 1 .3% .7%

*** Non-Analytical

Cases 50

Breast 59 19.4% 16.2% Total Cases

Accessioned 2005 354 100%

Facts on Cancer AT WADLEY HEALTH SYSTEM

** Diagnosed and all of the first course of treatment was preformed at reporting facility. *** Diagnosis and all of the first course of treatment was preformed elsewhere, recurrence or progression of disease cases at the reporting facility

The Breathe Easy ArkTex (BEAT) Tobacco Control Coalition continued its effort to reduce the health and economic toll

placed on the BI-State area due to tobacco use. In 2005, Texarkana, Texas implemented the city-wide smoke-free ordinance,

prohibiting smoking in most public places, including businesses and restaurants. Overall perception of the ordinance has been

positive. A formal study is underway to determine the economic impact (if any) as a result of the ordinance.

UAMS AHEC-SW is home to one of the tobacco interventionist from the College of Public Health Stamp Out Smoking Net-

work. This individual provides one-on-one and group counseling and works in the UAMS AHEC-SW residency and faculty

clinics assessing patients of their tobacco use and desire to quit. Referrals from other health care providers are accepted. Indi-

viduals needing help quitting can call the Quitline at 1-866-NOW-QUIT or the local interventionist at 870-779-6061.

Is Cancer in Your Genes? Tammy McKamie, RN, OCN

Cancer Genetics Educator

Ovarian cancer is the eighth most common cancer among women, excluding non-melanoma skin cancers. The

American Cancer Society estimates that over 20,000 new cases of ovarian cancer will be diagnosed in the United States

during 2005. This disease accounts for approximately 3% of all cancers in women. When ovarian cancer is found early

at a localized stage, about 94% of patients live longer than 5 years after diagnosis. Although only 19% of all ovarian

cancers are found at an early stage of disease.

Scientists continue to study the genes responsible for familial orgin cancer. Research in this area has led to improved

ways to detect high-risk genes and assess a woman’s ovarian cancer risk. I am very pleased to report in the year 2005

over 58 clients in the Cancer Genetics Program at Wadley Health System have been evaluated and educated. Out of

the clients, 23 clients have tested for a mutation in the BRACAI & 2 gene, and 6 were found to have a positive result.

Approximately 10% of ovarian cancers, as well as breast cancers are hereditary with a mutation in either the BRCA1 or

BRCA2 gene. Current cancer research shows that early detection of this particular gene, along with proactive medical

care helps to reduce the cancer risk and save lives. Wadley continues to offer this program “FREE” of charge. Saving

lives is our ultimate goal. Is Cancer in Your Genes?

It takes dedicated staff to coordinate the regulatory requirements for an Approved Cancer Program by the Commission on Cancer. The UAMS AHEC –SW staff have completed their sixteenth year as cancer registry for CSMHS & WHS. The staff coordinate the weekly Tumor Board conferences, the quarterly Cancer Committee meetings, tracking diagnoses and treatments, special studies, as well as the management of outcomes of patients treated at these facilities.

Many more charts are reviewed on each facilities disease index than are accessioned into the cancer registry database. The Registry staff accessioned 986 newly diagnosed cases in 2005 with an additional 85 non-analytic or recurrent cases being collected. Our staff have collected data over the past sixteen years on 17,636 patients.

I would like to take this opportunity to thank the cancer registry staff for their diligence in accurately abstracting the cases and following the patients. The abstractors are Susan Paxton and Donna Marlar. Our Registry Follow-Up Coordinator, Becky Mahone, accomplishes many searches to maintain the high follow up rate on our living patients. Currently we have 6,195 living patients and a follow-up rate of 98% for both facilities. A 90% rate is the required percentage by the CoC.

Dianne Ketchum, CTR

Director, AHEC Cancer Registry 30th ANNIVERSARY ANNUAL

ArCRA MEETING HOSTED

IN TEXARKANA

54 Registrars across the Bi-State area attended the 30th Anniver-

sary ArCRA meeting hosted by the UAMS AHEC-SW Cancer

Registry, CSMHS & WHS. We would like to thank these

physicians for their presentations.

“Update on Prostate Seed Implants”

Howard Morris, M.D.

“Anatomical & Surgical Evaluation of Treatment

of Head & Neck Carcinoma”

James A. Hutcheson, M.D.

“New Molecular Therapies for Cancer”

William McIntyre, PharmD

“New Emerging Chemotherapy for Brain Cancer, the Gliadel

Wafer”

Lee Buono, M.D.

“Breast Cancer Care, Eliminating the Need for Future Surgeries”

Ron Hekier, M.D.

“Introduction to Positron Emission Tomography”

Douglas Trippe, M.D.

UAMS AHEC-SW 300 E 6th Street ● Texarkana, AR

CHRISTUS St. Michael Health Sys-tem 2400 St. Michael Drive ● Texarkana, TX

Wadley Health System 1000 Pine ● Texarkana, TX

Commission on Cancer

Commendation Award

Given CHRISTUS St. Michael Health System and Wadley

Health System received a Three-Year Approval with Commendation by the Commission on Cancer (COC) of the American College of Surgeons as a Community Hospital Comprehensive Cancer Program in 2005.

Approval by the CoC is given only to those facilities that have voluntarily committed to providing the highest level of quality of cancer care and that undergo a rigorous evaluation process and review of their performance. To maintain approval, facilities with CoC-Approved Cancer Programs must undergo an on-site review every three years.

This is the highest accreditation category achieved and awarded to a non-teaching cancer program.

This report is produced and published by the UAMS AHEC-SW Cancer Registry and is supported by the Cancer Committee.

Special thanks to the talents of Lisa Mauk and Gary Miller, UAMS AHEC-SW Outreach Department, for the layout design. We appreciate Doug Breckweg, Wadley Health System Marketing and Graphic Design Specialist, for the cover design.