Cancer Registry Annual Report

2016

Cancer Committee Chairman’s Report

On behalf of the Cancer

Committee – a multidisciplinary

team of board-certified

physicians and health care

professionals – it’s my privilege

to share clinical excellence

highlights over the last year as

we continue to focus on quality,

safety and value-based health

care delivery.

In calendar year 2016, more than 2,000 patients from across Georgia, the Southeast and beyond chose Cancer Treatment Centers of America® (CTCA) at Southeastern Regional Medical Center (Southeastern) for their cancer care. Throughout the year, we deepened our clinical roster of more than 200 physicians across a variety of specialties including medical oncology, radiation oncology, surgical oncology, hematology and stem cell transplants, gynecologic oncology, plastic surgery and more. We further enhanced our multi-disciplinary team approach to providing personalized care with experts trained in breast, lung, genitourinary, hematology and gastrointestinal cancer. Through pharmaceutical sponsors such as AstraZeneca, Bristol-Myers Squibb and Novartis, we expanded our portfolio of clinical trials, disease-specific and targeted therapy for most cancer types. We also have a number of investigator-initiated studies underway, including trials that examine symptom management, healthy lifestyle changes and stress levels associated with treatment, in addition to studies that will focus on obesity and quality of life.

In addition, we launched numerous new services and offerings, including the Microvascular Plastics Program, Interventional Endoscopy, CivaSheet™, Inpatient Continuous Renal Replacement Therapy (CRRT) and we conducted our very first stem cell transplant in June. Amid this growth, we kept safety top-of-mind by implementing the Healthcare Performance Improvement (HPI) We Are Safe program.

It was also a year marked with accreditations and recognition for quality and patient experience. Southeastern renewed its accreditation from The Joint Commission, in which we were named a Top Performer on Key Quality Measures®, and received three-year accreditations from the Commission on Cancer (CoC) with commendation – silver level accommodation; National Accreditation Program for Breast Centers (NAPBC); Quality Oncology Practice Initiative (QOPI®), an affiiliate of the American Society of Clinical Oncology (ASCO) and American College Radiology (ACR) Radiation Oncology Practice Accreditation (ROPA). In addition, for the fourth consecutive year, we were named a top 10 company in Atlanta Journal Constitution’s Top Workplaces in Metro Atlanta.

Sean Cavanaugh, MD Cancer Committee Chairman Chief of Radiation Oncology Director, Genitourinary Center for Advanced Oncology

The Cancer Committee focuses on everything from prevention to life after cancer. The committee assessed the needs of the local community and offered lung, colon and breast screenings during our second annual Prevent Aggressively® Coweta Expo. Our Survivorship program contributed to CoC and NAPBC accreditations by exceeding requirements. In addition, 98 percent of breast cancer patients received post-treatment care plans to enhance their quality of life.

It’s been quite a year and we are grateful for the patients and families who trusted us with their care and the phenomenal team of physicians, clinicians and staff who call CTCA® home. We look forward to delivering personalized, compassionate and integrative cancer care to more patients in the future.

Sincerely,

Sean Cavanaugh, MD Cancer Committee Chairman Chief of Radiation Oncology Director, Genitourinary Center for Advanced Oncology

Contents

04 Cancer Registry Report

06 Accreditations, Certifications and Awards

08 Prevention and Screening

10 Primary Sites

12 Patients by Region

14 Cancer Conference Report

The information presented throughout the 2016 Cancer Registry Annual Report reflects the data collected from January 1 to December 31, 2015 unless otherwise noted.

1,192 Analytic

1,410 Non-Analytic

2 Non-Reportable

Cancer Registry Report

The Southeastern Registry

Department maintains a

data system designed for the

collection, management and

analysis of data on individuals

diagnosed with cancer. The

Cancer Registry has entered

8,882 analytic and non-analytic

cases into the Cancer Registry

database since January 1, 2013.

4

Cancer data is important for a variety of different reasons, including collecting and recording the most complete and accurate cancer data possible. During 2015, 2,604 cases were added into the Southeastern Cancer Registry database. Of these cases, 1,192 were analytic and 1,410 were non-analytic. An analytic patient is one who is diagnosed and/or receives all or part of their first course of cancer treatment at Southeastern. A non-analytic patient is one who receives subsequent cancer treatment due to progressive or recurrent disease. These patients came from 44 states, as well as Mexico and the Cayman Islands.

The Registry staff performs the daily functions of the Tumor Registry, and ensures data accuracy with continuous quality improvement reviews by Cancer Committee physicians. The Registry provides the Cancer Committee with information from which analysis of patient outcomes and evidence-informed clinical decision-making can be performed.

2,604 Total Patients at Southeastern Regional Medical Center

Cancer Registry CY2015 Activities

Responded to 85 requests for data during 2015 via phone, letters, e-mail and/or fax

Successfully submitted all required cases to the Georgia Center for Cancer Statistics monthly with a 90 percent accuracy rate

Coordinated and attended 12 monthly Cancer Committee and Breast Program Leadership meetings in 2015, with exceptional multidisciplinary attendance

Coordinated and attended 118 site-specific weekly cancer conferences

All Certified Tumor Registrars (CTR) maintain membership with the National Cancer Registrars Association

Coordinated and accomplished a successful NAPBC Survey Readiness Assessment

Two CTRs each published an article about the work of the Cancer Registrar

5

Accreditations, Certifications and Awards

Commission on Cancer (CoC) Southeastern is accredited by the Commission on Cancer (CoC), a quality program of the American College of Surgeons (ACS), with the silver level commendation—the highest level of commendation possible for a new program. The CoC recognizes cancer programs for their commitment to providing high-quality, comprehensive and integrative patient-centered care. CoC accredited cancer programs are dedicated to providing the best in patient-centered care. This accreditation recognizes programs that meet the CoC standards and are dedicated to prevention, research and education.

National Accreditation Program for Breast Centers (NAPBC) Southeastern received a three-year/full accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. Accreditation is granted to centers that have voluntarily committed to provide the highest level of quality breast care and undergo a rigorous evaluation process and review of their performance. Accredited breast centers are dedicated to enhancing the care they provide by addressing patient-centered needs and measuring the quality of the care they deliver.

The Joint CommissionSoutheastern is currently accredited by The Joint Commission with Full Standards Compliance. This accreditation decision is awarded to a health care organization that demonstrates satisfactory compliance with applicable Joint Commission standards in all performance areas. In 2015, The Joint Commission recognized Southeastern as a Top Performer on Key Quality Measures®, using data from 2014. The Top Performer program recognizes hospitals for improving performance on evidence-informed interventions that increase the changes of healthy outcomes for patients with certain conditions. Specifically, Southeastern was recognized for its surgical care and venous thromboembolism (VTE) performance measure sets.

Quality Oncology Practice Initiative (QOPI®)Southeastern was recognized by the QOPI® Certification Program (QCP™), an affiliate of the American Society of Clinical Oncology (ASCO), as successfully completing a three-year certification program for outpatient hematology-oncology practices that meet nationally recognized standards for quality cancer care. QCP builds on ASCO’s Quality Oncology Practice Initiative (QOPI®).

Guardian of Excellence AwardSM in Patient Experience, Press Ganey®, 2016, 2015In 2015 and 2016, Southeastern was recognized by Press Ganey as a Guardian of Excellence Award winner in the category of HCAHPS Patient Experience. This award recognizes outstanding hospitals that have consistently achieved the 95th percentile or above of performance in the realm of inpatient experience from amongst Press Ganey clients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey established by the U.S. Department of Health and Human Services.

6

In addition, Southeastern is accredited or certified by the following health care organizations:

American College of Radiology Radiation Oncology Accredited Facility

American College of Radiology Mammography Accredited Facility

American College of Radiology Magnetic Resonance Imaging (MRI) Accredited Facility

American College of Radiology Computed Tomography Accredited Facility

American College of Radiology Positron Emission Tomography Accredited Facility

American College of Radiology Breast Imaging Center of Excellence

American College of Radiology Breast Ultrasound

American College of Radiology Stereotactic Breast Biopsy

U.S. Department of Health and Human Services/Public Health Service/Food and Drug Administration

Certified Mammography Facility

Clinical Laboratory Improvement Act (CLIA)

College of American Pathologists

In 2016, Southeastern was also recognized by:

Clinical Center of Excellence in Pain Management by the American Pain Society

Quality Respiratory Care Recognition (QRCR)

Castle Connolly Top Doctors, Atlanta Magazine: George Daneker (since 2011); Rabih Bechara (since 2009); Scott Shelfo (since 2013); Daniel Miller (since 2007, 2009-present); Kelly Manahan (since 2013); John Geisler (since 2011); Kevin Watkins (since 2013)

Four consecutive years in the top 10 of Atlanta Journal Constitution’s Top Workplaces in Metro Atlanta, including #1 in 2015 (large company category)

7

8

Prevention and Screening

Southeastern continued its

community outreach efforts

in 2016, including hosting

its second annual Prevent

Aggressively® Coweta Expo.

We further supported the Community Health Needs Assessment (CHNA) conducted in early 2015 in the Coweta County community, which represents both the largest number of patients served at Southeastern and the hospital’s physical footprint. The results of the CHNA revealed that the top three cancer-related causes of death within the community include lung, colorectal and breast cancer, prompting Southeastern to host its second annual Prevent Aggressively Coweta Expo in August 2016.

We designed the expo to educate participants on the signs, symptoms and risk factors of each of the three cancers; and promoted the experience open to Coweta County and the surrounding communities. Specific features of the event included a Q&A panel discussion on each of the three cancers led by four Southeastern physicians and an offering of pre-scheduled breast (screening mammogram) and lung (low-dose lung CT) screenings. The educational expo also provided information on a number of topics related to cancer prevention and risk-reduction, including smoking cessation, nutrition, fitness, stress management and cancer survivorship. Community organizations, including the American Cancer Society®, Georgia Prostate Cancer Coalition, Leukemia and Lymphoma Society, Pancreatic Cancer Action Network, Susan G. Komen of Greater Atlanta, among many others, also helped raise awareness on cancer prevention and awareness.

Southeastern performed breast screenings at the event, with no participants requiring additional follow-up. Approximately 200 community members participated in the event and completed an event evaluation to determine the effectiveness of the event.

• 36 percent of respondents felt very informed before attending the event

• 86 percent of respondents felt very informed after attending the event

• 97 percent of respondents stated they would make lifestyle changes towards cancer prevention as a result of the event

86 percent of respondents felt very informed after attending

97 percent of respondents said they

would make lifestyle changes to help prevent cancer

9

Primary SitesSummary by Body System, Sex, Class and Best CS/AJCC Stage Report

Sex Class of Case Stage Distribution - Analytic Cases OnlyPrimary Site Total (%) M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 Unk BlankORAL CAVITY AND PHARYNX 68 (2.6%) 51 17 30 38 0 0 2 6 18 1 3 0

Lip 2 (0.1%) 1 1 0 2 0 0 0 0 0 0 0 0

Tongue 28 (1.1%) 23 5 13 15 0 0 0 3 9 0 1 0

Salivary Glands 9 (0.3%) 6 3 2 7 0 0 0 0 1 0 1 0

Floor of Mouth 1 (0.0%) 0 1 1 0 0 0 0 1 0 0 0 0

Gum and Other Mouth 5 (0.2%) 5 0 1 4 0 0 1 0 0 0 0 0

Nasopharynx 5 (0.2%) 2 3 2 3 0 0 1 0 1 0 0 0

Tonsil 14 (0.5%) 11 3 8 6 0 0 0 0 7 0 1 0

Oropharynx 1 (0.0%) 1 0 0 1 0 0 0 0 0 0 0 0

Hypopharynx 2 (0.1%) 1 1 2 0 0 0 0 2 0 0 0 0

Other Oral Cavity and Pharynx 1 (0.0%) 1 0 1 0 0 0 0 0 0 1 0 0

DIGESTIVE SYSTEM 697 (26.8%) 395 302 262 435 0 18 31 57 144 3 8 1

Esophagus 32 (1.2%) 27 5 10 22 0 1 0 1 7 0 1 0

Stomach 58 (2.2%) 33 25 26 32 0 1 4 4 15 0 2 0

Small Intestine 21 (0.8%) 13 8 9 12 0 0 3 2 3 0 1 0

Colon Excluding Rectum 211 (8.1%) 108 103 61 150 0 1 3 14 43 0 0 0

Cecum 46 25 21 14 32 0 0 0 2 12 0 0 0

Appendix 16 2 14 4 12 0 0 1 0 3 0 0 0

Ascending Colon 25 12 13 7 18 0 0 1 3 3 0 0 0

Hepatic Flexure 5 0 5 3 2 0 0 0 0 3 0 0 0

Transverse Colon 11 9 2 4 7 0 0 0 2 2 0 0 0

Splenic Flexure 8 4 4 3 5 0 1 0 1 1 0 0 0

Descending Colon 9 5 4 4 5 0 0 0 1 3 0 0 0

Sigmoid Colon 64 42 22 20 44 0 0 1 5 14 0 0 0

Large Intestine, NOS 27 9 18 2 25 0 0 0 0 2 0 0 0

Rectum and Rectosigmoid 104 (4.0%) 61 43 42 62 0 3 8 21 10 0 0 0

Rectosigmoid Junction 21 11 10 7 14 0 0 1 4 2 0 0 0

Rectum 83 50 33 35 48 0 3 7 17 8 0 0 0

Anus, Anal Canal and Anorectum 14 (0.5%) 10 4 5 9 0 1 0 2 0 0 2 0

Liver and Intrahepatic Bile Duct 53 (2.0%) 37 16 22 31 0 2 2 6 7 3 2 0

Liver 45 35 10 20 25 0 2 1 5 7 3 2 0

Intrahepatic Bile Duct 8 2 6 2 6 0 0 1 1 0 0 0 0

Gallbladder 11 (0.4%) 2 9 1 10 0 0 0 1 0 0 0 0

Other Biliary 16 (0.6%) 12 4 8 8 0 1 0 1 6 0 0 0

Pancreas 165 (6.3%) 90 75 76 89 0 8 11 5 51 0 0 1

Retroperitoneum 5 (0.2%) 2 3 1 4 0 0 0 0 1 0 0 0

Peritoneum, Omentum and Mesentery 7 (0.3%) 0 7 1 6 0 0 0 0 1 0 0 0

RESPIRATORY SYSTEM 284 (10.9%) 149 135 141 143 0 10 11 31 88 1 0 0

Nose, Nasal Cavity and Middle Ear 2 (0.1%) 1 1 0 2 0 0 0 0 0 0 0 0

Larynx 8 (0.3%) 6 2 4 4 0 0 1 1 2 0 0 0

Lung and Bronchus 274 (10.5%) 142 132 137 137 0 10 10 30 86 1 0 0

10

Primary Site Total (%) M F Analy NA Stg 0 Stg I Stg II Stg III Stg IV 88 UnkBONES AND JOINTS 3 (0.1%) 1 2 0 3 0 0 0 0 0 0 0 0

SOFT TISSUE 17 (0.7%) 6 11 9 8 0 3 1 2 2 1 0 0

SKIN EXCLUDING BASAL AND SQUAMOUS 40 (1.5%) 20 20 22 18 3 7 1 5 3 2 1 0

Melanoma — Skin 37 (1.4%) 19 18 20 17 3 7 1 5 3 0 1 0

Other Non-Epithelial Skin 3 (0.1%) 1 2 2 1 0 0 0 0 0 2 0 0

BASAL AND SQUAMOUS SKIN 4 (0.2%) 2 2 0 4 0 0 0 0 0 0 0 0

BREAST 603 (23.2%) 2 601 312 291 30 89 122 38 32 0 1 0

FEMALE GENITAL SYSTEM 219 (8.4%) 0 219 73 146 0 21 7 16 23 1 4 1

Cervix Uteri 60 (2.3%) 0 60 20 40 0 3 4 4 7 1 0 1

Corpus and Uterus, NOS 72 (2.8%) 0 72 29 43 0 15 1 5 7 0 1 0

Corpus Uteri 62 0 62 26 36 0 15 0 4 6 0 1 0

Uterus, NOS 10 0 10 3 7 0 0 1 1 1 0 0 0

Ovary 69 (2.7%) 0 69 18 51 0 2 1 6 8 0 1 0

Vagina 4 (0.2%) 0 4 2 2 0 0 1 1 0 0 0 0

Vulva 11 (0.4%) 0 11 4 7 0 1 0 0 1 0 2 0

Other Female Genital Organs 3 (0.1%) 0 3 0 3 0 0 0 0 0 0 0 0

MALE GENITAL SYSTEM 326 (12.5%) 326 0 177 149 0 39 106 9 21 0 1 1

Prostate 319 (12.3%) 319 0 175 144 0 38 105 9 21 0 1 1

Testis 7 (0.3%) 7 0 2 5 0 1 1 0 0 0 0 0

URINARY SYSTEM 152 (5.8%) 110 42 74 78 4 34 12 9 15 0 0 0

Urinary Bladder 61 (2.3%) 48 13 27 34 4 5 11 3 4 0 0 0

Kidney and Renal Pelvis 86 (3.3%) 58 28 44 42 0 28 1 5 10 0 0 0

Ureter 2 (0.1%) 1 1 2 0 0 1 0 0 1 0 0 0

Other Urinary Organs 3 (0.1%) 3 0 1 2 0 0 0 1 0 0 0 0

EYE AND ORBIT 2 (0.1%) 2 0 0 2 0 0 0 0 0 0 0 0

BRAIN AND OTHER NERVOUS SYSTEM 3 (0.1%) 0 3 3 0 0 0 0 0 0 3 0 0

Cranial Nerves Other Nervous System 3 (0.1%) 0 3 3 0 0 0 0 0 0 3 0 0

ENDOCRINE SYSTEM 10 (0.4%) 2 8 4 6 0 1 1 0 0 2 0 0

Thyroid 4 (0.2%) 1 3 2 2 0 1 1 0 0 0 0 0

Other Endocrine including Thymus 6 (0.2%) 1 5 2 4 0 0 0 0 0 2 0 0

LYMPHOMA 48 (1.8%) 21 27 26 22 0 3 3 7 12 0 1 0

Hodgkin Lymphoma 7 (0.3%) 3 4 4 3 0 0 1 2 1 0 0 0

Non-Hodgkin Lymphoma (NHL) 41 (1.6%) 18 23 22 19 0 3 2 5 11 0 1 0

NHL — Nodal 27 13 14 16 11 0 2 1 4 9 0 0 0

NHL — Extranodal 14 5 9 6 8 0 1 1 1 2 0 1 0

MYELOMA 27 (1.0%) 13 14 11 16 0 0 0 0 0 11 0 0

LEUKEMIA 30 (1.2%) 17 13 12 18 0 0 0 0 0 12 0 0

Lymphocytic Leukemia 20 (0.8%) 13 7 8 12 0 0 0 0 0 8 0 0

Chronic Lymphocytic Leukemia 19 12 7 8 11 0 0 0 0 0 8 0 0

Other Lymphocytic Leukemia 1 1 0 0 1 0 0 0 0 0 0 0 0

Myeloid and Monocytic Leukemia 10 (0.4%) 4 6 4 6 0 0 0 0 0 4 0 0

Acute Myeloid Leukemia 3 1 2 1 2 0 0 0 0 0 1 0 0

Chronic Myeloid Leukemia 7 3 4 3 4 0 0 0 0 0 3 0 0

MESOTHELIOMA 5 (0.2%) 2 3 1 4 0 0 0 1 0 0 0 0

MISCELLANEOUS 64 (2.5%) 24 40 34 30 0 0 0 0 0 34 0 0

Total 2,602 1,143 1,459 1,191 1,411 37 225 297 181 358 71 19 3

11

20

MIDWEST26

WEST

7

RESIDENTS OF OTHER

INTERNATIONALCOUNTRIES

14

VIRGINISLANDS

247

SOUTHWEST

234

EAST

2056

SOUTHEAST

12

Patients by Region

Total New Cases in 2015 by Region for Southeastern Regional Medical Center

These numbers represent the number of primary cancers seen at Southeastern Regional Medical Center.

2,604

13

Cancer Conference Report

In 2015, the Southeastern Cancer Registry coordinated weekly General, Breast, GI and Thoracic

Cancer Conferences. These were attended by a multidisciplinary team including physicians,

clinicians, nurses and ancillary service team members to ensure comprehensive representation and

care. Together, they reviewed cases in detail and discussed stage, prognostic indicators, national

guidelines, plans for appropriate diagnostic studies, therapies and clinical trials. These conferences

were prospective, patient-oriented treatment planning meetings that provided a free consultation

for our patients and education to our medical and hospital employees.

Total Patients Presented at General Cancer Conference

Cancer Site # of Cases Cancer Site # of CasesBreast 24 Bladder 3

Lung 1 Gastric 5

Colon 13 Prostate 4

Unknown 6 Thyroid 0

Pancreas 15 Tongue 4

Kidney 0 Ovarian 1

Rectal 6 Leiomyosarcoma 3

Liver 2 Endometrial 2

Lymphoma 0 Melanoma 3

Anus 1 Appendix 1

Bile Duct 1 Base of Tongue 1

Esophageal 4 Adrenal 1

Gallbladder 2 Cholangiocarcinoma 1

GIST 2 Brain 1

GE Junction 1 Hepatocellular 2

Head/Neck 0 Eyelid 1

Neuroendocrine 1 Maxillary Sinus 3

Sarcoma 3 Undiagnosed 1

Renal 4 Total 130

14

Total Patients Presented at Thoracic Cancer Conferences

Cancer Site # of CasesLung 205

Sarcoma 11

Breast 11

Colon 20

Rectum 4

Head & Neck 6

Mesothelioma 4

Undiagnosed 34

Unknown 6

Thymoma 2

Endometrial 7

Kidney 3

Pancreas 4

Appendix 1

Bladder 1

Prostate 1

Esophagus 7

Melanoma 3

Rectum 1

Adrenal 2

Liver 2

Leiomyosarcoma 2

Aryepiglottic 1

Ovarian 2

Uterine 1

Endometrial 7

Duodenal 1

Renal 1

Testicles 1

Ampulla 1

Oropharynx 1

Total 353

Total Patients Presented at GI Cancer Conferences

Cancer Site # of CasesPancreas 14

Colon 9

Liver 3

Rectal 1

Esophagus 4

Gallbladder 0

Stomach 1

Small bowel 1

Duodenum 1

Gastric 1

Neuroendocrine 1

Ovary 1

Cervical 1

Renal 1

Urachal 1

Anus 1

Unknown 3

Total 44

Total Patients Presented at Breast Cancer Conferences

Cancer Site # of CasesBreast 187

Colon 1

Ovary 1

CLL 1

Total 190

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