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Taussig Cancer Institute

2008Outcomes

9500 Euclid Avenue, Cleveland, OH, 44195

© The Cleveland Clinic Foundation 2009

Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education institute and a research institute.

Please visit us on the Web at clevelandclinic.org.

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Taussig Cancer Institute 85

Resources for Physicians

Cleveland Clinic Secure Online Services

Cleveland Clinic uses state-of-the-art digital information systems to offer secure online services such as online medical second opinions, medical record access, patient treatment progress for referring physicians (see below), and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.

MyChart This secure online tool connects patients to their own health information from the privacy of their home any time, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to GoogleTM Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice. To establish a MyChart account, visit clevelandclinic.org/mychart.

DrConnect Whether you are referring from near or far, DrConnect streamlines communication from Cleveland Clinic physicians to your office. This complimentary online tool offers secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

MyConsult Online Medical Second Opinion This secure online service provides specialist consultations from our Cleveland Clinic experts and remote medical second opinions for more than 1,000 life-threatening and life-altering diagnoses. MyConsult is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext 43223.

Critical Care Transport: Anywhere in the world

Cleveland Clinic’s critical care transport team serves critically ill and highly complex patients across the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed by physicians, critical care nurse practitioners, critical care nurses, paramedics and ancillary staff, and are customized to meet the needs of the patient. Critical care transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.279.CODE (2633). For all other transfers, call 216.444.8302 or 800.553.5056.

CME Opportunities: Live and Online

Cleveland Clinic’s Center for Continuing Education’s website, clevelandclinicmeded.com, offers hundreds of convenient, complimentary learning opportunities, from webcasts and podcasts to a host of medical publications including the Disease Management Project Online Medical Textbook, with more than 150 chapters. The site also offers a schedule of live CME courses, including international summits that focus on key areas of translational research. Many live CME courses are hosted in Cleveland, an economical option for business travel. Physicians can manage their CME credits by using the myCME Web Portal. Available 24/7, the site offers CME opportunities to medical professionals across the globe.


1

To promote quality improvement, Cleveland Clinic has created a series of Outcomes books similar to this one for many of its institutes. Designed for a physician audience, the Outcomes books contain a summary of our surgical and medical trends and approaches, data on patient volume and outcomes, and a review of new technologies and innovations.

Although we are unable to report all outcomes for all treatments provided at Cleveland Clinic — omission of outcomes for a particular treatment does not mean we necessarily do not offer that treatment — our goal is to increase

unavailable, we often report process measures associated with improved outcomes. When process measures are unavailable, we may report volume measures; a volume/outcome relationship has been demonstrated for many treatments, particularly those involving surgical techniques.

In addition to our internal efforts to measure clinical quality, Cleveland Clinic supports transparent public reporting of healthcare quality data and participates in the following public reporting initiatives:

(www.qualitycheck.org)

(www.hospitalcompare.hhs.gov)

Our commitment to providing accurate, timely information about patient care will also help patients and referring physicians make informed healthcare decisions.

quality/outcomes.

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Outcomes 20082

Dear Colleague,

On behalf of Cleveland Clinic, I am pleased to present our 2008 Outcomes books. The primary purpose of our annual Outcomes book initiative is to promote quality improvement at Cleveland Clinic, thereby optimizing the care we provide to our

accountability, transparency and results.

requiring hospitals to report more and more quality and patient safety data. We view our Outcomes books as voluntary supplements to the required public reporting and an opportunity to share selected innovations with colleagues across the country.

Designed for the physician reader, each book in the annual series focuses on care provided by one of our patient-centered

content informative.



what’s inside

Institute Overview 06

Quality and Outcomes Measures

Solid Tumor Oncology 12

Colorectal Cancer 20

Upper Aerodigestive Tract 28

Esophageal 28

Contact Information 82


Outcomes 20084

Chairman’s Letter

I am pleased to present our 2008 Outcomes, an abridged review of the Taussig Cancer Institute’s results, trends and research. The Taussig Cancer Institute continues its mission of providing innovative, high quality care through our commitment to meticulous clinical practice, augmented by a portfolio of clinical, translational and basic research, as well as undergraduate and graduate education.

As you will see in the pages that follow, we have had a busy year, with more than 600 publications (only a selection of which are listed in this book), more than 260,000 patient visits, and the acquisition of many new peer-reviewed grants, contracts, and discoveries, as well as increasing the involvement of our patients inclinical trials.

We have participated actively in many quality assurance initiatives, and have developed several business tools to

Hospital Review’s

2008, we created a new regional structure that combines our cancer initiatives across the Cleveland Clinic health

trials to open at regional sites, allowing patients to access novel therapy closer to home, and recruitment hasbeen brisk.

Our already robust translational research efforts were enhanced this year with the creation of a new Department

researchers continue to advance cancer diagnosis, prognosis and therapeutics.

prostate during radiation therapy for optimal treatment with minimal side effects.



more patients an opportunity to mobilize stem cells for transplantation.

provide another forum for community physician education in oncology, as do our regular grand rounds sessions that are broadcast to many sites. In this edition of our Outcomesbook, we provide data on our clinical outcomes and

interesting and useful in your own practice and look forward to continued collaboration with you.

Chairman and Director, Taussig Cancer Institute

5


Institute Overview

51Total number of

grants awarded

in 2008

Outcomes 20086



150 +Number of national

presentations made by


staff in 2008

150 +Number of courses

taught or directed by


staff in 2008

Cleveland Clinic’s Taussig Cancer Institute provides outstanding multidisciplinary

patients individualized treatment plans based on the best standard of care and access to new and emerging treatment options. The institute is organized to include the departments of:

In addition to these departments, the institute includes the

Taussig Cancer Institute was rated number one in Ohio by U.S. News & World Reportdepartments, which are focused on multidisciplinary care, groundbreaking research, and technological advancements. We are proud to offer the same care and variety of research opportunities at many of our Cleveland Clinic regional locations as we do at Cleveland Clinic main campus. In addition, we are focused on community outreach

chemocare.com

7


Outcomes 2008

Institute Overview


Total outpatient chairs 60

80%

patients enrolled

in investigator-

initiated trials

out of all patients

participating in

research trials

8



Hematology and Medical Oncology

Disease Group/Treatment Outpatient Visits/Consults Inpatient Visits/Consults Patients


10

Institute Overview

Radiation Oncology

Outcomes 2008

Radiation Oncology Special Procedures


Regional Oncology – Hematology Oncology

Regional Oncology – Radiation Oncology



Outcomes 2008

Solid Tumor Oncology | Respiratory

The multidisciplinary physician teams at the Taussig Cancer Institute are comprised of medical and radiation oncologists, surgical oncologists, and translational research physician scientists. These teams develop individual treatment plans for patients diagnosed with cancer including

productive and innovative translational research program.

Respiratory

service developed in collaboration with surgical, radiation and medical oncologists. The Thoracic

12



100

80

60

40

20

00-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-30 >30

Number of Patients

Days to Appointment

Percent Survival

Years Since Diagnosis

0

60

80

40

20

100

0 1 2 3 4 5

CCRef

Appointments beyond seven days at patient’s request

appointment or on the date that accommodates their scheduling preferences. The survival

J Clin Oncol

CC = Cleveland Clinic

National Cancer Institute; 2008. http://seer.cancer.gov/faststats/selections.php?series=cancer.

patients with lung

cancer are seen within

a week of their request

for an appointment.

Lung CancerDays from New Patient Appointment Request to Appointment forPatients with Lung Cancer (N = 275)2008

Five-Year Survival for Patients with Lung Cancer (N = 2,673)

13


14


0

60

80

40

20

100

0 1 2 3 4 5

Stage I CC (N = 644)Stage I RefStage II CC (N = 134)Stage II RefStage III CC (N = 864)Stage III Ref

Percent Survival

The Taussig Cancer

Institute Department

accrued the most

patients in lung

cancer trials in the

collaborative trials from


Outcomes 2008


software (www.seer.cancer.gov/seerstatwww.seer.cancer.gov)

Five-Year Survival of Patients with Lung Cancer by Stage at Diagnosis (N = 1,642)


15

Non-Small-Cell Lung Cancer

CC = Cleveland ClinicAJCC Cancer

Staging Manual


Staging Manual


The Department of

Radiation Oncology

accrued the most

patients in lung

cancer trials for the

Radiation Therapy

Oncology Group (RTOG)

collaborative trials

from 2005 to 2008.

Percent Survival

Years Since Treatment

0

60

80

40

20

100

0 1 2 3 4 5

Stage III CC (N = 640)Stage III RefStage IV CC (N = 289)Stage IV Ref

Overall Survival of Patients with Stage II Non-Small-Cell Lung Cancer Treated with Radiation (N = 93)

Overall Survival of Patients with Stage III and IV Non-Small-Cell Lung Cancer Treated with Radiation (N = 929)

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Stage II CCStage II Ref


Outcomes 2008

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5



Small-Cell Lung CancerOverall Survival of Patients with Stage III and IV Small-Cell Lung Cancer Treated with Radiation (N = 112)

16


Staging Manual



Solid Tumor Oncology | Genitourinary

The Taussig Cancer Institute’s Genitourinary (GU) Oncology Program is one of the largest and most comprehensive programs in the United States and is dedicated to exceptional clinical care including chemotherapy, radiotherapy and clinical research for patients with early through advanced disease. The primary mission is to provide clinical care and conduct clinical research for patients with GU neoplasms: testicular, bladder, prostate, kidney, and adrenal cancers. The GU Medical Oncology Program and Radiation Department enrolled 114 patients in clinical trials in 2008.

The department offers innovative state-of-the-art care for patients with prostate cancer. Image guidance for external beam radiation therapy delivery, enhanced cancer outcomes and reduced treatment-related morbidity. Cleveland Clinic’s prostate brachytherapy program is one of the largest in the country. The program also has been subjected to rigorous quality control reviews and continues its growth in both the number of patients served and the innovative approaches to treatment to reduce post-treatment toxicity. Cleveland Clinic’s prostate cancer program also is active in clinical research and was one of only six institutions to participate in a prospective study to assess quality of life after treatment for prostate cancer (Sanda MG, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250-61). Forty-two percent of all patients treated with brachytherapy in the trial were treated at Cleveland Clinic.

The GU Medical Oncology Program and Radiation Department enrolled 114 patients in clinical trials in 2008.

17

Outcomes 2008

Solid Tumor Oncology | Genitourinary

Treatment Type Five-Year Biochemical Relapse-Free Survival, %

Percent Biochemical Relapse-Free Survival


0

60

80

40

20

100

0 1 2 3 4 5 6 7 8 9 1310 11 12

RT (N = 497) RP (N = 1,135)PI (N = 737)

Prostate Cancer



0

60

80

40

20

100

0 1 2 3 4 5 6 7 8 9 1310 11 12

RT (N = 496)RP (N = 2,124)PI (N = 1,348)

Biochemical Relapse-Free Survival for Patients with Low Risk Prostate Cancer by Treatment Type (N = 3,968)

Biochemical Relapse-Free Survival for Patients with Intermediate Risk Prostate Cancer by Treatment Type (N = 2,369)


18






0

60

80

40

20

100

0 1 2 3 4 5 6 7 8 9 1310 11 12

RT (N = 777) RP (N = 654)PI (N = 231)

Biochemical Relapse-Free Survival for Patients with High Risk Prostate Cancer by Treatment Type (N = 1,662)

In 2008,for the second year in

Oncology Department

performed more

than prostate

brachytherapy

procedures.

19


Outcomes 2008

Solid Tumor Oncology | Gastrointestinal

treatment for patients with these and other rare gastrointestinal cancers such as neuroendocrine tumors and anal cancers.

of clinical trials sponsored by the National Cancer Institute, along with cooperative group trials, industry-sponsored trials,

genetic counseling to patients when warranted.

Colorectal Cancer

At the Taussig Cancer Institute, we strive to ensure patients are seen by an oncologist as soon as possible or on the date that

Ann Ocol. 2008

80

60

40

20

00-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-30 >30

Number of Patients

Days to Appointment

Days from New Patient Appointment Request to Appointment for Patients with Colon Cancer (N = 320)2008

20




CC = Cleveland Clinicwww.seer.cancer.gov/seerstat)

www.seer.cancer.gov

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5



http://seer.cancer.gov/faststats/selections.php?series=cancer

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

CCRef

Five-Year Survival for Patients with Colon Cancer (N = 2,502)

5-Year Survival of Patients with Stage III and IV Colon Cancer by Stage at Diagnosis (N = 1,074)


Outcomes 2008

Solid Tumor Oncology | Gastrointestinal

Surgical Expertise — Colorectal Liver Metastases

chemotherapy alone is near zero. But in a large, long-term follow-up study

Ann Surg

chorioembryonic antigen value before surgery were predictors of increasedsurvival in this study.

22



oncologists and plastic surgeons collaborate with each patient to develop an individualized treatment plan consistent with national and international guidelines. Weekly conferences of surgeons, medical oncologists, radiation oncologists, nurses, genetic counselors, radiologists and pathologists review

and radiation are treated at the Taussig Cancer Institute.

Breast Cancer

New patients requesting an appointment at the Taussig Cancer Institute are seen within a week or on the date they prefer. Diagnosis and treatment of breast cancer at an early stage clearly improves treatment outcomes. Time-to-treatment is also a factor that may impact outcomes and has been investigated with respect

surgery (J Clin Oncol. Breast Cancer Res and Treat.

4,845Number of

patients with

breast cancer

seen in 2008

120

80

100

60

40

20

00-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-30 >30

Number of Patients

Days to Appointment

Days from New Patient Appointment Request to Appointment for Patients with Breast Cancer (N = 374)2008

Solid Tumor Oncology | Gynecological



24


American Joint Committee on Cancer (AJCC) Stage I-IV breast cancer CC = Cleveland Clinic Ref = Reference group as reported in: Surveillance Epidemiology and End Results (SEER): NCI’s Surveillance Research Program. Bethesda, MD: National Cancer Institute; 2008. http://seer.cancer.gov/faststats/selections.php?series=cancer. Linked to Data Type- Seer Survival; Statistic Type – Relative Survival Rates by Survival Time; Year Range – 1988-2004; Race/Ethnicity – All Races; Sex – Female; Age Range – All Ages; Cancer Site – Breast, Female. Accessed March 18, 2009.

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

CCRef

Five-Year Survival for Female Patients with Breast Cancer (N = 3,815) 1996 – 2004

Outcomes 2008

25

American Joint Committee on Cancer (AJCC) cancer staging CC = Cleveland Clinic Ref = Software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 6.4.4. Data: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 17 Regs, Nov 2007 Sub (1973-2005 varying) - Linked To County Attributes - Total U.S., 1969-2005 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released March 2008, based on the November 2007 submission.

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Stage I CC (N = 1,831)Stage I RefStage II CC (N = 1,532)Stage II RefStage III CC (N = 311)Stage III RefStage IV CC (N = 144)Stage IV Ref

Five-Year Survival of Patients with Breast Cancer by Stage at Diagnosis (N = 3,818) 1996 – 2003


Outcomes 200826



al. AJCC Cancer Staging Manua


AJCC Cancer Staging Manual

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Stage 0 CC (N = 221)Stage 0 RefStage I or II CC (N = 1,518)Stage I or II Ref

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage 0, I and II Breast Cancer Treated with Radiation (N = 1,739)

Overall Survival of Patients with Stage III and IV Breast Cancer Treated with Radiation (N = 367)



Cervical Cancer

treatment for patients with cervical cancer.


Int J Gynaecol Obstet


Int J Gynaecol Obstet

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Stage I CC (N = 113)Stage I RefStage II CC (N = 61)Stage II Ref

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage I and II Cervical Cancer Treated with Radiation (N = 174)

Overall Survival of Patients with Stage III and IV Cervical Cancer Treated with Radiation (N = 124)


Outcomes 200828

Solid Tumor Oncology | Upper Aerodigestive Tract

The treatment of patients with cancers of the upper aerodigestive tract is based on a multidisciplinary approach involving patient assessment by surgical, medical and radiation oncologists. Individualized treatment plans for patients with these malignancies are developed through the collaborative efforts of all specialists. The treatment strategy is tailored for each patient according to the patient’s disease site, cancer stage, general health and the anticipated side effects of treatment.

chemotherapy to increase local regional control, cure rates and improve quality of life. Clinical research is primarily driven by in-house protocols.

Esophageal Cancer


http://seer.cancer.gov/faststats/selections.php?series=cancer

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

CCRef

Five-Year Survival for Patients with Esophageal Cancer (N = 441)



CC = Cleveland Clinicsoftware

(www.seer.cancer.gov/seerstatwww.seer.cancer.gov)

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Localized CC (N = 111)Localized RefRegional CC (N = 143)Regional RefDistant CC (N = 106)Distant Ref

Five-Year Survival of Patients with Esophageal Cancer by Stage at Diagnosis (N = 360)

29


Outcomes 200830


N Engl J Med

Percent Survival


0

6

8

4

2

10

0 1 2 3 4 5 6 7 8 9 10

Stage IIA (N = 86)Stage IIB (N = 38)Stage III (N = 161)Stage IVA (N = 61)Stage IVB (N = 34)

Overall Survival of Patients with Stage II, III and IV Esophageal Cancer Treated with Radiation (N = 380)

Percent Survival at Five Years by Stage

IIA IIB III IVA IVB



Hypopharynx Cancer


Staging Manual

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage III and IV Hypopharynx Cancer Treated with Radiation (N = 58)

31


Outcomes 200832



ID, et al. AJCC Cancer Staging Manual

Laryngeal Cancer



Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5

Stage I CC (N = 76)Stage I RefStage II CC (N = 58)Stage II Ref

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage I and II Laryngeal Cancer Treated with Radiation (N = 134)

Overall Survival of Patients with Stage III and IV Laryngeal Cancer Treated with Radiation (N = 153)



CC = Cleveland Clinic Ref = Reference group as reported in: Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer Science & Business Media; 2002.

Nasopharyngeal Cancer

Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage III and IV Nasopharyngeal Cancer Treated with Radiation (N = 43) 1996 – 2008

33

Outcomes 200834


Oral Cancer





Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage II Oral Cancer Treated with Radiation (N = 24)

Overall Survival of Patients with Stage III and IV Oral Cancer Treated with Radiation (N = 176)



Oropharyngeal Cancer



Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Percent Survival


0

60

80

40

20

100

0 1 2 3 4 5


Overall Survival of Patients with Stage II Oropharyngeal Cancer Treated with Radiation (N = 23)

Overall Survival of Patients with Stage III and IV Oropharyngeal Cancer Treated with Radiation (N = 329)




Outcomes 2008

Solid Tumor Oncology | Palliative Medicine

including prevalence and treatment. This program includes an acute inpatient palliative medicine unit, inpatient consultation

As reported by patients discharged in 2008 from palliative medicine service.

35% No35% No

65% Yes65% Yes

100%100%

Discussed at Admission/Transfer

26% No26% No

74% Yes74% Yes

100%100%

Discussed at Discharge

Advanced Directives Discussed with Patient (N = 891)2008

36





896Number of

patients admitted

to the palliative

medicine service

in 2008

700

600

500

400

300

100

200

0

Number of Patients

Pain Present atDischarge

Present at admission (N = 603)Developed during hospital stay (N = 23)Present at discharge (N = 436)

4% Worse4% Worse

15% Same15% Same

81% Better81% Better

100%100%

Pain Reported at Admission, Developed During Stay and at Discharge (N = 626)2008

Pain Status at Discharge (N = 626)2008

37


38




400

300

100

200

0

Number of Patients

Dyspnea Present atDischarge


15% Worse15% Worse

17% Same17% Same


100%100%

Shortness of Breath (SOB) / Dyspnea at Admission, Developed During Stay andat Discharge (N = 304)2008

Shortness of Breath (SOB) / Dyspnea Status at Discharge (N = 304)2008

Outcomes 2008


39



400

300

100

200

0

Number of Patients

Nausea Present atDischarge


8% Worse8% Worse11% Same11% Same

81% Better81% Better100%100%

Nausea at Admission, Developed During Stay and at Discharge (N = 293)2008

Nausea Status at Discharge (N = 293) 2008



Outcomes 2008




300

100

200

0

Number of Patients

Constipation Present atDischarge


21% Worse21% Worse

14% Same14% Same


100%100%

Constipation at Admission, Developed During Stay and at Discharge (N = 217)2008

Constipation Status at Discharge (N = 217)2008

40





300

100

200

0

Number of Patients

Pain Present atDischarge


30% Worse30% Worse

26% Same26% Same


100%100%

Delirium at Admission, Developed During Stay and at Discharge (N = 214)2008

Delirium Status at Discharge (N = 214)2008

41


Outcomes 2008

Hematologic Oncology and Blood Disorders | Bone Marrow Transplant

The Taussig Cancer Institute offers patients with cancers of the blood, bone marrow,

may include chemotherapy and bone marrow transplantation. There are several specialized programs within the Taussig Cancer Institute that ensure each patient is provided optimal care.

reduced intensity, related and unrelated transplants using cell sources including bone marrow, peripheral stem cell, and umbilical cord blood for patients with leukemias, lymphomas, and other hematological malignancies and bone marrow failure states.

to providing the best clinical care and novel treatment options emerging from the

Cleveland Clinic’s Taussig Cancer Institute.

42



Bone Marrow Transplant

peripheral stem cell and umbilical cord transplants are performed for patients with leukemias, lymphomas and other hematological malignancies and bone marrow

many ways we ensure our patients achieve successful outcomes.

100

80

02006 2007 2008

101N = 108 8948 64 62

60

40

20

Percent Survival

AllogeneicAutologous

30-Day Survival Rate in Autologous and Allogeneic Transplants (Including Mini-allo and Cord Treatment)

43


44

100

80

02006 2007 2008

101N = 108 8948 64 62

60

40

20

Percent Survival


120

02005 2006 2007

N = 192 101 0 108 5

100

60

80

40

20

Number

Non-Relapse MortalityAutologous Transplants

100-Day Survival Rate in Autologous and Allogeneic Transplants

Non-Relapse Mortality One Year After Autologous Transplant

Outcomes 2008

Hematologic Oncology and Blood Disorders | Bone Marrow Transplant


45

20

02006 2007 2008

101N = 108 8948 64 62

15

10

5

Days


40

02006 2007 2008

101N = 108 8948 64 62

30

20

10

Days


Average Number of Days to Engraftment for Autologous and Allogeneic Transplants

Average Length of Stay for Autologous and Allogeneic Transplants



46

Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL)

Log rank P = 0.2 Hazard ratio = 1.08 (P = 0.63)

Percent Survival


0

60

80

40

20

100

0 2 4 6 8

Weekend, median = 0.71 years (N = 82)Weekday, median = 0.75 years (N = 253)

Overall Survival for Patients with Acute Myeloid Leukemia by Weekday and Weekend Admission (N = 335) 1994 – 2008

Outcomes 2008

Taussig Cancer Institute’s Acute Leukemia Program is a worldwide leader in the treatment of acute myeloid and lymphoblastic leukemia. Each year, about 120 new patients with a diagnosis of acute leukemia are seen at Cleveland Clinic, making this one of the largest acute leukemia programs in the world. Patient care is provided on a dedicated inpatient unit by a multidisciplinary team of physicians, nurses, physician assistants, social workers and case managers, all specializing in leukemia. In addition, patients benefit from the team’s close collaboration with the Bone Marrow Transplant Program. This specialized care results in minimal delays to the initiation of chemotherapy; negates the effect of weekend vs. weekday admission; and results in treatment-related mortality rates that are much lower, and survival rates that are much higher, than national averages. Clinical research programs optimize personalized inpatient and outpatient approaches to treating acute leukemias that are age- and disease-specific.

Hematologic Oncology and Blood Disorders | Acute Myeloid Leukemia

47

Time to Triple Lumen Catheter and Induction Therapy for Patients with Acute Myeloid Leukemia by Patient Age 1994 – 2008

Characteristic < 60 yr ≥ 60 yr P-value (N = 189) (N = 216)

Time to triple lumen catheter, mean days 2.97 2.96 0.99

Time to induction, mean days 2.1 2.7 0.02

Mortality of Patients with Acute Myeloid Leukemia by Patient Age 1994 – 2008

Mortality < 60 yr, % ≥ 60 yr, % (N = 189) (N = 216)

In-hospital 6.9 16.2

30-day 5.8 14.7

Within 15 days of chemotherapy 1.1 4.9


Outcomes 2008

Percent Survival


0

60

80

40

20

100

0 2 4 6 8

Age ≥ 60, median survival = 0.53 years (N = 188)Age < 60, median survival = 1.3 years (N = 148)

Percent Disease-free Survival

Years Since Complete Remission

0

60

80

40

20

100

0 2 4 6

Age ≥ 60, median survival = 0.58 years (N = 73)Age < 60, median survival = 0.84 years (N = 52)

Overall Survival for Patients with Acute Myeloid Leukemia by Patient Age (N = 336)

Disease-free Survival for Patients with Acute Myeloid Leukemia by Patient Age(N = 125)

48

Hematologic Oncology and Blood Disorders | Acute Myeloid Leukemia



This research was originally published in Bloodet al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood

results and the aggregate results.

This research was originally published in Bloodbut not older, acute myeloid leukemia patients. Blood

Percent Survival


0

60

80

40

20

100

0 2 2 3 4

More than 5 days from diagnosis to treatment

P = 0.009

Less than or equal to 5 days from diagnosis to treatment

Percent Survival


0

60

80

40

20

100

0 1 2 3 4

More than five days from diagnosis to treatment

P = 0.81

Less than or equal to five days from diagnosis to treatment

Survival by Interval from Diagnosis to Treatment for Patients Less Than 60 Years Old with Acute Myeloid Leukemia(N = 653)

Survival by Interval from Diagnosis to Treatment for Patients 60 or More Years Old with Acute Myeloid Leukemia(N = 664)


Outcomes 200850

and their families, investigation of lymphoma pathobiology, and development of innovative treatments. Individualized patient care is achieved through weekly multidisciplinary clinicopathologic conferences to ensure accurate diagnosis and determine the best treatment plan for the patient.

Percent Survival

Years Since Transplant

0

60

80

40

20

100

0 1 2 3 4

Diffuse Large B Cell Lymphoma (N = 82)Hodgkin Disease (N = 61)Follicular Lymphoma (N = 45)

Overall Survival for Patients with Lymphoma Receiving Autologous Bone Marrow Transplants (N = 188)

Hematologic Oncology and Blood Disorders | Lymphoma


Outcomes 200852

Cleveland Clinic has placed a renewed emphasis on improving the patient

that patients seek more than solely a successful clinical outcome, the mission

the well-being of our patients, families and employees in a way that elevates Cleveland Clinic’s reputation as one of the world’s best hospitals.

institutes to research and implement innovative patient- and family-based programs that support this mission.

Outpatient – Taussig Cancer Institute

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor

Source: Quality Data Management, a national hospital survey vendor

2008 (N = 2,912)2007 (N = 2,824)

Overall Rating of Outpatient Care and Services

Patient Experience



Recommend Outpatient Provider

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor


2008 (N = 2,912)2007 (N = 2,824)

Rating of Outpatient Provider

100

80

0

60

40

20

Percent

ExtremelyLikely


Very Likely SomewhatLikely

SomewhatUnlikely

VeryUnlikely

2008 (N = 2,912)2007 (N = 2,824)


Outcomes 200854

100

80

0

6064% 64%

77%

40

20

Percent

Rate Hospital Would Recommend

% respondentschoosing 9 or 10

% respondents choosing'definitely yes'

Source: Quality Data Management and Press Ganey, national hospital survey vendors

For comparison purposes, 2007 and Q1 2008 HCAHPS scores have been adjusted toaccount for a survey mode administration change as recommended by CMS.

2008 total survey respondents = 4212007 total survey respondents = 341

76%

HCAHPS Overall Assessment

Inpatient – Taussig Cancer Institute

reporting are available at www.hospitalcompare.hhs.gov.

Patient Experience



100

80

0

60

40

20

Percent

DischargeInformation

DoctorCommunication

NurseCommunication

PainManagement

RoomClean

CommunicationNew Medications

Responsivenessto Needs

Quiet atNight

Respondents choosing 'always' or 'yes'

Source: Quality Data Management and Press Ganey, national hospital survey vendors

For comparison purposes, 2007 and Q1 2008 HCAHPS scores have been adjusted to account for a survey mode administration changeas recommended by CMS.

2008 total survey respondents = 4212007 total survey respondents = 341

HCAHPS Domains of Care


Surgical OverviewPatient Experience

New patients requesting an appointment are seen within a week or on the date they request.

5656 Outcomes 2008



New patients requesting an appointment at the Taussig Cancer Institute are seen within a

scheduling preferences.

Patient Access

5,000

4,000

3,000

2,000

1,000

00-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24 25-27 28-30 >30

Number of Patients

Days to Appointment

57



Innovations

58 Outcomes 2008



Patient Care Initiatives

Patient Navigation

decades, disparities in cancer treatment and outcomes

a potentially powerful intervention for addressing these disparities.

patients in overcoming barriers and guide the patient through

additional patient navigation programs and may serve as the basis for other potential interventions designed to eliminate disparities in cancer treatment.

understand what is available and to build relationships with community centers;

community outreach endeavors;

developing relationships between Cleveland Clinic

long term;

inpatient navigation role;

Cleveland Clinic.

enrollment began on Nov. 20, 2008. The sample of patients

new patients who require chemotherapy following surgery;

that requires additional testing. During this time, we are developing processes with pathology and radiology to identify

to ensure patients receive timely diagnosis and treatment.

The navigators are working closely with the social workers,

made to the social workers to address psychosocial issues outside the navigator’s scope of practice, such as housing, substance abuse, mental health issues and prosthetics.

The navigators have encountered various barriers to care. They are working to resolve barriers to care including transportation, access to healthcare, lack of insurance and

transportation and lack of insurance. We have developed processes to address the various barriers using resources within the community and organization. We created a resource manual to serve as a quick reference, providing information on services available locally and nationally.


Outcomes 2008

Innovations

Research Across Cleveland Clinic Health System

continues to lead the way in innovative trials availableto patients. In 2008, Taussig continued its robust research

research trials.

The new regional structure, effective in 2008, created a combined Cancer Center across Cleveland Clinic health

rising enrollment numbers because of the increased access to trials across Cleveland Clinic health system as well as a dedicated manager working as a liaison between Cleveland Clinic’s main campus and regional locations. This produced focus on choosing the most appropriate trials to open at the regional locations allowing patients to access novel therapy

disease sites.

The regional research program also is supported by the

Taussig Cancer Institute’s partnership called, “The Clinical

Taussig continues to lead the way in advances in care for patients with cancer and now provides that care closerto home.

60

700 +Number of patients

enrolled in research

trials in 2008



Translational Hematology and Oncology Research

translational researchers have taken in advancing cancer diagnosis, prognosis and therapeutics. As a result of improved understanding of the human genome and its

within the malignant cell that present more targets for which

SNP-A: Beyond Metaphase Cytogenetics

led to the application of whole genome scanning using high density DNA arrays as a diagnostic karyotyping test that

nucleotide polymorphisms array-based karyotyping greatly increases the diagnostic yield of traditional cytogenetics leading to detection of previously cryptic cytogenetic defects.

currently being introduced as a routine cytogenetic test.

novel, previously unappreciated type of chromosomal lesion in cancer called uniparental disomy or copy-neutral loss of heterozygosity. The importance of this type of lesion is in its relative prevalence and the fact that recurrent areas of uniparental disomy point towards the presence of mutations in genes contained in the affected areas. These studies show an association between homozygous mutations and somatic uniparental disomy, point toward a new paradigm in cytogenetics and pave the way to discovery of novel pathogenetic mutations in cancer. These studies resulted in multiple published manuscripts in Blood, British Journal of Hematology, Leukemia and Journal of Clinical Oncology.

61


Outcomes 2008

Innovations

62

Principles of SNP-A Karyotyping

Left:

Right:

probes, blue line represents average copy number) as well as allele copy number determination (green lines represent heterozygous cells).

decrease in the density of heterozygous cells.

Abbreviations:

This research was originally published in Blood Blood.

End-labeling

Whole genome view

CN

CN

AABBAB



Comparison of Current Technologies to Identify Clonal Chromosomal Lesions

clones, and ability to screen for new lesions is compared using four karyotyping techniques (top to bottom row): metaphase cytogenetics;

63

Output of Method Resolution Sensitivity UPD Dividing Cells Distinction of Screening forMethod Detection Needed Individual clones New Lesions

MetaphaseCytogenetics

FISH

SNP Arrays

CGH Arrays

Deletion 20q Trisomy 8


Outcomes 2008

Innovations

64

The Role of TET2 Mutations in Myelodysplastic Syndromes

Through application of whole genome scanning,

recurrent microdeletions and copy neutral loss of

inactivating mutations of this gene. TET2 appears to be a

stem cells. We have discovered that TET2 mutations are present in a large number of patients with chronic myelomonocytic leukemia in blasts crisis, myelodysplastic syndromes and myeloproliferative/myelodysplastic syndromes. This discovery has broad diagnostic implications and opens new research avenues into the pathogenesis of leukemias that result from this mutation.

evolution in several myeloid malignancies including some forms of acute myelogenous leukemia, chronic myelomonocytic leukemia and myelodysplastic syndrome.

the Cbl gene family establishing a new class of mutations in genes responsible for degradation of activated tyrosine

point towards pathogenic mechanisms and also convey very poor prognosis, they have diagnostic and therapeutic

CancerResearchsubmitted to The New England Journal of Medicine.



Overcoming Melanoma Resistance by Identifying andInhibiting Novel Targets

correction of causes of aberrant signaling and/or gene product

to overcome resistance to melanoma. The preliminary data generated has provided the basis for a new grant proposal

been evaluated as part of multi-institutional trials to improve currently available therapies. One of these, a monoclonal

Uveal Melanoma Micrometastasis

Department of Ophthalmic Oncology at Cleveland Clinic Cole Eye Institute, current studies in the laboratory of Dr. Triozzi have focused on uveal melanoma, the most common intra-ocular malignancy in adults. Even with advances in the diagnosis and local treatment, there has not been

disease still occuring frequently and often resulting in death. Angiogenesis is a critical step in the formation and progression of metastasis. The abnormal blood vessels that develop in metastatic tumors not only promote growth but also are a barrier to the delivery of therapeutic agents. The

in the understanding of the molecular mechanisms of tumor angiogenesis to the treatment of patients with uveal melanoma.

65


Outcomes 200866

Innovations

DNMT1 Depletion Is Targeted Therapy Against Cancer

cancer cells and encourage the growth of healthy cells. Current treatments kill both cancer cells and healthy cells, which lead to numerous side effects. They found that the mechanisms that cause cancer cells to divide and grow uncontrollably are often

the growth of the cancer cells. The alternative approach has not yet been tried in humans, but the team hopes to start clinical trials soon.



Development of Novel Chemotherapeutic Agents

continue to focus on the synthesis of a chemotherapeutic compound, nitrosylcobalamin (NO-Cbl) that consists of nitric

up by the cell, but inside lysosomes, the drug releases nitric

from institutional funds, an oral formulation of the drug

spontaneously occurring tumors have been treated with the

Preclinical Testing of Novel Therapeutic Agents

in various mouse cancer models. To date, this new

and has shown activity against several different human

Radiation Oncology

Hyperthermia Therapy for Surface and Recurrent Tumors

hyperthermia therapy, providing an important treatment option for patients with surface and recurrent tumors.

therapy, hyperthermia therapy allows radiation oncologists to increase the delivery of radiation to the tumor while minimizing damage to healthy tissues.

within a few centimeters of the surface of the body, such

recurrent disease, a second course of standard radiation therapy may not be possible because of the increased risk of damage to healthy tissues. By effectively increasing the radiation dose to the tumor without increasing unwanted side effects, hyperthermia therapy is an important treatment

delivered though a probe for prostate, head and neck, and


68

Innovations

Calypso™ 4D Localization System for Prostate Cancer

prostate during radiation therapy treatment for optimal targeting of radiation and minimizing side effects, such as impotence, incontinence and rectal bleeding.

During an outpatient procedure similar to a biopsy, three rice-grain-sized electromagnetic transponders are implanted in the prostate. The transponders communicate with Calypso using safe radiofrequency waves so that Calypso monitors

during treatment. Calypso allows radiation oncologists to precisely monitor radiation therapy and to make quick decisions about patient care.

at Taussig Cancer Institute participated in the initial clinical

Electronic Treatment Charts

treatment chart records in 2008—one of the few radiation oncology departments that have advanced to a completely paperless system. Electronic treatment chart records include information about radiation therapy such as electronic

radiation dose history, patient schedules, patient charges and dosimetric computer planning documents. The move to paperless treatment chart records allows physicians, physicists and therapists to simultaneously update patient treatment information from any location in the department or by radiation oncologists through secured remote access. Electronic treatment chart records help radiation oncology

providing faster treatment delivery to patients.

Outcomes 2008



Bone Marrow Transplant

Bicyclam Derivative for Hematopoietic Stem Cell Mobilization

investigator for an international study of a novel small-molecule bicyclam derivative for

cells for bone marrow transplantation. Based on

be able to undergo bone marrow transplantation

Surgery

Robotic Liver Resection

Cleveland Clinic surgeons have started a laparoscopic robotic-assisted liver resection program at the

accurate dissection. With the ultimate goal to do anatomic

laparoscopic robotic liver resection in the last quarter of 2008 for malignant liver tumors, including hepatocellular cancer, colorectal metastasis and sarcoma metastasis. Because the incisions are smaller, patients are discharged from the hospital in one to three days, returning home sooner. As of the fourth quarter 2008, there have been no complications using robotic-assisted liver resection. The laparoscopic robotic-assisted liver resection program at


Outcomes 2008

Selected Publications

The Taussig Cancer Institute staff authored more than

go to www.clevelandclinic.org/quality/outcomes.

600 PublicationsAdelstein DJ, Rodriguez CP. Current and emerging standards of concomitant chemoradiotherapy. Semin Oncol. 2008

Adelstein DJin head and neck cancer. J Clin Oncol

Advani ASSobecks R, Sekeres M, Copelan EKalaycio M. Time to post-remission therapy is an independent prognostic factor in adults with acute lymphoblastic leukemia. Leuk Lymphoma. 2008

Advani AS, Rodriguez CBaz R, Kalaycio M, Sobecks R, Sekeres M, Tripp B,

progression-free and overall survival in patients with newly Leuk Res

Cheriyath V Reu FJ, Borden EC.

Oncogene

Borden ECimatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors

J Clin Oncol

Borden ECperspective. Nat Rev Drug Discov

70



Maciejewski JP

inhibitor eculizumab for the treatment of patients with Blood

Bukowski RM. Optimizing utilization of targeted therapies in genitourinary cancers. Clin Genitourin Cancer. 2008

Bukowski RM. What role do combinations of interferon and

renal cell carcinoma? Clin Genitourin Cancer. 2008

Bukowski RM J Oncol Pract

Bukowski RMrenal cell carcinoma. Curr Oncol Rep

Bukowski RMnovel drug development? Clin Genitourin Cancer. 2008

Chao ST, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ,Neyman G Suh JHradiosurgery effectively treats recurrences from whole-brain radiation therapy. Cancer

Lichtin A, Pohlman B,Macklis R. Bilateral panocular involvement with mantle-cell lymphoma. J Clin Oncol

Ciezki JP

doubling time]. J Urol

71


Outcomes 200872


Cohen PA

dendritic cells. Blood

Bukowski R, Rini B, Finke JH, Tannenbaum C.

cell carcinoma, synergize to induce T-cell apoptosis. Cancer Res

Davis Msurvival prediction in the terminally ill: Commentary.J Palliat Med

Davis M. Opioids and fatal drug poisoning. J Pain Palliat Care Pharmacother

Davis MPthe ground are we? Support Care Cancer. 2008

Davis MP. Cancer constipation: are opioids really the culprit? Support Care Cancer

Davis MP. Oral nabilone capsules in the treatment of chemotherapy-induced nausea and vomiting and pain. Expert Opin Investig Drugs

Raghavan D. Circulating tumor cells predict

resistant prostate cancer. Clin Cancer Res. 2008

Dean RM

graft-versus-host disease. J Clin Oncol. 2008 Dec

Dreicer R

Cancer

Dreicer Rprogress: what’s wrong with this picture? Cancer. 2008

Dreicer R. Chemotherapy for the palliation of advanced prostate cancer. J Support Oncol

Dreicer Rpatients with metastatic prostate cancer. Urol Oncol. 2008

O’Keefe CLSekeres MA

Maciejewski JP

uniparental disomy and homozygous mutations, including novel missense substitutions of c-Cbl, in myeloid malignancies. Cancer Res

Estfan B, Walsh D. The cough from hell: diazepam for intractable cough in a patient with renal cell carcinoma.J Pain Symptom Manage

Finke JH, Rini BGarcia J, Dreicer R,

Bukowski Rand decreases T-regulatory cells in renal cell carcinoma patients. Clin Cancer Res

Raghavan D

prostate cancer trial. J Clin Oncol



Garcia JAinhibition as a therapeutic strategy in the management of urologic malignancies. Mol Cancer Ther. 2008

Garcia JA, Klein EA, Magi-Galluzzi C Triozzi P,Dreicer Rsargramostim and thalidomide in patients with locally advanced prostate carcinoma. Clin Cancer Res. 2008

Cockrell E, Silverstein RLinteractions with endothelial cell-derived microparticles and contributes to thrombosis in mice. J Clin Invest. 2008

O’Keefe CL, Sekeres MAMaciejewski JP. Chromosomal lesions and uniparental

Blood

Raghavan DSweetenham JW

Oncology. J Clin Oncol

Hansel DE, Rini BIrenal cancer: new genes and diagnostic and therapeutic opportunities. Expert Rev Anticancer Ther. 2008

Borden EC,

and clinical outcome in the North American Intergroup

J Clin Oncol

Juliano JJ Suh JHoncocytoma: A case report. Urol Oncol. 2008

Kalaycio M, Advani A, Pohlman B, Sekeres M, Tripp B,Sobecks R. Timed sequential induction

chemotherapy and risk-adapted postremission therapy foracute myelogenous leukemia. Am J Hematol. 2008

Kalaycio Mtreatment for patients with chronic lymphocytic leukemia. Clinical Leukemia

Adelstein DJBorden ECmalignant mesothelioma of the pleura: A phase II study of

Lung Cancer.

Lee DRini B

T cells in a dose-dependent fashion. Blood. 2008 Aug

Klein EA Raghavan D, Dreicer R.

prostatectomy. J Clin Oncol


Outcomes 200874


Lagman R, Walsh D LeGrand SB, Davis MP.A day in the life: a case series of acute care palliative medicine--the Cleveland model. Am J Hosp Palliat Care.

Bukowski RPelley R

capecitabine in patients with advanced colorectal cancer. Clin Cancer Res

Bolwell BJ Copelan E

of prior imatinib mesylate on the outcome of hematopoietic cell transplantation for chronic myeloid leukemia. Blood

LeGrand SB

practice. Ann Intern Med

Pohlman B, Sweetenham J

lymphomas. N Engl J Med

Lichtin AECleve Clin J Med

Maciejewski JPcytogenetic tool in hematologic malignancies. Blood. 2008

Macklis RM

American Journal of Hematology/Oncology

Bolwell BJ, Bredeson CN, Copelan EA

Blood. 2008

Spiro TP,Daw HA. The utility of

lymphoma. Am J Clin Oncol

Pohlman B

large B-cell lymphoma treated with anthracycline-based J Clin Oncol.

Pennell NA

in patients with advanced thyroid cancer. Thyroid. 2008



Raghavan D, Klein EAreinventing the wheel...but this time it is round. J Clin Oncol.

Raghavan Ddata. Cleve Clin J Med

Rini BI, Bukowski RM. Targeted therapy for metastatic renal cell carcinoma: a home run or a work in progress? Oncology(Williston Park)

Rini BIMekhail T, Garcia J, Dreicer R,

Bukowski RMwith metastatic renal cell carcinoma. Cancer

Rini BIfor molecularly-targeted therapy in renal cell carcinoma. Urol Oncol

Rini BI

compared with interferon alfa monotherapy in patients with J Clin

Oncol

Rini BI Bukowski RM,

Antitumor activity and biomarker analysis of sunitinib in patients with bevacizumab-refractory metastatic renal cell carcinoma. J Clin Oncol

Rini BI CurrOpin Oncol

Rini BIpatient? Oncology (Williston Park)

Rini BIcarcinoma. Community Oncology

Rini BI. Is sorafenib plus interferon alpha 2b safe and effective in patients with renal cell carcinoma? Nat Clin Pract Urol

Rini BIrenal cell carcinoma. Nat Clin Pract Oncol. 2008

Rini BI. Quantifying hypertension in patients with cancer treated with sorafenib. Lancet Oncol

Rini BIof rapamycin. Clin Cancer Res

Rini BIcarcinoma. Clin Adv Hematol Oncol

Lichtin AE. Use of epoetin and darbepoetin in patients

guideline update. Blood

Lichtin AE. Use of epoetin and darbepoetin in patients

guideline update. J Clin Oncol

Rodriguez CP, Adelstein DJ Saxton JP,Lorenz RR

preservation after multiagent concurrent chemoradiotherapy. Head Neck

75


Outcomes 200876


Rodriguez CP, Baz R Kalaycio ME,Advani A, Sobecks R, Sekeres MA. Impact of socioeconomic status and distance from treatment center on survival in patients receiving remission induction therapy for newly diagnosed acute myeloid leukemia. Leuk Res. 2008

Mahadevan A, Klein ECiezki J

Quality of life and satisfaction with outcome amongprostate-cancer survivors. N Engl J Med

Saunthararajah Y

effectiveness of decitabine in severe sickle cell disease. Br J Haematol

Maciejewski JP. Dasatinib, a small-molecule protein tyrosine kinase inhibitor, inhibits T-cell activation and proliferation. Blood

Dreicer R

patients with progressive prostate cancer and castrate levels

J Clin Oncol. 2008

Sekeres MAoutcomes in patients with myelodysplastic syndromes with

Clinical Leukemia. 2008

Sekeres MA, Maciejewski JP

cytopenias and response to lenalidomide in patients with lower-risk myelodysplastic syndromes. J Clin Oncol. 2008

Sekeres MAMaciejewski JP

physician surveys. J Natl Cancer Inst. 2008 Nov

Sekeres MA. Treatment of older adults with acute myeloid leukemia: state of the art and current perspectives. Haematologica

Sobecks RMKalaycio M, Andresen S, Pohlman B,

Dean R, Sweetenham J, Macklis RCopelan E, Maciejewski JP, Bolwell BJ

on achievement of T-cell complete donor chimerism in related donor nonmyeloablative allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008

Sobecks RM, Dean RMacklis R, Andresen S, Kalaycio M, Pohlman B

Sweetenham J, Copelan E, Bolwell BJ

allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant

Sweetenham JWHematol Oncol Clin North Am

Sweetenham JW

for radiation therapy. Leuk Lymphoma



Raghavan D

surgeon volume predict bleeding with open radical retropubic prostatectomy. BJU Int

Tendulkar RD

brachytherapy for recurrent airway obstruction from hyperplastic granulation tissue. Int J Radiat Oncol Biol Phys.

Triozzi PL, Aldrich W, Dombos C. Differential effects of imatinib mesylate against uveal melanoma in vitro and in vivo. Melanoma Res

Triozzi PL, Eng Cmelanoma. Cancer Treat Rev

Videtic GMabdominal wall: complete response with radiotherapy alone. Technol Cancer Res Treat

Videtic GMM

Energy Agency (IAEA) consultants’ meeting on elective nodal irradiation in lung cancer: non-small-cell lung cancer

Int J Radiat Oncol Biol Phys. 2008 Oct

Videtic GMM, Rice TW Suh JH, Saxton JP,Adelstein DJ, Mekhail TM. Utility of positron emission tomography compared with mediastinoscopy for delineating involved lymph nodes in stage III lung cancer: insights for radiotherapy planning from a surgical cohort. Int J Radiat Oncol Biol Phys

Wilkinson DA

Br J Radiol

Wu Y

immortalized endometrial stromal cells. Fertil Steril. 2008

Wu Yproliferation of endometriotic cells in vitro. Gynecol Obstet Invest

Cohen PA

CancerRes


Outcomes 20087878

Staff Listing

Chairman and Director

Deputy Director

Director of Scott Hamilton “CARES” Center

Department of Hematologic Oncology and Blood Disorder

ChairmanDirector, Bone Marrow Transplant Program

Department of Radiation Oncology

Chairman



Department of Regional Oncology

Chairman


Outcomes 20088080

Staff Listing

Department of Solid Tumor Oncology

Chairman

Section of Palliative Medicine

Chairman

Department of Translational Hematology andOncology Research

Chairman



Center for Clinical Research

Director

Taussig Cancer Institute.


clevelandclinic.org/staff.

8181


Outcomes 20088282

Contact Information

General Patient Referral

Taussig Cancer Institute Appointments/Referrals

Bone Marrow Transplant Program Appointments/Referrals

This internationally recognized program offers autologous, allogeneic, reduced intensity, related and unrelated transplants. Cell sources include bone marrow, peripheral stem cell and umbilical cord blood transplants for treating patients with leukemias, lymphomas, and other hematological malignancies and bone marrow failure states.

Bone Marrow Failure Clinic Appointments/Referrals

hemoglobinuria, large granular lymphocytic leukemia and other immune-mediated hematologic diseases.

Radiation Oncology Appointments/Referrals

Cancer Answer Line

second opinion

Helen Meyers McLoraine Patient Resource Center

teaching and educational video viewing

related events

On the Web at clevelandclinic.org/cancer

Additional Contact Information

General Information

Hospital Patient Information

Patient Appointments

Medical Concierge

Complimentary assistance for out-of-state patients and families

Global Patient Services/International Center

Complimentary assistance for international patients and families

clevelandclinic.org/gps

Cleveland Clinic in Florida

For address corrections or changes, please call



Institute Locations

Cleveland Clinic (Main Campus)


Beachwood Family Health and Surgery Center

Fairview Hospital

Hillcrest Hospital

Independence Cancer Center

Lorain Family Health and Surgery Center

Strongsville Family Health and Surgery Center

Westlake Family Health Center

Willoughby Hills Family Health Center

Wooster Family Health Center


Outcomes 20088484

Cleveland Clinic Overview

bundling all clinical specialties into integrated practice units called institutes. An institute combines all the

under a single roof. Each institute has a single leadership and focuses the energies of multiple professionals onto the

point-of-care service, institutes will improve the patient

outpatient clinic, specialty institutes and supporting labs

Cleveland Clinic Abu Dhabi (United Arab Emirates), a multispecialty care hospital and clinic, is scheduled to

associates and postdoctoral fellows are involved in laboratory-based, translational and clinical research. Total

federal agencies, non-federal societies and associations, endowment funds and other sources. In an effort to bring research from bench to bedside, Cleveland Clinic

at any given time.

offers all students full tuition scholarships. The program will

Cleveland Clinic is consistently ranked among the top hospitals in America by U.S.News & World Report, and our

clevelandclinic.org.



Resources for Physicians

Cleveland Clinic Secure Online Services

Cleveland Clinic uses state-of-the-art digital information systems to offer secure online services such as online medical second opinions, medical record access, patient treatment progress for referring physicians (see below), and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.

MyChart This secure online tool connects patients to their own health information from the privacy of their home any time, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to GoogleTM Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice. To establish a MyChart account, visit clevelandclinic.org/mychart.

DrConnect Whether you are referring from near or far, DrConnect streamlines communication from Cleveland Clinic physicians to your office. This complimentary online tool offers secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

MyConsult Online Medical Second Opinion This secure online service provides specialist consultations from our Cleveland Clinic experts and remote medical second opinions for more than 1,000 life-threatening and life-altering diagnoses. MyConsult is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext 43223.

Critical Care Transport: Anywhere in the world

Cleveland Clinic’s critical care transport team serves critically ill and highly complex patients across the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed by physicians, critical care nurse practitioners, critical care nurses, paramedics and ancillary staff, and are customized to meet the needs of the patient. Critical care transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.279.CODE (2633). For all other transfers, call 216.444.8302 or 800.553.5056.

CME Opportunities: Live and Online

Cleveland Clinic’s Center for Continuing Education’s website, clevelandclinicmeded.com, offers hundreds of convenient, complimentary learning opportunities, from webcasts and podcasts to a host of medical publications including the Disease Management Project Online Medical Textbook, with more than 150 chapters. The site also offers a schedule of live CME courses, including international summits that focus on key areas of translational research. Many live CME courses are hosted in Cleveland, an economical option for business travel. Physicians can manage their CME credits by using the myCME Web Portal. Available 24/7, the site offers CME opportunities to medical professionals across the globe.



2008Outcomes

9500 Euclid Avenue, Cleveland, OH, 44195

© The Cleveland Clinic Foundation 2009

Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education institute and a research institute.

Please visit us on the Web at clevelandclinic.org.


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