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Santa Rosa Memorial Hospital

2011 Cancer Program Annual Report

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Santa Rosa Memorial Hospital ~ 2011 Cancer Program Annual Report

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2011 ANNUAL REPORT

LUNG CANCER OVERVIEW Focus on 2000 – 2010 Data Years

Overall, this report demonstrates that our outcomes at Santa Rosa Memorial Hospital (SRMH) are quite consistent with the outcomes depicted at state, national and international levels regarding incidence, five-year survival data and treatment patterns for non-small cell and small cell carcinomas. During the study years 2000 through 2009 SRMH diagnosed and treated a total of 998 analytic cases as this report indicates. A total of 90 lung cancers were reported for 2010. Incidence of lung cancer is directly related to the prevalence of smoking and exposure to tobacco smoke either actively as a smoker or passively due to second hand exposure either in a work environment, as a spouse or as a child of a smoker. Non-small cell carcinoma is slower to progress than small cell carcinoma which is most often stage III or IV at presentation. Five-year survivals depicted in this report are 15% for all stages of non-small cell carcinoma and 6% 5-year survival for all stages of small cell carcinoma which is consistent with California and National 5-year survival data as demonstrated throughout this report. A recently published epidemiology study indicates that despite global efforts to stop smoking, incidence rates will remain unchanged over the next decade. Epidemiologists expect the number of incident cases of non-small cell lung carcinoma to remain stable in the US, Japan, France, Germany, Italy, Spain and the UK. This study predicts that adults age 70-74 will have the largest number of incident cases (80,310) followed by adults age 65-69 and 75-79 (73,500 cases and 71,300 cases, respectively). Once again SRMH data demonstrates the average age of diagnosis to be 72 years of age, which is consistent with the findings of the epidemiology study. The study states that incidence rates reflect exposure to tobacco smoke and that survival rates for lung cancer are lower for any cancer but with mortality rates nearly equivalent to incident cases as shown in the American Cancer Society predicted incidence and mortality rates as published in their Cancer Facts & Figures 2011. Risk Factors Smoking tobacco is the number one risk factor for lung cancer; however, people who have never smoked can develop lung cancer also. Other risk factors include: Second hand smoke Advancing age Exposure to asbestos or other pollutants Genetics and family history The lifetime risk of developing lung cancer is 1 in 13 for men and 1 in 16 for women. Though lung cancer is found in young people and even children, the average age at diagnosis is 71 years.


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Focus on Lung Cancer at Santa Rosa Memorial from 2000 through 2010 ______________________________________________________________________ Types and Stages of Lung Cancer Non-small cell lung cancers (NSCLC) account for nearly 80% of lung cancers and spread more slowly in the body. The types of non-small cell lung cancer include adenocarcinoma, squamous cell carcinoma and large cell carcinoma. Small cell lung cancers (SCLC) account for approximately 20% of lung cancers. They typically begin in the lung bronchi and spread quickly, often to other parts of the body. Other rarer types of lung cancer, including bronchial carcinoids and cancers that start in other parts of the lung such as mesotheliomas, will not be covered in this overview of incidence and survival outcomes for non-small cell lung cancer and small cell lung cancers seen at Santa Rosa Memorial Hospital. Lung Cancer in Women Though once thought of as a man’s disease, lung cancer in women is ever present and kills nearly twice as many women as breast cancer. Twenty percent of women diagnosed with lung cancer have never smoked. Lung cancer in women differs from that in men in many ways including the type of lung cancer most commonly found, the symptoms that are present at the time of diagnosis, and survival rates at each stage of the disease. Sadly, unlike the recent decrease in the number of cancers diagnosed in men, lung cancer in women continues to increase. The overall 5-year survival rate for lung cancer is only 15%. When lung cancer is caught at early stages, survival rates are much higher. Research is ongoing to evaluate methods of screening for lung cancer in an attempt to detect more lung cancers in earlier stages. New diagnostic tools and new treatments such as navigational bronchoscopy which is minimally invasive and allows biopsy access in the periphery of the lung with real time 3-D CT images. When loaded onto a computer, these images provide a virtual roadmap of the patient’s lung. This technology can also be used in connection with external beam radiation such as tomotherapy which delivers treatment directly to the tumor. In the area of chemotherapy XALKORI, a kinase inhibitor indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) that is anaplastic lymphoma kinase (ALK)-positive, may provide improved survivals for non-small cell lung cancers that are not amenable to surgical resection.


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Focus on Lung Cancer at Santa Rosa Memorial from 2000 through 2010 ______________________________________________________________________ Newly announced combination drug treatments that target estrogen production are still in the early clinical trial stages and may one day prevent lung cancers from developing as most lung cancers are positive for a type of estrogen receptor that makes lung tumors grow when exposed to estrogen. Early results suggest that anti-estrogen treatment in combination with an aromatase inhibitor prevents lung cancer development during tobacco carcinogen exposure and after carcinogen damage to the airways has already occurred. This would greatly reduce the risk for an ex-smoker to develop lung cancer. Presently, surgical resection is the most beneficial treatment for early stage lung cancers and provides the most optimistic survival outcomes. With improved minimally invasive surgical techniques now available, patients are often mobile on the first post- operative day which reduces risk of blood clot formation, allows shorter hospital stays and more rapid recovery. These statistics aside, lung cancer is still a largely preventable disease. Smoking cessation and avoiding second hand smoke can lower the risk of developing lung cancer. Studies also suggest that eating a healthy diet and exercising may reduce risk as well.

Samer Kanaan, MD

Thoracic Surgeon

References:

1) Cancer Facts and Figures, 2010, American Cancer Society, Inc., New York

2) National Lung Screening Trial (NLST), National Cancer Institute, NIH.

3) NCDB, Commission on Cancer, ACoS, CoC

4) Reduced Lung Cancer Mortality with Low-Dose Computed Tomographic Screening, N Engl J. Med 2011;

365:395-409, August 4, 2011


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Focus on Lung Cancer at Santa Rosa Memorial from 2000 to 2010: Incidence

Since the 1960’s lung cancer has been the most frequent cause of cancer death in men, and, for the past 20 years it has been the primary cause of cancer death in women. This disease remains the most common cause of cancer death in the United States. The American Cancer Society estimates that in 2010 approximately 157,300 people will die of lung cancer in the United States. Leading sites of new cancer cases and deaths for the most commonly reported cancers are shown in the ACS comparison listing directly below. Tables 1 and 2 provide the incidence of NSCLC and SC lung cancer at SRMH.

Table 2 Lung Cancer Incidence by Class, Gender and AJCC TNM Stage Group

2010 Analytic Cases, Class 00-22

Total Analytic Cases

Gender Stage Group

Male Female Stage 0 Stage I Stage II Stage III Stage IV Unk

Small Cell 10 4 6 2 0 1 0 6 1

Non-Small Cell 80 45 35 3 17 7 17 27 9

Totals 90 49 41 5 17 8 17 33 10

Male Female Stage 0 Stage I Stage II Stage III Stage IV NA Unk

Small Cell 134 61 73 0 11 6 37 77 0 14

Non-Small Cell 864 393 471 10 168 45 179 309 8 145

Totals 998 454 544 10 179 51 216 386 8 159

Lung Cancer Incidence by Class, Gender and AJCC TNM Stage Group Table 1

Gender Stage Group Total Analytic Cases

2000 to 2009 Analytic Cases, Class 00-22


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Non-Small Cell Lung Cancer Outcome Data

Figure 1 indicates the percentage of Small Cell and NSCLC compared to national incidence. Nationally, the American Cancer Society reports that for all new lung cancer diagnoses, 15% will be small cell and 85% will be non-small cell type. SRMH demonstrates comparable incidence for the 10 year period of 2000-2009. Figure 2 covers incidence for 2010.

Small Cell11%

Non-Small Cell89%

Figure 2

Santa Rosa Memorial HospitalNon-Small Lung Cancer versus Small Cell Cancer

2010 ~ Analytic Cases ~ Class 00-22 ~ n = 90

15%

13%

85%

87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Small Cell Lung Cancer Non-Small Cell Lung Cancer

Figure 1

Small Cell and Non-Small Cell Lung Cancer Incidence American Cancer Society (2010)

versus

Santa Rosa Memorial Hospital ~ 2000-2009 ~ Analytic Cases ~ Class 00-22

American Cancer Society Santa Rosa Memorial Hospital


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.

0%

5%

10%

15%

20%

25%

30%

35%

40%

30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years 90-99 years

n = 80

Figure 4Santa Rosa Memorial Hospital 2010

Non-Small Cell Lung Cancer - Analytic Cases - Classes 00-22 Age at Diagnosis

Mean = 71 yrs ~ Median = 71 yrsPercent NSCLC

Figure 3

Santa Rosa Memorial Hospital – 2000 to 2009 Non-Small Cell Lung Cancer ~ Analytic Cases ~ Classes 00-22

Mean = 70 yrs ~ Median = 72 yrs

0%

5%

10%

15%

20%

25%

30%

35%

40%

20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80-89 yrs 90-99 yrs

n - 864

Percent

Age at Diagnosis


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0% 5% 10% 15% 20% 25% 30% 35% 40%

Unknown

Not Applicable

Stage IV

Stage III

Stage II

Stage I

Stage 0

17%

1%

36%

21%

5%

19%

1%

Figure 5Santa Rosa Memorial Hospital

Non-Small Cell Lung Cancer by AJCC TNM Staging 2000-2009 ~Analytic Cases ~ Class 00-22 ~ n = 864

0% 10% 20% 30% 40%

Stage 0

Stage I

Stage II

Stage III

Stage IV

Unknown

4%

21%

9%

21%

34%

11%

Figure 6Santa Rosa Memorial Hospital

Non-Small Cell Lung Cancer by AJCC TNM Stage Group2010 ~ Analytic Cases ~ Class 00-22 ~ n = 80

0% 5% 10% 15% 20% 25% 30% 35% 40%

Unknown

Stage IV

Stage III

Stage II

Stage I

10%

37%

26%

7%

10%

Figure 7National Cancer Data Base - Community Hospitals (468)

Non-Small Cell Lung Carcinoma by AJCC TNM Stage Group2000-2009 ~ Analytic ~ Class 00-22 ~ n= 177,411


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Non-small cell lung cancers can be further classified by histological subtype as shown in Table 3 and Table 4.

Histologic TypeTotal

Cases

Percent

of Totals

ADENOCARCINOMA NOS 45 56%

SQUAMOUS CELL CARCINOMA NOS 14 18%

BRONCHIOLO-ALVEOLAR ADENOCARCINOMA NOS 4 5%

NON-SMALL CELL CARCINOMA 3 4%

MUCIN-PRODUCING ADENOCARCINOMA 3 4%

BRONCHIOLO-ALVEOLAR CARCINOMA MUCINOUS 2 3%

LARGE CELL NEUROENDOCRINE CARCINOMA 2 3%

CARCINOMA NOS 1 1%

ADENOSQUAMOUS CARCINOMA 1 1%

MUCINOUS ADENOCARCINOMA 1 1%

ATYPICAL CARCINOID TUMOR 1 1%

PAPILLARY ADENOCARCINOMA NOS 1 1%

Table 4

Non-Small Cell Lung Cancer by Histologic Type


Histologic Type Total Cases

Percent of Total

ADENOCARCINOMA NOS 288 34.1% NON-SMALL CELL CARCINOMA 191 22.6% SQUAMOUS CELL CARCINOMA NOS 138 16.3% CARCINOMA NOS 81 9.6% BRONCHIOLO-ALVEOLAR ADENOCARCINOMA NOS 40 4.7% MUCIN-PRODUCING ADENOCARCINOMA 23 2.7% LARGE CELL CARCINOMA NOS 22 2.6% CARCINOID TUMOR NOS (EXCEPT OF APPENDIX) 17 2.0% NEOPLASM MALIGNANT 16 1.9% LARGE CELL NEUROENDOCRINE CARCINOMA 10 1.2% ADENOSQUAMOUS CARCINOMA 5 0.6% MUCINOUS ADENOCARCINOMA 4 0.5% SQUAMOUS CELL CARCINOMA LARGE CELL NONKERATINIZING NOS 4 0.5% BRONCHIOLO-ALVEOLAR CARCINOMA MUCINOUS 3 0.4% SPINDLE CELL CARCINOMA NOS 3 0.4%

Table 3 Non-Small Cell Lung Cancer by Histologic Type

2000 – 2009 ~ Analytic Cases ~ Class 00-22 ~ n= 864


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Treatment options are determined by the histologic type of lung cancer (small cell or non-small cell) and stage of disease. Treatment options include surgery, radiation therapy, chemotherapy, and targeted therapies. First course of treatment given for analytic non-small cell lung cancers at SRMH for years 2000 through 2009 is shown in Table 5 and for 2010 in Table 6.

Stage 0 Stage I Stage

II

Stage

III

Stage

IVUnknown TOTAL

None 2 7 1 8 14 9 41

Surgery Only 0 7 3 2 1 0 13

Radiation Only 1 0 0 0 2 0 3

Chemotherapy Only 0 2 0 3 7 0 12

Surgery + Chemotherapy 0 0 1 1 0 0 2

Radiation + Chemotherapy 0 0 2 3 3 0 8

Surgery + Chemotherapy + Radiation 0 1 0 0 0 0 1

TOTAL 3 17 7 17 27 9 80

Table 6

Non-Small Cell Lung Cancer ~ First Course of Treatment

2010 ~ Analytic Cases ~ Class 00-22

Stage 0 Stage I Stage II Stage III Stage IV NA Unknown TOTAL

No Treatment 7 27 6 55 113 3 108 319 Surgery Only 1 110 20 9 10 3 9 162 Radiation Only 0 7 7 21 55 0 3 93 Chemotherapy Only 1 6 3 26 50 2 11 99 Biotherapy Only 0 0 0 0 1 0 0 1 Surgery + Radiation 0 5 2 2 5 0 1 15 Surgery + Chemotherapy 0 4 3 6 2 0 0 15 Radiation + Chemotherapy 1 9 2 54 71 0 11 148 Chemotherapy + Hormone 0 0 0 0 1 0 0 1 Chemotherapy + Biotherapy 0 0 0 0 1 0 0 1 Surgery + Radiation + Chemotherapy 0 0 2 6 2 0 0 10

TOTAL 10 168 45 179 311 8 143 864

2000 - 2009 ~ Analytic Cases ~ Class 00-22

Non-Small Cell Lung Cancer ~ First Course of Treatment Table 5


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Non-Small Cell Lung Cancer Survival

0 Years 1 Years 2 Years 3 Years 4 Years 5 Years

All Stages 100% 43% 28% 20% 19% 15%

Stage I 100% 75% 67% 50% 42% 25%

Stage II 100% 75% 75% 75% 75% 75%

Stage III 100% 71% 43% 21% 21% 21%

Stage IV 100% 16% 6% 3% 3% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Perc

enta

geFigure 8

All Stages Stage I Stage II Stage III Stage IV

Non-Small Cell Lung Cancer 5-Year Survival - Santa Rosa Memorial Hospital- 2003

Class 1 and 2 Cases

n = 74

Dx 1 Year 2 Years 3 Years 4 Years 5 Years

Stage I n=1076 100% 83% 70% 61% 56% 50%

Stage II n=368 100% 69% 50% 41% 33% 26%

Stage III n=1493 100% 44% 24% 17% 13% 9%

Stage IV n=2239 100% 22% 10% 6% 4% 3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Per

cent

age

Figure 95-Year Survivial - California State (97 Facilities) - 2003

National Cancer Data Base (NCDB) n = 5,176

Dx 1 Year 2 Years 3 Years 4 Years 5 Years

Stage I n=836 100% 66% 30% 30% 26% 21%

Stage II n=528 100% 66% 34% 24% 17% 15%

Stage III n=4242 100% 50% 24% 15% 12% 10%

Stage IV n=8696 100% 22% 6% 3% 2% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Per

cent

age

Years From Diagnosis

Figure 10Non-Small Cell Lung Cancer

5 - Year Survival - United States (1,281 Facilities) - 2003National Cancer Database (NCDB) n = 14,302


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Small Cell Lung Cancer Outcome Data

Small cell lung cancer accounts for 13% of all new lung cancer cases at SRMH. See Figure 2. A brief statistical review is shown below.

0%

10%

20%

30%

40%

30-39 yrs 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80-89 yrs 90-99 yrs

Figure 11Small Cell Lung Cancer

2000 - 2009 ~ Analytic Cases ~ Classes 00-22Mean = 69 years ~ Median = 70 years ~ n = 134

Age at Diagnosis

0%

5%

10%

15%

20%

25%

30%

35%

40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs 80-89 yrs


2010 ~ Analytic Cases ~ Classes 00-22Mean = 65 years ~ Median = 64 years ~ n = 10

Age at Diagnosis

Table 8

Small Cell Lung Cancer by Histologic Type 2010 ~ Analytic Cases ~ Class 00-22 ~ n = 10

Histologic Type Total Cases

Percent of

Totals

OAT CELL CARCINOMA 6 60%

SMALL CELL CARCINOMA NOS 3 30%

NEUROENDOCRINE CARCINOMA NOS 1 10%

Histologic TypeTotal

Cases

Percent

of Totals

OAT CELL CARCINOMA 88 66%

SMALL CELL CARCINOMA NOS 24 18%

NEUROENDOCRINE CARCINOMA NOS 22 16%

Table 7

Small Cell Lung Cancer by Histologic Type

2000 - 2009 ~ Analytic Cases ~ Class 00-22 ~ n = 134


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Looking at the stage of disease at the time of diagnosis, Figures 13 and 14 illustrate AJCC TNM stage group distribution for all analytic small cell lung cancers, classes 00-22.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Stage I (11)

Stage II ( 6)

Stage III (37)

Stage IV (66)

Unknown (14)

8%

4%

28%

49%

10%

Figure 13Small Cell Lung Cancer by AJCC TNM Stage Group2000-2009 ~ Analytic Cases ~ Class 00-22 ~ n = 134

AJCC TNM Stage

0% 10% 20% 30% 40% 50% 60%

Stage I (2)

Stage II (1)

Stage IV (6)

Unknown (1)

20%

10%

60%

10%

Figure 14Small Cell Lung Cancer by AJCC TNM Stage Group



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Treatment options are determined by the histologic type of lung cancer (small cell or non-small cell) and stage of disease. Treatment options include surgery, radiation therapy, chemotherapy and targeted therapies. First course of treatment given for analytic small cell lung cancers at SRMH for years 2000 through 2010 is shown in Table 9 and Table 10.

Stage 0 Stage I Stage II Stage III Stage IV Unknown TOTAL

None 1 0 0 0 1 1 3

Surgery 0 0 0 0 1 0 1

Radiation 0 0 1 0 0 0 1

Chemotherapy 0 0 0 0 1 0 1

Radiation & Chemotherapy 0 0 0 1 3 0 4

TOTAL 1 0 1 1 6 1 10

Table 10

Small Cell Lung Cancer - First Course of Treatment

2010 ~ Analytic Cases ~ Class 00 - 22

“It is estimated that approximately $10.3 billion

is spent in the United States each year on

lung cancer treatment.” ~ “A Snapshot of Lung Cancer,” Cancer Trends Progress Report, National Cancer Institute, 2011

Stage 0 Stage I Stage II Stage III Stage IV Unknown TOTAL Radiation + Chemotherapy 0 3 1 14 11 2 31 Observation Only 0 5 2 9 27 7 50 Surgery 0 1 1 0 0 0 2 Radiation 0 0 0 4 6 0 10 Chemotherapy 0 1 0 9 21 5 36 Surgery + Radiation 0 1 0 0 0 0 1 Surgery + Chemotherapy 0 0 1 0 0 0 1 Surgery + Radiation + Chemotherapy 0 0 1 1 1 0 3

TOTAL 0 11 6 37 66 14 134

2000 – 2009 ~ Analytic Cases ~ Class 00-22 Small Cell Lung Cancer ~ First Course of Treatment

Table 9


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Small Cell Lung Cancer Survival

0 Years 1 Years 2 Years 3 Years 4 Years 5 Years

All Stages 100% 44% 19% 13% 13% 6%

Stage I 100% 33% 0% 0% 0% 0%

Stage II 100% 100% 0% 0% 0% 0%

Stage III 100% 60% 20% 0% 0% 0%

Stage IV 100% 17% 17% 17% 17% 17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Observed Survival Rate

Years


5-Year Survival -Santa Rosa Memorial Hospital - 2003Class 1 and 2 Cases

All Stages Stage I Stage II Stage III Stage IV

Perc

ent

SRM

Figure 16 Small Cell Lung Cancer

5-Year Survival - California State (97 Facilities) - 2003 National Cancer Database (NCDB)

0 10 20 30 40 50 60 70 80

Stage I n=45 Stage II n=33 Stage III n=225 Stage IV n=427 Year

Percent

1 Year 2 Years 3 Years 4 Years 5 Years

Figure 17 Small Cell Lung Cancer

5 Year Survival - United States (1281 Facilities) - 2003 National Cancer Database (NCDB)

0 10 20 30 40 50 60 70

Stage I n=836 Stage II n=528 Stage III n=4242 Stage IV n=8696 Year

Percent

1 Year 2 Years 3 Years 4 Years 5 Years


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Multidisciplinary Approach to Patient Care

Collaborative diagnosis and treatment leads to more effective outcomes. The SRMH approach to patient care is multidisciplinary in nature. The Cancer Team is comprised of physicians in diverse fields that include medical oncology, thoracic surgery, radiation oncology, pulmonology, radiology, gastroenterology and pathology, representatives from the Redwood Regional Medical Group

(RRMG) Clinical Trials program and genetic risk assessment counselors. All are committed to a team approach that provides the finest and most advanced treatments available. Services offered include:

The Oncology Department providing multidisciplinary care including: medical oncology, chemotherapy infusion services, radiation oncology and imaging centers.

Full range of clinical, diagnostic, and imaging workup.

Surgical Oncology: The philosophy of the thoracic surgical team and thoracic oncology program at SRMH is to build a foundation of careful preoperative cancer staging and follow it with aggressive, stage-specific treatment.

Traditionally, thoracic surgeons make a large chest incision and cut the ribs to access the thoracic cavity in order to perform surgery; however, newer less invasive surgical techniques are now available. Minimally invasive thoracic surgery or MITS can be performed using video-assistance or robotic assistance:

Video-assisted thoracic surgery (VATS)

Video-assisted thoracic surgery or VATS is a surgical technique that involves insertion of a thoracoscope, a long thin tube with a camera attached on the end, through a small chest incision called a port. The thoracoscope allows the surgeon to visualize inside the chest cavity and to perform surgery using tiny surgical instruments inserted through one or two additional ports.

Robotic thoracic surgery

Robotic thoracic surgery is a newer surgical approach which greatly enhances the surgeon’s visualization of the operative field, precision, and control compared to the traditional “open” surgery approach. With robotic thoracic surgery, the surgeon makes small 1 cm incisions in the same rib space to perform, for example, a lobectomy (lung lobe removal), without spreading or cutting the breastbone or ribs, minimizing blood loss, pain and scarring. The surgeon controls the robot's movements from a nearby console in the operating room. The robot is equipped with high definition 3D imaging capabilities enabling surgeons to perform thoracic surgery through tiny 1-2 cm incisions.


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Multidisciplinary Approach to Patient Care

Dedicated Oncology Unit staffed with a dedicated team of oncology physicians, nurses, and a hospitalist who ensure that patients receive the best care possible.

Cancer Support Groups open to anyone in the community including family of patients with a cancer diagnosis.

Hospice facilities located in Santa Rosa and Petaluma

Cancer Conferences: The Cancer Conference, or Tumor Board, is a multidisciplinary forum for prospective -treatment planning and management of cancer patients. The conference is scheduled the first Tuesday of every month at 12:30 p.m. in the Conference Room B&C at the SRMH. CME credit is available for physicians. The Cancer Conference is open to all members of the medical staff and allied health professionals. It provides an educational opportunity for a multi-specialty approach to improve the quality of care of the cancer patient. The conference is well attended by general and specialty surgeons, medical oncologists, radiation oncologists, primary care physicians, diagnostic radiologists, pathologists, who play a part in the overall patient’s management. The ultimate treatment decisions rest with the managing/treating physicians who synthesize the various opinions and recommends what is the most appropriate management for the care of each patient.

“We bring people together to provide compassionate care, promote health improvement and create healthy

communities.”


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Overall Statistics

Total

Site Group Cases Analytic NonAn M F

Stage

0 Stage I

Stage

II

Stage

III

Stage

IV NA Unk

ALL SITES 631 557 74 266 365 56 142 128 74 83 36 38

BREAST 162 151 11 1 161 31 59 38 12 7 0 4

LUNG/BRONCHUS-NON SM CELL 84 80 4 38 46 2 15 10 16 27 0 10

COLON 50 48 2 25 25 4 6 14 13 10 0 1

BLADDER 43 36 7 27 16 17 6 11 2 0 0 0

PROSTATE 40 32 8 40 0 0 8 16 0 2 0 6

NON-HODGKIN'S LYMPHOMA 30 24 6 20 10 0 3 6 6 6 0 3

MELANOMA OF SKIN 28 24 4 24 4 0 10 11 2 0 0 1

UNKNOWN OR ILL-DEFINED 22 21 1 12 10 0 0 0 0 0 21 0

RECTUM & RECTOSIGMOID 21 14 7 11 10 0 2 2 6 2 0 2

THYROID 20 20 0 3 17 0 13 0 3 4 0 0

PANCREAS 18 15 3 7 11 0 4 5 0 6 0 0

STOMACH 12 8 4 7 5 0 1 3 2 1 0 1

LUNG/BRONCHUS-SMALL CELL 12 10 2 6 6 1 0 1 1 6 0 1

OVARY 9 6 3 0 9 0 1 0 3 0 0 2

ESOPHAGUS 7 5 2 6 1 0 1 1 0 2 0 1

LEUKEMIA 7 6 1 5 2 0 0 0 0 0 6 0

CORPUS UTERI 7 6 1 0 7 0 2 1 1 1 0 1

KIDNEY AND RENAL PELVIS 7 4 3 3 4 0 1 1 0 2 0 0

BILE DUCTS 5 5 0 2 3 0 0 0 0 3 0 2

TESTIS 5 5 0 5 0 0 2 0 3 0 0 0

SOFT TISSUE 4 4 0 1 3 0 2 2 0 0 0 0

OTHER NERVOUS SYSTEM 4 3 1 2 2 0 0 0 0 0 3 0

TONSIL 3 3 0 3 0 0 0 0 1 1 0 1

SMALL INTESTINE 3 3 0 3 0 0 0 0 2 1 0 0

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

LARYNX 3 3 0 3 0 1 1 0 0 1 0 0

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

SALIVARY GLANDS, MAJOR 2 2 0 1 1 0 1 0 0 1 0 0

FLOOR OF MOUTH 2 2 0 1 1 0 1 0 0 0 0 1

HYPOPHARYNX 2 2 0 0 2 0 1 1 0 0 0 0

PERITONEUM,OMENTUM,MESENT 2 1 1 0 2 0 0 0 0 0 1 0

PLEURA 2 2 0 1 1 0 0 1 0 0 1 0

OTHER SKIN CA 2 2 0 1 1 0 0 1 0 0 0 1

URETER 2 2 0 2 0 0 0 2 0 0 0 0

ANUS,ANAL CANAL,ANORECTUM 1 1 0 0 1 0 0 1 0 0 0 0

OTHER DIGESTIVE 1 1 0 0 1 0 0 0 0 0 1 0

MYELOMA 1 1 0 0 1 0 0 0 0 0 1 0

OTHER HEMATOPOIETIC 1 0 1 1 0 0 0 0 0 0 0 0

EYE 1 0 1 1 0 0 0 0 0 0 0 0

Class Sex Stage

Sorted from Most to Least Common

Santa Rosa Memorial Hospital

2010 Primary Site Table


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Statistics

In 2010 the Cancer Registry accessioned and reported a total of 631 new cancer cases, both analytic and non-analytic. Statistical data is reported as shown in the following tables and figures. Class of Case is shown in Table 11 and includes cases diagnosed at SRMH and those diagnosed elsewhere.

The top fifteen (15) primary sites for all cases diagnosed at SRMH or at an outside facility are shown in Table 12.

Type Class Description Cases % of Total Total by

Type % by Type

Class 0 0 Diagnosis Here, Treatment Elsewhere 35 5.5% 35 5.5%

Class 1 10 Diagnosis Here by Staff MD, Treatment Here 57 9.0% 405 64.2% 11 Diagnosis Staff MD, Part of Treatment Here 55 8.7% 12 Diagnosis Staff MD, All of Treatment Here 37 5.9% 13 Diagnosis Here, Part of Treatment Here 103 16.3% 14 Diagnosis Here, All of Treatment Here 153 24.2%

Class 2 20 Diagnosis Elsewhere, Treatment Here 9 1.4% 117 18.5% 21 Diagnosis Elsewhere, Part of Treatment Here 59 9.4% 22 Diagnosis Elsewhere, All Treatment Here 49 7.8%

Class 3 30 Diagnosis & Treatment Elsewhere, Workup Here 9 1.4% 74 11.7% 32 Diagnosis & Treatment Elsewhere, Disease Recurrence Here 63 10.0% 34 CoC Non Reportable / Diagnosis & Treatment Here 2 0.3%

Totals 631 631

2010 ~ All Cases CLASS OF CASE DISTRIBUTION

Table 11

Rank Site Cases % of Total 1 Breast 162 25.7% 2 Lung / Bronchus NSCLC 84 13.3% 3 Colon 50 7.9% 4 Bladder 43 6.8% 5 Prostate 40 6.3% 6 Non Hodgkin Lymphoma 30 4.8% 7 Melanoma of Skin 28 4.4% 8 Unknown or Ill-Defined 22 3.5% 9 Rectum & Rectosigmoid 21 3.3% 10 Thyroid 20 3.2% 11 Pancreas 18 2.9% 12 Stomach 12 1.9% 13 Lung/Bronchus Small Cell 12 1.9% 14 Ovary 9 1.4% 15 Esophagus 7 1.1%

TOP 15 PRIMARY SITES Table 12

2010 ~ All Cases n = 631


Page 19 of 20

Statistics

2010 cancer cases by gender and ethnicity are shown below in Figure 18 and Table 13.

Age at diagnosis for all classes of case (class 00-34) is shown here in Figure 18.

Figure 19 Age at Diagnosis

2010 ~ All Cases Mean = 67 yrs ~ Median = 68 yrs

0%

5%

10%

15%

20%

25%

30%

10-19 yrs

20-29 yrs

30-39 yrs

40-49 yrs

50-59 yrs

60-69 yrs

70-79 yrs

80-89 yrs

90-99 yrs

100-120 yrs

Unknown

Percent of All Cases

Female Male

365 cases 266 cases 57.8% of Total 42.2% of Total

n=631

Figure 18 Gender Distribution 2010 ~ All Cases

Race Cases % of Total WHITE 604 95.7% BLACK 7 1.1% AMERICAN INDIAN 1 0.2% CHINESE 1 0.2% JAPANESE 1 0.2% FILIPINO 2 0.3% HAWAIIAN 2 0.3% VIETNAMESE 2 0.3% LAOTIAN 1 0.2% ASIAN INDIAN 7 1.1% ASIAN OTHER/NOS 3 0.5%

Total Cases 631

2010 ~ All Cases ETHNIC DISTRIBUTION

Table 13


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Administration and Cancer Program Team

Executive Team

Kevin Klockenga President and CEO

Mich Riccioni CFO

Jo Sandersfeld Vice President of Mission Integration

Kathy Hardin Chief Nursing Officer

Debra Miller Vice President of Human Resources

Cancer Committee

Ian Anderson, M.D. Chairman, Medical Oncology

F. Scott Chilcott, M.D. Family Practice

Barbara Cohn, M.D. Radiology

Frederick David, M.D. Radiation Oncology

James Harwood, M.D. General Surgery

Gary Johanson, M.D. Palliative Care

Laura Norton, M.D. General / Breast Surgery

Ronald Van Roy, M.D. Radiation Oncology

Andrew Wagner, M.D. Palliative Care

Richard Wilbur, M.D. Pathology

Melissa Cerini Cancer Registry

Dan Cress Rehabilitation

Bill Dalton Pharmacy

Nori Dove, R.N. Hospice

Kris Hartigan, R.N. Redwood Regional Medical Group

Ediko Holman, R.N. Care Management

Linda Jund, B.S., CTR Oncology-N-Sync, Inc.

Michelle Kane, R.N. Nurse Manager, Oncology Unit

Kelly Kline-Cunningham Nutrition Services

Annette Lilly Spiritual Care

Laurel Mastro, R.N. Director, Oncology & Critical Care

Cherryl Nightingale, CTR Oncology-N-Sync, Inc.

Sue Pearce Social Services/Care Management

Pam Randall, RHIT, CTR Oncology-N-Sync, Inc.

John Robinson, DDS Dental Surgery

Chris Ryan Rehabilitation

Jeddi Scardino, RPh Pharmacy

Ali Seidman ACS Representative

Jennifer Tantarelli, FNP Palliative Care

Connie Vocature, R.N. Cancer Program Administrator


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