Cancer Program Annual Report 2004 Statistical Year

Cancer Program Annual Report

2004 Statistical Year

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Table of Contents

Investing in South Carolina: A Message from Kester Freeman.........................................................2

Committee Membership ..................................................................................................................3

2004 Cancer/Oncology Committee Goals .......................................................................................4

CoC Program Activity and Evaluation .............................................................................................5

Cancer Conferences.........................................................................................................................7

Community Outreach Goals............................................................................................................9

Cancer Prevention, Awareness and Education............................................................................9

Statewide Cancer Control Planning..........................................................................................12

Cancer Screenings and Early Detection. ...................................................................................12

Support Programs and Activities. .............................................................................................14

Cancer Data Management Activity.................................................................................................17

Focus on Selected Gynecological Cancers .....................................................................................21

Corpus Uteri ............................................................................................................................22

Cervix Uteri .............................................................................................................................28

2004 Cancer Program Annual Report Contributors.......................................................................34

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“The investments in health sciences

research that will result from this

collaboration give South Carolina the

fuel we need to attract more

researchers, generate more and

better research, secure more

national funding and attract more

out-of-state businesses that will

want to take advantage of the

intellectual powerhouse we create.”

Health Sciences South Carolina

Collaborative Partners:

• Palmetto HealthKester Freeman, CEO

• Greenville Hospital SystemFrank Pinckney, CEO

• Spartanburg Regional Health SystemIngo Angermeier, CEO

• Medical University of South CarolinaDr. Ray Greenberg, President

• University of South CarolinaDr. Andrew Sorensen, President

• Clemson UniversityJim Barker, President

Purpose:

• To promote health sciences research andbroad-based clinical trials in South Carolina

• To create a pipeline for new research findingsto be quickly transferred to clinical trials.

• To improve the health of our citizens

In April 2004, Palmetto Health signed a Memorandum ofUnderstanding to create Health Sciences South Carolina, aunique biomedical collaborative between the state’s three largesthealth systems and three research universities. Over a ten-yearperiod, $120 million has been pledged from the partners forjoint research and clinical studies, with additional state matchingfunds available. Already the collaborative is attracting nationalattention and serving as a model throughout the country.

Palmetto Health is first and foremost an acute care hospital system. Our vision statementsays our goal is to be the preeminent health system in the state. While we understand thecore mission is to run good hospitals, we don’t believe we can do that without theenhancement of state-wide relationships and education and research.

Great education must keep pace with great research. The University of South Carolina(USC) schools of Medicine, Public Health, Social Work, Nursing, Pharmacy and others willbe enhanced by a stronger research program. Andrew Sorensen, President of USC, hasreally focused the entire university with a more aggressive research emphasis. As a teachinghospital system, Palmetto Health will be part of and benefit from that direction.

South Carolina is a small state with huge health disparities. We have some of the highestincidences of disease in the nation for cardiovascular disease, certain cancers, diabetes,obesity and strokes. We have a diverse racial population, and a large retired populationincluding many frail elderly.

What excites me from a global perspective is, first, Health Sciences South Carolina bringstogether the state’s three largest health systems and three research universities in apartnership that is the first of its kind in the United States. It’s not easy, as we’ve learnedwith Palmetto Health, to put culturally different organizations together. Yet there are somany potential benefits.

Second, we now are beginning to be attractive to world-class researchers who can goanywhere to work and who formerly would not have considered coming to South Carolinabecause of our limited resources and the relatively small scale work we were doing.Together, we can create the kind of synergy to compete with anybody in the world.

Third, we believe there are other things that could spring out of this collaboration.For example, our information technology leaders are meeting regularly to talk aboutways we can share knowledge to improve our information systems. Our pharmacydirectors are meeting periodically to look at ways we can do more clinical trials to workcloser with pharmaceutical companies. Our fundraising arms will make sure we’re notcompeting for major donors. Just the goodwill and relationships we’re building betweensix large organizations is very good for South Carolina.

Currently, there are three clinical research areas of focus including cancer, neurosciencesand cardiovascular diseases. A second focus area will examine quality and patient safetyissues. The ultimate purpose here is to help relieve human suffering. And maybe, for oncein the history of this state, we can begin to develop a population base that isn’tdisproportionately poor or unhealthy. Maybe we can do something to change the culture;to not only treat but prevent diseases; to help people live longer, healthier lives.

Kester S. Freeman, Jr.Chief Executive Officer, Palmetto Health

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Investing in South CarolinaC

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Palmetto Health BaptistPHYSICIAN MEMBERSJames R. Wells, MD, Cancer Committee Chair (Otolaryngology)Mary A. Ackerman, MD, Community Outreach Coordinator

(Medical Oncology)Joseph Albert, MD (Colorectal Surgery)William H. Babcock, MD (Medical Oncology)Douglas M. Bull, MD (Radiology)William M. Butler, MD, Cancer Registry Data

Quality Control Coordinator (Medical Oncology)A. Atwell Coleman, MD (Pathology)Donen Davis, MD (Plastic Surgery)David Fulton, MD (Orthopaedic Surgery)Jeannette C. Fulton, MD (Radiology)Jorge L. Galan, MD (Internal Medicine)Burnett W. Gallman, MD (Internal Medicine)David J. Gatti, MD (General Surgery)Paul Guerry, MD (Pathology)Spencer Jenkins, MD (Internal Medicine)Edward E. Kimbrough, MD (Internal Medicine)Fred J. Kudrick, MD (Medical Oncology)William V. Lewis, MD (Pathology)Leland J. McElveen, MD (Medical Oncology)Sidney Morrison, MD (Colorectal Surgery)John Rawl, MD (Urology)James B. Tribble, MD (General Surgery)Robert Smith, MD (Medical Oncology)Bartlett J. Witherspoon, MD (Radiation Oncology)John Wofford, MD (Urology)Ben W. Wright, MD, Cancer Conference Coordinator

(Radiation Oncology)

NON-PHYSICIAN MEMBERSGloria Beard, MSW (Social Work and Case Management)Donnie Coker, MHA (Clinical Research)Perry Covington, PharmD (Pharmacy Services)Mary Ellen Doyle, FACHE (Cancer Program Administration)Carolyn Evans, RN, OCN (Oncology Nursing)Rev. Irene Henderson, MDiv, ACPE Supervisor

(Pastoral Services)Donna Keisler, CTR (Cancer Registrar)Holly Knight, RNC, MN (Hospice and Home Care)Sandra E. Lunden, MA, RHIA, CPHQ, CTR (Cancer Registrar)Vicki McLain, CTR, RHIT (Cancer Registrar)Shelby Reece, RN, MN (Administration)Debra D. Seale, RN, MN, Quality Improvement Coordinator

(Cancer Program) Pamela Stephens (Quality Review Department)Judy Weathersbee, BS, ARRT(R)(QM) (Imaging)

Palmetto Health RichlandPHYSICIAN MEMBERSNeal P. Christiansen, MD, Cancer Committee Chair

(Medical Oncology)James W. Curtis, Jr., DMD, Cancer Committee Vice-Chair

(General Denistry)Richard M. Bell, MD (Surgery)R. J. Boulware, MD, Cancer Conference Coordinator

(Radiation Oncology)William M. Butler, MD, Cancer Registry Data

Quality Control Coordinator (Medical Oncology)Stanley H. Greenberg, MD (Urology)Arturo E. Marchand, MD (Diagnostic Radiology)Kevin P. McRedmond, MD (Pediatric Oncology)James R. Wells, MD, Community Outreach Coordinator

(Otolaryngology)Jeffrey A. Welsh, MD (Pathology)James A. Williams, Jr., MD (Gynecological Oncology)Gerald A. Wilson, MD (Surgery)Rudolph L. Wise, MD (Medical Oncology)

NON-PHYSICIAN MEMBERSDonna Burrows, MSW (Social Work and Case Management)Donnie Coker, MHA (Clinical Research)Collin Cress, PT (Rehabilitative Services)Mary Ellen Doyle, FACHE (Cancer Program Administration)Shay Garrison, RPh (Pharmacy Services)Linda Grimes, RHIA (Quality Management)Donna Keisler, CTR (Cancer Registrar)Holly Knight, RNC, MN (Hospice and Home Care)Sandra E. Lunden, MA, RHIA, CPHQ, CTR (Cancer Registrar)Rev. Carson Rogerson, MDiv, ACPE Supervisor

(Pastoral Services)Debra D. Seale, RN, MN, Quality Improvement Coordinator

(Oncology Nursing) John J. Singerling, MHA, Vice President (Administration)

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Committee Membership

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CLINICAL

1. Increase awareness of the American Joint Committee on Cancer (AJCC) staging requirements so as toincrease managing/treating physician accuracy.

2. Follow Commission on Cancer (CoC) approved patient and treatment guidelines in breast, prostate, andcolorectal cancers.

3. Ensure that 90 percent of pathology reports that include a cancer diagnosis contain the scientificallyvalidated data elements outlined on the surgical case summary checklist of the College of AmericanPathologists (CAP) publication, Reporting on Cancer Specimens.

PROGRAM

1. Explore minimizing duplication by converting to a network facility.

2. Provide increased opportunities for the public to have access to cancer program data and activities.

3. Establish cancer conference frequency and format on an annual basis.

4. Establish the multidisciplinary attendance requirements for cancer conferences on an annual basis.

5. Ensure that the required number of cases are discussed at cancer conferences on an annual basis andthat at least 75 percent of the cases discussed are presented prospectively.

6. Monitor and evaluate the cancer conference frequency, multidisciplinary attendance, total casepresentation and prospective case presentation on a quarterly and annual basis.

7. Provide facility wide and/or site-specific multidisciplinary forums to provide education and discusspretreatment planning and follow-up.

Quality Improvement

1. Promote pre-treatment planning.

2. Improve compliance rate for AJCC staging by managing/treating physicians.

3. Study Topic 1: Review and report quarterly the results of patient satisfaction surveys.

4. Study Topic 2: Retrospective review of patients with prostate cancer treated with Intensity ModulatedRadiation Therapy (IMRT) to assess and document side effects of treatment.Plan: Ongoing into 2005.

5. Study Topic 3: Complete the five-year retrospective review of breast cancer screening, diagnostic andtreatment data (1998-2002).

Community Outreach

1. Increase accrual to cancer prevention clinical trials.

2. Provide leadership and direction to new statewide cancer organization, South Carolina Cancer Alliance.

3. Provide free cancer screenings.

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2004 CANCER COMMITTEE GOALS

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Increase awareness of AJCC staging requirements so as to increase managing/treating physician accuracy.

The AJCC staging form is available on the Palmetto Health intranet http://phanet/SCCStaging/. For enhancedavailability of AJCC forms outside the Palmetto Health servers, a CD of the AJCC staging form is available forinterested physician practices.

Follow CoC approved patient and treatment guidelines in breast, prostate, and colorectal cancers.

National Comprehensive Cancer Network (NCCN) treatment guidelines for breast, prostate and gastrointestinalcancers were distributed to comprehensive center medical staff for ongoing review and use. NCCN treatmentguidelines for site-specific cases are being reviewed and distributed with each case presentation at the monthlyGastrointestinal (GI) Cancer Conference. NCCN treatment guidelines and other respected clinical practice guidelinesfor site-specific cases were reviewed for cases presented at the General Cancer Conference. The NCCN patientguidelines are a standard part of the Nurse Navigators’ educational packet given to newly diagnosed patients withbreast and prostate cancers. Most breast and prostate cancer cases are referred to the Nurse Navigator. Since theGastrointestinal Cancer Nurse Navigator started in September 2004, some GI cancer cases are being referred. Also, allNCCN guidelines are available to patients, family members and the community through the services of the DubyThompson Patient and Family Cancer Resource Library.

Ensure that 90 percent of pathology reports that include a cancer diagnosis contain the scientifically validated dataelements outlined on the surgical case summary checklist of the College of American Pathologists (CAP) publication,Reporting on Cancer Specimens.

Review of pathology reports for 10 percent of the 2004 annual analytic caseload is currently under way. Of the casesreviewed thus far, 93% of the pathology reports contain the scientifically validated data elements as required by theCollege of American Pathologists. Final results of the review will be presented to Network Cancer Committee.

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CoC Program Activity and EvaluationThe Cancer Committee of Palmetto Health Baptist, a Community Cancer Program, and the Oncology Committee ofPalmetto Health Richland, a Teaching Hospital Cancer Program, each had the same annual goals and worked togetherto achieve success. The goals are accompanied by the Committees’ evaluation comments and supporting activities.

Clinical Goals

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Explore minimizing duplication by converting to a network facility.

Goal completed and ACoS CoC has been notified that we are pursuing Network Cancer Committee status beginningin 2005.

Provide increased opportunities for the public to have access to cancer program data and activities.

Participating in and routinely updating the ACoS CoC Facility Information Profile System (FIPS). A link to our website and cancer data also are available by accessing the South Carolina Cancer Alliance and National Consortium ofBreast Centers. The 2003 statistical year Oncology Annual Report in PDF format is available on the Palmetto Healthweb site, sccancercenter.palmettohealth.org, for the general public (hard copies are available as requested). Acalendar of events is publicized monthly in local media, including The State, Black News and Community Care.Educational and marketing endeavors, as well as public service announcements and advertisements, are ongoing forcancer prevention clinical trials and USC studies, support programs, cancer educational events, cancer screeningsand special events to commemorate cancer awareness months. These include March (Colorectal Cancer Awarenessmonth), September (Prostate Cancer Awareness month) and October (Breast Cancer Awareness month), among others.

“Breast Cancer Care: Changing Community Standards,” was published in the September/October 2004 issue of theJournal for Healthcare Quality. The authors – William M. Butler, MD, Joan E. Cunningham, PhD, Douglas Bull,MD, Tommy Cupples, MD, Paul Guerry, MD, James C. Reynolds, MD, and C. Alden Sweatman, MD – highlightbreast cancer care improvements and changes in practice patterns over time. The major clinical benefits to patientsincluded a significant improvement in needle biopsy rates, decreased utilization of second operative procedures,increased breast conservation surgery, conformity to guidelines for adjuvant chemotherapy administration, and asizable increase in discovery of small breast cancers by screening mammography.

“Nurse Navigators – Program Helps Patients Cope with Cancer Diagnosis and Treatment at Palmetto Health,Columbia, SC” was published in the May 31, 2004 issue of Advance for Nurses. The cover story highlightedPalmetto Health Nurse Navigators and the significant role they play in patient and family education, support andnavigation. The article focused on the Nurse Navigator program and staff including Joan Minor, RN, Prostate CancerNurse Navigator, and the Breast Cancer Nurse Navigators, Isabel Law, RN and Dottye Wodogaza, RN.

9th Annual Spring Breast Symposium – Friday, April 16, 2004

The symposium is for physicians, nurses and other healthcare professionals interested in the current concepts ofdiagnosis and management of breast cancer. Featured speakers included David J. Cole, MD, Surgical Oncology,Medical University of South Carolina (MUSC); Donald L. Fylstra, MD, Obstetrics and Gynecology, MUSC; O. M.Zack Howard, PhD, Staff Scientist, National Cancer Institute; Kelly M. McMasters, MD, PhD, Surgical Oncology,University of Louisville; S. Terry Smith, MD, Gynecologic Oncology, South Carolina Oncology Associates; C. AldenSweatman, MD, FACS, Surgery, Surgical Associates of South Carolina.

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Program Goals

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Cancer Conferences

Establish cancer conference frequency and format on an annual basis.

Establish the multidisciplinary attendance requirements for cancer conferences on an annual basis.

Ensure that the required number of cases (10% of analytic caseload) is discussed at cancer conferences on an annualbasis and that at least 75 percent of the cases discussed are presented prospectively.

Monitor and evaluate the cancer conference frequency, multidisciplinary attendance, total case presentation andprospective case presentation on a quarterly and annual basis.

Provide facility wide and site-specific multidisciplinary educational forums to promote pretreatment planning and todiscuss follow-up cases.

Promote pretreatment planning.

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Program Goals

Quality Improvement Goal

Cancer Conference ActivityPalmetto Health 2004 Statistical Year

Goals EvaluationConference Conference Number of Number of Cases % Analytic Cases Number of Prospective % Prospective Average Format Frequency Meetings Presented Presented Cases Presented Cases Presented AttendanceGeneral 64/year 68 145 8.1% 144 99.3% 14Medical Specialties Represented Surgery, Pathology, Diagnostic Radiology, Medical Oncology, Radiation Oncology

Breast 84/year 100 734 41.1% 734 100% 21Medical Specialties Represented Surgery, Pathology, Diagnostic Radiology, Medical Oncology, Radiation Oncology

Prostate 10/year 11 41 2.2% 41 100% 16Medical Specialties Represented Urology (Surgeons), Pathology, Medical Oncology, Radiation Oncology

GI 10/year 11 30 1.7% 25 83.3% 29Medical Specialties Represented Surgery, Gastroenterology, Pathology, Diagnostic Radiology, Medical Oncology, Radiation Oncology

Total 168/year 190 950 53.2% 944 99.4% 19

Improve compliance rate for AJCC staging by managing/treating physicians.

Current Cancer Data Management (CDM) 2004 audits reflect a 90.62% completion rate of AJCC staging bymanaging physician. For compliance, 90% of analytic cases must be staged by the managing physician. CDM’sdatabase, IMPAC/MRS, was upgraded in October 2004 and now can generate AJCC staging compliance reportsby the managing physician. Staging compliance rates were reported to the Cancer Committee quarterly.

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Studies of Quality

Study Topic 1: Review and report quarterly the results of patient satisfaction surveys

Study: The Press Ganey Patient Satisfaction Survey includes questions related to the following: patient’s admission,room, meals, nurses, tests and treatments, visitors and family, staff attitude, patient and family information regardingcondition and treatment, physician, discharge, personal issues, privacy, pain control, emotional needs, cheerfulness ofthe hospital, and overall rating of the care given.

Evaluation: The oncology units consistently have very high patient satisfaction ratings and rank among the highest inthe nation in our peer group.

Study Topic 2: Retrospective review of patients with prostate cancer treated with IMRT to assess and documentside effects of treatment

Study: Comparative analysis for prostate cancer treated with conventional external beam radiotherapy versus IntensityModulated Radiation Therapy (IMRT) to assess side effects of treatment and quality of life.

Evaluation: Expand length of study to include 2003 and/or 2004 data. Questionnaire design completed. Need tosubmit protocol through IRB for clearance to use data collection and findings in future publication(s). Continue studytopic into 2005.

Study Topic 3: Complete the five-year retrospective review of breast cancer screening, diagnostic and treatmentdata (1998-2002)

Study: Total mammograms, screening mammograms, diagnostic mammograms, needle biopsies, new analytic casesand genetic counseling referrals. Surgical procedures for T1a, T1b, T1c, T2: breast conserving surgery, mastectomyand sentinel node biopsy.

Evaluation: Completed 1998-2003 data and distributed to Cancer Committee and South Carolina ComprehensiveBreast Center medical and administrative staff. Additional follow up is necessary to (1) collect data on other mammog-rapher-identified clinical indicators; (2) work towards integration of appropriate databases to prevent duplication; and(3) make data collection less duplicative for patients and mammography center staff. Formed an ongoing breast cancerdata work group as a subcommittee of the Cancer Committee.

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Press Ganey Overall Rating 3rd Surgical 4th Medical 8th Averyt, Children’s Cancerof Inpatient Satisfaction Oncology, Richland Oncology, Richland Baptist and Blood Disorders

Jan - March 87.2% 88.4% 91.1% 86.9%

April - June 92.6% 90.6% 90.9% 88.0%

July - Sept 91.5% 91.4% 87.3% 89.6%

Oct - Dec 88.8% 89.2% 85.9% 89.9%

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Increase accrual to cancer prevention clinical trials.

The STAR and SELECT cancer prevention studies closedto accrual on 5/31/04 and 5/27/04, respectively. Over thelife of the STAR prevention trial at Palmetto Health, acumulative total of 21,782 people were prescreened,3,582 were screened, and 67 patients were randomized.Over the life of the SELECT prevention trial at PalmettoHealth, a cumulative total of 454 people were pre-screened, 456 were screened, and 86 patients wererandomized. Overall SELECT recruitment: 26 AfricanAmericans and 60 European Americans – reflecting veryhigh minority recruitment to this trial.

Buddy Call 19

Nationally recognized Buddy Call program promotingmonthly breast self-examination (BSE) cosponsored byPalmetto Health’s South Carolina Comprehensive BreastCenter and CBS affiliate WLTX-19. Over 84,000 womenparticipated in the program.

Colorectal Cancer Awareness Walk at Riverfront Park(March 13)

More than 450 people participated in the 4th annualwalk to raise awareness about colorectal cancer and theimportance of early detection through screening.

14th Annual First Ladies’ Walk for Life Steps AgainstBreast Cancer (October 2) More than 10,000 people par-ticipated in the breast cancer walk to raise awareness andfunding for education, programs, and research.

Held annually the third the Thursday in November,Palmetto Health, in collaboration with the University ofSouth Carolina’s Wellness Center, sponsored the GreatAmerican Smoke Out (November 18). Pledge cards weregiven to those smokers who committed to quit smokingfor a day. Literature and education were providedregarding the effects of cigarette smoking and lungcancer. Approximately 400 people signed pledge cards.

Nurse Navigators, Cancer Awareness and Education

The Cancer Nurse Navigators provided educationalpresentations to various audiences in the communitythroughout the year. Some of those audiences includedstudents, faculty and parents at the E.E. Taylor ParentClub, Sanders Middle School Parent Club, John P.Thomas Middle School, Midlands Technical College,Sister Care, and various churches including St. Mark’sBaptist Church, Central Baptist Church, Refuse TempleChurch, and the United Methodist Church inWinnsboro. Numerous other presentations/classes wereprovided for the American Cancer Society, local busi-nesses and community health fairs to reach out tothousands of South Carolinians.

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Community Outreach Goals

Community Outreach: Cancer Prevention, Awareness and Education

Palmetto Health is the 2004 recipient of the

South Carolina Hospital

Association’s Community Service Award.

On March 4, the South Carolina Hospital

Association recognized Palmetto Health for

community service contributions. The award

pays tribute and expresses gratitude to those

who have made significant contributions to the

health care field in South Carolina.

Palmetto Health is the first in the Midlands to acquire

Full Field Digital Mammography.

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Smoking Cessation Classes

Palmetto Health and the University of South Carolina’sdepartment of Family and Preventive Medicine offer freesmoking cessation classes. The comprehensive smokingcessation program combines motivational behavioralcounseling with medical consultation and provides nico-tine replacement therapy for each participant. Theappeal of this program has grown and six sessions areoffered monthly. In addition, one class a month is offeredat the University of South Carolina for students. In FY2004, 970 participants attended at least one or more ofthese classes and upon completion of the course,70 percent report they are no longer smoking.

SunSmart Awareness (April – September)

The SunSmart skin cancer awareness programincluded daily UV index readings on our website(PalmettoHealth.org) and educational presentationsin the community primarily targeted toward childrenand youth to help avoid harmful UV rays and sunburns.In addition, our mascot, Sunny, made appearances andoffered SunSmart tips at educational presentations andcommunity events.

African American breast cancer survivors attendedSurvivors and Sisters, an Evening of Elegance onWednesday, October 27 from 6 to 8 PM at PalmettoHealth Baptist. Each survivor brought a friend tothe breast cancer awareness dinner to encouragemammography screenings and the early detection ofbreast cancer. Sponsoring partners included Rich’s-Macy’s and Ortho Biotech.

Trumpeter Campaign and Contest (Fall and Spring)

Beginning with Red Ribbon week in the fall, trainedvolunteer speakers shared the powerful influence oftobacco advertising with area sixth-grade students.The educational program provided information onthe damaging effects of tobacco, skills to diffuse peerpressure to use tobacco products and awareness oftobacco advertising. More than 3,000 students wereeducated, and the spring contest culminated with anawards ceremony for winners representing the sevenparticipating schools across six school districts. Thecontest allowed students to compete for cash prizes bycreating counter-advertisements to tobacco messages.The contest awarded approximately $4,000 to middleschool students in school districts throughout Richlandand Lexington counties. Palmetto Health has awardedmore than $34,000 to Trumpeter contest participantsover the past six years.

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Trumpeter Campaign Contest Winners

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First place Trumpeter Contestwinners Emily Deahl and

Chelsea Eason from LexingtonIntermediate School are

featured with their prize winningrap. Poster reproductions

were distributed to area middleschools to spread theanti-tobacco message.

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Community Outreach: StatewideCancer Control Planning

Provide leadership and direction to new statewide cancerorganization, South Carolina Cancer Alliance (SCCA).

William M. Butler, MD (Medical Staff); Isabel Law, RN(Nurse Navigator – Patient Educator); Debbie Seale, RN,MN, (Program Manager, Comprehensive Centers); MaryEllen Doyle, FACHE (Administrative Director, SC CancerCenter); and James Hebert, MSPH, ScD (USC School ofPublic Health and Director, Statewide Cancer Prevention& Control Program, Hollings Cancer Center and SouthCarolina Cancer Center), were elected to serve on theSCCA Coordinating Council. In addition, Debbie Sealewas invited to participate in the Comprehensive CancerControl Leadership Institute in Washington, DC July28-30, 2004. Many other Palmetto Health staffparticipate in the SCCA and are active in the task forces,work groups and Core Planning Team to develop a newplan for cancer control.

In partnership with S.C. Department of Health &Environmental Control (S.C. DHEC) and the SCCA,Palmetto Health sponsored and hosted a communityforum on Tuesday, November 9 to review the SCCancer Plan objectives and discuss strategies withcommunity partners.

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Community Outreach: CancerScreenings and Early Detection

Provide free cancer screenings.

The Cancer Health Initiative has completed its seventhyear of providing services to the community. The CancerHealth Initiative addresses the following five cancers:breast, cervical, lung, prostate and colorectal. Throughthe use of clinics, health fairs, schools, faith-based andcivic organizations and businesses, breast, prostate,colon and cervical cancer screenings are made availableto the targeted population. Collaboration with localtelevision and radio affiliates has raised awarenessregarding smoking cessation programs, screening andearly detection of breast, cervical and prostate cancers.The targeted population includes residents of Richland,Lexington, Pickens and Fairfield counties that areunderinsured or who have no insurance. Since SouthCarolina has one of the highest prostate cancer mortalityrates in the nation, an exception was made by DHEC toprovide prostate cancer screenings to the general public.In addition, smoking cessation classes are provided tothe general public.

The Real Men Checkin’ It Out program, a faith-basedcollaborative, has been a huge success for the past fiveyears. This faith-based program provides a grant,primarily to African American faith-based and civicorganizations, to provide education, awareness andrecruitment of men for prostate cancer screening. InFY 2004, a record 58 churches and civic organizationsapplied for grants and 36 were awarded a stipend of upto $1,500 to recruit at least 40 men to participate in the

Cancer Screening Outcomes FY 2004

Screening Test FY 2004 Goals FY 2004 FY 2004 Cancer Outcomes

Clinical Breast Exams 650 586 -

Mammograms/Ultrasounds 650 664 3 Breast Cancers

Pelvic Exams 900 619 -

Pap Smears 900 586 14 Cervical Dysplasias

Colonoscopy 0 0 -

Smoking Cessation 500 970

Prostate Specific Test 2,300 2,713 -

Digital Rectal Exam 250 187 8 Prostate Cancers

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screenings. Through this partnership effort with the SCDHEC Office of Minority Health, more than 1,350 menwere screened this year. Since the program was started in2000, 125 community and church-based screeningevents have been held, 5,750 men have been screenedfor prostate cancer and 58 cases of prostate cancer havebeen diagnosed and treated.

During FY 2004, the Cancer Health Initiative hasscreened 3,049 participants for services and hasperformed over 6,300 screenings, finding 11 cancersand 14 cervical dysplasias. Due to a reduction in funds,colonoscopies were not performed. Colorectal cancerscreening assessments are done for age-appropriatepatients; they receive a fecal occult blood test and/or areferral to a primary health care provider of their choiceto be evaluated for a colonoscopy.

Harambe’

Benedict College hosts an annual African AmericanHeritage Celebration Month called Harambe’. Throughthis event, Palmetto Health’s Cancer Health Initiativewas able to screen men who would not ordinarily cometo churches or established clinics. This year, 93 menwere screened.

HealthWorks

The Palmetto Health Cancer Health Initiative workedwith HealthWorks, the Palmetto Health occupationalhealth and wellness and employee screening department,

to target area worksites for uninsured and underinsuredworkers. Through this effort, approximately 473 menwere screened for prostate cancer. Screening services wereperformed at the South Carolina Department ofTransportation, South Carolina Department of MentalHealth, Brennan Elementary School, DHEC, Hyatt ParkElementary School, Department of Social Services,Ridgeview High School and Columbia High School.

Other Community Health Events

A Women’s Health Breakfast (Saturday, May 15) and aMen’s Health Breakfast (Saturday, June 5), were held atPalmetto Health Baptist to provide free health informationand educational programs. A Women’s Health Day(Saturday, May 22) and a Men’s Health Day (Saturday,June 12) were held at Richland Primary Health Care fordiabetes, HIV, hypertension and cancer screenings.Diabetes and cancer screenings are offered every Mondayat the Free Medical Clinic.

Additional screening events were held throughout the yearat many locations including the Columbia Fire Stationand numerous churches and health fairs in Richland,Lexington and Pickens counties. Numerous communitypartners helped including the Parish Nurse Program,Council on Aging, DHEC, the Best Chance Network,American Cancer Society, National Black LeadershipInitiative for Cancer, Benedict College, Allen University,City of Columbia Mayor’s Task Force, South CarolinaCoalition of Black Churches, YWCA, professionalcolleagues in the local media and many communityfriends who volunteered their time, talents and resources.

Cancer Screening Outcomes for All Fiscal Years 1998-2004

Screening or Intervention Number of Exams/Number of Participants Outcomes

Breast Cancer Screenings 5,522 17 Breast Cancers

Cervical Cancer Screenings 6,988 54 Cervical Dysplasias

Prostate Cancer 12,001 60 Prostate Cancers

Lung Cancer (Smoking Cessation) 2,530 70% not smoking after treatment *

Colorectal Cancer Screenings 482 2 Colon Cancers

Totals 27,523 79 Cancers found and referred for follow-up treatment

*Evaluation analysis from the first six months of results show that smokers experienced significantly enhanced self-confidence in their ability andmotivation to quit smoking through participation in this program.

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With a variety of participating artists, this series ofprograms helps cancer patients and families learnpositive ways to express feelings, increase coping skills,uncover inner resources and find a deep wellspring ofemotional healing.

Altered Books and Stories of Your Journey led by Dr.Sharon Bray, Director of Wellspring Writers and a seniorpartner with Amherst Writers & Artists, was a day-longretreat on May 14th for cancer patients and a partner.

Arts & Healing® Exhibition andReception “Sometimes Words AreNot Enough” featuring original piecesand reproductions by cancer patientsfrom October 19 through December14 at the Richland County PublicLibrary; a reception for the artistsand the public was held onNovember 16, 2004 from 5:30 to 7:30pm.

Coming Home to Ourselves (September 9, 16, 23, 30and October 7)

A five-session support program designed for patientsto create a visual symbol of healing using mixedmedia collages.

Faces of Change (April 1, 8, 15, 22, 29)

A five-session support group designed for patients age16 and older to create a mask to portray their inner andouter self.

Healing Icons (February 5, 12, 19, 26 and March 4)

A five-session support program designed for patients tocreate a visual symbol of healing using mixed mediamaterials.

Healing Icons for Grieving Adults(September 13, 20, 27 and October 4)

A five-session support groupdesigned for grieving adults to use artto discover their inner resources forcoping with grief.

Shadowbox Illuminations: Finding Your Way Out ofDarkness (October 28, November 4, 11, 18 andDecember 2)

A five-session support program designed for patientsto create a visual symbol of healing using mixed mediaand sculpture.

Community Outreach: Support Programs and Activities

Blood Cancers Support Group

For adult patients who have blood disorders includingleukemia, lymphoma and myeloma.

Bosom Buddies

A monthly support group for breast cancer survivors.

Brett’s Rainbow Bereavement Camp

October 9-10 at White Oak Conference Center

A special weekend camp offered to children ages 6 to16 who have experienced the death of a family memberor other significant person in their lives. The campis offered free of charge and is made possible bycommunity contributions to Palmetto Health Hospice.

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Bridging the Bereavement Gap (March 8, 15, 22, 29 andApril 5, 12)

A six-week series of educational programs designed tohelp those who have lost a loved one through the griefprocess towards hope and healing.

“The C-Word” is a monologue by actress Barbara BatesSmith about her experiences as a breast cancer patientduring the past two years. Her diagnosis came while shewas playing the lead role of the cancer patient inMargaret Edison’s Pulitzer Prize-winning drama “Wit” ata regional theatre in North Carolina. Smith was encour-aged by Edison to write a personal story of her “Wit”role and incorporated her journal entries into the script.This premiere performance was held on Tuesday, March23 in the Palmetto Health Baptist Auditorium.

25th Annual Camp Kemo: A week-long summer camp forpatients 5-18 years of age and their siblings. Staffed byour physicians, nurses and volunteers, the camp offersswimming, boating, and hiking with a specialty focus onletting these campers simply enjoy childhood.

Camp New Horizons: A weekend bereavement camp tohelp brothers and sisters who have lost a sibling throughthe grieving process.

Celebrating the Holidays with inpatient parties and fulfill-ing “wish list” items for patients and their families.

The 25th birthday of the Children’s Center for Cancer andBlood Disorders and Camp Kemo was celebrated onOctober 2nd at EdVenture Children’s Museum.

Coleen Kettenhoffen, a colorectal cancer survivor, cele-brated Colorectal Cancer Awareness Month with herpresentation entitled “Turning a Negative into aPositive” on Tuesday, March 30th at the PalmettoHealth Baptist auditorium.

Recruitment begins for a new study on diet, exercise andmeditation, EASE (Eating Activity Stress Education), formen with a rising PSA after prostate cancer (April).

Family Matters Group

A monthly support group for family members of breastcancer survivors; the group met at the same time as theBosom Buddies support group.

Family Weekend Retreat for the Children’s Center forCancer and Blood Disorders; an educational/recreationalweekend for families who have had a child diagnosedwith cancer in the past two years.

Good Grieving (January 26 and February 2; April 19 and26; July 12 and 19; October 11 and 18)

A year-long program held on a quarterly basis for adultswho care for grieving children to help them cope withloss and death.

Good Grieving for Children (February 2, April 26, July 19and October 18)

An interactive and fun program designed to help childrenwho have experienced the death of a family member.

Handling the Holidays (November 2 and 9)

Helping adults who have experienced a loss learn howto cope during the holiday season.

I Can Cope

A series of classes planned for people facing cancerco-sponsored by the American Cancer Society,Southeastern Division.

Lasting Impressions Teen Support Group

A support group and program designed for teenagerswith cancer.

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Look Good, Feel Better (February 2, March 1, May 3, June7, August 2, September 6, November 1 and December 6)

Cancer patients were educated on ways to manage hairloss and other changes affecting appearance and self-image.

Lunch and Learn

A series of educational programs designed for parents ofchildren who are undergoing treatment for cancer orblood disorders.

Lymphedema Education

The monthly program offered lymphedema preventionand treatment information for patients following breastcancer surgery.

MARYS (also known as Meeting And Reviving Your Spirit)

An ongoing program intended for African Americanbreast cancer patients held at Celia Saxon Health Center.

Musical Diversion

Throughout the year, musicians play in the CancerCenter for the enjoyment of patients, families, visitorsand staff.

National Cancer Survivors Day (June 5)

The local celebration was held at Seawell’s Banquet andReception Center in Columbia and featured BeverlyKirkhart, author of “My Healing Companion.” Thebook is a revealing self-guided journal designed to helpthose dealing with cancer become their own heroes.Partners: American Cancer Society, Dorn VA Hospital,Moncrief Army Community Hospital, Palmetto HealthSouth Carolina Cancer Center and South CarolinaOncology Associates.

Preparing for the Holidays, part of the bereavement pro-grams, was offered for parents whose children had died.

Prostate Cancer Group

A monthly support group designed for prostate cancersurvivors and their wife or significant other.

School Re-entry Program

Children with cancer or blood disorders need tocontinue to keep pace with school assignments; thisprogram facilitates homebound instruction andschool re-entry.

Second Tuesdays

Providing support and information to cancer patientsand families through concurrent support groups forprostate cancer, women’s cancers, Quest (for childrenwhose family member has cancer), blood related cancers(cosponsored by The Leukemia & Lymphoma Society),I Can Cope (cosponsored by the American CancerSociety) and Family Group. Cancer Forum is an educa-tional program about advances in cancer and is heldimmediately prior to the support group meetings.

Sibling Salute

A program exclusively for siblings of children withcancer to visit areas of the hospital involved in cancertreatment including surgery, radiation oncology and thelaboratory. This day is special because siblings get totalk with other children who are experiencing similarcircumstances. The participants can readily understandeach other’s feelings and assist in coping with emotions.

17th Annual Spring Memorial Service was offered forfamilies and staff of the Children’s Cancer and BloodDisorders.

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Cancer Data Management (CDM) captures a completesummary of all cancer cases diagnosed or treated atPalmetto Health Richland and Palmetto Health Baptist.An extensive electronic database is maintained for eachcampus with the capability to provide merged, undupli-cated data for overall evaluation. In addition to thedetailed demographic, diagnostic, treatment and annualfollow-up information required by the American Collegeof Surgeons (ACoS) Commission on Cancer, CDM col-lects 46 supplemental site-specific prognostic and pre-dictive factors identified as clinically significant by thephysician leadership of our comprehensive centers.

Dedicated quality control measures assure the integrityof data utilized by physicians and researchers, while astrict code of confidentiality is enforced to protectpatient privacy. Current research projects using CDMdata include the South Carolina Cancer Center TissueBank, a collaborative effort between Palmetto Health andthe University of South Carolina School of Medicine, inwhich de-identified clinical data from CDM is linked tostored tissue specimens to form a database which is

available to researchers throughout the state. The datacollected by each facility also is reported to the SC StateCentral Registry and the National Cancer Data Base(NCDB) of the ACoS Commission on Cancer, impactingstudies of cancer incidence, patterns of care, and out-comes on a state and national level. During 2004, CDMparticipated in the following national ACoS Commissionon Cancer NCDB Special Studies:

• Outcomes of the 1998 Early Stage Breast CancerPatient Care Evaluation Study: Margin Width as aDeterminant of Local Recurrence and/or Mortality inPatients with Breast Conserving Surgery

• Local Excision for Rectal Cancer: Trends andOutcomes

• Assessments and Comparisons of Quality of CareCriteria for Localized Prostate Cancer between Blackand White Men

The Cancer Data Management team consists of theCDM Manager, a Quality System Analyst, five CancerData Analysts I/II, and two Cancer Data Coordinators.All eligible CDM staff members are Certified TumorRegistrars (CTR).

CDM also works closely with the Nurse Navigators ofthe comprehensive centers to support the site-specificbreast, prostate, GI and GYN cancer conferences on eachcampus, as well as coordinating facility-wide generalcancer conferences.

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Palmetto Health 2004 Statistical Year

Complete Database - Reference Year 1988 43,152

Total Cases 2,064

Analytic Cases 1,784

% Analytic Cases 86.4%

Follow-up Rate - 5 Year 94.1%

Follow-up Rate - Reference Year 1988 90.5%

Cases AJCC Staged by Managing Physician 90.6%

Clinical Trials 18%

Cancer Data Management Activity

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Frequency of Cancer - 2004 Analytic Cases Palmetto Health 1,784 Cases

Bronchus & Lung9.8%175

Colon7.8%140

Prostate8.1%145

Breast24.5%437

All Other44.3%790

Corpus Uteri5.4%97

Statistical Summary of Cancer DataPalmetto Health Statistical Year 2004

Total Cases 2,064

Analytic Cases 1,784

Top Five Sites Breast, Lung, Prostate, Colon, Corpus Uteri

Patient Population 62.8% Caucasian, 33.5% African-American, 3.6% Other

Distribution by County Richland 48.2%, Lexington, 14.6%, Kershaw 5.9%,Orangeburg 4.1%, Fairfield 3.7%, Other 23.5%

Early Stage Disease (Stage Group 0, I, II) 56.7%Ca

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All Cases Diagnosed and/or TreatedPalmetto Health Statistical Year 2004

AGE GROUPPRIMARY SITE 0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ CasesORAL CAVITY/PHARYNX 37Lip 0 0 0 0 2 1 0 0 3Tongue 0 0 1 1 1 0 1 0 4Mouth 0 1 3 4 4 0 2 1 15Parotid Gland 0 0 2 0 0 0 1 0 3Tonsil 0 0 3 2 0 0 0 0 5Nasopharynx 1 0 0 0 1 0 0 0 2Pyriform Sinus 0 0 0 1 1 0 1 0 3Hypopharynx 0 0 0 0 1 0 1 0 2Other and Unspecified Oral Cavity 0 0 1 1 0 0 0 0 2DIGESTIVE SYSTEM 325Esophagus 0 0 3 8 2 4 4 0 21Stomach 0 0 3 4 5 5 6 0 23Small Intestine 0 1 2 2 4 1 0 0 10Colon 1 5 17 39 40 31 18 2 153Rectosigmoid Junction 0 0 1 4 4 3 3 0 15Rectum 0 4 12 10 6 6 7 0 45Anus and Anal Canal 0 2 1 0 1 0 1 0 5Liver 1 0 4 7 4 2 1 0 19Gallbladder 0 0 2 1 0 1 0 0 4Pancreas 0 1 5 7 9 2 2 1 27Other and Unspecified Biliary Tract 0 0 0 1 0 1 0 1 3RESPIRATORY SYSTEM & INTRATHORACIC ORGANS 226Accessory Sinuses 0 0 0 0 1 2 0 0 3Larynx 0 1 3 6 1 4 1 0 16Bronchus and Lung 0 2 25 44 59 56 20 0 206Thymus 0 0 1 0 0 0 0 0 1BONES/JOINTS/ARTICULAR CARTILAGE 7 0 1 5 1 4 0 0 18HEMATOPOIETIC/RETICULOENDOTHELIAL SYSTEM 16 1 5 5 8 11 8 1 55SKIN 6 5 7 9 6 11 0 0 44PERIPHERAL NERVES/AUTONOMIC NERVOUS SYSTEM 0 1 0 0 0 0 0 0 1RETROPERITONEUM AND PERITONEUM 1 1 0 4 0 2 2 0 10SOFT TISSUE 4 0 1 4 3 2 2 0 16BREAST 4 24 102 139 97 82 20 2 470FEMALE GENITAL ORGANS 252Vulva 0 2 2 0 3 8 1 0 16Vagina 0 0 1 1 2 1 0 0 5Cervix Uteri 4 15 8 6 9 4 4 1 51Corpus Uteri 0 5 7 20 33 30 10 3 108Ovary 3 1 9 18 20 13 6 0 70Other and Unspecified Female Genital Organs 0 0 0 1 0 1 0 0 2MALE GENITAL ORGANS 225Penis 0 0 2 0 0 2 0 0 4Prostate 0 1 4 54 85 57 11 1 213Testes 2 2 3 1 0 0 0 0 8URINARY TRACT 164Kidney 0 4 4 13 24 14 2 1 62Renal Pelvis 0 0 0 0 1 3 4 0 8Ureter 0 0 0 0 0 3 2 0 5Bladder 0 1 10 10 25 22 14 5 87Other and Unspecified Urinary Organs 0 0 0 1 1 0 0 0 2EYE AND BRAIN 74Eye and Adnexa 2 0 0 1 1 0 0 0 4Meninges 0 3 5 4 2 3 1 1 19Brain 10 3 6 7 6 4 6 2 44Other CNS 2 2 0 2 0 1 0 0 7THYROID & ENDOCRINE GLANDS 49Thyroid Gland 2 6 4 9 7 4 0 0 32Other Endocrine Glands 2 5 1 4 4 1 0 0 17OTHER AND ILL-DEFINED SITES 1 0 0 0 0 0 0 0 1LYMPH NODES 7 7 10 11 14 12 5 0 66UNKNOWN PRIMARY SITE 0 0 4 8 8 5 4 0 29ALL SITES 76 106 285 479 506 419 171 22 2,064

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Analytic Cases by AJCC StagePalmetto Health Statistical Year 2004

AJCC Stage Group CasesPRIMARY SITE 0 I II III IV UNK N/A # %ORAL CAVITY/PHARYNX 28 1.6Lip 0 1 0 0 0 0 0 1 < 0.1Tongue 0 0 0 1 1 0 0 2 0.1Mouth 2 3 1 1 4 11 0 11 1.6Parotid Gland 0 1 2 0 0 0 0 3 0.2Tonsil 0 0 0 2 2 0 0 4 0.2Nasopharynx 0 0 0 0 1 0 0 1 < 0.1Pyriform Sinus 0 0 0 2 1 0 0 3 0.2Hypopharynx 0 1 0 0 1 0 0 2 0.1Other and Unspecified Oral Cavity 0 0 0 0 0 0 1 1 < 0.1DIGESTIVE SYSTEM 296 16.6Esophagus 0 2 4 4 7 0 0 17 1Stomach 0 8 1 4 6 0 3 22 1.2Small Intestine 0 1 3 0 2 0 3 9 0.5Colon 22 31 22 38 24 1 2 140 7.8Rectosigmoid Junction 1 4 2 3 4 0 0 14 0.8Rectum 3 12 8 12 4 1 1 41 2.3Anus and Anal Canal 2 2 1 0 0 0 0 5 0.3Liver 0 5 5 3 0 3 1 17 1Gallbladder 0 0 3 0 1 0 0 4 0.2Pancreas 0 2 3 6 12 2 0 25 1.4Other and Unspecified Biliary Tract 0 0 1 0 1 0 0 2 0.1RESPIRATORY SYSTEM & INTRATHORACIC ORGANS 188 10.5Accessory Sinuses 0 0 0 0 1 0 1 2 0.1Larynx 0 2 2 1 5 0 0 10 0.6Bronchus and Lung 0 28 12 39 81 12 3 175 9.8Thymus 0 0 0 0 0 0 1 1 < 0.1BONES/JOINTS/ARTICULAR CARTILAGE 0 5 7 0 0 3 2 17 1HEMATOPOIETIC/RETICULOENDOTHELIAL SYSTEM 0 0 0 0 0 0 44 44 2.5SKIN 11 13 5 2 1 3 4 39 2.2PERIPHERAL NERVES/AUTONOMIC NERVOUS SYSTEM 0 0 0 0 0 1 0 1 < 0.1RETROPERITONEUM AND PERITONEUM 0 0 0 0 0 0 10 10 0.6SOFT TISSUE 0 1 2 3 2 5 1 14 0.8BREAST 77 171 131 41 15 2 0 437 24.5FEMALE GENITAL ORGANS 214 12Vulva 1 6 1 4 3 0 0 15 0.8Vagina 0 2 0 0 0 0 0 2 0.1Cervix Uteri 0 19 0 9 1 1 4 34 1.9Corpus Uteri 0 50 5 10 13 2 17 97 5.4Ovary 0 16 6 34 6 0 2 64 3.6Other and Unspecified Female Genital Organs 0 1 1 0 0 0 0 2 0.1MALE GENITAL ORGANS 155 8.7Penis 2 1 0 0 0 0 0 3 0.2Prostate 0 0 117 17 10 0 1 145 8.1Testes 0 3 0 2 0 1 1 7 0.4URINARY TRACT 155 8.7Kidney 0 33 5 9 12 0 1 60 3.4Renal Pelvis 3 0 1 1 2 1 0 8 0.4Ureter 1 0 2 0 2 0 0 5 0.3Bladder 44 28 4 1 2 1 0 80 4.5Other and Unspecified Urinary Organs 1 0 0 0 0 0 1 2 0.1EYE AND BRAIN 68 3.8Eye and Adnexa 0 0 0 0 0 0 4 4 0.2Meninges 0 0 0 0 0 0 17 17 1Brain 0 0 0 0 0 0 40 40 2.2Other CNS 0 0 0 0 0 0 7 7 0.4THYROID & ENDOCRINE GLANDS 44 2.5Thyroid Gland 0 15 6 3 3 2 0 29 1.6Pituitary Gland 0 0 0 0 1 0 14 15 0.8OTHER AND ILL-DEFINED SITES 0 0 0 0 0 0 1 1 < 0.1LYMPH NODES 0 4 8 15 22 1 1 51 2.9UNKNOWN PRIMARY SITE 0 0 0 0 0 0 22 22 1.2ALL SITES 170 471 371 267 254 42 209 1,784

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FOCUS ON SELECTED GYNECOLOGICAL CANCERSThe 2004 detailed, statistical analysis provides an overview of all gynecological cancers and focuses on the diagnosis,treatment, and outcomes of corpus uteri (endometrial cancer) and cervix uteri (cervical cancer). These two cancersaccount for more than 60 percent of all gynecological (GYN) cancers at Palmetto Health. In anticipation of adding asite-specific GYN Cancer Conference and a nurse navigator-patient educator in 2005, the following data is presentedas the baseline benchmark prior to expanding the program. Establishing the baseline data will allow the CancerCommittee and other healthcare professionals to measure and evaluate quality improvements in the program.

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Site Distribution - 2004 GYN CancersPalmetto Health 252 Total Cases-214 Analytic Cases

0

20

40

60

80

100

120

Fallopian TubeVaginaVulva

Total Cases

Cervix UteriOvaryCorpus Uteri

Case

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Total Cases = All cases diagnosed or treated at Palmetto Health, including recurrent disease and cases reviewed by Pathology onlyAnalytic Cases = New cases diagnosed at Palmetto Health and/or received all or part of first course treatment at Palmetto Health

Analytic Cases

108

97

7064

51

34

16 15

5 2 2 2

GYN

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Age at Diagnosis - 2004 Analytic Corpus UteriPalmetto Health 97 Cases

0

5

10

15

20

25

30

90+80-8970-7960-6950-5940-4930-39

Case

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Age Distribution

45

18

29 28

10

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Distribution by Race - 2004 Analytic Corpus UteriPalmetto Health 97 cases

Caucasian50.5%

49

African-American43.3%

42

Other6.1%

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Histology Distribution - 2004 Analytic Corpus UteriPalmetto Health 97 Cases

0 10 20 30 40 50

CarcinosarcomaMullerian mixed tumor

Endometrial stromal sarcomaLeiomyosarcoma

Sarcoma, NOSAdenosquamous carcinoma

Papillary serous cystadenocarcinomaSerous cystadenocarcinoma

Endometrioid adenocarcinoma, secretory variantEndometrioid adenocarcinoma

Mixed cell adenocarcinomaNeuroendocrine carcinoma

AdenocarcinomaCarcinoma, undifferentiated

Cases

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1

2

512

3

1511

33

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Histology by AJCC/FIGO Stage – 2004 Analytic Corpus Uteri

Palmetto Health 97 Cases

Histology 1 1A 1B 1C 2A 2B 3A 3B 3C 4A 4B NA* UNK TOTAL

Carcinoma, undifferentiated 0 0 0 0 0 0 0 0 0 0 1 0 0 1Adenocarcinoma 0 0 1 0 0 0 0 0 0 0 3 0 0 4Neuroendocrine carcinoma* 0 0 0 0 0 0 0 0 0 0 0 1 0 1Mixed cell adenocarcinoma 0 0 0 0 0 0 1 0 0 1 0 0 0 2Endometrioid adenocarcinoma 1 12 25 2 3 2 1 0 2 0 3 0 0 51Endometrioid adenocarcinoma, secretory variant 0 0 0 0 1 0 0 0 1 0 0 0 0 2

Serous cystadenocarcinoma 0 2 0 1 0 0 0 0 0 0 0 0 0 3Papillary serous cystadenocarcinoma 0 2 1 0 0 0 1 0 3 3 4 0 1 15Adenosquamous carcinoma 0 0 0 0 0 0 0 0 1 0 0 0 0 1Sarcoma, NOS* 0 0 0 0 0 0 0 0 0 0 0 1 0 1Leiomyosarcoma* 0 0 0 0 0 0 0 0 0 0 0 3 0 3Endometrial stromal sarcoma* 0 0 0 0 0 0 0 0 0 0 0 3 0 3Mullerian mixed tumor* 0 0 0 0 0 0 0 0 0 0 0 5 0 5Carcinosarcoma* 0 0 0 0 0 0 0 0 0 0 0 5 0 5Total 1 16 27 3 4 2 3 0 7 4 11 18 1 97

*Staging scheme does not apply to histology

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

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rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

24

First Course Therapy - 2004 Analytic Corpus UteriPalmetto Health 97 Cases

0

10

20

30

40

50

60

70

No TreatmentAll Other**ChemotherapySurgery/Radiation/Chemotherapy

Surgery/Chemotherapy

Surgery*/RadiationSurgery

Case

s

62

129

4 4 3 3

*Includes one non-primary surgery** All other treatment includes Palliative Chemo (1), Palliative Chemo/Surg (1), and Chemo/Hormone (1)

First Course Therapy - 2004 Analytic Corpus UteriPalmetto Health-SCOA Radiation 101 Cases*

0

10

20

30

40

50

60

70

Radiation OnlyNo TreatmentAll OtherChemotherapySurg/Radiation/Chemotherapy

Surgery/Chemotherapy

Surgery**/Radiation

Surgery

Case

s

62

149

4 4 3 3 2

*Includes radiation therapy performed at SC Oncology Associates with no point of contact at Palmetto Health**Includes one non-primary surgery

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

25

Surgery of Primary Site - 2004 Analytic Corpus UteriPalmetto Health 97 Cases*

0

10

20

30

40

50

60

70

80

Hysterectomy, not Otherwise Specified

Radical Hysterectomy

Modified Radical Hysterectomy

Subtotal Hysterectomy (Supracervical)

Total Hysterectomy WITHOUT Removal of

Tubes or Ovaries

Total Hysterectomy WITH Removal of Tubes or Ovaries

Case

s

72

73 2 2 1

*10 Cases - No Surgery of Primary Site

GYN

Canc

er A

nalys

is

Ca

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P

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am

A

nn

ua

l

Re

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•2

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4

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ti

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Ye

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PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

26

Source: Cancer Data Management, Palmetto Health

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Corpus UteriPalmetto Health 1999-2004

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

Source: *CIRF (Cancer Information Reference File), IMPAC/MRS

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Corpus UteriNational* 1999-2004

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

27

Source: Cancer Data Management, Palmetto Health

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Corpus UteriPalmetto Health 1995-1996

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

Source: NCDB, Commission on Cancer, ACoS.

After 1 YearAt Diagnosis After 2 Years After 3 Years After 4 Years After 5 Years

Stage 1

Perc

ent S

urviv

ing

Five Year Survival Table for Uterus Cancer Cases Diagnosed in 1995 & 1996All States Data Reported from 1626 Hospitals Hospitals of Type: All

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

GYN

Canc

er A

nalys

is

Ca

nc

er

P

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am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

28

Distribution by Race - 2004 Analytic Cervix UteriPalmetto Health 34 cases

Caucasian64.7%

22

African-American26.4%

9

Other8.8%

3

Age at Diagnosis - 2004 Analytic Cervix UteriPalmetto Health 34 Cases

0

5

10

15

20

25

30

80-8970-7960-6950-5940-4930-3920-29

Case

s

Age Distribution

4

10

53

8

2 2

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

29

Histology Distribution - 2004 Analytic Cervix UteriPalmetto Health 34 Cases

0 3 6 9 12 15Carcinosarcoma

Mullerian mixed tumorLeiomyosarcoma

Adenosquamous carcinomaMucinous adenocarcinoma, endocervical

Adenocarcinoma, endocervical typeClear cell adenocarcinomaNeuroendocrine carcinoma

Adenocarcinoma, NOSSquamous cell carcinoma, large, non-keratinizing

Squamous cell carcinoma, keratinizingSquamous cell carcinoma

Small cell carcinomaCarcinoma, NOS

Cases

11

11

111

1

13

3

2

2

3

3

Histology by AJCC/FIGO Stage – 2004 Analytic Cervix Uteri

Palmetto Health 34 Cases

Histology 1 1A 1B 2A 2B 3A 3B 4A 4B N/A* TOTALCarcinoma, NOS 0 0 0 0 0 0 1 0 0 0 1Small cell carcinoma 0 0 0 0 0 0 1 0 0 0 1Squamous cell carcinoma 1 6 2 0 0 0 4 0 0 0 13Squamous cell carcinoma, keratinizing 0 0 2 0 0 0 1 0 0 0 3Squamous cell carcinoma, large, non-keratinizing 1 0 1 0 0 0 0 0 0 0 2Adenocarcinoma, NOS 0 1 1 0 0 0 1 0 0 0 3Neuroendocrine carcinoma 0 0 0 0 0 0 0 0 1 0 1Clear cell adenocarcinoma 0 0 0 0 0 0 1 0 0 0 1Adenocarcinoma, endocervical type 1 0 2 0 0 0 0 0 0 0 3Mucinous adenocarcinoma, endocervical 0 0 1 0 0 0 0 0 0 0 1Adenosquamous carcinoma 0 0 1 0 0 0 0 0 0 0 1Leiomyosarcoma* 0 0 0 0 0 0 0 0 0 1 1Mullerian mixed tumor* 0 0 0 0 0 0 0 0 0 2 2Carcinosarcoma* 0 0 0 0 0 0 0 0 0 1 1Total 3 7 10 0 0 0 9 0 1 4 34

*Staging scheme does not apply to histology

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

30

First Course Therapy - 2004 Analytic Cervix UteriPalmetto Health 34 Cases

0

5

10

15

20

25

No TreatmentChemotherapySurgery*/Chemotherapy

RadiationSurgery*/Radiation/Chemotherapy

Surgery

Case

s

21

7

2 21 1

*Includes one non-primary surgery

First Course Therapy - 2004 Analytic Cervix UteriPalmetto Health-SCOA Radiation 47 Cases*

0

5

10

15

20

25

No TreatmentChemotherapySurgery/Radiation

Surgery**/Chemotherapy

RadiationRadiation/Chemotherapy

Surgery**/Radiation/

Chemotherapy

Surgery

Case

s

21

10

65

2 1 1 1

*Includes radiation therapy performed at SC Oncology Associates with no point of contact at Palmetto Health**Includes one non-primary surgery

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

31

GYN

Canc

er A

nalys

is

Surgery of Primary Site - 2004 Analytic Cervix UteriPalmetto Health 34 Cases*

0

5

10

15

20

25

Modified Radical Hysterectomy

LEEP (LoopElectrosurgical

Excision Procedure)

Total HysterectomyWITHOUT Removal of

Tubes and Ovaries

Total HysterectomyWITH Removal of Tubes and Ovaries

Cone BiopsyRadical Hysterectomy

Case

s

20

32

111

*6 Cases - No Surgery of Primary Site

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

32

Source: Cancer Data Management, Palmetto Health

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Cervix UteriPalmetto Health 1999-2004

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

Source: *CIRF (Cancer Information Reference File), IMPAC/MRS

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Cervix UteriNational* 1999-2004

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

33

Source: Cancer Data Management, Palmetto Health

3 6 9 12 15 18 21 24 27 30

Number of Months

Stage 1

Perc

ent S

urviv

ing

33 36 39 42 45 48 51 54 57 60

Life Table Survival Best AJCC Stage - Cervix UteriPalmetto Health 1995-1996

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

Source: NCDB, Commission on Cancer, ACoS.

After 1 YearAt Diagnosis After 2 Years After 3 Years After 4 Years After 5 Years

Stage 1

Perc

ent S

urviv

ing

Five Year Survival Table for Cervix Cancer Cases Diagnosed in 1995 & 1996All States Data Reported from 1645 Hospitals Hospitals of Type: All

0

20

40

60

80

100

Stage 2 Stage 3 Stage 4

GYN

Canc

er A

nalys

is

Ca

nc

er

P

ro

gr

am

A

nn

ua

l

Re

po

rt

•2

00

4

St

at

is

ti

ca

l

Ye

ar

PAL

ME

TT

O H

EA

LTH

SO

UT

H C

AR

OL

INA

CA

NC

ER

CE

NT

ER

34

M. A. Ackerman, M.DJulian Adams, MDSwann Adams, PhDJoseph Albert, MDDarrell Alley, MDJ. R. Allison, MDStanton Atkins, MDWilliam H. Babcock, MDPhillip E. Baldwin, MDJohn Bayard, MDKaren Baxley, RN, MNGloria Beard, MSWJohn G. Beasley, MDRichard Bell, MDAnna Bouknight, MDRaleigh J. Boulware, MDJeff Brooker, MDKaren Brooks, MS, CGCJohn Brown, MDRex Brugh, MDDonna BucaloPhillip Buckhaults, DScDouglas M. Bull, MDRobert Bunch, MDRonald Burns, MDDonna Burrows, MSWWilliam M. Butler, MDNeal P. Christiansen, MDTim Close, MDDonnie Coker, MHAAtwell Coleman, MDPerry Covington, PharmDJoan Cunningham, PhD Tommy E. Cupples, MDEverett Dargan, MDDonen Davis, MDRonald Dew, MDKimberly Dewitt, ACNPMartin Dommers, MDMary Ellen Doyle, FACHEThomas Edmunds, Jr, MDThomas Edwards, MDCarolyn Evans, RN, OCNKaren Ferguson, PATonya Flake, RNHarold Freidman, MDDavid Fulton, MDJeanette Fulton, MDJorge Galan, MDBurnett W. Gallman, MDEdsel Garrick, MDDavid Gatti, MDSteven Glassman, MD

Francisco Gonzalez, MDKenneth Grant, MDLarry Grant, MDGwendolyn Green, RNStanley Greenburg, MDJanet GrovesPaul Guerry, III, MDSally Harding, MDIra Harrell, MDChuck Heaton, MDJames R. Hebert, MSPH, ScDSue Heiney, RN, PhD, FAANNichole Hendry, C-PAJames H. Herlong, MDCarey Hite, MDCharles Hubbard, Jr, MDGeorge Jenkins, MDSpence Jenkins, MDBetty Johnson, RNRam Kalus, MDAlan Kantsiper, MDDonna Keisler, CTRZachary Kilpatrick, MDEdward Kimbrough, MDPhillip W. Kinder, MDHolly Knight, RNC, MNKristy Koon, BAFred Kudrik, MDDavid Lamb, MDJohn Lauver, MDIsabel Law, RNWilliam Lewis, MDBrad Lindsey, MDLawrence Lough, MDMark Lovern, MDSandra Lunden, MA,RHIA,CPHQ,CTRJason Lynn, MDChinway Majmundar, MDAuturo Marchand, MDBen Massey, MDMark Mayson, MDL. Joseph McElveen, MDWilliam Meredith, MDHarry Metropol, MDStephen Metropol, MDBalbir Minhas, MDJoan Minor, RN, BSN, OCNMartin Mirra, MDJoe Modzelewski, MDSidney Morrison, MDWilliam Neglia, MDWilliam Newcomb, MDJames Nottingham, MD

H. Hart Parker, MDWayne Phillips, MSWDalton Prickett, MDJohn W. Popp, Jr., MDWilliam Rambo, MDJohn C. Rawl, MDShelby Reece, RN, MNJames C. Reynolds, MDNeal Reynolds, MDA. J. Richards, MDChad Rubin, MDJulian Ruffin, PhDJulian Salley, MDWilliam Savoca, MDDebra D. Seale, RN, MNCaroline Seigler, CNOJoseph Sheppe, MDJohn Singerling, MHABessie Smith, RNRobert E. Smith, Jr, MDS.T. Smith, MDRosemond Squirewell, RNAmy Steele, RN, BSN, OCNPamela StephensJ. Scott Strohecker, MDMelton Stuckey, MDC. Alden Sweatman, Jr, MDDaniel Sylvester, MDScott W. Taber, MDNguyen Thieu, MDJohn Thomas, MDDavid Tribble, MDJames B. Tribble, MDDiane Truesdale, MDAllan Walls, MDRichard Wassermann, MDKaylene Weircox, MDJames R. Wells, MDJeffrey A. Welsh, MDJames A. Williams, MDTheresa WilliamsonDennis Wilson, MDGerald Wilson, MDRudolph Wise, MDBartlett J. Witherspoon, MDDottye Wodogaza, RN, OCNJohn E. Wofford, MDBen W. Wright, Jr, MDAnn Vandersteenhoven, MDJacob Vandersteenhoven, MDRobert Young, PhDMohammed Yousufuddin, MDPeter Zvejnieks, MD

Cancer Program Annual Report Contributors

Ca

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Cancer Data Management Data AnalysisDonna Keisler, CTR

Dyonne Louden, CTRRebecca Heaberlin, RHIT, CTR

Faith JohnsonKristen Lauing

Michelle Ingham, CTRMona Carter, CTRBrenda CooperMarilyn Jenkins

Content CoordinationScottie Dye

Donna KeislerDebra D. Seale

35

National Cancer Institutehttp://www.cancer.gov

National Comprehensive Cancer Networkhttp://www.nccn.org

Oncology Nursing Societyhttp://www.ons.org

Society of Surgical Oncologyhttp://surgonc.org

South Carolina Cancer Alliancehttp://www.sccanceralliance.org/tiki-index.php

SC DHEC Central Cancer Registryhttp://www.scdhec.net/co/phsis/biostatistics/SCCCR/scccrmain.htm

http://www.scdhec.net/co/phsis/biostatistics/SCCCR/AboutARegistry.htm

American Cancer Societyhttp://www.cancer.org

American College of Surgeons Commission on Cancerhttp://www.facs.org/cancer/

American Head and Neck Societyhttp://www.headandneckcancer.org

American Society of Clinical Oncologyhttp://www.asco.org

American Urological Associationhttp://www.uanet.org

Association of Community Cancer Centershttp://www.assoc-cancer-ctrs.org

College of American Pathologistshttp://www.cap.org

Links to other web sites:

2004 Statistical Year Cancer Program Annual Report

7 Richland Medical ParkColumbia, South Carolina 29203

and

Taylor at Marion StreetColumbia, South Carolina 29220

p a l m e t t o h e a l t h . o r g803-296-3000

Patients are admitted to this facility and are rendered services without distinction due to race, color, national origin,

handicapping condition or age.