HSHS St. Nicholas Hospital cancer program
annual report 2015
“We are all instruments in the Master’s hands”
— Larry Wieberdink, cancer survivor
HSHS St. Nicholas Hospital was one of 74 hospitals across
the United States and one of three hospitals in Wisconsin
to receive the Outstanding Achievement Award.
Outstanding Achievement Award
When the Cancer Program at HSHS St. Nicholas Hospital was last
surveyed by the American College of Surgeons Commission on Cancer, it
was one of 74 hospitals across the United States and one of three hospitals
in Wisconsin to receive the Outstanding Achievement Award.
The award recognizes cancer programs that achieve excellence in
providing quality care to cancer patients.
“These 74 cancer programs currently represent the best of the best when
it comes to cancer care,” said Daniel P. McKellar, MD, FACS, and Chair
of the Commission on Cancer. “Each of these facilities is not just meeting
nationally recognized standards, they are exceeding them.”
HSHS St. Nicholas Hospital’s cancer program was evaluated on 34
program standards in five areas: cancer committee leadership, cancer data
management, cancer conferences, clinical services and quality improvement.
The statistic is sobering. Yet there are also very promising
statistics, such as:
•Over 14 million people are living in the U.S. with a previous
diagnosis of cancer
•The overall cancer death rate (for all types of cancer
combined) has declined since the early 1990’s
Through advances in detection and treatment we are creating more cancer survivors.
That means more holidays and special moments with loved ones, more opportunities to
contribute to our society, and more people helping us learn how to fight back against
their disease through clinical research studies.
In past decades, most of the focus was on treating the cancer — winning the battle. What
we learned as a result of that success is that patients are often left with ‘battle scars’ that
impact the quality of their lives after treatment. Today, in addition to the continued focus
on beating the disease, there is more and more focus placed on the residual effects of
cancer and its treatment. We want to not only help people survive their cancer, but to
enjoy their life after treatment has ended.
At HSHS St. Nicholas Hospital, our cancer program has implemented the AnewSM Cancer
Survivorship Program, focused on helping people with cancer regain energy, mobility
and spirit. As many as 90 percent of people treated for cancer have some residual
effect that can benefit from our AnewSM services. Whether it is lingering fatigue, lack of
flexibility, emotional concerns, or ‘chemo brain’, there are AnewSM services to help.
In the spirit of celebrating cancer survivorship and quality of life, we created this year’s
annual report as a calendar with a focus on some of our patients who are enjoying life
as a cancer survivor — day after day, month after month. We are extremely grateful for
their willingness to be a part of this report and we hope you will enjoy the information
provided. If you have any questions, please feel free to contact me directly.
Sincerely,
— S. Mark Bettag, MD
S. Mark Bettag, MD
Sheboygan Physicians Group, SC
Sheboygan Cancer & Blood Specialists
Sally Luehring, MSL
Executive Director, Cancer Services
HSHS Division - Eastern Wisconsin
Sally.Luehring@hshs.org
2 | Cancer program annual report 2015
“We are proud to have received this award
because it recognizes the quality of cancer
care provided at HSHS St. Nicholas
Hospital and demonstrates our commitment
to delivering exceptional, quality care and
service to our community on a daily basis.”
1 in 2 Men; 1 in 3 Women
will be diagnosed with cancer.
The HSHS St. Nicholas Cancer Program is improving cancer care for Sheboygan and its surrounding
communities. This cancer program encompasses the full continuum of services including prevention,
early detection, treatment, supportive services, surveillance and follow-up.
This report demonstrates our commitment to enhance the quality of care and value of services for our patients.
HSHS St. Nicholas Hospital Cancer Program Services
59
Breast
32
Prostate
Blood &
Lymphoma
29
Urinary
25
Respiratory
25
23
Other
20
Colorectal
Other
Digestive
17
14
Gynecologic
Brain & Central
Nervous System
8
Head & Neck
8
Other Male
Genital
2
0
10
20
30
40
50
Total Cases = 262
60
70
3 | Cancer program annual report 2015
Diagnostic Testing
Inpatient/Outpatient Oncology
Nurse Navigator
Imaging Services
•Chemotherapy administration
•Answer questions and provide
education about cancer care
•Digital mammography
•Blood and platelet transfusions
and diagnosis
•Stereotactic breast biopsy
•Blood draws for laboratory
•Identify & connect you with
testing
•Needle localization
resources
•Computerized tomography (CT) •Clinical trials
•Guide & empower you as you
•Access/flushing of PICC lines
•Ultrasound
make decisions
& ports
•Magnetic resonance imaging
•Streamline care transitions;
•Infusions & injections of
(MRI)
follow through the cancer
supportive medications
•Positron emission tomography
continuum
•Therapeutic phlebotomy
(PET)
•Provide support & advocate
•Nuclear medicine
Radiation Oncology
during treatment
•PICC (peripherally inserted
•3-dimensional conformal
Support Services
central catheter) insertions
therapy
•Home health care
•Thoracentesis, paracentesis,
•Brachytherapy
& aspirations
•Image guided radiation therapy •Hospice
•Intrathecal Chemotherapy
•Palliative care
(IGRT)
•AnewSM Cancer Survivorship
•Intensity modulated radiation
Pathology
Program (See the article in the
therapy (IMRT)
•Laboratory
back of the calendar.)
•Superficial skin cancer radiation
•Specialized staining for
•Nutritional counseling
treatment
cancer diagnosis
•Social work services
•Therapeutic radioisotopes
Center for Digestive Health
•Spiritual support
Surgery
•Colonoscopy
•Health & wellness programs
•Inpatient surgery
•Upper Endoscopy
•Loan cupboard for wigs/
•Minimally invasive surgery
headwear
•Outpatient surgery
•Sentinel node biopsy
HSHS St. Nicholas Hospital 2014 Incidence
of Cancer by Primary Site
Doris Gartman
“Beyond the science, technology and care, I
owe my survival to my upbringing, faith, family,
friends and the Lord. Our family was wonderful
in making sure we were okay, bringing meals,
support and smiles.
I am also thankful for Dr. Bettag, his team of
nurses and HSHS St. Nicholas Hospital.
Fighting cancer was tough and required
support from many people. Each time
I announced my progress in church, the
congregation applauded. They really held
me up!
After church one Sunday during my treatment,
my interim pastor asked me to pray with him.
I will never forget it. ‘Lord,’ he said, ‘I am
praying for a miracle.’ Now, nearly six years
later, I realize, I am that miracle!”
4 | Cancer program annual report 2015
January 2016
onal
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lth T
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H
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a
c
i
v
r
Ce
Awareness
Month
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7
Guidelines for Early Detection of
Cervical cancer
F
S
1
2
8
9
•Women between the ages of 21 and 29 should have
a Pap test every 3 years. Human Papilloma Virus
(HPV) testing should not be used in this age group
unless it is needed after an abnormal Pap test result.
•Women between the ages of 30 and 65 should have
a Pap test and an HPV test every 5 years. This is the
preferred approach, but it is OK to have a Pap test
alone every 3 years.
•Women over age 65 who have had regular cervical
cancer testing in the past 10 years with normal
results should not be tested for cervical cancer.
Source: American Cancer Society: September 2015
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17
11
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19TLC
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Survivorship
Session
6 p.m.
24
26
22
Play for PinK
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Sheboygan North
High School
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Cervical cancer mortality rates declined rapidly in the past decades due to
prevention and early detection as a result of screening with the Pap test.
Together We Live with Cancer (TLC)
TLC is a supportive community and welcomes
all area cancer patients/survivors and co-survivors.
Dr. H. Marshall Matthews (Matthews Oncology
Associates) and Dr. S. Mark Bettag (Sheboygan
Cancer & Blood Specialists) sponsor TLC,
which includes:
TLC Monthly “Survivorship Sessions” are open
to anyone experiencing cancer who is looking
for or willing to offer cancer-related support,
encouragement, information and guidance.
The TLC Quarterly Supportive Newsletter is a FREE
supportive newsletter sent to area cancer survivors.
TLC “Survivorship Can Be Fun” Gatherings offer
cancer survivors the opportunity to meet and connect
with other cancer survivors in fun, casual settings that
focuses on life beyond a cancer diagnosis.
To learn more, contact Tim E. Renzelmann,
MOA/SCBS, Patient Advocate at 920-458-7433 or
trenzelmann@physhealthnet.com.
5 | Cancer program annual report 2015
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25
15
Patricia Carroll
“Two months after I moved to Sheboygan
from North Carolina to join my son, Roderick,
I was diagnosed with breast cancer.
Roderick was always there for me. He took a
Family and Medical Leave of Absence (FMLA)
from work and drove me to my appointments
and chemotherapy treatments. However, after
nearly five months, his leave ran out and he
was not able to take me to radiation therapy
treatments. That is when we learned about
the American Cancer Society’s (ACS) Road to
Recovery program and met volunteer drivers,
John Pierce and Susan Prater.
Roderick, John, Susan, the people at Dr. Bettag’s
office and HSHS St. Nicholas Hospital gave
me the encouragement I needed. I could not
ask for better support or care.
Today, I no longer feel alone, like a stranger
in a new place. I’m enjoying my new friends,
John and Susan, and am grateful for the care
I received.
I am most appreciative of my son, Roderick.
He is my rock.”
6 | Cancer program annual report 2015
February 2016
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In 2015, HSHS St. Nicholas Hospital Cancer Program
colleagues reached out to more than 2,500 community
members at local health fairs and awareness events.
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3
4
5
6
During these presentations, colleagues discussed six
lifestyle changes for preventing cancer:
LooK Good..
Feel Better
2 p.m.
7
8
World
Cancer
Day
9
10
11
1. Avoid tobacco.
2.Eat a healthy diet.
12
13
21
22
29
6.Take early detection seriously.
16TL
17
19
20
Survivorship
Session
6 p.m.
Eating Well
During Cancer
Treatment
4 p.m.
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23
24
25
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27
C
Nationa
Cancer l
Prevent
i
Month on
American Cancer Society
Trained Cancer Information Specialists
are available 24 hours a day, every day
of the year to help you learn about the
six lifestyle changes above as well as other
services/programs. Call 1 (800) 227-2345,
or visit www.cancer.org
John Pierce and Susan Prater are volunteer
drivers for the American Cancer Society’s
Road to Recovery, which is a program that
provides transportation to and from treatment
for people with cancer who do not have a
ride or are unable to drive themselves. The
HSHS St. Nicholas Hospital AnewSM Cancer
Survivorship Program nurses help connect
patients to community resources like this one.
7 | Cancer program annual report 2015
28
15
4.Protect yourself from the sun.
5.Limit consumption of alcohol.
Living Beyond
Prostate Cancer
7 p.m.
14
3.Maintain a healthy weight and include physical
activity in your daily routine.
Carol Molinaro
“Dr. Bettag tells me that I am a miracle! There
is no doubt that I would not be here if it were
not for Dr. Bettag and Dr. Matthews’ care,
Dr. Heili’s surgical expertise and the staff at
HSHS St. Nicholas Hospital’s Chemotherapy
and Radiation Therapy Departments.
However, I believe the power of prayer got
me through my survival journey.
Family and friends were also supportive
especially when I started to feel sorry for
myself, or was thinking about giving up. I
remember getting a pep talk from my brother
when I was feeling especially low. He said,
‘You need to do what they tell you. Fight it
because we need you.’
Today I am five years cancer free. I am a
survivor who knows how precious life is. Prayer
is still an important part of my life as are the
love and support from my family and friends.
My life is blessed and I give thanks every day
for what the Lord provides.”
8 | Cancer program annual report 2015
Myths & Facts about colon cancer screening
March 2016
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2
3
4
5
Cancers of the colon and rectum are the third most
common cancer in U.S. women and men. Thanks to
testing, the good news is that rates of this disease have
been falling steadily over the past 20 years. Testing
helps find the disease at an earlier stage when it is
highly treatable, or can even prevent the disease by
finding and removing precancerous polyps. Talk to
your doctor about which test is best for you.
Testing
6
7
8
9
10
11
12
16
17
18
19
International
Women’s
Day
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15TL
C
Survivorship
Session
6 p.m.
20
21
22
23
24
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26
Starting at age 50, both men and women should follow
one of these testing plans:
Tests that find polyps and cancer
•Flexible sigmoidoscopy every 5 years*, or
•Colonoscopy every 10 years, or
•Double-contrast barium enema every 5 years*, or
•CT colonography (virtual colonoscopy) every
5 years*
Tests that mostly find cancer
•Yearly guaiac-based fecal occult blood test
(gFOBT)**, or
•Yearly fecal immunochemical test (FIT)**, or
•Stool DNA test (sDNA), every 3 years*
*If the test is positive, a colonoscopy should be done.
**The multiple stool take-home test should be used. One test done
in the office is not enough. A colonoscopy should be done if the test
is positive.
Source: American Cancer Society: Guidelines for the Early Detection of Cancer,
September 2015
29
30
31
Number of Patients
Easter
28
10
8
6
4
2
0
9
4
4
2
Stage 0
Stage I
1
Stage II Stage III
AJCC Stage
* American Joint Committee on Cancer
Stage IV
9 | Cancer program annual report 2015
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ancer
C
l
a
t
c
e
r
lo
o
C
Awareness
Month
HSHS St. Nicholas Hospital 2014 Colorectal
Cases by AJCC* Stage at Diagnosis
Neng Yang
When Neng Yang heard the word cancer, he
was scared. “All I could think about was my wife
and four children — they still needed me.”
Neng is a refugee from Laos. He moved to
the United States in 1988 and arrived in
Sheboygan by the time he turned 13. Of all the
things he endured, a diagnosis of cancer was
the most frightening.
“I am thankful for the doctors and nurses who
gave me the medical care and reassurance
I needed. I am fortunate to live in America
where medicine and technology is so
advanced.
Most of all, I am here today because of the
love and support of my family. I now have the
time I wanted with my family; I could not have
hoped for more!”
10 | Cancer program annual report 2015
Clinical Research
April 2016
cer
National Caonnth
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rol M
ContM
ticular
National Tweasreness
Cancer A th
M on
3
4
5
6
LooK Good..
Feel Better
2 p.m.
10
11
25
1
2
Since the beginning of the program at HSHS
St. Nicholas Hospital, 50 patients have participated
in a clinical trial. One of those patients who
participated in a clinical trial was Neng Yang.
7
8
9
12
13
14
15
16
National Oral, Head and NecK Cancer Awareness WeeK
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TLC
Survivorship
Session
6 p.m.
26
20
27
21
28
SKin Cancer
Screening
4 p.m., call
(920) 433-8488
for appointment
22
29
23
30
During his treatment at HSHS St. Nicholas
Hospital Cancer Center, Yang participated in
a clinical trial created to determine whether a
drug named sulfasalazine would help prevent
or reduce symptoms commonly associated with
radiation treatment to the pelvic area. The
clinical trial required him to take the drug every
day throughout his radiation treatment and
complete weekly questionnaires to determine
whether the medication was managing his
symptoms. Final results of this clinical trial will
be published soon.
The National Cancer Institute Community
Oncology Research Program
The National Cancer Institute (NCI) Community
Oncology Research Program (NCORP) has a
grant program that allows community cancer care
teams to offer clinical trials at their institutions.
The Cancer Research Institute at HSHS St. Vincent
Hospital Regional Cancer Center in partnership with
Marshfield Clinic and Gunderson Lutheran is one of
34 sites nation-wide to participate in this NCORP
grant program. “This partnership allows us, at HSHS
St. Nicholas Hospital, to participate in this network
and offer progressive clinical trials to our patients,
in our own community,” said Brenda Davies, Clinical
Research Associate.
11 | Cancer program annual report 2015
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World
Health
Day
Living Beyond
Prostate Cancer
7 p.m.
17
F
Cancer clinical trials are medical research studies
designed to find better ways to test new methods of
prevention, screening, diagnosis, symptom management
and treatment of cancer. Trials often compare the
most accepted cancer treatment with new treatment
modalities that doctors believe may be better.
Terry Kohler
“I was not worried when I learned about my
diagnosis. I believe the good Lord has a plan
for me and when my work here is finished,
He will take me. I also knew I was in good
hands at HSHS St. Nicholas Hospital.”
Terry is a man known by many — sailors,
aviators, entrepreneurs and leaders of
industry, politics and economics. As a man of
wealth traveling in these circles of influence,
he is able to follow God’s plan for him as a
philanthropist. “My purpose is to share my
wealth by taking an economic role in helping
others less fortunate or in need.”
Terry is fortunate to have so much, but he is
also accountable. “He has given me so much
and all God asks is, ‘What will you do with it?’
I try to live my life faithfully, quietly doing the
job the Lord assigned me. I am not worried or
afraid of dying because I am just an instrument.
I will be here until my work for HIM is finished.”
12 | Cancer program annual report 2015
Skin Cancer Prevention
May 2016
In the United States, more skin cancers are diagnosed
each year than all other cancers combined.
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2
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7
Melanoma
Monday
If you are going to be in the sun, follow the
American Cancer Society’s advice:
•Slip on a shirt.
•Slop on sunscreen.
•Slap on a hat.
•Wrap on sunglasses to
protect the eyes and skin
around them.
Mary Hendrickson Johnson (MHJ) Foundation
10
13
14
Number of Skin Cancer Screening Participants
17Eating 18
Well During Cancer
19
20
21
Treatment 3 pm
TLC Survivorship
Session
6 p.m.
22
30
24
31
World
No Tobacco
Day
110
26
27
99
90
90
2012
2013
2014
2015
Percentage of First Time Attending
28
S Kin C a
Detecti ncer
Prevent on and
ion Mo
nth
Cancer
Re
Monthsearch
104
100
80
25
105
80
75
70
65
60
78.9
76.3
72
67.4
2012
2013
2014
2015
Suspected Malignancies
40
30
20
10
0
34
26
2012
21
2013
26
2014
2015
13 | Cancer program annual report 2015
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The MHJ Foundation supports annual spring Skin
Cancer Screenings in northeastern Wisconsin in
collaboration with the American Cancer Society
and HSHS St. Nicholas Hospital.
Number of
Participants
16
12
National Women’s Health WeeK
National
Women’s
ChecKup Day
15
11
Percentage
9
Number
8
Mary A. Hughes
Mary’s cancer diagnosis was not her first, but
her treatment was more difficult due to the
location of her cancer and the lymphedema
that developed, leaving her in pain and unable
to walk great distances without the aid of
a wheelchair.
Today, thanks to the AnewSM program’s physical
and occupational therapists, Mary is nearly
pain-free and doing things that mean so
much — walking and playing the piano again.
“It is hard to believe that I could barely move
my fingers and now I can play the piano!
There are still things I cannot do, but I am
lucky to have a great husband, adult children,
grandchildren and great grandchildren who
help in so many ways. It is not always easy, but
I realize there are many people fighting out
there. Some are in life-long battles, so if
it takes me a little longer to get back on my
feet that is okay.
My survival is a journey made easier by my
family, the wonderful people at the hospital,
Dr. Bettag’s team, self-determination and music.”
14 | Cancer program annual report 2015
Men’s
S
HeaM
lth/Cancer T
Awareness
Month
5
6
June 2016
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13
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4
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22
11
16
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18
Space is limited. Watch for an invitation for you
and a guest to join us for this special event, or call
(920) 433-8488 to register.
25
National Cancer
Survivors Day 2015:
To celebrate the 125th anniversary
of HSHS St. Nicholas Hospital,
more than 100 cancer survivors
and their guests gathered at a
Red Carpet event at Pine Hills
Country Club for National
Cancer Survivors Day 2015.
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24
30
14.5 million people living in America
are cancer survivors. The HSHS
St. Nicholas Hospital Cancer
Registry is currently following nearly
2,000 individuals who have been
diagnosed with cancer since 1991.
28
29
15 | Cancer program annual report 2015
27
Fascinated by the human spirit and a collector of
stories, Brenda interacts with the audience and
delivers new ways of thinking about courageous
conversations on humor, health and happiness. She
understands first-hand the struggles of not enough
hours in the day, parenting, owning a business, cancer,
weight loss, weight gain and the havoc all these
challenges can create with self-esteem, health, serenity
and mismatched socks!
10
Survivorship
Session
6 p.m.
Men’s Health
WeeK
26
21TLC
Announcing National Cancer Survivors Day
Celebration 2016
June 8, 2016
The Bull at Pinehurst Farms, Sheboygan Falls, WI
Keynote speaker: Brenda Elsagher
Topic: “Celebrate Life with Laughter”
9
Men’s Health WeeK
Living Beyond
Prostate Cancer
7 p.m.
19
Annually, HSHS St. Nicholas Hospital celebrates
National Cancer Survivors Day with a special event.
Celebration of
National Cancer
Survivors Day
at The Bull
LooK Good..
National Cancer Feel Better
Survivors Day
2 p.m.
12
National Cancer Survivors Day Celebration
Larry Wieberdink
When Larry learned he had cancer, he did
something ‘guys’ don’t do. He joined the
Living Beyond Prostate Cancer Support
Group. “I realized I was not alone and there
was tremendous benefit in talking about
my concerns.”
Larry is an active man. He paddles canoes
and kayaks, hikes and backpacks with his
outdoor enthusiast buddies. When he began
experiencing inconvenient symptoms, he
tried Eastern medicine — acupuncture and
Tai Chi. “The Tai Chi helped reduce my stress
and the ability to center my thoughts, but
neither offered relief from the problem. Then,
I realized I should be grateful for who and
what I am now, rather than who and what I
was. That is when I placed myself in the
Lord’s hands.”
Survival is a tremendous gift and Larry
celebrates every time he paddles, hikes,
meets his bible study group, or attends
a support group meeting. “I am guided by
the hand of the Lord; I am grateful for and
celebrate each day!”
16 | Cancer program annual report 2015
S
UVMSaf
Monthety
July 2016
F
S
1
2
3
8
9
10
4
11
T
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12
W
6
13
T
Imaging Services
7
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16
Imaging Services at HSHS St. Nicholas Hospital
provides complete radiologic testing. In the detection
and diagnosis of cancer, the role of Radiology has
grown significantly over the years.
Today, radiologists are able to take tissue biopsies
using CT, ultrasound, X-rays and mammogram
technologies. “We have multiple modalities we can use
for obtaining tissue samples,” said Meghan Hanson,
MD, Diagnostic Radiologist, Green Bay Radiology,
HSHS St. Nicholas Hospital Imaging Services. For
example, to biopsy a lung mass, the CT scanner
is used to guide a needle to the concerning area. To
biopsy a liver mass, the radiologist uses ultrasound
for guiding the needle.
“In the past, for some biopsies, patients had to be put
to sleep and have surgery. Now, in many cases, we
can perform the biopsy more simply in Radiology and
in most cases the patient goes home the same day.”
— Meghan Hanson, MD
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18
19TLC
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22
23
Survivorship
Session
6 p.m.
24
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27
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30
The mammography program at HSHS St. Nicholas Hospital is accredited by the
American College of Radiology and Mammography Quality Standards Act, and
Ultrasound Services are accredited by the American College of Radiology.
A mobile PET/CT Scan is also available. “This is a
nuclear medicine test that helps us stage a patient’s
specific disease, along with CT and MRI,” said Dr.
Hanson. PET/CT scans sometimes find tumors that other
tests do not so it is complementary to CT and MRI.
Radiology is also important in monitoring patients’
cancer during their treatments. “As patients move
forward in their treatment, we repeat CT scans,
MRIs, and PET/CTs to see if the disease is responding
to the therapy and shrinking. PET/CT give us more
information on follow-up than just the size of the
tumor. Specifically, these scans help us determine
if there is active tumor versus scarring from the
patient’s therapy,” said Dr. Hanson.
17 | Cancer program annual report 2015
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25
After a patient is diagnosed with cancer, whether by
a biopsy performed by a radiologist or by another
doctor, they undergo a series of imaging tests,
including CT and MRI, to “stage” their cancer, or see
if and where the cancer has spread.
Robert and Sandy Steinbruecker
Imagine learning your cancer recurred just as your
wife is completing her own radiation therapy! That
is the story of two remarkable survivors, Robert and
Sandy Steinbruecker.
When asked what helped them on their survival
journey they answered in one breath, “Each other.”
“I got through my surgery and radiation because of
Bob’s love and understanding. He knew what I was
going through,” said Sandy. “Then with an unrelated
health concern, I learned my cancer was back and
I needed radiation,” added Robert.
If there is anything good that came from the journey
both Bob and Sandy had to travel, it is that they
came out of it closer than before.
One of their great pastimes is riding on their
Harley Davidson trike. It takes them on wonderful
adventures through beautiful countryside. Without
each other, their family, friends, Dr. Matthews, the
amazing radiation therapists and Dr. Minehan
at HSHS St. Nicholas Hospital, their ride would
not have been the same.
What a pair! What a ride!
18 | Cancer program annual report 2015
Pathology
August 2016
Prevea Pathology at HSHS St. Nicholas Hospital has a
significant role in the cancer continuum of care.
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LooK Good..
Feel Better
2 p.m.
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10
11
12
13
Living Beyond
Prostate Cancer
7 p.m.
14
15
16TL
17
23
24
C
18
19
20
Survivorship
Session
6 p.m.
21
29
30
Eating Well
During Cancer
Treatment
4 p.m.
31
25
26
27
Summe
Sun Sa r
f
Month ety
Patients at the HSHS St. Nicholas Hospital Cancer
Center benefit from the experience, subspecialty
training, and expertise of our pathologists — doctors
who specialize in interpreting laboratory tests and
evaluating cells, tissues, and organs to prevent,
diagnose, and treat disease. To ensure accuracy in their
findings, they use state-of-the-art equipment and the
most advanced techniques to analyze tissue samples.
The pathologist determines the precise type and
severity (stage) of the cancer and may work with other
members of the patient’s care team to recommend a
treatment strategy that could include observation,
surgery, chemotherapy, radiation therapy, or a
combination of these approaches.
“Many people do not realize how many specialty areas
of the hospital are on the cancer care team — all
working together for one purpose — to ensure that
our patients receive the best, most definitive diagnosis
and treatment care plan for the best outcome
possible,” said Dr. Cutlan.
Genetic Counseling
Genetic Counseling services, offered through our
sister hospital, HSHS St. Vincent Hospital in Green
Bay, help identify individuals and families at increased
risk for cancer, assist in their medical management and
promote awareness, risk assessment, early detection
and cancer prevention.
Diagnosing a hereditary cancer condition is
important because it can change a patient’s medical
management. The chance to develop cancer depends
on many factors including age, lifestyle and personal
and family history. Although most cancer is not
hereditary, about 5 to 10 percent of many types of
cancers are hereditary.
19 | Cancer program annual report 2015
28
22
“A complete and accurate pathology report is crucial
to getting a precise diagnosis and deciding on the best
treatment plan for our patients,” said Robert Cutlan,
MD, Prevea Pathology, HSHS St. Nicholas Hospital.
Rita Nettesheim
“When I step into God’s home, leaving the
noise outside, I can hear Him speak to me and
I am at peace.”
Rita is a sacristan for St. John the Evangelist
Church in Kohler and Ss. Cyril and Methodius
Church in Sheboygan. When diagnosed
with cancer she was overwhelmed with the
tremendous outpouring of support and prayers
from her church family.
“I trusted Dr. Bettag and his staff, knowing that
physically I was in very good hands. But
finding the strength — spiritually, mentally and
emotionally — came from my faith, family
and church.
I am also grateful for the help I received from
the Nurse Navigator at HSHS St. Nicholas
Hospital. She helped me find the resources to
relieve the stress of my financial burden.
Today I am a survivor with a different
perspective on how I live my life. I feel blessed
to wake to a new day and am forever grateful.”
20 | Cancer program annual report 2015
Prostate Cancer
September 2016
S
te Cancer
a
t
s
o
r
P
l
a
n
Natio reneM
T
onth
Awa ss M
Lymphoma
LeuKemia n&ess Month
Aware
Cancer
Gynecologics Month
Awarenes
h
eness Mont
r
a
w
A
r
e
c
n
a
Thyroid C
W
4
5
6
T
F
S
1
2
3
The American Cancer Society recommends that men
make an informed decision with their doctor about
whether to be tested for prostate cancer. Research
has not yet proven that the potential benefits of testing
outweigh the harms of testing and treatment.
Guidelines for the Early Detection of
Prostate Cancer
•Starting at age 50, men should talk to their doctor
about the pros and cons of testing so they can
decide whether testing is the right choice for them.
7
8
9
10
•If you are African American or have a father or
brother who had prostate cancer before age 65,
talk with your doctor starting at age 45.
•If you decide to be tested you should get a PSA
blood test with or without a rectal exam. How often
you are tested will depend upon your PSA level.
18
12
19
13
20TLC
14
21
15
22
16
23
17
24
HSHS St. Nicholas Hospital 2014 Prostate
Cases by Age at Diagnosis
Number of Patients
11
20
10
0
50-59
60-69
70-79
Age at Diagnosis
80-89
HSHS St. Nicholas Hospital 2014 Prostate
Cases by AJCC* Stage at Diagnosis
28
29
30
The relative 10 year survival
rate for all stages of prostate
cancer combined is 99%.
Number of Patients
27
3
25
20
15
10
5
0
21
7
0
Stage I
Stage II
Stage III
AJCC Stage
* American Joint Committee on Cancer
4
Stage IV
21 | Cancer program annual report 2015
26
9
5
5
Survivorship
Session
6 p.m.
25
15
15
Victoria Harmelink
“I was nursing our three-month-old son when I
noticed a lump. I tested positive for the BRCA1
earlier in life, so I knew the lump could be
serious despite the clean mammogram I had a
year prior. The lump turned out to be stage-3
aggressive breast cancer.”
The smiles from her small children and the
support of her husband and friends got her
through it. She started a blog to record her
story to help others become more aware.
It was also helpful in keeping her family and
friends up-to-date.
“I am fortunate that my care could take place
in Sheboygan and even made some friends
along the way, namely Sara, Nurse Navigator
and, Brenda, Clinical Research Specialist.
Today is a good day, the anxiety of waiting
to see how my scan went is over — it is clean!
I no longer focus on family milestones, but
rather celebrate each day. Smiles, hugs and
simple words like ‘mommy’ are my medicine
for survival.”
22 | Cancer program annual report 2015
What are BRCA1 and BRCA2 ?
October 2016
Cancer
t
s
a
e
r
B
l
Nationa eness Month
S
T
W
T
F
Awar M
r
Liver CancMe onth
Visit our Breast Health Video Library online at:
Awareness
https://www.stnicholashospital.org/Medical-Services/
S
2
3
4
5
6
7
8
9
10
11
12
13
14
15
17
18TLC
19
20
21
22
1
Imaging-Services.aspx
Metastatic
Breast Cancer
Awareness Day
Survivorship
Session
6 p.m.
23
31
25
26
Schedule M
ammogram
HSHS St.
Nichola
(920) 459- s Hospital
5 17 1
27
28
HSHS St. Nicholas Hospital 2014 Breast Cases
by Age at Diagnosis
29
Breast cancer, while primarily diagnosed in
women, can also occur in men. In 2014,
58 women and 1 man were diagnosed with
breast cancer at HSHS St. Nicholas Hospital.
20
15
10
5
0
19
12
1
10
8
6
3
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+
Age at Diagnosis
HSHS St. Nicholas Hospital 2014 Breast Cases
by AJCC* Stage at Diagnosis
35
28
21
14
7
0
29
14
12
4
Stage 0
Stage I
Stage II Stage III
AJCC Stage
* American Joint Committee on Cancer
0
Stage IV
23 | Cancer program annual report 2015
30
24
National
Mammography
Day
Source: American Cancer Society Guidelines for the Early Detection of Cancer,
September 2015
Number of Patients
Living Beyond
Prostate Cancer
7 p.m.
Mammography screening guidelines for
average-risk women
•Women ages 40 to 44 should have the choice to start
annual breast cancer screening with mammograms.
•Women ages 45 to 54 should get mammograms
every year.
•Women 55 and older should switch to mammograms
every two years, or can continue yearly screening.
•Screening should continue as long as a woman is
in good health and expected to live 10 more years
or longer.
•All women should be familiar with the known
benefits, limitations, and potential harms linked to
breast cancer screening. They should also know how
their breasts normally look and feel and report any
changes to their doctor right away.
Number of Patients
16
LooK Good..
Feel Better
2 p.m.
BRCA1 and BRCA2 are human genes that produce
tumor suppressor proteins. These proteins help repair
damaged DNA and play a role in ensuring the stability
of the cell’s genetic material. When either of these
genes is altered, cells are more likely to develop
genetic alterations that can lead to cancer. A harmful
BRCA1 or BRCA2 mutation can be inherited.
Xiong Lee
Xiong and Pang had not even celebrated
their second wedding anniversary when they
learned he had cancer. Newlyweds with one
thought, “how long did they have?”
About a week prior to starting his chemo,
doctors told Xiong that he might not be able
to have children. “We had just gotten married
and the thought of not being able to have
children saddened me the most.
Two months later, Pang learned she was
pregnant. We were thrilled and chose to name
her Hope!
I got through it because of my wife, family and
friends, but mostly my faith. If God says, it is
time for me to go home, then, it is time for me
to go. While it is important to know what I am
fighting, I cannot allow it to consume me.
Cancer taught us to appreciate the simple
things in life. We are three-year survivors
who take time to appreciate each other, our
friends, family and Hope. We are grateful for
and celebrate every day we are together!”
24 | Cancer program annual report 2015
Quitting Tobacco
November 2016
Quitting tobacco is hard work! Planning can help you
be successful. You can:
M
Lung Canceronth
M
Awareness
Cancer
Pancreatics Month
Awarenes
T
W
T
F
S
1
2
3
4
5
6
8
14
9
15TL
C
16
Survivorship
Session
6 p.m.
20
28
22
29
17
11
18
12
19
Great American
SmoKe Out
23
30
24
Screening guidelines for detecting lung cancer
The American Cancer Society does not recommend
tests to check for lung cancer in people who are at
average risk. However, there are screening guidelines
for those who are at high risk of lung cancer due to
cigarette smoking.
HSHS St. Nicholas Hospital 2014 Small Cell Carcinoma
of the Lung by AJCC* Stage at Diagnosis
25
26
5
4
3
2
1
0
4
0
Stage 0
1
Stage I
0
1
Stage II Stage III
AJCC Stage
Stage IV
HSHS St. Nicholas Hospital 2014 Non-Small Cell
Carcinoma of the Lung by AJCC* Stage at Diagnosis
A key turning point, National Lung Cancer
Screening Trial (NLST) finds low-dose lung CT
screening leads to reductions in mortality. For more
information about the low-dose lung CT screening
see the article in the back of this calendar.
10
8
6
4
2
0
9
3
2
0
Stage 0
Stage I
4
Stage II Stage III
AJCC Stage
* American Joint Committee on Cancer
Stage IV
25 | Cancer program annual report 2015
27
21
10
•Consider medication. The following seven
medications are approved by the FDA in combination
with counseling to assist you in quitting. Some are
over-the-counter; others are prescription
medications:
– Varenicline
– Nicotine lozenge
– Bupropion
– Nicotine inhaler
– Nicotine patch
– Nicotine spray
– Nicotine gum
Number of Patients
13
7
Eating Well
During Cancer
Treatment
3 p.m.
•Call the FREE Wisconsin Tobacco Quit Line at
800-QUIT-NOW (800-784-8669) or visit
www.WIQuitLine.org. The Quit Line can help you
create a personalized plan to quit.
Number of Patients
S
Rose Whipple
“When I learned about my diagnosis, I cried
all weekend. On Monday, when I visited
Dr. Edward Smith, I packed away the tears and
said, ‘Okay I cried all weekend and I’m done
with that now, what are we going to do to keep
me alive?’ He had one answer, ‘Keep your
positive attitude.’
My positive attitude was important, but without
the care and support from my ten-year-old
granddaughter, I would not be here. She
brought me liquids and did not leave my side
until I finished them. She told me, ‘Grandma
you have to drink this to stay alive for grandpa
and me.’
Dr. Smith saved my life; my granddaughter
gave me nourishment; and my husband gave me
understanding and support. Thanks to all
of them, my positive attitude and God’s plan
for me — I am a survivor.”
26 | Cancer program annual report 2015
December 2016
S
M
T
F
S
1
2
3
4
8
9
10
11
T
5
6
LooK Good..
Feel Better
2 p.m.
Feast of
St. Nicholas
12
13
W
Nurse Navigator
7
14
15
16
17
Living Beyond
Prostate Cancer
7 p.m.
18
19
A cancer diagnosis affects not only the patient, but
also family members and friends and raises many
emotions. Patients often feel a sense of numbness
and can become confused trying to sort through all
of the information. At HSHS St. Nicholas Hospital
Cancer Center, Nurse Navigator, Sara Kaffine, RN,
BSN, OCN® is a trained registered nurse who helps
patients take care of their health and provide personal
guidance throughout their treatment and beyond.
“As a navigator, I have a thorough understanding
of the many decisions cancer patients face and
specialize in their care and support. I am here to listen,
understand and guide them every step of the way,”
said Kaffine.
Our Nurse Navigator answers questions about
diagnosis and treatment; assists patients in
coordinating their appointments, tests, and
procedures; and helps them obtain emotional support
they may need.
Cancer is complicated and patients, regardless of
income or education level, need a person who can see
that they receive the necessary care and support.
20TLC
21
22
23
24
27
28
29
30
31
Survivorship
Session
6 p.m.
26
Christmas
List Source: The American Cancer Society
Sara Kaffine, RN, BSN, OCN®
Nurse Navigator
HSHS St. Nicholas Hospital
Cancer Center
27 | Cancer program annual report 2015
25
New screening method detects lung cancer earlier to improve survival rates
Lung cancer is one of the most common forms of
cancer in the United States and the leading cause of
cancer death, according to the Centers for Disease
Control and Prevention. Its symptoms often appear
when the cancer is advanced and more challenging
to treat successfully.
HSHS St. Nicholas Hospital Cancer Program offers
a new screening option that works to detect lung
cancer at an earlier stage when treatments are
more successful. “Lung Screenings came about as a
result of the National Lung Cancer Screening Trial
(NLST), which demonstrated a 20 percent mortality
benefit when using low-dose CT scans for screening
as compared to using X-rays,” said Sally Luehring,
Executive Director, Cancer Services, HSHS
Division - Eastern Wisconsin.
Estimated U.S. Cancer Deaths
by Site, 2014
160,000
120,000
The Low-Dose CT Scan is a type of X-ray that
produces detailed images of the patient’s lungs using
limited radiation.
The Low-Dose CT Scan is for high-risk individuals
with a long history of smoking. To be eligible,
individuals must be between the ages of 55 and 80
with 30 or more “pack years” of cigarette smoking.
Thirty “pack years” is equivalent to smoking:
•Two packs per day for 15 years
•One pack per day for 30 years
•Half a pack per day for 60 years
A key turning point: NLST finds lung low-dose CT
screening leads to reductions in mortality
20%
Pancreas
Percentage reduction in lung cancer mortality in
participants that received low-dose CT scans as compared
to participants who received standard chest x-rays
Under the Affordable Care Act (ObamaCare),
insurance companies are required to provide lung
cancer screening to individuals who meet high-risk
criteria as a preventative screening benefit without
coinsurance or deductible. In addition, Medicare
also provides coverage for high-risk individuals.
Former smokers who meet the criteria and who quit
within the last 15 years are eligible for the screening.
If smokers or former smokers do not meet the criteria
and are concerned about their risk for lung cancer,
they should speak with their doctor.
To schedule a lung cancer screening, or find out if
you are eligible for a screening, call (920) 458-7433
or (920) 452-1650. For more information about the
procedure, visit http://onefamilyofcare.com/Cancer/
Services/Lung/Lung-Cancer-Screening.htm.
Early detection boosts cost effectiveness
Compares Favorably Compared to
Other Screening Types
Screening Cost Effectiveness
Cost Per Life-Year Saved
Study in Brief: National Lung Cancer Screening Trial
Breast
Lung &
Bronchus
40,000
Colorectal
0
Other Cancers
Lung Cancer
$50-75 K
$31-51 K
•2011 study to assess effectiveness of low-dose lung CT screening
•53,454 current and former smokers were randomly assigned to be
screened once a year for three years with low-dose CT or chest x-ray
$11-26 K
•Participants who received low-dose CT scans had a 20% lower risk of dying
from lung cancer than participants who received standard chest x-rays
Lung CT
Screening
Source: The National Lung Screening Trial Research Team, “Reduced Lung-Cancer Mortality with
Low-Dose Computed Tomographic Screening,” New England Journal of Medicine, 365, 2011.
Cervical
Screening
$18-28 K
Breast
Colorectal
Screening Screening
Source: Pyenson B et al., “An Actuarial Analysis Shows That Offering Lung
Cancer Screening as An Insurance Benefit Would Save Lives at Relatively Low
Cost,” Health Affairs 31(4); Oncology Roundtable interviews and analysis.
28 | Cancer program annual report 2015
80,000
AnewSM
Cancer affects more than just your body. It affects who you are
as a person and the lives of the people closest to you. That is
why HSHS St. Nicholas Hospital developed the AnewSM Cancer
Survivorship Program.
While our medical team treats the cancer, our AnewSM team
supports the whole person — mind, body and spirit. Studies show
that up to 90 percent of cancer patients can benefit from AnewSM
services. It is a revolutionary approach to cancer care and it is
available here, at HSHS St. Nicholas Hospital Cancer Center.
AnewSM Cancer Survivorship
includes:
•Cancer Rehab:
– P hysical, Occupational and
Speech Therapies
– Behavioral Medicine
•Nurse Navigator
Survivorship care plan
When patients come to the end of their cancer treatment it is normal for them to
feel many emotions ranging from hope and happiness to uncertainty and fear.
At HSHS St. Nicholas Hospital, an interdisciplinary team creates survivorship
care plans to help guide patients’ follow-up care. “Because cancer is so
interdisciplinary there was a risk for duplicative services in their follow-up care.
Our Survivorship Care Plans allow us to identify which disciplines a patient needs,
at what times and what tests will be needed,” said Sara Kaffine, Rn, BSN, OCN(R),
Nurse Navigator, HSHS St. Nicholas Hospital Cancer Center. When a patient’s
treatment ends, Kaffine or Stacy Miller, NP at Dr. Bettag’s office meet with him/her
to review and discuss their follow-up care plan.
This approach brings the full continuum of the cancer care team together in
reviewing each patient’s care plan and assigning roles for carrying out the plan.
“The patient is our focus and participates fully in the planning.
Transitioning to survivorship care plans enforces our commitment to
take responsibility in easing patients’ anxiety and ensuring they have
an organized, coordinated team managing their follow-up care.”
— S ara Kaffine, RN, BSN, OCN®
Nurse Navigator
HSHS St. Nicholas Hospital Cancer Center
•Oncology Social Work
•Financial Counseling
•Dietitian services
•Massage & Relaxation Training
•Survivorship Care Plans
29 | Cancer program annual report 2015
Family donates Weerda Scope in mother’s memory
When families lose a loved one, no matter the age or circumstances,
the loss is heartbreaking. Sharon and Gary Pyrek grieved for Sharon’s
mother, Dorothy Van Sluys, who passed away due to health issues, which
included an esophageal condition that limited her ability to eat normally.
As they thought about Dorothy’s life, the joy she brought to people and
her dedication to volunteering with the Catholic faith community, they
decided to pay it forward by donating a Weerda Diverticuloscope to
HSHS St. Nicholas Hospital in Dorothy’s name. The Weerda Scope is an
instrument that treats esophageal conditions.
Because use of the scope is not a common procedure, HSHS St. Nicholas
Hospital previously rented it from a company in California. “The
Weerda Scope is used to repair a patient’s esophagus that developed a
pouch that traps food when they swallow,” said Dr. Edward Smith, DO,
Otolaryngology, who performs these procedures. “Patient’s frequently
have difficulty swallowing and at times food enters their lungs and results
in pneumonia. Now, patients no longer have to wait two to three weeks
for the equipment to arrive to have their surgery. They also avoid lengthy
hospital stays.”
“We donated this money to HSHS St. Nicholas Hospital to acquire
the Weerda Scope because it can give comfort to those suffering
with the discomfort my mom suffered with. My mom would have
wanted this. By donating the scope, we’re helping to make a
difference for future patients.”
— Sharon Pyrek
The donation was made possible in part by the generous gifts of Dorothy’s
family and friends to her memorial fund.
HSHS St. Nicholas Hospital is the only facility with this equipment in the
Sheboygan area.
The Weerda Scope would not have restored Dorothy’s health, but it
could have made her last days more comfortable.
30 | Cancer program annual report 2015
Sharon Pyrek and her husband, Gary,
donated a Weerda Diverticuloscope,
to HSHS St. Nicholas Hospital, in memory
of her mother.
In 2015, HSHS St. Nicholas Hospital celebrated its 125 Anniversary.
During these 125 years, health care advanced phenomenally and people with many
conditions, including cancer, have brighter futures than those first founding Sisters
could have ever imagined.
31 | Cancer program annual report 2015
HSHS St. Nicholas
Hospital
3100 Superior Ave., Sheboygan, WI
stnicholashospital.org