Chairman’s Letter
2013 was a busy year for the Arthur Temple Sr. Regional Cancer Center and the
cancer program at Memorial Health System of East Texas. We now have over
14,000 patients who have been diagnosed and/or treated in our facility over the
years, and in 2012 another 585 patients were added to those numbers. Even
more remarkable, more than 10,000 are survivors!
Survivorship is something to celebrate! Now that cure rates for cancer overall are
2 out of 3, and for many early cancers 9 out of 10, we are going to see more and
more of our friends, neighbors, and relatives survive cancer. Survivorship is also
going to be a focus for cancer providers and healthcare systems in the coming
years.
Each year, we review our cancer program and comment on certain trends or
statistics of note. Despite our successes, we have a long way to go to ensure
that cancer care – from prevention to early detection to state of the art treatment
and follow up – is available to everyone. Memorial’s mission to care for all, along
with our collaboration with organizations like the American Cancer Society, are
helping us get closer to that goal.
Sidney C. Roberts, MD, FACR
Cancer Committee Chair
Tumor Board Conferences 2013
Tumor Board conferences are educational conferences held for the benefit of the
Medical Staff, allied health personnel and others. In 2013, a total of 99 different,
interesting, controversial or unusual cases of cancer were presented in a forum
designed to give clinicians a way to share opinions and discuss treatment options
that may improve individual patient care. In addition, category 1 Continuing
Medical Education (CME) credit is offered for each meeting a physician attends.
Cases discussed in 2013 included major sites such as lung, breast, colorectal,
lymphomas, and bladder, as well as less common cancers involving diverse sites
such as the head and neck region, cervix and endometrium, esophagus, and
melanoma. Anal, vulvar, pancreatic, penile, gastric, testicular, gallbladder,
thyroid, and other rare tumors were also discussed.
The ability to present cases in a multi-disciplinary forum, where treatment options
can be discussed in a prospective fashion, is one of the criteria that set an
accredited cancer program apart. Almost all of our presentations were
prospectively addressed, although an occasional patient was presented in followup so that our members could learn the outcome of our discussions.
Cancer Committee Members 2013
Sidney Roberts, MD, (Radiation Oncology), Chairman, Cancer Liaison Physician
Munir Ahmad, MD (Medical Oncology)
Bramham Reddy, MD- (Medical Oncology)
Kavitha Pinnamaneni, MD (Medical Oncology)
David Todd, MD (Pathology)
Mariela Vasquez, MD (Pathology)
Charles Evans, MD (Family Medicine)
Melvin Cole, MD (General Surgeon)
Brian Humphreys, MD (ENT)
Troy Coleman, MD (Radiology)
Johnny Alexander, MD (ENT)
Dan Fuentes, D.O., President of Medical Staff (Orthopedic Surgery)
Mary Norris, MSN, FNP-C
Jennie Ferguson, CPCS
Madelene Collier, RN, OCN, Research Data Manager
Jackie Gilmore, Cancer Registry Coordinator
Charlotte Wammel, CTR
Jewel Randle, RT, (R)(T), Cancer Center
Brenda Taylor, RN, MSN, Nurse Manager, Inpatient Oncology
Sheila Davila, Rehabilitation Services Director
Angie Whitley, RN, Community Outreach Coordinator
Bill Malnar, MS, RT(R)
Apollonia Ellis, LMSW
Tim Scallon, MS, RD, Nutrition Services
Peggy Mortensen, COO
Alicia Bergeron, American Cancer Society
Daisy Drinkard, American Cancer Society
Paul Johnson, LMSW, IPR (Hospice in the Pines)
Tumor Registry Report
The Tumor Registry is a critical component of the Cancer Program at Memorial
Health System of East Texas, supporting efforts in the area of patient care,
education and research. Identification and monitoring of all cases meeting the
eligibility criteria established by the hospital’s Cancer Committee is a laborintensive task which plays a vital part in the accreditation of the hospital’s cancer
program by the American College of Surgeons.
The Tumor Registry has been in existence at Memorial Health System of East
Texas since 1990. The Registry, under the direction of the Cancer Committee,
maintains a complete database of all cancer cases diagnosed and/or treated at
Memorial. In 2012, there were 523 newly diagnosed and/or treated cancer cases
at Memorial.
In order to encourage continued medical surveillance and to provide valid endresult statistics, every patient in the Registry is followed on an anneal basis. The
Registry, with the aid of its computerized database, is able to provide valid
information regarding the current medical status of the patient to the physicians
following the case.
The Registry also provides the physicians and hospital with survival information
about patients treated in our Cancer Center. Patient confidentiality is strictly
enforced under HIPAA guidelines. Currently we are able to maintain a high rate
of successful follow-up.
The Registry’s efforts in these areas yield useful demographic, diagnostic,
therapeutic and follow-up data. This data is used to help support efforts in
reviewing patient care and treatment procedures. Our cancer program is
accredited by the American College of Surgeons Commission on Cancer, having
once again received the coveted Accreditation with Commendation. Registry
data is also very useful in helping to create more effective patient education
programs or research protocols.
Physicians may request information or cancer statistics by contacting the
Registry at (936) 639-7141.
2012 Statistics
Total # of Cases in Registry = 14,845
Analytical Cases (diagnosed and/or treated here) = 8,758
Total Number of Expired Cases = 4,129
Total Number of Cases Lost to Follow-Up = 1,240
Total Number known to Be Alive = 10,716
Percent of Cases with Current Follow-Up Information = 79%
Primary Site Table 2012
In 2012, 585 new cases of cancer were diagnosed and/or treated at Memorial
Health System of East Texas.
BRONCHUS & LUNG
BREAST
PROSTATE GLAND
COLON/RECTOSIGMOID
URINARY BLADDER
BLOOD & BONE MARROW
LYMPH NODES
UNK PRIMARY
CORPUS UTERI
KIDNEY
SKIN
ESOPHAGUS
ANUS & ANAL CANAL
THYROID GLAND
LIVER & BILE DUCTS
PANCREAS
OVARY
BRAIN
CERVIX UTERI
VULVA
STOMACH
LARYNX
BASE OF TONGUE
OTHER PARTS OF TONGUE
OTHER/UNSPECIFIED PARTS OF MOUTH
NASOPHARYNX
CONNECTIVE SUBCU. OTHER SOFT TISSUE
KIDNEY, RENAL PELVIS
TONSIL
SMALL INTESTINE
OTHER BILIARY TRACT
HEART MEDIASTINUM PLEURA
PAROTID GLAND
OROPHARYNX
HYPOPHARYNX
GALLBLADDER
PENIS
TESTIS
URETER
ORBIT, NOS and OVERLAPPING LESION
137
100
67
44
32
24
19
17
16
15
9
8
8
8
7
7
7
7
6
5
4
4
3
3
3
3
3
3
2
2
2
2
1
1
1
1
1
1
1
1
23.42%
17.09%
11.45%
7.52%
5.47%
4.10%
3.25%
2.91%
2.74%
2.56%
1.54%
1.37%
1.37%
1.37%
1.20%
1.20%
1.20%
1.20%
1.03%
0.85%
0.68%
0.68%
0.51%
0.51%
0.51%
0.51%
0.51%
0.51%
0.34%
0.34%
0.34%
0.34%
0.17%
0.17%
0.17%
0.17%
0.17%
0.17%
0.17%
0.17%
TOTAL CASES
585
100.00%
Top Site Comparison 2012
MHSET CANCER CASES DIAGNOSED 2012
*NATIONAL COMPARISON OF SELECTED CANCER SITES
*Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2012
PRIMARY SITE
BREAST
LUNG
PROSTATE
COLORECTAL
BLADDER
NH LYMPHOMA
CORPUS UTERI
MELANOMA
LEUKEMIA
CERVIX
ALL OTHERS
TOTAL CASES
CASES
100
137
67
44
32
19
16
9
24
6
131
585
MHSET
PERCENT
17.1%
23.4%
11.5%
7.5%
5.5%
3.2%
2.7%
1.5%
4.1%
1.0%
22.4%
100.0%
CASES
15,050
14,810
15,730
9,700
3,940
4,750
2,500
4,020
3,530
1,080
35,360
110,470
TEXAS
PERCENT
13.6%
13.4%
14.2%
8.8%
3.6%
4.3%
2.3%
3.6%
3.2%
1.0%
32.0%
100.0%
NATIONAL
CASES
PERCENT
226,870
13.8%
226,160
13.8%
241,740
14.8%
143,460
8.8%
73,510
4.5%
70,130
4.3%
47,130
2.9%
76,250
4.7%
47,150
2.9%
12,170
0.7%
474,340
28.9%
1,638,910
100.0%
SELECTED CANCER SITES 2012
17.1%
BREAST
13.6%
13.8%
23.4%
LUNG
13.4%
13.8%
11.5%
PROSTATE
14.2%
14.8%
7.5%
COLORECTAL
8.8%
8.8%
5.5%
BLADDER
3.6%
4.5%
3.2%
NH LYMPHOMA
4.3%
4.3%
2.7%
CORPUS UTERI
2.3%
2.9%
1.5%
MELANOMA
3.6%
4.7%
4.1%
LEUKEMIA
3.2%
2.9%
CERVIX
1.0%
1.0%
0.7%
Your Hospital Name
ACS Projected Figures TX 2012
ACS Projected Figures National 2012
The top five cancer sites nationwide are breast, lung, prostate, colorectal, and
bladder. This is the first year that breast cancer has surpassed lung cancer in
incidence. Texas statistics match national statistics. However, in East Texas,
lung cancer remains our #1 site. Smoking rates in East Texas remain higher than
the national average.
2012 Stage Distribution
2012-ANALYTICCASES
CS STAGE GRP
0
I
II
III
IV
UNK
N/A
TOTAL CASES
NBR_CASES
35
100
119
80
107
34
48
PERCENT
6.69%
19.12%
22.75%
15.30%
20.46%
6.50%
9%
523
100.00%
Almost half of our patients are diagnosed at an early stage (Stage 0, I, II), and
only one in five are diagnosed with late stage (IV) disease. Cure rates are higher
when cancer is caught earlier.
119
107
120
100
100
80
80
60
34
35
48
40
20
0
0
I
II
III
IV
UNK
N/A
2012 Treatment
Many patients receive a combination of therapies – such as radiation and
chemotherapy together – or even all three types of treatment. A significant
percentage of patients still opt for no treatment or are not recommended for
treatment based on the advanced stage of their disease at presentation, or
perhaps desire for observation.
None 27.8%
Surgery 46.7%
Radiation 26%
Chemotherapy 30.8%
Hormone Therapy 8.8%
First Course of Treatment
None
Surgery
Radiation
Chemotherapy
Hormone Therapy
2012 Age by Gender
Age at diagnosis ranges from teens to 90s, with the majority of patients being
diagnosed in their 50s through 70s. As people live longer, we will see more
cancer diagnosed in octagenarians and nonagenarians.
90
80
70
60
50
40
30
20
10
0
Male
Female
10 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 - 79
80 - 89
2012 Race
81% of our 2012 cases are White, non-Hispanic/Latino, with 14% African
American and 5% Hispanic/Latino. Only a handful of 3 patients were Asian (2) or
American Indian (1).
0%
Race Distribution
0%
14%
WHITE
5%
HISPANIC/LATINO
BLACK
ASIAN
AMER INDIAN
81%
PROSTATE STUDY
In 2012, a total of 76 cases of prostate cancer were diagnosed and/or treated at
Memorial Health System of East Texas.
Age at Diagnosis
Most men were over the age of 60, although there was a significant minority of
men (25%) diagnosed in their 50s.
Age Graph
2012PROSTATE
Age Range
50 - 59
60 - 69
70 - 79
80 - 89
90 - 99
19
31
13
9
1
Age By Sex Graph 2012-PROSTATE-REPORT Male
35
30
25
Age By Sex Graph
2012-PROSTATEREPORT Male
20
15
10
5
0
50 - 59
60 - 69
70 - 79
80 - 89
90 - 99
Stage at Diagnosis
The majority of prostate cancers are confined to the prostate gland (stage 2 or
less) at diagnosis.
PROSTATE
Stage 0
n=0
0%
Stage 1
n=14
18%
Stage 2
n=39
51%
Stage 3
n=3
4%
Stage 4
n=8
11%
Unknown
n=12
16%
PROSTATE
60%
50%
40%
30%
20%
10%
0%
4
n=
Un
8
kn
ow
n
n=
12
n=
3
St
ag
e
3
St
ag
e
n=
39
2
St
ag
e
1
St
ag
e
St
ag
e
0
n=
0
n=
14
PROSTATE
Race at Diagnosis
Most patients in our registry are White.
PROSTATE
White
n=63
83%
Black
n=13
17%
90%
80%
70%
60%
50%
Series1
40%
30%
20%
10%
0%
White n=63
Black n=13
First Course of Treatment
The majority of prostate cancer patients diagnosed and/or treated at Memorial
are treated surgically initially. The general population may not be aware of the
availability of IMRT radiation for prostate cancer and its effectiveness. For
example, for most patients with low risk disease and reasonable life expectancy,
surgery, radiation, or brachytherapy (seeds) are considered equally effective,
according to NCCN Guidelines. Patients in the “no treatment” row could be
advanced patients, or they could be early/favorable patients who are under active
surveillance only.
Rx TYPE
SURG
NONE
HOR
RAD/HOR
RAD
SURG/HOR
SURG/BRM
SURG/RAD
SURG/RAD/HOR
Rx
Combination
Graph
2012-PROSTATE-REPORT
NBR_CASES
35
14
9
7
5
3
1
1
1
TOTAL CASES
PERCENT
46.05%
18.42%
11.84%
9.21%
6.58%
3.95%
1.32%
1.32%
1.32%
76
100.00%
Initial Treatment Modality
14
NONE
20
HORMONE
14
RADIATION
41
SURGERY
0
10
20
30
40
50
number of patients
Prostate Survival with Radiation
Survival with radiation is similar at Memorial Health System of East Texas (red
line) to what is expected nationally (blue line).