2011 Cancer Annual Report

Saint Francis Cancer Treatment Center 2011 Annual Report


Today’s clinical trial,tomorrow’s best care.

M. Sitki Copur, M.D., FACP

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Table of Contents

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2011 Data Presentation ................................................................................. 4

2011 Comparison of Cancer Data ................................................................. 6

2011 Cancer Program Highlights ................................................................. 10

Breast Cancer .............................................................................................. 12

2011 CP3R Performance Rates .................................................................... 15

2011 Breast Cancer Report .......................................................................... 16

Fiscal Year 2012 Cancer Program Goals ....................................................... 19

2011 Director’s Note ................................................................................... 20

Health Connect at Home ............................................................................. 22

Health Connect at Home Hospice ............................................................... 23

2011 Support Programs ............................................................................... 24

Scientific Publications from Saint Francis Cancer Treatment Center ............. 26

Cancer Committee 2011 .............................................................................. 34

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It is with great pleasure and pride that I present the 2011 Cancer Report data at Saint Francis Cancer Treatment Center. This has been a remarkable year of growth bringing excellence to all aspects

of our cancer services from prevention, screening and diagnosis to navigation, treatment, survivorship and end of life care. With the continued availability of resources provided by the National Community Cancer Centers Program (NCCCP) grant in its fourth year now, along with the resources provided by the National Oncology Service Line (NOSL) of our mother institution Catholic Health Initiatives (CHI), Saint Francis Cancer Treatment Center has thrived to become an exemplary community oncology program. This year, CHI-NOSL has launched an initiative to achieve pre-determined goals with a dashboard of key metrics in the areas of People, Quality, Cancer Registry, and Stewardship. This has perfected and expanded the American College of Surgeons’ (ACOS) existing standards that we follow.

Under People, we look at overall patient satisfaction, outpatient satisfaction with pain management, and percentage of certified oncology nurses in our cancer center.

Under Quality, we focus on measures of Cancer Program Practice Performance (CP3R) improvements from ACOS, patient safety, and clinical trials. CP3R measures include: administration of radiation therapy within one year of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer; administration of tamoxifen or third generation aromatase inhibitors within one year of diagnosis for women with Stage I to III hormone receptor positive breast cancer; removal of at least 12 regional lymph nodes for pathological examination for resected colon cancer; consideration of adjuvant chemotherapy within four months of diagnosis for Stage III colon cancer; and consideration of radiation therapy

within six months of diagnosis for patients with Stage III rectal cancer. Patient safety measures include chemotherapy variances resulting in patient harm or not; and clinical trials measures include availability of various types of clinical trials and percentage of patients enrolled, quality assurance, and patient and physician education on this topic.

Under Cancer Registry we measure abstract completion and registry follow-up rate, and all-case registry follow-up rate for the last five years (or reference date if < 5 years ).

Under Stewardship, we focus on inpatient/outpatient contribution margin, 30-day re-admission rates (all readmissions) and 30-day re-admission rates for oncology.

Saint Francis Cancer Treatment Center has performed at top percentiles in all of these metrics in 2011.

This year we have expanded our cancer support staff with the addition of a project coordinator and a multidisciplinary breast conference coordinator. We continued to have the services of nurse navigator and genetic counselor, and a rehab team in supportive care, end of life care and survivorship. We completed the data collection and self-review process under the Quality Oncology Practice Initiative (QOPI) through ASCO, and received our QOPI certification after our survey in 2011. In 2011, our cancer registry identified a total of 604 newly diagnosed cancer cases. 561 of those were analytic and 43 were non-analytic. (Figure 1) Breast cancer incidence again occupied the first place with 17%, followed by prostate with 15%, lung 13%, colorectal 11%, and Non-Hodgkin Lymphoma with 6%.

Seventeen percent incidence of breast cancer this year was above both national and Nebraska state incidence of 15% and 13% respectively. Saint Francis Cancer Treatment Center remains the main referral center in central Nebraska for the most needed services in the management of

2011 Data Presentation

Saint Francis Cancer Treatment CenterM. Sitki Copur, M.D., FACPMedical Director, Saint Francis Cancer Treatment CenterChair Person, Saint Francis Cancer Center Cancer CommitteeProfessor, Adjunct Faculty, University of Nebraska Medical Center

M. Sitki Copur, M.D., FACP


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breast cancer. Our strong and well-committed team of primary care, pathology, radiology, surgery, medical and radiation oncology provider teams, along with a large variety of clinical trials and a nurse navigation program makes Saint Francis Cancer Treatment Center the best place for multidisciplinary breast cancer care in central Nebraska. We have already met requirements for certification by the American College of Radiology (ACR) and the National Accreditation Program for Breast Centers (NAPBC). The National Quality Measures for Breast Centers (NQMBC) program is in progress. Our cancer program already meets and exceeds 28 different standards, covering all aspects of breast cancer care, including multidisciplinary breast conferences, excellence in radiation oncology, pathology, radiology, surgery, medical oncology, nurse navigation, genetic counseling, nursing, clinical trials, and community outreach, making our cancer program the most sought-out cancer center for breast cancer care.

This year prostate cancer took second place with an incidence of 15%, which is very similar to both the national and state average of 14 to 15 %. (Figure 2) Most of our cases are diagnosed at an early stage. Saint Francis Cancer Treatment Center continued to offer radical prostatectomy, radiation, chemotherapy and hormonal therapy as well as a variety of clinical trials for both hormone refractory and sensitive prostate cancer patients.

Lung cancer came in third place this year, with 13% incidence; higher than last year, but very similar to the national and state average of 13 to 14%. Saint Francis Cancer Treatment Center has teamed up with the University of Nebraska Medical Center and Eppley Cancer Center, and is able to offer all of the multidisciplinary services needed for lung cancer patients. Several national clinical trials, both in adjuvant and metastatic settings utilizing novel targeted therapies, are available for lung cancer patients. As part of NCCCP-ARRA Project 9, Saint Francis Cancer Treatment Center is participating in a Multidisciplinary Care Research Study involving both lung and colorectal cancers. Our smoking cessation counselor has been an invaluable asset to our team efforts for educating the patients and their families as well as helping our patients to quit smoking. Colorectal cancer came in fourth place this year with an 11% incidence, again similar to the

national and state average of 9 to 10 %. Saint Francis Cancer Treatment Center expanded its colon cancer awareness program with educational and screening activities through its existing resources and genetic counseling services. We are planning to implement a universal Lynch Syndrome screening program through our CHI-National Oncology Service Line in the upcoming year. Saint Francis Cancer Treatment Center has a great surgical and pathological team performing colorectal cancer surgeries with 90% of patients having more than 12 lymph nodes examined after surgery. Our pathology department now has a 100% synoptic reporting rate. Collaboration with the radiology department in performing rectal MRIs, along with collaboration with the radiation oncology department for neoadjuvant chemoradiation therapy for rectal cancers, and having several national clinical trials available makes Saint Francis Cancer Treatment Center a referral site for colorectal cancer patients. Saint Francis Cancer Treatment Center is taking part in NCCCP-ARRA Project 9, a Multidisciplinary Care Research Study involving colorectal cancer at NCCCP sites.

Non-Hodgkin lymphoma took fifth place with an incidence of 6%, slightly higher than both state and national averages of 4 to 5%. We continue to work closely with the University of Nebraska Lymphoma Study Group and enroll our patients in University of Nebraska Lymphoma Study Group protocols.

Saint Francis now has an exemplary dedicated clinical oncology pharmacy service, including three dedicated oncology pharmacists, a USP-797 compliant ante-room, Class II biological safety cabinet, and positive pressure ISO Class 7 chemotherapy preparation room. The quality, safety and efficiency of our dedicated oncology pharmacy program were highlighted in a Wall Street Journal article this year.

The Saint Francis Cancer Treatment Center team is on its way to new national recognition awards and has become a leader in the entire continuum of cancer care with its exceptional team.

My sincere thanks and gratitude to this exemplary team.

M. Sitki Copur, M.D.

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2011 Comparison of Cancer DataAt Saint Francis Cancer Center there were 604 new cases of cancer and other reportable disease accessioned to the Cancer Registry in 2011. Of those, 561 were analytic and 43 were non-analytic.

Overall Most Frequently Diagnosed Sites

New Cases at Saint Francis Medical Center

Female - Top 5 Sites Male - Top 5 Sites

6

562541

555564

550

600573

604

500

520

540

560

580

600

620

Most Frequently Diagnosed Sites

Age at Diagnosis at Saint Francis Medical Center

7

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Breast Prostate Lung ColoRectal NHL All other

SFMC

NE

National

0

20

40

60

80

100

0-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

MALE FEMALE

Distribution of Cases by Sex at Saint Francis Medical Center


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2011 Cancer Program Highlights

• A third medical oncologist, Dr. Melham Jabbour, joined the Cancer Treatment Center in August of 2011.

• A third midlevel care provider, Megan Schriner, P.A., also joined the Cancer Treatment Center in 2011.

• Dr. M. Sitki Copur, Medical Director of Oncology and Cancer Committee Chair, was invited to serve as a member of ASCO (American Society of Clinical Oncology) Cancer Research Committee from 2011 through 2014.

• Dr. M. Sitki Copur became a member of the Eppley Breast Center Collaborative Registry Steering Committee.

• Efforts to make Saint Francis Cancer Treatment Center a Breast Center of Excellence were launched in 2011.

• Multidisciplinary care was launched for breast cancer patients.

• As part of the establishment of multidisciplinary care at Saint Francis Cancer Treatment Center, two breast cancer conferences were added to our monthly multidisciplinary cancer conferences, bringing the number of tumor conferences to three per month.

• Clinical Oncology Pharmacy program was established and thrived to become an exemplary practice. Wall Street Journal interviewed Dr. Copur and published an

article on data highlighting the strength of our clinical oncology program and chemotherapy safety measures that Saint Francis Cancer Treatment Center has in place.

• Six new clinical trials were opened in 2011, for a total of 29 open studies with 166 patients enrolled.

• The Saint Francis Cancer Treatment Center was the first recipient of the CHI (Catholic Health Initiatives) Research and Innovation Award for performance in clinical trials.

• Dr. James Omel continued to be a strong patient advocate member of the Cancer Committee. Dr. Omel played an important role at FDA hearing on carfilzomib, serving as the myeloma patient representative on the Oncologic Drugs Advisory Committee. Dr. Omel has been working for the past six years on the Alliance (formerly CALGB) Cooperative Group PAC (Patient Advocacy Committee). Dr. Omel is also on the Alliance Myeloma Committee which plans new Alliance myeloma clinical trials.

• Began participation in the National Cancer Institute (NCI) Community Cancer Center Program Patient Reported Symptom and Surveillance and Disparities Study.

M. Sitki Copur, MD, FACP

Melhem Jabbour, MD

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• Successfully implemented the requirements of the Community Oncology Research Support Grant, by the American Society of Clinical Oncology (ASCO), 2010-2011, $30,000.

• Received the Outreach Risk Awareness Project grant by the Susan G. Komen Foundation, 2011-2012.

• The Hastings Clinic continued to grow successfully.

• Continued to participate in the ASCO Quality

Oncology Practice Initiative (QOPI) and prepared for QOPI certification.

• Hosted six pharmacy students in 2011.

• Continued to participate in the ARRA 9 project.

• Continued to be a participant in the Commission on Cancer’s Rapid Quality Reporting System (RQRS).

• Sponsored Gruen Von Behrens, an oral cancer survivor, to talk to Grand Island Middle School students and educate them on the harmful effects of tobacco use.

• Cancer Survivorship care plans were initiated for patients at the end of their treatment.

• The NCCN (National Comprehensive Cancer Network) Distress Thermometer, a recommended screening tool to identify

patients experiencing treatment-related distress, was implemented in 2011.

• Met the requirements and goals for continued support of the NCI Community Cancers Center Program (NCCCP) pilot.

• Radiation oncology fepartment hosted one radiation therapy student from UNMC and one from Mary Lanning for several weeks.

• Rapid Arc radiation therapy was initiated in 2011, allowing us to spare normal tissue and give greater tumor doses while treating with significantly lower monitor units and less time on the table.

• Conducted focus groups to better understand the needs of our patient population. There was a breast cancer group, a group for all other cancers, and a caregivers group.

• Courtney Fuller, R.N., attained her Certified Clinical Research Professional (CCRP) credential.

• Angela Obermiller, RP and Pharmacy Supervisor was promoted to Adjunct Assistant Professor.

• Jennifer Scott, R.N., received her OCN certification.

• Beth Gonnerman, BS, attended the AONN (Academy of Oncology Nurse Navigators) workshop in Texas.

• Participated in Relay for Life.

Ryan Ramaekers, MD

Megan Schriner, PA


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• Began participation in the American Cancer Society’s PRO (Patient Reported Outcomes) study.

• Provided multiple support groups for patients and their families.

• Submitted Cancer Registry data to the National Cancer Data Base (NCDB).

• Met American College of Surgeons (ACOS) requirements for patient follow up.

• Three abstracts accepted for publication by the American Society of Clinical Oncology 2011 meeting:

o Copur MS, Percich S, Jordan AM, Obermiller AM, Loberiza FR, BenzelH, Langford-Karre J, Mickey M, Norvell M, Friesen L, Bolton M, Mleczko K, Ramaekers RC. Cancer Genetic counseling services in a community-based cancer center in rural Nebraska:Effect of National Community Cancer Centers Program. J Clin Oncol 2011:29S:e11137.

o Obermiller AM, CopurMS, Bolton M, Ramaekers R, Hays R, Nelson D, Benzel H, Mickey M, Norvell M, Olsen J, Tharnish M, Lebbe

B, Schneider S, Woodward S, Keenportz S, Frankforter S, Mlinar L. Fulvestrant and Letrozole combination in second-line or more for estrogen receptor positive metastatic breast cancer:Efficay and predictors of response. J Clin Oncol 2011:29S:e16508.

o Ramaekers RC, Benzel H, Loberiza FR, ObermillerAM, Fuller C, Gulzow M, Hadenfeldt R, Nielsen N, Norvell M, Mickey M, Goering J, Copur MS. Clinical trial enrollment and related activities in a community based cancer center in rural Nebraska before and after National Community Cancer Centers Program. J Clin Oncol 2011;29S:e16509.

• Eight scientific articles were published in peer reviewed journals:

o Copur MS, Obermiller, A. Largest randomized trial of biliary tract cancer treatment with cisplatin plus gemcitabine versus gemcitabine alone: An excellent opportunity to evaluate the prognostic value of tumor marker Ca 19-9. Clin Colorectal Cancer 2011;10:70-71.

o Kummar S, Copur MS, Rose M, Wadler S, Stephenson J, O’Rourke M, Brenckman M, Tilton R, Liu S-H, Jiang Z, Su T , Cheng Y, Chu E. A Phase I Study of the Chinese Herbal Medicine PHY906 as a Modulator of Irinotecan-Based Chemotherapy in Patients with Advanced Colorectal Cancer Clin Colorectal Cancer 2011;10:85-96.

o Copur MS, Obermiller A. An Algorithm for the Effective Management of Hypertension in the Setting of Vascular Endothelial Growth Factor Signaling

2011 Cancer Program Highlights (continued)

Deborah Nelson, APRN

Rita Hays, APRN

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Inhibition. Clin Colorectal Cancer 2011;10:151-156.

o Fulvestrant High Dose versus Lodaing Dose versus Approved Dose, Have we found the optimum dose? Obermiller A, Copur MS. Clin Breast Cancer 2011;11:195.

o Obermiller AM, Copur MS. The longstanding quest for a better endocrine therapy Continues High Dose Fulvestrant: Have we found the effective dose, combination, setting, or sequence. Contemporary Oncology 2011;34-37.

o Sherman S, Shats O, Fleissner E, Bascom G, Yiee K, Copur M et al. Multicenter breast cancer collaborative registry. Cancer Informatics 2011;10:217-226.

o Copur MS, Obermiller A. Ipilimumab plus dacarbazine in melanoma. N Engl J Med 2011;365:1256-1257.

o Copur MS, Obermiller AM, Ramaekers R et al. Letrozole and fulvestrant combination in second line or more for estrogen receptor positive metastatic breast cancer.Efficacy and predictive factors of response. Copur et al., J Cancer Sci Ther 2011, S2.

• Five book chapters were published in DeVita and Physicians Cancer Manual textbooks:

o Copur MS. Rose M, Gettinger S. Miscellaneous Chemotherapeutic Agents In: Cancer Principles & Practice of Oncology DeVita VT, Lawrence TS, Rosenberg SA 455-458 9th edition, 2011.

o Chu E, Obermiller A, Harrold LJ, Tiedemann D, Copur MS

Chemotherapeutic and Biologic Drugs. In Physicians Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 5-395;2011.

o Copur MS, Tiedeman D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 396-413;2011.

o Copur MS, Chu E, Harrold LJ, Deshpande H, Levy AL. Common Chemotherapy Regimens in Clinical Practice. In Physicians Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 414-542;2011.

o Deshpande H, Copur MS, Harrold LJ, Chu E, Levy AL. Antiemetic Agents for the treatment of Chemotherapy-Inducued Nausea and Vomiting In Physicians Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 543-581;2011.


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Breast CancerBreast Cancer can be a devastating diagnosis both physically and emotionally for women and their families. One in eight women will be diagnosed with breast cancer. Excluding skin cancer, breast cancer is the most common cancer among women, accounting for one in three cancer diagnoses in women.1 Over 280,000 new cases of breast cancer were estimated to be diagnosed in 2011.1 Only lung cancer accounts for more

cancer deaths than breast cancer, with an estimated 39,520 breast cancer deaths in 2011.1

Breast cancer affects a wide range of ages. As can be seen in graph 1, 95% of breast cancers are diagnosed in women age 40 or older. Saint Francis Cancer Treatment Center’s numbers are similar to both the state and national numbers for age at diagnosis.

There are a number of risk factors that increase a woman’s chance of breast cancer. Some of these risk factors can be modified while others cannot. Factors such as

increasing age, family history of breast cancer, early menarche, and late menopause are not modifiable. Other risk factors such as obesity, post-menopausal hormone exposure, physical inactivity, and alcohol consumption are modifiable.1

Most women with breast cancer are diagnosed at an early stage, which can be seen in graph 2. This is important because the patient’s cancer stage at diagnosis is the best predictor of that patient’s long term survival and outcome. The earlier a breast cancer is diagnosed, the better a patient’s chances of survival will be. This is shown in graph 3. Therefore, screening for breast cancer is the most important thing a patient can do to diagnose breast cancer at an early stage. The American Cancer Society has screening guidelines for the average-risk, asymptomatic woman. For women age 20-39, a clinical breast exam is recommended every three years and self breast exam is optional. For women age 40 and over, a yearly screening mammogram along with yearly clinical breast exam is recommended and self exam is optional.1

When an abnormal mammogram or mass is found on exam, a biopsy of that lesion is

Dr. Brant Luebbe

Graph 1

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recommended. This is often done as an outpatient procedure under ultrasound or x-ray guidance with a small needle. Fortunately, the majority of abnormal findings on mammograms will show benign findings when biopsied. For those patients that are diagnosed with breast cancer, the breast cancer nurse navigator will help guide them through the process of meeting with the team of specialists who treat breast cancer.

Patients diagnosed with breast cancer will typically meet with various members of the breast cancer treatment team which includes the patient’s primary care doctor, medical oncologist, radiation oncologist, and surgeon. These specialists then meet as a team along with the radiologists and pathologists during the biweekly breast cancer conference, where each breast cancer patient’s case is discussed so that a unified cancer treatment plan for each patient can be agreed upon by all the specialists. Patients can be assured that their cancer is discussed in a prospective fashion in an open forum amongst the specialists so that the appropriate treatment plan is developed.

Women usually have a variety of surgical options to choose from when treating breast cancer. Generally, women can choose between breast conserving therapy (lumpectomy) along with radiation after surgery, or mastectomy. If a patient chooses mastectomy, she can also choose to do breast reconstruction on the affected side. For women with invasive breast cancer, the lymph nodes on the affected side need to be sampled. This is done with a sentinel lymph node biopsy where one or two lymph nodes are removed from the axilla at the time of her breast surgery.2 This allows the surgeon to determine if the cancer has spread to the lymph nodes.

Women treated for breast cancer at Saint Francis Medical Center can be confident that they will receive all surgical options for breast cancer treatment. This includes implant-based reconstruction after mastectomy, along with nipple reconstruction and tattooing of the nipple. Certain patients may also be candidates for nipple-sparing mastectomy with reconstruction. Selected patients who choose lumpectomy may be candidates for oncoplastic surgery, which is the blending of oncologic surgery and plastic surgery techniques. Various techniques are used to

Graph 2


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Breast Cancer (continued)

minimize scarring and achieve the best aesthetic outcome while performing the best cancer surgery. This can be as simple as hiding the incision in areas of the breast, such as the areola, that may not be as visible. A more complex example is breast reduction surgery in conjunction with a lumpectomy in patients with larger breasts. This allows the surgeon to remove a larger lumpectomy specimen while reducing the size of the breast to relieve the symptoms associated with large breasts. Most women have many surgical options to choose from, but no matter what a patient chooses, she can be assured that the surgeons at Saint Francis Medical Center will approach her breast cancer by doing the best cancer surgery while striving to obtain the best aesthetic outcome.

Certain patients with breast cancer will require chemotherapy. There are a variety of chemotherapy regimens available depending on the type and stage of the cancer. Saint Francis Cancer Treatment Center has the advantage of being an affiliate of the Eppley Cancer Center at the University of Nebraska Medical Center allowing patients the opportunity to participate in numerous breast

cancer treatment studies. This means that women are being offered the most up to date chemotherapy regimens.

Radiation therapy is also available for women who choose lumpectomy, and for those women with lymph node involvement or advanced breast cancers. These treatments usually occur daily for several weeks. Each treatment session is brief to minimize the disruption to the patient’s daily activities.

Women diagnosed with breast cancer who receive their treatment at Saint Francis Cancer Treatment Center can be assured that they are receiving the most up-to-date cancer treatment available. Breast cancer requires a team of physicians to offer the best treatment to our patients. Saint Francis Cancer Treatment Center has this team of physicians in place to treat all breast cancer patients with compassion and efficiency to minimize the stress and disruption in the patient’s life.

1 Breast Cancer Facts and Figures 2011-2012. American Cancer Society.

2 Feif, B W. et al. The M.D. Anderson Surgical Oncology Handbook. Fourth Edition. Lippincott Williams & Wilkins. 2006.

Graph 3

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CP3R Performance Rates for all Eligible Cases 2008-2009Reported by National Cancer Database

The Cancer Program Practice Profile Report (CP3R) is designed to provide comparative information to help providers assess their utlization of accountability measures endorsed by the National Quality Forum (NQF). The following tables show a comparison of data submitted to the National Cancer Database from our facility, against other COC accredited hospitals.

1. Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.

2. Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage II or III hormone receptor negative breast cancer.

3. Tamoxifen or third generation aromatase inbibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or Stage II or III hormone receptor positive breast cancer.


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This year was very exciting for the breast cancer program at Saint Francis Medical Center. It was also a year filled with many new hopeful breakthroughs in the treatment of breast cancer of all stages. This brief article will highlight our achievements, introduce our breast program services,

and also provide a concise update on some of the major advances seen in breast cancer research in 2011.

First of all, we began a formal multidisciplinary breast program at Saint Francis in early 2011 that led to a very prestigious designation from the National Accreditation Program for Breast Centers (NAPBC). This organization awards centers with this recognition based on a strict audit of 28 different standards that must be achieved, covering all aspects of breast cancer care, including multidisciplinary breast conferences as well as excellence in radiation oncology, pathology, radiology, surgery, medical oncology, nurse navigation, genetic counseling, nursing, clinical trials, and community outreach. We were recognized for full compliance with every one of the standards--a rare achievement--and were granted a full 3-year accreditation.

We also received designation as a Breast Imaging Center of Excellence through the American College of Radiology, indicating excellence in all aspects of breast imaging and diagnostic evaluation. We are also in the second year of a three year application

process to become an accredited breast center by the National Quality Measures for Breast Centers (NQMBC), which would complete our three accreditations to receive designation as a CHI Breast Center of Excellence.

These accreditations represent a validation of our high quality multidisciplinary care of breast cancer patients. We adhere to strict standards in pathology assessment and reporting, radiology services of imaging performance and interpretation to biopsy evaluation, surgical care for breast cancer removal and breast reconstruction, and radiation and medical oncology treatment. We also offer exceptional supportive care services and clinical trials options for patients. On a bi-weekly basis, we conduct a multidisciplinary breast cancer conference that includes the radiologists, pathologists, surgeons, medical oncologists, radiation oncologist, and primary care physicians to optimize our delivery of excellent patient care.

Our program at Saint Francis Medical Center provides a wide spectrum of supportive services for our breast cancer patients. When a patient is first diagnosed with breast cancer, our nurse navigator immediately provides counseling to the patient and helps arrange and also attend their oncologic and surgical evaluations. The navigator then assists the patient throughout their entire treatment experience, making their journey much more comforting and reassuring. We have two genetic counselors that assist in identifying and counseling patients or family members with high risk genetic syndromes. Our team also includes certified nicotine cessation facilitators, a dietitian, family counselor, and chaplain. We also have multidisciplinary rehabilitation rounds on a weekly basis to discuss individual patient needs for supportive services.

2011 Breast Cancer Report

Dr. Ryan Ramaekers

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A perennial strength of our cancer center has been our clinical trials program. In 2011, we offered several different breast cancer treatment and registry trials for patient participation. We feel privileged to provide patients with this unique opportunity to help further scientific advancement and to also be a possible direct beneficiary of new treatments today that may be our future standard of care. We continue to be an affiliate of the Eppley Cancer Center (a National Cancer Institute designated center) which provided us with access to an adjuvant breast cancer trial using cyclophosphamide and paclitaxel in a dose-dense fashion for six cycles. We had very high accrual to this trial in 2011, both helping our patients and providing enrichment to the scientific endeavors of the Eppley Cancer Center. We look forward to our participation in the upcoming Eppley Cancer Center’s neoadjuvant trial of cyclophosphamide and paclitaxel that also utilizes full gene expression profiling and whole exome DNA sequencing correlation to response and outcome.

We were fortunate to have three breast-cancer related abstracts presented at our recent American Society of Clinical Oncology (ASCO) annual meetings. One presentation was very well-received and reported on our center’s experience in 2011 using half-dose pegfilgrastim (with 61% of patients on breast cancer treatment) for the prevention of chemotherapy-induced neutropenia, showing that there was no decrease in efficacy but improved tolerance with less arthralgias and leukocytosis compared with standard full-dose pegfilgrastim . Our other abstract reported on our experience with the combination of letrozole and fulvestrant (at 250 mg monthly) in 32 patients with metastatic breast cancer, showing a mean duration of benefit of 15

months . Interestingly, this finding was then validated by a recent Southwest Oncology Group (SWOG) phase III trial demonstrating that the combination of anastrazole (an aromatase inhibitor similar to letrozole) and fulvestrant (also at 250 mg monthly) had a 15 month progression-free survival (PFS) compared to a statistically significantly inferior PFS for patients on exemestane alone. Our third abstract reported on our genetic counseling services, demonstrating that our designation as a National Cancer Insititute Community Cancer Centers Program (NCCCP) directly resulted in our patients receiving a higher rate of genetic counseling and testing.

Patient participation in clinical trials over the years in the United States has led to significant improvements in our detection, prevention, and treatment of breast cancer. In 2011, we learned that exemestane, an aromatase inhibitor non-chemotherapeutic oral medication, was highly effective at preventing breast cancer in women considered to be at higher risk based on their family or personal history. We also had further validation in 2011 that regular exercise, weight loss, a healthy diet, smoking cessation, and moderate or less alcohol intake helps prevent breast cancer development and recurrence.

For the treatment of metastatic breast cancer, we had some exciting advances for patients with Her2/neu positive disease, with the demonstration that pertuzumab and TDM-1 are both very effective. It was also discovered that the lapatinib plus trastuzumab combination provided better disease control that either drug alone.

Everolimus was found in estrogen-receptor positive disease to overcome hormone resistance when given with exemestane.


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Eribulin was shown in a large trial to improve the survival of women with metastatic breast cancer that had received several prior lines of chemotherapy. And finally, despite numerous studies demonstrating improved progression-free survival, the FDA approval of bevacizumab was withdrawn based on a lack of convincing overall survival improvement.

Again, the treatment of breast cancer has improved dramatically over the past several years and continued to see significant gains in 2011. This disease has transformed from a rapidly fatal disease several years ago to now a more chronic disease state with several effective and tolerable treatment strategies available. We are proud to be able to offer our patients at the Saint Francis Medical Center access to all of the newest approved breast cancer therapies, the breast cancer treatments of the future through our clinical trials, and recognized excellent care by all of our providers across a multidisciplinary spectrum.

1Ramaekers RC, Olsen J, Copur MS et al. Efficacy and safety of half-dose pegfilgrastim in cancer patients receiving cytotoxic chemotherapy. J Clin Oncol 2012;30:suppl abstr e9110.

2Obermiller AM, Copur MS et al. Fulvestrant and letrozole combination in second-line or more for estrogen receptor-positive metastatic breast cancer: efficacy and predictive factors of response. J Clin Oncol 2011; 29:suppl abstr e11137.

3Mehta RS, Barlow WE, Hortobagyi GN et al. Combination anastrazole and fulvestrant in metastatic breast cancer. N Engl J Med 2012;367:435-444.

4Copur MS, Percich S et al. Cancer genetic counseling services in a community-based cancer center in rural Nebraska: effect of National Community Cancer Centers Program (NCCCP). J Clin Oncol 2011;29:suppl abstr e16508.

5Goss PE, Ingle JN et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med 2011;364:2381-91.

6Hortobagyi GN, Piccart M et al. Everolimus for postmenopausal women with advanced breast cancer: updated results of the BOLERO-2 phase III trial. Abstract S3-7 2011 San Antonio Breast Cancer Symposium.

7Cortes J, O’Shaughnessy J et al. Eribulin monotherapy versus treatment of physician’s choice in patients with metastatic breast cancer (EMBRACE): a phase III open-label randomized study. Lancet 2011;377:914-23.

2011 Breast Cancer Report (continued)

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• Implement new Oncology-based Electronic Medical Record

• Implement Chemotherapy Library into Electronic Medical Record

• Participate in Chemosafety Initiative through Catholic Health Initiatives (CHI)

• Complete ARRA Project related to Multidisciplinary Care

• Complete other NCCCP related projects

• Improve and expand Nurse Navigation Program

• Expand the Time to Heal program to include caregivers

• Utilize TeleHealth to make Cancer Conferences available at the Memorial Health building

for healthcare providers unable to otherwise attend

• Explore options for improved patient parking areas

• Continue 3 monthly didactic Cancer Conferences

• Implement new Cancer Registry software

• Obtain QOPI (Quality Oncology Practice Initiative) certification in 2012

• Obtain accreditation from the National Accreditation Program for Breast Centers (NABPC)

• Recruit additional Medical Oncologist for growing practice

• Achieve a 45% Oncology Nursing Certification rate for oncology nurses.

• Create and implement a differentiated practice model for nurses

• Provide continuing education to professional healthcare providers

• Continually strive for improvement in pain management

• Continue to provide community education programs

• Maintain timeliness of data entry for growing cancer program

• Continue offering rotations to our UNMC Oncology fellows

• Continue offering educational rotation to UNMC Pharmacy students

• Continue offering rotations to our UNMC Radiation Therapy students

Fiscal year 2012 Cancer Program Goals


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2011 Director’s NoteSaint Francis Cancer Treatment Center, accredited by the American College of Surgeons with commendation, is committed to being a leader in the continued evolution of cancer treatment. This commitment begins at prevention, continues with diagnosis, and does not end with treatment.

Saint Francis has three board certified medical oncologists,

a board certified radiation oncologist, a certified oncology physician assistant and two certified nurse practitioners. The leadership of these professionals has positioned the Cancer Treatment Center as a leader in clinical trials, consistently exceeding accrual goals in National Cancer Institute trials. Because of our staunch commitment to research, patients have the opportunity to receive cutting-edge therapy close to home.

Advancements made in radiation therapy allow targeting of specific cancer cells while sparing healthy ones. Continuation of Intensity Modulated Radiation Therapy has allowed patients to receive high dose radiation to the site where it is most needed – the tumor – while sparing the surrounding healthy tissue of certain side effects. Saint Francis was the first cancer center in Nebraska to install a Linear Accelerator with RapidArc technology, and is currently one of only four locations in the state equipped with this technology. RapidArc technology rotates in a smooth arc around the patient, more accurately targeting the tumor. It also features an On-Board Imager and a Cone Beam CT scanner, which use images to guide patient placement and treatment delivery. This treatment is made possible by a highly-trained radiation oncologist, dosimetrist, physicist, and radiation therapists. Saint Francis Cancer Treatment Center is committed to staying on the cutting edge of radiation therapy.

As the patient, family, and oncologist make treatment decisions, a team of medical professionals guides patients through each stage of their cancer care. Specialized oncology nurses provide compassion, knowledge, and professionalism to patient care. An on-site pharmacy provides expertise regarding side effects, drug interactions, and current therapy practices. The rehabilitation team, which consists of social work, dietary, pastoral care, occupational therapy, physical therapy, speech therapy, physicians, nursing, and home health, is present to assist in any way possible. The cancer rehabilitation coordinator provides direction of the team by conducting meetings with patients and assessing their individual needs. A patient and family counselor assists patients and their families in learning to cope with the social and emotional concerns associated with cancer. The genetic counselor provides hereditary cancer risk assessment, education, genetic testing and risk management. The breast cancer nurse navigator acts as the liaison between breast cancer patients and our entire team of cancer professionals, guiding the patient through the treatment process. A variety of support groups, including tobacco cessation classes, are also available to assist patients and families during this difficult time.

The nurse navigator played a pivotal role this year in the development of our multidisciplinary care program (MDC) for breast cancer patients. Multidisciplinary care is an integrated approach to cancer care in which a team of health care professionals collaborate to develop an individual treatment plan for each patient. MDC begins at diagnosis, ensuring each patient is given all treatment options prior to surgery. The nurse navigator will meet with the patient at the first appointment after an abnormal biopsy, and will follow the patient through diagnosis, treatment and survivorship, assisting with appointment scheduling, answering questions and providing any needed support.

Max Norvell, Pharm. D.

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The MDC team brings together the medical and radiation oncologists, pathologists, radiologists and surgeons, along with the nurse navigator and other key members of the care team. This comprehensive team meets formally on a bi-weekly basis to review new cases and share insights from their own patient care and research. This collaborative approach leads to the most appropriate and well-rounded treatment plan for each patient.

Multidisciplinary care coordination is part of the Cancer Treatment Center’s larger goal to become a Breast Center of Excellence. This designation is given to breast centers that have achieved accreditation in three pillars – radiology and imaging, quality and standard of care. Saint Francis Medical Center’s Mammography Center completed the first pillar in 2010, and was designated a Breast Imaging Center of Excellence by the American College of Radiology. The quality pillar, which involves meeting 30 standards set by the National Quality Measures for Breast Centers (NQMBC), is the most involved and is expected to be completed in late 2013. The third pillar, the National Accreditation Program for Breast Centers (NAPBC), involves meeting 27 standards measuring quality of care, and should be complete by mid-2012.

Saint Francis Cancer Treatment Center continues to be a leader in clinical trials accrual. This commitment to research has been strengthened by Saint Francis’ participation in the National Community Cancer Centers Program (NCCCP) over the past five years. Saint Francis is one of five cancer centers within Catholic Health Initiatives (CHI) and 21 cancer centers nationwide to participate in this National Cancer Institute-sponsored program.

The NCCCP pilot program allows us to reach out to disparate populations, open clinical trials that were previously restricted to NCI-designated academic centers, enhance quality of care, expand survivorship and palliative

care, contribute tissue samples to a national biospecimen bank, and implement the use of electronic health records.

In 2011, Saint Francis Cancer Treatment Center was granted the Outstanding Achievement Award by the Commission on Cancer of the American College of Surgeons. This award places Saint Francis among a select group of 90 accredited cancer programs across the United States. The Outstanding Achievement Award is designed to recognize cancer programs that strive for excellence in providing quality care to cancer patients. The award is granted to facilities that demonstrate a commendation level of compliance with seven standards that represent six areas of cancer program activity: cancer committee leadership, cancer data management, clinical management, research, community outreach and quality improvement.

Because of our high patient accrual rates and commitment to cancer research, Dr. M. Sitki Copur, medical director of oncology, was selected to serve on the American Society of Clinical Oncology’s (ASCO) Cancer Research Committee for the 2011-2014 term. The committee is comprised of a select group of oncologists from around the country who specialize in cancer research. This committee is charged with the responsibility to promote, develop, and implement ASCO activities related to cancer research.

Cancer not only affects the individual, but the family as well. Thousands of Nebraska households will experience the challenge of a cancer diagnosis this year. Healing the whole person - mind, body, and spirit – will be important elements of their treatment. Saint Francis Cancer Treatment Center is proud to have established itself as a leader in treating these aspects of cancer care.

Max Norvell, Pharm.D.


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Health Connect at Home

HealthConnect at Home Saint Francis Medical Center provides Home Health Care to people in Hall, Howard, Greeley, Nance, Boone, Merrick, Hamilton and portions of Adams, Buffalo, Madison, Platte, Valley, Sherman and Wheeler counties who have a need for Skilled Nursing Services, Physical Therapy and/or Speech Therapy. If the patient has a skilled care need, they may also qualify for additional services such as Occupational Therapy, Personal Care Aide, Social Work and in home Tele-monitoring Services. Patients may use Home Health Care to bridge the gap between home and the hospital or Nursing Home. Home Health Care is ordered by a physician and is paid for by Medicare, Medicaid, the Veteran’s Administration and many insurance policies, when criteria for coverage are met. Home Health Care Staff are available to help determine if you qualify and meet the payment criteria for home health care.

Home Health Professionals in our program provide many of the services usually associated with a hospital, such as giving injections, inserting and caring for urinary catheters, wound management and Wound VACs, Infusion Access devices and the management and maintenance, helping patients with complex medication regimens and helping to arrange for equipment such as hospital

beds, wheelchairs and walkers. Home Health Aides are available Monday through Friday for assistance with bathing and personal care needs on an intermittent basis. Patients may be discharged from the hospital knowing Home Health will help them and their caregiver manage their complex health needs in their home or place of residence. A registered nurse is on-call 24 hours each day for patients who have symptoms needing assessment and instruction. Services are provided for all ages, infant through elderly.

Referrals are accepted from physicians, hospitals, families, patients, friends and interested agencies.

HealthConnect at Home Saint Francis Medical Center is Medicare Certified, and has been serving patients for over 40 years.

For further information, please call 308.398.2600 or 800.353.4894.

Ruth FrerichsClinical Manager of Home Health

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Health Connect at Home Hospice

Hospice is a philosophy of care which believes that when a cure is no longer possible, a special kind of caring can enhance the quality of life remaining for both the patient and his or her family. Hospice approaches death as a natural part of life and assists the patient and family to deal with the often complicated problems which accompany terminal illness.

Hospice care is directed by an interdisciplinary team comprised of the patient’s primary physician, the Hospice Medical Director, nurses, aides, social worker, pastoral services, dietician, bereavement counselor, pharmacist, and volunteers. The Hospice team works to achieve physical comfort as well as emotional, psychosocial and spiritual well-being. Care is primarily provided in the home but also in contractual facilities, such as nursing care facilities. HealthConnect at Home Saint Francis Hospice has contracts with nursing home facilities in our service areas and provides respite or inpatient care at Saint Francis Medical Center or the local hospitals. A physician’s order is required prior to admission and the physician must certify that he/she believes the patient’s prognosis to be six months or less if the disease follows its normal course. Hospice is fully paid for by Medicare and Medicaid, and most private insurances also have a hospice benefit. Bereavement care is provided for family members and includes support through visits, phone calls, education and counseling about grief for 13 months after the death of the patient, allowing for support to the family through all major holidays and important anniversaries. A memorial service is also provided for patient’s families and the Hospice staff annually.

HealthConnect at Home Saint Francis Medical Center Hospice is Medicare Certified and serves persons in Hall, Hamilton, Merrick, Howard, Sherman, Greeley, Nance and Boone counties and portions of Adams, Buffalo, Madison, Platte, Valley and Wheeler counties.

For further information, please call 308.398.2600 or 800.353.4894.

Cathy Ferguson RN, CHPNClinical Manager Health

Connect at Home Hospice


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2011 Support Programs

ACS I Can CopeCo-sponsored by Saint Francis Medical Center, this educational program is an annual retreat called “Celebrating Life.” This retreat is designed to help patients and their families cope with diagnosis, treatment, and day-to-day survival of cancer through communication, laughter, spirituality and understanding.

ACS CansurmountCo-sponsored by Saint Francis Medical Center, Cansurmount is a monthly support group designed to help individuals with cancer and their families to continue to live each day with hope and gain strength to look towards the future. This goal is accomplished through mutual sharing and caring of individual group members.

United Ostomy AssociationThis program aids in the rehabilitation of all ostomates. Saint Francis Medical Center’s Wound, Ostomy, Continence Nurse is an advisor of this program.

ACS Reach For RecoveryThis is a patient-to-patient visitation program for women who have been diagnosed with breast cancer. Visits are made in the acute care setting.

Wig BankLocated at a local beauty salon, this program provides patients with a free wig, depending on availability.

Look Good, Feel BetterThis program is designed to help the patient handle the personal appearance changes that may result from chemotherapy or radiation treatment. Cosmetologists, along with volunteers, work with patients diagnosed with cancer at the Saint Francis Cancer Treatment Center, offering ideas on makeup, hairstyling and accessorizing. Look Good, Feel Better is a public service program developed by the American Cancer Society and the National Cosmetology Association.

From Surviving To ThrivingThis is a support group designed to help those dealing with life after cancer treatment. Surviving cancer is a life experience that needs to be shared and understood. From Surviving to Thriving is designed to provide cancer survivors with opportunities for increased support and education. Those attending will also learn about resources available to improve quality of life.

Men’s LuncheonThis informal lunch, at a Grand Island restaurant, is sponsored by Saint Francis Hospice and offers men who have experienced the death of someone they love the opportunity to share at a monthly luncheon.

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Breast Cancer Support GroupThis monthly support group is designed to help women with breast cancer develop coping strategies. This is accomplished through mutual sharing and caring of individual group members. The goal of the group is to provide support to each individual, recognizing the personal, emotional and spiritual needs that are unique to women.

Male Caregivers Support GroupThis support group is available for men who are offering care to their loved ones experiencing cancer. It is a safe place to share concerns, thoughts and feelings and receive support, care and understanding in a confidential setting.

Bereaved Parent Support GroupSaint Francis Hospice offers this support group to any parent who has experienced a death of a child. It is offered monthly.

Young Women’s Breast Cancer Support GroupThis monthly support group is designed to help younger women with breast cancer develop coping strategies. This is accomplished through mutual sharing and caring of individual group members. The goal of the group is to provide support to each individual, recognizing the personal, emotional, and spiritual needs that are unique to women.

A Time to HealThis is a 12-week holistic rehabilitation program designed to assist women in regaining their physical, emotional, and spiritual health after breast cancer treatment. The program is offered to women who have completed surgery and chemotherapy and/or radiation for a first diagnosis of breast cancer. This program is offered twice a year.

Survivorship NewsletterPublished quarterly and sent to cancer survivors of the Saint Francis Medical Center Cancer Treatment Center.

Metastatic Breast Cancer Support GroupThis group is offered to assist women with the unique challenges of having a metastatic breast cancer diagnosis. This group is offered monthly.


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Scientific Publications from Saint Francis Cancer Treatment Center

1. Copur MS, Ledakis P. Weekly docetaxel and estramustine in hormone refractory prostate cancer. Can Con Highlights, 4;6-9, 2000.

2. Copur MS, Ledakis P, Novinski D, Bolton M. Two cases of hormone refractory prosate cancer treated with weekly docetaxel/estramustine. Case Stud Onc 2;2-6,2000.

3. Copur MS, Ledakis P, Muhvic J. Patients 65 years of age or older in cancer treatment trials. N Engl J Med 343(20);1531,2000.

4. Copur MS, Ledakis P, Norwell M. Prevention of delayed emesis caused by chemotherapy. N Engl J Med 343(12):888-890,2000.

5. Copur S, Matamaros A, Capadano M, Goertzen T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemothrapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. J Clin Oncol 19;2404-2412:2001.

6. Copur S, Ledakis P, Muhvic J. Fludarabine for chronic lymphocytic leukemia. N Eng J Med 344;1166-1168:2001.

7. Copur MS, Ledakis P, Lynch J, Hauke R, Tarantolo S, Bolton M, Norwell M, Muhvic J, Hake L, Wendt J. Weekly docetaxel and estramustine in patients with hormone refractory prostate cancer. Semin Oncol 27(4); 2001.

8. Copur S, Ledakis P, Novinski D, Mleczko K, Frankforter S, Bolton M, Fruehling R, Van Wie E, Norvell M, Muhvic J. Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy. Clin Colorectal Can 1;55-58:2001.

9. Copur MS, Ledakis P, Bolton M, Norwell M, Muhvic J. Is arimidex superior to tamoxien. J Clin Oncol, 19;2578-2581:2001.

10. Copur S, Ledakis P, Bolton M, Morse AK, Werner T, Norvell M, Muhvic J, Chu E. An adverse interaction between warfarin and capecitabine: a case report and review of the literature. Clin Colorectal Can 1(3);182-184:2001.

11. Copur S, Matamoros A,Capadano M, Goertzen T, McCowan T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. Proc ASCO 18;249:1999.

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12. Copur S,Tarantolo S, Ledakis P, Bolton M, Muhvic J, et al.Weekly estra-mustine taxotere and dexamethasone in patients with hormone refractory prostate cancer. Proc ASCO 19;347:2000.

13. Ledakis P, Copur MS, Norvell M, Lynch J, Bolton M, Elson J, March W, Woodman S, Muhvic J, Mickey M, Stroup N, Nott J, Hays R, Fuller C, Haire W. Continuous infusion versus bolus instillation of tissue plasminogen activator(tpa) in restoring the patency of occluded central venous access devices(CVADs). Proc ASCO 20;397a: 2001.

14. Copur MS, Ledakis P, Bolton M, Lynch J, Termuhlen P, Brand R, Norvell M, Muhvic J, Swantek S, Frost V, Vanpelt E, Mleczko K, Frankforter S. Weekly cisplatinum and gemcitabine in patients with locally advanced metastatic pancreatic cancer. Proc ASCO 20:156a;2001.

15. Copur MS, Chu E. Commentary on “Thymidylate Synthase Pharmacogenetics in Colorectal Cancer” Clin Colorectal Can 1(3):167-168:2001.

16. Copur MS, Ledakis P, Norvell M. Nephrectomy for metastatic renal cancer. N Eng J Med 346;1095-1096:2002.

17. CopurMS, Ledakis P, Bolton M. Molecular profiling of lymphoma. N Eng J Med 347;1376-1377:2002.

18. Copur S, Matamoros A,Capadano M, Goertzen T, McCowan T, Brand R, Lynch JC, Tempero M. Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. Proc ASCO 18;249:1999.

19. Copur S,Tarantolo S, Ledakis P, Bolton M, Muhvic J, et al.Weekly estra-mustine taxotere and dexamethasone in patients with hormone refractory prostate cancer. Proc ASCO 19;347:2000.

20. Ledakis P, Copur MS, Norvell M, Lynch J, Bolton M, Elson J, March W, Woodman S, Muhvic J, Mickey M, Stroup N, Nott J, Hays R, Fuller C, Haire W. Continuous infusion versus bolus instillation of tissue plasminogen activator(tpa) in restoring the patency of occluded central venous access devices (CVADs). Proc ASCO 20;397a: 2001.

21. Copur MS, Ledakis P, Bolton M, Lynch J, Termuhlen P, Brand R, Norvell M, Muhvic J, Swantek S, Frost V, Vanpelt E, Mleczko K, Frankforter S. Weekly cisplatinum and gemcitabine in patients with locally advanced metastatic pancreatic cancer. Proc ASCO 20:156a;2001.


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Scientific Publications (continued)22. Copur MS, Ledakis P, Bolton M, Lynch J, Norvell M, Muhvoc J, Marsh W, Novinski D,

Allen J, Swantek S, Beran M, Reynolds J, Folk J, Woodward S. Weekly Docetaxel and irinotecan in previously treated metastatic non-small cell lung cancer. Proc ASCO 20: 2002.

23. Ledakis P, CopurMS, Bolton M, Lynch J, Reynolds J, Norvell M, Muhvic J, Mickey M, Beisner D, Stroup N, Frost V, Mleczko KL, Frankforter S. Weekly Paclitaxel and carboplatin with concurrent radiation followed by paclitaxel carboplatin consolidation for locally advanced non-small cell lung cancer. Proc ASCO 20:2002.

24. Copur MS, Ledakis P, Bolton M, Lynch J, Norvell M, Muhvic J, Lundgreen K, Mondolfo N, Reynolds J. Capecitabine and irinotecan on a two-week on one-week off schedule for previously treated metastatic colorectal cancer. Proc ASCO 22:2003.

25. Maung K, Lee D, DeGrendele HC, Schilsky R, Chu E, Jain VK, Copur S. Highlights from 27th congress of the European Society for Medical Oncology. Nice, France, October 18-22, 2002. Clin Colorectal Cancer. 2(3);140-145:2002.

26. Hightower M, Klem J, Lee D, Chu E, Copur S, Vain KJ. Highlights from 14th EORTC-NCI-AACR symposium on molecular targets and cancer therapeutics. Clin Colorectal Cancer 3(1);10-14:2003.

27. Maung K, Copur MS, Jain VK. New Strategies for the treatment of chemotherapy induced diarrhea. Supportive Cancer Therapy 1(2);70-74:2004.

28. Copur MS, Ledakis P, Novinski D, Fu K, Hutchins M, Frankforter S, Mleczko, Sanger WG, Wing CC. An unusual case of composite lymphoma involving chronic Lymphocytic leukemia follicular lymphoma and Hodgkin disease. Leukemia & Lymphoma 45(4);1071-1076:2004.

29. Copur MS, Deshpande A, Mleczko K, Norvell M, Hrnicek GJ, Woodward S, Frankforter S, Mandolfo N, Fu K, Chan WC. Full clinical recovery after topical acyclovir treatment of Epstein-Barr virus associated cutaneous B-cell lymphoma in patient with mycosis fungoides. Croat Med J 2005;46:458-462.

30. Copur MS, Norvell M, Obermiller A. Chemotherapy and immunotherapy in metatstatic colorectal cancer. N Eng J Med 2009;360:2135.

31. Copur MS. Sorafenib in advanced hepatocellular carcinoma.N Eng J Med 2008;359:2498. 2498-9.

32. Abuzetun JY, Loberiza F, Vose J, Bierman P, Bociek RG, Enke C, Bast M, Weisenburger D, Armitage JO; Nebraska Lymphoma Study Group. The Stanford V regimen is effective in patients with good risk Hodgkin lymphoma but radiotherapy is a necessary component. Br J Haematol. 2009 Feb;144(4):531-7. Epub 2008 Nov 26.

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33. Copur MS. Impact of older age on the efficacy of newer adjuvant chemotherapy regimens in colon cancer, a subgroup analysis of a meta-analysis: Practice changing? Certainly not; Hypothesis generating? Perhaps Clin Colorectal Can 2009 Oct;8(4):190-1.

34. Saif MW, Kaley K, Chu E, Copur MS. Safety and Efficacy of Panitumumab Therapy after Progression with Cetuximab experience at two Institutions. Clin Colorectal Cancer 2010;9:315-318.

35. R.P. Lackner, A. Ganti, W. Zhen, M.D. Copur, I. A. Vaziri, M. Bolton, T. Hlavaty, K. P. Trujillo, M. A. Kessinger,; Trimodality therapy for locally advanced non-small cell lung cancer. J Clin Oncol 2010:28 (abstr e17529).

36. Robert NJ, Saleh MN, Paul D, Generali D, Gressot L, Copur MS, et. Al. Sunitinib plus paclitaxel versus bevasizumab plus paclitaxel for first-line treatment of patients with advanced breast cancer: a Phase III, randomized, open-label trial. Miami Breast Conference. March 2010.

37. Benzel H., Fuller C., Gulzow M., Obermiller A., Mickey M., Norvell M., Copur MS, A Clinical Trial Accrual System: What a Coordinator Can Do. Experience from a Community Based Cancer Center in Rural Nebraska April 2010. http://university.asco.org/CT2010.

38. Copur MS, Benzel H, Haynatzki G, Obermiller A, Fuller C, Gluzow M, Mickey M, Norvell M; Clinical Trial Accrual and Related Activities in a Rural Nebraska Hospital before and after National Community Cancer Centers Program (NCCCP) April 2010. http://university.asco.org/CT2010.

39. Copur MS, Obermiller, A. Largest randomized trial of biliary tract cancer treatment with cisplatin plus gemcitabine versus gemcitabine alone: An excellent opportunity to evaluate the prognostic value of tumor marker Ca 19-9. Clin Colorectal Cancer 2011;10:70-71.

40. Kummar S, Copur MS, Rose M, Wadler S, Stephenson J, O’Rourke M, Brenckman M, Tilton R, Liu S-H, Jiang Z, Su T , Cheng Y, Chu E. A Phase I Study of the Chinese Herbal Medicine PHY906 as a Modulator of Irinotecan-Based Chemotherapy in Patients with Advanced Colorectal Cancer Clin Colorectal Cancer 2011;10:85-96.

41. Copur MS, Obermiller A. An Algorithm for the Effective Management of Hypertension in the Setting of Vascular Endothelial Growth Factor Signaling Inhibition. Clin Colorectal Cancer 2011;10:151-156.

42. Fulvestrant High Dose versus Lodaing Dose versus Approved Dose, Have we found the optimum dose? Obermiller A, Copur MS. Clin Breast Cancer 2011;11:195.

43. Obermiller AM, Copur MS. The longstanding quest for a better endocrine therapy Continues High Dose Fulvestrant: Have we found the effective dose, combination, setting, or sequence. Contemporary Oncology 2011;34-37.


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Scientific Publications continued

44. Sherman S, Shats O, Fleissner E, Bascom G, Yiee K, Copur M et al. Multicenter breast cancer collaborative registry. Cancer Informatics 2011;10:217-226.

45. Copur MS, Obermiller A. Ipilimumab plus dacarbazine in melanoma. N Engl J Med 2011;365:1256-1257.

46. Copur MS, Obermiller AM, Ramaekers R et al. Letrozole and fulvestrant combination in second line or more for estrogen receptor positive metastatic breast cancer. Efficacy and predictive factors of response. Copur et al., J Cancer Sci Ther 2011, S2.

Book Chapters

1. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 31-366;2002.

2. Copur MS, Harrold L, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E DeVita VT ed. 441-475;2002.

3. Chu E, Mota A, Bromberg M, Copur S, Harrold LJ, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicicans’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 21-369;2003.

4. Chu E, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur S. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 391-469;2003.

5. Copur MS, Harrold LJ, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 471-506;2003.

6. Chu E, Mota A, Bromberg M, Copur S, Harrold LJ, Tiedemann D, Fogarasi M. Chemo -therapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed.21-375;2004.

7. Chu E, Noronha V, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed.397-488;2004.

8. Copur MS, Harrold LJ, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-527;2004.

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9. Copur MS, Rose M, Chu E. Miscellaneous Chemotherapeutic Agents In: Cancer Principles & Practice of Oncology DeVita VT, Hellman S, Rosenberg SA 7th edition, 2004.

10. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 21-373;2005.

11. Chu E, Noronha V, Roy S, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-487;2005.

12. Copur MS, Harrold LJ, Kim R, Chu E. Antiemetic Agents for the Treatment of Chemotherapy-Induced Nausea and Vomiting In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 489-529;2005.

13. Chu E, Mota A, Bromberg M, Copur S, Harrold L, Tiedemann D,Roy S, Fogarasi M. Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 23-374;2006.

14. Chu E, Noronha V, Roy S, Mota A, Nabbout N, Harrold LJ, Tiedemann D, Fogarasi M, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2006.

15. Chu E, McGowan M, Elfiky A, Harrold L, Tiedemann D,Roy S, Copur S Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 15-378;2007.

16. Chu E, Noronha V, Roy S, Harrold LJ, Tiedemann D, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E,DeVita VT ed. 393-530;2007.


18. Chu E, McGowan M, Elfiky A, Harrold L, Tiedemann D,Roy S, Copur S Chemotherapeutic and Biologic Drugs In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 15-378 ;2008.

19. Chu E, Noronha V, Roy S, Harrold LJ, Tiedemann D, Copur MS. Common Chemotherapy Regimens in Clinical Practice In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2008.


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22. Copur MS, Tiedemann D, Chu E. Guidelines for chemotherapy and dosing modifications In Physicians’ Cancer Chemotherapy Drug Manual. Chu E,DeVita ed. 382-400;2009.

23. Copur MS, Chu E, Rosado MF et al. Common chemotherapy regimens in clinincal practice In: In: Physicians’ Cancer Chemotherapy Drug Manual. Chu E, DeVita VT ed. 393-530;2009.


25. Chu E, Harrold LJ, Tiedemann, Copur MS. Chemotheraputic and Biologic Drugs. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 7-386;2010.

26. Copur MS, Tiedemann D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 387-403;2010.

27. Copur MS, Chu E, Harrold LJ et al. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 404-514;2010.

28. Deshpande H, Copur MS, Harrold LJ et al. Antiemetic Agents for the Treatment of Chemotherapy Induced Nausea and Vomiting. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 515-551;2010.

29. Copur MS. Rose M, Gettinger S. Miscellaneous Chemotherapeutic Agents In: Cancer Principles & Practice of Oncology DeVita VT, Lawrence TS, Rosenberg SA 455-458 9th edition, 2011.

30. Chu E, Obermiller A, Harrold LJ, Tiedemann D, Copur MS Chemotherapeutic and Biologic Drugs. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 5-395;2011.

31. Copur MS, Tiedeman D, Chu E. Guidelines for Chemotherapy and Dosing Modifications. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 396-413;2011.

Scientific Publications continued

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32. Copur MS, Chu E, Harrold LJ, Deshpande H, Levy AL. Common Chemotherapy Regimens in Clinical Practice. In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 414-542;2011.

33. Deshpande H, Copur MS, Harrold LJ, Chu E, Levy AL. Antiemetic Agents for the treatment of Chemotherapy-Inducued Nausea and Vomiting In Physicians’ Cancer Chemotherapy Drug Manual. Chu E, De Vita ed. 543-581;2011.


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Cancer Committee 2011The Cancer Committee is comprised of representatives from primary and specialty care physicians, as well as representatives from ancillary departments involved in the care of cancer patients. The multidisciplinary committee meets quarterly to evaluate overall program activity, evaluate the quality of the program, and set goals for future improvement.

M. Sitki Copur, M.D., FACPChairman, Medical Oncology

Mark Bolton, Ph.D., M.D.Radiation Oncology

William Marsh, M.D.Diagnostic Radiology

Rebecca Steinke, M.D.Family Practice

Deb Nelson, A.P.R.N.Oncology Nurse Practitioner

Mary Mickey, R.N.Manager, Medical Oncology

Heather Benzel, R.N.Oncology Research Nurse

Beth Gonnerman, B.S., MAMCancer Rehabilitation

Coordinator

Mary Ann Kalinay, M.S., LMHPSocial Work

Cindy Linke, R.H.I.A.Director, Health Information

Christina PetersManager, Health Information

Ann Tvrdy, MSN, CRNIOncology Project Coordinator

Melham Jabbour, M.D.Medical Oncology

Michael Horn, M.D.Vice President of Medical Affairs

Kris Mleczko, M.D.Pathology

James Omel, M.D.Patient Advocate

Dale HartwigVice President Ancillary Services

Marlene Hinrichs, BSRS, R.T.Manager, Radiation Oncology

LuAnn Carraher, R.N.Hospice Coordinator

Connie Hameloth, R.N.Community Outreach

Coordinator

Jill KochAmerican Cancer Society

Erin MartinezOncology Marketing

Stephanie Percich, MSGenetic Counselor

Deb Wilson, R.N.Clinical Quality Specialist

Ryan Ramaekers, M.D.Medical Oncology

Brant Luebbe, M.D.Surgery, Cancer Liaison

Steven Schneider, M.D.Surgery

Rita Hays, A.P.R.N.Oncology Nurse Practitioner

Max Norvell, Pharm.D.Director, Oncology Services

Beth Bartlett, R.N.Director, Nursing Supervisors

Courtney Fuller, R.N., OCNOncology Research Nurse

Sherry Huffman, M.Ed.Director, Educational Services

Jacque Langford, B.S.N.Nurse Navigator

Leslie Mlinar, CTRCancer Program Coordinator

Patty Tripp, R.H.I.T, CTRCancer Data Coordinator

35

Saint Francis Cancer Treatment Center Locations:

Grand Island2116 W. Faidley AvenueGrand Island, NE 68803

(308) 398-5450

Hastings2nd Street & Marian Road

Hastings, NE 68901(402) 461-5588

M. Sitki Copur, MD, FACPRyan Ramaekers, MD, BPL

Melhem Jabbour, MD

Medical Oncologists:

Radiation Oncologist:

Mark Bolton, PhD, MD

Date post:	30-Mar-2016
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2011 Cancer Annual Report

Documents