32
Annual Report 2015
Annual Report 2015
Centra Cancer Care Services Annual Report 2015
OVERVIEW OF CANCER CARE SERVICESAbout the Centra Alan B. Pearson Regional CancerCenter ...................................................................2Report From The Cancer Liaison............................3CP3R Performance Report .....................................3Summary of Services .............................................5Clinical Trials ........................................................ 7Quality Studies ......................................................9Quality Improvements .........................................11Prevention and Screening Programs ....................15Skin Cancer Screening.........................................16Monitoring Compliance ......................................18Cancer Registry Report ........................................202014 Didactic Presentations ................................21
CENTRA CANCER STATISTICS, 2014 Primary Site - All Cases ........................................22Primary Site - Analytic Cases................................23Distribution By Age And Sex ...............................24Distribution By Treatment....................................24Distribution By TNM Stage..................................24Distribution By Stage And Sex.............................25Locality Of New Cases.........................................25Site Tabulation By Sex .........................................26Site By AJCC Tabulation.......................................27Site By Treatment ................................................28Site By Race.........................................................29
© September 2016
About the Centra Alan B. Pearson Regional Cancer Center
2
Centra Cancer Care Services offers high quality,
comprehensive, compassionate care for patients
through education, screening, treatment and
survivorship services. From the latest cancer-fighting
technology to state-of-the-art facilities and services,
Centra cares for patients and their families
throughout Central Virginia. Our services and
treatments range from the newest minimally invasive
robotic surgery and Trilogy linear accelerator to
chemotherapy to genetic testing and clinical trials. We
treat a broad range of cancers, including lung,
prostate, breast, brain, kidney, bladder, ovarian,
lymphoma, leukemia, colon, uterine and rectal
cancers as well as many others.
This year, Cancer Services received reaccreditation
from the Commission on Cancer of the American
College of Surgeons (CoC). For cancer patients and
their families, this means comprehensive care, a range
of excellent services and equipment, quality treatment
options, and access to cancer-related information,
education and support. The Centra Comphrensive
Breast Cancer Program was also reaccredited by the
National Accreditation Program for Breast Cancers
(NAPBC). Our program was evaluated on the highest
level of standards, including cancer committee
leadership, cancer data management, access to
resources and support, as well as ongoing clinical trials
and the best treatment options. Additionally, Cancer
Services continued to earn Quality Oncology Practice
Initiative (QOPI) certification, which recognizes
practices committed to delivering the highest quality of
cancer care, with a focus on patient care and safety.
In 2015, the Brainlab Stereotactic Radiosurgery
platform was installed on the Truebeam linear
accelerator in Radiation Oncology. This system enables
us to treat cancer with substantially greater precision
than before. Treatments with this precision can
provide much higher doses to the target without
increasing the side effects of therapy. This greatly
increases the effectiveness of the treatments. The first
patients using this system were treated in October, and
we will continue to expand the use of this system.
Centra is committed to providing an exceptional,
multidisciplinary approach throughout all phases of
cancer treatment, from initial diagnosis to survivorship
classes. While we understand the diagnosis of cancer
can be life changing, our commitment is to help
patients throughout their journey with excellent care,
for life.
Matt Foster, MD
Associate Medical Director
Cancer Committee Chairman
Curt Baker
Vice President
Oncology
Carol Riggins, RN, MSN, GCNS-BC
Managing Director
Alan B. Pearson
Regional Cancer Center
3
A Report From The Cancer Liaison
CP3R Performance Report continued on next page
The year 2015 was one ofcontinued refinement
and improvement. One ofthe tools we use in analyzingwhere we are is our CancerProgram Practice ProfileReport (CP3R). The CP3Rdata allows us to see wherewe are nationally and makeadjustments as needed. Thedata is submitted annually tothe National Cancer Database(NCDB) that provide feedback to the Commision onCancer (CoC) to assure patients are being treatedaccording to nationally accepted guidelines.
With no significant changes to the cancer careservice team, we focused primarily on careful self-assessment with a goal of making measureddifferences in the delivery of patient care. Each areahas its strengths, its stand-out processes that simplywork. With that information we are able to work atadapting the measures to the varied patientpopulations and treatments; and with that we willpaint them over the entire cancer center with abroad brush.
John M. Salmon, M.D.
For example, the breast cancer program hasalways been the leader in screening and navigation.However, because of differences in imaging, patientdemographics and therapy options, these successfultechniques cannot simply be rubber-stamped ontothe world of lung cancer. By working to betterdevelop our lung cancer screening, we now have amore robust method of identifying patients earlier,similar to what we have been doing for many yearswith breast cancer. We have also continued to adaptthe multidisciplinary approach that so easily fitsbreast cancer treatment to these same patients,shortening and simplifying the voyage fromdiagnosis to definitive treatment.
This may seem a small advance, but learning tobetter adapt the system as a whole is possibly thesingle most important skill we can develop whileusing the data gained from our CP3R data, as wemove to use the same technique in all areas ofpatient care, from diagnosis to treatment, tosurvivorship and supportive care. Because, for thesake of all those in the Central Virginia area, wedon't want to be the best at breast cancer treatmentor lung cancer treatment; we want to be the best atcancer treatment.
John M. Salmon, M.D.
CP3R Performance Report: Colon
MEASURE SPECIFICATIONS COC OUR CANCERDIAGNOSIS YEAR 2013 REQUIREMENT PROGRAM
At least 12 regional lymph nodes are removed andpathologically examined for resected colon cancer. (QualityImprovement)
Adjuvant chemotherapy is recommended or administeredwithin four months (120 days) of diagnosis for patients underthe age of 80 with AJCC stage III (lymph node positive) coloncancer. (Accountability)
12RLN 4.5 / 85% 94.00
ACT Not Applicable 90.50
4
CP3R Performance Report
Breast
MEASURE SPECIFICATIONS COC OUR CANCERDIAGNOSIS YEAR 2013 REQUIREMENT PROGRAM
Radiation is administered within one year (365 days) ofdiagnosis for women under the age of 70 receiving breastconservation surgery for breast cancer. (Accountability)
Tamoxifen or third generation aromatase inhibitor isrecommended or administered within one year (365 days) ofdiagnosis for women with AJCC T1c or stage IB-III hormonereceptor positive breast cancer. (Accountability)
Radiation therapy is recommended or administered followingany mastectomy within one year (365 days) of diagnosis ofbreast cancer for women with >= 4 positive regional lymphnodes. (Accountability)
Image or palpation-guided needle biopsy to the primary site isperformed to establish diagnosis of breast cancer. (QualityImprovement)
Breast conservation surgery rate for women with AJCC clinicalstage 0, I, or II breast cancer. (Surveillance)
Combination chemotherapy is recommended or administeredwithin four months (120 days) of diagnosis for women under70 with AJCC T1cN0, or stage IB - III hormone receptornegative breast cancer. (Accountability)
BCSRT 4.4 / 90% 89.30
HT 4.4 / 90% 91.00
MASTRT 4.4 / 90% 90.00
nBx 4.5 /80% 96.50
BCS Not Applicable 52.40
MAC Not Applicable 100.00
Lung
MEASURE SPECIFICATIONS COC OUR CANCERDIAGNOSIS YEAR 2013 REQUIREMENT PROGRAM
Systemic chemotherapy is administered within four months today preoperatively or day of surgery to six monthspostoperatively, or it is recommended for surgically resectedcases with pathologic lymph node-positive (pN1) and (pN2)NSCLC. (Quality Improvement)
Surgery is the first course of treatment for cN2, M0 lungcases. (Quality Improvement)
At least 10 regional lymph nodes are removed andpathologically examined for AJCC stage IA, IB, IIA and IIBreseted NSCLC. (Surveillance)
LCT 4.5 / 85% 88.90
LNoSurg 4.5 / 85% 85.00
10RLN Not Applicable 72.50
5
Summary of Services
Radiation Oncology Radiation Oncology uses a multidisciplinary
approach, in which our board-certified radiationoncologists determine the best treatment plan andwork with a team of nurses, technicians, physicistsand others to provide continuous care throughcancer diagnosis and treatment. Additionally, withthe installation of the TrueBeam STx system andBrainLab ExacTrac system, clinicians can deliverpowerful radiation treatments with greater accuracyand precision.
Oncology Nurse NavigatorsCentra nurse navigators are bachelor- or master-
prepared, oncology-certified registered nurses whoensure continuity of care for patients by coordinatingcare from diagnosis through treatment and recovery.Navigators are able to provide education and supportto ensure that patients are well informed andunderstand the information provided. Nursenavigators also lead oncology quality initiatives andprovide education to the community aboutprevention, screenings and cancer care at Centra.
Breast Imaging ServicesCentra’s breast imaging team is composed of
medical and technical staff dedicated to the detectionand diagnosis of breast cancer. Because of our highlevel of care, image quality, and patient safety, we areaccredited by the American College of Radiology as aBreast Imaging Center of Excellence. Our fully digitalscreening and diagnostic services also include 3Dtechnology, also called tomosynthesis, which enablesour fellowship-trained radiologists to more clearlyidentify and characterize structures in the breast.
Social WorkOur licensed and master’s degree prepared social
worker is available to assist with the psychosocial needsof patients and caregivers. She is certified in oncology,hospice and palliative care and also provides servicesthat assist patients with logistical concerns related to lifewith cancer.
Centra oncology
nurse navigators
ensure continuity
of care for
patients by
coordinating care
from diagnosis
through
treatment and
recovery.
continued on the next page
6
Summary Of Services (continued)
Palliative Care Palliative Care is specialized medical care focusing
on providing patients with relief from the symptoms,pain and stresses of a serious illness. The Palliative Careteam’s goal is to help patients and families maintain andachieve their treatment goals throughout their illness.Our team became one of the first 25 programsnationally to earn advanced certification for palliativecare through the Joint Commission, which recognizedour exceptional patient- and family-centered care forpatients with serious, life-limiting illnesses.
To accommodate our growth, we implementedgreater flexibility in our hours and team approach. Notonly have we been able to offer an earlier start time forconsults, we also have implemented a triage method tobest ensure appropriate timing for such importantdiscussions. As a team, we understand the importanceof timing as well as having the right family, friends orcaregivers present to create optimum outcomes.
Centra HospiceCentra Hospice is a locally owned, not-for-profit
organization that has been serving the community formore than 30 years. Hospice is a philosophy of carethat is committed to helping a person live out the lastmonths, weeks and days of life as fully as possible.Hospice is for individuals seeking comfort and reliefof symptoms rather than curative treatment andserves patients in their homes, assisted living, nursingfacilities, hospitals and Centra's Hospice House.Hospice care extends to the family, caregivers andfriends, providing culturally sensitive care for peopleof any background, faith or diagnosis.
Centra Hospice provides a team-oriented
approach to expert medical care, pain managementand emotional and spiritual support tailored to thepatients and families’ needs. Centra Hospice offersmany options for personalized services, includingmusic therapy, comfort touch massage, aromatherapyand pet therapy. Our hospice services offer morechoices and options for care than traditionalhospices. Centra Hospice has a dedicated, full-timemedical director, physicians, nurse practitioners,nurses, pharmacists, home care aides, social workers,chaplains, volunteers and therapists.
Centra Hospice is a member of the NationalHospice and Palliative Care Association, a member ofthe Virginia Association for Home Care and Hospiceand certified by the Joint Commission, Medicare, andMedicaid. Centra Hospice was founded in 1983 asHospice of the Hills and was one of the first inVirginia. Since its founding, Centra Hospice hasprovided service to hundreds of patients living inCentral Virginia.
Centra Medical Group Lynchburg Hematology Oncology
Centra Medical Group Lynchburg HematologyOncology is a medical oncology and hematologypractice located on the second floor of the CentraAlan B. Pearson Regional Cancer Center. Ourphysicians and staff provide compassionate andcomprehensive care to patients with cancer andblood disorders. The practice is QOPI certified by theAmerican Society of Clinical Oncology and offersclinical trials in partnership with various local,regional and national healthcare organizations.
GENITOURINARY CANCERS
SWOG 0931
AllianceA031201
SWOG 1216*New*TAK-700(millenniumPharma., Inc.) isprovided forarm 1 patients
S1400“Lung Map”Trial(for squamouscell)
A151216ALCHEMIST
EA6134*New*
EA6141*New*
Phase III study for patients with renal cell cancerfollowing full surgical resection and must beconsidered intermediate high risk or very high risk.
Phase III trial of Enzalutamide Versus Enzalutamide,Abriaterone and Prednisone for Castration ResistantMetastatic Prostate Cancer.
A Phase III randomized trial comparing AndrogenDeprivation Therapy + TAK-700 with AndrogenDeprivation Therapy + Bicalutamide in patients withnewly diagnosed metastatic hormone sensitiveprostate cancer.
Phase II/III Biomarker-Driven Master Protocol forSecond Line Therapy of Squamous Cell LungCancer (Trial has two steps: Step one - patientconsents to Foundation One test, Step two -patient consents to assigned treatment arm.Eligibility varies for each arm.
Adjuvant lung Cancer enrichment markeridentification and sequencing trial.
Patients are screened for EGFR/ALK/ PDL1 mu(even if already known) and proceed torandomization (placebo trial) after surgery andafter adjuvant therapy if required.
Trial of Dabrafenib plus Trametinib followed byIpilimumab plus Nivolumab/Ipilumumab atProgression vs. Ipilumumab plus Nivolumabfollowed by Dabrafenib plus Trametinib atProgression in patients with advancedBRAFV600 mutant melanoma.
Randomized phase II/III study of Nivolumab plusIpilimumab plus Sargramostim versus Nivolumab plus Ipilimumab in patients with unresectable stage III or stage IV Melanoma
LUNG CANCER
Clinical Trials
7
OncologyClinical Trials
Clinical trials open to accrual -Summer 2016
Lynchburg Hematology-Oncology Clinic1701 Thomson DriveSuite 200Lynchburg, Virginia24501
MELANOMA
8
Clinical Trials (continued)
OncologyClinical Trials
Clinical Research Contacts:
Research Registration/Treatment Coordinator:
Donna Washburn, MSN, RN,CNS
434.200.1495
CRA/Regulatory Management:Leigh McConaghy, BSN, RN
434.200.1496
CRA/Data ManagementBrenda Young, LPN
434.200.1416
BREAST CANCER
PREVENT
ECOG 2112
NSABP B55OLIMPIA
A011401
S1404
EAY131MATCH
Preventing anthracycline cardiovascular toxicity withstatins. New diagnoses of Stage 1 to 3 breast cancer orlymphoma scheduled to receive an anthracycline
A Randomized Phase III Trial of endocrine therapyplus Entinostat/placebo in postmenopausal patientswith hormone receptor-positive advanced breastcancer.
Phase III study of Olaparib Versus placebo asadjuvant treatment in patients with BRCA ½mutations and high risk HER2 negative primarybreast cancer who have completed definitive localtreatment.
Randomized Phase III trial evaluating the role ofweight loss in adjuvant treatment of overweightand obese women with early breast cancer.
A Phase III randomized trial comparing physician/patient choice of either high dose Interferon orIpilimumab to MK-3475 (Pembrolizumab) inpatients with high risk resected melanoma.
Molecular Analysis for Therapy Choice (MATCH) forpatients with solid tumors and lymphomas whosedisease has progressed following at least one line ofstandard systemic therapy or for whom nostandard therapy exists.
PENDING STUDIES
9
Quality Studies
TopicRate of excisional biopsy for primary breast cancer
diagnosis
Statement of the problemAs part of the quarterly review of dashboard goals
and compliance with NAPBC standards, there wasconcern raised over the rate of excisional biopsy ordefinitive surgical excision as the primary method ofobtaining a breast cancer diagnosis. This is NAPBCstandard 2.9:
The standard says that: Palpation-guided or image-guided needle biopsy is the initial diagnostic approachrather than open biopsy.
Either fine needle aspiration for cytologic evaluationor core needle biopsy constitutes the initial diagnosticapproach for palpable or occult lesions. Open surgicalbiopsy as an initial approach should be avoided as itdoes not allow for treatment planning and is associatedwith a high reexcision rate.
Data collected by the program and reported to thebreast leadership committee indicated a non-invasivebiopsy rate of 91.8 percent for patients in the programin 2014. Although this number is a better average thanthe average of 90 percent recommended by the NCBC,it is well below our comprehensive breast program’sgoal of 95 percent. The NQF also recommends thatneedle biopsy should precede a surgicalexcision/resection, and the NAPBC Standard 2.9requirement states “open surgical biopsy should beavoided.” A study was proposed to explore the issue andany need for corrective action.
Study design• A list of the 2014 breast cancer patients counted as
having their primary diagnosis made by excisionwas prepared by Cancer Registry with capsulesummaries of each patient’s diagnostic history andsupplied to Karl Biesemier, MD.
• Dr. Biesemier reviewed the list and correlated withadditional information from the pathologyinformation system (CoPath).
• Results of the analysis were reported to the breastleadership committee for discussion.
Study objectives• Assess the accuracy of the collected data on rates of
excisional surgery for initial breast cancer diagnosis.• Assess the need for corrective action.
Findings• Twenty-three patients were identified as not
meeting the NAPBC standard by the registry.• On review, Dr. Biesemier found that only five of the
patients actually qualified as having primarydiagnosis by excision without prior attempt at anon-invasive biopsy.
• Dr. Biesemier reiterated the interpretation of thestandard that a non-invasive biopsy, either FNA orcore biopsy, should be the initial approach toobtaining a diagnosis for palpable or occult breastlesions.
• Eighteen of the initially identified 23 patients had anon-invasive biopsy prior to having definitivediagnosis made on an excisional specimen. Thosebiopsies ranged from non-diagnostic to atypical.
• The five patients who had a breast cancer diagnosiswithout a prior attempted non-invasive biopsy allhad documented contraindications, includingcoagulopathies and refusal to undergo non-invasivebiopsy.
• The corrected rate of non-invasive biopsy as theinitial method for obtaining a diagnosis is 199/204= 97.5 percent, above both the national benchmarkand also the Centra comprehensive breast programsown benchmark.
The rate of excisional biopsy for primary breast cancer: Patient care study of quality standard 4.7
continued on the next page
10
Quality Studies
Recommendations1. In assessing this quality indicator, NAPBC standard
2.9, cases should only be considered not meeting thegoal if the patient has no FNA or core biopsy of alesion prior to diagnosis of breast carcinoma.
2. Although the success (positive predictive value) of
Patient care study of quality standard 4.7 continued
non-invasive biopsies is a different measure than thestudied standard, this rate should be evaluated byBreast Imaging as part of our ongoing qualityassessment.
3. Corrective action was found to be needed by thisstudy.
The use of PET scans on eligible lung patientsPatient care study of quality standard 4.7
TopicQuality of physicians’ following of NCCN
guidelines on eligible lung patients in use of PET scans
Statement of the problemAt our weekly thoracic cancer conferences there was
a question of concern that physicians within thethoracic program were not offering PET scans to alleligible newly diagnosed lung patients in accordance toNCCN guidelines that recommend patients receive PETscans for clinical stages I, II and III. This raised concernthat the thoracic program may have an issue withfollowing NCCN guidelines and may need to be moreclosely reviewed.
Study criteria• John Salmon, MD, to conduct study reviewing
eligible lung patients• Clinical stages I, II, III• Nine eligible lung patients reviewed • Cases diagnosed between June 1, 2015 – June 30, 2015• Report findings to cancer committee
ObjectivesAssess the accuracy of following NCCN guidelines
of PET scans on eligible lung patients.
FindingsPET scans on eligible lung patients:Results and Discussion:• Of the 121 lung patients, it was found that 82
patients received PET scans• Thirty patients were Stage IV and not eligible for
this study• Nine patients were found eligible as they were
found with no PET scanso Four patients passed away prior to scano Two opted to go elsewhereo One refused all serviceso One was not eligible due to multiple medical
problemso One SNL biopsy only
RecommendationsDr. Salmon concluded that although the number of
patients who have not had PET scans seems high, PETscans were offered to all eligible patients. We willcontinue to monitor the PET scan rates in terms ofcomparison with NCCN to the rest of the country andfollow up during our weekly thoracic conference.
11
Quality Improvements
Project descriptionBreast leadership identified a misinterpretation of
data as a result of study performed to analyze rate ofexcisional biopsy for breast cancer (standard 4.7) andcompliance with NAPBC standards (standard 2.9).There was concern raised over the rate of excisionalbiopsy or definitive surgical excision as the primarymethod of obtaining a breast cancer diagnosis. Theconcern was that our needle biopsy rate reflected only91.8 percent eligible patients had biopsy prior tosurgery. With 204 new cases in 2014, this would suggestat least 16 women went to the operating room forbiopsy.
Although this number is a better average than theaverage of 90 percent recommended by the NCBC, it iswell below our own comprehensive breast program goalof 95 percent. Also, the NQF recommends that needlebiopsy should precede a surgical excision/resection, andthe NAPBC Standard 2.9 requirement states “opensurgical biopsy should be avoided.” Certainly there arecases diagnosed at excision, such as suspectedpapillomas, sent directly for excision that are found tocontain DCIS. Thus, are patients with high risk resultsat biopsy (ADH, ALH etc) considered to not havebiopsy proven disease if they are found to havemalignancy at excision?
A study (standard 4.7) was initiated to review thispossibility. Twenty-three patients were identified as notmeeting the NAPBC standard by the registry. Onreview, Karl Biesemier, MD, found that only five of thepatients actually qualified as having primary diagnosisby excision without prior attempt at a non-invasivebiopsy. Eighteen of the initially identified 23 patientshad a non-invasive biopsy prior to having definitivediagnosis made on an excisional specimen. Thosebiopsies ranged from non-diagnostic to atypical. The
Patient care quality improvement standard 4.8Quality improvement based on study documenting the rate of excisional biopsyof primary breast cancer from standard 4.7
five patients who had a breast cancer diagnosis withouta prior attempted non-invasive biopsy all haddocumented contraindications, includingcoagulopathies and refusal to undergo non-invasivebiopsy. The corrected rate of non-invasive biopsy as theinitial method for obtaining a diagnosis is 199/204 =97.5 percent, in line with the national benchmark.
Processes changedDr. Biesemier discussed the findings of his study
with the registry, specifically that the registry wasincorrectly counting positive biopsies and not non-diagnostic or only atypical biopsies as the initialdiagnostic approach for palpable or occult lesions. Hereiterated to the breast leadership and registry staff thata non-invasive biopsy, either FNA or core biopsy, shouldbe the initial approach to obtaining a diagnosis forpalpable or occult breast lesions. Corrective action hastaken place in the registry in regard to how the data willbe interpreted and information is submitted in the ERSsystem.
Quality improvementIt was found that the registry was incorrectly
counting only positive biopsies and not non-diagnosticor only atypical biopsies as the initial diagnosticapproach for palpable or occult lesions. Based oneducation of registry staff by Dr. Biesemier, eligiblebreast biopsies that lead to a positive diagnosis of breastcancer will now be counted. Based on discussion withbreast program leadership, there is increased awarenessamong the medical staff and breast physician leadershipof the importance of a non-invasive biopsy as the initialapproach to obtaining a diagnosis for palpable or occultbreast lesions.
12
Quality Improvements
PlanSeveral near misses have occurred during treatment
when therapists have been entering data into the recordand verify system or using information fromdocuments inside the vault. Studies have shown that themanual entry of data is a weakness in a radiationoncology quality assurance program and can be adisproportionate source of errors.1 These errors can havea severe impact on the quality of treatment the patientreceives.2, 3 These events have been recorded in theRadiation Oncology – Incident Learning System (RO-ILS) database.4 An examination of the cause of theseerrors led to the conclusion that the therapists needworkstations with EMR access in the treatment rooms.We have implemented these workstations and aremeasuring their impact on error reduction.
PredictionsWe examined the rate of treatment incidents after
the implementation of Computers on Wheels (COWs)to determine if the source of these errors has beenadequately addressed.
DoThe purchasing process for the Computers on
Wheels was somewhat lengthy because the preferredvendor for the carts was changed in the middle. It wasnot until July 2015 that they were actually delivered. Weran into several challenges putting the carts into clinicaluse. There were no wireless access points in the
Implementing COWs to reduce data transcription errors to and from the radiation oncology record and verify system
treatment vaults, making it impossible to access theEMR within them. Those had to be added. Even then,there were problems with the wireless signal strengthfrom those points. This proved to be an important issuebecause the therapists would be logged out of the CitrixEMR environment if the wireless signal was lost.Logging back into the EMR took a few minutes, whichdistracted the therapists away from patient care.Eventually, these wireless signal issues were straightenedout.
Another issue was the privacy timeout on theworkstations that locked the screen after a certainperiod of inactivity. When the screen locked out, it wasfound that the wireless signal also was dropped. Thislogged out the therapists and forced them to log inagain. We are still working out a solution to this issue.
StudyIn the six months since we put the COWs into
clinical use, there have been no further incidents of theincorrect entry of treatment parameters. We willcontinue to collect statistics to determine whether thischange has had a positive impact.
ActWe have adjusted our treatment simulation process
to incorporate electronic entry of treatment parameters.Early results suggest that this change has resulted inimproved quality of our treatment simulations, and hastherefore improved patient safety.
1. Clark BG, Brown RJ, Ploquin J, et al. Patient safety improvements in radiationtreatment through 5 years of incident learning. Pract Radiat Oncol3:157–163. 2013.
2. ] Klein, Eric E et al. Errors in Radiation Oncology: A Study in Pathways andDosimetric Impact. Journal of Applied Clinical Medical Physics, [S.l.], v. 6, n.3, aug. 2005.
Citations3. Macklis RM, Meier T, Weinhous MS. Error rates in clinical radiotherapy. J Clin
Oncol. Feb;16(2):551-556. 2009.
4. Suzanne B. Evans, Special Series: Quality Care Symposium - Perspective:Patient Safety Across Disciplines: Radiation Oncology Incident LearningSystem JOP JOP.2015.004341; published online on April 21, 2015
13
Quality Improvements
Radiation oncology:Daily huddle and pre-appointment review
PlanIt was determined that there was a need to have
physician and additional therapist involvement in thedaily huddle for the radiation oncology department.The time for the huddle was changed to the beginningof the day with the objective being to discuss safety andtreatment for patients that are scheduled for that day.The patients for the following appointments are thepriority of the daily huddle: initial simulation (in CT orat treatment unit), verification simulations for initialand boost treatment plans and patients who will bestarting their treatments that day. Information aboutother patients and questions are also discussed.
PredictionsThe huddle was moved to the beginning of the day
to improve attendance by physicians and radiationtherapists to ensure verification that all planning, QAchecks and documents are completed and approvedprior to the patient’s appointment. This is to alleviateany delay once the patient is on the treatment table.Therapists are to review all of the planning informationand documentation the evening prior to the patient’sappointment and if there are any issues that need to becompleted before the patient comes in, the responsibleparty will be notified in the daily huddle.
Examples of the topics of discussion that areexpected during the daily huddle.: physicians can givethe CT Sim therapist any needed/helpful informationabout their patients for that day; dosimetry can relayany information about a patient’s treatment plan thatmay be slightly out of the ordinary.
Plan for collection of data The therapists in CT Sim and Treatment will review
the necessary information for their patients for the nextday and record on the daily huddle sheet if theinformation is not completed and/or approved and ifthere are any questions about the patients.
DoThe therapist in CT Sim and Treatment will review
and record the necessary information for the patientsscheduled. Review is to be done in the afternoon the daybefore or the morning of the patient’s appointmentbefore daily huddle.
In the daily huddle, the therapist will instruct theappropriate person to complete any unfinishedinformation and/or approvals and find answers toquestions that may have arisen during the informationreview prior to the patient’s appointment.
The lead therapist will review the daily huddlesheets to determine information that needs to becompleted and approved by the morning of the patient’sappointment.
This will be used to determine areas that arehindering completion and approval of the information.
We will work with these areas to determine whatneeds to be adjusted in the workflow to be able to getthe information completed and approved by themorning of the patient’s appointment.
StudyThe predictions were correct. This process has
provided communication between the treatment units
continued on the next page
14
Quality Improvements
Centra Alan B.
Pearson Regional
Cancer Center
nourishes the
minds and bodies
of cancer patients
and their families
with fresh
produce from
its vegetable
garden.
and CT Sim with the rest of the department about thepatients scheduled for the day. It has enabled therapiststo ask questions to the physicians, dosimetrist andnursing about any issues they have had or foresee with aparticular patient and vice versa.
The time change from 10 a.m. to 8 a.m. has allowedboth the physicians and additional therapists to attendhuddle before patient appointments begin.
New knowledge gained• Additional appointment types were added to the list
of patients being reviewed in the daily huddle aftera review of the questions.
• Information about patient’s chemo appointmentsor start dates have been answered.
• Nursing has notified therapy staff of inpatientstatus with treatment for that day or they have beenasked to check on a patient about his treatment forthat day.
• Physicians have relayed information about a patientthat would be helpful when communicating with orworking with a particular patient.
ActThis improvement plan is still being evaluated.
Adjustments will continue to be made to the process asthe evaluation continues.
Radiation oncology: Daily huddle and pre-appointment review continued
15
Prevention and Screening Programs
Standard 4.1 Prevention Programs
Each year, the cancer committee provides at least onecancer prevention program that is targeted to meet
the needs of the community and should be designed toreduce the incidence of a specific cancer type. Theprevention program is consistent with evidence-basednational guidelines for cancer prevention.
• By partnering with local farmers and CentraNutrition Services about the ways in which a healthydiet helps prevents cancer, we arranged two free farmersmarkets with in-season fruits and vegetables. During thefarmers markets, Nutrition Services demonstrated howto prepare healthy meals. Approximately 70 peopleattended the demonstrations. They were pleased withwhat they learned and planned to make an effort tochange their behavior and eat healthy foods in an effortto reduce their chances of developing cancer.
• Research has shown that about 20 percent of allcancers diagnosed in the United States could beattributed to physical inactivity, therefore certaincancers could be prevented by incorporating physicalexercise in a person’s daily routine. Through ourcommunity outreach, we offer weekly yoga, tai chi andwalking classes to help people adapt to daily exercise inthe hopes of substantially reducing and/or preventingcertain cancers.
• We had over 900 participants in the “GreatAmerican Smokeout” who have been equipped with thetools and assistance to quit smoking.
Standard 4.2 Screening Programs
Each year, the cancer committee provides at least onecancer screening program that is targeted to
decreasing the number of patients with late-stagedisease. The screening program is based on communityneeds and is consistent with evidence-based nationalguidelines and evidence-based interventions. A processis developed to follow up on all positive findings.
• During our 2015 skin cancer screening, localdermatologists and other healthcare professionalsspecially trained in detecting skin cancer offered freeskin screenings. Participating providers includedCentral Virginia Dermatology, DermatologyConsultants, Grace A. Newton, MD, Dermatology andRidge View Dermatology. One hundred and sevenpatients were screened, and biopsies wererecommended for 36 patients.
• We have also partnered with the Centra Foundationto provided free mobile mammography screenings inan effort to raise awareness of the importance of breastcancer screenings. The mobile mammogram van travelsto locations where breast cancer screenings are notreadily available with a population of uninsured orunderinsured. An average of 2,700 people werescreened, with 50 patients called back and zero cancersdetected.
• There were 116 lung screenings performed in 2015,of which two cancers were diagnosed using low dose CTscans.
16
Screenings
As a result of the communityneeds assessment, a barrier
identified was access to care; theopportunity was early detection;and the strategy was cancerscreenings.
A skin cancer screening washeld in May at the Centra Alan B.Pearson Regional Cancer Center.Local dermatologists and otherhealthcare professionals speciallytrained in detecting skin canceroffered free skin screenings.
Participating providersincluded Central VirginiaDermatology, DermatologyConsultants, Grace A. Newton,MD, Dermatology and Ridge ViewDermatology. One hundred andseven patients were screened, andbiopsies were recommended for 36patients.
Skin cancer screenings 2015
RECOMMENDED SCREENINGS BIOPSY
16 7
49 8
9 8
33 10
Biopsies were
recommended
for 36 patients
out of 107 that
were screened
for skin cancer at
the Centra Alan
B. Pearson
Regional Cancer
Center.
17
Centra Cancer Committee
Tammy Anderson, LCSW, MSW, OSW-C, ACHP-SW, ACMOncology Social Worker
Robert Armock, M.D.Hospitalist, Medical Director, Palliative Care
Arley Baker, R.N., BSN, OCNUnit Manager, Inpatient Oncology
Curt BakerVice President, Oncology/Cardiovascular Services
Karl Biesemier, M.D.Breast Program Leader, Pathology
Robert Brindle, M.D.Mammography
Angela BryantDirector, Marketing
Robert Cook, M.D.Urology
Phyllis Everett, N.P. Genetics
Anita Gillespie, RTRMManager, Breast Imaging
Tim Hellewell, M.D.Radiology
A. Joy Hilliard, M.D.Medical Director, Radiation Oncology
Jane JohnsonAmerican Cancer Society
William Kittrell, M.D.Physician Liaison, Surgery
Kara Lamb, R.N., MSN, OCNOncology Breast Navigator
Anita LoweCommunity Liaison
Cecilia MacCallum, M.D.Medical Oncology
Joyce Martin, CTRCoordinator, Cancer Registry
Charles Mulligan, M.D.Medical Director, Thoracic Surgery
Dwight Oldham, M.D.Medical Director, Medical Oncology
Patricia Pletke, M.D.Medical Director, Hospice
Carol Riggins, R.N., MSN, GCNS-BC, OCNManaging Director, Centra Alan B. Pearson Regional Cancer Center
John Salmon, M.D.Physician Liaison, Pathology
Andrea Stutesman, M.D.Physiatrist
Donna Washburn, R.N., MSN, CNS, ACNS-BC,AOCNS Coordinator, Clinical Trials
Matthew Foster, M.D.Chairman, Cancer Committee, Pathology
18
Monitoring Compliance With Evidence-Based Guidelines
Retrospective review of DCIS 2014
Purpose1. Determine if patients with DCIS were treated
within NCCN guidelines2. Determine if patients who received radiotherapy
were treated with NCCN guidelines regarding doseand techniques
3. Assess type of surgical management of DCIS
PlanBreast cancer was chosen as the site to review for
NCCN national guidelines for our 2015 study. Wewanted to assess whether patients with DCIS whounderwent a lumpectomy received radiation treatmentthat followed NCCN guidelines regarding dose andtechniques. We also examined the type of surgicalmanagement of DCIS and wanted to assess the breastconservation rate for DCIS. Joy Hilliard, MD, willreview cases identified by the registry for abstractingyear 2014.
ResultsTwenty-four patients were treated with mastectomy
(10 bilateral, nine unilateral and five withreconstruction).
Fifteen were treated with breast conservationsurgery; one patient with lobular carcinoma in situreceived hormonal therapy and was not included in thisanalysis of DCIS. Of the remaining 14 patients withDCIS, 10 patients received radiation therapy, four didnot receive radiation. These patients were ages 69, 69,67, and 64. Two of the four patients were seen inradiation oncology and only one of the patients that didnot receive treatment would be considered outside therecommended management per NCCN guidelines. Thispatient had a 3.7 cm area of high grade DCIS with a0.7 mm margin and refused radiation or furtherexcision or mastectomy. The patient was seen at anoutside institution and agreed to further excision toachieve negative margins but refused any adjuvanttreatment or mastectomy. One patient receivedradiation therapy elsewhere and was not included inthis analysis.
The nine
patients who
received
radiation
therapy for
stage 0 breast
cancer at Centra
followed NCCN
guidelines.
19
Monitoring Compliance With Evidence-Based Guidelines
Details Of Cases Not Receiving Radiation
HORMONAL SEEN BYAGE SURGERY SIZE GRADE MARGINS THERAPY RAD ONC
69 Lumpectomy 1.5 cm Low Grade 3 mm Yes Yes
67 Lumpectomy 1.3 cm Intermediate 0.5 mm No NoGrade
69 Lumpectomy Extensive* Low Grade Positive No No(no reexcision)
64 Lumpectomy 3.7 cm High Grade 0.7 mm No YesRefused
50 Lumpectomy N/A LCIS N/A Yes No
* Low grade DCIS was present in two separate lumpectomies within the same breast implying disease not only within the lumpectomy but also between the two specimens.
ConclusionsThe majority of women with a diagnosis of DCIS
at Centra in 2014 were treated with mastectomy. Thenine patients who received radiation therapy for stage 0breast cancer (DCIS) at Centra followed NCCNguidelines. Of these patients, four were treated withCanadian fractionation (three to four weeks) and fivewith conventional fractionation. One patient was not
treated by NCCN guidelines by not receiving radiation(64 year old with 3.7cm of high grade DCIS withcomedo necrosis and a 0.7 mm margin). Patient wasoffered but refused radiation therapy. Additionally,there may be an opportunity to explore psychosocialbarriers that create patient reluctance to undergoradiation therapy despite a strong clinical indication.
20
Cancer Registry Report
The Oncology Information Center (Cancer Registry)utilizes a data system designed for the collection,
management, analysis and reporting of information onpatients with cancer who have been diagnosed and/ortreated through the Centra healthcare system. Asrequired by the Code of Virginia, all new diagnoses atCentra are reported to the Virginia Cancer Registry(VCR), a division of the Virginia Department ofHealth. Annually, Cancer Registry data is reported tothe National Cancer Database (NCDB) for use innational comparative studies. Centra is enrolled in theRapid Quality Reporting System (RQRS).
Data transmission was completed to the 2015NCDB post-treatment surveillance in breast, colorectaland lung cancers (PQORI) study. The Cancer Registryworks closely with the Cancer Care Committee toassure the hospital's cancer program meets standardsestablished by the Commission on Cancer.
The data maintained in the registry is available foruse by the medical staff and other healthcareprofessionals for special studies, reports and research.In 2015, the registry responded to 25 requests for datafrom clinicians and administrative staff. The data wasused for treatment planning and evaluation, outcomemeasurement, clinical research and cancer programstrategic planning.
The cancer program is accredited by the American
College of Surgeons (ACoS), Commission on Cancer(CoC) as a Comprehensive Community CancerProgram. Three cancer registrars staff the Centra CancerRegistry. Registry staff attended the 2015 Virginia cancerregistrars meetings in Danville and Fishersville, Virginia,and the National Cancer Registrars AssociationConference in San Antonio, Texas. All staff members areactive in the association.
Through various manual and electronic processes,Centra registrars identified approximately 1,450diagnoses of cancer in 2014. Of those, approximately1,410 were analytic cases being diagnosed and/or treatedfor first course of treatment at Centra. The CancerRegistry captures a complete summary of each cancercase from diagnosis through treatment and posttreatment follow-up, which is maintained in the registrydatabase. Each patient is provided with an annuallifetime follow-up service, which serves as a continuingmonitor for diagnostic and treatment results. Follow-upserves as an automatic reminder to both physician andpatient to schedule regular physical examinations. Thecancer registry follows more than 16,857 patientsannually throughout Virginia, the southeast and UnitedStates. The registry maintains a successful follow-up rateof 90 percent of these cases. Compliance of the follow-up standards allows accurate analysis of survivaloutcomes and recurrence rates.
The Cancer
Registry captures
a complete
summary of
each cancer case
from diagnosis
through
treatment and
post treatment
followup.
21
Cancer Registry Report (continued)
• January 7, 2015 .....................................................Dianne, Witt, RN, BSN, CNIIIUsing Skype to Facilitate Presence at End of Life
• January 21, 2015.....Tammy Anderson, LCSW, MSW, OSW-C, ACHP-SW, ACM25 Important Documents
• January 28, 2015.................................................Amy Clemons, BSN, LCSW, RN Xofigo Radiopharmaceutical Treatment
• February 4, 2015 ...............................................................Magen Calland, NP-CThe Death Rattle Dilemma
• February 11, 2015.............................................Lindsay Lacey, RNIII, BSN, OCNOvarian Suppression in Breast Cancer
• February 25, 2015 ..Elizabeth Curley, Director Practice Operations, Centra True North Metrics and Lean Strategies
• March 4, 2015..........................................Kara Lamb, RNIV, MSN, OCN, CBCNBasal-like Breast Cancer
• March 18, 2015 .........................................................Gay Payne, MSN, RN, OCNFollicular Lymphoma
• March 25, 2015 ...................................................Katherine Rice, RN, BSN, OCNRadiation Therapy: Use in Heterotopic Ossification
• April 1, 2015 ...........................Donna Washburn, RN, MSN, AOCNS-BC, OCNWalking Improves Sleep in Individuals With Cancer
• April 8, 2015..........................................................Dianne, Witt, RN, BSN, CNIIIJehovah’s Witnesses: Medical Therapy and Related Matters
• April 15, 2015...................................Cheryl Moore, Specialist Service ExcellenceThe Centra Experience: AIDET 2.0
• April 23, 2015...................................................Matthew Foster, MD, PathologistAssociate Medical Director, Centra Alan B. Pearson Regional Cancer Center
Chair, Cancer CommitteeAtypical Hyperplasias of the Breast and Risk of Future Cancer: New Thoughts onan Old Topic
• April 29, 2015 ......................Phyllis C. Everett, MSN, RN, AOCN, APNG, NP-CMulti-gene Panel Testing in the Community Cancer Center
• May 06, 2015 ........Tammy Anderson, LCSW, MSW, OSW-C, ACHP-SW, ACMCalming an Overactive Brain
• May 13, 2015.......................................................Amy Clemons, BSN, LCSW, RNSupporting Patients Coping with Illness
• May 20, 2015.......................................................................Magen Calland, NP-CEasing the Burden of Surrogate Decision Making
• June 3, 2015 ......................................................Lindsay Lacey, RNIII, BSN, OCNRadiation Cystitis
• June 10, 2015 ...................................................Amanda Bruffy, RN, BSN, CNRNE-Cigarettes and Vaping
• June 17, 2015 ...........................................Kara Lamb, RNIV, MSN, OCN, CBCNSoy: Is It Safe?
• June 25, 2015 ...........................David Euhus, MD, Chief, Breast Surgery SectionJohn Hopkins University
Reducing Cancer Incidence in Genetic High Risk Population
• July 1, 2015 ...........Jane Simms, CMT, MLDT, Certified Oncology Massage TherapistGentle Tissue Mobilization Techniques for the Post-MastectomyClient, Arlington,Virginia Instructor: Jamie Elswick, LMT BSc
• July 8, 215 .......Aimee Strong, MSN, Adult-Geriatric Acute Care NP, Board CertifiedCancer Prevention Through Lifestyle Choices
• July 22, 2015...........Mona G White, RN/CCHP Director of Nursing for BRRJABlue Ridge Regional Authority
• July 29. 2105 ...........................Donna Washburn, RN, MSN, AOCNS-BC, OCNFactors Influencing Oral Adherence
• August 05, 2015..............Liz Wade R.D., Ida Proco, Manager Clinical NutritionMDP-Malnutrition Documentation Program
• August 12, 2015 .....Tammy Anderson, LCSW, MSW,OSW-C, ACHP-SW, ACMArticle Review: Psychosocial Distress in Cancer Care: An Analysis of Adherence,Responsiveness, and Acceptability
• August 26, 2015 ....................................................................Christina DelzingaroFree Clinic of Central Virginia
• September 2, 2015.....................................................................Mick O’Neill, MDCannabis: How High Is the Potential
• September 9, 2015............................Carol Riggins, RN, MSN, GCNS-BC, OCNEmployee Engagement
• September 23, 2015..................................Kara Lamb, RNIV, MSN, OCN,CBCNRethinking DCIS
• October 7, 2015.........................................................Gay Payne, MSN, RN, OCNTeratoma
• October 22, 2015................................................... Victor Yazbeck, MD, NCORP, Lymphoma Leader, Massey Cancer Center, VCU
Lymphoma Updates: What’s New in 2015
• October 28, 2015 Cynthia Hedrick, RN, BSN, OCN, QOPI
• November 4, 2015 ..................Donna Washburn, RN, MSN, AOCNS-BC, OCN Stress and Inflammation Combine to Fuel Cancer Growth
• November 11, 2015 ..........................................................................Liz Wade, RDA Healthier Holiday Season
• November 18, 2015........Tammy Anderson, LCSW, MSW,OSW-C, ACHP-SW, ACMCoping with Cancer During the Holidays
• November 25, 2015 ............................................Amy Clemons, BSN, LCSW, RNProstate Cancer
• December 2, 2015 .................................................................................C.J. BishopTransAmerica Retirement
• December 9, 2015 ..................................Kara Lamb, RNIV, MSN, OCN, CBCNHigh Blood Sugar and the Relationship to Cancer Diagnosis and Comorbidities
• December 16, 2015 .............................................................Magen Calland, NP-CWhat Is Palliative Care Video Viewing?
• December 23, 2015 ..............................Amanda Bruffy, RN, BSN, CNRN, OCNSpecialty Certification: What’s the Big Deal?
The 2015 cancer conference schedule included 140 conferences on multiple sites and the following didactic presentations:
2015 Didactic Presentations
22
Primary Site – All CasesCentra Cancer Statistics
PRIMARY SITE CLASS SEX AJCC STAGE2014 All Cases TOTAL Analytic Non-Analytic M F 0 I II III IV UNK N/A
ALL SITES 1450 1410 40 671 779 130 324 253 220 301 75 147ORAL CAVITY 19 18 1 12 7 2 2 3 0 10 2 0LIP 6 5 1 3 3 2 1 1 0 0 2 0TONGUE 4 4 0 2 2 0 1 0 0 3 0 0OROPHARYNX 2 2 0 2 0 0 0 0 0 2 0 0HYPOPHARYNX 0 0 0 0 0 0 0 0 0 0 0 0OTHER 7 7 0 5 2 0 0 2 0 5 0 0
DIGESTIVE SYSTEM 246 242 4 126 120 3 23 51 74 74 19 2ESOPHAGUS 17 17 0 11 6 0 2 2 6 7 0 0STOMACH 16 16 0 12 4 0 2 3 4 6 1 0COLON 99 99 0 41 58 2 13 25 31 21 7 0RECTUM 44 44 0 30 14 1 4 6 18 13 2 0ANUS/ANAL CANAL 13 12 1 3 10 0 1 5 5 1 1 0LIVER 13 11 2 9 4 0 0 5 2 2 4 0PANCREAS 33 33 0 18 15 0 0 4 5 20 3 1OTHER 11 10 1 2 9 0 1 1 3 4 1 1
RESPIRATORY SYSTEM 284 279 5 167 117 0 52 23 54 142 11 2NASAL/SINUS 5 4 1 3 2 0 0 0 0 4 0 1LARYNX 10 10 0 8 2 0 5 0 1 4 0 0LUNG/BRONCHUS 264 260 4 153 111 0 47 22 52 132 10 1OTHER 5 5 0 3 2 0 0 1 1 2 1 0
BLOOD & BONE MARROW 67 57 10 44 23 0 2 0 0 0 0 65LEUKEMIA 34 29 5 24 10 0 2 0 0 0 0 32MULTIPLE MYELOMA 16 15 1 11 5 0 0 0 0 0 0 16OTHER 17 13 4 9 8 0 0 0 0 0 0 17
BONE 0 0 0 0 0 0 0 0 0 0 0 0CONNECT/SOFT TISSUE 4 3 1 3 1 0 0 0 2 0 1 1SKIN 50 50 0 22 28 14 20 4 5 4 1 2MELANOMA 46 46 0 21 25 14 17 4 5 4 1 1OTHER 4 4 0 1 3 0 3 0 0 0 0 1
BREAST 298 296 2 8 290 64 113 73 26 17 5 0FEMALE GENITAL 87 76 11 0 87 8 42 3 21 4 9 0CERVIX UTERI 15 14 1 0 15 0 3 1 7 2 2 0CORPUS UTERI 51 49 2 0 51 0 35 1 8 2 5 0OVARY 10 10 0 0 10 0 2 0 6 0 2 0VULVA 7 2 5 0 7 5 1 1 0 0 0 0OTHER 4 1 3 0 4 3 1 0 0 0 0 0
MALE GENITAL 135 132 3 135 0 0 24 77 11 20 3 0PROSTATE 133 130 3 133 0 0 22 77 11 20 3 0TESTIS 2 2 0 2 0 0 2 0 0 0 0 0OTHER 0 0 0 0 0 0 0 0 0 0 0 0
URINARY SYSTEM 124 122 2 92 32 39 33 11 13 14 13 1BLADDER 79 77 2 62 17 38 19 10 2 4 6 0KIDNEY/RENAL 39 39 0 26 13 0 14 1 9 8 7 0OTHER 6 6 0 4 2 1 0 0 2 2 0 1
BRAIN & CNS 50 50 0 22 28 0 0 0 0 0 0 50BRAIN (BENIGN) 3 3 0 2 1 0 0 0 0 0 0 3BRAIN (MALIGNANT) 23 23 0 14 9 0 0 0 0 0 0 23OTHER 24 24 0 6 18 0 0 0 0 0 0 24
ENDOCRINE 20 20 0 8 12 0 5 5 4 0 1 5THYROID 15 15 0 4 11 0 5 5 4 0 1 0OTHER 5 5 0 4 1 0 0 0 0 0 0 5
LYMPHATIC SYSTEM 44 44 0 22 22 0 8 3 9 15 9 0HODGKIN'S DISEASE 9 9 0 4 5 0 1 2 5 1 0 0NON-HODGKIN'S 35 35 0 18 17 0 7 1 4 14 9 0
UNKNOWN PRIMARY 18 17 1 9 9 0 0 0 0 0 1 17OTHER/ILL-DEFINED 4 4 0 1 3 0 0 0 1 1 0 2Number of cases excluded: 0. This report INCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases.
23
PRIMARY SITE CLASS SEX AJCC STAGE2014 Analytic Cases TOTAL Analytic Non-Analytic M F 0 I II III IV UNK N/A
ALL SITES 1410 1410 0 653 757 121 322 248 218 292 72 137ORAL CAVITY 18 18 0 12 6 2 2 3 0 10 1 0LIP 5 5 0 3 2 2 1 1 0 0 1 0TONGUE 4 4 0 2 2 0 1 0 0 3 0 0OROPHARYNX 2 2 0 2 0 0 0 0 0 2 0 0HYPOPHARYNX 0 0 0 0 0 0 0 0 0 0 0 0OTHER 7 7 0 5 2 0 0 2 0 5 0 0
DIGESTIVE SYSTEM 242 242 0 123 119 3 23 48 74 73 19 2ESOPHAGUS 17 17 0 11 6 0 2 2 6 7 0 0STOMACH 16 16 0 12 4 0 2 3 4 6 1 0COLON 99 99 0 41 58 2 13 25 31 21 7 0RECTUM 44 44 0 30 14 1 4 6 18 13 2 0ANUS/ANAL CANAL 12 12 0 2 10 0 1 4 5 1 1 0LIVER 11 11 0 7 4 0 0 3 2 2 4 0PANCREAS 33 33 0 18 15 0 0 4 5 20 3 1OTHER 10 10 0 2 8 0 1 1 3 3 1 1
RESPIRATORY SYSTEM 279 279 0 164 115 0 52 23 53 138 11 2NASAL/SINUS 4 4 0 2 2 0 0 0 0 3 0 1LARYNX 10 10 0 8 2 0 5 0 1 4 0 0LUNG/BRONCHUS 260 260 0 151 109 0 47 22 51 129 10 1OTHER 5 5 0 3 2 0 0 1 1 2 1 0
BLOOD & BONE MARROW 57 57 0 39 18 0 2 0 0 0 0 55LEUKEMIA 29 29 0 20 9 0 2 0 0 0 0 27MULTIPLE MYELOMA 15 15 0 11 4 0 0 0 0 0 0 15OTHER 13 13 0 8 5 0 0 0 0 0 0 13
BONE 0 0 0 0 0 0 0 0 0 0 0 0CONNECT/SOFT TISSUE 3 3 0 2 1 0 0 0 1 0 1 1SKIN 50 50 0 22 28 14 20 4 5 4 1 2MELANOMA 46 46 0 21 25 14 17 4 5 4 1 1OTHER 4 4 0 1 3 0 3 0 0 0 0 1
BREAST 296 296 0 8 288 63 113 73 26 16 5 0FEMALE GENITAL 76 76 0 0 76 0 41 3 21 3 8 0CERVIX UTERI 14 14 0 0 14 0 3 1 7 1 2 0CORPUS UTERI 49 49 0 0 49 0 34 1 8 2 4 0OVARY 10 10 0 0 10 0 2 0 6 0 2 0VULVA 2 2 0 0 2 0 1 1 0 0 0 0OTHER 1 1 0 0 1 0 1 0 0 0 0 0
MALE GENITAL 132 132 0 132 0 0 24 76 11 18 3 0PROSTATE 130 130 0 130 0 0 22 76 11 18 3 0TESTIS 2 2 0 2 0 0 2 0 0 0 0 0OTHER 0 0 0 0 0 0 0 0 0 0 0 0
URINARY SYSTEM 122 122 0 90 32 39 32 10 13 14 13 1BLADDER 77 77 0 60 17 38 18 9 2 4 6 0KIDNEY/RENAL 39 39 0 26 13 0 14 1 9 8 7 0OTHER 6 6 0 4 2 1 0 0 2 2 0 1
BRAIN & CNS 50 50 0 22 28 0 0 0 0 0 0 50BRAIN (BENIGN) 3 3 0 2 1 0 0 0 0 0 0 3BRAIN (MALIGNANT) 23 23 0 14 9 0 0 0 0 0 0 23OTHER 24 24 0 6 18 0 0 0 0 0 0 24
ENDOCRINE 20 20 0 8 12 0 5 5 4 0 1 5THYROID 15 15 0 4 11 0 5 5 4 0 1 0OTHER 5 5 0 4 1 0 0 0 0 0 0 5
LYMPHATIC SYSTEM 44 44 0 22 22 0 8 3 9 15 9 0HODGKIN'S DISEASE 9 9 0 4 5 0 1 2 5 1 0 0NON-HODGKIN'S 35 35 0 18 17 0 7 1 4 14 9 0
UNKNOWN PRIMARY 17 17 0 8 9 0 0 0 0 0 0 17OTHER/ILL-DEFINED 4 4 0 1 3 0 0 0 1 1 0 2Number of cases excluded: 0. This report INCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases.
Primary Site – Analytic Cases
24
2014 CANCER CASESBY AGE/SEX
0 50 100 150 200 250
0-9
10-20
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-99
188190
214
105
2488
63
1
204
715
137
7
Male
Female
16
17
4
100
93
Surgery46%
ChemotherapyRadiation
16%
Chemo15%
None23%2014 CANCER CASES
BY TREATMENT
Centra Cancer Statistics
2014 CANCER CASESBY TNM STAGE
Stage IV292 Cases20.71%
Stage III218 Cases15.46%
Stage I322 Cases22.84%
Stage II248 Cases17.59%
Stage 0121 Cases
8.58%
Stage 0121 Cases
8.58%
N/A137 Cases
10%
N/A137 Cases
10%
Unknown72 Cases5.11%
Unknown72 Cases5.11%
25
LOCALITY OF NEW2014 ANALYTIC CASESNUMBER OF CASESBY LOCALITY
0100 200 300 400 500
000
31
15
18
22
43
66
76
90
167
177
195
466
Other
Charlotte
Danville
Prince Edward
Bedford (City)
Halifax
Pittsylvania
Appomattox
Bedford
Amherst
Campbell
Lynchburg (City)
Nelson
44
2014 CANCER CASESBY STAGE/SEX
0 50 100 150 200 250
Female
Male
N/A
Unknown
Stage IV
Stage III
Stage II
Stage I
Stage 085
217
135
61
126
13%
166
35
36
105
113
100
118
37
76
26
Site By Sex
SITE NAME NBR2014 Cases CASES MALE FEMALELIP 5 0.35 3 60 2 40BASE OF TONGUE 1 0.07 0 0 1 100OTHER PARTS OF TONGUE 3 0.21 2 66.67 1 33.33PALATE 1 0.07 1 100 0 0OTHER/UNSPECIFIED PARTS OF MOUTH 1 0.07 1 100 0 0PAROTID GLAND 2 0.14 2 100 0 0TONSIL 2 0.14 0 0 2 100OROPHARYNX 2 0.14 2 100 0 0NASOPHARYNX 1 0.07 1 100 0 0ESOPHAGUS 17 1.21 11 64.71 6 35.29STOMACH 17 1.21 13 76.47 4 23.53SMALL INTESTINE 4 0.28 0 0 4 100COLON 101 7.16 41 40.59 60 59.41RECTOSIGMOID JUNCTION 6 0.43 3 50 3 50RECTUM 38 2.7 27 71.05 11 28.95ANUS & ANAL CANAL 12 0.85 2 16.67 10 83.33LIVER & BILE DUCTS 11 0.78 7 63.64 4 36.36OTHER BILIARY TRACT 4 0.28 2 50 2 50PANCREAS 33 2.34 18 54.55 15 45.45NASAL CAVITY & MIDDLE EAR 1 0.07 1 100 0 0ACCESSORY SINUSES 3 0.21 1 33.33 2 66.67LARYNX 10 0.71 8 80 2 20BRONCHUS & LUNG 260 18.44 151 58.08 109 41.92THYMUS 2 0.14 1 50 1 50HEART MEDIASTINUM PLEURA 5 0.35 3 60 2 40BONES JOINTS & OTHER UNSPECIFIED SITES 1 0.07 0 0 1 100BLOOD & BONE MARROW 54 3.83 37 68.52 17 31.48SKIN 49 3.48 21 42.86 28 57.14RETROPERITONEUM & PERITONEUM 2 0.14 0 0 2 100CONNECTIVE SUBCUTANEOUS OTHER SOFT TISSUE 3 0.21 2 66.67 1 33.33BREAST 296 20.99 8 2.7 288 97.3VULVA 2 0.14 0 0 2 100CERVIX UTERI 14 0.99 0 0 14 100CORPUS UTERI 38 2.7 0 0 38 100UTERUS NOS 11 0.78 0 0 11 100OVARY 10 0.71 0 0 10 100OTH FM. GENITAL ORGN. 1 0.07 0 0 1 100PROSTATE GLAND 130 9.22 130 100 0 0TESTIS 2 0.14 2 100 0 0KIDNEY 35 2.48 23 65.71 12 34.29KIDNEY, RENAL PELVIS 4 0.28 3 75 1 25URETER 4 0.28 2 50 2 50URINARY BLADDER 77 5.46 60 77.92 17 22.08OTHER & UNSPECIFIED URINARY ORGANS 2 0.14 2 100 0 0MENINGES 20 1.42 4 20 16 80BRAIN 26 1.84 16 61.54 10 38.46OTHER NERVOUS SYSTEM 4 0.28 2 50 2 50THYROID GLAND 15 1.06 4 26.67 11 73.33OTHER ENDOCRINE GLANDS 5 0.35 4 80 1 20LYMPH NODES 46 3.26 24 52.17 22 47.83UNK PRIMARY 17 1.21 8 47.06 9 52.94
TOTAL CASES 1410 100 653 46.31 757 53.69
27
Site By AJCC Stage Tabulation
SITE NAME NBR STG STG STG STG STG STG2014 CASES (%) 0 (%) I (%) II (%) III (%) IV (%) UNK (%) N/A (%)LIP 5 0 2 40 1 20 1 20 0 0 0 0 1 20 0 0BASE OF TONGUE 1 0 0 0 0 0 0 0 0 0 1 100 0 0 0 0OTHER PARTS OF TONGUE 3 0 0 0 1 33 0 0 0 0 2 67 0 0 0 0PALATE 1 0 0 0 0 0 1 100 0 0 0 0 0 0 0 0OTHER/UNSPECIFIED PARTS OF MOUTH 1 0 0 0 0 0 0 0 0 0 1 100 0 0 0 0PAROTID GLAND 2 0 0 0 0 0 0 0 0 0 2 100 0 0 0 0TONSIL 2 0 0 0 0 0 0 0 0 0 2 100 0 0 0 0OROPHARYNX 2 0 0 0 0 0 0 0 0 0 2 100 0 0 0 0NASOPHARYNX 1 0 0 0 0 0 1 100 0 0 0 0 0 0 0 0ESOPHAGUS 17 1 0 0 2 12 2 12 6 35 7 41 0 0 0 0STOMACH 17 1 0 0 2 12 3 18 4 24 6 35 1 6 1 6SMALL INTESTINE 4 0 0 0 0 0 1 25 1 25 2 50 0 0 0 0COLON 101 7 2 2 14 14 25 25 31 31 22 22 7 7 0 0RECTOSIGMOID JUNCTION 6 0 0 0 1 17 1 17 2 33 1 17 1 17 0 0RECTUM 38 3 1 3 3 8 5 13 16 42 12 32 1 3 0 0ANUS & ANAL CANAL 12 1 0 0 1 8 4 33 5 42 1 8 1 8 0 0LIVER & BILE DUCTS 11 1 0 0 0 0 3 27 2 18 2 18 4 36 0 0OTHER BILIARY TRACT 4 0 0 0 0 0 0 0 2 50 0 0 1 25 1 25PANCREAS 33 2 0 0 0 0 4 12 5 15 20 61 3 9 1 3NASAL CAVITY & MIDDLE EAR 1 0 0 0 0 0 0 0 0 0 1 100 0 0 0 0ACCESSORY SINUSES 3 0 0 0 0 0 0 0 0 0 2 67 0 0 1 33LARYNX 10 1 0 0 5 50 0 0 1 10 4 40 0 0 0 0BRONCHUS & LUNG 260 18 0 0 47 18 22 8 51 20 129 50 10 4 1 0THYMUS 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 100HEART MEDIASTINUM PLEURA 5 0 0 0 0 0 1 20 1 20 2 40 1 20 0 0BONES JOINTS, OTHER UNSPECIFIED SITES 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 100BLOOD & BONE MARROW 54 4 0 0 0 0 0 0 0 0 0 0 0 0 54 100SKIN 49 3 14 29 20 41 4 8 5 10 4 8 1 2 1 2RETROPERITONEUM & PERITONEUM 2 0 0 0 0 0 0 0 1 50 1 50 0 0 0 0CONN. SUBCUTANEOUS OTHER SOFT TISSUE 3 0 0 0 0 0 0 0 1 33 0 0 1 33 1 33BREAST 296 21 63 21 113 38 73 25 26 9 16 5 5 2 0 0VULVA 2 0 0 0 1 50 1 50 0 0 0 0 0 0 0 0CERVIX UTERI 14 1 0 0 3 21 1 7 7 50 1 7 2 14 0 0CORPUS UTERI 38 3 0 0 27 71 1 3 7 18 0 0 3 8 0 0UTERUS NOS 11 1 0 0 7 64 0 0 1 9 2 18 1 9 0 0OVARY 10 1 0 0 2 20 0 0 6 60 0 0 2 20 0 0OTH FM. GENITAL ORGN. 1 0 0 0 1 100 0 0 0 0 0 0 0 0 0 0PROSTATE GLAND 130 9 0 0 22 17 76 58 11 8 18 14 3 2 0 0TESTIS 2 0 0 0 2 100 0 0 0 0 0 0 0 0 0 0KIDNEY 35 2 0 0 13 37 1 3 7 20 7 20 7 20 0 0KIDNEY, RENAL PELVIS 4 0 0 0 1 25 0 0 2 50 1 25 0 0 0 0URETER 4 0 1 25 0 0 0 0 2 50 1 25 0 0 0 0URINARY BLADDER 77 5 38 49 18 23 9 12 2 3 4 5 6 8 0 0OTHER & UNSPECIFIED URINARY ORGANS 2 0 0 0 0 0 0 0 0 0 1 50 0 0 1 50MENINGES 20 1 0 0 0 0 0 0 0 0 0 0 0 0 20 100BRAIN 26 2 0 0 0 0 0 0 0 0 0 0 0 0 26 100OTHER NERVOUS SYSTEM 4 0 0 0 0 0 0 0 0 0 0 0 0 0 4 100THYROID GLAND 15 1 0 0 5 33 5 33 4 27 0 0 1 7 0 0OTHER ENDOCRINE GLANDS 5 0 0 0 0 0 0 0 0 0 0 0 0 0 5 100LYMPH NODES 46 3 0 0 10 22 3 7 9 20 15 33 9 20 0 0UNK PRIMARY 17 1 0 0 0 0 0 0 0 0 0 0 0 0 17 100
OVERALL TOTALS 1410 100 121 9 322 23 248 18 218 15 292 21 72 5 137 10
28
Site By Treatment
SITE NAME NBR SURG NONE CHEM RAD CHEM OTHERS2014 CASES (%) NBR (%) NBR (%) NBR (%) NBR (%) NBR (%) NBR (%) LIP 5 0.4 5 100 0 0 0 0 0 0 0 0 0 0BASE OF TONGUE 1 0.1 0 0 0 0 0 0 1 100 0 0 0 0OTHER PARTS OF TONGUE 3 0.2 0 0 1 33 1 33 0 0 0 0 1 33PALATE 1 0.1 0 0 1 100 0 0 0 0 0 0 0 0OTHER/UNSPECIFIED PARTS OF MOUTH 1 0.1 0 0 0 0 0 0 0 0 0 0 1 100PAROTID GLAND 2 0.1 0 0 0 0 1 50 0 0 0 0 1 50TONSIL 2 0.1 0 0 0 0 2 100 0 0 0 0 0 0OROPHARYNX 2 0.1 0 0 0 0 2 100 0 0 0 0 0 0NASOPHARYNX 1 0.1 0 0 0 0 0 0 0 0 0 0 1 100ESOPHAGUS 17 1.2 2 12 2 12 7 41 2 12 0 0 4 24STOMACH 17 1.2 2 12 4 24 2 12 4 24 3 18 2 12SMALL INTESTINE 4 0.3 2 50 1 25 0 0 1 25 0 0 0 0COLON 101 7.2 45 45 9 9 1 1 4 4 37 37 5 5RECTOSIGMOID JUNCTION 6 0.4 1 17 0 0 0 0 1 17 2 33 2 33RECTUM 38 2.7 5 13 2 5 9 24 3 8 1 3 18 47ANUS & ANAL CANAL 12 0.9 0 0 1 8 8 67 0 0 0 0 3 25LIVER & BILE DUCTS 11 0.8 0 0 5 45 0 0 5 45 0 0 1 9OTHER BILIARY TRACT 4 0.3 0 0 1 25 1 25 0 0 2 50 0 0PANCREAS 33 2.3 0 0 10 30 4 12 13 39 2 6 4 12NASAL CAVITY & MIDDLE EAR 1 0.1 0 0 0 0 0 0 0 0 0 0 1 100ACCESSORY SINUSES 3 0.2 0 0 1 33 1 33 0 0 0 0 1 33LARYNX 10 0.7 1 10 0 0 3 30 1 10 0 0 5 50BRONCHUS & LUNG 260 18.4 45 17 51 20 62 24 46 18 7 3 49 19THYMUS 2 0.1 0 0 0 0 0 0 0 0 1 50 1 50HEART MEDIASTINUM PLEURA 5 0.4 0 0 1 20 0 0 3 60 1 20 0 0BONES JOINTS, OTHER UNSPECIFIED SITES 1 0.1 0 0 0 0 0 0 0 0 0 0 1 100BLOOD & BONE MARROW 54 3.8 0 0 15 28 0 0 19 35 0 0 20 37SKIN 49 3.5 44 90 1 2 0 0 0 0 0 0 4 8RETROPERITONEUM & PERITONEUM 2 0.1 0 0 0 0 0 0 2 100 0 0 0 0CONN. SUBCUTANEOUS OTHER SOFT TISSUE 3 0.2 1 33 0 0 0 0 0 0 0 0 2 67BREAST 296 21 44 15 4 1 1 0 1 0 9 3 237 80VULVA 2 0.1 1 50 0 0 0 0 0 0 0 0 1 50CERVIX UTERI 14 1 3 21 1 7 6 43 0 0 1 7 3 21CORPUS UTERI 38 2.7 28 74 1 3 0 0 0 0 2 5 7 18UTERUS NOS 11 0.8 5 45 0 0 1 9 1 9 2 18 2 18OVARY 10 0.7 2 20 1 10 0 0 2 20 5 50 0 0OTH FM. GENITAL ORGN. 1 0.1 0 0 0 0 0 0 0 0 1 100 0 0PROSTATE GLAND 130 9.2 23 18 24 18 0 0 1 1 0 0 82 63TESTIS 2 0.1 2 100 0 0 0 0 0 0 0 0 0 0KIDNEY 35 2.5 25 71 6 17 2 6 1 3 0 0 1 3KIDNEY, RENAL PELVIS 4 0.3 2 50 0 0 0 0 1 25 1 25 0 0URETER 4 0.3 3 75 1 25 0 0 0 0 0 0 0 0URINARY BLADDER 77 5.5 53 69 2 3 0 0 1 1 6 8 15 19OTHER & UNSPECIFIED URINARY ORGANS 2 0.1 0 0 0 0 0 0 0 0 1 50 1 50MENINGES 20 1.4 11 55 9 45 0 0 0 0 0 0 0 0BRAIN 26 1.8 1 4 5 19 4 15 1 4 1 4 14 54OTHER NERVOUS SYSTEM 4 0.3 2 50 2 50 0 0 0 0 0 0 0 0THYROID GLAND 15 1.1 3 20 0 0 0 0 0 0 0 0 12 80OTHER ENDOCRINE GLANDS 5 0.4 3 60 2 40 0 0 0 0 0 0 0 0LYMPH NODES 46 3.3 1 2 9 20 3 7 4 9 2 4 27 59UNK PRIMARY 17 1.2 0 0 11 65 3 18 2 12 0 0 1 6
OVERALL TOTALS 1410 100 365 26 184 13 124 9 120 9 87 6 530 38
ALL
This report was run with the following criteria: Include CA in-situ cervix cases, squamous & basal cell skin cases, and intraepithelial neoplasia cases• Include only the first course of treatments • Include all treatment hospitals
RAD/
29
Site By Race
SITE NAME NBR WHITE BLACK ASIAN ORIENTAL INDIAN OTHER2014 CASES % NBR % NBR % NBR % NBR % NBR % NBR %LIP 5 0 5 100 0 0 0 0 0 0 0 0 0 0BASE OF TONGUE 1 0 1 100 0 0 0 0 0 0 0 0 0 0OTHER PARTS OF TONGUE 3 0 3 100 0 0 0 0 0 0 0 0 0 0PALATE 1 0 0 0 1 100 0 0 0 0 0 0 0 0OTHER/UNSPECIFIED PARTS OF MOUTH 1 0 1 100 0 0 0 0 0 0 0 0 0 0PAROTID GLAND 2 0 1 50 1 50 0 0 0 0 0 0 0 0TONSIL 2 0 2 100 0 0 0 0 0 0 0 0 0 0OROPHARYNX 2 0 1 50 1 50 0 0 0 0 0 0 0 0NASOPHARYNX 1 0 1 100 0 0 0 0 0 0 0 0 0 0ESOPHAGUS 17 1 13 76 4 24 0 0 0 0 0 0 0 0STOMACH 17 1 10 59 7 41 0 0 0 0 0 0 0 0SMALL INTESTINE 4 0 3 75 1 25 0 0 0 0 0 0 0 0COLON 101 7 66 65 34 34 1 1 0 0 0 0 0 0RECTOSIGMOID JUNCTION 6 0 5 83 1 17 0 0 0 0 0 0 0 0RECTUM 38 3 32 84 6 16 0 0 0 0 0 0 0 0ANUS & ANAL CANAL 12 1 10 83 2 17 0 0 0 0 0 0 0 0LIVER & BILE DUCTS 11 1 8 73 3 27 0 0 0 0 0 0 0 0OTHER BILIARY TRACT 4 0 3 75 1 25 0 0 0 0 0 0 0 0PANCREAS 33 2 21 64 12 36 0 0 0 0 0 0 0 0NASAL CAVITY & MIDDLE EAR 1 0 1 100 0 0 0 0 0 0 0 0 0 0ACCESSORY SINUSES 3 0 3 100 0 0 0 0 0 0 0 0 0 0LARYNX 10 1 8 80 2 20 0 0 0 0 0 0 0 0BRONCHUS & LUNG 260 18 213 82 47 18 0 0 0 0 0 0 0 0THYMUS 2 0 1 50 1 50 0 0 0 0 0 0 0 0HEART MEDIASTINUM PLEURA 5 0 4 80 1 20 0 0 0 0 0 0 0 0BONES JOINTS & OTHER UNSPECIFIED SITES 1 0 1 100 0 0 0 0 0 0 0 0 0 0BLOOD & BONE MARROW 54 4 48 89 6 11 0 0 0 0 0 0 0 0SKIN 49 3 49 100 0 0 0 0 0 0 0 0 0 0RETROPERITONEUM & PERITONEUM 2 0 2 100 0 0 0 0 0 0 0 0 0 0CONN. SUBCUTANEOUS OTHER SOFT TISSUE 3 0 3 100 0 0 0 0 0 0 0 0 0 0BREAST 296 21 239 81 56 19 0 0 0 0 1 0 0 0VULVA 2 0 2 100 0 0 0 0 0 0 0 0 0 0CERVIX UTERI 14 1 9 64 5 36 0 0 0 0 0 0 0 0CORPUS UTERI 38 3 34 89 4 11 0 0 0 0 0 0 0 0UTERUS NOS 11 1 10 91 1 9 0 0 0 0 0 0 0 0OVARY 10 1 9 90 1 10 0 0 0 0 0 0 0 0OTH FM. GENITAL ORGN. 1 0 1 100 0 0 0 0 0 0 0 0 0 0PROSTATE GLAND 130 9 90 69 40 31 0 0 0 0 0 0 0 0TESTIS 2 0 2 100 0 0 0 0 0 0 0 0 0 0KIDNEY 35 2 25 71 9 26 1 3 0 0 0 0 0 0KIDNEY, RENAL PELVIS 4 0 4 100 0 0 0 0 0 0 0 0 0 0URETER 4 0 4 100 0 0 0 0 0 0 0 0 0 0URINARY BLADDER 77 5 67 87 10 13 0 0 0 0 0 0 0 0OTHER & UNSPECIFIED URINARY ORGANS 2 0 2 100 0 0 0 0 0 0 0 0 0 0MENINGES 20 1 14 70 6 30 0 0 0 0 0 0 0 0BRAIN 26 2 24 92 2 8 0 0 0 0 0 0 0 0OTHER NERVOUS SYSTEM 4 0 4 100 0 0 0 0 0 0 0 0 0 0THYROID GLAND 15 1 10 67 5 33 0 0 0 0 0 0 0 0OTHER ENDOCRINE GLANDS 5 0 4 80 1 20 0 0 0 0 0 0 0 0LYMPH NODES 46 3 37 80 9 20 0 0 0 0 0 0 0 0UNK PRIMARY 17 1 15 88 2 12 0 0 0 0 0 0 0 0
OVERALL TOTALS 1410 100 1125 80 282 20 2 0 0 0 1 0 0 0
AMER
Note: Asian includes Asian Indian, Pakistani and other Asian. Oriental includes Chinese, Japanese, Filipino, Korean and Vietnamese. Other includes all races not listed above and/or unknown.
Centra Cancer Care Services1701 Thomson Drive
Lynchburg, Virginia 24501
434.200.4522
Cancer.CentraHealth.com
