Chairman's Report - Central Maine Medical Center

CANCER COMMITTEEChairman’s ReportThe past year has been one of significantchange and growth of the cancer programat Central Maine Medical Center. We arepleased to present this annual report tohighlight our accomplishments in patientcare, education and research.In June 2004, the CMMC cancer program was surveyed bythe American College of Surgeons Commission on Cancer.The ACoS has established standards for approval of cancerprograms and conducts program surveys according to thosestandards. Approval awards may then be recommended.The American College of Surgeons does this to encouragehospitals to improve cancer control efforts in prevention,early diagnosis, pretreatment evaluation, staging, treatment,rehabilitation, and to enhance the care of the terminallyill patient.Oncologist-hematologist Nicholette L. Erickson, M.D.,is chairman of the CMMC Cancer Committee.A physician surveyor visited CMMC in June 2004 to conducta site visit. This review included eight areas of evaluation,covering the entire scope and performance of the cancerprogram — institutional resources, inpatient and outpatientcare, cancer data management, community outreach andresearch to name just a few. I am happy to report that theComprehensive Cancer Program at CMMC was awarded athree year approval, with no deficiencies sited. We are approvedas a Community Hospital Cancer Program, the highestlevel of certification outside of a teaching institution.Other events of the past year include a continued emphasison community outreach and education. The Sam and JennieBennett Breast Care Center was the sponsor of a springfashion show for the purpose of raising public awarenessregarding breast cancer, and to raise funds for providingmammograms for low income women of our community.In partnership with local businesses such as Gammon

TREATMENT OFRectal Cancer at CMMCCancers of the colon and rectum are thethird most common malignancy diagnosedin men, and the second most commoncancer diagnosed in women. As such,colorectal cancer represents a majorpublic health problem.It is slightly more common in men then women, althoughmortality rates are nearly identical. The lifetime risk ofdeveloping colorectal cancer appears to be 4.6% in men and3.2% in women.The primary risk factor for colorectal cancer is age, withmore than 90% of cases diagnosed in individuals over theage of 50. A personal or family history of colorectal canceror polyps increases the risk for this disease. Other riskfactors include smoking, alcohol consumption, obesity,physical inactivity, diets rich in red meat, as well asinadequate intake of fruits and vegetables.Incidence rates of this disease, as well as mortality, havebeen declining since the mid-1980’s and continue today.This is likely a result in increased screening throughsigmoidoscopy and colonoscopy with polyp removal, aswell as changes in dietary habits.Surgery is the most common form of treatment for colorectalcancer. For cancers in early stages, it is frequentlycurative. A permanent colostomy is not usually necessary.Chemotherapy and radiation are used as adjuncts to treatmentin patients whose cancer has more deeply penetratedthe bowel wall or has spread to the lymph nodes.A study was undertaken to evaluate the types of patientsdiagnosed with cancer of the rectum at Central MaineMedical Center, and to compare the survival of thesepatients with patients nationwide. We reviewed all patientsdiagnosed with rectal cancer from 1999-2003, but havefocused on patients with Stage III disease, cancers that3 | CMMC CANCER PROGRAM ANNUAL REPORT

RECTAL CANCER BY MAINE COUNTIESspread into the regional lymph nodes. A total of twentytwo patients were diagnosed with Stage III rectal cancerat CMMC during this time frame. Stage III cancers werechosen for evaluation because they represent a significantfraction of our patients with rectal cancer, approximately25%. Additionally, these patients typically are treated withcombined modality therapy including surgery, radiation andchemotherapy, and appropriate use of these treatments canhave a significant impact on survival.OXFORD27.3%FRANKLIN18.2%36.4%ANDROSCOGGIN9.1%9.1%KENNEBECCUMBERLANDIn our cohort of twenty two patients, 15 were men, and7 were women. This predominance of male patients isconsistent with national data. The age range of patientswas spread widely, from patients in their 30’s to their 80’s.However, the largest single group were patients from age60-69. All patients had been diagnosed with adenocarcinoma,the most common form of rectal cancer. The majorityof patients treated at CMMC were from Androscoggin andOxford counties, though one-third were residents ofFranklin, Kennebec or Cumberland counties.The vast majority of patients, 87%, did receive multimodalitytherapy with surgery, radiation and chemotherapy,consistent with national treatment guidelines. One patientdid not receive surgery, and two did not receive radiationtherapy. This high rate of multi-modality therapy appearsto correlate well with an excellent five year survival rate forthese patients. The overall five year survival for this groupof patients was 82%. This compares very favorably withdata from the National Cancer Data Bank. Data reportedfrom the State of Maine, including eleven reporting hospitals,identified a five year survival rate of 31% for StageIII patients. Survival for Stage III patients throughout NewEngland was 45% at five years. The survival data providedby the Tumor Registry at Central Maine Medical Center wellexceeds this, and is an achievement to be proud of.PERCENT OF CASES30Male Female2520151050MALE vs FEMALE BY AGE AT DIAGNOSIS30-39 40-49 50-59 60-69 70-79 80-89AGE DISTRIBUTIONCMMC CANCER PROGRAM ANNUAL REPORT | 4

CANCER REGISTRY2003 ReportTOP FIVE SITES FOR FIVE YEARS180160140120100806040200800700600500400300200100013212311562231999 2000 2001 2002 2003Breast Lung Prostate Colorectal BladderTOTAL ANALYTIC CASES PER YEAR686144129661421999 2000 2001 2002 2003FOLLOW UP STATISTICS (As of June 1, 2004)171157154144144135134 136 1294726 24 21703 775Complete Registry Total = 15,121 Cases (Reference Date = 1982)Follow-up Rate = 87% (Target Rate is 80%)Alive Follow-up Rate = 95% (Target Rate is 90%)794677175429A system to monitor all types of cancerdiagnosed or treated in an institution isa critical element in cancer care.The Cancer Registry collects demographic, cancer identification,treatment and follow-up data on each eligiblecancer patient. This data contributes to treatment planning,staging, and continuity of care for patients. Accurate andcomplete registry data is a valuable resource for researchinvestigations.In the past two years, the Cancer Registry at CMMC hascomplied with many new requirements in the cancer datacollection process. The 6th Edition of the AJCC StagingManual was implemented for cancer cases diagnosedbeginning in January 2003. This staging manual is used byphysicians and health care practitioners to determine theextent of disease. The cancer stage is then used to guide themanagement of patient care. This new edition incorporatesnewly acquired knowledge on the etiology and pathologyof cancer for several sites. In particular, the staging rules formelanoma, breast and colorectal cancer saw several changesin the staging guidelines.In addition, changes have been made in the procedures forcollecting information in the cancer registry. All Commissionon Cancer (CoC)- approved cancer programs are requiredto evaluate and collect cancer data in a uniform way. Thisinformation is then submitted to the National Cancer DataBase (NCDB). The CMMC Registry is required to submit dataon a yearly basis in accordance with the American Collegeof Surgeons Standards for cancer program accreditation.The requested cases for submission in 2003 totaled 2,431cancer cases. All cases were reviewed via numerouscomputer based edit checks and then electronically submittedto the NCDB. CMMC’s cases passed the NCDB computerbank edit review without quality issues or errors, thusearning a commendation for the high quality of workbeing done in our cancer registry. This would not have beenpossible without meticulous attention to detail, and theexpertise of our certified tumor registrar Mary Cyr.7 | CMMC CANCER PROGRAM ANNUAL REPORT

2003 Cancer Incidence StatisticsNumber of Cases % of 2003 2003 Estimated Presented atSite 2001 2002 2003 Analytic Cases National Percent CA Conference**Breast 171 154 144 20.1 16 195Lung/Bronchus 134 136 135 18.9 13.2 49Prostate 157 144 129 18.1 16.6 24Colorectal/Anus 53 67 54 7.5 11.4 17Urinary Bladder 21 23 29 4.0 4.3 5Pancreas 15 22 19 2.6 2.3 8Leukemia 9 18 18 2.5 2.3 3Central Nervous System/Brain 20 13 16 2.2 1.4 9Non- Hodgkin Lymphoma 24 24 15 2.1 4.0 18Thyroid Gland 2 8 15 2.1 1.6 6Melanoma/Skin 12 25 14 2.1 4.4 11Corpus Uteri 14 17 13 1.8 3.0 2Unknown Primary 28 10 12 1.7 2.6 9Larynx 4 7 11 1.5 .7 5Esophagus 18 16 11 1.5 1.0 13Stomach 6 8 9 1.3 1.7 4Multiple Myeloma & Plasmacytoma 10 8 9 1.3 1.1 3Kidney 9 18 8 1.1 2.4 1Cervix Uteri 5 11 8 1.1 .9 1Pharynx 10 15 6 .8 .6 2Ovary/Fallopian Tube 4 7 5 .7 1.9 5Sarcoma Tumors 5 7 5 .7 .6 7Penis/Testis 10 7 5 .7 .7 5Hodgkin Lymphoma 6 7 4 .6 .6 18Extrahepatic Bile Duct 1 1 4 .6 .5 1Lip & Oral Cavity 6 2 4 .6 1.4 4Vulva/Vagina 7 3 3 .4 .4 0Myeloproliferative Disorder 1 2 3 .4 N/A 0Bone 1 2 2 .3 0 0Small Intestines 1 0 1 .1 .4 0Liver 2 1 1 .1 1.3 3Gallbladder 1 1 1 .1 .5 0Immunoproliferative Disease 0 1 1 .1 N/A 0Renal Pelvis/Ureter 0 0 1 .1 .2 0Myelodysplastic Syndrome 0 3 1 .1 N/A 0Mesothelioma 2 1 1 .1 0 0Salivary/Parotid Glands 3 2 0 0 0 2Peritoneum 0 2 0 0 0 0Nasal Cavity 1 1 0 0 0 0Thymus 2 0 0 0 0 0Totals 775 794 717 100% 100% 430* Analytic = Cases diagnosed and/or receiving first course treatment at CMMC** Total presented may be greater than total for site because of multiple presentations or non analytic cases presented2003 United States Estimated New Cancer Cases = 1,334,100American Cancer Society Facts & Figures

COMMUNITY HOSPITALComprehensive Cancer CenterCentral Maine Medical Center’sComprehensive Cancer Care Program hasagain been approved by a national healthcarequality review organization.The CMMC cancer program has once again been recognizedby the American College of Surgeons (ACoS) as aCommunity Hospital Comprehensive Cancer Center – thehighest level of approval granted to community hospitals.To gain ACoS approval a hospital must offer the fourmajor components of an approved cancer program: amultidisciplinary cancer committee that provides thecancer program with leadership; cancer conferences thatfacilitate consultations among service providers; a patientcare evaluation system; and a cancer registry for trackingand managing information regarding cancer patients.Commission on Cancer approval is awarded only to thosefacilities that have voluntarily committed to provide thebest in diagnosis and treatment of cancer and undergoa rigorous evaluation process and performance review.To maintain approval, facilities must undergo an on-sitereview every three years.More than two-thirds of Americans with cancer receivetheir care in institutions with ACoS approved programs.Nicholette L. Erickson, M.D., a hematologist-oncologistand chairman of the medical center’s Cancer Committee,said the approval “demonstrates the high quality servicesoffered at CMMC. Our program is reviewed every threeyears and has received approval since 1937.”The cancer program has a long-term research affiliationwith the world-renowned Dana Farber Cancer Institutein Boston. These attributes of the cancer program meanthat patients and families are assured that the care theyreceive at CMMC is the best cancer care available.9 | CMMC CANCER PROGRAM ANNUAL REPORT

“My health has been and is literally in my care provider’s hands. He has beenexceptional in [meeting] my individual needs and on going care.”AnonymousCancer conferences at CMMC provide educational opportunitiesfor the medical staff and promote consultationsbetween cancer care providers. The conferences covermost cancers, and are attended by physicians from allmedical disciplines, nurses, social workers, cancerregistrars and other healthcare professionals.CMMC’s patient care evaluation system identifies waysin which patient care can be improved. The ACoSCommission on Cancer requires that approved programsconduct annual studies to assess treatment processesand outcomes.The CMMC Cancer Registry collects and manages thedata base used to evaluate the cancer program’s effectivenessin treating patients. Each confirmed cancer caseis entered into the registry with detailed information ondiagnosis, extent of disease, treatment and demographics.A history of medical, family and occupational-industrialfactors, and personal habits is maintained. This systemprovides information on changes in a person’s disease.The registry’s statistical reports enable physicians toevaluate the success of specific cancer treatments andare a valuable resource for cancer researchers. Informationcollected through the CMMC Cancer Registry allowsCMMC to participate in national studies designed toimprove patient care. The Cancer Registry at CMMC wasstarted in 1954.The goals of CMMC’s cancer program are to decrease theincidence of disease and mortality of patients withcancer, improve the medical center’s comprehensivecancer control efforts, and enhance the care of terminally-illpatients.Established by the American College of Surgeons in1932, the Approvals Program sets standards for cancerprograms and reviews the programs to assure conformitywith those standards. Receiving care at a Commission onCancer approved cancer program ensures that a patientwill have access to:• High quality care close to home.• Comprehensive care offering a range of state-of-theart services and equipment.• A multispecialty team approach to coordinate the besttreatment options available to cancer patients.• Information about cancer clinical trials, education, andsupport.• Lifelong patient follow-up through a cancer registrythat collects data on type and stage of cancers andtreatment results.• Ongoing monitoring and improvement of care.There are currently more than 1,400 Commission onCancer approved cancer programs in the U.S. and PuertoRico, representing close to 25 percent of all hospitals. This25 percent of hospitals diagnose and/or treat 80 percentof newly diagnosed cancer patients each year.The Commission on Cancer is composed of Fellows ofthe American College of Surgeons and other membersrepresenting 39 national cancer-related organizations.Postgraduate courses, symposia, and programs aboutcancer are developed by the Commission for health careprofessionals involved in cancer care.The Commission, through a joint project with the AmericanCancer Society, also tracks national, regional, andlocal cancer care patterns and trends through theNational Cancer Database. The Commission sets standardsfor cancer registry data collection used by all approvedcancer programs and conducts national quality managementand improvement studies for specific cancer sites.Results of these studies are used by cancer programleadership to monitor and improve patient care.

DEPARTMENT OF RADIATION ONCOLOGYBrachytherapySince 1999, the Department of RadiationOncology has been performing Iodine125 seed implantation bracytherapy forprostate cancer. To date 288 have beenperformed. The first 100 cases performedfrom 8/99 to 1/02 form the basis of thisreport.Sue A. Mandell, M.D.Chief of Radiation OncologyBrachytherapy is a form of radiation where tiny pelletscontaining radioactive material are implanted directly intothe prostate. In brachytherapy, radiation is limited to shortdistances. It is a technique where the radioactive iodinepellet is applied in close proximity to a malignancy. Therefore,it can deliver a higher dose of radiation to the prostatewhile sparing nearby tissue/adjacent organs not at risk tocontain disease. During the 1980’s advances in imagingtechnologies made this procedure more feasible. Transrectalultrasound (TRUS) and computerized tomography allowedfor accurate placement of the radioactive seeds. Using aperineal template guidance system, and TRUS, a uniformseed distribution is performed through the template withneedle punctures. Dose distribution and seed placement isdesigned based on computer software programs.National studies have demonstrated a 14 year diseasefree survival of 79% and a local control rate of 90%. Ourpatient selection criteria and dosing strategy has beenestablished by the American Brachytherapy Society. Anideal candidate for seed implantation alone would be;stage T1, T2a, early T2b; a gleason score of less than 7;a PSA value of less than 10ng.ml; a prostate volume lessthan 50grams; and no history of a prior TURP with alarge volume deficit. Patients with higher but still localizeddisease stages, higher PSA’s and higher Gleasonscores may still be candidates for a seed implant inconjunction with five weeks of 3D-conformal externalbeam radiation which treats the surrounding tissues atrisk to contain microscopic disease. Seeds alone deliver145 Gray to the prostate while combined therapy delivers45 Gy to the prostate and surrounding tissues with11 | CMMC CANCER PROGRAM ANNUAL REPORT

external beam followed 1 month later with an additional110Gy to the prostate using seeds.The role of androgen ablation in conjunction with permanentIodine 125 radiation has not been established.Anaylsis of National data does not demonstrate anyadvantage to short term androgen ablation. Certainlypatients at higher risk with higher PSA’s, greater than orequal to 7 Gleason score and higher stages do benefitfrom long term androgen ablation of 2-3 years. Thisadjuvant therapy has been established as standard treatmentin conjunction with external beam radiation.Androgen ablation is also useful short term in downsizinglarge glands in preparation for an implantation.While the ASTRO Consensus Panel definition of threeconsecutive rises in PSA value is widely accepted as thedefinition of biochemical failure after external beamradiation therapy, it is questioned after brachytherapy.In addition, the occurrence of benign PSA “spike orbounces” confound this issue of success versus failure.Approximately 35% of brachytherapy treated patients willexhibit a temporary rise in PSA values in an average timeof 24-36 months post-implantation. This phenomenonis postulated to be related to late radiation reaction ofnormal prostate tissue; although the exact mechanismis unknown. The magnitude of the rise can be as high as2..0ng/ml, but can occasionally be substantial. These risesdo not appear to suggest an adverse prognosis. Failure torecognize a benign spike can result in the inappropriatediagnosis of failure and the institution of unnecessaryhormone therapy.“As I reflect over the past 24 years of caring foroncology patients, there is so much that hasinspired me. The shared laughter, smiles,tears, and hugs – along with times of silence– holding a hand during a difficult time…prayers before surgery… listening as theyare coping with the anger and frustration oftaking each day at a time… being there withpatients through the long journey of treatmentwith the positive hope for healing andrecovery. All of these shared experiences havemade being a nurse so rewarding for me.”Catherine Colby, LPN, Medical OncologyFollow-up of the first 100 patients ranged from 31 to 60months. All patients returned one month out from theimplantation to undergo a CT scan for post implant dosimetryreview. Ages ranged from 60-84 years. 3 patientshave been lost to follow-up; one patient who refused toreturn except for his one month dosimetry review check,and 2 patients who left Maine both controlled at 15 and18 months respectively. All stages were clinically determined.55 patients were T1c, 39 patients T2a, and 6 patientsT2b. Gleason scores ranged from 3-9. PSA’s rangedfrom 0.8 to 21.7. Brachytherapy alone was delivered to75 patients, and combined modality to 25 patients. It wasnot possible to determine the effects of adjuvant androgenablation because strict criteria was not used. MostContinued on Page 13

Continued from Page 12patients were started on hormone therapy before beingseen in consultation by a radiation oncologist. Hormoneswere used for downsizing the gland, as treatment longterm for high risk disease but also for early stages.A total of 8 patients appeared to have a benign PSAspike. At this writing, 5 patients are still being followedonly 3 years from their implant, and their PSA’s are stillunder 3.0. The PSA values of the 3 others have decreasedwith follow-up only, and are all less than 0.3.There have been 3 failures only at follow up. Two patientshave been started on hormones and remain in remissionwith PSA’s less than 0.3. One patient who was a clinicalStage IIa with a Gleason grade 9 has failed with bonemetastases while on adjuvant hormonal therapy fortreatment. His PSA value never went below 1.0, and hewas treated with an aggressive approach up front. Heremains alive with disease.There have been 7 deaths total, none from prostatecancer. 4 men died of other cancers with their PSA’s allless than 0.2. I man died of respiratory causes, and 2others from cardiac disease.It is our practice to place all patients on an alpha Iblocker immediately after their implant. This medicineis used to treat the associated urinary symptomatology.Most patients remain on a blocker for 3-12 months postimplantation. Approximately 15% of patients are alreadyon medication prior to the implant because of urinaryobstructive symptoms. 29% remain on alpha blockingdrugs long term. All the rest were back to their urinarybaseline or better at their last follow-up. Nearly all ofour patients have experienced some degree of frequency,urgency, and obstructive urinary symptoms. Three patientshave required a suprapubic cystostomy from 6 -12months post-implantation. This 3% is consistent with thenational data of 5-6%.Gastrointestinal symptoms short and long term areextremely rare. Only 2 patients have had symptoms. Onepatient had an acute incident of a rectal ulcer whichhealed 6 months after its diagnosis with supportivemeasures. That patient had received five weeks of externalbeam as part of his cancer treatment. One otherpatient developed a mild but chronic prostatitisdiagnosed on colonscopy that has to date notrequired treatment.We continue to follow these and others who have receivedan Iodine 125 seed implantation. Longer follow-upwill allow us to assess our local response rates and overallrelapse free survival. In addition, we are interested in ourpatients quality of life issues, and are presently developinga patient questionnaire for assessment.Sue A. Mandell, M.D.“The social worker provided hours of stress relief by listening when I talked about thedifficulties of my situation. She also provided some very helpful information about thefree prescription drug program. That, too, was invaluable to us and we benefited greatlyfrom it. The support and guidance through this difficult time was greatly appreciated.”Anonymous13 | CMMC CANCER PROGRAM ANNUAL REPORT

COMPREHENSIVE CANCERResearch ProgramThe Comprehensive Cancer Programresearch program met the AmericanCollege of Surgeons (ACOS) CommunityCancer Center accreditation requirementof enrolling a minimum of 2% of cancerpatients seen at CMMC onto a clinicaltrial in 2003.The Cancer Committee has set a new goal of increasingthese numbers to achieve ACOS commendation levels of4% of all cases. In an effort to accomplish these goals,we have taken several steps to enhance accrual. Withinthe last year, we increased our research staffing by hiringa full-time Research Coordinator. The research programis currently being expanded to incorporate medicaloncology, radiation oncology, as well as surgical oncologyprotocols. We are also in the process of upgrading ourCancer Program website, which will incorporate currentclinical trial information for reference for both patientsand referring practioners.In 2004, we will continue to open new studies in oncology,improving accessibility to national clinical trialsfor our cancer patients. Among the 20 studies that arecurrently available at CMMC is a study of the radioimmunotherapyagent, Zevalin, and maintenance Rituxan inNon-Hodgkin’s lymphoma. We have expanded ourparticipation to include a Radiation Therapy OncologyGroup (RTOG) study, which is a comparison of preventativebrain irradiation versus observation in patients withlocally advanced non-small cell lung cancer. We are alsoin the process of opening our first surgical oncologystudy, which involves surgically treating patientsdiagnosed with esophageal cancer or high grade dysplasiawith a technique called minimally invasiveesophagectomy.If you have questions about the research program, wouldlike a complete list of our open trials, or are interestedin enrolling a patient onto a specific clinical trial, pleasecontact our research coordinator, Tracy Ackley, RTT, at(207) 795-7549.CMMC CANCER PROGRAM ANNUAL REPORT | 14

WELLNESS FOR LIFE FORPeople Living With CancerIn recent years, exercise has been receivingsubstantial attention as a method ofadvancing the quality of life of cancerpatients both during and after treatment.Exercise rehabilitation has been shown to significantlyimprove lung function, energy capacity, and muscularendurance and strength, and has decreased fatigue anddepression in cancer survivors (Schneider, 2004). Exercisemay also reduce side effects from chemotherapy, includingneutropenia and thrombocytopenia, and may reducehospital length of stay for oncology patients (Dimeo,Fetscher, Lange, Mertelsmann & Keul, 1997).Deborah J. McIntosh“Wellness for Life” participantIn response to these findings and to the growing requestsfor a local cancer exercise rehabilitation program, theComprehensive Cancer Program and the Health &Wellness Center of CMMC are jointly offering a newexercise rehabilitation program. “Wellness for Life” is asafe, affordable wellness program for oncology patientsdesigned to improve health and wellbeing throughphysical exercise and conditioning, as well as mind/body/spirit modalities. The program includes opportunities forindividual consultation and evaluation with a personalhealth counselor; a group exercise program (see sidebar);and participation in the Cancer Wellness & SupportGroup. Patients must be referred to the program by theirprimary care physician, oncologist, or surgeon. CMMC isseeking grant funding to enhance program offerings andsupplement patient participation fees. At this time,patients who cannot otherwise afford to participate inthe program can apply for financial assistance throughthe Immediate Needs Fund.A committee comprised of individuals from both the cancerprogram and the Wellness Center, under the oversightof Dr. Jeffrey Miller, are working together to plan, develop,offer, and evaluate program offerings.Please contact Kerry Irish, the program’s coordinator, at795-7118, for more information.15 | CMMC CANCER PROGRAM ANNUAL REPORT

“Since I was diagnosed with leukemia in October of 2002 my life has seemedto spiral out of control. This disease has brought with it a lot of changes:hair loss, fatigue, depression, nausea… and one thing that I had notexpected: weight gain. My hair is growing back finally, but the fatigue anddepression hasn’t done much to promote an active and healthy life style.After talking at length with my oncologist, Dr. Miller, about my situation,he suggested the Wellness for Life program, not only to help with my weightgain but also with the fatigue. I jumped at the opportunity! I was anxiousto regain some control of my life.It has been one of the best things that has happened in my life since mydiagnosis. I feel like I am actually contributing to my recovery. Going tothe Wellness Center has forced me to get out on a daily basis, interact withpeople and get active again. The staff members at the Center are great!They all are very knowledgeable and positive and help me to stay motivated.Even the other patrons are supportive. I truly enjoy my time there, and theworkouts just remind me how much I am fighting for.I am truly grateful for the opportunity to participate in the Wellness forLife program”Deborah J. McIntosh“Wellness for Life”Group Exercise ClassThis special exercise and wellness class isdesigned for people with cancer, whethercurrently in or post-treatment. Participantswork in a low-key fashion to increaserange of motion, energy levels, and flexibility.Sessions will include 1⁄2 hour ofgroup exercise and 1⁄2 hour of instructionin a variety of mind/body spirit techniques,such as nutrition, meditation, stressmanagement, etc. We will work together ina supportive, non-competitive groupatmosphere. Spouses/Caregivers/Familymembers of cancer patients are alsowelcome to participate in this class.REFERENCES | Dimeo, F., Fetscher, S., Lange, W., Mertelsmann, R., & Keul,J. (1997) Effects of Aerobic Exercise on the Physical Performance andIncidence of Treatment-Related Complications After High-Dose Chemotherapy.Blood. Cited in Coping, September/October 2003, 56.Call the Wellness Center at 795-2473 formore information.Schneider, Carole M. (2004). Working Out Fatigue. Cure, Spring 2004,58.CMMC CANCER PROGRAM ANNUAL REPORT | 16

LIVING WITH CANCERSouth Paris woman valuesroutine in cancer fightLisa Anderson of South Paris firstnoticed a pain in her thigh about the timeof the American Lung Association ofMaine’s Trek Across Maine in June 2003.But since she’d been training for the185-mile bike ride since January, sheaccepted a doctor’s diagnosis that it wasa sports injury and pressed on. “It hurtmore to walk than to bike,” she thought,dismissing the pain as an annoyance.Lisa AndersonA month later she stubbed her toe and fell. After the fallshe experienced pain in her hip that transcended annoyance.The next few days were frustrating and confusing asLisa visited her local emergency department and her doctorbefore finally being admitted to the hospital. Nearly a weekpassed before a radiologic exam revealed a broken hip. Oncethe trouble was identified, her doctors became even moreconcerned and ordered a battery of tests. These follow uptests indicated that she had metastatic cancer.When her doctors told her that the cancer had spread fromher breast, she was even more surprised. Just two weeksearlier, she’d had a mammography that revealed what wasdescribed as “calcifications.” She was told to get anothermammography in six months.“At the time they were telling me, it didn’t sink in becauseI wanted my hip fixed so badly,” Lisa recalls. “Dealing withthe cancer diagnosis kind of came gradually because I washaving so many problems with my bones.”Early in August, orthopedic surgeon David Brown, M.D.,repaired her fractured hip, but her bone problems didn’tend there. A pain in her neck was found to result from thecollapse of a vertebra weakened by cancer. Michael Regan,M.D., an orthopedic surgeon who works in collaborationwith Dr. Brown, removed the damaged bone and fused those17 | CMMC CANCER PROGRAM ANNUAL REPORT

on either side it to preserve the integrity of her spine. She’ssubsequently had two more back surgeries. Cancer has alsobeen discovered in her ribs and brain. The brain tumor wastreated with radiation therapy.Lisa was referred to Hematology-Medical Oncology Associates,a Central Maine Medical Center physicians group thatspecializes in cancer care. Her doctor, Hans Boedeker, M.D.,prescribed a course of chemotherapy that Lisa says has had“fairly minor” side effects, the most bothersome being achange in the way she perceives the taste of food.Since her diagnosis more than a year ago, Lisa has had afew setbacks in her battle with the disease. But the physicalstruggle she wages has not overtaken her sense of identity.In June, she participated in her seventh Trek AcrossMaine, covering the demanding course in three days. Andshe’s planning to begin training in January for nextspring’s event.“I’m trying very hard to keep my life the same as it wasbefore. If I didn’t maintain a routine and sat around thehouse, I’d start feeling sorry for myself,” she says.Lisa admits to being something of an exercise addict, soeasing back on her physical fitness routine hasn’t been easy.“I usually exercise a lot. Not being able to exercise drivesme crazy,” she confesses. In January, she says, she’ll resumetraining for next spring’s Trek Across Maine, a commitmentthat amazes virtually everyone who knows her. “Some ofthem thought I was crazy before I got sick,” she says. “Nowthey really think I’m crazy.”“I usually exercise a lot. Not beingable to exercise drives mecrazy,” she confesses. In January,she says, she’ll resume training fornext spring’s Trek Across Maine, acommitment that amazes virtuallyeveryone who knows her. “Some ofthem thought I was crazy before Igot sick,” she says. “Now they reallythink I’m crazy.”Lisa AndersonGetting back to her job as a medication management casemanager at Tri-County Mental Health is another goal thatshe wants very much to accomplish. “I feel functional,” shesays, a bit of frustration creeping into her voice. “I feel like Icould be working and should be working.”Besides her dedication to her family – including her husband,Raymond, mother, Shirley Twitchell, two horses, twogoats, two dogs, and cat – and her devotion to exercise andwork, Lisa says prayer also helps her through the manychallenges she faces. “Having faith and praying is important,”she says. “I’ve had churches from here to Manitobapraying for me.”

2004 Cancer Committee MembersNicholette Erickson, M.D., ChairHans Boedeker,M.D.Mark Cabelin, M.D.Michael Eng, M.D.Yue Guo, M.D.Maria Ikossi, M.D.Grenville Jones, M.D.Paul Mailhot, M.D.Sue Mandell, M.D.Jeffrey Miller, M.D.Hugh Phelps, M.D.Susan Schraft, M.D.CMMC Administrative Dietitian Jean Elie, B.S., M.S., R.D.Donna Thompson, M.D.Mary Cyr, Cancer RegistrarTamara English, R.N., Oncology Data ManagerDiane Mulkhey, R.T.T., Radiation OncologyDoug DiVello, VP, Clinical ServicesSharron Sieleman, Director, Acute ServicesKathi Varney, NPJackie D’Auteuil, R.N., Manager, M-1