Alan Twiggs trusted the McDowell Cancer Center because his family ...

The Year in ReviewTechnology and research continued to grow and provide a majoremphasis on our program, allowing us to provide more diagnostics andtherapies to our patients.MCDOWELL INPATIENT ONCOLOGY UNIT (5400)Through the generosity of former patients and their families, the MineardFamily Lounge and Hershey Family Room were completely updated in 2005.These facilities provide a living room, kitchen, bed, desk and seating to offermore comfort for families during inpatient stays. Additional class space wasalso renovated to double as an outpatient treatment room, if needed.MCDOWELL OUTPATIENT CANCER TREATMENT CENTEROrientation Express, a weekly class that helps educate patients and theirfamilies on cancer treatment, premiered in July. The class provides an overviewof chemotherapy, side effects, symptom management and support services. Italso offers them a chance to meet our treatment team and ask questions.Involving patients in their care can mean a better treatment experience.MEDICAL HEMATOLOGY & ONCOLOGYMedical Oncology & Hematology added the use of several agents includingAvastin, Cetuximab and Revlimid to enhance the response to standardapproaches to therapy. Hematology & Oncology developed and met cleargoals for each of the subcommittees of the Cancer Committee. Multispecialtyprograms, such as the Breast Health Center, helped reduce diagnosis timeand time to cancer treatment. Plans for a Lung Cancer Clinic in 2006were underway.SURGERY2005 marked the first year of a BreastSurgery Fellowship program in conjunctionwith Aultman Hospital and its Cancer CenterMedical Director, Eleftherios (Terry)Mamounas, MD. This new position supportsan expanding partnership with the geneticscounseling services of Akron Children’sHospital to explore genetics counseling forbreast and colon cancer.Research efforts of the Department ofSurgery continued to be multifocal, withstudies involving early breast cancer, sentinel lymph node biopsy and less prolongedmethods to irradiate the primary tumor. Clinically, the use of intraoperativeultrasound has played an expanded role during surgery to help removeor obliterate tumors.MCDOWELL RADIATION ONCOLOGY DEPARTMENTIn 2005, the Department of Radiation Oncology facilitated 27, 954 treatments.The purchase of a multileaf linear accelerator allowed more patients to receiveIntensity Modulated Radiation Therapy (IMRT) at a partnering hospital inPortage County – closer to their home, where they feel the most comfortable.We also began offering High Dose Radiation (HDR) Therapy services, enablingmore precise treatment of cervical cancer patients.GYNECOLOGIC ONCOLOGYThe first total laparoscopic hysterectomy and the first hand-assisted totallaparoscopic hysterectomy for uterine cancer were performed in 2005 at AkronGeneral Medical Center.A GYN Subcommittee was formed to review registry data, evaluate compliancewith National Comprehensive Cancer Network (NCCN) guidelines and developgoals for gynecologic cancer services.CANCER RESEARCHAkron General Medical Center participates in National Cancer Institutesponsored clinical trials, as well as pharmaceutical industry sponsored trials.All research studies are given vigorous scrutiny by a review committee,endorsement by disease site specific subcommittees and final approval byAkron General Medical Center’s Institutional Research Review Board. Theoncology clinical research department in 2005 continued its participation in avariety of clinical trials for all stages and types of cancer.Akron General Medical Center is a member of six National Cancer Institutecooperative groups. This provides our patients access to a wide menu ofclinical trials.Registrations for cooperative, pharmaceutical and in-houseinvestigator-initiated studies in 2005:American College of RadiologyImaging Network (ACRIN) 1American College of SurgeonsOncology Group (ACOSOG) 1Radiation Therapy Oncology Group (RTOG) 6Southwest Oncology Group (SWOG)[Includes Phase III trials from the Clinical Trial Support Unit (CTSU)] 27National Surgical AdjuvantBreast and Bowel Project (NSABP) 27Gynecologic Oncology Group (GOG) 9Pharmaceuticals 23In-house Investigator-initiated 61Total Registrations 155The Commission on Cancer requires a 6% accrual rate for commendationstatus. Total registrations at Akron General Medical Center represent nearly an11% accrual rate of total analytic cases.

COMMUNITY OUTREACH• 371 uninsured women received screening mammograms at no costthrough Akron General’s Muffins for Mammograms program. 2005 markedthe program’s 13th year.• 407 men, through the Brother-to-Brother project, received PSA screeningtests without charge at community-based locations. These are men whomight not otherwise have been screened for prostate cancer.Akron General was a key partner in this grass-roots awareness program.Both the Muffins for Mammograms and theBrother-to-Brother Project were selected by theOhio Department of Health as Ohio CancerControl Model Programs based on their creativityand impact on cancer detection and prevention.• Participated in local health fairs in the communityand at area business. The most attended eventwas the 9th Annual Summit County MinorityHealth Fair, which offered a variety of healthscreenings and information for 1,500 attendees.• Participated as an active member of the SummitCounty Colorectal Task Force in conjunction with American Cancer Society.Akron General continues working on initiatives to improve prevention andearly detection of colorectal cancer.• Continued collaboration with the American Cancer Society, the medicalcommunity, and other groups to assist our patients in gettingneeded services.• Offered PICS (Photos in Cancer Surveillance), an educational seminar onskin-self photography of pigmented skin lesions. The program provided ateaching tool on the types of skin cancer, how to do a skin-self exam andsun avoidance.• 173 people were screened at the Annual Skin Cancer Screening onApril 30 at the McDowell Cancer Treatment Center.• Offered ongoing support to Stewart’s Caring Place - a local organizationthat offers support groups, resource information and a menu of programsand services free of charge to patients and families affected by cancer.McDowell Cancer Center staff assisted with presentations, support groupsand other programs.• Offered Conversations on Cancer, an educational series for patients, theirfamilies and the community, that helped individuals learn more about theircancer risks, early detection and treatment options. Physician specialistsand other healthcare professionals presented information on cancer topics.• Promoted prevention, early detection and screening programs throughguest appearances on Akron WAKR 1590 Good Health Radio Hour andCleveland WKYC TV- 3.PROFESSIONAL EDUCATION2005 Hematology & Oncology SummitOur three major oncology programs were combined to honor 30 years ofprofessional education in oncology on November 2, 2005. They included the30th annual James M. Perelman Visiting Professorship, the Herbert E. Croft, MD,Visiting Professorship in Hematology and the 20th annual “Joan Ashley FiffickMemorial Lectureship in Nursing.” These educational opportunities foroncology professionals are funded each year through the generous supportof our donors.James M. Perelman VisitingProfessorship speaker: John H. Winston,III, MD, FACS, FASCRS, AssistantProfessor of Surgery, James CancerCenter, presented “LaparoscopicColectomy for Cancer.”Herbert E. Croft, MD, VisitingProfessorship in Hematology speaker:James M Rossetti, DO, AssistantDirector, Blood & Marrow TransplantProgram, Western Pennsylvania Hospital,presented “Myelodysplasia:Recent Advances.”Joan Ashley Fiffick MemorialLectureship in Nursing speakersincluded Sandra Hazra, MD, CM, Assistant Professor of Internal Medicine,Northeastern Ohio Universities College of Medicine, presented “Joan, YouTaught Us a Lot…. We ARE Getting Better;” and Sally Karioth, RN, PhD,Motivational Speaker, The Goodman Speakers Bureau, Inc., presented, “Put onYour Own Oxygen Mask First.”PHILANTHROPYOver the years, the Akron General Development Foundation, the AkronGeneral Women’s Board, private donors and local companies have continuedto provide significant support through fundraising for the programs andservices of the McDowell Cancer Center – including research dollars,professional education, community education and awareness, screeningprograms and patient support services.Through donations and dollars raised from events in 2005, Akron General wasable to provide much needed services and items, including 371 mammogramsat no cost to women in the community, free prostate cancer screenings for407 local men, a renovated family space for our inpatient unit, camisolesfor mastectomy patients, medications, medical equipment and supplies andmuch more.For 30 years, educational endowments have supported local educationalopportunities for oncology professionals and physicians and nurses, to ensurethat the highest level of cancer care is available right here in our community.Net Proceeds in 2005 from Akron General Development Foundation eventsand donations to benefit the McDowell Cancer Center and cancer patientstotaled: $445,570.2005 Fundraising Events5th Annual Dolores Sawan 5K Memorial Run & 1-Mile Walk forOvarian CancerMuffins for MammogramsWQMX’s Bosom Buddies to benefit Muffins for Mammograms13th Annual Janell B. Izzo Golf Tournament5th Annual Grape Escape wine and food-tasting event

Site Analysis:Head and neck cancers are one of the less common disease categories treated atAkron General Medical Center, but they often require very complicatedtreatments with careful coordination of care between many departments. Themajority of these patients present at middle age or later and usually havecomorbid conditions that affect our ability to render appropriate care easily.The backgrounds of many but not all of these patients include extensive tobaccoand alcohol use, which may already have led to emphysema, diabetes mellitus,chronic heart disease, malnutrition and cirrhosis. Furthermore, head and neckcancers are a diverse set of malignancies, which require individualization of carefor each site and stage of disease. The sites of disease are formally divided intonasopharynx, hypopharynx, and oral cavity, and are subclassified into Stages I, II,III, and IV, each of which is treated in unique fashion.Treatment of the earlier stages is generally surgical, but with advanced stagesradiation and chemotherapy are added and given concurrently, vastlycomplicating delivery of care. These latter treatment programs may result in majormorbidity during care and long-term complications.The treatment of a Stage IV patient may require an extensive range ofservices including:• ENT for diagnosis, staging and occasionally tracheostomy;• Interventional Radiology for placement of feeding gastrostomy tube andR-Port placement for intravenous access for infusional chemotherapy, as wellas for providing detailed imaging studies;• Radiation Oncology for IMRT planning and treatment;• Medical Oncology for chemotherapy planning;• Oral Surgery for acute dental care;Figure 3 Head & Neck Cancer Treatment at Diagnosis (2000 - 2003)AGMC vs. Ohio vs. NCDBPercent of Cases3530252015105020.531.1 30.8AGMC = 107 OHIO= 4,062 NCDB = 90,25213.1 13 12.824.3 25.2 20.924.313Surgery Radiation Surg/R R/C S,R&C Chemo Other18.6Head and NeckCancers8.46.65.81.9.5 .72.8 2.43.1Data Source, NCDB, Commision on Cancer, ACoS Benchmark Reports• Cancer Treatment Center nurses and outpatientinfusion services for administration ofchemotherapy;• Nutrition services for dietary support;• Social Services for financial and social support(as many of these patients lack insurance andfamily resources);• Internal Medicine to manage the chronicmedical diseases which may be severe;by Esther H. Rehmus, MD• Rehabilitation therapy to assess speech and acute swallowing problems andhelp with rehabilitation once the antineoplastic treatment is completed.It is also common for these patients to require inpatient care during treatment todeal with the dehydration, pain, skin reactions, and infectious complications ofthese intensive treatments.In the years 2000-2003 we saw 107 head and neck cancer patients at AkronGeneral Medical Center. The age and stage at diagnosis are comparable toOhio and NCDB patients (See Fig. 1 & 2). Reflecting the multidisciplinaryapproach used at Akron General and following national guidelines, fewer patientswere treated with surgery alone but rather with combination therapy comparedto state and national data (Fig. 3). Despite the predominance of late stagepresentations and the difficulties inherent in treatment, head and neck cancerscan be cured.Figure 4 shows the five-year survival by stage. Overall five-year survival data fromAkron General patients from 1995-2000 shows that our patients do somewhatbetter compared with Ohio and National patients (See Fig. 5). Our hope is thatover the next years more effective chemotherapy and the use of IMRT will lead togreater overall five-year survival rates and reduction of the attendant morbidityof treatment.Given the variability of patient presentation and the difficulty of treatment, fewclinical trials are available for head and neck cancer patients. Five patients havebeen entered in study protocols since in 2003. Two new clinical trials were openedin 2005, one for treatment of relapsed disease in previously treated patients; thesecond protocol uses chemotherapy and radiation therapy with Cetuximab(a monoclonal antibody) for advanced stage head and neck cancer patients.Patients who achieve five-year disease-free survival seldom develop recurrence oftheir head and neck cancers. They remain at increased lifetime risk for secondmalignancies. Our hope is that tobacco use can be eliminated as a significant riskfactor for these cancers. We thus take great pride in Akron General’s smokingcessation programs and policies and plans for a smoke-free campus.Figure 4 Head & Neck Cancer Survival by Stage (1995 - 2000)AGMC = 184 casesPercent of Cases1009080706050403020100Stage 0 Stage I Stage II Stage III Stage IV10093.583.374.274.172.18783.3 83.383.2 82.678.16457.253.950.551.644.844.842.135.30 12 24 36 48 60Months71.266.744.843.333.6Data Source, NCDB, Commision on Cancer, ACoS Benchmark ReportsFigure 5Percent of Cases1009080706050403020100Head & Neck Cancer Overall Survival by Life Table(Observed) 1995 - 2000 5 year survival AGMC vs. Ohio vs. NationalAGMC = 184 OHIO = 1,057 National = 23,4381000 12 24 36 48 60Months of Survival48.746.244.4Data Source, IMPAC Medical Systems

2005 Primary Site Incidence ReportTotal Male Female Analytic Non- ClinicalCases Analytic TrialsHEAD & NECK SITESTongue 6 3 3 5 1 0Salivary Glands 4 3 1 4 0 0Floor of Mouth 1 1 0 1 0 0Gum & Other Mouth 3 3 0 3 0 0Nasopharynx 2 1 1 2 0 0Tonsil 2 2 0 2 0 0Oropharynx 1 0 1 1 0 0Hypopharynx 2 0 2 2 0 0Oth Oral Cavity & Pharynx 0 0 0 0 0 0Total Head & Neck 21 13 8 20 1 0DIGESTIVE SYSTEMEsophagus 12 9 3 12 0 0Stomach 16 10 6 12 4 0Small Intestine 4 4 0 4 0 0Large IntestineCecum 23 8 15 23 0 0Appendix 2 1 1 2 0 0Ascending Colon 10 7 3 10 0 1Hepatic Flexure 5 3 2 5 0 2Transverse Colon 5 1 4 5 0 2Splenic Flexure 4 3 1 4 0 0Descending Colon 3 2 1 3 0 0Sigmoid Colon 16 9 7 16 0 1Large Intestine, NOS 5 1 4 2 3 0Total Colon, excluding rectum 73 35 38 70 3 10Rectosigmoid Junction 7 3 4 7 0 0Rectum 41 24 17 39 2 2Total Rectum & Rectosig Junct 48 27 21 46 2 2Anus Canal 5 2 3 4 1 1Liver 4 4 0 4 0 0Intrahepatic Bile Duct 1 1 0 1 0 0Total Liver & Intrahep Bile 5 5 0 5 0 0Gallbladder 1 0 1 1 0 0Other Biliary 2 1 1 2 0 0Pancreas 22 7 15 21 1 4Retroperitoneum/Peritoneum 0 0 0 0 0 0Total Digestive System 188 100 88 177 17 17RESPIRATORY SYSTEMNose, Nasal Cavity 2 1 1 2 0 0Larynx 15 12 3 15 0 0Non-small Cell Lung 178 100 78 164 14 7Small Cell Lung 37 14 23 36 1 3Trachea, Mediastinum 0 0 0 0 0 0Total Respiratory System 232 127 105 217 15 10BONES AND JOINTS 3 2 1 3 0 0SOFT TISSUE - INCLUD. HEART 12 8 4 12 0 0SKINMelanoma 72 32 40 70 0 0Non-melanoma skin 9 6 3 7 2 0Total Skin Sites 81 38 43 77 4 0Total Male Female Analytic Non- ClinicalCases Analytic TrialsMALE ORGANSProstate 235 235 0 217 18 0Testis 18 18 0 18 0 0Penis/Other Male Organs 4 4 0 4 0 0Total Male Organs 257 257 0 239 18 0GENITOURINARYUrinary Bladder 76 54 22 68 8 0Kidney & Renal Pelvis 44 28 16 42 2 1Ureter 1 1 0 1 0 0Other Urinary Organs 2 2 0 1 0 0Total Genitourinary System 123 85 38 113 10 1CENTRAL NERVOUS SYSTEMEye & Orbit 1 0 1 0 1 0Brain & Cranial Nerves 36 21 15 33 3 5Oth Central Nervous System 8 2 6 7 1 0Total Central Nervous System 45 23 22 40 5 5ENDOCRINE SYSTEMThyroid 21 4 17 21 0 0Other Endocrine-incl Thymus 5 4 1 3 2 0Total Endocrine System 26 8 18 24 2 0LYMPHOID SYSTEMHodgkin Disease 20 14 6 18 1 6Non-Hodgkin Lymphoma 33 23 10 29 4 7ExtraNodal Lymphoma 20 13 7 19 1 0Total for Lymphoid System 73 50 23 67 6 13HEMATOPOIETIC/RETICULOLeukemia 20 10 10 19 1 9Multiple myeloma 10 5 5 8 2 3Total Hemato/Reticulo 30 15 15 27 3 12OTHERMesothelioma 5 3 2 5 0 0Kaposi sarcoma 0 0 0 0 0 0Unknown Primary Site 35 16 18 31 4 0Total Other 39 19 20 35 4 0SPECIAL STUDIESMGUS 1EPC Study 9Mood & Cognitive Function 44Total Special Studies 9 1 44ACCUMULATIVE TOTAL 1522 747 775 1421 101 155Note: the American Joint Committee on Cancer (AJCC) limits its classification to specific anatomical sites andapplicable to carcinoma, sarcoma, lymphoma, and melanoma occurring within those sites.BREAST 239 2 237 227 12 31FEMALE ORGANSCervix Uteri 23 0 23 22 1 0Corpus Uteri 76 0 76 75 1 8Uterus, NOS 1 0 1 1 0 0Ovary 35 0 35 30 5 3Vagina 2 0 2 2 0 0Vulva 13 0 13 10 3 0Other Female Genital 2 0 2 2 0 0Total Female Organs 152 0 152 142 10 42

CANCER REGISTRY STAFFKay F. Lain, RHIT, CTR, CoordinatorColeen DeSalvo, CTR, Cancer RegistryCoding TechnicianVictoria Rae, BA, CTR, CodingTechnician/Follow Up SpecialistHannah Carr, SecretaryDEFINITION OF TERMSCLASS OF CASEAnalyticPatients that were first diagnosed and/orreceived all or part of their first course oftreatment at Akron General.Non-AnalyticPatients diagnosed before the reference dateof the registry, or diagnosed and treated atanother facility or diagnosed at autopsy.REVIEW BOARDIRRB - Institutional Research Review BoardSTAGE“Manual for Staging of Cancer”, Sixth Edition,American Joint Committee on Cancer,J.B. Lippincott Co., Philadelphia, 2002.American Cancer Society, A Cancer Journalfor Clinicians, 2005400 Wabash AvenueAkron, Ohio 44307330-344-HOPE (4673)www.akrongeneral.orgOn the CoverAlan Twiggs attributes his recovery fromtonsillar cancer not just to his care team at theAkron General McDowell Cancer Center, but tohis family, friends and co-workers.He is pictured on the cover with wife, Mary,daughters Alana 20, Miranda 12 and Bryanna 8,and three-year old twins Blake and Bryce.Twiggs is a zone manager for the AkronBeacon Journal and his wife Mary is a callcenter specialist for Akron General’sCentralized Scheduling Department.In December 2002, Twiggs saw his familyphysician, Jon Tosino, MD, for swollen tonsilsand difficulty swallowing. It was Ear, Nose andThroat Specialist Janet Griffin, MD, whoperformed a tonsillectomy and broke the newsto Twiggs that a mass found in his tonsilwas malignant.“I had just found out my wife was pregnant with twin boys. I knew from the day Dr. Griffin told me,that I was going to be fine. It was going to work out okay…I was going to get to see my boys.”Twiggs was referred to Akron General Oncologist Elizabeth Connelly, DO. Twiggs elected toparticipate in an industry-sponsored clinical trial that was available at the McDowell Cancer Centerusing a combination of chemotherapy and radiation therapy.Having never spent a day in the hospital before, Twiggs spent a total of 30 days as an inpatientthroughout the course of his treatment. A port was placed in a central vein for easier delivery ofchemotherapy. Alan also had to have a feeding tube placed due to extreme weight loss.That year he wasn’t the only AkronGeneral patient in his family.“Our sons were born on February 26,at Akron General. At the time Marywent into labor, she was staying withme at the hospital during the day andnight, so she’d brought her overnightbag with her,” recounts Twiggs. “Whenit was time to deliver, she walkeddownstairs and checked in as apatient. They wheeled me down, sothat I could sit beside her duringdelivery and cut the boys’umbilical cords.”Twiggs attributes his strength infighting cancer to his family and theongoing support of his physicians andCancer Center staff. He also recognizeshis co-workers in helping him to fighthis cancer.“The people that I work with were sogracious and wonderful through thewhole ordeal. I was off workapproximately seven months. If theyweren’t calling, they were stopping byto help us around the house.”“As a research site with access to a broadrange of clinical trials, our patients areinformed of and offered the opportunity toparticipate in protocols they may qualify toenter, such as the one Mr. Twiggsparticipated in,” says Cathy Farmer, RN,OCN, Coordinator of Research andEducation at the McDowell Cancer Center.Akron General participates in NCIsponsoredgroups that conduct clinicaltrials such as Southwest Oncology Group,Radiation Therapy Oncology Group,Gynecologic Oncology Group, NationalSurgical Adjuvant Breast and Bowel Project,American College of Surgeons OncologyGroup, American College of RadiologyImaging Network and the Cancer TrialsSupport Unit. Patients can also participatein industry sponsored, as well asinvestigator-initiated, studies at theMcDowell Cancer Center.