2011

CANCER CONTROLANNUAL REPORT

TEACHING HOSPITALCANCER PROGRAMACCREDITED BY THE AMERICAN COLLEGE

OF SURGEONS WITH COMMENDATION

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TEACHING HOSPITAL CANCER PROGRAMUMC TREATMENT AND DIAGNOSTIC PROGRAMS

The American College of Surgeons has designated University Medical Center as a Teaching Hospital Cancer Center.

This designation indicates that the hospital program has met very stringent requirements for the care of cancer patients.

UMC Medical Staff Cancer Control Committee supervises the program. The UMC Teaching Hospital Cancer Center

offers a full range of diagnostic and treatment capabilities for the patients who have been found to have one of the

many forms of cancer.

The staff of the Teaching Hospital Cancer Center includes physicians with special interest, training, and abilities in the

care of the cancer patient. Members of the UMC medical staff with special interests in oncology include internal medicine,

obstetrics/gynecology, thoracic and cardiovascular surgery, general surgery, colorectal surgery, genitourinary surgery,

neurosurgery, pediatrics, plastic surgery, radiology, and pathology.

The specially trained and experienced nursing staff is of vital importance in the management of the patient.

The separate oncology nursing unit assure continuity of care for our patients to include rehabilitation, home health care

and hospice care.

Treatment may require surgical care, radiation or chemotherapy/biotherapy either as an inpatient on the oncology

inpatient unit for adults and pediatrics or as an outpatient in the pediatric outpatient clinic for pediatric patients.

Radiation treatment is provided by an affiliation with the 21st Century Radiation Center. The Nevada Cancer Research

Foundation – Community Clinical Oncology Program provides cancer patients with participation in clinical trials and

supports the physicians in their care of the patient.

The Pharmacy Department plays an active role in the preparation of chemotherapy/biotherapy, pain control and

assistance with research protocols. With their expertise, the pharmaceutical services ensure safe and accurate

distribution of medications. Pharmacists are responsible for compliance with the American Society of Hospital

Pharmacists and OSHA guidelines for chemotherapy/biotherapy preparation, handling, and dispensing of

chemotherapeutic and biological agents.

Rehabilitation of patients is done with the assistance of the UMC Rehabilitation Center, the HOPE Chaplains and

counseling programs at UMC and the American Cancer Society. University Medical Center partners with the

American Cancer Society (ACS) in providing the Look Good Feel Better (LGFB) Program. The LGFB program is free

and teaches beauty techniques to women in active treatment to help them with appearance-related side effects of

cancer treatment. A general Cancer Survivor Support Group is facilitated onsite at the UMC Family Resource Center.

An enterostomal therapist is available to provide specialized care and treatment for patients with ostomies,

skin problems, decubitus ulcers and draining wounds. Patients receive pre-and-post operative counseling, treatment

and education.

Registered Dieticians are available to provide adequate nutritional support to patients receiving supplements,

such as TPN or tube feedings, and to assist with planning special menus.

The Cancer Control Committee supervises the Teaching Hospital Cancer Center. Their educational programs include

the UMC Tumor Board, which reviews cases and furnishes an annual review of cancer diagnosis and therapy.

The committee is responsible for supervision of the cancer registry, participation in studies of the American College

of Surgeons and the publishing of the Cancer Control Annual Report.

Professional Education

Screening Activities

Program Activities

2010 Cancer Control Committee Members:

John Ellerton, M.D., C.M., Medical Oncology/Hematology, Chairperson

Wydell Williams, M.D., Surgery, Liaison Physician

Craig Voss, M.D., Pathologist

Laura Bilodeau, M.D., Pathologist

Dianne Mazzu, M.D., Diagnostoc Radiologist

Susan Reisinger, M.D., Radiation Oncologist

Harvey Riceberg, PharmD, Hematology/Oncology

Joshua Mark, PharmD, Hematology/Oncology

Jonathan Gerber, PharmD, Hematology/Oncology

Vicki Huber, RN, Chief Nursing Officer

Kim Voss, RN, Performance Improvement

Marivella G. Abad, RN, Oncology Clinical Manager

Fina Wardle, RN, BSN, Director of Medical-Surgical Services

Doris Cowell, RN, BSN, OCN, Oncology Program Coordinator

Evelyn McGuckin, RN, Nursing Administration

Jeanette Aguilera, RN, Pediatrics

Wendy Voight, RN, PICU

Karen Sartell, RN, M.A., Nevada Cancer Research Foundation Program Coordinator

Shannon Yule, CRA, Nevada Cancer Foundation

Robyn Simon, CTR, Cancer Registrar

Liza Morris, LSW, Social Services

January 2010 - December 2010

ONS Chemotherapy and Biotherapy Course – March 2-3, 2010 & May 5-6, 2010

Greater Las Vegas Chapter ONS Oncology Nursing Symposium – March 2010

Medical Grand Rounds – 2010 CME programs were provided through the VA physicians and the Lancy Foundation:

August 27, 2010 entitled Targeted Treatment Decisions for Patients With Advanced Non-Small-Cell Lung Cancer presented by Paul A. Bunn Jr., M.D., James Dudley Endowed Professor of Lung Cancer Research, Division of Medical Oncology School of Medicine, University of Colorado Cancer Center, Denver CO

September 24, 2010 entitled From Theory To Practice An Update on Prostate, Head and Neck, and Non-Small Cell Lung Cancers presented by Susan Urba, M.D., Associate Professor Division of Hematology/Oncology University of Michigan Medical Center Ann Arbor, Michigan

October 29, 2010 entitled From Theory To Practice: An Update on RCC, CML, and Bone Metastases presented by James R. Berenson, M.D., President and Chief Executive Officer Medical and Scientific Director Institute for Myeloma and Bone Cancer Research, West Hollywood, CA

December 17, 2010 entitled Advanced Renal Cell Carcinoma: Molecular Pathways and Clinical Applications presented by Wolfram Samlowski, M.D. Professor and Chief, Section of Melanoma Renal Cancer and Immunotherapy Nevada Cancer Institute, Las Vegas, NV

July 16, 2010 entitled Individualization of Care in the Management of Metastatic Colorectal Cancer: A Grand Rounds Program presented by Wells Messersmith, M.D. Director, GI Cancer Program Associate Professor University of Colorado Cancer Center Denver, CO

Annual Nursing Chemotherapy/Biotherapy Certification Competency – November 2010

CNE Home Studies to include the following: Labs & Tests Pertinent to Cancer Patients; Oncology Nursing Overview; Oncologic Emergencies; Pain Management in the Cancer Patient

Melanoma at Family Resource Center – Senior Celebrations program – May 2010

UMC Community Outreach Breast Cancer Screening October 2010–

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American Cancer Society Look Good Feel Better Program –

June 2010, August 2010, and October 2010

UMC Cancer Survivor Picnic – May 2010

UMC Cancer Survivor Holiday Party – December 2010

Community Outreach Activities

Support Groups

UMC Cancer Survivor Support Group –

Last Wednesday of the Month

Acronym Glossary

ACSAJCCCCOPCMECNELGFBONS OSHA UMC

American Cancer SocietyAmerican Joint Commission on CancerCommunity Clinical Oncology ProgramContinuing Medical EducationContinuing Nursing EducationLook Good Feel BetterOncology Nursing SocietyOccupational Safety and Health AssociationUniversity Medical Center

In-Depth Study - Colorectal CancerLeslie Browder, M.D., F.A.C.S.

Community Outreach 2010 Breast Cancer ScreeningDoris Cowell, RN, BSN, OCN Oncology Program Director

In an effort to provide a community-accessible cancer screening program, the UMC Community Outreach Cancer

Screening Committee was formed in 2006. This collaborative health care team consists of physicians, nurses, social

workers, eligibility workers, language interpreters, UMC’s Public Relations and Admitting Departments, along with

various community partners/resources. The addition of these community partners/resources has led to easier access

to follow-up care for those patients who need it. Case in point: the participants who attended the 2010 Breast Cancer

Screening held at UMC. The community partners who participated in that event include the Red Rose Program,

through St. Rose Dominican Hospital, serving women age 49 and younger with screening/diagnostic mammography,

ultrasound, and breast biopsy, the Women’s Health Connection, Access To Healthcare Network, serving women age

50 and older, Nevada Health Centers Mammovan, serving women age 40 and older, and the American Cancer Society.

The Nevada Cancer Institute (NVCI) was on hand to provide screening mammograms through their NVCI Hope Coach.

The screening was conducted in a simple, straightforward manner. The participating physicians performed clinical

breast exams (CBE) for 189 women. In addition, each participant was given BSE (breast self exam) instructions, and

ACS (American Cancer Society) educational materials regarding cancer screenings for women, breast health, and sun

safety. After receiving the CBE, women who needed further screening via mammography or ultrasound, were referred

to the appropriate community partners who were on site for the event. Of the 189 women, approximately 21% received

a clinical breast exam without the need for further screening. Of those women needing mammograms, 16% were

referred to the Women’s Health Connection, Access To Healthcare Network, 63% were referred to the Red Rose

Program, and 27% were provided screening mammograms through the NVCI Hope Coach mobile mammography unit.

The demographics were as follows: 61% Hispanic, 16% Caucasian, 12% African-American, 3% Asian, and 3%

unknown (ethnicity not specified). None of the 189 women were found to have breast cancer via this screening event.

However, 14% of the women who were given diagnostic mammography/ultrasound referrals failed to report for them

and were not able to be reached by telephone or mail during follow-up. Approximately 2% of the women who needed

diagnostic mammograms declined to get them, and 2% of the women who needed breast biopsies chose not to have

them. It should be noted that all of the breast biopsies (3% of the women receiving mammograms) performed during

this screening had negative results.

In conclusion, the breast cancer screening data reveals challenges to follow up care even though access to health care

was readily available. Those 14% who failed to report for their mammograms/ultrasounds did not receive further

diagnostic screenings in spite of our best efforts to contact them. Additionally, a small percentage of women had

opted not to receive breast biopsies, which may have resulted in a cancer diagnosis. Because of this, it would seem

that further education is needed from our community outreach programs regarding cancer screening and prevention

programs, as well as the availability of these programs in our community.

According to the American Cancer Society (ACS), colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer death in the United States in both men and women. The ACS estimates that for the year 2012; 103,170 primary colon and 40,290 primary rectal cancers will be newly diagnosed. Furthermore, 51,690 deaths from CRC will occur. More than one third of people with CRC will have metastatic disease at some point during the course of their disease. Recent national trends reveal a slight decrease in both the incidence of and mortality from CRC. This is assumed to be secondary to increased screening colonoscopy rates leading to polypectomy and the diagnosis of cancers at an earlier stage. However, only about 50% of those aged 50 or older get screened and the lifetime risk of CRC approaches 6%.

The national overall 5-year relative survival rate for CRC has increased from 51% for cases diagnosed in the mid-1970’s to 67% for cases diagnosed from 1999-2006. The introduction of 5-fluorouracil-based adjuvant chemotherapy for resectable (operable) stage III colon cancer in the late 1980’s, is responsible for the reduced mortality rate. According to the ACS, only 39% of colorectal cancer patients diagnosed between1999-2006 had localized-stage disease. The 5-year relative survival rates for patients diagnosed at the regional and metastatic stages are 70% and 12%, respectively.

While the vast majority of cases of CRC are still considered to be sporadic, genetic causes or predispositions are more commonly sited as risk factors. It is still assumed, however, that upwards of 70% of all CRCs are sporadic in nature. The risk factors for CRC are listed in Table 1: Risk Factors (below). Additional referred-to charts, graphs,and figures are on Page 5.

Age>50Race: African American males show a slight predominance

Family history of polyps or cancerPersonal history of polyps or cancerInflammatory bowl disease

Tobacco consumptionAlcohol consumptionPhysical inactivityDiet high in red meats and animal fatsLow fiber diet

Chronic ulcerative colitisCrohn's disease

Lifestyle/Environmental Risks

FAP (Familial Adenomatous Polyposis)HNPCC (Hereditary Non-Polyposis Colorectal Cancer) or Lynch SyndromeHamartomatous polyposis

Inheritable Genetic Conditions

The University Medical Center of Southern Nevada (UMC) serves as the county hospital in Clark County, Las Vegas, Nevada. The hospital traditionally serves an underserved and minority population. Unfortunately, many of the patients are financially disadvantaged. Data regarding CRC were collected from 2006 to 2010 and analyzed, comparing the information provided by the National Cancer Database (NCDB) and Surveillance Epidemiology and End Results (SEER) data.

At UMC in 2006, a total of 51 colon cancer cases were identified. There were five Stage I, eight Stage II, fifteen Stage III, and twenty-three Stage IV cancers. The 5-year survival rates were documented for these patients and are considerably lower than national data (Figure 1). Furthermore, in 2008, UMC colon malignancies were defined by the American Joint Commission on Cancer (AJCC) staging system and compared to the NCDB. UMC saw a higher number of Stage III and Stage IV cancers (Figure 2). In 2010, UMC colon malignancies were defined according to AJCC stage and compared to NCDB information. Again, there were less early stage cancers and a more equal amount of late stage cancers. Twenty percent of the cancers identified were not included in the analysis secondary to inadequate staging, as there were biopsy specimens only and presumed to receive their surgical treatment outside of UMC (Figure 3).

The finding of higher stage disease at UMC is most likely due to the lack of access to medical care and funding in a majority of patients. This leads to lack of screening colonoscopy in this patient population, and thus a higher staged cancer at diagnosis. Furthermore, this is supported by the payor source identifiers found in the 2010 data, where as the majority of patients (61%) at UMC are the uninsured and government insured population (Figure 4).

In the United States, CRC incidence and mortality rates are highest in African American men and women. Incidence rates are 20% higher and mortality rates are about 45% higher than those in Caucasians. Incidence and mortality rates among other major racial/ethnic groups are lower than those among Caucasians.

At UMC, ethnicity varied from the NCDB in that most cancers at UMC were among Caucasians (Figure 5). Contributing factors may include regional variations in risk factors and access to screening and treatment. These factors are influenced by socioeconomic factors, legislative policies, and proximity to medical services. Across the CRC literature, the incidence of CRC in Caucasians is considerably lower in western states, with the exception of Nevada.

2010 malignancies were almost equally divided between male and female gender (Figure 6). The overall incidence in the US shows that there is a slightly higher predominance of males diagnosed with CRC compared to females.

The highest incidence of location was in the sigmoid followed by the cecum (Figure 7). This is within the literature of the NCDB in that the majority of cancers are left sided/sigmoid, with a trend toward right-sided cancers.

According to Surveillance Epidemiology and End Results (SEER) data, the median age at diagnosis for CRC was 70 years of age. At UMC< the majority of patients were diagnosed between the ages of 50-59 (Figure 8). This is slightly younger than SEER data. The younger age combined with the later stage of diagnosis in the UMC population helps support the theory that lower socioeconomic levels and environmental differences may influence CRC.

This in-depth study in CRC at UMC leads to support the education of the general public and medical personnel in Las Vegas. Through education and funding people could be encouraged to obtain screening colonoscopies, thus preventing and/or diagnosing CRC at an earlier survivable stage.

(Continued on Page 5)

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In-Depth Study - Colon Cancer - Continued (Neoplasm Graphs)

Leslie Browder, M.D., General SurgeonUniversity Medical Center Medical Staff

2010 All Sites By Systems

2010 Cases By Ethnicity

2010 By Pay Source

2010 Age At Diagnosis

UMC 2010 Malignant Colon Neoplasm

by Subsite

UMC CANCER REGISTRYRobyn Simon, CTR

UMC 2010 By Gender

The Cancer Registry at UMC is just one of the important parts of an American College of Surgeons approved Teaching Hospital Cancer Program. The registry collects, manages, and analyzes data on patients who are diagnosed with a malignancy or treated for a malignancy at UMC. In 2011, the registry performed two Long Term Survival PCE studies on Analytic COLON Malignancies and Analytic LUNG Malignancies diagnosed in 2006. The Cancer Registry at UMC was established in 1979 and its’ reference year is 1995. There are approximately 14,000 cases in its database with 861 new cases accessioned into the registry in 2010 and approximately 5,400 patients followed annually. The registry’s primary goal is to assist the hospital in providing optimal care to the cancer patients. To ensure a credible database, the registry performs ongoing quality control checks through IOP (Improving Organizational Performance) improvement procedures on case finding for both pathology and Disease Index List sources of cases and also maintains the quality of registry data with a review of ten percent of analytical cases by Cancer Control Committee Member. These findings are reported to the Cancer Control Committee quarterly.

UMC 2010 Malignant Colon Neoplasm

by Pay Source

UMC 2010 Malignant Colon Neoplasm

by Age

UMC 2010 Malignant Colon Neoplasm

by Gender

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Percentage of Patients

Percentage of Patients

UMC 2010 Malignant Colon Neoplasm

by AJCC Stage

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UMC 2006 Malignant Colon Neoplasm

5-Year Survival by AJCC Stage

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Colon Malignancy - Continued

John Ellerton, M.D., C.M.Medical Oncology/Hematology, Chairperson

2006 Colon Malignancies, Distribution by Gender

2006 Colon Malignancies, by Ethnicity

2006 Colon Malignancies, by Patient Status

2006 Colon Malignancies, Distribution by Subsite

2006 Colon Malignancies, Distribution by Age Range

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2006 Colon Malignancies, 5-Year Survival by AJCC Stage

2008 Colon Malignancies, 5-Year Survival by AJCC StageUMC Data Compared to National Cancer Data Base

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Colon Malignancy

John Ellerton, M.D., C.M.Medical Oncology/Hematology, Chairperson

According to the American Cancer Society, it is estimated that 147,000 people will be diagnosed with colorectal cancer in 2011. Among all cancers, is the second leading cause of death in the United States and affects both men and women equally. Colorectal cancer is both sporadic and familial; with the incidence higher in developed countries than in under developed countries. However, the past decade has shown a decrease in the incidence of colorectal cancer in the United States among adults 50 years and older. (1)

There is strong evidence of environmental associations for colorectal cancer. However, data from prospective trials indicates that these associations are not clear. Recently there has been some recognition that the regular use of non-steroidal anti-inflammatory agents may have a protective effect against colorectal adenomas and colorectal cancer.

Colorectal cancer has been identified as a major priority by the American Cancer Society because of the great potential for prevention. This includes the number of techniques to detect the presence of polyps allowing them to be removed before they can become malignant.

In 2006, University Medical Center of Southern Nevada diagnosed 72 patients with colon cancer. In keeping with the reported even gender distribution, 54% were female and 46% male. Ethnicity was represented with Caucasian at 57%; Black at 27%, Hispanic at 12% and 4% Other. The median age range was 50-59 at 34%, followed by 60-69 at 27% and 40-49 at 15%, respectively. Subsite analysis of these cases shows the highest percentage occurred in the cecum at 23%; with the ascending colon showing 12% of the cases and 7% located at the hepatic flexure. Thus, 42% of the cancers were on the right side or proximal part of the colon which reflects the trend over the past few years for the cancers to be more frequent in the proximal colon.

In comparison with the National Cancer Data Base, the AJCC stages of Colon cancer patients seen at UMC reflect a much higher percentage of Stage IV disease (UMC at 35% vs. NCDB at 17%) and a much lower percentage of earlier Stages I and II disease (UMC at 7% and 11% vs. NCDB at 19% and 24% respectively). Later stages of disease may be attributed to the socioeconomic climate in Southern Nevada and the Las Vegas community with UMC as a safety net hospital for the indigent. Of the random sampling of charts reviewed, 85% of colon cancer patients had cancer directed surgery at UMC. According to NCCN guidelines, standard of care for Colon cancer patients Stage III is surgery followed by adjuvant chemotherapy. 73% of the patients diagnosed at UMC in 2006 were stages III and IV and of these patients, 47% received chemotherapy and 53% did not. For patients not receiving chemotherapy, 40% expired, 40% refused treatment and the remaining 20% were not medically stable to receive chemotherapy. It should be noted that 46% of these patients had expired within the first year, directly reflected by the advance stage of disease documented at the time of diagnosis. Of the charts reviewed, 13% were Stage I, 8% were Stage II, 29% were Stage III and 50% were Stage IV. The 5-year survival rates for these patients are 66% for Stage I (non-cancer-related death), 100% for Stage II, 57% for Stage III and 0% for Stage IV, for an overall 5-year survival rate for all combined stages of only 33%. UMC data shows a considerably lower overall 5-year survival rate when compared to the national 5-year survival rate of 67% (2), which correlates with the hospital’s higher incidence of Stage IV disease.

Although more research is needed, the introduction of targeted therapies and genetic testing for colon cancer has improved prognosis for these patients. For example, discoveries of inherited genes that may increase the risk of colon cancers are already being used in genetic testing. Also, the discovery of gene mutations such as K-ras and BRAF allow cancer treatments to be tailored to the patient. Research in the area of chemoprevention has lead to lowering a person’s risk of developing colon cancer. Clinical trials are currently available at UMC in these areas of research in the ongoing search for a cure.

(Footnotes)(1) ACS Cancer Facts and Figures 2011-2013(2) ACS Cancer Facts and Figures 2011-2013 (Continued on Page 8)

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In 2010, of the estimated 1.5 million new cancer cases diagnosed in the United States, 222,500 were new lung cancer cases with 157,300 deaths. Lung cancer accounts for about 15% of all cancer diagnoses, but 28% of all cancer deaths. More women have died from lung cancer than from breast cancer annually since 1987. Lung cancer death rates in women began to stabilize in 2003 and perhaps have started to drop after continuously increasing for several decades, with a peak at 6% per year. In addition, the lung cancer death rate in men has declined by 1.3% per year from 1990-1994 and by 2.0% per year from 1994-2006. The state of Nevada will account for approximately 1,920 new lung cancer cases, with 1300 deaths. Current statistics report that 85% (189,125 new cases) are non-small cell lung cancers. Death from lung cancer in women have just recently started to decline, compared to the decline in male lung cancer death rates that began in the 1990s. That trend can be accounted for by the fact that women began smoking later than men and, thus, incidence of lung cancer in women peaked later than men. As smoking cessation programs became more prevalent and successful, deaths due to lung cancer declined. The results of the National Lung Screening Trial may also impact the death rates if the final analysis of the data confirm early reports that screening high risk populations with low dose CT scans does impact the mortality due to lung cancer.

The University Medical Center of Southern Nevada (UMC) serves as the county hospital in Clark County. It serves a large portion of the underserved and minority population in the county. In 2006, 37% of the diagnosed lung cancer patients had Medicare, 22% were self-pay/uninsured; 33% had private insurance and 8% had HMO coverage (Figure 1, by payor source). During that year, 55% of the lung cancer patients served were Caucasian, 19% Asian, 15% African-American, and 11% Hispanic, with 44% female and 56% male (Figures 2 and 3). The median age for lung cancer diagnosis approximately 70 years. The median age of a lung cancer patient at UMC was lower than the national median (see Figure 4, distribution by age range). Lung cancer patients at UMC were diagnosed at later stages compared to the NCDB: only 7% were diagnosed as Stage I, 5% as Stage II (23% and 7% in the NCDB, respectively), compared to 27% Stage III and 48% Stage IV (23% and 34% in the NCDB) (Figure 5). This may reflect the fact that there is currently no validated and approved screening test for lung cancer and that lung cancer frequently does not cause symptoms until later stages of the disease. Reflective of the higher stage at diagnosis, only 7% remained alive at the time of data extrapolation (Figure 6, current patient status, at 4 yrs) compared to the national average for 5-year survival across all stages of 16%. Histologic classification of non-small cell lung cancer is important in prognosis and treatment. In 2006, 41% of all non-small cell lung cancers diagnosed at UMC were adenocarcinoma, 22% squamous cell carcinoma, with the remaining grouped into non-small cell carcinoma without further histologic subtyping (Figure 7). The percentages identified as adenocarcinomas and squamous cell carcinomas are close to the national distribution of 35-40% adenocarcinomas and 25-30% squamous cell carcinomas. However, the group not further classified remains high. With prognosis and treatment options dependent on accurate classification, this group labeled as “non-small cell carcinoma” will need to eventually be reduced to as low a level as possible in order to optimally treat patients. The preferred treatment for early stage lung cancer is surgical resection. Chemotherapy alone is not considered curative for lung cancer. Nevertheless, randomized prospective trials have demonstrated the benefit of chemotherapy following surgery for resectable lung cancer. In specific instances, multi-modality therapy (surgery, chemotherapy and radiation therapy) is recommended for locally advanced lung cancers. Figure 8 reflects the treatment provided which, in turn, is dependent upon the stage at diagnosis. Of note, 44% of patients did not receive any treatment. The available data do not indicate whether this was due to poor patient performance status, patient choice, or other factors. As a result, this reflects on the poor survival of this patient population, 7% alive at 4 years compared to a 16% 5-year survival across all stages.

The treatment and survival rates of lung cancer patients diagnosed at UMC may reflect the socio-economic demographics of the patient population served by this hospital. UMC has a commitment to provide care to this population, ideally through multi-disciplinary team assessment. Despite the fact that mortality from non-small cell lung cancer remains high, scientists and clinicians are developing new drugs through better understanding of the biology of this disease or set of diseases. Newer therapies such as stereotactic radiation can be utilized to cure patients with Stage I and some Stage II lung cancers who would otherwise not be considered surgical candidates. Drugs targeting specific cell signaling pathways are now under investigation in lung cancers that appear to be dependent upon these pathways for signaling.

(Continued on Page 10)

Lin-Chi Chen, M.D., Ph.D.Medical Oncology - Nevada Cancer Institute

Lung Study

(Continued on Page 11)

UMC 2006 Lung Malignancies, Distributionby Treatment, All Atages

UMC 2006 Lung Malignancies,Distribution by Gender

UMC 2006 Lung Malignancies, Metastatic Sitesfor Stage IV Malignancies

UMC 2006 Lung Malignancies,Distribution by Clinical Tumor Size

UMC 2006 Lung Malignancies, Patient StatusAll Stages

UMC 2006 Lung Malignancies,Distribution by Age Range

Lin-Chi Chen, M.D., Ph.D.Medical Oncology - Nevada Cancer Institute

Lung Study - Continued

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The Nevada Cancer Research Foundation Community Clinical Oncology Program

Lung Study - Continued

Lin-Chi Chen, M.D., Ph.D.Medical Oncology - Nevada Cancer Institute

UMC 2006 Lung Malignancies, Distribution byAJCC Stage, UMC vs NCDB

UMC 2006 Lung Malignancies,Distribution by Ethnicity

UMC 2006 Lung Malignancies,Distribution by Laterality

UMC 2006 Lung Malignancies,Distribution by Pay Source

UMC 2006 Lung Malignancies,Distribution by Histology*

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Karen Sartell, M.A., CCRP Program Administrator

The Nevada Cancer Research Foundation – Community Clinical Oncology Program (NCRF-CCOP) is a non-

profit, clinical trials oncology program that has been funded since 1983 by a grant from the Division of Cancer

Prevention, National Cancer Institute (NCI). The mission of the NCI-supported Community Clinical Oncology

Program Network is to develop and conduct state-of-the-art cancer prevention, control, and treatment clinical

trials with significant involvement of community oncologists and populations they serve. The CCOP Network

mission includes: (1) accelerating development of interventions to prevent and treat cancer and its symptoms

by increasing accrual to trials; (2) fostering quality care in the community through adoption of results from

clinical trials; and (3) increasing the involvement of minority and underserved patient/participant populations in

cancer clinical trails.

The NCRF-CCOP is fortunate that the University Medical Center of Southern Nevada (UMCSN) has been

affiliated with the NCRF-CCOP since 1983. To assist the NCRF-CCOP, UMCSN provides a regulatory umbrella

so that studies are reviewed and approved by its Institutional Review Board so that these studies are available

for patients being treated at the hospital and in local oncologists’ and radiation oncologists’ offices. This

affiliation has allowed patients in the Las Vegas area to participate in national clinical trials that would

otherwise not have been available to them.

These clinical trials are available to the patients because UMCSN is a member of national cooperative

oncology groups through its affiliation with the NCRF-CCOP. These cooperative oncology groups serve as

‘research bases’ for the NCRF-CCOP and provide a portfolio of clinical trials from which the NCRF-CCOP and

UMCSN are able to choose studies that best fit the patient population. The Cooperative Groups which UMCSN

is affiliated with via the NCRF-CCOP include: the Cancer and Leukemia Group B (CALGB), Eastern

Cooperative Oncology Group (ECOG), Southwest Oncology Group (SWOG), National Surgical Adjuvant

Breast and Bowel Program (NSABP), and the Radiation Therapy Oncology Group (RTOG). There are

approximately 75 studies that are active currently and many more studies that are closed to new patient

enrollment but the NCRF-CCOP and UMCSN continue to collect data on these patients. This collaboration will

continue for many years as each study has a unique period of time where the patient is followed after active

treatment. This may range from a few months to the lifetime of the patient.

In 2008, UMCSN became a member of the Children’s Oncology Group. The UMCSN now has about 65

pediatric oncology studies available for children with leukemia and renal cancers as well as correlative science

and quality of life studies.

UMCSN has been instrumental in the success of the NCRF-CCOP program due to the support and

commitment of the UMC administration, as well as the medical and nursing staff of the Pediatric and Oncology

Units.

For more information on the Nevada Cancer Research Foundation – Community Clinical Oncology Program,

telephone (702) 384-0013.

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One of my key roles as case manager is essentially that of a utilization reviewer for various private, federal and

non-insured patients. During this aspect of my job there is an attempt to provide needed clinical data often

times requested by these entities that reflect the reason for an acute in-patient setting for level of care support.

In addition, it is also vitally important for me to work collaboratively with our social worker who is considered the

lead as our particular institution’s discharge planner, as it relates to the company’s team matrix model.

Oncology Case Management David Osman, R.N., M.A. COMMUNITY OUTREACH 2010

189 women were screened and provided informationregarding women's health during this event.

Provided entertainment with Mark O'Toole,Lymphoma Cancer Survivor, local singer/performer

and Sun Safety, Doris Cowell, RN, UMC Oncology Program Coordinator

However, my work in case management and discharge planning collaboration is not limited to our social

worker, but it also includes working closely with patient’s primary care physician, knowledgeable primary care

staff, other departmental disciplines as well as the patient in order to ensure that our team effort is impacting

the patient’s stay with the most effective delivery of services to include preparing the patient and their family for

eventual safe and supportive discharge.

The role of case managing and discharge planning can have synonymous meanings and truly is defined by

which company or institution one works. Nevertheless, this role in many ways attributes to all who has contact

with patients and their family. Due to our collectively roles as a team of professionals the role process of case

management and the discharge planning can include, but not limited to; our food services, maintenance, house

keeping, and various ancillary departments.

Partnerships and or collaborations throughout the varying levels of our institution and with outside entities and

professionals are essential for the healthy experience and outcomes of our patients. In closing, this role in my

job is probably the most rewarding and that is as an ambassador for the delivery of the highest quality of care

and service to our cancer patient population.