Cary East Raleigh Garner Raleigh Main Raleigh Blue Ridge Wakefield

UNC REX CANCER CARE

ANNUAL REPORT 2017

A COMPREHENSIVE COMMUNITY CANCER PROGRAM Accredited by the American College of Surgeons Commission on Cancer National Accreditation Program for Breast Centers

On the cover: UNC REX Cancer Care of Wakefield 11200 Governor Manly Way, Raleigh, NC 27614

UNC REX Cancer Care locations Cary ~ East Raleigh ~ Garner ~ Raleigh Main ~ Raleigh Blue Ridge ~Wakefield

For more information or to schedule an appointment with UNC REX Cancer Care

Call 919-784-3105 www.REXhealth.com

Mission

Our mission at UNC REX Cancer Care is to provide our patients with exceptional cancer care and to ensure

timely and convenient access to the most effective strategies that prevent, treat, and ultimately cure cancer

in the future. UNC REX Cancer Care provides expert, compassionate care to patients with cancer through

close collaboration among providers across all disciplines of oncology.

Core Values

Impact

We strive to provide timely access to care in a caring and compassionate setting close to patients’ homes

and to relieve the burden of disease now and for the future through our research, clinical care, education,

outreach and advocacy.

Excellence

We pursue excellence relentlessly and with integrity in all that we do, adhering always to the highest

standards of conduct.

Compassion and Respect

We strive to exceed expectations for compassion and respect for those in our care and for one another.

UNC REX Cancer Care Mission and Core Values

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UNC REX Cancer Care Annual Report 2017

Table of Contents Page

Mission and Core Values 3

Introduction 5

Accreditations and Eligibility Requirements 6

Feature: Prevention and Screening Programs 7

Patient Family Advisory Council 14

Tumor Registry and Site Distribution 15

Clinical Trials 17

Publications and Presentations 2017 18

Comprehensive Community Cancer Care 19

Cancer Care Services and Locations 20

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Introduction The REX Cancer Care Committee is the designated multidisciplinary body for program leadership, administrative oversight, development, and review of oncology services at UNC REX Cancer Care. The Cancer Care Committee is a committee of the UNC REX Hospital Medical Staff responsible for the overall direction of the oncology program including coordination with Hospital and UNC Health System leadership. Its composition, as required by the Commission on Cancer, includes Board-certified physicians from Surgery, Medical Oncology, Radiation Oncology, Diagnostic Radiology, and Pathology, along with the Cancer Liaison Physician, Clinical Research Manager, Palliative Care Specialist, and representatives from Hospital Administration, Nursing, Pharmacy, Psychosocial Services, Cancer Registry and Quality.

Annually, as required by the Commission on Cancer, the UNC REX Cancer Care Committee prepares an annual report with a focus on program outcomes. For 2017, the Committee selected CoC Standards 4.1 and 4.2: Prevention and Screening Programs as the focus for the Annual Report. These findings, published here in the UNC REX Cancer Annual Report, are also made publicly available to the organization and the community.

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Cancer Care Committee Membership 2017

Courtney Bui, MD Committee Chair Yale Podnos, MD ACoS Cancer Liaison Physician/ Surgical Oncology Susan Moore, MD Medical Director, Rex Hematology Oncology Associates David B. Eddleman, MD Surgeon / Breast Care Committee Chair Tom Grates, MBA Executive Director, UNC REX Cancer Care Chad Lefteris, MHA VP Operations UNC Rex Health Hiren Mehta, MD Pulmonologist, Chair Cancer Conference Committee Charles Eisenbeis, MD Hematology Oncology Nathan Sheets, MD Radiation Oncology Keith Volmar, MD Pathology Jay Alley, MD / Duncan Chapman, MD Radiology Kathleen Foote, MBA, CTR Cancer Registry Manager Nancy Burns, RN, OCN Cancer Research Manager Cynthia Jones, BS, CPHQ Quality Coordinator Kimberly Fradel, MSW,LCSW Social Work /Psychosocial Services Coordinator Jan Kimball, NP/ Ann Yeager, MD Palliative Care Mendy Moody, MSN, OCN Oncology Nurse Manager (OP) / Clinical Leadership Catherine Fine, MS, CGC / Ofri Leitner, MS, CGC Genetic Counseling Emmeline Madsen, MPH Community Outreach Coordinator / Director

Additional Supporting General Membership 2017 Matthew Strouch, MD ~ Surgery Douglas Hammer, MD ~ Family Practice Meena Mohan, MD ~ Hospitalist Robert Wehbie, MD ~ Medical Oncology Jon Gerber, PharmD ~ OP Pharmacy Becky Jones, PharmD ~ IP Pharmacy Jennifer Headen, MHA ~ RHOA Administrator Heather Sasser, RN, OCN Nancy Reifsteck, OTR ~Rehab Suzanne Smith, RD, CSO, LDN~ Nutrition Gordon McGirt, MBA ~ Manager (OP RHOA) Kelsey Williams, RN, Manager (IP) Katie Hardison, BS ~Staff /Committee Assistant Robbie Tilley ~American Cancer Society

UNC REX Cancer Care is voluntarily accredited by the American College of Surgeons Commission (ACoS) per the Commission on Cancer (CoC) Standards as a Comprehensive Community Cancer Program (CCCP). The pro-gram assesses more than 2,800 newly diagnosed cancer cases each year, provides a full range of diagnostic and comprehensive treatment services as noted below, either on-site or by referral, as well as participates in cancer-related clinical research and cancer-related clinical trials, per CoC Standards. UNC REX Cancer Care is voluntarily accredited by the National Accreditation Program for Breast Centers (NAPBC), which holds organizations to the highest standards of care for patients with diseases of the breast. UNC REX Care is also accredited by the Joint Commission and ACR Breast Imaging Center of Excellence.

UNC REX Cancer Care meets and /or exceeds the Commission on Cancer’s 12 Eligibility Requirements:

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UNC REX Cancer Care Accreditations

Eligibility Requirements Specifications

Cancer Committee Responsibilities Annual monitoring, assessing, and identifying changes that are needed in each of the eligibility requirements.

Facility Accreditation The facility is accredited by a recognized federal, state, or local authority.

Cancer Committee Authority Bylaws or policy and procedure define the cancer committee’s authority and responsibility for the program.

Cancer Conference Policy Program policy addresses the frequency, format, multidisciplinary attendance, attendance rate, prospective case presentations and total case presentations, discussion of stage and treatment planning, clinical trial options, and methods to address opportunities.

Oncology Nurse Leadership An oncology nurse provides leadership within the program.

Cancer Registry Policy and Procedure Policy and procedure addresses the use of Commission on Cancer data and all other cancer registry activities.

Diagnostic Imaging Services are provided. *

Radiation Oncology Services Radiation treatment service locations are currently accredited by a recognized authority or, if not accredited, follow standard quality assurance practices. *

Systemic Services Policies or procedures are in place to guide the safe administration of systemic therapy.*

Clinical Trial Information A policy or procedure is used to inform patients about clinical trials.

Psychosocial Services A policy or procedure is in place to ensure patient access to psychosocial ser-vices.*

Rehabilitation Services Rehabilitative services are provided. *

Nutrition Services Nutrition services are provided.*

Source: CoC, 2016 * Services are available either on-site, at locations that are facility owned, or by referral.

UNC REX Cancer Care has a strong history of community engagement and outreach to increase awareness of cancer risk, prevention and early detection. Our programs are developed to align with community areas of need, to build on successful strategies and to be consistent with evidence-based practices. COMMUNITY NEEDS ASSESSMENT UNC REX Cancer Care uses information from multiple community health needs assessments to in-form our community outreach activities. Each year findings from the following community health needs assessments are reviewed by the Cancer Care Committee: UNC REX Cancer Care Incidence and Mortality Trends American Cancer Society Facts and Figures Wake County Community Health Needs Assessment Komen Community Health Needs Assessment. Behavioral Risk Factor Surveillance System

UNC REX Healthcare participates in a collaborative Wake County Com-munity Health Needs Assessment (CHNA) that identifies the health needs of Wake County residents as well as the resources available to address those needs. The CHNA is conducted every three years through the col-laborative efforts of Wake County Human Services, Advance Community Health, Duke Raleigh Hospital, UNC REX Healthcare, WakeMed Health and Hospitals, United Way of the Greater Triangle, and the Wake County Medical Society Community Health Foundation. The CHNA identified the following county priority areas to be addressed through community health improvement efforts: Health Insurance Coverage, Transportation, Access to Health Service, Mental Health and Substance Abuse.

In the capital city of Raleigh, NC, there are nu-merous community resources available to resi-dents that may not be available in surrounding counties. The UNC REX Cancer Care service area includes Wake, Franklin, Johnston, and Harnett counties. Not surprisingly, the Komen Community Health Needs Assessment identified the highest priority cancer risk reduction and prevention activities need in the counties border-ing the service area. Our needs assessments also identified key trends in incidence and mortality. In North Carolina cancer incidence rates are highest among breast, lung, prostate, and colorectal diagnoses. The highest mortality rates are in lung, colorectal, breast, hepatopancreatic, and prostate diagnoses.

UNC REX Cancer Care: Prevention and Screening Programs

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The top five identified cancers diagnosed at late stage at UNC REX Cancer Care are Oral (42%), Lung (41%), Lymphatic (31%), Digestive (25%), and Gynecologic (16%).

North Carolina ranks in the top ten states for screening for breast, colorectal and cervical cancer and is above the national average in mammography, pap tests, fecal occult blood testing, and endoscopy. Although these screening rates are higher than many other states, improvement opportunities remain. Of note, North Carolina is ranked poorly for cancer risk factors including overweight and obesity prev-alence, HPV vaccinations rates, and tobacco related risk factors.

Cancer incidence disparities also exist in individuals with lower socioeconomic categories. Individuals in this population are more likely to engage in high risk behaviors and have less access to health care and healthy behavior resources. Racial and ethnic disparities are similarly reflective of poor access to health care resources. Prostate cancer rates for example are notably higher in African American men including North Carolina and the UNC REX Cancer Care service area. Hispanics have lower rates for the most common cancers but are highest in those associated with cancer-related infections. Findings from the American Cancer Society and other sources on cancer risk factors have focused heavily on achieving and maintaining a healthy weight, participating in an active lifestyle, consuming a healthy diet, limiting alcohol consumption, refraining from tobacco use and accessing medical care. Despite the impact of these recommendations to decrease cancer risk, many cancers can be positively impacted with early detection and treatment including breast, prostate, and lung, colorectal, skin, and cervical. The UNC REX Cancer Care outreach programs strive to increase awareness, improve access to care and increase community engagement to reduce cancer incidence and mortality rates. PREVENTION PROGRAMS Lay Health Advisor Program: Brothers & Sisters of Rex Brothers & Sisters of Rex is a Lay Health Advisor program utilizing the skills and time of over 30 specially trained volunteers to provide education to the community on cancer prevention and early detection. Some of the volunteers are from the original Save Our Sisters program that was created in the mid-1990’s through a Breast and Cervical Cancer Early Detection Program (BCCEDP) funding require-ment to have a lay health component of program offerings.

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That group, which focused on address-ing the breast health needs of African American women, joined UNC REX Healthcare in 2001 when funding from Wake County was. In 2014, Save Our Sisters expanded to become Brothers & Sisters in collaboration with efforts of the North Carolina Minority Prostate Cancer Awareness Action Team to reach out to individuals on the importance of prostate cancer awareness and education. The volunteer group quickly expanded and developed a knowledge base to inform out-reach efforts on breast, prostate and colorectal cancer risk, prevention, and early detection. In 2017, members were trained on lung cancer and tobacco prevention and cessation messaging to in-clude in outreach efforts. Members of Brothers & Sisters provide health talks and information throughout the year at community locations and reach an average of 5000 individuals each year. Faith-Based Campaigns UNC REX Cancer Care conducts a community campaign in local faith-based organizations in areas with increased need for cancer awareness and early detection behaviors. Specially trained Lay health advisors (LHAs) engage pastors and con-gregation members in discussion on early detection of cancers. A faith-based campaign has proven to be a very effective method of engaging the community given in positive behavior change. LHAs are equipped to engage and answer questions immediately and refer appropriately. A simultaneous message directed to both men’s and women’s health issues have worked well to address multiple cancer risks. Annual Goals and Objectives: Engage community churches in discussion on self-care and health behaviors Engage with community members to increase awareness of breast cancer, prostate cancer, and

colorectal cancer risk, prevention, and screening Increase access to UNC REX Healthcare services for early detection, treatment, and survivor-

ship

Results: 2016: 11 churches 1570 individuals reached

2017: 17 churches 955 individuals reached

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Barbershop and Salon Campaigns Another community awareness campaign was conducted in local beauty salons and barbershops in are-as with increased need for cancer awareness and early detection behaviors. Lay health advisors engage barbers/stylists and clients in discussion on early detection of cancers. Annual Goals and Objectives: Engage individuals in discussion on self-care and health behaviors Engage with community members to increase awareness of

breast cancer, prostate cancer, and colorectal cancer risk, prevention, and screening

Increase access to UNC REX Healthcare services for early detection, treatment, and survivorship

Results: 2016: 14 Barbershops 275 Individuals reached

10 Salons 316 individuals reached

2017: 13 Barbershops 245 Individuals reached 11 Salons 281 Individuals reached

Similar to faith-based campaigns, a community campaign within salons and barbershops can be a very effective method of engaging the community. Although individual clients are engaged during the visits, the stylists participate in the mes-saging and sharing of information during the awareness month and serve as a point of contact for clients if there are needs or concerns related to cancer.

Digital Campaigns UNC REX Cancer Care conducted a breast cancer awareness campaign in 2017 to increase access to information on breast cancer early detection. The campaign was developed with input from on-line focus group participants to determine imagery and wording that would resonate in the community. The targeted population was on-line users seeking information on breast health and breast cancer. During the campaign, there were 167,384 digital im-pressions with over 2,500 individuals engaged in watching video content or additional digital content. There were 88 follow up actions for appointments for breast care services. UNC REX OnLine Health Library UNC REX Cancer Care strives to ensure that access to information on healthy lifestyle and cancer risk and risk reduction is available to visitors to our web sites. The main UNC REX Healthcare website provides highlights on information during cancer awareness months throughout the year and provides access year-round to information for users on a variety of cancer related topics.

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Given that more and more individuals are seeking health information on-line, UNC REX Healthcare partnered with Healthwise to provide on-line access to infor-mation for patients and the community. Healthwise develops content through col-laborative team efforts to provide information that is comprehensive, evidence-based, and pertinent to users. Interactive tools are available for health and fitness and lifestyle check-ups along with personal calculators to assist individuals in learning more about health. Numerous on-cology topics are provided through information summaries from the National Cancer Institute. YOUR LIFE / REX CONNECTS / UNC REX Health Talk Your Life is an electronic newsletter that provides information to subscribed users throughout the year. Rex Connects is an on-line blog created by UNC REX Healthcare. Both the newsletter and the blog space allow experts to provide in-formation in the on-line community on health information and risks. The content is developed to engage the audience in accessing information on health and to in-crease access to services available at UNC REX Healthcare. Impressions and engagement to these resources have increased notably. In 2017

there were 27,653 impressions and engagement of over 986 individuals with information on-line pertinent to cancer prevention and risk reduction.

SCREENING PROGRAMS Low Dose CT Screening UNC REX Healthcare developed a Low-Dose CT lung cancer screening program in 2016. The pro-gram includes an on-line assessment, a nurse prescreen, an in-person nurse visit, a referral to an Ad-vance Practice Provider for informed decision making and establishment of care, the LDCT screening, and appropriate follow-up. A patient can be referred directly for a LDCT screening by a referring physician as well. The UNC REX Program is identified as a Lung Cancer Screening Center by the American College of Radiology. Data is tracked and uploaded to a national Lung Cancer Registry. Annual Goals and Objectives: Increase awareness of lung screening Provide access to low-dose CT lung screening at UNC REX Healthcare Provide access to a self-assessment tool to inform on risk and eligibility for lung screening Screen patients for eligibility to identify appropriate individuals for care utilizing a clinical re-

source to inform referral to medical assessment Conduct LDCT Screenings on patients and ensure adequate follow-up Reduce late stage lung cancer diagnoses

Results: 2016 297 patients screened 2 cancers diagnosed 2017 528 patients screened (YTD) 5 cancers diagnosed

The LDCT program is proving to be a very effective program in growth of screening for lung cancer and is a critical element in any Comprehensive Community Cancer Center.

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Mammography Assistance Program Rex Mammography Assistance Program (MAP) is a program supported through The Rex Healthcare Foundation Pink Ribbon Fund to provide fi-nancial support to individuals in need of breast cancer screening and diag-nostic imaging. The program provides access to screening and diagnostic imaging services for individuals who might not otherwise access those services Annual Goals and Objectives: Increase breast cancer screening rates in underserved communities Decrease mortality and morbidity from breast cancer Provide assistance to individuals without access to care Fill gaps not met by the NC Breast and Cervical Cancer Control Program and other community

resources Engage individuals in UNC Patient Financial Assistance Program for additional support to sup-

port any additional follow up care or treatment Results: In 2016, the following patients were provided services through MAP Screening 432 $192,800 Diagnostic Mammography 396 $58,900 Ultrasound 179

o Five (5) malignancies were diagnosed through the program

Mobile Mammography Program The Rex Mobile Mammography program is a mobile breast cancer screening program. The mobile unit provides access to convenient screening in a 15 county region in central/eastern North Carolina. The mobile mammography program focuses on providing access to care in areas that are otherwise underserved. Annual Goals and Objectives: Increase breast cancer screening rates in underserved communities Decrease mortality and morbidity from breast cancer Provide assistance to individuals without access to care Provide screening resources to community and corporate locations Further develop the partnerships with community health centers to ensure access to care Further develop partnerships with local corporations to provide access to convenient screening Maintain funding for Mobile Mammography Program

Results: 2016: 1837 screening mammograms

o Two (2) individuals were diagnosed with cancer

2017: 3556 screenings have been conducted YTD. o Ten (10) individuals have been diagnosed with cancer

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The mobile mammography program effectively extends services into a service area with otherwise limited access to care, provides convenience for service, and engages Community Health Center part-

ners with a collaborative service offering to in-crease rates of screening and detection of cancer at an early stage.

RESOURCES AND REFERENCES American Cancer Society. Facts and Figures 2016. https://www.cancer.org/content/dam/cancer-

org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2016/cancer-facts-and-figures-2016.pdf

Commission on Cancer. American College of Surgeons. 2016. https://www.facs.org/quality-

programs/cancer/coc Lung Aware. Free Lung Aware online health assessment. https://www.rexhealth.com/rh/care-

treatment/heart-vascular/diagnostics-screening/health-aware/lung-aware/ Lung Cancer Screening Could Save Your Life. https://www.rexhealth.com/rh/care-

treatment/cancer/early-detection/lung-screening/

REX Connects: A Health and Wellness Blog from REX Healthcare. https://www.rexhealthblog.com/

UNC REX Mobile Mammography https://www.rexhealth.com/rh/care-treatment/imaging-radiology/mammography/mobile/

UNC REX Cancer Care. https://www.rexhealth.com/rh/care-treatment/cancer/

Wake County Community Health Needs Assessment. Executive Summary 2016: Opportunities and Chal-

lenges. www.rexhealth.com/app/files/public/6311/pdf-rex-community-2016-wake-county-chna-executive-summary.pdf

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Patient and Family Advisory Council The UNC REX Cancer Patient and Family Advisory Council (PFAC) is a dedicated team of cancer survivors and volunteers who have an active role in improving the patient and family care experience by identifying opportunities, gathering and providing feedback and perspectives on plans, activities and programs related to patient and family health care. Integrating the PFAC within the UNC REX Cancer Care setting is an excellent approach to learn from our patients through their unique perspectives and experiences to actively increase the quality of care together. UNC REX Cancer Care recognizes the many benefits of working with patients and families towards improving quality and safety, financial performance, patient outcomes as well as improving the patient and family experience. The PFAC is supported by executive sponsors, volunteer advisors and cancer center staff.

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UNC Rex Cancer Center Patient and Family Advisory Council Charter Members 2017 Louis Arp, Advisory Chair Annie “Anna” Moore Freeman

Carla Reynolds Caroline Sullivan

Dr. Jean Carter Henry Lovett

Mary Mullins Patricia “Trish” Bell

Robert “Bob” Rohde Sharon McCloud

Sophia Palles Tyrrone “Ty” Cohen

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UNC REX Cancer Tumor Registry The UNC REX Cancer Registry has added over 65,000 cancer cases into the database since its inception in 1988. In 2016, the registry added a record 3136 cases, with 2,826 as analytic cases with initial diagnosis and/or first course of treatment at REX Healthcare. The additional 310 cases are non-analytic cases representing patients with recurrent disease, initially diagnosed and/or treated elsewhere. Analytic cases (A) are defined as patients diagnosed and/or treated at the reporting facility. The CoC requires that analytic cases be abstracted by accredited programs. Non-analytic cases (NA) are defined as patients diagnosed and/or treated elsewhere and seen at the reporting facility for diagnostic workup, in-transit care, disease recurrence or persistence. Although the CoC does not require abstraction of non-analytic cases, these are required by the NC Cen-tral Cancer Registry. The primary function of the Cancer Registry is to collect and manage statistical data and clinical elements on the UNC REX Cancer population. Information collected includes patient demographics, medical history, anatomical site and histology of the primary cancer, extent of disease and treatment. Patient follow-up is an important part of cancer care and maintaining the Registry. Each patient in the Registry is followed annually to update information on disease recurrence, subsequent treatment, length of survival and overall well-being. This information is utilized by the cancer program for studies and research by the American Cancer Soci-ety and North Carolina Central Cancer Registry. Follow up information is obtained through communication to physi-cians and patients.

The Registry’s excellent Follow-up rate is 94% (90% or greater as required by the CoC Standard. 5.3)

The UNC REX Cancer Tumor Registry Team are Certified Tumor Registrars and Members of the Association of North Carolina Cancer Registrars

Top Ten Cancer Sites by Group UNC REX Cancer Registry CY 2016

PRIMARY SITE TOTAL CLASS SEX AJCC STAGE (% of Total) A NA M F 0 I II III IV Unk N/A ALL SITES 3136 2826 310 1255 1881 300 765 582 379 477 276 357 BREAST 916 (29%) 845 71 4 912 170 351 241 66 46 42 0 DIGESTIVE 454 (14%) 414 40 242 212 9 69 92 114 120 44 6 RESPIRATORY 347 (11%) 328 19 181 166 4 97 40 58 140 7 1 MALE GENITAL 289 (9%) 224 65 289 0 0 41 135 49 34 30 0 BLOOD & BM 239 (8%) 205 34 116 123 0 0 2 1 1 1 234 URINARY 215 (7%) 199 16 147 68 77 42 15 8 24 48 1 SKIN 142 (5%) 131 11 82 60 34 63 12 3 5 20 5 LYMPHATIC 142 (5%) 130 12 77 65 0 23 27 25 46 19 2 GYNECOLOGIC 110 (4%) 89 21 0 110 6 27 8 24 19 26 0 ENDOCRINE 110 (3%) 101 9 24 86 0 45 7 18 5 20 15

UNC REX Cancer Registry Site Distribution Detail CY 2016

PRIMARY SITE TOTAL CLASS SEX AJCC STAGE A NA M F 0 I II III IV Unk N/A ALL SITES 3136 2826 310 1255 1881 300 765 582 379 477 276 357 BREAST 916 845 71 4 912 170 351 241 66 46 42 0

DIGESTIVE 454 414 40 242 212 9 69 92 114 120 44 6 ESOPHAGUS 18 15 3 12 6 0 0 2 9 4 3 0 STOMACH 45 40 5 22 23 0 12 4 4 17 8 0 COLON 147 136 11 68 79 1 29 39 47 28 3 0 RECTUM 84 80 4 49 35 1 15 17 22 14 15 0 ANUS/ANAL CANAL 25 18 7 11 14 7 0 7 5 1 5 0 LIVER 19 17 2 14 5 0 3 3 3 6 0 4 PANCREAS 69 63 6 44 25 0 4 14 9 39 3 0 OTHER 47 45 2 22 25 0 6 6 15 11 7 2 RESPIRATORY 347 328 19 181 166 4 97 40 58 140 7 1 NASAL/SINUS 2 2 0 1 1 0 1 0 0 1 0 0 LARYNX 20 19 1 15 5 3 5 4 3 5 0 0 LUNG/BRONCH 323 306 17 163 160 1 90 36 55 134 7 0 OTHER 2 1 1 2 0 0 1 0 0 0 0 1 BLOOD and BM 239 205 34 116 123 0 0 2 1 1 1 234 LEUKEMIA 93 81 12 48 45 0 0 2 1 1 1 88 M. MYELOMA 56 50 6 26 30 0 0 0 0 0 0 56 OTHER 90 74 16 42 48 0 0 0 0 0 0 90 MALE GENITAL 289 224 65 289 * 0 41 135 49 34 30 0 PROSTATE 273 210 63 273 0 40 135 46 34 18 0 TESTIS 14 12 2 14 0 1 0 3 0 10 0 OTHER 2 2 0 2 0 0 0 0 0 2 0 URINARY 215 199 16 147 68 77 42 15 8 24 48 1 BLADDER 143 134 9 103 40 73 32 13 5 11 9 0 KIDNEY/RENAL 67 60 7 40 27 3 10 2 2 13 37 0 OTHER 5 5 0 4 1 1 0 0 1 0 2 1 LYMPHATIC 142 130 12 77 65 0 23 27 25 46 19 2 HODGKIN'S 18 18 0 14 4 0 4 6 3 5 0 0 NON-HODGKIN'S 124 112 12 63 61 0 19 21 22 41 19 2 SKIN 142 131 11 82 60 34 63 12 3 5 20 5 MELANOMA 129 120 9 73 56 34 60 10 3 4 17 1 OTHER 13 11 2 9 4 0 3 2 0 1 3 4 ENDOCRINE 110 101 9 24 86 0 45 7 18 5 20 15 THYROID 95 91 4 17 78 0 45 7 18 5 20 0 OTHER 15 10 5 7 8 0 0 0 0 0 0 15 GYNECOLOGIC 110 89 21 * 110 6 27 8 24 19 26 0 CERVIX UTERI 10 9 1 10 1 3 1 3 0 2 0 CORPUS UTERI 61 52 9 61 0 21 4 13 8 15 0 OVARY 24 20 4 24 0 2 3 6 8 5 0 VULVA 7 2 5 7 4 1 0 0 0 2 0 OTHER 8 6 2 8 1 0 0 2 3 2 0 ORAL 54 52 2 39 15 0 4 3 9 30 8 0 LIP 0 0 0 0 0 0 0 0 0 0 0 0 TONGUE 28 27 1 23 5 0 4 1 3 14 6 0 OROPHARYNX 0 0 0 0 0 0 0 0 0 0 0 0 HYPOPHARYNX 0 0 0 0 0 0 0 0 0 0 0 0 OTHER 26 25 1 16 10 0 0 2 6 16 2 0 BRAIN & CNS 54 48 6 23 31 54 BRAIN (Benign) 2 1 1 1 1 Brain and CNS Tumors

World Health Organization (WHO) grading system

2 BRAIN (Malignant) 13 13 0 9 4 13 OTHER 39 34 5 13 26 39 CONT TISSUE 16 15 1 6 10 0 3 0 2 3 8 0 BONE 1 1 0 1 0 0 0 0 0 0 1 0

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With the collective help of our doctors and cancer patients who choose to participate, cancer clinical trials enable testing of the latest research findings at the National Cancer Institute (NCI) and other research organizations. These trials can take several years to complete, but the knowledge gained has led to an increase in the number of people who survive cancer. UNC REX Cancer Care participates in ongoing cancer clinical trials, including many in collaboration with UNC’s Lineberger Comprehensive Cancer Center. Available clinical trials include biobanking and diagnostic studies, therapeutic trials, quality-of-life and supportive care trials.

Breast

ABC Trial A011502 -Adjuvant node + Breast ca

BWEL A011401 –Weight loss in early breast ca

COMET AFT-25 - DCIS

KEYNOTE 355 (MK-3475 PN355) -Untreated Locally

recurrent or Stg IV mTNBC

LCCC 1410 - Exercise and p16 in older breast ca pts

LCCC 1525 - 2nd line mTNBC

LCCC 1609: GETSET Motivation in endocrine therapy

NRG-BR002 -Radiation in Oligometastatic breast ca

NRG-BR003 - Adjuvant High Risk TNBC

NSABP B54-i PENELOPE-b: High risk post neoadjuvant

SWOG 1207 - Adjuvant High Risk

Gastrointestinal

CHALLENGE NCIC CTG C0.21 - Exercise in high

risk colon ca

HALO-109-301 -Stg IV pancreatic ca

LCCC 1317- Metastatic Colorectal (1st Line)

LCCC 1324 -Exercise and p16 in adjuvant colorectal ca

RTOG 0848 – Resected Pancreatic

To learn about clinical trials offered by UNC REX Cancer Care, or your eligibility Call 919-784-7209 http://www.rexhealth.com/rh/care-treatment/clinical-trials/cancer/

Thoracic

LCCC 1210 –Lung cancer: second line for elderly

LCCC 1516 - Consolidation after 1st line platinum in-

duction in Stg IV NSCLC

GYN

NRG-GY004 - Ovarian, Fallopian or Peritoneal

Head and Neck

LCCC 1612 – Radiation and chemo in p16+ Oro-

pharyngeal Squamous Cell Cancers

Leukemia and Lymphoma

CC-5013-NHL-008 MAGNIFY - Relapsed/Refractory

Follicular, MZL or MCL Lymphoma

LCCC 0824 – Biospecimen submission

UTX-TGR-304: Treatment naïve and/or previously treated

CLL

Other

LCCC 0916 -Registry Carolina Senior

LCCC 9001 -Tissue Procurement

LCCC 1540 –Whole Brain Radiation and xerostomia

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Clinical Trials

UNC REX Excellence in Publications and Presentations 2017

Publications Analytic validation of immunohistochemical assays: a comparison of laboratory practices before and after introduc-

tion of an evidence-based guideline. Fitzgibbons PL, Goldsmith JD, Souers RJ, Fatheree LA, Volmar KE, Stuart LN, Nowak JA, Astles JR, Nakhleh RE. Arch Pathol Lab Med 2017;141(9):1247-1254.

Analytic validation of immunohistochemical assays: new benchmark data from a survey of 1085 laboratories. Stuart LN, Volmar KE, Nowak JA, Fatheree LA, Souers RJ, Fitzgibbons PL, Goldsmith JD, Astles JR, Nakhleh RE.. Arch Pathol Lab Med 2017;141(9):1255-1261.

Comparison of Patient Report and Medical Records of Comorbidities: Results From a Population-Based Cohort of Patients With Prostate Cancer. Ye F, Moon D, Carpenter W, Reeve B, Usinger DS, Green RL, Spearman K, Sheets N, Pearlstein K, Lucero AR, Waddle M, Godley PA, Chen RC. JAMA Oncol. 2017 Aug 1;3(8):1035-1042.

Dosimetric Predictors of Patient-Reported Xerostomia and Dysphagia With Deintensified Chemoradiation Therapy for HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Chera B, Fried D, Price A, Amdur R, Mendenhall W, Lu C, Das S, Sheets N, Marks L, Mavroidis P. Int J Radiat Oncol Biol Phys. 2017 Aug 1;98(5):1022-1027.

Professional practice evaluation for pathologists: development, life and death of the Evalumetrics program. Volmar KE, McCall SJ, Schifman RB, Talbert ML, Tworek JA, Hulkower KI, Guidi AJ, Nakhleh RE, Souers RJ, Bashleb-en CP, Blond BJ. Arch Pathol Lab Med 2017;141(4):551-558.

Presentations Advances in Surgery: The Primary Care Pearls: Movie Night with the Surgeons. March 25, 2017. Wake Area

Health Education Conference. UNC REX Surgical Specialists, Raleigh, NC. Back to the Future? The Jolie Effect, and a Thoughtful Approach to Breast Cancer. Rachel Jendro, DO The Good, The Bad, and The Ugly: Atypical Benign Breast Disease. David Eddleman, MD C.T.: An Extra-Terrestrial (Surgeon’s) Guide to Computed Tomography. Richard Chiulli, MD Assessment of the Effect of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Pa-

tients with Cancer. Elizabeth C. Weddendorf, PharmD; Rebecca Jones, PharmD, BCPS; Jeffrey Crane, MD; W. Russell Laundon, PharmD, MS, BCPS; Jared Peak, PharmD, CPP; Madison Sasser, PharmD, BCPS; S. Wayne Smith, MD. Poster presentation at American Society of Health-Systems Pharmacist (ASHP) annual meet-ing and Southeastern Residency Conference

Bridging the Gap: Improving Patient Care through Science and Innovation. Radiosurgery Society Annual Scientific

Meeting. November 2, 2017. Physics Session: Failure mode and effects analysis of linear accelerator-based in-tercranial stereotactic radiosurgery using differing collimation, fractionation, and # of isocenters. Don Roback PhD

Impact of College of American Pathologists Evidence-based Guideline on Immunohistochemistry Assay Validation

Practices. Nakhleh RE, Goldsmith JD, Souers RJ, Fatheree LA, Volmar KE, Stuart LN, Nowak JA, Astles R, Fitzgibbons PL. Mod Pathol. 2017;30(S2):514A. Poster presentation at USCAP 2017.

Pearls in Surgery Lecture Series: Women’s Health Edition. October 21, 2017. Wake Area Health Education Con-

ference. UNC REX Surgical Specialists. UNC REX Healthcare, Raleigh, NC. New Paradigms in DCIS: Observation and Management. David Eddleman, MD, MA Radiographic Breast Screening: Best Practices and Latest Technology. Susan Holley, MD, PhD

New Benchmark Data from College of American Pathologists for Immunohistochemical Assay Validation. Nakhleh

RE, Stuart LN, Volmar KE, Nowak JA, Fatheree LA, Souers RJ, Fitzgibbons PL, Goldsmith JD, Astles R,. Mod Pathol. 2017;30(S2):514A. Poster presentation at USCAP 2017.

Surgical Pathology Diagnostic Error Prevention United States and Canadian Academy of Pathology Annual Meet-

ing. CME Course. March 10, 2017. San Antonio, TX. . Keith Volmer, MD, and Nakhleh RE *UNC REX contributors highlighted in bold

ANNUAL REPORT | 18

UNC REX Cancer Care provides patients of Wake County and surrounding communities with exceptional cancer care, including access to innovative treatments and support services. As the first nationally accredited Comprehen-sive Community Cancer Center in North Carolina, we provide expert care, close to home, in several convenient lo-cations. In collaboration with UNC Lineberger Comprehensive Cancer Center, our physicians also access the latest in clinical trials. Our physicians are at the helm of ongoing cancer research. Multidisciplinary care is the heart of our program. Our board-certified physicians meet regularly and work together as a team to develop a comprehensive treatment plan tailored to our patients’ needs.

UNC REX Cancer Care includes:

REX Hematology Oncology Associates

o Raleigh – Main Campus, Raleigh - Blue Ridge, East Raleigh, Cary, Garner, Wakefield

UNC REX Radiation Oncology

o Raleigh-Main Campus, East Raleigh, Clayton, Smithfield, Wakefield

UNC REX Surgical Oncology

o REX Surgical Specialists

Raleigh, Knightdale, Garner, Knightdale

o REX Thoracic Surgical Specialists

o REX Neurosurgery and Spine Specialists

Raleigh, Cary

UNC Gynecologic Oncology at REX

UNC REX Comprehensive Breast Care Program

UNC REX Cancer Genetics Program

We also provide patients and their families with access to oncology support services, including:

Patient Navigation

Clinical Trials

Cancer Rehabilitation

High Risk Nutritional Management

Social Work and Psychosocial Support

Financial Counseling

Educational Programs

Support Groups

Survivorship Support

Wellness Services

Comprehensive Community Cancer Care ANNUAL REPORT | 19

REX HEMATOLOGY AND ONCOLOGY ASSOCIATES

RALEIGH – Main Campus Raleigh -BLUE RIDGE CARY 4420 Lake Boone Trail 2605 Blue Ridge Road Parkway Professional Park Suite 200 Suite 190 150 Parkway Court, Suite 200 Raleigh, NC 27607 Raleigh, NC 27607 Cary, NC 27518 T: 919-784-6818 T: 919-784-6060 T: 984-974-2150 F: 919-784-6826 F: 919-784-6061 F: 984-974-2151

WAKEFIELD GARNER EAST RALEIGH 11200 Governor Manly Way 300 Health Park Drive 117 Sunny Brook Road Suite 102 Suite 220 T: 919-334-3900 Raleigh, NC 27614 Garner, NC 27529 F: 919-250-9280 T: 919-570-7550 T: 919-250-5955 F: 919-570-7551 F: 919-250-5954

UNC REX RADIATION ONCOLOGY

RALEIGH WAKEFIELD EAST RALEIGH 4420 Lake Boone Trail 11200 Governor Manly Way 117 Sunny Brook Road Suite 100 Suite 102 Raleigh, NC 27610 Raleigh, NC 27607 Raleigh, NC 27614 T: 919-334-3900 T: 919-784-3018 T: 919-570-7550 F: 919-250-9280 F: 919-784-1473 F: 919-570-7551

CLAYTON RADIATION ONCOLOGY SMITHFIELD RADIATION ONCOLOGY Johnston Professional Plaza Johnston Medical Mall 2076 Highway 42 West Suite 1200 Suite 120 514 N. Bright Leaf Boulevard Clayton, NC 27520 Smithfield, NC 27577 T: 919-585-8550 T: 919-209-3555 F: 919-585-5882 F: 919-938-7400 UNC REX BREAST CARE REX BREAST CARE CENTER REX SURGICAL ASSOCIATES (Diagnostic Imaging) (Breast Surgery) 3100 Duraleigh Road, Suite 204 3100 Duraleigh Road, Suite 205 Raleigh, NC 27607 Raleigh, NC 27607 T: 919-784-6186 T: 919-784-4160 F: 919-784-2708 UNC REX COMPREHENSIVE BREAST CARE PROGRAM 4420 Lake Boone Trail Raleigh, NC 27607 T: 919-784-6878 F: 919-784-6899

UNC REX Cancer Care Locations ANNUAL REPORT | 20

REX NEUROSURGERY AND SPINE SPECIALISTS T: 919-784-1410 F: 919-784-1409 RALEIGH CARY 4207 Lake Boone Trail, Suite 220 1505 SW Cary Parkway, Suite 302 Raleigh, NC 27607 Cary, NC 27511

REX SURGICAL SPECIALISTS

T: 919-784-7874 F: 919-784-2708 RALEIGH GARNER Medical Office Building 300 Health Park Drive 2800 Blue Ridge Road, Suite 300 Suite 110 Raleigh, NC 27607 Garner, NC 27529

KNIGHTDALE WAKEFIELD 6602 Knightdale Blvd, Suite 201 11200 Governor Manly Way, Suite 208 Knightdale, NC 27545 Raleigh, NC 27614

REX THORACIC SURGICAL SPECIALISTS RALEIGH T: 919-784-5650 F: 919-784-5651 4420 Lake Boone Trail, Suite 100 Raleigh, NC 27607

UNC GYNECOLOGIC ONCOLOGY AT REX 4420 Lake Boone Trail, Suite 201 Parkway Professional Park Raleigh, NC 27607 150 Parkway Court, Suite 200 T: 919-784-6875 F: 919-784-6890 Cary, NC 27518

UNC REX Cancer Care Locations

ANNUAL REPORT |21

ANNUAL REPORT | 22

A- REX Cancer Care- Main Campus

B - REX Hematology Oncology Associates – Wakefield

C - REX-UNC Radiation Oncology – Wakefield

D - REX Surgical Specialists – Wakefield

E - REX Hematology Oncology Associates – Cary

F - REX Thoracic Surgical Specialists - Cary

G - REX Neurosurgery and Spine Specialists – Cary

H - REX Hematology Oncology Associates – Garner

I - REX Surgical Specialists – Garner

J - UNC Radiation Oncology at Clayton

K - UNC Radiation Oncology at Smithfield

L - UNC REX Cancer Care of East Raleigh

For more information or to schedule an appointment with

UNC REX Cancer Care

Call 919-784-3105 www.REXhealth.com

UNC REX Cancer Center 4420 Lake Boone Trail Raleigh, NC 27607 919-784-3105 www.REXhealth.com