BUILDINGOn STRENGTH - Baylor Health Care System

Transcription

BUILDING On STRENGTH
2013 Annual Report
Multidisciplinary Clinical Teams + Patient Navigation
+ Genetic Counseling + Clinical Research + Clinical
Education + Integrative Medicine + Patient Support
and Education + Innovative Clinical Trials Center
+ Survivor Celebrations + Community Outreach
Contents
1
Baylor Dallas Leadership: Building on Strength
Medical Director’s Letter
2
2013 Cancer Committee Membership
3
Baylor Charles A. Sammons Cancer Center at Dallas
5
Areas of Focus
Blood and Marrow Transplant Program
Innovative Clinical Trials Center
Colon Cancer Genetics: Lynch Syndrome
BUILDING On
STRENGTH
13 Cancer Center Highlights
Community Events/Outreach
• Mobile Mammography Program
• American Cancer Society
• Virginia R. Cvetko Patient Education and Support Center
Site-Tumor Conferences
Clinical Research Coordination
Patient Navigation
Cancer Genetics Program
23 Patient Spotlight: Teri Rodgers
25 Cancer Registry
29 Patient Outcome Studies
Cancer research studies on the campus of Baylor University Medical
Center at Dallas are conducted through Baylor Research Institute,
Texas Oncology, and US Oncology. Each reviews, approves, and conducts clinical trials independently. Their clinical trials are listed together,
in this publication, for the convenience of patients and physicians.
• Acute Myelogenous Leukemia at Baylor Charles A. Sammons
Cancer Center from 2010 to 2012
• Radiation Treatment for Glioblastoma Multiforme: The Baylor
Charles A. Sammons Cancer Center Experience, 2010 to 2012
37 Cancer Center Publications
41 Campus and Area Maps
43 Contact Information
3410 Worth St.
Dallas, TX 75246
1.800.4BAYLOR
214.820.3535
BaylorHealth.com/DallasCancer
Physicians are members of the medical staff at one of Baylor Health
Care System’s subsidiary, community, or affiliated medical centers and
are neither employees nor agents of those medical centers, Baylor
University Medical Center, or Baylor Health Care System.
© 2014 Baylor Health Care System. All rights reserved. Photographs
may include models or actors and may not represent actual patients.
SAMMONS_444_2014 SC
1 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 2
Letter from Leadership
Cancer Committee Members
Over the past several years, our annual reports have concentrated on building. We have built physical facili-
Required Members:
Research Coordinator)
W. Scott Webster, MD
ties including the Baylor Charles A. Sammons Cancer at Dallas which opened in March 2011, and in 2012,
John T. Preskitt, Sr., MD, Chair [Surgery]
Kathleen Shuey, MS, RN, AOCN,
Barry N. Wilcox, MD
the Baylor T. Boone Pickens Cancer Hospital. In addition to our advanced facilities, we continue to build
(Cancer Registry Quality Coordinator)
APRN BC [Oncology Nurse]
Laith Abushahin, MD (House Staff
hope through innovative treatment opportunities and outstanding patient support. Erin Bowman, MD [Radiology]
Sheryl Walker, CGC [Genetics]
Representative)
B. Scott Cheek, MD [Radiation Oncology]
Kathy Thomas Welch, LMSW
Sarah Swineford McFadden, MD
Peter A. Dysert, II, MD [Pathology]
(Social Work)
(House Staff Representative)
In 2013, we continued to build, but not so much with bricks and mortar, but building on our strengths. The
Blood and Marrow Transplant Program celebrated 30 years of providing curative treatment opportunities and
“In 2013, we continued to build, but
Leah Zhrebker, MD (House Staff
Robert L. Fine, MD [Palliative Care]
Representative)
E. Colin Koon, MD, PhD [Cancer Liaison
Other Members:
Physician]
Carlos Becerra, MD
Carolyn M. Matthews, MD (Quality
Yvonne Coyle, MD
Invited to Attend:
Improvement Coordinator)
Karen L. Fink, MD
Patrick Allgood, RN, BSN
Robert G. Mennel, MD [Medical Oncology]
James W. Fleshman, MD
Anna Barber
Site-Tumor conferences, a mainstay of our academic approach to multidisciplinary treatment planning, have
Amy J. Wilson, MD [Rehabilitation]
JaNeene Jones, RN, FACHE
Jane Dempster, RN, MBA
expanded and new conferences centered around pancreatic and colorectal cancer were added. Scientific
Johanna Bennoch, RN, CPHQ [Performance
Ronald C. Jones, MD
Ann Giddens, ACS
publications in peer-reviewed journals continued to rise and have doubled in the past five years.
Improvement/Quality Management]
Kartik Konduri, MD
Kimberlee Hanna, RN, BSN, OCN,
Pam Carnevale, MHA (Cvetko Center/
Z. H. Lieberman, MD
CHPN
There has been growth in the cancer genetics program with expansion of the genetics counseling program
Community Outreach Coordinator)
Alan M. Miller, MD, PhD
John McWhorter, President BUMC
with additional counselors, more cancers covered and expansion to other Baylor facilities. In addition, our
Sylvia Coats [Cancer Program Administrator]
John C. O’Brien, MD
Nolan Ngo, PharmD
stellar patient navigation program continues to serve more patients every year.
Michelle Murray, PhD (Psychosocial Services
John E. Pippen, Jr., MD, FACP
Lynn Randolph, VP Nursing
Coordinator)
Charles T. Richardson, MD
Taryn Pemberton, Marketing
Throughout the following pages you will read of how the Baylor Charles A. Sammons Cancer Center at
Janet Reynolds, CTR [CTR] (Cancer
Raphaelle Vallera, MD
Laura Siciliano, RN, CTR
Dallas is building on these and other strengths to provide more options and hope to those with cancer.
Conference Coordinator)
Estil A. Vance, III, MD
Julie Smith, Marketing
Cheryl Sampson, CCRP, MBA (Clinical
David L. Watkins, MD
performed the 5000th transplant since the program’s inception. Clinical trials opportunities increased with
the opening in September of the Swim Across America Innovative Clinical Trials Center. With the generous
support of the Swim Across America organization, we can now offer more patients the opportunity to
participate in clinical trials of advanced investigational therapies including targeted and immunotherapies.
Chief of Oncology, Baylor Health Care System
Medical Director, Baylor Charles A. Sammons Cancer Center at Dallas
not so much with bricks and mortar,
but building on our strengths.”
BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 4
3 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Baylor Charles A. Sammons
Cancer Center at Dallas
Baylor Charles A. Sammons Cancer Center at Dallas offers treat-
For nearly four decades, Baylor Charles
in McKinney and Carrollton also offer
ment for all forms of cancer, with particular emphasis on lung,
A. Sammons Cancer Center has provided
oncology services and are expected to
pancreas, colon, breast, prostate, and gynecologic cancers.
quality clinical care, advanced technology,
carry the Baylor Charles A. Sammons
Physicians on the medical staff of Baylor Sammons Cancer
and clinical research to patients, along
Cancer Center name in the future.
Center at Dallas also have special expertise in treating blood and
with comprehensive support services and
bone marrow cancers such as leukemia, lymphoma and myeloma.
programs for patients and their families.
With the opening of the 10-story outpa-
Baylor T. Boone Pickens
Cancer Hospital
Baylor offers a full spectrum of oncology services, from education
tient treatment facility and integration with
This is the first dedicated cancer hospital
to advanced treatment options and rehabilitation programs.
Baylor T. Boone Pickens Cancer Hospital
in North Texas and only the second in
Specialists and staff work diligently to treat patients in an environ-
in Dallas, it is now the largest outpatient
the state. This 96-bed, 175,000-square-
ment filled with compassionate, quality care by using effective
cancer center in North Texas. Annually,
foot facility has been specially designed
methods in prevention, diagnostic, and treatment.
more than 90,000 cancer visits occur at
to provide a place of healing, calming,
Baylor Sammons Cancer Center at Dallas,
and spirituality. A skybridge connects the
Depending on the type of cancer and the needs of each
and more than 800 people participate in
inpatient hospital to the many outpatient
individual patient, both standard and innovative treatment options
research trials.
services of Baylor Sammons Cancer
Center at Dallas. Larger rooms enable
are available. Therapies include blood and marrow transplantation,
Baylor Charles A. Sammons Cancer
Center Network
patient families and caregivers to have
ablation for liver cancer, and ultrasound-guided transperineal
Seven facilities across Baylor Health Care
givers have access to two areas in the
radioactive seed implants. Scientists at Baylor Sammons Cancer
System carry the Baylor Charles A.
hospital for showering, washing clothes,
Center perform extensive cancer research, and support services
Sammons Cancer Center name as part
working or relaxing.
like the Cvetko Patient Education Center, Ernie’s Appearance
of the system’s focus to bring patients
Center, and the Healing Environment Program help Baylor
throughout North Texas quality clinical
Sammons Cancer Center treat the whole patient.
care and advanced technology. Facilities
surgery, chemotherapy, immunotherapy, radiation, CyberKnife®
and Gamma Knife® radiosurgery, monoclonal antibodies, thermal
their own space, and families and care-
5
Areas of Focus 2013 +
Blood and Marrow Transplant Program:
Curative Cell Research
Celebrating more than 30 years and
At Baylor University Medical Center at
Healing Power
5,000 transplants, the Blood and Mar-
Dallas, the BMT team is performing a
About 70 percent of individuals requiring a stem cell transplant
row Transplant (BMT) Program at Baylor
study comparing the use of umbilical
are not able to find a suitable match in their family. Through
Charles A. Sammons Cancer Center at
cord blood versus conventional marrow
the BMT program’s research efforts, patients have access to
Dallas, is one of the leading blood and
or peripheral blood stem cell transplants.
donated cord blood units that have been frozen and stored for
marrow programs in the state of Texas,
The stem cells in cord blood have a rare
transplantation. “Not long ago, cord blood was discarded,”
and has grown into one of the largest and
capacity to repair bone marrow and boost
says Dr. Pineiro. “It is incredible that today it can be utilized to
most comprehensive in the nation. Led
immune system recovery. “The patient’s
perform life-saving procedures.”
by Edward Agura, MD, medical direc-
diseased bone marrow with cancer is
tor, our BMT program continues to move
completely eliminated with high doses of
Unlike adult hematopoietic — or blood-forming — stem cells,
research forward to improve outcomes
chemotherapy and sometimes radiation,
cord blood stem cells are young, flexible cells that can easily
for those affected by blood cancers and
or a combination of the two,” says Luis
develop into different blood cell types that perform specialized
deficiencies for which bone marrow trans-
Pineiro, MD, FACP, a hematologic oncolo-
tasks. For people with blood cancers such as leukemia, lym-
plantation may provide lifesaving treat-
gist on the medical staff at Baylor Dallas.
phoma and myeloma, an infusion of cord blood stem cells can
ment. “If a patient comes to us today for
“Healthy stem cells from a donor will
regenerate bone marrow following cancer therapy. For individu-
a bone marrow transplant, there is almost
repopulate the bone marrow. In the case
als with inherited disorders of red blood cell production, such
no reason we cannot find a donor for him
of inherited deficiencies, the ‘deficient’
as sickle cell anemia or thalassemia, cord blood stem cells can
or her,” says Dr. Agura.
cells will be replenished by the healthy
replace defective cells with a genetically normal counterpart,
transplanted donor cells.”
thus restoring red-cell function: the delivery of vital oxygen to
the body. In immune deficiency disease, cord blood stem cells
help fend off infections and diseases by replacing defective
white blood cells with their healthy counterparts.
“If a patient comes to us today for
a bone marrow transplant, there is
almost no reason we cannot find a
donor for him or her.” - Dr. Agura
Cherysee Daniels, Cancer Survivor and
Dr. Edward Agura, MD
Blood and Marrow Transplant Program:
Curative Cell Research
Flexible Fit
For a transplant to be successful, the human leukocyte antigen
(HLA) markers in the donor’s stem cells must match those of the
recipient. Because cord blood stem cells are better able to adapt
themselves to a patient’s body, there is less chance of immunologic side effects such as rejection or graft-versus host disease.
“When used for transplantation these cells are more tolerant,
and therefore less likely to get ‘activated’ when exposed to their
new environment in the recipient. The end result is less rejection
and less graft-versus-host reaction,” says Dr. Pineiro. “Since we
expect to see less immunologic activation, we can then use ‘less
than perfect’ matches for transplantation. This has increased the
number of patients in which stem cell transplant is feasible.”
Program Highlights
• More than 5000 transplantations performed since the
program’s inception in 1983.
• Texas’ first unrelated donor bone marrow transplanta
Although cord blood contains fewer stem cells than a marrow or
tion was performed by the transplant physicians on the
blood stem cell transplant, Baylor researchers are able to com-
medical staff at Baylor Charles A. Sammons Cancer
bine cord blood products from multiple donors, thereby increasing
the number of stem cells infused and providing faster recovery of
blood counts.
Center at Dallas in 1988.
• Continuously accredited by the Foundation for the
Accreditation of Cellular Therapy (FACT) since 1998.
• Among an elite group of facilities designated as a Center
for Excellence in most major insurance
networks for meeting strict quality of care standards.
9 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Areas of Focus 2013 +
Innovative Clinical Trials Center:
Moving Cancer Care Forward
BUILDING
BUILDINGOn
OnSTRENGTH
STRENGTH| | Baylor
BaylorCharles
CharlesA.A.Sammons
SammonsCancer
CancerCenter
CenteratatDallas Dallas 10
9
on June 7, 2013, the ICTC WAS
OFFICIALLY named the Swim
Across America Innovative
Clinical Trials Center at
Baylor Charles A. Sammons
Cancer Center at Dallas.
The first open-water swim, held in June
announced on June 7, 2013, the day
Baylor Charles A. Sammons Cancer Center at Dallas boasts a
2011 at Lake Ray Hubbard in Rockwall,
before the open-water swim.
6,375-square-foot facility, the Swim Across America Innovative
Texas, was the beginning of a four-year
Clinical Trials Center (ICTC), offering patients better access to
commitment to the ICTC, with the goal
Under the leadership of Carlos Becerra,
a wide range of new research and treatment options. The ICTC
of raising in excess of $1 million during
MD, medical director of the ICTC, the
expands the already extensive program of cancer clinical trials
those four years to benefit the phase 1
center plans to use the expanding knowl-
offered at Baylor Sammons Cancer Center.
clinical trials program. SAA-Dallas is likely
edge about the biology and genetics of
to exceed that goal with the third swim
cancer in exploring novel treatments for
With the cost of bringing a new drug to market currently hover-
in June 2013 bringing the total amount
patients with hard-to-treat cancers. Says
ing around $1 billion, or more, phase 1 clinical trials at the ICTC
raised to $950,000. “We hope and
Dr. Becerra, “in the past, for breast cancer
continue, in part, due to funding sponsors from pharmaceutical
anticipate that this commitment will be
or colon cancer, as examples, we treated
or biotechnology companies; however, for those agents without a
extended for many, many more years to
everyone the same. Now, as we dissect
sponsor, other funding must be found to run the clinical trials. An
come,” says Watters.
tumors at the molecular genetic level, we
Recognizing the critical importance of phase 1 trials,
have learned that colon or breast cancer
ideal match was found for the ICTC when Swim Across America
(SAA), a national organization that holds swim-related events to
In recognition of the support and dedica-
can be subdivided into different types of
raise funds supporting cancer research, prevention and treat-
tion of SAA-Dallas, the ICTC has been
disease that need to be treated differently.
ment, came forward with an offer to support the center. According
named the Swim Across America In-
This gives us the knowledge to be smart-
to Daniel Watters, chairman of the SAA-Dallas committee and a
novative Clinical Trials Center at Baylor
er in treating our patients, using specific
member of the 1988 U.S. Olympic swim team, SAA-Dallas chose
Charles A. Sammons Cancer Center at
drugs to shut down specific pathways.”
to support the ICTC at Baylor Sammons Cancer Center at Dallas
Dallas. The naming was officially
after an intensive search for “the best of the best” in terms of
cancer research and treatment in North Texas.
Colon Cancer Genetics:
Lynch Syndrome
Because of current genetic research, physicians now have
Boland’s theory about a genetic link,
working with entire families,” Dr. Boland
the tools to identify specific genetic mutations passed down
Henry T. Lynch, MD, had published
says. “Then, we are able to alter how
through families that are responsible for a large number of
papers to support just that. In one of his
Lynch affects a person and their rela-
colon cancers. “The current estimate is that one in 350 people
own papers, Dr. Boland named the con-
tives.”
has one of these genetic mutations,” says C. Richard Boland,
nection “Lynch syndrome.”
Genetic counseling at Baylor Charles A.
MD, chief of gastroenterology and a physician on the medical
staff at Baylor University Medical Center at Dallas. The
Today, researchers have not only con-
Sammons Cancer Center at Dallas can
condition is called Lynch syndrome, and knowing its genetic
firmed that Lynch syndrome is surpris-
help identify patients who are at risk of
roots gives people the chance to protect themselves and their
ingly common, but they’ve identified how
developing colon cancer as a result of a
families from the cancers it can cause.
the mutations lead to cancer. Research
genetic mutation. Board-certified genetic
also shows that, among people with
counselors help patients understand
Experts estimate that three out of every 100 colon cancers
Lynch syndrome, the chance of having
their diagnosis, the inheritance pattern,
are caused by Lynch syndrome. Screening is critical because
colorectal cancer is 70 percent in men
and the recommended screening and
colorectal cancer is the third most common cancer – about
and 40 percent in women. Women also
prevention options.
150,000 Americans are diagnosed annually. It’s also the third
have a 40 percent chance of having
most deadly, claiming about 50,000 lives each year, according
endometrial cancers (in the lining of the
to the American Cancer Society.
uterus), plus smaller risks of having a
variety of other cancers. Also, a child
When Dr. Boland first theorized that inherited genes were the
of someone with the condition has a 50
cause, he did not have to go far to find a family to study. “My
percent chance of having it, a fact that
father first got colon cancer when he was in his mid-20s,” he
leads to large clusters of affected
says. “Ten out of 13 of his siblings had cancer of some kind. So
relatives, as in Dr. Boland’s family. “Once
for me, this is personal.” Though few others supported Dr.
we identify one person with it, we end up
Cancer Center Highlights +
Community Events/Outreach:
Baylor Health Care System Mobile Mammography Program
Getting an annual mammogram is important, but life sometimes
locations in the fall of 2013. The mobile
gets in the way of keeping that potentially lifesaving appoint-
machine enables women to have quality
ment. “Women often don’t take the time to take care of their
breast screening at a location convenient
health like they should,” says Sherry Fox, mobile account
for them. The bus serves patients with
executive at Baylor University Medical Center at Dallas. “By
two changing rooms with direct access to
making mammograms convenient and efficient though, they’re
the mammography area assuring conve-
much more likely to follow through.” Baylor Dallas’ Darlene G.
nience and privacy. The mobile program
Cass Women’s Imaging Center Mobile Mammography aims
can serve up to 50 women per day and
to do just that. The 41-foot coach is staffed by two women,
the vehicle is equipped with internet
including a certified mammographer, and travels to businesses,
capabilities to sync patient data with the
churches, school districts and corporations to bring mammog-
hospital.
raphy services to women right where they are.
“The mobile program features digital
The specially-designed bus equipped with three-dimensional
mammography that includes Computer
breast imaging technology began making regular stops at key
Assisted Detection (CAD), an application
that scans the patient’s screening
mammogram to identify suspicious
features that may warrant a second
review by the radiologist,” says Ethel
Randall, director of breast imaging for
Baylor Health Care System’s Baylor
Charles A. Sammons Cancer Center.
“Digital mammography technology also
provides faster processing times and the
ability to store images electronically.
Community Events/Outreach:
Taking Cancer Information and Screening to the Community
Virginia R. Cvetko Patient Education
and Support Center
American Cancer Society
American Cancer Society knows how
Through the Patient Navigation Program,
The American Cancer Society is the only
Cancer education and support are two vital components in one’s
Baylor Sammons Cancer Center facilities
The American Cancer Society has been an
important each and every birthday can be.
patient navigators provide free and
organization offering cancer patients and
cancer journey. Baylor Charles A. Sammons Cancer Center
host several cancer education events, free
incredible supporter of Baylor Sammons
In May of 2013, the Society celebrated
confidential support and guidance to all
their families around-the-clock guidance
boasts a beautiful patient education and support center named
screenings and participate in many health
Cancer Center at Dallas to deliver lifesaving
its 100th birthday – one-hundred years of
patients and their caregivers during their
and support through their toll-free line,
in honor of one of our former patients, Virginia R. Cvetko. The
fairs throughout the community. In 2013,
results. Together, we are a relentless force
saving lives and twenty years supporting
cancer journey.
1-800-227-2345 and at www.cancer.org.
Cvetko Center provides many disease-specific education and
34 community education/outreach events
fighting cancer. American Cancer Society
Baylor hospitals. In the last two decades
support programs to help patients and their caregivers under-
were held and were attended by a total of
representatives collaborate with oncology
the Society has contributed to a 20%
stand and navigate the physical, emotional and spiritual chal-
nearly 3,700 participants. staff to deliver support, and serve on the
decline in cancer death rates in the US.
lenges of fighting cancer. cancer committee to help provide re-
Last year the Society and Baylor hospitals
sources to fulfill the Commission on Cancer
reached over 2,100 patients with more
standards for cancer care. than 6,000 programs and services, that’s
1-in-4 cancer patients treated at Baylor
In 2013, the American Cancer Society
Together,
• Amyloid Support North Texas: Quarterly
we are a
receiving valuable services by the Society
served 1,026 patients with 3,148 services
Disease-Specific Support Groups
• Bladder/Kidney Cancer Support Group: Monthly
• Breast Cancer Support Group:Monthly
relentless
• Carcinoid Cancer Texas Survivors: Monthly
at Baylor University Medical Center at Dal-
Patients at Baylor University Medical
las. Patients received weekly support from
Center at Dallas are able to receive
the Society’s ACS Day representative and
guidance on Society programs, includ-
all newly diagnosed patients received a
ing the Reach To Recovery® program
Personal Health Manager kit from the
for those coping with their breast cancer
Society which provides personalized
experience. Female patients may also get
information on their specific cancer type,
involved in the Look Good Feel Better®
as well as helping patients and caregivers
program, dedicated to improving the
• Prostate Cancer Education and Support Group: Monthly
keep appointments, test results and pre-
self-esteem and quality of life of people
• Waldenstrom’s Macroglobulinemia Support Group: Bimonthly
scriptions organized throughout treatment.
undergoing treatment.
• Young Adult Cancer Survivors: Bimonthly
As the official sponsor of birthdays, the
force
fighting
• Colon Cancer Support Group: Monthly
• Graft-Versus-Host Disease Support Group: Quarterly
• Gynecological Cancer Support Group: Every other Monday
• Lung Cancer Education Support Group: Monthly
• North Texas Myeloma Support Group: Monthly
• Ovarian Cancer Support Group: Every other Monday
cancer.
• Oral and Head and Neck CancermSupport Group: Monthly
Virginia R. Cvetko Patient Education and Support Center
Free Community Screenings
circus style performance group. The high-
Young Adult Cancer Survivors’ Summit
Baylor Sammons Cancer Center at Dallas hosted a head and
light of the reunion was when John King
In an effort to better meet the needs of
neck cancer screening on April 27 followed by a skin cancer
a leukemia survivor from Bossier City,
young adult cancer survivors (YACS), the
screening conducted on May 11. In all, a total of 38 patients
Louisiana met his blood donor match,
Young Adult Cancer Survivors’ Coalition
received abnormal results and were contacted by a member
Camila Bresciani who traveled from Dubai
hosted the annual Down with Cancer, Up
of our patient navigation team to facilitate an appointment
to meet the man her donation saved. with Survival YACS Summit in April at the
with a member of our medical staff.
Through the Be The Match® National
University of Texas at Arlington. Marrow Donor Program database, Camilia
This year’s event featured keynote speak-
Community Outreach Events
was identified as a perfect match for Mr.
ers: Heidi Adams, a young adult cancer
On October 6, women from throughout Dallas gathered to
King, enabling him to receive his life sav-
survivor, author and president and CEO of
take a proactive stand against breast and ovarian cancers at
ing transplant on June 6, 2012.
Critical Mass along with Karen Albritton,
MD, a researcher specializing in young
this year’s Sole Sisters™ event held at Tower Club
Dallas. This health & beauty boot camp event promotes
Baylor Charles A. Sammons Cancer
adult cancers at Cook Children’s Medical
good health/fitness practices and early detection. More than
Center at Dallas hosted a lighted vigil
Center at Fort Worth. Event attendees
100 women enjoyed spa treatments, group workout classes
as part of a national campaign to raise
participated in interactive breakout ses-
and health/beauty consultations. A special highlight of the
awareness for lung cancer on November
sions covering topics such as: nutrition,
event was an interactive discussion panel covering genetics,
14, 2013. Dallas joined more than 100
caregiving and building emotional support.
prevention/screening, integrative medicine and survivorship. communities across the nation in host-
Ivana Hall, Miss Texas 2013 served as event emcee.
ing a Shine a Light on Lung Cancer Vigil
in collaboration with the Lung Cancer
More than 100 survivors and their families attended the
Alliance. The purpose of this vigil was
Blood and Marrow Transplant Reunion: Cirque du Celebra-
designed to provide hope, support and
tion, on September 29, 2013. Attendees enjoyed carnival
compassion to the thousands who are
style games, treats and were entertained by Circus Freaks, a
diagnosed with lung cancer.
Site-Tumor Conferences
the interventional radiologist or surgeon
held 350 site-specific tumor conferences
Exposure to interesting and
problematic cases:
in 2013, where more than 1500 patients
The conferences are a clearing-house for
the same images may point out that the
were discussed. Nearly 8,000 physicians,
the most interesting and difficult cases
procedure to get the tissue may be much
trainees, nurses and allied health staff
seen at Baylor. In this one place a health
more involved than originally thought and
attended these conferences focusing
care professional can learn about every
fraught with significant risk for the patient.
on malignancies in Bone & Soft Tissue,
aspect of a patient’s case, the pathology,
This could change the whole care of the
Breast, Chest, Colorectal, Endocrine, GI,
the radiological findings, the genetics, the
patient.
Baylor Sammons Cancer Center at Dallas
sitting in the same room and looking at
Gynecology, Head & Neck, Liver, Neuro-
social impediments to the therapy, etc.
Oncology, Pancreas, Skin, Urology and
The whole book of business about the pa-
Hematopoietic Diseases.
Education leading ultimately to better
patient care:
ease teaches everyone about the disease.
tient’s problem is presented in one venue.
It has tremendous value and efficiency of
These conferences have all levels of train-
patient care.
Value of Tumor Conferences by Robert
G. Mennel, MD
time for the health care practitioner.
ees from students to staff and all disci-
The value of the tumor conferences can
presented that apply to this patient’s disEducation and discussion lead to better
plines from general surgeons to
Professional camaraderie:
genetic counselors. Interpreting X-rays
In this era of increasing ways of commu-
be summed up in 4 benefits:
Insight into other disciplines’ thought
processes towards the same problem:
with a radiologist teaches the other disci-
nication (Emails, tweets, webinars, etc)
[1] Exposure to interesting and
Different disciplines, by virtue of their
plines how to interpret X-rays, what is the
but decreasing depth of communication,
problematic cases
training, approach the same problem from
best X-ray to order, and the problems the
these conferences put everyone in the
[2] Insight into other disciplines’ thought
different angles. For example the patholo-
radiologist faces in interpreting the film.
same room, face to face, to engage in
processes towards the same problem
gist and medical oncologist may need
The same is true for anatomic patholo-
education and friendly professional ban-
[3] Education, leading ultimately to better
more tissue for a diagnosis and think
gists, molecular pathologists, surgeons,
tering that builds the ties within this can-
that this would be a minor procedure of
medical oncologists, and radiation
cer center. This camaraderie may be the
very little risk for the patient. However,
oncologists. Having the scientific studies
major benefit of our tumor conferences.
patient care
[4] Professional camaraderie.
INSIGHT
CASE-SOLVING
EDUCATION
CAMARADERIE
Clinical Oncology Research Coordination (CORC) Office
Patient Navigation
Clinical Oncology Research Coordination (CORC) Office
SOCRD is a central location where information from all of these
patients, investigators, and sponsors. In
At Baylor Charles A. Sammons Cancer
nurses that partner with patients and their
community. In 2013, we screened 109
The Clinical Oncology Research Coordination Office underwent
sources can be stored, validated, and accessed for feasibility
August 2013, M.Y. Levy, MD, became the
Center at Dallas, we understand the over-
families to serve as an advocate, guide,
individuals and found 38 of them to be
a major change in April of 2013 when Angelia Drake, MSN, RN,
and future research.
medical director of Hematological Malig-
whelming nature of a cancer diagnosis. and resource through cancer treatment
at risk for either skin cancer or head and
nancies of the ICTC. Thanks to Dr. Levy
Understanding and following complex
and recovery.
neck cancer. To make sure those at-risk
and Dr. Carlos Becerra, medical director
treatment recommendations can be diffi-
assumed the role of director. In addition to being responsible
for this system-wide office she also supervises the Division of
Currently, Drake and her staff are re-vamping the infrastructure
Surgical Oncology and the development of the Surgical Oncol-
and processes in the department to accommodate the rapid
of Heme Malignancies, there has been a
ogy Clinical Research Database or SOCRD. SOCRD is a meta-
expansion of clinical trials in Baylor Health Care System. While
registry where multiple databases are connected from the tumor
individuals are connected with a physician
cult for both the cancer patient and family
Our patient navigation team also works
on staff at Baylor as quickly as possible,
big increase in the number of phase I and
members. This is why every family that
very closely with our Virginia R. Cvetko
patient navigators will call each person to
focusing on continuing the growth of these trials, as well as
II trials being offered through the clinic.
walks through our doors has access to a
Patient Education and Support Center.
facilitate setting up an appointment with
registry data imports, multi-disciplinary tumor conferences,
trials in the Innovative Clinical Trials Center (ICTC), the depart-
At present, oncology clinical trials are
patient navigator. Our patient navigation
Free cancer screenings are one of many
the appropriate provider.
investigator-initiated clinical trials, pathology, and radiology.
ment is maintaining its focus on providing quality and service to
being conducted at the Dallas, Fort Worth,
team is a group of dedicated registered
resources our Cvetko Center offers to the
and Irving campuses. CORC hopes to
expand to more of the Baylor Health Care
400
2011- 2013 Patient Accruals to
Baylor Clinical Oncology Trials
350
301
Patient Accruals
300
System hospitals in the near future. The
339
expanded network of locations for clini-
2011
2012
250
2013
number of clinical trials and the number of
• Answer questions and address patient concerns
patients enrolled in the trials.
• Educate and empower patients to make an informed decision
• Work with a multi-disciplinary team of doctors to provide
200
136
150
66
37 33
efficient, timely, and quality care
121
100
50
Patient Navigators:
cal trials should result in growth of the
45 37
120
4 1
2
56
50
29
14
• Assist patient and family members with finding appropriate
90
85 80
80
6 11
8
resources
35 34
21
0
Breast
Chest
GI
GU
Gyn
Head and Neck
Healthy
Donors
Hemotology
Neuro
Other
Skin
• Explore and assist with financial resources
Patient Profile +
Teri Rodgers :
Melanoma – Immunotherapy – Interleukin II
In 2007, 38 year-old Teri Rodgers was
live past the end of the year. He advised
wasn’t the standard of care. It was risky, it
In thinking about her experience, Rodg-
district. She enjoys every day with her
In addition to working full time, Rodgers
leading an active, normal life. She was
us to get our affairs in order.”
was aggressive, it was cutting edge.”
ers isn’t shy about her feelings. “I love
husband and children and she says
enjoys traveling, spending time with her
Baylor. I have been to multiple hospitals
every day she remembers how far she
family, gardening, cooking and having
and her family have come and how
friends over to her home. “I love the feel
blessed they are.
and sound of a house full of friends and
a wife, mother of a four-year old and a
seven-year-old and working full-time as
Rodgers was shocked and couldn’t un-
Rodgers treatment regimen was intense.
and cancer care facilities and Baylor is
an elementary school assistant principal
derstand why she had cancer. There was
She spent one week in the intensive care
number 1. Everyone – the secretaries,
in Arlington, Texas. An autumn day in Oc-
no history of melanoma in her family and
unit, received treatment consisting of
the nurses, the physicians, the lab tech-
tober would change her life and the lives
the only cancer she knew of was when
two doses twice a day, recovered, had
nicians, they knew my children by name.
of her family, forever.
her grandmother dealt with lymphoma.
scans to check the size of the tumor, then
They became my family and they treated
“The ‘C’ word was a heavy blow, but I
scheduled another week in the ICU to
me as family as well.”
“I felt a lump under my left arm pit,”
knew I didn’t have an option, that I had
repeat the process. This was repeated
remembers Rodgers. “At first, I brushed it
to do everything I could to survive and
over four cycles. Rodgers says she was
In 2009, Rodgers’ scans revealed
off, not thinking much about it. After a few
work to stay alive. I wanted aggressive
fortunate that her body was able to toler-
another tumor. She began a two-year
weeks, when it hadn’t gone away, I began
treatments, so we followed the old adage
ate the aggressive therapy.
clinical trial testing another form of
to worry. I saw my physician who referred
about the squeaky wheel getting the oil.
me to an oncologist in Arlington. I’ll never
We were squeaky, calling, emailing, show-
“I was scanned every month, CT scans
Sammons Cancer Center at Dallas.
forget the day he told me I had a golf ball
ing up at physicians’ offices. I worked
and PET scans,” recalls Rodgers. “I
Today, she has been cancer free for two
sized tumor that was stage 3-4 melanoma
with my oncologist to locate a melanoma
could see each time we scanned that the
with no external spot. The first thing that
specialist. We found Baylor Charles A.
ran through my mind was, OK, it was skin
“I’m living
proof that
family and the memories that are being
“I’ve always had a servant’s heart and
made,” she says.
immunotherapy
a willingness to help others, but now I
works and that
have a real life battle and I’m committed
“Being in remission is a new place for
to being a living testimony to share with
me because for the past several years
others and help them fight for what they
I’ve been living and dealing with cancer,”
want or aspire to become. Unfortunately,
Rodgers admits. “I’m living proof that
there’s a lot of grief and struggle in our
immunotherapy works and that there can
at the end of
world. Yet I get to share my success
be hope and a light at the end of the tun-
story and hopefully encourage others
nel. The research continues to identify
the tunnel.”
along their journey. The gift of life is
new treatment options. Whatever we can
years. Rodgers credits her physicians
precious and I don’t ever want to take
do to increase the research, increase the
tumors were shrinking. It didn’t happen
and the clinical trials offered through
it for granted. I’ve lost several friends
opportunities for new clinical trials to
Sammons Cancer Center at Dallas. After
immediately, but the tumor decreased a
Baylor Institute for Immunology
along this journey and I know that I am
occur and increase the other outcomes
cancer. But, after extensive tests, we real-
evaluating my health history and health
centimeter here and a centimeter there.
Research for her remarkable recovery.
here for a reason. I don’t ever want to
to increase the survival rate and have
ized the prognosis was dire. The oncolo-
status, my doctor recommended immuno-
After the four rounds of Interluken II, we
miss out on an opportunity God has put
more survivors, then I’m all for it!”
gist told us there was only a 20% chance
therapy using high dose Interleukin II. This
finally got to a no evidence of disease
Rodgers has taken a new position as a
of surviving and that I probably wouldn’t
was seven years ago and immunotherapy
status.”
school counselor in a smaller school
immunotherapy at Baylor Charles A.
there can be
hope and a light
me here for.”
25 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH CoC State
of Texas
Performance
Rate
Oncology Quality Metrics 2012
NCDB Target
Cancer Registry +
summary of 2012 : cancer registry data
BHCS ALL FACILITIES BY SITE 2012
BUMC BMCP BASMC BMCG BMCI BMCG BMCW BMCC
Oral Cavity 80 72 75 5 4 11 2 2
Digestive System
586 83 147 100 84 71 36 21
Respiratory System
229 31 104 116 56 58 17 20
Blood/Bone Marrow
141 12 21 30 15 15 1 5
Bone 13 10 8 2 1 1 0 0
Connective/ Soft 35 19 12 2 2 1 0 0
Tissue
Skin
Breast Cancer
2010 & Prior 2012 Forward
CoC Census
Region (West)
Performance
Rate
All CoC
Programs
Performance
Rate
Diagnosis Year 2011 (CoC)
Baylor University Medical Center
Performance Rate
*2009
*2010
*2011
*2012
Post Breast Conserving Surgery Irradiation:
Radiation therapy is administered within 1 year
(365 days) of diagnosis for women under age
70 and receiving breast conserving surgery for
breast cancer (Accountability Measure)
NCDB,
CoC, NQF,
NAPBC
90%
90%
86.8%
88.8%
91.8%
97.2%
95%
95.6%
95.6%
Adjuvant Chemotherapy: Combination
chemotherapy is considered or administered
within 4 months (120 days) of diagnosis for
women under 70 with AJCC T1cNoMo, or
Stage II or III hormone receptor negative breast
cancer (Accountability Measure) NCDB,
CoC, NQF,
NAPBC
90%
90%
90%
90.5%
92.5%
96.6%
94.3%
96%
96%
Adjuvant Hormonal Therapy: Tamoxifen or
third generation aromatase inhibitor is considered or administered within 1 year (365 days)
of diagnosis for women with AJCC T1cNoMo,
or Stage II or III hormone receptor positive
breast cancer (Accountability Measure)
NCDB,
CoC, NQF,
NAPBC
90%
90%
86.1%
87.1%
90.3%
94.9%
91.7%
95.1%
95.1%
Adjuvant Chemotherapy: Adjuvant chemotherapy is considered or administered within 4
months (120 days) of diagnosis to patients
under age 80 with AJCC III (lymph node positive) colon cancer (Accountability Measure)
NCDB,
CoC, NQF
90%
90%
88.5%
89.4%
90.6%
89.3%
92.6%
95.2%
95.2%
Surgical Resection Includes at Least 12
Lymph Nodes: At least 12 regional lymph
nodes are removed and pathologically examined for resected colon cancer (Surveillance
Measure)
NCDB,
CoC, NQF
80%
80%
90.5%
89%
87.8%
97.4%
97.2%
95.9%
95.9%
NCDB,
CoC, NQF
90%
90%
91.6%
90.6%
91.8%
100%
100%
100%
100%
Colorectal Cancer
91 88 37 5 1 4 2 0
Breast
593 231 340 154 91 90 75 23
Female Genital
207 10 116 19 7 32 4 1
Male Genital
163 24 47 33 2 27 2 1
Urinary System
186 38 40 27 6 45 21 4
Brain/CNS 149 13 26 31 13 14 8 4
Endocrine/Thyroid
151 30 87 20 20 15 4 4
Lymphatic System
107 25 49 37 15 22 8 9
Unknown Primary
51 18 8 10 4 10 9 3
Other/Ill-Defined
11 2 9 1 1 4 0 0
Total 2793 706 1126 592 322 420 189 97
Rectal Cancer
Radiation Therapy for Rectal Cancer:
Radiation therapy is considered or administered within 6 months (180 days) of diagnosis
for patients under the age of 80 with clinical or
pathological AJCC T4NoMo or Stage III receiving surgical resection of rectal cancer (Surveillance Measure)Connect/Soft Tissue
*Source: American College of Surgeons National Cancer Data Base
Baylor University Medical Center Dallas: Analytic/non Analytic Cases Diagnosed 2012
Primary Site Total Ananalytic Nonanalytic Male Female In Situ Local Regional Distant NA/Unknown 4050
2811
1239
1810
2240
150
1345
775
795
985
124
5
51
4
2
62
83
3
36
2
0
42
41
2
15
2
2
20
81
2
33
3
2
41
43
3
18
1
0
21
1
0
1
0
0
0
32
2
18
0
0
12
62
1
25
3
1
32
11
0
3
1
0
7
18
2
4
0
1
11
Digestive System
Esophagus
Stomach
Colon
Rectum
Anus/Anal Canal
Liver
Pancreas
Other
796
31
43
174
136
8
221
127
56
592
21
30
113
110
4
178
88
48
204
10
13
61
26
4
43
39
8
498
29
26
97
87
5
167
58
29
298
2
17
77
49
3
54
69
27
6
1
0
0
2
0
0
2
1
260
8
3
38
44
5
128
22
12
233
7
17
61
43
1
52
37
15
158
4
11
45
21
0
15
46
16
139
11
12
30
26
2
26
20
12
Respiratory System
Nasal/Sinus
Larynx
Lung/Bronchus
Other
386
3
34
346
3
233
1
18
212
2
153
2
16
134
1
206
1
28
175
2
180
2
6
171
1
2
0
1
1
0
62
0
8
53
1
77
3
12
62
0
163
0
5
158
0
82
0
8
72
2
Blood & Bone Marrow
Leukemia
Multiple Myeloma
Other
266
160
87
19
143
92
44
7
123
68
43
12
148
86
50
12
118
74
37
7
0
0
0
0
6
1
5
0
1
1
0
0
238
141
78
19
21
17
4
0
Bone
18
13
5
8
10
0
7
7
1
Connect/Soft Tissue
47
34
13
23
24
0
28
8
134
124
10
94
89
5
40
35
5
79
72
7
55
52
3
8
8
0
58
54
4
30
29
1
All Sites
Oral Cavity
Lip
Tongue
Oropharynx
Hypopharynx
Other
Skin
Melanoma
Other
Primary Site Total Analytic Nonanalytic Male Female In Situ Local Regional Distant NA/Unknown Breast
806
595
211
5
801
99
371
170
35
131
Female Genital
Cervix Uteri
Corpus Uteri
Ovary
Vulva
Other
261
39
141
54
17
10
207
22
127
40
12
6
54
17
14
14
5
4
0
0
0
0
0
0
261
39
141
54
17
10
3
0
0
0
3
0
115
7
92
4
9
3
63
13
31
10
5
4
39
3
9
27
0
0
41
16
9
13
0
3
Male Genital
Prostate
Testis
Other
277
267
9
1
163
157
5
1
114
110
4
0
277
267
9
1
0
0
0
0
0
0
0
0
144
141
2
1
34
34
0
0
21
16
5
0
78
76
2
0
Urinary System
Bladder
Kidney/Renal
Other
233
76
150
7
189
65
119
5
44
11
31
2
161
57
99
5
72
19
51
2
31
29
0
2
129
34
91
4
23
3
20
0
27
1
25
1
23
9
14
0
Brain & CNS
Brain (Benign)
Brain (Malignant)
Other
229
15
77
137
147
10
32
105
82
5
45
32
89
9
40
40
140
6
37
97
0
0
0
0
39
0
39
0
2
0
2
0
2
0
2
0
186
15
34
137
Endocrine
Thyroid
Other
198
129
69
152
106
46
46
23
23
80
41
39
118
88
30
0
0
0
60
59
1
45
45
0
7
6
1
86
19
67
3
Lymphatic System
Hodgkin’s Disease
Non-Hodgkin’s
186
24
162
104
9
95
82
15
67
105
13
92
81
11
70
0
0
0
31
2
29
19
5
14
74
9
65
62
8
54
6
5
Unknown Primary
73
52
21
42
31
0
0
0
1
72
10
10
0
28
23
5
Other/Ill-Defined
16
10
6
8
8
0
3
1
2
10
Data Source: Electronic Registry System, Baylor Health Care System Cancer Registry
This report INCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases phoma/myeloma category.
Table 1. Prognostic Value of Cytogenetics
Patient Outcome Studies +
Prognostic Group
5-year Survival
Mutation
Favorable
65%
t(8;21)(q22;q22)
inv(16)(p13.1q22)
Acute Myelogenous Leukemia at Baylor Charles A. Sammons Cancer Center
from 2010 to 2012
t(16;16)(p13.1;q22)
t(15;17)(q22;q21)
Normal karyotype with mutated CEPBA,
or mutated NPM1 without FLT-3
Background
According to the American Cancer
Society, in 2012 there was an estimated
13,780 new cases of acute myelogenous
blood or bone marrow occurring de novo
or in a patient with a prior diagnosis of
myelodysplastic syndrome or myeloproliferative neoplasm. In the setting of
41%, and 14%, respectively. Table 1 lists
the mutations related to each prognostic
group. Classification among risk groups
provides information regarding treatment
Normal
AML diagnosis, cytogenetic analysis is
evaluation. While conventional cytogenet-
miaNet. These guidelines, in addition to
+8
considered mandatory as part of the
ic studies are considered mandatory, mo-
the frequently updated NCCN guidelines,
+21
diagnostic evaluation. Cytogenetic abnor-
lecular cytogenetic studies are optional.
serve as a reference and guide for the
+22
malities are present in approximately 55%
In non-study patients who have AML with
published from the international Leuke-
Intermediate
41%
leukemia (AML) and 10,200 deaths. While
specific genetic abnormalities, however,
response in addition to survival. Those
diagnosis and risk stratification of newly
del(7q)
of adult AML cases, and they provide the
normal cytogenetics (CN-AML), testing
the 5-year relative survival of patients
the requirement for a blast count of 20%
classified as favorable show complete
diagnosed cases of AML.
del(9q)
most important prognostic information.
for mutations in the NPM1, CEBPA, or
Abnormal (11q23)
Additionally, they allow, in cases of t(8;21),
FLT3 genes is not currently considered
Complex cytogenetics
t(15;17), inv(16), or t(16;16), the AML diag-
mandatory, but it is recommended.
-5
diagnosed with AML is only 24%, there
are large differences in patients’ prognoses, which are influenced by patientspecific factors and perhaps most
importantly the genetics of the disease.
While AML was initially classified by the
French-American-British system, which
used cell morphology and cytochemical
or more does not apply. These specific
response rates to treatment of 90%, while
Adverse
14%
have a complete response rate of approxi-
Current Recommendations and Practice
Guidelines
nosis to be made with <20% blasts in the
Traditionally classified as intermediate
mately 60%.
Based on the previous guidelines, mor-
del(5q)
peripheral blood or bone marrow aspirate.
risk, the CN-AML group includes approxi-
t(15;17)(q22;q12). In addition to the WHO
phologic assessment of blood and bone
-7
As the results of the karyotype are the
mately 40% to 45% of young adults with
classification
Among patients with normal cytogenet-
marrow smears using Wright-Giemsa
Abnormal 3q
strongest prognostic factor for predicting
AML. Identifying the presence of these
ics, or those considered to be at inter-
stains and assessment of the bone mar-
response to therapy and overall survival,
particular mutations has provided further
mediate risk, a more detailed analysis
row aspirate remain fundamental to
should include all blast forms with the
In addition to morphologic assessment,
recommendations suggest that a mini-
prognostic information and allowed for
exception of erythroblasts, though in the
immunophenotyping using multiparam-
mutations include t(8;21)(q22;q22), inv(16)
(p13.1q22) or t(16;16)(p13.1;q22), and
acute promyelocytic leukemia (APL) with
system for AML, the international European LeukemiaNet (ELN) guidelines for
those in the adverse or unfavorable group
stains to categorize the disease, a newer
reporting genetic alterations in AML were
for the presence of molecular markers is
the routine diagnostic workup for AML.
mum of 20 metaphase cells be analyzed
stratification within the intermediate-risk
classification system developed by the
published recently, further delineating
needed. Examination of the FLT-3, NPM1,
Specifically, when evaluating blood and
case of pure erythroid leukemia these
eter flow cytometry or immunohistochem-
to define an abnormal karyotype, and that
group to intermediate-I and intermediate-
World Health Organization (WHO) that
AML patients based on genetics as well
CEPBA, RUNX1, MLL, and EVI1 genes
bone marrow smears, it is recommended
should be counted. In addition to the
istry is also essential in new AML diagno-
this cell number is mandatorily assessed
II. Evaluation for the presence of specific
incorporates genetic studies is now used.
as age.
allows further risk stratification among the
that 200 leukocytes be counted on blood
assessment of blood and bone marrow
ses for determination of cell lineage, with
before diagnosing a normal karyotype.
isolated mutations has also allowed for
prognostic group, potentially influencing
smears and 500 nucleated cells counted
aspirate smears, assessment of a bone
a preference towards use of flow cytom-
For cases with inadequate or failed
movement among risk groups. Isolated
treatment and treatment response. Due
on bone marrow aspirate smears contain-
marrow trephine biopsy may provide valu-
etry. While consensus data do not give
cytogenetic analyses, fluorescence in
mutations of the NPM1 and CEBPA
to the significant progress that has been
ing adequate spicules. With the exception
able information regarding cellularity, cell
a specific cutoff point for considering a
situ hybridization (FISH) may be used for
genes offers a favorable prognosis as-
made in identifying these molecular mark-
of cases with t(8;21), t(15;17), inv(16), or
maturation, and bone marrow stroma;
specific marker to be positive, expression
detection of gene rearrangements.
sociated with higher complete response
ers and their role in pathogenesis, new
t(16;16), the diagnosis of AML through
however, expert panel recommendations
of specific markers in >20% of leukemic
recommendations have been developed
morphologic assessment requires the
consider this evaluation optional, except
cells is commonly used.
in the setting of a “dry tap,” where no
material is obtained in the biopsy.
This system, most recently updated in
2008, combines the traditional clinical
features, morphologic features, and immunophenotypic criteria with cytogenetic
and molecular analyses. Based on the
WHO categorization of myeloid neo-
Cytogenetic information not only influences the classification of AML but also
provides important prognostic information
regarding remission rates, risk of relapse,
and overall survival. Patients with favor-
plasms, AML is defined as the presence
able, intermediate, or adverse cytogenet-
that define general practice guidelines for
presence of a blood or marrow leukemic
of 20% or more blasts in the peripheral
ics have 5-year survival rates of 65%,
the diagnosis of AML, the most recent
blast count of at least 20%. Blast counts
For all patients with a new or suspected
rates, reduced relapse risk, and longer
Based on expert panel recommendations,
overall survival. In comparison, mutations
blood and marrow specimens should be
of the FLT3 gene, whether present as a
collected routinely for molecular genetics
single mutation or in combination, are
Table 3. Results
Table 2. Patient Demographics
considered intermediate-I risk, conferring
Review and documentation of a patient’s
Center, a tertiary referral center in Dallas.
of presentation, with a mean of 33.1%
Years 2010
2011
2012
Total
Years
poorer prognosis due to inferior disease-
performance status, comorbidities, basic
Cases were identified through our tumor
(range, 0–95%).
Total patients Diagnostic CBC
25252777
2010 (n = 25) 2011 (n = 25) 2012 (n = 27)
free survival and overall survival rates.
blood counts and chemistry profile,
registry and then reviewed for demo-
All cases had histologic evaluation of the
Age, years Mutations in KIT, have also been noted to
coagulation studies, hepatitis and HIV
graphic information, initial laboratory
bone marrow accompanied by flow cyto-
18 to 60 9
11
17
37 (48%)
be of prognostic significance in patients
testing, chest x-ray and electrocardiogram,
assessments and pathologic evaluations
metric analysis. The mean blast percent-
61 to 65 2
5
4
11 (14%)
with t(8;21)(q22;q22) or inv(16)(p13.1q22) .
and transplant assessment should all be
performed at presentation, as well as
age in the bone marrow was 60% (range,
>65 14
9
6
29 (38%)
Among this specific patient population a
performed based on standard guidelines
cytogenetic and molecular studies per-
9%–98%). Conventional cytogenetic
Sex
mutation of KIT is associated with a worse
and expert panel recommendations.
formed. The mean age of patients in our
analysis was completed in 74 patients
Male 14
13
17
44 (57%)
prognosis changing the risk status from
Documentation of these various factors to
cohort was 58 years (range, 20–83 years).
(96%). Based on results of conventional
Female 11
12
10
33 (43%)
favorable to intermediate.
determine higher risk is important, as age
Males represented 57% of the patients.
cytogenetics, 17 patients (22%) were
Comorbidities
>60 years and medical comorbidities,
Fourteen patients, or 18%, had a history
given a prognostic classification of favor-
Prior malignancy 9
3
2
14 (18%)
specifically diabetes, coronary artery
of prior malignancy. Diabetes mellitus was
able, 34 patients (44%) were classified as
Diabetes 5
6
6
17 (22%)
Favorable risk 3 7
Intermediate risk 13 8
Adverse risk
8 10
Not done
1 0
2
3
4
9 (11.6%)
Molecular Cytogenetics performed
1
2
2
5 (6.4%)
Yes
No
Testing for the presence of additional
fusion genes via reverse transcriptase-
disease, and chronic obstructive pulmo-
the most common comorbidity present in
intermediate risk, and 23 patients (30%)
Coronary artery disease polymerase chain reaction, such as
nary disease, have been associated with
17 patients (22%), followed by coronary
were classified as adverse; 3 patients
Chronic obstructive pulmonary disease RUNX1-RUNX1T1, CBFB-MYH11,
adverse prognostic outcomes. Among
artery disease in 9 patients (11.6%) and
were not classified.
DEK-NUP214, and PML-RARA, can be
treatment guidelines, age >60 is associ-
chronic obstructive pulmonary disease in
performed, but these tests are presently
ated with higher prevalence of other
5 patients (6.4%). Demographic informa-
considered optional, although recent
unfavorable factors, such that this is
tion is summarized in Table 2.
alterations in the WHO classification have
considered a division point for therapeutic
categorized these as individual entities.
recommendations. Patients considered
Additional studies for mutations in the
White blood cells 30.8
33.8 43.1 4.0-11.0
(1000/μL) (0.5–163.2) (0.8–212.0) (0.8–212.0) Hemoglobin (g/dL) 8.7 8.7 8.4 12.0-17.0 (3.6-12.0) (6.3–10.5) (6.4–11.6)
Platelets (K/μL) 59.5 48.2 54 140-400
(7-150) (6–203)
(12–217)
Risk Group by Karyotype
Total
20 23
5 2
7
13
5
2
findings correlated with conventional
HLA typing performed
HLA typing at presentation was complet-
mation. Overall, complete cytogenetic
cytogenetics, which demonstrated the
ed in 38 patients (49%). Of those patients
evaluation was performed in 98.6% of
presence of t(15;17)(q22;q21) consistent
Yes
No
in the intermediate and adverse risk
our patients. For the single patient who
with a diagnosis of APL. Overall, patients
Laboratory results are summarized in
categories 58.8% and 56.5%, respec-
did not have cytogenetic evaluation, the
with APL accounted for 11% of our new
potential candidates for allogeneic stem
Table 3. All patients had a complete
tively were tested, and of those below age
reason is not clear, as charts were not
AML diagnoses.
specific genes WT1, RUNX1, MLL, KIT,
cell transplant should have HLA typing
blood count at initial presentation. The
60, 60% had HLA testing at presentation
reviewed for treatment or survival data.
RAS, TP53, TET2, and IDH1 for prognos-
performed at diagnosis, along with typing
mean white blood cell count was 35.9
(Table 4).
tic assessment are currently considered
of their first-degree relatives, an assess-
K/uL (range, 0.5–349 K/uL). All patients
investigational and only advised for use in
ment of key importance particularly in
except one were anemic at presentation,
Conventional cytogenetic evaluation is
clinical trials.
patients with adverse cytogenetics.
with mean hemoglobin levels of 8.6 g/dL
considered standard in the diagnosis
(range, 3.6–12.0 g/dL). Thrombocytopenia
and workup of new cases of AML. In our
was present at presentation in 72 patients
and genetic studies to establish a diag-
Acute Myelogenous Leukemia at Baylor
Sammons Cancer Center
nosis of AML, several additional tests and
FFrom February 2010 to December 2012,
assessments should be performed as a
77 new cases of AML were diagnosed
standard in the initial patient evaluation.
at Baylor Charles A. Sammons Cancer
13 11
12 14
17 (22%)
34 (44%)
23 (30%)
3 (4%)
23 66 (86%)
4
11 (14%)
the necessary diagnostic genetic infor-
In addition to bone marrow examination
Normal values
14
13 38 (49%)
39 (51%)
Table 4. Performance of HLA typing by risk group and age
HLA TypingYesNo
Risk Group
Four patients had inv(16)(p13.1;q22) by
Favorable Risk 5
12
Optional/Investigational Studies
conventional cytogenetics. In three of
Intermediate Risk 20
14
Additional molecular cytogenetic evalu-
these patients, molecular cytogenetics
Adverse Risk 13
10
ation via FISH was performed in 66 pa-
was performed, and all demonstrated
Age
tients (85.7%). The presence of the PML/
the presence of the CBFB-MYH11 gene
<60 years
21
14
cohort, conventional cytogenetics was
RARA gene rearrangement was identi-
rearrangement. Patients with inv(16)
>60 years
17
25
(93.5%) and the mean platelet count was
performed in only 96% of the patients;
fied in eleven patients. Of those eleven
(p13.1;q22) accounted for 5.2% of our
53.9 K/uL (range, 6–217 K/uL). The pres-
however, of the three patients without
patients, all but one had conventional
new AML diagnoses.
ence of blasts in the peripheral blood was
conventional cytogenetics, molecular cy-
cytogenetic evaluation. Of the remain-
also assessed in all patients at the time
togenetics was performed in two, giving
ing ten patients, molecular cytogenetic
Mutations in the RUNX1 gene were
detected in nine patients by molecular
isolated NPM1 mutations, while seven
tional cytogenetics performed and 20
cally, these mutation analyses were only
acterized by a variety of genetic and
ease while avoiding unnecessary genetic
cytogenetics. Three of the nine patients
patients had mutations of both NPM1 and
had molecular cytogenetics. In 2011 of
considered of prognostic significance,
molecular mutations with the potential
evaluations which come at increased cost.
had the gene rearrangement RUNX1-
FLT-3. This additional information obtained
25 new AML cases 24 had conventional
and therefore were only recommended as
to significantly impact diagnosis, choice
Reflex testing has been adopted at Baylor
RUNX1T1, which was consistent with the
by mutation analysis allowed for the
cytogenetic analysis and 23 had molecu-
an optional assessment in patients with
of therapy, response to treatment, and
University Medical Center for specific
conventional cytogenetic finding of t(8;21)
reclassification of the five patients with an
lar cytogenetic evaluation. The results
CN-AML. Among our patient cohort 24
survival. For these reasons, a thorough
types of lung, colon and uterine cancer
(q22;q22) in two of the patients. Muta-
isolated NPM1 mutation from the inter-
were again similar in 2012 with 21 of 22
patients had a normal karyotype war-
diagnostic evaluation establishing an
and is being discussed for several others.
tions in RUNX1 were present in 11.7% of
mediate risk group to the favorable risk
patients having conventional cytogenetics
ranting further mutation analyses for the
accurate diagnosis and classification for
our patient cohort, with 2.6% occurring in
group. Four patients with CN-AML did not
and 18 of 22 having molecular cytoge-
NPM1, CEBPA, and FLT-3 genes, but
new AML cases is of utmost importance.
Our study did not evaluate how choice of
association with t(8;21)(q22;q22).
undergo any mutation analysis for further
netic evaluation.
these mutation analyses were performed
Our data demonstrate that patients newly
therapy or overall survival were influenced
only in 18 of the 24 patients. Moreover,
diagnosed with AML at Baylor University
by the additional genetic and molecular
risk stratification.
The t(6;9)(p23;q34) DEK-NUP214 was
Further investigational mutation analysis
Patient evaluation and characterization
these analyses were also performed in 31
Medical Center at Dallas undergo thor-
evaluations, however complete informa-
diagnosed in one patient by conventional
was performed for the presence of the
by molecular diagnostics was compared
patients without CN-AML.
ough diagnostic evaluation in keeping with
tion allows for the most informed treatment
cytogenetics. One additional patient with
C-KIT mutation in 20 patients (26.0%) and
from year to year with a noted increase in
Based on the European LeukemiaNet
current recommendations. In addition,
planning. Only 49% of patients with AML
multiple cytogenetic abnormalities dem-
was positive in only one patient (1.3%). In
use of molecular genetics from 2010 to
2010 guidelines, in addition to muta-
a large portion of patients had further
received upfront HLA testing, including
onstrated the presence of DEK(6p23) and
total, 53 patients (68.8%) underwent addi-
2012. Of newly diagnosed AML patients
tion testing of the NPM1, CEBPA, and
genetic and molecular evaluations, which
57% in the intermediate and high risk
NUP214(9q34).
tional analysis for the presence of muta-
in 2010, 8% had molecular genetics
FLT-3 genes, testing for the presence of
although considered optional or investiga-
groups, and 60% in those under 60. It
tions in NPM1, CEBPA, FLT3, or C-KIT.
performed. Of those cases evaluated in
mutations in other genes such as KIT
tional by current recommendations have
should be a goal to provide HLA testing
AAmong the 24 patients with a normal
Also considered to be investigational, mo-
2011 and 2012, 16% and 27% of the
was considered investigational. Of the
prognostic significance. While this addi-
as early as possible in those patients who
karyotype (CN-AML) by conventional
lecular genetics studies evaluating for the
cases had molecular genetics performed,
20 patients who underwent KIT mutation
tional useful and prognostically significant
may benefit from allogeneic transplant to
cytogenetics, 13 (54.2%) had further
presence of fusion genes were performed
respectively. Similar to cytogenetic
analysis, the testing was only relevant in
testing is frequently performed we did find
avoid delays in identifying a donor. One
molecular cytogenetic evaluation by FISH
in 15 patients (19.5%): 13 patients were
evaluation, rates of mutation analysis
one patient. In one additional patient in
that the population of people undergoing
can hope that continued efforts to obtain
and 20 (83%) had mutation analysis.
assessed for PML/RARA and two patients
over this time were fairly consistent being
whom the analysis was prognostically rel-
this testing needs to be more specifically
all available prognostic information and
Mutation analysis among patients with
for BCR-ABL. Of those evaluated, eight
performed in 72% of cases in 2010 and
evant, testing was not performed. Overall
defined. Currently, we are investigating
biomarkers translate to improvements in
a normal karyotype included evaluation
patients demonstrated the presence of the
2011, and in 68% of cases in 2012. Per
in our cohort, of the 55 patients who had
having patients undergo reflex genetic
treatment and patient survival.
for the presence of FLT-3, which was
PML/RARA fusion gene, and both analy-
expert recommendations on behalf of the
mutation analyses performed, 39 patients
testing to better define their specific dis-
performed in 19 patients (77%) and was
ses for BCR-ABL were negative.
European LeukemiaNet published in Jan-
had testing that would not be consid-
positive in 11 patients (50%); NPM1,
Overall the rates of conventional and
uary 2010, mutation analysis for the pres-
ered standard or optional and should be
performed in 17 patients (79.2%) and
molecular cytogenetic evaluation of
ence of mutations in the NPM1, CEBPA,
restricted to investigation.
positive in 12 patients (50%); and CEBPA,
patients presenting to Baylor Sammons
and FLT-3 genes were considered an op-
performed in three patients (12.5%), all
from year to year were consistent. In 2010
tional assessment at the time of diagnosis
Conclusion
of which were negative. Five patients had
of 25 new AML patients 24 had conven-
for all patients in our cohort. More specifi-
AML is a heterogeneous disease char-
Patient Outcome Studies +
Radiation Treatment for Glioblastoma Multiforme: The Baylor
Charles A. Sammons Cancer Center Experience, 2010 to 2012
SAMMONS XRT • 39 PATIENTS
OUTSIDE SAMMONS XRT
Expired prior to
recommended treatment
Expired prior to
recommended treatment
Gliomas are tumors that arise from glia,
National Comprehensive Cancer Network
Results
receiving less than the recommended dos-
or support cells from within the central
(NCCN) guidelines or enroll in clinical trials
A total of 39 patients were diagnosed with
age, two patients had stopped their treat-
nervous system. Grade IV glioma, or
to add to our knowledge base and improve
GBM at Baylor Dallas from 2010 to 2012.
ment and were transferred to hospice care,
glioblastoma (GBM), is the most common
their chances of survival.
and most aggressive glioma in humans.
Of these 39 patients, 37 patients had sur-
while the remaining patient had whole-
gery. Thirty of these 39 patients received
brain radiation treatment. This patient was
Refused radiation
treatment
Refused radiation
treatment
13% (5)
Unknown
10% (4)
Treatment to <45 Gy
8% (3)
Treatment to <45 Gy
Treatment to <60 Gy
69% (27)
Unfortunately, GBMs are very infiltrative,
We determined how radiation treatment
chemotherapy. In the remaining 9 patients,
discovered to have gliomatosis cerebri, a
and the median survival remains dismal at
of patients at Baylor University Medical
four refused chemotherapy and five died
rare diffusely infiltrating glial tumor of the
14.3 months with standard therapy. Based
Center at Dallas (Baylor Dallas) from 2010
prior to the recommended therapy. Among
cerebral cortex, and whole-brain radiation
on data from the Central Brain Tumor
to 2012 compared with NCCN guidelines.
those who died, one patient had Gliadel
is the recommended treatment for this rare
Registry of the United States, 15.6% of
Treatment for GBM involves a combination
wafers implanted at the time of surgery and
brain tumor.
all brain tumors are GBMs, and 45.2% of
of surgery, radiation treatment, and che-
died before planned systemic therapy.
malignant brain tumors are GBMs. They
motherapy. The recommended radiation
Of the patients treated at the Baylor Dallas
In addition to the 39 patients who received
are more common in older adults and are
dose for high-grade gliomas is 60 Gray in
campus from 2010 to 2012, 30 patients
all of their treatment at Baylor Dallas,
was referred to but was never seen by
Thus, for patients treated entirely or partially at Baylor Dallas, the NCCN guidelines
7% (2)
7% (2)
4% (1)
7% (2)
Treatment to <60 Gy
77% (20)
approximately 1.5 times more common in
1.8- to 2.0-Gray fractions. A slightly lower
received radiation therapy. Among the
27 patients received some of their care
Dr. Fink, so was lost to follow-up. Finally,
men than women. The 5-year survival of
dose of 55 to 57 Gray can be applied
nine patients who did not receive radiation
at Baylor Dallas from 2010 to 2012. Of
these same 22 patients out of 27 who
were followed regarding radiation treat-
patients with GBMs is poor, normally less
when the tumor volume is very large, such
therapy, four declined it and five died prior
these 27 patients, 24 underwent surgery
received chemotherapy also received ra-
ment of GBMs. When patients did not
than 5%. Thus, GBMs are one of the most
as in gliomatosis or grade III astrocytoma.
to the recommended treatment. Of the
to remove all or part of their tumor, and
diation therapy. Of the 22 patients who did
receive the recommended treatment, the
challenging types of brain tumors to treat.
For debilitated patients or the elderly, a hy-
30 patients who were treated with radia-
22 received chemotherapy. Amongthose
receive radiation treatment, 20 received
reason was the death of the patient or
treatment of patients at Baylor
With research dedicated to better under-
pofractionated accelerated course of 3 to
tion, 27 had up to the recommended 55
who did not receive chemotherapy, for one
the full 60-Gray doses, while one received
patient choice, not any decisions made by
standing this disease, along with clinical
4 weeks with a total dose of 40 to 50 Gray
to 60 Gray of radiation, and three patients
patient it was not recommended; another
a total only 32 Gray fractions, expiring
their oncologist.
University Medical Center at Dallas
trials testing new treatments, survival is
has also been found to be effective.
received less than 45 Gray of total frac-
patient refused treatment, two patients
before the end of treatment. The remaining
improving. It is important that patients
tions. When the records were checked to
died before they could get the recom-
patient received radiation treatment, but at
receive the standard of care according to
determine the reason for these patients
mended treatment, and the other patient
an unknown dosage.
Physicians are members of the medical staff at one of Baylor Health Care
System’s subsidiary, community or affiliated medical centers and are neither
employees nor agents of those medical centers, Baylor University Medical
Center at Dallas or Baylor Health Care System. © Baylor Health Care System
We determined how radiation
(Baylor Dallas) from 2010 to 2012
compared with NCCN guidelines.
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Floyd Street
Baylor
College of
Dentistry
air P
are accessible from U.S. 75 (North Central
ark
Roberts
Hospital
Parking Garage 10
Jonsson
Hospital
Barnett
Tower
Y.
S
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Lot 46
Underground Parking Garage 30
(Patient/Visitor)
2nd Floor
Skybridge
Healing Garden
Hall Street
Pauline Street
d.
Blv
Patient Drop-Off
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D
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lvd
Valet Parking
The campus is also accessible via the
Cancer Center is a two-block walk.
Lot 14
Lot 41
Underground Parking
Garage 39
a
–F
XB
Self Parking
Medical Center station. Baylor Sammons
Baylor
School of
Nursing
RCE
Baylor Tom Landry
Fitness Center
DOWNTOWN DALLAS
Lot 13
RT
H
O
W
N
T
RO
BE
RT
B
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AL
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Lot 43
Victor Street
Lot 44
STATE FAIR
GROUNDS
I-30
Lot 42
Crutcher Street
M
AI
L
HASKEL
FIRS
BAYLOR SAMMONS
CANCER CENTER
BAYLOR UNIVERSITY
MEDICAL CENTER
AT DALLAS CAMPUS
I-30
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garage 4 or valet in front of the hospital.
AK
ME
Lot 40
DL
CB
Ma
Pickens Cancer Hospital is available in
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COM
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Self-parking for the new Baylor T. Boone
N
O
Worth Street
Bass
Hall
Underground
Parking Garage
AK
O
T
AS
ELM
I-35
Center in garage 4.
DART Green Line to Baylor University
(Staff)
H
LL
I-45
Baylor Charles
A. Sammons
Cancer Center
adjacent to Baylor Sammons Cancer
VE
Parking
Garage 6
D
Self-parking is conveniently located
RO
TO
N
W
Elevator to
Level 3
for Skybridge
Emergency
Department
entrance and other nearby locations.
Parking
Garage 5
(Patient/Visitor
and Staff)
AR
G
HALL
Lot 19
Parking
Garage 4
C
X
DART®
Rail Station
at Baylor
Baylor
Worth
T. Boone
Street
Pickens
TowerCancer Hospital
IN
LI
DA
LL
H
O
O
KE
W
AS
OLM
Valet parking is available at the front
Underground Parking Garage 3
(Staff)
Baylor Hamilton Heart
& Vascular Hospital
RO
G
AS
MALC
highway access to the medical center.
Washington Avenue
A map on the facing page illustrates
Baylor
Medical
Pavilion
Junius Street
Junius Street
LL
I-35E
Underground
Parking
Garage 8
Lot
25
FW
DG
.
Blvd
Expressway/I-45) and I-30.
Hoblitzelle
Hospital
Truett
Hospital
Nussbaumer Street
AS
G
0
F
ink–
University Medical Center at Dallas, and
Wadley
Tower
E
L
CBD
are located on the campus of Baylor
Washington Avenue
Baylor T. Boone Pickens Cancer Hospital
5E
.
N. CENTRAL EXPY
Hall Street
Baylor Sammons Cancer Center and
I-3
U
TO
AK
H
H
N
PE
US 75
Gaston Aveue
Gaston Avenue
TZ
LI
I-3
Lot 9
FI
AK
O
RT
H
Lot 27
VE
O
only)
ON
Lot 28 (BIR
M
Lot 9
LLWAY
DALLAS N. TO
Floyd Street
Baylor
Institute for
Rehabilitation
(BIR)
W
Lot 26
M
LE
Campus and Area Maps
US
17
5
O
LM
X
UL
LU
M
43 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Contact Information
Referrals
Baylor Sammons Cancer Center at Dallas
Patient Navigation Program
Physician ConsultLine
214.820.3535
1.800.9BAYLOR
Administration
JaNeene Jones, RN, FACHE
Vice President/Oncology,
Baylor Health Care System
Chief Operating Officer,
Baylor Sammons Cancer
Center/Baylor T. Boone
Pickens Cancer Hospital
214.820.2800
Medical Director, Baylor
Sammons Cancer Center
214.820.2881
Eric Presson, MHA, FACHE
Director, Blood and Marrow
Transplant/Oncology, Baylor
Health Care System
214.820.7833
Support Services
Gynecologic Oncology
C. Allen Stringer, Jr., MD,
Director
214.820.1756
A. Webb Roberts Center for
Continuing Education
214.820.2317
Lymphedema Prevention and
Treatment Services
Cancer Registry
214.820.3976
214.820.6767
Concierge Desk
214.820.2617
Oncology Outpatient Clinic
214.820.6767
Patient Navigation
214.820.3535
214.370.1300
Medical Oncology and Precision Medicine
Robert G. Mennel, MD,
Director
214.820.9611
Oncologic Pathology
Peter Dysert, MD, Director
214.820.3021
Cancer Center Programs
214.820.4141
214.820.3136
Department of Oncology
Chief of Oncology, Baylor
Health Care System
214.820.2608
Liver and Pancreas Disease
Center
Surgical Oncology
John T. Preskitt, MD, Director 214.826.6267
Doug Lawson, MHA
214.820.3101
Chief Operating Officer, Baylor
University Medical Center at Dallas
Foundation
Integrative Medicine Program
Radiation Oncology
Barry N. Wilcox, MD, Director 214.370.1400
Alan M. Miller, MD
214.820.2881
Medical Director of Oncology
Medical Education
John McWhorter, MHA
President, Baylor University
Medical Center at Dallas
Divisions
214.820.2881
Blood and Marrow Transplant
Inpatient Services
•
•
•
Outpatient Center
Cutaneous Lymphoma
Clinic
Graft-Versus-Host
Disease
214.820.3535
214.370.1500
214.370.1500
214.370.1500
Clinical Oncology Research
Coordination
214.818.8471
Darlene G. Cass Women’s
Imaging Center
214.820.2430
W.H. & Peggy Smith Breast
Center
214.820.9600
•
•
•
•
Breast cancer prevention
research trials
Breast Care for Lifetime™
Breast health education
Personal risk evaluation
Bone and Soft Tissue Tumor Clinic
Cardiology Services
Dental Clinic
FitSteps for Life®
Head and Neck Clinic
Physical Medicine and Rehabilitation
Radiology Services
Skin Cancer Screening Clinic
Skull Base Clinic
Speech Therapy
Supportive and Palliative Care Services
Radiosurgery Center
214.820.7285
Office of Scientific Publications 214.820.3549
Research
Clinical Oncology Research
Coordination
214.818.8471
Baylor Institute for Immunology
Research
214.820.7450
Yong-Jun Liu, MD, PhD,
Director
Baylor Research Institute
Michael A.E. Ramsay, MD,
President
214.820.2687
Breast Cancer Prevention
Research Trials
214.820.9600
Joyce A. O’Shaughnessy, MD,
Director
Cancer Genetic Program
• Breast and ovarian
• Gastrointestinal
•
•
•
•
•
•
•
•
•
•
•
214.820.9600
214.820.2692
US Oncology/Texas Oncology
Research
Joanne L. Blum, MD, PhD,
Site Leader
214.370.1000
Marketing and Public Relations 214.820.2116
Ernie’s Appearance Center
214.820.8282
• Prostheses and specialty care items for cancer patients
• Nutraceuticals
Sammons Events and
Community Relations
214.818.8473
Screenings
214.820.6767
• Head and neck cancer (April)
• Skin/melanoma (May)
Smoking Cessation Program
•
•
Dental Clinic—Oncology
Outpatient Clinic
214.820.6767
Martha Foster Lung Care
Center
214.820.9791
Virginia R. Cvetko Patient
Education and Support
Center
•
•
214.820.2608
Patient/family education
and support programs
Patient resource centers/
oncology libraries
Valet Parking
214.820.8077
Patient Transport
214.818.6400
Beating
cancer
3410 Worth St.
Dallas, TX 75246
1.800.4BAYLOR
214.820.3535
BaylorHealth.com/DallasCancer

BUILDINGOn STRENGTH - Baylor Health Care System

Transcription

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