2015 Annual Report

Transcription

2015 Annual Report

ETMC CANCER INSTITUTE
2015 Annual Report
Cancer care
that revolves
around you.
721 Clinic Drive • Tyler, TX • (903) 595-5550 • etmc.org
2015 ANNUAL REPORT
Table of Contents
2 | Mission Statement
4 | 2014-15 Cancer Committee
5 | Chairman/Administrative Report
7 | Radiation Oncology
11 | Community Outreach
12 | Continuing Medical Education
13 | Clinical Trials
14 | Cancer Data Services
15 | Oncology Psychosocial Program
16 | Dedicated Oncology Unit
17 | Breast Care Center
18 | Summary of Program Components
22 | Colon – Michael Ashigbi, MD, Medical Oncology/Hematology
24 | Graphic Presentation of Colon Cancer
28 | With Gratitude
2015 ANNUAL REPORT | ETMC CANCER INSTITUTE
1
Our Mission
East Texas Medical Center Cancer Institute
Mission Statement
Cancer care that revolves around you.
The mission of the East Texas Medical Center Cancer Institute
is to prevent, detect and treat cancer with dedication to the
health of the people of East Texas. To accomplish this mission,
we are committed to the following standards:
The East Texas Medical Center Cancer Institute will…
• Provide for the physical, emotional and spiritual needs
of the patient in order to promote quality of life in a
compassionate manner.
• Create superior multidisciplinary programs in order to provide
the most appropriate cancer care.
• Assure a highly trained professional staff and will provide
them with the best available resources and technology in
order to render the most advanced patient care.
• Continually improve the quality of patient care by assessing
and improving those managerial, clinical and support
processes that most affect patient outcomes.
• Manage its financial and human resources in an effective
manner that contributes to the fulfillment of its mission.
2
Cancer Program Chairman
(Beginning in 2009 cancer program chairman serves a three-year term.)
1986 – 1989 |
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
2008 – 2011 |
2011 – present |
Gary Gross, MD, medical oncology/hematology
Dale Lakomy, MD, radiation oncology
Gary Kimmel, MD, medical oncology/hematology
Arielle Lee, MD, medical oncology/hematology
JoAnne Carrignan, MD, medical oncology/hematology
Mitchell Anderson, MD, radiation oncology
Robert Droder, MD, medical oncology/hematology
Leonard DeCarlo, MD, urology
James Kolker, MD, radiation oncology
William Lunn, MD, pulmonology
JoAnne Carrignan, MD, medical oncology/hematology
Heidi McKellar, MD, radiation oncology
Myrtha Basile, MD, medical oncology/hematology
Charlie Haas, MD, medical oncology
Michael Klouda, MD, diagnostic radiology
Joseph Martins, MD, medical oncology/hematology
Michael Ashigbi, MD, medical oncology/hematology
Andrew Kulaga, MD, pathology
Cancer Program Physician Liaisons
1986 | Joseph Selman, MD, radiation oncology
H.R. Fender, MD, surgery
1987 – 1991 | H.R. Fender, MD, surgery
Joseph Selman, MD, radiation oncology
1994 – 1997 | Joseph Selman, MD, radiation oncology
2015 – present | Jeffrey Gilroy, MD, radiation oncology
3
Cancer Committee Members
2014-2015
Andrew Kulaga, MD, chairman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pathology
Michael Ashigbi, MD, past chairman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Jeffrey Gilroy, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cancer Program Physician Liaison
Robert Fender, MD, conference coordinator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surgery
Joseph Martins, MD, lung conf. moderator. . . . . . . . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Arielle Lee, MD, community outreach coordinator . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Charles Haas, MD, quality control of registry. . . . . . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Michael Klouda, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diagnostic Radiology/Breast Center
Katrina Glover, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Gary Gross, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Oncology/Hematology
Thomas Grahm, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neurosurgery
Thomas Hayes, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diagnostic Radiology
Thomas McGovern, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surgery
Hope Short, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Family Medicine
Ancillary Members
Dianne Adelfio, RN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vice President, Oncology Services
Amy Averett, RN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hospice of East Texas
Rebecca Berkley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public Relations Manager
Tawana Burgess, RN, OCN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oncology Nurse
Blas Caroprese, PhD, DABR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chief Physicist
Regina Davis. . . . . . . . . . . . . . . . . . . . . . . . . . . . ETMC Breast Care Center/ETMC Cancer Institute Director
Perry Edwards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chaplain
Lee Folsom, RT(R)(T). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Radiation Therapy Tech/Q.I. Director
Kris Freeman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Genetics
Cathy Hanks, RN, OCN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Manager
Linda Harden. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rehabilitation
Courtney Hicks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . American Cancer Society
Stephen Hubbard, PC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Atty/Public Member of Community
Almarie Moore, CTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cancer Data Services Manager
Jeanetta Patterson, RN, OCN, BA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Trials Coordinator
Suzie Roden. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dietary/Nutrition
Laura Scritchfield, RN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oncology Nursing Director/6 South
Carla Stuart, RN, OCN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cancer Nurse Manager
Janice Terry, LCSW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ETMC Behavioral Health Therapist
Misty Weathers, RN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CyberKnife Coordinator
Cynthia Willis, Pharm D.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pharmacy
4
Chairman / Administrative Report
The ETMC Cancer Institute is a leader in the provision and
coordination of a comprehensive cancer program. The
program has long been devoted to cancer education, early
detection, prevention, diagnosis, advanced treatment and
follow up care for the communities of East Texas. Registry
data is used to plan for and facilitate cancer screening,
diagnostic treatment and recovery programs that directly
address primary cancers seen in our communities. While
the quantitative portion of this report focuses on data
obtained in 2014, the program information included
provides an overview of the activities and services
associated with our program in 2015.
Team members and providers associated with the ETMC
Cancer Institute are committed to quality patient care and
outcomes. State-of-the-art technology and availability
of services to patients in our community is comparable
with care available in larger communities and cancer
centers. We are proud to offer a high level of care in a
personalized care setting.
The ETMC Cancer Institute accreditation through
the American College of Surgeons Commission on
Cancer (ACoS) was renewed this year with multiple
commendations received. The ACoS accreditation
recognizes cancer programs for meeting and exceeding
established standards that guide the quality of care
delivered by member programs. We are proud of our
cancer program’s accomplishments, as well as the
physicians and staff that make up our program.
We continually strive to improve the care provided to
our patients originating in regional areas of East Texas.
Our medical oncologists treat patients in several of
our affiliate locations including Athens, Henderson,
Jacksonville and Pittsburg; improving access to care
for patients in these communities. Many of our other
specialists (urology, pulmonology, gastroenterology,
cardiology) also provide consultative services to the
affiliate communities, bringing the highest level of
medical care to areas that are traditionally underserved.
In addition to our dedicated staff of medical
professionals, ETMC’s Cancer Institute has access to some
of the most advanced cancer treatment technologies
in East Texas. We are the only facility in the region
with the CyberKnife® Stereotactic Radiosurgery System,
a revolutionary treatment for tumors that may have
otherwise been considered inoperable or untreatable.
The CyberKnife® Robotic Radiosurgery System is an
outpatient, non-invasive alternative to surgery for
treatment of both cancerous and non-cancerous tumors
located anywhere in the body, including the prostate,
lung, brain, spine, liver, pancreas and kidney. Beams
of high-dose radiation are delivered to tumors with the
CyberKnife’s extreme accuracy.
The ETMC Cancer Institute’s radiation oncology facility
began treating patients with a new linear accelerator,
the Varian TrueBeam™ system, in February 2013. The
TrueBeam™ system integrates respiratory gating, real
time tracking, imaging and treatment delivery to provide
a stereotactic radiosurgery and precise radiotherapy for
lesions, tumors and conditions anywhere in the body
where radiation therapy is indicated. Unlike conventional
IMRT treatments, during which the machine must rotate
several times around the patient or make repeated stops
and starts to treat a tumor from a number of different
angles, VMAT/RapidArc delivers the radiation dose to the
entire tumor in a 360-degree rotation, typically in less
than two minutes. RapidArc uses special software and the
TrueBeam to deliver IMRT treatments up to eight times
faster than what was previously possible.
Through our highly qualified oncologists, other physician
specialists and state-of-the-art cancer treatment
technologies, we strive to fulfill our mission to prevent,
detect and treat cancer with dedication to the health of
the people of East Texas.
Our comprehensive cancer program includes:
• Radiation oncology
• Mammography (including a mobile mammography unit)
• Medical oncology
• Screening/prevention programs
• Surgical oncology
• Cancer conferences
• Stereotactic radiosurgery
• Cancer data registry
• Specialized inpatient care
• Clinical trials
• Breast care center
• Cancer support services
5
The ETMC Pin-a-Sister™ program continues to expand
across our community by reaching out to minority
communities, hosting educational programs and ‘pinning
ceremonies’ designed to encourage women to receive
breast cancer screenings. This largely volunteer-driven
effort has been recognized by many organizations for
the impact it is making in breast cancer awareness and
prevention.
The ETMC breast program provides clinical oversight
and mammography screenings in Carthage, Fairfield
and Cedar Creek Lake. As an extension of the Breast
Care Center in Tyler, digital mammography is also
available in south Tyler, Quitman and Pittsburg. Our
digital mammography bus serves many other businesses
and communities in surrounding areas. Michael Klouda,
MD, and his team of professionals work to ensure
women identified in these communities with breast
related conditions are moved quickly through the
diagnostic process. These cases receive the benefit of
case discussion by a team of physicians at our weekly
cancer conferences, ensuring they receive real-time case
review and planning of nationally recognized standards/
treatment options.
Community education, support, involvement and
prevention programs continue to be an important part
of our comprehensive cancer program. Early detection is
vital to the successful treatment of cancer. The activities
the ETMC Cancer Institute participates in are central to our
mission of raising awareness of cancers that most often
impact the communities we serve. ETMC participated in
events and programs such as these in 2015:
NeuroFocus symposium – The ETMC Neurological
Institute offered a full day of instruction from leaders in
the neurosciences. Medical participants learned about the
latest advances in treatment of brain and spinal cancers,
as well as many other neuro topics such as ALS, trauma
and palliative care.
Genetic testing KnowledgeFirst program – An
educational program for men and women in the
community to become aware of how the tests are
performed, how the results are evaluated and the
counseling provided to patients for whom it is determined
there is a greater risk for developing cancer.
Pink Ribbon Getaway – 2015 marked the ninth year
we have held this day-long retreat for breast cancer
survivors. Anne McCrady, a well-known motivational and
inspirational keynote speaker, spoke to a full conference
room of participants. An abundance of support and
laughter was had during the motivational program.
6
Great Getaway Retreat – Established in 1997, ETMC’s
18th annual camp was again a great success. The retreat
was well attended with various events and activities
offered. The annual retreat promotes relaxation,
adventure and a community spirit for both newly
diagnosed cancer patients, as well as cancer survivors.
Susan G. Komen Race for the Cure® – ETMC participated
in this annual event in an effort to support and raise
funds for the Komen Foundation and to raise community
awareness of breast cancer. Most of the funds raised
stay in Tyler to provide screening and diagnostic breast
services for women without the ability to pay. ETMC
brought in a breast model that people could walk
through to see how cancer forms inside the breast.
American Cancer Society Relay for Life® – ETMC
employees and survivors fielded teams and raised money
and community cancer awareness for this annual event.
ACS Cattle Barons’ Gala – ETMC was a sponsor in this
fundraiser for the American Cancer Society.
Henry Bell Jr. Golf Tournament – This event raises
awareness of cancer and treatment options in the
community. This annual event is well attended with lots
of enthusiastic golfers and activities.
Marketing campaign – Throughout the year we run print
ads about cancer topics and importance of screening. We
also participate in numerous media interviews on various
topics along with the KnowledgeFirst series of speakers
on various medical topics throughout the year.
Our program has continued to implement the new 2015
ACoS standards throughout the year. The new standards
focused on patient navigation, psycho-social support,
care coordination and quality outcomes. These standards
provide ongoing opportunity for all accredited programs
to demonstrate excellence in cancer care.
This report illustrates the various methods and personnel
we have enlisted to battle cancer here in East Texas. We
look forward to continuing to serve the patients and
families in our community.
Dianne Adelfio
VP, ETMC Cancer Institute
Andrew Kulaga, MD
Chairman, Pathology
Radiation Oncology
The nurses work closely with the radiation oncologist
to monitor your health during treatment and to provide
information and support to you and your family.
Regardless of his or her job, each member of our staff is
here for one reason only – to serve you and your family.
It is our privilege to take care of you.
Jeffrey Gilroy, MD
Cancer Program Physician Liaison,
ETMC Cancer Institute in Tyler
The ETMC Cancer Institute opened in 1982 to provide
radiation therapy services to East Texans. Radiation
therapy provides techniques for destroying abnormal
cells. In many instances, radiation therapy is the single
best method for the treatment and cure of cancer.
Radiation therapy may also be combined with surgery
and/or chemotherapy to cure or control the disease. In
other cases, radiation therapy can be used as a supportive
measure to reduce discomfort, bleeding or pain.
Bruce Ellerin, MD
Radiation Oncologist,
ETMC Cancer Institute in Athens
More than 20,000 cancer patients have been treated at
the ETMC Cancer Institute by an expert team of health
specialists, including physicists, dosimetrists, radiation
therapists, nurses and other support personnel. The
team is led by the radiation oncologist, a physician who
specializes in the treatment of cancer with radiation. This
specialist decides what type of radiation therapy is best,
plans the treatments and carefully monitors each patient.
After your treatments begin, you will be seen regularly
by your radiation oncologist or at any time a question or
problem arises.
The physicists and dosimetrists assist the radiation
oncologist by ensuring that the radiation is delivered
in the most efficient manner, sparing as much normal
tissue as possible. They make sure the prescribed dose is
delivered as the radiation oncologist intended.
The radiation therapists work with the radiation
oncologist to set up and deliver your daily treatment on
one of the high-energy linear accelerators at the ETMC
Cancer Institute.
7
Radiation Oncologists
JEFFREY GILROY, MD
BRUCE E. ELLERIN, MD
Jeffrey Gilroy, MD, is a board-certified radiation
oncologist whose professional knowledge of
cancer is matched by his personal knowledge of
cancer’s effects on members of his own family.
“It’s a difficult time not only for patients but for
their families. They’re scared, and I would like to
make it as unintimidating as possible and be there
as much as possible for them to go through this
difficult journey.”
Bruce Ellerin, MD, is a board-certified radiation
oncologist who has treated a wide variety of
malignancies. He believes in collecting all relevant
information before deciding on a treatment goal that is
acceptable to his medical colleagues and, above all, to
the patient. “The patient has to be comfortable with the
plan. The patient’s wishes must never be disregarded.”
Board-certified radiation oncologist
Dr. Gilroy practiced in California, Arizona, Missouri
and Wyoming before coming to East Texas. He
earned his bachelor of science degree at Texas
Christian University and his doctor of medicine at
the University of Nebraska College of Medicine.
He completed his internship in internal medicine
at Creighton University and his residency at the
University of Florida in Gainesville. Dr. Gilroy
said he’s proud that ETMC can offer the latest
technology and state-of-the-art treatments to all
patients. “I’d like them to be treated exactly the
way I would like my family to be treated.”
8
Board-certified radiation oncologist
Dr. Ellerin, who speaks several languages, has practiced
medicine in big cities and rural communities, both
inside and outside of Texas. He relishes being in East
Texas, which provides just the right balance between
urban and rural life: The commercial, educational and
entertainment offerings of the city are just over an hour
away, while the beauty of the East Texas landscape is
right here. With family in Dallas and Houston, he finds
the location ideal.
The son of two attorneys and a graduate of Harvard
Law School, Dr. Ellerin worked briefly as a lawyer
before choosing a career in medicine, which he
gravitated to because the results were more visible and
immediate. He finds the most rewarding part of his
work as a physician to be “the ability to see in real time
the outcomes that improve the life expectancy and the
quality of life of my patients.”
Oncology Nurse Profiles
DEE CRABTREE, RN
ETMC Cancer Institute Athens
Clinical staff nurse
Dee Crabtree has been an oncology nurse at the ETMC Cancer Institute in Athens for over a year. She started
her nursing career as a shift nurse and worked in cardiology and home health nursing in Tyler for eight years
before finding her calling.
“I’ve always loved what I do as a nurse. Athens is a very relaxing, calm, environment to heal in and the patients
love it. We’re a team and we always have the patient as the center of everything; it’s everybody working
together for the patient.”
Her experiences in her career and in her life have confirmed her choice. “People think bigger towns have better
doctors or better this and that, but I don’t believe that’s true at all.” Personally and professionally, Dee’s heart is
in Athens — and at ETMC.
“ETMC is an excellent system. I have worked for others but prefer this. They have the same beliefs I do that the
patient comes first, no matter what. I just think it’s a wonderful place and if I had cancer, I would be treated here.”
SALLY STORY, RN, OCN
ETMC Tyler
6 North charge nurse
Growing up — long before she watched oncology nurses take care of her mother — Sally Story knew she
wanted to be a nurse.
“I always knew oncology was where I wanted to be. I became an oncology-certified nurse because I wanted to
be the best nurse I could be for the patients.”
Sally is the charge nurse for 6 North at ETMC Tyler, where cancer patients are treated.
“The oncology doctors are wonderful. You can just tell they love their patients, and that makes a big difference.
The patients love them as well.”
The coursework and board examination to become an oncology-certified nurse are stringent. So is the
continuing education required to maintain certification, but she understands that some aspects of caring for
patients can’t be taught.
“What a greater privilege is there than to be at their bedside? You get to know them and be part of their family.
You get to give them comfort, hold their hand and love them. I can’t imagine doing anything else, I love my job
and everyone I work with.”
9
Oncology Nurse Profiles
PAT BRANHAM, RN, OCN
Blood and Cancer Center of East Texas
Nurse manager
Pat Branham began her medical career at ETMC in the dietary department as a hostess. She enjoyed working
with patients and went back to school to become a registered nurse.
“I have had the privilege of working in various areas of nursing, but none have been more rewarding than the
last nine and a half years in oncology. I have always been drawn to oncology since my father was diagnosed
with prostate cancer at 59 and lost his battle a few months after diagnosis.”
Pat works for Dr. Gary Gross at the Blood and Cancer Center of East Texas.
“I have come to believe that nursing is a calling and not just a job. I also believe that we are put here to make a
difference in the lives of others, so with this belief I make it my practice everyday to offer hope and support to
my patients and their families.”
ANNALA SHIRLEY, RN, OCN
Tyler Hematology Oncology, P.A.
Director of Clinical Services
Annala Shirley has been a nurse for over 20 years with most of that time in oncology. She has worked at Tyler
Hematology Oncology, P.A., since 2012.
“Although it takes years to train and become proficient in oncology, there is much more to being an oncology
nurse. We are skilled in chemotherapy, radiation, infection control, dietary considerations and modifiers that
will interfere with treatment. We are also highly skilled at listening, compassion and empathy. We are given the
opportunity to accompany a patient during the most difficult time of their life.”
Annala says oncology nursing is a wonderful job. “It’s not easy, but I have found that most of our patients have
decided that it is not important to live but to live life to the absolute fullest degree possible. The saying ‘live like
you are dying’ is a great motto to have, with or without a cancer diagnosis.”
Annala says oncology nurses help people understand the process they are facing and work hard to know they
are with them every step of the way.
“Oncology is rewarding; having the ability to touch a life and make an impact is a great feeling at the end of
a long day. I have met many people over my years in nursing, and I gave a little piece of myself to each and
every one of them. I can’t imagine being a nurse in any other area in healthcare.”
10
Community Outreach
Each year, the ETMC Cancer Institute offers a number
of cancer outreach programs designed to enhance
community access to cancer prevention, early detection
and treatment. Lung, breast, colon/rectal, prostate and
bladder ranked as the most frequently diagnosed cancers
in the ETMC Cancer Registry 2014. The 2015 outreach
efforts were concentrated in those areas.
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Low Dose CT Lung Screening Program
Lung cancer is the leading cause of cancer death in the
United States. Most patients are diagnosed with advanced
disease, resulting in a very low five year survival rate.
Screening for lung cancer has the potential to identify the
disease in the earlier stages of development and reduce
the risk of death due to lung cancer (American Society of
Clinical Oncology).
NCDB Customized Tumor Registry Data Base Search 2012
data indicated 41 percent of patients were diagnosed with
lung cancer at Stage 4 compared to 3 percent with other
cancer programs participating in the NCDB data base.
Center for Health Statistics 2009 Health Facts Profiles for
Texas indicate the rate for respiratory/lung cancer deaths
is 57.4 percent (Smith County) and the state (Texas) rate is
45.7 percent.
Program
Low dose CT lung screenings are performed at the ETMC
Cancer Institute. The program applied the American Society
of Clinical Oncology clinical guidelines, the National Lung
Screening Trial protocol and the U.S. Preventive Services
Task Force recommendations. The patient’s physician is
listed as the attending to receive the report.
Eligibility Criteria
• 55 to 77 years
• and with a smoking history of at least 30 pack-years
(this means one pack a day for 30 years, two packs a
day for 15 years, etc.)
• and currently a smoker or past history of smoking (less
than 15 years ago).
If all answers are yes, patient is eligible for low dose CT
lung screening
The program was marketed to consumers and physicians
utilizing consumer flyers, newspaper ads and ETMC
KnowledgeFirst lectures. ETMC First Physicians and
Pulmonary Specialists of Tyler are community partners.
The ETMC Cancer Institute conducted 75 lung screenings
with 25 (33 percent) requiring additional testing with
zero lung cancers detected. Each screen requiring follow
up was referred to the ETMC Lung Nodule Patient
Navigator for tracking and compliance with screening
recommendation, i.e. additional testing.
Community Based Outreach
In 2015, the ETMC Cancer Institute staff participated in a
number of employer-based health fairs in collaboration
with HealthFirst insurance, as well as communitybased health fairs. Each health fair participant received
information regarding screening mammography, early
detection of colon cancer, smoking cessation and
prostate cancer.
In 2015, ETMC conducted its first men’s health lecture
series specifically targeting colon and prostate cancer
with outreach efforts directed toward African American
men — an at risk population. Community outreach was
further supported through a community-based lecture on
genetic testing. This lecture was led by Michael Klouda,
MD, medical director of the East Texas Medical Center
Breast Care Center. The lecture included an informational
packet and a question/answer session. One hundred
community residents attended. Also the participants
provided very valuable comments that ETMC will
incorporate when planning ETMC’s next lecture series.
ETMC took its skin cancer detection program to the
schools and day care centers. Cancer staff members
provided interactive lectures to 150 middle school
students and distributed over 500 brochures to
elementary schools and day care centers.
11
Continuing Medical Education
Accredited by the Texas
Medical Association since
1998, the continuing medical
education (CME) department
at ETMC has continued to
grow and attract dynamic
speakers for various topics
of interest to our area
physicians. In February 2013,
we attained another full,
four-year accreditation as a
designated CME provider.
The CME department plays a vital role in keeping ETMC
physicians and staff on the forefront of the latest medical
information and current medical advancements. We offer
both regularly scheduled educational opportunities, such
as oncology prospective treatment planning conferences
and trauma committee morbidity and mortality
conferences, as well as one-day seminars such as the
annual Hot Trauma Topics, Wound Management and
NeuroFocus symposiums.
The purpose of the oncology series is to continually
improve the care of cancer patients at ETMC with goals
such as providing up-to-date information on diagnostic
and treatment options for cancer patients; improving the
continuum of care through applicable departments and
services; focusing on problem cases and on pretreatment
evaluation, staging and treatment strategy; representing
a case mix as reported by the cancer registry at ETMC
and encouraging multidisciplinary participation. The
educational lecture series included topics such as the
intersection of neurology and palliative care, stereotactic
radiosurgery as a neurosurgical tool and recent
advancements in the treatment of high grade gliomas.
The CME department has granted more than 100 CME
credits with an increase in attendance by physicians and
allied health professionals.
The first annual Gastrointestinal Oncology Symposium
was held on June 13, 2015. The overall conference
objectives included: 1) Describe advances in the
management of gastrointestinal cancers 2) Explain
new molecular pathways used to treat patients with
gastrointestinal cancers 3) Describe the effectiveness
of genomic assays in the treatment plan for cancer
patients to improve patient outcomes 4) Explain the
use of combination drug therapy in the treatment of
metastatic disease 5) Describe new surgical techniques
in the treatment of gastrointestinal cancer and 6) Explain
the benefits of multi-disciplinary treatment plans in
the management of gastrointestinal cancers. Twenty
12
eight MD/DO/PAs and 24 RN/LVN/NPs attended the
conference. Lectures were presented by speakers from
Houston, Dallas, New York and Tyler. Topics included
metastatic gastroesophageal cancers, update on
surgical management of GI malignancies, pancreas
adenocarcinoma, update on management of neuro
endocrine tumors, case presentations, novel strategies
for metastatic colorectal cancer and advances in
immunotherapy: focus on immune checkpoint inhibitors.
The post-event evaluation tool’s comments support
the success of the first annual GI Oncology Symposium
by providing oncologists, surgeons and primary care
physicians a comprehensive update on gastrointestinal
malignancies, as well as discussion of the latest clinical
trial evidence and clinical guidelines that physicians can
incorporate into their clinical practice.
Our most popular education topics continue to be:
cardiology • medical ethics • neurology • oncology • trauma
palliative care • pain management • wound management
With continued feedback and analysis from our
CME committee and our ETMC physicians, the CME
department will continue to grow and offer even more
educational forums to our physicians in the future.
Life-long learning by medical personnel promotes the
excellent standard of care that our patients deserve. As a
CME provider, our department will assist in keeping that
standard high.
Sandy Campbell
Continuing Medical Education Coordinator
Clinical Trials
• multiple myeloma registry
• breast cancer
• kidney cancer
• lymphoma
• chronic lymphocytic leukemia
The clinical trials office is responsible for assisting
physicians in the recognition and evaluation of
appropriate patients for clinical research studies. Our
office also is responsible for registration, compilation of
data, maintaining follow-up records and submission of
data to the sponsor.
Clinical trials are a final step in the long and careful
process to develop better ways of preventing, diagnosing
or treating cancer. Clinical trials test new medical
approaches in cancer patients and are important in
developing new treatments for cancer. Many of the
standard treatments that we have today were developed
based on the results of previous clinical trials.
The oncology clinical trials program at ETMC has been
enrolling patients since 1986. Through the program,
patients can gain immediate access to new and
promising treatment regimens for different types of
cancer. Published studies on a number of cancer types
suggest that patients who participate in clinical trials
generally have better survival rates than comparable
groups that do not participate. Ultimately, people who
take part in clinical trials contribute to future progress
against cancer – helping to shape new approaches in the
fight against cancer.
Numerous trials offered by the ETMC clinical trials
program evaluate investigational drugs and are of
national and international significance. Some of the
studies in 2014 targeted the following cancer patient
populations:
• non-small cell lung cancer
Our research staff works closely with the medical and
radiation oncologists to complete Phase II through Phase
IV trials. Our clinical trials program employs individuals
who are certified in oncology (OCN) and certified in
clinical research to ensure that our research activities are
conducted utilizing good clinical practice standards. The
physician investigators are experienced and dedicated to
performing high-quality studies.
All studies are reviewed and monitored for adherence
to strict standards and protocols by ETMC’s Institutional
Review Board and other central IRBs. The IRBs are
made up of interested and knowledgeable community
members who review and approve any patient-related
research conducted at ETMC and community oncology
physician groups.
Jeanetta Patterson, RN, OCN, BA
Clinical Trials Coordinator
Judy Lanier, RN
Clinical Trials Nurse
Lisa Seagroves, RN
Clinical Trials Nurse
JoAnn Hampton, BS, CCRP
Certified Clinical Research Professional
• prostate cancer
13
Cancer Data Services
The cancer data services
department (cancer registry)
of the ETMC Cancer Institute
is a case-specific database
with detailed information
about each patient’s type of
cancer.
The registry is a central
component of the ETMC
Community Hospital
Comprehensive Cancer
Program, and it plays a large role in improving quality
through the retrospective analysis of patterns and trends
in the diagnosis and treatment of cancer.
The approved cancer program benefits patients,
professional staff members, the hospital and the
community through:
• institutional commitment to the provision of
high-quality cancer care
• access to multi-disciplinary consultation
• annual followup
The registry identifies cancer patients seen at ETMC by
utilizing a computer software program, IMPAC Medical
Systems-METRIQ, designed especially for cancer data
collection. We collect extensive data on each patient,
including demographic data, diagnostic findings, primary
site of malignancy, histology, stage of disease, treatment
and survival data.
• availability of registry data
In 2014, a total of 1,197 new cancer cases were
accessioned into the ETMC registry database. Since our
reference date of January 1996, a total of 18,926 cases
have been accessioned into the registry. In addition, we
follow 12,602 patients for a lifetime, and our successful
follow-up rate since registry date is 93.2 percent and
92.06 percent for the past five years of analytic cases.
• high-quality, multi-disciplinary care available close
to home
We report statistical information to the Texas Department
of Health Cancer Registry Division and to the National
Cancer Database. This statistical information is used for
research purposes, to gain insight into cancer incidence
and to assess effective treatment modalities for cancer.
The cancer data services personnel are active members
in the National Cancer Registrar Association (NCRA),
the Texas Tumor Registrars Association (Tx-TRA) and
participate in the East Texas Regional Workshop
for Registrars. Also, staff actively participates in the
quarterly ETMC Cancer Committee meetings and
14
weekly prospective treatment planning conferences.
We participate in the American College of Surgeons’
(CP3R) Cancer Program Practice Profile, Rapid Quality
Reporting System (RQRS) and National Cancer Database
Comparison Benchmark, as well as in-house audits, which
monitor quality of patient care.
• educational programs
• research protocols
• comparison of regional clinical experiences with
national data
• cancer resource/patient counseling
• ongoing cancer screening programs
The cancer data services department is a service
designed to promote the continuity of quality care for
cancer patients. Great emphasis is placed on high-quality
cancer registry data and a foundation for future analyses
at the ETMC Cancer Institute.
ETMC Cancer Data Services Personnel
Almarie Moore, CTR
Cancer Data Services Manager
Shanita Farmer, CTR
Cancer Registrar
Dena Wright
Registry Associate
Oncology Psychosocial Program
The ETMC Cancer Institute
provides several programs
to meet the psychosocial
and educational needs of
cancer patients and their
families. The diagnosis of
cancer and its treatment
often creates a major crisis
for individuals and families
that results in psychosocial
problems. Most patients and
family members experience anxiety, fear and a feeling
of hopelessness when they hear the words “it is cancer.”
Uncertainty of what is to follow can be as devastating as
the dreaded diagnosis. A critical component of treatment
is the availability of a comprehensive support program
to assist patients and families as they struggle to cope
with diagnosis, fears, treatment and outcomes. The social
worker will be contacted by a healthcare professional,
if indicated by the distress screening tool (moderate to
severe stress) and/or clinically indicated.
This evaluation will confirm the presence of physical,
psychological, social, spiritual and financial support needs
and indicate the need to link patients with psychosocial
services offered by referral.
When community psychosocial resources are designated
as the most appropriate resource to meet the patient or
family needs, referrals are made by physicians, nursing
staff, clinical social workers or other staff.
Counseling Services
Individual, marital or family counseling is offered to
provide patients and families with improved coping and
communication skills. Counseling sessions are available
by appointment for the inpatient unit, radiation oncology
and breast care centers. Contact Janice Terry, licensed
clinical social worker, at 903-595-5550.
Support Groups
ETMC offers the following support groups to help in
dealing with the emotional impact of cancer. These groups
bring patients, survivors, caretakers and family members
together for encouragement, education and emotional
support. The following groups are presently offered:
• Cancer Support Group – For patients and family
members in Tyler and Athens.
• Crafters – For patients and family members.
• Ostomy Support Group
Janice Terry, LCSW
Licensed Clinical Social Worker
15
Dedicated Oncology Unit
The medical oncology unit
at ETMC is composed of
knowledgeable trained
registered nurses, bringing
compassion and assistance
in providing the best
outcome for our patients.
Our goal is to achieve and
maintain 25 percent of
our nurses with oncology
certification, which brings
to our team a vast amount of knowledge to proficiently
care for the patient diagnosed with cancer. Registered
nurses providing chemotherapy are certified to
administer chemotherapy to our patients. Our hospital
is a member of the Commission on Cancer, a program
of the American College of Surgeons, which recognizes
cancer care programs for their commitment to providing
comprehensive, high-quality and multi-disciplinary,
patient-centered care. This commission sets patient care
standards that we meet in order to be associated with
this regulatory commission.
Not only is our nursing staff knowledgeable, but they also
bring the tender side of nursing to our patients through
compassion, empathy and love. They bond with their
patients and their families making the stay at the hospital
comforting. They work closely with our physicians,
informing them of any problems, concerns or needs.
The patient is not alone in dealing with this traumatic
diagnosis; comforting the patient and their loved ones is
what we do.
Our nurses apply evidence-based practice to achieve
the best outcome for our patients, ensuring that the
physical, emotional, spiritual and long-term care needs
are met. Multiple disciplines work together as a team
involving nursing, physical therapy, nutrition, pharmacy
and case management to ensure that the patient has the
best outcome possible and making sure their needs are
met when discharged. Our nurses initiate hospice and/
or palliative care with physician’s order as a patient’s
condition warrants. Our nursing team is vital in the care
of our patients and we take our role seriously. Although
the outcome of the patient may or may not be what
everyone had hoped, knowing that an oncology nurse,
trained in end-of-life care is beside you all the way, helps
lighten the burden on the patient and their family.
Ron Owen wrote a note regarding the care he received.
“On Dec. 22, 2014, I was admitted to ETMC 6 North
16
for Burkitts Lymphoma. When I arrived there was a
genuine show of compassion and care given to me. I
started my journey with cancer and chemo treatments
which consisted of 96 hours of continuous infusion
of chemo each trip and there would be six of these
treatments. The nursing staff is second to none. They are
so compassionate about what they do and give you the
motivation to work harder to get well. If someone has
to go through this horrible illness, I would recommend
they go to ETMC as their time in the hospital will be very
pleasant and uplifting. I have since gone through four
more out-patient chemo treatments and will be getting
a stem cell transplant. I attribute my positive outcome
thus for to God and the staff at ETMC. May God bless the
ETMC oncology nurses and staff.”
Janice Southworth also wrote a note regarding the care
her husband received. “Losing someone you love with
all your heart is a devastating experience. My husband,
Jim, was in and out of the ETMC oncology center for two
years. His crusade with cancer was emotional, difficult and
extremely overwhelming. We could not have fought as
hard as we did without nursing staff providing support and
encouragement. They treated Jim with dignity, respect and
always seemed to have time to talk with us concerning
his treatment. The staff was honest, compassionate and
informative. Even though Jim passed away, we could not
have been more thankful for the care he received and the
sincere love we felt from the entire staff.”
Laura Scritchfield, RN
Director of Nursing
Twana Burgess, RN, OCN
Inpatient Oncology
Breast Care Center
service. We work with various programs including the
Susan G. Komen Foundation, Texas Agrilife and the Breast
and Cervical Cancer Program (BCCP) to provide services
to uninsured patients.
The ETMC Breast Care Center continues its mission
of early breast cancer detection through a dedicated,
compassionate, personalized and comprehensive
breast care program. We offer a full range of services
for screening and early detection of breast cancer
including diagnostic and screening mammograms,
breast ultrasounds, stereotactic biopsies, ultrasound
guided biopsies, breast MRI, cyst aspirations, hook
wire placements, sentinel lymph node injections and
galactograms. Bone density testing also is available at
the center.
One of the greatest assets any breast cancer screening
program can offer is its personnel. The certified
mammography technologists that staff our breast care
center and mobile mammography unit boast more than
110 years of breast imaging experience. All patients
receive personalized, one-on-one interaction with a
technologist who understands their apprehension
regarding this necessary screening exam.
Along with obtaining mammographic images, these
technologists collect information from each patient
regarding their family’s cancer history with an emphasis
on breast and ovarian cancers.
The ETMC Pin-A-Sister™ program is a faith-based breast
cancer awareness program targeting African American
women in Smith County. The program began in 2010
and to date over 10,500 women have participated in
ETMC Pin-A-Sister™ activities receiving health information
on the importance of obtaining an annual screening
mammogram. The program has expanded to include the
WISE woman program, annual breast health summits
and community-based mobile mammograms.
Of all the breast cancer diagnosed at ETMC Breast Care
Center, 28 percent were stage 0 (DCIS) and 27 percent
were stage I. This small tumor size at diagnosis affords
many women the option of choosing among various
therapies to treat their cancer, as well as providing the
obvious survival benefit that early detection provides.
Certain breast cancers may be amendable to
treatment by stereotactic technique, employing either
radiofrequency oblation therapy, excisional therapy or
cryotherapy. Biomolecular tumor characteristics are being
investigated so that specific treatment programs can be
employed based on the findings of these biomolecular
probes. As these new investigative techniques prove
to be beneficial, they will be adopted quickly into the
treatment armamentarium of the multi-disciplinary
approach that we utilize at ETMC.
Michael J. Klouda, MD
Medical Director, ETMC Breast Care Center
Regina Davis, MHA
Director, ETMC Breast Care Center
Genetic testing is offered to patients who meet certain
criteria, and a comprehensive cancer risk assessment is
made for patients whose family history suggests there
may be an elevated risk present. If a woman is found
to fall in the ‘high risk’ category (lifetime risk to develop
breast cancer > 20 percent), then screening contrastenhanced MR mammography is available to her annually.
The mobile mammography unit continues to make
screening mammograms available throughout the
region. Mobile services are provided in conjunction with
employer-based health fairs, school districts, ETMC First
Physicians clinics and local businesses. Fifteen to 20
percent of breast cancers detected at the breast care
center received screening mammograms via the mobile
17
2014 Summary of Program Components
1,197 new cancer cases accessioned
509 total licensed beds
Pathology
36 oncology beds
Diagnostic radiology
32 full-time oncology nurses
General surgery
8 OCN (oncology certified nurses)
Specialized surgery
Medical oncology/hematology
Community hospital comprehensive oncology program
Radiation oncology
Components of ETMC Cancer Institute’s ACoS Approved Cancer Program
Multi-disciplinary cancer committee
Clinical trials
General weekly prospective treatment planning conferences
Continuing medical education (CME)
Site-specific weekly prospective breast cancer treatment
planning conference
Cancer resource/patient counseling
Site-specific weekly prospective lung cancer treatment
planning conference
Patient care evaluations (PCEs)
Breast care center with mobile mammography unit
Fully computerized cancer registry
2014 Prospective Treatment Planning Conferences Primary Cancers Presented
Sites Discussed
TOTAL
Bile Duct
2
Brain21
Breast260
Colo-Rectal
21
CNS8
Esophagus
2
Gallbladder
1
Gastric/Stomach
2
GI, NOS
2
GYN
6
Head & Neck, NOS
1
Hodgkin’s/Non-Hodgkin’s
5
Kidney
7
Liver10
Sites Discussed
TOTAL
Lung
246
Myeloma
2
Neuroendocrine
3
Neurofibromatosis
1
Pancreas5
Parotid Gland
1
Pituitary5
Prostate2
Skin
3
Small Intestine
1
Testicle1
Thyroid
3
Tongue
2
Unknown Primary
9
TOTAL632
18
Primary Site
Analytic Cases
Non-Analytic Cases
Total Cases
Lip, Oral Cavity/Pharynx
31
8
39
Tongue
14
4
18
Salivary Gland
3
3
Mouth
5
1
6
Tonsil
8
8
Hypopharynx
2
2
Nasopharynx
1
1
Oropharynx
1
1
Digestive System
245
44
289
Esophagus
19
5
24
Stomach
21
6
27
Small Intestine
7
2
9
Colon
83
16
99
Rectum/Rectosigmoid
50
3
53
Anus and Anal Canal
6
2
8
Liver/Intrahepatic Ducts
20
1
21
Gallbladder
3
1
4
Other Unspecified Biliary
3
3
6
Pancreas
29
4
33
Peritoneum, Omentum & Mesentery
3
1
4
Other Digestive Organs
1
1
Respiratory System
297
40
337
Nose, Nasal Cavity & Middle Ear
2
2
Larynx
16
4
20
Lung & Bronchus
279
36
315
Bone and Joint
2
2
Soft Tissue
4
1
5
Skin (excluding Basal & Squamous)
15
14
29
Melanoma – Skin
14
13
27
Other Non-Epithelial Skin
1
1
2
Breast
181
30211
Female Genital Organs
27
9
36
Cervix Uteri
1
4
5
Corpus Uteri/Uterus
14
2
16
Ovary
9
3
12
Vulva
1
1
Other Female Genital Organs
2
2
Male Genital Organs
80
50
130
Prostate
73
50
123
Testis
4
4
Penis
3
3
Urinary System
133
12
145
Bladder
63
6
69
Kidney/Renal Pelvis
69
6
75
Ureter
1
1
Central Nervous System
44
6
50
Brain
24
2
26
Meninges/Other CNS
20
4
24
Endocrine System
32
6
38
Thyroid
19
1
20
Other Endocrine Glands including Thymus
13
5
18
Lymphoma
52 1264
Hodgkin’s
4
2
6
Non-Hodgkin’s Lymphoma
48
10
58
Lymphatic/Hematopoietic
30
1949
Myeloma
16
7
23
Leukemia
14
12
28
Mesothelioma
11
Miscellaneous Sites
23
10
33
Total # of New Cases for 2014
1,197
261
1,458
19
1996-2014 Total Registry Cancer Cases
Diagnosed and/or initially treated at ETMC
1400
1200
Number of cases
1000
800
600
400
200
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
ETMC Five Major Sites
2014 Total Analytic Cases
25
Percent of cases
20
15
10
5
0
Lung
Breast
Colo-Rectal
Prostate
Bladder
Distribution by County
35
30
Percent of cases
25
20
15
10
5
0
20
Smith
Wood
Henderson
Cherokee
Van Zandt
Anderson
All Other
2014
Distribution by Age at Diagnosis
35
30
25
20
15
10
5
0
40-49
50-59
60-69
70-79
80-89
90-100
Distribution by Initial Therapy
Palliative
Rad Hormone
Hormone
Surg Rad
Surg Horm Rad
Surg Hormone
Surg Rad Chemo
Radiation
Surg Chemo
Rad Chemo
Chemo
Surgery
0
5
10
15
20
25
30
Distribution by General Summary Stage
40
35
Percent of cases
30
25
20
15
10
5
0
In Situ
Local
Regional
Distant
Unknown
21
SPECIAL REPORT
Colon Cancer
22
Cancer of the colon and
rectum may originate
anywhere in the large
intestine or rectum, but
can spread to local tissues,
regional lymph nodes and
distant organs. It is the
third most frequent cancer
encountered at ETMC in both
men and women after breast
and lung in women and
prostate and lung in men.
Nationally, it is estimated that 93,090 cases of colorectal
cancer will be diagnosed in 2015 with an estimated
39,610 deaths. Across the country, the incidence of
colorectal cancer has been in decline for the past
several decades, and much of this decline is attributed
to increasing colorectal screening rates among persons
over 50. It has been suggested that the removal of
precancerous colorectal polyps before they get the
chance to transform into cancer, may be the mechanism
for the decline in incident of colorectal cancers. This
decline seems to be confined to those over 50 for whom
most guidelines uniformly recommend colorectal cancer
screening. Incident rates have actually increased by 1.8
percent per year in this year’s group, as compared to
a decrease of 4.3 percent per year from 2007 to 2011.
Mortality from colorectal cancer also has been on the
decline since 1980 and in most recent data available,
from 2007 to 2011, the overall death rate has declined
by 2.5 percent per year. Many have attributed this
decline to early stage of diagnosis and improvement
in therapy for both early and advance stages of the
disease when diagnosed. Because many patients with
early stage colorectal cancer have no symptoms,
unscreened populations such as those less than 50 are
only evaluated for symptoms and so tend to present with
cancer with more regional and distant spread.
Colorectal cancer risk increases with age so that in 2011,
90 percent of these cancers presented at 50 or older.
The other risk factors may be classified as modifiable
(obesity, physical inactivity, moderate to heavy alcohol
use, smoking, high consumption of red/processed meats
and low intake of calcium, fruits, vegetables and dietary
fiber. Other risk factors included: diabetes, hereditary
colon cancer syndromes, such as HNPCC (hereditary non
polyposis colon cancer), FAMP (familial adenomatous
polyposis), and inflammatory bowel disease (Crohn’s and
ulcerative colitis).
At ETMC in 2014, 11 percent of the colorectal cancers
presented in people less than 50 years old, while 72
percent presented in individuals of age 50-79 years, the
rest were in those 80 or older. Forty-eight percent of
the colorectal cancers here were confined to the bowel,
while 52 percent had spread either regionally or distally.
Treatment was by surgery alone 46 percent of the time;
25 percent had surgery followed by chemotherapy and
12 percent had surgery, radiation and chemotherapy
(likely rectal cancer patients), 4 percent had radiation
and chemotherapy without surgery (likely anal cancer
patients). Some 9 percent received palliative care only.
Identifying individuals with hereditary colorectal
cancer has significant implications of increased risk for
other cancers as well as increased risk for close family
members of such a patient, and present an opportunity
for certain intervention that might mitigate such risk such
as earlier screening or more frequent screening and even
prophylactic colon resections. Individuals less than 50
with colorectal cancer are more likely to have hereditary
colorectal cancer and are easily identifiable based on
their age.
The National Comprehensive Cancer Network, as
well as other cancer care groups, has advocated that
patients be screened for hereditary colorectal cancer
and to consider testing those who meet the Bethesda or
Amsterdam Criteria for hereditary colorectal cancer. At
ETMC, we have embarked on an initiative to increase
genetic testing for hereditary colorectal cancer in those
diagnosed with the disease at age less than 50, as a
pilot before hopefully expanding this to those who meet
broader Bethesda or Amsterdam Criteria for genetic
testing of the disease. The ETMC cancer program has
implemented an initiative to increase genetic testing at
ETMC for our younger colorectal cancer patients as part
of a Commission on Cancer (C0C) quality study to address
the identified gap in identification and genetic testing of
individuals below 50 with this cancer, who may be at risk
for having HNPCC. This is based on a review of a small
internal 2014 data set of our patients. In that review, 30
percent of those less than 50 with colorectal cancer were
tested for HNPCC and 20 percent of those tested were
positive for a HNPCC mutation. HNPCC mutation carriers
have lifetime increased risk for several cancers, including
colorectal cancer 52-82 percent, endometrial cancer 2560 percent, gastric cancer 6-13 percent, ovarian cancer
4-12 percent and others up to 9 percent.
This quality initiative hopes to increase the tested
percentage of appropriate patients in the target age
group to over 80 percent. Every patient diagnosed with
colorectal cancer at age below 50 generates a reminder
to the doctors involved in the patient’s care to consider
testing or referring the patient for genetic testing. We also
have screening forms in doctors’ offices to capture family
history of cancers that may screen for those that need to
be tested. Our hope is that at some point in the future, we
can expand to the broader group of patients who meet
the Bethesda or Amsterdam Criteria for testing.
See Colorectal Cancer Facts & Figures at cancer.org/statistics
for more information about colorectal cancer.
Michael Ashigbi, MD
Medical Oncology/Hematology
23
Number of New Colo-Rectal Cancer Cases
Annually Diagnosed at ETMC
160
Number of cases
140
120
100
80
60
40
20
0
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Distribution by County
2014 Colo-Rectal Cancer Cases (133 Total Analytic Cases)
40
35
Percent of cases
30
25
20
15
10
5
0
Smith
Henderson
Wood
Anderson
Van Zandt
All Other
Distribution by Age at Diagnosis
2014 Total Analytic Colo-Rectal Cancer Cases (133)
30
Percent of cases
25
20
15
10
5
0
24
0-39
40-49
50-59
60-69
70-79
80-89
2014
Distribution by Initial Therapy
2014 Total Analytic Colo-Rectal Cancer Cases (133)
Palliative
Rad Chemo
Surg Rad Chemo
Chemo
Surg Chemo
Surgery
0
5
10
15
20
25
30
35
40
45
50
Percent of cases
Distribution by AJCC Stage
2014 Total Analytic Colo-Rectal Cancer Cases
35
Percent of cases
30
25
20
15
10
5
0
In Situ
Stage I
Stage II
Stage III
Stage IV
Five Year Survival Statistics
Colo-Rectal Cancer Cases
100
Percent of cases
80
60
40
20
0
All Stages
Local
ETMC 2003-2009
Regional
State 2003-2009
Distant
National 2004-2010
25
Tyler Hematology Oncology, P.A.
Tyler Hematology Oncology, P.A., specializes in the care and treatment of patients with cancer and
blood disorders. The physicians and clinical team have provided a “tradition of caring” since 1985. We
care for patients across East Texas and surrounding areas.
Our physicians are on the attending staff of ETMC Tyler and Trinity Mother Frances Hospital. We
also are on the consulting staff of ETMC hospitals in Athens, Henderson and Jacksonville, as well as
the ETMC Specialty Hospital, the ETMC Rehabilitation Center and HealthSouth
Rehabilitation Center.
Our physicians are board certified in internal medicine, medical oncology and/or
hematology, hospice and palliative care.
Tyler Hematology Oncology, P.A., provides state-of-the-art treatments in addition
to clinical trials. Each of our locations in Athens, Cedar Creek Lake, Henderson,
Jacksonville and Tyler provide a “tradition of caring” and hope.
Michael Y. Ashigbi, MD
Myrtha E. Basile, MD
Board certified: Internal medicine, hematology,
medical oncology
Professional degree: University of Ghana Medical School
Board certified: Medical oncology, hematology
Professional degree: University of Pittsburgh
Robert M. Droder, MD
medical oncology
Professional degree: Hahnemann University College of
Medicine, Philadelphia
Joseph T. Martins, MD
medical oncology
Professional degree: University of Texas Southwestern
Medical School, Dallas
Marc E. Usrey, MD
medical oncology
Professional degree: University of Texas Medical
School, Houston
26
Katrina Y. Glover, MD
Board certified: Internal medicine, medical oncology
Professional degree: University of Texas Southwestern
Medical School, Dallas
Arielle S. Lee, MD
medical oncology, hospice and palliative medicine
Professional degree: Baylor College of Medicine,
Houston
Maung M. Oo, MD
medical oncology
Professional degree: Institute of Medicine (1) Rangoon,
Burma. Case Western Reserve University, Cleveland,
M.S. Pathology
The Blood and Cancer Center of East Texas was founded by Dr. Gary Gross in June 2003. We are
a group of physicians with an experienced staff specializing in the treatment of cancer and blood
disorders. Our physicians have been instrumental in developing research affiliations with the Southwest
Oncology Group, the National Surgical Adjuvant Breast and Bowel Project, the Sarah Cannon Cancer
Research Network and numerous private drug companies.
Dr. Gross initiated clinical research in Tyler more than two decades ago. Dr. J.J. Sharma, who joined
our group in February 2010, has been at the forefront of cancer research and healthcare technology in
the Dallas area. We are committed to participating in research to discover new and effective treatment
regimens for cancer and blood disorders, while maintaining a personal relationship with our patients
and their families.
Our physicians are board certified in internal medicine and medical oncology. At the Blood and Cancer
Center of East Texas, we are able to provide the same quality of chemotherapy treatment available at
larger cancer centers. Our small size and our caring staff allow us to focus on the patient’s individual
needs. This enables us to deliver treatment in an environment that promotes a sense of wellness and
well-being. Our patients and their families rave about our family atmosphere.
Gary E. Gross, MD, FACP
Board certified: Internal medicine and medical oncology
Professional degree: Columbia University College of Physicians and Surgeons, New York
Jivesh J. Sharma, MD
Board certified: Internal medicine and medical oncology
Professional degree: University of Texas Medical Branch at Galveston
27
With Gratitude
Thinking Pink
Each October, during National Breast Cancer Awareness
Month, the ETMC Cancer Institute and Breast Care Center
host the Pink Ribbon Getaway, a one-day retreat for
women who have experienced breast cancer. The event,
created in 2007, brings together those who are newly
diagnosed – sometimes just in the past few days – with
long-term breast cancer survivors.
The goal of this free initiative is to provide hope and
healing through a support program that combines
medical education, inspiration and fellowship in a
relaxed setting. The Pink Ribbon Getaway keeps the
needs of working women in mind, as well as medically
underserved populations and others who may not
normally access support programs. Sometimes there are
tears, often there is laughter, but always there is a spirit
of grace that unites these women.
The words of Pink Ribbon Getaway participants say it best:
• The program was so well planned and could not have
been better.
• It’s been a great day to learn and relax – the perfect
getaway.
• Thank you for the opportunity to share with others.
• Great seminar. Wonderful doctors on the panel.
• Could not have been more informational and inspirational.
• Thank you for making us feel special and putting your heart
into this event.
The Pink Ribbon Getaway agenda varies each year
to include specialists in nutrition, exercise, relaxation,
lymphedema, hair and beauty guidance, genetics and
other relevant topics, plus a multi-discipline physician
Q&A panel. Due to generous community support, ETMC
also annually provides a dynamic keynote speaker –
women from broadcasting, sports, business and other
backgrounds – who share their personal message on
overcoming cancer.
The Pink Ribbon Getaway is just one of the ways that
ETMC truly cares for people, while treating cancer – and
charitable support is essential to our mission. Thanks to
the wonderful spirit of philanthropy, the ETMC Cancer
Institute advances technology, provides community
education and overall brings hope and healing to our
patients and their families.
With heartfelt appreciation,
The caregivers of the ETMC Cancer Institute
and the ETMC Foundation
Seeing pink! More than 100 East Texas breast cancer survivors attend ETMC’s Pink Ribbon Getaway each year in Tyler, for a relaxing day of
health information, motivation and the special bond shared through survivorship.
28
Recent donors to the ETMC Cancer Institute include:
CyberKnife of Texas
ETMC Cancer Institute Crafts Group
ETMC Tyler Volunteers
Great Getaway Volunteers
Henry M. Bell, Jr. Memorial Golf Tournament sponsors
Hospitality House
Komen for the Cure, Tyler Chapter
Metro Aviation, Inc.
ETMC Pin-A-Sister™ and WISE woman volunteer teams
Pink Ribbon Getaway volunteers and speakers
Estate of Mary and Wayne Poindexter
Suddenlink
Travel Masters
Tyler Firefighters
Tyler Hematology-Oncology
Many others who made tribute gifts through the
ETMC Cancer Institute Remembrance Fund, the Great Getaway and the Pink Ribbon Getaway.
721 Clinic Drive • Tyler, TX • (903) 595-5550 • etmc.org

2015 Annual Report

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