Franciscan St. Elizabeth Health Cancer RegistryThe Franciscan St. Elizabeth Health Cancer Registry is accredited by the American College of Surgeons Commission on Cancer and is staffed by a certified cancer registrar. The Registry maintains cancer data and follow-up on patients diagnosed and/or treated at Franciscan St. Elizabeth Health. This data is reported to both the Indiana State Department of Health Cancer Registry and the American College of Surgeons National Cancer Data Base.

In 2014, there were 457 (174 male/283 female) analytic cases accessioned. These cases were used in the statistical analysis of the 2015 Franciscan St. Elizabeth Health Cancer Annual Report data. The top four diagnoses for men were lung, prostate, colorectal and bladder. The top four diagnoses for women were breast, lung, colorectal and endometrium.

The Franciscan St. Elizabeth Health Cancer Registry currently maintains follow-up on approximately 6,385 patients. Lifetime follow-up is collected on all analytic cases to compare treatment outcomes and survival rates. The Registry consistently maintains a lost-to-follow-up rate of 10 percent or less as mandated by the American College of Surgeons Commission on Cancer.

Studies completed in 2014:• NHL & HD 2009-2011 Age/Stage Comparison with NHL & HD 2003-2006 Survival Comparison – Dr. Kazumi Chino• NHL & HD 2009-2011 Treatment Within NCCN Guidelines Comparison – Dr. Kazumi Chino• Lafayette Oncologists Adherence to Current Therapy Utilizing Personalized Targeted Therapy in Advanced Lung,

Colorectal, and Melanoma Cancers – Dr. Mario Contreras–Charla J. Dark, CTR, Manager, Cancer Registry

2015 Cancer Annual ReportUsing data from 2014

Franciscan St. Elizabeth Health Cancer Cases Diagnosed – 2014* National comparison of selected cancer sites* Estimated numbers of new cases from The American Cancer Society Cancer Facts & Figures 2014

Franciscan St. Elizabeth Health

Indiana National

PRIMARY SITE CASES PERCENT CASES PERCENT CASES PERCENT

Breast 128 28.0% 4,590 12.9% 232,670 14.0%

Lung 93 20.4% 5,540 15.6% 224,210 13.5%

Prostate 21 4.6% 4,390 12.3% 233,000 14.0%

Colorectal 43 9.4% 3,020 8.5% 136,830 8.2%

Bladder 24 5.3% 1,600 4.5% 74,690 4.5%

Corpus Uteri 20 4.4% 1,070 3.0% 52,630 3.2%

Melanoma 18 3.9% 1,550 4.4% 76,100 4.6%

All others 110 24.1% 13,800 38.8% 635,410 38.2%

TOTAL CASES 457 100.0% 35,560 100.0% 1,665,540 100.0%

28.0%

20.4%

4.6%

9.4%

5.3%

4.4%

3.9%

12.9%

15.6%

12.3%

8.5%

4.5%

3.0%

4.4%

14.0%

13.5%

14.0%

8.2%

4.5%

3.2%

4.6%

BREAST

LUNG

PROSTATE

COLORECTAL

BLADDER

CORPUS UTERI

MELANOMA

SELECTED CANCER SITE NEW CANCERS 2014

Franciscan St Elizabeth 2014ACS Projected Figures IN 2014ACS Projected Figures National 2014

Franciscan St. Elizabeth Health Cancer Deaths – 2014

* National comparison of selected cancer sites * Estimated Numbers of New Cases from: The American Cancer Society Cancer Facts & Figures 2014

Franciscan St. Elizabeth Health

Indiana National

PRIMARY SITE CASES PERCENT CASES PERCENT CASES PERCENT

Breast 21 12.0% 860 6.4% 40,430 6.9%

Lung 49 28.0% 4,140 31.0% 159,260 27.2%

Prostate 10 5.7% 580 4.3% 29,480 5.0%

Colorectal 16 9.1% 1,090 8.2% 50,310 8.6%

Pancreas 10 5.7% 840 6.3% 39,590 6.8%

All others 69 39.4% 5,860 43.8% 266,650 45.5%

TOTAL CASES 175 100.0% 13,370 100.0% 585,720 100.0%

12.0%

28.0%

5.7%

9.1%

5.7%

39.4%

6.4%

31.0%

4.3%

8.2%

6.3%

43.8%

6.9%

27.2%

5.0%

8.6%

6.8%

45.5%

BREAST

LUNG

PROSTATE

COLORECTAL

PANCREAS

ALL OTHERS

SELECTED CANCER SITE DEATHS 2014

Franciscan St Elizabeth 2014ACS Projected Figures IN 2014ACS Projected Figures National 2014

Franciscan St. Elizabeth Health County of Residence at Diagnosis 2012–2014

2012 2013 2014PRIMARY SITE CASES PERCENT CASES PERCENT CASES PERCENT

Benton 27 5% 17 4% 19 4%

Carroll 20 4% 20 4% 26 6%

Cass 8 2% 8 2% 9 2%

Clinton 31 6% 25 5% 23 5%

Fountain 22 4% 10 2% 25 6%

Jasper 25 5% 21 5% 20 4%

Montgomery 22 4% 32 7% 36 8%

Newton 12 2% 15 3% 10 2%

Pulaski 11 2% 6 1% 2 0%

Tippecanoe 254 52% 241 52% 220 49%

Warren 4 1% 9 2% 13 3%

White 57 12% 59 13% 44 10%

Other Counties/State 13 NA 14 NA 10 NA

TOTAL CASES 493 100.0% 463 100.0% 447 100.0%

BENTON

CARROLL

CASS

CLINTON

FOUNTAIN

JASPER

MONTGOMERY

NEWTON

PULASKI

TIPPECANOE

WARREN

WHITE

COUNTY OF RESIDENCE AT DIAGNOSIS

2012 2013 2014

NHL & HD 2009 – 2011 Treatment within NCCN Guidelines ComparisonFranciscan St. Elizabeth Lafayette – National Cancer Data BaseThe treatment of NHL continues to evolve, and is complicated since some lymphomas are more aggressive (diffuse large B cell) than others (follicular) while still falling into the category of NHL. Generally, there is not a large role for surgery in the treatment of NHL, other than the occasional need for splenectomy and other individual circumstances. Likewise radiation therapy is frequently reserved for bulky disease or sometimes for lymphoma limited to a single site. There is no role for hormonal therapy. The backbone of NHL treatment is with chemotherapy and immunotherapy with targeted agents.

At Franciscan St. Elizabeth Health, 4.6% of patients were treated with surgery alone, vs. 7.0% of patients nationally. 4.6% of our patients received radiation alone, vs. 2.3% of patients nationally. 1.5% of our patients received surgery and radiation, vs. 1% nationally. 24.6% of patients locally received surgery with chemotherapy, vs. 6.5% nationally. 4.6% of patients locally received chemotherapy and radiation, vs. 4.5% nationally. 33.8% of our patients received chemotherapy alone, vs. 29.0% nationally. Interestingly, though no patients received hormonal therapy as part of their treatment for NHL, 15.5% of patients did nationwide. 4.6% of patients here had some other form of treatment not included above, vs. 11.4% of patients nationally. And 21.5% of patients locally had no treatment at all, vs. 22.9% of patients nationwide. A higher proportion of patients treated locally had some form of surgery involved with their treatment (30.7% of our patients vs 16.8% of patients nationally). It may be that our patients who just had excisional biopsies as part of their diagnosis are being counted as having surgery as part of treatment.

Per the NCCN guidelines, the backbone of treatment HD is with chemotherapy (ABVD or Stanford V regimens). In Stage I/II disease, chemotherapy is generally to be followed with limited field radiation. Like other lymphomas, there is not a formal role for surgery in the treatment of HD, though it may prove helpful in individual circumstances. Likewise, we are not aware of any defined role for a hormonal therapy in lymphomas in general. In comparing the way patients at Franciscan St. Elizabeth Health were treated for HD in 2009-2011 to treatments received by patients nationwide in the same time period, local physicians adhered much closer to the NCCN guidelines. 45.5% of local patients received some combination of surgery and chemotherapy, 9.1% received chemotherapy and radiation, 18.2% received chemotherapy alone, and 18.2% received surgery, chemotherapy and radiation. 9.1% of our local patients did not have any treatment. By comparison, nationally 4.1% of patients received surgery alone, 11.1% received surgery and chemotherapy, 16.5% received chemotherapy and radiation, 39.2% received chemotherapy alone, 6.0% received surgery, chemotherapy and radiation, and 11.4% received no treatment. Additionally, 4% of patients nationwide received chemotherapy with hormonal therapy, and 7.4% received other therapy.

In summary, though our numbers are small, it appears that patients with lymphomas in this community are being treated appropriately according to the NCCN guidelines.

Treatment FSEH – Lafayette

NCDB

S 4.0% 7.0%

R 4.0% 2.0%

S/R 1.0% 1.0%

S/C 28.0% 7.0%

R/C 5.0% 6.0%

C 32.0% 30.0%

S/X/C 3.0% 1.0%

S/C/H 0.0% 2.0%

C/H 0.0% 12.0%

Other 4.0% 11.0%

None 20.0% 21.0%

Totals 76 15406