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DOYLESTOWN HOSPITAL
CANCER INSTITUTE
ANNUAL REPORT
2009
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Special thanks to Elsie White, Peter Fernandez, and the
Arboretum Committee for their dedication, hard work and
passionate belief in the mission of Doylestown Hospital. Your
healing gardens and most especially the “Dancing Cranes” have created an atmosphere of serenity and hope for our patients.
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Letter from the Cancer Committee Chair… This year 2009 marks the fifth year of my tenure as Medical Chair of
the Doylestown Hospital Cancer Program. I would like to begin by
thanking you for entrusting us with the cancer care of your patients. I
am proud to report nearly 4 of 5 patients diagnosed at the hospital choose to follow up with oncology services locally. I believe that our
efforts to provide comprehensive care close to home provides better
quality of life, continuity of care, and favorable outcomes for our
patients.
This year also marks the end of an era of wanting to provide the
complete spectrum oncology services on site. The ground breaking
ceremony for the Cancer Institute at Pavilion II occurred on October
28th. This venture will place University of Pennsylvania Radiation Oncology services under the same roof as Medical Oncology. The
design of the physical space has been meticulously reviewed and
includes space for adjunct support services and an express elevator
connecting the two departments directly. The affiliation with the University of Pennsylvania will also allow our patients preferential
access to Proton Therapy.
We continue to enjoy excellent complimentary service from the department of surgery and interventional radiology. Surgery has
continued to expand the use of the da Vinci robot in oncologic
applications. The Interventional Radiologists have had extensive
experience performing radiofrequency ablation and chemoembolization of both metastatic and primary tumors. At your leisure take the time
to review the outcomes data and summery articles that follow in this annual report. Mitchel l Alden, D.O.
Medical Director, Cancer Services/Cancer Committee Chair
Doylestown Hospital is a member of
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Cancer Committee The Cancer Committee is a multidisciplinary team organized to provide leadership, responsibility and accountability for all the activities of the
Doylestown Hospital Cancer Program. This leadership body is
responsible for goal setting, planning, initiating, implementing,
evaluating, and improving all cancer-related activities of the facility to ensure that the highest quality of care is provided to our patients.
Physician Education Programs Sponsored by
Cancer Committee
July 2, 2009 “Staging Education for Physicians” Joseph Curci, MD, Cancer Liaison Physician
September 22, 2009 Annual Cancer Symposium
“Medical Ethics and Palliative Care/Pain”
Art Caplan, MD, Director of the Center for Bioethics, Univ of PA David Howell, MD, Univ of Michigan
Veronica Coyne, MD, Hospice Director, Doylestown Hospital
Cancer Conferences/Tumor Board Cancer Conferences are a bimonthly forum for multidisciplinary review
of newly diagnosed cancer cases. Physicians representing medical
oncology, radiation oncology, surgery, radiology, and pathology convene to share information about challenging cases, review
standards of care such as the National Comprehensive Cancer Network
Guidelines, or discuss rare tumor types for educational purposes and
multidisciplinary input. For patients at Doylestown Hospital, these collaborative efforts are integral to the quality care and excellent
outcomes for which we are known.
In 2009, 70 cases were presented, representing 10% of our
accessioned cases.
Cancer Conference Physician Education ! June 4, 2009 – “ASCO Breast Cancer Update”
Kevin Fox, MD, Univ of PA
! October 1, 2009 – “Treatment of NSCLC” James Stevenson, MD, Univ of PA
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Community Outreach/Support Programs Skin Cancer Screening
Drs. Adler, Santoro, Spiers, Toporcer and Willard
! 130 Screened
! 47 Referred for suspicious lesions
Prostate Cancer Screening
Drs Izes and Flashner
! 41 Screened
! 4 Referred for suspicious DRE or PSA
Smoking Cessation Classes
! 6 classes
! 73 participants attended
Cancer Survivor Day – A Celebration of Life
! “ Laugh for the Health of It”
! Keynote Speaker: Hedda Matza-Haughton, a dynamic
speaker whose presentation highlighted the benefits of laughter in your life
! 80 Patients/Family members attended
Cancer Survivor Day: ‘Laugh for the Health of It”
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Central Bucks Relay for Life ! Doylestown Hospital Cancer Center Team ! $2000 donated to American Cancer Society
Coaches vs. Cancer
! Collaboration between Doylestown Hospital and CB South High School to support the American Cancer Society
! Breast Cancer Awareness/Education Program for CB South High School Students and Community
Other Support Services
! Breast Cancer Support Group
! Man to Man Prostate Cancer Support Group
! Cancer Fit
! Reach to Recovery ! I Can Cope
! Look Good Feel Better
! Lymphedema Management & Support Group
! Nutrition classes ! Music Therapy
! Pet Therapy
Cancer Risk Evaluation Program The University of Pennsylvania’s Cancer Risk Evaluation Program
(CREP) at Doylestown Hospital completed its second year in October 2009. This comprehensive program, developed at the University of
Pennsylvania’s Abramson Cancer Center, provides our community
access to information, evaluation and genetic counseling to assess a
woman’s personal susceptibility for breast and ovarian cancer.
Since its inception, the Cancer Risk Evaluation Program has generated
great interest among the women in our community. To date 89 women
have entered the program, 53 were tested (3 positive for a BRCA 1 or
2 genetic mutation) and 16 women chose to enlist in genetic research studies at the University of Pennsylvania.
For more information or to refer your patients to this free risk
assessment program contact:
Kathy Nellett, RN, OCN, CBCN Breast Care Coordinator, at
215-345-2200 ext. 4871 or 215-918-5872.
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Breast Care Coordinator The Breast Care Coordinator Program is designed to ensure that all breast cancer patients at Doylestown Hospital receive the best possible
services and highest quality care. “I serve as a resource for patients
who have seen alterations in their breast health or a breast cancer
diagnosis,” says Kathy Nellett. “Whenever a woman has a biopsy performed in the Women’s Diagnostic Center (WDC), I support her
through the procedure, answer questions, and provide information,
even if the result is not positive for cancer.”
Our Breast Care Coordinator works closely with Family Physicians,
Radiologist, Surgeons, Medical Oncologist, and Radiation Oncologists
to help coordinate all aspects of care as well as assistance with
referrals for second opinions, if requested. “It’s hard at the beginning to know where to turn…I’m here to help our patients navigate the
system to get the best possible care,” says Nellett.
The response to the Breast Care Coordinator program has been
overwhelmingly positive. Year to date 2009, 323 women were seen in WDC; 89 (28%) were diagnosed with cancer; and of those 65 (73%)
were treated by DH physicians.
CBCN Certification
! In 2009, the Oncology Nursing Society offered the very first “Breast Care Certification (CBCN) Exam” to test the knowledge and tasks that are important to the competent performance of registered
nurses who provide breast care. Kathy Nellett successfully
completed the examination and was awarded the “CBCN” credential
attesting to her advanced knowledge in caring for women diagnosed
with breast cancer.
Hospice The Hospice Program at Doylestown hospital is a specialized part of
the Visiting Nurse/Home Care Department. It is not a place. Rather,
it is a coordinated program of home care and support services for the
terminally ill and their families, and a way for patients to remain comfortably in the familiar surroundings of their homes with people
who love them.
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The Hospice support team members, including nurses, home health
aides, a social worker, chaplain, physician, and volunteers work
together to provide emotional, physical, and spiritual support to the patient and the family.
These services are generally covered by health insurance, but
generous donations and memorials help to ensure hospice care for those who need it. Specially trained volunteers provide
companionship, personal care, letter writing, etc. Since becoming
Medicare certified in the late 1980’s Hospice has provided services to
more than 4000 patients and families.
Hospice also offers bereavement services to family and friends of
Hospice patients for up to 13 months following the death of a loved
one. For more information or to refer a patient please call 215-345-2201
Cancer Center Volunteers: In 2009, our wonderful volunteers logged more than 2200
hours to help ensure smooth operations and, most importantly,
to provide for the comfort and care of our patients.
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Clinical Trial News
Clinical Trials are the way we make progress against disease. Doylestown Hospital Cancer Center offers clinical trials to the patients
in our community allowing them to receive the best quality of care
close to home. Each year patients enter clinical trials and have the
chance to help others and improve health care. Clinical trials have
recently discovered a mutation of the KRAS Oncogene in colon cancer tumors (see Howard Zipin, MD report), giving medical oncologists the
opportunity to choose a more specific treatment for these patients.
Since January 2007 the Cancer Center has enrolled a total of 31 patients in clinical trials. The Cancer Program has again met National
Cooperative Group accrual goals. The following clinical trials are currently open to enrollment at
Doylestown Hospital Cancer Center.
Breast - Adjuvant:
PACCT-1: Program for Assessment of Clinical Trials Tests – Trial
Assigning Individualized Options for Treatment - TAILORx Trial
SWOG s0307: Phase III trial of Bisphosphonates as adjuvant therapy
for primary breast cancer. (Stage I,II,III)
Breast - Metastatic:
CALGB 40503: Endocrine therapy in combination with anti-VEGF therapy; randomized double-blind, placebo-controled phase III trial of
endocrine therapy alone or endocrine therapy plus Bevacizumab for
women with hormone receptor-positive advanced breast cancer. Colon - Adjuvant:
E5202 : A Randomized Phase III Study Comparing 5-FU, Leucovorin and Oxaliplatin versus 5-FU, Leucovorin, Oxaliplatin and Bevacizumab
in Patients with Stage II Colon Cancer at High Risk for Recurrence to
Determine Prospectively the Prognostic Value of Molecular Markers
N0147: A Randomized Phase III Trial of Oxaliplatin (OXAL) Plus 5-
Fluorouracil (5-FU)/ Leucovorin (CF) with or without Cetuximab (C225) after Curative Resection for Patients with Stage III Colon Cancer
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Colon or Rectal – Metastatic:
CALGB 80405: A Phase III Clinical Trial of Irinotecan/5-FU/Leucovorin or Oxaliplatin/5-FU/Leucovorin with Bevacizumab, or Cetuximab
(C225), or with the Combination of Bevacizumab and Cetuximab for
Patients with Untreated Metastatic Adenocarcinoma of the Colon of
Rectum. (Combination Arm closed)
Genitourinary:
E2805: A Randomized, Double-Blind Phase III Trial of Adjuvant Sunitinib versus Sorafenib versus Placebo in Patients with Resected
Renal Carcinoma
U of PA - 703123: Inherited genetic variation and predisposition to
testicular germ cell tumor.
Lung – Adjuvant: ECOG 1505: Phase III randomized study of adjuvant chemotherapy with or without Bevacizumab in patients with completely resected
Stage IB – IIIA NSCLC
Lung – Advanced:
SWOG S0819: A randomized, phase III study comparing
Carboplatin/Paclitaxel or Carboplatin/Paclitaxel/Bevacizumab with or
without concurrent Cetuximab in patients with advanced NSCLC
Myeloma:
ECOG 1A05: A Randomized Phase III trial of consolidation therapy with Velcade-Revlimid-Dexamethasone vs Velcade-Dexamethasone for
patients with multiple myeloma who have completed a dexamethasone
based induction regimen.
Prostate, Breast, Multiple Myeloma – Metastatic:
CALGB C70604: Randomomized phase III study of standard dosing vs.
longer dosing interval of zoledronic acid in metastatic cancer.
For more information on oncology research contact:
Laura B. Heacock, RN, BSN, OCN 215-345-2378, fax 215-345-2031
Clinical Research Nurse lheacock@dh.org
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What’s New in Cancer Care…
Tumor Directed Treatments
Cancer therapies have been evolving at a rapid pace and a particular
area of active growth is in minimally invasive tumor directed therapies.
At Doylestown Hospital we have very active and experienced Interventional Radiologists who specialize in minimally invasive cancer
therapy. We offer expertise in several tumor directed treatments such
as chemoembolization, radiofrequency ablation, and radioembolization,
procedures previously available only at academic teaching centers. Our
interventionalists perform numerous embolization and ablation procedures on routine basis at Doylestown Hospital as well as a other
locations. Interventional radiologists are experts in endovascular and
image-guided treatments. When treating cancer patients,
interventional radiologists use sophisticated imaging guidance to precisely target and attack tumors locally without surgery or systemic
side effects.
Chemoembolization
Chemoembolization is a minimally invasive procedure designed for the
treatment of primary or metastatic cancer to the liver. The procedure
is designed to deliver a high dose of chemotherapy intra-arterially into the feeding vessels of the tumor and subsequently embolizing these
vessels using embolic beads. Hence, we are attacking the tumor in
two ways; one is the effect of the intra-arterial chemotherapy resulting
in high concentrations of drug within the tumor, and the second is effect of embolization to prevent drug washout and also deprive the
tumor of nutrients and oxygen. In this procedure, the interventional
radiologist uses angiography to identify the vascular supply to the liver
and tumors. Microcatheter techniques are used to select the arterial supply to the tumors and allow for precise directed therapy. Usually
one lobe of the liver can be treated during a procedure and the second
lobe treated 1 month later. This procedure can be repeated over time.
Patients are admitted overnight for observation of post-embolization
syndrome which includes pain, nausea, vomiting, fever, and loss of appetite. This is a self-limited process that can occur after tumor
embolization related to a cytokine release. This procedure is useful to
help obtain local tumor control in patients who have primary cancer in
the liver (HCC, cholangiocarcinoma) or those with liver metastases (colon, neuroendocrine, etc.). Chemoembolization is useful in patients
who do not respond to standard therapy, cannot tolerate systemic
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effects of chemotherapy, or who have progressive disease within the
liver.
Radiofrequency Ablation
Radiofrequency ablation (RFA) is a minimally invasive, image-guided
therapy used to treat primary or metastatic cancer in a variety of organs including; the liver, kidney, lung, adrenal gland, and bone. RFA
is a form of thermal ablation that uses heat to destroy tumors via a
percutaneous approach. RFA is locally directed therapy designed for
those patients who are not candidates for surgical resection of their
tumor. We know that many patients are not surgical candidates for resection due to tumor location, patient condition, or extent of disease.
Thermal ablation is based on the principle that if you heat a cell,
cancer cell or normal cell, to above 50ºC the proteins denature, cell
membrane falls apart, and the result is cell death. RFA is a procedure in which an interventional radiologist guides a 17g electrode through
the skin and into a tumor in the body using imaging guidance such as
CT or ultrasound. Radiofrequency energy is applied to the electrode
and the tumor heats to near 100ºC, resulting in coagulative necrosis of the tumor. This can be performed with a high degree of precision to
spare the adjacent normal tissues. We have extensive experience in
RFA of a wide variety of tumor types and organs. RFA of RCC has
extensive literature with excellent long term results in tumors up to
3.5 cm and good results in even larger tumors. RFA of liver tumors, primary or isolated metastases, has excellent results in tumors up to 5
cm. We are also one of few locations that can offer RFA of lung masses
including inoperable NSCLC or isolated metastases. Lung RFA has also
shown synergistic effects when combined with conventional radiation therapy for larger lesions. In the bone, RFA can provide significant
pain relief for those patients with painful bone metastases. RFA can
help to control both primary and metastatic tumors in a variety of
settings.
Radioembolization
Radioembolization is the latest technology being developed and
available at only few cancer centers nationwide. The interventional radiologists at Doylestown currently perform this procedure at a
regional cancer center and this could become available locally at
Doylestown Hospital in the future. This technology is a progression
from chemoembolization. Instead of using intra-arterial chemotherapy and blocking off the blood supply to tumors, radioembolization is a
similar procedure that uses tiny glass beads coated with a radioactive
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ß-emitter(Yttrium-90). This is performed through the arteries in the
liver just like chemoembolization, but uses internal radiation emitted
by the tiny beads that lodge in the fine arteries within the liver tumors. The internal radiation provides another means of cancer cell death by
the radiation effect. This is currently under investigation at several
sites although may be beneficial in those patients with primary liver
cancer and metastatic colon cancer. Use in other cancer types is currently under investigation.
This year alone at Doylestown Hospital we have performed 9 RFA
procedures, 4 chemoembolization procedures, and 1 combined RFA/chemoembolization. These procedures have been successful and
helped a variety of patients including those with; renal cell carcinoma,
cholangiocarcinoma, neuroendocrine tumors, and metastatic colon
cancer to the liver.
The above is a summary of highly technical and at times complex
procedures. These procedures are typically very well tolerated and
require only an overnight hospital stay. Depending on the tumor
location and type, one or more treatments may be required. The specific procedural risks and side effects vary according to the patient
and specific procedure. All patients are seen in consultation with an
interventional radiologist and we will help determine which procedure
is most appropriate and work with the referring physician to aid in patient management and follow-up.
The above treatments provide cancer patients additional options that
can be used in conjunction with standard treatments or can help to provide local control if other therapies fail. The goal of tumor directed
treatments is to destroy cancer cells using a minimally-invasive,
locally-directed, and image-guided procedure to help cancer patients
extend and improve quality of life.
Steven C. Wagner, M.D.
Interventional Radiologist
Chemoembolization: representation of intra-arterial tumor directed therapy.
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Angiogram during chemoembolization of a liver tumor, metastatic colon cancer.
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CT image shows RFA electrode placement into a primary renal cell cancer.
Advances in Chemotherapy for Colon Cancer: The use of
Molecular Markers
Colon cancer remains the second most common cause of cancer
death in the United States. Until recently, the palliative treatment of
metastatic colon cancer solely employed the empiric use of cytotoxic chemotherapy agents either alone or in combination and was guided
based on the results of controlled clinical trials. As we have entered
the 21st Century, there have been remarkable advances in the
understanding of cancer biology especially on a molecular level. These advances have begun to dramatically improve outcomes in patients
with colon cancer based on discovery of new biologic “targeted” agents
that specifically inhibit or target proteins that play a role in
carcinogenesis. Some specific examples that demonstrate this “targeted” approach in colon cancer are agents in the Anti-VEGF
antibody and Anti-EGFR antibody classes. What we are also finding
out is that these same approaches are showing great promise in many
other tumor types in addition to colon cancer which was the prototype for these agents.
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Vascular Endothelial Growth Factor Blocker: Avastin
In Febuary 2004, bevacizumab (Avastin®), a humanized monoclonal antibody that recognizes and blocks vascular endothelial
growth factor (VEGF), was approved by the FDA for use in combination
with cytotoxic chemotherapy based on data promising data
improvements in outcomes. VEGF is a chemical signal that stimulates the growth of new blood vessels also know as Angiogenesis. Its initial
approval came following studies which used the drug in combination
with intravenous, fluorouracil (5-FU)-based chemotherapy.
Bevacizumab’s toxicity profile is quite atypical when compared to side-
effects of standard chemotherapy. Side effects such as are bleeding/hemorrhage, headache, hypertension, rhinitis, proteinuria,
taste alteration, dry skin are some the more commons ones seen. It
also can effect post operative wound healing which combined with a
long half life makes elective and unexpected surgery more challenging; serum half-life is approximately 20 days (range, 11–50
days). Nevertheless, these differences allows for synergistic use more
easily because toxicities are not additive as they typically are with
many other combination chemotherapy regimens. In addition to its effectiveness in colon cancer, bevacizumab now has formal FDA
approvals for use in a variety of malignancies. In October 2006, it was
approved to treat unresectable locally advanced or metastatic
nonsquamous, non-small-cell lung cancer (NSCLC) in combination with
carboplatin and paclitaxel, and in February 2008, it was approved for use with paclitaxel for patients who have not received chemotherapy
for metastatic HER2-negative breast cancer. Just this year, it was also
approved for use in metastatic renal cell carcinoma and glioblastoma.
In addition, it continues to be studied in a variety of other tumor types.
Epidermal Growth Factor Receptor Blockers: Erbitux and
Vectibix Even more recently, the monoclonal antibodies cetixumab
(Erbitux®) first, followed by panitubimab (Vectibix®) have been
approved. These monoclonal antibodies inhibit a slightly different
target, the epidermal growth factor receptor (EGFR), which also has
been implicated cancer growth and metastasis. They function by binding to the EGFR protein and thus inhibit its cell-signaling function.
Unlike bevacizumab, they have been shown to have activity on their
own, in addition to enhancing the activity of standard forms of
chemotherapy when used together. One recent and very important
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finding was that the benefits of these agents are predominately seen
in colon cancers that specially carry unmutated copies of the well
described K-ras oncogene, so-called K-ras wild type cancer. K-ras is a GTP-binding protein that acts as a critical off-on switch for cellular
growth and survival pathways. In cancers with mutated K-ras, there
were little to no benefits from these agents seen. Based on these
findings, the FDA amended its approval for this class of anti-EGFR monoclonal antibodies. This is one of the earliest examples of the
approval of a drug therapy for solid tumors that is based on a genetic
test.
VEGF and EGFR are just two of hopefully many molecular targets that we as oncologists can use to customize our therapy and improve
the prognosis of patients with all stages of colon cancer, and for that
matter, other types of cancers. The relatively new drugs
bevacizumab, cetixumab, and panitubimab have been newly approved for treatment in colon cancer over the past five years as antibodies
against these specific targets. Their use both alone in some instances
and in combination with cytotoxic chemotherapy has improved patient
outcomes in oncology in general and specifically in colon cancer. As
we move forward, these technologies will continue to be an integral part of cancer therapeutics.
Howard S. Zipin, MD
Bux-Mont Oncology Hematology Medical Associates, P.C.
Robotics in Surgical Oncology At Doylestown Hospital
In 2008, Doylestown Hospital made a major investment in its
Oncology program with the acquisition of Intuitive Surgical’s da Vinci
Surgical System. This innovative system has enabled Doylestown Hospital surgeons to greatly expand the number of minimally-invasive
procedures that can be provided to our cancer patients. The robotic
surgical platform represents a significant advancement beyond
standard laparoscopic surgery. Compared to traditional, open surgery
and standard laparoscopic surgery, the da Vinci robotic system offers vastly superior visualization with its high-definition, three-dimensional,
ten-fold magnified field of view. The robotic, wristed instrumentation
provides the surgeon with unparalleled ability to precisely dissect
cancerous tissues away from healthy tissues and subsequently reconstruct the patient’s healthy anatomy. Post-operative pain and
scarring are substantially reduced. Blood loss and post-surgical
infections are greatly diminished. Hospital stays are shorter and
resumption of normal activities faster.
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Doylestown Hospital surgeons have eagerly embraced the da Vinci
system for prostate, kidney, ureteral and bladder cancers with terrific
results. The robotic system is also used by the cardiothoracic surgery team during mitral valve repairs and by our gynecologists for
hysterectomies, oophorectomies and fallopian tube reanastamoses.
The oncologic surgeons of Doylestown Hospital are proud to be able to
provide our patients with university-caliber care in the community setting. The da Vinci Surgical System demonstrates the Hospital’s and
its surgeons’ commitment to remaining at the cutting edge of Surgical
Oncology.
Kevin Fitzgerald, MD
Central Bucks Urology
Cancer Program Quality Improvement Annually, the Cancer Committee evaluates the care and outcomes of cancer patients treated at Doylestown Hospital to measure quality and
to provide an opportunity to enhance patient outcomes. The National
Cancer Data Base (NCDB) serves as a benchmark against which the
Cancer Committee can compare its caseload in an effort to evaluate trends that are unique to our community.
Doylestown Hospital Cancer Program is an American College of
Surgeons, Commission on Cancer, designated Community Hospital Cancer Program. The following comparison includes data from all
Pennsylvania Community Hospital Cancer Programs (PA CHCP),
Doylestown Hospital (DH), and the National Cancer Data Base (NCDB)
The following statistical analysis was performed using registry data to
evaluate breast and colon cancer diagnosed at Doylestown Hospital
and includes age and stage at diagnosis. Overall 5-year survival is
included for the top 5 sites diagnosed at Doylestown Hospital. Age
and stage comparison is based on the year 2008 caseload and 5 year and overall survival is based on the year 2001 registry accessions and
follow-up data.
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Breast Cancer
Breast Cancer Age at Diagnosis
0
5
10
15
20
25
30
16-2
9
30-3
9
40-4
9
50-5
9
60-6
9
70-7
9
80-8
9
90+
0
5
10
15
20
25
30
35
PA Centers %
DH %
DH 2008
Breast Cancer Stage at Diagnosis
0
10
20
30
40
50
0 1 2 3 4
unknow
n
0
10
20
30
40
50
PA Centers %
DH %
DH 2008
Age at Diagnosis: Historical data reveals a younger age distribution at diagnosis at DH when
compared to the National Cancer Data Base (NCDB). Between the years
2000 –2006, 19% of patients were diagnosed before 50 years of age as
compared to 15% reported by the NCDB. In 2008, 23% of patients were diagnosed before the age of 50 likely reflecting continued aggressive
community screening. The majority of patients (29%) were diagnosed between
age 60 to 69.
Stage at Diagnosis: The stage distribution of breast cancer has not changed over previous years
and corresponds almost exactly with that reported from the NCDB from
2000 – 2006. New cases follow this trend with 19% of patients presenting
with stage 0 disease; 41% with stage I disease; and 26% with stage II disease.
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Colon Cancer
Colon Cancer Age at Diagnosis
0
5
10
15
20
25
30
35
<40 40-49 50-59 60-69 70-79 80-89 90+
PA CHCP%
DH%
DH 2008
Colon Cancer Stage at Diagnosis
0
5
10
15
20
25
30
0 1 2 3 4
unknow
n
0
5
10
15
20
25
30
PA Centers%
DH%
DH 2008
Age at Diagnosis:
Historically, the distribution by age at DH has been very similar to that
reported by the NCDB with the incidence increasing each decade. However, in 2008, there is an increase in patients being diagnosed between age 50 to
59 reflecting the increase of community education and screening. There is a
downward trend in those patients diagnosed between the ages of 70 to 79.
Seven percent of patients were diagnosed in their 90’s which is consistent with national and regional trends.
Stage at Diagnosis:
The distribution of stage of colon cancer at DH compares favorably with historical data from the NCDB. In 2008, 51% of patients at DH presented with
stage II or less disease giving them a 75% chance of cure with surgery alone.
Twenty-seven percent (27%) of patients presented with stage III disease and
treated aggressively with adjuvant chemotherapy which significantly improves
the 5-year disease free survival rate.
21
Doylestown Hospital Cancer Registry
Site Specific Cancer Cases Diagnosed at Doylestown
Hospital 2005 - 2008
0
20
40
60
80
100
120
140
160
180
Breast Lung Colon Prostate Bladder
# o
f P
ath
olo
gic
Ac
ce
ss
ion
s
2005
2006
2007
2008
These figures represent the Cancer Program’s four-year caseload for the
5 most frequently occurring site-specific cancers: breast, colorectal, lung,
prostate and bladder.
Total Cancer Cases Diagnosed at Doylestown
Hosptial
0
100
200
300
400
500
600
700
800
2005 2006 2007 2008
Total
Cancer cases accessioned by Doylestown Hospital’s Cancer Registry reflect
the continued growth of cancer services.
22
The following graph represents Doylestown Hospital’s five-year
survival rates for the five most common cancers we treat compared to
the National Cancer Data Base (NCDB) and Pennsylvania Community
Hospital Cancer Programs (CHCP). The cancer patients we treat have
superior or equivalent survival rates when compared to national and
regional averages.
Overall 5 Year Survival for Top 5 Sites
0
10
20
30
40
50
60
70
80
90
100
Breast Colon Prostate Lung Bladder
NCDB
PA CHCP
DH
Cancer Program Recognized for Quality
Doylestown Hospital Cancer Program was surveyed in 2009 by the American College of Surgeons, Commission on Cancer
(CoC) and received a 3-Year Approval with Commendation as a
Community Hospital Cancer Program. This Commendation
rating means that Doylestown Hospital Cancer Program exceeded the standards required by the CoC.
Only 40% of institutions surveyed receive this rating!
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All Cancers by Site
Primary Site 2008 2007 2006
ORAL CAVITY & PHARYNX 6 15 9
DIGESTIVE SYSTEM
Esophagus 12 4 10
Stomach 6 5 5
Small Intestine 4 5 1
Colon (excluding rectum) 50 66 49
Rectum/Rectosigmoid 17 20 16
Anal 1 1 2
Liver 3 4 2
Gallbladder 3 2 1
Other Biliary 0 2 1
Pancreas 18 11 9
Peritoneum 0 0 1
RESPIRATORY SYSTEM
Nasal Cavity/Middle Ear 2 1 0
Larynx 6 3 4
Lung & Bronchus 98 92 73
Trachea/Mediastinum 1 0 0
BONES & JOINTS 0 1 0
SOFT TISSUE (including Heart) 3 1 2
SKIN (excluding basal & squamous)
Melanoma 38 25 22
Other nonepithelial skin 1 1 1
BREAST 141 154 124
FEMALE GENITAL SYSTEM
Cervix Uteri 3 2 2
Corpus & Uterus 18 12 10
Ovary 8 6 5
Vulva 0 1 2
Other 0 0 1
MALE GENITAL SYSTEM
Prostate 59 68 66
Testis 10 4 3
Other 0 0 1
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URINARY SYSTEM
Urinary Bladder 65 49 37
Kidney & Renal Pelvis 18 29 24
Ureter 2 2 2
Other 0 1 2
EYE & ORBIT 1 0 1
BRAIN & NERVOUS SYSTEM
Brain 8 5 5
Other Nervous System 14 8 3
ENDOCRINE SYSTEM
Thyroid 16 17 15
Other (including Thymus) 2 0 1
LYMPHOMAS
Hodgkin Lymphoma 4 2 4
Non-Hodgkin Lymphoma 35 26 38
MULTIPLE MYELOMA 7 4 7
LEUKEMIAS
Lymphocytic 9 5 8
Myeloid & Monocytic 8 4 10
Other Leukemia 1 0 0
MESOTHELIOMA 3 0 3
KOPOSI SARCOMA 0 1 0
MISCELLANEOUS 23 22 22
TOTAL 724 681 604
25
Exceptional Cancer Care in the Heart of Our
Community The Doylestown Hospital Cancer Center is located on the third floor of
The Pavilion, suite #302. Our patients receive the quality care they
expect from a leader in cancer diagnosis and treatment close to home.
The hospital’s membership in the Penn Cancer Network further serves to bring the very latest knowledge of cancer and its treatment to the
very heart of our community.
Infusion Services – Much More Than Chemotherapy The spacious and comfortable Outpatient Infusion unit in the Cancer
Center provides services for patients being treated for cancer as well
as a wide range of medical conditions. An onsite clinical pharmacist works closely with the patient’s physician and infusion nurses to
coordinate care and ensure the best possible outcomes. Therapies
include:
• Antibiotics, Antivirals and Antifungals
• Biologic Response Modifiers
• Bisphosphonates
• Blood Products
• Chemotherapy
• Corticosteriods
• Endocrine Testing
• Immune Globulin
• IV Iron
• Phlebotomy
• Remicade
• Rituxan
• Targeted therapies
• Therapeutic Injections
• Xolair
Expert Clinicians Provide the Latest in Cancer Care
• Board Certified Medical Oncologists
• Oncology Certified Nurses (OCN)
• Clinical Research Nurse
• Certified Breast Care Coordinator/Genetics Nurse • Onsite Oncology Pharmacist
• Onsite Lab/Certified Medical Lab Technician
26
2009 Cancer Committee Members
Mitchell Alden, D.O.
Medical Director, Cancer Services
Cancer Committee Chair
Eleanor Wilson, RN MSN, MHA………………………..Vice President, Patient Services
Robert J. Trotta, MD, PhD………………………………….……….Department of Pathology
Joseph J. Curci, MD, FACS…………………….…….………..……..Department of Surgery
Brett M. Harrison, MD………...………….….………………………….Department of Surgery
William R. Rate, MD, PhD………………...….…….Department of Radiation Oncology
Eileen Engle, MD……………………………………………………….Department of Gynecology
Veronica Coyne, MD………………………………………………………………...Director, Hospice
Michele Kopach, MD………………………….….………………..…..Department of Radiology
Albert Ruenes, MD………………………….….…………….…………….Department of Urology
Joanne Spiegle, MD……………………………………………………..Department of Radiology
Elizabeth Mathew, Pharm D ……….………...……………..….Department of Pharmacy
Jean Chubb, RN, MSN…………………..…Coordinator, Doylestown Hospital Hospice
Grace Schellinger, RNC…….…….…..…………… ………………………...Case Management
Ruth Doyle………………………………...……..VIA Representative, Doylestown Hospital
Margaret George…………………..….…… ……… ………………Community Cancer Advisor
Jeanne Rogers, RN, MEd…………….……….………………………..Administrative Director,
University of Pennsylvania Cancer Network
Karen Quinlan, RN, MSN, OCN……….…………..……………..Director, Cancer Services
Laura Heacock, RN, BSN, OCN….…….………..… ……………...Clinical Research Nurse
Jacqueline Ridge, BS, CTR……………….…… ..…………………………….Cancer Registrar
Karen McCurdy……………………………….….……..……..……………….Community Relations
Lisa Strouse ………………………………….….……..……………..Sr. Administrative Assistant
Cancer Program Coordinators
Robert Trotta, MD – Cancer Conference
Joseph Curci, MD – Community Outreach
Brett Harrison, MD – Quality Control of Registry William Rate, MD – Quality Improvement
To schedule an appointment in the Doylestown
Hospital Cancer Center call 215-345-2489.
To schedule an appointment with a Medical Oncologist
affiliated with Doylestown Hospital call:
Barry Tonkonow, MD: 215-348-1595
Bux-Mont Oncology Hematology: 215-345-8444
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