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FranciscanStFrancis.org/cancer
INDIANAPOLIS8111 S. Emerson Ave.Indianapolis, IN 46237(317) 528-1420
CARMEL12188-B N. Meridian St.Carmel, IN 46032(317) 927-5770
MOORESVILLE1215 Hadley Road, Suite 105Mooresville, IN 46158(317) 834-5900
2015 Cancer Report
I am pleased to share the Franciscan St. Francis Health Cancer Center 2015 annual report,
which presents a summary of our activity and services in 2014. In this issue, we highlight
the success of our Aspire Tobacco-Free Program and our plans to expand the program to
help more Hoosiers quit smoking.
Lung cancer accounts for about 27 percent of all cancer deaths and is by far the leading
cause of cancer death among both men and women. The American Cancer Society reports
that, each year, more people die of lung cancer than of colon, breast and prostate cancers
combined. With our Aspire program, we have introduced a comprehensive approach to
helping our residents quit smoking and, in turn, lower their risk of developing lung cancer, as well as cancer of the mouth,
trachea, esophagus and other organs. This low-cost, multi-faceted program is yielding promising results.
Franciscan St. Francis Health is also proud to be a charter member of the Lung Force professional women’s cabinet,
formed by the American Lung Association in 2014 to bring attention to lung cancer in women.
Other 2014 highlights include:
• We welcomed breast and melanoma surgeon Juliana Meyer, MD, and medical oncologist Meghana Raghavendra, MD, to the program and Franciscan Physician Network.
• Thanks to a grant from the Livestrong Foundation, we implemented the Vital Hearts Program, a secondary trauma resiliency training program for cancer caregivers including both nurses and physicians.
• We opened an Interventional Pulmonology Clinic, staffed by Faisal Khan, MD, and a Prostate Cancer Multidisciplinary Clinic.
• We opened a Supportive Care Clinic for cancer patients and physicians. This clinic is designed to provide helpful health resources, including psychological and social services, either on an ongoing basis or as single-visit needs. It is staffed with a nurse practitioner, licensed therapist, registered dietitian and speech therapist.
• We have expanded our services by creating partnerships with Putnam County Hospital, Decatur County Memorial Hospital, Rush Memorial Hospital and Major Hospital.
• We formed an affi liation with the National Institutes of Health’s Offi ce of Research Services and became main members of the Alliance for Clinical Trials in Oncology and NRG Oncology, two primary organizations involved in the facilitation of research funded by the federal government.
• We built on our existing partnership with the Cancer Support Community by adding licensed therapists, support groups and education sessions to the network’s outreach efforts.
• We implemented a specifi c multidisciplinary tumor board for melanoma cancer cases.
Patient-centered care is a priority at the Franciscan St. Francis Health Cancer Center. We believe with these additions,
and advancements to our staff and programs, we continue to position ourselves to provide exemplary cancer care to
our patients, now and in years to come.
Sincerely,
Peter Garrett, MDChairman, Cancer CommitteeMedical Director, Cancer ServicesFranciscan St. Francis Health
Letter from the Cancer Committee Chairman
Number of cases excluded: 0
*This report EXCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, intraepithelial neoplasia cases
PRIMARY SITE TABLE (2014 Analytic Cases*)
Total Sex AJCC StageM F 0 I II III IV UNK N/A
ALL SITES 1557 636 921 73 392 243 231 316 49 253Oral Cavity 50 37 13 0 9 4 11 24 1 1
Lip 2 2 0 0 1 0 1 0 0 0Tongue 11 9 2 0 2 2 1 6 0 0Oropharynx 2 1 1 0 0 0 0 2 0 0Hypopharynx 0 0 0 0 0 0 0 0 0 0Other 35 25 10 0 6 2 9 16 1 1
Digestive System 303 155 148 19 63 69 72 69 9 2Esophagus 16 14 2 1 1 1 7 5 1 0Stomach 15 11 4 0 3 3 3 6 0 0Colon 98 44 54 8 19 25 26 19 1 0Rectum 85 49 36 8 21 18 27 10 1 0Anus/Anal Canal 18 3 15 2 2 10 3 0 1 0Liver 14 9 5 0 5 2 2 4 0 1Pancreas 43 20 23 0 9 8 3 22 1 0Other 14 5 9 0 3 2 1 3 4 1
Respiratory System 301 152 149 0 74 33 54 133 5 2Nasal/Sinus 4 4 0 0 1 0 0 2 0 1Larynx 25 18 7 0 7 4 5 9 0 0Lung/Bronchus 270 128 142 0 65 29 49 122 5 0Other 2 2 0 0 1 0 0 0 0 1
Blood & Bone Marrow 126 70 56 0 1 0 0 1 0 124Leukemia 70 40 30 0 1 0 0 1 0 68Multiple Myeloma 39 22 17 0 0 0 0 0 0 39Other 17 8 9 0 0 0 0 0 0 17
Bone 2 1 1 0 1 1 0 0 0 0Connect/Soft Tissue 9 5 4 0 0 2 3 3 1 0Skin 44 25 19 1 14 11 4 6 4 4
Melanoma 41 24 17 1 13 10 4 6 4 3Other 3 1 2 0 1 1 0 0 0 1
Breast 211 1 210 32 80 70 16 10 3 0Female Genital 143 0 143 1 82 9 33 11 5 2
Cervix Uteri 15 0 15 0 9 4 1 1 0 0Corpus Uteri 80 0 80 0 64 4 8 2 2 0Ovary 29 0 29 0 2 0 19 7 1 0Vulva 12 0 12 0 6 0 3 1 2 0Other 7 0 7 1 1 1 2 0 0 2
Male Genital 49 49 0 0 5 23 5 11 5 0Prostate 42 42 0 0 3 22 4 11 2 0Testis 5 5 0 0 2 1 1 0 1 0Other 2 2 0 0 0 0 0 0 2 0
Urinary System 94 61 33 20 27 12 2 19 12 2Bladder 38 29 9 17 6 5 0 7 3 0Kidney/Renal 49 27 22 1 21 6 1 11 9 0Other 7 5 2 2 0 1 1 1 0 2
Brain & CNS 79 27 52 0 0 0 0 0 0 79Brain (Benign) 5 1 4 0 0 0 0 0 0 5Brain (Malignant) 14 7 7 0 0 0 0 0 0 14Other 60 19 41 0 0 0 0 0 0 60
Endocrine 54 16 38 0 23 3 12 5 3 8Thyroid 46 11 35 0 23 3 12 5 3 0Other 8 5 3 0 0 0 0 0 0 8
Lymphatic System 55 23 32 0 13 5 13 23 1 0Hodgkin's Disease 4 2 2 0 1 1 0 2 0 0Non-Hodgkin's 51 21 30 0 12 4 13 21 1 0
Unknown Primary 24 10 14 0 0 0 0 0 0 24Other/Ill-Defi ned 13 4 9 0 0 1 6 1 0 5
Peter Garrett, MDPeter Garrett, MD
2015 Cancer Report 03
2014 TOTAL CASE DISTRIBUTION BY COUNTY OF RESIDENCE(at time of diagnosis)
ADAMS
ALLEN
BARTHOLOMEW
BENTON
BLACKFORD
BOONE
BROWN
CARROLL
CASS
CLARK
CLAY
CLINTON
CRAWFORD
DAVIESS
DEARBORN
DECATUR
DEKALB
DELAWARE
DUBOIS
ELKHART
FAYETTE
FLOYD
FOUNTAIN
FRANKLIN
FULTON
GIBSON
GRANT
GREENE
HAMILTON
HANCOCK
HARRISON
HENDRICKS
HENRY
HOWARD
HUNTINGTON
JACKSON
JASPER
JAY
JEFFERSON
JENNINGS
JOHNSON
KNOX
KOSCIUSKO
LA GRANGE
LAKE
LA PORTE
LAWRENCE
MADISON
MARION
MARSHALL
MARTIN
MIAMI
MONROE
MONTGOMERY
MORGAN
NEWTON
NOBLE
OHIO
ORANGE
OWEN
PARKE
PERRY
PIKE
PORTER
POSEY
PULASKI
PUTNAM
RANDOLPH
RIPLEY
RUSH
ST JOSEPH
SCOTT
SHELBY
SPENCER
STARKE
STEUBEN
SULLIVAN
SWITZERLAND
TIPPECANOE
TIPTON
UNION
VANDERBURGH
VERMILLION
VIGO
WABASH
WARREN
WARRICK
WASHINGTON
WAYNE
WELLSWHITE
WHITLEY
1 - 5 Cases
6 - 9 Cases
10 - 99 Cases
100 - 299 Cases
> 300 Cases
Note: There were 14 out-of-state cases
Source: Franciscan St. Francis
Tumor Registry
1 - 5 Cases
6 - 9 Cases
10 - 99 Cases
100 - 299 Cases
> 300 Cases
Note: There were 14 out-of-state cases
Source: Franciscan St. Francis
Tumor Registry
ADAMS
ALLEN
BARTHOLOMEW
BENTON
BLACKFORD
BOONE
BROWN
CARROLL
CASS
CLARK
CLAY
CLINTON
CRAWFORD
DAVIESS
DEARBORN
DECATUR
DEKALB
DELAWARE
DUBOIS
ELKHART
FAYETTE
FLOYD
FOUNTAIN
FRANKLIN
FULTON
GIBSON
GRANT
GREENE
HAMILTON
HANCOCK
HARRISON
HENDRICKS
HENRY
HOWARD
HUNTINGTON
JACKSON
JASPER
JAY
JEFFERSON
JENNINGS
JOHNSON
KNOX
KOSCIUSKO
LA GRANGE
LAKE
LA PORTE
LAWRENCE
MADISON
MARION
MARSHALL
MARTIN
MIAMI
MONROE
MONTGOMERY
MORGAN
NEWTON
NOBLE
OHIO
ORANGE
OWEN
PARKE
PERRY
PIKE
PORTER
POSEY
PULASKI
PUTNAM
RANDOLPH
RIPLEY
RUSH
ST JOSEPH
SCOTT
SHELBY
SPENCER
STARKE
STEUBEN
SULLIVAN
SWITZERLAND
TIPPECANOE
TIPTON
UNION
VANDERBURGH
VERMILLION
VIGO
WABASH
WARREN
WARRICK
WASHINGTON
WAYNE
WELLSWHITE
WHITLEY
1 - 5 Cases
6 - 9 Cases
10 - 99 Cases
100 - 299 Cases
> 300 Cases
Males Females
Primary Site FSFH National Primary Site FSFH National
Lung 20.1 % 13.6 % Breast 22.8 % 28.7 %
Rectum 7.7 % 2.7 % Lung 15.4 % 13.4 %
Colon 6.9 % 5.7 % Corpus Uteri 8.7 % 6.5 %
Prostate 6.6 % 27.2 % Colon 5.9 % 6.0 %
Leukemia 6.3 % 3.5 % Brain & CNS 5.6 % 1.3 %
Bladder 4.6 % 6.6 % Rectum 3.9 % 2.0 %
Kidney/Renal/Pelvis 4.2 % 4.6 % Thyroid 3.8 % 5.9 %
Brain & CNS 4.2 % 1.5 % Leukemia 3.3 % 2.7 %
Other Oral Cavity 3.9 % 0.2 % Non-Hodgkin Lymphoma 3.3 % 4.0 %
Melanoma 3.8 % 5.1 % Ovary 3.1 % 2.7 %
2014 TOP NEW CANCER CASES BY SEX
*Rounded to nearest tenth. National data is based on the Estimated New Cancer Cases by Sex in the U.S., 2014. Cancer Facts & Figures 2014.
American Cancer Society, Inc., Surveillance Research. Estimated new cases are based on 1995-2010 cancer incidence rates reported by the
North American Association of Central Cancer Registries (NAACCR), representing about 89 percent of the U.S. population.
04 2015 Cancer Report 2015 Cancer Report 05
In 2011, more than 25 percent of Hoosiers smoked or used
smokeless tobacco products (Centers for Disease Control,
2011 statistics). Franciscan St. Francis Health responded to
the clinical health issue and adopted the Aspire Tobacco-Free
Program in 2011. This low-cost, behavior-changing program
was specifi cally designed for tobacco cessation and relapse
prevention for those within the communities we serve.
Lung Cancer: Aspiring to quit smokingThe Aspire program is patient-centered and customized
to individual needs. Treatment guidelines involve four
to six individual counseling sessions led by our Mayo
Clinic-trained tobacco treatment specialists. During
these weekly or biweekly sessions, patients develop their
own unique “quit plans” through coaching, medication
management and motivational interviewing. Patients
also attend group classes, held in Indianapolis and
Mooresville, and receive a year of follow-up support.
When a participant cannot attend sessions in person,
the specialists follow up with a phone call.
Due to the highly-addictive quality of the drug nicotine
present in tobacco products and its availability, it is very
diffi cult for individuals to quit, and the relapse rate is
high. In 2012, the Centers for Disease Control reported
that 68.8 percent of adult smokers wanted to quit, and
that 48 percent of high school smokers had tried to
quit.2 The combination of physical symptoms of nicotine
withdrawal and psychological dependency increases
that challenge. Research has shown that counseling and
medication together, as offered by programs like Aspire,
leads to better outcomes than either approach alone.
In 2014 alone, 233 patients participated in the Aspire
program, and 35 percent completed all program sessions.
Sixty percent of participants were 50 to 79 years of age,
64 percent were female and 75 percent were Caucasian.
Success rates for quitting tobacco were 51 percent three
months after completion of the Aspire program and 18
percent a full year post-completion — which is more
than double the rate of individuals who attempt to quit
on their own.1
At Franciscan St. Francis Health, the Aspire program has
been shown to be effective in helping individuals not
only quit smoking, but enjoy better health and quality of
life. In the future, the hope is to expand the hospital’s
program to more underserved areas of Indiana,
especially where tobacco use is high.
1 Fiore et al, 2008
2 Centers for Disease Control and Prevention. “Quitting Smoking,”
www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting (16 October 2015).
The management of patients with suspected or known lung
cancer from smoking or second-hand smoke is becoming
increasingly complex, but the time from diagnosis to the
start of treatment doesn’t need to be.
The Franciscan St. Francis Health Cancer Center Lung
Clinic is designed to bring our nationally recognized team
of physicians together to meet with a patient during the
same offi ce visit. This includes leading cancer experts
in pulmonology, medical oncology, radiation oncology,
cardiothoracic surgery, pathology, radiology and many
others. By meeting with our entire team in one visit, patients
save several weeks of waiting and traveling to multiple offi ce
appointments and locations. This approach also ensures
the best possible treatment plan is designed quickly in
partnership with the patient and his or her family.
Patients also have access to our dedicated lung cancer nurse
navigator through each phase of treatment. The nurse
navigator serves as a point person to coordinate the best
care possible, while helping patients maintain control and
maximize the quality of their life.
Our research coordinators also participate on the Lung Clinic
team to facilitate access to advanced treatment options not
yet available with standard care. As a leading research center,
Franciscan St. Francis Health participates in cutting-edge
cancer research studies and clinical trials, including multiple
trials for lung cancer.
Multidisciplinary Lung Clinic
Age 30-3932 PATIENTS
Age 20-2911 PATIENTS
Age 40-4946 PATIENTS
Age 50-5970 PATIENTS
Age 60-6952 PATIENTS
Age 60-6952 PATIENTS
Age 70-7920 PATIENTS11 PATIENTS
Age 80-892 PATIENTS
2014 ASPIRE COMMUNITY BY AGE – Total Patients 233
0
20%
40%
60%
80%
100%
1 month
69%
3 months
51%
6 months
37%
1 year
18%
ASPIRE COMMUNITY SUCCESS RATES (as of 12/31/14)
Cheryl Streeval, RN, BSN, Lung Cancer Nurse Navigator
2015 Cancer Report 0706 2015 Cancer Report
DETECTING LUNG DISEASE EARLIEREarly detection is the key to beating lung cancer. Most lung
cancers are fi rst diagnosed based on symptoms. Unfortunately,
symptoms often don’t occur until the disease is in a late stage
when treatment options are limited. Franciscan St. Francis Health
offers a variety of screenings and interventional pulmonology
procedures that expand care beyond diagnostic into advanced
therapies to treat lung cancer that are less invasive than
traditional surgical options.
LUNG SCAN Franciscan St. Francis Health was the fi rst in
Indiana and one of the fi rst in the nation to offer a lung CT
screening program for the early detection of lung cancer.
The lung screening is safe, simple and non-invasive with a minimal
amount of radiation exposure. The screening is recommended
for men and women who are either a current or former smoker
between the ages of 55 and 75 and for those who have averaged
smoking one pack of cigarettes a day for thirty years (two packs a
day for fi fteen years, three packs a day for ten years, etc.).
ELECTROMAGNETIC NAVIGATIONAL BRONCHOSCOPY Franciscan St. Francis Health was the fi rst hospital in central
Indiana to use Electromagnetic Navigational Bronchoscopy (ENB),
an innovative procedure to diagnose lung cancer, quickly and
safely without surgery. Using GPS-like technology to navigate a
unique set of tools deep into the lungs, pulmonologists can access
suspicious areas that usually are hard to reach. This technology
helps physicians detect lung cancer earlier, even before patients
experience symptoms. Before ENB, a patient with a suspicious
spot on his or her lung had the options of major surgery to
remove a section of the lung or a “watch-and-wait” approach to
see if the spot was cancerous and grew.
ENDOBRONCHIAL ULTRASOUND (EBUS) is a more
precise, less invasive way of assessing a patient’s lymph nodes
and determining if lung cancer has spread to other parts of the
body. EBUS offers an alternative to surgery and leads to quicker
diagnosis and staging of lung cancer, and early treatment.
RIGID BRONCHOSCOPY is a procedure used to treat lung
cancer to gain better access to a patient’s airway, and permits
the passage of larger instruments and cameras in order to
diagnose and treat airway disease. It also allows for larger
biopsies and for placing airway devices, such as tracheobronchial
stents to keep airways open. It is estimated that less than six
percent of pulmonologists in the United States are trained to
perform rigid bronchoscopy.
FranciscanStFrancis.org/cancer
INDIANAPOLIS8111 S. Emerson Ave.Indianapolis, IN 46237(317) 528-1420
CARMEL12188-B N. Meridian St.Carmel, IN 46032(317) 927-5770
MOORESVILLE1215 Hadley Road, Suite 105Mooresville, IN 46158(317) 834-5900
2015 Cancer Report
