Pardee Cancer Center

2007 Annual Report

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Table of ContentsChairman’s Message 3

Oncology Director’s Report 4-5

Cancer Care Conferences 5

Tumor Registry Report 6

Cancer Committee Goals and Objectives 6

Frequency Report Summary 7

Radiation Oncology 8

Medical Oncology Unit 8

Continuing Medical Education 9

Clinical Trials 9

Center for Women’s Health 10

Social Work & Transition Planning 11

Spiritual Care Program 12

Pharmacy 12

Fund Development 13

Food and Nutrition 13

Community Cancer Screenings & Education 14-15

Focus on Lung Cancer 16-17

Home Care and Hospice 18

Service Directory 19

Membership 2008-2009 Mark Horness, M D , General Surgeon, Chairman

Ellsworth Ludwig, M D , Breast Surgeon, Vice-Chairman, Liaison Physician, ACoS

Ahmed Abdel-Maksoud, M D , Hematologist/Medical Oncologist

Timothy Berka, M D , Diagnostic Radiologist

Daniel Danso, M D , Hematologist/Medical Oncologist

John Hysell, M D , Pathologist

Rajesh Kotecha, M D , Radiation Oncologist

Charles Sanislow, M D , Surgeon

Melwyn Sequeira, M D , General Surgeon

Amir Tirmizi, M D , Internist, Director of Hospice

Suramanyan Yadam, M D , Pulmonologist

Natalie Clarke, M D , Family Practice Resident

Amy Behmlander, PharmD, Assistant Director of Pharmacy

Carole Calvert-Baxter, M A , L L P C , Manager, Center for Women’s Health, Director Primary Care Strategic Business Unit

Susan Fry, R N , Certified Breast Health Nurse

Paula Dodman, M S N , R N , O C N , Oncology Nurse Manager

Joan Herbert, PharmD, Director of Oncology Strategic Business Unit

Stephanie Leibfritz, R N , Community Education Coordinator

Blanche Myers, CPC, Tumor Registry

Larry Randall, R N , B S N , O C N , Clinical Research Assistant, Supervisor Infusion Center

Maria VanOchten, L M S W , O S W -C , Oncology Social Worker

Sandra Winchester, R H I T , C T R , Tumor Registrar

Kelley Kent, Patient Services Coordinator, American Cancer Society

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Chairman’s Message The cancer committee is a multidisciplinary team of medical staff, clinical staff and hospital administration that are involved in the care of cancer patients at MidMichigan Medical Center–Midland’s Pardee Cancer Center Together we are pleased to present the 2007 Annual Report, highlighting our comprehensive community cancer program This program is accredited by the American College of Surgeon’s Commission on Cancer and is dedicated to providing the residents of the region high quality and comprehensive oncology services Those services encompass education, prevention, screening, diagnosis, treatment, rehabilitation, palliative and supportive care and hospice services

According to the American Cancer Society, 1,444,920 new cancer cases were expected to be diagnosed in 2007 and 559,650 Americans, more than 1,530 each day are predicted to die from cancer These figures are slightly down from 2006, once again proving that patients with cancer are getting diagnosed at an earlier stage and living longer

Early Detection is KeyThe primary key to long-term survival with cancer is early detection Diagnostic capabilities and screening tools are being introduced at a rapid pace This allows physicians the best chance at catching this disease early and preventing a premature death Several diagnostic advances for cancer patients were implemented this year, including digital mammography at the Center for Women’s Health and the addition of receptor status testing for breast cancer by our clinical laboratory

Dedicated Medical ProfessionalsThe strength of our program lies in our dedicated medical professionals Our health care team continues to give unselfishly of their time and talent Each physician, nurse, therapist, pharmacist and other members of our cancer team provide compassion, respect, and concern for the individual patient This has made MidMichigan’s Pardee Cancer Center the preferred provider for oncology care in our primary service areas of Midland, Clare and Gladwin Counties In 2007 patients from surrounding counties also sought care at our cancer center including those from Arenac, Bay, Gratiot, Isabella, Ogemaw, Roscommon and Saginaw Counties

Barbara Ann Karmanos Cancer InstituteOur affiliation with the Barbara Ann Karmanos Cancer Institute of Detroit continues to grow and professional relationships develop This year we partnered with the Barbara Ann Karmanos Cancer Institute to bring oncology fellows to the region for specialty clinics in breast, hematology and urology cancers Together with specialists from the MidMichigan medical staff, the attending physicians and Karmanos fellows reviewed and presented patient cases at our weekly multidisciplinary cancer conference

Community SupportOur cancer program is fortunate to have strong community support Volunteers at MidMichigan Medical Center–Midland are generous with their time in the inpatient and outpatient areas of our Medical Center The Elsa U Pardee Foundation for many years has been generous in their support of our tumor registry and the annual Elsa U Pardee Memorial Cancer lecture Many past patients and family members continue to provide financial support with donations to our MidMichigan Home Care and Hospice programs Employees and physicians have given personal time to participate in committees and the weekly multidisciplinary cancer conference

It is our hope that this report will increase your awareness of the broad range of oncology services available through MidMichigan’s Pardee Cancer Center We are grateful for your support and

welcome your comments

Mark Horness, M.D., General and Vascular Surgery Chairman, Cancer Committee

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Director’s Report Under the leadership of President and CEO Richard Reynolds and Vice President Karen Calkins, the oncology strategic business unit continued the implementation of the key initiatives outlined in the 2005 strategic plan for MidMichigan’s Pardee Cancer Center

The volume of cancer cases in 2007 remained similar to 2006 with 747 newly diagnosed patients With this volume of activity we retain our status as a Community Comprehensive Cancer Center, designated by the American College of Surgeons Commission on Cancer

Four Key Initiatives were outlined in the strategic plan for MidMichigan’s Pardee Cancer Center:

Physican Manpower and Leadership

Patient and Referring Physician Experience

Medical Staff Involvement in Decision Making and

Quality Measures for the Cancer Program

In 2007 the following progress was made for each of these initiatives:

Physician Manpower and LeadershipRecruitment efforts began for the following specialties:

Hematology/Oncology

General Surgery with Interest in Breast and Oncology

A new general surgeon, Kelly Wirsing, M D , was recruited and began practicing at MidMichigan Medical Center–Midland In addition to general surgery, she is participating in the breast clinic at the Center for Women’s Health

A new Hematologist/Medical Oncologist, Ahmed Abdel-Maksoud, M D , was recruited and will begin practicing in July 2008 His practice is located in MidMichigan Medical Offices–Campus Ridge 2, along with the Infusion Center In addition to seeing patients in Midland he will have satellite clinics in Freeland and Mt Pleasant

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Patient and Referring Physician ExperienceA new 11,000-square-foot infusion center was designed and built

on the campus at MidMichigan Medical Center–Midland This is

in a beautifully wooded area of our campus There are large

windows looking out into the

natural setting for patients to enjoy while receiving their treatments in a recliner in a private room

Groundbreaking occurred the first week of April 2007 and the building was occupied the first week of December 2007 There are 16 treatment recliners and three private rooms

The Medical Center has moved the outpatient infusions from the inpatient acute care building to this area for our chemotherapy, hydration, transfusion and other outpatient IV patients The building is called MidMichigan Medical Offices–Campus Ridge 2, located at 4500 Campus Ridge Drive Midland, Michigan 48640

Following the move to Campus Ridge 2, patient satisfaction scores have soared with over 90 percent of our patients stating that their

experience was excellent

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Medical Staff Involvement And Decision MakingA technology survey is completed each year with the medical staff members who participate in the Medical Center’ Cancer Committee and the following were identified as needs for the oncology program:

Digital Mammography – A goal of complete conversion to all- digital machines was set The first digital mammography machine was implemented in February 2007 and full conversion was completed by June 2007

Large Bore CT Simulators for Radiation Oncology Centers in Midland and Bay City were planned These were installed and operational by December 2007

Receptor Status Testing – This testing determines the estrogen and progesterone status of a breast cancer tumor This testing was brought on sight in the clinical laboratory at MidMichigan Medical Center–Midland speeding up the time to treatment for breast cancer patients

Stereotactic Radiotherapy – MidMichigan has extensive experience with stereotactic radiosurgery of the brain using Gamma knife During 2007 an upgrade to the next generation of Gamma Knife – the Perfexion was completed, as well as an evaluation of expansion of the current Varian Linac to be able to perform stereotactic radiotherapy in other body sites The Perfexion was installed and operational in October 2007 and expansion of stereotactic radiotherapy using Varian’s Body Array system will be completed by May 2008

Quality Measurements of the Pardee Cancer Center

In 2007 the comprehensive breast program at the Center for Women’s Health began participation in the quality measures offered through the National Consortium for Breast Centers (NCBC) MidMichigan’s Breast Program scored consistently higher on nearly every benchmark than breast centers from all around the nation Accreditation standards from the American College of Surgeons are predicted to be published in 2008 for breast programs, and MidMichigan will be included in this process

Joan Herbert, Pharm.D., Administrative Director Oncology Strategic Business Unit

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Cancer Care Conferences A cancer conference is a multidisciplinary consultation that is integral to patient management and outcomes Physicians specializing in surgery, urology, medical oncology, radiation oncology, diagnostic radiology, pathology and a variety of other specialties discuss the course that an individual patient’s treatment will take This gives the patient the benefit of expertise in many areas without the inconvenience of traveling from physician to physician

Cancer Care Conferences are scheduled at MidMichigan Medical Center-Midland once each week The Cancer Committee has set the goal of having at least 40 conferences per year In 2007, a total of 43 conferences were held, with 144 patients being discussed Four were brought again for follow-up, and seven were discussed retrospectively There was an average physician attendance of 14 at each conference Many ancillary staff also attended Continuing medical education credit is offered to attendees

The Cancer Committee has also set a goal of 70 percent for attendance by physicians from surgery, medical oncology, radiation oncology, pathology and diagnostic radiology All specialties exceeded that goal with an attendance of at least 95 percent overall

The top sites discussed mirror the top sites accessioned by the Tumor Registry:

Breast: 59 cases discussed, 142 cases accessioned

Lung: 20 cases discussed, 137 cases accessioned

Colorectal: 10 cases discussed, 63 cases accessioned

Prostate: 8 cases discussed, 123 accessioned

All physicians are welcome to add a patient to the cancer conference agenda by calling the Tumor Registry

Sandy Winchester, RHIT, CTR Certified Tumor Registrar

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Tumor Registry ReportThe Tumor Registry at MidMichigan Medical Center-Midland is responsible for collecting and sorting information, and conducting periodic follow-up on every patient who is diagnosed and/or treated for a malignancy or benign brain or central nervous system tumor at our facility In 2006, the Registry also began collecting this data from affiliated MidMichigan Medical Centers in Clare, Gladwin and Alma

Demographic information, cancer identification, treatment and follow-up data are collected for each eligible case This data contributes to treatment planning, staging and continuity of care for patients The goal of the Tumor Registry is to improve cancer patient management at our facilities as well as nationally

In 2007, 747 new analytical cases were added to the database in Midland Analytical cases are those that are initially diagnosed and/or receive their first course of treatment at the same facility Benign brain and central nervous system tumors are also required to be collected by the American College of Surgeons (ACoS) and the State of Michigan, for 26 additional cases The American College of Surgeons, which accredits our oncology program in Midland, requires that 10 percent of the 747 case abstracts be reviewed by a physician to assure accuracy Mark Horness, M D , has completed this requirement with weekly reviews of 73 cases throughout 2007

Life long follow-up is conducted on an annual basis on all analytical patients The purpose of follow-up is to keep patients under close medical supervision, to determine the status of the patient’s cancer, and the effectiveness of treatments Over 4,300 patients are followed annually by the registry with a success rate of nearly 97 percent

During 2007 the Registry was staffed by two full-time tumor registrars One is certified, and one is eligible to take the exam in 2009 Both were active in state and national organizations, such as the National Cancer Registrars Association and Michigan Cancer Registrars Association

Sandy Winchester, RHIT, CTR Certified Tumor Registrar

Goals and Objectives Highlights from 2007

Programmatic AccomplishmentsHired a casual CTR to help the Tumor Registry catch up the backlog Opened a new MidMichigan Physicians Group Hematology/Oncology practice at MidMichigan Medical Offices-Campus Ridge 2, and outreach clinics in Mt Pleasant, Auburn and Freeland Held at least 40 cancer conferences with a 75 percent attendance requirement for surgery, pathology, diagnostic radiology, medical oncology and radiation oncology Implemented multidisciplinary chemotherapy class for all first time chemotherapy patients

Offered ONS chemo/bio safe handling course 1-2 times/year

Quality ImprovementImprove customer service scores for Outpatient Infusion Center by focusing on patient comfort measures and navigation Expand benchmarking for the Breast Program utilizing the National Consortium of Breast Centers’ data and implement performance improvement measures - see page 10 for details

ClinicalDevelop and implement guidelines for DVT prophylaxis for cancer patients and measure impact of compliance

Community OutreachDeveloped and implemented five-part Survivorship Series in collaboration with Midland Community Cancer Services and American Cancer Society Developed successful annual fundraiser for the Cancer Program that engaged community members into support for our cancer patients and cancer center

Sandy Winchester, RHIT, CTR Certified Tumor Registrar

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Frequency Report Summary by Site / Sex / Class / Status / Stage2007 Total Cases

Primary Site Total PERC Sex Class of Case Alive Exp Summary Stage/Analytic Only

M F Analy N-Analy I/S LOC REG DIS UNK B/B

Lip 1 .1 1 0 1 0 1 0 0 1 0 0 0 0

Base of Tongue 6 .8 5 1 6 0 6 0 0 0 5 1 0 0

Palate 1 .1 1 0 1 0 1 0 0 0 1 0 0 0

Parotid Gland 2 .3 1 1 2 0 1 1 0 1 0 1 0 0

Tonsil 3 .4 2 1 3 0 3 0 0 1 2 0 0 0

Oropharynx 1 .1 1 0 1 0 1 0 0 1 0 0 0 0

Pyriform Sinus 1 .1 0 1 1 0 1 0 0 1 0 0 0 0

Hypopharynx 1 .1 1 0 1 0 1 0 0 1 0 0 0 0

Oth Lip, Oral Cav & Phar 1 .1 1 0 1 0 0 1 0 0 1 0 0 0

Esophagus 7 .9 3 4 7 0 2 5 0 0 3 3 1 0

Stomach 6 .8 5 1 6 0 4 2 0 1 5 0 0 0

Small Intestine 4 .5 3 1 4 0 4 0 0 1 2 1 0 0

Colon 45 6.0 27 18 45 0 37 8 1 18 13 12 1 0

Rectosigmoid Jct 4 .5 4 0 4 0 2 2 0 1 1 2 0 0

Rectum 14 1.9 7 7 14 0 11 3 0 8 4 2 0 0

Anus and Anal Canal 5 .7 1 4 5 0 5 0 0 2 2 1 0 0

Liver-Intrahep Bile Dcts 8 1.1 5 3 8 0 3 5 0 6 1 1 0 0

Gallbladder 3 .4 0 3 3 0 2 1 0 1 1 0 1 0

Oth & Unspec Pts of Bili 6 .8 5 1 6 0 2 4 0 3 0 1 2 0

Pancreas 18 2.4 11 7 18 0 6 12 0 0 1 15 2 0

Nasal Cav/Middle ear 4 .5 1 3 4 0 3 1 0 3 0 1 0 0

Accessory Sinuses 2 .3 1 1 2 0 2 0 0 2 0 0 0 0

Larynx 6 .8 5 1 6 0 6 0 0 4 1 1 0 0

Bronchus and lung 137 18.3 77 60 137 0 61 76 0 28 43 65 1 0

Heart, mediastinum and P 4 .5 4 0 4 0 2 2 0 0 1 3 0 0

Bones, Jnts, Art Cart Ot 3 .4 2 1 3 0 3 0 0 1 0 2 0 0

Hematopoietic/Reticuloen 16 2.1 10 6 16 0 8 8 0 0 0 16 0 0

Skin 6 .8 4 2 6 0 4 2 0 3 1 2 0 0

Retroperitoneum and Peri 1 .1 1 0 1 0 1 0 0 0 0 0 1 0

Conn, Subq and other soft 3 .4 3 0 3 0 2 1 0 3 0 0 0 0

Breast 142 19.0 0 142 142 0 141 1 18 69 50 5 0 0

Vagina 1 .1 0 1 1 0 1 0 0 1 0 0 0 0

Cervix Uteri 7 .9 0 7 7 0 6 1 0 2 3 1 1 0

Corpus Uteri 10 1.3 0 10 10 0 10 0 1 6 2 0 1 0

Ovary 6 .8 0 6 6 0 3 3 0 0 4 1 1 0

Prostate Gland 123 16.5 123 0 123 0 117 6 0 96 24 3 0 0

Testis 7 .9 7 0 7 0 7 0 0 4 2 1 0 0

Other male genital orgs 1 .1 1 0 1 0 1 0 0 0 0 1 0 0

Kidney 10 1.3 5 5 10 0 8 2 0 7 2 1 0 0

Renal Pelvis 1 .1 0 1 1 0 1 0 0 0 1 0 0 0

Ureter 1 .1 1 0 1 0 1 0 0 1 0 0 0 0

Bladder 49 6.6 36 13 49 0 43 6 26 17 3 1 2 0

Meninges 6 .8 2 4 6 0 5 1 0 0 0 0 0 6

Brain 11 1.5 5 6 11 0 7 4 0 9 1 1 0 0

Other central nervous Sy 7 .9 2 5 7 0 6 1 0 1 0 0 0 6

Thyroid Gland 13 1.7 4 9 13 0 11 2 0 8 5 0 0 0

Oth Endocrine Glds/Rel S 3 .4 2 1 3 0 3 0 0 0 0 0 0 3

Other ill-defined sites 1 .1 0 1 1 0 1 0 0 0 0 0 1 0

Lymph Nodes 22 2.9 11 11 22 0 19 3 0 3 6 11 2 0

Unknown Primary Site 7 .9 1 6 7 0 2 5 0 0 0 0 7 0

Total 747 100 392 355 747 0 578 169 46 315 191 156 24 15

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Radiation Oncology Centers in Four LocationsMidMichigan Medical Center–Midland has four radiation oncology centers They are located in Alma, Bay City, Midland and Saginaw The Bay City location is a joint agreement with Bay Regional Medical Center The Saginaw location is a joint agreement with Covenant and Bay Regional Medical Center

Our mission is to provide state-of-the-art radiation oncology services in a caring and compassionate environment while preserving the dignity and hope of each patient and their loved ones

Radiation Oncology at MidMichigan Medical Center–Midland continues to provide state-of-the-art radiation techniques and technology with such techniques as intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) The IGRT is able to focus the most radiation on the cancer and the least on surrounding healthy tissue To accomplish this precision targeting, the system adjusts for tumor movement, bodily changes over the course of treatment and every breath a patient takes during every treatment session The system also is synchronized with MidMichigan’s treatment planning and information management systems, a step that streamlines imaging and treatment for additional precision, convenience and patient safety

In 2007 we added a 16-slice GE RT scanner for all of our patient treatment planning (pictured above) This provides physicians with the most detailed images to aide them in the most accurate and precise 3-Dimensional, 4-Dimensional, and IMRT plans

We continue to provide state-of-the-art equipment close to home and to stay on the forefront with the fight against cancer

Courtney Szelesi, R.T., (R)(T)Manager, Radiation OncologyMidMichigan Medical Center–Midland

Medical Oncology Unit F100 Inpatient CareF100 is a 38-bed adult medical unit designated for the care of patients living with the cancer experience The inpatient population may be here for diagnosis, cancer treatment, symptom management, and/or secondary health complications We maintain a multidisciplinary team approach for our oncology services

In 2007 our team included two medical oncologists, registered nurses, licensed practical nurses, a dietitian, a medical social worker, a home care coordinator, an occupational therapist, an oncology pharmacist, and a chaplain

Available to all patients is the complimentary kitchen, educational materials, visual therapy, music therapy, volunteer services, turbans and transportation assistance

Paula E. Dodman, M.S.N., R.N., O.C.N., Manager, F100

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CME Cancer Programs Continuing Medical EducationDuring 2007, the following oncology continuing medical eduation progrtams were offered at MidMichigan:

March 12, 2007

Medical Grand Rounds: Breast Cancer Update

Lawrence Flaherty, M D , Karmanos Cancer Institute

April 19, 2007

Role of the Primary Care Provider in Breast Cancer Prevention

Victor Vogel, M D & D Lawrence Wickerham, M D

University of Pittsburgh School of Medicine

May 10, 2007

2nd Annual Oncology Dinner Symposium

Lung Cancer Treatment Update

Robert N Jones, M D , Michigan Cardiovascular Institute

Antionette Wozniak, M D , Karmanos Cancer Institute

August 13, 2007

Medical Grand Rounds: Prostate Cancer for the Internist

Ulka Vasichampayan, M D , Karmanos Cancer Insitute

September 26, 2007

Annual Pardee Lecture

Cancer Survivorship: Care and Life Following Disease & Treatment

Deborah Schrag, M D , Johns Hopkins Medical Center

October 18, 2007

Medical Grand Rounds: Breast Imaging Modalities

Jeffrey Herman, M D , Midland Radiology Associates

October 25, 2007

Family Practice Department Meeting: 2006 Consensus Guidelines

on Management of Abnormal Pap Smears Andrew Bone, M D &

Gail Colby, M D , MidMichigan Medical Center–Midland

Julie Hart, Continuing Medical Education Coordinator

Clinical Trials Experienced Research Team In order to maintain its status as the preferred provider of oncology care in the region, MidMichigan maintained its clinical trials program in 2007 This program continues to be in affiliation with the Barbara Ann Karmanos Cancer Institute in Detroit The clinical trials research team includes experienced oncology doctors, nurses, pharmacists and administrators on staff at the Medical Center The MidMichigan research program was successfully audited by the Southwest Oncology Group (SWOG) in 2007 and received a 100 percent approval rating with no deficiencies

The clinical trials program at MidMichigan continues to include the original four investigators, who were approved as cooperative group member’s of SWOG and are registered investigator’s with the National Cancer Institute (NCI) The MidMichigan research team includes investigators : medical oncologists Daniel Danso, M D , and Michel Hurtubise, M D , and radiation oncologists Rajesh Kotecha, M D , and Rajnikant Mehta, M D Research team members receiving special training at the Barbara Ann Karmanos Cancer Institute include the clinical coordinator of oncology services for pharmacy, Amy Behmlander, PharmD; and clinical research assistant Larry Randall, R N , B S N , O C N The research team also includes the director of oncology services Joan Herbert, PharmD Dr Hurtubise is the principle investigator leading the research team

There is a tremendous advantage for patients who participate in nationally sponsored clinical trials These patients are allowed access to cutting edge treatments right in their hometown, avoiding lengthy travel times and delays in treatment caused while commuting to urban medical centers In 2007, the Medical Center was able to offer patients participation in phase III clinical trials involving treatment for cancer of the breast, lymphoma, and melanoma Phase III trials compare the current standard treatment against the new treatment

Eligibility criteria for participation in a clinical trial are extremely specific to the patient’s disease and medical condition The clinical trials office screens potential eligible candidates daily The clinical trials program successfully enrolled and treated four new patients in 2007 This brings the number of patients receiving active treatment in a clinical trial at MidMichigan to eight

Larry Randall, R.N., B.S.N., O.C.N.Clinical Research Assistant

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Center for Women’s Health The Center for Women’s Health provides a comprehensive program with a wide range of breast screening, diagnostic and support services in a convenient, comfortable and private atmosphere The program team consists of a medical director, breast health coordinators, radiologists, surgeons, mammographers and other support personnel The team’s focus is to ensure that timely, integrated and coordinated breast services are available to women within the MidMichigan Health area

Mammography at the CenterThe Center for Women’s Health is fully accredited by the American College of Radiology (ACR) and certified by the Food and Drug Admistration (FDA) In 2007, the Center for Women’s Health performed more than 14,000 mammograms for women in the MidMichigan region The Center’s goal is to provide the most technologically advanced equipment and services to our patients To stay consistent with that goal, the Center transitioned from mammography equipment utilizing film/screen technology to digital mammography equipment in 2007

The benefits of digital mammography equipment are many Digital equipment has the capability of being manipulated by the radiologists Images can be easily stored in digital format and transferred to different sites for review or presentation The R-2 digital imaging technology software for a computerized “second read” of a mammogram is integrated in the unit and most important, it is much more sensitive in detecting abnormalities than the standard film mammogram Digital imaging has been found to be especially beneficial in detecting breast abnormalities in women 50 years of age and under, premenopausal women and women with dense breast tissue at any age In addition to the added sensitivity and improved image quality afforded by digital machines, the Center realized operational benefits in having this newer technology Imaging time takes approximately half as long as standard film imaging This time saving improves the quality of the imaging experience for patients, improves operational efficiencies and staff utilization within the Center for Women’s Health and increases the number of patients who can be seen during the course of a typical day Full conversion to digital mammography technology is one of

the many ongoing steps that the Medical Center is taking to maintain its commitment to the Center for Women’s Health and to the many patients undergoing screening or diagnostic procedures in this modern facility

Record Number of Patients SetThe Breast Health Team set a record in 2007, with 629 patients seen in the Breast Health Clinic These appointments were for patients who either required second opinions or for patients who have initial findings that were suspicious for breast disease Of the 629 patients seen in the clinic, 66 were found to have breast disease

Patient EducationOne of the key roles of the Breast Health Program is to provide patient specific education and support for patients undergoing additional investigative and/or interventional procedures for breast disease Of the 66 patients with positive findings, 56 patients participated in the pre-operative breast education classes These classes provide patients with education on different treatment options available, exercise programs specific for patients with breast disease, nutritional education and an introduction of the range of resources that are available for patients diagnosed with breast disease Some of these resources include community services, prosthetic options and different types of support groups that are available to meet the variety of needs of women served through the clinic

During 2007, the Center for Women’s Health began to submit data to the National Consortium of Breast Centers about performance standards This voluntary program is intended to identify breast centers across the country, that achieve excellence in the provision of breast health care Standardized performance criteria data is compared against a national set of bench marks that compare our performance to that of other centers of similar size and level of activity While the Center for Women’s Health compares very well to the national standards, an area of opportunity was identified The length of time between the ordering of a breast ultrasound at the Center was found to be longer than the benchmark time period Because of this finding, a team was assembled who examined our process flow for breast ultrasounds that allowed us to cut our performance of an ultrasound from 14 days to just seven days without any increased expenses or personnel The Center will continue to explore and implement strategies to ensure achievement as a Center of Excellence in the near future

Carole Calvert-Baxter, M.A., L.L.P.C., Manager

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Social Work & Transition Medical social workers assist patients admitted to the hospital, outpatients and those receiving treatment in Radiation Oncology They work in all areas of the Medical Center, providing cancer patients and families with counseling services, education and resource coordination They also assist with discharge and transitional care planning Social workers arrange placement in adult foster care, sub-acute settings and extended care facilities Home nursing care or hospice is also arranged by the discharge planner

Services continue to be offered to patients experiencing a first time chemotherapy treatment, along with those who have advanced disease who are hospitalized Networking with community agencies is done on a regular basis and linkages are made Referrals may include, but are not limited to Cancer Services of Midland, Gladwin and Clare Counties; Senior Services and Pardee Treatment Funds in the counties of Bay, Midland, Clare, Gladwin, Isabella and Gratiot Access to other resources in the local area, across the state and on the Internet is coordinated by the medical social worker

The oncology social worker and discharge planner have collaborated with MidMichigan Hospice to facilitate patients with a terminal prognosis in receiving respite care in the hospital setting The team has also been successful in coordinating the care of patients with end-stage disease in local adult foster care homes with payment through hospice benefits Medical social workers coordinate with the patient’s physician(s) and make referrals for palliative care services to assist with symptom management

Patient care conferences are held daily, and the medical social worker networks with the staff and other agencies for appropriate discharge plans, depending on the individual patients’ needs

For patients with an interest in support groups, the Medical Social Worker provides verbal and written information tailored to the patient’s disease, site and prognosis

Social workers at MidMichigan Medical Center–Midland facilitate an educational support group for cancer survivors These survivorship series groups are provided every winter and fall

The American Cancer Society continues to sponsor the Look Good-Feel Better program for cancer patients Professional cosmetologists educate patients about using color, accessories and other techniques to enhance their looks and improve their self-esteem while undergoing treatment

As part of the Medical Center’s comprehensive Cancer Center, the medical social worker has an active role in providing continuing education to hospital staff about the “Phone A Friend” (also sponsored by the American Cancer Society) and “Look Good-Feel Better” programs

Maria VanOchten, L.M.S.W., OSW-C Oncology Social Worker

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Spiritual Care Program Chaplain Offers Caring SupportThe purpose of life and the relationships with self, others and God are what spirituality encompasses When one is ill and in need of physical care, the purpose of life is challenged and at times compromised resulting in a spiritual crisis The role of the chaplain is to bring support, care, pastoral counseling and prayer to those who are in need, for either the patient, family or the staff Presence is the most important part of ministering for spiritual needs The presence of the chaplain conveys the message that God does care and is with each person in times of need

Each year the chaplain sees about 1,500 patients, families and staff at the hospital to provide spiritual care About one-fourth of those patients, families and staff who receive care from the chaplain have cancer A number of those patients and families experience visits from the chaplain throughout their journey and keep them connected with their faith base, as requested The goal is to see that spiritual care is available and provided as needed 24 hours a day, seven days a week To assure that this can continue to happen, there are also 10 ministers who volunteer their time for being on-call chaplains

Annually, the Spiritual Care Program hosts a bioethics seminar This seminar is held in the winter Past years have seen presentations on end-of-life decision making, futile care, multi-cultural issues in health care, and in 2007 on end-of-life spiritual care, spirituality of the caregiver and doing the right thing when caring for others The seminar is open to the medical community as well as the community-at-large

There is a Spiritual Care Center available for patients, families and staff for prayer, meditation and reflection It is open 24 hours a day, seven days a week, 365 days a year It is located adjacent to the Harlow lobby of the Medical Center

Rev. W. Roger Stauffer, Chaplain, MDiv, BCC

Pharmacy The professionals from the pharmacy department of MidMichigan Medical Center–Midland provide a variety of special services to oncology patients In 2007, oncology outpatients were moved from the inpatient unit on F100 to the Infusion Center Because over 90 percent of all treatments are now administered in the outpatient setting, the pharmacists and pharmacy technicians were also relocated and the satellite pharmacy on F100 was closed A clinical pharmacist remains on F100 to provide consultation and dosing services for oncology inpatients, as well as the medical inpatients on this unit A clinical pharmacist and certified pharmacy technician are dedicated to the oncology outpatients Monday through Friday They manage physician order reviews and entry into the electronic medical record, dosing, education and drug monitoring functions

Amy Behmlander, Pharm D is the clinical manager and is assigned to oncology services In this role, she provides leadership and direction for pharmacy services to cancer patients Working closely with physicians, nurses and patients, the pharmacy team verifies that appropriate protocols are ordered, reviews orders for medication interactions, performs dose calculations and assures safe and proper handling of chemotherapy and biological agents Pharmacists verify lab results prior to dispensing chemotherapy and adjunctive medications Current drug information is provided to medical oncologists regarding chemotherapy and other medications Pharmacists also provide assistance with management of pain, nausea and vomiting, parenteral (IV) nutrition and the treatment of infectious diseases

The clinical manager participates as the lead pharmacist in clinical trials She is responsible for all ordering, receiving, dispensing, and control of investigational agents She works closely with the nursing supervisors to review protocols and standardize workflow between nursing and pharmacy She also assists with access to indigent drug programs and certain specialty drug programs Various continuing education was provided throughout the year to the oncology nursing staff and pharmacists

New Aranesp® orders and protocols were developed in 2007 to match the new reimbursement guidelines Reclast® was also added to formulary this year for use in the Outpatient Infusion Center This is a unique agent that is administered annually for postmenopausal osteoporosis and Paget’s disease

Amy Behmlander, Pharm.D.

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Fund DevelopmentThere is another valuable dimension that assists those with cancer Many in the community joined together in 2007 to donate money to the Medical Center to support the special needs of those we serve with this disease These contributions came through memorials, outright gifts, grant requests for specific cancer-related purposes and events

One such event occurred at the ballpark where the Great Lakes Loons celebrated MidMichigan Health’s Breast Cancer Awareness Night The evening was highlighted by a Loons’ Pink Jersey-Off-The-Back Auction that raised more than $11,000 from fans to benefit the Medical Center’s new Infusion Center

Cancer patients are also being supported through a two-year $127,440 donation from the Elsa U Pardee Foundation to the Oncology Fellow Partner Program, a joint venture between MidMichigan and the Barbara Ann Karmanos Cancer Institute This new program brings specialists and physician fellows from the Karmanos Cancer Institute to the Midland community on a quarterly basis Karmanos physicians host clinics with MidMichigan physicians, and participate in some of the multidisciplinary cancer conferences held weekly at the Medical Center

These multidisciplinary cancer conferences bring physicians and other professionals together to collaboratively discuss specific patient treatment and follow-up options The final recommendations are then shared with each patient

We would like to add our voice to the many others in recognizing and acknowledging the Elsa U Pardee Foundation This Foundation continues to be instrumental in developing MidMichigan’s oncology program including its ongoing support of the annual Elsa U Pardee Memorial Cancer Lecture and Tumor Registry Our deepest appreciation is extended to them and to all who have chosen to help those who face the challenges of cancer through their gifts of generosity and hope

Carlene Skorczewski, Fund Development Coordinator www.midmichigan.org/donations

Food and Nutrition Dietitian Specializes in Oncology Nutritional assessment and management is essential in the care of the oncology patient Cancer, chemotherapy and radiation can often cause a loss of appetite and unexpected weight loss Additionally, some medications such as steroids given as an adjunct to treatment can cause weight gain Maintaining and boosting the patient’s nutritional status helps with the healing process A clinical registered dietitian that specializes in the care of oncology patients is available for consultation

The oncology dietitian provides nutritional care to all acute care cancer patients upon admission and to outpatients on a referral basis Following a nutritional assessment, an individualized care plan is formulated integrating the diagnosis, stage of the disease and treatment into the overall plan Nutrition counseling is part of the first time chemotherapy teaching that is provided in the inpatient and outpatient settings at MidMichigan Medical Center– Midland

The oncology dietitian is available for community programs and often speaks at cancer support groups, health fairs and other educational venues

Sherry Elford, R.D., Oncology Dietitian

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Making Strides Against Breast Cancer MidMichigan was a community champion of the American Cancer Society’s Making Strides Against Breast Cancer in October to benefit Breast Cancer Research One hundred plus MidMichigan employees walked in support of this event, which raised $170,000

HPV Education The family practice residents under the leadership of Rachel Williams, M D , have incorporated HPV and the Gardasil® vaccine into the health science programs at the Midland high schools The residents teach over 300 students each year, and will provide information on the pros and cons of women becoming vaccinated

Freedom from Smoking Twelve-week classes were available at MidMichigan Medical Center–Midland, MidMichigan Medical Center–Gladwin and MidMichigan Medical Center–Clare throughout the year A handful of participants completed these courses

Tobacco Facilitator Program The tobacco facilitator program began in November and is available for all counties MidMichigan serves Their role is to answer questions, explain treatment options and provide assistance to match the needs of community members who wish to quit One-on-one counseling is also available for free

Breast Cancer Prevention The “Just Between Women: Breast Health Update” program was held in Alma, Gladwin, Houghton Lake and Midland The presentations were provided by breast health coordinators Nancy Hieb and Joni Kaiser This program attracted 100 attendees

Look Good Feel Better Programs MidMichigan Medical Center–Midland; MidMichigan Medical Center–Gladwin and Jeppesen Radiation Oncology Center each hosted quarterly Look Good, Feel Better programs This nationwide program, which is offered in partnership with the American Cancer Society, the National Cosmetology Association and the Cosmetic, Toiletry, and Fragrance Association Foundation, provides trained volunteers who teach women how to cope with skin changes and hair loss that can occur during treatment for cancer Four to five women, on average, attend each session

Community Cancer Screenings & Education

In 2007, a total of 791 men participated in prostate screenings throughout the region served by MidMichigan A breakdown of sites and abnormal results are in this table:

Colorectal Screening: “Take the Test that May Save Your Life ” Direct Mail, in the form of both a targeted postcard and the To Your Health newsletter, was used to promote early detection of colorectal cancer This message reached households throughout MidMichigan Health Recipients were educated on the importance of early detection, as well as the symptoms that may be an indicator of colon cancer There were 589 calls to request a colorectal kit in the mail

Community Cancer Education and SupportSurviving Breast Cancer by Stealing 2nd Base was presented on October 27 by Lillie Shockney, R N , who is the administrative director of Johns Hopkins Avon Foundation Breast Center She is a nurse who has taken care of women with this disease, and a 15-year breast cancer survivor Seventy-one community members attended this event, and each received a copy of her book, Beating Breast Cancer by Stealing Second Base.

Celebration of Life Cancer Services and MidMichigan Health Pardee Cancer Center co-sponsored a Celebration of Life Event on June 7, prior to the MATRIX:MIDLAND Festival appearance of best-selling author John Grogan The reception honored cancer survivors–several of whom shared their stories

Prostate ScreeningsDates Affiliate # Screens

Performed# Positive

PSA’s9/12 Clare 64 1

9/13 Midland, Auburn 358 14

9/17, 18, 19, 20, 21

Gratiot 131 6

9/21, 9/28 Gladwin 155 7

9/21, 9/27 & 10/12

Houghton Lake & Roscommon

59 2

9/14 Mt. Pleasant 49 0

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MidMichigan Tobacco Cessation Robert Jones, M D , presented “Quit Now Here’s How” on March 7 in Midland There were 35 community members in attendance Vendors from the American Cancer Society, Midland Community Cancer Services, pharmaceutical companies; alternative therapies (such as hypnosis); MidMichigan Medical Center–Midland Pulmonary Services; American Lung Association; and the Michigan Tobacco Quitline were on hand

Cancer Support Groups Referrals are made on an ongoing basis to Cancer Services support groups in Midland which include separate support groups for patients with breast and prostate cancer and a general support group for all others called “Coping with Cancer ” MidMichigan Gratiot Cancer Center also provides a Coping with Cancer support group in Alma, Michigan

Chemoprevention A community program on chemoprevention entitled, “Say Yes to Preventing Breast Cancer,” was provided in Midland on April 19 This program was introduced by Michel Hurtubise, M D , of East Central Oncology, and presented by Victor Vogel, M D Dr Vogel is the director of the Magee-Women’s Breast Health Cancer Program at the University of Pittsburgh Medical Center The program had 75 attendees and received excellent reviews from the audience

Pardee Lecture The Pardee Lecture, held on September 26, attracted 65 attendees, with a focus this year on survivorship Deborah Schrag, M D , from Sloan Kettering, spoke on survivorship from a physician perspective She was joined by Andy Miller, director of survivorship programs for the Lance Armstrong Foundation Mr Miller outlined the history of survivorship programs, and current recommendations and programs supported by the Lance Armstrong Foundation MidMichigan’s Survivorship Series a joint effort of MidMichigan Medical Center-Midland, Cancer Services, and the American Cancer Society slated to begin in January 2008 was announced

Special Events and Health FairsBreast Cancer Awareness Night at the Great Lakes Loons Game at Dow Diamond took place on May 10 Player jerseys were auctioned, raising $11,000 to benefit the outpatient infusion center The players wore pink jersey’s, one of which was signed for a prize drawing The health fair provided information on mammograms, cancer services, sun safety and more MidMichigan Medical Centers in Midland, as well as Gladwin and the Gratiot Medical Center were presented with the American Cancer Society, Great Lakes Division, Inc Five Star Community Investor Award and the Five Star Investor Award during this event

Wellness Day and Senior Expo Information on cancer including genetics and Mammosite® information was provided at the Midland Mall’s Wellness Day on Feb 11 and at the Spring Senior Expo on April 25

Skin Cancer Awareness and Prevention We provided sun safety/skin cancer prevention information, sun screen, lip balm and free skin cancer assessment guides at various events, as indicated below, throughout the spring and summer

The First Annual Pennant Race, April 21, in Midland

Dow Run/Walk June 2 in Midland

Louie’s Loft Dow Diamond in Midland for 12 game days in May

Senior Life with Style June 13, in Houghton Lake

American Cancer Society Relay for Life July 28 and 29 MidMichigan Medical Center–Midland sponsored the survivor reception on Saturday, July 28 Kevin Leach, a MidMichigan cancer survivor, provided an inspirational speech about his journey with cancer followed by MidMichigan Hospice volunteer, Harry Grether who was this year’s caregiver speaker Mr Grether writes of his families experience with a daughter who was diagnosed at a young age with cancer in his book entitled, “Lessons from an Inperfect World ” Mr Grether donates copies of his book to MidMichigan to give as a gift to our patients when they complete their treatment

Stephanie Leibfritz, R.N.

Community Education Coordinator

•

•

•

•

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Focus on Lung CancerMore people die from lung cancer than from any other type of cancer This is true for both men and women Lung cancer is responsible for more deaths than breast, prostate and colon cancer combined The risk factors for lung cancer include smoking, exposure to carcinogens and family history

Lung cancer is divided into two main groups for the purpose of treatment, small cell and non-small cell In 2007, 6,342 cases of non-small cell lung cancer were diagnosed nationwide At MidMichigan Medical Center–Midland, 85 cases were diagnosed

Lung cancer is diagnosed using chest x-rays, CT scans and PET scans Tissue diagnosis is done through sputum, bronchial washings, bronchoscopes and fine needle aspirations Mediastinoscopy is done to assess mediastinal nodes, which is important for patients whose disease is amenable to surgery

More men than women are diagnosed with lung cancer, but the gender gap is closing The risk of dying from lung cancer increases with age Almost 50 percent of patients both nationwide and at MidMichigan were over 70 years of age when diagnosed

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Treatment options are based on the stage of the cancer at diagnosis Survival is also related to the stage or the extent of the disease Unfortunately 34 1 percent of patients nationwide and 38 8 percent of MidMichigan patients were stage IV when diagnosed

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Of the patients treated by surgery in 2007 at MidMichigan Medical

Center–Midland, 75% were treated with Video Assisted Thoracic

Surgery (VATS) The VATS lobectomy involves the placement of

three to four ports through which the same anatomic resection is

performed as the open lobectomy The VATS procedure has almost

half the complication rate as the open procedures The patients

have less post operative pain and shorter hospital stays as well

VATS patients have better lung function when the same amount of

tissue is removed and better shoulder function post operatively

Many patients return to their usual activities in about one week

Patients who undergo open-chest procedures may spend a week in

the hospital and take four to six weeks to fully recover Survival

rates are comparable for the two procedures

MidMichigan Medical Center–Midland five year survival rates are

comparable to National statistics Approximately 55% of patients

diagnosed with Stage I lung cancer are alive at 60 months Only

about 3% of patients first diagnosed with Stage IV cancer are

living at the end of five years Stage II and Stage III five year

survival rates are about 30% and 16% respectively

The patients in stage IV are usually treated with chemotherapy,

though metastatic lesions in the brain can be treated with Gamma

Knife Stage III patients are treated with a combination of

chemotherapy and radiation Stage II patients may be treated with

surgery and/or a combination of chemotherapy and radiation

Stage I patients are treated surgically

National treatments are comparable to treatments at MidMichigan

Medical Center–Midland:

Treatment ComparisonNational MidMichigan

Surgery 25.7% 25.9%

Radiation/Chemotherapy 14.1% 15.3%

Chemotherapy 10.3% <5%

All Other Treatments 31.9% 35%

No Treatment 18% 18.8%

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2007 INITIAL THERAPYNON-SMALL CELL LUNG CANCER

MIDLAND

SURGERY25.9%

ALL OTHER22.4%

NO TREATMENT18.8%

RAD CHEMO15.3%

SRG RAD CHM9.4%

RAD8.2%

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2007 INITIAL THERAPYNON-SMALL CELL LUNG CANCER

CIRF DATA

SURGERY25.7%

ALL OTHER24.0%

NO TREATMENT18.0%

RAD CHEMO14.1%

CHEMO10.3%

RAD7.9%

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MidMichigan Home Care Home Care and Hospice Services Assist Cancer PatientsHome Health Oncology Nursing MidMichigan Home Care offers a specialized oncology program, which includes a complete range of in-home services to meet the complex needs of cancer patients Home care helps patients avoid emergency visits to the hospital and provides care in the comfort of the patients’ own homes

MidMichigan Home Care cares for hundreds of home health cancer patients each year The specialized program involves education for the patient and their family, in which nurses assist patients and families in managing the disease process by educating about, side effects of treatment, IV antibiotics, and in-home chemotherapy administration as needed

Palliative Care Living with cancer can cause patients great difficulty in all aspects of their lives – physical, emotional, spiritual and social Palliative care helps patients manage pain and other symptoms related to cancer Each of the cancer patients in the palliative care program this year worked with a support team including physicians, a nurse practitioner, nurses and social workers to help improve their overall quality of life

Hospice Hospice is a program for terminally ill individuals and their families It provides clinical management of symptoms and pain, enabling patients to live as fully and comfortably as possible while remaining in the familiar surroundings of home, or wherever the patient is most comfortable Hospice regards dying as a normal process – one of life’s greatest challenges This past year, MidMichigan Home Care worked to cover end-of-life needs for 243 patients in Midland County, with an average length of stay of 42 days Fifteen percent of Midland County hospice patients this year, or 36 individuals, were on service for lung cancer, with an average length of stay of 32 days

Under the hospice program, cancer patients are provided with necessary medical equipment, medications related to the terminal diagnosis, volunteer support, short-term respite, symptom management and therapies, as well as 13 months of bereavement support for families However, supplemental funds are needed to assist patients who do not have adequate hospice benefit coverage in their time of need Several fundraisers, including the Stars in the Gardens holiday event, Fire Fly Golf Outing and Hospice Benefit Luncheon, were held and raised a of total of $35,000, helping to make it possible for patients to receive these services with peace of mind, free from financial concerns

Private Duty Private duty services include private pay nursing, therapy, social work or home health aide services for patients who require extra assistance Services may include transportation to medical appointments, meal preparation, light housekeeping, personal care or medication management, among other tasks

The Looking Glass Shoppe Cancer patients sometimes have difficulty maintaining confidence MidMichigan Home Care’s Looking Glass Shoppe, located in the Center for Women’s Health on the campus of MidMichigan Medical Center–Midland, specializes in products and services that assist women who have undergone some form of breast surgery The Shoppe offers private consultations and a variety of women’s health care products to help patients feel natural and confident after breast surgery Some of these products include post-surgical camisoles, turbans, breast prostheses and lingerie, swimwear and wicking pajamas

Jill A. Roby-Snyder, R.N.Hospice Director, MidMichigan Home Care

Amid Tirmizi, M.D.Hospice Medical Director, MidMichigan Home Care

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Pardee Cancer Center Service DirectoryBreast Health Nurse (989) 837-9070 Susan Fry, R N

Center for Women’s Health (989) 837-9060 Carole Calvert-Baxter, Manager

Central Scheduling (Outpatient Services) (989) 839-1800 For all imaging studies

Director Oncology Strategic Business Unit (989) 839-3556 Joan Herbert, Pharm D

Gamma Knife (989) 839-1781 Dennis Ouillette, R N , Coordinator

Hematologists / Oncologists East Central Oncology Associates, P C (989) 631-3975 MidMichigan Medical Offices–Midland Suite 1000 Michel Hurtubise, M D , Medical Oncologist Daniel Danso, M D , Hematologist Oncologist MidMichigan Physicians Group (989) 839-6188 Hematology/Oncology MidMichigan Medical Offices–Campus Ridge 2 Ahmed Abdel-Maksoud, M D , Hematologist Oncologist

Infusion Center (989) 839-6200

Laboratory (989) 839-3460

Medical Oncology Inpatient Unit, F100 (989) 839-3760 Paula Dodman, M S N , R N , O C N

MidMichigan Home Care (989) 633-1400 Toll Free Number (800) 852-9350 Hospice (989) 633-1400 Toll Free Number (800) 852-9350 Looking Glass Shoppe (989) 631-7724 Toll Free Number (800) 388-7721

Oncology/Dietitian (989) 839-3846 Sherry Elford, R D

Oncology Social Worker (989) 839-3000 Maria VanOchten, L M S W , OSW-C Pager 282

Palliative Care and Hospice (989) 837-9200 Amir Tirmizi, M D

Pardee Cancer Treatment Fund (989) 839-3929

Pharmacy (989) 839-3557 Amy Behmlander, Pharm D

Radiation Oncology (989) 839-3450 Rajnikant Mehta, M D Rajesh Kotecha, M D Ramesh Vedula, M D Courtney Szelesi, R T (R)(T) (989) 839-1319 Manager–Midland

Spiritual Care (989) 839-3998 Rev W Roger Stauffer, Chaplain, MDiv BCC

Tumor Registry (989) 839-3260 Sandy Winchester, R H I T , C T R Blanche Myers, CPC

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Pardee Cancer Center4005 Orchard DriveMidland, Michigan 48670Phone (989) 839-3000www midmichigan org/cancer

LLB 11/2008