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					   Clinical Trials
    Offer New Horizons
       of Treatment




Transitions Program
  Helps Cancer Survivors
   Return to Normal Life     Doug
                             McBroomenjoys
                             Lung cancer survivor
                             easy recovery from minimally
                             invasive surgery                                      5

   Some Healing
     Helpers                                        da Vinci® System
  Are of the Furry Variety
                              Now offers robotic surgery across five specialties
                   5
                                                                   5                                       TABLE OF CONTENTS

                                                                                                    2
                                                                                                        • Five Specialties, 11 Surgeons, One Robot
                                                                                                    3
                                                                                                        • ABC Program Helps Breast Cancer Survivors Return
                                                                                                          to Fitness
                                                                                                    4
Five                                                                                                    • Melanoma Is One of the Most Prevalent —
                                                                                                          and Preventable —Types of Cancer

Specialties,                                                                                        6-7
                                                                                                        • Focus Study: Melanoma

                                                                                                        • Life After Lung Cancer: Patient Enjoys Easy Recovery

11 Surgeons,                                                                                              From Minimally Invasive Surgery
                                                                                                        • CRMC Provides Full Spectrum of Treatment for


One Robot
                                                                                                          Lung Cancer
                                                                                                        • Focus Study: Lung Cancer
                                                                                                    8
                                                                                                        • Brain Cancer Survivor Shares His Story
                                                                                                        • Focus Study: Brain Cancer
                                                                                                    9
                                                                                                        • Transitions Program Helps Cancer Survivors
      he first in the state of Tennessee to
T     offer robotic surgery across five spe-
cialties, Cookeville Regional Medical
                                                                                                    10
                                                                                                          Return to Normal Life

                                                                                                        • Genetic Tests Help Cancer-Prone Patients Make
                                                                                                          Important Decisions
Center is indeed unique in that it now                                                                  • Family Learns From Testing
offers the option of robotic surgery in                                                             11
urology; gynecology; general surgery;                                                                   • Clinical Trials Offer New Horizons of Treatment
ear, nose and throat (ENT); and cardio-         Here is what three of our surgeons had to           12
thoracic surgery.                               say about da Vinci:                                     • Some Healing Helpers Are of the Furry Variety
                                                 • "It's remarkable how the robotic arms feel       13
                                                                                                        • Moore Earns 2011 Cancer Liaison Physician
Surgeons at Cookeville Regional offering           much like your own arms, much different                Outstanding Performance Award
robotic surgery are urologist Quinton              than laparoscopy where you're dealing                • Volunteers: the Heart of The Cancer Center
Cancel, M.D.; urologist Lee Moore, M.D.;           with more two-dimensional movements,"            14-15
gynecologist Bert Geer, D.O.; gynecologist         said Gerndt. "The robotic arms allow you             • In the Community
Christine Pham, M.D.; gynecologist                 to move much like your own hands would,          16
Michael Pippin, M.D.; gynecologist Paige           and the visualization is better than what            • The Cancer Center in the News
Gernt, M.D.; surgeon Brian Gerndt, M.D.;           you'd see in open surgery due to the high-       17-18
                                                                                                        • 2010 Cancer Statistics
surgeon Kevin Purgiel, D.O.; ENT special-          definition technology that we have."             19
ist Grant Rohman, M.D.; cardiothoracic                                                                  • Thank You to Cancer Program Physicians and All
surgeon Lewis Wilson, M.D.; and cardio-          • "In my field, it's very exciting because               Those Behind the Scenes
thoracic surgeon Timothy Powell, M.D.              it's an opportunity to surgically treat some         • Cancer Committee Members
                                                   patients, particularly some head and neck        20
                                                                                                        • Supportive Services Offered
Since 2007, Cookeville Regional has                cancer patients, who before we considered
offered robotic surgery with one of the            not to be surgical candidates," said
most advanced surgical tools ever devel-           Rohman. "Clearly I think that Cookeville
oped – the da Vinci® Surgical System. It’s a       Regional Medical Center is on the cutting
robotic device that enhances the skills of         edge in the state of Tennessee."
our nationally recognized surgeons, allow-                                                        Some of the benefits for patients include:
ing them to perform complex and delicate         • "We're better surgeons with robotic sur-        • Significantly less pain
procedures through tiny incisions. The             gery," said Geer. "The da Vinci robot mag-      • Less blood loss
smaller entry points mean less scarring and        nifies our ability to see by 14 times and       • Less scarring
faster recovery times for patients, all while      puts it in a full 3-D aspect, and we can        • Shorter recovery times
still receiving the highest level of care at       actually do a better job robotically than       • A faster return to normal daily activities
Cookeville Regional.                               we can with the patient open."                  • In many cases, better clinical outcomes

          For more information about CRMC's robotic and minimally invasive surgical options, visit CRMCHealth.org.




   2 The Cancer Program at Cookeville Regional Medical Center | 2011
      he Putnam County Family YMCA, in conjunc-
T     tion with Cookeville Regional Medical Center,
is proud to be able to offer the After Breast Cancer®
(ABC) Outreach Program. Funded entirely by grants
and the YMCA’s Annual Giving Campaign, the pro-
gram is open to anyone in the Upper Cumberland
who has had a diagnosis of breast cancer.




   ABC Program Helps
   Breast Cancer Survivors
   Return to Fitness
  The ABC Program includes:
   • Free 16-week membership to the YMCA,
     including unlimited use of all facilities,
     equipment and classes
   • Eight sessions with a Pink Ribbon Certified              A breast cancer survivor works out with the help of a Pink Ribbon Certified Trainer through the Putnam
                                                              County YMCA’s After Breast Cancer Outreach Program.
     personal trainer
   • Four consultations with a registered dietitian
   • Lymphedema education and screening by a                 “Some may have issues with range of motion, so we             this program, and we're going to continue raising money
     physical therapist specializing in lymphedema           know that, because of surgery, they may not be able to        until we can offer this program to everyone in the Upper
   • Monthly educational meetings addressing a               put their arms straight up at 180 degrees — they may          Cumberland who has had breast cancer.”
     variety of topics from local experts and provid-        only be able to go up to 90 degrees,” said Maxwell. “So
     ing social support for survivors                        it's up to us to help them get their range of motion back.”   Maxwell has a special passion for the program because
                                                                                                                           she saw her mother deal with breast cancer and its
                                                                                                                           effects when she was a child.

The YMCA has partnered with the hospital to help
                                                               “... I know what they have gone                             “Going through all of this and knowing that we were
with nutritional consultations and provide a lym-                 through physically, and now                              going to bring this program on board, I started asking a
phedema specialist. In addition, three staff members                                                                       lot of questions and am starting to understand what
at the Putnam County YMCA have become Pink                      I’m able to understand which                               she went through,” she said. “So I'm very passionate
Ribbon Certified Trainers.                                                                                                 about this program, and we just want to help women
                                                                  exercises will help them and                             after surgery to have hope.”
“I've gotten training to learn about the different surger-
ies and what kinds of things happen after surgery and              which they need to avoid.”                              For more information about the After Breast Cancer
reconstruction,” said Kendall Maxwell, wellness and                                                                        Outreach Program, call the Putnam County YMCA
group fitness director at the Putnam County YMCA.                                                                          at (931) 528-1133, or visit ABC.YMCAMidTN.org.
“I might not know what these women are going through         The ABC Outreach Program was started 10 years
mentally, but I know what they have gone through phys-       ago at Cool Springs YMCA in Nashville by a breast
ically, and now I’m able to understand which exercises       cancer survivor who saw the need for a program that
will help them and which they need to avoid.”                gave breast cancer patients guidance about what to
                                                             do after surgery and treatment.
Patients can begin immediately before surgery to learn
post-surgery, range-of-motion exercises; immediately after   “Now it's at about six YMCAs in the Middle Tennessee
surgery for help with range-of-motion exercises; and after   area, and we felt that this was a big need, not just in
chemotherapy to help regain energy levels more quickly       Putnam County, but the Upper Cumberland,” said
and learn proper techniques for strength training.           Maxwell. “So we have been raising money to help fund




                                                                                                       The Cancer Program at Cookeville Regional Medical Center | 2011 3
                                                    Melanoma —
                                                    Is One of the Most Prevalent
                                                    and Preventable —Types of Cancer
                                                                           hile the incidence of breast and colon cancers has been found to be
                                                                    W      decreasing in recent years, there has been a great upswing in the rates
                                                                    of melanoma, the potentially fatal form of skin cancer.



                                                                                 “The number of people at
                                                                                risk is much higher than for
                                                                                 breast or colon cancer...”

                                                                    “Between 1992 and 2004, there was a 45-percent increase in the number of
                                                                    cases of melanoma,” said Dr. Venumadhav Kotla, an oncologist at CRMC.
                                                                    “The number of people at risk is much higher than for breast or colon cancer.
                                         Dr. Venumadhav Kotla       You're talking about a one in 34 lifetime risk.”




Focus Study: Melanoma Cancer
 According to the American Cancer Society, 70,230 new cases of melanoma will occur in the U.S. during 2011, with 1,800 of those being in Tennessee.
 Roughly 5 percent of all cancers diagnosed are melanoma of the skin and can be diagnosed in any area of the body. Men and women are diagnosed
 equally until around age 65, at which time the diagnosis rate doubles for men.*


Risk Factors                                                        Survival Rates
 • Ultraviolet (UV) light exposure                                  Survival rates for melanoma depend on the stage of cancer at diagnosis. Staging of cancer
 • Moles                                                            details the extent of the cancer in the body. Factors determining the stage include the size
 • Family history of melanoma                                       of the tumor, involvement of nodes, noninvasive or invasive cancer, and if it has spread to
 • Fair skin, freckling, and light hair color                       other areas in the body. Staging plays a vital role in a patient’s prognosis and treatment
Signs & Symptoms                                                    planning. The lower the stage number, the less the cancer has spread. A higher number,
 • Moles with a change in asymmetry, border, color, or diameter     such as Stage 4, means a more serious or advanced cancer. Over 80 percent of melanoma
                                                                    cancer is diagnosed at a localized stage with survival rates as high as 90 percent. Cases that
Diagnostic Evaluation                                               are diagnosed at a regional stage have a survival rate of 62 percent, with a survival rate of
 • Skin exam by a health care provider                              16 percent for late stage. ^Nationally, 70 percent of melanoma diagnosed is at an early
Treatment Options                                                   stage with a 90 percent survival rate, and locally, over 50 percent are diagnosed early with
 • Surgery                                                          an 88 percent survival rate.
 • Chemotherapy
 • Radiation                                                        *Source: American Cancer Society- www.cancer.org
 • Immunotherapy                                                    ^Source: National Cancer Data Base, Commission on Cancer, American College of Surgeons




4 The Cancer Program at Cookeville Regional Medical Center | 2011
Here are some skin cancer statistics:                   Here are some of the ways you can prevent harm-
 • Almost all skin cancers are related to UV            ful sun exposure:
   exposure.
 • Two million people are diagnosed with skin            • Get a sunscreen of at least 15 SPF that blocks
                                                                                                                       The ABCDEs
   cancer each year.                                       both UVA and UVB rays and has been
                                                                                                                              of Melanoma
 • Almost 75 percent of the cancer deaths from             endorsed by the American Academy of
   skin cancer are caused by melanoma.                     Dermatology (AAD).
 • Melanoma accounts for nearly 8,000 deaths             • Apply sunscreen 15 to 30 minutes before you              How can you tell if a mole
   per year, which translates to one every hour.           go into the sun, and don’t rub it in too much,           is a cause for concern?
 • At least 70 to 80 percent of skin cancers are           or it will lose effectiveness. Be sure to apply it
   preventable.                                            to overlooked parts of the body, like the ears,
                                                                                                                    Follow these guidelines:
 • Ninety-five percent of skin cancers are treat-          backs of the hands and neck.
   able if caught early.
 • Only 30-40 percent of people use sunscreen
                                                         • Reapply sunscreen as needed based on the
                                                           SPF and the amount of time you will be out-              Asymmetrythe other half.
                                                                                                                    One half is unlike
   the way they should, or at all.                         side. If you’ll be in the water, use a waterproof
 • Having five or more sunburns in your lifetime           sunscreen and reapply every hour or two.
   increases your risk of developing melanoma.           • Don't forget to apply sunscreen to the lips.
                                                         • When possible, cover up by wearing long
                                                                                                                    Birregular, scalloped or poorly
                                                                                                                    An
                                                                                                                       ORDER
There are many things that people can do to                sleeves, wide-brimmed hats and sunglasses                defined border
prevent and detect melanoma.                               with a UV rating of at least 400.

1. Determine Your Personal Risk
The first step to staying safe in the sun is under-
                                                        It’s also important to be aware of how sunscreen
                                                        works.
                                                                                                                    COLORone area to another;
                                                                                                                    Varied from
standing your personal risk, which is affected by                                                                   has shades of tan, brown, or black;
a variety of factors:                                   “What that SPF rating is telling you is how long            is sometimes white, red or blue
                                                        you can stay out in the sun before you get a sun-
 • Who you are — Race, skin complexion and              burn; it’s not saying you won't get a sunburn,” said
   eye color all influence your risk of getting         Kotla.“That means that if you have an SPF of 5,             DIAMETER greater than
                                                                                                                    Melanomas are usually
   burned. Those with lighter complexions               you can stay in the sun five times longer before you
                                                                                                                    6mm (the size of a pencil eraser) when
   usually develop a sunburn more quickly.              actually have a sunburn. So if you usually have a           diagnosed, but they can be smaller
 • Your sun tolerance — How long can you stay           sunburn after two minutes in the sun with no pro-
   in the sun before you notice a sunburn? It’s         tection, if you use an SPF of 5, you will have a sun-
   very important to know.
 • Where you live — Your area’s UV index can
                                                        burn in 10 minutes.”
                                                                                                                    EVOLVING that looks
                                                                                                                    A mole or skin lesion
   give you an idea of your level of exposure in        3. Seek Early Detection                                     different from the rest or is changing
   your geographical area and in particular             Learn what to look for to determine whether you             in size, shape or color
   weather conditions. Also, the closer to the          are developing skin cancer.
   equator you are, the greater your exposure to                                                                    • Source: American Academy of Dermatology
   ultraviolet rays.                                     • Have your physician examine your skin for
                                                           areas of concern during regular exams.
2. Practice Prevention                                   • Do monthly self-exams using a mirror to see
When you get exposed to ultraviolet light, there           the back of the body and checking easily for-
is no part of the body that gets spared.                   gotten areas like the scalp, underarms, ears and     “People today are more aware of the problem of
                                                           back of the neck.                                    melanoma and are more keen to finding out if they
“The skin under the clothes gets exposed, and there      • If you notice changes that you aren’t sure           have it, so they probably examine themselves and
are a lot of parts that you don't think of automati-       about, use the ABCDE scale as a guideline.           have suspicious spots checked out more than they
cally that get exposed, like the ears and the tops of      If you’re still concerned, see a dermatologist       did before,” said Kotla.“The motivating factor is
the hands and back of the neck,” said Kotla. “And          or your physician.                                   that you can prevent it, because 95 percent of these
even the eyes, when they get exposed to ultraviolet                                                             cancers are treatable.”
rays, can form melanoma.”




                                                                                              The Cancer Program at Cookeville Regional Medical Center | 2011 5
                                                                     Life After Lung Cancer:
                                                                     Doug McBroom Enjoys Easy Recovery
                                                                     From Minimally Invasive Surgery




        hen Doug McBroom went to get a rou-                Because they caught it early, the tumor only         “I had never had any kind of surgery, and I was
W       tine physical from his physician, Dr. Brad
Seitzinger, he wasn't prepared for what he found
                                                           measured 3 cm and was at Stage 1, which
                                                           meant it was still small enough to remove sur-
                                                                                                                nervous about it from what I had heard about
                                                                                                                how they have to cut through all the muscles and
out. Because McBroom had smoked for many                   gically. However, McBroom was dreading the           ribs,” said McBroom.
years, Seitzinger ordered an X-ray and found a             surgery because he had heard about the pain
“shadow.” Further testing found that the shadow            and long recovery time involved with tradi-          Then he learned that his lung specialist, Dr.
was actually a malignant tumor on McBroom’s                tional lung surgery.                                 Timothy Powell, a thoracic surgeon at CRMC,
left lung.                                                                                                      was going to perform the minimally invasive



   A Team Approach: Cookeville Regional Provides the Full Spectrum of Treatment for Lung Cancer
   When it comes to diagnosing and treating lung           and will also include the involvement of his/her    • Advanced imaging studies including PET/CT
   cancer, Cookeville Regional Medical Center offers       primary care doctor.                                  scanning
   a multidisciplinary approach with the involvement                                                           • Pulmonary rehabilitation
   of many different physicians and services. A diag-      In addition to a wide range of diagnostic servic-   • Nutrition support
   nosis of lung cancer may involve the patient being      es, services offered at Cookeville Regional for     • Spiritual support
   seen by several different specialists including a       the treatment of lung cancer include:               • Emotional support
   pulmonologist (lung specialist), thoracic surgeon,      • Thoracic surgery (including minimally invasive
   medical oncologist and/or a radiation oncologist –        and robotic procedures)                           A diagnosis of lung cancer can be a daunting and
   all of which are available at Cookeville Regional.      • Chemotherapy                                      confusing one. At Cookeville Regional, we help
   Also involved in the patient’s care are pathologists,   • Radiation therapy                                 patients fight the disease and have a better quality
   anesthesiologists and radiologists. Each patient’s      • Tomotherapy                                       of life while battling lung cancer.
   care will be individualized based on his/her needs      • Clinical trials




   6 The Cancer Program at Cookeville Regional Medical Center | 2011
                                                         Focus Study: Lung Cancer
                                                         According to the American Cancer Society, 221,130 new cases of lung cancer will occur in the U.S.
                                                         during 2011, accounting for approximately 14 percent of cancers diagnosed each year. Currently, lung
video-assisted thoracoscopic surgery (VATS) pro-         cancer rates are starting to decline in women and men, this coming after years of high occurrence rates.
cedure instead of the traditional thoracotomy.           There are mainly two types of lung cancer: small cell or non-small cell.

                                                         Risk Factors                                          • Fiber-optic examination of bronchial passage
"That made me feel a huge amount better," said
                                                         • Smoking                                             • Analysis of cells in sputum
McBroom.                                                 • Exposure to asbestos                                • Molecular markers in sputum
                                                         • Secondhand smoke                                    • Computed tomography (CT) scans
With VATS, the surgeon makes two incisions               • Radon
that are each about a centimeter long — one to                                                                 Prognostic Factors
                                                         • Genetics, which could produce
                                                                                                               • Pleural invasion
put a camera through and one to put the surgical           diagnosis at a young age
                                                                                                               • Vascular invasion
instrument through — and a third incision that
                                                         Signs & Symptoms                                      • Stage of tumor
is between six and eight centimeters long. A tra-        • Persistent cough                                    • Tumor histology
ditional thoracotomy is much more invasive, as           • Voice change                                        • Age
it involves making a large incision through the          • Chest pain
back muscles and between the patient's ribs and                                                                Treatment Options
                                                         • Blood in sputum
                                                                                                               • Surgery
then spreading the ribs apart to allow room for          • Recurrent pneumonia or bronchitis
                                                                                                               • Radiation
the doctor to work.                                      Diagnostic Evaluation                                 • Chemotherapy
                                                         • Chest X-ray                                         • Targeted therapies
   "He was back playing golf
                                                         First Course of Treatment (Data below based on 2008 year of diagnosis)
     in about four weeks"                                               Non-Small-Cell Cancer                       CRMC           Tennessee         National
                                                         Surgery Only                                                 14%              25%             21%
                                                         Radiation Only                                               16%              12%             13%
“With the traditional thoracotomy, you usually
                                                         Surgery & Chemotherapy                                       2%               5%               5%
have a lot more pain afterwards and a recovery
                                                         Radiation & Chemotherapy                                     33%              21%             21%
time of three to four months. With VATS, it’s usu-
                                                         Chemotherapy Only                                             9%              11%             13%
ally three to four weeks,” said Powell. “And the hos-
                                                         Surgery, Radiation, Chemo                                    5%               3%               3%
pital stay is usually shorter with VATS, depending
on how long the drainage tubes have to stay in.          No 1st Course of Treatment or Other 1st Course               21%              23%             24%
Typically, we bring them in for surgery on Monday                           Small-Cell Cancer                       CRMC           Tennessee         National
and they’re able to leave on Thursday.”                  Radiation Only                                               5%               6%               5%
                                                         Radiation & Chemotherapy                                     52%              36%             39%
Traditional thoracotomy patients usually require         Chemotherapy Only                                            36%              29%             30%
pain medication for three or four weeks after            No 1st Course of Treatment or Other 1st Course               7%               29%             26%
surgery, and Powell instructs them not to lift
anything heavy for at least six weeks. But after
the VATS procedure, they're allowed to return            Five-Year Survival Rates by Stage of Disease at Diagnosis
to normal activity whenever they feel ready.                   Stage of Disease              CRMC         Tennessee         National
                                                                        0                       +              +             15%
McBroom went in for surgery on a Monday and                             1                     30%            38%             44%
was able to go home on Friday.                                          2                     25%            25%             25%
                                                                        3                       9%            9%             10%
“I didn't take a single thing for pain, not even                        4                       0%            2%              2%
aspirin, and I feel really good now,” said McBroom.
                                                         Staging of cancer details the extent of the cancer in the body. Factors determining the stage include the
                                                         size of the tumor, involvement of nodes, noninvasive or invasive cancer, and if it has spread to other
“He was back playing golf in about four weeks,”
                                                         areas in the body. Staging plays a vital role in a patient’s prognosis and treatment planning. The lower
said Dr. Powell. “It would have taken at least three     the stage number, the less the cancer has spread. A higher number, such as Stage 4, means a more serious
months for someone to do that after a traditional        or advanced cancer.
thoracotomy, and generally the thoracotomy
patients require pain medication for three or four       Source: American Cancer Society- www.cancer.org
                                                         Source: National Cancer Data Base, Commission on Cancer, American College of Surgeons
weeks after surgery.”
                                                         + denotes insufficient number of cases to display survival information

Added McBroom, “It went great for me considering
what it could have been. I would have hated to not had
Dr. Powell. I feel glad that I ran into him for sure.”




                                                                                        The Cancer Program at Cookeville Regional Medical Center | 2011 7
                                                                                                                            After the tumor was successfully removed, Ratermann
                                                                                                                            underwent several rounds of chemotherapy and radiation.

                                                                                                                            “It all went really well,” said Ratermann. “All the nurses
                                                                                                                            and staff, they were super. The doctors … you couldn’t
                                                                                                                            ask for any better.”

                                                                                                                            And fortunately for Ratermann, treatments for his
                                                                                                                            type of brain cancer have recently advanced.

                                                                                                                            “It's only been in the last five to seven years that we've
                                                                          Bryan Ratermann, left, talks with                 had any chemotherapy that makes a big difference with
                                                                          his oncologist, Dr. Algis Sidrys.                 this tumor,” said Sidrys. “He's doing better than average
                                                                                                                            for this type of tumor right now.”


Brain Cancer Survivor                                                                                                       Ratermann was also fortunate to have the less aggres-
                                                                                                                            sive form of the tumor. Sidrys said he sees two or three

Shares His Story                                                                                                            patients per year with the type of tumor Ratermann
                                                                                                                            had, but he sees about one patient each month with
                                                                                                                            the more aggressive form.
     ryan Ratermann was enjoying life as normal —              Ratermann’s surgery was scheduled for two weeks
B    running his flooring business, attending church
and spending time with his wife and three daughters
                                                               after the seizure, so he went back to work until time
                                                               for his surgery.
                                                                                                                            Now, a year and a half after that big seizure, he is still
                                                                                                                            cancer free and is back at work, back at his post as
— when he was stopped in his tracks by a brain tumor                                                                        deacon of his church, and back to reading stories to
that he had no idea had been growing in his head.              “I was more in shock than anything,” he said. “I wasn’t      his girls and “hunting.”
                                                               scared of the surgery I had to have. It would have been
He had just come home from church and was reading              devastating if I hadn’t had my church family. The only       “I get out and, I want to say hunt, but I don’t really hunt
a story to his middle daughter — or thought he was             bad thing about having surgery is my speaking. I could-      — I carry a rifle around in the woods and get my exercise,”
— when a massive seizure struck.                               n’t speak for a month or two afterwards. I can speak         said Ratermann. “All of this has worked out for the best.”
                                                               now, but I have to search for words.”
“I opened up the book, and Liberty looked at me and said,
‘Dad aren’t you going to read?’ and I looked at her and fell
back. I had a grand mal seizure,” said Ratermann.
                                                                   Focus Study: Brain Cancer
He came to briefly, heard sirens, and asked his wife what          According to the American Cancer Society, 22,340 new cases of brain cancer will occur in the U.S.
was happening. She told him the ambulance was there                during 2011. The National Cancer Data Base reports the most common histology to be glioblas-
for him and that his eyes had rolled back in his head.             toma. Around 50 percent of brain cancers diagnosed fall into this category. Most brain tumors are
                                                                   diagnosed between the ages of 60-69 and affect males and females equally.^*
“I don’t even remember the trip to the hospital,” said             Signs & Symptoms                                                    Treatment Options
Ratermann. “The next thing I know, I’m being woken                 • Seizure, nausea, headache, hemiparesis                            • Surgery-Craniotomy
up by neurosurgeon Dr. Joseph Jestus, who said I had a             • Memory, neurological, or personality deficit                      • Radiation
brain tumor.”                                                                                                                          • Chemotherapy
                                                                   Diagnostic Evaluation
According to oncologist Dr. Algis Sidrys, Ratermann                • Most brain tumors are found when symptoms arise
had an anaplastic astrocytoma, a malignant tumor                    First Course of Treatment           CRMC         Tennessee       National
that measured about 2 1/2 inches in diameter.
                                                                    Surgery Only                          14%            30%           26%        Five-year survival rates
                                                                    Radiation Only                        7%             5%             4%        range from 21 percent
“Brain tumors don't usually cause a lot of problems until
                                                                    Surgery & Radiation                   14%            6%             7%        nationally to 16 percent
they start interfering with mind function,” said Sidrys.
                                                                    Surgery & Chemotherapy                 +             5%             4%        statewide. CRMC’s survival
“The typical presentation is either headaches, neurologi-
                                                                    Radiation & Chemotherapy              7%             7%             9%        rate was lower than the
cal changes that are very similar to a stroke, or seizures,
                                                                    Surgery, Radiation, Chemo             36%            26%           29%        national average.
as Mr. Ratermann had.”
                                                                    No 1st Course of Treatment            22%            21%           21%
                                                                   Data above based on 2008 year of diagnosis
                                                                   ^Source: American Cancer Society - www.cancer.org
                                                                   *Source: National Cancer Data Base, Commission on Cancer, American College of Surgeons
                                                                   + denotes insufficient number of cases to display survival information


    8 The Cancer Program at Cookeville Regional Medical Center | 2011
   Transitions Program
   Helps Cancer Survivors
   Return to Normal Life
    arbara Wheeler has been through a world of pain
B   with cancer. Her daughter was diagnosed with
breast cancer at age 34 in 2008, went through chemo
and radiation and was told she would never be able to
have children. As she was finishing her treatments in
June 2009, her father — Barbara's husband — died, and
three months later, Barbara herself was diagnosed with
breast cancer and had to have both breasts removed.

“When you have cancer, it’s a trauma, it’s a drama, it’s
every bad thing you can think of rolled up into one,” said
Barbara. “And if you allow yourself to get down and out,
you get in that rut where your mind is just thinking
about all the bad things that have happened in your life-
time, and it overshadows the good things.”

It was at that point in Barbara's journey that she dis-
covered CRMC's Cancer Transitions program, which
is designed to support, educate and empower people
with cancer in the transitional period after treatment
is over. Started with a $4,000 award from the LIVE-
STRONG® Community Impact Project, the program
includes classes and speakers on issues that survivors
face such as returning to work, fatigue, physical issues,
depression, fears, sexual issues, nutrition and finances.


    “It was uplifting, it was a learning
     process, and it jump-started me                            LIVESTRONG Program facilitator Tricia Apple, left, chats with breast cancer patient Barbara Wheeler in
                                                                the Cancer Center Healing Garden.
         on the road to recovery...”

“I went to all of the sessions because I enjoyed them,         But the most valuable part of the program for Barbara         Barbara's daughter's cancer has since returned, and
and every time I went I learned something new,” said           was learning that she was not alone in her struggles.         Barbara is taking her to treatments and helping her in
Barbara. “It was uplifting, it was a learning process,                                                                       any way she can through all of it. Fortunately, her
and it jump-started me on the road to recovery because         “I guess just listening to other people’s stories helped me   doctors have said that she will be completely cured
it seemed like I was just getting slapped down every time      to realize I wasn’t in the boat by myself,” said Barbara.     when her treatment is complete. And the strength
I turned around.”                                              “Everybody had a story, but then they also had a tri-         Barbara has gained through the Transitions program
                                                               umph story after the fact.”                                   is helping her to get through it all.
The exercise portion of the program has especially
helped Barbara with the weakness in her arms that              And now, Barbara has a triumph story of her own.              “Sometimes you just want to crawl up in a corner and
developed after her surgery.                                   Despite the fact that her daughter was told she would         lie there, but you can’t do that,” said Barbara. “You
                                                               never have children, she had twin sons in the summer          have to get up and do this and do that, and I think
“I learned to do the proper exercises because I have no        of 2010.                                                      the Cancer Transitions has helped me to do that.”
strength in my upper body,” she said. “I might try to pick
up something and it slide right through my right hand,         “For me, my little grandbabies are the triumph story,”        For more information about CRMC's Cancer
but it’s getting better. A physical therapist taught me the    said Barbara. “The ray of sunshine in all of it is those      Transitions™ program, call (931) 783-2026. To learn
right kinds of exercises to do so that I won’t hurt myself.”   two little boys.”                                             more about LIVESTRONG, visit Livestrong.org.




                                                                                                          The Cancer Program at Cookeville Regional Medical Center | 2011 9
                                                                                                                     Family Learns From Testing
                                                                                                                     Recently treated for ovarian cancer and testing
                                                                                                                     positive for the BRCA-2 mutation, Sandra
                                                                                                                     Beaty knows the pain of having a strong fami-
                                                                                                                     ly history of breast cancer that included her
                                                                                                                     mother and two sisters. Her oncologist, Dr.
                                                                                                                     Venumadhav Kotla, recommended that she


Genetic Tests Help
Cancer-Prone Patients Make Important Decisions
                                                                                                                     undergo genetic testing to help with the med-
                                                                                                                     ical management of her disease, as well as
                                                                                                                     identify if a genetic mutation is involved that
                                                                                                                     may affect her entire family.

     RMC, through its comprehensive breast               might be right for one family member might not              “Everyone that’s done it, they wanted to do it
C    program, offers genetic testing for women
thought to be at high risk for breast and ovarian
                                                         be right for another, which can lead to turmoil
                                                         and stress,” said Young.
                                                                                                                     after me and my sister had ours and tested
                                                                                                                     positive,” said Sandra.
cancers. These tests screen for mutations in the
BRCA 1 and 2 genes, because studies have found           Because of their increased risk of developing               Because she tested positive, other family
that between 7 and 10 percent of breast cancer           cancer, an aggressive approach to medical man-              members, including her daughters, elected
patients have a family history that includes a mutat-    agement is sometimes necessary for individuals              to be tested, understanding the impact it
ed gene that is inherited from the mother or father.     who carry these genetic mutations, although                 will have on their own breast and ovarian
                                                         there are several different approaches a patient            health. Each family member has a 50/50
“A woman who carries the BRCA 1 or 2 mutation            and her physician might choose.                             chance of being a carrier. Sandra feels
has a 50- to 87-percent lifetime risk of developing                                                                  blessed that one of her daughters has tested
breast cancer, as well as a 27- to 44-percent lifetime   To reduce cancer risk to its lowest possible level, a       negative. She has finished her course of
risk of developing an ovarian cancer,” said CRMC         patient might consider prophylactic surgeries such          treatment, and her PET scan currently
Breast Health Nurse Navigator Erin Young.                as bilateral mastectomy (removal of the breasts) or         shows she is cancer free.
                                                         oophorectomy (removal of the ovaries).
Genetic testing may be recommended for:                                                                              “Now I’ll just keep a close watch, and God
 • A woman with breast or ovarian cancer                 “Prophylactic mastectomy reduces the risk as much as        will get me through it and will give me the
   before the age of 50                                  90 percent or more in patients that are mutation car-       strength to deal with it if it does happen,”
 • A male with breast cancer                             riers,” said CRMC general surgeon Dr. Jeff McCarter.        said Sandra.
 • A woman of any age with both breast and               “However, prior to surgery, patients should be coun-
   ovarian cancer                                        seled regarding the impact on libido, sexual function,   A third option which can be used instead of, or in
 • A woman of any age with breast and/or                 body image, bone and cardiac health.”                    addition to, imaging involves chemo prevention.
   ovarian cancer who has one first- or second-
   degree blood relative younger than 50 with            “Removal of the ovaries at the completion of child-      “Women who do not opt for risk-reducing surgery
   breast and/or ovarian cancer                          bearing years rather than intensified screening is a     may consider surveillance and prevention with
 • A person with bilateral breast cancer                 better option to minimize risk than screening            Tamoxifen or Raloxifene,” said medical oncologist
 • A woman who has not had cancer but has                alone.The lack of success detecting an early-stage       Dr. Paul Jacquin.“Though less effective than sur-
   two or more relatives diagnosed with cancer           ovarian cancer utilizing serum CA-125 and trans-         gery, it has been shown to decrease the incidence of
   under the age of 50                                   vaginal ultrasound leads us to this decision in most     breast cancer by approximately 50 percent. As we
                                                         cases,” added gynecological surgeon Dr. Bert Geer.       learn more about genetics and genomics, we will
It is important for anyone considering testing to                                                                 continue to identify different processes that will
understand that it’s more than just a blood draw.        Another option for breast cancer screening is to         provide individual treatment plans and preven-
Genetic counseling is important to the process. A        increase surveillance by adding MRI screenings           tion strategies for our patients.”
counselor completes a detailed family history that       every six months.
shows a patient’s lifetime risk for many types of                                                                 “Regardless of family history, women should have
cancer, not just breast and ovarian, and might rec-      “Increased surveillance in BRCA-positive patients is     annual mammograms after the age of 40, be famil-
ommend other types of tests besides the BRCA 1           proving to be of considerable benefit in the early       iar with the look and feel of their breasts and get a
and 2. Furthermore, the genetic counselor makes          detection of subtle breast cancers,” said radiologist    good clinical breast exam annually,” said Young.
sure the patient is emotionally prepared to receive      Dr. Spencer Madell. “Due to the fact that this popu-
the information the tests will provide.                  lation tends to develop cancers at a younger age         Young is available to answer questions; do high-
                                                         when the breasts are more dense, resulting in some       risk assessments; and provide education, support
“It’s very important to understand each patient is       limitation in detection by mammography, alternat-        and informed consent along with the blood draw
in charge of her own health care. Sometimes families     ing mammography with breast MRI at six month             if deemed medically necessary by the patient’s
impose their belief systems on each other. What          intervals is rapidly becoming the standard of care.”     physician. She can be reached at (931) 783-2922.




   10 The Cancer Program at Cookeville Regional Medical Center | 2011
                                                                             Clinical Trials Offer New
                                                                             Horizons of Treatment
                                                                              Cookeville Regional has to         There are several different reasons patients typi-
                                                                              offer clinical trials to be con-   cally choose to participate in clinical trials.
                                                                              sidered an institution of high
                                                                              enough quality to be accred-       • They can take advantage of the latest treat-
                                                                              ited by the Commission on            ments when there may be no other currently
                                                                              Cancer. Also, because quali-         approved options.
                                                                              fying for cooperative or           • Trials, especially those from pharmaceutical
                                                                              pharmaceutical trials is a           companies, are often offered at no cost to
                                                                              very selective process, a            patients.
                                                                              hospital must demonstrate          • Patients have access to well-thought-out proto-
                                                                              that it can perform trials to        cols by experts from around the world.
                                                                              an exacting standard.              • Patients enjoy a more intense level of care and
                                                                                                                   are monitored much more closely than with
                                                                             "It’s a process where the phar-       standard treatments.
                                                                             maceutical company has to           • Patients can gain from the knowledge that
 CRMC oncologists Dr. Venumadhav Kotla, left,
                                                                             be satisfied with the ability of      they are helping future patients.
 and Dr. Paul Jacquin discuss clinical trials.                               a site to be able to conduct tri-
                                                                             als according to the guidelines,    Said Hilliker, "Something to keep in mind when
                                                                             and also that they meet the         you consider clinical trials is that the standard of
                                                                             criteria to pass a rigorous         care that we have today is because of the clinical
      ookeville Regional is proud to offer           inspection audit over which the FDA has oversight,"         trials of yesterday."
C     patients a wide variety of clinical trials
from the National Cancer Institute (NCI) as
                                                     said CRMC oncologist Dr. Venumadhav Kotla.

well as from the nation's leading pharmaceuti-       Trials come in four phases. Phase 1 is to deter-
cal companies.                                       mine whether a drug is safe to use on human
                                                     patients and whether it's effective for its intend-
Clinical trials are studies conducted with patients ed use. In Phase 2, there is human data, and the
to evaluate new and promising treatments that        desired blood levels and dosing are established.
have not yet been approved for use, or to test the   Phase 3 compares the treatment to the previous
use of an existing drug in a new way.                standard of care, and Phase 4 tests for side
                                                     effects on drugs that are already FDA approved.
CRMC's access to NCI trials is made possible
through an affiliation with Southwest Oncology "We on the CRMC Cancer Committee like to deal
Group (SWOG) through the University of               with Phase 2 or 3 at a minimum, and maybe a 4, so
Tennessee at Memphis. Pharmaceutical trials,         we're not really dealing with the earliest, potentially
on the other hand, are sponsored by the makers       unknown types of trials," said Dr. Paul Jacquin, an
of a drug or device that they are evaluating         oncologist at CRMC. "We tend to choose trials that
before bringing it to market.                        are applicable to our patient population who have dis-
                                                     eases for which the existing therapy is less than ideal."
"We can recruit pharmaceutical trials, or the phar-
maceutical companies come to us and present trials CRMC places the utmost importance on                          Clinical Trials Data Manager Linda Moore,
that we may be interested in," said Joy Hilliker,    patient safety and choice during clinical trials.           left, works in the lab with Clinical Trials
RN, CRMC clinical trials research coordinator.                                                                   Research Coordinator Joy Hilliker, RN.
"So then we look at our population of types of can-  "It's a situation where a patient is in control, so they
cer. Lung is our highest cancer type here, and so we get to choose to be part of it, and they always have
obviously look to have lung trials open and run-     the power to withdraw if they don't want to be part         For more information on the clinical trials pro-
ning to benefit the population."                     of it," said Kotla. "So it's very much a patient-safe-      gram at Cookeville Regional, visit our website
                                                     ty-driven, patient-centric type of clinical care."          at CRMCHealth.org.




                                                                                             The Cancer Program at Cookeville Regional Medical Center | 2011 11
Some Healing Helpers
Are of the Furry Variety
                                                                                                               Volunteer MaryDell Sommers introduces
                                                                                                               pet therapy dog Button to chemotherapy
    tudies have established that through pet-         It complements our mission to provide a therapeu-        patient David Rodak.
S   ting, touching and talking with an animal,
a patient’s blood pressure is lowered, stress is
                                                      tic, healing environment to patients fighting can-
                                                      cer,” said Lisa Bagci, Cancer Center director.         Through the sale of two small “Button books”
relieved, depression and anxiety are eased and                                                               for $5 each, the Button Fund has raised a sur-
there is a significant increase in the secretion of   The pet therapy program, in place for six years        prising amount of money.
an immunoglobulin that helps protect the body         now at CRMC, currently consists of two dogs
against germs trying to enter it.                     and their “delivery systems”: Button, with han-        “The Button Fund is there as a source of support
                                                      dler MaryDell Sommers, and Phoebe, with han-           for patient needs that are not addressed through
The power of the human-animal connection              dler Charlie Mays.                                     the multiple funding sources already in place
and the joy it creates explain why Cookeville                                                                through the CRMC Foundation,” said Sommers.
Regional is so committed to pet therapy.              Button and Phoebe warm hearts and elicit
                                                      smiles almost daily for patients in The Cancer         The funds have been used to buy nutritional
“Pet therapy allows our patients to experience the    Center’s chemotherapy infusion suite. Patients         supplements such as Boost® and Ensure® for
love and healing that only a therapy dog can bring.   get to hold and snuggle the dogs and feed them         patients who are not able to afford them, and to
                                                      treats, and occasionally the pooches will take a       meet other needs that arise that go beyond the
                                                      snooze in patients’ laps.                              coverage of other patient-help sources.

                                                      And there’s one more important way Button and          “What started as a small way of assisting with
                                                      Phoebe help patients — through the Button Fund.        patient needs in The Rehabilitation Center has
                                                                                                             become a major effort to raise funds that will
                                                      “If there's any one pursuit that I'm almost obses-     enhance the patient’s experience and add increased
                                                      sively devoted to, it's the Button Fund and what       quality to their stay,” said Sommers.
                                                      it's been able to do and what it will continue to do
                                                      as long as we're blessed with the support that we      Now that’s something to howl about!
   Therapy dog Phoebe chills out in The               get,” said Sommers.
   Cancer Center.




    12 The Cancer Program at Cookeville Regional Medical Center | 2011
Moore Earns 2011
Cancer Liaison Physician
Outstanding Performance Award
     ookeville urologist and Cancer Liaison Lee     CLPs are nominated for the award by their
C    Moore, M.D., is one of only 20 physicians in
the U.S. to receive the Commission on Cancer's
                                                    state chair, cancer committee chair, or their
                                                    facility’s registrar.
(CoC's) prestigious 2011 Outstanding Performance
Award. Each year the Cancer Liaison Program gives   The Cancer Liaison Program is composed of a
the Outstanding Performance Award to Cancer         network of 1,500 Cancer Liaison Physicians
Liaison Physicians (CLPs) who go above and          serving CoC-accredited cancer programs and
beyond the scope of their normal duties.            approximately 64 state chairs who provide leader-
                                                    ship to the CLPs in their state or region. CLPs
The Outstanding Performance Award recog-            are a required component of CoC-accredited
nizes individuals who have proven excellence        cancer programs and serve a three-year term with
in the following areas:                             eligibility to serve an unlimited number of terms.
 • Improving the quality of care delivered
   at a CoC-accredited facility                     The Commission on Cancer is composed of
 • Contributing to the accreditation status         Fellows of the American College of Surgeons              Dr. Lee S. Moore
   of the cancer program                            and other members representing 36 national
 • Exceeding CLP expectations to strengthen         cancer-related organizations. The Commission          for cancer registry data collection used by all
   the cancer program                               on Cancer tracks national, regional and local         approved cancer programs and conducts national
 • Demonstrating cancer-control leadership          cancer-care patterns and trends through the           quality management and improvement studies
   in the community                                 National Cancer Data Base, another joint proj-        for specific cancer sites. Results of these studies
 • Serving as a champion and role model for         ect with the American Cancer Society. In addi-        are used by cancer program leadership to moni-
   other members of the cancer program team         tion, the Commission on Cancer sets standards         tor and improve patient care.




                                               Volunteers: the Heart                                     We're grateful to the following volunteers
                                                                                                         for all that they do.
                                               of The Cancer Center                                      • Joanne Sidwell           • Bonnie Green
                                               Nearly 20 volunteers dedicate their time each             • Jody Norton              • Pete Bratjan
                                               week to assist Cancer Center patients, doing              • Linda Bratjan            • Jim Mitchell
                                               everything from directing patients at the welcome         • Barbara Smith-           • Jim Decker
                                               desk to performing clerical work; making coffee;            Robinson                 • Gil Fredrick
                                               providing pillows, blankets, books and refresh-           • Diane Decker             • Lori Benassi
                                               ments; playing the harp and guitar; carving canes;        • Carol Simmons            • Judy Sullivan
                                               tending the Healing Garden; and visiting with             • Dale LoStocco            • Charlie Mays &
                                               patients who are receiving treatments.                    • Joy Mitchell               Phoebe
                                                                                                         • Gwen Ray                 • MaryDell Sommers
                                                                                                         • Jerry Hill                 & Button




CRMC Auxiliary volunteer Gwen Ray helps with patient needs in The Cancer Center.




                                                                                      The Cancer Program at Cookeville Regional Medical Center | 2011 13
In the Community
CRMC, its staff, and community partners sponsor and help support                      Free Mammogram Days
many events each year to fund research and benefit cancer patients.
                                                                                      Save Lives
                                                                                     Free Mammogram Days are held quarterly for
                                                                                     women who are uninsured or who have a high
                                                                                     insurance deductible. This year they have been
                                                                                     funded by money raised by the annual Pink
                                                                                     Ribbon of Hope Gala event and the annual
                                                                                     CRMC Golf Classic. Free Mammogram Days
                                                                                     began in 2008 with a grant from Komen Upper
                                                                                     Cumberland, and as of October 2011, more than
                                                                                     1,240 women have received free mammograms.
                                                                                     Through the program, two breast cancers and two
                                                                                     “high-risk” biopsy results have been found.




 Among the many enjoying this year's Pink Ribbon of Hope Gala are cochair Michelle
 Zellner, left, and committee member Adrienne Newson. The event, held at DelMonaco
 Winery, raised $44,000, which provided mammograms and biopsies for women who are
 either uninsured or have high deductibles.


                                                                                     Larco Sponsors Golf Classic for Ninth Year
                                                                                     For the third consecutive year, Larco Medical,
                                                                                     Inc., was this year’s presenting sponsor for
                                                                                     Cookeville Regional Medical Center’s ninth
                                                                                     annual Golf Classic and Celebrity Dinner. Major
                                                                                     sponsors were Journey Financial Planning/
                                                                                     Charles A. Sewell, CFP, and Turner Universal.
                                                                                     All three sponsors have been longtime support-
                                                                                     ers of the tournament. Since the tournament was
                                                                                     first organized nine years ago by a group of 10
                                                                                     hospital employees, the CRMC Golf Classic has
                                                                                     raised over $383,480 in net proceeds to assist
                                                                                     countless individuals through the Cancer Care
                                                                                     Fund, the Caring Hands Fund and the Save-A-
                                                                                     Life Mammogram Project. In the past year, 660
                                                                                     uninsured or underinsured patients have received
                                                                                     much-needed assistance totaling over $135,538
                                                                                     in direct financial aid.

                                                                                     From left, in front, Brad Simmons of Turner Universal;
                                                                                     Debbie Baker, chairperson of the 2011 Golf Classic;
   CRMC’s Relay For Life team raised more than $6,000 with their 5K run and other    CRMC CEO Dr. Menachem Langer; Randy Chaffin of
   Relay fund-raisers.                                                               Larco Medical; Charles and Cory Sewell of Journey
                                                                                     Financial; and in back, Gary Curto, executive director of
                                                                                     the CRMC Foundation; and Steve Vaughn and Richard
                                                                                     Chaffin of Larco Medical




  14 The Cancer Program at Cookeville Regional Medical Center | 2011
    KOMEN RACE                                                                                                   Susie Birdwell Davis
    CRMC had two teams in this year’s Susan G. Komen Race for                                                    enjoys one of the many
                                                                                                                 paintings that were on
    the Cure. Successful Komen events such as this race and the
                                                                                                                 display at the Lilly
    Tee It Up for the Cure golf tournament have raised more than                                                 Oncology on Canvas    SM



    $100,000 to fund life-changing and life-saving programs in the                                               Exhibition, held
    Upper Cumberland.                                                                                            October 25 at The
                                                                                                                 Cancer Center. The
                                                                                                                 show featured works by
                                                                                                                 people who have been
                                                                                                                 affected by cancer, from
                                                                                                                 the patients themselves
                                                                                                                 to their family, friends,
                                                                                                                 caregivers and health
                                                                                                                 care providers.




                                                                                    Resources:
                                                                                      Cookeville Regional Medical Center
                                                                                      (931) 528-2541 • www.crmchealth.org
                                                                                      Cookeville Regional Cancer Center
                                                                                       1-866-258-5416 • (931) 783-2497
                                                                                         Breast Health Nurse Navigator
                                                                                         Erin Young RN, BSN, CBPN-C
                                                                                    (931) 783-2922 • eyoung@crmchealth.org
                                                                                            Cancer Support Groups
                                                                                         Patricia Apple • (931) 783-2026

                                                                                          Clinical Trials Coordinator
                                                                                     Joy Hilliker RNC, BSN, OCN, CCRC
                                                                                                 (931) 783-2714
                                                                                           American Cancer Society
                                                                                     Sandy Carr, Local District Representative
                                                                                   (931) 520-7757 – Upper Cumberland Office
                                                                                        (800) 227-2345 – National Office

      SUN PATROL                                                                                 www.cancer.org
                                                                                         Susan G. Komen Foundation
                                                                                          Upper Cumberland Chapter
                                       This past summer The Cancer             (931) 303-0096 • www.komenuppercumberland.org
                                       Center at Cookeville Regional                   (877) 465-6636 – National Office
                                                                                               www.komen.org
                                       and JWC Broadcasting teamed
                                       together to promote skin can-                       National Cancer Institute
                                                                                        (800) 422-6237 • www.cancer.gov
                                       cer awareness and prevention.
                                       Every week from May to June                    Cookeville Regional Tumor Registry
                                                                                                (931) 783-2292
                                       the “JWC/CRMC Sun Patrol”
visited area lakes handing out sunscreen to boaters to remind them of              For a complete list of support groups,
the importance of prevention.                                                         go to www.crmchealth.org




                                                                        The Cancer Program at Cookeville Regional Medical Center | 2011 15
    In the News
     The CRMC Cancer Program is a frequent subject of local
     headlines. Our continued dedication to the most advanced
     cancer treatment, our high level of patient care and the
     national recognition our program receives are of great
     interest to the communities we serve.




16 The Cancer Program at Cookeville Regional Medical Center | 2011
CRMC Cancer
Patients                                                           C    ancer data on the following two pages is collected by the



       County of Residence
                                    2010                                Tumor Registry Department at Cookeville Regional and
                                                                   is submitted to the State of Tennessee Cancer Registry and to
                                                                   a national cancer database. This information is used locally
                                                                   and nationally for cancer research purposes. Data collected
                                           Pickett Co.
                                                                   includes types of cancer a patient has, along with diagnosis
 Macon Co.            Clay Co.
                                                                   and treatment outcomes.
                Jackson Co.         Overton Co.     Fentress Co.

   Smith Co.                                                                           Top Five Malignancies
                          CRMC
                          Putnam Co.

         DeKalb Co.
                              White Co.
                                                  Cumberland Co.
                                                                                                  Lung
Cannon Co.

                          Van Buren Co.
             Warren Co.

                                                                               Bladder                              Breast

    County                         Percentage
      Putnam                              38%                                      Prostate                   Colon
       White                              13%

      Overton                             10%

   Cumberland                              9%

     Fentress                              7%                             Patient Diagnosis & Treatment Patterns
      Jackson                              4%                                                                            Diagnosed at
                                                                   Diagnosed at another                                CRMC, received
                                                                    facility and received                            treatment elsewhere
      DeKalb                               3%
                                                                    treatment at CRMC
                                                                          26%                                                3%
        Clay                               3%

      Warren                               3%

       Pickett                             2%

    Van Buren                              2%

       Smith                               1%

       Macon                               1%                                                                            Diagnosed and
                                                                                                                        treated at CRMC
    All Others                             2%
                                                                                                                              71%
   Out of State                            2%




                                                                             The Cancer Program at Cookeville Regional Medical Center | 2011 17
     CRMC Cancer Cases 2010                                                                                         Proven Quality
     PRIMARY SITE                        TOTAL
                                                   M
                                                      SEX
                                                       F           0
                                                                       **AJCC STAGE GROUP
                                                                           I      II    III     IV UNK N/A
                                                                                                                    Cancer Care
ALL SITES                                  835    420 415         53     141     176    127     157 74 107          Every year, Cookeville Regional
Oral Cavity                                 25     21   4          0       3       9      5       5  3   0          Medical Center submits cancer data to
 Tongue                                     10      7   3          0       1       3      3       2  1   0
 Oropharynx                                  1      1   0          0       0       0      0       1  0   0          the National Cancer Data Base. The
 Other                                      14     13   1          0       0       1      4       7  1   1          information is reviewed for voluntary
Digestive System                           120     57  63          3      13      24     21      35 21   3
 Esophagus                                   9      6   3          0       0       3      1       4  1   0          compliance with nationally recognized
 Stomach                                    10      6   4          0       1       1      1       5  2   0          performance measures related to breast,
 Colon                                      53     19  34          2       6      14     15      11  5   0
 Rectum                                     24     13  11          1       3       2      2       3 13   0          colon and rectal cancers. CRMC con-
 Anus/Anal Canal                             1      0   1          0       0       1      0       0  0   0          tinues to excel in outcomes, once again
 Liver                                       1      0   1          0       0       0      0       0  0   1
 Pancreas                                   15      8   7          0       2       2      1      10  0   0
                                                                                                                    proving that the care residents of the
 Other                                       7      5   2          0       1       1      1       2  0   2          Upper Cumberland receive is of the
Respiratory System                         182    110 72           1      32      17     58      69  4   1          highest quality and encompasses com-
 Nasal/Sinus                                 5      3   2          0       2       0      0       3  0   0
 Larynx                                     14     11   3          1       6       2      2       3  0   0          mitment from many dedicated specialty
 Lung/Bronchus                             159     94  65          0      23      14     55      63  4   0          medical and clinical staff members.
 Other                                       4      2   2          0       1       1      1       0  0   1
Blood & Bone Marrow                         56    24 32            0       0       0      0       0  0 56
 Leukemia                                   27     13  14          0       0       0      0       0  0  27                PERFORMANCE MEASURE
 Multiple Myeloma                           12      5   7          0       0       0      0       0  0  12
 Other                                      17      6  11          0       0       0      0       0  0  17
Bone                                         2      1   1          0               0      0       0  2   0          Breast Cancer - Radiation therapy
                                                                          0                                                                             CRMC 98%
Connect/Soft Tissue                          4      2   2          0      0        1      2       0  0   1          is administered within 1 year of
Skin                                         6      5   1          0       0       0      0       2  4   0          diagnosis for women under age 70 TN      86%
 Melanoma                                    4      3   1          0       0       0      0       2  2   0          receiving breast-conserving surgery
                                                                                                                                                        US   86%
 Other                                       2      2   0          0       0       0      0       0  2   0          for breast cancer
Breast                                     142      1 141         27      46      44     10       8  7   0
Female Genital                              31      0  31         0       10       3      5       8  5   0          Breast Cancer - Combination
 Cervix Uteri                               11      0  11          0       4       3      1       3  0   0          chemotherapy is considered or
 Corpus Uteri                               12      0  12          0       6       0      3       1  2   0                                            CRMC 100%
                                                                                                                    administered within 4 months of
 Ovary                                       6      0   6          0       0       0      1       4  1   0
 Vulva                                       1      0   1          0       0       0      0       0  1   0          diagnosis for women under 70 with TN   83%
 Other                                       1      0   1          0       0       0      0       0  1   0          AJCC T1c N0 M0 or Stage II or
                                                                                                                                                      US   87%
Male Genital                                95     95   0          1       8      63      8       2 13   0          III ERA- and PRA-negative breast
 Prostate                                   90     90   0          0       6      63      8       2 11   0          cancer
 Testis                                      3      3   0          0       2       0      0       0  1   0          Breast Cancer - Tamoxifen or a
 Other                                       2      2   0          1       0       0      0       0  1   0          third generation aromatase inhibitor
Urinary System                              69     53  16         21      20      10      5       5  8   0                                               CRMC 94%
                                                                                                                    is considered or administered within
 Bladder                                    44     36   8         19      10       7      3       2  3   0
                                                                                                                    1 year of diagnosis for women with TN     76%
 Kidney/Renal                               23     15   8          0      10       3      2       3  5   0
                                                                                                                    AJCC T1c N0 M0 or Stage II or III
 Other                                       2      2   0          2       0       0      0       0  0   0                                               US   80%
Brain & CNS                                 21     10  11          0       0       0      0       0  0  21          ERA- and/or PRA-positive breast
 Brain (Benign)                              2      2   0          0       0       0      0       0  0   2          cancer
 Brain (Malignant)                          13      7   6          0       0       0      0       0  0  13          Colon Cancer - Adjuvant
 Other                                       6      1   5          0       0       0      0       0  0   6          chemotherapy is considered or
Endocrine                                   17      8   9          0       6       2      0       3  2   4                                              CRMC 100%
                                                                                                                    administered within 4 months
 Thyroid                                    13      6   7          0       6       2      0       3  2   0          of diagnosis for patients under the TN   75%
 Other                                       4      2   2          0       0       0      0       0  0   4          age of 80 with AJCC Stage III
Lymphatic System                            42     22  20          0       5       8     11      12  6   0                                              US   88%
                                                                                                                    (lymph-node positive) colon
 Hodgkin’s Disease                           6      3   3          0       0       3      3       0  0   0
 Non-Hodgkin’s                              36     19  17          0       5       5      8      12  6   0          cancer
Unknown Primary                             19     10   9          0       0       0      0       0  0  19          Rectal Cancer - Radiation therapy
Other/Ill-Defined                            4      1   3          0       0       0      0       3  0   1          is considered or administered
                                                                                                                                                         CRMC 100%
                                                                                                                    within 6 months of diagnosis for
** AJCC Staging details the extent of cancer in the body. Staging plays a vital role in a patient’s prognosis and
treatment planning. The lower the stage number, the less cancer has spread. A higher number reflects a more         patients under the age of 80 with TN      90%
serious extent of disease.                                                                                          clinical or pathologic AJCC T4
                                                                                                                                                         US   89%
                                                                                                                    N0 M0 or Stage III receiving
                                                                                                                    surgical resection for rectal cancer




   18 The Cancer Program at Cookeville Regional Medical Center | 2011
                                                                                                      Cancer
  In an effort to provide the best care to patients of the Upper Cumberland,
      several physicians go above and beyond their level of responsibility.
                                                                                                     Committee
                                                                                                All the members of the Cancer Committee work
    Through their dedication to both the patient and the disease of cancer,                      collaboratively to manage the CRMC Cancer
        we are able to offer the highest level of cancer care in the region.                     Program. The success of the program depends
                                                                                                     upon the effectiveness of this committee.
A very special “thank you” goes to the physicians that take time from                            The committee is responsible for goal setting,
     their busy schedules to present cases at cancer conferences.                               planning, initiating, implementing, evaluating
                                                                                                        and improving all cancer-related
                                                                                                              activities for CRMC.
        Dr. Jonas Sidrys                    Dr. Mark Kriskovich
        Dr. Paul Jacquin                    Dr. Scott Keith
        Dr. Algis Sidrys
        Dr. Venumadhav Kotla
                                            Dr. Grant Rohman
                                            Dr. Thomas Lawrence                                            Members
                                                                                            Jonas Sidrys M.D., Cancer Committee Chairman,
        Dr. Lee Moore                       Dr. Bronn Rayne
        Dr. Scott Copeland                  Dr. Charles Jordan                              Radiation Oncology
        Dr. Joseph Jestus                   Dr. Bernadette Hee                              Lee Moore M.D., Physician Liaison, Cancer
        Dr. Jason Nolan                     Dr. Todd Chapman                                Committee, Urology
        Dr. Sam Glasgow                     Dr. Lewis Wilson                                Jeff McCarter M.D., Vascular/General Surgery
        Dr. Sam Kincaid                     Dr. Quinton Cancel                              Algis Sidrys M.D., Medical Director of Cancer
        Dr. Glenn Hall                      Dr. Harry Stuber                                Center, Radiation Oncology/Medical Oncology
        Dr. Tim Collins (pathology)         Dr. Richard Scott Hall                          Paul Jacquin M.D., Medical Oncology
        Dr. Josue Montanez                  Dr. Dale Douglas                                Venumadhav Kotla M.D., Medical Oncology
        Dr. Ginny Charnock                  Dr. Richard Courtney                            Josue Montanez M.D., Radiology
        Dr. Spencer Madell                                                                  Jason Nolan M.D., Pathology
                                                                                            Harry Stuber M.D., Gynecology
                                                                                            Patricia Craig RN, Nurse Practitioner, Cancer Center
                  Thank you for giving your time                                            Rhonda Crouch, Oncology Billing Manager
              and participating in cancer conferences!                                      Bruce Elswick BS, Rhb, Director of
                                                                                            Rehabilitation/Sports Medicine
                                                                                            Eileen Stuber, Susan G. Komen Foundation,
                                                                                            President-Upper Cumberland Affiliate
                                                                                            Ellen Casey RN, OCN, Medical Oncology Nurse
                                                                                            Coordinator

                  Thank You!                                                                Erin Young RN, BSN, CBPN-C, Breast Health
                                                                                            Nurse Navigator
                                                                                            Ivan Cordrey Ph.D., Medical Physicist
                                                                                            Jennifer Jones Bertram MS, RD, LDN, Oncology
       A special “thank you” to the people who work behind the scenes                       Dietitian
                   to help make our tumor boards a success!                                 Joy Hilliker RNC, BSN, OCN, CCRC, Clinical
                                                                                            Trials Coordinator
                    Carol Ann Rudd, Cookeville Pathology                                    Lisa Bagci BS, RHIA, CTR, Director, Cancer Center
                 Ali Bagci, Radiology Department at CRMC                                    Lynda Richardson, Quality Department
     Joellen Stafford and Patti Qualls, Radiology Department at CRMC                        Buffy Key, Director, Quality Management
         Crystal Garrett, Upper Cumberland Otolaryngology Clinic                            Melahn Finley, Director of Marketing and Public
           Brenda Turnage, Upper Cumberland Surgical Associates                             Relations
           Nina Richardson, Upper Cumberland Urology Associates                             Patricia Apple CMSW, Oncology Social Worker
             Brian Hardin, Middle Tennessee Surgical Specialists                            Rita Phillips RN, Radiation Oncology Nurse
                                                                                            Coordinator
                AUXILIARY VOLUNTEERS at CRMC!!!                                             Sandy Carr MPA, American Cancer Society
                                                                                            Sharon Lee RN, Women’s Center Nurse Educator
A VERY SPECIAL “thank you” to Amy Sullivan in the Education Department                      Stephanie Miller, Vice President of Ancillary Services
              and Judy Phillips, Catering Supervisor!!                                      Susie Davis BS, RHIT, CTR, Oncology Data
                                                                                            Research Coordinator
                                                                                            Syd Byrd RN, Nursing Director, Medical/Oncology Unit
                                                                                            Wanda Richardson RN, Community Relations
                                                                                            Thirman Bulluck, Clergy




                                                                               The Cancer Program at Cookeville Regional Medical Center | 2011 19
                                                                                                                                        PRSRT STD
                                                                                                                                       U.S. Postage
                                                                                                                                          PAID
                                                                                                                                      Permit No. 94
                                                                                                                                      Cookeville, TN
     One Medical Center Blvd.
     Cookeville, TN 38501
     931-528-2541
     www.crmchealth.org




Supportive Services Offered:
After diagnosis and treatment, sometimes a patient needs support from others who are
knowledgeable of their needs and can answer questions and give guidance. CRMC offers a
wide range of support groups and employs a full-time Breast Health Nurse Navigator, Social
Workers and Registered Dietitian dedicated to patients in The Cancer Center.

• Breast Health Nurse Navigator                                              • Quit 4 Life: Free
• Oncology Dietitian                                                           smoking-cessation
• Oncology Social Workers                                                      classes that meet
• Pastoral Services                                                            weekly and are
• Reference Library                                                            highly successful at        Dr. Jonas Sidrys reviews a patient file with
• Hospice                                                                      helping people quit         Brooke Ryan, RN.
• Susan G. Komen Foundation: A nonprofit that provides education               smoking
  and support for patients diagnosed with breast cancer                      • Let’s Quit: Classes for adolescents that discuss the importance of not
• Women’s Wednesday: Programs offered by The Women’s Center                    smoking and the dangers of secondhand smoke
  that discuss breast cancer, skin cancer and other related topics           • Vitality Survivors Boutique: A store that offers specialty items for
• Us Too: A support group that helps local prostate cancer patients            cancer patients such as wigs, clothing and accessories
  and their caregivers                                                       • CLIMB Children’s Support Group: A supportive network for children
• Look Good...Feel Better: A program sponsored by the American                 who have had a family member diagnosed with cancer
  Cancer Society and other agencies that focuses on appearance-related       • Multiple Myeloma Support Group: A monthly support group for
  changes due to cancer treatment                                              patients with multiple myeloma
• Health Fairs: Cancer screening and prevention programs offered at          • Grief Share Support Group: A group for adults hurting from the death
  several health fairs each year                                               of a loved one
• Circle of Hope: A support group for patients who are diagnosed with        • Cancer Transitions: A LIVESTRONG-supported program that offers
  any type of cancer, and their families                                       support, education and empowerment to people with cancer in the tran-
• Reach to Recovery: A program that helps patients cope with breast cancer     sitional period after treatment is over
  by arranging visits between survivors and newly diagnosed patients
• Breast Cancer Support Group: An emotional and educational support
  group for women with breast cancer
• Journey™ to Breast Health: A program to help women navigate the
  path to health and healing




                                                                                  1 Medical Center Blvd. • Cookeville, TN 38501 • crmchealth.org

				
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