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Rush Cancer Annual Report 2013

VIEWS: 40 PAGES: 28

									ThoUghTfUl Medicine
   2013 Rush University Cancer Center Annual Report
On the cover (clockwise from top left): Michael Liptay, MD, thoracic surgeon; Vivian Joffré, BS,
RT (R) (CT), radiology technician; Sohrab Mobarhan, MD, gastroenterologist; and Jitesh Pratap,
PhD, and Manish Tandon, PhD, researchers.

Photography by Eric Herzog, Scott Strazzante and Rush Photo Group.
                   While there are more tools than ever before,
                   we must determine which are best suited
                   for each patient. At Rush, both clinicians
                   and researchers strive to apply these tools in
                   meaningful ways to advance quality patient
                   care. It’s an approach referred to as

                   thoughtful medicine.




2 Chair’s Report                   10 Carrying the Torch: An Interview   16 Disease Site Programs
                                      With Breast oncologist
4 Thoughtful Patient Care             Melody Cobleigh, MD                19 Representative Publications

6 Thoughtful Use of Technology     14 Rush University Cancer Center      22 2012 Cancer Registry Report
                                      in Brief
8 Thoughtful Application of Data                                         25 Cancer Mortality at Rush
ChAIR’S RepoRt

                               As new technologies, innovative therapeutic options
                               and outcome data become available, the roles of cancer
                               specialists become more challenging. While there are
                               more tools than ever before, we must determine which
                               are best suited for each patient.


ThoughTful Medicine
At Rush, both clinicians and researchers strive to apply these tools in meaningful ways to advance quality patient
care. In an approach referred to as thoughtful medicine, they focus on providing the following:

•	 Fewer	unnecessary	tests	and	treatments

•	 Less	toxic	drugs

•	 Greater	access	to	care	for	underserved	populations

•	 Better	patient	experiences	and	quality	of	life

•	 Ongoing	support	for	emotional	and	physical	needs



A Mindful ApproAch To pATienT cAre, Technology, dATA And More
In this report, we take a look at our tumor 2012 registry numbers (see p. 22) as well as showcase work at Rush that
illustrates this more mindful approach and how it is applied to patient care, use of technology and application of
data.	Below	are	some	additional	examples:

expanding access: In July 2014, the Rush Radiation Therapy Center at Rush oak Park hospital opened. The center
offers	patients	in	the	near	western	suburbs	external	beam	radiation	therapy	along	with	other	treatments,	such	as	
three-dimensional conformal radiation therapy and intensity-modulated radiation therapy. These treatments are
performed by the same specialists using the same equipment as those at Rush in Chicago.
improving safety and quality: Medical oncologist philip Bonomi, Md, and his staff will soon implement
the “lean” method for improving patient safety and quality while reducing costs in The Coleman foundation
Comprehensive lung Cancer Clinic at Rush. By addressing processes step-by-step, the lean approach is designed
to enhance patient care.

Bonomi and his staff are also collaborating with pharmacy staff to develop and validate chemotherapy regimens
while standardizing supportive care agents in preparation for the implementation of the electronic oncology module
BEACON.	The	number	of	infusion	patients	has	tripled	over	the	last	six	years	and	has	increased	by	23	percent	in	the	
last year.




                                                                                                                           Cancer Annual Report 2013
Taking a lead with outcomes data: gynecologic oncologist Summer dewdney, Md, played a lead role in designing
the Society of gynecologic oncology’s new clinical outcomes registry. This is one of the first national databases to
focus on surgical gynecologic oncology, including ovarian, endometrial and cervical cancers. Rush is among the first
sites nationwide enrolling patients in the registry, which will allow hospitals to improve the quality of patient care.

Targeted approaches for prostate cancer: Ajay nehra, Md, charles McKiel, Jr., Md, and other urologists at
Rush are the first in Chicago to offer a powerful new tool for visualizing and monitoring the prostate in men who
have high prostate-specific antigen levels. The new technology fuses magnetic resonance (MR) and ultrasound
images using a tiny tracking sensor attached to an ultrasound probe. A sophisticated computer program maintains
the fusion of MR and ultrasound images, even if a patient moves. During a 20-minute outpatient procedure,                        2
physicians can more precisely obtain biopsies, rather than randomly sampling the prostate (an approach that has
                                                                                                                                 3
been in use since the 1980s).

clinical trials: Many clinicians at Rush are actively involved in research on targeted therapies, including medical
oncologists Marisa hill, Md, and John Showel, Md. hill is principal investigator in a multicenter randomized Phase
III trial of targeted radioembolization therapy (during which radioactive particles are delivered to tumors through the
bloodstream) for patients with liver metastasis from colon cancer. Showel is conducting phase III studies of a dendritic
cell immunotherapy in advanced renal cell carcinoma.



A collABorATive efforT
I would like to take this opportunity to thank the many organizations with which Rush collaborates to provide
high-quality patient care, including the Commission on Cancer of the American College of Surgeons.

In	addition,	I’d	like	to	extend	my	gratitude	to	everyone	involved	in	the	cancer	program	for	their	dedication	
and commitment to our patients. At each and every level at Rush, staff make unique contributions that raise our
standards of care.




Aidnag diaz, Md, Mph
Chair, Cancer Committee
ThoUghTfUl patient caRe




At the Rush University Cancer Center, multidisciplinary teams are
mindful of the unique complexities involved in treating cancer
patients. Clinical trials on innovative immunotherapies offer hope
for less toxic treatments. Efforts to improve access to quality care
allow more patients to have a chance for successful outcomes.
And new initiatives address short- and long-term side effects of
life-saving treatment.




Neuro-oncologist Nina A. Paleologos, MD, conducts vaccine trials at Rush.
“ The immune response is directed only against tumor cells. This spares
  patients side effects and toxic effects seen with other therapies.”
                                                                                   Nina A. Paleologos, MD, neuro-oncologist


 cloSing The gAp in BreAST cAncer SurvivAl
 While breast cancer mortality has decreased in recent years, racial disparity has increased, with black women in
 Chicago nearly 40 percent more likely to die from the disease than white women. According to research by the
 Metropolitan Chicago Breast Cancer Task force — a group co-chaired by david Ansell, Md, Mph, Rush’s chief
 medical officer — regular, high-quality mammography screening can help close this gap. Access to quality screening,
 diagnosis and treatment are considered key.

 •	 Promoting	access:	At Rush in 2013, a Susan g. Komen foundation nurse navigator offered services ranging
    from breast health education to transportation for underserved women so they could obtain high-quality
    mammograms. Janice lott-hopgood, RN, oCN, hPCRN, CBCRN, followed patients with suspicious findings
    to ensure they received prompt, quality diagnosis and treatment.




                                                                                                                                Cancer Annual Report 2013
 •	 New	space,	digital	technology:	high-quality breast imaging is available at the newly constructed Regenstein
    Breast Imaging Center at Rush, which offers a soothing environment and advanced imaging technology. Under the
    leadership of breast radiologist peter Jokich, Md, the center now features digital imaging as well as separate facilities
    for women receiving screening and diagnostic mammograms to allow care to be better tailored to the unique needs
    of each group.


 deTecTing And MAnAging Side effecTS of life-SAving TreATMenT
                                                                                                                                      4
 As more and more cancer patients are living longer, they may need support with issues related to surviving cancer,
 including managing short- and long-term effects of cancer therapies, as they transition from treatment and return                    5
 to their normal lives.

 •	 Survivor	clinics	for	leukemia	and	breast	cancer: Multidisciplinary teams led by breast oncologists Melody
 	 Cobleigh,	MD, and ruta rao, Md, and hematologist/oncologists Melissa larson, Md, and parameswaran
    venugopal, Md, work closely with advanced practice nurses (Sarah Anzevino, APN-NP; Teri Dougherty, APN-NP;
    and Allison Morin, APN-NP) to provide survivor services for patients with breast cancer and leukemia.

   Services include assessment of physical and psychosocial issues related to treatment, surveillance for recurrence,
   screening and prevention for other cancers and development of lifestyle strategies. Rush plans to open survivor
 	 clinics	for	all	of	its	cancer	programs	in	the	next	year	or	two.

 •	 Addressing	cardiac	impact:	In the new cardio-oncology clinic at Rush, Tochi M. okwuosa, do, an onco-
    cardiologist, collaborates with medical oncologists to prevent, detect and manage the effects of chemotherapies and
 	 radiation	therapy	on	the	heart,	as	well	as	to	manage	patients	with	existing	cardiac	comorbidities	so	they	can	tolerate		
    necessary treatment. Since chemotherapy- or radiation-induced cardiac problems sometimes develop years after
    successful cancer treatment, doctors at Rush encourage long-term follow-up.


 hArneSSing pATienTS’ iMMune SySTeMS
 Several investigators at Rush are evaluating vaccines and other treatments that may improve function and survival, and
 are more easily tolerated by patients.

 •	 Vaccine	trials:	Neuro-oncologist nina A. paleologos, Md, for	example,	is	principal	investigator	at	Rush	of	two		
    multicenter trials of CDX 110, a vaccine against a variant of epidermal growth factor receptor (EgfR) called EgfRvIII
 	 in	patients	with	glioblastoma	multiforme	whose	tumor	cells	overexpress	that	specific	receptor.	One	trial	is	for		
    patients with newly diagnosed tumors (ACT IV), and the other is for patients whose tumor has recurred (REACT).
    The vaccine is given with standard treatments.

   These therapies are very specific. EgfR is present on many normal tissue cells, but EgfRvIII is present only on tumor
   cells and not normal brain cells or other cells in the body. “The immune response is directed only against tumor
 	 cells,”	Paleologos	says.	“This	spares	patients	side	effects	and	toxic	effects	seen	with	other	therapies.”
ThoUghTfUl use of technology




At Rush, physicians have the latest technology at their fingertips.
But before using technology, they carefully consider which patients
can most benefit and how a particular technology can be tailored to
each patient’s needs. They pursue ways to use technology to provide
early diagnosis yet avoid unnecessary tests, prolong survival with
the highest quality of life and monitor treatment efficiently with the
fewest side effects.




Radiation oncologist David Sher, MD, MPH, and diagnostic radiologist Palmi Shah, MD, are collaborating to investigate the
use of dual energy CT to monitor the effectiveness of radiation therapy.
“ By using this technology for patients with metastatic brain cancer,
 we can focus on improving quality of life, not just prolonging it.
 We want to help our patients live better lives.”
                                                                           Aidnag Diaz, MD, MPh, radiation oncologist


 coupling Technology WiTh innovATion in lABorATory TeSTing
 Results from the National Cancer Institute’s National lung Cancer Screening Trial showed that screening high-risk patients
 for lung cancer with low-dose spiral CT reduced mortality by 20 percent relative to chest X-ray, but more than 95 percent
 of the nodules detected were not cancer. These false positives will trigger additional diagnostic procedures, which carry
 significant cost and risks.

 •	 Blood test offers promise: “A blood test being developed by biochemist Jeffrey A. Borgia, phd, at Rush could
   help greatly reduce or eliminate unnecessary invasive diagnostic tests in select patients and bring those numbers
   down,” says pulmonologist Mark A yoder, Md, who conducted follow-up studies of low-dose spiral CT at Rush.




                                                                                                                                   Cancer Annual Report 2013
 •	 Published	results:	Borgia, Yoder, thoracic surgeon Michael liptay, Md, and colleagues at Rush recently published an
    article in the Journal of Thoracic Oncology that demonstrates that their blood test is highly efficient at ruling out lung
    cancer in patients with indeterminate lung nodules. More recent refinements to the test in Rush’s laboratories have
    improved its accuracy in confirming cancer. Researchers plan to validate the test in prospective multi-institutional trials.

   In the future, the test could also be adapted to identify additional candidates who might benefit from screening
   CT but who don’t qualify under current guidelines.


 exTending QuAliTy of life Along WiTh SurvivAl
                                                                                                                                         6
 Aggressive treatment of brain metastases has been shown to increase survival time significantly in select patients.
                                                                                                                                         7
 •	 Aggressive	yet	mindful: Radiation oncologist Aidnag diaz, Md, Mph, and neurosurgeon lorenzo Muñoz,Md,
    treat eligible patients with cerebral metastasis with a combination of surgical resection followed by stereotactic
 	 radiosurgery	using	the	TrueBeam	STx	linear	accelerator.	The	treatment	is	appropriate	for	patients	with	up	to	five		
    brain lesions.

   Compared with previous stereotactic equipment, the TrueBeam provides the following according to Diaz:
   ° higher-level imaging
   ° More comfort for patients
   ° Eradication of lesions in half the time
 •	 Meaningful	results:	This allows patients to preserve brain function longer, including cognition, with few side
    effects. Diaz and Muñoz published results of their treatment in Surgical Neurology International showing treatment
    is well-tolerated and survival statistics compare favorably with national averages.


 uSing duAl-energy cT To TAilor lung cAncer TreATMenT
 Traditional CT and PET scans cannot adequately monitor treatment for lung cancer, says radiation oncologist david
 Sher, Md. That’s why he and diagnostic radiologist palmi Shah, Md, are investigating at Rush a novel use of dual-
 energy CT to monitor treatment response for stage III non-small cell lung cancer.

 •	 Measuring	blood	volume: The dual-energy CT can measure blood volume in a tumor or lymph node earlier
    in the course of treatment to see if chemotherapy and radiation are working. This potentially crucial information can
    be obtained without increasing the amount of radiation or contrast dye. Blood volume may provide information
    that will allow physicians to determine which patients are responding well and which might benefit from surgery or
    need increases in radiation or chemotherapy.

   If they find that the use of this technology can more effectively monitor responses, Sher plans to develop a
   national protocol to test it on larger numbers of patients.
ThoUghTfUl application of data




Rush is among the first medical centers in the country to use an
approach called clinical program redesign to streamline care, improve
outcomes and reduce costs. This approach combines data analysis
with multidisciplinary face-to-face discussions to drive process
changes that improve outcomes.




From left to right: Thoracic surgeons Michael Liptay, MD, and Gary Chmielewski, MD, have collaborated with others
at Rush to implement changes leading to more positive outcomes.
“We continue to ask the question: ‘ Can we do better than ourselves?’
                                                                                Michael liptay, MD, thoracic surgeon


finding WhAT WorKS And MAKing iT The STAndArd of cAre
By fine-tuning their approaches to make patient care even more efficient and effective, the care teams at Rush can get
patients on the road to recovery, out of the hospital and back to their lives as quickly and safely as possible.

•	 The	process: According to david Ansell, Md, chief medical officer at Rush, here’s how the process works:

  °		Physician-led	multidisciplinary	teams	examine	quality	metrics	to	spotlight	areas	that	need	improvement,	such		
     as complication rates and postoperative mortality.

  ° The team discusses what care processes might be changed to bring about improvement, such as removing
    catheters or beginning patient ambulation sooner.

  ° In the process, the team often decides to reduce or eliminate routine tests and procedures, such as frequent




                                                                                                                          Cancer Annual Report 2013
     blood draws, that offer no evidence of patient benefit.

  ° After implementing changes, they measure the effects, and successful processes become the new standard of
    care. The standards appear as new defaults on the order sets in the electronic medical record system.

•	 Raising	the	quality	bar: “This mindful approach to data has been used in several programs in the Rush University
   Cancer Center,” Ansell says. “It has helped us raise already high-quality care to an even higher level. And it has
	 also	reduced	costs.”	Within	the	next	few	years,	all	of	the	Rush	cancer	programs	plan	to	implement	clinical	program		
   redesign, which is part of a Rush-wide initiative.
                                                                                                                                8

ThorAcic Surgery SucceSSeS                                                                                                      9
Several programs at Rush have instituted clinical program redesign. These programs include colon and rectal surgery,
bone marrow transplant and thoracic surgery.

•	 Reducing	length	of	stay	and	mortality: length of stay and readmission rates for thoracic surgery were
   already lower than University healthSystem Consortium (UhC) averages when thoracic surgeon Michael liptay, MD,
   and his team began clinical program redesign. Even so, liptay says, “We continue to ask the question: ‘Can we do
   better than ourselves?’”
  And so the health care team decided to look at how they might improve their own numbers.

  changes:    ° Removed patients’ chest tubes on day one.
               °			When	deemed	clinically	safe,	encouraged	patients	to	walk	every	six	hours	after	surgery.
              ° Rounded sooner and more frequently with patients postoperatively to recognize and treat
                complications at an earlier, less critical stage.
  outcomes: ° length of stay in fiscal year 2013 dropped to 3.5 days, below the UhC average of five days for lobectomy.

              ° for lobectomy, they achieved the lowest postoperative mortality rate (0.7 percent) among Society
                of Thoracic Surgeons’ general thoracic surgery database participants.. The national mortality rate was
                1.4 percent.
lEgACY INTERVIEW caRRying the toRch
An interview with breast oncologist Melody Cobleigh, MD




In her years at Rush, Melody Cobleigh, MD, has played a pivotal role researching treatments that have
saved the lives of thousands of breast cancer patients. A graduate of Rush Medical College, Cobleigh
returned to Rush in 1989 to work with breast oncologist Janet Wolter, MD, who had been her mentor
during an oncology fellowship.

Along with Wolter, Cobleigh was co-investigator on the multinational trials of trastuzumab (Herceptin),
which revolutionized the treatment of breast cancer in 1998, when it became the first monoclonal
antibody to receive FDA approval.

Director of medical oncology at Rush, Cobleigh is soft-spoken and self-effacing, despite scores of
published papers demonstrating her scientific rigor in pursuit of better and gentler breast cancer
treatments, and her leadership in organizations such as the American Society of Clinical Oncology, the
Eastern Cooperative Oncology Group, and the National Surgical Adjuvant Breast and Bowel Project. She
is devoted to the patients she cares for in the clinic, who hold her in the highest regard, according to her
colleague, breast oncologist Ruta D. Rao, MD, director of The Coleman Foundation Comprehensive Breast
Cancer Cancer Clinic.

Rao recently sat down with Cobleigh, who was her mentor, to discuss Cobleigh’s medical career.

Photo caption: Medical oncologist Melody Cobleigh, MD, (left) is the Brian Piccolo Professor for Cancer Research
at Rush Medical College. She and Ruta Rao, MD, also a breast oncologist, collaborate to bring the latest cancer
therapies to patients at Rush through The Coleman Foundation Comprehensive Breast Clinic.
“It’s wonderful taking care of patients but it’s also extremely exciting to
 contribute to the body of knowledge that advances medicine.”
                                                                             Melody Cobleigh, MD, breast oncologist


 rao: It’s been my honor and pleasure to work with you as my mentor. I couldn’t have asked for a better person, and
 I’m	excited	to	have	this	opportunity	to	ask	you	some	questions.	First	of	all,	how	did	you	decide	to	choose	medicine	as	
 your career?
 Cobleigh: After I finished college, I was a graduate assistant in psychology, a job I didn’t like. And I asked myself,
 “how can I find a job that’s interesting, where I help people, make a good living, and am my own boss?” And I
 thought being a doctor is one of those jobs, so that was it. Well, actually, there’s a little more to the story. I always
 liked a TV program, “Marcus Welby, MD.” he was a general practitioner. And you never really saw him in the hospital,
 he was always sitting at someone’s house, having a cup of coffee, talking with families. And I said, “That is what I
 want to do.”




                                                                                                                             Cancer Annual Report 2013
 rao: Do you feel that the reasons that you went into it were satisfied by the career that you’ve had?
 Cobleigh: Three of the four. It’s an interesting job, I’ve helped people, and I’ve made a good living. But I’ve never
 been my own boss.

 rao: once you went into medicine, how did you decide to go into medical oncology?
 Cobleigh:	I started out wanting to be a surgeon. But I graduated from Rush Medical College mid-year, and residencies
 didn’t	start	until	summer.	The	chairman	of	medicine	said,	“We’ll	make	you	a	six	month	sub-intern,”	which	meant	
 internal medicine. And I think he knew I would get hooked on internal medicine. I realized I didn’t want to be a
 consultant, called in once or twice, but again, like Marcus Welby, I wanted to get to know the patient and family,                10
 so that made medical oncology appealing.
                                                                                                                                   11
 rao: once you became a medical oncologist, what brought you to the field of breast cancer in particular?
 Cobleigh:	Dr. Janet Wolter, (professor emerita of medicine at Rush and one of its first medical oncologists). She’s
 such a wonderful, warm person. She was kind of a female Marcus Welby. She’s just an all around good egg: a very
 intelligent person, a very kind person and a very selfless person.

 rao: So	I	think	that	leads	to	my	next	question:	Who	most	influenced	you	in	your	career?
 Cobleigh: That would be Dr. Wolter, of course. She was a superstar. Not only was she a wonderful doctor, she was
 involved in the design of some of the very first adjuvant chemotherapy trials in breast cancer. She became involved
 early on. Two national cooperative groups for clinical trials, the Eastern Cooperative oncology group (ECog) and the
 National Surgical Adjuvant Breast and Bowel Project (NSABP), which was started in 1958 by a surgeon. When Janet
 came into oncology in 1964, the initial clinical trials were mainly surgical trials: comparing mastectomy with or without
 axillary	resection,	for	instance.	She	was	there	when	these	two	groups	decided	to	collaborate.	The	meeting	was	small,	
 about a dozen when they collaborated on the first trial.
 Their biggest concern was that American and Canadian women would not accept a medication that would make their
 hair fall out. So they started with a drug l-phenylalanine mustard, or l-PAM, because it did not cause hair loss. And
 the drug turned out to significantly reduce the risk of recurrence in breast cancer patients with positive lymph nodes.

 rao: Can you tell me a little bit about how The Coleman foundation Comprehensive Breast Cancer Center came
 about?
 Cobleigh:	Yes, it was started in 1985 by Janet Wolter, and frank hendrickson, MD, who was then chairman of
 radiation oncology, and surgeon Thomas Witt, MD. Another radiation oncologist who was involved was Anantha
 Murthy, MD.
 Cancer care was becoming multidisciplinary, because chemotherapy was just starting to be administered. And they
 were talking one day and said, “We really ought to see patients together.” And Steve Economou, MD, chairman of
 surgery at the time, supported the idea. So we had the chairman of surgery and the chairman of radiation oncology
 behind the concept. And even though she wasn’t a chair, Janet was a tour de force from internal medicine.
As far we know, it was the first one in the Midwest, and it’s still a unique center. There may be places that say they
have a comprehensive center, but not everybody actually gets together as a multidisciplinary group and sees the
patient,	talks	to	and	examines	the	patient,	and	formulates	a	joint	decision,	the	way	we	do	here.	Many	of	them	are	just	
conferences, where the case is presented but the patient is not there. As you well know, seeing a patient and hearing
about a patient are two entirely different things.

rao:	I’d	like	to	talk	about	your	career.	If	you	could	pick	one,	what	would	you	say	has	been	the	most	exciting	moment	
of your career?
Cobleigh:	That would have to be when we started treating patients with herceptin, and we realized it was a breakthrough.

Cobleigh:	I	started	practice	in	1982,	the	year	that	the	first	paper	was	published	on	the	use	of	tamoxifen	as	an	
adjuvant treatment. Chemotherapy was being used, but most of the trials were negative, and we wondered if there
was ever going to be an advance. And then came herceptin.
At the time, they couldn’t get investigators interested in the early trials, because herceptin was a monoclonal antibody
that interferes with the hER2neu receptor on cells, not a typical chemotherapy drug. We were afraid those trials were
not going to be completed. Because Janet Wolter had a background in endocrinology, she understood the drug’s
potential. She was the PI for the original herceptin trials, testing it in women with metastatic breast cancer.
The response was astounding. As you know, one of the places breast cancer spreads is to the lymph nodes in the neck
and near the collarbones. Women would come in with large masses in their necks and after taking herceptin, the
masses just started “melting” almost immediately. for people who respond to herceptin either as a single agent or in
combination with chemotherapy, it’s like a “lights out” phenomenon, it’s very quick.
At the time, we were seeing patients every week. I remember patients coming into my office saying, “look, it’s shrunk
since last week.” Patients were in the treatment room, talking to each other, feeling each other’s necks. And at my
weekly	lunch	with	Janet,	I	said,	“You	know,	I	think	this	stuff	works.”	And	then	the	next	week,	she	said,	“I’ve	seen	it,	
too.” That was really something.

rao: I remember a patient who I started treating when I was a fellow. And she was close to death at our first new
patient visit with you. And I remember how, with the herceptin treatment, you basically brought her back to life within
a matter of weeks. So I can’t imagine what it must have been like when you were involved in the clinical trials. Before
you even knew if the drug was going to work or not.
Cobleigh: I remember one other patient who was very, very ill. She was in the randomized trial. And her disease was
progressing rapidly. We were able to unblind her and get her on the drug instead of the placebo she’d been taking.
She recovered, and a month later, she was scuba diving on vacation with her son.
Women got wind of the fact that this was working and wanted to try it. So the drug company actually changed the
design of the trial so that people in the control group whose disease progressed could then go on the drug if they had
been on the control arm and therefore did not get it at the beginning of their treatment in the randomized trial.

rao: That must have been amazing.
Cobleigh: Yes, it was. And another amazing thing is seeing the very long-term survivors from those original trials. In
fact, I just saw one yesterday. She’s had her 20th anniversary.
Janet and I were authors on some of those pivotal papers. I’m the co-author on the phase II trial studies published
in the Journal of Clinical Oncology in 1998. Janet was senior author of the article on the phase III trials in the New
England Journal of Medicine in 2001, which led to fDA approval.
When herceptin was approved in 1998, it was the first therapeutic antibody targeted to a specific cancer-related
molecular marker to receive fDA approval.
The	next	big	leap	was	the	adjuvant	trial.	There	was	a	frustrating	three-year	period	when	we	knew	it	was	a	great	drug,	
but the adjuvant trials were still being designed.
When	the	trials	opened,	in	2001,	we	gladly	participated.	We	had	the	experience	with	the	drug,	and	we	were	not	
afraid to use it. In 2005 the drug was finally approved as adjuvant treatment, and it cut the risk of recurrence by 50
percent compared with standard adjuvant therapy..

rao: What has been your favorite part of your job so far?
Cobleigh: I think my favorite part of my job has really been getting to know patients and their families.
rao: What has surprised you the most about working with breast cancer patients?
Cobleigh: I have been surprised and impressed by patients’ courage. And the fact that people can have so much
wrong with them and still want to press on with their normal lives. As you know, we offer to sign authorizations for
people to go on disability when they have metastatic disease and they know they’re going to die. And what do they
say? They say, “I want to keep working.”

It’s also been interesting to watch people change their lives because they realize — as we all should realize — that life
is limited. I’ve seen people who really were unhappy in their marriages get divorced. I’ve seen people get married. And
I’ve seen people change jobs. And I love seeing the little things that really come to the fore. Birthdays and graduations
and all of those things become so much more important to people when they’ve faced serious illness.

rao: I know clinical research is one of your passions. What are the most interesting or promising studies that you’re
involved in today?
Cobleigh: There’s a new and improved herceptin called TDM-1, which consists of a chemotherapy drug fused to
herceptin. I was the PI for those original trials at Rush. It has the advantage of combining the chemotherapy with
Herceptin	without	the	toxicity	of	chemotherapy.	It’s	designed	to	dissolve	cancer	cells	from	within	and	leaves	normal	cells	




                                                                                                                              Cancer Annual Report 2013
alone. So it’s meant to be very kind and gentle on the patients — we’ve observed no hair loss, no nausea, no vomiting.
It’s	exciting	because	even	HER2-positive	patients	who	had	stopped	responding	to	regular	Herceptin	respond	to	this	TDM-
1. This drug was approved by the fDA in 2013 for treatment of metastatic hER2+ breast cancer. We are fortunate to be
the only center in Chicago to study it in the adjuvant setting as part of an international study, NSABP B50-I.
There’s also an international trial called B43, under the auspices of the NSABP. It’s looking at herceptin in non-invasive
breast cancer. I’m the international PI for that trial, and we are close to our accrual goal for patients. We’ve processed
nearly 8,000 specimens at Rush for patients who’ve entered the trial.
And	I’m	excited	by	the	clinical	trial	you’re	doing,	the	one	in	which	you’re	the	principal	investigator	of	the	drug	called	
palbociclib. It could be a breakthrough in estrogen receptor- positive, hER2-negative breast cancer. As you know,
                                                                                                                                    12
when you combine this with an anti-estrogen therapy, we’re seeing huge improvements — as much as a year — in
progression-free survival in women with metastatic breast cancer. Your trial is for patients whose disease has already              13
progressed	on	one	anti-estrogen	treatment.	It’s	very,	very	exciting.	

rao: Yes, it is. What do you think are the biggest challenges facing clinical researchers today?
Cobleigh: funding is the number one. funding over the last 10 years from the National Institutes of health for clinical
cancer research — studies of new drugs in patients — has been flat. And yet the cost of conducting clinical trials has
increased with inflation and increasing regulation. That’s a huge challenge. Another challenge in breast cancer is that
we’re doing so well, we’re curing 80 percent of the people who walk in the door. But the 20 percent who recur are
the cases we need to study. To actually be able to detect a difference with new drugs, we need enormous trials. And
that’s	very	expensive.	

Another huge challenge is going to be using the information that’s coming out of the ability to sequence individual
tumors. We’re going to find that maybe only a half a percent of patients with breast cancer benefit from a particular
drug. Well, how will we develop drugs for such small groups? So there are challenges but there are also huge
opportunities.

rao: What would be your advice to younger oncologists entering the field today?
Cobleigh: I would advise young oncologists to participate in cancer research. It’s wonderful taking care of patients but
it’s	also	extremely	exciting	to	contribute	to	the	body	of	knowledge	that	advances	medicine.

rao: on a more personal note, what would be your advice to younger female physicians trying to balance work and
family life? Because I know you have been able to do that successfully.
Cobleigh: You need to have a good partner at home. That’s the key. As long as you’re a team, then it works.

rao: I have one last question. What would you like your legacy to be?
Cobleigh: I’m not planning to retire any time soon. There’s too much work to be done, as we’ve just been discussing.
But	I	guess	I’d	like	my	legacy	to	be	simply	the	next	generation	of	physicians,	like	you.	And	maybe	that	I	helped	a	few	
families through a difficult time.
RUSh UNIVERSITY CANCER CENTER in BRief

The Rush University Cancer Center comprises all cancer-                                      •	 Cancer	biology

                                                                                             •	 Clinical,	behavioral	and	translational			
related clinical, research and educational efforts at Rush,                                     research

crossing 20 departments, divisions and sections; inpatient                                   •	 Molecular	signatures	and	cancer		
                                                                                                outcomes
                                                                                                                                             	


and outpatient areas; professional clinical activities; and                                  •	 Tumor	immunology

the colleges of Rush University.                                                             infuSion cenTerS
                                                                                             Rush patients have access to three
                                                                                             infusion centers, which are staffed with
SupporT ServiceS                               •	 Survivorship	services	for	lymphoma		 	     certified,	experienced	oncology	nurses:	
                                                  and breast cancer survivors
Rush is committed to helping patients                                                        •	 Rush	University	Medical	Center	
and their families cope with cancer’s          reSidency And                                    (48 chairs) - Chicago
psychological, emotional and spiritual         felloWShip progrAMS
effects. These support services are at Rush:                                                 •	 Rush	Oak	Park	Hospital	(nine	chairs)	-		
                                               •	 Residency	in	radiation	oncology               oak Park, Ill.
•	 An	American	Cancer	Society	patient			
   navigator who meets with patients           •	 Residency	in	nuclear	medicine              •	 DuPage	Medical	Group	
   and families to provide vital support,                                                       (19 chairs) - lisle, Ill.
                                               •	 Residency	in	pharmacy
   including information about available
                                                                                             recogniTion And
   treatments, programs and community          •	 Fellowship	in	hematology/medical		 	
                                                  oncology
                                                                                             AccrediTATionS
   services
                                                                                             • Rush has received three consecutive
•	 The	Cancer	Integrative	Medicine		   	       •	 Fellowship	in	orthopedic	oncology
                                                                                               outstanding achievement awards
   Program, through which patients have                                                        from the Commission on Cancer of the
                                               •	 Fellowship	in	hospice	and	palliative		 	
   access to complementary therapies —                                                         American College of Surgeons.
                                                  medicine
   such as psychotherapy and nutritional
   counseling, massage therapy, yoga and       AdvAncing Medicine                            • The Coleman foundation Blood and
   acupuncture — that promote their            Through reSeArch                                Bone Marrow Transplantation Clinic
   well-being and help maintain their                                                          is accredited by the foundation for the
   quality of life                             The Rush University Cancer Center fosters        Accreditation of Cellular Therapy.
                                               research across four broad programs
•	 A	palliative	and	supportive	care		    	     that aim to deepen our understanding          • Rush’s pathology and clinical
   program that offers distress screening,     of cancer to better prevent, detect and         laboratories are accredited by the Joint
   pain management and many other              treat it:                                       Commission.
   services




                                               ruSh cAncer neTWorK*

                                                      rush university Medical center                dupage Medical group
                                                 1    Chicago
                                                                                               5    DuPage County

                        4
                2                                     rush oak park hospital                        riverside Medical center
                                                 2    oak Park, Ill.
                                                                                               6    Kankakee, Ill.
           5
     3
                    7                                 rush copley Medical center                    pronger Smith Medical Associates
                                                 3    Aurora, Ill.
                                                                                               7    Tinley Park, Ill.

                                                      Swedish covenant hospital                     *Sites affiliated with Rush’s cancer program
                                                4     Chicago                                       that remain separate and independent with
                    6                                                                               respect o professional judgment and liability.
 • Three times in a row, Rush has received     Rush,	which	serves	both	adults	and	children	with	
    Magnet status — the highest recognition    cancer, is home to The coleman foundation
   	for	nursing	excellence	—	from	the		    	   comprehensive clinics. in these multidisciplinary
   American Nurses Credentialing Center.       clinics, a team approach is applied to patient care.
 • The Regenstein Breast Imaging               The clinical team gathers to discuss the patient’s
   Center at Rush is an American               condition, review diagnostic tests and develop a
   College of Radiology-accredited             treatment	plan,	often	in	collaboration	with	the	
   Center	of	Excellence.	This	designation	     patient’s diagnosing physician.
   is awarded to centers that have
   received full accreditation in
                                               The comprehensive clinics are dedicated to the following:
   mammography, breast ultrasound, and
   stereotactic and ultrasound-guided          •	Blood	and	bone	marrow	transplants
   needle biopsies.




                                                                                                           Cancer Annual Report 2013
                                               •	Brain	cancer
 • The Association for the Accreditation       •	Breast	cancer
   of human Research Protection
   Programs has awarded Rush full              •	Chest	and	lung	tumors
   accreditation with distinction in           •	Gastrointestinal	cancers
   Community Programs, giving special
   recognition to Rush’s community-based       •	Gynecologic	cancers
   participatory research.                     •	Head	and	neck	cancers
 • Rush has been named among the top           •	Inherited	susceptibility	to	cancer
                                                                                                                 14
   hospitals in the country for quality,       •	Leukemia
   safety and efficiency five consecutive                                                                        15
   times by the leapfrog group, a nation-      •	Lymphoma
   al organization that promotes health        •	Melanoma	and	soft	tissue	tumors
   care safety and quality improvement.
                                               •	Multiple	myeloma
                                               •	Myelodysplastic/myeloproliferative	neoplasms
                                               •	Prostate	cancer
                                               •	Sarcomas
                                               •	Spine	tumors




 for more information about cancer
   programs at Rush or to refer a
patient for an initial visit or a second
         opinion, please call
 (312) canceR-1 (226-2371).

                                               for information about open clinical trials, visit
                                               www.rush.edu/cancerclinicaltrials.
DISEASE SITE pRogRaMs

BreAST cAncer
 BreAST cAncer                            gASTroinTeSTinAl cAncerS
                                           gASTroinTeSTinAl cAncerS                  geniTourinAry cAncerS
clinical Specialists                      clinical Specialists                      clinical Specialists
Diagnostic radiologists:                  Colorectal surgeons:                      Medical oncologists:
Anne Cardwell, MD; Carol Corbridge,       Marc Brand, MD; Bruce orkin, MD;          John Showel, MD; Nicklas Pfanzelter, MD
MD; Janice Dieschbourg, MD; Mireya        Joanne favuzza, Do
Dondalski, MD; Peter Jokich, MD; gene                                               Radiation oncologist:
Solmos, MD; lisa Stempel, MD              gastroenterologists:                      David Sher, MD, MPh; Dian Wang, MD, PhD
                                          A. Aziz Aadam, MD; Salina lee, MD;
Medical oncologists:                      John losurdo, MD; Joshua Melson, MD;      Urologists:
Melody Cobleigh, MD; Katherine            Sohrab Mobarhan, MD                       Christopher Coogan, MD; leslie Deane,
Kabaker, MD; Ruta Rao, MD;                                                          MBBS; Shahid Ekbal, MD; lev Elterman,
lydia Usha, MD                            general surgeons:                         MD; Jerome hoeksema, MD; Kalyan
                                          Daniel Deziel, MD; Minh luu, MD; Keith    latchamsetty, MD; laurence levine, MD;
Pathologists:                             Millikan, MD; Jonathan Myers, MD          Charles McKiel Jr., MD; Ajay Nehra, MD;
Paolo gattuso, MD; Ritu ghai, MD                                                    Dennis Pessis, MD
                                          Interventional radiologists:
Plastic and reconstructive specialists:   Bulent Arslan, MD; Allen T. Chen, MD;      genitourinary Tumor conference
John Cook, MD; gordon Derman, MD;         Jayesh Soni, MD; Ulku Cenk Turba, MD
                                                                                     last Tuesday of the month, 7 to 8 a.m.
george Kouris, MD; Norman Weinzweig, MD
                                          Medical oncologists:                       neurosurgery conference room 1115
Radiation oncologists:                    Mary Jo fidler, MD; Marisa hill, MD;       professional Building
Katherine griem, MD                       William leslie, MD

Surgical oncologists:                     Pathologist:                               gynecologic cAncerS
Steven Bines, MD; Kambiz Dowlatshahi,     Shriram Jakate, MD
MD; Darius francescatti, MD; John                                                   clinical Specialists
greager, MD; Alicia growney, MD;          Nephrologists:
                                          Jochen Reiser, MD; Samuel Saltzberg, MD   gynecologic oncologists:
Katherine A. Kopkash, MD; Andrea                                                    Summer Dewdney, MD; Alfred guirguis,
Madrigrano, MD; Thomas Witt, MD;          Radiation oncologist:                     Do; Jacob Rotmensch, MD;
Norman Wool, MD                           Ross Abrams, MD
                                                                                    Medical oncologist:
 Breast Tumor conference                  Radiologist:                              lydia Usha, MD
 Mondays, 4 to 5 p.m.                     John hibbeln, MD
                                                                                    Pathologists:
 Janet Wolter, Md, clinical and
                                          Thoracic surgeons:                        Pincas Bitterman, MD; Ritu ghai, MD
  educational conference room
                                          gary Chmielewski, MD; Michael liptay,
 1010 professional Building                                                         Radiation oncologist:
                                          MD; Christopher W. Seder, MD; William
                                          Warren, MD                                Jessica Zhou, MD

 endocrine cAncerS
endocrine cAncerS                         Transplant hepatologists:                  gynecologic Tumor conference
                                          Eric Cohen, MD; Sheila Eswaran, MD;        fridays, 7 to 8 a.m.
clinical Specialists                      Nikunj N. Shah, MD                         pathology conference room
Endocrine surgeon:                                                                   562 Jelke Building
                                          Transplant surgeons:
Katy heiden, MD
                                          Edie Chan, MD, Sameh fayek, MD;
Endocrinologists:                         Martin hertl, MD; Edward hollinger,
David Baldwin, MD; Tiffany hor, MD;       MD, PhD; Stephen Jensik, MD; Dolamu        heAd And necK cAncerS
Brian Kim, MD; Chung Kay Koh, MD;         olaitan, MD
                                                                                    clinical Specialists
Sirimon Reutrakul, MD; Kristina
Todorova-Koteva, MD                        gastrointestinal Tumor conference        Medical oncologists:
                                           Tuesdays, 12:30 to 1:30 p.m.             Mary Jo fidler, MD; John Showel, MD
 endocrine Tumor conference                Janet Wolter, Md, clinical and
                                                                                    Neurosurgeons:
 Wednesdays (location varies                educational conference room
                                                                                    Richard Byrne, MD; Roham Moftakhar,
 each month), 8 to 9 a.m.                  1010 professional Building
                                                                                    MD; lorenzo Muñoz, MD
 250 professional Building
   for more information about cancer programs at Rush or to refer a patient for an initial visit
                    or a second opinion, please call (312) canceR-1 (226-2371).



Neuroradiologist:                          Radiologists:
Miral Jhaveri, MD                          Amjad Ali, MD; David Turner, MD             lung and Thoracic conference
                                                                                       Thursdays, 10 to 11 a.m.
Neurotologist:                             Stem cell transplantation specialists:      Janet Wolter, Md, clinical and
R. Mark Wiet, MD                           John Maciejewski, MD, PhD; Sunita            educational conference room
                                           Nathan, MD                                  1010 professional Building
otorhinolaryngologists/head and            for a listing of pediatric hematologist/
neck surgeons:                             oncologists, go to p. 18.
Samer Al-Khudari, MD; Joseph Allegretti,
MD; Pete Batra, MD; David Caldarelli,       hematologic cancer conferences            MelAnoMA And
MD; Paul J. Jones, MD; Phillip loSavio,                                               cuTAneouS cAncerS
                                            lymphoma
MD; Andrew lerrick, MD; Thomas              Thursdays, 8 to 9 a.m.                    clinical Specialists
Nielsen, MD
                                            leukemia                                  Dermatologists:
Plastic and reconstructive specialist:      Mondays, 1 to 2 p.m.                      Jeffrey Altman, MD; lady Dy, MD; James




                                                                                                                               Cancer Annual Report 2013
gordon Derman, MD; george Kouris, MD                                                  Ertle, MD; Sheetal Mehta, MD; Marianne
                                            Myelodysplasia/Myeloproliferative         o’Donoghue, MD; Warren Piette, MD;
Radiation oncologists:                      disorders                                 Arthur Rhodes, MD, MPh; Michael
Aidnag Diaz, MD, MPh; David Sher, MD,       Alternate fridays, 9 to 10 a.m.           Tharp, MD
MPh
                                            Multiple Myeloma                          Dermatopathologist:
 head and neck Tumor conference             Alternate fridays, 8 to 9 a.m.            lady Dy, MD; Vijaya Reddy, MD
 first and third Wednesdays,
                                            All conferences are held in the Janet     Diagnostic radiologist:
 7 to 8 a.m.
                                            Wolter, Md, clinical and educational      Joy Sclamberg, MD
 Janet Wolter, Md, clinical and                                                                                                      16
                                            conference room, 1010 professional
  educational conference room
                                            Building.                                 Immunologists:
 1010 professional Building                                                                                                          17
                                                                                      Amanda Marzo, PhD; Carl Ruby, PhD;
                                                                                      Andrew Zloza, MD, PhD
                                            lung And ThorAcic cAncerS                 Medical oncologist:
 heMATologic cAncerS
                                                                                      Nicklas Pfanzelter, MD
                                           clinical Specialists
clinical Specialists
                                           Medical oncologists:                       Neurosurgeon:
Dermatologist:                             Marta Batus, MD; Philip Bonomi, MD;        lorenzo Muñoz, MD
Warren Piette, MD                          Mary Jo fidler, MD
                                                                                      ophthalmologists:
geneticist:                                Pathologists:                              Adam Cohen, MD; Tamara fountain, MD
Wei-Tong hsu, MD                           Paola gattuso, MD; Rita ghai, MD;
                                                                                      Plastic and reconstructive surgeon:
hematologist/oncologists:                  Mark Pool, MD
                                                                                      gordon Derman, MD
lisa Boggio, MD; Sefer gezer, MD;          Pulmonary and critical care medicine
Stephanie gregory, MD; Reem Karmali,                                                  Radiation oncologists:
                                           specialists:
MD; Melissa larson, MD; Agne Paner,                                                   Ross Abrams, MD
                                           Robert Balk, MD; Elaine Chen, MD;
MD; Jamile Shammo, MD; Parameswaran        Michael Silver, MD; Betty Tran, MD, MS;    Stem cell transplantation specialists:
Venugopal, MD                              Mark Yoder, MD                             John Maciejewski, MD, PhD; Sunita
hematopathologists:                                                                   Nathan, MD
                                           Radiation oncologist:
Jerome loew, MD; Brett Mahon, MD;          David Sher, MD, MPh                        Surgical oncologists:
Ira Miller, MD
                                                                                      Steven Bines, MD; Keith Monson, MD
                                           Thoracic radiologist:
Radiation oncologist:                      Palmi Shah, MD
Ross Abrams, MD
                                           Thoracic surgeons:
                                           gary Chmielewski, MD; Michael liptay,
                                           MD; Christopher Seder, MD; William
                                           Warren, MD
 neurologicAl cAncerS                        pediATric cAncerS                        SArcoMAS And SofT
                                                                                      TiSSue TuMorS
clinical Specialists                        clinical Specialists
Neuro-oncologists:                          orthopedic oncologist:                   clinical Specialists
Robert Aiken, MD; Nina A. Paleologos, MD    Steven gitelis, MD                       Diagnostic radiologists:
                                                                                     John Meyer, Do; Anthony Zelazny, MD
Neuropathologist:                           Pediatric hematologist/oncologists:
Sukriti Nag, MD, PhD                        Nisha Kakodkar, MD; Paul Kent, MD;       Medical oncologist:
                                            Allen Korenblit, MD; Mindy Simpson, MD   Marta Batus, MD
Neuroradiologists:
Sharon Byrd, MD; Miral Jhaveri, MD;         Pediatric neuroradiologists:             orthopedic oncologist:
Mehmet Kocak, MD                            Sharon Byrd, MD; Mehmet Kocak, MD        Steven gitelis, MD

Neurosurgeons:                              Pediatric neurosurgeon:                  Pathologists:
Richard Byrne, MD; Roham Moftakhar,         lorenzo Muñoz, MD                        Jerome loew, MD; Brett Mahon, MD;
MD; lorenzo Muñoz, MD; John o’Toole,                                                 Ira Miller, MD; Vijaya Reddy, MD
MD                                          Plastic and reconstructive surgeon:
                                            gordon Derman, MD                        Pediatric hematologist/oncologists:
Neurotologist:                                                                       Paul Kent, MD; Allen Korenblit, MD
R. Mark Wiet, MD                            Radiation oncologists:
                                            Ross Abrams, MD; Aidnag Diaz, MD,        Pediatric physiatrist:
Pediatric hematologist/oncologist:          MPh                                      laura Deon, MD
Paul Kent, MD
                                                                                     Plastic and reconstructive surgeon:
Radiation oncologist:                                                                gordon Derman, MD
Aidnag Diaz, MD, MPh
                                                                                     Radiation oncologists:
 Brain Tumor conference                                                              Ross Abrams, MD; Krystyna Kiel, MD

 Tuesdays, 11:30 a.m. to 12:30 p.m.                                                  Surgical oncologists:
 Janet Wolter, Md, clinical and                                                      Steven Bines, MD
 educational conference room
 1010 professional Building                                                           Sarcoma conference
                                                                                      Wednesdays, 9 to 10 a.m.
 Spine Tumor conference                                                               Janet Wolter, Md, clinical and
 Thursdays, 9 a.m. to noon                                                            educational conference room
 Woman’s Board cancer Treatment                                                       1010 professional Building
 center
 500 S. paulina St.




                       for information about open clinical trials, visit www.rush.edu/cancerclinicaltrials.
REPRESENTATIVE puBlications
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palpable breast masses. J Am Coll Radiol.        Mod Pathol. 2013;26(11):1508-1513.             Marsh Jc, Ziel gE, diaz aZ, Wendt JA,
2013;10(10):742-749.e1-3.                                                                       gobole R, Turian JV. Integral dose delivered
                                                 lerret nM, Marzo al. Adoptive T-cell           to normal brain with conventional intensity-
hellstrom I, Swisher E, hellstrom KE, Yip YY,    transfer combined with a single low            modulated radiotherapy (IMRT) and
Agnew K, luborsky Jl. Anti-hE4 antibodies        dose of total body irradiation eradicates      helical tomotherapy IMRT during partial
in infertile women and women with ovarian        breast tumors. Oncoimmunology.                 brain radiotherapy for high-grade gliomas
cancer. Gynecol Oncol. 2013;130(3):629-633.      2013;2(2):e22731.                              with and without selective sparing of the
                                                                                                hippocampus, limbic circuit and neural stem
Jolley J, Saclarides T, Jakate s, Mora-Pinzon    lester-Coll Nh, goldhaber SZ, sher dJ,         cell compartment. J Med Imaging Radiat
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carcinoma of the rectum. Am Surg.                cancer versus cardiovascular mortality
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S, larson Ml, Venugopal p, gregory sa,           2013;119(10):1808-1815.                        2013;37(4):172-180.
christopherson KW ii. Aggressive disease
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S, Amatruda T, Bines sd, Clark JI, Curti B,      receptor primes prostate cancer cells to       host-microbiota interaction and intestinal
Ernstoff MS, gajewski T, gonzalez R, hyde        apoptosis through down-regulation of           stem cells in chronic inflammation and
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for Immunotherapy of Cancer consensus            Peters Jh, Rustgi A, onaitis MW, Kiernan       Schleiermacher	G,	Janoueix-Lerosey	I,	Cohn	
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Jotte RM, Beck T, Richards DA, guba SC,             Sheean PM, Kilkus JM, liu D, Maciejewski          tropism but do not accelerate breast cancer
liu J, frimodt-Moller B, John WJ, obasaju           J, Braunschweig CA. Incident hyperglycemia,       tumorigenesis in a somatic mouse breast
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                                                                                                      care considerations during concurrent                   20
Rana KA, Meyer J, Ibrahim S, Ralls M, Kent          Siziopikou KP, Anderson SJ, cobleigh Ma,          chemoradiotherapy for pancreatic
pM. The role of imaging of malignant bone           Julian TB, Arthur DW, Zheng P, Mamounas EP,       adenocarcinoma: lessons learned from clinical           21
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of metastatic breast cancer: unanswered             hER2 testing in ductal carcinoma in situ          Toll BA, gritz ER, hutson A, Dibaj S, herbst
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Russell W, herskovic A, gessert D, cohen Ja,        Sokol l, Cripe l, Kantarjian h, Sekeres           clinical oncology policy statement update.
Rubenstein JB, gregory sa.	Ocular	adnexal	          MA, Parmar S, greenberg P, goldberg Sl,           J Clin Oncol. 2013;31(25):3147-3157.
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sanchez Varela V, Zhou ES, Bober Sl.                with myelodysplastic syndrome. Leukemia.          independently	of	NF-ΔB	activation.	Cell.
Management	of	sexual	problems	in	cancer	            2013;27(4):977-980.                               2013;152(1-2):304-315.
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Schneider BP, gray RJ, Radovich M, Shen f,          o, Rademaker A, Zakarija A, McMahon               breast cancer in peripheral blood. Biomed Res
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JR, Dickler MN, cobleigh Ma, Perez EA,              differences in disease characteristics and
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tumor vascular endothelial growth factor gene       Sutton P, Borgia Ja, Bonomi p, plate JM.          cancer cells is critical for tumor growth and
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2012 canceR RegistRy RepoRt

pRiMaRy site                                                                total   analytic   nonanalytic   Male    feMale
oral cavity & pharynx                                                          99      77          22          65       34
lip                                                                            3        3           0           2        1
Tongue                                                                         39      29          10          27       12
Salivary glands                                                                9        7           2           5        4
floor of Mouth                                                                 3        2           1           1        2
gum & other Mouth                                                              15      11           4           9        6
Nasopharynx																																							                             5        3           2           4        1
Tonsil                                                                         11      10           1           8        3
Oropharynx																																								                             9        8           1           5        4
Hypopharynx																																							                             3        2           1           3        0
Other	Oral	Cavity	&	Pharynx                                                    2        2           0           1        1
digestive System                                                              411     318          93         239      172
Esophagus                                                                      31      22           9          23        8
Stomach                                                                        46      30          16          25       21
Small Intestine                                                                8        6           2           4        4
Colon	Excluding	Rectum																								                                108      82          26          52       56
Rectosigmoid Junction                                                          4        4           0           1        3
Rectum                                                                         48      33          15          27       21
Anus, Anal Canal & Anorectum                                                   9        5           4           5        4
liver & Intrahepatic Bile Duct                                                 79      64          15          62       17
gallbladder & other Biliary Tract                                              18      16           2          10        8
Pancreas                                                                       52      48           4          29       23
Retroperitoneum                                                                2        2           0           1        1
Peritoneum, omentum, Mesentery, & other Digestive organs                       6        6           0           0        6
respiratory System                                                            464     382          82         220      244
Nose, Nasal Cavity, Middle Ear                                                 14      13           1           7        7
Larynx																																												                             20      13           7          17        3
lung & Bronchus                                                               429     355          74         196      233
Trachea, Mediastinum & other Respiratory organs                                1        1           0           0        1
Bones & Joints                                                                 18      15           3          12        6
Soft Tissue                                                                    57      48           9          29       28
Skin	(excludes	basal	&	squamous	cell	carcinomas)                              101      82          19          53       48
Melanoma - Skin                                                                94      76          18          51       43
other Nonepithelial Skin                                                       7        6           1           2        5
Breast                                                                        469     402          67          12      457
female genital System                                                         322     280          42           0      322
Cervix	Uteri		(excludes	carcinoma	in	situ)																																				 38      35           3           0       38
Corpus & Uterus, NoS                                                          167     152          15           0      167
ovary                                                                          75      62          13           0       75
Vagina                                                                         9        5           4           0        9
Vulva                                                                          25      19           6           0       25
other female genital organs                                                    8        7           1           0        8
Male genital System                                                           148     117          31         148        0
Prostate                                                                      134     104          30         134        0
Testis                                                                         12      11           1          12        0                                                         Breast
Penis                                                                          2        2           0           2        0
urinary System                                                                131     120          11          88      43                                                           lung
Urinary Bladder                                                                53      47           6          44       9
Kidney & Renal Pelvis                                                          76      71           5          43      33                                                     lymphomas
Ureter & other Urinary organs                                                  2        2           0           1       1
Eye	&	Orbit																																							                             16      13           3           8       8                                                        Brain &
                                                                                                                                                                               other cnS
Brain & other nervous System                                                  205     171          34          87      118
endocrine System                                                              120     100          20          43      77                                                   corpus uterus
Thyroid                                                                        60      56           4          11      49
other Endocrine (includes thymus)                                              60      44          16          32      28                                                      leukemias
lymphomas                                                                     198     142          56         104      94
hodgkin lymphoma                                                               24      16           8          11      13                                                           colon
Non-hodgkin lymphoma                                                          174     126          48          93      81
Multime Myeloma                                                                73      54          19          34      39                                                        prostate
                                                                                                                              Analytic: Cases diagnosed and/or received
leukemias                                                                     165     125          40          98      67     all or part of first course of care at Rush
Mesotheliomas                                                                  8        7           1           6       2     University Medical Center.                          rectum
unknown primary                                                                12       9           3           3       9
                                                                                                                                                                                Kidney &
ill-defined & unspecified                                                      19      16           3          12       7                                                     renal pelvis
                                                                                                                              Nonanalytic: Cases diagnosed and all first
other and unspecified (Kaposi Sarcoma)                                         1        1           0           1       0
                                                                                                                              course treatment completed elsewhere.
total                                                                    3,037       2,479         558       1,262    1,775
    neW cAncer incidence By firST conTAcT yeAr, 2008 - 2012                                                                                                                    Top 5 ruSh AnAlyTic SiTeS, 2012

                                 3000                                                                                                                                       Breast

                                                                                                                                                                                                       200
                                 2500                         2680          2671                                                                                                                                                    Stage 0             85
                                               2570                                      2608




                                                                                                                                                                            Number	of	Analytic	Cases
                                                                                                      2479
    Analytic caces at rush




                                                                                                                                                                                                                                    Stage 1             156
                                                                                                                                                                                                       150
                                 2000
                                                                                                                                                                                                                                    Stage 2             99

                                                                                                                                                                                                       100                          Stage 3             38
                                 1500
                                                                                                                                                                                                                                    Stage 4             25
                                 1000                                                                                                                                                                   50                          unknown             0

                                                                                                                                                                                                                                    Not	Applicable 0
                                  500
                                                                                                                                                                                                        0
                                                                                                                                                                                                             Stages
                                    0
                                               2008          2009           2010         2011         2012
                                                                            year                                                                                            lung

                                                                                                                                                                                                       150
                                                                                                                                                                                                                                    Stage 0              2




                                                                                                                                                                            Number	of	Analytic	Cases
                                                                                                                                                                                                       120                          Stage 1              110




                                                                                                                                                                                                                                                                        Cancer Annual Report 2013
     AnAlyTic cASe diSTriBuTion By gender And Age AT diAgnoSiS, 2012                                                                                                                                                                Stage 2              47
                                                                                                                                                                                                        90
                                                                                                                                                                                                                                    Stage 3              69
                                 500
                                                                                                                                                                                                        60                          Stage 4              127

                                                                                                                                                                                                                                    unknown              0
                                                                                                                                                                                                        30
                                                                                           455                                                                                                                                      Not	Applicable 3
                                 400                                                                                     female
                                                                                                                         Male                                                                           0
                                                                                                                                                                                                             Stages
      Number	of	Analytic	Cases




                                                                               344
                                 300                                                                                                                                        corpus uteri
                                                                                                293                                                                                                    100
                                                                                                                                                                                                                                    Stage 0                 3                 22
                                                                                                       257
                                                                                                                                                                            Number	of	Analytic	Cases    80                          Stage 1                 93
                                                                                   228
                                 200                                                                                                                                                                                                                                          23
                                                                                                            211                                                                                                                     Stage 2                 8
                                                                                                                                                                                                        60
                                                                     183
                                                                                                                                                                                                                                    Stage 3                 22
                                                                                                                                                                                                        40                          Stage 4                 20
                                 100
                                                                                                                   105                                                                                                              unknown                 0
                                                                       96
                                                        83                                                            82                                                                                20
                                                        98                                                                                                                                                                          Not	Applicable          0
                                          54
                                               40
                                                             32                                                                9     7                                                                  0
                                   0                                                                                                                                                                         Stages
                                            0-29        30-39       40-49      50-59       60-69       70-79       80-89       90+
                                                                             Age in years

                                                                                                                                                                            prostate

                                                                                                                                                                                                        60
                                                                                                                                                                                                                                     Stage 0                 0
                                                                                                                                                                            Number	of	Analytic	Cases




     Top 10 nATionAl AnAlyTic SiTeS, 2012                                                                                                                                                               50
                                                                                                                                                                                                                                     Stage 1                 26
                                                                                                                                                                                                        40                           Stage 2                 58
                                                                                                                       15.47%
t                                        Breast                                                                                                                                                                                      Stage 3                 10
                                                                                                                  13.98%                                                                                30
                                                                                                                                                                                                                                     Stage 4                 10
                                                                                                                  14.15%
g                                          lung                                                                                                                                                         20
                                                                                                                  13.80%                                                                                                             unknown                 0
                                                                             6.53%                                                                                                                      10                           Not	Applicable          0
s                                 lymphomas
                                                                     4.83%
                                                                                                                                                                                                        0
&                                     Brain &                                 6.76%                                                                                                                          Stages
S                                   other cnS       1.40%
                                                                                                                                            rush
    Site




                                                                       5.51%
s                                 corpus uteri                                                                                              uSA
                                                         2.88%                                                                                                              colon
                                                                                                                                         Note: The graph compares USA
                                                                       5.44%                                                             data with that from Rush for the
s                                   leukemias                                                                                                                                                           25
                                                          2.88%                                                                          top 10 national analytic sites.
                                                                                                                                                                                                                                     Stage 0                9
                                                                                                                                                                            Number	of	Analytic	Cases




                                                              3.56%                                                                                                                                     20
n                                         colon                                                                                                                                                                                      Stage 1                18
                                                                            6.30%
                                                                                                                                                                                                        15                           Stage 2                17
                                        prostate                  4.42%
e                                                                                                                                                                                                                                    Stage 3                20
                                                                                                                     14.75%                                                                             10
                                                             3.10%                                                                                                                                                                   Stage 4                23
m                                  Melanoma                                                                                                                                                             5
                                                                  4.65%                                                                                                                                                              unknown                0
&                                    Kidney &           2.51%                                                                                                                                           0                            Not	Applicable         0
s                                  renal pelvis              3.95%

                                                   0%        2%        4%          6%      8%         10%      12%       14%       16%                                                                       Stages
                                                                                     percentage
                                                                                                                                                                            Note: Data is based on stage as defined by the American Joint Committee on Cancer (AJCC).
colorecTAl MeASure reSulTS, 2011


                                                                             coMMission
   MeasuRes         definition                                                on canceR               2011          case
                                                                              thReshold                             ReVieW



   Colon Measure    Adjuvant chemotherapy is considered or
   Accountability   administered within four months (120 days) of                  90%                100%            act
                    diagnosis for patients under the age of 80 with
                    American Joint Commission on Cancer (AJCC)
                    stage III (lymph node positive) colon cancer. [ACT]



   Colon Measure    At least 12 regional lymph nodes are removed
   Improvement      and	pathologically	examined	for	resected	colon	                80%                100%          12 Rln
                    cancer. [12RlN]




   Rectal           Radiation therapy is considered or administered
   Surveillance     within	six	months	(180	days)	of	diagnosis	for	
                                                                                   90%                90%           adJ Rt
                    patients under the age of 80 of with clinical or
                    pathologic AJCC T4N0M0 or stage III receiving
                    surgical resection for rectal cancer. [AdjRT]




                    Reached	or	exceeded	Commission	on	Cancer	benchmark.
                    ACT = adjuvant chemotherapy; RlN = regional lymph nodes; AdjRT = adjuvant radiation therapy




BreAST MeASure reSulTS, 2011


                                                                             coMMission
   MeasuRes         definition                                                on canceR               2011          case
                                                                              thReshold                             ReVieW



   Breast           Radiation therapy is administered within one year
   Accountability   (365 days) of diagnosis for women under age                    90%               93.7%            Bcs
                    70 receiving breast conserving surgery for breast
                    cancer. [BCS/RT]




   Breast           Combination chemotherapy is considered or
   Accountability   administered within four months (120 days)
                    of diagnosis for women under 70 with (AJCC)                    90%               97.5%           Mac
                    T1cN0, or stage IB - III hormone receptor negative
                    breast cancer. [MAC]



   Breast           Tamoxifen	or	third	generation	aromotase	inhibitor	
   Accountability   is considered or administered within one year
                                                                                   90%               94.3%             ht
                    (365 days) of diagnosis for women with AJCC T1c
                    or stage IB-III hormone receptor positive breast
                    cancer. [hT]




                    Reached	or	exceeded		Commission	on	Cancer	benchmark.
                    BCS = breast-conserving surgery; RT = radiation therapy; American Joint Commission on Cancer = AJCC;
                    MAC = multi-agent chemotherapy; hT = hormone therapy
     oBServed SurvivAl for lung cASeS diAgnoSed in 2003 - 2006




   stage 1                                                       Rush n=151           Nat’l n=77276                                                  stage 2                                                 Rush n=57             Nat’l n=26440

                           100                                                                                                                                                   100
                                    100 100
                                      100                                                                                                                                              100 100
                                                                                                                                                                                         100
cumulative Survival rate




                                                                                                                                                      cumulative Survival rate
                                                     84.6
                            75                              80                                                                                                                    75

                                                                     69.1                                                                                                                          66.7 66.7
                                                                             66.2
                                                                                      60.3
                            50                                                                56.9                                                                                50                               54.4
                                                                                                       52.4 50.1
                                                                                                                        48.5                                                                                               46.9     47.4
                                                                                                                                44.6
                                                                                                                                                                                                                                            36.7     34.7
                            25                                                                                                                                                    25                                                                         30.4     30.8
                                                                                                                                                                                                                                                                              26.2



                             0                                                                                                                                                     0
                                     dx         1 year             2 years          3 years          4 years          5 years                                                          dx        1 year          2 years          3 years          4 years          5 years




                                                                                                                                                                                                                                                                                     Cancer Annual Report 2013
                                                                 Rush n=212           Nat’l n=112500                                                                                                         Rush n=307             Nat’l n=189008
        stage 3                                                                                                                                            stage 4
                           100                                                                                                                                                   100
                                     100 100
                                       100                                                                                                                                             100 100
                                                                                                                                                                                         100
cumulative Survival rate




                                                                                                                                                      cumulative Survival rate




                            75                                                                                                                                                    75


                                                     62.3
                            50                                                                                                                                                    50                                                                                                       24
                                                            46.7
                                                                     43.9
                                                                                                                                                                                                   35.8
                                                                                                                                                                                                                                                                                           25
                            25                                                         31.1                                                                                       25
                                                                             25.5                      25.6             21.9                                                                              22.3
                                                                                              17.3                                                                                                                15.4
                                                                                                               13.2             10.7                                                                                       8.7      9.7 4.9           8      3.2      4.8
                                                                                                                                                                                                                                                                              2.4
                             0                                                                                                                                                    0
                                     dx         1 year             2 years          3 years          4 years          5 years                                                          dx        1 year          2 years          3 years          4 years          5 years




   cAncer MorTAliTy (inpATienT) AT ruSh, fy13*



                                                                               Actual Mortality Rate             Predicated Mortality Rate                        Predicated Mortality Rate               “Compared with top cancer hospitals (U.S. News)**”

                            Surgical Oncology                                  1.54                              2.01                                             2.01                                    9th out of 19

                            Medical Oncology                                   1.71                              2.21                                             2.21                                    6th out of 19

                            Bone Marrow Transplant                             2.56                              1.96                                             1.96                                    18th out of 19




                                                                        * Actual mortality = number of deaths per 100 discharges; predicted mortality = deaths expected based on how sick the
                                                                             patients are, per 100 discharges; mortality index = actual rate/predicted rate (index <1 means fewer patients died
                                                                             than predicted).


                                                                      ** Comparison is with hospitals ranked in the top 20 by U.S. News & World Report, which ranks hospitals based on a number
                                                                             of different measures including in-hospital mortality (Rush is not ranked in this list; of the top 20, one hospital does not
                                                                             submit data to the University HealthSystem Consortium [UHC]).

                                                                             Source: University HealthSystem Consortium clinical database, FY 2013 data.
The rush university cancer center comprises
all of the cancer-related clinical, research
and educational efforts at rush, crossing 20
departments, divisions and sections; inpatient
and outpatient areas; professional clinical
activities; and the colleges of rush university.



for more information about cancer programs
at Rush or to refer a patient for an initial visit or
a second opinion, please call
(312) canceR-1 (226-2371).




Rush is a not-for-profit health care, education and research enterprise comprising
Rush University Medical Center, Rush University, Rush oak Park hospital and Rush health.

PLEASE NOTE: All physicians featured in this publication are on the medical faculty of Rush University Medical Center.
Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees
of Rush University Medical Center.

								
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