Strength behind every patient. - Missouri Baptist Medical Center

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					                 Missouri Baptist Medical Center
                 2009 Cancer Program Annual Report

Strength behind every patient. Compassion in everything we do.

               Annual Report Contents
               page   1      Letter from Chairman,
                             Cancer Committee
                                                                           Paul K. Schultz, MD, Chairman, Cancer Committee;
                                                                           Medical Oncology
                                                                           Jason Li, MD, Cancer Liaison Physician; Hematology/
               page   2      Focus on Lung Cancer:
                                                                           Michael Bolger, MD, Hematology/Oncology
                                                                           Humberto Fagundes, MD, Medical Director, Radiation
                               Radiation Therapy                           Oncology
                               Systemic Therapy                            Marcio Fagundes, MD, Radiation Oncology
                               RapidArcTM Technology                       Geoffrey Hamill, MD, Diagnostic Radiology
                                                                           Zaheed Kaleem, MD, Director of Pathology
               page   8      Cancer Registry Data for 2008                 John Kelly, MD, Gastroenterology
                                                                           Alan Lyss, MD, Medical Oncology; Director, Heartland
                                                                           Cancer Research CCOP
               page   11     Breast HealthCare Center News
                                                                           Joseph Marcus, MD, Pathology
                                                                           Larry Mendelow, MD, Surgery
               page   12     Cancer Research Program                       Michael Murphy, MD, FACS, Director, Cardiothoracic

               page   13     Patient Family Advisory Council
                               T Mazzuca
                                                                           Michael Polinsky, MD, Neurosurgery
                                                                           Matthew Powell, MD, GYN Oncology
                               Patricia Niehaus                            Gary Ratkin, MD, Hematology/Oncology, Medical
                                                                           Director, Oncology Services
                               Richard Schumacher
                                                                           Hashim Raza, MD, Internal Medicine
                                                                           Barry Rosenblum, MD, ENT
               page   20     Education Updates
                                                                           Atif Shafqat, MD, Hematology/Oncology
                                                                           Premal Thaker, MD, GYN Oncology
               page   21     Complementary Therapies                       Chris Vulin, MD, Urology
                                                                           Deborah Wienski, MD, Hematology/Oncology
               page   21     Community Events                              Paul Yazdi, MD, Breast Surgery, Surgical Director,
                                                                           Breast HealthCare Center
                                                                           Michael Zerega, MD, Gastroenterology
                                                                           Connie Anderson, RHIT, CTR, Cancer Registry
Strength behind every patient.                                             Gail Behling, MA, CTR, Cancer Registry

Compassion in everything we do.                                            Vicki Boehmer, RN, MAHCM, Palliative Care Specialist
                                                                           Melissa Clenin, RN, BSN, OCN, Nurse Manager,
                                                                           Cancer and Infusion Center
The Cancer Center at Missouri Baptist . . .
                                                                           Sarah Ernsky, RN, BSN, Manager, Breast HealthCare
• One of only 63 community hospitals in the U.S. granted the prestigious
                                                                           Diane Grove, RHIA, CTR, Cancer Registry & Support
  Community Clinical Oncology Program (CCOP) designation by the            Staff Supervisor
  National Cancer Institute.
                                                                           Lynn Hayward, RN, OCN, Supervisor, Cancer and
                                                                           Infusion Center
• Received a “three-year approval with commendation” from the Commission
                                                                           Ros Hofstein, LCSW, Supervisor, Social Services
  on Cancer of the American College of Surgeons.
                                                                           Linette Kallaos, CTR, Cancer Registry
• Named a Breast Imaging Center of Excellence by the American College of   Jo Anne Meives, RN, MSN, Community Education
  Radiology.                                                               Debbie Mercier, RN, MSN, AOCNS, Director, Oncology
                                                                           Services and the Breast HealthCare Center
                                                                           Trevor Waldo, Performance Improvement

The Cancer Committee gratefully acknowledges Rhonda Veenhuis               Michelle Wheelehan, Manager, Therapy Services
as Editor of the 2009 Cancer Program Annual Report.                        Mary Wojcik, RT, (R)(T), Manager of Radiation
                                                                           Oncology Services
                                                                                        Letter from
                                                                                        the chairman
The practice of medicine is often described as a combination of art and science.
At Missouri Baptist Cancer Center, our goal has always been to combine the best
technology with strength and compassion. In this year’s report, we share with
you our progress in delivering that combination — the best of science combined
with compassionate care — for every patient.

Last year, we were honored to receive first prize for our annual report in the
Show-Me Excellence Awards given by the Missouri Hospital Association. In this
year’s report, we aspire to achieve the same level of excellence, just as we strive
to achieve excellence in all we do for our patients.

We feature some of the technical advances recently implemented at our Center,
including our new linear accelerator equipped with RapidArcTM technology, which
provides more precise and faster radiation treatment, and new mammography
units equipped with state-of-the-art digital imaging. The continued expansion of
our use of an electronic medical record has allowed more accurate data collection
for analysis on how we are delivering care and how we measure against national

Our report also has a special section devoted to the care of patients with the
cancer that remains the most deadly — lung cancer. The number of deaths
every year from this mostly preventable cancer still outnumber those from
breast cancer, colon cancer, pancreatic cancer and prostate cancer combined.
Drs. Jason Li, Michael Murphy, Humberto Fagundes and Marcio Fagundes
report on the multidisciplinary efforts utilized to battle this disease. The most
recent statistics show that lung cancer deaths in woman have, at last, leveled off
and deaths in men have been falling for several years. Nevertheless, lung cancer
remains a great challenge.

We also report on our efforts to deliver on our mission of serving the patients
of our community. With financial assistance from the Susan G. Komen for the
Cure St Louis® and collaboration with medical clinics and businesses throughout
the region, our program is expanding its efforts to reach the uninsured and             “We always work to bring
the underinsured. We continue to integrate educational conferences and
                                                                                        the best of science and
complementary therapies into our program. We also are grateful for the initiatives
born from the efforts of our Patient and Family Advisory Council (PFAC). The            compassionate care to
unique stories about three of our PFAC members are shared as well.                      our patients.”
As this letter is composed, the attention of the nation is on our healthcare delivery
system and how it can be improved. This year at Missouri Baptist, we have made
a strong commitment to LEAN process improvement. Through LEAN Rapid
Improvement Events, where processes undergo intense scrutiny, we have been
able to increase efficiencies, enhance care delivery and improve communication.
Whatever changes in healthcare may be forthcoming, we are confident that our
tradition of excellence in both technology and people can endure and grow.

Paul Schultz, MD
Chairman, Cancer Committee

      SI T E
    F E AT U RE
                                             Multidisciplinary Treatments for Lung Cancer Patients

                      By Humberto Fagundes, MD, radiation oncologist; Marcio Fagundes, MD, radiation oncologist; Jason Li, MD, medical
                      oncologist; and Michael Murphy, MD, FACS, cardiothoracic surgeon

                        Lung cancer is the leading cause of cancer death in the                                           Surgery, radiation therapy (RT) and chemotherapy
                        United States with an estimated 215,020 new cases                                                 are the three modalities commonly used to treat
                        (114,690 in men and 100,330 in women) diagnosed                                                   patients with NSCLC. They are used either alone or in
                        in 2008 and 161,840 deaths due to the disease.                                                    combination depending on the disease stage.
                        Unfortunately, only 15% of all lung cancer patients are
                        living five years or more after the diagnosis. Lung cancer
                        is somewhat unique because the main etiologic agent is                                            Surgery
                        an “industry” and more than 85% of cases are caused
                        by voluntary or involuntary (“second-hand”)                                                       Lung cancer is the leading cause of cancer deaths in the
                        cigarette smoking.                                                                                United States for both men and women, far exceeding
                                                                                                                          the combined total for breast, colon and prostate
                        There is a causal relationship between active smoking                                             cancers. In general, for patients with stage I/II disease,
                        and lung cancer and a 20% to 30% increased risk for                                               surgery provides the best chance for cure. The surgical
                        lung cancer associated with living with a smoker. Late                                            procedure used depends on the extent of disease and the
                        diagnosis is a fundamental obstacle to improving lung                                             cardiopulmonary reserve of the patient.
                        cancer outcomes. Fortunately at Missouri Baptist, there
                        are a greater number of patients diagnosed at an early                                            Missouri Baptist Medical Center’s multidisciplinary
                        stage of disease, which is more treatable and increases                                           approach begins with a weekly Chest Conference where
                        the overall survival.                                                                             several lung cancer cases are discussed by medical
                                                                                                                          and radiation oncologists, radiologists, pulmonologists,
                                                                                                                          pathologists, surgeons and registered nurses. This
                    Stage of Lung, Bronchus – Non-Small Cell
                                                                                                                          process begins with careful diagnostic procedures,
                    Carcinoma Cancer Diagnosed 2000 to 2006                                                               staging and discussion of appropriate treatment options.
                                                                                                                          All participants in this multidisciplinary team work on
                                      35                                                                                  the Missouri Baptist campus, which makes it easy and
                                                                                                                          expedient to integrate care in a convenient and efficient
                                                        30.1                                                              “one stop” process.
                  Percent Diagnosed

                                                                                      23.1 24.2
                                      20                                                                                  The four thoracic surgeons at the hospital perform a
                                      15                                                                                  high volume of operations each year for the diagnosis
                                                                                                                          and treatment of lung cancer and its complications,
                                                                                                                          including the latest minimally invasive techniques.
                                                                          7.9 7.2                               8.0 8.4
                                       5                                                                                  Our pulmonologists and radiologists offer state-of-
                                            0.1 0.3
                                       0                                                                                  the-art diagnostic and staging procedures, including
                                                0              I             II           III         IV        UNKNOWN
                                                                                  Stage                                   bronchoscopy, endobronchial ultrasound and image-
                                           Missouri Baptist Cancer Center           Cancer Centers (average)              guided interventions to more carefully stage patients
                                                                                                           Source: NCDB   with lung cancer prior to definitive therapy.
                        Because localized tumors can be managed curatively and
                        because survival in other solid tumors (eg, breast, cervix,                                       We are able to offer each patient a procedure tailored to
                        colon, prostate) appears to be increased by screening                                             their individual physiology and designed to completely
                        and early detection, lung cancer would be a suitable                                              remove the tumor and minimize the chance of a
                        candidate for a population-based screening approach.                                              recurrence. Surgical options range from lobectomy to
                        Unfortunately, available data are conflicting. The                                                pneumonectomy to segmentectomy or wedge resection
                        National Lung Screening T (NLST) is a randomized,
                                                   rial                                                                   with implantation of I-125 radiation seeds for those
                        controlled study involving 50,000 current or former                                               unable to tolerate a more radical resection. Our Thoracic
                        smokers assessing the risks and benefits of spiral CT                                             Program participates in the STS General Thoracic
                        scans compared with chest X-rays for detecting lung                                               Surgery Database, submitting data twice annually, which
                        cancer. The study is closing in 2009 and data will be                                             allows us to monitor quality improvement and compare
                        analyzed shortly.                                                                                 our outcomes to national benchmarks.

                                                                disease, generally sequential chemotherapy followed by
Radiation Therapy                                               RT is employed, unless the surgical margins are (+), in
                                                                which case concurrent chemo/RT is preferred. Patients
Modern 3-dimensional conformal RT techniques with
                                                                with Stage IIIB disease are generally managed with
CT or CT/PET-based treatment planning should
                                                                concurrent chemoradiotherapy. However, in a subset
be used on all patients. The dose volume histograms
                                                                of patients with T4 tumors, such as superior sulcus or
(DVH) for the lungs, esophagus, heart, liver, kidney and
                                                                chestwall lesions, surgical resection should be considered.
spinal cord should be carefully used to minimize normal
                                                                Generally, patients with Stage IV disease are treated with
tissue toxicity. Respiratory management techniques,
                                                                chemotherapy, reserving RT for palliative intent.
such as respiratory gating should be incorporated into
the radiation planning and delivery. This advanced
technology is available at Missouri Baptist. If the tumor          Non-Small Cell Lung and Bronchus Cancer
is fixed, such as a superior sulcus lesion, intensity-             Observed Survival Rate - Stage 1
modulated radiotherapy (IMRT) should be considered
                                                                                100           100.0
to avoid overdose of normal tissues. Involved field (IF)                                         100.0
radiation without elective nodal targeting is associated
with less toxicity, low risk of isolated nodal recurrence                        80                           79.4
and even better outcomes because treatment                                                                              70.6
                                                             Percent Survived

                                                                                                    78.1                   65.3
interruptions, due to acute toxicity, may lead to tumor                                                                               62.2
                                                                                 60                                                      55.6
repopulation and poor outcomes.                                                                                      62.4                           54.3
                                                                                                                                   52.6                        44.5
Patients with compromised pulmonary reserves who                                 40                                                              45.1
have Stage I/II peripheral tumors may be candidates for                                                                                                        39.4
a wedge resection with placement of a brachytherapy
I-125 mesh along the wedge surgical bed at the time                                   YEAR 0        YEAR 1           YEAR 2       YEAR 3        YEAR 4        YEAR 5
of surgery. This approach reduces the local recurrence                                   MBMC Survival Rate                   NCDB               NCDB Midwest Region
from ~20% down to 6%, is quite well tolerated and
has been performed at Missouri Baptist since 2008.
                                                                Observed Survival Rates - Non-Small Cell
An additional approach being introduced at Missouri
                                                                Lung Cancer
Baptist is Stereotactic Body Radiotherapy (SBRT). This
                                                                A total of 144 patients with Stage I disease were treated
is an option for patients with node-negative, peripheral
                                                                at Missouri Baptist. At five years, 44.5% were alive,
tumors who either refuse surgery or are medically
                                                                compared to 42.8% from the National Cancer Database
inoperable. Local control has been reported up to 85%
                                                                (NCDB) and 39.4% from the Midwest NCDB. For
at five years. A multi-institutional study has completed
                                                                patients with Stage II, the survival rates were 17.8%,
accrual (RTOG 0236) delivering 3 fractions of 20 Gy
                                                                23.7% and 21.8% respectively. In the Stage III groups,
to a total dose of 60 Gy, treating patients with node-
                                                                the survival rates were 8.8%, 8.6% and 8.1% respectively
negative peripheral tumors up to 5 cm. Currently the
                                                                at 5 years. In the group with Stage IV disease, Missouri
RTOG 0915 is open for accrual, comparing two different
                                                                Baptist patients achieved a survival rate of 4.7% at 5
dose schemes. Patients are randomized to either 12 Gy x
                                                                years, next to 2.1% for the NCDB and 1.6% for the
4 fractions to 48 Gy versus one single fraction of 34 Gy.
                                                                Midwest NCDB.

Patients with Stage IIIA disease may be managed with
all three treatment modalities — surgery, chemotherapy
and radiation. The ongoing debate centers on which
modalities to use and what sequence. For patients
with unresectable Stage IIIA, chemoradiation has been
shown to have better outcomes than radiation therapy
alone or sequential chemotherapy followed by radiation
therapy. Patient selection is essential because concurrent
chemoradiotherapy is associated with higher morbidity,
mainly esophagitis. In resected patients with Stage IIIA

      SI T E
    F E AT U RE
                         Multidisciplinary Treatments for Lung Cancer Patients (continued)

                  Small Cell Lung Cancer                                            Prophylactic Cranial Radiotherapy
                                                                                    Prophylactic Cranial Radiotherapy (PCI) has been
                  Thoracic Radiotherapy                                             a common practice for patients with limited stage
                  The addition of thoracic radiotherapy to chemotherapy             disease who achieve a good or complete response to
                  in patients with limited stage disease has improved               chemoradiotherapy. Meta-analyses have shown an
                  patients’ overall survival. Typically, thoracic radiotherapy      increase in overall survival for patients who undergo
                  is initiated after 1 or 2 cycles of chemotherapy to a dose        PCI. A recent prospective randomized trial concluded
                  of 60 Gy to 70 Gy with conventional fractionation once            that patients with extensive stage disease who achieve
                  a day of 1.8 Gy to 2 Gy. A thought-provoking ECOG/                a good to complete response to chemotherapy also
                  RTOG study evaluating twice-a-day radiotherapy to                 experienced a meaningful survival advantage.
                  45 Gy was analyzed. This phase two study showed an
                  improvement in outcome for patients treated twice per
                  day versus once-a-day radiotherapy. Unfortunately the
                  radiation dose in the once-a-day group was 50.4 Gy,
                  considered sub-optimal by today’s standards.

         Systemic Therapy in Non-                       Bevacizumab (Avastin®)                        Cetuximab (Erbitux®)
                                                        Cancer cells need to make new blood           Cetuximab also targets the Epidermal
         Small Cell Lung Cancer                         vessels to grow, the process known            Growth Factor Receptor (EGFR). Adding
                                                        as angiogenesis. Bevacizumab is an            cetuximab to standard chemotherapy
         Lung cancer remains a major cause of           angiogenesis inhibitor – a medication         as first-line treatment improves overall
         cancer death throughout the world. It is       that works to prevent cancers from            survival by about five weeks for patients
         an extremely lethal malignancy. More           making blood vessels. It is used              with advanced non-small cell lung
         than 80% of patients who develop               in combination with conventional              cancer. Cetuximab is given as an
         this neoplasm will die of their disease.       chemotherapy as frontline therapy for         intravenous therapy once a week.
         Despite the overall poor prognosis, a          advanced non-small cell lung cancer
         number of new chemotherapeutic drugs           and appears to prolong survival in those      At Missouri Baptist Cancer Center,
         and regimens have been developed               patients. It is given as an intravenous       we have participated actively in the
         recently, which result in clinically           therapy every three weeks.                    clinical trials that lead to new standard
         meaningful improvements in survival                                                          treatments. There are multiple
         for patients with non-small cell lung          Erlotinib (Tarceva®)                          clinical studies currently available
         cancer. New medical treatments,                The surface of lung cancer cells are          for lung cancer patients through
         called targeted therapies, are becoming        covered with a protein called Epidermal       Heartland Cancer Research, our
         available for lung cancer. Unlike              Growth Factor Receptor (EGFR), which          National Cancer Institute-designated
         traditional chemotherapy, targeted             helps the cells divide. Erlotinib inhibits    Community Clinical Oncology Program.
         therapy blocks the growth of cancer            EGFR, therefore blocking the signal           One particular intriguing study is to
         cells by interfering with specific             transduction cascade that is required         investigate the role of bevacizumab
         molecules needed for tumor growth,             for cancer cell proliferation. Erlotinib      in combination with chemotherapy in
         rather than by simply interfering with         has been shown to increase survival in        patients with completely resected non-
         rapidly dividing cells. Three targeted         metastatic non-small cell lung cancer         small cell lung cancer with primary goal
         therapies used in advanced lung cancer         when used as second line therapy.             of improving overall survival.
         include:                                       New data also showed that erlotinib
                                                        improved survival in patients with
                                                        advanced non-small cell lung cancer
                                                        when used as maintenance therapy
                                                        immediately after initial chemotherapy.
                                                        Erlotinib is given as a daily oral

Missouri Baptist is Region’s First to Acquire New Tumor-Fighting Technology

  The Cancer Center at Missouri Baptist Medical Center         brachytherapy and hypofractionated radiotherapy, which
  has made a great investment in patient care by acquiring     consists of IMRT delivered over 17 days as opposed to
  the region’s first linear accelerator equipped with          six and one-half weeks, literally reducing the overall
  image-guided RapidArcTM technology (IGRT). RapidArc          treatment days by 50%.
  provides cancer patients with faster, more precise
  radiation therapy to shrink prostate, head and neck, lung,   In addition, Missouri Baptist also acquired new
  breast and other tumors. We treated our first patient in     respiratory gating to help manage tumor motion during
  March 2009.                                                  treatment. An optical camera monitors the patient’s
                                                               respiratory motion and turns the radiation beam on and
  Missouri Baptist was the first cancer center in Missouri     off at a predetermined point in the patient’s breathing
  to adopt this new FDA-approved, tumor-fighting               cycle to compensate for respiration motion.
  technology. RapidArc is a faster way of delivering
  advanced image-guided, intensity-modulated                   Radiotherapy is considered to be the standard treatment
  radiotherapy (IMRT). It is up to eight times faster than     for patients with early-stage (stages I and II) lung cancer
  conventional IMRT T. reatment planning analyses show         who refuse surgery or who are not surgical candidates
  that RapidArc matches or exceeds the precision of            because of significant medical problems. These patients
  conventional IMRT systems for many cancers.                  may benefit significantly from the delivery of radiation
                                                               treatments using respiratory gating, which corrects for
  In the past, IMRT treatments were                            respiration-induced motion and, thus, can provide the
                                                               capability of radiating less normal lung around the cancer.
  more time consuming for patients                             In selected patients with small, peripheral tumors,
  because tumors are targeted by a                             radiation therapy can be delivered in a few, large, daily
  complex sequence of fixed radiation                          fractions. Stereotactic body radiation therapy (SBRT)
                                                               involves the delivery of a single, high-dose radiation
  beams from multiple angles. The
                                                               treatment or a few fractionated radiation treatments
  RapidArc treatment can be done in as                         (usually up to five treatments). A high-potent, biological
  little as two minutes, with better dose                      dose of radiation is delivered to the tumor, improving
  conformity.                                                  the cure rates for the tumor, in a manner previously not
                                                               achievable by standard conventional radiation therapy.
  The new RapidArc technology brings considerable              This requires appropriate immobilization of patients,
  benefits to patients who require radiotherapy for head       coupled with respiratory gating and very precise image
  and neck cancers. Prior to the introduction of RapidArc,     guidance.
  conventional intensity-modulated radiotherapy would
  take between 20 to 30 minutes for delivery of each           Using Dynamic T   argeting IGRT  ,
  treatment.                                                   there is the potential to substantially
  Head and neck cancers frequently have very complex,
                                                               improve treatment outcomes by
  irregular shapes and are nearly always surrounded by         protecting healthy tissue while
  multiple normal structures, such as the major salivary       delivering more powerful doses to
  glands, which need to be spared from high doses of
                                                               cancerous tumors.
  radiation. RapidArc may improve the capability of
  sparing the salivary glands while still providing optimal
  dose coverage of the tumor.

  Missouri Baptist’s Radiation Oncology Department
  also offers various options for patients with breast
  cancer, including breast IMRT partial breast radiation,

    Registry Report for 2009 Annual Report

        The Cancer Registry at Missouri Baptist Medical Center       and the National Cancer Database (NCDB). On each
        plays a very active role in the Cancer Program. The          new case, the Registry collects well over 100 data
        Registry coordinates the collection, research and analysis   elements, including patient demographics, diagnosis,
        of cancer information. In addition to the routine registry   stage of disease, specific tumor markers and treatment.
        functions, the Cancer Registry also coordinates the          This allows comparative analysis with other hospitals.
        Commission on Cancer (CoC) accreditation process and         Data reports for specific sites can be performed on local,
        ensures that the Missouri Baptist Cancer Program meets       state and national levels comparing elements, such as
        or exceeds all CoC Program Standards.                        site, demographics, histology, stage of disease, treatment
                                                                     modalities and survival. This information forms the
        Since the Registry’s inception in 1992 almost 26,000         basis of much of the research and development of
        patients have been entered into our database. In 2008,       cancer treatments. It also provides our cancer program
        for the first time, we added more than 2,000 new cases       benchmarking opportunities to review patterns of
        in a single year. Ninety-four percent of these cases         patient care and survival.
        were analytic, meaning these were patients who were
        diagnosed and/or received first course of treatment at       The Registry also provides for lifetime followup of
        Missouri Baptist. The top cancer site in 2008 was breast,    patients diagnosed at Missouri Baptist. The information
        followed by lung, prostate and colon.                        ensures continuous medical surveillance and provides
                                                                     information which enables us to look at our end
        The data collected by the Cancer Registry is                 results and survival. It also is used to assess treatment
        electronically submitted to the Missouri Cancer Registry     effectiveness.

                                                                                 We are very proud to announce that in
                                                                                 2008 the Missouri Baptist Cancer Program
                                                                                 received the CoC Three-Year Approval
                                                                                 Award with commendations in six areas.
                                                                                 Those areas included outcomes analyses,
                                                                                 NCDB data submission, AJCC staging,
                                                                                 clinical trials accrual, early detection and
                                                                                 cancer prevention programs, and cancer
                                                                                 program quality improvements.

                                                                                 We encourage physicians and other
                                                                                 healthcare professionals to utilize the data
                                                                                 collected. The Cancer Registry Staff can be
                                                                                 reached at 314-996-5455.

                                                                                  Missouri Baptist’s Cancer Registry
                                                                                  reports that 94 percent of new cases
                                                                                  were analytic, meaning patients were
                                                                                  diagnosed and/or received first course
                                                                                  of treatment at Missouri Baptist.

Analysis of Cancer Cases 2008
Missouri Baptist Medical Center 2008 Accessioned Cases

Primary Site                                  Total     M         F    Analytic✣ Analytic✽
ORAL CAVITY & PHARYNX                          19       9       10         16          3
Lip                                             1       0        1          1          0
Tongue                                          6       2        4          5          1
Salivary Glands                                 4       0        4          3          1
Gum & Other Mouth                               4       3        1          3          1
Tonsil                                          3       3        0          3          0
Hypopharynx                                     1       1        0          1          0
DIGESTIVE SYSTEM                              440     205      235        414         26
Esophagus                                      28      20        8         26          2
Stomach                                        25      12       13         24          1
Small Intestine                                12       5        7         12          0
Colon Excluding Rectum                        106      46       60         97          9
Cecum                                          22       7       15         21          1
Appendix                                        3       1        2          3          0
Ascending Colon                                15       6        9         15          0
Hepatic Flexure                                 5       2        3          5          0
Transverse Colon                               14       7        7         14          0
Splenic Flexure                                 2       0        2          2          0
Descending Colon                                9       3        6          8          1
Sigmoid Colon                                  31      18       13         29          2
Large Intestine, NOS                            5       2        3          0          5
Rectum & Rectosigmoid                          41      20       21         37          4
Rectosigmoid Junction                           6       2        4          5          1
Rectum                                         35      18       17         32          3
Anus, Anal Canal & Anorectum                    9       0        9          8          1
Liver & Intrahepatic Bile Duct                 15       9        6         14          1
Liver                                          12       9        3         11          1
Intrahepatic Bile Duct                          3       0        3          3          0
Gallbladder                                     6       3        3          6          0
Other Biliary                                  31      16       15         29          2
Pancreas                                      162      74       88        156          6     Missouri Baptist Cancer Center
Retroperitoneum                                 1       0        1          1          0     has seven medical oncologists
Peritoneum, Omentum & Mesentery                 4       0        4          4          0     and two radiation oncologists.
RESPIRATORY SYSTEM                            296     156      140        283         13
                                                                                             Pictured is Atif Shafqat, MD,
Larynx                                          4       4        0          3          1
Lung & Bronchus                               291     151      140        279         12     medical oncologist.
Trachea, Mediastinum
& Other Respiratory                             1       1        0          1          0
BONES & JOINTS                                  2       2        0          2          0
Bones & Joints                                  2       2        0          2          0
SOFT TISSUE                                    12       7        5         11          1
Soft Tissue (including Heart)                  12       7        5         11          1
SKIN EXCLUDING BASAL & SQUAMOUS                50      26       24         49          1
Melanoma -- Skin                               48      25       23         47          1
Other Nonepithelial Skin                        2       1        1          2          0
BREAST                                        393       1      392        364         29
Breast                                        393       1      392        364         29

✣Analytic cases: Diagnosed and/or received first course treatment at Missouri Baptist.
✽Non-analytic cases: Received subsequent treatment at Missouri Baptist (diagnosed and all
first course treatment received elsewhere).
     Analysis of Cancer Cases 2008
     Missouri Baptist Medical Center 2008 Accessioned Cases

     Primary Site                          Total    M       F    Analytic✣ Analytic✽
     FEMALE GENITAL SYSTEM                 133       0    133      116       17
     Cervix Uteri                           15       0     15       14        1
     Corpus & Uterus, NOS                   71       0     71       67        4
     Corpus Uteri                           69       0     69       66        3
     Uterus, NOS                             2       0      2        1        1
     Ovary                                  32       0     32       21       11
     Vagina                                  1       0      1        1        0
     Vulva                                   9       0      9        8        1
     Other Female Genital Organs             5       0      5        5        0
     MALE GENITAL SYSTEM                   306     306      0      290       16
     Prostate                              295     295      0      279       16
     Testis                                 11      11      0       11        0
     URINARY SYSTEM                        131      91     40      122        9
     Urinary Bladder                        73      54     19       68        5
     Kidney & Renal Pelvis                  51      33     18       47        4
     Ureter                                  4       2      2        4        0
     Other Urinary Organs                    3       2      1        3        0
     EYE & ORBIT                             1       0      1        0        1
     Eye & Orbit                             1       0      1        0        1
     BRAIN & OTHER NERVOUS SYSTEM           42      23     19       41        1
     Brain                                  20      14      6       19        1
     Other Nervous System                   22       9     13       22        0
     ENDOCRINE SYSTEM                       24       4     20       22        2
     Thyroid                                22       3     19       20        2
     Other Endocrine (including Thymus)      2       1      1        2        0
     LYMPHOMAS                              95      42     53       90        5
     Hodgkin Lymphoma                       11       5      6       11        0
     Hodgkin - Nodal                         9       5      4        9        0
     Hodgkin - Extranodal                    2       0      2        2        0
     Non-Hodgkin Lymphoma                   84      37     47       79        5
     NHL - Nodal                            57      25     32       57        0
     NHL - Extranodal                       27      12     15       22        5
     MULTIPLE MYELOMA                       11       5      6       10        1
     Multiple Myeloma                       11       5      6       10        1
     LEUKEMIAS                              34      19     15       32        2
     Lymphocytic Leukemia                   16      13      3       14        2
     Acute Lymphocytic Leukemia              1       1      0        1        0
     Chronic Lymphocytic Leukemia           14      11      3       12        2
     Other Lymphocytic Leukemia              1       1      0        1        0
     Myeloid & Monocytic Leukemia           17       6     11       17        0
     Acute Myeloid Leukemia                  8       3      5        8        0
     Acute Monocytic Leukemia                1       0      1        1        0
     Chronic Myeloid Leukemia                8       3      5        8        0
     Other Leukemia                          1       0      1        1        0
     MESOTHELIOMA                            8       8      0        7        1
     Mesothelioma                            8       8      0        7        1
     MISCELLANEOUS                          35      15     20       34        1
     Miscellaneous Sites                    35      15     20       34        1
     TOTAL                                2,032    919   1,113   1,903      129
Missouri Baptist Named a                                        Breast HealthCare Center
Breast Imaging Center of                                        Serving the Uninsured and
   Excellence                                                   Underinsured Population

         The Breast HealthCare Center (BHCC) at                 Missouri Baptist is committed to helping the uninsured
         Missouri Baptist Medical Center has been               and underinsured patients in the St. Louis area, as well
recognized by the American College of Radiologists              as reaching out to 11 rural counties in Missouri. Grant
(ACR) as a Breast Imaging Center of Excellence. The             funding through the Susan G. Komen for the Cure
BHCC also received the highest patient satisfaction for         St. Louis® are used to educate and screen women for
breast centers in the country per the National PRC.             breast cancer.

The BHCC uses digital mammography, which offers                 In addition, we bring our mobile mammography van to
the most advanced mammographic imaging technology               many locations throughout the St. Louis metropolitan
available today, along with computer-aided detection.           area. We also collaborate with a variety of businesses,
The Center’s demand for digital mammograms increased            community organizations, medical clinics and
by 12% over last year.                                          Dierbergs Markets. We understand the multiple
                                                                responsibilities of busy women today. This mobile
The BHCC has six dedicated radiologists who specialize          outreach program allows us to provide our convenient
in mammography and breast imaging. We receive                   services in their neighborhoods, schools and places of
referrals from all over the bi-state area for breast biopsies   employment.
and surgical consults. We also offer breast MRI and
breast MRI biopsy to select patients who are high risk          Through our partnership with Komen, in our grant
or have had cancer detected in their breasts. Same day          year 2008, we successfully screened and educated
service is provided to women with breast problems               more than 500 women on our mobile mammography
either self-detected or detected by their physician.            van and in our breast center with funds provided
                                                                from Komen’s Rural and Reaches grants. Eight breast
Established within the BHCC, our Multidisciplinary              cancers were detected and these women were placed
Breast Clinic brings together specialists in breast             into appropriate treatment programs. The Komen
diagnostics, breast surgery and breast cancer treatment.        grant also allowed the Breast HealthCare Center to
An Advanced Practice Nurse (APN) Navigator trained              provide more than 100 women, who had problems in
in oncology and breast health coordinates patient               their breasts, with diagnostic care.

Breast cancer cases are presented in a multidisciplinary
breast conference with breast surgeons, pathologists,
radiologists, medical oncologists, radiation oncologists
and registered nurses. The best course of treatment,
surgically and medically, is discussed for each individual

The Multidisciplinary Breast Clinic both streamlines
the evaluation process and provides comprehensive
services for all breast problems, ranging from unusual
symptoms to breast cancer for both women and
men. Should the diagnosis be breast cancer, the APN
navigator initiates care by meeting with and assessing
the patient within 24-48 hours of diagnosis, coordinating
all future multidisciplinary appointments, and ensuring
                the patient’s treatment plan is established
                   quickly and coordinated across our
                     multidisciplinary team.

     Cancer Research Program Helps Future Cancer Treatments

         Missouri Baptist Medical Center is a member of                contribute more than one-third of the patients who are
         the Heartland Cancer Research CCOP a National                 enrolled on NCI-sponsored trials each year.
         Cancer Institute (NCI)-designated Community Clinical
         Oncology Program. The Heartland CCOP combines                 The Heartland CCOP website is
         the program resources of Missouri Baptist Cancer     It is a valuable resource for
         Center and the Center for Cancer Care and Research.           cancer patients, the general public, and health care
         Heartland provides St. Louis County patients, as              professionals. It contains information about the types of
         well as the Missouri Baptist rural outreach affiliates,       cancer, treatment side effects, reasons to participate in
         the opportunity to participate in more than 75 active         clinical research, and research studies available through
         research studies. By participating in clinical research       Heartland. There are multiple links on the Heartland
         studies, our patients benefit from the development of         website to complimentary resources on the Missouri
         new drugs and treatments and help build upon a legacy         Baptist website.
         that will benefit future cancer patients.
                                                                       Heartland is affiliated with several research databases
         The CCOP award has allowed us to expand our                   including:
         involvement in clinical research trials, and has enhanced     • Cancer and Leukemia Group B (CALGB)
         our ability to provide newly developed cancer prevention      • National Surgical Adjuvant Breast and Bowel Project
         and cancer treatment advances to our community.                 (NSABP)
                                                                       • North Central Cancer T   reatment Group (NCCTG)
         Alan P Lyss, MD, is director of Missouri Baptist’s            • Wake Forest University Comprehensive Cancer
         Cancer Research Program and principal investigator for          Center (WFCCC)
         Heartland Cancer Research. The mission of the CCOPs           • Cancer T rials Support Unit (CTSU)
         is weighted equally in cancer treatment studies and
         cancer control/prevention trials. Nationally, CCOPs           All research protocols are reviewed by the Institutional
                                                                       Review Board (IRB) of Missouri Baptist Medical Center,
                                                                       which has been granted the endorsement of the Federal
                                                                       Office for Human Research Protections (OHRP),
                                                                       a division of the Department of Health and Human

                                                                       Members of Heartland, many at Missouri Baptist,
                                                                       continue to play an active role in cooperative group
                                                                       life. Four papers have been published in peer-reviewed
                                                                       journals over the past year.

                                                                       In the fourth year of the Heartland CCOP grant, 128
                                                                       new patients were entered into cancer treatment and
                                                                       cancer control studies.

                                                                     Alan P Lyss, MD, is director of Missouri
                                                                     Baptist’s Cancer Research Program and
                                                                     principal investigator for Heartland
                                                                     Cancer Research.

                                                                                                               P FA C
Patient and Family Advisory Council Enhances
                                                                                                             AND ITS
Patient-Centered Care at Missouri Baptist

In May 2008, our Cancer Center formed its first Patient
and Family Advisory Council (PFAC) as part of our
                                                              Mission: The Patient and Family Advisory
                                                              Council will be a partner with the Missouri Baptist
continuing mission to provide excellent care to our
                                                              Cancer Center team, involved in decision-making and
patients and families. The PFAC has helped define the
                                                              committed to creating an environment of safety, dignity,
true meaning of ‘patient-centered care.’
                                                              respect and honesty to assure the very best for patients
                                                              and families.
In September 2007, the proposal was made by the BJC           Vision:     To be a revolutionary leader in raising the
Process Improvement team to form a Cancer Center              standard of excellence for cancer care.

A planning committee was developed that consisted
of several patients, a family member, a Cancer Center
physician, nurse, radiation therapist and social worker.
The planning committee met weekly for 2 ½ months.
Initial guidelines and by-laws were written, and a referral
and interview process was developed to enlist at least 12
patients/family members on the PFAC.

In May 2008, the Cancer Center PFAC began its formal
journey. Many accomplishments have been made by this
dedicated group of our patients and family members.
The PFAC meets monthly, and among some of its
accomplishments during 2008 are:
• participated in the development of a New Patient
  Binder for all new patients undergoing chemotherapy
  or radiation therapy
• assisted in the creation of the Cancer Center website
• provided feedback on marketing materials, patient
  processes both within the Cancer Center as well as
  within other hospital departments
• developed a patient orientation process for new
  chemotherapy patients and family members, which
  is provided by the trained Cancer Center treatment
  room volunteers.

As of 2009, there are 16 active patient and family
members participating on the PFAC. These members
know they are being listened to, and are making a
difference within the Cancer Center and the hospital. In
it’s first year, the PFAC has demonstrated the essence of
‘patient-centered care’ at Missouri Baptist.

On the following pages, we feature
three PFAC members who also are
cancer survivors . . . .

     Serving on the PFAC is a way I can help other young
     moms being treated for cancer.

Inspired to Volunteer Her Time in Helping Others

Toni Mazzuca has a long personal history with cancer.        Toni said that the camaraderie
Rather than feel devastated by that, T instead has
been inspired to volunteer her time helping others.
                                                             and warmth within the PFAC
                                                             group is heartfelt. “We can cry
At the age of 15, she lost her dad to prostate cancer, and   and get emotional and not feel
at age 20, she lost her mom to breast cancer. In addition,   uncomfortable,” she explained.
her sister has had and survived breast cancer twice.
                                                             When Toni was going through cancer treatments, her
Then, four years ago at age 43, T herself was                four children were three, six, nine and 13. “I had to
diagnosed with breast cancer.                                reach out and ask for help and it was the hardest thing
                                                             I ever had to do,” said Toni. “Serving on the PFAC is
Today, she too is a survivor.                                a wonderful way I can help other young moms going
                                                             through the same thing.”
Besides serving as a PFAC volunteer in Missouri Baptist’s
Cancer Center, T   oni, RN, BSN, is a part-time nurse on     During her treatment, Toni was particularly sensitive to
its obstetrics floor.                                        her kids’ needs and never mentioned scary words, such
                                                             as tumor, surgery or chemotherapy. Toni explained only a
“I’ve always wanted to do something more for others,”        little each step of the way and mostly assured them that
said Toni, “so when Ros Hofstein asked me to consider        she would be fine.
being a member of the Patient and Family Advisory
Council, I agreed.” Hofstein, MSW, LCSW, is the              As a personal goal, Toni said she’d like the PFAC to be
supervisor of oncology social services, and staff liaison    instrumental in developing more assistance for mothers
for the committee.                                           who have to bring a child to the hospital when they have
                                                             treatments. “From my own personal experience, I think
The committee, known as PFAC for short, is a group of        mothers would appreciate simply being reassured that it
cancer survivors, family members and Missouri Baptist        is okay if they have to bring a child with them,” said Toni.
Medical Center staff members, who meet routinely to
discuss ways to improve cancer care for patients being                                        oni
                                                             During her battle with cancer, T said her husband was
treated at the Cancer Center. The PFAC was formed            phenomenal and every night prayed for her recovery.
about 18 months ago.                                          oni
                                                             T also feels blessed that, although her parents died
                                                             when she was young, they taught her and her siblings
“They really do listen to us,” said Toni, about the          that, in life, you must always keep a sense of humor.
influence of the PFAC on the Cancer Center. “We can
see the changes they have made after receiving our           As a PFAC member, Toni likes it when it’s her turn to
suggestions.”                                                visit patients in the Cancer Center. “We ask them if they
                                                             have any suggestions,” she said.
“People were getting lost in the hospital,” said Toni,
who noted that signage now has improved. She also
mentioned the new binder that patients are given when        “I enjoy listening and sharing with
they begin their cancer journey. “Getting the binder         them and establishing that bond from
created may be one of the biggest accomplishments of         my personal experience with cancer.”
the PFAC to date,” she said.

     Spirited Grandmother Focuses on Survivorship for Herself and Others

          Patricia Niehaus is 68 years old, but you might not guess    Pat also said that new patient orientation is ‘so good’
          that. Most weeks, she goes to the gym five days and          now. Volunteers take patients and family members
          works out. She’s a grandmother to 11 children, a mother      around the Cancer Center and treatment area to show
          to three grown children, and has been married to her         them where things are, from sodas in the refrigerator
          husband, George, for 48 years. She also is a volunteer at    that they may help themselves to, to where the gift shop,
          Missouri Baptist’s Cancer Center.                            cafeteria and chapel are located. “We want them to be
                                                                       comfortable,” she said.
          You also wouldn’t guess that Pat is a
                                                                       Pat loves visiting with patients in the treatment center
          breast cancer survivor.                                      as part of PFAC activities. “We get to talk with them
                                                                       and ask them to grade us from one to 10,” she said. “It’s
          “I just celebrated my 10-years of survivorship,” said Pat.
                                                                       so nice to hear comments, such as ‘when I’m here, I feel
          “And, boy, did I have a party!” She and her girlfriends
                                                                       like I’m the only person here. The nurses make us feel so
          went to the wineries, ate lunch and bought fun t-shirts.

          Pat also is a Patient Family and Advisory Council
                                                                       Like other PFAC members, Pat would like to see
          (PFAC) member at the hospital. PFAC is a group of
                                                                       survivorship addressed by the committee. “How can
          cancer survivors, family members and Missouri Baptist
                                                                       we help the patients after they are done with their
          Medical Center staff members, who meet routinely to
                                                                       treatments?” she said. “After treatments are completed,
          discuss ways to improve care for cancer patients. The
                                                                       patients often wonder, ‘what do I do now?’ and ‘how do
          PFAC was formed about 18 months ago.
                                                                       I rebuild my strength?’”

          “I served on the planning committee and then was asked
                                                                       She explained that when a patient finishes treatment,
          to stay on as a member,” she said. “I never want to leave
                                                                       they might not see their physician for three months or
          the PFAC,” laughed Pat, “but I also know we will need
                                                                       so. “Patients bond with each other while they are in
          new energy and new blood.”
                                                                       the treatment center, and it would be great if we could
                                                                       provide something in addition to the annual wellness
          “My generation did not talk about cancer much,” said
                                                                       seminar Missouri Baptist offers,” she said. “It’s important
          Pat. “My grandfather died of cancer and we just knew it
                                                                       for patients to keep contact with other survivors.”
          as the big ‘C.’”
                                                                       “My goal before leaving the PFAC is to have a program
          By serving on the PFAC, Pat said, “We are trying to do
                                                                       in place for survivors,” she added.
          things to make life easier for patients.”

          Now, the Cancer Center offers patients a special binder
          with pages they can fill out along their journey. The
          PFAC helped develop the binder, and said Pat, “I wish I’d
          had something like it when I had treatment to help keep
          track of things, like my medications.”

                         Pat told a story about her grandchildren: “It was hot in the kitchen when we
                         were cooking Thanksgiving dinner. My grandchildren were there and I told them
                         I was going to take my wig off, but not to laugh, because I was bald from all the
                         medicines doctors were giving me to help me get well. So, I removed my wig and
                         we all burst out laughing. They were so at ease with it and that was wonderful.”

I just celebrated my 10-years of survivorship.

     I’m excited to see Missouri Baptist take such an affirmative stance
     and be responsive to patients and family members.

Life-Changing Experience Leads to New Career and Volunteerism

During the last 22 years, Richard Schumacher, now 53,       As a PFAC member, Richard enjoys talking with
has survived cancer three times. Eighteen years ago,        current Cancer Center patients and then relaying their
during his second recurrence of Hodgkins Lymphoma,          suggestions to other PFAC members and staff. “Patients
his family was essentially told to gather around for his    are very appreciative and see changes being made,”
impending death.                                            said Richard. “I also was so impressed when Missouri
                                                            Baptist’s president Joan Magruder came to a PFAC
“Thanks to the skill of doctors, the prayers of thousands   meeting. Many of the doctors and nurses also have come
and the grace of God,” said Richard, “I’m still here.”      to meetings and that demonstrates tremendous interest
In 2004, his third bout with cancer, he battled Non-        in the patient care here.”
Hodgkins Lymphoma and once again survived.
                                                            Richard reflects that the differences between his care
“It was life changing,” stated Richard.                     in 1987 to 2004 have included not only the medical
                                                            advances, such as better drug therapies, but also the
“I began to see my cancer experience                        emotional, psychological and spiritual aspects of care. “I
as a way to help others.”                                   commend the nursing staff for their training and ability to
                                                            work with cancer patients,” said Richard.
Richard, who had been a banking executive, spent eight
years going to seminary, first part-time at night, then     Richard, who has been married for 30 years and has
full-time to earn his master’s in divinity in 2001. Today   three children, said his wife has coped well and had
he is regional associate superintendent, Evangelical Free   strong support systems. He said, “Cancer is part of our
Church of America Central District, for Missouri and        life experience.”
                                                            For the future, Richard would like to see the PFAC
When his medical oncologist Gary Ratkin suggested he        continue to be the voice for patients and families, and
serve on the Patient and Family Advisory Council at         address survivorship issues, such as ‘what comes next’
Missouri Baptist’s Cancer Center, Richard said that it      after cancer treatments are completed. “I’d also like to
“was a natural extension to do something positive.”         see that, what the PFAC is doing for the Cancer Center,
                                                            have a broader application for healthcare in general,” said
Known as PFAC for short, the Council is a group of          Richard.
cancer survivors, family members and Missouri Baptist
Medical Center staff members, who meet routinely to         Richard stated that we are so lucky here in the United
discuss ways to improve care for cancer patients. The       States. When visiting a cancer hospital in Russia, as part
PFAC was formed about 18 months ago.                        of a global church mission, Richard saw that they have no
                                                            hope and few resources in a state-run medical system.
“I’m excited to see Missouri Baptist take such an           “There is very little concern about the emotional aspects
affirmative stance and be responsive to patients and        of patients,” he said.
family members,” Richard said. “It is a compassionate
move and sets Missouri Baptist apart.”
                                                            “Here we continue to make strides
Richard said that he has seen the influence of PFAC,        that are so positive and remarkable to
for example, with changes made in the reception area        watch,” said Richard.
for patients coming into the treatment center. Richard
mentioned an informational card that now is provided to
patients explaining what is happening behind-the-scenes
for their treatments while they are waiting.

     Education Update for Physicians and Staff

             Educational programs available to                             Radiation Oncology Review. Monthly case reviews
                                                                           to include the entire staff where patients undergoing
             physicians and staff include:
                                                                           radiation treatments are discussed. The plan of treatment
                                                                           is reviewed between the physicians, physicist, dosimetrist
             Quarterly Tumor Education. Topics presented in 2009
                                                                           and therapists. Any nursing or social service needs also
                                                                           are discussed at this time.
             Minimally Invasive Gynecologic Cancer Surgery: Focus
             on Robotic Surgery- the future?” - Matthew Powell, MD,        Nursing and ancillary support staff meets frequently for
             Missouri Baptist                                              updates on new drugs and therapies. Oncology-certified
             “Frontiers in Thyroid Cancer” - James Etzkorn, MD,            nurses undergo an annual competency evaluation on
             Missouri Baptist                                              oncologic emergencies, administration and safe handling
                                                                           of chemotherapeutic agents and new drugs.
             “Update on Breast Cancer Surgery” - Paul Yazdi, MD,
             Missouri Baptist
             “Are Anthracyclines Necessary for Early Breast Cancer?
             Risk of Cardiac Toxicity” - Stephen Jones, MD, Medical
             Director, US Oncology Research Houston TX, Director
             Breast Cancer Research, Baylor-Sammons Cancer Center,
                                                                             Community Education
             Texas                                                           Provides Education and
             “Management of Aggressive T-cell Lymphomas”
             - Kenneth Carson, MD, and Amanda Cashen, MD,
             Washington University School of Medicine
                                                                             Missouri Baptist’s community and
             “Head and Neck Cancers” - Bruce Haughey, MBChB,
             FACS Washington University School of Medicine                   employee education programs provide
                                                                             a variety of opportunities for people to
             Cancer Conference. Includes medical oncologists,                learn more about early detection and
             radiation oncologists, pathologists, surgeons, radiologists
                                                                             the treatment of cancer.
             and other subspecialty physicians along with ancillary
             support staff who gather weekly to discuss cancer cases
                                                                             In 2009, more than 2,900 community members and
             prospectively. Paul Schultz, MD, medical oncologist,
                                                                             employees attended our community and employee
             remains the Cancer Conference Coordinator.
                                                                             events. Our screening programs screened 650
                                                                             individuals for prostate and skin cancer. In addition to
             Pulmonary Conference. In a similar fashion as Cancer
                                                                             the screenings, the 2009 programs included:
             Conference, pulmonologists, thoracic surgeons, medical
                                                                             • Pearls of Wisdom (a women’s event)
             and radiation oncologists and pathologists meet weekly.
                                                                             • Prostate Cancer Screening (a partnership with the
                                                                               St. Louis Men’s Group Against Cancer and Fox 2)
             Breast Conference. Each week, all breast cancer cases
                                                                             • Hope, Health, Healing: A Cancer Wellness Event
             are discussed by a team of radiologists, medical and
                                                                             • Komen Race silver level sponsorship
             radiation oncologists, and surgeons prior to all cancer
                                                                             Anticipating an even greater need this year due
                                                                             to the economy, Missouri Baptist Medical Center
             Palliative Care Conference. Chaired by Gary Ratkin, MD,
                                                                             teamed with KMOX and created “The Voice of
             medical oncologist, and meets monthly for a didactic
                                                                             Breast Health” team for the Komen race. The Breast
             session followed by a case presentation.
                                                                             HealthCare Center, along with on-air co-hosts
                                                                             Debbie Monterey and Carol Daniels, reached their
             Gastrointestinal Conference. Meets monthly to support
                                                                             goal – a team 600 strong helping to raise funds to
             the treatment and care of gastrointestinal cancers
                                                                             provide underserved women with mammography
             presented at conference.
                                                                             screenings and breast health education.

                                                                4th Annual Cancer Fair

                                                                In early October of 2009, the Cancer Center
                                                                held its 4th annual FREE cancer health fair:
                                                                Hope, Health, Healing: A Cancer Wellness Event.
                                                                The event attracted more than 140 participants.

                                                                Survivorship issues were a focus as those faced
                                                                with cancer often have common concerns. Keynote
                                                                speakers were Gary Ratkin, MD, medical oncologist,
                                                                whose presentation was titled, “ I Completed
                                                                Treatment: Now What?” and Scott Burton, a
Complementary Therapies Offer                                   cancer survivor and comedian. With humor, Scott
                                                                helped survivors see the human side of the cancer
Creative Outlets for Patients                                   battle and to remember that their lives are still
and Their Family Members                                        present, vital and precious.

                                                                Five breakout sessions were offered, including:
More than 800 patients and family members participated in       1) a panel discussion on Side Effects: Now and Later
our Complementary Therapy Program this year.                       with Deborah Wienski, MD, medical oncologist,
                                                                   James Corder, MD, internal medicine, and Israel
Music continues to be performed monthly in our treatment           Zighelboim, MD, GYN oncologist;
room and the popular art therapy program, called “Your          2) Shake It with Zumba, a demonstration by an
Tile Matters,” resulted in the addition of more than 200           instructor from the Wellness Community;
tiles to the columns in the Cancer Center. The tiles are        3) Fitness with Cancer, presented by a Missouri
hand-painted and created by patients and family members.           Baptist occupational therapist;
                                                                4) Self-Identity: Who Am I Now?, presented by a
“The tiles provide inspiration to those visiting the center,”      Wellness Community instructor;
said Ros Hofstein, MSW, LCSW, supervisor, oncology              5) Essentials for Sun-Sensitive Skin, presented by
social services and staff liaison for the Patient and Family       Helen Kim-James, MD, dermatologist.
Advisory Council.
                                                                In addition, the program featured a number of
Complementary chair massages or hand massages were              educational displays, complimentary chair massages
enjoyed by more than 500 participants and were                  and an art therapy experience.
offered weekly.

In partnership with the American Cancer Society,
the Cancer Center continued to provide the monthly
‘Look Good, Feel Better Program.’ Almost 70 women
undergoing cancer treatments participated by receiving
a makeover and skin and hand care suggestions from a
trained cosmetologist. Special hints for head coverings also
are demonstrated during this popular session.

The Complementary Therapy Program expanded in 2009
to include an “Ask the Dietitian” program since nutrition is
an important aspect of patient care.

“The dietitian is available twice a month to address the
nutritional concerns or questions that our patients have
while undergoing cancer therapy,” said Hofstein.

                         Director, Medical Oncology
                         Gary Ratkin, MD

                         Director, Oncology Services and the Breast
                         HealthCare Center
                         Debbie Mercier RN, MSN, AOCN

                         Manager, Cancer and Infusion Center
                         Melissa Clenin, BSN, RN, OCN

  Our Mission            314-996-5093

                         Manager, Radiation Oncology
 To improve the health   Mary Wojcik, RT (R)(T)
   of the people and
                         Manager, Breast HealthCare Center
communities we serve.    Sarah Ernsky, RN, BSN

                         Heartland Cancer Research CCOP
                         Director and Principal Investigator
                         Alan Lyss, MD
                         Jean Roark - Manager

                         Supervisor, Oncology Social Services
                         Ros Hofstein, MSW, LCSW

                         Cancer Registry
                         Diane Grove, RHIA, CTR

                         Cancer and Infusion Center

                         Missouri Baptist Outpatient Center –
                         Sunset Hills

                         Hospice/Supportive Care

                         Community Education and Physician Referral
                         314-996-LIFE (314-996-5433)

                         Cancer Education and Information Center
                         Complementary Therapy Services

                         Centralized Scheduling

                         Missouri Baptist Medical Center
                         3015 N. Ballas Road • St. Louis, MO 63131