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HCC ANNUAL REPORT Powered By Docstoc
					Accredited by the American College of Surgeons since 1987 as a Community Hospital Comprehensive Cancer Program
Hulston Cancer Center’s mission is to improve the quality of life for cancer patients and   enhance the services we offer. At the foundation of our mission are our core values – Integrated,
their families through quality, compassionate health care, education and research.          Quality Health Care; Compassionate Care; Education; Research and Technologic Excellence.

Our cancer program is rooted in a commitment to provide consistent, excellent care.         Our continual focus on these core values provides the vision for the role Hulston Cancer Center
Our hope for the future keeps us diligently searching for new ways to improve and           will have in our community.
Table of

       1                          3–4                                                  11–12                                                         23–24                                                  33–34
       Letter from the Chairman   U n f o l d i n g t h e Te x t u r e s               Insights for                                                  Hunger for Advancements                                Sounding Out Innovations
                                  of a Healing Environment                             Comprehensive Care                                            i n B r e a s t C a n c e r Tr e a t m e n t           in Colorectal Cancer Care
       Cancer Committee Members   5–6    Single-Point-of-Service-Plan                  13–14 Caregiver Spotlight:   Oncology Hematology Associates   25–26   Breast Cancer Outreach                         35      Colorectal Cancer Outreach
                                  7–8    Spotlight: Rick and Lori Allenbrand           15–18   Cancer Registry Report                                27–30   Lymphedema Study                               36–38   Rectal Carcinoma Study
                                  9–10   Complementary/Alternative Medicine            19      Cancer Research for the Ozarks                        31      New Breast Care Technologies                   39      Caregiver Spotlight: Jose Dominguez, MD
                                                                                       20      Caregiver Spotlight: Dental Oncology                  32      Caregiver Spotlight: Breast Care Clinic Team   40      Survivor’s Story: Olan D. Payne
                                                                                       21      Mohs Procedure
                                                                                       22      Caregiver Spotlight: Craig Naugle, MD

                                  41–42                                                47–48                                                         51–52                                                  55–56
                                  Envisioning the Future of                            To u c h i n g o n I m p r o v e m e n t s                    A Ta s t e f o r L e a r n i n g                       The Breath of Hope
                                  Prostate Cancer Therapy                              for Lung Cancer
                                                                                                                                                     53      Community Outreach                             57      Lending Support
                                  43     Prostate Cancer Outreach                      49       Lung Cancer Outreach                                 54      Professional Education                         58      Caregiver Spotlight: Barbara Wachtel-Nash, PsyD
                                  44–45 New Views on Radiation Therapy                 49       Caregiver Spotlight: Terrence Coulter, MD                                                                   49–52   Donors
                                  46    Caregiver Spotlight: Radiation Oncology Team   50       Nd:YAG Laser Photoresection Study
                               Dear Colleagues,                                                                                 Ibrahim Abdalla, MD                        Barry Farber, MD                           John Pacyniak, PhD
                                                                                                                                Radiation Oncology                         Urology                                    Radiation Physicist
                               Once again it is my pleasure to present the Hulston Cancer Center Annual Report for
John W. Clouse, MD             2001-2002. All the components of our cancer program continue to grow and improve. A              Michael Albritton, MD                      L. Wayne Goodin, DDS                       Jeff Robinson
Cancer Committee Chairman      number of new services are now available on our campus including Moh’s surgery for select
                               skin cancers, interstitial brachytherapy for prostate carcinoma, bronchoscopic stenting and
                                                                                                                                Radiation Oncology                         Dental Oncology                            Director, Radiation Oncology
                               photo resection for obstructing bronchial lesions. Further details on these procedures, as
                               well as the medical and professional staff who provide them, are included in this report.        A.J. Bonebrake, MD                         Deanna Gunnett, RN                         Martee Robinson, PhD
                                                                                                                                Gynecologic Oncology                       Breast Care Clinic                         Coordinator,
                               We are pleased to welcome Dr. Amy Rabe, medical oncologist, who joined the staff at                                                                                                    Complementary/Alternative Medicine
                               Oncology-Hematology Associates this year. Dr. Craig Naugle, dermatologist, also joins            Ginny Butler                               Gregory Haake, MD
                               us in Plaza II and brings with him expertise in Moh’s surgery.                                                                                                                         JoAnne Schahuber, RT(M), (QM)
                                                                                                                                Administrative Secretary,                  Pathology
                               The Allenbrand Cancer Resource Center is scheduled for construction and grand opening            Hulston Cancer Center                                                                 Director, Breast Care Clinic
                               this year. Trained staff will be available to patients and their families exploring the latest
                                                                                                                                                                           Arthur Hawes, MD
                               developments in cancer diagnosis, treatment and research.                                        Robert Carolla, MD                         Plastic Surgery                            Susan Sloan, RN
                                                                                                                                Medical Director, Hulston Cancer Center;                                              Educational Services
                               Also on the ground level at Plaza II, the Radiation Oncology suite will be expanded, new                                                    Bruce Hedgepeth, MD
                                                                                                                                Internal Medicine/Oncology
                               treatment equipment added and IMRT (Intensity Modulated Radiation Therapy) will be                                                          Radiology/Breast Care Clinic               Ina Stafford, CTR
                               available. Outpatient oncology services will expand to the second floor of Plaza II and
                               Oncology-Hematology Associates will be moving to larger offices on the sixth floor.              Brad Chadwick, RTR, RDMS, RDCS                                                        Cancer Registry
                                                                                                                                                                           Melissa Hollis
Robert Carolla, MD             The Breast Care Clinic has added digital mammography with CAD (Computer Aided                                                               Social Services                            Barbara Wachtel-Nash, PsyD
Medical Director,              Detection) technology to assist in accuracy of interpretation, and the clinic is planning a      Chairman John Clouse, MD                                                              Behavioral Medicine
Hulston Cancer Center          larger suite in the future.                                                                                                                 June Johnson, RN
                                                                                                                                                                           Director,                                  Ronald Wachter, MD
                               We remain dedicated to our single-point-of-service plan. We continue to improve and refine       Radiation Oncology
                                                                                                                                                                           Hulston Cancer Center Support Services     Pathology
                               our cancer program in our effort to enhance the healing environment for our patients. We
                               strive for the highest quality, multispecialty diagnosis and treatment using the latest proven   Terry Coulter, MD
                                                                                                                                                                           Marcy Keltner, RN, OCN                     Suzi Waltke, RN
                               technology and research. We also seek to preserve dignity, respect and compassion in the         Pulmonology
                               care of our patients. Our efforts in this direction are reflected in the pages that follow.                                                 Nurse Manager, Oncology Unit               Nurse Educator, Hulston Cancer Center
                                                                                                                                José Dominguez, MD
                               Sincerely yours,                                                                                                                            Karen Kramer, MSHA                         Nancy Waring
                                                                                                                                American College of Surgeons Cancer
                                                                                                                                                                           Administrative Director,                   Director, Women’s Center
                                                                                                                                Liaison; Colon and Rectal Surgery
                                                                                                                                                                           Hulston Cancer Center
                                                                                                                                Beth Donovan                                                                          Jan Weiss
                               John W. Clouse, MD
                                                                                                                                                                           Richard Martens, DMD                       Rehabilitation Services
                                                                                                                                Community Education Coordinator
                                                                                                                                                                           Dental Oncology
                                                                                                                                Sharon Duvall                                                                         Cindy Whitten, RN, MS
                                                                                                                                                                           Dean Matthews, BS, MBA, JD                 Director of Nursing, Nursing
                                                                                                                                Quality Resource Department
                                                                                                                                                                           Director, Cancer Research for the Ozarks   Administration
José Dominguez, MD
American College of Surgeons                                                                                                    Robert Ellis, MD
Cancer Liaison                                                                                                                  Internal Medicine/Oncology
There is never a time of greater need in the life of an individual or family than after a diagnosis of cancer. Survival
becomes the focus and the gentle pleasures of everyday life can be lost in the fight.

Hulston Cancer Center strives to offer comfort to cancer patients and their loved ones at all levels. Upon entering the
center, soft piano music brings joy to the ears. Calming colors bring peace to the eyes. Fragrant aromas and palatable
flavors come to mind. These gentle pleasures are the textures of a healing environment.
Ser vice Plan
The smooth transition to a dedicated cancer center       Cancer Center, the Allenbrand Cancer Resource             Inside the Allenbrand Cancer Resource Center is our         the patient-centered plan for this expanded facility.
at CoxHealth is nearly complete. Upon entering           Center will offer an oasis of comfort and information.    new SilverLeaf Salon. Gifts, cards, specialty teas, aro-    Our indoor aviary, specially equipped with ventila-
Hulston Cancer Center you are surrounded by our          Trained staff will be available to help patients and      matherapy products and therapeutic massage services         tion and temperature controls, will offer our patients
healing environment. Our patient-centered approach       their families find the latest developments on cancer     will be available along with items of particular interest   the comfort and serenity of the outdoors. Gentle
to cancer care means that radiation oncology,            diagnosis, treatment and research. In addition, the       to those involved in cancer treatment. Now cancer           chirping and the soft fluttering of wings along with
medical oncology, the Breast Care Clinic, oncology       center will provide entertainment and relaxation          patients will be able to shop for items such as wigs,       the playful antics only live birds can provide will
psychology services, cancer research and dental          videos and tapes, free Internet access to health infor-   hats and scarves without the tiring experience of a trip    transform patient waiting time into a calming,
oncology are all conveniently located in one building.   mation sites and a place for family and friends to        to the mall. Massage services, which are available with     nature-filled experience.
                                                         wait comfortably during patient treatment. Computer       a physician order, can provide much needed relaxation
The Allendbrand Cancer Resource Center and               connections for those who want to bring a laptop to       before cancer treatment. The SilverLeaf Salon will          A dedicated cancer facility is more than bricks and
greatly expanded radiation therapy facilities are also   keep up with correspondence or work will be avail-        carry a wide selection of breast prostheses and post-       mortar. Our single-point-of-service concept focuses
coming soon to further enhance our single-point-of-      able. The center will also have accommodations for        mastectomy bras, and will be staffed by trained fitters.    on patient and family convenience. Because cancer
service concept. Located in the entry of Hulston         support group meetings and educational programs.          A gift registry will allow patients to identify products    patients may experience pain and low energy reserves,
                                                                                                                   and services most important to them so loved ones can       this concept is extremely important for the delivery
                                                                                                                   select the right item.                                      of compassionate, patient-focused care. The opening
                                                                                                                                                                               of the Allenbrand Cancer Resource Center and the
                                                                                                                   The Radiation Oncology department will soon see a           expansion of Radiation Oncology will move Hulston
                                                                                                                   two-fold expansion in patient care space. Additional        Cancer Center to a new level in cancer care, and
                                                                                                                   treatment rooms and larger, more comfortable wait-          ensure that we continue to meet the needs of cancer
                                                                                                                   ing areas will be included. Soothing colors, natural        patients and their families in the future.
                                                                                                                   lighting and a special indoor aviary are all part of
                                 Rick and Lori

     Rick Allenbrand is a young, vibrant, athletic man. When he walks into a room,      Allenbrands have experienced since his diagnosis have had a profound impact on their
people notice him. He smiles and makes eye contact from across the crowd. He’s          lives. They now have different hopes, dreams and goals for the future.
just one of those people with whom you are instantly comfortable. On his arm is               One of Rick Allenbrand’s new goals is to use his personal experience to help
Lori, his vivacious and personable wife. When Lori laughs, her inner beauty is as       others diagnosed with life-threatening disease. During his illness, he learned that
apparent as her outer good looks. Together they are the picture of a happy couple       in addition to the advanced medical treatments prescribed by Dr. Robert Carolla,
without a care in the world. What doesn’t show is that Rick and Lori are involved in    he also needed help with stress management and education in relaxation techniques
the battle of their lives. In July, 1999 Rick Allenbrand was diagnosed with leukemia.   to battle his disease. He also found that as his family and friends dealt with his
     That hot summer day all of Rick and Lori’s hopes, dreams and plans for the         diagnosis, they too were in need. Many people are affected by a cancer diagnosis
future came to a halt. Suddenly they were replaced with worry, doubt and fear.          in addition to the patient – and they all need help.
Rick says the only pain is in knowing that family and friends are suffering and not           To answer this need, the Allenbrands have established an endowment fund
knowing what to do, where to turn and who to turn to. The couple spent the next         to offer hope, education and support to people affected by cancer. The Rick and
several months learning about his diagnosis, traveling to doctor’s appointments and     Lori Allenbrand Endowment Fund was established through the Cox Healthcare
treatments, and coping with the physical and emotional challenges that accompa-         Foundation in 2000. The result of their efforts is Hulston Cancer Center’s new
nied his illness.                                                                       Cancer Resource Center. Here patients, their families and their friends can find
     Rick credits the love and commitment of his family and friends, as well as his     information and research about cancer and its treatment. In addition, there are
faith in God for enabling him to make it through the many days and long nights of       many resources about complementary and supportive approaches for easing the
treatment. He feels that he has been “blessed with a wonderful doctor and the most      mind and promoting a strong, healthy body. Rick Allenbrand says, “All of these
amazing nursing staff that anyone could wish for” at Hulston Cancer Center and adds     things played a key role in my healing, and I only wish to be able to help others
that his faith in God has been an instrumental part of his healing. The changes the     who are in urgent need of healing and compassion.”
                                                                                                                                    At Hulston Cancer Center, we believe health care should recognize the

Complementar y/Alternative                                                                                                          unique needs of individuals. The Complementary/Alternative Medicine
                                                                                                                                    (CAM) program at CoxHealth offers patients the opportunity to explore

Medicine                                                                                                                            and use techniques and methods that complement traditional health care
                                                                                                                                    and assists them in achieving optimum health.

                                                                                                                 CAM employee fairs were held at the north and              techniques and a speakers bureau is available for
Integrating CAM Into Patient Care                          bedside and in the chemotherapy area of Oncology
                                                           Hematology Associates. Music and relaxation tapes,    south campuses of CoxHealth. Attendees had the             educational presentations to community groups.
The CAM program is available as a resource for
                                                           along with personal tape players, are available to    opportunity to experience a variety of CAM therapies
Hulston Cancer Center patients who are seeking a
                                                           outpatients through our Cancer Resource Center.       including massage, juicing, aromatherapy and music,        The Wise Reader Book Club is a senior group that
holistic approach to their care. Throughout our center
                                                                                                                 as well as learn about the forms of CAM being used         meets monthly to share new information on CAM.
there is an understanding that providing support for
                                                           Hospitalized patients may request help in finding     by their patients.                                         The Women’s Community Education Group offers
healing can be as important to our patients as curing.
                                                           aromas that bring a sense of calmness through our                                                                members an opportunity to share facts about
                                                           aromatherapy program. This service is especially      Also available to employees is the “Ask Martee” Web        advanced CAM techniques. Our ongoing interaction
Our inpatient oncology unit has been designed with
                                                           beneficial to those patients dealing with food        page for questions about CAM therapies. The purpose        with these groups helps us ensure we continue to
special attention to visual comfort. We have a nation-
                                                           aversions. Massage therapy brings gentleness to the   of this online resource is to connect practitioners with   meet the CAM educational needs of our community.
ally recognized volunteer program that includes a
                                                           spirit through relaxation and circulation. Massage    research information and reliable, publicly accessible
resident artist to greet and meet with patients who
                                                           is available by physician order for inpatients and    documentation on topics related to CAM.                    The Jane A. Meyer Endowment was awarded to the
want to participate in an art project or just enjoy
                                                           outpatients at Hulston Cancer Center.                                                                            Cox CAM program in April 2002. This endowment
visual art during hospitalization. In addition, this
unit boasts a patient resource library, a kitchen for
                                                                                                                 Taking CAM Into the Community                              will assist us in providing music therapy to patients

patient and family use, home-style lighting and infor-
                                                           Introducing CAM to Practitioners                      Because one in three people in the United States           and make CAM education available to practitioners.
                                                           Providing CAM education to health care providers      uses some form of alternative medicine, CoxHealth
mal workstations that invite patients to collaborate
                                                           is an important way to build a bridge between con-    is committed to serving the community as a leader          Hulston Cancer Center is proud to acknowledge the
in their care with practitioners.
                                                           ventional and complementary/alternative medicine.     in CAM. We offer community education programs              addition of complementary/alternative therapies to
                                                           In November 2001, Dr. Martin Sullivan, associate      and we continue to gather input through discussion         our outstanding array of cancer services. The success-
Music is also available throughout Hulston Cancer
                                                           director of science and healing at Duke Center for    and focus groups.                                          ful bridging of conventional and complementary/
Center. Gentle piano music fills the air at the
                                                           Integrative Medicine, presented “The Hard and Soft                                                               alternative medicine is important to our vision of the
Allenbrand Cancer Resource Center. The piano was
                                                           Science of CAM” during a two-day symposium.           Free monthly CAM brown bag lunch programs are              holistic approach to individual care.
a gift from Virginia Cox Bussey to support music as
                                                           Physician participants were given an introduction     offered through Hulston Cancer Center. The most
a healing art for those receiving care at the Hulston
                                                           to CAM and received information on national           current printed CAM information is available at
Cancer Center. It plays on its own, or welcomes
                                                           trends in CAM therapies. In addition, Dr. Sullivan    the Allenbrand Cancer Resource Center. The CAM
patients and visitors to sit and create their own sooth-
                                                           presented CAM information at a community forum.       office offers a resource directory for specific CAM
ing tunes. Music therapy is available at the inpatient
At Hulston Cancer Center we respond to the needs of our community by providing comprehensive health care services.
Offering this high quality cancer care requires analyzing current and past patient data, envisioning future research
breakthroughs, recognizing pressing needs and making the latest advancements available to those we serve.
                                    Oncology Hematology
Ca re g i ve r Sp o t l i g h t :   Associates

                                          In 2001, the physicians of Oncology Hematology Associates provided care to patients            William Cunningham, MD, joined Oncology Hematology Associates in 1984. He is
                                    through more than 25,000 hospital and office visits. They are committed in their response      originally from Idaho and graduated magna cum laude with a degree in zoology from
                                    to people with cancer and blood disorders, and provide state-of-the-art consultations and      Brigham Young University in Provo, Utah. Dr. Cunningham earned his medical degree at
                                    therapeutic services. Their belief in the dignity of each person is evident as they help       the University of Utah in Salt Lake City. His medical internship, residency and medical
                                    patients make informed, intelligent choices throughout their illness.                          oncology and hematology training were at Duke University Medical Center in Durham,
                                          The nursing staff of Oncology Hematology Associates is comprised of highly trained,      N.C. He is board-certified in internal medicine and medical oncology and is a fellow of the
                                    caring individuals who are concerned with the physical and emotional needs of their            American College of Physicians. Dr. Cunningham’s research was in the areas of the “kinetics
                                    patients. Four nurses have certification in oncology nursing, which exemplifies a commit-      of macrophage-induced tumor cell cytotoxicity” and “activated macrophage-induced L1210
                                    ment to the care of oncology patients. Pharmacy and administrative assistants complete         cell cytotoxicity (murine system).” He has been a member of the Hulston Cancer Center            William Cunningham, MD
                                    the non-physician staff.                                                                       cancer committee since 1986 and serves on both the executive and steering committees of
                                          Robert Carolla, MD, has served as the medical director of cancer services at CoxHealth   Cancer Research for the Ozarks, for which he also serves as associate principle investigator.
                                    since 1996. He is co-founder and managing partner of Oncology Hematology Associates.                 Robert Ellis, MD, earned his medical degree at the University of Missouri-Kansas City
                                    Dr. Carolla is originally from Ohio, and graduated with honors with a bachelor’s degree in     in 1989. As a recipient of the Navy’s Health Professional Scholarship Program, he did his
                                    biology and chemistry from Capital University in Columbus. He received his medical degree      internship and later his internal medicine residency at Naval Hospital, Oakland and Naval
                                    from Ohio State University College of Medicine. He trained in internal medicine at Duke        Medical Center, San Diego, Calif., respectively. He served as an internal medicine doctor
                                    Hospital and the University of Missouri-Columbia. Dr. Carolla received his medical oncology    and director of clinical services at the U.S. Naval Hospital, Roosevelt Roads in Puerto Rico
                                    and hematology training at the National Cancer Institute in Bethesda, Md., and he is board-    from 1994 to 1997. While in the Navy, he received two Navy commendation medals: the
                                    certified in internal medicine and medical oncology. He is a member of numerous professional   first in 1992 for service aboard U.S. Navy ships, and the second in 1997 for his service in
                                    organizations including the American Society of Clinical Oncology and the American College     Puerto Rico. He returned to the states in 1997 and completed his fellowship in both hema-
                                    of Physicians - American Society of Internal Medicine.                                         tology and oncology at the Kansas University Medical Center in Kansas City, Kan. Dr. Ellis
                                          For five years, Dr. Carolla was an assistant professor of medicine in the division of    is board-certified in internal medicine, oncology and hematology. He joined Oncology
                                    hematology-oncology at the University of Missouri Medical Center. He joined the staff at       Hematology Associates in October 2000.
                                    CoxHealth in 1978 and was awarded the Salute to Health Care Award by the Springfield                 Dr. Ellis has published multiple papers in peer reviewed journals and has particular
                                    Area Chamber of Commerce in 2000 for his leadership in promoting efforts to improve            interest in aplastic anemia and breast cancer. He presently serves on the Hulston Cancer
Robert Carolla, MD                  the health of Springfield area residents.                                                      Center cancer committee and the institutional review board at CoxHealth.                         Robert Ellis, MD
                                          Ruth Grant, MD, is the co-founder with Dr. Carolla and a managing partner of                   Amy Rabe, MD, received her undergraduate degree with honors in psychology from
                                    Oncology Hematology Associates. Dr. Grant is the laboratory director at Oncology               the University of Kansas. She received her medical degree, trained in internal medicine
                                    Hematology Associates. She grew up in New Jersey and graduated from Douglass College           and pathology, and completed her fellowship in hematology and oncology at the University
                                    in New Brunswick, N.J., where she performed research in organic chemistry. She graduated       of Kansas School of Medicine. Dr. Rabe is board-certified in internal medicine. Her most
                                    Phi Beta Kappa and with the highest honors in chemistry. She received her medical degree       recent research has been in the areas of the “outcome of high dose chemotherapy in
                                    from the University of Chicago-Pritzker School of Medicine and is a member of the Alpha        metastatic breast cancer” and the “human herpesvirus-6 infection in bone marrow
                                    Omega Alpha Honorary Society. She completed her internship and medical residency at            transplant patients.” Dr. Rabe joined the staff at Oncology Hematology Associates in 2002.
                                    Vanderbilt University in Nashville, Tenn. Dr. Grant completed her hematology fellowship              Southwest Missouri is fortunate to have access to the wealth of experience and expertise
                                    at the Mayo Graduate School of Medicine in Rochester, Minn. where she performed special        of these physicians. Hulston Cancer Center is proud and honored to be affiliated with
                                    studies in laboratory hematology, including coagulation and dysproteinemias.                   Oncology Hematology Associates.
                                          Dr. Grant is board-certified in internal medicine and hematology. She is a member of
                                    numerous professional organizations including the American Society of Clinical Oncology,
                                    the American Society of Hematology, the American College of Physicians/American Society
                                    of Internal Medicine and the Missouri State Medical Association. Dr. Grant has been an
                                    attending physician at CoxHealth since 1979. She has special interest in coagulation
Ruth Grant, MD                      disorders, thrombotic thrombocytopenic purpura and acute leukemia.                                                                                                                              Amy Rabe, MD
Cancer Registr y
                                                                                                                                     need for breast health services we have three screen-
The Role of the Cancer Registr y                        Information Services Cancer Data System is state-of-                                                                                                                                             Analyzing Data
                                                        the-art technology that allows the Cancer Registry to                        ing mammography facilities in Springfield: Ferrell
The Cancer Registry provides the insights for the                                                                                                                                                                                                        Hulston Cancer Center constantly strives to improve
                                                        continue serving as a vital link between patients and                        Duncan Clinic, Cox North and the Breast Care
comprehensive care at Hulston Cancer Center.                                                                                                                                                                                                             services for patients. Understanding trends in cancer
                                                        the medical and administrative staff – as well as provide                    Clinic in Cox Medical Plaza II, which is also the
Research and follow-up on cancer patients is vital                                                                                                                                                                                                       cases helps us evaluate our care and guide future
                                                        meaningful statistics and definitive research reports.                       location of our diagnostic mammography service.
to improving the quality of life for them and their                                                                                                                                                                                                      improvement efforts. Comparisons to state and
families. At Hulston Cancer Center the Cancer                                                                                                                                                                                                            national statistics as noted in Figure 2 helps us meas-
Registry collects, analyzes and records data about
                                                        2001 Database Additions                                                      The number of patients diagnosed and treated for
                                                                                                                                                                                                                                                         ure and evaluate our efforts. The state and national
                                                        In 2001 the Hulston Cancer Registry entered 1,450                            other types of cancer during 2001 at CoxHealth also
patients diagnosed with or treated for cancer at                                                                                                                                                                                                         statistics are estimates, while the numbers represent-
                                                        newly diagnosed cancer cases into their database.                            increased. Newly diagnosed lymphoma cases increased
CoxHealth. Demographic information along with                                                                                                                                                                                                            ing newly diagnosed cases at the Hulston Cancer
                                                        This number represents a 15 percent increase in newly                        from 61 to 75 (23 percent). Upper GI cases increased
details of all aspects of diagnosis, treatment and                                                                                                                                                                                                       Center are actual. This immediate comparison is used
                                                        diagnosed cases over a five-year period. The majority                        from 21 to 35 (67 percent). Figure 1 shows the num-
long-term outcome, is stored in a computer database.                                                                                                                                                                                                     as an estimate until data is finalized at the state and
                                                        of patients (40.7 percent) originated from Greene                            ber of cases diagnosed or treated at CoxHealth by site.
This information provides the critical elements                                                                                                                                                                                                          national levels. CoxHealth’s case mix is similar to
                                                        County. Another 22.6 percent originated from                                                                                                                                                     both Missouri and national data.
necessary for creating a healing environment for
                                                        contiguous counties. Patients from other counties
                                                                                                                                                        2001 Analytic Cases:
the patients at Hulston Cancer Center.
                                                        in Missouri totaled 34 percent. Arkansas residents
                                                                                                                                                        Distribution by Site
                                                                                                                                                           Total: 1,450                                                                                CoxHealth Major Sites, 2001
Follow-Up                                               accounted for an additional 2.1 percent and 0.6
                                                                                                                                                                                                                                                     Compared to Estimated new Cases
                                                        percent of the patients were from seven other states.                                         Breast                                                                            263
The dedicated staff of the Cancer Registry completes
                                                        An additional 123 non-analytic cases (previously                                                Lung                                                                219                         for Missouri and National
annual follow-up on all patients newly diagnosed                                                                                              Colon-Rectum                                                            179
                                                        treated elsewhere and presented to our facility for
with or treated for cancer at CoxHealth. Research                                                                                                   Prostate                                                   152
                                                                                                                                                                                                                                                                                                                               National Estimates
                                                        treatment of a recurrence or persistent disease),                      Uterine Cervix (Includes CIS)                                 76                                                                                                                                Missouri Estimates
pertaining to clinical outcomes is made possible,
                                                        and 18 cases of benign meningioma were also added.                                                                                                                                                                                                                      Cox Actual Cases
                                                                                                                                                 Lymphoma                                    75                                                     20
in part, by this lifetime follow-up. During 2001 the
                                                                                                                                                    Bladder                             58
                                                        Since its inception in 1982, the Cancer Registry                                                                                                                                                              18%
staff followed 8,016 patients to identify and record                                                                                  Leukemia / Myeloma                               54                                                                                                                    16%
                                                        has entered into the database a total of 24,144 cases.
any additional treatment received over the past year.                                                                                       Uterine Corpus                         41
                                                                                                                                                                                                                                                          15%                     15% 15%
                                                                                                                                                  Upper GI                   35
                                                                                                                                                                                                                                                    15                                                             14%
Hulston Cancer Registry was successful in obtaining                                                                                                                                                                                                             13%         13%
                                                        Breast cancer continued to be the number one cancer                                          Kidney                  33
information on 92 percent of these patients, which                                                                                                      Skin                 32
                                                        diagnosed at CoxHealth in 2001, with 263 new cases.                                                                                                                                                                                  11% 11%
exceeds the 90 percent rate required by the                                                                                          Oral Cavity / Pharynx                   27                                                                                                                                          10%
                                                        There has been a 21 percent increase over the last five                                                                                                                                     10
Commission on Cancer.                                                                                                                                  Brain             25
                                                        years in newly diagnosed breast cancers at CoxHealth.                                      Pancreas              20

Registr y Update                                                                                                                                    Thyroid


                                                                                                                                                                        15                                                                           5
                                                        CoxHealth is a major referral center for the diagnosis                                                                                                                                                                                                                  4% 4% 5%
There are three full-time certified tumor registrars                                                                                                 Ovary          14
                                                        and treatment of breast cancer. Our service offers a                                  Liver / Biliary       6
(CTR) employed at the Hulston Cancer Registry
                                                        comprehensive program for education, early detec-                                     All other sites                                      111
and one part-time registry technician. The Impath                                                                   Figure 1                                                                                                                         0                                                                                              Figure 2
                                                        tion and treatment. To keep up with the growing                                                         0                 50         100         150         200          250         300           Breast                Lung      Colon/Rectum      Prostate          Lymphoma
                                                                                                                  Determining the                                                                     Stage 0
CoxHealth Cancer Cases by Site                                                                                    Stage of Cancer                                                                     Stage I
and Gender, 2001                                                                                                  Staging information is critical for                                                 Stage II
Of the 1,450 new cancer cases for 2001, 792 were         Of the 1,450 new cases for 2001, 658 were male           physicians to be able to properly assess
                                                                                                                                                                                                      Stage III
female patients. Breast cancer represents 33 percent     patients. Prostate cancer represents 23 percent of all   the extent of cancer and determine
                                                                                                                  the most effective treatment plan.
                                                                                                                                                                                                      Stage IV
of all our female cases. While uterine and ovarian       our male cases – decreased from 27 percent last year.
cancers (as a percent of the total cases) decreased by   Lymphoma cases have increased from 4 to 6 percent.       The TNM Staging System used by
                                                                                                                  the Cancer Registry is based on the                                 5%
one and two percent respectively from 2000 to 2001,      The male to female ratio for cancer patients treated
cases of upper GI and skin cancers were new to the       at CoxHealth is 1:1.2.                                   extent of the primary tumor (T),
top 10 list – each with two percent of the total cases                                                            the absence or presence of regional
during the same time period.                                                                                      lymph node involvement (N), and
                                                         Top 10 Cancers 2001, Male                                the absence or presence of distant                                  18%
                                                         Prostate                                        23%      metastases (M). Based on these ele-            49%

Top 10 Cancers 2001, Female                              Lung                                            19%      ments the disease is assigned a stage
                                                         Colon/Rectum                                    13%                                                                        25%
Breast                                          33%                                                               group using the following definitions:
Lung                                            12%      Bladder                                          7%
Colon/Rectum                                    12%      Lymphoma                                         6%      Stage 0          In Situ
Uterine Cervix (includes CIS)                   10%      Leukemia/Myeloma                                 5%                                                             Breast
                                                                                                                  Stage I          Localized
Uterus                                           5%      Upper GI                                         4%
                                                                                                                  Stage II & III   Regional beyond organ of
Lymphoma                                         4%      Oral Cavity/Pharynx                              3%                                                                                        2%
                                                         Kidney                                           3%                       origin, or with involvement
Leukemia/Myeloma                                 3%
                                                         Skin                                             2%                       of regional nodes or both
Ovary                                            2%
Upper GI                                         2%
                                                                                                                  Stage IV         Distant metastasis                          7%
                                                         All Sites                                  658 cases                                                                        9%
Skin                                             2%
                                                                                                                  Figure 3 illustrates TNM staging for                                                            15%
All Sites                                 792 cases                                                               the top five major sites diagnosed at          51%
                                                                                                                  CoxHealth. The majority of breast,                                33%
                                                                                                                  colon/rectum and prostate cancers                                                      34%
                                                                                                                  are in the 0, I, or II stage groups.
                                                                                                                  Screening availability along with
                                                                                                                  more noticeable symptoms may                         Lymphoma                      Lung
                                                                                                                  account for the earlier diagnosis of
                                                                                                                  these types of cancer. Lymphoma and                   1%      2%
                                                                                                                  lung cancer have the highest number
                                                                                                                  of stage IV findings, perhaps because
                                                                                                                                                                                5%                          13%
                                                                                                                  symptoms often do not appear until                            8%                          8%
                                                                                                                  these diseases are relatively advanced.
                                                                                                                                                                 41%                 22%    41%                    15%

                                                                                                                  CANCER                                                                    27%
                                                                                                                  Ina Stafford, CTR
                                                                                                                  Rosie Maggi, RHIT, CTR                                Prostate                  Colon/Rectum
                                                                                                                                                                                                                         Figure 3
                                                                                                                  Melanie Curtis, RHIT, CTR
                                                                                                                  Delia Lindeman, RHIT
Cancer Research
                                                                                                                     Caregiver Spotlight:

                                                                                                                     Dental Oncology
for the Ozarks
                                                                                                                          In 2001 the dental oncology staff consulted with nearly 400 cancer patients.
                                                                                                                     Oral care for cancer patients is vital to their quality of life. In addition
                                                                                                                     to assisting with care for patients with oral cancers, care is often needed to deal
                                                                                                                     with the side effects chemotherapy and radiation have on the oral membranes.
                                                                                                                          L. Wayne Goodin, DDS, has been director of the dental oncology program
                                                                                                                     at CoxHealth for 15 years. Dr. Goodin received his bachelor’s degree in zoology
                                                                                                                     and chemistry from the University of Missouri-Columbia. He graduated from the
                                                                                                                     University of Missouri at Kansas City Dental School and began his private dental
                                                                                                                     practice in Springfield in 1970. Dr. Goodin has served as president of the local
                                                                                                                     dental society and is active in the Missouri Dental Association. He serves as a guest
                                                                                                                     lecturer at local colleges and universities and is active on numerous community
                                                                                                                     boards. Dr. Goodin authored the book How to Save Money and Your Teeth. He
                                                                                                                     was instrumental in starting the dental assisting program at Vatterott College
                                                                                                                     and the Ozarks Technical Community College Dental Hygiene School. In 1996,
                                                                                                                     Dr. Goodin received the presidential citation from the Missouri Dental Association
                                                                                                                     for his work in establishing new dental assisting programs in Springfield.
                                                                                                                          In 1997, Richard Martens, DMD, joined Dr. Goodin’s practice. He attended
CoxHealth and St. John’s jointly established a cancer   In addition to providing the newest research treatments      Southern Illinois University at Carbondale and received his doctor of medical
research program in 1987 named Cancer Research for      to fight cancer, Cancer Research for the Ozarks provides     dentistry from Southern Illinois University at Alton. Emily Burks, registered
                                                                                                                     dental hygienist, assists Drs. Goodin and Martens with the dental oncology
the Ozarks (CRO). Through CRO, cancer patients          access to a significant, relatively new form of cancer       program. Burks received her associate’s degree in dental hygiene from Missouri
have access to national clinical trials of the newest   research known as cancer prevention and control.             Southern State College in Joplin.
cancer therapies. Treatment and follow-up care is                                                                         In addition to the practice of dental oncology, Dr. Martens and Dr. Goodin
                                                                                                                     also provide general dentistry for adults and children. They employ an additional
provided locally by the patient’s own physician.        One of the better known ongoing studies is STAR (Study       hygienist, four chair-side dental assistants and four business office personnel.
                                                        of Tamoxifen and Raloxifene), a breast cancer prevention     Hulston Cancer Center is fortunate to have a dental oncology team to care for
CoxHealth and St. John’s use the National Cancer        trial. Since the trial opened, CRO has enrolled more than    the oral needs of our patients.
Institute’s format known as the Community Clinical      50 women in the study. Post-menopausal women from
Oncology Program or (CCOP). CCOPs are used by           families with a history of breast cancer are encouraged to
other health systems throughout the nation. Research    participate in the program.
partners known as Groups (affiliations of major
university medical research centers and academic        Another cancer prevention trial called SELECT is
physicians) provide the study designs and statistical   a study of the effect of Selenium and vitamin E on
analysis that transform the data into cancer treat-     the rate of new prostate cancers. SELECT is for men
ment standards.                                         over the age of 55 (over 50 for African-American
                                                        men). Cancer Research for the Ozarks has enrolled
Residents of southwest Missouri, Arkansas, Kansas       33 men in this study since it opened in 2001.
and Oklahoma are able to receive these treatments
regionally rather than having to travel to a major      In the last 12 months, Cancer Research for the
university in a metropolis like Houston or Chicago.     Ozarks registered more then 200 new participants
Cancer Research for the Ozarks has served more than     into treatment and prevention trials. Hulston Cancer
2,100 patients from 37 surrounding counties over        Center, by providing ongoing integrated support
the last 15 years.                                      to CRO, plays a major role in the delivery of this
                                                        vital state-of-the-art research to the community and
                                                        contributes to the national fight against cancer.            L.Wayne Goodin, DDS                                                      Richard Martens, DMD
Mohs                     Micrographic Surgery
The American Cancer Society estimates that more          Initially, Dr. Mohs removed thin layers of tissue
than 1.3 million people will be diagnosed with skin      which were frozen before being pathologically
cancer in 2002. Not only is skin cancer frightening      examined. He developed a unique technique of
and potentially life threatening, this diagnosis and     color-coding specimens and created a mapping
its related treatments can be very disfiguring. Due to   process to accurately identify the location of
our commitment to bring the latest advancements in       remaining cancerous cells.                                                                                  Caregiver Spotlight:
cancer care to our patients, Hulston Cancer Center
is now offering a new skin cancer treatment.             Surgeons now examine the fresh tissue immediately
                                                         after the tumor and tissue layers are removed. This                                                         Craig Naugle, MD
Mohs micrographic surgery is an advanced treatment       reduces the treatment time to one visit, allowing
procedure for skin cancer. It relies on the accuracy     for immediate reconstruction of the area. The color-
of a microscope to trace and ensure removal of skin      coded mapping of specimens and their thorough
cancer down to its roots. This procedure allows der-     microscopic examination – 100 percent of the
matologists who are trained in Mohs surgery to see       surgical margin – remains the definitive part of
beyond the disease visible to the naked eye and pre-     the Mohs micrographic surgical procedure.
cisely identify and remove the entire tumor, leaving
healthy tissue unharmed. The procedure is most           Used primarily to treat basal and squamous cell
often used in treating two of the most common            carcinomas, Mohs can be used to treat less common
forms of skin cancer: basal cell carcinoma and           tumors including melanoma. This treatment is
squamous cell carcinoma.                                 indicated when:
                                                         • the cancer was treated previously and recurred,
Clinical studies have shown that the five-year cure        or scar tissue exists in the area of the cancer             Craig W. Naugle, MD, brought Mohs micrographic surgery to Hulston Cancer Center in
rate for Mohs micrographic surgery is the highest        • the cancer is in an area where it is important to     August 2002. Dr. Naugle is new to Hulston Cancer Center, but he is not new to our area.
of all treatments for basal cell and squamous cell         preserve healthy tissue for maximum function                A Nixa, Mo. high school graduate, Dr. Naugle attended the University of Missouri and received
                                                                                                                 a bachelor’s with honors in biological sciences in 1993. He was awarded the Floyd A. Barnett scholar-
carcinomas of the skin – up to 99 percent for new          and cosmetic result, such as eyelids, nose, ears      ship and graduated cum laude from the University of Missouri-Columbia School of Medicine.
cancers and 95 percent for recurrent cancers. Mohs,        and lips                                              Dr. Naugle completed an internship in internal medicine at University of Oklahoma Health Sciences
the most exact and precise method of tumor removal,      • the cancer is large or the edges of the cancer        Center. After a two-year residency in dermatology at the University of Oklahoma Health Sciences
                                                                                                                 Center and serving there as chief resident in dermatology for one year, Dr. Naugle completed a
minimizes the chance of regrowth and lessens the           cannot be clearly defined                             one-year fellowship in Mohs micrographic surgery at Scripps Clinic in LaJolla, California, and is now
potential for scarring or disfigurement.                 • the cancer grows rapidly or uncontrollably.           a fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.
                                                                                                                       Dr. Naugle’s most recent writing, “Nutrition and Skin Cancer Risk Prevention,” a chapter in
                                                                                                                 Functional Foods and Nutraceuticals in Cancer Prevention and Treatment, was published in June 2002.
Developed in the 1930s by Frederic E. Mohs, MD,          Mohs is just one example of the visionary cancer care   He has also published articles and presented on the topics of glycolic acid peels, Mohs micrographic
the Mohs micrographic surgical procedure has been        available at Hulston Cancer Center.                     surgery, skin cancer in the immunocompromised patient and melanoma in pregnancy.
refined and perfected for more than half a century.                                                                    Board-certified in dermatology by the American Board of Dermatology, Dr. Naugle has returned
                                                                                                                 home to the Ozarks to share his experience and expertise with his former neighbors. We are proud to
                                                                                                                 welcome him to the team of caregivers at Hulston Cancer Center.
Hulston Cancer Center is serious in its commitment to fight breast cancer. Because one in eight women will develop
breast cancer some time in her life, Hulston Cancer Center is there every step of the way providing women with the
weapons they need to fight this disease.

We offer a comprehensive breast health plan including education about risk factors and breast self-exam, state-of-the-
art mammography technology and a multidisciplinary team of health professionals. Included with this innovative,
progressive approach to breast health is a promise to use every available resource to ensure we meet the needs of
the women in our community.
Breast Cancer Outreach

Breast cancer, with 263 new cases, continued to be            CoxHealth employees making 30 percent of the calls.    fought a courageous battle with breast cancer.          Breast cancer education and awareness are year-round
the number one cancer diagnosed at CoxHealth in               As a result of these efforts, four women received a    Mary Marcdante’s presentation, “My Mother, My           activities at Hulston Cancer Center. More than
2001. Throughout the year, Hulston Cancer Center              positive diagnosis and were able to begin treatment    Friend” encouraged all who attended to communicate      5,000 women benefited this year from educational
focuses on early detection and treatment of this              for breast cancer.                                     with loved ones today. Marcdante, a featured guest on   programs, meetings and health fairs provided by
disease. In 2001, more than 18,000 screening mam-                                                                    numerous television talk shows, is a contributing       professionals at CoxHealth. In addition, we regularly
mograms were performed at CoxHealth facilities and            The annual Pink Ribbon Luncheon, attended by           author to the Chicken Soup for the Soul book series.    write about the latest issues in breast cancer for local
nearly 11,000 diagnostic procedures were conducted.           90 women this year, offered the opportunity to         Following the program, she signed copies of her new     publications including Today’s Woman Magazine,
Education about self-breast exam was provided to              investigate complementary and alternative therapies    book, My Mother, My Friend. The rally was highlight-    Unite and the Springfield-Greene County Library
7,500 female patients pre-admitted for health care            for breast cancer. Martee Robinson, PhD, coordina-     ed by an artwork exhibit by breast cancer survivors.    Newsletter. These publications reach approximately
services at CoxHealth.                                        tor of the Cox CAM program discussed “The Things                                                               15,000 members of our community.
                                                              That Make Us Feel Better.” The presentation includ-    The fifth annual Ozarks Women’s Links Golf
Hulston Cancer Center intensifies its efforts to              ed experiencing various CAM modalities such as         Tournament brought 118 golfers and more than            Hulston Cancer Center is dedicated to the fight against
promote screening and heighten awareness during               aromatherapy, laughing, dancing (the group enjoyed     200 businesses together to raise more than $16,000.     breast cancer. Through education, early detection and
Breast Cancer Awareness Month each October. In                participating in the hokey-pokey), journaling, music   Proceeds assist women in our community with             the latest in treatment options, we will lead women in
conjunction with the American Cancer Society’s                and looking at picture albums.                         diagnostic mammography expenses.                        our community into a future free of this disease.
“Tell-A-Friend-Tuesday” program, employees at
CoxHealth are encouraged to call friends to remind            For the ninth year, the Pink Ribbon Rally presented
them to have a screening mammogram. In 2001,                  women in our community an outlet for celebrating
986 women in our community were contacted, with               survivorship and remembering all those who have

                                                                                                                     Ozarks Women’s Links golf
                                                                                                                     tournament at Millwood Golf
                               9th annual Pink Ribbon Rally                                                          and Racquet Club.
Breast Cancer
Lymphedema Study

                                                                                                                    Of the 26 women with breast cancer who participated         ment. The survey addressed physical, functional and
Background                                                Study
                                                                                                                    in this study, mastectomy with axillary node dissection     psychosocial concerns. The patients indicated on a
Each year approximately 180,000 women and 1,500           Patients treated at CoxHealth who develop lymphede-
                                                                                                                    had been performed on 21. The other five women had          rating scale of 1-7 (1=no complaints and 7=severe
men are diagnosed with breast cancer in the United        ma following breast cancer treatment are commonly
                                                                                                                    lumpectomy with axillary node dissection.                   complaints), the extent to which these issues
States. Most of these individuals undergo surgery         referred to the CoxHealth lymphedema outpatient
                                                                                                                    Lymphedema developed in the non-dominant arm                impacted them.
and/or some form of adjuvant therapy. Lymphedema          treatment program. Physical or occupational therapists
                                                                                                                    in 14 participants and in the dominant arm in 12.
is chronic swelling of the extremities due to an accu-    help establish a treatment program based on the
                                                                                                                    Participant ages ranged from 30-89, with the majority       Following a complete course of treatment, surveys
mulation of fluid caused by an obstruction of lymph       patient’s individual needs. If indicated, the patient
                                                                                                                    in the 40-69 age group. The time from surgery and           were completed again. The total scores for quality
vessels. Although statistics on the incidence of post-    undergoes a program of manual lymph drainage,
                                                                                                                    the onset of swelling to treatment varied widely among      of life were obtained for each complaint area. Survey
breast cancer lymphedema vary widely among reports,       compression bandaging, skin care and exercise. At
                                                                                                                    those in the study. Edema volume also varied widely         scores obtained before and after treatment were
many sources agree that lymphedema develops in            the completion of treatment, patients are measured
                                                                                                                    before and after treatment among participants.              compared. Patient demographics and characteristics
about 30 percent of patients treated for breast cancer.   for a compression sleeve and/or glove to be worn daily.
                                                                                                                                                                                were initially entered into the analysis to assess
                                                          Project goals established for a study undertaken for
Lymphedema has been reported to adversely affect          the CoxHealth cancer committee were:
                                                                                                                    Methodology                                                 potential differences in scores that may have been
                                                                                                                    Patients completed a quality of life survey designed        due to factors other than treatment. This assessment
the quality of life of individuals with this disorder.         • to assess the impact of post-breast cancer
                                                                                                                    by the primary investigator during the initial treat-       is shown in Table 1.
Numerous physical, functional and psychosocial                     lymphedema on patient quality of life
problems arise due to the swelling. Physical                   • to assess whether improvement in quality
                                                                                                                                                Demographics and Patient Characteristics
impairments may include increased limb girth,                      of life occurs after treatment of lymphedema
pain, infection and diminished movement.                           with complete decongestive therapy.                          Characteristic                        Number   Percent     Average + SD       Range
                                                                                                                                Location of Edema:
Functional deficits become apparent as lymphedema                                                                                    Dominant arm                     12       46.2
progresses. Psychosocial issues often occur due to        The study was performed at the CoxHealth                                   Non-dominant arm                 14       53.8
the visible deformities caused by the swelling.           Outpatient Lymphedema Clinic. Eligible patients                       Age                                                                           30-90 years
                                                          were referred to the clinic between April 1999 and                    Living alone:
                                                                                                                                     Yes                              6        23.1
Complete decongestive therapy is a state-of-the-art       March 2002, and complete decongestive therapy                              No                               20       76.9
treatment currently available to decrease swelling in a   treatment was indicated. Twenty-six of the eligible                   Body Mass Index                                            29.9 ± 5.9         18.6 – 44.5
limb or portion of the body affected by lymphedema.       patients agreed to participate.                                       Edema volume change with treatment:
                                                                                                                                     Dominant arm                                          210.48 cm3
This is a conservative treatment shown to be highly
                                                                                                                                     Nondominant arm                                       181.71 cm3
effective in reducing and managing lymphedema.                                                                                  Months since onset of edema                                30.7 ± 64.4        1.0 – 200.0
                                                                                                                                                                                                                                Table 1
Results                                                        Discussion                                                 receiving treatment to control the edema, those with
                                                                                                                          lymphedema in the dominant limb seem to perceive
The average quality of life scores for physical, func-         Studies have shown that patients with lymphedema
                                                                                                                          that it more severely impacts their quality of life than
tional and psychosocial complaints are shown in Table          in the upper or lower extremities have significant
                                                                                                                          those affected in the non-dominant limb.
2. Results are shown for dominant and non-dominant             improvement in quality of life after complete
arms because of the difference in significance. A              decongestive therapy treatment. This study examined
decrease in score indicates quality of life improvement.       quality of life following treatment of lymphedema
                                                                                                                          Survival from breast cancer continues to improve
                                                               resulting from breast cancer surgery alone and found
   Average Quality of Life Scores                              significant improvement in those with non-dominant
                                                                                                                          as earlier diagnosis and effective treatments become
                                                                                                                          available. Today many breast cancer survivors are
Physical                                                       arm lymphedema.
                         Pre-treatment      Post-treatment                                                                living long, productive lives. This indicates the
Dominant Arm             20.5               17.2                                                                          importance of treating the cancer and maximizing
                                                               The results of this study suggest that complete
Non-dominant arm         22.9               13.2                                                                          quality of life. Lymphedema treatment following
                                                               decongestive therapy treatment improves quality of
Functional                                                                                                                breast cancer surgery is of great importance for the
                                                               life more dramatically in those with lymphedema in
                         Pre-treatment      Post-treatment                                                                health and well-being of an individual. Even though
                                                               the non-dominant arm as opposed to the dominant
Dominant Arm             16.2               12.7                                                                          a cure for lymphedema is not known at the present
Non-dominant arm         13.4               8.6                arm. The reason for the difference in significance is
                                                                                                                          time, effective management with complete decon-
                                                               not entirely clear and may be due to the small popu-
Psychosocial                                                                                                              gestive therapy assists greatly in minimizing the
                                                               lation size in the study. It did not appear that quality
                         Pre-treatment      Post-treatment                                                                progression of the condition, its affect on function
Dominant Arm             7.7                7.3                of life improvement was related to severity of edema
                                                                                                                          and psychosocial outlook and the likelihood of
Non-dominant arm         8.1                5.2                pre-treatment or amount of reduction resulting from
                                                                                                                          developing serious infections in the limb. It has
                                                     Table 2   treatment since there was no significant average
                                                                                                                          furthermore been demonstrated that treatment for
                                                               volume difference between the two groups.
                                                                                                                          lymphedema can significantly enhance one’s quality
Quality of life improved after treatment for patients
                                                                                                                          of life. Continuing studies with larger populations
with lymphedema in the dominant arm, but improved              Perhaps the most likely explanation for the difference
                                                                                                                          may provide a clearer representation of the impact
significantly only for those with lymphedema in the            in significance between the two groups may be related
                                                                                                                          of lymphedema treatment on quality of life.
non-dominant arm. There was a greater decrease in              to the chronic nature of lymphedema and the tenden-
quality of life scores post-treatment for patients with        cy to aggravate the condition by overuse or injury to
lymphedema in the non-dominant arm and the                     the affected limb. Lymphedema in most cases is a life-
                                                                                                                          Summar y
                                                                                                                          Lymphedema following treatment for breast cancer
improvement was statistically significant for all three        long condition once it develops, and treatment is only
                                                                                                                          is a lifelong complication adversely affecting an
complaint areas measured by the survey tool (physical          a means of managing, not curing the edema.
                                                                                                                          individual’s quality of life. Treatment which has
and functional P < .001, and psychosocial P < .01).
                                                                                                                          been shown to control swelling and improve quality
                                                               Considerable emphasis during treatment is placed on
                                                                                                                          of life is now available and should be offered to
Patient characteristics, with the exception of limb            education related to the care of the impacted limb
                                                                                                                          those with lymphedema.
dominance, were not found to have a significant                and about avoiding trauma or infection. Even after
impact on any of the quality of life areas from
pre-to post-treatment. There was significant volume
reduction from pre-to post-treatment for both
dominant and non-dominant arm groups, with
no significant difference between groups.
                                                                   Breast                                              Ca re g i ve r
                                                                                                                       Sp o t l i g h t :

                                                                   Care                                                                     The Breast Care
                                                                   Technologies                                                             C l i n i c Te a m
                                                                                                                                                  In 2001, more than 22,000 mammographic procedures were performed at the Breast Care Clinic.
                                                                                                                                            This means that approximately every six minutes during regular business hours, Hulston Cancer
                                                                                                                                            Center is assisting a woman in our community in taking care of her breast health. Meeting that need
                                                                                                                                            requires a strong team of committed professionals.
                                                                                                                                                  There are 21 mammographers on the staff at the Breast Care Clinic, and all are registered tech-
                                                                                                                                            nologists in mammography by the American College of Radiology American Registry of Radiologic
                                                                                                                                            Technologists. Seven of the staff are also registered diagnostic medical sonographers. Three of those
                                                                                                                                            seven are board-certified in breast ultrasound. The two registered nurses working at the Breast Care
                                                                                                                                            Clinic bring a combined 46 years of medical, surgical and emergancy services to our patients. Our
                                                                                                                                            team also includes a dedicated group of clerical professionals. They assist in preparing patients for
Breast tissue is an extremely challenging part of the     the ability to create clearer images, this technology                             their mammogram and the important task of maintaining their breast care history.
                                                                                                                                                  The Breast Care Clinic works in conjunction with the staff of Litton & Giddings Radiological
body on which to perform diagnostic testing. The          eliminates the need for film – the image can be trans-
                                                                                                                                            Associates. Three members of their staff assist regularly at the Breast Care Clinic providing their
breast may be comprised of very dense tissue or           mitted via the telephone for diagnostic review.”                                  expertise in interpreting mammography and performing diagnostic breast procedures; all have
fatty tissue. Not only is every breast different, but a                                                                                     completed fellowships in breast imaging.
                                                                                                                                                  Anne Smid, MD, is a Springfield native. She received her medical degree from the University
woman’s breasts can change and still remain healthy       In addition to digital mammography, Hulston
                                                                                                                                            of Missouri-Kansas City. After an internship in internal medicine at UMKC, she completed a three-
over the course of her lifetime. This means that if we    Cancer Center has added a Computer Aided                                          year residency in the department of radiology at the University of Michigan Hospitals in Ann Arbor.
are to stay on the cutting edge of breast health, every   Detection system to their arsenal against breast                                  Following her residency, Dr. Smid completed a one-year fellowship in angiography and interventional
                                                                                                                                            radiology, and an additional one-year fellowship in mammography and ultrasound at the University
new opportunity to improve our ability to diagnose        cancer. This equipment digitizes the image of a
                                                                                                                                            of Michigan. Dr. Smid’s publications include, “Percutaneous Large-Core Breast Biopsy. A Multi-
unhealthy changes in the breast must be explored.         traditional film mammogram and transmits it to                                    Institutional Study”, and “Stereotactic Breast Biopsy of Nonpalpable Lesions: Determinants of Ductal
                                                          a computer which can “flag” areas of subtle abnor-                                Carcinoma in Situ Underestimation Rates.” In addition, she also presents to professional organizations
                                                                                                                                            as an expert on the subject of mammography. She brought her experience and knowledge back to
The digital mammogram, the latest breakthrough in         mality. This will greatly assist radiologists in detecting
                                                                                                                                            Springfield joining Litton & Giddings in 1988, and has served as the medical director of the Breast
mammography, offers just that kind of opportunity.        hard-to-find breast cancers.                                                      Care Clinic since 1992.
CoxHealth Women’s Center Breast Care Clinic is                                                                                                    Bruce L. Hedgepeth, MD, is originally from Oregon. He graduated magna cum laude from
                                                                                                                                            Arizona State University in Tempe and earned his medical degree at the University of Arizona College
now equipped to perform mammograms utilizing              When utilizing the CAD equipment, the radiologist
                                                                                                                                            of Medicine in Tucson. He finished his residency in diagnostic radiology at Southern Illinois University
Senographe 2000D Full-Field Digital Mammography           will first review the mammography film and then                                   in Springfield, serving as chief resident from 1993 to 1994. Dr. Hedgepeth completed a fellowship at
equipment. This equipment sends a digital image of        compare it with the CAD digitized image to check                                  Duke University in diagnostic radiology-women’s imaging. He has written on Non-surgical Diagnosis
                                                                                                                                            and Treatment of Infertility, and he was certified by the American Board of Radiology in 1994. In 1996
the breast tissue to the radiologist by computer for      for “flags.” Karen Kramer, administrative director
                                                                                                                                            he came to Springfield as a member of Litton & Giddings Radiological Associates.
review. The computer software enables the radiologist     of Hulston Cancer Center, states, “This system                                          Tracy Roberts, MD, originates from Springfield and received her undergraduate degree from the
to closely examine the mammogram and clarify the          gives the radiologists another tool in diagnosing                                 University of South Carolina. After earning her medical degree at the University of South Carolina
                                                                                                                                            School of Medicine, Dr. Roberts did a residency in diagnostic radiology at the Allegheny General
image if necessary. The picture can be lightened, dark-   breast cancer when it is the most curable – in the
                                                                                                                                            Hospital in Pittsburgh, Pa. She completed a mammography fellowship at the Mallinckrodt Institute
ened or enlarged to improve diagnostic capabilities.      early stages. CoxHealth’s investment in this technolo-                            of Radiology in St. Louis and joined the staff at Washington University School of Medicine as an
                                                          gy may enable us to find breast cancers earlier in 50                             instructor in radiology and then as an assistant professor. Her publications include: The Incidence of
                                                                                                                                            Breast Cancer Following Mantle Field Radiation Therapy as a Function of Dose and Technique, and Self-
JoAnne Schahuber, director of the Breast Care Clinic at   or more women each year. It is another example of
                                                                                                                                            Evaluation Syllabus on Breast Disease II. Case 12: The Fat-Containing Mass. Case 23: Proper Indications
Cox, says, “This is the first major technical improve-    our commitment to breast health and the women                                     of Mammographic Needle Localization. She is certified by the American Board of Radiology.
ment in mammography in several years. In addition to      in our community.”                                                                Dr. Roberts joined the Breast Care Clinic team in 1999.
Hulston Cancer Center’s program is rooted in a commitment to provide consistent, excellent care. As we continue to
diligently search for new ways to improve and enhance the services we offer, we are focusing on the importance of
early detection and treatment of colorectal cancer.
                                                                                                                                                                  Rectal Carcinoma Study:
Colorectal Cancer                                                                                                                                                 Local Excision
Outreach                                                                                                                                                          Background
                                                                                                                                                                  Colorectal cancer is the second most common cause                                 • surgery performed at CoxHealth
                                                                                                                                                                  of cancer mortality in the United States. The American                            • initial diagnosis 1989 to 1996.
                                                                                                                                                                  Cancer Society’s Cancer Facts & Figures estimates
                                                                                                                                                                  148,300 new cases of colorectal cancer will be diag-                 Based on these criteria, 46 patients were included in the
Excluding skin cancers, colorectal cancer is the third                                                Cox colorectal surgeon, José Dominguez, performed           nosed in the United States in 2002, with 28 percent                  study. The patients ranged in age from 41 to 91 years.
most common cancer diagnosed in men and women                                                         a colonoscopy on a local TV news anchor who                 (41,000) of these occurring in the rectum. Cancer
in the United States. The American Cancer Society                                                     underwent the televised procedure to promote col-           Facts & Figures also estimates 8,500 deaths from rectal              The distribution by age at time of diagnosis is shown
estimates that approximately 148,300 new cases of                                                     orectal cancer awareness. In addition, free colorectal      cancer will occur in the United States in 2002.                      in the following graph:
colon and rectal cancer will be diagnosed in 2002.                                                    cancer detection kits were offered to viewers as a first
These cancers are expected to cause 56,600 deaths                                                     step in detection of this disease.                          Sphincter sparing procedures are more widely advo-                             Rectal Carcinoma Cases
this year. In 2001, 179 cases of colorectal cancer                                                                                                                cated to avoid permanent colostomies. Endoscopic                       Treated by Local Excision at CoxHealth
were diagnosed at CoxHealth.                                                                          Educational information was displayed during                polypectomy (EP), local excision (LE) and extended                                   1989–1996:
                                                                                                      Colorectal Cancer Awareness Month in March at               low anterior resection with coloanal anastomosis are                         Distribution by Age at Diagnosis
Hulston Cancer Center hears the need for early                                                        Hulston Cancer Center and at the Cox North and              examples of these procedures. Local excision includes
diagnosis and treatment of colorectal cancer. In                                                      South hospitals. Members of the community were given        transanal excision and transsacral excision.                                 50                                                   Male
response, promotion of symptom driven testing                                                         the opportunity to learn about the signs and symptoms
in our community has been a focus this year.                                                          of colorectal cancer and to sign up to receive additional   Study                                                                        40

                                                                                                      facts about hereditary colorectal cancers. Educational      In 2001, the Cox cancer committee agreed to review
                                                                                                      posters were displayed at the colorectal surgeon’s office   treatment of rectal cancer using endoscopic polypec-                                                            33%         33%
CoxHealth OP Colonoscopy Proedures

                                                                                                                                                                                                                            PERCENT OF CASES
                                                                                                      and educational flyers were mailed to nearly 1,500          tomy and local excision in the treatment of rectal                           30
                                                                                                      people in Springfield and the surrounding area.             cancer. Radiation and chemotherapy were utilized as
                                                                                                                                                                                                                                                              23%      23%
3000               North                                                                                                                                          indicated based on clinical situations.
                   South                                                                       2758
                   Total                                                                              The American Cancer Society states that the death rate                                                                                                              17%
2500                                                                                                  from colorectal cancer has been declining for the past      Sixty-three patients who were treated by EP or LE                                                                     14%
                                                                                                      20 years. But even with this improvement, the need          between 1989 and 1996 were available for the study.
                                                                    2072                                                                                                                                                                       10      8%
2000                                                   1906                                           for symptom driven testing remains. Only 37 percent         Excluded from the study were patients who under-
                                                                                                                                                                                                                                                                4%                                   4%
                                                                                                      of colorectal cancers are found at an early stage when      went partial tumor destruction procedures, those with

                                                                                                      the five-year relative survival rate is 90 percent.         familial adenomatous polyposis and those who had                              0
                                                                                                                                                                                                                                                      40-49   50-59     60-69   70-79    80-89      90+
                                                                                                                                                                  synchronous or metachronous colorectal carcinoma
                   1188                                                                                                                                                                                                                                               AGE DISTRIBUTION
                                                                                                      Over the past five years, the number of colonoscopy         or carcinoma of unknown primary site. Study inclu-
                                                                                                      procedures performed at CoxHealth has increased             sion criteria were as follows:                                       The surgical approach for 30 of the patients
                                                                                                      132 percent. Because the need is so great and the                • rectal adenocarcinoma                                         (65 percent) in the study was transanal excision.
                                                                                                      stakes are so high, Hulston Cancer Center will con-              • American Joint Commission on Cancer (AJCC)                    Fifteen of the patients (33 percent) underwent
       44                  63
                                                                                                      tinue to shout the message of the importance of early               T categories TIS - T3                                        endoscopic polypectomy and one patient (2 percent)
        1997                1998                1999            2000                2001              diagnosis and treatment to our community.                        • local surgical/endoscopic treatment                           had transsacral excision.
Methodology                                                           no recurrence, one (5.5 percent) had local recurrence                                  Survival comparisons to national data were made and                                         Five Year Survival for T2 Rectal
                                                                      and one (5.5 percent) had regional recurrence. Four                                    calculated by the life table method. These compar-                                        Carcinoma Patients Treated by Local
Pathology reports were reviewed and cases were
separated by T category (based on the depth of tumor
                                                                      of the five patients (80 percent) with T 2 tumors had                                  isons were divided by T category and are reflected in                                    Excision CoxHealth and National Data
                                                                      no recurrence, and one (20 percent) had local recur-                                   the following three graphs.                                                                           1989–1996
invasion into the wall of the rectum). Pathology slides
                                                                      rence. The T 3 patient in this study experienced a
were reviewed if staging was unclear in the report.                                                                                                                  Five Year Survival for TIS Rectal
                                                                      regional recurrence at two years and expired from                                                                                                                                                                                                      Cox Data
The addition of radiation and chemotherapy to surgi-                                                                                                               Carcinoma Patients Treated by Local                                                           100                                                         National Data
                                                                      rectal carcinoma.
cal treatment was individualized (T1 - 17 percent, T2                                                                                                             Excision CoxHealth and National Data
- 60 percent, and T3 - 100 percent). The distribution                                                                                                                           1989–1996
                                                                      Five-year survival rates for TIS – T 2 patients were                                                                                                                                                80
by T category for all patients in the study was:                                                                                                                                                                                    Cox Data
                                                                      as follows:                                                                                                100                                                National Data

         Rectal Carcinoma Cases                                                                                                                                                                                                                                           60

                                                                                                                                                                                                                                                      PERCENT SURVIVING
        Treated by Local Excision                                      Five Year Survival for TIS-T2 Rectal
         CoxHealth 1989–1996:

                                                                                                                                                             PERCENT SURVIVING
                                                                       Carcinoma Patients Treated by Local                                                                                                                                                                40
        Distribution by T Category                                    Excision CoxHealth and National Data                                                                        60
                                      T2              2% (1patient)                                                                                   TIS                         40
                                     11%                                                                                                              T1
                                  (5 patients)                                                                                                        T2
                                                                                                                                                                                                                                                                           0   0   3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
              39% (18 patients)                                                                                                                                                   20                                                                                                               NUMBER OF MONTHS

                                        TIS                                                80
                                  48% (22 patients)
                                                                                                                                                                                   0   0   3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
                                                                       PERCENT SURVIVING

                                                                                                                                                                                                           NUMBER OF MONTHS
                                                                                                                                                                          Five Year Survival for T1 Rectal                                            1. The treatment of rectal carcinoma continues
Results                                                                                    40                                                                           Carcinoma Patients Treated by Local                                              to be a difficult oncologic problem requiring a
                                                                                                                                                                       Excision CoxHealth and National Data
Cancer Registry data was analyzed to determine                                                                                                                                                                                                           multidisciplinary approach.
recurrence (local, regional and distant) and survival.                                                                                                                                                                                                2. Recurrence of rectal carcinoma in situ (TIS)
                                                                                           20                                                                                                                                        Cox Data
Nineteen of the 22 patients (86 percent) with rectal                                                                                                                             100                                                 National Data       can occur especially in large lesions mandating
carcinoma in situ (TIS) had no recurrence. Three of                                                                                                                                                                                                      close follow up. Degeneration to invasive carcino-
these patients (14 percent) had local recurrence. Of                                        0                                                                                                                                                            ma and even distant metastasis can be seen.
                                                                                                0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
the 18 patients with T 1 tumors, 16 (89 percent) had                                                               NUMBER OF MONTHS
                                                                                                                                                                                  80                                                                  3. Recurrence rates increase with T category of
                                                                                                                                                                                                                                                         the tumor.
                                                                                                                                                                                                                                                      4. The addition of adjuvant radiation and

                                                                                                                                                              PERCENT SURVIVING
                                                                                                                                                                                                                                                         chemotherapy is warranted in aggressive T 1
                                                                                                                                                                                                                                                         and in all T 2 tumors not treated with radical
                                                                                                                                                                                  40                                                                     excision (low anterior resection or abdomino-
                                                                                                                                                                                                                                                         perineal resection).
                                                                                                                                                                                                                                                      5. Radical surgery such as low anterior resection
                                                                                                                                                                                  20                                                                     or abdominiperineal resection is warranted for
                                                                                                                                                                                                                                                         T 3 tumors.
                                                                                                                                                                                                                                                      6. Data for rectal cancer treatment at CoxHealth
                                                                                                                                                                                   0   0   3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60      are comparable to national data.
                                                                                                                                                                                                           NUMBER OF MONTHS
Caregiver Spotlight:

                              Dominguez, MD
                                                                                                 When Olan Payne recently parachuted out of an airplane he
                                                                                           wasn’t being a daredevil or pulling a stunt. The 70-year-old Ash
                                                                                           Grove resident was fulfilling a promise.
                                                                                                 Payne was diagnosed with colon cancer in 1997. He under-
                                                                                           went colon resection surgery the same year, but the cancer had
                                                                                           spread to his lungs. Since then he has been on chemotherapy and
                                                                                           receiving treatment at Hulston Cancer Center.
                                                                                                 “I promised myself that if Dr. Carolla could keep me alive
                                                                                           until I was 70, I would make the jump,” he says.

                                                                                                                                                                    Olan D. Payne:
                                                                                                 In June, with little instruction and a lot of gumption, he para-
                                                                                           chuted 4,200 feet from a single engine 182 Cessna airplane.
            José Dominguez, MD, of Ferrell-Duncan Clinic is the only residency-trained,    Jumping out of an airplane not only celebrated his health in spite of
      board-certified colon and rectal surgeon in the Springfield area. Originally from    cancer; it also marked a significant feat for the man who served two
      Topeka, Kan., Dr. Dominguez grew up in Baltimore, MD. and received his               tours in Vietnam.
                                                                                                                                                                          a survivor’s story
      undergraduate degree in biology from the University of Missouri-Kansas City.               Payne was a replacement platoon sergeant for the Army’s elite
      After graduating from UMKC School of Medicine, Dr. Dominguez completed               101st Airborne. The platoon performed helicopter raids in Vietnam,
      his residency in general surgery at Rush-Presbyterian-St. Luke’s Medical Center      but all the platoon members, except Payne, were jump qualified. So
      in Chicago. He completed his fellowship in colon and rectal surgery at the Mayo      June 15, 2002, after only three hours training, the proud veteran
      Clinic in Rochester, Minn.                                                           and determined cancer survivor performed his first ever jump at Fort
            Dr. Dominguez joined Ferrell-Duncan Clinic in 1995 and has served on the       Campbell, Ky., the current home of the 101st Airborne. The jump
      Hulston Cancer Center cancer committee as American College of Surgeons cancer        came as part of a reunion with members of his platoon from
      liaison since 1997. In addition, he has been program director of the 2000, 2001,     Vietnam, whom he had not seen since the war, and as active mem-
      and 2002 CoxHealth Annual Hulston Cancer Center oncology seminar. He is a            bers of the 101st were returning home from Afghanistan.
      fellow of the American Society of Colon and Rectal Surgery and the American                “It was an amazing experience,” Payne says. “I just can’t
      College of Surgeons. In 1996, Dr. Dominguez was named Teacher of the Year by         describe the feeling.”
      the Family Practice Residency program of CoxHealth. In 2002 he was listed in               Now that Payne has kept his promise he says he takes life day
      417 Magazine as a Top Doctor in Springfield, Colon and Rectal Surgery. He has        by day – which incidentally means running his own light hauling
      published extensively, his most recent works including a full paper, “Summit on      business, caring for his home and 20 acres of land, and acting as the
      biological and chemical terrorism: Preparedness for the health care worker,” and a   legislative coordinator for a group of retired veterans. Activities he
      chapter titled “Large Bowel Obstruction” in the book Common Surgical Diseases:       credits being able to do to Hulston Cancer Center.
      An Algorithmic Approach to Problem Solving.                                                “I couldn’t get better treatment than at Hulston Cancer
            A Major in the medical corps of the United States Army Reserves, 313th         Center,” Payne says. “The chemo nurses are top notch and the doc-
      Hospital Unit (Surgical) in Springfield, Mo., Dr. Dominguez was deployed to          tors take a lot of the worry for you.”
      Kosovo in 2000. In 2002, he was awarded the Military Outstanding Volunteer                 What’s next? “Possibly another jump,” Payne says with a smile.
      Service Medal.                                                                       “But definitely no slowing down.”
At Hulston Cancer Center we take every opportunity to bring advances in the prevention, diagnosis and treatment of
cancer to our patients. For men diagnosed with prostate cancer we offer a world-class team of health professionals
equipped with the latest technological innovations. Our continual focus on the needs of our patients enhances our
ability to provide exceptional care.
Prostate cancer is the most common cancer, excluding

skin cancers, in American men. The American Cancer
                                                                                             Caregiver Spotlight:

Society estimates that during 2002 about 189,000 new

cases of prostate cancer will be diagnosed in the United
                                                               The Radiation
States, and 30,200 men will die from this disease. New         O n c o l o g y Te a m
cases of prostate cancer were diagnosed in 152 men

during 2001 at CoxHealth.
                                                                In 2001, more than 33,000 procedures were performed in Hulston Cancer Center’s Radiation Oncology department.
                                                           Providing this level of high quality patient care requires a well-organized team of health care professionals.
Hulston Cancer Center has set its sights on early diag-         Patients first meet our dedicated clerical staff. They are responsible to schedule and assist patients as they prepare for radi-
                                                           ation therapy. All of our radiation therapists are board-certified in radiation therapy by the American Registry of Radiologic
nosis of prostate cancer. Urologists at CoxHealth donate   Technologists. One of these therapists is dedicated exclusively to the simulation process, a key element in developing a
                                                           patient’s individual treatment plan. Our radiation dosimetrists have additional advanced certification by the Medical
their time to provide free prostate cancer screening to    Dosimetrist Certification Board. The nursing staff includes three Oncology Certified Nurses who have a combined 35 years
                                                           of oncology patient care experience.
men in our community. Over the past two years at our            We are fortunate to include two physicists on our team. John Pacyniak, PhD, is our Chief Medical Physicist. He has
                                                           more than 28 years of experience in the field of radiation oncology. Born in Loches, France, Dr. Pacyniak came to the U.S.
screening events, five cases of prostate cancer were       when he was 14 years old. He attended the University of Illinois in Chicago, graduating with a degree in physics in 1968.
                                                           After a 13-month tour with the 7th Marines in DaNang, Viet Nam, he returned to Camp LeJeune, North Carolina, complet-
diagnosed. An additional 55 men learned they had           ing the remainder of his three years of active duty as a combat intelligence officer. Dr. Pacyniak received his PhD in 1977
                                                           from Greenwich University. Regarding advancements in his field, Dr. Pacyniak states, “The field of radiation oncology has
abnormal rectal examinations, and 44 discovered they       grown a great deal since the days of Cobalt-60 therapy and with new diagnostic imaging tools, our work has become even
                                                           more precise.” He has written and presented extensively; his most recent publication is titled “Advances in Radiation
had elevated prostate-specific antigen test results.
                                                           Oncology.” Dr. Pacyniak is a Diplomate of both the American Board of Medical Physics (Radiation Oncology Physics) and the
                                                           American Board of Radiology (Therapeutic Radiological Physics) and is a fellow of the American College of Medical Physics.
                                                                Amanda Krintz, a master’s level physicist, graduated from the University of Texas-Graduate School of Biomedical
                                                           Sciences at the M. D. Anderson Cancer Center in Houston in 2002. She brings to Hulston Cancer Center a fresh outlook
                                                           on cutting-edge technologies.

                                     Prostate Cancer
                                                                John Clouse, MD, is the medical director of the department of Radiation Oncology at CoxHealth and has been chair-
                                                           man of the Hulston Cancer Center cancer committee for 10 years. Dr. Clouse began his education at Hastings College in
                                                           Nebraska, graduating magna cum laude with a degree in mathematics. He earned his doctor of medicine at the University
                                                           of Nebraska College of Medicine in Omaha and continued his education in radiation oncology at Washington University

                                     Outreach              Hospital in St. Louis, Mo. After completing his residency in radiation oncology at Mallinckrodt Institute of Radiology, Dr.
                                                           Clouse spent two years in Fargo, North Dakota serving as head of the Radiation Oncology department at Fargo Clinic and
                                                           as chairman of the department of Radiation Oncology at St. Luke’s Hospital. He brought his education and experience to
                                                           Springfield in 1986, joining Radiation Oncology of the Ozarks. He was involved with the development of the new Radiation
                                                           Oncology department in its new location in Hulston Cancer Center. Dr. Clouse is certified by the American Board of
                                                           Radiology, Therapeutic Radiology and has published articles on “The Late Effects of Radiotherapy on Cerebellar
                                                           Medulloblastoma Patients” and “The Changing Management of Wilms’ Tumor Over a 30 Year Period 1949-1978.”
                                                                Ibrahim Abdalla, MD, joined the team at Hulston Cancer Center in 2000. Dr. Abdalla earned his doctor of medicine at
                                                           the University of Aleppo Medical School in Syria, completing a combined pre-medical and medical program. After an intern-
                                                           ship and residency in internal medicine at the University of Illinois at Chicago Hospital, Dr. Abdalla did his residency in the
                                                           Department of Radiation and Cellular Oncology at the University of Chicago Hospitals serving as chief resident from 1996
                                                           to 1997. Before coming to Springfield, Dr. Abdalla started a successful Prostate Brachytherapy Program at the University of
                                                           Chicago, where he was awarded a joint appointment in the Radiation Oncology and Surgery and Urology departments.
                                                                Dr. Abdalla has published extensively, his latest topics including “An Evidence-Based Analysis of the Management of
                                                           Localized Prostate Cancer” and “Intensity-Modulated Radiotherapy for a Prostate Patient with a Metal Prosthesis.” He was awarded
                                                           a grant from the Department of Defense in 1998 to develop a micro-simulation model of the cost-effectiveness analysis of
                                                           prostate cancer screening and treatment. Dr. Abdalla is board-certified in radiation oncology by the American Board of
                                                           Radiology and has been instrumental in developing the prostate seed brachytherapy program at Hulston Cancer Center.
New Views on Radiation Therapy:
Prostate Brachytherapy and HDR Permanent Seed

Permanent seed and high-dose rate (HDR)                   because it requires admission to the hospital and is     to the invasive surgical prostectomy or conventional     more accurately than ever before while sparing
brachytherapy are the latest treatment options avail-     always combined with five weeks of external beam         external radiation therapy. Both permanent seed and      surrounding healthy tissue.
able for cancer of the prostate gland, and they are       radiation. There are some major benefits:                HDR therapies can be completed in much less time
available now for patients at Hulston Cancer Center.           • HDR is more versatile and is the most precise     than the usual six-to eight-week course of therapy       IMRT is especially effective for prostate cancer.
                                                                  method to give radiation to the prostate gland   required for traditional external beam radiation.        It enables us to avoid the rectum and surrounding
Permanent seed brachytherapy involves the place-               • HDR can deliver high radiation doses to the       Brachytherapy offers less chance of rectal tissue        tissue, thereby substantially decreasing side effects
ment of tiny, radioactive seeds directly into the                 extra capsular tissue and seminal vesicles,      damage, incontinence and impotence when com-             and positively impacting survival and quality of life.
prostate gland using ultrasound guidance. This                    allowing for treatment of more advanced          pared to traditional modes of treatment.                 The American College of Radiation Oncology has
enables the physician to directly visualize where                 prostate cancer                                                                                           stated that IMRT will completely change radiation
the seeds are being placed. The seeds emit a low               • HDR can sculpt the radiation dose to fit the
                                                                                                                   Intensity Modulated Radiation                            oncology practice within this decade.
radiation dose that is highly confined to the prostate            gland’s anatomy, thus boosting the dose to
gland with little dose to the surrounding tissues.                the tumor and delivering less dose to the        Therapy (IMRT)                                           Hulston Cancer Center offers an excellent range of
This confined therapy helps reduce bowel and                      rectum and urethra                               Heralded as the most advanced cancer fighting tech-
                                                                                                                                                                            options for men with cancer of the prostate. We
urinary side effects such as incontinence and                  • radiation doses are more homogenous with          nology to date, intensity modulated radiation therapy
                                                                                                                                                                            remain steadfast in our commitment to pursue the
impotence. The seeds stay in place permanently.                   HDR.                                             is fast becoming the cancer treatment of choice and it
                                                                                                                                                                            newest techniques for the treatment of prostate and
                                                                                                                   is on its way to Hulston Cancer Center. IMRT
                                                                                                                                                                            other cancers.
Prostate seed brachytherapy is most beneficial to         Brachytherapy can be used either as a single therapy     allows the precise delivery of multiple “beamlets” of
patients with early stage prostate cancer that is         or in combination with external beam radiation.          high-dose radiation that are focused and contoured
confined to the prostate gland. Because the pro-          Combining traditional treatment with brachytherapy       to fit the shape of the tumor. This is accomplished by
cedure is completed in one day, it is a convenient        provides physicians and patients multiple treatment      the use of a breakthrough technology called inverse
option for the prostate cancer patient.                   options. Together they can decide on the best course     treatment planning. This planning system utilizes
                                                          of therapy to adequately treat the cancer and mini-      state-of-the-art equipment and computer software.
Hulston Cancer Center is the first facility in south-     mize risks to the patient’s quality of life.
west Missouri to offer HDR brachytherapy. The                                                                      The physician, along with the physicist and
therapy is similar to permanent prostate seed therapy,    The American College of Radiology has stated,            dosimetrist, enters the prescribed dosage, position,
but radiation is not left permanently in the body. As     “There has been such an increase in the utilization      size, shape and volume of cancerous and non-can-
with the prostate seed procedure, catheter-like needles   of prostate brachytherapy procedures that by the year    cerous tissue. Through the use of algorithms, com-
are placed under the guidance of ultrasound into the      2005 it is expected that one-third of prostate cancer    plex beam-shaping plans are developed. Simply put,
prostate gland. Then a temporary, high-dose-produc-       patients with organ confined disease will be treated     we tell the computer how we want to treat a cancer
ing radiation source is then administered. HDR is not     by brachytherapy.” Brachytherapy treatment for early     and it calculates a plan. This technology allows the
as convenient as the prostate seed brachytherapy          stage prostate cancers offers an excellent alternative   radiation oncologist to hit the tumor harder and
Lung cancer is one of the three most common cancers diagnosed in the United States. Although there have been
steady improvements in the treatment of lung cancer, at Hulston Cancer Center we know that the greatest defense
against this disease is cancer prevention. By focusing our efforts on education and assistance with smoking cessation
we are bringing hope for the future to the communities we serve.
Lung Cancer Outreach
The American Cancer Society estimates that during                prevention group comprised of area health systems,
2002 there will be approximately 169,400 new cases               the local and state health departments, the American
of lung cancer diagnosed and approximately 154,900               Cancer Society, the American Lung Association,
people will die from this disease. More people die of            numerous public school organizations and many
lung cancer than of colon, breast and prostate cancers           others. They target youths by providing smoke-free
combined. There were 219 new cases of lung cancer                activities and education for teens and adolescents.
diagnosed at CoxHealth in 2001.                                  They presented “Tobacco Challenge: Do You Fear
                                                                 the Facts?” to 258 youths at two area high schools.
Hulston Cancer Center is working hard to educate                 This program discusses the facts about tobacco, its
the community about the prevention of this disease.              dangers and how to quit using tobacco.
The TIPS (Tobacco-free Individualized Plans for
Smoke-free living) program continues to assist
people to overcome their addiction to nicotine by
                                                                 Breathe Easy Springfield is a community coalition of
                                                                 organizations including CoxHealth, the American
                                                                                                                               N d : YA G L a s e r
providing education and planning. In 2001, 670
individual TIPS sessions were conducted along
with five support groups.
                                                                 Cancer Society, the American Lung Association, the
                                                                 Community Partnership of the Ozarks and several
                                                                 others. This group is working to establish smoke-free
                                                                                                                               Photoresection                                                        in the Community Setting
                                                                 homes, cars and businesses. They published a                  Tracheobronchial obstruction from benign or                  stent may be placed. The patients are extubated in the
CoxHealth also participates in numerous community                “Smoke-Free Restaurant Honor Roll” in the local               malignant lesions can cause significant morbidity            recovery room, with most noticing an immediate
partnerships aimed at the reduction of smoking. The              newspaper and offer life skills training to middle            in affected patients. Acute respiratory distress, post-      relief of their shortness of breath. Depending upon
2015 Youth and Tobacco committee is a tobacco use                school teachers in the community.                             obstructive pneumonia, atelectasis, asphyxia or even         the case, some patients are observed overnight while
                                                                                                                               death can result from various degrees of airway              others are discharged home later that same day.
                                                                                                                               obstruction. Nd:YAG laser photoresection (LPR)
                                                                                                                               is the most effective therapy for treating obstructive       Since this service was initiated 20 months ago, seven
Caregiver Spotlight:                                                                                                           lesions; however, the widespread use of this technique       cases have been performed at CoxHealth. Five were
                                                                                                                               is limited by the need for expensive equipment,              for non-small cell bronchogenic carcinoma and two

                                 Te r r e n c e                                                                                specialized skills and ancillary staff training. As a con-
                                                                                                                               sequence, most LPR is performed in the university/
                                                                                                                                                                                            for metastatic colon adenocarcinoma. All cases had a
                                                                                                                                                                                            favorable outcome demonstrated by restoration of

                                 C o u l t e r, M D
                                                                                                                               academic setting. Recently, CoxHealth has performed          patency of the airway and reversal of atelectasis of the
                                                                                                                               LPR on select cases with favorable outcomes.                 involved area of the lung. Self-expandable metallic
                                                                                                                                                                                            stents were placed in two patients. All patients
                                                                                                                               All cases were performed in the operating room under         received adjuvant radiation and chemotherapy. All
                                   Terrence Coulter, MD, was raised in Springfield, Mo. He attended the University of
                                                                                                                               general anesthesia. The procedure begins with passing        patients were discharged to their home. Follow-up
                               Missouri-Kansas City and received his medical degree from their School of Medicine in 1992.
                               Dr. Coulter spent five years in the Department of Internal Medicine at Yale University School   a flexible bronchoscope through the endotracheal             has found all cases have survived at least six months.
                               of Medicine in New Haven, Conn. where he served as chief medical resident the final year.       tube. The obstructing lesion is identified and the           Most would have had a life expectancy of less than
                               He completed his fellowship in pulmonology, critical care and sleep medicine at the Cleveland   physician checks to see if the airway is open past the       one month without the procedure.
                               Clinic Foundation in Cleveland, Ohio.                                                           site of obstruction by gently dilating the airway with a
     Dr. Coulter has written and presented extensively. His most recent publication is Endobronchial Sarcoidosis. He was       balloon. The laser filament is then passed through the       This series demonstrates that in select patients LPR
a co-investigator for the “Ultraflex Endobronchial Stent Quality of Life Study” conducted from 1998 to 2000 at the
                                                                                                                               bronchoscope and energy is delivered at the lesion. As       can be performed safely and effectively in the com-
Cleveland Clinic. Dr. Coulter is board-certified in internal medicine, pulmonary medicine, critical care medicine and
sleep medicine.                                                                                                                tissue vaporization occurs patency of the airway is          munity setting. Although this treatment is considered
     In 2000, Dr. Coulter joined the staff of the Ferrell-Duncan Clinic. He serves on the critical care committee, the         gradually restored. If upon completion of the proce-         palliative, patients had prolonged survival, better
endoscopy committee and the Hulston Cancer Center cancer committee.                                                            dure the airway remains partially occluded, a metallic       quality of life and shortened hospital stays.
Hulston Cancer Center places great value on education. To improve the health of the communities we serve, we focus
much of our effort on cancer prevention and early detection. Community education classes and cancer screening
programs are essential parts of our plan. We strive to provide convenient access to information and resources that
will assist cancer patients in making informed decisions regarding their care.

Staying ahead of rapid advances in health care and oncology is crucial to providing quality patient care. Members
of Hulston Cancer Center’s multidisciplinary team have the opportunity to savor the latest in educational programs.
Throughout the year, Hulston Cancer Center pro-
vides a variety of educational opportunities to the
community. Information about cancer warning signs
                                                            of monthly education classes for cancer patients, their
                                                            families and friends. This year participants learned
                                                            about a variety of subjects including pain management,
and risk factors are displayed at Cox hospital facilities
and at Hulston Cancer Center.
                                                            available resources, nutrition and communication.

                                                            Experiential classes are provided at our monthly
Cancer Prevention and Screening Guidebooks are              Complementary/Alternative Medicine brown bag
provided to patients upon pre-admission to the              lunches. This year’s topics included: The Rainbow
hospital. They are also distributed at health fairs         Colors of Wellness, There are No Magic Pills, The           Ensuring professional educational programs are avail-     chemotherapy administration, pain management
and offered to the public through radio advertising.        Art of Healing and Movement in Alternative Healing.         able to all members of our multidisciplinary cancer       and palliative care were offered. Also presented were
These guidebooks provide general information on                                                                         team is imperative to maintaining our high quality        programs pertaining to specific cancer diagnoses,
cancer risk reduction and the importance of early           CoxHealth participates in the local Senior Outreach         patient care.                                             assessing fatigue, lymphedema, new diagnostic
detection and treatment.                                    and Prevention for Cancer program for adults age                                                                      methods and oncology emergencies.
                                                            50 and older. Participants meet monthly to learn            Physicians and staff attend weekly cancer conferences
The Internet has become a valuable tool in helping          about nutrition, pet therapy, exercise, cancer screenings   to discuss the latest in innovative diagnostic and        Oncology nurses at Hulston Cancer Center take
CoxHealth offer quality health information and              and more. At the end of the program a graduation            treatment methodologies. This collaborative team          seriously the importance of continuing education
state-of-the-art services to the community.                 ceremony is held and bachelor’s, master’s and doctorate     effort allows caregivers across the continuum to          and professional certification. There are 17 Oncology
CoxHealth’s Web site,, provides           “degrees” are issued based on a point system.               ensure a multidisciplinary approach to their patients’    Certified Nurses working in our oncology inpatient
a comprehensive listing of cancer services and profes-                                                                  treatment plan. In addition, this team receives infor-    and outpatient areas, radiation therapy department,
sionals in the field of oncology, as well as detailed       A full-time nurse educator was added to the staff at        mation on new developments in cancer care. Topics         oncology physician offices and in our research
health information about all types of cancer, risks,        our Cancer Information and Resource Center this             for didactic programs this year included advances in      department. Registered nurses may become oncology
symptoms, prevention and much more.                         year. Available in the center to assist patients and        allogenic stem cell transplantation, new develop-         certified after obtaining one year of nursing experi-
                                                            their families in finding needed materials, the nurse       ments in the treatment of non-Hodgkin’s lymphoma,         ence, providing 1,000 hours of care to oncology
New this year is the Personal Health Manager on             also provides free educational programs to the com-         and the use of chemotherapy and targeted therapy          patients, earning a minimum of 10 continuing Patients may register for secure,            munity on a variety of cancer topics.                       for metastasized cancer.                                  education credits in oncology and successfully com-
personal interaction with our Web tools. There are                                                                                                                                pleting a certification examination. Continuing edu-
assessments for topics such as women’s health, breast                                                                   The second annual Hulston Cancer Center oncology          cation is necessary for oncology nurses to maintain
health, prostate health, depression and many others.        Cancer Screening                                            symposium was held in September 2001. Information         their certification with renewal due every four years;
Within each of these condition centers patients will        Cancer of the skin is the most common of all cancers.       on the total care of cancer patients was presented to     re-testing is mandatory at least every eight years.
find risk assessments, a library of information includ-     This year alone, more than 53,000 cases of melanoma,        primary care physicians, specialists and other members
ing interactive demonstrations such as breast self-         the most dangerous type of skin cancer, will be diag-       of the allied health team. Participants learned about     Oncology nurses at CoxHealth initiated the develop-
exams and health news specific to those topics.             nosed. This number has nearly doubled since 1973.           screening and follow-up for colorectal cancer, innova-    ment of a Chapter Interest Program (CHIP) for the
Individuals may set health goals and track improve-         In 2002, the American Cancer Society estimates that         tive treatments for lung cancer, complementary and        Oncology Nursing Society (ONS) in 2001. ONS is
ments for smoking cessation, nutrition, fitness, etc.       9,600 people will die from skin cancers.                    alternative medicine, screening for cancer by primary     the largest professional membership oncology associa-
Visitors to the site can utilize a personal health record                                                               care physicians, pain management for cancer care,         tion in the world. Formation of a CHIP is the first
or set up a record for their spouse, children and par-      In May 2001, three dermatologists donated their time        stereotactic surgery and prostate brachytherapy. Forty-   step toward the establishment of an official local
ents, too. Personal health reminders can be added to        to participate in the annual Hulston Cancer Center          two of the 75 who attended were physicians.               chapter of the ONS. This group of dedicated oncology
help patients remember appointments, screenings or          skin cancer screening. Eleven of the 71 people screened                                                               nurses meets monthly to share their experiences and
annual exams. In addition, monthly highlights and           were recommended to have biopsies and an additional         The staff at Hulston Cancer Center has an insatiable      learn about trends in oncology care. Marcy Keltner,
news items on the latest research in health care            16 people were referred for further evaluation of skin      hunger for information and education that will assist     RN, BSN,OCN, president of the Heart of the Ozarks
appear on the home page.                                    abnormalities. Radio and television interviews aired        them in providing the best care to cancer patients.       CHIP says, “I am extremely proud of what we have
                                                            prior to the screening event promoting skin cancer          In 2001, a total of 112 educational programs were         accomplished in this short length of time. We are forg-
In conjunction with the American Cancer Society,            awareness to 50,000 people in our community.                presented to 3,154 employees. Courses on                  ing ahead and will apply for our charter in 2003.”
Hulston Cancer Center offers “I Can Cope,” a series
We take seriously our commitment to be each patient’s ally in the fight against cancer. As we embark on an era of
unprecedented advances in the prevention, diagnosis and treatment of this disease, cancer patients and their families
have many reasons to hope. At Hulston Cancer Center, we share that hope. It’s the reason we’ll never stop the fight.
Lending Support
At no other time is support more important than          Orientation/Information Group because this is more
after receiving a diagnosis of cancer. Support groups    than just a support group. It is also informational,
play a significant role in cancer care. These groups,    and that is important for both new and long-term
led by cancer survivors and health care professionals,   cancer patients,” she says.
provide patients and their loved ones with an oppor-
tunity to meet and share with others who are living      CoxHealth continues as a corporate sponsor of the
with the same disease. Hulston Cancer Center is          American Cancer Society’s Relay for Life. This com-
proud to sponsor and participate in a number of          munity-wide effort is an annual May event. In 2002,
support groups in our community.                         the three teams from CoxHealth helped the
                                                         Springfield Relay to raise over $360,000.
Reach Together, co-sponsored by CoxHealth
Women’s Center and the American Cancer Society, is       While we continue to search for a cure for cancer,
for women whose lives are touched by breast cancer.      millions of Americans are valiantly living with this
Image Reborn is a group for women who have had           disease. The challenges of dealing with serious illness                                                             Caregiver Spotlight:
breast reconstruction. New Hope provides a support       and the emotional and practical problems it can
network for women with gynecologic cancers. The
Lymphedema Support Group of the Ozarks and the
United Ostomy Association give support to people
                                                         create are difficult. Fortunately, patients at Hulston
                                                         Cancer Center do not have to fight the battle alone.
                                                         Hulston Cancer Center established the Patient
coping with these special concerns. Hope Support
Group provides friendship and understanding for
people who have cancer and for their families. A new
                                                         Advocacy Program in 2001.

                                                         Patient advocates serve as a vital link for our patients
                                                                                                                        Wachtel-Nash, PsyD
support group began meeting in June 2002 to help         to the resources available to help. With assistance             Barbara Wachtel-Nash, PsyD, with Burrell Behavioral Health Psychological Services, specializes in psycho-oncology.
those affected by blood disorders develop coping         from the Glauser Oncology Fund, this program is            She began her work in oncology in collaboration with Oncology Hematology Associates six years ago, with services that
                                                                                                                    include individual and family therapy, relaxation, meditation, guided imagery and pain management techniques. Dr. Nash
strategies for dealing with their disease.               available free of charge to all Hulston Cancer Center
                                                                                                                    was drawn to psycho-oncology by personal experience – both her mother and sister experienced breast cancer diagnoses.
                                                         patients. The patient advocates identify each patient’s    Her sister lost her battle with the disease at age 46, shortly before Dr. Nash started working in this field.
The Patient Orientation/Information Group meets          unique needs and then matches those needs to                    Originally from Kansas, Dr. Nash earned her degree in psychology at Marymount College in Salina. She attended gradu-
monthly in the Cancer Resource Center. Facilitated       resources available at Hulston Cancer Center,              ate school at the Chicago School of Professional Psychologists, receiving her PsyD in 1992.
by Dr. Barbara Wachtel-Nash and Brenda Haden,            CoxHealth, its affiliates or in the community. In its           The strong clinical emphasis of her education led Dr. Nash to Burrell Behavioral Health in Springfield. She says, “Burrell
RN, from Oncology Hematology Associates, these           first year the program assisted more than 400 cancer       was my first choice for an internship because it would enable me to learn about a variety of different specialties.” Dr. Nash was
                                                                                                                    Burrell’s first postdoctoral candidate when she began her residency in family therapy in 1993. She went on to specialize in the
meetings are for people newly diagnosed with cancer,     patients with needs ranging from transportation to
                                                                                                                    treatment of children and families at Burrell for three years.
those dealing with a long-term diagnosis and others      funeral planning.                                               Patients at Hulston Cancer Center are fortunate to have access to the psycho-oncology services of Dr. Nash. She says,
who want to learn about treatment and resources                                                                     “The patients I meet are amazing people. They may be sick, scared and exhausted, but they’re concerned about their family.
available at Hulston Cancer Center.                      The Hulston Cancer Center Patient Services Fund            This is an extremely rewarding line of work – you are truly able to become part of the patient’s support network.”
                                                         was established to provide financial assistance for
Members of the group share their experiences and         urgent needs of cancer patients. This year the “Knot
provide each other with caring, understanding and        Forgotten” program was developed to support this
support. Support persons often attend with cancer        fund. Gold “knots,” along with honor/memory cards
patients and are encouraged to share insights about      were sold throughout CoxHealth facilities. Knots
caring for and living with a loved one with cancer.      were pinned on collars – close to the heart – and
Dr. Nash says the important role of this group is        honor/memory cards were posted on a display board.
apparent in its name. “It’s called the Patient
Do n o r s
As the first approved Community Hospital Comprehensive Cancer Center in Springfield, Hulston Cancer Center
has achieved a high level of respect and credibility throughout the Ozarks. As we strive to continually improve the
quality of care for oncology patients in our community, they actively support our efforts.

Advances in health care and oncology occur rapidly, and funding is essential to provide the flexibility to capitalize
on these changes, as well as the versatility to exceed the needs and expectations of our patients.

It is the generous gifts from individuals in our community that offer the breath of hope to those we serve.

A.G. Edwards & Sons, Inc.          Baird, Kurtz & Dobson –             Dr. & Mrs. Loren Broaddus            Ms. Tamera Cagle                  Continental Casualty Company     Mr. & Mrs. Phillip Daniels      Mr. & Mrs. Charles M. Edwards    Mr. & Mrs. W. Thomas Frogge
Accountants’ Liability Assurance      Springfield                      Broken Arrow Social Fund             Mr. & Mrs. Richard A. Callahan    Mr. & Mrs. John R. Cooper        Mr. & Mrs. Herbert G.           Mr. & Mrs. Steve Edwards         Mr. & Mrs. Richard L. Gafner
   Company, Ltd.                   Mr. Brian Barham                    Mr. & Mrs. Michael E. Brooks         Mr. & Mrs. John C. Carder         Cooper Estates Property             Dannenfeldt                  Mr. & Mrs. Robert W. Elgin       Jeanne Gamble
Moss Adams, LLP                    Ms. Rhonda Barnett                  Mr. & Mrs. Donald R. Brown           Mrs. Norma Carolla                  Owner’s Assoc.                 Mr. & Mrs. William A. Darnell   Noel Elliott                     Ms. Ruth E. Gammon
Affinity Lawyers                   Mary Beth Barrett                   Mr. & Mrs. Gary A. Brown             Dr. & Mrs. Robert Carolla         Mr. & Mrs. Jack W. Corkren       Judith A. Dasovich, MD          Mr. & Mrs. Al Ellison            Scott Gaustad
Mrs. Flodell Alexander             Mr. & Mrs. Joe M. Barron            Mr. James E. Brown                   Tawanna Carroll                   Mr. & Mrs. Cal Cowan             Mr. & Mrs. Michael Davenport    Mr. & Mrs. Richard Etherington   Mr. & Mrs. Carl and
Mr. & Mrs. Joel G. Alexander       Mr. Alan Bates                      Ms. Pat Brown                        Mr. & Mrs. Paul E. Case           CoxHealth Cardiopulmonary        Kimberly D. Davis               Michael Eubanks                     Ellen George
Ms. Carolyn Allen                  Mr. Stevan Battles                  Mr. & Mrs. Richard E. Brown          Mr. & Mrs. George J. Casey          Rehab                          Michael Davis                   Extended Office Services         Dr. & Mrs. Frank C. Giddings
Mr. & Mrs. Rick Allenbrand         Dr. & Mrs. Robert D. Bazley         Mr. & Mrs. Robert Brown              Linda A. Casey                    CoxHealth                        Mr. & Mrs. Walter M. Davis      Farnsworth Group, Inc. –         Cynthia Gilmore
Mr. & Mrs. Hearld Ambler           Rev. Janice M. Beadleston           Mr. Steven Brown                     Cynthia Sue Catlett               Mr. Michael Alan Crabb           Mr. & Mrs. Edward Deck             Wischmeyer                    Ms. Edith Glauser
Mr. Jon Ames                       Ms. Patricia E. Becker              Ms. Mary E. Brunner                  Center for Internal Medicine      Ms. Andrea M. Croley             Mr. & Mrs. Gordon G. Denison    Feeley & Driscoll, P.C.          Mr. Howard Glauser
Kori C. Anderson                   Mr. & Mrs. Dannie L. Beeman         Mr. & Mrs. Hal Bryant                Mr. & Mrs. Charles H. Chalender   The Honorable &                  Mr. Joe L. Dial                 Mr. & Mrs. John P. Ferguson      Mr. & Mrs. James E. Glauser
Jana Perry Anderson, CPA           Mr. & Mrs. Robert Bezanson          Billy & Grace Buckingham             Donald Chalmers                     Mrs. John Crow                 Mr. Bill W. Dickerson           Dr. & Mrs. John and Patricia     Mr. & Mrs. John C. Glauser
Mr. & Mrs. Robert B. Andrews       Mr. Arlie and Marie Biles           Mr. & Mrs. Darryl E. Bueker          Mr. & Mrs. Donald E. Chaney       Mr. & Mrs. William L.            Mr. & Mrs. Howard H.               Ferguson                      Mrs. Rosemary Glauser
Mr. & Mrs. Robert Arnold           Mr. & Mrs. M. R. Biles              Mr. & Mrs. James B. Bugg             Mr. & Mrs. Jerry L. Chaney          Crowder                           Dieckmann                    Mr. & Mrs. William E.            Mr. & Mrs. Robert C. Glazier
Dr. & Mrs. Cecil R. Auner          Ora & Ruby Black                    Mr. & Mrs. Joseph A. Bulger          Mr. Roger Chism                   George Crowley Insurance, Inc.   Mrs. Ila Mae Dieckmann             Fingland Jr.                  Janet Glover
Mr. & Mrs. Norb Bagley             Ms. Mildred H. Blanche              Mr. & Mrs. Steven M. Bullard         Ms. Cathy Clayton                 Nancy S. Cruse-Moad              Mr. Robert C. Dillard           Mr. & Mrs. Carl W. Fisher        Ms. Carol A. Gough
Ms. Anna Lee Bail                  Mr. & Mrs. Steve Blumreich          Ms. Helen P. Burbank                 Commerce Bancshares               Mr. & Mrs. Michael E.            Direct Rate, Inc.               Mrs. Letha Flynn                 Dr. & Mrs. Jeffrey C. Gower
Eide Bailly                        Albert J. Bonebrake, MD             Burrell Behavioral Health               Foundation                       Cunningham                     Dixon Odom, PLLC                Mr. & Mrs. Lawrence A. Fogel     Great Southern Bank
Baird, Kurtz & Dobson –            Gina M. Botello                     Ms. Dina Burton                      Community Blood Center            Mr. & Mrs. Jack Curtis           Mr. & Mrs. David Dodson         Mr. & Mrs. Harry Foster          Mr. & Mrs. O. Wayne
   Fort Smith                      Mr. & Mrs. Charles F. Bousman Jr.   Ms. Virginia C. Bussey                  of the Ozarks                  Melanie S. Curtis                Mr. & Mrs. Gerald F. Doran      Mr. & Mrs. Gary L. Frala            Greenwood
Baird, Kurtz & Dobson –            Mr. & Mrs. Ronald Bradley           Butler, Rosenbury & Partners, Inc.   Compere & Robinette               Mr. & Mrs. Donald C. Dailey      John A. Duff, MD                Ms. Judy A. Friend               Mr. & Mrs. John D. Grider
   Bowling Green                   Brauer Excavating Co., Inc.         Buzbee Dental Clinic, Inc.           Mr. & Mrs. Paul Conley            George & Verna Dalton            Ms. Gladys N. Dugger            Friendly Ford, Inc.              Mr. & Mrs. Larry G. Grinstead
Clifton Gunderson, LLC          Mr. & Mrs. Jerry Jared           Katrina Lile                      Ms. Billie Jean Miller          Ozark Anesthesia Associates      Mr. & Mrs. Terry E. Reeves        Mr. & Mrs. James I. Sparks     Mr. Victor H. Vogel
Dr. & Mrs. Lawrence E. Gurian   Harold Jasper                    Dr. & Mrs. Lyle D. Litton         Mr. Ronald G. Miller            Mr. & Mrs. Stephen Palenik       Regional Services Staff           Mr. & Mrs. Neal D. Spencer     Mr. & Mrs. Randall C. Voss
Mr. & Mrs. Charles R. Hall      Jessie’s Old Place               Litton and Giddings               Mr. & Mrs. W. E. Miller         Mr. John R. Parker               Susan Reichert                    Spencer, Fane, Britt &         Mr. & Mrs. George M.
Dr. & Mrs. Stan Hall            Jason Paul Johnson                  Radiological Associates        Mr. & Mrs. Delbert K. Mills     Dr. & Mrs. Bernie Parrish        Mr. Dan Reid                         Browne LLP                     Waggoner
Dr. Larry W. Halverson          June Johnson                     Dr. & Mrs. Richard H. Loeb        Dr. & Mrs. Jay L. Milne         Pathology Services of            Mr. Jeffrey A. Rice               Mr. & Mrs. John P. Squires     Mr. & Mrs. Jimmy B. Wallace
Mr. & Mrs. Robert A.            Mr. & Mrs. M. L. Johnson         Mr. & Mrs. Louis B. Loebner       Mr. & Mrs. Brian Moen              Springfield, P.C.             Mr. & Mrs. Gregory Richardson     St. John’s Health System       Mr. & Mrs. Larry D. Wallis
   Hammerschmidt                Pam Johnson                      Veronica Logan                    Mr. Larry Moen                  Janice Pattinson                 Dr. & Mrs. Gary L. Robinson       Debbie Stanton                 Mr. & Mrs. John Eric
Mr. & Mrs. Sam F. Hamra         Sandra Jones                     Ms. Sharon S. Logsdon             Dr. & Mrs. Richard Moist        Mr. Dennis R. Peare              Martee Robinson                   Mr. & Mrs. Ronald K. Stenger      Wanamaker
Mr. & Mrs. Joe Hankins          Mr. & Mrs. Randy S. Kanoy        Mr. & Mrs. Morris N. Long         Dr. Peter Molberg &             Mr. & Mrs. Robert Peck           Bruce Robison                     Mr. & Mrs. Clifton R. Stepp    Ms. Nancy A. Ward
Mr. & Mrs. Eric L. Hansen       Anne R. Kasmer                   Mr. & Mrs. William R. Luckfield      Mrs. Nazeema Karim           Pendleton Company                L. P. Rocos                       Mr. & Mrs. Howard L. Stone     Nancy Waring
Mr. John Harris, – Olive, LLP   Mr. & Mrs. Thomas T. Keating     Wilda Y. Lyle                     Faye K. Moon                    Mr. & Mrs. Larry Pennel          Mr. & Mrs. Charles L. Rodgers     Sandy Stormzand                Mr. & Mrs. Al Warner
Catherine Harrold               Mr. & Mrs. Timothy J. Keller     Mr. & Mrs. William E. Magee       Ms. Anna E. Moore               Mrs. Marjorie Penninger          Marcella Rohde                    Mr. & Mrs. Gordon K. Stucky    Mr. & Mrs. Ralph L. Waters
Terry Hasty                     Mr. Carl N. Kelley               Mr. & Mrs. John B. Mahaffey       Mr. & Mrs. Eugene A.            Mr. & Mrs. Robert L. Perrin      Rondo Baptist Church              Mr. & Mrs. Edgar Stump         Patricia Flynn Webb
Ms. Lillian Hawthorne           Marcella R. Keltner              Mr. Robert L. Mandel                 Morgenthaler Jr.             Mr. & Mrs. Bob L. Perryman       Mr. Phillip L. Roper              Sunrise Communication, Inc.    M. R. Weiser & Co., LLP
Ms. Mary Hawthorne              Mr. & Mrs. Danny L. King         Mr. & Mrs. Al Mangrum             Ms. N. Jane Morrison            Mr. & Mrs. Jerry and             Mr. & Mrs. John R. Rowland        Emily Swift                    Mr. & Mrs. Charles A. Wells Jr.
Mr. & Mrs. David A. Hayob       Mr. James L. Kinkade             Mr. & Mrs. James L. Martin        Mr. Chester Morton                 Darlene Peterson              Shirley Rusher                    Sarah Taylor                   Mr. & Mrs. Richard A. Wells
Ms. Alice M. H’Doubler          Dr. & Mrs. Robert E. Kipfer      Ms. Patricia A. Martin            Mr. & Mrs. Michael L. Morton    Pfizer                           Mr. & Mrs. Randall Russell        Mr. & Mrs. Thomas N. Taylor    Mr. Donald R. Wessel
Mr. Robert Helm                 Mr. & Mrs. William E. Kirkman    Mr. & Mrs. Ken Marx               Mr. & Mrs. Walter Morton        Physicians at The                Carol Russo                       Ms. Tiffany L. Taylor          Mr. & Mrs. William L. Wessels
Mr. & Mrs. David R. Henderson   R. A. Knapp Construction, Inc.   Mr. William Mathis                Mr. & Mrs. George E. Moschner      Diagnostic Clinic             Sac River Market                  Mr. & Mrs. Vern Thielmann      Mr. & Mrs. Jim White
Mr. Paul Hill                   Mr. & Mrs. John Koch             Mr. & Mrs. William L.             Angela Moyle                    Mr. & Mrs. William A. Pickert    Mr. & Mrs. J. A. Schaefer         Beverly Thomas                 Dr. & Mrs. Courtney Whitlock
Mrs. Mildred E. Hillme          Jeffrey & Karen Kramer              Matthews                       Mr. & Mrs. Robert Muehling      Ms. Connie Pinkman               Dr. & Mrs. Todd Schaible          Leslie Jane Thomas             Linda Whitman
Mr. & Mrs. Billy E. Hixon       Mr. & Mrs. Ben H. Krull          Mr. Joe Maxon                     Carol Mullins                   Ms. Connie Piper                 Mr. & Mrs. Rodney S. Schellack    Ms. Nancy K. Thompson          James Wiese
Mr. & Mrs. Robert W. Hord       Mr. J. Fred Kubik                Ms. Joan Maynard                  Kathleen Murman                 Ms. Gail Plain                   Mr. & Mrs. Kenneth R. Schmidt     Mr. & Mrs. Larry Thurk         Mr. E. Edward Wilkinson
Rachel House                    Ms. Sheila Langley               Terry and Terri McAllister        Mr. & Mrs. Jerry O. Murphree    The partners at Plante &         Dr. & Mrs. Carle and              Robert C. Tindall              Mr. & Mrs. L. Duane Wilson
Mr. & Mrs. Bob H. Houston       Soynia & Wanda Larsson           Mr. Charles McClintock            Mr. & Mrs. Robert B. Murray        Moran, LLP                       Jeaninne Schroff               Mr. & Mrs. Jack L. Tindle      Angela Winebrinner
Mr. & Mrs. Ed Howard            Ms. Sharon Latham                Willene McCullough                Mr. & Mrs. Chris W. Nattinger   Mr. & Mrs. James B. Porter Jr.   Schwartz Benefit Services, Inc.   Ms. Juanita Tremain            John E. Wolfe, MD
Mr. & Mrs. Ronald L. Hubbard    Lathrop & Gage, LC               Mrs. Jane McElvaine               Mr. & Mrs. Steven P. Nelson     Mr. & Mrs. Curtis L. Pounds      Mr. & Mrs. Jay C. Scott           Tri-State Traffic Control      Mr. & Mrs. Tal C. Wooten Jr.
Shirley M. Huffman              Mrs. Rose Lee Lauer              Ms. Jane C. McHugh                Dr. & Mrs. Thomas L. Nelson     Mr. & Mrs. Morris Powell         Mr. Howard E. Sharfman            Triangle Insurance             Mr. & Mrs. David C. Wortley
Mr. John K. Hulston             Mrs. Kathy B. Laursen            Mr. & Mrs. Howard McMichael       Mr. & Mrs. Adolph S.            Primrose Healthcare Services     Mr. & Mrs. John J. Sheehan           Management, Ltd.            Mr. & Mrs. Gary L. Wortman
Hulston Cancer Center Staff     Ms. Ruth B. Leach                Jane H. McMullin                     Neubauer                     Sharon Pryor                     Mr. & Mrs. Lyle Shipman           Tri-County State Bank of       Ms. Carolyn Joye Yandell
Hulston Family Foundation       Mr. & Mrs. Andy Lear             Mr. & Mrs. John A. McNabb         Mr. & Mrs. Darren Newton        Ms. Lillian Quast                Mr. & Mrs. Ralph H. Slavens          El Dorado Springs           Ms. Barbara Yates
Mr. & Mrs. Bob Hunter           Lemme Insurance Group, Inc.      Mr. & Mrs. Douglas M. McNeal      Mr. & Mrs. Gus Nickels          Mr. & Mrs. Steven B. Rafferty    Mr. & Mrs. Charles T. Smith       Mr. & Mrs. William V. Turner   Mr. & Mrs. Robert L. Yendrek
Mr. & Mrs. Paul D. Hunter       Leslie’s Craft Carousel          Mr. & Mrs. James W. Meador        Rusty D. Norman                 Rev. & Mrs. Norman H.            Harold and Doris Smith            Mr. & Mrs. Douglas E. Tye      Joe & Becky Young
Mr. & Mrs. Donald Hutson        Martha Levine                    Dr. & Mrs. Donald Menchetti       Mr. & Mrs. Donald Norris           Rahmoeller                    Mr. & Mrs. Richard Smith          Mr. M. James Van Dyke          Mr. & Mrs. Michael S. Young
John Hyde                       Sarah C. Lewis                   Dr. & Mrs. Carl and Karen         Mr. & Mrs. Richard A. Oler      Mr. & Mrs. Daniel W. Randall     Mr. Ted Smith                     Mr. & Mrs. Larry D. Vanhorn
Mr. Jerald L. Isaacs            Liberty Painting                    Mentgen                        Mr. & Mrs. Stephen P.           Mr. & Mrs. Charles V. Rees       Snider Insurance Agency, Inc.     Ver-Mac
Mr. & Mrs. Wayne O. Jacobi      Mr. & Mrs. George O. Likins      Mr. & Mrs. Kenneth E. Meyer          O’Rourke

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