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.
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
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
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
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.
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
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
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
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
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
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.
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
Skin 2% of regional nodes or both
Upper GI 2%
Stage IV Distant metastasis 7%
All Sites 658 cases 9%
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
symptoms often do not appear until 8% 8%
these diseases are relatively advanced.
41% 22% 41% 15%
Ina Stafford, CTR
Rosie Maggi, RHIT, CTR Prostate Colon/Rectum
Melanie Curtis, RHIT, CTR
Delia Lindeman, RHIT
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.
Of the 26 women with breast cancer who participated ment. The survey addressed physical, functional and
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
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-
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
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
3000 North indicated based on clinical situations.
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-
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
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
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
Treated by Local Excision Five Year Survival for TIS-T2 Rectal
Carcinoma Patients Treated by Local 40
Distribution by T Category Excision CoxHealth and National Data 60
T2 2% (1patient) TIS 40
(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
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
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
4. The addition of adjuvant radiation and
chemotherapy is warranted in aggressive T 1
and in all T 2 tumors not treated with radical
40 excision (low anterior resection or abdomino-
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
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
Society estimates that during 2002 about 189,000 new
cases of prostate cancer will be diagnosed in the United
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.
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
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, www.coxhealth.com, 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
coxhealth.com. 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.
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
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
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