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2008 CANCER PROGRAM ANNUAL REPORT

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					              2008

  CANCER PROGRAM

    ANNUAL REPORT




               BASED ON
2008 CANCER PROGRAM ACTIVITIES AND
      2007 CANCER REGISTRY DATA
                                TABLE OF CONTENTS



Introduction                                                                  3

A Word from the Cancer Chair                                                  4

Continuum of Care Role Statement                                              5

The Cancer Committee                                                          5

Cancer Registry Report                                                        6

2007 Cancer Registry Data Statistics                                          7

   Accessioned Analytical Cases 2000-2007 (Graph A)                           7

   2007 Analytical Cancer Cases by Site and AJCC Stage (Graph B)              8

   2007 Analytical Cancer Cases by County (Graph C)                           9

   Male vs. Female by Age at Diagnosis (Graph D)                              9

   PSJMC Five Most Frequent Analytic Cancer Sites by Sex for 2007 (Graph E)   10

   Cancer Incidence Comparison by Sex – 2007 Analytical Cases (Graph F)       10

2002 – 2003 Colorectal Cancer Study                                           11

   Colon Cancer Comparison by AJCC Stage at Diagnosis (Graph 1)               14

   Rectal Cancer Comparison by AJCC Stage at Diagnosis (Graph 2)              15

   First Course of Treatment (Graph 3)                                        15

   Colon Cancer Five-Year Observed Survival Comparison (Graph 4)              16

   Rectal Cancer Five-Year Observed Survival Comparison (Graph 5)             16

Clinical Research                                                             17

Cancer Diagnostic and Therapeutic Services                                    18

Cancer Resources and Support Services                                         22

Community Outreach                                                            24

Glossary of Terms                                                             27

References                                                                    28

Special Thanks                                                                28




                                                                                   2
                              INTRODUCTION

                                  As we begin a new year it is appropriate to reflect on our
                                  accomplishments of 2008 and look forward to all that is to
                                  come in 2009. I am extremely proud to announce the opening
                                  of the new 199 private room patient tower, which is scheduled
                                  to open the first quarter of 2009 and to continue to provide
                                  quality care to the communities in which we serve.

                                      •   In 2008 advances in new technology were added
                                          including the da Vinci Robotic Surgery for prostate
                                          and now hysterectomy surgery.
                                      •   New programs such as Lap Band Surgery, Code
                                          Stroke, Code STEMI, Pediatric Hospitalists, Joint
                                          Camp, Maternal Fetal Medicine and an intensivist
                                          program were implemented.
                                      •   Provena Saint Joseph Medical Center expanded our
                                          ancillary/outpatient services with the addition of
                                          services in our tertiary service area including
                                          Plainfield where our Immediate Care and Imaging
                                          Facilities opened, New Lenox- OB/GYN and
                                          Primary Care, Manhattan- Primary Care and
                                          Occupational Medicine, Channahon- Primary Care, a
                                          new Geriatrician in Plainfield and Lockport- Primary
                                          Care.
                                      •   62 new physicians were added to the Medical Staff
                                          raising the total to 543.
                                      •   New efforts include successful negotiations with INA
                                          and IBEW, operations center- throughput, 262
                                          successful community events and the Foundation
                                          raised $1.2 million to date and provided $650,000 to
                                          Provena Saint Joseph Medical Center for programs,
                                          services and capital.
                                      •   Our new patient bed tower is on schedule and on
                                          budget.




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                                                                                             3
                              FROM THE CANCER COMMITTEE CHAIR
Dear Colleagues:

I am pleased to inform you that the cancer program at Provena Saint Joseph Medical Center was surveyed
by the Commission on Cancer on September 24, 2008 and received an accreditation for three years.

The PSJMC Cancer Center celebrated National Cancer Survivor’s Day on Sunday, June 1, 2008.
Approximately 225 people attended the Cancer Survivors’ Day Picnic held at the Joliet Park District. The
guest speaker was Colleen Kettenhofen, speaker, author, trainer, and colon cancer survivor who has
presented over 1000 programs in 47 states and six countries for top corporations and associations since
1995.

The Cancer Registry staff participated in Joliet Oncology Hematology Associates 11th Annual Patient
Appreciation Day on Saturday, June 14, 2008 from 10:00 a.m. to 1:00 p.m. at Joliet Oncology
Hematology Associates, Ltd. Office. Staff distributed breast cancer awareness clip/magnets as well as
general cancer awareness information.

PSJMC Cancer Care Center employees participated in the American Cancer Society “Relay For Life” at
Joliet West High School. Over $3,000.00 was raised for the American Cancer Society. Provena Saint
Joseph Medical Center also donated an additional $50,000.00 to the American Cancer Society on behalf
of the Joliet, Plainfield, and Lincoln-Way Relays.

The tumor registry continued to perform epidemiological and quality studies throughout the year. Patient
care improvements and studies of quality for 2008 included: PSJMC 2002-2003 Colorectal Cancer Study;
implementation of new nutritional screening form; development and implementation of standard
screening guideline form to be given to patients; PDSA on handling of surgical specimens; PSJMC 2007
Stage II colon cancer/appropriateness of adjuvant chemotherapy recommendation; compilation of all
services available at PSJMC for patients with prostate, breast, lung, and colorectal cancer.

The surveyor commended the committee and the institute for participating in clinical research trials
available in the past. I hope that we can continue to offer the Provena Saint Joseph Medical Center
patients the option of enrolling on clinical trials when IRB is functioning again. The clinical research
participation is an essential and important aspect of the accreditation process.

The committee would also like to thank cancer registry staff, administration, physicians, ancillary staff,
and volunteers for the continued support of the Provena Saint Joseph Cancer Program.




Sanjiv S. Modi, M.D.
Cancer Committee Co-Chair
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                                                                                                        4
CARE CONTINUUM ROLE STATEMENT

The Sister Theresa Cancer Care Center and the inpatient unit consist of a team of health care professionals who
provide individualized, compassionate, quality cancer care and related services close to home.

We dedicate ourselves to the treatment of people with cancer and other chronic diseases, relief of their symptoms,
and promotion of comfort. We constantly strive to meet the physical, emotional, and spiritual needs of our patients
and their families.

CANCER COMMITTEE

The success of the cancer program depends on the cancer committee leadership to plan, initiate, stimulate, and
evaluate all cancer-related activities in the facility. The committee membership includes multidisciplinary physician
members from the diagnostic and therapeutic specialties, as well as allied health professionals involved in the care
of cancer patients. The cancer committee at Provena Saint Joseph Medical Center met six times in 2008.

2008 Cancer/Transfusion Committee Membership
Quorum Members
Sanjiv Modi, M.D., Hematology/Oncology, Cancer Committee Co-Chair
Peter Tomas, M.D., Pathology, Cancer Committee Co-Chair
Kwabena Boateng, M.D., Obstetrics/Gynecology
Janet Chin, M.D., Hematology/Oncology
Paul Crossan, M.D., Radiation Oncology
Brian Fagan, M.D., Radiology
Ommar Hla, M.D., Radiation Oncology
Marius Katilius, M.D., General Surgery
Ankit Patel, M.D., Otolaryngology Ear, Nose, Throat/ Head & Neck Surgery
Mohin Samaraweera, M.D., Family Practice
Sandeep Sawhney, M.D., Urology
Jason Suh, M.D., Hematology/Oncology
Goran Tubic, M.D., Anesthesiology/Cardiovascular Anesthesiology/Pain Management

Non Quorum Members
Jackie Medland, Vice President of Patient Care Services
Se Choi, Director Pharmacy
Dianna Douglas, Assistant Patient Care Manager Surgery
Susan Harrison, Director of Nursing
Catherine Jeropke, Patient Care Manager Seventh Floor
Carol Jushkewich, Dietitian
Jennifer Kennedy, MSW, Social Worker
Shirley Koren, Director Laboratory Services
Sue Krueger, MS, RT (R)(T), Manager Cancer Care
Paul Lagomarcino, Director OP/Acute Rehab
Laura McHugh, Quality Improvement Analyst
Judy Militello, Director of Business Development Joliet Area Community Hospice
Jane Mitchell, Director of Behavioral Health
Janice Nemri, Director Imaging
Dana Nylen, RHIA, Director Health Information Services
Sandy Peterson, Manager Community Outreach
Beth Rader, CTR, Lead Cancer Registrar
Jacqueline Rohaly-Davis, RN, Clinical Nurse Specialist
Karen Schlueter, CTR, Cancer Registrar
Eva Stobbe, Clinical Dietitian
Pat Stroud, Blood Bank Clinical Specialist
Michelle Turner, American Cancer Society Patient Services Representative


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                                                                                                                   5
                                     CANCER REGISTRY REPORT



T   he Cancer Registry monitors all types of reportable neoplasms diagnosed and/or treated at Provena Saint Joseph
    Medical Center (PSJMC). This is a critical element in the evaluation of oncology care. Registry data collected
    include patient demographics, diagnosis, treatment, and disease outcome. Data management contributes to each
    patient’s treatment planning, staging, and continuity of care. Complete and accurate cancer registry data enables the
    facility cancer program and administration to plan and allocate hospital resources and is a valuable resource for
    research activities. The Cancer Registry reports to the Manager of the Cancer Care Center.


    2008 CANCER REGISTRY ACCOMPLISHMENTS:

    •        Abstracted and reported the 2007 cancer cases accessioned at Provena Saint Joseph Medical Center to the
             Illinois State Cancer Registry as mandated by the Illinois Health & Hazardous Substances Registry Act.
             Abstracting was completed and submitted electronically to the Illinois State Cancer Registry
    •        A follow-up rate of over 90% was maintained. Current rate is 92% for all analytic patients since our cancer
             registry reference date and 94% for all analytic patients diagnosed within the last five years
    •        Coordinated 30 Cancer Conferences and six Cancer Committee meetings in 2008
    •        Organized the data for the 2008 Cancer Program Annual Report and arranged for its distribution to
             Administration and the Medical Staff as well as its posting on our Medical Center’s web site
    •        Presented to the Cancer Committee quality assurance reports on quality of CAP protocol use; AJCC staging
             completeness/accuracy/discrepancies; abstracting accuracy; and administration/consideration of adjuvant
             chemotherapy for AJCC Stage III colon cancers
    •        Responded to the Commission on Cancer’s National Cancer Data Base Annual Call-For-Data
    •        Participated in the Cancer Information Reference File (CIRF) call for data by IMPAC Information Services
    •        Responded to internal and external requests for data from staff physicians, other cancer registries, research
             facilities, as well as Medical Center and corporate departments
    •        Cancer program Quality Improvement activities included: PSJMC 2002-2003 Colorectal Cancer Study;
             implementation of new nutritional screening form; development and implementation of standard screening
             guideline form to be given to patients; PDSA on handling of surgical specimens; PSJMC 2007 Stage II
             colon cancer/appropriateness of adjuvant chemotherapy recommendation; compilation of all services
             available at PSJMC for patients with prostate, breast, lung, and colorectal cancer
    •        Participated in the Commission on Cancer Approvals Program Survey on September 24, 2008 in the
             Community Hospital Comprehensive Cancer Program category
    •        Requested by Commission on Cancer to use our “Staging Discrepancy Report” as a best practice example.
    •        Participated in the Commission on Cancer Facility Information Profile System
    •        The registry staff participated in educational sessions presented by the Chicago Area Cancer Registrars
             Association, the Cancer Registrars of Illinois, the Commission on Cancer, and IMPAC Medical Systems.
             The registry’s two certified tumor registrars attended the Commission on Cancer “Survey Savvy:
             Implementing Best Practices to Improve Cancer Program Performance” program. Facility educational
             programs included annual education, HIPAA training, and employee customer service forums. Beth Rader
             is currently President of the Chicago Area Cancer Registrars Association.




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                                                                                                                        6
                                           2007 CANCER REGISTRY DATA STATISTICS



I   n 2007, the cancer registry abstracted 933 reportable oncology cases - 816 analytic cases and 117 non-analytic cases.
    We experienced an increase of 12 analytic cases from 2006 to 2007 (see Graph A). Since 1995, the cancer registry
    has abstracted 10,833 cases into our database. Of those, we are currently following 4,543 cases. Our current
    follow-up rate since our cancer registry reference date is 92%. Our follow-up rate for analytic patients diagnosed
    within the last five years is 94%.

    The following data for 2007 includes only analytic cases. Approximately 84% of our patients live in Will County
    (see Graph C). The 2007 analytic cases consisted of 360 males and 456 females. Twenty-eight percent of male and
    22% of female patients were diagnosed between the ages of 70 and 79 (see Graph D). Breast, bronchus/lung,
    colorectal, hematopoietic/reticuloendothelial, and brain/meninges were the five most frequent sites of reportable
    neoplasms for both sexes combined (see Graph B). Bronchus/lung was the most frequent site for cancer in men
    while breast was the most frequent site for women at PSJMC (see Graph E). In the USA in 2007, the three most
    frequent cancer sites in males were bronchus/lung, colorectal, and prostate (see Graph F). In the USA in 2007, the
    three most frequent cancer sites in females were breast, bronchus/lung, and colorectal (see Graph F).




                                                  PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
                                              GRAPH A: ANALYTIC CANCER CASES ACCESSIONED 2000-2007

                         900




                                                                                     852
                         850
                                                                                                837

                                                                                                                        816
                                               805                     804                                  804
       Number of Cases




                         800




                                                           751
                         750

                                 725



                         700




                         650
                               Year 2000     Year 2001   Year 2002   Year 2003    Year 2004   Year 2005   Year 2006   Year 2007
                                                                         Accession Year




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                                                                                                                                  7
                       2007 CANCER REGISTRY DATA STATISTICS

PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
GRAPH B: 2007 ANALYTIC CANCER CASES BY SITE AND AJCC STAGE

Primary Site                  Stage 0   Stage 1   Stage 2    Stage 3    Stage 4    Stage 99   Stage 88      Total
Lip & oral cavity                   0         0         1          1          2           0          0         4
Pharynx                             0         0         0          0          4           0          0         4
Parotid gland                       0         1         0          1          0           0          0         2
Larynx                              0         5         2          2          4           0          0        13
Esophagus                           1         0         1          0          3           2          0         7
Stomach                             0         2         2          2          9           6          3        24
Small intestine                     0         0         1          1          1           0          1         4
Colon & rectum                    20        23        19         25         17           10          2       116
Anus & anal canal                   0         1         0          1          0           0          0         2
Liver/Intrahepatic ducts            0         1         1          2          2           0          0          6
Gallbladder                         0         0         0          0          2           0          0          2
Pancreas                            0         0         0          3          7           2          0        12
GI NOS                              0         0         0          0          0           0          3         3
Nasal cavity/middle ear             0         0         0          0          1           0          0          1
Bronchus & lung                     0       36          7        31         66            1          0       141
Pleura & mediastinum                0         0         2          1          1           0          0          4
Bones, joints, cartilage            0         0         0          0          0           0          2         2
Hematopoietic/
Reticuloendothelial                0         1          0          0          0           0         48         49
Skin                               2         5          2          1          1           0          0         11
Retroperitoneum/
Peritoneum                         0         1          0          1         0           0           1          3
Soft tissues                       0         1          0          1         0           1           0          3
Breast                            26        63         37         17         3           2           0        149
Vulva                              0         0          0          1         0           1           0          2
Vagina                             1         0          0          0         0           0           0          1
Cervix uteri                       0         3          1          3         2           0           0          9
Corpus uteri                       0         7          1          1         1           0           1         11
Ovary                              0         2          0          4         1           2           0          9
Penis                              0         0          0          0         1           0           0          1
Prostate gland                     0         0         31          1         6           0           0         38
Testis                             0         4          0          1         0           0           0          5
Kidney                             0        14          2          2         4           1           1         24
Renal pelvis & ureter              2         1          1          5         0           0           0          9
Urinary bladder                   22         6          3          1         3           2           0         37
Brain & meninges                   0         1          0          0         0           0          39         40
Other central nervous syst         0         0          0          0         0           0           5          5
Thyroid gland                      0        20          3          2         2           0           0         27
Adrenal gland                      0         0          0          0         0           0           1          1
Pituitary gland                    0         0          0          0         0           0           6          6
Lymph nodes                        0         0          2          4         6           2           0         14
Unknown primary                    0         0          0          0         1           0          14         14
Total                             74       198        119        115       149          32         129        816

Cases with Stage 99 disease have an unknown stage of disease. Not enough information was available for the physician to
complete the staging. Stage 88 is used for sites and/or histologies without an AJCC staging scheme.


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                                                                                                              8
                                      2007 CANCER REGISTRY DATA STATISTICS



PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
GRAPH C: 2007 ANALYTIC CANCER CASES BY COUNTY ANALYSIS


 Illinois County                                                    Number of analytic cases   Percentage of total cases
 Will                                                                        685                       83.9%
 Grundy                                                                       58                        7.1%
 Cook                                                                         17                        2.1%
 DuPage                                                                       14                        1.7%
 LaSalle                                                                      12                        1.5%
 Not in state – IN, MI, WI, FL, PA, Pakistan                                   9                        1.0%
 Kendall                                                                       6                        0.7%
 Kankakee                                                                      4                        0.5%
 Kane                                                                          3                        0.4%
 Iroquois                                                                      2                        0.2%
 Livingston                                                                    2                        0.2%
 Lake                                                                          1                        0.1%
 McLean                                                                        1                        0.1%
 Perry                                                                         1                        0.1%
 Schuyler                                                                      1                        0.1%




                                             PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
                                             GRAPH D: MALE VS FEMALE BY AGE AT DIAGNOSIS




                          30




                          25




                          20
       PERCENT OF CASES




                          15




                          10




                           5




                           0
                               0-29      30-39      40-49    50-59       60-69       70-79     80-89      90+
                                                             AGE DISTRIBUTION


                                                             MALE    FEMALE


PSJMC data is based on 360 males and 456 females.


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                                                                                                                           9
                       2007 CANCER REGISTRY DATA STATISTICS



PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
GRAPH E: PSJMC FIVE MOST FREQUENT ANALYTIC CANCER SITES BY SEX FOR 2007
(The percentages for PSJMC are based on 816 analytic cases – 360 males and 456 females.)

Male:                                                       Female:
Bronchus & lung                   20%                       Breast                            33%
Colorectal                        17%                       Bronchus & lung                   15%
Prostate gland                    11%                       Colorectal                        12%
Hematopoietic/reticuloendothelial 8%                        Brain and meninges                 6%
Urinary bladder                    7%                       Thyroid gland                      5%




PSJMC 2008 CANCER PROGRAM ANNUAL REPORT
GRAPH F: CANCER INCIDENCE COMPARISON BY SEX – 2007 ANALYTICAL CASES*

MALE                              USA      PSJMC            FEMALE                    USA     PSJMC
Prostate                          25%       11%             Breast                    26%      33.0%
Bronchus & lung                   15%       20%             Bronchus & lung           14%      15.0%
Colon & rectum                    10%       17%             Colon & rectum            10%      12.0%
Urinary bladder                    7%        7%             Corpus uterus              6%       2.0%
Non-Hodgkin lymphoma               5%        3%             Non-Hodgkin lymphoma       4%       3.0%
Melanoma of the skin               5%        3%             Thyroid                    4%       5.0%
Kidney & renal pelvis              4%        5%             Melanoma of the skin       4%       0.2%
Leukemia                           3%        4%             Ovary                      3%       2.0%
Oral cavity & pharynx              3%        2%             Kidney & renal pelvis      3%       2.0%
Pancreas                           3%        3%             Pancreas                   3%       0.7%

*The percentages for the USA are based on approximately 745,180 cases for males and 692,000 cases for females.
The percentages for PSJMC are based on 816 analytic cases – 360 males and 456 females.




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                                                                                                             10
                             2002-2003 COLORECTAL CANCER STUDY


S
    tandard 2.11: Each year, the cancer committee, or other appropriate leadership body, analyzes patient outcomes and
    disseminates the results of the analysis. This analysis includes the facility’s experience and comparison to National
    Cancer Data Base (NCDB) data through benchmark reports. The analysis includes the facility’s experience with
    diagnostic evaluation; treatment modalities; prognostic factors; survival data by American Joint Committee on
    Cancer (AJCC) stage of disease; and comparison with NCDB benchmarks and other comparative data.
    (Commission on Cancer, Cancer Program Standards 2004 Revised Edition)

    Standard 8.1: Each year, based on category, the cancer committee, or other appropriate leadership body, completes
    and documents the required studies that measure quality and outcomes. A summary of each study’s findings,
    analysis, recommendations, and the process to implement changes in program activity is documented in cancer
    committee minutes. For the Community Hospital Comprehensive Cancer Program (COMP) category, facilities must
    complete one study based on registry data and one additional study. (Commission on Cancer, Cancer Program
    Standards 2004 Revised Edition)

    Study topic: Analytic colorectal cancer cases accessioned at PSJMC in 2002 and 2003.

    Criteria: The Cancer Committee determined the review criteria:
    Site C18.0, C18.2-C18.9, C209
    Histology 8000/3, 8010/2-8140/3, 8260/3-8490/3
    AJCC stage at diagnosis
    First course of treatment
    Residual tumor in surgical resection specimen of rectal cancers treated with neoadjuvant chemotherapy/radiation
    therapy.
    PSJMC five-year observed survival as compared to NCDB survival

    Findings: Colorectal cancer is the third most frequently diagnosed cancer in men and women. There will be an
    estimated 108,070 new cases of colon cancer and 40,740 cases of rectal cancer diagnosed in the US in 2008.
    Incidence rates of colorectal cancer have decreased in the last 20 years, in part due to increased screening efforts,
    which can detect and remove colorectal polyps before the polyps progress to cancer. (American Cancer Society
    Cancer Facts & Figures 2008)

    In 2002 and 2003, 191 cases of colorectal cancer were diagnosed and/or given all or part of the first course of
    cancer-directed treatment at PSJMC. This study is based on 183 cases of colon cancer and 39 cases of rectal cancer
    that fit these study criteria. Excluded from this study were cancers of the appendix and rectosigmoid junction as
    well as three cases lost to follow-up.

    Treatment planning and recommendations are based on AJCC stage of disease at diagnosis. The percentage of
    patients diagnosed in each stage is highlighted in Graph 1 for colon cancer and Graph 2 for rectal cancer. In 2002
    and 2003, 28% of the colon cases were diagnosed with Stage IV disease. But in 2007, that number dropped to 15%.
    In 2007, the percentage of Stage III colon cancer cases increased which may be due to the fact that more surgical
    resection specimens in 2007 contained 12 or more lymph nodes for pathological examination. The Medical Center
    also saw an increase in 2007 of Stage I colon cancer cases, which would be expected due to increased screening and
    early detection initiatives. Twenty-six percent of the rectal cancer cases in 2002-2003 were considered unstageable.
    Four of those cases did not have a complete staging workup. The other six patients received neoadjuvant therapy.
    In 2007, 35% of the cases were not staged. Beginning with cases diagnosed on or after January 1, 2006, staging by
    the managing physician is not required for cases diagnosed at our facility that then get their first course of treatment
    elsewhere. Clinical staging of rectal cancer should increase as more facilities add endoscopic ultrasound (EUS) to
    the services provided. In the future, few rectal cancer cases should be unstageable, at least clinically.

    Surgery is the most common treatment for colorectal cancers. If the cancer has not spread, surgical excision alone
    may be curative. Chemotherapy (in combination with radiation therapy for rectal cancer) is administered
    preoperatively or postoperatively when the cancer has penetrated the bowel wall deeply or spread to lymph nodes.
    Oxaliplatin in combination with 5-fluorouracil (5-FU) and leucovorin is one chemotherapy regimen for metastatic
    colorectal carcinoma. The US Food and Drug Administration have approved three new targeted monoclonal

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                                                                                                                         11
antibody therapies for the treatment of metastatic colorectal cancer. Bevacizumab (Avastin) blocks growth of blood
vessels to the tumor. Cetuximab (Erbitux) and panitumamab (Vectibix) block the effects of hormone-like factors
that promote cancer cell growth. (American Cancer Society Cancer Facts & Figures 2008)

“The NCCN Clinical Practice Guidelines in Oncology™ is the recognized standard for clinical policy in the
oncology community. These guidelines are updated continually and are based upon evaluation of scientific data
integrated with expert judgment by multidisciplinary panels of expert physicians from NCCN Member Institutions.
The breadth and scope of this collaborative effort, which now covers more than 97% of all cancers, represents a
significant advance beyond any previously developed guidelines. The NCCN guidelines have become the most
widely used in oncology practice. Treatment recommendations are specific and are being implemented through
performance measurement. In addition, the NCCN guideline panels address cancer detection; risk assessment and
reduction; and supportive care areas such as nausea and vomiting, distress management, cancer-related fatigue, and
cancer pain management.” (National Comprehensive Cancer Network)

The NCCN Clinical Practice Guidelines in Oncology™ recommends adjuvant chemotherapy with 5-
FU/leucovorin/oxaliplatin or Capecitabine or 5-FU/leucovorin for colon cancer patients whose pathologic stage is
T1-3, N1-2, M0 or T4, N1-2, M0. Adjuvant radiation therapy should be considered for T4 with penetration to a
fixed structure.

Graph 3 lists the first course of therapy administered to PSJMC colon and rectal cancer patients in 2002 and 2003.
Six patients with Stage III colon cancer did not receive adjuvant chemotherapy. Administration of chemotherapy
was contraindicated for three of those patients due to patient risk factors; two patients died prior to planned
chemotherapy; one patient refused chemotherapy.

Per the NCCN guidelines, patients considered to be N0 but have less than 12 lymph nodes pathologically examined
are suboptimally staged and should be considered at high risk of recurrence. In 2002-2003, 25% of patients with
Stage II colon cancer and 27% of patients with Stage III colon cancer had 12 or more lymph nodes pathologically
examined. In 2007, patients were more optimally staged pathologically. In 2007, 67% of Stage II colon cancer
patients (10 of 15 patients) and 55% of Stage III colon cancer patients (11 of 20 patients) had 12 or more lymph
nodes pathologically examined.

Neoadjuvant chemotherapy and radiation therapy are recommended for rectal cancers clinically staged T3, N0 or T
any, N1-2 or T4 and/or locally unresectable. In 2002 and 2003, eleven rectal cancer patients received preoperative
chemotherapy and radiation therapy (see graph 3). Two of those patients had no residual disease after neoadjuvant
treatment.

There will be an estimated 49,960 cancer deaths from colorectal cancers in 2008. Mortality rates have declined in
the last 20 years. Decreases are due to declining incidence rates and a combination of earlier detection and
improved treatment. (American Cancer Society Cancer Facts & Figures 2008)
The National Cancer Data Base (NCDB), a joint program of the Commission on Cancer (CoC) and the American
Cancer Society (ACS), is a nationwide oncology outcomes database for more than 1,400 Commission-approved
cancer programs in the United States and Puerto Rico. Some 75% of all newly diagnosed cases of cancer in the
United States are captured at the institutional level and reported to the NCDB. The NCDB, begun in 1989, now
contains approximately 20 million records from hospital cancer registries across the United States. These data are
used to explore trends in cancer care, create regional and state benchmarks for participating hospitals, and to serve
as the basis for quality improvement. (Commission on Cancer website)
The following statement was taken directly from the Commission on Cancer website:
“The American College of Surgeons, Commission on Cancer collects and maintains the National Cancer Data Base
(NCDB). Therefore, use of any information from these Reports in educational material or your organization’s
website must provide a prominent credit line. That line is to read as follows:
         (Commission on Cancer, American College of Surgeons, NCDB Benchmark Reports, v1.1. Chicago, IL
         2002.
         The content reproduced from the applications remains the full and exclusive copyrighted property of the
         American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or
         derivative works based on the original Text, Tables, or Figures.)”


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                                                                                                                  12
Graph 4 compares five-year observed survival rates by AJCC stage for PSJMC and the NCDB colon cancer cases.
PSJMC colon cancer data is based on the following numbers of cases:
    Stage 0         20                                     Stage III      20
    Stage I         16                                     Stage IV       36
    Stage II        30                                     Stage unknown    6

    NCDB colon cancer data is based on the following numbers of cases:
    Stage 0         5879                                  Stage III              19628
    Stage I        17073                                  Stage IV               14574
    Stage II       22692
    NCDB data does not include cases with stage unknown.

    Graph 5 compares five-year observed survival rates by AJCC stage for PSJMC and the NCDB rectal cancer
    cases. PSJMC rectal cancer data is based on the following numbers of cases:
    Stage 0          4                                       Stage III          7
    Stage I          6                                       Stage IV           4
    Stage II         8                                       Stage unknown 10

    NCDB rectal cancer data is based on the following numbers of cases:
    Stage 0         2069                                   Stage III             5396
    Stage I         7180                                   Stage IV              3057
    Stage II        5042
    NCDB data does not include cases with stage unknown.

Detection of early stage colorectal cancers requires screening since early stage colorectal cancer usually has no
symptoms. Later stage disease may cause rectal bleeding, blood in the stool, change in bowel habits, and cramping
lower abdominal pain. (American Cancer Society Cancer Facts & Figures 2008)

Risk factors: age 50 and older, certain inherited genetic mutations (familial adenomatous polyposis and hereditary
non-polyposis colorectal cancer), personal or family history of colorectal cancer and/or polyps, personal history of
chronic inflammatory bowel disease. Other modifiable risk factors include obesity, physical inactivity, smoking,
heavy alcohol consumption, diet high in red or processed meat, and inadequate intake of fruits and vegetables.
(American Cancer Society Cancer Facts & Figures 2008)

Screening and early detection: Patients at moderate or high-risk of developing colorectal cancer should speak with a
physician about an appropriate colorectal cancer-screening schedule. Beginning at age 50, both men and women at
average risk for developing colorectal cancer should use one of the screening tests below. The tests that are
designed to find both early cancer and polyps are preferred if these tests are available and the patient is willing to
have one of these more invasive tests.

Tests that find polyps and cancer

         flexible sigmoidoscopy every 5 years*
         colonoscopy every 10 years
         double contrast barium enema every 5 years*
         CT colonography (virtual colonoscopy) every 5 years*

Tests that mainly find cancer

         fecal occult blood test (FOBT) every year*,**
         fecal immunochemical test (FIT) every year*,**
         stool DNA test (sDNA), interval uncertain*

*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. FOBT or FIT
done during a digital rectal exam in the doctor's office is not adequate for screening. (American Cancer Society
Cancer web site)

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                                                                                                                   13
                                2002-2003 COLORECTAL CANCER STUDY GRAPHS



                                                PSJMC 2002-2003 COLORECTAL CANCER STUDY
                                      GRAPH 1: COLON CANCER COMPARISON BY AJCC STAGE AT DIAGNOSIS


                         30%

                                                                                                    27%

                                                    24%                                  24%
                         25%
                                                               23%



                         20%
   Percentage of Cases




                                                                      18%

                               16%                                                 16%
                                     15%                                                                  15%
                         15%
                                              13%



                         10%



                                                                                                                  5%   4%
                         5%




                         0%
                                Stage 0        Stage I           Stage II           Stage III        Stage IV   Stage unknown
                                                                   AJCC Stage at Diagnosis

                                                          PSJMC 2002-2003 COLON       PSJMC 2007 COLON

PSJMC 2002-2003 colon cancer data is based on 128 cases. PSJMC 2007 colon cancer data is based on 82 cases.




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                                                                                                                                14
                                2002-2003 COLORECTAL CANCER STUDY GRAPHS

                                                PSJMC 2002-2003 COLORECTAL CANCER STUDY
                                     GRAPH 2: RECTAL CANCER COMPARISON BY AJCC STAGE AT DIAGNOSIS


                         40%

                                                                                                                                   35%
                         35%


                         30%

                                                                                                                            26%
   Percentage of Cases




                         25%

                                                                21%
                                     20%                                                   20%
                         20%                                                         18%


                                              15%
                         15%

                               10%                                     10%                                    10% 10%
                         10%

                                                    5%
                         5%


                         0%
                                Stage 0        Stage I           Stage II             Stage III               Stage IV     Stage unknown
                                                                     AJCC Stage at Diagnosis

                                                         PSJMC 2002-2003 RECTUM        PSJMC 2007 RECTUM

PSJMC 2002-2003 rectal cancer data is based on 39 cases. PSJMC 2007 rectal cancer data is based on 20 cases.




PSJMC 2002-2003 COLORECTAL CANCER STUDY
GRAPH 3: FIRST COURSE OF TREATMENT


                                                             AJCC        AJCC        AJCC           AJCC         AJCC AJCC Stage
COLON: First course of therapy                             Stage 0      Stage I    Stage II       Stage III    Stage IV Unknown          Total
No treatment                                                     3           1           0               0          12         4           20
Chemotherapy                                                     0           0           0               0            3        0            3
Surgery                                                        17           14         18                6            7        2           64
Surgery + chemotherapy                                           0           0         11              13           14         0           38
Surgery + radiation                                              0           0           1               0            0        0            1
Surgery + radiation + chemotherapy                               0           1           0               1            0        0            2
Subtotal colon                                                 20           16         30              20           36         6          128

                                                             AJCC        AJCC        AJCC           AJCC         AJCC AJCC Stage
RECTUM: First course of therapy                            Stage 0      Stage I    Stage II       Stage III    Stage IV Unknown          Total
No treatment                                                     0           0           0               0            1        2            3
Chemotherapy                                                     0           0           0               0            1        0            1
Radiation                                                        0           0           0               0            0        1            1
Radiation + chemotherapy                                         0           0           0               1            1        1            3
Surgery                                                          4           5           3               0            0        1           13
Surgery + chemotherapy                                           0           0           0               0            1        0            1
Surgery + radiation                                              0           1           0               0            0        0            1
Surgery + radiation + chemotherapy                               0           0           5               6            0        5           16
Subtotal rectum                                                  4           6           8               7            4       10           39


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                                                                                                                                                 15
                                                2002-2003 COLORECTAL CANCER STUDY GRAPHS
                                                          PSJMC 2002-2003 ANALYTIC COLORECTAL CANCER STUDY
                                                    GRAPH 4: COLON CANCER FIVE-YEAR OBSERVED SURVIVAL COMPARISON

                                    90


                                    80          78.4
                                                            75    74.6

                                    70
                                                                                   63.5
                                         61.8
    Percent of Patients Surviving




                                    60
                                                                          56.1
                                                                                                              49.4
                                    50

                                                                                                        40
                                    40
                                                                                                                                           33

                                    30


                                    20


                                    10
                                                                                                                                5.9

                                     0
                                          Stage 0            Stage I          Stage II                  Stage III      Stage IV            Stage 99
                                                                                AJCC Stage at Diagnosis

                                                                                         PSJMC    NCDB

PSJMC data is based on 128 colon cancer cases accessioned in 2002 and 2003. NCDB data is based on 79,846 colon cancer cases
diagnosed in 1998-2000 and submitted by 522 facilities in the Comprehensive Community Cancer Center approvals category.


                                                         PSJMC 2002-2003 ANALYTIC COLORECTAL CANCER STUDY
                                                  GRAPH 5: RECTAL CANCER FIVE-YEAR OBSERVED SURVIVAL COMPARISON

                                    90
                                                81.9
                                    80
                                         75                      75.2

                                    70
   Percent of Patients Surviving




                                                                                 59.9
                                    60
                                                                                                             52
                                                            50           50
                                    50


                                    40                                                            38.1

                                                                                                                                      30
                                    30


                                    20


                                    10
                                                                                                                          5.6

                                    0
                                          Stage 0           Stage I       Stage II                 Stage III         Stage IV         Stage 99
                                                                              AJCC Stage at Diagnosis

                                                                                     PSJMC       NCDB

PSJMC data is based on 39 rectal cancer cases accessioned in 2002 and 2003. NCDB data is based on 22,744 rectal cancer cases diagnosed
in 1998-2000 and submitted by 522 facilities in the Comprehensive Community Cancer Center approvals category.

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                                                                                                                                                      16
                                          CLINICAL RESEARCH



T   he oncology program has been in effect since 1992. The program is affiliated with the University of Chicago Phase
    II Cancer Consortium and the Cancer & Leukemia Group B (CALGB) as an affiliate of the University of Chicago.
    Through our CALGB affiliation we can also offer our patients additional protocols sponsored by the National
    Cancer Institute’s Cancer Trial Support Unit. In 2004 we expanded into Pharmaceutical Trials. Currently we have
    17 Pharmaceutical Trials, 5 University of Chicago Phase II Cancer Consortium trials and 15 CALGB trials. Thus
    far in 2008 we have enrolled 92 patients on trial and we have 171 patients in follow-up.

    PSJMC Research Activities - Summary of cases accrued to cancer-related clinical trials
    CoC Standard 5.2: As appropriate to the category, the required percentage of cases is accrued to cancer-related
    clinical trials on an annual basis.
    Patients eligible to meet this standard are those:
    • Seen at PSJMC for diagnosis and/or treatment and placed on a trial through PSJMC.
    • Seen at PSJMC for diagnosis and/or treatment and placed on a trial through the office of a staff physician.
    • Seen at PSJMC for diagnosis and/or treatment and placed on a trial through another facility.
    • Seen at PSJMC for any reason and placed on a prevention or cancer control trial.
    At the community hospital comprehensive cancer program (COMP) category, the minimum required percentage
    accrual to clinical trials is two percent of the number of annual analytic cases. For commendation, the percentage
    accrual to clinical trials is four percent of the number of annual analytic cases.


     Research Group                                                                                            2007
     American College of Surgeons Oncology Group (ACOSOG)
     Cancer and Acute Leukemia Group B (CALGB)                                                                    11
     Children’s Oncology Group (COG)
     Early Detection
     Eastern Cooperative Oncology Group (ECOG)                                                                     2
     Economics of Care
     Gynecologic Oncology Group (GOG)
     National Surgical Adjuvant Breast & Bowel Project (NSABP)                                                     1
     National Cancer Institute Sponsored Cooperative Group Outreach Program (CGOP)
     National Cancer Institute Sponsored Community Cancer Oncology Program (CCOP)
     North Central Cancer Treatment Group (NCCTG)                                                                  5
     Pharmaceutical Company Sponsored Research                                                                    40
     Primary Prevention such as STAR or SELECT
     Quality of Life
     Radiation Therapy Oncology Group (RTOG)
     Southwest Oncology Group (SWOG)                                                                               3
     Locally Developed, Peer-Reviewed Studies
     University-Related Research                                                                                  10
     Clinical Trials, Not Otherwise Specified
     Total                                                                                                        72
     Annual Analytic Caseload                                                                                    816
     Percent Accrued                                                                                          8.82%




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                                                                                                                   17
                                           CANCER PROGRAM
                          THERAPEUTIC AND DIAGNOSTIC SERVICES



C   ENTER FOR WEIGHT LOSS AND SURGERY
    The Center for Weight Loss and Surgery is committed to providing relief for the overweight. Our multidisciplinary
    care team uses surgical expertise, medical technology, psychological insights and social concerns to address each
    patient as a unique and important individual during his/her journey with us. After surgery, we have four private
    rooms with clothing, medical equipment, and furniture specially designed for overweight individuals. An important
    aspect of the program is intense follow-up care for five years post-operatively to insure that the patient is making the
    transition of a new lifestyle in a healthy manner. We also offer support groups for post-surgical patients and people
    who are interested in having the surgery. We cover many topics geared towards lifestyle changes needed after
    surgery, focusing on diet, nutrition, and exercise




I   MAGING SERVICES
    Provena Saint Joseph Medical Center’s Imaging Services provides comprehensive diagnostic studies for diagnosis
    of malignant disease. Nuclear Medicine has two dual head gamma cameras and a computer network to enhance
    image processing for all of its cameras. Nuclear Medicine continues to be an imaging modality that has numerous
    applications in diagnosis and staging of the oncology patient. The Imaging Department also has two GE 1.5 Sigma
    MRI scanners. Mammography acquired three Senographe 800T mammography units. A digital mammography unit
    was installed in 2008.

    Provena Saint Joseph Medical Center’s new 64-slice CT scanner is now operational, another example of the Medical
    Center’s ongoing commitment to building excellence and providing state-of-the-art care to the community. The 64-
    slice computed tomography scanner has four times as many detectors as a typical multi-detector CT scanner and
    provides a very high quality image in a remarkably short time. It can produce detailed pictures of any organ and
    blood vessels in a few seconds in three-dimensional imaging, which provides physicians with a clearer view. In
    about five seconds, the 64-slice scanner can generate a high-resolution image of a heart, brain or a pair of lungs. In
    the case where a physician may be searching for a blood clot or embolism, a scan of the whole body takes about 30
    seconds. This technology allows for a much more intricate, sophisticated view of the body and its organs, which
    will aid physicians in treating patients.

    Used for CT and MRI, X-ray, and ultrasound and nuclear medicine machines, the technology of the Enhanced
    Imaging system allows physicians and medical personnel to view any image, at any time, from any place. This
    creates unprecedented advantages for the radiology department. This system, called PACS (Picture Archiving
    Communication System), allows instant access for physicians, eliminates lost films, and provides a greater range of
    access and enhanced communication for physicians and healthcare facilities. The image data is extremely secure.
    Image loss is eliminated and retrieval of archived images is much faster. Patient information is also very secure -
    physicians have a password, so files are not accessible by anyone else.

    Provena Saint Joseph Medical Center uses the R2 Mammography CAD – also known as Computer Aided Detection.
    Radiologists use this technology to assist them in reading medical images, to enhance the detection of breast-related
    cancers. Radiologists use this system to assist in reading mammographies. The software works by identifying
    features - including abnormalities or unusual occurrences - on a patient’s medical images. The software then brings
    these features to the attention of the radiologist.

    During 2002, PSJMC acquired an interest in Glenwood Imaging, a freestanding Imaging Center located
    approximately two blocks from the Medical Center. The center has a mobile PET scanner that is available one day
    per week.

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                                                                                                                         18
I   MAGING SERVICES, cont’d
    PSJMC opened Provena Immediate Care Plainfield and Provena Imaging Center Plainfield in 2008. A board
    certified emergency room physician staffs the center. The center offers x-ray, CT, ultrasound, lab and EKG.

    Interventional Radiology offers various procedures to assist oncology patients. Some of those offered are
    chemotherapy embolization, radio-frequency ablation and kyphoplasty. In chemo embolization, anti-cancer drugs
    are injected directly into a cancerous tumor and an embolic agent is placed inside the blood vessels that supply blood
    to the tumor. Radiofrequency ablation supplies heat to the cancerous cells and destroys them. Patients with a spinal
    fracture due to cancer may be candidates for kyphoplasty. Orthopedic balloons are inserted in the spinal column and
    the fracture bone is lifted off the disc.



I   NPATIENT ONCOLOGY
    The Inpatient Oncology unit is located on the 7th floor and is dedicated to the care of the oncology and general
    medical-surgical patients and includes a telemetry wing. This 51-bed unit includes nine private rooms, two negative
    pressure rooms, and one room designated for I-131 patients. The nursing staff initiating chemotherapy are certified
    as Cancer Chemotherapy Providers in accordance with the curriculum of Oncology Nursing Society. Clinical
    members of the staff have received their hospital based radiation certification to care for I-131 patients. The range
    of oncology patients goes from early diagnosis and treatment to symptom management to palliative care and
    hospice. The staff receives continual education through in-services, guest speakers, and online education. The
    department is supported by a nationally certified Advance Practice Nurse.




L   ABORATORY/PATHOLOGY SERVICES
    Board certified Pathologists are responsible for the diagnosis of cancer made on tissue biopsies, specimens, and
    blood. A wide range of laboratory tests, various specialized testing, and staining of tissue samples helps achieve
    accurate diagnosis and maximum outcomes for patients. The Pathology Department also interprets the
    immunohistochemistry stains for breast carcinoma receptors, with the aid of the Chromavision system. This color-
    based imaging technology, coupled with automated microscopy, provides very accurate and sensitive results to the
    Oncologist.



N   EUROSURGICAL SERVICES
    Our neurosurgery department expanded its services to include full neuroendovascular coverage through advanced
    radiological images; our neuroendovascular surgeons are able to provide comprehensive treatment for acute strokes,
    intracranial aneurysms, arteriovenous malformations, brain tumors, head and neck cancer, and intracranial
    atherosclerotic disease. Comprehensive epilepsy, spine, neurosurgical, and stroke care are the main goals for the
    upcoming academic year.



N   UTRITIONAL SUPPORT
    The clinical nutrition team of Registered Dietitians and Dietetic Technicians works with the Sister Theresa Cancer
    Care Center team to provide nutritional assessments, counseling, and individual guidance for patients. Samples of
    nutritional supplements are available, as well as educational materials to both inpatients and outpatients. Initial
    screening for the patient’s level of nutritional risk is performed and continuously monitored during the patient’s
    hospital stay or during outpatient radiation therapy treatments.

    Provena Saint Joseph Medical Center is pleased to offer At Your Request: Room Service Dining for all patients.
    This innovative dining program allows patients to select meals from an expansive menu, as well as determine their
    own meal times. This is especially advantageous to some cancer patients due to changes in food tolerance and
    appetite. To order a meal, patients review the menu and call extension 3663 (FOOD). The meal is delivered within
    one hour. Guest trays are available for a nominal fee. To obtain a guest tray, guests may purchase a meal ticket
    from our cashiers in the cafeteria. Guests also place their order by calling extension 3663 (FOOD).
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                                                                                                                       19
P   HARMACY
    The Cancer Care Center relies on Pharmacy for three important areas of patient care. Pharmacy reviews orders of
    appropriateness and prepares oral and intravenous chemotherapeutic medications, verifying chemotherapy dosing
    based on patient weight and/or body surface area. The Pharmacy Department prepares patient-specific pain control
    medications for implantable pumps.



R   EHABILITATION CONTINUUM OF CARE
    Rehabilitation services are sometimes necessary during and after cancer treatment. PSJMC offers an acute inpatient
    Rehabilitation program that includes physical, occupational and speech therapy along with rehabilitation nursing.
    Physical therapists help patients improve functional mobility. Occupational therapists assist patients in improving
    activities of daily living. Speech pathologists teach patients, especially those patients with oral and laryngeal cancer,
    the strategies and techniques to maximize swallowing and speaking. The rehabilitation nurses provide appropriate
    levels of nursing care that include teaching the patient and/or family about medications and skin care as well as
    collaborative reinforcement of issues presented by other members of the rehabilitation treatment team. Care
    Management staff and/or the Rehabilitation Case Coordinators assist with discharge planning and link patients with
    needed services after discharge. Provena Saint Joseph Medical Center also offers a lymphedema treatment program
    and a lymphedema support group. We offer inpatient and outpatient physical therapy, occupational therapy, speech,
    and audiology services. We also offer incontinence rehabilitation following prostate surgery. Physical therapy is
    available at seven geographic locations (two in Joliet, one each in New Lenox, Shorewood, Plainfield, Romeoville,
    and Frankfort).



R   ADIATION ONCOLOGY
    The Sister Theresa Cancer Care Center is dedicated to meeting the needs of the community, patients, staff, and
    physicians by providing the highest quality cancer care in an efficient, resourceful manner. Using advanced
    technology, the Center provides service to cancer patients with a caring touch in a convenient, community setting.
    Board certified Radiation Oncologists offer radiation services to inpatients and outpatients. The Center has two
    state-of-the-art linear accelerators, a 3-D conformal treatment planning system, a computerized tomographic (CT)
    simulator, and HDR brachytherapy suite. Electronic imaging is also utilized for ongoing documentation and review
    of treatment parameters. In 2006, the Center upgraded its Varian 2100 C/D linear accelerator with electronic
    imaging, allowing for timely quality images, resulting in more accurate treatments. In 2007, the Cancer Center
    installed its state-of-the-art Varian Trilogy, which is capable of both Stereotactic RadioSurgery (SRS) and Image
    Guided Radiation Therapy (IGRT). To further enhance our technology, a new Record & Verify System, ARIA was
    installed, as was Varian's Eclipse, a highly advanced treatment planning system. With the installation of Trilogy,
    intracranial Stereotactic RadioSurgery was quickly implemented. The Cancer Center has further expanded upon the
    SRS program by including extracranial procedures in 2008. In addition, IGRT procedures now include Cone Beam
    Cat Scan (CBCT) to further isolate and aggressively treat specific tumor sites. The Cancer Center has enhanced
    breast brachytherapy procedures by utilizing both MammoSite® and the newly introduced product Contura®.
    Combining these services, the Sister Theresa Cancer Care Center offers an up-to-date approach to treating cancer,
    including IMRT (Intensity Modulated Radiation Therapy). One hundred percent of radiation therapists and
    dosimetrists are certified and licensed through the state.

    Specifically regarding IMRT and 3D conformal radiation therapy, PSJMC meets specific guidelines. The American
    Association of Physicists in Medicine (AAPM), Quality Assurance Review Center (QARC), National Cancer
    Institute (NCI), and North Central Cancer Treatment Group (NCCTG) work cooperatively to provide benchmarks
    for 3D conformal radiation therapy and IMRT. The IMRT and 3D CRT benchmarks have been accepted by all of
    the NCI funded cooperative groups and Quality Assurance Offices as a minimum standard for an institution to be
    credentialed for use of IMRT and 3D CRT in clinical trials.

    Within the Center, the Infusion Suite allows patients to receive chemotherapy, blood component therapy and
    transfusions, antibiotic therapy, and a wide range of other infusions. Nursing staff is consistently monitoring
    patient’s progress and providing patients and families with support needed. One hundred percent of Cancer Care
    nursing staff initiating chemotherapy are certified as Cancer Chemotherapy Providers in accordance with the
    curriculum of Oncology Nursing Standards. Participation in national trials and research protocols are available,


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                                                                                                                          20
R   ADIATION ONCOLOGY, cont’d
    allowing patients access to the latest treatment options. In 2008, the Sr. Theresa Cancer Care Center implemented
    the use of CADD outpatient infusion pump for the use of continuous infusion of chemotherapy.

    Other services offered at the Center include the following: iodine ablation therapy, radiopharmaceutical therapy for
    pain control, and visual therapy. The Cancer Center offers a number of prostate screenings as well as an annual skin
    cancer screening. The Cancer Center’s updated décor as well as renovated patient waiting areas enhance patient
    flow and provide a friendly atmosphere, making the patients and their families feel welcome as soon as they enter
    the Center.



S   URGICAL SERVICES
    Provena Saint Joseph Medical Center's Surgical Services offer a comprehensive set of services with a focus on
    quality care. The surgery department is staffed with surgeons, nurses, surgical technicians, and other supportive
    staff that are specially trained to provide our patients with safe care in a compassionate manner. There are several
    types of surgery accessible in our 12 operating room suites including: general surgery, urology, gynecological
    surgery, orthopedic surgery, neurosurgery, ophthalmic surgery, plastic surgery, podiatric surgery, ENT surgery, and
    cardiac surgery.
    The Surgical Services department has placed an emphasis on giving quality care with the most sophisticated
    technology available. We have added the da Vinci Robotic Surgery capabilities to our state of the art procedures.
    Presently, we are performing radical prostatectomies and will be initiating advanced Gynecological procedures
    using the Robot technology. The surgeries are very precise and are giving our patients excellent outcomes. The
    bariatic patients are now being offered the Lap-Band® surgery option, which reduces their risk and the amount of
    time spent in the hospital. Computer Navigation systems are used by the Neuro and Orthopedic Surgeons.
    Laparoscopic surgery is performed often and with great skill at the Medical Center. There are many benefits to
    laparoscopic surgery including less post-operative pain and faster healing time. Surgeries that can be done
    laparoscopically include knee surgeries, shoulder surgeries, appendectomies, bowel resections, nephrectomies, and
    more. A state-of-the-art Integrated OR suite was completed in January 2007.

    Our neurosurgery department has now expanded to offer surgery with neurosurgeons that are affiliated with the
    University of Illinois at Chicago. Our excellent heart team, including the hard-working nurses and exceptional
    cardiac surgeons, has been named a Center of Excellence by United Healthcare insurance company for the
    outstanding outcomes achieved by this team.
    The Endoscopy Services offer both Upper and Lower Endoscopic procedures, advanced interventional ERCP
    studies, and Bronchoscopy procedures. They are able to study Esophogeal Motility and PH monitoring with their
    new sophisticated equipment. They also offer Small Bowel Capsule Endoscopy.




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                                                                                                                     21
                                           CANCER PROGRAM
                                  RESOURCES AND SUPPORT SERVICES

A   MERICAN CANCER SOCIETY
    The ACS Patient Resource Center opened at PSJMC on January 8, 2007. The Resource Center is located in the
    Imaging Waiting Room and is staffed by ACS Volunteers/Staff on Mondays from 8:30 a.m. to 12:30 p.m. and on
    Wednesdays from 12:00 p.m. to 4:00 p.m.


C   ANCER CONFERENCES
    Thirty cancer conferences (Tumor Boards) were held in 2008. One hundred two cases involving 31 different sites
    were discussed. Sites presented included anus, bone marrow, brain, breast, cervix, colon, esophagus, gallbladder, GI
    tract, kidney, lung, lymph nodes, nasopharynx, ovary, pancreas, peripheral nerve lower limb, pituitary gland,
    prostate, rectosigmoid junction, rectum, renal pelvis, retroperitoneum, skin, soft tissue, stomach, thyroid, tongue,
    tonsil, unknown primary, urinary bladder, and uterus.

    In 2008, cancer conferences were held on Tuesday mornings at 7:00 a.m. The purpose of these educational
    discussions is to improve patient care and treatment through the exchange of information by a multidisciplinary
    team of physicians and ancillary staff members. The attending or consulting physician presents a patient’s history
    and physical examination, diagnostic procedures performed, and, if applicable, the first course of treatment given. A
    Pathologist presents slides of surgical/cytological specimens and a Radiologist presents the patient’s radiology
    images. A Medical Oncologist, Radiation Oncologist, and Surgeon also attend to discuss the patient cases presented
    and offer opinions to the attending or consulting physician. All physicians attending cancer conferences at PSJMC
    receive one hour of Category I Continuing Medical Education (CME) credit for each cancer conference that they
    attend. Information about upcoming Tumor Boards is posted in the Medical Staff lounge, the CME bulletin board,
    and on the CME web site at www.cmedonline.com.


E   THICS CONSULTATION SERVICE
    The Ethics Consultation Service assists all stakeholders (physicians, staff, patients, and families) reach consensus on
    an ethically principled course of action when ethical dilemmas arise. The service is coordinated by and accessed
    through the chair of the Medical Center’s Ethics Committee.


J   OLIET AREA COMMUNITY HOSPICE
    The mission of Joliet Area Community Hospice is to provide comprehensive, holistic, community based support
    services and care for terminally ill persons, their caregivers, and loved ones without regard to economic status; to
    enable the dying person to live peacefully, in comfort, and with dignity to the last moment of life.
    Joliet Area Community Hospice is the only non-profit community-based, Medicare-certified hospice serving Will,
    Grundy and Kendall counties and southern DuPage and Cook counties. Because of the community support, Joliet
    Area Community Hospice was able to build the first Hospice Home in the State of Illinois, bringing cutting edge
    hospice care to our area. The staff at Joliet Area Community Hospice goes above and beyond the call of duty to
    meet the needs of both patient and family as they face the end of life looking at not only the physical and
    psychological needs, but also the environmental, social, spiritual, and emotional needs.

    Joliet Area Community Hospice has a dedicated pediatric team that has received referrals from area hospitals as well
    as many specialty hospitals such as Children’s Memorial Hospital, Ronald McDonald Children’s Hospital of Loyola
    University Medical Center, University of Chicago Comer Children’s Hospital and St. Jude Children’s Research
    Hospital. In addition to the Pediatric Hospice program (Hugs and Hearts), there is a Pediatric Palliative Care
    (Sunshine) program for children that may not qualify for hospice services, but could still benefit from comfort care
    and family support services.

    In 2006, Joliet Area Community Hospice introduced a new service call Palliative Care Services to provide comfort
    and compassion to patients facing a life-limiting illness, but who may not qualify or are not ready for hospice
    services. As a not for profit agency, Joliet Area Community Hospice receives additional funding from the United
    Way of Will and Grundy Counties, grants, memorials, general donations and bequests.

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                                                                                                                        22
P   ALLIATIVE CARE SERVICES
    Palliative Medicine is the specialized care that emphasizes symptom management, interdisciplinary support and
    coordination of services specific to each patient’s disease experience. In 2005, Provena Saint Joseph Medical
    Center was the first hospital in Will County to have a board-certified physician in Hospice & Palliative Medicine.
    Joliet Area Community Hospice (JACH) is proud to participate in the excellent care provided to residents within our
    region—demonstrated by Provena Health System’s efforts to foster similar initiatives among its other Illinois
    hospitals. PSJMC joins the national trend of leading medical centers providing comprehensive care with palliative
    services: Only about 25% of the nation’s hospitals presently offer a formal Palliative Care Program. Examples of
    these offerings at Provena include provision of Grand Rounds, availability of In-Patient consultations, participation
    in Tumor Board conferences and updates on current educational initiatives in Palliative Medicine. The benefits of
    this enhanced type of care already experienced by PSJMC patients, their families and staff include superior control
    of symptoms, reduced length of hospitalization and better discharge planning coordination with improved levels of
    satisfaction. JACH is excited to continue our long-standing cooperation with PSJMC in serving our community
    with the most all-inclusive care available.




P   ASTORAL CARE DEPARTMENT
    Chaplains from the Pastoral Care Department of Provena Saint Joseph Medical Center are available seven days a
    week to offer comfort, compassion, guidance, support, and prayer for patients, family members, and staff. Our
    chaplains are also available to facilitate the completion of Advance Directives. The Sacred Heart Chapel, located on
    the first floor of the Medical Center, is available for quiet reflection and prayer.




P   ROVENA HOME CARE
    Provena Home Care, a Medicare certified home care agency, offers a full range of services and products tailored to
    meet our patients’ needs. Provena Home Health provides skilled nursing, home health aides, physical therapy,
    occupational therapy, speech therapy, medical social worker, diabetic education, infusion therapy and cardiac care.
    For more information regarding any of these services, please call 815-741-7371.

    Provena Care at Home provides private duty services that include skilled nursing, medication management, home
    health aides, sitter/companions, nasal CPAP and Lifeline (a personal response system), and Provena Home Medical
    Equipment offering a full line of home medical equipment including oxygen, hospital beds, walkers, canes and
    wheelchairs. For information regarding any of these services, please call 815-773-7868.




S   OCIAL SERVICE
    The Care Management/Social Service Department works closely with the Sister Theresa Cancer Care Center in
    coordinating high priority services for cancer patients including home care, the use of medical equipment, hospice,
    and nursing home placement. Social workers also play an important role in developing discharge plans for each
    patient. In addition, they provide emotional support and intervene in crisis situations. They also help in facilitating
    the Positive People support group.




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                                                                                                                        23
                                     2008 COMMUNITY OUTREACH



C   ancer Screenings
    Free colorectal screening kits
    Skin cancer screening
                                       (September 9, 2008)
                                       (September 9, 2008)
    Prostate cancer screening          (September 17, 2008; November 15, 2008)

    October 2007 – Breast Cancer Awareness Month
    To stress the importance of early detection, PSJMC Mammography Department offered extended evening hours and
    additional Saturday hours to meet the scheduling needs of our patients. Each patient receiving a mammogram in
    October received a complimentary gift and had her name entered into a drawing for a gift basket.




C   ommunity Education Programs
    American Cancer Society Patient Resource Center
    To enhance patient access to ACS services and information, the Medical Center worked with the ACS to provide an
    ACS Patient Resource Center within our facility. The ACS Patient Resource Center opened at PSJMC on January 8,
    2007. The Resource Center is located in the Imaging Waiting Room and is staffed by ACS Volunteers/Staff on
    Wednesdays from 12:00 p.m. to 4:00 p.m.

    PSJMC staff and visitors raised money for the American Cancer Society (ACS) by purchasing daffodils and other
    gifts at the ACS Daffodil Days on February 22, 2008. The Cancer Care Center provided each of their patients with a
    bouquet of daffodils.

    Susan G. Komen for the Cure Foundation in partnership with PSJMC presented its semi-annual Wacoal Fit For the
    Cure Event on Saturday, April 26, 2008 from 10:00 a.m. to 6:00 p.m. in the Macy’s intimate apparel department.
    Participants received a complimentary bra fitting in a Wacoal bra from a fit specialist. For every woman who
    participated, Wacoal donated $2 to the Susan G. Komen for the Cure. Additionally, Wacoal donated $2 for every
    Wacoal bra purchase during the event.

    National Cancer Survivor’s Day Celebration Sunday, June 1, 2008
    Approximately 225 people attended the Cancer Survivors’ Day Picnic held at the Joliet Park District. Guest speaker
    Colleen Kettenhofen, speaker, author, trainer, and colon cancer survivor has presented over 1000 programs in 47
    states and six countries for top corporations and associations since 1995.

    The Cancer Registry staff participated in Joliet Oncology Hematology Associates 11th Annual Patient Appreciation
    Day on Saturday, June 14, 2008 from 10:00 a.m. to 1:00 p.m. at Joliet Oncology Hematology Associates, Ltd.
    Office. Staff distributed breast cancer awareness clip/magnets as well as general cancer awareness information.

    American Cancer Society’s “Relay For Life” June 21st and 22nd, 2008
    PSJMC Cancer Care Center employees participated in the American Cancer Society “Relay For Life” at Joliet West
    High School. Over $3,000.00 was raised for the American Cancer Society. Provena Saint Joseph Medical Center
    also donated an additional $50,000.00 to the American Cancer Society on behalf of the Joliet, Plainfield, and
    Lincoln-Way Relays.

    On Saturday, September 6, 2008, PSJMC was proud to be the presenting sponsor of the “Shorewood Scoot,” a 5K
    walk and run with the proceeds going to the Mark Staehely Pediatric Cancer Foundation and to continue Mark’s
    annual Christmas Toy Drive. Mark, a Shorewood resident, passed away in the spring of 2006 from neuroblastoma.
    He raised money every year to buy Christmas presents for the patients at Children’s Memorial Hospital because
    when he was a patient there at Christmas, he felt bad for the kids who had no family to bring presents. Mark asked
    his parents to keep his fundraiser alive and make sure hospitalized kids always have Christmas presents.

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                                                                                                                   24
C   ommunity Education Programs, cont’d
    The 7th Floor Inpatient Oncology staff participated in a breast cancer walk-a-thon sponsored by the American
    Cancer Society on October 18, 2008

    You’re Skin and You – October 20, 2008 at 11 a.m.
    Dr. Joan Covault gave a free presentation on caring for your skin including tips for prevention of dryness, wrinkle
    control, and signs and symptoms of more serious problems that need to be checked by a physician. Free skin cancer
    self-exam cards were included.

    The American Cancer Society CAN Fight Back Express bus tour stopped at PSJMC on Friday, October 24, 2008
    from 12:45 – 1:30 p.m. All were invited to share their story with Members of Congress through the Picture A Cure
    program and sign a petition to support access to quality health care for all Americans.

    Provena Saint Joseph Medical Center is part of the Spirit of Women national network for women's health. The
    network is comprised of American hospitals, physicians, nurses, therapists, and corporate partners joined together to
    find innovative ways to educate and inspire women and their families to better health. PSJMC is now part of a
    network of more than 120 hospitals dedicated to advancing the cause of women’s health. The mission of Spirit of
    Women is to motivate women to make positive changes in their lives by emphasizing total well being: mind, body,
    and spirit. The Spirit of Women program is for women of all ages and backgrounds. With focus on the whole
    woman, this special resource offers insight into health and wellness issues at every life-stage and seeks to address
    the specific needs and interests of women within Will County. Spirit of Women signature events and core
    components are “Day of Dance,” “Girls’ Night Out,” “When They Rely on You” and discount programs. In this
    region, Provena Saint Joseph Medical Center is the exclusive Spirit of Women program provider. Events will be
    held locally, at varied days and times. For more information, call 815-725-9438.

    The Winter/Spring 2008 issue of PSJMC One Life magazine, which is distributed to approximately 110,000 homes,
    featured several relevant articles:
    “Men’s 5 Top Health Concerns”
    “Letter From The President”
    “Fortified Food Facts”

    The Summer 2008 issue of One Life magazine featured several relevant articles:
    “Surgeries of the Future Are Here Now”
    “Leading-Edge Technology at Provena Health”
    “Imaging When and Where You Need It”
    “Need Immediate Care?”
    “Out with the Old, In with the New”
    “Defining Excellence in Cancer Care”

    The Fall 2008 issue of One Life magazine features several relevant articles:
    “Surgical Help for Weight Loss”
    “The Fight Against Childhood Obesity”

    The PSJMC web site at www.provenasaintjoe.org provides information about the Sister Theresa Cancer Care Center
    and radiation oncology services; infusional therapy; inpatient oncology unit; clinical trials; support services and
    counseling; rehabilitation services; surgical services; support groups; facility accreditations and affiliations; and
    specific information about breast, prostate, and colorectal cancers.




H   ealth & Wellness Programs
    Smoking Cessation
    Individuals who have decided to give quitting a try meet one-on-one with a healthcare professional that will provide
    information and education on smoking cessation techniques and help develop a quitting plan in order to successfully
    maintain a smoke-free lifestyle. To schedule an appointment, individuals can call (815) 725-7133, extension 3147.
    The cost is $50.
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                                                                                                                      25
H   ealth & Wellness Programs, cont’d
    “Smoke-Free 4 Life”
    A four-step approach to a healthier life, free of nicotine and tobacco dependence. The program consists of four,
    one-on-one sessions with our healthcare professionals who provide educational materials and the tools and
    techniques necessary to develop a plan to successfully maintain a smoke-free lifestyle. For more information, call
    (815) 725-7133 extension 3147.

    In coordination with the Will County Health Department’s Smoke Free Joliet Coalition, the Medical Center and
    Silver Cross Hospital have joined together to become tobacco-free campuses starting on January 16, 2007. This is
    an important initiative to promote the health and welfare of all those who enter the doors of the Medical Center. As
    leaders in the community, it is important for our patients and community to understand that we are committed to
    providing the healthiest environment possible for all. As a health care provider, it is important that we educate and
    model healthy behaviors for our communities. With the implementation of this policy, the use of all tobacco
    products will be prohibited – inside and outside - on either campus or at any building owned, leased or operated by
    both hospitals, to ensure a healthier environment for patients, visitors, physicians, staff and volunteers. This
    includes no smoking outside the building on any hospital grounds. The current smoke areas will be removed, and
    those who begin work smelling of smoke will be subject to disciplinary action in accordance with the new tobacco-
    free policy. Guests and coworkers deserve a smoke and tobacco-free environment for their health. Signage will be
    in place to remind everyone that smoking is not allowed. To support employees and volunteers in quitting smoking,
    Provena Saint Joseph Medical Center and Silver Cross Hospital will both be offering smoking cessation classes in
    conjunction with the Will County Health Department’s Smoke Free Coalition. In fact, both hospitals will be
    covering the cost of the $20 class, and will provide additional financial assistance for smoking cessation supplies for
    employees who can prove they have completed the classes and are dedicated to leading a healthier lifestyle. This is
    being done to promote a healthier lifestyle for the community, our patients, our staff, our physicians, our volunteers,
    and all who step onto our campus. As healthcare representatives, it is important that we lead by example.

    “Treatment Options for Weight Loss Including Surgery” January 7th, February 25th, May 5, 2008, 6-8 p.m.
    Dr. Peter Mihalakakos explained what weight-loss surgery is, who is a likely candidate, and what it takes to achieve
    significant weight loss. The seminar included a presentation on obesity, the effects of obesity, different surgical
    options including the LAP-BAND® procedure, and the risks and benefits of weight-loss surgery.

    National Anxiety Screening Day on Thursday, May 8, 2008 at 6:00 p.m.
    If you feel you may be suffering from depression, join us for a free screening to determine if you are and start on the
    road to healing. To register, call (815) 725-9438.

    Eating Right - A comprehensive nutrition consultation provided by a license dietitian that will focus on eating well
    for a healthy heart and the right ways to improve your fitness and reduce your health risks to achieve an overall
    healthier lifestyle. Cost $70, P.E.P. talk session for additional $30, follow-up consultations available.

    P.E.P Talk: Personal Exercise Prescription
    A comprehensive health and fitness consultation performed by an exercise physiologist specializing in the
    assessment of cardiovascular health and fitness. Cost $30.

    Beauty, Balance, and Breath – July 24, 2008, 6:30 – 8:30 p.m. in New Lenox
    Spirit of Women event featuring education, relaxation and fun.

    From the Community Outreach Department:
    4/08/08 Inwood Athletic Center - Prostate Cancer talk
    4/15/08 New Lenox Village Hall - Prostate Cancer talk
    5/17/08 Bolingbrook Relay for Life - Volunteers shared skin and breast cancer info
    6/07/08 Smith YMCA, Joliet, Skin cancer talk Dr Rushia Butler
    6/13/08 Lincoln Way East High School Relay for Life - Volunteers passed out info on breast and skin cancer
    6/21/08 Joliet West High School Relay for Life - Volunteers raised money and shared information on breast and
    skin cancer
    6/28/08 Plainfield North High School Relay for Life - Volunteers shared information on skin and breast cancer
    7/18/08 Alex Martino Junior High School New Lenox Relay for Life - Volunteers passed out skin cancer and breast
    cancer information
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                                                                                                                        26
    10/20/08 Dr. Joan Covault spoke on skin cancer at New Lenox Senior Center
    10/23/08 Spirit of Women Event at Republic Hall in Joliet - Dr. Wendy Marshall, Breast Surgeon and cancer
    survivors Stacy Peters and Sandy Peterson spoke on breast cancer
    10/25/08 All Nations Church in Joliet - Jacque Rohaly-Davis RN, Oncology Department and Survivor Sandy
    Peterson spoke on breast cancer
    11/15/08 FREE Prostate Screening at Mount Zion Baptist Church - Physicians from Advanced Urology Limited &
    Cancer Treatment Group.



C   ancer Support Services
    Bariatric Support Group (meets the third Monday of each month, 6:30 - 8 p.m.)
    Breath Takers (meets the third Thursday of each month, 1:00 - 3:00 p.m.)
    Beat Strong: A Journey to Health and Wellness (meets second Monday of each month 6:30 – 7:00 p.m.
             at Provena Saint Joseph Inwood Athletic Club)
    Caregiver Support Group – Leeza’s Place Support Group
             (meets Tuesdays, 11 a.m. – 12 p.m. and 5:30 – 6:30 p.m.)
    Lymphedema Support Group (meets the last Monday of each month)
    Positive People (meets the first and third Thursday of each month, 3 - 5 p.m.)
    Second Voice Club (call Sister Theresa Cancer Care Center at 815-741-7560 for dates & times)




G   lossary of Terms

    Abstract: A summary of pertinent information about the patient, cancer, treatment, and outcome. Components
    include patient identification, cancer identification, stage of disease at initial diagnosis, first course of treatment,
    recurrence, treatment for recurrence or progression, and follow-up.

    AJCC: American Joint Committee on Cancer (TNM staging).

    Analytic case: Any patient diagnosed and/or receiving all or part of the first course of cancer treatment at Provena
    Saint Joseph Medical Center.

    Non-analytic case: Any patient diagnosed elsewhere and received their entire first course of cancer treatment at
    another facility, or a patient diagnosed at autopsy.

    Class of case: Determination of patient’s diagnosis and/or treatment status at first admission or encounter for cancer
    at our facility.

    First course of therapy: Cancer-directed treatment or series of treatments, which is planned and usually initiated
    within four months of diagnosis.

    TNM staging: Classification given to the extent of disease by the American Joint Committee on Cancer. The TNM
    letters correspond to the extent of disease for the tumor, nodal involvement, and distant metastases.




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                                                                                                                         27
R   eferences

    American College of Surgeons Commission on Cancer National Cancer Data Base Benchmark Reports
    Commission on Cancer Facility Oncology Registry Data Standards (FORDS)
    Commission on Cancer: Cancer Program Standards 2004 Revised Edition
    American Cancer Society Cancer Facts and Figures 2008
    AJCC Cancer Staging Manual Sixth Edition
    AJCC Cancer Staging Manual Fifth Edition
    IMPAC Information Services
    The NCCN Clinical Practice Guidelines in Oncology




S   pecial Thanks
    Cancer Committee Members
    All physicians and staff who provided information for the 2008 Cancer Program Annual Report
    Sanjiv Modi, M.D., Hematology/Oncology, Cancer Committee Chair
    Peter Tomas, M.D., Pathology, Cancer/Transfusion Committee Co-Chair
    Joliet Oncology Hematology Associates
    Midwest Center for Hematology/Oncology
    Arvind Kumar, M.D., Hematology/Oncology
    Susan Krueger, Manager Cancer Care
    Dana Nylen, RHIA, Director Health Information Services
    Elizabeth Rader, CTR, Cancer Registrar
    Karen Schlueter, CTR, Cancer Registrar




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