Docstoc

message - Cancer Services at Sutter Health

Document Sample
message - Cancer Services at Sutter Health Powered By Docstoc
					            Annual Summary of Program Activities




          message
          Cancer services and programs

                                Dear Colleagues:

                                The members of the Sutter Oncology Division, whose programs have been approved by
                                the American College of Surgeons (ACoS), are pleased to present our 2006 Annual Report.
                                This report features a statistical overview of the Sutter Health 2005 Cancer Registry data,
                                summarizing the almost 8,200 new cases of cancer seen in 2005 at our nine American
                                College of Surgeons accredited institutions. Our cancer registries are responsible for
                                collecting comprehensive data on all these patients, providing demographic, diagnostic,
                                treatment, and long-term follow-up information. The most common cancers are detailed in
      Michael J. Cassidy, MD
Chair, Cancer Program Group     particular and their prevalence compared with trends seen across California and nationally.

                                Each year our report provides a detailed study of one of the five most common malignancies
                                seen within our system. This year, we highlight Prostate Cancer, the most common
                                malignancy reported in U.S. males (other than skin cancer). We review 9,782 cases accrued
                                from 1996-2005, emphasizing demographics, treatment modalities, and survival data. Our
                                thanks to Dr. Patrick Swift and Eric Gold, Oncology Analyst, for their review and analysis of
                                these data.

                                We continue our cooperative efforts in the areas of prostate cancer, breast cancer and
                                palliative care, with multidisciplinary teams of representatives of our various hospitals,
          Ian Leverton, MD      working together to establish and review quality indicators and share best practices to
              Vice President,
         Clinical Integration   improve the quality of care throughout our system. Our Prostate Cancer Committee has
                                developed a patient guide, which is being tested as part of a pilot project to see if we can
                                help patients play a more meaningful and satisfying role in their difficult decision-making
                                process regarding treatment options.

                                Detailed as well in our report are the many activities and accomplishments of our individual
                                member institutions. We are proud of the fine efforts made by so many members of our
                                hospitals to develop systems of comprehensive care, allowing the overwhelming majority of
                                our patients to be treated in their local community.

                                This cmprehensive report is a combined effort of many individuals at each of our nine
                                ACoS-accredited centers who deserve our thanks for their dedication, not only for this
                                report, but also for the many activities they participate in and programs they provide to
                                benefit patients throughout our health system.



                                Michael J. Cassidy, MD                     Ian Leverton, MD
                                Chair, Cancer Program Group                Vice President, Clinical Integration




                                                                          2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   1
Sutter Health Cancer Services and Programs




Sutter Health
Cancer Program Facilities

Many dedicated individuals make this report, and the     The Sutter Health Cancer Programs offer a complete array of services for
programs and services described in it, possible. Their
contributions are gratefully acknowledged.               cancer patients, including screening, diagnosis, treatment, education and
ABSMC-Alta Bates
                                                         support. These services include advanced treatments such as bone marrow
Michael Cassidy, MD, Medical Director                    transplants, specialized treatments such as cryosurgery, and complementary
Norman Cohen, MD, Cancer Committee Chair                 medicine approaches such as interactive guided imagery.
Jeffrey Wolf, MD, Medical Director, BMT Program
Pam Davis, RN, Director Oncology Services
Stephen Bishop, CTR, Manager, Cancer Data Services       Services are available in nine geographic locations throughout the
Eric Gold, Oncology Analyst/Programmer                   Sacramento/Sierra Region, the Central Valley and the San Francisco Bay Area.
CPMC                                                     See page 3 for a complete listing of services offered at each organization.
Kathleen Grant, MD, Medical Director
John Holt, Director of Oncology
Joyce Louie, RHIT, CTR, Oncology Data Analyst
                                                         Sutter HealtH CanCer ProgramS are available at:
EMC
Ravi Arora, MD, Cancer Committee Chair
Bryan Daylor, Vice President, Ancillary and              Alta Bates Summit Medical Center           Mills-Peninsula Health Services
 Support Services                                        – Alta Bates (ABSMC)                       (MPHS)
Margaret Courtney-Wildman, Tumor Registrar
                                                         2450 Ashby Avenue                          Dorothy E. Schneider Cancer Center
MGH
Lloyd Miyawaki, MD, MPH, Medical Director                Berkeley, CA 94705                         100 South San Mateo Dr.
Linda Tavaszi, Executive Director of Physician           510-204-2793                               San Mateo, CA 94401
 Relations
Lois Inferrera, CTR, Coordinator, Cancer                                                            650-696-4509
 Data/Registry Services                                  California Pacific Medical Center
MMC                                                      (CPMC)                                     Sutter Medical Center,
David Shiba, MD, Medical Director and Cancer
Committee Chair                                          2333 Buchanan Street                       Sacramento (SMCS)
Beverly Paderes, Cancer Services Manager                 P.O. Box 7999                              2800 L Street
Cheryl Casey, Cancer Registry and Special
 Projects Coordinator                                    San Francisco, CA 94115                    Sacramento, CA 95816
Annette Glass, CTR, Certified Tumor Registrar            415-600-2080                               916-454-6500
MPHS
Brian Henderson, MD, Cancer Committee Chair              Eden Medical Center                        Sutter Roseville Medical Center
Sheila Littrell, RN, Director of Cancer Program
Michelle Alexander, CTR and Nancy Richards, CTR,         (EMC)                                      (SRMC)
Cancer Registry Coordinators
                                                         20103 Lake Chabot Road                     One Medical Plaza
ABSMC - Summit
Lisa Bailey, MD, Medical Director                        Castro Valley, CA 94546                    Roseville, CA 95661
Larry Strieff, MD, Medical Director                      510-537-1234                               916-781-1617
Pam Davis, RN, Director Oncology Services
Stephen Bishop, CTR, Cancer Data Services
 Coordinator                                             Marin General Hospital                     Sutter Solano Medical Center
SMCS                                                     (MGH)                                      (SSMC)
Gregory Graves, MD, Medical Director
Antoine Sayegh, MD, Medical Director, BMT Program        250 Bon Air Road                           100 Hospital Drive
Margaret Mette, Assistant Administrator                  P.O. Box 8010                              Vallejo, CA 94589
Lindsey Holloway, Clinical Research Manager
Cheryl Nightingale, CTR, Tumor Registrar                 Greenbrae, CA 94912                        707-554-4444
SRMC
                                                         415-925-7000
Uma Gowda, MD, Medical Director
Deborah Dix, RN, Oncology Director                       Memorial Medical Center       (MMC)
Diana Pope, CTR, Cancer Center Supervisor

SSMC
                                                         1700 Coffee Road
Elizabeth Odumakinde, MD, Medical Director               Modesto, CA 95355
Janice Hoss, RN, BSN, OCN, Administrative Director       209-526-4500
Data analyses contributed by Eric Gold, Oncology
Analyst/Programmer at Alta Bates Medical Center




2   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Clinical and Patient Support Services



Introduction
Cancer Support Services
    This table displays the broad range of services available from the Sutter Health ACoS Cancer Programs. For specific
    facility locations and contact information, see page 2. Although this table is reflective of actual services physically
    at the locations, we understand that many of you offer these services through referrals within your region and other
    Sutter Affiliates.

   	 SERVICES	                                         ABSMC	 CPMC	 EMC	    MGH	    MMC	 MPHS	 SMCS	 SRMC	 PAMF	 Solano
    ACoS-Certified Cancer Center                         Y     Y       Y      Y      Y       Y      Y       Y
    Bone Marrow transplants                              Y                                          Y
    Brachytherapy                                        Y      Y             Y      Y       Y      Y       Y              Y
    Cancer Surgery                                       Y      Y      Y      Y      Y       Y      Y       Y      Y       Y
    Cancer Clinical trials & prevention trials           Y      Y             Y      Y       Y      Y       Y      Y
    Cancer education programs                            Y      Y      Y      Y      Y       Y      Y       Y      Y       Y
    Cancer Support Groups                                Y      Y      Y      Y      Y       Y      Y       Y              Y
    Community Screenings for Cancer                      Y      Y             Y      Y       Y      Y       Y              Y
    indoor pool for patient/rehab                               Y                            Y              Y
    Core needle Biopsy - ultrasound                      Y      Y      Y      Y      Y       Y      Y       Y              Y
    Core needle Biospy - Stereotactic                    Y      Y      Y      Y              Y      Y       Y
    Stereotactic radiosurgery & radiotherapy on Site     Y      Y      Y      Y                     Y
    Cryosurgery                                          Y      Y     Y              Y              Y                      Y
    Gamma Knife on Site                                         Y                                   Y
    infusion therapy                                     Y      Y      Y      Y              Y      Y       Y      Y       Y
    interventional radiology                             Y      Y      Y      Y       Y      Y      Y       Y              Y
    liver transplant for Hepatoma                               Y
    Mammography                                          Y      Y      Y      Y              Y      Y       Y      Y       Y
    Minimally invasive Surgery                           Y      Y      Y      Y       Y      Y      Y       Y              Y
    pediatric Cancer Care and Surgery                    Y      Y                                   Y
    pet – positron emission tomography on Site           Y    4/07     Y      Y      Y       Y      Y       Y    pAMF
    image-Guided prostate radiation therapy              Y      Y      Y      Y      Y              Y       Y              Y
    radiation oncology Services                          Y      Y      Y      Y      Y       Y      Y       Y    pAMF      Y
    radiofrequency Ablation on Site                      Y      Y                            Y      Y
    iMrt                                                 Y      Y      Y      Y      Y       Y      Y       Y    pAMF      Y
    SpeCt                                                Y      Y      Y      Y                     Y       Y
    tumor Board                                          Y      Y      Y      Y      Y       Y      Y       Y              Y
    tumor registry (in-house)                            Y      Y      Y      Y      Y       Y      Y       Y              Y


   	 OUTPATIENT		SERVICES	                               		     		     		     		      		     		      		     		      		         	
    valet parking                                        Y      Y             Y              Y      Y       Y
    Comprehensive Breast Center                          Y      Y      Y      Y              Y      Y       Y              Y
    Cancer treatment Center                              Y             Y      Y      Y       Y      Y       Y      Y       Y
    Chemotherapy treatment                               Y      Y      Y      Y      Y       Y      Y       Y      Y       Y
    Home Care & Hospice                                  Y      Y      Y      Y      Y       Y      Y       Y
    nutrition Services                                   Y      Y      Y      Y      Y       Y      Y       Y      Y       Y
    pain Management                                      Y      Y      Y      Y                      Y      Y              Y
    Complementary Medicine program                       Y      Y             Y      Y       Y      Y       Y


                                                                2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |       3
Annual Summary of Program Activities




ABSMC
Alta Bates Summit Medical Center
Charles C. Jenkins, MD, FACS
Chairman, ABSMC Cancer Committee



In 2006, in response to a Commission on Cancer (CoC)               The Carol Ann Read Breast Health Center is closer to
mandate that our facility be surveyed as a single cancer           being a reality having submitted the building plans to
program, the Alta Bates Summit Cancer Program was                  OSHPOD for final approval.
created through the merger of the individual program
components on both its campuses. The ABSMC admin-                  The Compassionate Peer Advocacy and Support Plan
istration formed a multidisciplinary Cancer Committee              (COMPASS), which trains breast cancer survivors to
in January, 2006 to insure compliance with the CoC                 assist new patients in coping with their diagnosis and
program standards and to oversee the direction of the              the complexity of their treatments, has been a model of
unified cancer program, which accessions more than                 success.
1900 patients annually.
                                                                   Clinical Research remains a strong component of our
The ABSMC Cancer Committee includes physicians,                    cancer program We participate in over 85 clinical trials
administrative representatives, and support person-                through the Bay Area Tumor Institute and the coopera-
nel from the Alta Bates and Summit campuses as well                tive group programs administered by the Sutter West-
as the Comprehensive Cancer Center on the Herrick                  ern Division of Cancer Research.
campus. It meets monthly on alternating campuses. The
                                                                   This ABSMC Cancer Committee has brought together
meetings have been well attended—with over thirty
                                                                   many physicians and other personnel from our multiple
members attending each month. So far we have accom-
                                                                   sites who have not previously worked together to coop-
plished the following.
                                                                   eratively manage the activities of our cancer program,
1. Committee rules and regulations have been drafted.              which is now the largest COC accredited program in the
2. Quality improvement indicators of our cancer service            Sutter Network. Although much has been accomplished
   lines are being reviewed and revised by our cancer              this year, much work remains to be done before our first
   site-specific subgroups (Breast. GI, Prostate, Lung.            accreditation survey in March of 2008.
   Hematology, and Research).
                                                                   We expect that our merged program will significantly
3. Specific cancer patient care issues such as PET/CT
                                                                   enhance the quality of care provided to our patients and
   access and shortening the stereotactic breast biopsy
                                                                   continue to make an important contribution to fulfilling
   waiting time have already been addressed.
                                                                   the mission of Alta Bates Summit Medical Center: “To
4. Our Community Outreach program has been very                    enhance the health and well being of people in the com-
   active through the Carol Ann Read Breast Health                 munities we serve through compassion and excellence.”
   Center, the Markstein Cancer Education Center and
   the Ethnic Health Institute.
5. We now have a joint Prostate Tumor Board that meets
   on alternate campuses every other month.

Cancer education for the community and professional
has been strengthened by multiple mock tumor boards
for patients, lectures by physicians, formation of sup-
port groups for breast and prostate cancer, and multidis-
ciplinary tumor boards and breast pretreatment confer-
ences on all of our campuses.




4   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Annual Summary of Program Activities




CPMC
California Pacific Medical Center
Kathleen Grant, MD
Chief, Division of Hematology and Medical Oncology



In 2005, the California Pacific Medical Center (CPMC)           In addition, the Department sponsors a support group
Cancer Program continued its steady growth as one of            that includes psychosocial services, nutrition consults,
the largest cancer programs in the Sutter system. The           massage therapy and guided imagery, and pastoral
Program had 1,833 accessioned cases, of which 1701              services. CPMC continues to participate in the Race for
were analytic cases. The most frequent diagnoses were           the Cure, Great American Smoke Out, Light the Night
breast cancer (397 cases), prostate (176), non-small            Walk, AIDS Walk with Alice radio station, and the
cell lung cancer (132), liver cancer (125), pancreatic          American Cancer Society’s Relay of Life.
cancer (122) and colorectal (107). The 132 nonanalytic
cases, frequently representing more advanced cancers            In 2005, California Pacific Medical Center’s Radiation
transferred to CPMC for specialized management,                 Oncology passed the accreditation survey of its
including cutaneouos melanoma; breast; lung and                 Radiation Oncology Residency Program. Currently, the
prostate cancers; leukemia and colon cancer.                    program has four residents.

In the past twelve months, the Department of Radiology
has installed a 64-slice CT scanner, completed
                                                                Technical advancements in the last year include
installation of the PACS system with voice recognition
                                                                respiratory gating treatment and image guided
for reporting, converted the Breast Health Center
                                                                radiotherapy (IGRT) which allows for enhanced
into a completely digital mammography center, and
                                                                accuracy of radiation delivery. These treatment
completed construction of five direct radiography (DR)
                                                                modalities allow for tighter planning margins, resulting
rooms. Most recently, CPMC acquired a new PET/CT
                                                                in less normal tissues treated and less treatment related
scanner to be located on the Pacific Campus.
                                                                morbidity. In 2005, the Radiation Oncology Department
Highlights of the cancer program include educational            delivered over 13,500 external beam treatments to
materials for the Spanish-speaking community and                737 patients. Approximately 20% of external beam
translations of material into Russian and Chinese,              treatments were IMRT. Thirty-nine patients were
several continuing education programs including the             treated with stereotactic radiotherapy. CPMC had 122
Mini-Medical School, complementary and alternative              interstitial brachytherapy cases and 99 high dose rate
services offered by CPMC’s Institute of Health and              brachytherapy.
Healing (expanding to provide complementary
                                                                The growth and development of CPMC’s scheduled
massages to oncology patients), and a 12-week wellness
                                                                subspecialty tumor boards continued. There are now
program for women with cancer. The continuum of
                                                                boards for gastrointestinal cancers, head and neck
cancer care also includes a Palliative Care Program with
                                                                cancers, genitourinary cancers, neuro-oncology, and
consultations available for patients and outpatients,
                                                                gynecologic, breast and lung cancers. All of these
and dedicated palliative care beds on two of the three
                                                                tumors boards, in addition to the regular general cancer
campuses.
                                                                tumor board, include surgeons, medical oncologists,
The Department of Radiology continues to be an                  radiation oncologists, radiology and pathology.
integral supporter of the CPMC African American
Breast Health Program, now in its second year of
providing at no cost to African American women: first-
time breast screening; annual mammogram screening;
breast self-examination instructions, financial assistance
and health education to individuals, churches and other
San Francisco community groups.



                                                             2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   5
Annual Summary of Program Activities




EMC
Eden Medical Center
Ravi Arora, MD
Medical Oncology Chair, Cancer Committee



In 2005, Eden Medical Center (EMC) provided a                      Last year, the integration of San Leandro Hospital with
comprehensive, multidisciplinary cancer care to its 322            Eden’s Tumor Registry was initiated and is planned for
newly diagnosed analytic cases. The majority of them               completion in 2006. Radiology Department acquired
were Breast (57), Brain (45), Lung (42) and Colorectal             a new Fischer Stereotactic Breast Biopsy machine for
(35).                                                              mammographically detected microcalcifications and
                                                                   pathologic diagnosis were successfully established
Our Cancer Program was awarded a 3-year approval                   with its use in 66 cases. Our Neuroscience Center
with six commendations from the American College of                witnessed an increase in Brain cases from 9 in 2000 to 45
Surgeons (ACOS) for the Commission on Cancer (COC)                 cases in 2005. Radiation Oncology Services have been
in May 2005. Areas of excellence included Outcome                  enhanced by the addition of stereotactic radiosurgery
Analysis, Abstracting Timeframe, Quality of NCDB                   and radiation therapy capabilities for treatment of brain
Data Submissions, AJCC Staging, Prevention and Early               tumors. Chemotherapy services are available in an
Detection, and Cancer Related Improvements. These                  outpatient setting.
outstanding achievements were accomplished through
firm commitment and total staff dedication by the                  Nursing education in oncology is emphasized with
Tumor Registry and other departments.                              ongoing chemotherapy education Seminars at EMC
                                                                   and with continued participation in Bay Area Tumor
Eden’s multidisciplinary cancer conferences presented              Institute sponsored programs.
99 newly diagnosed cases, covering all major sites. This
provided opportunities for discussion on new clinical              Finally, as per ACOS recommendations, we completed a
trials for Protocol eligible patients. With the opening            study on Stage III Colon Cancer patients to ensure that
of the New East Bay Neuroscience Surgery Center                    they are being advised about their need for adjuvant
(EBNSC) in 2005, Neuroscience Tumor Boards were                    chemotherapy.
initiated with great success, and a total of 33 Brain cases
were discussed.                                                    Similarly, we completed a community wide survey
                                                                   involving primary care physicians, about their
Cancer Education Program and Community Outreach                    awareness of the American Cancer Society guidelines on
at EMC continued its successes in 2005, as multiple                Early Detection of cancers in men and women.
Lectures/symposiums were held on topics such as
“Latest Advances in Cancer Treatment”, Prostate and                For more information, please visit our website at
Colon Cancers. All were advertised in newspapers, on               http://www.edenmedcenter.org/.
Eden’s website, and Eden’s “Your Health” publication
in order to meet the Cancer Committee’s goal for
expanding our Community Outreach Program.

As to our stated goal from 2004 of improving pathology
reports, a detailed format to include TNM Staging
according to the college of American Pathologists (CAP)
Protocols was successfully implemented in 2005. Even
though COC requires that chart audits be performed on
10% of analytic cases; at EMC, the Tumor Registry far
exceeded this requirement by performing chart audits
on 30%.




6   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Annual Summary of Program Activities




MGH
Marin General Hospital
Lloyd Miyawaki, MD, MPH
Medical Director, Marin Cancer Institute Chair, Cancer Committee



The Marin Cancer Institute (MCI) provides                    Gastrointestinal Oncology Program
comprehensive cancer care through the integration of         We developed a multidisciplinary GI Oncology program
innovative multidisciplinary programs, state-of-the-         to enhance the coordination of care for patients with GI
art technology, holistic complementary care, patient         cancers. With the establishment of consensus treatment
and family support services, and community health            guidelines, a GI Oncology Case Conference was initiated
education and promotion.                                     to discuss all newly diagnosed cases and ongoing
                                                             treatment issues. Featuring a multidisciplinary panel of
Cancer Program Accreditation
                                                             speakers, we produced a colorectal cancer educational
MCI, a Community Hospital Comprehensive Cancer               symposium for primary care providers. As a quality
Program, underwent an accreditation survey in 2005.          improvement project to improve disease prevention and
The American College of Surgeons Commission on               early detection, we studied colorectal cancer screening
Cancer recognized MCI with full program approval and         rates and provided feedback to individual providers as
seven commendations.                                         well as intervention strategies to maximize screening rates.
Breast Health Program featuring Digital Mammography          Palliative Care Program
The Breast Health Center underwent expansion,                In conjunction with the Hospice of Marin, an inpatient
remodeling, and installation of digital mammography          palliative care program was launched to improve pain
with computer-aided diagnosis, making it one of only         management and end-of-life care. The program eases the
8% of centers with digital mammography nationwide.           transition between the inpatient setting and outpatient
Every breast cancer patient continued to receive             and hospice care.
personalized comprehensive care through a nurse
navigator and multidisciplinary case review at the           Community/Professional Recognition
weekly Breast Cancer Case Conference. “An Evening            The San Francisco Bay Area Lymphoma Research
with the Experts,” a multidisciplinary breast cancer         Foundation honored Dr. Jennifer Lucas with the 2005
educational symposium for the community, highlighted         “Rosetta Stone Medical Award”. Dr. Miyawaki received
an extensive array of patient support services and           the Marin Breast Cancer Watch 2005 Honor Thy Healer
public health education programs.                            “Healing Professional” Award.
Genitourinary Oncology/Prostate Cancer Program               MCI Goals for 2006
Our unique multidisciplinary Patient Conference              • Complete installation of new CT simulator and HDR
offered patients and their significant others the              brachytherapy unit
opportunity to discuss their diagnosis and care with         • Initiate Mammosite partial breast treatment program
their entire health care team and a patient survivor/        • Begin construction to replace linear accelerators,
advocate. Discussion of new diagnoses and ongoing              including Varian Triology System
treatment issues in the weekly GU Oncology Case              • Complete prostate cancer patient education book
Conference ensured seamless quality care. Our
                                                             • Produce prostate cancer educational symposium for
community health promotion events included a
                                                               primary care providers
multidisciplinary presentation on prostate cancer risk
                                                             • Enhance holistic complementary care services with
reduction, nutrition lectures, and a hands-on class for
                                                               Therapeutic Lifestyle Change (TLC) program
healthy cooking. Committed to serving our entire
community, we offered a free prostate cancer screening       • Launch Cancer Survivorship Program
in the Canal region of Marin to specifically target the      • Develop first annual women’s retreat for cancer
underserved Latino population.                                 survivors
                                                             • Offer free skin cancer screening
                                                             • Create new website for Marin Cancer Institute


                                                          2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   7
Annual Summary of Program Activities




MMC
Memorial Medical Center
David Shiba, MD, PhD
Medical Director, Cancer Services
Chair, Cancer Committee



MMC’s American College of Surgeons accredited                      survivors. In 2006, movement therapy will add Pilates
Community Hospital Comprehensive Cancer Program                    and exercise.
continues to provide state- of- the art cancer care for
patients in Stanislaus and surrounding counties.                   Work has continued on establishing a pain and
                                                                   palliative care consultative service with addition of
Quality Improvement Activities                                     an anesthesiologist specializing in interventional pain
In 2005, we continued our work with the Sutter Health              management to the medical staff and commitment by
system-wide breast cancer project.Patient satisfaction             several physicians to the service.
and pain management continue to be a major focus
of our program. Patient satisfaction for nursing care              A new dual- energy linear accelerator and CT simulator
reached into the 90+ % as did satisfaction with pain               will be installed in fall, 2006. The seven story patient-
management.                                                        care tower will open April 2007 allowing expansion of
                                                                   many services to our cancer patients.
Nationally recognized speakers brought the latest in
                                                                   Community Collaboration and Benefit
cancer care to our professional community.
                                                                   The monthly television program “The Cancer Report”
Our 22nd Annual Cancer Symposium focused on breast                 is into its 4th season focusing on cancer-related topics,
cancer including targeted therapy, Oncotype DX, partial            cancer survivors, and caregivers. This year included
breast radiation and lymphedema therapy.                           many topics filmed throughout Northern California,
                                                                   spotlighting physicians and services at many other Sut-
For 2006, quality of TNM staging will focus on                     ter Health affiliates.
educating the entire medical staff on accurate staging.
                                                                   Our staff continues to be actively involved with various
Clinical research through our ECOG affiliation with                cancer- related organizations including The American
Stanford and the Cancer Trials Support Unit (CTSU)                 Cancer Society, Community Hospice, Make-A-Wish
provide opportunities for the latest treatments for our            Foundation, Leukemia and Lymphoma Society, and the
patients with 2 % of newly diagnosed patients being                Lance Armstrong Foundation.
treated on study protocols. Studies offered include
breast, colorectal, lung, prostate, gastric, gynecological,        We continue to provide community educational forums
renal cancers and lymphoma.                                        on colon, prostate, and breast cancers and multiple pa-
                                                                   tient, caregiver, and family support groups. We also par-
Our Cancer Registry had an analytic caseload of 833 in             ticipate in health fairs, prostate screening, and celebrate
2005 with an accuracy rate of 99% and a follow–up rate             survivorship with events like Daffodil Delight and an
of > 93%.                                                          “Evening of Hope” fashion show featuring breast cancer
New Program Services, Technology
                                                                   survivors. We continued sponsorship of Bear Facts for
And Equipment                                                      the children of cancer patients and ROCK (Recreational
                                                                   Opportunities for Cancer Kids).
Complementary therapies continue to expand having
again been chosen for the MMC Foundation’s fund-                   For more information, please visit our website at
raising campaign for 2005 and the recently announced               http://www.memorialmedicalcenter.org/cancer.
2006 campaign. The community-based introductory
complementary therapy series “The Healing Journey”,
art therapy, and “Writing Through Cancer” were added
to the ongoing inpatient music and touch therapy
improving the lives of increasing numbers of cancer



8   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Annual Summary of Program Activities




MPHS
Mills-Peninsula Health Services
Brian Henderson, M.D
Medical Director, Cancer Program



Mills-Peninsula continued its commitment in 2005 to           Expanding Research
providing cancer programs and services that not only          This year radiation oncology participated in its first
meet community needs, but also exceed expectations for        industry research project, using Cesium-131, a relatively
the level of care available in a community hospital.          new encapsulated isotope for brachytherapy for
                                                              prostate cancer. As one of only eight sites in the country,
From development of our new Women’s Center,                   the study was so successful that radiation oncologist
which introduced the region’s first full-field digital        Steven Kurtzman, M.D., will be a principal investigator
mammography, to the expansion of our research                 for the newest Cs-131 study in early 2007. We also
program, the focus has been on nurturing multi-               continue to participate in National Cancer Institute
disciplinary connections to ensure a full continuum of        clinical trials through SWOG, RTOG and the NSABP
care.                                                         with the Sutter Health Cancer Research Group.
The Women’s Center                                            Treating the whole person
The new Women’s Center, constructed during 2005               Mills-Peninsula continues to grow programs and
and opened in Spring 2006, expands the record for             services that focus on the whole person through our
excellence established during the 12-year history of          Institute for Health and Healing. This added expertise
Mills-Peninsula’s Breast Center, where more than 70           improves our ability to help our patients discover new
percent of cancers detected have been at Stage 0 (DCIS)       ways of healthy living and healing. Programs such as
or Stage 1, the most curable.                                 massage, guided imagery and mindful meditation allow
The new Center brings together breast health services         us to integrate conventional medicine with proven
including digital mammography, stereotactic biopsy,           practices from around the world.
MRI-guided biopsy, ultrasound, genetic counseling and         And we continue to expand the reach of education
personal guidance by a cancer nurse specialist.               and screening with help from our partner the African
Dorothy E. Schneider Cancer Center                            American Community Health Advisory Committee and
                                                              a growing collaboration with the Latino community.
In 2005, thanks to a targeted community outreach,
Mills-Peninsula enrolled hundreds of new participants
to the Lung Cancer Screening Project at the Dorothy E.
Schneider Cancer Center.

The I-ELCAP (International Early Lung Cancer Action
Project) study is looking at whether CT scanning
technology can identify lung cancer at an earlier stage.
The Schneider Cancer Center is proud to be the only site
in Northern California participating in the worldwide
study.




                                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   9
Annual Summary of Program Activities




SMCS
Sutter Medical Center,
Gregory M. Graves, MD
Medical Director



Throughout 2006, Sutter Medical Center, Sacramento                  Support Service Enhancements
(SMCS) continued to build upon its specialty team                   SMCS has expanded its Cancer Risk program by hiring
approach to cancer diagnosis, treatment and research.               a certified genetics counselor. This has enabled the
Patients with breast, lung, prostate or gynecologic                 program to increase the numbers of cancer patients and
cancers are cared for by board-certified, specialty                 family members served, as 100% of breast cancer cases
teams of diagnostic radiologists, surgeons, medical                 are now screened for potential need of this service.
and radiation oncologists, and support staff whose
focus is the comprehensive care of each patient. In                 The Palliative Care program, started as a pilot in 2005,
2007, the specialty team model will be expanded into                demonstrated improvements in patient and nursing
gastrointestinal, lymphoma/leukemia, and head and                   satisfaction and symptom management, as well as more
neck cancers.                                                       appropriate hospital resource utilization for patients at
                                                                    the end of life. In 2006, the program was expanded from
Review of the 2005 site table shows that SMCS                       the ICU to other areas of the hospital.
diagnosed and/or treated over 1,400 new cancer
patients. Increases in numbers of patients seen from                Quality Improvement Activities
2004 to 2005 occurred in breast, prostate, renal and                In March 2006, Sutter Cancer Center’s Medical Advisory
thyroid cancers, while fewer colorectal, gynecologic,               Committee approved and implemented the Oncology
melanoma and non-Hodgkin’s lymphoma cancers                         Clinical Quality Dashboard. The dashboard is made
were seen than in the previous year. The top five                   up of 56 quality indicators with national benchmarks
malignancies--breast, lung, prostate, colon and thyroid-            for comparison. Data collection is underway for
-accounted for 51% of total cancers. Almost one in every            breast, colon, lung, and prostate sites, as well as
four cancer patients diagnosed or treated at SMCS is a              for chemotherapy, radiation therapy, bone marrow
breast cancer patient.                                              transplant and palliative care. The dashboard will be
                                                                    used to identify areas in which SMCS excels as well as
New Program Services, Technology and Equipment                      areas that can benefit from implementing pathways
Much of the growth in the number of prostate patients               using best practice guidelines. Ultimately, the goal is to
treated at SMCS in 2005 was a result of implementing                share quality data with payors and patients.
the da Vinci® robotic surgical program in January
2005. A total of 47 radical prostatectomies were
performed in 2005 using the da Vinci® system, and
all expected improvements in patient outcomes were
observed: da Vinci® patients had shorter hospital
stays than open prostatectomy patients (36 hours vs.
3 days); da Vinci® patients had fewer complications
(average da Vinci® blood loss was 75 mL vs. average
open prostatectomy blood loss of 500-1000 mL); plus
decreases in catheterization time, post-operative pain
and narcotic usage were observed. Data collection for
long-term incontinence and impotence outcomes is still
in progress. The use of the da Vinci® robotic system is
now expanding into gynecologic oncology surgeries.
More information about da Vinci® can be found at
www.suttermedicalcenter.org/services/davinci.html.




10   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Annual Summary of Program Activities




SRMC
Sutter Roseville Medical Center
Seth A. Rosenthal, M.D., F.A.C.R.
Cancer Committee Member;
Medical Director, Roseville Radiation Oncology Center
Co-Director, Sutter Roseville Prostate Seed Implant Program



The Sutter Cancer Center, Roseville is a multidisci-              Other significant clinical programs at our Cancer Center
plinary team responding to the wide variety of needs              include lung cancer, lymphomas and leukemias, Gastro-
unique to the treatment of cancer patients. The Cancer            intestinal cancers, and CNS tumors.
Center’s health care provider team consist of physicians,
physician sub specialists, nurses, technologists, data            The Sutter Cancer Center, Roseville as a weekly tumor
managers, social workers, researchers, research coordi-           board . This popular and well-attended program pro-
nators and many volunteers who strive to provide state            vides a multifaceted approach to the treatment and care
of the art medical care with a holistic approach. The             of all cancer patients. It provide3s valuable opportuni-
Cancer Center has defined three component groups that             ties for collaboration and continuing education for the
we serve: the patient, families of the patients and the           physicians in our community.
care givers who provide services.
                                                                  Thirty-four patients participated in treatment trials in
In the year 2005, over one thousand patients received             2005. Leading sites for clinical trial accrual are Breast
treatment for their cancer at the Sutter Cancer Center,           and Prostate cancer. Twenty-three patients were en-
Roseville. The two most prevalent cancers were breast             rolled in Radiation Therapy Oncology Group (RTOG)
(185) and prostate (155).                                         studies in conjunction with our Radiation Oncology
                                                                  physicians. There are approximately 37 active therapeu-
The Sutter Roseville Campus has become a referral cen-            tic protocols available to patients for a variety of disease
ter for cancer care. In addition to serving patients from         sites. Sutter Roseville physicians are involved as prinici-
the local area, many patients are referred from regional          pal investigators on national studies. Our participation
communities to take advantage of the specialized oncol-           in national research protocols allows many patients to
ogy programs available at our facility.                           have access to investigational treatment protocols in our
                                                                  own community.
The Breast Health Center currently provides the fol-
lowing state of the art services in one facility including:       We continued to work toward improving patient care
digital mammography, CAD, stereotactic core biopsy,               by focusing on our treatment timeline for Breast Cancer
ultrasound guided core biopsies, cyst aspirations, wire           Patients. The cancer committee is collaborating be-
localizations and breast ultrasound. We plan to add               tween specialties to improve care and reduce anxiety for
Dexascan to the array of services in the coming year.             women receiving treatment for breast cancer.

A Breast Health Nurse Consultant who leads the patient            Our commitment for 2006 is to provide state of the art
from pre-surgery through long-term emotional and                  medical care in a compassionate and holistic setting for
physical support during treatment and follow-up is an             all Sutter Roseville cancer patients.
important part of our service. The patient’s family is in-
cluded in the patient’s well being and recovery process
through a variety of family and friends support groups

Prostate Cancer is also a major focus of our cancer pro-
gram. Sutter Roseville provides Prostate Seed Implant
therapy to the greater Sacramento region. Our Program,
which started in 1999, continues to provide an alterna-
tive for many men facing treatment for prostate cancer.
Over 300 patients have had prostate brachytherapy
since 1999. A full scope of prostate cancer therapies are
also offered for men at our medical center


                                                              2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   11
Annual Summary of Program Activities




SSMC
Sutter Solano Medical Center
James Krasno, M.D.
Chair, Cancer Committee



The Sutter Solano Cancer Center opened its doors in                 The Cancer Committee of the Center oversees the cancer
November 2005. By June 2006, the center’s radiation on-             education program for professionals and community,
cology service earned accreditation, with no deficiency             regular tumor boards, screenings and other cancer
identified, from the Joint Commission on Accreditation              related activities. During the past year, Sutter Solano
of Healthcare Organizations during a very thorough,                 hosted or participated in:
unannounced survey.                                                 • Cancer support programs: American Cancer
                                                                       Society’s (ACS) “Look Good Feel Better” classes and
The center offers patients advanced cancer treatment
                                                                       Cancer Support Groups in collaboration with the
and support services delivered by an expert team of
                                                                       Wellness Community of San Francisco East Bay
highly qualified professionals:
                                                                    • Cancer events: ACS Relay for Life and Celebration of
• Radiation Oncologists
                                                                       Survivors
• Medical Oncologists
                                                                    • Community:
• Radiation Therapists
                                                                       a. Education and screenings: Breast, Prostate, Skin
• Oncology Clinical Nurse Specialist                                      and Colorectal. Lectures also included topics such
• Oncology/Chemotherapy ONS Certified Nurses                              as stress reduction, nutrition and legal issues
• Physicists                                                              affecting cancer patients.
• Dosimetrist                                                          b. Health fairs: Sisters’ Life Block Walk, African
                                                                          American Juneteenth, and Tribute to Seniors
• Social Worker
                                                                       c. In addition to the bi-monthly tumor board, the
• Nutritionist
                                                                          center offered continuing medical education on
• Cancer Registrar                                                        several site-specific cancers such as Pancreatic,
                                                                          Lung, Colorectal, GYN, Prostate, Breast, and
The center provides radiation therapy, infusion therapy,
                                                                          also covered Radiation Oncology and Symptom
massage therapy, laboratory services, community cancer
                                                                          Management.
education and screenings. It also has a resource center
and serenity room.                                                  • Educational material – the center collaborated with
                                                                       other Sutter affiliates to develop a “Breast Cancer
The Registry accessioned over 330 cases during 2005                    Notebook” for newly-diagnosed breast cancer
and the top five primary sites were breast, prostate,                  patients. The notebook covers all aspect of breast
colorectal, lung and lymphoma. Fifty percent of our                    cancer from diagnosis to care after treatment. It is
cases were diagnosed at early stage. As part the hospital              intended to help women make informed decisions
performance improvement program, the Registry con-                     and become active participants in their own care.
tinues to monitor compliance of the TNM staging.                    2006 was a year of growth and opportunity for the
                                                                    cancer center, but it is ready to face more challenges
At the center, the technology centerpiece is the linear
                                                                    and opportunities in coming years. To measure success
accelerator, capable of delivering multiple energies with
                                                                    and to assure continuous improvement of services, the
various techniques including IMRT (Intensity Modulat-
                                                                    center developed its own patient satisfaction survey.
ed Radiation Therapy) providing clinicians with greater
                                                                    The center is in the process of preparing for the Ameri-
accuracy and enabling delivery of high doses of radia-
                                                                    can College of Surgeons and Commission on Cancer
tion to specific cancer sites while minimizing exposure
                                                                    accreditation which is expected in the first quarter of
to surrounding healthy tissue.
                                                                    2007. The center is also looking forward to providing
                                                                    clinical trials in collaboration with Sutter Health and to
                                                                    continue its outreach programs and lectures.


12   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)




Focus on Prostate Cancer
Patrick Swift, M.D., Director of Radiation Oncology, Alta Bates Summit Comprehensive Cancer Cente
Eric Gold, Oncology Analyst/Programmer, Alta Bates Summit Medical Center
See page two for abbreviations for Sutter Health institutions.




OvERvIEW                                                                            1975   1980   1985    1990        1995       2000
                                                                                   350                                                       350
Prostate cancer is the most common non-skin cancer
reported in U.S. males, with an estimated 234,460 new
cases expected in 2006, representing 33% of all new
cancer diagnoses in men . There will be an estimated                               300                                                       300
27,350 deaths due to this disease in the same year,
accounting for 9% of all male cancer-related deaths.
Over the past twelve years the prostate cancer death
rate has declined and it is now third largest cause of                             250   African-American                                    250
cancer-related deaths, behind only lung and colorectal                                       Incidence
cancers. As the baby boomer population continues to
age, the severity of the problem will remain a major
                                                                Rate per 100,000


health issue for males in the United States.                                       200                                                       200

An awareness of the importance of prostate screening
with digital rectal examinations (DRE) and Prostate-
Specific Antigen (PSA) testing has increased over                                  150                                                       150
the past decade. This is due in part to personally                                                                Caucasian
affected prominent individuals coming forth publicly                                                              Incidence
to educate the population on the problem (Senator
John Kerry, Colin Powell, Joe Torre, Nelson Mandela,                               100                                                       100
General Norman Schwarzkopf, etc.) and also due to                                          African-American Mortality
the emergence of an increasing number of education
and free screening programs available for high-risk
populations. However, if we are to continue the recent                              50                                                       50
trend towards lower mortality rates for this disease the                                      Caucasian Mortality
call for screening needs to be accepted more widely
in certain communities in the nation. Although it is
not possible to say definitively that increased PSA and                              0                                                       0
DRE screening has improved survival, the declining                                  1975   1980   1985    1990        1995       2000
mortality rate reported by the American Cancer Society                                     Year of Diagnosis/Death
mirrors the increasing use of such screening in the U.S.        FIGURE 1
                                                                Focus on Prostate Cancer (1996-2005)
(Figure 1).                                                     Sutter Health 2006 Cancer Programs Annual Report
                                                                U.S. ProState CanCer InCIdenCe and MortalIty:
At the same time, however, early detection has led to           CaUCaSIanS vS. afrICan-aMerICanS
a dramatic and costly rise in over-treatment of many            1975-2003 (Seer data, nCI, 2006)
men who may have been appropriately followed closely
rather than being subjected to expensive treatments             1
                                                                 Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L,
with substantial quality of life impairment. The large          Eisner MP, Horner MJ, Howlader N, Hayat M, Hankey BF, Edwards BK (eds).
                                                                SEER Cancer Statistics Review, 1975-2003, National Cancer Institute. Bethesda,
spike in incidence identified in the curves in the early        MD, http://seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER
1990’s is due to the introduction of the PSA test and its       data submission, posted to the SEER web site, 2006

widespread use. We must do a better job of identifying           In 2007 Sutter Solano Medical Center will become the ninth Sutter Health
                                                                2

                                                                System institution accredited by the American College of Surgeons. However,
those patients who require immediate treatment, and             because their cancer registry has only been fully operational since 2002, their data
                                                                could not be included in this report.




                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                         13
Prostate Cancer (1996-2005)


                   FIGURE 2
                   Focus on Prostate Cancer (1996-2005), Sutter Health 2006 Cancer Programs Annual Report
                   nUMber of analytIC CaSeS andPerCent of total regIStry CaSeS
                   1996-2000 vS. 2001-2005




those who can safely be managed by an approach of                          NUMBER OF ANALYTIC CASES AND
watchful waiting. The identification of gene expression                    PERCENT OF TOTAL REGISTRY CASES
profiles in microarray assays may prove superior to
current prognosticators (PSA, grade, stage, percentage                     Over the ten-year span of this study, prostate cancer case
of biopsies positive) in differentiating high risk prostate                volume generally reflected the size of the underlying
cancer from indolent and clinically irrelevant disease.                    oncology population at each hospital. During the 1996-2005
At the same time, identification of ways to reduce the                     time period prostate cancer accounted for 12% of all newly-
risk of developing the disease will continue, through                      diagnosed cancer cases seen in the Sutter system, which
trials such as the ongoing SELECT Trial (Selenium and                      was slightly below that seen nationally (17%, NCI SEER,
Vitamin E Cancer Prevention Trial), testing the value of                   1996-2005). Relative incidence (percentage of cases relative
selenium and vitamin E as preventive agents for men at                     to the total number of registry cancer cases) at individual
high risk for prostate cancer.                                             hospitals ranged from 5% (SMCS) to 17% (MGH).

                                                                           Figure 2 shows both the actual number of prostate cancer
STUDY OF SUTTER HEALTH CASES                                               cases seen at each of the Sutter institutions and the relative
                                                                           incidence, broken down by 5-year time period. There was
FROM 1996-2005
                                                                           a decrease in the number of prostate cancer cases seen
This study represents an analysis of 9781 new cases of                     throughout the Sutter system over the two 5-year periods
invasive prostate cancer diagnosed and/ or receiving                       analyzed, mirroring trends seen nationally. This decrease
first course of treatment at the eight Sutter Health                       was observed in all but one center (SRMC).
institutions during the 1996-2005 time period. For
homogeneity of data purposes, only adenocarcinomas                         However it should be noted that the number of prostate
were included in this study. The data collected during                     cancer cases accessioned by hospital cancer registries
the last five years reflects the changes that were                         may not reflect the actual prevalence of prostate cancer
recommended after the last data review five years                          in the communities served by each hospital. This is be-
ago, with regard to prognostic factors such as Gleason                     cause each of the Sutter hospitals has a different set of
score and changes in staging definition. For full                          contractual agreements in place with health plans in their
comprehension of the Sutter Health prostate cancer                         individual communities, as well as different arrangements
experience, we will need to continue to capture new                        for the delivery of radiation services, which can strongly
data that has relevance for outcome analysis, such                         affect whether or not certain prostate cancer cases are
as PSA level at the time of treatment and other new                        accessioned by hospital-based cancer registries. For ex-
prognosticators as they achieve confirmational status.                     ample, whereas the majority of centers have integrated in-
                                                                           house Radiation Oncology facilities, Sutter Medical Center,
                                                                           Sacramento (SMCS) and Eden Medical Center (EMC) do
                                                                           not. Instead, free-standing radiotherapy centers exist in
                                                                           the communities of both of these centers and it is common
                                                                           for staff urologists to refer patients directly to these fully
                                                                           independent outpatient facilities, resulting in the cases not
                                                                           being captured in cancer registry databases.


14   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)




                                                        AGE AT DIAGNOSIS
                                                        The overall median age at diagnosis was 68 years,
                                                        ranging from 65 (SMCS) to 70 (EMC). During the two
                                                        five-year time periods there was a slight trend towards
                                                        younger age at diagnosis (68 years, 1996-2000 vs.
                                                        67 years, 2001-2005). Distribution by age group was
                                                        similar throughout Sutter hospitals, peaking in the 60-79
                                                        age group, which represented over 70% of the cases
                                                        overall. Very few cases were diagnosed under age 50
 FIGURE 3                                               or over age 89. Figure 3 shows that over time there was
 Focus on Prostate Cancer (1996-2005)                   a clear increase in patients diagnosed in the 50-59 age
 Sutter Health 2006 Cancer Programs Annual Report
                                                        range (16% to 20%) and a decrease in patients diagnosed
 age dIStrIbUtIon                                       in the 70-79 age group (37% to 32%).
 1996-2000 vS. 2001-2005
                                                        The time periods encompassed by this study include
                                                        the years since PSA testing achieved widespread accep-
                                                        tance, and nationally, the routine use of the PSA test has
                                                        resulted in patients being diagnosed at an earlier age
 FIGURE 4                                               with smaller burden disease.
 Focus on Prostate Cancer (1996-2005)
 Sutter Health 2006 Cancer Programs Annual Report
 raCe/ethnICIty dIStrIbUtIon
                                                        RACE/ETHNICITY
                                                        The racial/ethnic variations noted for each institution
                                                        reflect the diversity of the communities served (Figure 4).
                                                        Sutter Health serves a broad population base throughout
                                                        Northern California. CPMC has the highest percentage
                                                        of Asian patients (25%), MMC and EMC have the
                                                        highest percentage of Hispanic patients (11% and 13%,
                                                        respectively), and ABSMC has the highest proportion of
                                                        African-Americans (24%). These patterns are consistent
                                                        with Sutter Health site-specific studies done over the last
                                                        ten years.




                                                    2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   15
Prostate Cancer (1996-2005)


Table 1: AJCC TNM Staging System for Prostate Cancer


    Stage Group       T(umor)          N(odes) M(etastases) Gleason Grade
    Stage I              1a               0         0          2,3 or 4
    Stage II             1a               0         0           5 or 6
                     1b,c,2a,b,c          0         0            Any
    Stage III             3               0         0            Any
    Stage Iv              4               0         0            Any
                        Any               1         0            Any
                        Any              Any        1            Any


TNM STAGE AT DIAGNOSIS
Overall, stage of disease has been shown to be one of the            diagnosis, especially in comparison to Caucasian men.
most important predictors of outcome after treatment                 A trend noted in the previous Sutter Health prostate
for prostate cancer. Table 1 shows the current AJCC                  cancer report for Hispanic men to have relatively less
TNM scoring scheme for prostate cancer. Patients treat-              Stage II (localized) disease and relatively more Stage
ed surgically tended to be classified according to their             III (regional) disease disappeared in the most recent
pathologic stage, while those treated primarily with                 time period, possibly suggesting successful screening
radiation tended to be clinically staged. This difference            outreach to the Hispanic population.
makes it impossible to cleanly compare outcomes of
different treatment modalities according to stage, since
clinical staging underestimates extent of disease in up to           HISTOLOGIC GRADE AT DIAGNOSIS
a third of patients. Clinical staging under-represents the           The Gleason pattern score is built into all prospective
proportion of patients with microscopic spread to lymph              intergroup clinical trials due to its proven importance
nodes (or microscopic extension to seminal vesicles or               as a powerful prognosticator. Overall survival and
outside the capsule), whereas surgical (pathological)                biochemical disease-free survival rates are well-
sampling will identify a number of such cases.                       correlated with the Gleason score (GS). The last review
                                                                     of Sutter Health prostate cancer data (1994-2000)
Over 80% of men with prostate cancer were diagnosed                  recommended systematic recording of Gleason data
at TNM stage I or II (clinical T1c, nonpalpable, PSA                 by our cancer registries. As a result of this initiative,
elevated; or T2, clinically palpable but organ-confined).            these data are available for the 2001-2005 time period
A minority of patients presented with stage III or IV dis-           in this report. Gleason pattern is a two-digit system,
ease (clinical or surgically-proven extension beyond the             where the first digit (ranging from 1 to 5) indicates
capsule or metastatic disease; 9% and 4%, respectively).             the predominant histologic pattern identified, and
                                                                     the second number represents the secondary pattern.
There was a trend towards earlier stage disease over
                                                                     Gleason score is the numerical sum of the primary and
the time periods analyzed (Figure 5, next page). In the
                                                                     secondary pattern. For example, a Gleason pattern
1996-2000 cohort, the percentage of patients with stage
                                                                     of 4+3 (GS=7) would indicate a preponderance of
I or stage II disease overall was 81% of cases, rising to
                                                                     cells graded as 4 with a smaller percentage of better-
85% in the 2001-2005 cohort. A decrease in the inci-
                                                                     differentiated grade 3 cells.
dence of stage I disease (low-grade disease discovered
incidentally at the time of another procedure such as a              Prostate cancer patients can be broken down into three
TURP) from 13% to 3% overall reflected a decrease in                 groups based on Gleason pattern and score:
the percentage of patients undergoing TURP over those
                                                                     • Low-grade – Patients with truly low-grade disease
time periods. EMC was remarkable for having the high-
                                                                        (GS=6 or less with no Gleason pattern 4 disease
est percentage of patients with stage IV disease in the
                                                                        identified)
2001-2005 time period (16%, compared to 2-4% for other
hospitals). Otherwise, the pattern of distribution of cases          • Intermediate-grade – Patients with intermediate risk
by TNM stage was generally similar among the Sutter                     disease (GS=7, pattern 3+4 or 4+3 or GS=6, pattern
institutions. Figure 6 (next page) shows a persistent                   2+4 or 4+2)
trend over time for a relatively large percentage of Af-             • High-grade – All high risk patients (GS=8-10)
rican-American men to present with stage IV disease at
3
    Not shown




16    | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)




FIGURE 5
Focus on Prostate Cancer (1996-2005)
Sutter Health 2006 Cancer Programs Annual Report
tnM Stage dIStrIbUtIon
1996-2000 vS. 2001-2005




FIGURE 6
Focus on Prostate Cancer (1996-2005)
Sutter Health 2006 Cancer Programs Annual Report
tnM Stage by raCe/ethnICIty
1996-2000 vS. 2001-2005




                                                   2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   17
Prostate Cancer (1996-2005)


                                                                      FIGURE 7
                                                                      Focus on Prostate Cancer (1996-2005)
                                                                      Sutter Health 2006 Cancer Programs Annual Report
                                                                      gleaSon grade dIStrIbUtIon




Figure 7 reveals that over 50% of the men studied in                  Over the 2001-2005 time period Sutter overall
the 2001-2005 time period were diagnosed with low-                    experienced a downward trend in the percentage of
grade disease, a third of patients were diagnosed with                cases diagnosed with low-grade disease and a gradual
intermediate-grade disease, and 14% had high-grade                    concomitant rise in the percentage of cases showing
disease. Among the various Sutter hospitals analyzed,                 intermediate-grade disease (Figure 8). An analysis
there was a marked variability in the distribution of                 of Gleason grade by racial group revealed no clear
cases by Gleason grade. EMC had the lowest incidence                  differences in distribution.
of low grade disease and the highest rate of high grade
disease (26% and 36% respectively), while SRMC saw
just the reverse (79% and 6%). This variability may be
a reflection of differences in treatment referral patterns
among the Sutter institutions discussed earlier in this
report.

                                                                      FIGURE 8
                                                                      Focus on Prostate Cancer (1996-2005)
                                                                      Sutter Health 2006 Cancer Programs Annual Report
                                                                      gleaSon grade by year of dIagnoSIS (2001-2005)




4
    Hormonal therapy includes chemotherapy and immunotherapy.




18     | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)


                                                                           FIGURE 9
                                                                           Focus on Prostate Cancer (1996-2005)
                                                                           Sutter Health 2006 Cancer Programs Annual Report
                                                                           treatMent ModalIty by Stage of dISeaSe
                                                                           1996-2000 vS. 2001-2005




TREATMENT MODALITIES
Prostate cancer specialists throughout the Sutter                 • Stage I/II: Overall, 60% underwent definitive
system have at their disposal a comprehensive array                 radiation and 28% definitive surgery. Comparing
of all major specialized treatment approaches used                  cases diagnosed 1996-2000 with those diagnosed
throughout the country, including nerve-sparing                     2001-2005, there was a small increase in cases
prostatectomies (both open and robotic), laser,                     undergoing definitive radiation and a small increase
focused ultrasound, cryotherapy, image-guided                       in definitive surgery. Evaluating the relative use of
highly conformal external beam radiation, high-                     brachytherapy versus external beam radiation in
dose rate temporary interstitial brachytherapy and                  these patients will be important for future prostate
permanent seed implantation. In order to better un-                 cancer studies.
derstand patterns of treatment at Sutter Health centers,          • Stage III: Overall, 35% had definitive radiation, 51%
modalities were organized into five categories: Radio-              had surgery and 12% had a combined approach. The
therapy with or without hormonal therapy (R±H),                     large incidence of stage III patients who undergo
Surgery with or without hormonal therapy (S±H), both                definitive surgery reflects the fact that those patients
surgery and radiotherapy with or without hormonal                   who are clinically stage II but pathologically up-
therapy (S+R±H), hormonal therapy alone, and no                     staged to III are collected as stage III patients in the
cancer-directed treatment (None).                                   data. In the last five years while cases undergoing
                                                                    definitive surgery increased, there was a slight
As mentioned above, the existence of free-standing
                                                                    decrease in those undergoing definitive radiation
radiation facilities that are independent of Sutter centers
                                                                    and combination treatment. In coming years a rise
strongly skews both the number and type of prostate
                                                                    is expected in the percentage of stage III patients
cancer cases seen at EMC and SMCS. Since cancer regis-
                                                                    treated with surgery followed by radiation based on
try data from these two centers would not capture the
                                                                    recently released studies suggesting an improvement
true split between radiation and surgical treatments,
                                                                    in outcome in post-surgical radiation in patients with
they were excluded from this analysis of treatment
                                                                    high risk features.
modality.
                                                                  • Stage IV: A comparison of the study’s two five-
Figure 9 looks at changes in the distribution of                    year time periods reveals a large decline in the use
treatment modality by stage of disease over the ten-year            of definitive surgery accompanied by increases in
span of this study.                                                 definitive radiation and combination approaches.
                                                                    Hormonal ablation therapy, in conjunction with
                                                                    radiation, is playing a prominent role for patients
                                                                    with locally aggressive or regional disease, and as
                                                                    sole therapy for patients with advanced regional or
                                                                    metastatic disease.


                                                              2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |    19
Prostate Cancer (1996-2005)


FIGURE 10
Focus on Prostate Cancer (1996-2005)
Sutter Health 2006 Cancer Programs Annual Report
treatMent ModalIty by year of dIagnoSIS (2001-2005)
horMonal vS. non-horMonal treatMent for low-rISk PatIentS




In recent years new radiation technologies have been                The use of salvage therapies for recurrent disease are
introduced, such as Intensity Modulated Radiation                   more difficult to review based on the data readily
Therapy (IMRT) and High Dose Rate radiation (HDR),                  available in our cancer registries, but exciting work has
that allow for safer delivery of higher radiation doses,            led to breakthroughs in this cohort of patients. Androgen
decreasing the need for routine hormonal blockade in                blockade remains the cornerstone of treatment strategies
low and intermediate risk patients. This trend is clearly           for most patients who fail either surgery or radiation.
reflected in Sutter Health prostate cancer patients, as             New studies showing the benefit of taxane-based
Figure 10 shows that there was a steady decline over                chemotherapy regimens for hormone-refractory disease
the last five years in the use of hormonal blockade                 have led to the widespread use of these drugs within
along with radiation in stage I/II patients with low-               the Sutter system. Research programs, sponsored by
grade disease.                                                      the cooperative groups and industry looking at new
                                                                    agents such as tyrosine kinase inhibitors, vaccines, anti-
                                                                    angiogenesis agents and new chemotherapeutic agents
                                                                    are thriving at many of the sites.




20   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)


FIGURE 11
Focus on Prostate Cancer (1996-2005)
Sutter Health 2006 Cancer Programs Annual Report
5-year relatIve SUrvIval
SUtter hoSPItalS vS. UnIted StateS Seer: 1996-2003




SURvIvAL
In order to directly compare survival rates for Sutter
Health prostate cancer patients with the most recently
available national data we calculated relative survival
for patients diagnosed in the 1996–2003 time period.
Figure 11 shows that relative five-year relative survival
rates are comparable to estimates reported by SEER for
the entire U.S. at all hospitals except EMC, where there
was documented a high case load of stage IV patients
(Figure 5) and patients with high-grade disease (Figure
7). Also, African-American men treated in the Sutter
Health system fared slightly better overall compared
with those in the national sample.


5
    SEER Public Use CD-ROM, 2006
6
 Relative survival data must be interpreted with caution. The relative survival rate facilitates comparison of survival data from different groups of patients by taking
into consideration the likelihood that patients in a given age group will die from causes unrelated to their cancer. Relative survival adjusts the actual observed survival
rates of a given patient population for the popu-lation’s age and gender structure relative to a “standard” U.S. population. This adjustment doesn’t take into account
factors such as race and socioeconomic status, which are known to affect survival rates for persons with colorectal cancer. Also, the U.S. five-year relative survival value
used in this report for comparison purposes is based upon SEER data obtained from population-based cancer registries covering only about 10% of the U.S. population.
To the extent that the patients seen at Sutter Health facilities during the 1996-2003 period differ from the U.S. subpopulation utilized for the SEER statistics, compari-
sons must be made with caution. Finally, comparisons among Sutter Health facilities with respect to survival rates must take into account the demographic variability
seen across Sutter Health institutions.




                                                                                   2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                         21
Prostate Cancer (1996-2005)


FIGURE 12
Focus on Prostate Cancer (1996-2005)
Sutter Health 2006 Cancer Programs Annual Report
obServed SUrvIval by Stage, gleaSon grade,
and “PrognoStIC SCore”




In order to examine factors affecting prostate cancer                                  In clinical practice, the use of multiple factors (PSA, PSA
survival among men seen at Sutter Health institutions                                  doubling time, Gleason score, T stage, and percentage of
we generated actuarial (observed) overall survival                                     positive biopsies) allows for cleaner division of patients
curves looking at race, stage of disease and Gleason                                   into low, intermediate and high risk groups. However,
score. Survival curves based on stage alone fail to show                               cancer registries at present are unable to collect data on
substantial differences in outcome between stages I, II                                most of these factors.
and III disease, but a markedly poorer outlook for stage
IV disease is obvious (Figure 12A). Similarly, patients
with low-grade or intermediate-grade disease were not
well differentiated within the 2001-2005 time period for
which we have Gleason data (Figure 12B), although
greater differences would be expected with additional
follow-up time. When TNM stage and Gleason grade
were combined to create a simplified “prognostic score”
there was better resolution of patients falling into the
intermediate risk category (Figure 12C).




7
 The “prognostic score” is the simple numerical sum of each patient’s stage at diagnosis and their Gleason grade disease with values assigned as follows: Stage I/II = 2,
Stage III = 3, Stage IV = 4, Gleason Low-grade = 1, Gleason Intermediate-grade = 2, and Gleason High-grade = 3. Thus values ranged from 3 to 7.




22   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Prostate Cancer (1996-2005)




CONCLUSION
Prostate cancer remains a major focus of each of the          high dose rate brachytherapy techniques for carefully
cancer centers within the Sutter system. The magnitude        selected patients has also marked a significant change
of the problem, while relatively stable in terms of           in the management of this disease. These improvements
percentages within the population, will continue to           in both external radiation and brachytherapy have
grow given the aging of the growing population of             resulted in increased local control of the disease and
Northern California. Enhanced screening will lead             decreased morbidity. All of these factors (increased
to a rise in newly diagnosed cases in most areas, and         screening, earlier stage at diagnosis and improved
the new challenge will be to correctly identify those         treatment techniques) have resulted in the declining
patients who require treatment and those who can be           death rate.
safely followed. Sutter Health continues to provide
an outstanding array of treatment options for the             This analysis has pointed out several opportunities
communities served, with excellent reported outcomes.         for improvement in future studies on prostate cancer
                                                              patients seen at Sutter Health. Given the relatively slow
Within Sutter Health, the care and management of              course of the disease in most men, any meaningful
prostate cancer patients continues to improve. As             survival analysis must extend at least ten years from
screening guidelines of the American Cancer Society           diagnosis. In future studies we will refine our case
and American Urologic Association are implemented,            selection parameters to facilitate full 10-year relative
the disease is diagnosed at an earlier stage, prior to        survival comparisons between Sutter Health and
the development of symptoms. Across the nation, the           the U.S. population. Also, efforts will be made to
average age of the patient at diagnosis has declined,         standardize and insure data acquisition for clinically
and the average stage has decreased, and these                relevant prognostic indicators such as PSA and
trends are evident in the Sutter system as well. These        percentage of positive biopsies. Capturing the PSA data
younger men are faced with an expanding array of new          has proven to be an elusive goal, since there is often a
treatment options.                                            great deal of time that passes between diagnosis and
                                                              treatment, and no current mechanism is in place to
Major accomplishments have been realized in the               identify and capture the most relevant blood test results.
reduction of morbidity associated with the two main           As newer genetic markers are identified, they in all
treatment modalities, surgery and radiation therapy.          likelihood will make the current prognostic indicators
Improved surgical techniques have led to a reduction          less relevant in the next decade. Such markers will
in the need for transfusions, shortened hospital stays,       hopefully help us identify those patients who require
and improved sexual outcome through nerve-sparing             treatment and those who have truly indolent disease.
procedures. Newer techniques, such as the robotic             The ultimate goal remains – to see a further decline in
prostatectomy, are furthering this trend towards              the mortality rate from prostate cancer, continuing the
reduced hospital stays. In radiation oncology, powerful       trend of the past eight years.
treatment planning programs combined with improved
imaging techniques, such as magnetic resonance
imaging with spectroscopy and real-time identification
of the location of the prostate on a daily basis (IGRT
– image guided radiation therapy), have made it safer
to deliver higher doses of external beam radiation with
decreasing doses to adjacent critical structures. The
rapid expansion of both permanent low dose rate and



                                                          2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   23
Overview of Cancer Registries




Registries
Sutter Cancer Program


Stephen Bishop
Cancer Data Services Coordinator
Alta Bates Summit Medical Center
Cancer Registry Data Collection
And Analysis
The cancer registries of the Sutter Cancer Program                  Data collected by each hospital are shared and
provide data management services to comply with                     aggregated for reports, studies, and cancer statistics
mandatory state cancer reporting regulations, as well as            for the Sutter Cancer Program as a whole. The ability
the data needs of clinicians, administrators, and other             to look at our combined Sutter Health data provides a
qualified users across the Sutter network. In addition,             unique opportunity to evaluate care across our network.
Sutter cancer registries also provide data to national-             At present, system-wide studies and quality assurance
level cancer surveillance organizations for incidence               projects are accomplished through data exports and
measurement and epidemiological studies. The Sutter                 manual aggregation and statistical analysis of the
Cancer Registries have collected data for a total of                data. Through comparison with regional and national
197,846 cases, with 9,584 new cases entered for the                 statistics, the combined data enables Sutter clinicians
calendar year 2005.                                                 to more effectively monitor trends in the incidence,
                                                                    staging, treatment, outcome and survival of cancer
The local registry databases contain demographic and                patients treated within our network.
clinical information from diagnosis through treatment,
as well as annual lifetime follow-up data. The follow-up            In addition to their routine cancer registry
process, in addition to providing critical information              responsibilities, Sutter Cancer Registrars are often
about disease status and treatment outcomes, also                   asked or volunteer to coordinate or participate in
performs a valuable service for physicians and patients             other Cancer Program activities outside of the Cancer
by reminding them that regular reassessment of the                  Registry. At any of the nine ACOS accredited facilities
disease is vital for early detection of recurrences or              in the Sutter Cancer Program, the Cancer Registrar may
subsequent primaries. As of the end of 2005, the Sutter             coordinate or supervise Cancer Screening Programs,
Cancer Registries are actively following 62,638 living              Cancer Support Services, Continuing Medical Education
patients.                                                           (CME) for Oncology, Cancer Research, or Volunteers
                                                                    and Auxillary Staff Members. Sutter Cancer Registrars
                                                                    are often members of other standing medical staff or
                                                                    hospital committees, especially Quality Improvement
                                                                    Committees. Cancer Registrars often participate in or
                                                                    coordinate American Cancer Society (ACS) activities,
                                                                    community health fairs and public education activities
                                                                    such as Breast Cancer Awareness Month events in
                                                                    October and Prostate Cancer Awareness Month events
                                                                    in November.




24   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
    Overview of Cancer Registries




    Registries
    Sutter Cancer Program


    Each Cancer Program facility is accredited by the
    American College of Surgeons and is regularly re-
    surveyed to assure continuous compliance with its
    accreditation standards. In most cases, Sutter Cancer
    Registrars serve as the ACOS Certification Coordinators
    at their facilities, devoting many hours outside of their
    data management responsibilities to insure that their
    cancer programs meet or exceed all ACOS Cancer
    Program standards for their respective categories of
    approval.

    The following table briefly summarizes the volume of
    activity of each registry for calendar year 2005:


    Table 1
    2005 Sutter Health Analytic Cancer Cases              SUtter CanCer regIStry StatIStICS

                                                ABSMC     CPMC        EMC        MGH        MHA       MPHS        SMCS      SRMC       SSMC*

Reference Date                                 01/01/85   01/01/93   01/01/98   01/01/83   01/01/90   01/01/95   01/01/92   01/01/90   01/01/02

Total Cases in Database                         47,148    37,889     10,012     23,735     23,134     23,915     18,276     12,297      1,440

Total Cases in 2005                              1,922     1,834       355        672        853        829       1,762      1,020       337

Total Active Follow-Up                          16,211     5,913       927       6,543     17,137      3,594      7,963      3,590       760

Follow-up Success %                               92%      90%       99.5%      90.5%      92.3%      95.2%       92%       91.1%       93%

Tumor Board Case Presentations                    396       318        99         531        148        310        237        235        53

  ■ General Tumor Board                           174       97         94         129        148        85         90         155        53

  ■ Breast Tumor Board                            222       52          0         165         0         174        15         80            0

  ■ Other Special Tumor Boards                      0       169         5         237         0         51         132         0            0

Total Data Requests                                36       72         26         13         23          7         21         15            6

    *Pending Cancer Program accreditation by the ACOS




                                                                       2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |    25
Statistical Overview




Sutter Health
2005 Cancer Registry Data
Eric Gold, Oncology Analyst/Programmer
See page two for abbreviations for Sutter Health institutions.




This overview presents an analysis of 8,190 new cases of cancer diagnosed and/or treated at the nine American
College of Surgeons accredited Sutter Health institutions during 2005. This represents a small (3%) decrease in
system-wide volume over last year’s totals..2


PATIENT vOLUME BY CLASS OF CASE                                                        AGE AT DIAGNOSIS
(Figure 1)                                                                             Overall – Generally similar patterns were seen at all
Figure 1 shows the variability in the total number of                                  institutions, with the number of cancer patients peak-
cancer cases reported in 2005 at each of the nine Sutter                               ing in the 60-79 age range. Two-thirds of cancer patients
Health hospitals. Year 2005 overall case volume ranged                                 were diagnosed in the 50-79 age range and 84% were
from 324 at EMC to 1,895 at ABSMC for a total of 9,516                                 age 50 or over at the time of diagnosis. The median
cases system-wide. Eighty-six percent of these cases                                   age at diagnosis was 65 years overall and ranged from
(8,190) were newly diagnosed and/or received the first                                 63 (CPMC) to 70 (MPHS). CPMC and SMCS had the
course of treatment at one of the nine Sutter centers.                                 youngest cancer patient populations and MPHS and
These are designated as “analytic” cases and all further                               EMC had the oldest. These trends reflect differences in
analyses are restricted to these data.                                                 both the underlying demographics of the communities
                                                                                       served and the relative incidence of the most prevalent
                                                                                       cancers seen at each institution. The male cancer patient
                                                                                       population is slightly older than the female cancer pa-
                                                                                       tient population (median age 67 vs. 64). These data are
Figure 1
2005 Sutter Health Analytic Cancer Cases                                               consistent with those seen over the last ten years in the
PatIent volUMe by ClaSS of CaSe
                                                                                       Sutter Health cancer patient population.




1
 In order to be consistent with previous Sutter Health Cancer Programs Annual Reports, which included only malignant neoplasms, this analysis does not include
benign neoplasms of the brain and central nervous system, which are reportable in the state of California beginning with cases diagnosed 01/01/2001 and later.
However, these cases have been included in the primary site tables for each facility at the end of this report.
2
 The 8,190 analytic cases examined include 287 cases from Sutter Solano Medical Center, which did not appear in last year’s report. The 3% drop in analytic cases does
not include these cases. It is also important to note that hospital cancer registry data reflect patients diagnosed and treated in the hospital, unlike population-based
cancer registry data such as those reported by the California Cancer Registry and at the SEER registry of the National Cancer Institute, which represent all patients
diagnosed in a defined population




26   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Statistical Overview




Overview
2005 Cancer Registry Data


AGE DISTRIBUTION BY GENDER (Figure 2)
Males – The nine hospitals show modest differences. The greatest number of cases fell into either the 60-69 age
group (ABSMC, CPMC, MGH, SMCS, SSMC) or into the 70-79 age group (EMC, MMC, MPHS, SRMC), resulting
in an overall parity for these two age groups (27% and 26% overall, respectively). Overall, 53% of the males were
diagnosed in the 60-79 age range.

Females - Overall females
show a flatter and somewhat
more varied distribution
than males. Age distribution
peaked in the 50-59 range for
females at ABSMC, CPMC,
and SSMC, in the 60-69 range
at MGH, SMCS, and SRMC,
and in the 70-79 range for
women at EMC, MMC, and
MPHS. Overall, only 40% of
the females were diagnosed in
the 60-79 age range, contrasted
with 53% in males. These
gender differences probably
reflect differences in the age
at diagnosis for the two most
dominant gender-specific
cancers: prostate and breast
cancer (see Figure 5). Within
each gender, prostate and
breast cancer account for 25%
and 41%, respectively, of all
newly-diagnosed cases. The
median age at diagnosis for
prostate cancer was 67 vs. 58
for female breast cancer.




Figure 2
2005 Sutter Health Analytic Cancer Cases
age dIStrIbUtIon by gender




                                                        2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   27
Statistical Overview




Sutter Health
2005 Cancer Registry Data


GENDER RATIO (Figure 3)
As seen in past years in the Sutter Health system, the              to prostate cancer, while SSMC, MGH, and SRMC have
female cancer patient population is significantly larger            the lowest incidence of breast, uterine, and ovarian
than the male population. Females account for 55% and               cancers relative to prostate cancer.
males account for 45% of the newly diagnosed cancers
seen in 2005. This trend was observed at all institutions           It is important to note that the female-to-male ratio
except SRMC. The largest disparity in gender ratio was              in population-based registries such as the California
at EMC, SMCS, and ABSMC while gender proportions                    Cancer Registry is 1:1, whereas our Sutter hospital-
were most equal at MGH, SRMC and SSMC. These                        based registries record a preponderance of female
differences are mostly a reflection of the relative                 patients. These differences are due to hospital referral
incidence of male-specific cancers (mostly prostate)                patterns and the inherent nature of these two different
and female-specific cancers (mostly breast, uterus, and             types of cancer registries.
ovary). For example, SMCS and EMC have the highest
incidence of breast, uterine, and ovarian cancers relative




Figure 3
2005 Sutter Health Analytic Cancer Cases
gender ratIo




28   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Statistical Overview




Overview
2005 Cancer Registry Data


RACE/ETHNICITY (Figure 4)
The distribution of patients by race/ethnic group              population with the largest Asian component (22%).
reflects the diversity seen in the communities served by       CPMC and ABSMC together account for over 60%
each institution. The SSMC and ABSMC cancer patient            of the Asian Sutter Health population. A relatively
populations are the most ethnically diverse with the           large Hispanic component is seen at MMC (14%). The
fewest Caucasians (55% and 56%, respectively) and              cancer patient populations at SRMC and MGH are
large African-American (18% and 23%, respectively)             the least ethnically diverse (96% and 90% Caucasian,
and Asian3 (19% and 14%, respectively) components.             respectively).
ABSMC alone accounts for almost 60% of the entire
Sutter Health African-American cancer patient
population. CPMC also has a relatively diverse patient




Figure 4
2005 Sutter Health Analytic Cancer Cases
raCe/ethnICIty




3
    Asian includes Asian and Pacific Islander.




                                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   29
Statistical Overview




Sutter Health
2005 Cancer Registry Data




Figure 5
2005 Sutter Health Analytic Cancer Cases
toP 10 PrIMary CanCer SIteS (overall) by InStItUtIon by gender



TOP 10 PRIMARY CANCER SITES (Figure 5)
The distribution of the most prevalent cancers seen in the Sutter Health system has changed very little over the
past ten years. The top five cancers sites account for over 60% and the top ten cancer sites encompass 75% of the
newly-diagnosed cancers seen in the Sutter Health system. Female breast cancer accounts for over one-fifth of all
new cancers seen in the Sutter Health System. Lung (13%), prostate (11%), colorectal (10%), and non-Hodgkin’s
lymphoma (4%) account for 38% of cancers newly diagnosed in 2005.
Some additional trends observed were:
• Breast Cancer: Highest relative incidence seen at MGH (26%), and the lowest at SSMC (19%)
• Lung Cancer: Highest relative incidence at EMC (19%), and the lowest at CPMC (8%)
• Prostate Cancer: There are many possible factors that affect the relative incidence of prostate cancer at community
  hospitals. The relatively high incidence seen at MGH (19%) may be due to the fact that it has a relatively older
  underlying patient population and also socioeconomic factors leading to higher PSA screening penetrance and
  thus higher detection/overdetection of Marin County men with prostate cancer. SMCS had the lowest incidence
  (5%) and in this case it is likely result of community referral patterns. Many of the prostate cancer cases are
  diagnosed in physician offices and referred for treatment at a large independent radiation oncology practice in the
  community. Appropriately, the SMCS cancer registry does not record these patients and the result is an under-
  representation of prostate cancer in their database.
• Colorectal Cancer: Highest relative incidence at SSMC (13%), and the lowest at SMCS (7%)
• Non-Hodgkin’s Lymphoma: Highest relative incidence at CPMC (6%) and the lowest at MGH (2%)
• Bladder Cancer: Lowest relative incidence at CPMC (2%)
• Pancreatic Cancer: Highest relative incidence at CPMC (6%) and the lowest at EMC (1%)
• Uterine Cancer: Highest relative incidence at EMC (6%) and lowest relative incidence at SRMC (1%)
• Renal Cancer: Highest relative incidence at MMC (4%)
• Melanoma of the Skin: Lowest relative incidence at SSMC (<1%)


30   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Statistical Overview




Overview
2005 Cancer Registry Data
RELATIvE INCIDENCE OF MAJOR INvASIvE CANCERS —
COMPARISON WITH STATE AND NATIONAL ESTIMATES4 (See Figure 6, next page)

    overall Sutter HealtH ComPared witH California and tHe united StateS:
                                 Oral, Lung, Colon & Rectum, Urinary, Leukemia/Lymphomas, Uterus and Ovary
                           — Sutter Health was generally similar to statewide and national estimates.

    Female Breast                                     — Higher than seen in California and the U.S. (36% vs. 32%)

    Prostate                               — Lower than seen in California and the U.S. (26% vs. 29% & 33%)
    Pancreas                                      — Slightly higher than seen in California and the U.S. (4% vs. 2%)

    individual Sutter HealtH inStitutionS ComPared witH California and tHe united StateS:
    Oral               — No significant deviations for males or females from patterns seen with California and the U.S.

    Lung        — Relatively high rates in MMC (21%), EMC, SMCS, and SRMC (all 19%) males compared with California
                                                  (14%) and the U.S. (13%)
                      — Relatively low rate in CPMC males compared with California and the U.S. (9% vs. 14% & 13%)
                      — Relatively high rates in EMC females compared with California and the U.S. (20% vs. 12%)
                      — Relatively low rates in CPMC and MGH females compared with California and the U.S. (8% &
                          10% vs. 12%).

    Pancreas                  — Relatively high rate in CPMC males compared with California and the U.S. (6% vs. 2%)
                           — Relatively high rate in CPMC females compared with California and the U.S. (6% vs. 2%)

    Colorectal             — Relatively high rate in EMC males compared with California and the U.S. (18% vs. 11% & 10%)
                           — Relatively high rate in SSMC females compared with California and the U.S. (14% vs. 11%)
                           — Relatively low rate in SMCS females compared with California and the U.S. (5% vs. 11%)

    Urinary           — Relatively high rate in MGH males compared with California and the U.S. (15% vs. 9% & 10%)
                      — Relatively high rate in MPHS females compared with California and the U.S. (7% vs. 4% & 5%)
                      — Relatively low rate in ABSMC females compared with California and the U.S. (2% vs. 4% & 5%)

                                                                     Leukemia/Lymphomas
                           — Relatively high rates in CPMC and SMCS males compared with California and the U.S. (11% vs.
                             8% & 7%).
                           — Relatively low rate in EMC males compared with California and the U.S. (1% vs. 8% & 7%)

    Uterus                  — Relatively low rate at SRMC compared with California and the U.S. (2% vs. 5% & 6%)

    Ovary                   — Relatively low rate at EMC compared with California and the U.S. (1% vs. 4% & 3%)
                            — Relatively high rate at SSMC compared with California and the U.S. (7% vs. 4% & 3%)

    Female Breast             — MGH had a relatively high rate compared with California and the U.S. Ranged from 46% at
                                  MGH down to 30% at EMC (vs. 32% for California and the U.S.)

    Prostate — The most variable of any of the major sites examined. Ranged from 40% at MGH down to 14% at SMCS
                                                      (vs. 29% & 33% for California and the U.S.)
4
    Both state and national estimates are derived from NCI SEER data published by the American Cancer Society.


                                                                                 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   31
Statistical Overview




Sutter Health
2005 Cancer Registry Data




Figure 6
2005 Sutter Health Analytic Cancer Cases
relatIve InCIdenCe of Major InvaSIve CanCerS — CoMParISon wIth State and natIonal eStIMateS




32   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Statistical Overview




Overview
2005 Cancer Registry Data




Figure 7
2005 Sutter Health Analytic Cancer Cases
geograPhIC dIStrIbUtIon by CalIfornIa CoUnty




GEOGRAPHIC DISTRIBUTION (FIGURES 7-17)
Figure 7 displays the distribution of cases by California county. In 2005 one in five cases were diagnosed in Alameda
County. 8,064 (98.5%) of the cases were diagnosed in California, 119 (1.5%) were diagnosed in the United States,
outside California, and seven (0.1%) were diagnosed outside of the United States. The geographic distribution of
cases by California county can be summarized as follows:

ABSMC – 74% Alameda County, 19% Contra Costa County
CPMC – 60% San Francisco County, 8% San Mateo County, 6% Marin County
EMC – 95% Alameda County
MGH – 84% Marin County, 7% Sonoma County
MMC – 85% Stanislaus County
MPHS – 93% San Mateo County
SMCS – 70% Sacramento County, 8% Placer County, 7% Yolo County
SRMC – 62% Placer County, 26% Sacramento County
SSMC – 86% Solano County


5
 Cases were mapped using a process known as “geocoding”, whereby U.S. Postal Service data are used to assign nine digit zip codes for each case and these are
then matched to a precise latitude/longitude using U.S. Census Bureau TIGER/ZIP data files for California. The cases are then mapped graphically based on their
geographic coordinates using Geographic Information System (GIS) software.




                                                                               2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                       33
Statistical Overview
Figures 8-17 display 8,033 (98%) of the 8,190 analytic cases examined in this analysis, mapped by nine digit zip code.




geographic
Mapping
                                                              Figure 8
                              geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                                               2005 Sutter Health Analytic Cancer Cases




                                    Sutter	Health	System	Cancer	Centers	
                                         8033	Cases	Mapped	(98%)



34   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Sutter Health 2005 Cancer Registry Data




geographic
Mapping
                                         Figure 9
             geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                          2005 Sutter Health Analytic Cancer Cases




             Alta	Bates	Summit	Medical	Center	(ABSMC)	
                      1695	Cases	Mapped	(98%)



                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   35
Statistical Overview




geographic
Mapping
                                                              Figure 10
                              geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                                               2005 Sutter Health Analytic Cancer Cases




                                 California	Pacific	Medical	Center	(CPMC)	
                                        1612	Cases	Mapped	(96%)



36   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Sutter Health 2005 Cancer Registry Data




geographic
Mapping
                                         Figure 11
             geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                          2005 Sutter Health Analytic Cancer Cases




                       Eden	Medical	Center	(EMC)	
                       1612	Cases	Mapped	(96%)



                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   37
Statistical Overview




geographic
Mapping
                                                              Figure 12
                              geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                                               2005 Sutter Health Analytic Cancer Cases




                                         Marin	General	Hospital	(MGH)	
                                          600	Cases	Mapped	(98%)



38   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Sutter Health 2005 Cancer Registry Data




geographic
Mapping
                                         Figure 13
             geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                          2005 Sutter Health Analytic Cancer Cases




                    Memorial	Medical	Center	(MMC)	
                      806	Cases	Mapped	(99%)



                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   39
Statistical Overview




geographic
Mapping
                                                              Figure 14
                              geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                                               2005 Sutter Health Analytic Cancer Cases




                                 Mills-Peninsula	Health	Services	(MPHS)	
                                        817	Cases	Mapped	(99%)



40   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Sutter Health 2005 Cancer Registry Data




geographic
Mapping
                                         Figure 15
             geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                          2005 Sutter Health Analytic Cancer Cases




              Sutter	Medical	Center,	Sacramento	(SMCS)	
                      1321	Cases	Mapped	(99%)



                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   41
Statistical Overview




geographic
Mapping
                                                              Figure 16
                              geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                                               2005 Sutter Health Analytic Cancer Cases




                                  Sutter	Roseville	Medical	Center	(SRMC)
                                         610	Cases	Mapped	(98%)


42   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
Sutter Health 2005 Cancer Registry Data




geographic
Mapping
                                         Figure 17
             geograPhIC MaPPIng of reSIdenCe at tIMe of dIagnoSIS
                          2005 Sutter Health Analytic Cancer Cases




                 Sutter	Solano	Medical	Center	(SSMC)
                       283	Cases	Mapped	(99%)


                                           2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |   43
primary site tables
Alta Bates Summit Medical Center – Alta Bates




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



44   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
primary site tables
California Pacific Medical Center




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



                                                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                                   45
primary site tables
Eden Medical Center




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



46   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
primary site tables
Marin General Hospital




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



                                                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                                   47
primary site tables
Memorial Medical Center




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



48   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
primary site tables
Mills-Peninsula Health Services




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



                                                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                                   49
primary site tables
Sutter Medical Center, Sacramento




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



50   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
primary site tables
Sutter Roseville Medical Center




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



                                                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                                   51
primary site tables
Sutter Solano Medical Center




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



52   | 2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review
primary site tables
Sutter Health network




Legend: N/R = not recorded Includes analytic cases that could not be staged because no AJCC staging exists for the particular primary site or histologic type. This includes most hematopoetic
cancers (leukemia, myeloma, etc.), endocrine cancers, cancers of the brain and nervous system, sarcomas, cancers of the peritoneum, thymoma, and cancers where the primary site is ill-de-
fined or unknown. Abbreviations: A = analytic; N/A = non-analytic; M = male; F = female.



                                                                                            2006 AnnuAl CAnCer Center report — 2005 StAtiStiCAl review |                                   53

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:31
posted:8/15/2011
language:English
pages:53