Cancer Center Annual Report by xiangpeng

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									                                                            2010
                                                            Annual
                                                            Report




Moses Cone Health System is accredited
by Community Hospital Comprehensive
Cancer Program with commendation.
                                         2010 Annual Report with statistical data from 2009
Ta b l e o f C o n t e n t s




                     4         Cancer Committee Report


                     5         2010 Cancer Committee Members


                     6         2010 Cancer Registry - using
                               2009 statistical data


                    13         2010 Cancer Committee Study


                    21         Breast Cancer Program


                    23         TomoTherapy


                    24         Clinical Research


                    25         Patient and Family Support Services


                    26         Oncology Community Outreach


                    28         2010 Community Cancer Screenings


                    31         Upcoming Community Screenings
                               and Other Events




                                                                     2
3
                                  Cancer Committee Report


We’re happy to bring you this report on behalf of the Moses Cone Regional Cancer Center. This has been an exciting
time for the Regional Cancer Center as we continue to develop our existing programs and create new ones that will better
serve the Piedmont Triad’s cancer care needs. In 2009, the year for which we have the most recent data, our team of 17
oncologists and six radiation oncologists, working from six locations, evaluated and treated more than 3,000 cancer
patients. Of these, 20 percent were breast cancer cases, 16 percent were lung cancer and 8 percent were colorectal cancer.

Regional Cancer Center has multidisciplinary programs in place to provide optimal coordinated care for our patients. The
Breast Cancer Multidisciplinary Program is one example. This program involves a weekly meeting where surgeons, diagnostic
radiologists, radiation and medical oncologists, and other staff members review every new breast cancer case and make
preliminary treatment plans. These plans are then discussed with the individual patients during a weekly Breast Cancer Clinic.

In addition, the Breast Cancer Working Group meets monthly to review emerging data on breast cancer evaluation and
to set guidelines for treatment in our region. Multidisciplinary conferences are also in place for thoracic, gastrointestinal,
genitourinary and malignancy cases. Similar programs are being developed for hematologic malignancies and brain tumors.

We’re also proud that our Radiation Oncology department has fully implemented the TomoTherapy program started in 2009.
TomoTherapy targets tumors deep within the body while minimizing damage to healthy tissue. This sophisticated technology,
which is particularly useful in lung, head-and-neck and prostate cancers, is not yet available elsewhere in North Carolina.

We continue our community outreach activities with free screening programs for skin, prostate and cervical cancers.
All abnormal results lead to referrals for additional care. We also have added a full-time nutritionist to provide an integrated
and complementary component to our services.

Overall clinical research programs enrolled a total of 328 patients in 2010. We continue to add protocols to provide new
and emerging treatments for our patients, including one - a study using an oral form of taxane therapy - not available elsewhere
in North Carolina.

As we look toward the future, we’re excited about the community’s response that helped us raise $5 million to build a new
wing of the Regional Cancer Center. Scheduled to open at the end of 2011, this 35,000-square-foot, $15 million addition
will be divided between the Alight Breast Cancer Center on the first floor and the Doris S. Tanger Center for Patient and
Family Support on the second floor. The new space will allow us to better integrate services—including genetics, financial
and nutritional counseling—as well as the development of a High Risk Clinic for relatives of our cancer patients who may
be concerned about their family medical history.

This new wing also will contain an auditorium so we can host educational programs for the community and our ongoing
Gynecological Oncology Clinic, which focuses on ovarian, endometrial and cervical cancers. This program was developed
in conjunction with Daniel Clarke-Pearson, MD, chair of the Department of Obstetrics and Gynecology (Division of
Gynecologic Oncology) and Robert A. Ross Distinguished Professor at the University of North Carolina at Chapel Hill
School of Medicine.

We appreciate your support of the Regional Cancer Center as we strive to provide exceptional care for our patients.




        Gustav Magrinat, MD,                        Mohomed K. Mohamed, MD,                     Matthew Manning, MD,
          Medical Director                              Medical Director                    RADONC Physician Practice Manager




                               Robert Murray, MD,                            Gary B. Sherrill, MD,
                                Medical Director                           Medical Oncology Director

                                                                                                                                   4
                           2010 Cancer Committee Members



    cancer committee officers
    Chairman                                                                                 Dr. John Feldmann
    Liaison Physicians                                                      Dr. Matthew Martin, Dr. Faera Byerly
    Secretary                                                                   Adaline Brown, RHIT, CCS, CTR



    required physician membership categories
    (one in each of these categories)
    Diagnostic Radiology                                                  Dr. Gretchen Green, Dr. Mark Gallerani
    Pathology                                                                                       Dr. Joshua Kish
    General Surgeon                                                    Dr. Edward Gerhardt, Dr. Matthew Martin,
                                                                        Dr. Houston Kimbrough, Dr. Lester Borden
    Surgical Oncologist                                                                            Dr. Faera Byerly
    Radiation Oncology                                                   Dr. Matthew Manning, Dr. James Moody
    Medical Oncology                                               Dr. John Feldmann, Dr. Mohamed Mohamed,
                                                                              Dr. Eric Neijstrom, Dr. Firas Shadad

    other physician members
    Family Practice                                                                               Dr. James Breen
    Internal Medicine                                                                         Dr. Charles Rogers
    Palliation, Pain Control                                                                  Dr. Nimish Gosrani

    required non-physician members
    Cancer Program Coordinator                            Jim Whiting, MHA, Vice President, Oncology Services
    Oncology Nurse                                                      Youland Williams, RN, MSN, NEA-BC
                                                                                                   Helen Lee, RN
    Social Worker or Case Manager                                         Joanna Saporito, BSW, MSW, LCSW
    Certified Tumor Registrar                     Adaline Brown, RHIT, CCS, CTR (Cancer Registry Coordinator)
    Quality Management                                                                         Julie Barker, SSBB
    Research                                                                          Vivian Sheidler, RN, MSN
    American Cancer Society                                                                   Amanda Wyckoff
    Pharmacist                                                          Lew Iacovelli, BS, PharmD, BCOP, CPP
    Radiation Oncology                              Anita Williamson, AARRT/2 (Director - Radiation Oncology)
    Breast Multidisciplinary Clinic Coordinator                         Tami Knutson, RN, BSN, OCN, CBCN
    Dietitian                                                                 Elizabeth McKee, MPH, RD, LDN



    required commission on cancer coordinators
    Cancer Conference Coordinator                                                               Dr. John Feldmann
    Quality of Registry Data Coordinator                                                            Dr. Joshua Kish
    Outcomes Coordinator                                                              Christine Brannock, RN, BS
    Quality Improvement Coordinator                                                         Dr. Matthew Manning




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                                                             Submitted By
                                                    Adaline Brown, RHIT, CCS, CTR

                                  Our Cancer Registry was established Jan. 1, 1990, to collect, manage
                                  and analyze statistical data on all cancer patients diagnosed and/or
                                  treated within Moses Cone Health System. Several programs merged
                                  into the registry since its original establishment. Wesley Long Community
                                  Hospital and The Women’s Hospital of Greensboro merged in 1998,
                                  followed by Annie Penn Hospital in 2001 and the oncology satellite
                                  offices at Stoney Creek and High Point within the past three years. In
                                  2008, the reference year for the cancer registry was changed to 2001.
                                  The registry is responsible for helping ensure compliance with all standards
                                  set forth by the American College of Surgeons for accreditation.

                                  The registry’s program is patterned to meet the requirements of the
                                  American College of Surgeons’ (ACoS) Commission on Cancer (CoC)
                                  and is designed to describe characteristics, modalities of therapy and
                                  patient survival experiences. One of the principal objectives of the registry
                                  is to collect and abstract basic cancer information related to our cancer
                                  population so that data can help determine the effectiveness of cancer
                                  treatments. This information can be used to improve patient outcomes.
                                  Physicians, hospital administrators and researchers use the data to track
                                  cancer incidence among their patient population, which then drives the
Mohamed Mohamed, MD               staffing and equipment needs of the Regional Cancer Center as it seeks
                                  to provide the highest quality diagnostic and treatment techniques.

                                  A total of 3,308 cases were accessioned into the database in 2009.
                                  Of these, 2,825 were analytic cases. Analytic cases include all
                                  reportable cases first diagnosed and/or receiving all or part of their initial
                                  treatment within Moses Cone Health System. Of these, 483 were non-
                                  analytic cases. Non-analytic cases include patients who received at least
                                  one complete course of therapy elsewhere and are being seen within
                                  Moses Cone Health System for the first time for subsequent treatment for
                                  progression, metastatic disease or recurrent disease. In 2009, we saw
                                  a sharp increase in the number of non-analytic patients seen within the
                                  system compared to 205 in 2008. In July 2010, the Commission on
                                  Cancer changed the classification for all cases within the database.
                                  As a result, some cases that were only reportable to the state and not to
                                  the Commission on Cancer and previously coded as analytic cases
                                  have now become non-analytic cases.




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    The registry maintains lifetime follow-up on all analytic patients entered into the database. This includes any additional
    treatments received, current cancer status and last date of contact with the patient. It also serves as a reminder to physicians
    and patients to schedule physical examinations to ensure continued medical surveillance in hopes of improving early
    detection of recurrent or metastatic disease. Since Jan. 1, 2001, a total of 34,130 analytic patients were accessioned in
    the database. Of these, 8,579 have expired, while 21,551 are living and their cases are being followed. The American
    College of Surgeons requires at least an 80 percent follow-up rate on all patients accessioned in the database since it was
    established. Our current follow-up rate since inception is 89.7 percent. The ACoS requires at least a 90 percent follow-up
    rate on all patients accessioned in the database for the past five years. Our current follow-up rate is 92.35 percent for the
    past five years. Some of the main sources for gathering follow-up information are medical records, physicians, hospitals
    and the Social Security index.

    To keep registrars informed of current treatments and issues related to cancer, the staff attends various meetings throughout the
    year. In 2010, the registry staff attended the NCRA National Meeting in Palm Springs, Calif., and the state meeting
    in Hickory. In addition to these conferences, registrars are required to attend various software seminars and others related
    to cancer treatments.

    The Cancer Registry submits data to the NC Central Cancer database for all reportable cases (new and recurrent cases) on
    a quarterly basis. On a yearly basis, the Cancer Registry submits all new cancer cases to the National Cancer Data Base
    (NCDB). In addition to submitting information to the state and national database, we provide information to physicians,
    clinical researchers, Health System administration, our marketing department, and cancer committee for reports and studies.


                                                 top four sites 2006 - 2009
                           600
                                 563 584         559
                                           538
                           500                                    491
                                                        444 443         446               456
                                                                                    408
     Number of New Cases




                           400                                                                  390
                                                                              367
                                                                                                                306
                           300                                                                            282

                                                                                                                      217 212
                           200


                           100


                            0
                                     Breast                   Lung                  Prostate                    Colorectal


                                     2006              2007          2008         2009

    The graph above shows the top four sites for 2006-2009. Our top four sites during this time period have been Breast,
    Lung, Prostate and Colorectal, respectively. Colorectal cases had a sharp decline in 2008 but remained steady in 2009.
    Lung cases saw an increase in the number of cases in 2008 but declined in 2009. Breast cases saw a 4 percent increase
    in the number of new cases seen in 2009 compared to 2008.

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                  2009 Occurrence of Cancer seen within
                  Moses Cone Health System (continued on page 9)

                                     Sex            Class                Dominant AJCC Stage Group
 Primary Site            Total
                                 M         F       A       n/a   0        I       II       III       IV    None   n/a
Anus/Anal Canal            11        6         5       9     2       0        2        3         3     0      0     3
Bile Ducts                  5        4         1       5     0       0        3        1         1     0      0     0
Bone                        3        3         0       0     3       0        0        0         0     0      0     3
Breast                    634        3     631     559      75   110     241      172       50        18      5    38
Cervix Uteri               26        0      26         5    21    17          3        0         2     3      0     1
Colon/Rectum              250    141       109     212      38       1    58       46       66        49      1    29
Corpus Uteri-Carcinoma     71        0      71      61      10       1    41           3         4     3      1    18
Esophagus                  21     15           6    17       4       0        0        5         6     9      0     1
Fallopian Tube              2        0         2       2     0       0        0        1         1     0      0     0
Gallbladder                 5        3         2       5     0       0        2        2         0     1      0     0
Hodgkin’s Lymphoma         29     10        19      21       8       0        4    13            3     5      1     3
Hypopharynx                 4        4         0       4     0       0        0        0     4         0      0     0
Kidney                     88     53        35      80       8       0    50           6    10        13      0     9
Larynx-Supraglottis        16     15           1    15       1       0        1        3     1        10      0     1
Larynx-Glottis             19     16           3    16       3       1        6        7     1         3      0     1
Lip/Oral Cavity            12        9         3       9     3       0        0        0     2         5      0     5
Liver                      33     24           9    25       8       0        3        3    13         7      2     5
Lung                      488    285       203     446      42       0   119       25      135       186      3    20
Lymphoma, NH              112     64        48      94      18       0    34       15       26        22      3    12
Major Salivary Glands       7        3         4       7     0       0        1        1     1         4      0     0
Melanoma                   77     44        33      55      22   11       26           6     6        10      2    16
Mesothelioma                2        1         1       2     0       0        0        0     1         1      0     0
Nasal Cavity/Ethmoids       2        1         1       2     0       0        0        1     1         0      0     0
Nasopharynx                 2        2         0       1     1       0        0        0     1         0      0     1
Oropharynx                 31     26           5    27       4       1        1        0     1        26      0     2
Ovary                      36        0      36      30       6       0        7        3    13         6      2     5
Pancreas                   78     46        32      70       8       0        6    23       10        29      1     9
Penis                       3        3         0       3     0       0        1        1     0         1      0     0
Prostate                  456    456           0   390      66       0        0   363       23        31      6    33
Renal Pelvis/Ureter        13        9         4    11       2       4        0        0         7     0      0     2
Skin Carcinoma             11        6         5       0    11       1        3        4         1     1      0     1




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                             2009 Occurrence of Cancer seen within
                             Moses Cone Health System (continued from page 8)

                                                  Sex             Class                 Dominant AJCC Stage Group
      Primary Site                  Total
                                              M         F        A       n/a    0        I       II       III       IV    None   n/a
     Small Intestine                    7         5         2        6     1        0        0        1         3     2      0     1
     Soft Tissue Sarcoma                8         3         5        6     2        0        3        0         1     2      0     2
     Stomach                           25      19           6     22       3        0        5        1         6     8      0     5
     Testis                            14      14           0     14       0        0    12           1         0     0      1     0
     Thyroid                           73      17        56       70       3        0    40       12            9     5      2     5
     Urinary Bladder                 127       97        30      117      10    68       23       13            8     8      4     3
     Vagina                             4         0         4        3     1        3        0        0         0     1      0     0
     Vulva                             34         0      34       14      20    26           3        3         1     1      0     0
     Brain/CNS                       113       40        73       97      16        0        0        0         0     0    113     0
     Eye                                2         1         1        1     0        0        0        0         0     0      2     0
     Granulocytic                      26      12        14       23       3        0        0        0         0     0     26     0
     Large Intestine                    6         0         6        5     1        0        0        0         0     0      6     0
     Lymphocytic                       36      18        18       20      16        0        0        0         0     0     36     0
     Myeloma                           50      29        21       47       3        0        0        0         0     0     50     0
     Other Digestive                    9         4         5        8     1        0        0        0     0         0      9     0
     Other Female                       1         0         1        1     0        0        0        0     0         0      1     0
     All other sites                 226       92       134      188      39        0        0        0     0         0    226     0
     Totals                         3,308   1,603     1,705     2,825    483   244      698      738      421       470   503    234


    The occurrence of cancer in Guilford County and the surrounding counties for 2009 by gender and stage of disease is
    displayed in the chart above. The 2009 Site Table includes all new patients seen in 2009 and recurrent cancers seen
    for the first time within Moses Cone Health System. Of the total number of new cases seen in 2009, 1,441 (51.1%) of
    the cases were female and 1,384 (48.9%) were male.




9   Lauretta I. Odogwu, MD
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                                        C o u n t y at D i a g n o s i s
                                   35              20        12                             12
                                                             10        2       7
                                         2
                                                             6
                                                                   1          5        24
                                  34                                                         12
                        18                          31
                                              14
                                                             9                                    11
                                                                   3               8                        19
                  16                                                                                              22
                                                                                       28
                   29             2                          13   26
                                         30                                                                            32
                                              27
                                                                                             15

                                                                                                                             33

                                                                                       21
                                                                                                            23

                                                                                                             25

                                                                                                       17




County at Diagnosis                                                        County at Diagnosis (continued)
1-Guilford                                         1,868                   19-Wilson                                         1
2-Rockingham                                        431                    20-Surry                                          1
3-Randolph                                          210                    21-Robeson                                        1
4-Outside of the state                                  85                 22-Pitt                                           1
5-Alamance                                              81                 23-Pender                                         1
6-Forsyth                                               50                 24-Orange                                         1
7-Caswell                                               25                 25-New Hanover                                    1
8-Chatham                                               21                 26-Montgomery                                     1
9-Davidson                                              12                 27-Mecklenburg                                    1
10-Stokes                                                7                 28-Lee                                            1
11-Wake                                                  4                 29-Henderson                                      1
12-Durham                                                3                 30-Gaston                                         1
13-Stanly                                                2                 31-Davie                                          1
14-Iredell                                               2                 32-Craven                                         1
15-Cumberland                                            2                 33-Carteret                                       1
16-Buncombe                                              2                 34-Caldwell                                       1
17-Brunswick                                             2                 35-Ashe                                           1
18-Yancey                                                1                 Grand Total                                      2,825


This chart outlines the surrounding counties within the Moses Cone Health System treatment area. Our top five counties are
Guilford (66.1%), Rockingham (15.3%), Randolph (7.4%) and Alamance (2.9%) with the patients coming out of state on the
Virginia/North Carolina border (1.7%) rounding off the top five counties.




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                                            2 0 0 9 A n a ly t i c C a s e s A g e at D i a g n o s i s

                                                                                      Male           Female

                                    500
                                                                                                        434
               Number of Patients




                                    400                                                                       367   356
                                                                                                                          306
                                    300                                                    284 286

                                                                                                                                      203
                                    200                                             178
                                                                                                                                155
                                                                               93
                                    100                                 54
                                            3    3      14   15   28                                                                          17   29
                                     0
                                            0-19      20-29       30-39        40-49        50-59       60-69        70-79      80-89         90-99

                                                                                    Age at Diagnosis

       On the age at diagnosis graph above, we see the prevalence of cancer increase sharply at age 40 for women and 50
       for men. It continues to increase until about age 79, at which time it starts to drop off slightly. At age 80, there is a drop in
       the number of cases seen and, at age 90, it drops significantly which is the norm with state and national trends.



                                          Total Number of Cases Treated in Last Five Years

                                                                        Analytic                  Non-Analytic
                              3,600
                                                                                          3,145
                                                                                                               2,980
                               3,000                              2,826                                                               2,825
     Number of Cases




                                             2,529
                               2,400

                                1,800

                                1,200

                                    600                                      350                  471                                          483
                                                     215                                                                  205
                                     0
                                                2005                   2006                  2007                   2008                    2009

                               Total:           2,744                  3,176                3,616                   3,185               3,308


          The total number of cancer cases seen yearly within Moses Cone Health System has continued to increase. The total number
          of cases seen have increased about 20 percent overall from 2005 (2,744) to 2009 (3,308). In 2009 we saw a decrease
          in the number of analytic cases because Randolph Hospital opened its own radiation department and Alliance Urology
          implemented a pathology system within their facility.




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                                                Class of Case




                                                                                     Diagnosed elsewhere and
                                                                                     came here for treatment
                                                                                     9.4%


                                                                                         Diagnosed here and went
                                                                                         elsewhere for treatment
 Diagnosed here and stayed                                                               5.1%
         here for treatment
                               85.5%




 Class of Case                                                                          Total Cases       % of Total Cases
 Diagnosed here and stayed here for treatment: Class 1                                      2,415               85.5%
 Diagnosed elsewhere and came here for treatment: Class 2                                     266                 9.4%
 Diagnosed here and went elsewhere for treatment: Class 0                                     144                 5.1%
 Grand Total                                                                                2,825              100.0%


Information on this page outlines our analytic case load. We had a total of 2,825 analytic cases diagnosed in 2009 and
out of those 2,415 (85.5%) were Class 1 (patients initially diagnosed within Moses Cone Health System who received all
or part of their first course of treatment within the System). Of the 2,825 cases, 266 (9.4%) patients were Class 2 (patients
initially diagnosed elsewhere and came to the Health System for part of their first course of treatment). Of the 2,825 analytic
cases, only 144 (5.1%) patients were Class 0 (biopsies and/or clinical diagnosis only and went elsewhere for all of their
first course of treatment). We saw a decrease in the number of Class 2 cases after Randolph Hospital opened its new
cancer center in October 2008 and added radiation oncology services.




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                                                           Submitted By
                                                     Matthew A. Manning, MD


     At the Moses Cone Regional Cancer Center, experienced healthcare providers continuously implement state-of-the-art
     treatment strategies. Through these efforts, significant strides in treatment results are achieved. There are a variety of factors
     which have led to improved outcomes. Two important priorities have been screening efforts and multidisciplinary care. Early
     detection of cancer through active screening leads to discovery of smaller tumors which can produce improved treatment
     results and lead to treatments with less toxicity. Multidisciplinary care is an equally important development. Cancer treatment
     is increasingly moving toward multidisciplinary collaborative strategies, including combinations of surgery, chemotherapy and
     radiation therapy. By combining the benefits of each modality, the intensity of individual treatments can potentially be reduced
     to decrease toxicity. The treatment of rectal cancer is a paradigm for this multidisciplinary model.


                                                                   There were an estimated 39,670 new rectal cancers diagnosed in
                                                                   the United States in 2010 (NCI Data). Since early detection leads to
                                                                   better outcomes, there are recommended screening studies.

                                                                   Beginning at age 50, the American Cancer Society recommends
                                                                   that men and women undergo:
                                                                        •   Flexible sigmoidoscopy every five years, or
                                                                        •   Colonoscopy every 10 years, or
                                                                        •   Double-contrast barium enema every five years, or
                                                                        •   CT colonography (virtual coloscopy) every five years.

                                                                   In addition, they recommend annual:
                                                                        •   Fecal occult blood test (gFOBT) or
                                                                        •   Fecal immunochemical test (FIT) or
                                                                        •   Stool DNA test (sDNA)

                                                                   There are some factors that can increase the risk for rectal cancer
                                                                   including a history of colorectal cancer in family members. Rectal
                                                                   cancer may present symptoms, including gastrointestinal bleeding,
                                                                   abdominal pain and intestinal obstruction. Patients diagnosed with
                                                                   rectal cancer undergo testing to determine the extent or stage of cancer.

                                                                   These studies include:
     Matthew A. Manning, MD
                                                                        •   Digital rectal exam.
                                                                        •   Complete colonoscopy to rule out other cancers
                                                                            elsewhere in the bowel.
                                                                        •   CT scans of the chest, abdomen and pelvis to look for
                                                                            distant sites of cancer spread.
                                                                        •   Endorectal ultrasound (EUS) to determine the depth of tumor
                                                                            invasion and to identify abnormal lymph nodes nearby.
                                                                        •   A blood test called carcinomembryonic antigen (CEA)
                                                                            which can be used to assess treatment response.
                                                                   All of these tests are available at Moses Cone Health System.


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   The rectum is the portion of the colon located within the pelvis measuring between 10 and 15 inches in length. After a rectal
   cancer has been surgically removed, there is a risk of recurrence within the pelvis. Patients with stage II and stage III rectal
   cancer have been proven to benefit from chemotherapy and radiation treatment directed to the pelvis. The location of a rectal
   cancer influences the potential surgical options. If a rectal tumor is located too close to the anal sphincter, surgical removal
   of the cancer may require removal of the anal sphincter, leaving patients with a permanent colostomy. Chemotherapy and
   radiation can be given before or after surgery to reduce the risk of recurrence. Emerging evidence suggests that delivering
   chemotherapy and radiation before surgery is better tolerated. Also, preoperative chemotherapy and radiation can shrink
   the tumor and help the surgeon completely remove the cancer while sparing the anal sphincter. An organized cohesive
   team approach before treatment is needed to develop a plan using chemotherapy and radiation prior to surgery to get the
   best result for the patient. It is in this setting that the benefits of an organized multidisciplinary team -- including surgeons,
   medical oncologists and radiation oncologists -- lead to better treatment results and improved quality of life for patients. The
   chart below, from the National Cancer Data Base (NCDB) for patients who received radiation, illustrates the trend toward
   preoperative or neoadjuvant radiation in North Carolina patients from 2004 to 2008.




                      400                                                          384
                                                                                               358
                                                                             336         332
Number of New Cases




                                                                                                     299
                      300
                                        263 262 269
                                  246
                            230

                      200

                                                                                                                 128
                                                                                                           104         105
                                                      98 91 91                                                               98 98
                      100                                         82 86



                       0
                              Neoadjuvant                 Post Op                 Low Anterior               Abdominoperineal
                               Radiation                 Radiation               Resection (LAR)              Resection (APR)


                                   2004           2005           2006              2007              2008

   Coordinated multidisciplinary care is an important emphasis at the Regional Cancer Center. This commitment is reflected by
   Multidisciplinary Tumor Conferences and Clinics geared toward breast cancer, lung cancer, prostate cancer, head and neck
   cancers, and gastrointestinal cancers, among others. The pathology results, radiological tests and clinical histories of patients
   with rectal cancer are presented for discussion at the gastrointestinal tumor conference. Between 2000 and 2007, a total
   of 477 patients with rectal cancer were diagnosed at Moses Cone Health System. The chart on the next page shows the
   patients diagnosed during this time, organized by age, cancer stage and form of treatment.




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              Age Group by First Course Treatment of Rectal Cancer
                       Diagnosed From 2000 to 2007                                  •   All Diagnosed Cases

                                                 First Course Treatment                                                   Totals
                                                                    Surgery,
     Age Group                     Surgery &     Radiation and     Radiation
                                                                                         Other
                                                                                                       No 1st
                 Surgery Only
                                 Chemotherapy    Chemotherapy        and/or
                                                                                        Specified
                                                                                                      Course Rx     N                %
                                                                                        Therapy
                                                                 Chemotherapy

                                                                 STAGE: 0
      30 - 39      2   (100%)          -               -               -                    -             -           2             3.4%
      40 - 49      7   (87.5%)         -               -               -                    -         1   (12.5%)     8            13.8%
      50 - 59      8   (72.7%)         -           1   (9.1%)          -                    -         2   (18.2%)    11             19%
      60 - 69    11    (73.3%)         -               -               -                1   (6.7%)    3   (20%)      15            25.9%
      70 - 79    12    (92.3%)         -               -               -                    -         1   (7.7%)     13            22.4%
      80 - 89      9   (100%)          -               -               -                    -             -           9            15.5%
      Subtotal   49    (84.5%)         -           1   (1.7%)          -                1   (1.7%)    7   (12.1%)    58            100%
                                                                 STAGE: 1
      20 - 29      1   (100%)          -               -               -                    -             -           1             0.6%
      30 - 39      1   (33.3%)         -               -               -                    -         2   (66.7%)     3             1.9%
      40 - 49      6   (37.5%)     2   (12.5%)     3   (18.8%)     5   (31.3%)              -             -          16            10.3%
      50 - 59    30    (75%)           -           1   (2.5%)      7   (17.5%)          1   (2.5%)    1   (2.5%)     40            25.6%
      60 - 69    24    (63.2%)     1   (2.6%)      1   (2.6%)     11   (28.9%)          1   (2.6%)        -          38            24.4%
      70 - 79    31    (79.5%)         -               -           7   (17.9%)              -         1   (2.6%)     39             25%
      80 - 89    12    (80%)           -               -           1       (6.7%)       2   (13.3%)       -          15             9.6%
       90 +        3   (75%)           -               -               -                    -         1   (25%)       4             2.6%

      Subtotal   108   (69.2%)     3   (1.9%)      5   (3.2%)     31   (19.9%)          4   (2.6%)    5   (3.2%)    156            100%

                                                                 STAGE: 2
      30 - 39          -               -               -           4   (100%)               -             -           4             4.5%

      40 - 49          -               -           1   (11.1%)     7   (77.8%)              -         1   (11.1%)     9            10.1%

      50 - 59          -               -           2   (18.2%)     9   (81.8%)              -             -          11            12.4%

      60 - 69      2   (9.1%)      4   (18.2%)     2   (9.1%)     13   (59.1%)          1   (4.5%)        -          22            24.7%
      70 - 79      5   (17.9%)         -           7   (25%)       8   (28.6%)          3   (10.7%)   5   (17.9%)    28            31.5%
      80 - 89      3   (25%)           -           2   (16.7%)     4   (33.3%)          3   (25%)         -          12             13.5
       90 +        3   (100%)          -               -               -                    -             -           3             3.4%
      Subtotal   13    (14.6%)     4   (4.5%)     14   (15.7%)    45   (50.6%)          7   (7.9%)    6   (6.7%)     89            100%
                                                                 STAGE: 3
      30 - 39          -               -               -           1       (100%)           -             -           1             1.5%
      40 - 49          -               -               -          11       (100%)           -             -          11            16.7%
      50 - 59          -           1   (7.1%)          -          11   (78.6%)              -         2   (14.3%)    14            21.2%
      60 - 69          -           5   (21.7%)     1   (4.3%)     16   (69.6%)          1   (4.3%)        -          23            34.8%
      70 - 79          -           2   (18.2%)     2   (18.2%)     5   (45.5%)          2   (18.2%)       -          11            16.7%
      80 - 89          -               -               -           4   (66.7%)              -         2   (33.3%)     6             9.1%
      Subtotal         -           8   (12.1%)     3   (4.5%)     48   (72.7%)          3   (4.5%)    4   (6.1%)     66            100%

15
                2 0 1 0 L o n g - Te r m R e c t a l C a n c e r S t u dy



Age Group by First Course Treatment of Rectal Cancer (cont.)
                   Diagnosed From 2000 to 2007                                               •    All Diagnosed Cases

                                                       First Course Treatment                                                                    Totals
                                                                                 Surgery,
Age Group                           Surgery &          Radiation and            Radiation
                                                                                                    Other
                                                                                                                       No 1st
              Surgery Only
                                  Chemotherapy         Chemotherapy               and/or
                                                                                                   Specified
                                                                                                                      Course Rx          N                 %
                                                                                                   Therapy
                                                                              Chemotherapy

                                                                              STAGE: 4
 40 - 49            -               2        (25%)        1       (12.5%)       1   (12.5%)         1       (12.5%)    3       (37.5%)       8            12.9%
 50 - 59            -               2        (18.2%)      2       (18.2%)       6   (54.5%)             -              1       (9.1%)     11              17.7%
 60 - 69       2    (15.4%)         6        (46.2%)          -                 2   (15.4%)             -              3       (23.1%)    13                21%
 70 - 79       1    (5.9%)               -                9       (52.9%)       1   (5.9%)          2       (11.8%)    4       (23.5%)    17              27.4%
 80 - 89       4    (30.8%)         2        (15.4%)          -                     -               4       (30.8%)    3       (23.1%)    13                21%
 Subtotal      7    (11.3%)        12        (19.4%)    12        (1.94%)      10   (16.1%)         7       (11.3%)   14       (22.6%)    62               100%
                                                                            STAGE: UNK
 40 - 49       3    (60%)                -                    -                 1   (20%)               -              1       (20%)         5            10.9%

 50 - 59      12    (80%)                -                    -                 1   (6.7%)              -              2       (13.3%)    15              32.6%

 60 - 69       5        (55.6%)          -                1       (11.1%)       2   (22.2%)             -              1       (11.1%)       9            19.6%
 70 - 79       6    (75%)                -                1       (12.5%)           -                   -              1       (12.5%)       8            17.4%
 80 - 89            -                    -                2       (28.6%)       2   (28.6%)             -              3       (42.9%)       7            15.2%
   90 +        1    (50%)                -                    -                     -                   -              1       (50%)         2             4.3%
 Subtotal     27    (58.7%)              -                4       (8.7%)        6   (13%)               -              9       (19.6%)    46               100%
                                                                            STAGE: TOTAL
 20 - 29        1   (100%)               -                    -                     -                   -                  -                 1             0.2%
 30 - 39        3   (30%)                -                    -                 5   (50%)               -              2       (20%)      10               2.1%
 40 - 49      16        (28.1%)      4       (7%)         5       (8.8%)       25   (43.9%)         1       (1.8%)     6       (10.5%)    57              11.9%
 50 - 59      50    (49%)            3       (2.9%)       6       (5.9%)       34       (33.3%)     1        (1%)      8       (7.8%)    102              21.4%
 60 - 69      44        (36.7%)    16        (13.3%)      5       (4.2%)       44       (36.7%)     4       (3.3%)     7       (5.8%)    120              25.2%
 70 - 79      55        (47.4%)      2       (1.7%)      19       (16.4%)      21       (18.1%)     7        (6%)     12       (10.3%)   116              24.3%
 80 - 89      28    (45.2%)          2       (3.2%)       4       (6.5%)       11       (17.7%)     9       (14.5%)    8       (12.9%)    62               13%
   90 +         7       (77.8%)          -                    -                     -                   -              2       (22.2%)     9               1.9%
Grand Total   204   (42.8%)        27        (5.7%)      39       (8.2%)      140   (29.4%)        22       (4.6%)    45       (9.4%)    477              100%




                                                                                                                                                                  16
               2 0 1 0 L o n g - Te r m R e c t a l C a n c e r S t u dy



        Stage of Rectal Cancer Diagnosed from 2000 to 2007
                Stage               My (N)              Oth. (N)            My (%)               Oth. (%)

                   0                      58            14,066               12.16%                  7.56%
                   I                     156            47,146                32.7%               25.34%
                   II                     89            34,573               18.66%               18.58%
                  III                     66            36,688               13.84%               19.72%
                  IV                      62            22,797                   13%              12.25%
                  NA                       -                419                      -               0.23%
                 UNK                      46            30,398                9.64%               16.34%
                TOTAL                    477           186,087                 100%                   100%


         From 2000 to 2007, data from the National Cancer Data Base (NCDB) suggests that our community
         of physicians actively screens and diagnoses rectal cancer in earlier stages than our national
         counterparts. The chart above shows the distribution of rectal cancers according to stage at Moses
         Cone compared against the National Cancer Data Base. A larger percentage of cases with
         Stage 0 or Stage I cancers are diagnosed at Moses Cone Health System. Approximately 12 percent
         more patients are diagnosed at these earlier stages.



     First Course Treatment of Rectal Cancer from 2000 to 2007

           First Course Treatament             My (N)           Oth. (N)          My (%)             Oth. (%)


                 Surgery Only                    204              1,920          42.77%           32.55%

                  Surgery &
                                                   27               296            5.66%              5.02%
                Chemotherapy
                 Radiation &
                                                   39               457            8.18%              7.75%
                Chemotherapy
            Surgery, Radiation &
                                                  140              2,173          29.35%             36.84%
               Chemotherapy
                Other Specified
                                                   22               429            4.61%              7.27%
                   Therapy

               No 1st Course Rx                   45                624           9.43%           10.58%

                        TOTAL                    477              5,899            100%               100%


         Fortunately, Stage 0 and Stage I rectal cancers may even be surgically treated without requiring
         radiation or chemotherapy. Since cancers diagnosed within Moses Cone Health System
         were in an earlier stage, they were more likely to receive surgery alone. The chart above
         demonstrates the variety of treatments used for patients at Moses Cone Health System compared
         against national ounterparts.
17
           2 0 1 0 L o n g - Te r m R e c t a l C a n c e r S t u dy



   Gender of Rectal Cancer Diagnosed from 2000 to 2007

           Gender                My (N)              Oth. (N)              My (%)                Oth. (%)


             Male                  273                3,317                57.23%                 56.23%

           Female                  204                2,582                42.77%                 43.77%

            TOTAL                  477                5,899                  100%                  100%


     The chart above shows rectal cancer is more common in men than women in our data. This is
     comparable to other hospitals in North Carolina.




Race/Ethnicity of Rectal Cancer Diagnosed from 2000 to 2007

        Race/Ethnicity             My (N)              Oth. (N)              My (%)              Oth. (%)


             White                   367               150,572              76.94%               80.91%

              Black                    93               17,385               19.5%                 9.34%

            Hispanic                     3                9,115              0.63%                   4.9%

               API                       2                5,292              0.42%                 2.84%

       Native American                   3                  529              0.63%                 0.28%

       Other/Unknown                     9                3,194              1.89%                 1.72%

             TOTAL                   477               186,087                100%                  100%


     In terms of patient ethnicity, rectal cancers are common in all racial groups. For this reason, it is
     important that screening efforts and public awareness campaigns be directed across a variety of
     socioeconomic and ethnic groups. The chart above demonstrates the diverse ethnicity of
     patients diagnosed with rectal cancer at Moses Cone Health System compared to the National
     Cancer Data Base.




                                                                                                             18
                                2 0 1 0 L o n g - Te r m R e c t a l C a n c e r S t u dy



                                                 Rectal Cancer Survival Rates
                                  Moses Cone Health System - North Carolina - NCBD

                                                      Moses Cone Health System                NC         NCDB

                     100%
                                 93.5
                         90%            86.1
                                               82.7       84.8
                                                                 80.7
                         80%                                            76.1
                                                                                  71.9
                         70%
                                                                                         65.2
                                                                                                62.5
                         60%                                                                                      58.3
                                                                                                           54.9
         Survival Rate




                                                                                                                         53.9
                         50%

                         40%

                         30%

                         20%
                                                                                                                                           11.7
                         10%                                                                                                                        8
                                                                                                                                      0
                           0%
                                     Stage 0                  Stage 1                 Stage 2                   Stage 3                   Stage 4


         Moses Cone
                                         93.5%                    84.8%                      71.9%                 54.9%                       0%
        Health System


                         NC              86.1%                    80.7%                      65.2%                 58.3%                    11.7%

                         NCDB            82.7%                    76.1%                      62.5%                 53.9%                       8%

     * Most current data available               ** USA data reported from 1,398 hospitals             *** State of NC / data reported from 31 hospitals




     The survivals achieved at Moses Cone Health System according to patient stage are comparable to the five- year survivals
     elsewhere in North Carolina and elsewhere around the United States. The chart above shows five- year survivals for
     Moses Cone Health System versus North Carolina and the National Cancer Data Base.




19
                   2 0 1 0 L o n g - Te r m R e c t a l C a n c e r S t u dy


In reviewing these long-term outcomes from 2000 through 2007, it appears the Moses Cone Regional Cancer Center
has achieved results which are comparable to national averages. For patients treated in 2008 and 2009, we do not
yet have the long -term survival results. We can evaluate whether the trend toward increasing multidisciplinary care and
pre-operative chemotherapy with radiation is maintained. In fact, in 2008, 10 patients with rectal cancer received
combined chemotherapy and radiation, and six of these patients received this treatment prior to surgery (Pre-Op). In 2009,
the number of patients receiving combined chemotherapy and radiation increased to 15, and 12 received this treatment
pre-operatively. As seen below, this data shows the number of patients receiving chemotherapy and radiation increased.
It also shows a trend favoring pre-operative over post-operative therapy.




      Patients Receiving Chemotherapy and Radiation Therapy
                                        Pre-Op vs. Post-Op - 2008-2009

                                                     Pre-Op                 Post-Op


          12


          10


           8


           6


           4


           2


           0
                                        2008                                                2009


In summary, this study of our rectal cancer outcomes suggests that our goals of early detection and implementation of
multidisciplinary coordinated care have successfully led to high quality results during the past several years. The Moses Cone
Regional Cancer Center is displaying an unwavering trend to increasingly emphasize these fundamental strategies in an effort
to continually improve treatment outcomes.

The Moses Cone Regional Cancer Center strives to offer the most recent developments in cancer evaluation and treatment
from experienced providers. We remain committed to promoting earlier cancer detection and improved multidisciplinary care.




                                                                                                                                 20
                                              Breast Cancer Program


                                                          Submitted By
                                               Tami Knutson, RN, BSN, OCN, CBCN


                                                      With a new diagnosis comes a new journey. The mission of the
                                                      Multidisciplinary Breast Cancer Program at Moses Cone Health System
                                                      is to guide patients – and their families – on that journey. Our specialized
                                                      team is dedicated to helping breast cancer patients navigate the path
                                                      ahead; providing compassionate, comprehensive care on the leading
                                                      edge of cancer treatment.

                                                      Case Conferences
                                                      Our patients quickly learn they are not alone on their journey. Soon
                                                      after their diagnosis, a team of specialized physicians comes together
                                                      to review each patient’s case in detail and determine the most effective
                                                      treatment to achieve the best possible outcome. This medical team includes
                                                      oncologists from Moses Cone Health System Regional Cancer Center, as
                                                      well as specialists from The Breast Center of Greensboro Imaging and
                                                      Solis Women’s Health Breast Center, which are comprehensive breast
                                                      imaging and diagnostic centers. They are joined by surgeons from Central
                                                      Carolina Surgery, which provides surgery for benign and malignant breast
     Tami Knutson, RN, BSN, OCN, CBCN
                                                      disease. Patients take great comfort in seeing the close collaboration and
     Breast Program Coordinator
                                                      communication among members of the medical team.

                                                      The Journey
                                                      The journey through treatment is not a straight road, so we have a series
                                                      of programs at the Moses Cone Regional Cancer Center to help patients
                                                      deal with their diagnosis and navigate their care. That process begins
                                                      with Kasie Mahan, the breast clinic navigator, who calls all new patients
                                                      soon after they are diagnosed. She answers medical questions about their
                                                      breast cancer diagnosis and possible treatments. If the patient has needs
                                                      that might interfere with treatment, she continues to call regularly. She also
                                                      provides referrals to the Regional Cancer Center’s multidisciplinary team for
                                                      financial, social and emotional support as needed.

                                                      Each patient also receives a three-ring binder called “Journey” with
                                                      information about what to expect during treatment, as well as a listing of
                                                      the many resources available. In addition, we invite patients to use the
                                                      book as a place to journal their experiences. From financial counseling to
                                                      tips on talking to children about illness, this book is an excellent guide for
                                                      each new survivor.
     Courtney Jones, Breast Cancer Survivor           Patients who need further guidance can find help through Tami Knutson,
                                                      Breast Program Coordinator at Moses Cone Regional Cancer Center. She
                                                      makes patients her priority, answering their questions and addressing their
                                                      concerns, from diagnosis to finding their “new normal.”
21
                                         Breast Cancer Program


Mind, Body and Spirit
Our goal is to promote healing through mind, body and spirit. Because each individual’s needs are different, we offer
patients a variety of options and programs. Patients can arrange to speak to our dietitian, a social worker, the chaplain or
a psychologist. Or they can join one of our support groups. Options include yoga, massage therapy, stress management
classes, retreat days and the Healing Arts Program. We also offer Finding Your New Normal, a program for patients
transitioning to life after treatment.

Because family and friends are an invaluable part of each patient’s journey and support system, they are invited to participate
with the patient in all programs and support groups.

Clinical Trials
Since 1980, the Regional Cancer Center has offered the latest clinical trials from the National Cancer Institute and
pharmaceutical companies. Our breast cancer patients have the opportunity to participate in these groundbreaking research
studies, which also can pave the way for further advances in breast cancer treatment.

Exceptional People, Exceptional Care
Care is provided to breast cancer patients by a multidisciplinary team, including physicians, nurses, pharmacists, therapists,
front desk staff and more. Our entire team focuses on each patient as a person in need of individualized attention.

Treatment is led by three medical oncologists who specialize in breast cancer: Kalsoom K. Khan, MD; Gustav C. “Gus”
Magrinat, MD; and Peter Rubin, MD. Each doctor sets aside specific times for consultations with newly diagnosed breast
cancer patients. The doctors are committed to working at the leading edge of breast cancer treatment nationally, constantly
reviewing literature on advances in care and attending at least one national breast cancer conference annually. Both the
medical oncologists and our radiation oncologists participate in weekly breast cancer conferences for newly diagnosed
breast cancer patients and in monthly breast cancer working group meetings.

Patients who have gone through breast cancer treatment at the Regional Cancer Center are often quick to praise the doctors
and other professionals who provided them with state-of-the-art care close to home. They also appreciate the individual
attention they received and the compassionate help in navigating a very personal journey, from newly diagnosed breast
cancer patient to breast cancer survivor.




Gustav Magrinat, MD, Kalsoom Khan, MD, and Peter Rubin, MD


                                                                                                                                  22
                                                      To m o Th e r a p y



                                                         Submitted By
                                                       Robert J. Murray, MD


     A revolutionary method for delivering radiation therapy made its North Carolina debut in 2009 at the Moses Cone Regional
     Cancer Center. TomoTherapy Hi - ART® (Highly Integrated Adaptive Radiotherapy) combines an advanced form of intensity
     modulated radiation therapy (IMRT) with the accuracy of CT scanning technology, all in one machine. This approach uses
     radiation to treat hard-to-reach tumors that often sit close to healthy tissues and organs, while minimizing damage to the
     surrounding tissue. This is made possible by the first re-design of a radiation linear accelerator in more than 40 years.
     TomoTherapy abandons the standard static treatment arm and couch platform for a helical CT platform. The radiation source
     is miniaturized to a height of 18 inches, allowing it to be placed on a CT gantry and used for both imaging and treatment.
     Before every treatment, advanced helical CT scanning technology provides a 3D image of the body so the radiation beams
     can be targeted according to the size, shape and location of the tumor(s) on that specific day.

                                                                  TomoTherapy treatments can be delivered continuously from
                                                                  all angles around a patient. The beam is modulated by a
                                                                  unique multileaf collimator that divides the radiation beam into
                                                                  “beamlets,” all aimed at the tumor. Typically, tens of thousands
                                                                  of beamlets are used in a single TomoTherapy treatment session.
                                                                  Each TomoTherapy treatment takes about 20 minutes, which
                                                                  includes time for the CT scan, treatment set-up and the radiation
                                                                  treatment delivery. The unprecedented accuracy in treatment
                                                                  delivery allows us to increase tumor dose, thereby increasing
                                                                  the likelihood of cancer cure, while at the same time reducing
                                                                  treatment complications in healthy tissue. Unlike any other
                                                                  radiation delivery system, the CT images obtained each day can
                                                                  be used to determine if future treatments should be modified, a
                                                                  process called “adaptive radiation therapy.”


                                                                  TomoTherapy excels in the most difficult to treat cases.
            New photo of Dr. Murray by TomoTherapy
                                                                  TomoTherapy has allowed us to treat patients who previously
                                                                 would have had to seek treatment elsewhere. With its unparalleled
                                                                 treatment accuracy, TomoTherapy allows for re-treatment of
                                                                 patients who previously had no other option. It has allowed us
     Robert J. Murray, MD
                                                                 to begin a stereotactic radiosurgery program, providing surgical
                                                                 equivalent therapies for both the brain and body. We treated our
     first patients on Oct. 1, 2009. Prostate and head and neck cancers represent approximately one-half of the patients treated.
     Primary lung cancers and metastatic cancers to brain dominate the radiosurgery workload.

     B.J. Sintay, Ph.D., of our physics staff presented a report on our first year of experience at the NC IMRT-IGRT Symposium in
     Greensboro in the fall of 2010. As the first medical facility in North Carolina to acquire TomoTherapy, patients around the
     region are turning to us for this specialized treatment closer to home.




23
                                    Clinical Research - 2010



                                                      Submitted By
                                               Vivian Sheidler, RN, MS


                                                          The clinical research program provided more diverse opportunities
                                                          for 328 patients enrolled into clinical trials in 2010. This includes
                                                          146 patients enrolled at the Regional Cancer Center and 182
                                                          patients enrolled at outside institutions. We currently have 36 trials
                                                          open to accrual.

                                                          Our collaborative relationship as a community network site with
                                                          the Lineberger Cancer Center at the University of North Carolina
                                                          (UNC) in Chapel Hill expanded during 2010. We contributed
                                                          a total of 147 patients (enrollment began in 2009) to a study
                                                          that involved tamoxifen metabolism in women with breast cancer.
                                                          The enrollment into this study is the largest number of patients we
                                                          have enrolled in a single study. We also began a new study to
                                                          examine PK levels of 5-FU for patients receiving FOLFOX-based
                                                          chemotherapy to treat colon cancer. In addition to clinical trial
                                                          enrollment, several medical oncologists and the research staff
                                                          took part in UNC’s first Network conference, which was held
                                                          in Chapel Hill in April. With the telemedicine equipment that
                                                          we have from UNC, some staff were able to take part in the
Peter Rubin, MD                                           conference remotely from a classroom at Wesley Long
                                                          Community Hospital.
Under the direction of Peter Rubin, MD, the current
                                                          Medical leadership for the clinical research department changed
clinical research staff includes:
                                                          at the end of 2010. Peter Rubin, MD, became the Medical
Manager                      Vivian R. Sheidler, RN MS
                                                          Director for Clinical Research.
Research Nurses                 Nikki Eldreth, RN, BSN
                                    Gail Lott, RN, BSN    As a 1987 charter member of one of the first Community Clinical
                         Cindy Shaw, RN, BSN, CCRP        Oncology Programs in the country (titled the Southeast Cancer
                  Mary Wegenka, RN, MSN, AOCN             Control Consortium), the clinical research program of the Moses
Research Assistants                         Anna Hurd     Cone Regional Cancer Center contributes to advances in cancer
                                      Chantay Witcher     care by enrolling patients into important clinical trials.
Regulatory Assistant                 Sharon Norwood




                                                                                                                                   24
                         Pat i e n t a n d Fa m i ly S u p p o r t S e r v i c e s


     Cancer disrupts every aspect of the lives of patients and families and challenges their psychological, social, spiritual and
     financial resources. The Patient and Family Support Team offers support services and programs to help patients through the
     diagnosis, treatment and survivorship process in a variety of ways.

     Joanna Saporito, licensed clinical social worker, assists patients with crisis management related to transportation and
     housing, health insurance and benefits, medication assistance resources, supportive patient and family counseling, translation
     services, advance directives, information about community resources, and resources for in-home and residential care.
     In 2010, she had 2,438 direct patient contacts and allocated $69,000 in financial assistance to patients through the
     Regional Cancer Center Indigent Fund and the Alight Breast Cancer Grant Fund.

     Jeanne Peters, Ph.D., clinical psychologist, offers counseling services to patients and family members served by the Regional
     Cancer Center. Research indicates that 35 percent of oncology patients experience depression and anxiety. She helps
     patients and family members with coping skills and concerns related to depression, suicidal ideation, coping with grief and
     loss, chronic pain, family or marital problems, insomnia and anxiety. In 2010, she saw more than 300 patients and their
     families and had 1,600 direct contacts with patients, their families or other healthcare providers involved in their care.

     Terry Moore-Painter, chaplain, provides support to cancer patients and their families who are addressing questions about
     quality of life, meaning, purpose, hope and healing. Her compassion also is especially comforting for families whose loved
     ones bravely battled cancer. She ensures patients and families are aware of available support services and programs as well
     as makes referrals to specific support programs, the Cancer Center’s psychologist and for counseling in the Department of
     Pastoral Care. During the past year, she provided individual support for more than 400 patients and family members. She
     also coordinates support groups, yoga, tai chi, Look Good/Feel Better, expressive art workshops, retreats and the Finding
     Your New Normal program (for life after treatment). In 2010, the Cancer Center offered 160 support programs with total
     attendance of 1,610 participants.




     Joanna Saporito                              Jeanne Peters, Ph.D.                         Terry Moore-Painter




25
                    O n c o l o g y C o m m u n i t y O u t r e ac h



               cancer prevention and treatment series
            Topic                         Date                        Number/Result


                                                           •   Total Registered=33
 What Coping Mechanisms
                                                           •   Registered/Attended=26
Help Cancer Patients Survive      Monday, Jan. 11, 2010
                                                           •   Walk-ins=2
Longer and Liver Fuller Lives?
                                                           •   Total Attendance=28

                                                           •   Total Registered=55
                                                           •   Registered/Attended=35
     Colorectal Cancer           Monday, March 1, 2010
                                                           •   Walk-ins=0
                                                           •   Total Attendance=35

                                                           •   Total Registered=15
   Nutrition and Cancer                                    •   Registered/Attended=2
                                 Thursday, March 4, 2010
  Prevention (Kernersville)                                •   Walk-ins=2
                                                           •   Total Attendance=4

                                                           •   Total Registered=61
                                                           •   Registered/Attended=18
     Pancreatic Cancer           Monday, March 8, 2010
                                                           •   Walk-ins=0
                                                           •   Total Attendance=18

                                                           •   Total Registered=15
                                                           •   Registered/Attended=5
 Cervical Cancer and HPV         Monday, April 12, 2010
                                                           •   Walk-ins=2
                                                           •   Total Attendance=7

                                                           •   Total Registered=29
                                                           •   Registered/Attended=18
     Multiple Myeloma            Thursday, June 3, 2010
                                                           •   Walk-ins=3
                                                           •   Total Attendance=21

                                                           •   Total Registered=28
                                                           •   Registered/Attended=20
  Metastatic Bone Cancer          Monday, June 7, 2010
                                                           •   Walk-ins=4
                                                           •   Total Attendance=24

                                                           •   Total Registered=43
   Spice Up Your Diet For                                  •   Registered/Attended=19
                                 Monday, July 12, 2010
     Cancer Prevention                                     •   Walk-ins=15
                                                           •   Total Attendance=34

                                                           •   Total Registered=25
                                                           •   Registered/Attended=6
      Ovarian Cancer              Monday, Aug. 9, 2010
                                                           •   Walk-ins=6
                                                           •   Total Attendance=12



                                                                                        26
                     O n c o l o g y C o m m u n i t y O u t r e ac h



                 cancer prevention and treatment series
             Topic                         Date                      Number/Result


                                                           •   Total Registered=88
                                                           •   Registered/Attended=59
         Breast Cancer            Tuesday, Oct. 26, 2010
                                                           •   Walk-ins=5
                                                           •   Total Attendance=64




     upcoming 2011 cancer prevention and treatment series
             Topic                        Date                          Location




      Gynecologic Cancers        Monday, Jan. 17, 2011            Regional Cancer Center




          Lung Cancer            Thursday, Jan. 27, 2011          Regional Cancer Center




        Colorectal Cancer        Monday, March 7, 2011            Regional Cancer Center


      Nutrition and Cancer
                                 Monday, June 6, 2011            Regional Cancer Center
            Prevention


     Non-Hodgkins Lymphoma       Monday, July 11, 2011           Regional Cancer Center




27
            2010 Community Cancer Screenings



Screening
              Location        Date                            Results
   Site

                                        • Participants=27
              Regional                  • Total Number of Normal Results=25
                            Monday,
 Prostate   Cancer Center               • Total Number of Abnormal Results=2
                            Jan. 18,
 Cancer          at                       - Abnormal DRE and PSA=0
                             2010
            Stoney Creek                  - Abnormal DRE ONLY=1
                                          - Abnormal PSA ONLY=1

                                        •   Participants=208
                                        •   Total Number of Pap Smears=208
                            Monday,
Cervical      Regional                  •   Normal Pap Smears=142
                            Jan. 25,
Cancer      Cancer Center               •   Normal Pap Smears with an Abnormal Exam=54
                             2010
                                        •   Abnormal Pap Smears=11
                                        •   Unsatisfactory for Evaluation=1

                                        •   Participants=171
                                        •   Pap Smears=170
                            Monday,
Cervical      Regional                  •   Normal Pap Smears=132
                            Feb. 8,
Cancer      Cancer Center               •   Normal Exam (No Pap Smear)=1
                             2010
                                        •   Normal Pap Smears with an Abnormal Exam=33
                                        •   Abnormal Pap Smears=5

                                        •   Participants=84
                            Monday,     •   Pap Smears=84
Cervical     MedCenter
                            Feb. 15,    •   Normal Pap Smears=58
Cancer       High Point
                             2010       •   Normal Pap Smears with an Abnormal Exam=15
                                        •   Abnormal Pap Smears=11

                                        •   Participants=73
                                        •   Pap Smears=71
                            Monday,
Cervical     MedCenter                  •   Normal Pap Smears=54
                            Feb. 22,
Cancer       Kernersville               •   Normal Exam (No Pap Smear)=2
                             2010
                                        •   Normal Pap Smears with an Abnormal Exam=13
                                        •   Abnormal Pap Smears=4

                                        •   FOBT kits distributed at class=35
                            Monday,
 Colon        Regional                  •   Received=22
                            March 1,
 Cancer     Cancer Center               •   Positive=1 (Patient diagnosed with colon cancer)
                             2010
                                        •   Negative=21

                                        •   Participants=24
                                        •   Pap Smears=21
                            Monday,
Cervical     Annie Penn                 •   Normal Pap Smears=15
                            March 15,
Cancer        Hospital                  •   Normal Exam (No Pap Smear)=3
                             2010
                                        •   Normal Pap Smears with an Abnormal Exam=3
                                        •   Abnormal Pap Smears=3




                                                                                               28
                 2010 Community Cancer Screenings



     Screening
                   Location        Date                         Results
        Site

                                             •   Participants=58
                   Regional
                                 Monday,     •   Pap Smears=58
     Cervical    Cancer Center
                                 April 19,   •   Normal Pap Smears=43 Normal
     Cancer           at
                                  2010       •   Normal Pap Smears with an Abnormal Exam=8
                 Stoney Creek
                                             •   Abnormal Pap Smears=7


                                 Saturday,   • Participants=68
       Skin        Regional
                                  May 1,     • Normal Exams=56
      Cancer     Cancer Center
                                   2010      • Abnormal Exams=12



                                 Monday,     • Participants=91
       Skin        Regional
                                 May 3,      • Normal Exams=62
      Cancer     Cancer Center
                                  2010       • Abnormal Exams=29



                                 Monday,     • Participants=21
       Skin       Annie Penn
                                 May 10,     • Normal Exams=19
      Cancer       Hospital
                                  2010       • Abnormal Exams=2



                                 Thursday,   • Participants=25
       Skin       Annie Penn
                                  May 13,    • Normal Exams=16
      Cancer       Hospital
                                   2010      • Abnormal Exams=9


                                             • Participants=25
                                             • Normal Results=22
                                 Monday,
      Prostate    MedCenter                  • Abnormal Results=3
                                 May 17,
      Cancer      Kernersville                 - Abnormal DRE and PSA=0
                                  2010
                                               - Abnormal DRE ONLY=0
                                               - Abnormal PSA ONLY=3

                                             • Participants=83
                                  Friday,    • Normal Exams=70
       Oral       HealthServe
                                 Aug. 20,    • Normal Exams Suspicious for Cancer
      Cancer      Greensboro
                                   2010        with other Abnormal Findings=10
                                             • Abnormal Exams=3

                                             •   Participants=123
                                             •   Pap Smears=121
                                 Monday,
     Cervical      Regional                  •   Normal Pap Smears=88
                                 Aug. 30,
     Cancer      Cancer Center               •   Normal Exam (No Pap Smear)=2
                                  2010
                                             •   Normal Pap Smears with an Abnormal Exam=27
                                             •   Abnormal Pap Smears=6




29
            2010 Community Cancer Screenings



Screening
              Location       Date                         Results
   Site

                            Monday,
 Prostate    MedCenter
                            Sept. 13,   CANCELED
 Cancer      High Point
                             2010

                                        • Participants=90
                                        • Normal Results=76
                                        • Abnormal Results=14
                            Monday,
 Prostate     Regional                    - Abnormal DRE and PSA=0
                            Sept. 20,
 Cancer     Cancer Center                 - High Risk PSA and Abnormal DRE=1
                             2010
                                          - High Risk PSA and Normal DRE=3
                                          - Abnormal DRE and Normal PSA=6
                                          - Abnormal PSA and Normal DRE=4

                                        • Participants=76
                                        • Normal Results=60
                                        • Abnormal Results=16
                            Tuesday,
 Prostate     Regional                    - Abnormal DRE and PSA=0
                            Sept. 21,
 Cancer     Cancer Center                 - High Risk PSA and Abnormal DRE=0
                              2010
                                          - High Risk PSA and Normal DRE=11
                                          - Abnormal DRE and Normal PSA=3
                                          - Abnormal PSA and Normal DRE=2

                                        • Participants=68
                                        • Pap Smears=68
                            Monday,     • Normal Pap Smears=54
 Cervical    MedCenter
                            Sept. 27,   • Normal Exam (No Pap Smear)=0
 Cancer      High Point
                             2010       • Normal Pap Smears with an Abnormal Exam=11
                                        • Abnormal Pap Smears=2
                                        • Unsatisfactory for Evaluation=1

                                        • Participants=32
                                        • Normal Results=26
                                        • Abnormal Results=6
                            Tuesday,
 Prostate    Annie Penn                   - Abnormal DRE and PSA=0
                            Sept. 28,
 Cancer       Hospital                    - High Risk PSA and Abnormal DRE=0
                              2010
                                          - High Risk PSA and Normal DRE=1
                                          - Abnormal DRE and Normal PSA=1
                                          - Abnormal PSA and Normal DRE=4

                                        • Participants=36
                                        • Pap Smears=36
                            Monday,
 Cervical    MedCenter                  • Normal Pap Smears=29
                            Oct. 4,
 Cancer      Kernersville               • Normal Exam (No Pap Smear)=0
                             2010
                                        • Normal Pap Smears with an Abnormal Exam=5
                                        • Abnormal Pap Smears=2




                                                                                       30
                   2010 Community Cancer Screenings



     Screening
                      Location       Date                               Results
        Site

                                                       • Participants=19
                     Regional                          • Pap Smears=19
                                   Monday,
      Cervical     Cancer Center                       • Normal Pap Smears=16
                                   Oct. 11,
      Cancer            at                             • Normal Exam (No Pap Smear)=0
                                    2010
                   Stoney Creek                        • Normal Pap Smears with an Abnormal Exam=3
                                                       • Abnormal Pap Smears=0

                                                       • Participants=46
                                                       • Pap Smears=44
                                   Monday,
      Cervical       Annie Penn                        • Normal Pap Smears=30
                                   Oct. 18,
      Cancer          Hospital                         • Normal Exam (No Pap Smear)=2
                                    2010
                                                       • Normal Pap Smears with an Abnormal Exam=9
                                                       • Abnormal Pap Smears=5




                 Community Screenings and Other Events

                     upcoming 2011 community screenings
           Screening Site                   Location                              Date


           Prostate Cancer         MedCenter High Point                 Monday, Feb. 21, 2011


           Cervical Cancer         Regional Cancer Center              Monday, March 14, 2011


           Cervical Cancer         Regional Cancer Center              Monday, March 21, 2011


           Cervical Cancer         MedCenter High Point                Monday, March 28, 2011


           Cervical Cancer         MedCenter Kernersville               Monday, April 4, 2011


           Cervical Cancer          Annie Penn Hospital                 Monday, April 11, 2011

                                   Regional Cancer Center
           Cervical Cancer                                              Monday, April 18, 2011
                                      at Stoney Creek

             Skin Cancer           Regional Cancer Center                Monday, May 2, 2011


             Skin Cancer           Regional Cancer Center               Saturday, May 7, 2011


             Skin Cancer            Annie Penn Hospital                  Monday, May 9, 2011

             Skin Cancer            Annie Penn Hospital                 Thursday, May 12, 2011

                                   Regional Cancer Center
             Skin Cancer                                                Monday, May 16, 2011
                                      at Stoney Creek
31
      Community Screenings and Other Events



                       other events

          Event                Date / Time                  Number/Result


                       Wednesday, Jan. 13, 2010                  2 people

                       Wednesday, Feb. 10, 2010                  3 people

                      Wednesday, March 10, 2010                  2 people

                      Wednesday, April 14, 2010                  5 people

                       Wednesday, May 12, 2010                   2 people

Smoking Cessation
                       Wednesday, June 9, 2010                   2 people
Support Group meets
second Wednesday
                       Wednesday, July 14, 2010                  2 people
of every month

                      Wednesday, Aug. 11, 2010                   1 person

                       Wednesday, Sept. 8, 2010                  2 people

                       Wednesday, Oct. 13, 2010                  2 people

                       Wednesday, Nov. 10, 2010                  3 people

                       Wednesday, Dec. 8, 2010                   2 people

                      Class One: April 6 - May 18      3 people completed class
                       Noon - 1:30 p.m. session           and 2 quit smoking

                       Class Two: April 27 - June 8    4 people completed class
                        Noon - 1:30 p.m. session          and 2 quit smoking

                      Class Three: July 13 - Aug. 24   4 people completed class
                        Noon - 1:30 p.m. session          and 2 quit smoking
Smoking Cessation
Program 2010
                                                       4 people completed class and
                                                       none of them completely quit.
                                                          They have either cut back
                                                       drastically or are still having
                      Class Four: Sept. 14 - Oct. 26
                                                        slips after a couple of weeks
                        Noon - 1:30 p.m. session       of not smoking. Have encour-
                                                       aged all of them to attend the
                                                         smoking cessation support
                                                          group that meets monthly.




                                                                                         32
             Community Screenings and Other Events




                        upcoming 2011 community screenings

                Event                     Date / Time               Number/Result


                                  Class One: Jan. 17 - Feb. 28            TBD

     Smoking Cessation
                                  Class Two: March 1 - April 12           TBD
     Program 2011

                                  Class Three: May 3 - June 14            TBD

                                   Wednesday, Jan. 12, 2011               TBD

                                   Wednesday, Feb. 9, 2011                TBD

     Smoking Cessation
                                  Wednesday, March 9, 2011                TBD
     Support Group meets
     second Wednesday
                                  Wednesday, April 13, 2011               TBD
     of every month

                                   Wednesday, May 11, 2011                TBD

                                   Wednesday, June 8, 2011                TBD




                                   other events
                Event                      Date / Time                Number/Result


     Slip Slop Slap (Sun Safety        March – July 2010          113 classes completed
     Education Program for
     children ages 4-6)                March – July 2011                 T.B.D.




33
   Regional Cancer Center




New Expansion Opening in 2011
        Exceptional People. Exceptional Care.




501 N. Elam Avenue | Greensboro, NC 27403 | www.mosescone.com/cancer

								
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