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					ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
   We Believe…
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER-
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
                                            ANNUAL REPORT 2008
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ROPER ST. FRANCIS CANCER CENTER ROPER ST. FRANCIS CANCER CENTER
ANNUAL REPORT 2008



       TABLE OF CONTENTS


       We believe…in Vision

          Message from Leadership ..................................................................................2

          Growth Initiatives..............................................................................................2

          Cancer Committee Membership...................................................................3-4

       We believe…in Excellence

           Accreditation by Commission on Cancer.........................................................5

           Outcomes .........................................................................................................5

          Cancer Registry .................................................................................................6

          Cancer Liaison Physician .................................................................................7

          Cancer Conference............................................................................................7

          2007 Statistical Overview ............................................................................7-13

       We believe…in Outreach

           Community Outreach Programs ....................................................................14

           Clinical Trials Program....................................................................................14

       We believe…in Support

           Palliative Care..................................................................................................16

           ACS Patient Resource Navigator ...................................................................17

           Breast Health Navigator .................................................................................17

       RSF Cancer Center Lung Cancer Review ....................................................18-21

       Lung Cancer Data .........................................................................................22-23




                                                                                                                            1
We believe in Vision
                              MESSAGE FROM                              GROWTH INITIATIVES:
                              LEADERSHIP                                HOSPITAL WITHIN
                                                                        A HOSPITAL
                              The Roper St. Francis Cancer Center
                              remains at the forefront of the           In response to the Cancer Center’s
                              ongoing fight against cancer. As an       current high levels of market share and
                              accredited comprehensive community        the significant anticipated growth in
                              hospital cancer center, our team of       many of the communities served,
                              board certified doctors, nurses and       plans for enhancement of existing
                              other professionals uses the most         facilities and expansion of services into
                              advanced technologies to provide          new markets are underway. At Roper
                              highly effective and personalized care.   Hospital, the concept of a “Cancer
                              As 2008 closes, Roper St. Francis         Hospital within a Hospital” is being
                              Cancer Center looks back on eighteen      developed. Oncology nursing services,
                              months of unprecedented growth,           including inpatient medical and
                              a period in which we lead the region      surgical oncology and infusion
                              in offering the latest in cancer          therapy, are being consolidated on the
Scott Broome, FACHE
                              fighting technology, including the        5th floor. The objective is to provide
Director, Oncology Services
                              introduction of the Lowcountry’s          one convenient service location within
                              first da Vinci Surgical Robot, South      Roper Hospital for most cancer
David Ellison, MD             Carolina’s first CyberKnife, and a new    services.
Medical Director,             state-of-the-art IGRT capable linear
Cancer Committee Chairman     accelerator. While technology will
                              continue to be a major focus, Cancer
                              Center leadership is hard at work         WEST ASHLEY
                              furthering other initiatives, as this
                              report outlines.
                                                                        CANCER CENTER
                                                                        In response to regional growth and
                              The Roper St. Francis Cancer Center
                                                                        changing demographics in West Ashley
                              is committed to maintaining our
                                                                        and the North area, a freestanding
                              position as a technology leader in
                                                                        Outpatient Cancer Center at Bon
                              the fight against cancer as well as the
                                                                        Secours St. Francis Hospital is in the
                              market share leader for treatment of
                                                                        planning phases with construction
                              many cancers in the Tri-county area.
                                                                        expected to begin during early 2009.
                              We are proud of the care we provide,
                                                                        This comprehensive outpatient
                              and excited about new opportunities
                                                                        oncology center will feature PET/CT,
                              to help more patients and families live
                                                                        diagnostic imaging, chemotherapy
                              the life that they and we envision – a
                                                                        infusion services and radiation therapy.
                              life free from fear of cancer. We value
                                                                        It will also house physicians’ offices,
                              your support and partnership in this
                                                                        cancer registry, social workers and
                              important work.
                                                                        clinical trials staff, as well as
                                                                        comfortable, inviting spaces for our
                                                                        patient support groups and
                                                                        a cancer resource library.



2
PHYSICIAN MEMBERS OF CANCER COMMITTEE
David Ellison, MD . . . . . . . . . . . . . . Hematology/Medical Oncology/Chairman

Angus Baker, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Palliative Care

Paul Baron, MD . . . . . . . . . . . . . . . . . . . . . . . . . . General Surgery/ACoS Liaison

Amy Bethea, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diagnostic Radiology

Walter “Bo” Blessing, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Surgery

Frank Brescia, MD . . . . . . . . . . . . . . . . . . . . . . . Hematology/Medical Oncology

William Carter, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Urology

Elizabeth Christian, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Oncology

Louise Clay, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Radiation Oncology

Mary Decker, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Radiation Oncology

George Geils Jr, MD . . . . . . . . . . . . . . . . . Hematology/Medical Oncology/BMT

Chris Hawk III, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Surgery

Scott Jennings, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GYN Oncology

Raymond Kaplan, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Otolaryngology

George Keogh, MD. . . . . . . . . . . . . . . . . . . . . . . Hematology/Medical Oncology

John Mitchell, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pulmonology

David Peterseim, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thoracic Surgery

Steven Shapiro, MD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Genetics/Primary Care

Stanley Wilson, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Surgery

Frederick Worsham, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pathology

Curtis Worthington, MD. . . . . . . . . . . . . . . . . . . . . . . . Neurology/Neurosurgery




                                                                                                               3
    NON-PHYSICIAN MEMBERS OF CANCER COMMITTEE
    Scott Broome, FACHE . . . . . . . . . . . . . . . . . . . . Service Line Director, Oncology

    Lynn Brennan, RN, BSN . . . . . . . . . . . . . . . . . . . . . . . . . Palliative Care Director

    Anita Carner, RN . . . . . . . . . . . . . . . . Roper St. Francis Medical Center Berkeley

    Ashley Cashon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . American Cancer Society

    Nichole Cassells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marketing Director

    Phillip Creger, Pharm D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pharmacy Director

    Jacqueline Dioses, RT(T) . . . . . . . . . . . . . . . . . . . . Radiation Oncology Manager

    Marilyn Fox, RN . . . . . . . . . . . Clinical Benchmarks/Performance Improvements

    Ellen Kolender, RHIA, CTR . . . . . . . . . . . . . . . . . . . . . Cancer Registry Manager

    Kathy Laporte, RN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physical Rehab Services

    Wynde Limehouse, RN, OCN. . . . . . Clinical Research, OP Oncology Manager

    Catherine Meza, RN, OCN . . . . . . . . . . . . . . . . . . . . . . . . . . . Manager, 5 South

    Jody McCrain, LBSW . . . . . . . . . . . . . . . . . . . . . . . . . . . . Case Manager, 5 South

    The Reverend Robert Morris . . . . . . . . . . . . . . . . . . . . . Pastoral Services Director

    Elizabeth McCaleb, LMSW . . . . . . . . . . . . . . . . . . . . . . Oncology Social Worker

    Holly Neal, RD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dietary

    Kelly Pabst, RN, OCN . . . . . . . . . . . . . . . . . . . . . . . . . . Clinical Nurse Specialist

    Teresa Pischner, RN, OCN . . . . . . . . . . . . . . . . . . . . . . . . . Breast Care Navigator

    Carolyn Swanigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physicians’ Services

    Kelly Weeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACS Patient Navigator




4
We Believe in Excellence
ACCREDITATION WITH                           IMPRESSIVE OUTCOMES
COMMENDATION
                                                                                         Impressive Five-year
                                             Roper St. Francis Cancer Center is          Survival Rates
The Roper St. Francis Cancer Center          proud to be the Tri-county market
was surveyed by the Commission               share leader for treatment of breast,
                                                                                         According to 2007 Cancer
 on Cancer (CoC) of the American             colorectal and prostate cancers. In fact,
                                                                                         Registry data, the RSF Cancer
College of Surgeons during July of           the Cancer Center treats more breast
                                                                                         Center is the Tri-county market
2008 and was awarded full Three-Year         and colorectal cancers than all other
                                                                                         leader for the treatment of
Accreditation, with Commendation,            Tri-county hospitals combined, with
                                                                                         breast, colorectal and prostate
as a Comprehensive Community                 market share percentages of 53%
                                                                                         cancer, which represent the
Hospital Cancer Program. Overall,            and 51%, respectively. The Cancer
                                                                                         region’s most commonly
accreditation requires compliance            Center has a 43% market share for
                                                                                         diagnosed cancers. This means
with thirty-six standards representing       treatment of prostate cancer and treats
                                                                                         that more area residents choose
the full scope of the cancer care            approximately one-third of Tri-county
                                                                                         RSF Cancer Center for their
continuum, including center                  patients who have lung cancer.
                                                                                         care than any other local
leadership, data management and              Additionally, and most importantly,
                                                                                         provider.
reporting, patient care services, clinical   our 5-year survival rates for all four of
trials, community outreach and               these cancers compare favorably to          • Our five-year survival rates
quality improvement. Further,                both South Carolina and National              for breast, colorectal,
commendation is awarded in nine              Cancer Database norms.                        prostate and lung cancer
areas where there is evidence that                                                         surpass both state and
programs are not only compliant, but                                                       national benchmarks.
have components that go above and                                                        • We treat 53% of breast
beyond requirements. Roper St.                                                             cancer patients in the
Francis Cancer Center was awarded                                                          tri-county, with a 5-year
commendation in six of these areas,                                                        survival rate of 86%,
including patient treatment services,                                                      compared to 82% in SC
clinical trials, data management and                                                       and 83% nationally;
reporting, prevention and early
                                                                                         • We treat 51% of colon
detection.
                                                                                           cancer patients in the
                                                                                           tri-county, with a 5-year
                                                                                           survival rate of 56%,
                                                                                           compared to 51% in SC
                                                                                           and 52% nationally;
                                                                                         • We treat 43% of prostate
                                                                                           cancer patients in the
                                                                                           tri-county, with a 5-year
                                                                                           survival rate of 85%,
                                                                                           compared to 82% in SC
                                                                                           and 84% nationally;
                                                                                         • We treat 35% of lung cancer
                                                                                           patients in the tri-county,
                                                                                           with a 5-year survival rate of
                                                                                           18%, compared to 14% in
                                                                                           SC and 16% nationally.

                                                                                                                            5
                                                CANCER REGISTRY
                                                                  Ellen Kolender, RHIA, CTR
                                                                  Cancer Registry Manager
                                                                  The Cancer Registry is an electronic database
                                                                  of information from medical records of
                                                                  patients diagnosed and/or treated for cancer
                                                                  within the Roper St. Francis Healthcare
                                                                  system. Our Cancer Center Registry dates
                                                                  from January 1, 1992, with over 23,954 cases
                                                                  entered since that time, 20,750 of which
                                                                  were newly diagnosed cases treated January 1,
                                                                  1992 or later. Cancer registries provide data
                                                                  that serve as a valuable research tool for
                                                                  understanding the development, diagnosis,
                                                                  and treatment of cancer. Registry data also
                                                                  may point to risk factors leading to the
                                                                  development of cancer and help signal the
                                                                  need for preventive measures, which can help
                                                                  reduce the burden of cancer. The American
                                                                  College of Surgeons Commission on Cancer
                                                                  and other National Organizations govern
                                                                  the information collected for the database.
                                                                  Examples of the data elements collected
                                                                  include demographic data, cancer site,
                                                                  histology, staging, treatment information and
                                                                  follow-up data.

                                                                  At the end of the year, the Cancer Registry
                                                                  submits data to the SC Central Cancer
                                                                  Registry and the National Cancer Data Base.
                                                                  Our cancer center benchmarks its data
                                                                  annually against these other data to measure
                                                                  performance. Different cancer sites are
                                                                  reviewed by treatment and stage to determine
                                                                  survival rates and how our statistics compare
                                                                  to the state and nationwide data. Strict
    Roper St. Francis Cancer Center breast cancer survivors       confidentiality is maintained at all times.
                                                                  An essential component of the Registry is
                                                                  providing lifetime follow-up of cancer
                                                                  patients, allowing for early detection, evidence
                                                                  of recurrent cancer or identification of a new
                                                                  primary malignancy. This follow-up serves as
                                                                  an automatic reminder to physicians and
                                                                  patients to schedule regular physical exams,
                                                                  assuring continued medical supervision.
                                                                  Annual patient follow-up is required by state
                                                                  and national accrediting agencies.
6
CANCER LIAISON PROGRAM OF                            CANCER CONFERENCE                         2007 RSF CANCER
THE COMMISSION ON CANCER                                                                       CENTER STATISTICS
                                                     In 2007, Roper St. Francis Cancer
                                                     Center held 55 Cancer Conferences
                           Paul Baron, MD                                                      The most common cancers treated at
                                                     and discussed 237 cases, which made       the Roper St. Francis Cancer Center
                           General Surgeon
                                                     up 15% percent of the 2007 analytic       in 2007 were, in order of highest to
                             The Cancer Liaison      caseload. Of these cases 94 percent       lowest: breast, lung and bronchus,
                             Program of the          focused on problem solving,               prostate, colon and rectum, and
                             Commission on           pretreatment evaluation, staging or       kidney and renal pelvis. Compara-
                             Cancer (CoC) was        treatment strategy. Cases selected for    tively, the most common cancers in
                             developed as a          presentation are those that will          the United States estimated for 2007
                             network of physician    facilitate case management decisions,     were, in order of highest to lowest,
                             volunteers willing to   demonstrate new diagnostic and            prostate, lung and bronchus, breast,
manage clinically related cancer activities in       treatment techniques or offer a           colon and rectum, and urinary
their local institutions and surrounding             second opinion to cancer patients.        bladder. There were 1,445 new cases
communities. Cancer Liaison Physicians               Each conference includes a clinical       of cancer at Roper Hospital and 153
(CLPs) are volunteer physicians serving a            presentation by the attending             treated at Bon Secours St. Francis
three-year term, providing the leadership and        physician, a presentation of              Hospital, for a combined system total
direction to establish, maintain, and support        radiological and pathological findings    of 1,598 cancer cases in 2007. The
their facility’s cancer program. They are            and a general case discussion. All        Cancer Center treated nine percent
charged with the task of spearheading CoC            major cancer sites seen at Roper St.      more female patients with cancer than
activities at the facility and community level.      Francis Cancer Center are discussed       male patients, likely due to its high
                                                     and a representative from radiation       market share of breast cancer cases
Dr. Paul Baron served as one of our Physician        oncology, pathology, radiology,           diagnosed. The age of patients at
Champions within our Cancer Program to               general surgery, thoracic surgery,        diagnosis ranged from two patients
help obtain and maintain CoC Approval by             medical oncology, GYN oncology,           between 15 and 19 years of age to 98
serving on the RSFH Cancer Committee,                plastic surgery, urology, and             patients diagnosed after age 85 with a
being an advocate for our cancer registry,           pulmonology, as well as referring         mean age being 63 years of age. The
evaluating our facility’s compliance with            physicians, cancer registry staff and     majority of the patients treated by the
adopted guidelines, promoting participation          nursing attend the conference.            Cancer Center reside in Charleston
in clinical trials and promoting our CoC             Through this collaborative,               County. The distribution of the top
Approval.                                            multidisciplinary approach, treatment     four counties from which patients
                                                     plans can be evaluated and tailored       originate is as follows: Charleston
As Liaison between the CoC and our Cancer            to specific patient needs. Weekly
Program, Dr. Baron has promulgated CoC                                                         County (1,143), Berkeley County
                                                     conferences covering all sites are held   (179), Dorchester County (88) and
initiatives at the local level by regularly          at Roper Hospital on Thursday
reporting CoC initiatives to the cancer                                                        Colleton County (55). Little change
                                                     mornings, and monthly Urology             has been seen in this geographic
committee and facilitating participation in the      conferences and Thoracic conferences
Facility Information Profile System (FIPS).                                                    distribution since the registry began
                                                     are held on the second and fourth         collecting data in 1992.
He has served as an agent of change in the           Wednesdays, respectively.
community developing and strengthening
relationships with the American Cancer
Society and improving the health of the
community by facilitating provision of
support services and community outreach
activities.


                                                                                                                           7
    LEADING SITES OF NEW CANCER CASES (Estimated New Cases*)
              MALE                                                            FEMALE
    2007 National RH 2007                                             2007 National RH 2007
    Estimates      Actual             Site                            Estimates      Actual

                              Breast                                  178,480 (26%)    369 (40%)
    218,890 (29%)             Prostate
                       300 (36%)
    114,760 (15%)             Lung & Bronchus
                       112 (13%)                                      98,620 (15%)     102 (11%)
    79,130 (10%)              Colon & Rectum
                       81 (10%)                                       74,630 (11%)     81 (9%)
    50,040 (7%)        26 (3%)Urinary Bladder                         17,120 (2%)      11 (1%)
                              Corpus Uterus                           39,080 (6%)      51 (5%)
    34,200 (4%)    29 (3%)    Non-Hodgkin Lymphoma                    28,990 (4%)      26 (3%)
    24,800 (3%)    23 (3%)    Leukemias                               19,440 (3%)      15 (2%)
    245,040 (32%) 265 (32%) All Others Sites                          221,700 (33%)    273 (29%)
    766,860 (100%) 836 (100%) Total                                   678,060 (100%)   928 (100%)

    Excludes basal and squamous cell skin cancers and in situ carcinoma.
    2007, American Cancer Society, Inc., Surveillance Research estimated new cases
    2007, Roper Hospital actual new cases




8
DISTRIBUTION OF CANCER CASES BY COUNTY 2007




                Greenville          Cherokee
                   1                                   York
         Pickens           Spartanburg
            1                  2
Oconee                                               Chester
  1                                       Union                    Lancaster      Chesterfield
                                                                                                   Marlboro
          Anderson
                             Laurens
                                                                                                            Dillon
                                                      Fairfield       Kershaw           Darlington            3
                                       Newberry                                            1
              Abbeville
                                                                                  Lee                       Marion
                          Greenwood                                                                          4
                                   Saluda                      Richland                          Florence
                McCormick                                         1            Sumter               5
                                                  Lexington                                                          Horry
                                                                                 3                                    16
                              Edgefield              1
                                                                  Calhoun         Clarendon
                                                                     1                2     Williamsburg
                                       Aiken                                                     10
                                         1
                                                               Orangeburg                               Georgetown
                                                                   15                                       26
                                             Barnwell
                                                2      Bamberg                          Berkeley
                                                          2               Dorchester      179
                                                Allendale                        88

                                                      Hampton       Colleton
                                                        9             55
                                                                                  Charleston
                                                                                    1,144
                                                          Jasper



                                                          Beaufort
                                                             2




                                                                                                                             9
     2007 DISTRIBUTION OF CASES

     ROPER ST. FRANCIS HEALTHCARE SYSTEMWIDE PRIMARY SITE TABLE
                                       Total   Class of Case     Sex
     Primary Site                      Cases   Analytic NA Male Female Stg 0   Stg I   Stg II Stg III Stg IV   Stg   Unk
     Buccal Cavity & Pharynx             33       25      8  23      10  0       2       1       7      7       1      7
     Tongue                               7        6      1    6      1  0       1       1       1      2       0     1
     Salivary Glands                      5        3      2    4      1  0       0       0       2      1       0     0
     Floor of Mouth                       2        1      1    2      0  0       0       0       0      0       0     1
     Gum & Other Mouth                    5        4      1    2      3  0       1       0       1      1       1     0
     Nasopharynx                          3        3      0    2      1  0       0       0       3      0       0     0
     Tonsil                               3        3      0    2      1  0       0       0       0      0       0     3
     Oropharynx                           4        2      2    2      2  0       0       0       0      0       0     2
     Hypopharynx                          4        3      1    3      1  0       0       0       0      3       0     0
     Digestive System                   323      283     40 171     152  7      52      71      60     60      20     13
     Esophagus                           28       22      6   21      7  0       5       7       4      4       0      2
     Stomach                             24       20      4   17      7  0       6       1       1      7       4      1
     Small Intestine                     15       14      1    8      7  0       0       4       0      2       8     0
     Colon Excluding Rectum             124       111    13  62      62  6      24      26      35     18       1      1
     Cecum                               27       25      2   12     15  2       5       6      10      2       0      0
     Appendix                             2        2      0    1      1  0       0       0       1      0       1     0
     Ascending Colon                    22        21      1   10     12  1       5       9       3      3       0      0
     Hepatic Flexure                      1        1      0    1      0  0       0       1       0      0       0     0
     Transverse Colon                    15       14      1    8      7  1       1       3       8      1       0     0
     Splenic Flexure                      3        3      0    2      1  0       1       1       0      1       0     0
     Descending Colon                     9        9      0    3      6  0       3       1       3      2       0     0
     Sigmoid Colon                      40        31      9  23      17  2       9       4       9      6       0      1
     Large Intestine, NOS                 5        5      0    2      3  0       0       1       1      3       0     0
     Rectum & Rectosigmoid Junction     56        45     11  27      29  1      10      11       9      9       1      4
     Rectosigmoid Junction                6        5      1    5      1  0       1       0       2      2       0     0
     Rectum                             50        40     10  22      28  1       9      11       7      7       1      4
     Anus, Anal Canal & Anorectum        13        11     2    3     10  0       2       8       1      0       0      0
     Liver & Intrahepatic Bile Duct      11       10      1    9      2  0       2       2       3      2       0     1
     Liver                               11       10      1    9      2  0       2       2       3      2       0     1
     Gallbladder                          1        1      0    1      0  0       0       0       0      1       0     0
     Other Biliary                        4        4      0    3      1  0       0       1       2      0       0     1
     Pancreas                            39       37      2   16     23  0       3      11      5      16       0     2
     Retroperitoneum                      1        1      0    1      0  0       0       0       0      1       0     0
     Peritoneum, Omentum & Mesentery      3        3      0    1      2  0       0       0       0      0       2     1
     Other Digestive Organs               4        4      0    2      2  0       0       0       0      0       4     0
     Respiratory System                 248      230     18  137    111  3      69      10      48     79       2     18
     Nasal Cavity, Middle Ear &           1        0      1    0      1  0       0       0       0      0       0     0
       Accessory Sinuses
     Larynx                             14       12     2    12    2     2       6      2       0       2      0      0
     Lung & Bronchus                   232       217   15   124   108    1      63      8      48      77      1     18
     Trachea, Mediastinum & Other        1        1     0    1     0     0       0      0       0       0      1      0
       Respiratory Organs
     Bones & Joints                      1        1     0    1      0    0       0       0      0       0      0      1
     Bones & Joints                      1        1     0    1      0    0       0       0      0       0      0      1
     Soft Tissue                         8        6     2    7      1    0       2       1      0       1      0      2
     Soft Tissue (including Heart)       8        6     2    7      1    0       2       1      0       1      0      2
     Skin excluding Basal & Squamous   99        59    40   59    40    14      33       6      2       2      0      2
     Melanoma - Skin                    97      58     39   59    38    14      33       5      2       2      0      2
     Other Nonepithelial Skin            2        1     1    0      2    0       0       1      0       0      0      0
     Breast                            377      349    28    1    376   77     146      83     27       9      0      7
     Breast                            377      349    28    1    376   77     146      83     27       9      0      7
     Female Genital System             107       97    10    0    107    2      44       7     28       8      3      5
     Cervix Uteri                       15       14     1    0     15    0       6       2      5       0      1      0
     Corpus and Uterus, NOS             52       48     4    0     52    1      30       2      8       4      2      1
     Corpus Uteri                       50       46     4    0    50     1      30       1      8       4      1      1
     Uterus, NOS                         2        2     0    0      2    0       0       1      0       0      1      0
     Ovary                              32       29     3    0     32    0       7       3     14       3      0      2
     Vagina                              3        2     1    0      3    0       0       0      0       1      0      1
     Vulva                               2        2     0    0      2    1       0       0      0       0      0      1
     Other Female Genital Organs         3        2     1    0      3    0       1       0      1       0      0      0

10
ROPER ST. FRANCIS HEALTHCARE SYSTEMWIDE PRIMARY SITE TABLE
                                       Total       Class of Case    Sex
Primary Site                           Cases       Analytic NA Male Female Stg 0             Stg I   Stg II Stg III Stg IV   Stg   Unk
Male Genital System                     330          206 124 330         0   0                 2      176     16      7       1     4
Prostate                                323          202 121 323         0   0                 1      176     15      7       0     3
Testis                                    5            3      2   5      0   0                 1       0       0      0       1     1
Penis                                     1            0      1   1      0   0                 0       0       0      0       0     0
Other Male Genital Organs                 1            1      0   1      0   0                 0       0       1      0       0     0
Urinary System                          119          109     10  64     55  29                58       7       4      8       0     3
Urinary Bladder                          52           46      6  34     18  28                11       3       2      2       0     0
Kidney & Renal Pelvis                    66           62      4  30     36   0                47       4       2      6       0     3
Ureter                                    1            1      0   0      1   1                 0       0       0      0       0     0
Eye & Orbit                               4            0      4   1      3   0                 0       0       0      0       0     0
Eye & Orbit                               4            0      4   1      3   0                 0       0       0      0       0     0
Brain & Other Nervous System             54           51      3  18     36   0                 0       0       0      0      51     0
Brain                                    18           17      1  11      7   0                 0       0       0      0      17     0
Benign/Borderline Primary Intracranial  36            34      2  7      29   0                 0       0       0      0      34     0
   and CNS
Endocrine System                         40           37       3      9      31       0       20          2   0       4      10     1
Thyroid                                 29            27       2      5      24       0       20          2   0       4       0     1
Other Endocrine (including Thymus)       11           10       1      4       7       0        0          0   0       0      10     0
Lymphomas                               68            51      17     35      33       0       18         13   5      14      0      1
Hodgkin Lymphoma                          7            4       3      4       3       0        2          2   0       0       0     0
Hodgkin - Nodal                           5            4       1      3       2       0        2          2   0       0       0     0
Hodgkin - Extranodal                      2            0       2      1       1       0        0          0   0       0       0     0
Non-Hodgkin Lymphoma                     61           47      14     31      30       0       16         11   5      14      0      1
NHL - Nodal                              37           29       8     16      21       0        7          6   5      11       0     0
NHL - Extranodal                         24           18       6     15       9       0        9          5   0       3       0     1
Myeloma                                  18           13       5     10       8       0        0          0   0       0      13     0
Multiple Myeloma                         18           13       5     10       8       0        0          0   0       0      13     0
Leukemias                                39           29      10     24      15       0        0          0   0       0      29     0
Lymphocytic Leukemia                     13            6       7      7       6       0        0          0   0       0       6     0
Chronic Lymphocytic Leukemia             13            6       7      7       6       0        0          0   0       0       6     0
Myeloid & Monocytic Leukemia             25           22      3      16       9       0        0          0   0       0      22     0
Acute Myeloid Leukemia                   15           14       1     10       5       0        0          0   0       0      14     0
Acute Monocytic Leukemia                  2            2       0      0       2       0        0          0   0       0       2     0
Chronic Myeloid Leukemia                  5            4       1      3       2       0        0          0   0       0       4     0
Other Myeloid/Monocytic Leukemia          3            2       1      3       0       0        0          0   0       0       2     0
Other Leukemia                            1            1       0      1       0       0        0          0   0       0       1     0
Other Acute Leukemia                      1            1       0      1       0       0        0          0   0       0       1     0
Mesothelioma                              9            9       0      8       1       0        3          0   1       4       1     0
Mesothelioma                              9            9       0      8       1       0        3          0   1       4       1     0
Kaposi Sarcoma                            2            1       1      2       0       0        0          0   0       0       1     0
Kaposi Sarcoma                            2            1       1      2       0       0        0          0   0       0       1     0
Ill-Defined/Unspecified                  43           41       2     22      21       0        0          0   0       0      41     0
Ill-Defined and Unspecified Sites        43           41       2     22      21       0        0          0   0       0      41     0
Invalid                                   6            1       5      1       5       0        0          0   0       1       0     0
**Invalid Site                            6            1       5      1       5       0        0          0   0       1       0     0

Total                                   1,928        1,598 330      923     1,005    132     449     377      198   204      173   64

Note:
- This report excludes primary sites with a count of '0'.
- Groups in gray font aggregate to form the category immediately above the 1st item in the group.
** Invalid Site group includes:
1. Any site or histology code not within valid range or site code not found in the primary site table.
2. Cases with unusual primary site/histology codes that have been over-ridden in an edit.
3. Sites with a primary site code of C44* with histology codes 8000-8110
Invalid Site group does NOT include cases where the Behavior code is 0 or 1.
(NAACCR Volume III, Data Analysis and Reporting, Process Standards Chapter III.B.1)




                                                                                                                                         11
     2007 DISTRIBUTION OF CASES

      ROPER HOSPITAL 2007 PRIMARY SITE TABLE
                                                Total     Class of Case   Sex
      Primary Site                              Cases     Analytic NA Male Female Stg 0             Stg I   Stg II Stg III Stg IV Stg NA

      Buccal Cavity & Pharynx                     32        24       8     22        10      0        2       0       7        7       1
      Tongue                                       6          5       1      5        1      0        1       0       1        2       0
      Salivary Glands                              5          3       2      4        1      0        0       0       2        1       0
      Floor of Mouth                               2          1       1      2        0      0        0       0       0        0       0
      Gum & Other Mouth                            5         4       1       2        3      0        1       0       1        1       1
      Nasopharynx                                  3          3       0      2        1      0        0       0       3        0       0
      Tonsil                                       3          3       0      2        1      0        0       0       0        0       0
      Oropharynx                                   4          2       2      2        2      0        0       0       0        0       0
      Hypopharynx                                  4          3       1      3        1      0        0       0       0        3       0
      Digestive System                           280        242      38    152      128      6       47      62      50       52      15
      Esophagus                                   26         21       5     19        7      0        5       7       4        4       0
      Stomach                                     21         17       4     15        6      0        6       1       1        4       4
      Small Intestine                             11         10       1      5        6      0        0       3       0        2       5
      Colon Excluding Rectum                     102        90       12     54       48      6       21      20      29       13       1
      Cecum                                       23         21       2     10       13      2        5       4       9        1       0
      Appendix                                     2          2       0      1        1      0        0       0       1        0       1
      Ascending Colon                             16         16       0      7        9      1        3       7       2        3       0
      Hepatic Flexure                              1          1       0      1        0      0        0       1       0        0       0
      Transverse Colon                            11         10      1       6        5      1        0       3       6        0       0
      Splenic Flexure                              2          2       0      2        0      0        1       1       0        0       0
      Descending Colon                             7          7       0      3        4      0        3       0       3        1       0
      Sigmoid Colon                               36         27       9     22       14      2        9       3       8        5       0
      Large Intestine, NOS                         4          4       0      2        2      0        0       1       0        3       0
      Rectum & Rectosigmoid Junction              48         37      11    24        24      0        8      11       6        9       0
      Rectosigmoid Junction                        5          4       1      5        0      0        1       0       1        2       0
      Rectum                                      43         33      10     19       24      0        7      11       5        7       0
      Anus, Anal Canal & Anorectum                12         10       2      3        9      0        2       7       1        0       0
      Liver & Intrahepatic Bile Duct              11         10       1      9        2      0        2       2       3        2       0
      Liver                                       11         10       1      9        2      0        2       2       3        2       0
      Gallbladder                                  1          1       0      1        0      0        0       0       0        1       0
      Other Biliary                                4         4       0       3        1      0        0       1       2        0       0
      Pancreas                                    37         35       2     16       21      0        3      10       4       16       0
      Retroperitoneum                              1         1       0       1        0      0        0       0       0        1       0
      Peritoneum, Omentum & Mesentery              3         3       0       1        2      0        0       0       0        0       2
      Other Digestive Organs                       3          3       0      1        2      0        0       0       0        0       3
      Respiratory System                         229        212      17    124      105      2       65      10      46       69       2
      Nasal Cavity, Middle Ear
      & Accessory Sinuses                         1          0       1       0       1       0       0        0      0        0        0
      Larynx                                      13         11      2       11      2       1       6        2      0        2        0
      Lung & Bronchus                            214        200      14     112     102      1       59       8      46       67       1
      Trachea, Mediastinum
      & Other Respiratory Organs                  1           1       0      1        0       0       0       0       0       0        1
      Bones & Joints                              1           1       0      1        0       0       0       0       0       0        0
      Bones & Joints                              1           1       0      1        0       0       0       0       0       0        0
      Soft Tissue                                 8           6       2      7        1       0       2       1       0       1        0
      Soft Tissue (including Heart)               8          6        2      7        1       0       2       1       0       1        0
      Skin excluding Basal & Squamous            90          51      39     54       36      13      26      6       2        2        0
      Melanoma - Skin                            88         50       38     54       34      13      26       5       2       2        0
      Other Nonepithelial Skin                    2           1       1      0        2       0       0       1       0       0        0
      Breast                                     370        342      28      1      369      77     143      79      27       9        0
      Breast                                     370        342      28      1      369      77     143      79      27       9        0

     Note: - This report excludes primary sites with a count of '0'. - Groups in gray font aggregate to form the category immediately above
     the 1st item in the group. ** Invalid Site group includes: 1. Any site or histology code not within valid range or site code not found in
     the primary site table. 2. Cases with unusual primary site/histology codes that have been over-ridden in an edit. 3. Sites with a pri-
12   mary site code of C44* with histology codes 8000-8110 Invalid Site group does NOT include cases where the Behavior code is 0 or 1.
     (NAACCR Volume III, Data Analysis and Reporting, Process Standards Chapter III.B.1)
ROPER HOSPITAL 2007 PRIMARY SITE TABLE
                                         Total   Class of Case   Sex
Primary Site                             Cases   Analytic NA Male Female Stg 0   Stg I   Stg II Stg III Stg IV Stg NA

Female Genital System                    104       95    9      0   104   2       43      7      28      8      3
Cervix Uteri                              15       14    1      0    15    0       6      2       5      0       1
Corpus and Uterus, NOS                    51       47    4      0    51    1      29      2       8      4       2
Corpus Uteri                              49       45    4      0    49    1      29      1       8      4       1
Uterus, NOS                                2        2    0      0     2    0       0      1       0      0       1
Ovary                                     31       29    2      0    31    0       7      3      14      3       0
Vagina                                     2        1    1      0     2    0       0      0       0      1       0
Vulva                                      2        2    0      0     2    1       0      0       0      0       0
Other Female Genital Organs                3        2    1      0     3    0       1      0       1      0       0
Male Genital System                      305      184   121   305    0    0       1      161     13      6      0
Prostate                                 300      182   118   300     0   0        0     161     13      6      0
Testis                                     4        2    2      4     0    0       1      0       0      0       0
Penis                                      1        0    1      1     0    0       0      0       0      0       0
Urinary System                            89       80    9     49    40   20      43      5       3      6       0
Urinary Bladder                           37       32    5     26    11   19       8      2       1      2       0
Kidney & Renal Pelvis                     51       47    4     23    28    0      35      3       2      4       0
Ureter                                     1        1    0      0     1    1       0      0       0      0       0
Eye & Orbit                                4        0    4      1     3    0       0      0       0      0       0
Eye & Orbit                                4        0    4      1     3    0       0      0       0      0       0
Brain & Other Nervous System              41       39    2     15    26    0       0      0       0      0      39
Brain                                     14       13    1      9     5    0       0      0       0      0      13
Benign/Borderline Primary Intracranial
and CNS                                  27       26     1     6    21     0       0       0      0       0     26
Endocrine System                         38       35     3     8    30     0      19       2      0       4      9
Thyroid                                  28       26     2     4    24     0      19       2      0       4      0
Other Endocrine (including Thymus)       10        9     1     4     6     0       0       0      0       0      9
Lymphomas                                62       46    16    33    29     0      14      13      4      14     0
Hodgkin Lymphoma                          7        4     3     4     3     0       2       2      0       0      0
Hodgkin - Nodal                           5        4     1     3     2     0       2       2      0       0      0
Hodgkin - Extranodal                      2        0     2     1     1     0       0       0      0       0      0
Non-Hodgkin Lymphoma                     55       42    13    29    26     0      12      11      4      14      0
NHL - Nodal                              32       24     8    14    18     0       3       6      4      11      0
NHL - Extranodal                         23       18     5    15     8     0       9       5      0       3      0
Myeloma                                  16       11     5    10     6     0       0       0      0       0     11
Multiple Myeloma                         16       11     5    10     6     0       0       0      0       0     11
Leukemias                                38       28    10    23    15     0       0       0      0       0     28
Lymphocytic Leukemia                     13        6     7     7     6     0       0       0      0       0      6
Chronic Lymphocytic Leukemia             13        6     7     7     6     0       0       0      0       0      6
Myeloid & Monocytic Leukemia             24       21     3    15     9     0       0       0      0       0     21
Acute Myeloid Leukemia                   14       13     1     9     5     0       0       0      0       0     13
Acute Monocytic Leukemia                  2       2      0     0     2     0       0       0      0       0      2
Chronic Myeloid Leukemia                  5        4     1     3     2     0       0       0      0       0      4
Other Myeloid/Monocytic Leukemia          3        2     1     3     0     0       0       0      0       0      2
Other Leukemia                            1        1     0     1     0     0       0       0      0       0      1
Other Acute Leukemia                      1        1     0     1     0     0       0       0      0       0      1
Mesothelioma                              8        8     0     7     1     0       3       0      1       3      1
Mesothelioma                              8        8     0     7     1     0       3       0      1       3      1
Kaposi Sarcoma                            2        1     1     2     0     0       0       0      0       0      1
Kaposi Sarcoma                            2        1     1     2     0     0       0       0      0       0      1
Ill-Defined/Unspecified                  41       39    2     21    20     0       0       0      0       0     39
Ill-Defined and Unspecified Sites        41       39    2     21    20     0       0       0      0       0     39
Invalid                                   6        1     5     1     5     0       0       0      0       1      0
**Invalid Site                            6        1     5     1     5     0       0       0      0       1      0

Total                                    1,764   1,445 319    836   928   120    408     346    181    182     149


                                                                                                                        13
We Believe in Outreach
                             In 2007, the Roper St. Francis Cancer Center participated in 47 community
 Breast Cancer Screenings:
                             events that reached 32,443 participants from more than six counties. Event
 39 Normal                   participants were educated on cancer prevention and early detection for all disease
 4   Required follow-up      sites, with a focus on breast, prostate, skin, colorectal and lung cancers. 250 of the
                             participants completed a cancer risk assessment that covered those cancer sites.

 Prostate Screenings:        The Oncology Research Department offered cancer screenings throughout the
                             year, with the help of volunteer physicians. These screenings included skin,
 47 Normal
                             prostate and breast cancer for 249 participants.
 31 Required follow-up


 Skin Cancer Screenings:
                             CLINICALTRIALS AND RESEARCH
 128 screenings
                             The Cancer Center maintains an active clinical trials department that offers
                             patients the ability to participate in national research studies through our
                             association with the Southeast Cancer Control Consortium, Inc (SCCC). SCCC
                             is a community clinical oncology program located in Winston-Salem, N.C.
                             Roper St. Francis Cancer Center’s participation in SCCC provides our physicians
                             with access to clinical trials through various research groups such as Cancer and
                             Leukemia Group B (CALGB), National Surgical Adjuvant Breast and Bowel
                             Project (NSABP), Southwest Oncology Group (SWOG), Radiation Therapy
                             Oncology Group (RTOG), University of Michigan Oncology Group (UMCC),
                             and University of Rochester Oncology Group (URCC). Cancer clinical trials
                             allow us to provide state-of-the-art treatment in cancer care. The clinical trials
                             department has studies open in all disease sites with an average of 30 studies open
                             for treatment and prevention at any time. Participation in clinical trials demon-
                             strates our commitment to further cancer treatment and prevention. Areas where
                             patients are currently being enrolled in trials include breast, colorectal, lung,
                             pancreas, prostate, gallbladder, lymphoma, skin, head and neck, gastric and
                             esophagus and myleodysplasia.




14
15
We Believe in Support
                                    GROWTH IN PALLIATIVE CARE
                                    Life becomes precious for cancer patients with advancing disease or severe
                                    symptoms from their cancer. The Roper St. Francis Palliative Care Team uses the
                                    advances of modern medicine and applies them not to cure or treatment but to
                                    the relief of physical and emotional suffering. The palliative medicine service tries
                                    to meet the needs, not just of the patient in and out of the hospital, but also of
                                    the patient's family, helping to navigate the medical complexities, to obtain the
                                    assistance for recovery or to ease the patient through the end of life and make
                                    decisions about treatments as an illness progresses.

                                    Palliative care has become integrated into best practice for the treatment of cancer
                                    patients. Roper St. Francis leaders, recognizing the importance of providing this
                                    high quality and compassionate care, have now employed 2 full-time physicians
                                    who are board certified in the specialty of palliative medicine. These physicians
                                    work alongside an interdisciplinary team of nurses, social workers and chaplains
                                    to provide sophisticated medical management of symptoms, such as pain and
                                    fatigue, as well as enhanced communication about patient choices. In 2007, 34%
                                    of system-wide palliative medicine consults (433) had a diagnosis of cancer (116).
                                    The palliative care team also saw a significant decrease in the number days from
                                    the patient admission to the request for a palliative care consult.




 RSFH PALLIATIVE CARE CONSULTS WITH A CANCER DIAGNOSIS
                          ALOS*
                           Admit             from PC               Home              Inpatient
              Referrals    to PC            Consult to            Hospice             Hospice            Expired as
 Year          to PC      Consult               DC               Discharge           Discharge            Inpatient

 2005            39       20.3 days          9.4 days               18%                  3%                  45%
 2006            92       15.9 days          6.4 days               30%                  19%                 24%
 2007            116      8.0 days           4.8 days               17%                  40%                 24%

*Average length of stay




16
AMERICAN CANCER
SOCIETY PATIENT
NAVIGATOR
The Roper St. Francis Cancer Center
is the only cancer program in South
Carolina with a full-time American
Cancer Society (ACS) Patient
Navigator. Through this free,
confidential program, a specially
trained navigator helps patients
manage the day-to-day concerns that
can often accompany a cancer
diagnosis, helping them stay on track
with treatments and follow-up care.
The ACS Patient Navigator connects
patients and families with resources
for transportation, lodging and other
local assistance, and helps them
navigate the complexities of financial
and insurance needs.



BREAST HEALTH
NAVIGATOR
Much like the ACS Patient Navigator,
only dedicated solely to the needs and
well-being of breast cancer patients,
our Breast Health Nurse Navigator is
focused on guiding breast cancer
patients through the complex maze of
information, treatment and therapy
regimens. The Breast Health
Navigator acts as a familiar resource
person, offering personalized caring
support throughout the breast cancer
experience. Our Nurse Navigator is a
clinical specialist trained to ensure
patients receive optimum continuity
of care, which can help improve
clinical outcomes.




                                         17
Review of Diagnosis, Treatment
and Survival of Non-small Cell
Lung Cancer at Roper Hospital
Matthew A. Beldner, MD; Elizabeth M. Kline, MD; Ellen R. Kolender, RHIA, CRT and J. Scott Broome, FACHE


INTRODUCTION                                diagnosed in the state. South Carolina
                                            compares unfavorably with national
In 2007, an estimated 215,000 new           data with respect to incidence of, and
cases of lung cancer (non-small cell        mortality from, lung cancer. Specifi-
and small cell combined) will be            cally, compared to national averages,
diagnosed. It is also estimated that        an additional six South Carolinians
nearly 162,000 American men and             per 100,000 are diagnosed with and
women will die of lung cancer during                                                Matthew A. Beldner, MD Elizabeth M. Kline,MD
                                            die from lung cancer. More strikingly,
2007, making it the leading cause of        huge disparities exist between South
cancer-related deaths for Americans.        Carolina counties with respect to both
Unfortunately, lung cancer accounts         incidence and survival of lung cancer.
for 15% of all cancers diagnosed in         Annually, it is estimated that in South
America annually and the corres-            Carolina counties with the highest
ponding 5-year observed survival rates      lung cancer mortality rates, an
                                                                                     METHODS
for lung cancer, all stages, are            additional 34 persons per 100,000        Lung cancer data from the Roper
uniformly less than 20%. Even more          will die from the disease and an         St. Francis Cancer Registry were
troubling is the fact that overall lung     additional 24 persons per 100,000        compiled for years 2000-2005 and
cancer survival over the last 30 years      will be diagnosed. (SC counties with     studied for a multitude of variables
has not improved significantly.             highest mortality: Marlboro County --    ranging from American Joint
Specifically, 5-year observed survival      88.8 vs. 54.1 per 100,000; SC highest    Committee on Cancer (AJCC) stage
rates for lung cancer, all stages, for      incidence: Colleton County 98.4 vs.      at presentation, histology of diagnosis,
patients diagnosed during 1975-1977         74.2 per 100,000).                       first line therapy and 5-year survival.
were 13%; from 1984-1986, this                                                       Five-year cumulative observed survival
figure had not changed. More                Based on 2007 data, the Roper St.        rates for the period 1996-2005 were
recently, 5-year observed survival rates,   Francis Cancer Center diagnosed 219      also studied from the National Cancer
all stages, for the period 1996-2003        cases of new lung cancer, which          Institute’s Surveillance Epidemiology
had improved slightly to 16%. Stage         represents 13% of all cancer cases       and End Results (SEER) database and
specific observed survival analysis         diagnosed by the cancer center for the   are reported here. State data collected
suggests more optimistic results for        year. 120 of these cases were male       and used for comparison were taken
patients diagnosed with Stage I             patients and 99 were female. Non-        from the South Carolina Central
disease, with slightly less than 50% of     small cell lung cancer accounted for     Registry (SCCR), and with the
those patients surviving five years.        86% of lung cancer cases diagnosed,      exception of survival data, national
Therefore, these statistics underscore      with 14% classified as small cell lung   statistics are from the National Cancer
the importance of screening and early       carcinoma. Of the non-small cell lung    Database (NCDB). For purposes of
detection with lung cancer, which is        cancer patients, 38% were diagnosed      this analysis, only non-small cell lung
discussed later in this article.            in the early stages (cancer was          cancer was considered. The Roper St.
                                            localized) of disease, 27% of patients   Francis Registry data reflects cases
During 2007, approximately 3,400            had disease present in lymph nodes       from Roper Hospital only, and does
South Carolinians were diagnosed            and/or regional sites at diagnosis, and  not include Bon Secours St. Francis
with lung cancer, making it the             35% of patients had distant spread at    Hospital data.
second most frequent cancer                 diagnosis.
18
RESULTS                                   findings, potentially supporting better    Often radiation therapy alone as a first
                                          biopsy techniques and improved             line modality is reserved for patients
First, on the basis of AJCC stage at      sampling in association with a more        with a worse performance status
presentation, Roper St. Francis Cancer    highly skilled pathology department,       and/or symptomatic disease. The fact
Center lung cancer data for 2000-         which understands the significance of      that more patients receive some form
2005 were compared to state and           histological subtypes in treatment         of treatment versus supportive care
NCDB data for the same time period.       planning. Advances in chemotherapy         alone may also support the hypothesis
Roper St. Francis Cancer Center saw       have provided alternative therapies        of early diagnosis.
37.8% of patients diagnosed as less       depending on histological subtypes,
than or equal to AJCC stage II versus     reinforcing the importance of accurate     Finally, survival rates for lung cancer
31.1% for NCDB and 33.2% for              diagnoses.                                 patients at the Roper St. Francis
South Carolina. Patients diagnosed as                                                Cancer Center are favorable to state
greater than or equal to AJCC stage       Findings on first course treatment         and national norms. Data used to
III or IV varied by less than 1% with     options for lung cancer patients at the    demonstrate this finding were 5-year
state and national norms. Notably, for    Roper St. Francis Cancer Center            cumulative observed survival for non-
the Roper St. Francis Cancer Center,      suggest physicians favor regimens          small cell lung cancer, all subtypes, for
less than 1% of patients were staged as   containing chemotherapeutic agents         years 1996-2005 compared to data
“unknown” versus 8.4% of NCDB             either alone or in combination with        from Surveillance Epidemiology and
patients and 6.9% for South Carolina.     other modalities when compared to          End Results (SEER), compiled and
To the extent that accurate staging       national and state normative data.         reported by the National Cancer
effects treatment, more accurate and      Specifically, only 9.24% of Roper St.      Institute. It should be noted that
complete staging of patients at the       Francis Cancer Center patients receive     SEER data are not presented in AJCC
Roper St. Francis Cancer Center is a      radiation therapy as a single modality     staging format so correlating these
favorable finding.                        versus 15.7% and 16.4% of patients         data with NCDB survival data is
                                          at other centers in the nation and         difficult. For local disease at diagnosis,
Roper St. Francis lung cancer data        state, respectively. Correspondingly,      43.1% of patients treated at Roper St.
were compared to state and NCDB           19.4% of Roper St. Francis patients        Francis were living five years after
data for histological classification at   receive first line chemotherapy only       diagnosis versus 39.2% of patients
diagnosis for the period 2000-2005.       versus 11.6% and 9.3% of patients at       treated at any SC center and 42.9% of
Roper St. Francis reports 43.2% of        other centers in the nation and state,     patients treated at any center
non-small cell lung cancer patients as    respectively. Utilization rates of first   nationwide. For regional disease at
adenocarcinoma versus 35.8% and           line regimens combining                    diagnosis, 19.6% of Roper St. Francis
30.5% of NCDB and SCCR patients,          chemotherapy with radiation therapy        patients survived five years versus
respectively. Correspondingly, Roper      and/or surgery appear similar to both      14.1% of patients treated at any SC
St. Francis reported fewer large cell     national and state norms. Finally, the     center and 20.4% of patients treated
carcinoma (2.2% vs. 5.4%, 9.3%,           data demonstrate that approximately        at any center nationwide. And for
NCDB, SCCR, respectively) and             13.7% of patients at Roper St. Francis     patients with distant disease at
non-small cell carcinoma (15.1% vs.       do not receive any first line therapy      presentation, 3.8% of Roper St.
19.7%, 18.7%, NCDB, SCCR,                 versus 21.3% and 22.1% of patients         Francis patients were living five years
respectively) patients than NCDB or       at national and state centers              after diagnosis, compared to only
state with all other subtypes being       respectively. Due to the higher            2.7% and 3.2% of patients treated at
approximately equivalent. At 24.7%,       incidence of earlier stage disease as      any center in the state or nation,
Roper St. Francis reported a slightly     compared to national and state             respectively. Although, not evaluated
fewer patients with squamous cell         averages, it is likely patients have a     statistically, the survivorship of Roper
carcinoma than state and national         better performance status at time of       St. Francis patients compares favorably
percentages at 28.1% and 25.5%,           diagnosis, making it more likely they      with state averages and possibly even
respectively. These are interesting       would receive more aggressive              superior to the national level.
                                          therapies to try and achieve a cure.
                                                                                                                            19
     CONCLUSIONS                                  a better response to certain
                                                  chemotherapy regimens and this alone
     This review of Roper St. Francis             may support the improved
     Cancer Center Registry data for non-         survivorship demonstrated in patients
     small cell lung cancer cases diagnosed       at various stages of disease.
     during the period 2000-2005 suggests         Additionally, the histological subtype
     several interesting findings. First, it      is important, as certain systemic
     appears from the data that Roper St.         treatments would be contraindicated.
     Francis patients had less advanced           The value of knowing the correct
     disease at diagnosis than other state        histological subtype is paramount in
     and national centers. This conclusion        designing a treatment plan that is
     is somewhat uncertain because other          tailored to each individual patient.
     centers have notably more patients
     staged as “unknown” versus less than         Survival rates, using SEER data for
     one percent at Roper St. Francis,            1996-2005, for non-small cell lung
     however it is unlikely that all of the       cancer patients at the Roper
     unknown patients would be less than          St. Francis Cancer Center appear
     or equal to stage II. Regardless, there is   favorable to statewide South Carolina
     an effort by the Commission on               rates (SCCR) and approximately
     Cancer to move requirements for              equivalent to national (NCDB) rates,
     clinical stage documentation to earlier      regardless of stage of disease at
     in the diagnostic process because of         presentation. Many Roper St. Francis
     the necessity of staging data for use in     program attributes contribute to this
     treatment planning. Therefore,               finding, including consistent
     whether Roper St. Francis patients are       presentation of lung cancer cases at
     less advanced at presentation or not,        weekly cancer conferences for
     definitive staging at Roper St. Francis      multidisciplinary feedback, depth of
     patients is helpful.                         board certified surgeons, oncologists
                                                  and pulmonologists on staff with
     It was noted that a greater percentage       experience in lung cancer, access to
     of Roper St. Francis non-small cell          latest diagnostic and therapeutic
     lung cancer patients are diagnosed as        technologies, and excellent radiologic
     having the adenocarcinoma subtype            and pathologic diagnosticians
     when compared with patients at other         supporting the treating physicians.
     state and national centers.                  Additionally, while the importance of
     Correspondingly, less Roper                  this variable cannot be defined within
     St. Francis patients are diagnosed with      the scope of this analysis, the finding
     large cell carcinoma, non-small cell         of less than one percent of Roper St.
     carcinoma, and squamous cell                 Francis cases with incomplete stage
     carcinoma. This finding could be due         (versus 7-8% at other centers) is in
     to more complete work-up by                  keeping with the Commission on
     pathologists during assessment of            Cancer’s recent focus on use of clinical
     specimens for tissue diagnosis, better       stage in treatment planning.
     biopsy or sampling techniques by
     surgeons, or a real difference in
     presentation at the community level.
     Adenocarcinoma does appear to have

20
EARLY DETECTION AND                        offers smoking cessation programs to
                                           its employees and the public based on
PREVENTION                                 the QuitSmart methodology,
                                           developed at Duke University Medical
As with all cancers, prevention and
                                           Center.
early detection are critical components
of improving survival and longevity        Addressing other common cancer-risk
with lung cancer. Unfortunately with       reducing factors is also important.
lung cancer, an early detection strategy   According to the American Cancer
is difficult because patients are often    Society everyone, smokers and non-
asymptomatic until disease has             smokers, may be able to reduce their
progressed. In fact, many early lung       risk of lung cancer by eating a healthy,
cancers are diagnosed incidentally,        balanced diet with at least five serving
discovered as a result of tests            of fruits and vegetables every day.
performed for an unrelated medical         People should find out if they are
condition. Because of the aggressive       exposed to cancer-causing chemicals
nature of the disease, the generally       at work and take appropriate measure
poor prognosis for lung cancer             to protect themselves. Monitoring
patients and the challenges with early     indoor radon levels, especially in the
detection, prevention is clearly the       home, can also protect against lung
best therapeutic strategy.                 cancer. Risk factor assessment is
                                           critically important as high-risk
Quitting smoking, or not starting at
                                           individuals, such as smokers or those
all, is by far the best way to prevent
                                           with occupational exposures, can be
lung cancer. 87% of lung cancer
                                           screened more frequently, starting at
deaths in this country are directly
                                           an earlier age. As part of our aggressive
linked to cigarette smoking.
                                           outreach effort, the Roper St. Francis
According to the American Cancer
                                           Cancer Center provides educational
Society, those who successfully quit
                                           information on lung cancer and other
smoking reap health benefits at any
                                           related topics to approximately 52,000
age. Only one to nine months after
                                           people per year. Additionally, 115
quitting, coughing and shortness of
                                           people per year take a directed lung
breath decrease and lung function
                                           cancer risk assessment tool designed to
improves; one year after quitting, the
                                           help people understand and reduce
risk of heart disease is cut in half and
                                           their risk for developing the disease.
five years after quitting, the risk of
stroke is reduced. For those who have
quit smoking for 10 years, the risk of
dying from lung cancer is cut in half,
and the risk of cancer of the mouth,
throat, esophagus, bladder, cervix and
pancreas decrease. Second hand
smoke should also be avoided. All
Roper St. Francis facilities have been
smoke-free since 2006 and the system




                                                                                       21
     LUNG CANCER DATA

     STAGE AT INITIAL PRESENTATION (2000-2005)
            Stage           NCDB        Roper       SC            NCDB     Roper     SC
             0               1,939        11         26             0.3%     1.3%    0.3%
             1             145,449       249       2,337           23.4%    28.8%    24.7%
             2              45,987        67        775             7.4%     7.7%     8.2%
             3             157,371       227       2,400           25.3%    26.2%    25.4%
             4             220,043       304       3,262           35.3%    35.1%    34.5%
          Uknown            52,083        8         651             8.4%     0.9%    6.9%
                           622,872       866       9,451          100.0%   100.0%   100.0%


         AJCC Stage         NCDB       Roper        SC
     Stage < / = 2          31.0%      37.8%       33.2%
     Stage > / = 3          60.6%      61.3%       59.9%
     Unknown                 8.4%      0.9%        6.9%


     HISTOLOGY AT DIAGNOSIS (2000-2005)
          Histology         NCDB        Roper       SC            NCDB     Roper     SC
     LCC                    33,756        19        883             5.4%    2.19%    9.3%
     **NSCC                122,374       131       1,769           19.7%   15.13%    18.7%
     Squamous CC NOS       158,620       214       2,658           25.5%   24.71%    28.1%
     Adenocarcinoma        223,174       374       2,878           35.8%   43.19%   30.5%
     Broncho-Av Adeno C     21,200        28        287             3.4%   3.23%      3.0%
     Other                  63,748       100        976            10.2%   11.55%    10.3%
                           622,872       866       9,451          100.0%   100.0%   100.0%

     FIRST COURSE OF TREATMENT AT ROPER HOSPITAL (2000-2005)
         Treatment          NCDB        Roper       SC            NCDB     Roper     SC
     Surg                  131,328       185       2,078           21.1%    21.4%   22.0%
     XRT                    97,817        80       1,548           15.7%     9.2%    16.4%
     Surg XRT                143           0         43            0.0%      0.0%     0.5%
     Surg Chemotherapy       173           0         79            0.0%      0.0%     0.8%
     XRT CT                127,293       206       1,969          20.4%    23.8%    20.8%
     CT                     71,954       168        883            11.6%    19.4%    9.3%
     Surg XRT CT            19,511        40        286             3.1%     4.6%     3.0%
     Other                  42,107        68        473            6.8%      7.9%     5.0%
     No 1st Course Tx      132,546       119       2,092           21.3%    13.7%    22.1%
                           622,872       866       9,451          100.0%   100.0%   100.0%


     LCC = Large Cell Carcinoma NSCC = Non-Small Cell Carcinoma
     Broncho-Av Adeno C = Broncho-Aveolar Adenocarcinoma
     XRT = Radiation Therapy CT = Chemotherapy
22
5-YEAR CUMULATIVE OBSERVED SURVIVAL RATE (%)
FOR NON-SMALL CELL LUNG CANCER
BY SEER STAGE AT DIAGNOSIS

      5-YR CUMULATIVE OBSERVED SURVIVAL RATE
Time Period   Stage at Diagnosis   RH     SC     SEER
1996-2005           Local          43.1   39.2   42.8
                  Regional         19.6   14.1   20.4
                   Distant         3.8    2.7    3.2
                UnK/Unstg/NA        1.3   8.3    6.3




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