The Valley Hospital Cancer Program Annual Report December 2009

The Valley Hospital Cancer Program 2008 Annual Report December 2009 T he Staff of T he Val le y Hospital Ca nce r Ce nte r The 2008 Valley Hospita...
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The Valley Hospital Cancer Program 2008 Annual Report

December 2009

T he Staff of T he Val le y Hospital Ca nce r Ce nte r

The 2008 Valley Hospital Cancer Committee Robert J. Korst, M.D. Chairman, Cancer Committee; Physician Liaison, American College of Surgeons Commission on Cancer; Director, Thoracic Surgery; Medical Director, Blumenthal Cancer Center Anusak Yiengpruksawan, M.D. Vice Chairman Subspecialty Director, Surgical Oncology Arthur Antler, M.D. Gastroenterology Harold Bruck, M.D. Surgery (General) William Burke, M.D. Gynecologic Oncology Lisa Cannon, M.D. Pulmonology Allen Chinitz, M.D. Oncology/Hematology Chad DeYoung, M.D. Radiation Oncology Barry Fernbach, M.D. Medical Oncology Howard Frey, M.D. Urology Ganepola A.P. Ganepola, M.D. Surgery

Andrey Gritsman, M.D. Director, Pathology & Laboratory Medicine Noah Goldman, M.D. Gynecologic Oncology Peter Kaye, M.D. Colorectal Surgery Eli Kirshner, M.D. Medical Oncology Dawn Lazarus, M.D. Diagnostic Imaging Linda Marcus, M.D. Director, Dermatology Viswanathan Rajaraman, M.D. Neurosurgery Thomas Rakowski, M.D. Medical Oncology Mitchell Rubinstein, M.D. Vice President, Medical Affairs Arnold Scham, M.D. Psychiatry Metin Taskin, M.D. Pathology Robert Tassan, M.D. Medical Oncology Michael Wesson, M.D. Medical Director, Radiation Oncology Ignatios Zairis, M.D. Thoracic Surgery

Jeff Lieto Vice President, Ambulatory & Strategic Development Sandy Balentine Director, Clinical Oncology Cynthia Brady Chaplain, Pastoral Care Patricia Caputo Director, Radiation Oncology Veronica Dalcero Oncology Social Worker Moises Junchaya, Rh.P. Clinical Pharmacy Specialist Nancy Librera Assistant Vice President, Oncology Service Kris MacMillan, R.N., M.S.N. Director, Valley Hospice Nancy Palumbo, R.N., B.S.N. Oncology Program Coordinator Cheryl Parish, R.N., B.S.N., M.B.A. Manager, Clinical Trials Kim Marie Robles, R.N. Director, Quality Assessment/Improvement & Regulatory Compliance Nina Rubin, R.D. Supervisor, Nutrition & Wellness Patrice Wilson, R.N., M.S.N., M.A., C.S. Manager, Inpatient Oncology

A Message from the Chairman

It is with great pride that I present our 2008 Annual Report on behalf of the physicians and staff of the Daniel and Gloria Blumenthal Cancer Center. Last year was an exemplary year for The Center as many of our newest programs and innovations established themselves through clinical excellence, outstanding patient care and exceptional service to patients throughout the region. Valley has earned a formidable reputation as a leader in the prevention, diagnosis and treatment of the most prevalent cancers we face: lung, prostate, gynecologic, breast, and gastrointestinal, among others. In demonstration of our commitment, we have performed what I believe to be world-class research through our clinical trials, genomic studies and laboratory work. Our appointment in 2007 of a research scientist for our Center for Cancer Research and Genomic Medicine is proof of our growing commitment to finding clues to cancer’s most complex questions. I would like to acknowledge the many staff members and doctors who participated in the planning and presentation of our annual symposium: “Breast Cancer 2008: Contemporary Management Issues.” In this publication, you will find reports on cancers of the pancreas and prostate. I am grateful to Anusak Yiengpruksawan, M.D., and Howard Frey, M.D., for their analyses, and Allen Chinitz, M.D., for his insightful commentaries. As Cancer Committee Chairman I extend gratitude to my colleagues at the Daniel and Gloria Blumenthal Cancer Center for their continuing dedication to our patients and for their ongoing efforts to provide the excellent, compassionate care for which Valley is known. I look forward to another exceptional year. Sincerely, Robert J. Korst, M.D. Medical Director, Daniel and Gloria Blumenthal Cancer Center Director, Thoracic Surgery Chairman, Cancer Committee

From the Assistant Vice President, Oncology Service I am pleased to present our 2008 Annual Report. Over the past year, I have had the privilege of working with the region’s most accomplished physicians, dedicated nurses and skilled support staff. It is an honor to serve alongside you every day. It is a significant time for cancer care at The Valley Hospital. With a cutting edge research laboratory, new applications in minimally invasive and robotic surgery, and the highest caliber diagnostic and treatment tools, Valley has distinguished itself among cancer programs in the region. In addition to our strong commitment to diagnosis and treatment, our efforts towards survivorship and meeting the needs of those living with and beyond the cancer diagnosis have taken center stage. Our cancer team has pledged to lead the way in developing systems to support and promote the needs of cancer survivors. We remain committed to providing excellent clinical care, innovative programs and technology, promising clinical trials and a compassionate and respectful environment for patients and their families. We appreciate and thank you for your continued support. Sincerely,

Nancy Librera Assistant Vice President, Oncology Service

Highlights and Accomplishments

SITE

2006

2007

2008 ■ ■ ■ ■ ■ ■ ■ ■

13

24

24

Digestive System

303

319

358

Respiratory System

190

210

244

5

11

7

24

45

30

Breast

337

348

292

Female Genital

102

153

123

Male Genital

177

243

220

Urinary

90

108

117

Brain and other Nervous System

28

41

75

Endocrine System

53

59

72

Lymphoma

59

77

84

Myeloma

6

10

11

Leukemia

18

24

32

1

6

10

36

39

47

1443

1717

1746

Oral Cavity/Pharynx

Soft Tissue Skin (excl Basal & Squamous)

Mesothelioma Unknown Primary TOTAL

Valley Sees Rise in Analytical Cases The Valley Hospital's Cancer Program experienced another rise in the number of cancer patients treated. The total number of analytic cases in 2008 was 1,746. At left, is a three-year comparison.

Surgeon First to Complete New Fellowship Program ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Valley’s MIS Fellowship is a one-year training program aimed at providing advanced training to surgeons in minimally invasive (laparoscopic) GI/abdominal surgery, robotic surgery, and interventional endoscopy. With the advent of minimally invasive surgery over the last 2 decades, a need has arisen for training programs dedicated exclusively to these techniques, since surgery residents graduating from general surgery training programs do not get adequate experience in advanced laparoscopic/robotic/endoscopic techniques.

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In 2008, Jesse Moskowitz, M.D., became the first surgeon to complete the program. Program Directors are Robert J. Korst, M.D., and Anusak Yiengpruksawan, M.D. Faculty members are: Daniel Davis, D.O. (Bariatrics), Joseph Licata, M.D. (General Surgery), Thomas Ahlborn, M.D. (General Surgery), William Burke, M.D. (Pelvis/Gyn), Anusak Yiengpruksawan, M.D. (Oncology/Abdomen, Endoscopic Ultrasound), and Robert J. Korst, M.D. (Esophagus, Interventional Endoscopy).

Highlights and Accomplishments

Department of Radiation Oncology Awarded Re-accreditation In 2008, the Radiation Oncology Department of The Valley Hospital was once again awarded a three-year accreditation by the American College of Radiology (ACR). The ACR awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation. Evaluations are conducted by board-certified physicians and medical physicists who are experts in the field. They assess the qualifications of the personnel and the adequacy of facility equipment. The surveyors report their findings to the ACR’s Committee on Accreditation, which subsequently provides the practice with a comprehensive report.

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G ynecologic Cancer Specialist Appointed to Medical Staff Last year, The Valley Hospital welcomed gynecologic oncologist Noah A. Goldman, M.D., to the Medical Staff. Dr. Goldman joins William M. Burke, M.D., in the Subspecialty of Gynecologic Oncology. Board certified in Obstetrics and Gynecology and in Gynecologic Oncology, Dr. Goldman specializes in the surgical treatment of all types of gynecologic cancers and is a specialist in the use of minimally-invasive surgical techniques – including the use of the DaVinci Robotic Surgical System™ — for the treatment of gynecologic malignancies. Dr. Goldman received his medical degree from the University of Medicine

and Dentistry of New Jersey and completed his residency in Obstetrics and Gynecology at Mount Sinai School of Medicine. He completed a Galloway Fellowship in Gynecologic Oncology at Memorial Sloan Kettering Cancer Center during his residency, and a 3-year fellowship in Gynecologic Oncology at the Albert Einstein College of Medicine and Montefiore Medical Center.

CT Simulator The Department of Radiation Oncology acquired a new GE Lightspeed CT Simulator with 4D capability. The new technology has the ability to capture the full range of motion of critical internal structures and lesions during a respiratory cycle. The system’s powerful software can process 2,000 images within 5 minutes.

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Research Scientist Appointed David H. Chang, Ph.D., was appointed Research Scientist for The Valley Hospital Center for Cancer Research and Genomic Medicine, part of the Daniel & Gloria Blumenthal Cancer Center. The Research Center brings the latest research methods to Valley's physicians, surgeons and scientists in order to help develop better diagnostic and treatment plans for cancer patients. The lab integrates physicians’ clinical knowledge with scientists’ experimental techniques to study cancer using tissue samples collected at Valley. On-premises research already underway includes projects on colon cancer, bladder tumors and lung cancer. Upcoming studies include work on prostate, pancreatic and breast cancers. Dr. Chang received his doctorate from Columbia University, and completed his postdoctoral training at the Rockefeller University. His work includes research on dendritic cell vaccines, anti-tumor immunity and immunotherapy, cancer gene regulation and signal transduction, and multiple myeloma and lymphoma studies.

Five Gold Seals In 2008, Valley’s cancer program was the recipient of an impressive five Gold Seals of Approval for healthcare quality from the Joint Commission. Valley now holds Joint Commission Disease-Specific Care Certification for colorectal cancer, lung cancer, breast cancer, pancreatic cancer and prostate cancer. To earn this distinction, Valley underwent an extensive, on-site evaluation by a team of Joint Commission reviewers. Valley is the only hospital in New Jersey with five gold seals for cancer care.

”Valley’s cancer program was the recipient of an impressive five Gold Seals of Approval for healthcare quality from the Joint Commission.” ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

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Highlights and Accomplishments

Surgical Oncologist Hosts Colleagues from China

Tumor Registry Receives Award

In 2008, Anusak Yiengpruksawan, M.D., Director of Minimally Invasive and Robotic Surgery at The Valley Hospital, hosted physicians from Beijing, China. The physicians, who are on staff at the People's Liberation Army Second Artillery Corps General Hospital, visited Valley to meet with Dr. Yiengpruksawan to discuss his use of the da Vinci® Surgical System to perform minimally invasive robotic surgeries.

The Valley Hospital’s Tumor Registry received the Award for Excellence from The Oncology Registrars Association of New Jersey (ORANJ) in recognition of the timely and complete reporting of cancer data to the state. ORANJ, formerly known as the Tumor Registrars Association of New Jersey (TRANJ), is a non-profit professional organization that has been representing New Jersey Cancer Registrars since 1983.

The physicians from China sought out Dr. Yiengpruksawan’s expertise as a result of his clinical reputation in the field of robotic surgery. They were particularly interested in learning about Dr. Yiengpruksawan’s techniques for performing liver surgery using the daVinci System.

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Cancer Research Director the First Physician Ever Invited to Annual Global Forum Ganepola A.P. Ganepola, M.D., F.A.C.S., Medical Director of The Center for Cancer Research and Genomic Medicine at The Valley Hospital, was the first doctor to participate in last year’s Performance Theatre in New Delhi, India. The annual forum, sponsored by The Performance Theater Foundation in Oslo, Norway, typically seeks chairmen and CEOs of Fortune 500 companies and Nobel Laureates to discuss global economic and social issues, making Dr. Ganepola’s invitation most noteworthy. Dr. Ganepola was chosen to participate because of his background in traveling to many parts of the world as a visiting professor to promote healthcare education.

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Clinical Trials Honored Valley’s Department of Oncology Clinical Trials was honored in 2008 by the American College of Surgeons Oncology Group as a "Top 3 Performer" in the country for data, patient eligibility, and follow-up.

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Valley Health System’s Oncology Programs and Services Barrett’s Esophagus and GERD Center Brachytherapy Brain Lab Butterflies Program Cancer Genetics Program Cancer Resource Center Center for Cancer Research and Genomic Medicine Center for Colorectal Cancer Center for Complementary Therapies Center for Prostate Cancer Clinical Pathology Clinical Trials and Research Comprehensive Breast Center Cytodiagnostic Center Data Management Diagnostic Imaging Genetic Testing and Counseling Gynecologic Oncology Home Care Hospice and Palliative Care I-ELCAP Lung Cancer Screening Program Image Recovery Center Infusion Center Inpatient Oncology Institute for Robotic and Minimally Invasive Surgery Integrative Healing Services Journeys

Mammosite (Breast Brachytherapy) Medical Oncology Multidisciplinary Cancer Treatment Planning Conferences Multimodality Therapy Nutritional Counseling Lung Cancer Center Oncology Registry Oncology Social Work Outcomes Assessment Pain Management Pastoral Care Services PET Scanning Pet Therapy Pharmacy Consultation Professional and Community Education Pulmonary Nodule Center Radiation Oncology Retail Pharmacy Rehabilitation Services Screening and Early Detection Smoking Cessation Specimen Bank Stereotactic Radiosurgery Support Services Surgical Oncology Targeted Therapy TomoTherapy

Focus on Pancreatic Cancer

by Anusak Yiengpruksawan, M.D., Subspecialty Director of Surgical Oncology and Medical Director of The Valley Hospital Institute for Robotic and Minimally Invasive Surgery Since 1995, we have seen small improvements in the 5-year survival rates for pancreatic cancer (from 3% in 1995 to 5% in 2006). Nevertheless pancreatic cancer remains one of the most lethal cancers. In 2009, deaths caused by pancreatic cancer nationally are estimated to be 35,240 (6% of all cancer deaths). It is the fourth leading cause of death in both men (behind lung, prostate and colorectum) and women (behind lung, breast, and colorectum). In New Jersey, estimated deaths due to pancreatic cancer are projected to be 1,080 out of 16,480 cancer deaths. Although there has been significant progress in all fronts of cancer diagnosis and treatment, the impact on pancreatic cancer remains small. The majority of patients with pancreatic cancer die within a year of diagnosis. Even in patients with node-negative resectable disease, the best 5-year survival rate is still below 30%. At the present time, early detection is the only hope at improving this grim number. At Valley, our efforts have been to raise awareness of pancreatic cancer both within the hospital and the community through outreach education programs, newsletters, and tumor board conferences. We established the pancreatobiliary center of excellence in 1995 and initiated multidisciplinary consultation for pancreatic cancer patients to help guide them through the process of diagnosis and treatment. Through these combined efforts at the community level, patients are now more educated and more aware of signs and symptoms of pancreatic cancer. Primary care physicians are also increasingly sensitive to the warning signs of pancreatic cancer such as the sudden onset of type II diabetes in elderly patients, weight loss of unexplained etiology, and unusual abdominal symptoms associated with chronic pancreatitis or diabetes. A patient with one of these signs is now aggressively investigated using diagnostic imaging techniques and biomarkers such as the blood level of CA19-9. As a result, we have seen a steady increase not only in the number but also in the percentage of early stage cancer cases referred from both local physicians and outside the area.

On the diagnostic front, along with the increasing sophistication of imaging technology such as dynamic spiral CT performed according to a defined pancreas protocol, our radiologists, with accumulating experience dealing with pancreatic cancer, are more aware of early subtle changes that occur within the pancreas, which may signify cancer. These changes include focal pancreatitis, localized stricture of main pancreatic duct with distal dilatation, and cystic dilatation of the main or branch duct associated with irregularity. A strong recommendation for further investigation by a radiologist alerts the primary physician to pursue the next step such as MRI or endoscopic ultrasound, both of which are available at Valley. Our center was one of the first in Bergen County to offer an endoscopic ultrasound (EUS) service. EUS is a complementary diagnostic imaging to CT for diagnosing pancreatic cancer but it is more valuable for differentiating subtle lesions which might suggest the presence of a cancer. EUS-guided fine needle aspiration cytology/biopsy is recommended in an unresectable pancreatic cancer patient whose tissue diagnosis is required to determine the course of therapy. Generally it is not necessary or advised for those who have resectable lesions since it poses the risk, albeit small, of seeding of malignant cells along the needle tract. For palliative purposes, EUS-guided celiac plexus neurolysis is offered for patients with tumor-associated abdominal pain. Other services offered at our endoscopic center include ERCP. ERCP with placement of biliary stent provides relief for patients with obstructive jaundice from an unresectable tumor. Currently, we are in the process of expanding our capability to establish a diagnosis of pancreatic cancer earlier by adding more sophisticated equipments along with the recruitment of skilled interventional endoscopists, Dr. Peter Stevens, and Dr. Rosario Ligresti.

Pancreas Cases Diagnosed Comparison TVH Cases N J Cases National Cases

60

3.4%

1440

3.1%

44,270

3.1%

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Focus on Pancreatic Cancer ■ ■ ■ ■ Surgical treatment – Current Status According to recent literature, surgery for pancreatic cancer should be done at high volume institutions defined as greater than 20 resections per year. We, in fact, are such an institution. For the past ten years, we have been performing more than 20 complex pancreatic resections annually with excellent outcomes that equal that seen at the top national institutions. Current criteria defining resectability include no distant metastases, clear fat plane around major vascular structures (celiac and superior mesenteric artery) and patent superior mesenteric and portal veins. Minimally invasive surgery (MIS) has been applied increasingly for various pancreatic lesions. Its use for malignant tumor, although controversial, has the support from several clinical trials, which compared MIS to open surgery for GI malignancies such as colorectal and stomach and showed no significant difference between them. The most obvious benefit for patients is less trauma and pain, which translates into earlier recovery and a shorter hospital stay. Valley is one of the first hospitals to offer MIS for pancreatic resection. We were the first to successfully use the daVinci surgical system to remove the pancreas in both proximal (Whipple’s procedure) and distal sites. Patients who underwent this approach were found to recover much sooner and leave the hospital earlier and with fewer complications.

■ ■ Chemoradiotherapy – ■ ■ Current Status

Pancreas Cancer - Stage of Disease at Diagnosis 2008 TVH Compared TVH 2006 and 2006 NCDB

Unfortunately, there has been no significant breakthrough in chemotherapy for pancreatic cancer. Currently, 5-FU-based chemoradiation or gemcitabinebased chemotherapy continues to be the first line therapy for patients with locally advanced disease, or as adjuvant therapy. The CONKO trial supports the use of post-operative gemcitabine as adjuvant chemotherapy in resectable pancreatic cancer.

Pancreas Cancer - Age at Diagnosis TVH 2008 Compared to TVH 2006 and NCDB 2006

Stage O

Stage I

Stage II

Stage III

Stage IV

■ TVH 2008 ■ TVH 2006 ■ NCDB 2006 The use of gemcitabine-based chemotherapy is frequently combined, sequentially, with 5-FU based chemoRT. For metastatic disease, gemcitabine is considered standard frontline therapy. Second-line therapy may consist of cepecitabine, FOLFOX, or CapeOx. More recently, a targeted therapy utilizing Erlotinib (Tarceva) in combination with gemcitabine has been shown to be of value in treating advanced disease and we have been participating in clinical trials to assess this combination in the adjuvant setting. Other targeted agents are being tested in clinical trials as well.

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Focus on Pancreatic Cancer

Observed Survival for Pancreas Cases Diagnosed in 1998-2001 ■ Valley ■ National

At the forefront of pancreatic cancer management, we are involved in basic research aimed at discovering the presence of pancreatic cancer at the earliest possible stage. Such efforts could greatly enhance our ability to increase the cure rate. Under the leadership of Dr. Ganepola A.P. Ganepola, the project to discover biomarkers associated with pancreatic cancer has been ongoing since 2007. The specific goals of this research are to identify sensitive, specific and reliable surrogate markers from tumor tissue and corresponding patient’s plasma to hopefully result in the early diagnosis of pancreatic cancer as well as help in designing new therapeutics. The approaches we use include: comparing the protein profiles of plasma samples from pancreatic cancer patients to samples obtained from normal subjects; and depending on the availability, comparing the protein profiles of pancreatic cancer tissues (from pancreatic patients) with non-cancerous tissues (from normal or non-pancreatic cancer subjects). Extensive proteomics technologies are employed to achieve these goals. Although not yet conclusive, preliminary data have shown some promising results.

In summary, although the management of pancreatic cancer has not significantly changed over the past several decades, there has been an increase in the awareness of this disease. Early physical signs and symptoms are more aggressively pursued. Diagnostic and therapeutic decisions increasingly involve multidisciplinary consultation and are driven by standards of care as referenced by the National Comprehensive Cancer Network (NCCN). When resection is required, it is generally recommended that it should be done at a high volume institution (>20 pancreatic resections annually) like Valley. Minimally invasive surgery for pancreatic cancer has gradually replaced open surgery and has proven to improve short-term outcome for patients with this dismal disease. Early detection via identification of reliable biomarkers may greatly impact the treatment and hopefully improve the prognosis of patients with pancreatic cancer.

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Update on Prostate Cancer

by Howard Frey, M.D. Prostate cancer remains the cancer most frequently diagnosed in men with 186,000 estimated cases for 2008. There will be 28,000 deaths in 2008 reflecting the second most common cause of death in men from cancer exceeded only by lung cancer. Clearly prostate cancer remains a significant cause of morbidity and mortality despite the generally accepted attitude that men “will die with prostate cancer and not because of it.” Colon, pancreatic, liver, leukemia, esophageal, bladder, lymphoma and, kidney all produce fewer deaths in men than prostate cancer yet none of these are thought to be insignificant. However, prostate cancer presents the additional challenge that the ratio of incidence to death is higher than in other cancers making many of these prostate cancers in fact insignificant. Controversy over the benefits of screening for the detection of prostate cancer appeared with the publication of a New England Journal of Medicine article from March 18, 2009, showing little overall benefit from screening. An American study the Prostate Lung Colorectal Ovary Cancer Screening Trial, PLCO, showed no mortality benefit while the European study, European Randomized Study of Screening for Prostate Cancer Trial, ERSPC, showed a 20% relative reduction in mortality from prostate cancer screening. This latter study estimated that 48 prostate cancer patients needed to be treated for every life saved. The potential risks involved with the treatment of some prostate cancer patients that might do well without any treatment highlights the clinical dilemma facing these patients and their physicians. The challenge, of course, will be to devise a molecular test to differentiate the lethal prostate cancer from the benign form that will allow treatment of only those patients who definitely need it.

Prostate Cancer - Age at Diagnosis TVH 2008 Compared to TVH 2006 and NCDB 2006

■ ■ Age at Diagnosis ■ ■ Prostate cancer occurs predominantly in an older population approximately 80% occurring after age 60. It is often assumed that men over the age of 80 have some prostate cancer whether it is diagnosed or not. The assumption comes from autopsy studies in which complete autopsies are done in men who have died of unrelated (no-cancer) deaths. More than 50% will have an incidental prostate cancer. Projections now estimate that life expectancy will increase from one million men over age 80 currently to seven million men by the year 2050. Additionally of the 30 thousand deaths from prostate cancer, 2/3 currently occur in men older than 75. Thus, as life expectancy increases, prostate cancer may become a more significant disease in the elderly.

■ ■ Percentage by Stage ■ ■

■ TVH 2008 ■ TVH 2006 ■ NCDB 2006

Since PSA testing, the stage at diagnosis has improved. Stage II disease, localized prostate cancer, potentially curable predominates in sharp contra-distinction to the years prior to PSA testing when Stage III and Stage IV occurred at least as often as Stage I and II. Whether this has made a difference in mortality from prostate cancer is controversial. The PLCO study and the ERSPC study have cast doubt on the benefits of PSA screening in saving lives. However, the mortality from prostate cancer has decreased approximately 4% each year since 1992 approximately five years after PSA testing began and when one might expect to see a beneficial result from PSA screening.

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Prostate Cancer - Stage of Disease at Diagnosis 2008 TVH Compared TVH 2006 and 2006 NCDB

Update on Prostate Cancer

■ ■ Initial Treatment ■ ■

Prostate Cancer - Initial Treatment 2008 TVH Compared to 2006 ACS Eastern Division

Initial treatment at The Valley Hospital was split between radiation and surgery. Improved radiation techniques with less morbidity have evolved. Intensity modulated radiation therapy causes less side effects and allows for higher radiation doses that are necessary for tumorcidal effects. Cesium 131 has largely replaced palladium for brachytherapy at The Valley Hospital. Cesium offers advantages of higher energy with a shorter half life yielding more homogeneous radiation with fewer side effects. Treatment guidelines as referenced by the National Comprehensive Cancer Network serve as a model for treatment planning. Minimally invasive robotic radical prostatectomy offers less morbidity than open surgery and therefore has become a more advantageous option for the patient.

■ ■ Five Year Survival Table ■ ■ The five year mortality for prostate cancer remains excellent. Data between 1998 and 2001 show The Valley Hospital to be at 91.5 % overall (inclusive of all stages) five year survival which compares favorably to national data of 84.9% overall five year survival.

Prostate Cases Diagnosed Comparison TVH Cases NJ Cases National Cases

215

12%

5090

11.1%

186,320

13%

Observed Survival for Prostate Cases

Cumulative Survival Rate

Diagnosed in 1998-2001

■ TVH ■ ACS East Division

■ ■ Conclusion ■ ■ Prostate cancer causes significant morbidity and mortality as reflected in the number of diagnoses made and the number of deaths that occur annually in the United States. Controversy concerning the role of PSA screening in preventing deaths exists and needs to be more accurately defined. Regardless, the mortality from prostate cancer has decreased by approximately 4% yearly since 1992. Whether this reflects the role of PSA screening, better radiation or surgical techniques, or other unknown factors has not yet been clarified. Separating prostate cancer that will progress and cause death from prostate cancer that is inconsequential remains a significant challenge. Observation may become increasingly important and the Multidisciplinary Prostate Cancer Center at The Valley Hospital may play a prominent role in helping patients make very difficult treatment decisions.

■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ TVH ■ National

0

1

2

3

4

5

Years from Diagnosis

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Clinical Commentary on Studies in this Report

Allen Chinitz, M.D., Medical Oncologist, comments below on the two studies included in this report: “Focus on Pancreatic Cancer” by Anusak Yiengpruksawan, M.D., and “Update on Prostate Cancer” by Howard Frey, M.D. In this annual report, data and analysis are presented concerning two cancers – pancreatic and prostate. These two cancers illustrate the remarkable clinical and biological diversity that can exist among cancers arising in different organs. Pancreatic cancer develops in an organ which is situated deep in the abdominal cavity and it usually becomes symptomatic only late in its development, when it has unfortunately usually spread locally or metastasized to a distant organ such as the liver. As is illustrated in Dr. Yiengpruksawan’s discussion this presents difficulties in both arriving at an early diagnosis and in planning effective therapy. To date, the outlook for most patients who develop pancreatic cancer is poor. The results achieved here at The Valley Hospital generally equal or exceed what has been accomplished at major institutions throughout the United States. The prostate gland is an organ which is more accessible than the pancreas and as seen in Dr. Frey’s presentation the diagnosis is usually made at an earlier stage (i.e. stage II). The prognosis of prostate cancer can be quite variable and is dependent upon many factors including the stage and the grade of the tumor (i.e. Gleason score). The utility of a commonly measured biomarker in prostate cancer (the PSA) has been brought into question but it remains in widespread use. There is yet to be developed a biomarker to serve as a useful tool for the early diagnosis of pancreatic cancer. There are unfortunately limited therapeutic options available to treat pancreatic cancer. There are multiple therapeutic options available to treat prostate cancer. This availability of therapeutic options to treat prostate cancer often results in confusion for the patients and their families and that has led us here at The Valley Hospital to create a Multidisciplinary Prostate Cancer Center to guide patients in their treatment selection. The treatment spectrum spans choices from no treatment (observation only) to surgery (robotic or otherwise) to radiation utilizing a variety of techniques (seed implantation, external beam or a combination of both) as well as the consideration of certain hormonal therapies or chemotherapy. All of these treatments may be offered individually or in some combination. Again the therapeutic results achieved here at The Valley Hospital in treating prostate cancer equal or exceed what has been documented in the National Cancer Database.

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What is common, however, to these two tumor types is the promise that is offered by ongoing studies focusing on the genetic profiling of these tumors as well as the characterizing of proteins that they may produce and secrete, and which might be measurable in the patient’s blood. These studies, some of which are conducted here at this hospital could yield valuable information which might translate into an ability to detect both of these cancers at earlier stages and which could result in more effective therapies. Another benefit of such research could be to enable us to offer more precise prognostications, particularly with regard to prostate cancer so as to allow us to determine who requires early treatment and who can be safely observed and thus avoid potential adverse consequences associated with treatment. It is realistically anticipated that for cancer patients generally and more specifically for those who already have cancer of either the pancreas or of the prostate the future will indeed be brighter.

”The therapeutic results achieved here at The Valley Hospital in treating prostate cancer equal or exceed what has been documented in the National Cancer Database.”

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Distribution of Five Major Sites

”Valley has earned a formidable reputation as a leader in the prevention, diagnosis and treatment of the most prevalent cancers we face: lung, prostate, gynecologic, breast, and gastrointestinal, among others.“ Robert J. Korst, M.D. Medical Director, Daniel and Gloria Blumenthal Cancer Center

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Timeline of Achievement

January – April

May – August

The Valley Hospital Center for Complementary Therapies and Jodie Katz, M.D., present a course on Mindfulness Based Stress Reduction. This unique meditation technique enables individuals to develop a heightened awareness of their body and emotions, to take charge of their lives, and to learn to consciously and systematically work with stress, pain, illness and the demands of everyday life.

The Radiation Oncology Department of The Valley Hospital was once again awarded a three-year accreditation by the American College of Radiology (ACR). The ACR awards accreditation to facilities for the achievement of high practice standards after a peerreview evaluation. Evaluations are conducted by board-certified physicians and medical physicists who are experts in their field.

Colorectal Cancer Screening is held. Cancer Committee approves the goal of planning a Cancer Survivorship Program. Arthur Antler, M.D., and John McConnell, M.D., present lectures to Valley employees on the importance of being screened for colon cancer.

”Our cancer team has pledged to lead the way in developing systems to support and promote the needs of cancer survivors.” Nancy Librera Assistant Vice President, Oncology Services

September – December Valley’s cancer program earns an impressive five Gold Seals of Approval for healthcare quality from the Joint Commission. Valley holds Joint Commission Disease-Specific Care Certification for colorectal cancer, lung cancer, breast cancer, pancreatic cancer and prostate cancer. To earn this distinction, Valley underwent an extensive, on-site evaluation by a team of Joint Commission reviewers. The Valley Hospital’s John C. McConnell, M.D., completes his 5,500 mile bicycle ride to raise awareness of colorectal cancer and to raise money for the Blumenthal Cancer Center. His trek ends in Key West, Florida.

Free Skin Cancer Screenings are conducted. Each screening includes a close physical examination by a board-certified dermatologist, and participants receive a profile sheet indicating if a significant lesion is present, a preliminary diagnosis, and a list of board certified dermatologists if further medical care is recommended. The Valley Hospital’s John C. McConnell, M.D., begins a 5,500 mile bicycle ride to raise awareness of colorectal cancer and to raise money for the Blumenthal Cancer Center. His trek begins in Fairbanks, Alaska, and takes him across the United States. Jesse Moskowitz, M.D., is the first surgeon to complete Valley’s MIS

The colorectal surgeon spread the message that colorectal cancers are preventable and raised more than $100,000 for Valley’s cancer program. A symposium titled “Breast Cancer 2008: Contemporary Management Issues” is presented for physicians, nurses and other healthcare professionals from throughout New Jersey and southern New York. The conference featured speakers from Cooper Cancer Institute, Memorial Sloan-Kettering Cancer Center, Mayo Clinic College of Medicine, and Valley. Prostate Cancer Screening is presented by The Valley Hospital and Valley Health Medical Group.

Fellowship, a one-year training program aimed at providing advanced training to surgeons in minimally invasive (laparoscopic) GI/abdominal surgery, robotic surgery, and interventional endoscopy. Valley Hospital’s Blumenthal Cancer Center honored cancer survivors with ”A Celebration of Life,” a special program honoring the personal victories made against cancer. The theme was ”Journey Through Survivorship.” A special exhibition of Lilly Oncology on CanvasSM – an art exhibition honoring the journeys traveled by millions of people affected by cancer worldwide – was on display. Attendees also had the opportunity to hear a presentation from Robert J. Korst, M.D., Medical Director, Blumenthal Cancer Center; learn about Living Strong, Living Well, sponsored by the Ridgewood YMCA; and chart their years of survivorship on the Ladder of Life. Valley and Tenafly Middle School partner for a Walk-a-Thon that raises more than $14,000 for Valley’s Cancer Program. Valley participates in the American Cancer Society's Relay for Life, raising $18,200.

Representative Scott Garrett tours The Valley Hospital Breast Center in an event that complemented his recent Certificate of Excellence award from the National Breast Cancer Coalition (NBCC) for his perfect voting record on breast cancer issues. Garrett praised Valley’s professionals for their continuing leadership in improving breast care for both women and men in the area. A new patient station is added to Ambulatory Infusion, bringing to 21 the number of stations. Maureen Bottiglieri, massage therapist for Integrative Healing Services, becomes certified as a Certified Practitioner in Clinical Aromatherapy.

2008 Analytical Cases

Oral Cavity & Pharynx Lip

24 0

Female Genital System

123

Cervix Uteri

12

Tongue

6

Corpus Uteri

64

Salivary Glands

8

Uterus, Nos

1

Floor of Mouth

0

Ovary

32

Gum & Other Mouth

1

Vagina

5

Nasopharynx

2

Vulva

7

Tonsil

3

Other Female Genital Organs

2

Oropharynx

2

Male Genital System

220

Hypopharynx Other Oral Cavity & Pharynx Digestive System Esophagus Stomach Small Intestine Colo/Rectal Anus & Anal Canal Liver Intrahepatic Bile Duct Gallbladder

2 0 358 19 45 7 184 3 13 1 11

Prostate Testis Penis Other Male Genital Organs Urinary System Urinary Bladder Kidney & Renal Pelvis Ureter Other Urinary Organs Brain & Other Nervous System Brain

215 5 0 0 117 67 48 1 1 75 25

Other Biliary Pancreas Retroperitoneum Peritoneum, Omentum Other Digestive Organs Respiratory System Nose, Nasal Cavity & Middle Larynx Lung & Bronchus Pleura Trachea & Mediastinum Bones & Joints Soft Tissue-Including Heart Skin Excl Basal & Squamous Melanomas - Skin Other Non-Epith Skin Breast

10 60 0 4 1 244 2 12 229 1 0 0 7 30 24 6 292

Cranial Nerves, Other Nerves Eye & Orbit Endocrine System Thyroid Other Endocrine Including Thymus Lymphoma Hodgkin Disease Non-Hodgkin Lymphomas Myeloma Leukemia Lymphocytic Myeloid & Monocytic Other Mesothelioma Kaposi Sarcoma Misc - Unknown Primary Site

50 0 72 57 15 84 8 69 10 24 11 20 1 10 0 47

TOTAL

1,746

Five Gold Seals from the Joint Commission

Recipient of “Gold Seals of Approval” for cancer care. Breast. Colorectal. Lung. Pancreatic and Prostate.

Community Hospital Comprehensive Cancer Program w w w. v a l l e y h e a l t h c a n c e r c e n t e r. c o m 223 North Van Dien Avenue, Ridgewood, NJ 07450