2010 Cancer Program Annual Report with Statistical Data from 2009

2010 was a year of building for Cancer Services at Northwest Community Hospital—building both our new cancer unit in the South Pavilion and exciting new additions to our cancer program.

On May 1, 2010, Northwest Community Hospital

opened its new South Pavilion—and with it, our

new Cancer Inpatient and Palliative Care Unit on

the ninth floor.

It took nearly ten years to design this modern, yet

welcoming patient care addition; doctors, nurses and

patients were consulted on detailed room and floor

designs. Every element within the Cancer Unit itself is

aimed at improving patient care, comfort and safety.

Each of the 31 new cancer patient rooms is spacious

and private, with a pull-out bed so a family member

can stay overnight. Sophisticated medical equipment

is built right in, and nurses are close at hand so they

can spend more time with patients.

Our new Palliative Care unit offers patients comfort

care—along with emotional, practical and spiritual

support—from the time of diagnosis throughout

the course of their illness. Physicians and specially

trained nurses provide expert care in an exception-

ally soothing environment that promotes comfort

and healing.

The Cancer unit and the South Pavilion are part of an

ongoing commitment by NCH to create a world-class

hospital that pursues excellence at every level, with

one objective: delivering the best patient care.

Building the Building

Building the Program

In 2010, we continued to expand our Cancer Services

program across multiple disciplines to provide world-

class care for the members of our community. Here

are a few highlights from this year’s activities.

Genetics

This summer, we launched our new Cancer Genetic

Risk Assessment Program aimed at offering genetic

counseling to high-risk individuals. Healthcare

providers throughout NCH—particularly in our

breast, prostate, pancreas and gastroenterology

specialty services—treat people every day who have

had cancer or whose family histories may predispose

them to cancer. This program will enable us to

identify and assist these patients and ensure that

they are able to be proactive about their health.

Prostate Second Opinion Program

As the regional leader in prostate cancer diagnosis

and treatment, NCH developed a Second Opinion

Program to give primary care physicians and patients

immediate access to prostate cancer experts on the

wide array of treatment options available. Talking to

several specialists—including a urologist, a radia-

tion oncologist and a medical oncologist—allows

patients and their families to learn as much as they

can about each option, its side effects and expected

outcomes before making their treatment decision.

Linear Accelerator for Radiation Therapy

This past year, the Radiation Therapy department

has completed installation of Elekta Infinity™, a new

linear accelerator that provides state-of-the-art

radiation treatment options for patients with cancer.

The new accelerator provides our patients with the

latest generation of radiation therapies such as

Image Guided Radiation Therapy (IGRT), Volumetric

Arc Therapy (VMAT) and Intensity Modulated

Radiatiotherapy (IMRT). Advanced hardware and

software allow radiation oncologists to achieve

better tumor conformality, adaptive treatment plans

and dose modeling. All of these allow us to provide

exceptional care for our patients.

Oncology Information Systems

This past year, Cancer Services has made significant

upgrades to its information management system.

These upgrades will allow for a tighter integration

between the treatment planning, treatment delivery,

and electronic communication and storage process.

The latest upgrades to the cancer registry software

will allow for a more robust data collection platform

and the ability to extract data that lead to clinical

research and improved patient care.

Cancer Seminar for Primary Care Physicians

In November, we offered our first cancer seminar for

primary care physicians. This half-day symposium

was designed to help doctors on the frontlines of

patient care stay up-to-date on the latest screenings

and advanced treatment options for cancer care.

The Cancer Services program at Northwest Community

Hospital will continue to provide exceptional multidis-

ciplinary care to our patients through state-of-the-art

technology, clinical expertise and compassionate

care. Here are a few of our plans for 2011.

ACR Accreditation for Radiation Oncology

The Radiation Oncology department is on track to be

fully accredited by the American College of Radiology in

2011. ACR accreditation, the gold standard in medical

imaging and radiation oncology, ensures that patients

are receiving the highest quality care possible.

3T Magnet MRI

In 2011, Radiology will be installing a 3T MRI. This

extremely powerful system will allow for better

imaging of smaller, more difficult-to-read areas, as

well as advanced imaging studies that are on the

cutting edge of technology. This system will reduce

patient motion to improve image quality.

Survivorship Program

Finally, we are developing an exciting new program

for cancer survivors, one that helps patients cope

with the void many feel after the whirlwind of diagno-

sis, testing and other treatments are over. Counselors

and health experts craft the plans that would help

cancer survivors who may otherwise get lost in the

transitions from the care they received during treat-

ment through the return to activities of daily living,

including family life, work and exercise.

Commission on Cancer

Next year our Cancer Program is due for the

American College of Surgeon’s Commission on Cancer

Survey. The Commission on Cancer has introduced

many new standards to their accreditation process that

will continue to test the strength of cancer programs

nationwide. This coming year we will be planning and

developing processes to meet the new guidelines.

As always, we want to recognize the many people

who, through their efforts at NCH, provide the energy

and expertise that make our Cancer Program so

strong. A special thank you to members of our

Cancer Committee who help direct these life-

changing programs.

Stephen Nigh, MD

Chairman, Cancer Committee

Building the Future

The cancer registry is a vital component of the

Cancer Program, providing data for programmatic

and administrative planning, research, and for moni-

toring patient outcomes. Data is collected according

to the current standards of the Commission on

Cancer (CoC) to create a detailed cancer-focused

record for all reportable tumors diagnosed and/

or treated at our hospital. Each record entered into

the database contains information on the diagnosis,

extent of disease, treatment received, recurrence of

disease and lifetime follow-up for each patient.

A cancer registrar performs the collection,

interpretation, analysis and reporting of cancer data.

The National Cancer Registrars Association defines

cancer registrars as data management experts

who collect and report cancer statistics for various

healthcare agencies. Registrars work closely with

physicians, administrators, researchers and health-

care planners to provide support for cancer program

development, ensure compliance of reporting stan-

dards, and serve as a valuable resource for cancer

information with the ultimate goal of preventing and

controlling cancer. The cancer registrar is involved in

managing and analyzing clinical cancer information

for the purpose of education, research and outcome

measurement. The cancer programs at Northwest

Community Hospital make accurate data collection

a priority.

Registry data is annually submitted 100% error-

free to the National Cancer Data Base (NCDB) as

a requirement of the Commission on Cancer for all

accredited cancer programs. Submission of data to

the National Cancer Database provides feedback

to assess the quality of patient care. This feedback

enables cancer programs to compare treatment and

outcomes with the regional, state and national

patterns. Major differences between the facility data

and the national data are reviewed in an effort to

identify the reasons for these differences. Cancer

data is also submitted to Illinois State Central Reg-

istry (ISCR) that supports research, tracks trends,

initiates epidemiologic studies, generates journal

articles and provides data for allocation of services.

The data is analyzed to identify opportunities for

community cancer awareness and screening where

higher stages (III-IV) of cancers are seen. This data

also provides a means of identifying possible cancer

clusters within the state.

Cancer Registry

Activities and Accomplishments

1,595 Analytic and 98 Non-Analytic Cases

accessioned in 2009

90% follow-up rate averaged throughout the year

Completed quality study as recommended by CoC

surveyor on Stage Distribution at Presentation -

Head and Neck Cancer

Over 15% of cases reviewed by a physician for

quality of registry data

Collaborative Staging accuracy exceeds 90%

Compliance with College of American

Pathologists protocols per CoC rates remains 90%

Physician staged cases by AJCC Staging

continue to meet the 90% goal

Attended state and national cancer registry

educational programs

Participated in advanced registry management train-

ing webinars and workshops throughout the year

We sincerely thank all of the staff physicians and

office personnel who respond to our letters request-

ing treatment and follow-up information. The registry

also wishes to thank volunteers, nursing staff and

allied health professionals who give their time and

support to the registry throughout the year, thus

enabling it to grow and fulfill its commitment to

providing a valuable resource to the Hospital and

the community.

GLOSSARY OF REGISTRY TERMS

AJCC Staging American Joint Committee on Cancer; TNM Staging & Classification system is a method for measuring the extent of disease at the time of diagnosis. Clinical and pathological staging both are used as appropriate, based on type of cancer.

Analytic Cases A category or class of case which indicates that the cancer was initially diagnosed and/or treated at a specific healthcare facility and is eligible for inclusion in that registry’s statistical reports of treatment efficacy and survival.

NCBD A clinically oriented electronic database of cancer cases submitted to the Commission on Cancer by approved cancer programs of American College of Surgeons in the United States, which can be used as a reference database to compare the management of cancer patients in one facility or region with similar patients in other regions or nationally.

ACoS American College of Surgeons

CoC Commission on Cancer

•

•

•

•

•

•

•

•

•

Total

73

37

5

28

3

425

25

32

9

110

48

6

14

7

28

142

200

340

104

54

31

19

%

4.6

26.7

12.5

21.3

6.5

Male

32

20

5

6

1

205

18

12

6

40

28

4

8

1

15

73

100

3

0

0

0

0

Female

41

17

0

28

2

220

7

20

3

70

20

2

6

6

13

69

100

337

104

54

31

19

Total

133

128

5

96

68

28

86

6

80

47

33

37

22

12

10

14

5

9

11

11

3

40

1595

%

8

6

5.4

2.3

1.4

0.9

0.7

0.7

0.2

2.5

100%

Male

133

128

5

71

55

16

41

5

36

21

15

22

7

3

4

5

2

3

7

8

3

19

656

41%

Female

0

0

0

25

13

12

45

1

44

26

18

15

15

9

6

9

3

6

4

3

0

21

939

59%

PRIMARY SITE DISTRIBUTION NCH 2009—Analytic Cases

*Includes Hodgkins & Non-Hodgkins Lymphomas (nodal & extranodal) **Includes benign Brain tumor

Site

HEAD & NECK

Lip, Oral Cavity

& Pharynx

Larynx

Thyroid

Other

DIGESTIVE SYSTEM

Esophagus

Stomach

Small Intestine

Colon

Rectum & Rectosigmoid

Anus, Anal Canal

& Anorectum

Liver & Intrahepatic

Bile Duct

Gallbladder

Other Biliary

Pancreas

LUNG

BREAST

FEMALE SYSTEM

Corpus Uteri, Uterus

Ovary

Other

Site

MALE SYSTEM

Prostate

Other

URINARY SYSTEM

Bladder

Kidney, Renal Pelvis

& Ureter

LYMPHOMA*

Hodgkin Lymphoma

NON-HODGKIN LYMPHOMA

NHL–Nodal

NHL–Extranodal

MELANOMA–SKIN

BRAIN & CNS **

Brain

Cranial Nerves

& Meninges

LEUKEMIA

Lymphocytic Leukemia

Myeloid & Monocytic

Leukemia

MYELOMA

SOFT TISSUE

MESOTHELIOMA

OTHER & UNKNOWN PRIMARY

TOTAL

CANCER INCIDENCE BY SITE AND SEX NATIONAL COMPARISONNorthwest Community Hospital (NCH) and American Cancer Society (ACS) Analytic Cases 2009

Males NCH% ACS- Females NCH% ACS- US%* US%

Prostate 20 25 Breast 36 27

Lung 15 15 Lung 11 14

Colorectal 10 10 Colorectal 10 10

Pancreas 11 3 Corpus Uteri 6 6

Bladder 8 7 Ovary 3 3

Leading Cancer Types for the estimated new cancer cases* by Sex US 2009. Estimates are rounded to the nearest 10. Note: percentages may not total 100% due to rounding. American Cancer Society, Facts & Figures Cancer Statistics 2009

Num

ber o

f Pat

ient

s

2009 CANCER CASES AT NCHMale vs Female by Age at Diagnosis, n = 1595

Age Distribution

250

200

150

100

50

00-29 30-39 40-49 50-59 60-69 70-79 80-89 90+

MALE = 656 FEMALE = 939

120

100

80

60

40

20

0

Num

ber o

f Pat

ient

s

100

80

60

40

0

Num

ber o

f Pat

ient

s

AJCC Stages at Diagnosis

120

100

80

60

40

0

140

Stg 0

UNK Stg

Num

ber o

f Pat

ient

s

30

20

15

10

0

35

Num

ber o

f Pat

ient

s

40

60

50

40

30

20

10

0

Num

ber o

f Pat

ient

s

Stg II

Stg III

Stg IV

AJCC Stages at Diagnosis

Stg 0

UNK Stg

Stg I

Stg III

Stg IV

AJCC Stages at Diagnosis

Stg 0

UNK Stg

Stg I

Stg III

Stg IV

AJCC Stages at Diagnosis

Stg 0

UNK Stg

Stg I

Stg II

Stg III

Stg IV

AJCC Stages at Diagnosis

Stg 0

UNK Stg

Stg II

Stg III

Stg IV

BREAST CANCER BY STAGEn = 340

PROSTATE CANCER BY STAGEn = 128

COLORECTAL CANCER BY STAGEn = 158

PANCREATIC CANCER BY STAGEn = 142

LUNG CANCER BY STAGEn = 200

Multidisciplinary Cancer Conferences

Northwest Community Hospital offers prospective,

patient-oriented and multidisciplinary Cancer Confer-

ences, which provide free consultative services

to our patients and education to the medical and

Hospital staff. Medical oncology, radiation oncol-

ogy, diagnostic radiology, pathology and surgery

specialties are present at the conferences to discuss

possible treatment options for the types of cancers

presented at the conferences. Patient identities are

kept confidential.

National Comprehensive Cancer Network (NCCN)

practice guidelines in oncology, information on open

clinical trials and facility data are provided for the

cancer sites presented.

2009 CASES PRESENTED

Anatomical Site Number of Cases

Breast 197

Lung 60

Pancreas 40

Colorectal 16

Other GI 14

Lymphoma 13

Gynecologic Sites 11

Head and Neck 9

Brain and Nervous System 7

Bladder, Kidney, 5

Renal Pelvis, Prostate

Other Sites 15

TOTAL 387

Total prospective Analytic Case presentation: 365/1,595 cases: 20% (10% required by CoC standard)

Cancer Conferences are held weekly:

Tuesday mornings, 7– 8:30 am, in Hospital room

1– 6, 1–7 as follows:

Breast Conference 7 am every Tuesday

General Tumor Board 7:45 am on the first

Tuesday of the month

Thoracic Conference 7:45 am on the second and

fourth Tuesdays of the month

GI Conference 7:45 am on the third

Tuesday of the month

Gyne-Oncology Conf. 7:45 am on the fifth

Tuesday of the month

In addition, the CyberKnife conference is held

every Thursday 7–8 am in the Radiation Oncology

department.

The NCH CME department also routinely offers

relevant and timely oncology-related educational

programs. Educational offerings in 2009 included:

21st Century Technologies in Pain Management

Yuriy Bukhalo, MD

Colorectal Cancer Prevention and Early Detection

Willis Parsons, MD

Reducing the Risk of Cervical Cancer & Genital Warts

Josh Tunca, MD

Skin Cancer Treatments

Jeffery Altman, MD

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Clinical Care & Support Programs

Ambulatory Infusion Clinic

The Ambulatory Infusion Center (AIC) at NCH

provides a full range of outpatient infusion and

injection services, including chemotherapy, blood

transfusions and supportive oncology therapies.

Additional offerings include, but are not limited to,

antibiotics, biphosphonates, immunizations and

biological response modifiers.

To optimize cancer patient care, we implemented

chemotherapy protocol templates for lymphoma, leu-

kemia, gynecologic, head and neck, and lung cancer

diagnoses in collaboration with medical oncologists

and an oncology pharmacist. The templates ensure

safety and accuracy in chemotherapy orders. In the

coming year, additional oncology templates will be

added as part of ongoing quality improvements. As

new pharmaceutical drugs enter the market, the AIC

is positioned to work in cooperation with physicians

to provide these infusion/injection therapies.

With easy access to laboratory and radiology

services, comprehensive care is provided by

registered nurses, an oncology pharmacist, an

oncology certified dietitian, breast and prostate

nurse navigators, and a licensed social worker.

Chemotherapy services are delivered by quali-

fied staff that have successfully completed and

maintained certification with the Oncology Nursing

Society chemotherapy and biotherapy courses.

Services are by appointment and are provided in

private infusion areas throughout a 12-hour week-

day schedule. A weekend schedule is available for

limited services.

Breast Center

Early detection remains the focus for all breast

care given at the NCH Breast Center. We are proud

to have our quality measures rank well above the

national benchmarks. This includes:

4.6 business days between screening mammogram

and diagnostic mammogram

8 business days between diagnostic mammogram

and needle core biopsy

14 business days between needle biopsy and breast

cancer surgery

Over 75% of breast patients have a diagnosis by

needle core biopsy. This minimally invasive tech-

nique helps to speed the process of diagnosis and

treatment so that further imaging and treatment can

be started quickly if a diagnosis of cancer is found.

Overall, NCH patients have fewer sleepless nights

and quickly get on the road to recovery.

NCH participated with 54 Chicagoland hospitals

and the Chicago Department of Public Health on the

first-ever comprehensive look at breast care. Ret-

rospective data was submitted for patients initially

screened, diagnosed or treated during calendar year

2006. The sole purpose of this study is to improve the

quality of breast health services provided in Metro-

politan Chicago and reduce morbidity and mortality

associated with breast cancer. NCH met or exceeded

all of the ACR or CoC benchmarks for 2006, which

was the year of data submitted to the Consortium.

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This past year, the Breast Program, in conjunction

with our Wellness Center, has focused on developing

a lymphedema screening, education and prevention

program for our breast cancer survivors. In the past,

our focus had been on early intervention and therapy.

With this individualized program we hope to continue

to decrease the co-morbidities of breast cancer

surgery and improve the quality of life for our breast

cancer survivors.

Outreach and call-to-action for the “under 40”

female population was taken up by the Breast Center

Community Advisory Council. Marketing materials

were developed and distributed by the Council to

local vendors where the women in our community

gather. The materials were also used by NCH staff for

community outreach.

Clinical Trials

Cancer clinical trials at Northwest Community

Hospital evaluate new ways of diagnosing, treating

or preventing cancer. Clinical trials are among the

final stages of a long and careful process of cancer

research. National regulations and policies have

been developed to protect the rights, safety and well-

being of people who take part in clinical trials and to

ensure that trials are conducted according to strict

scientific and ethical principles. Locally, the Hospi-

tal’s Institutional Review Board, chaired by Richard

Regan, MD, assures trials are conducted ethically,

that informed consent takes place and that patient

rights are protected.

The National Cancer Institute sponsors large

numbers of trials in which community hospitals like

NCH are able to participate in. Our radiation oncolo-

gists, medical oncologists, surgical oncologists,

surgeons and radiologists offer many types of studies

that give the patient the opportunity to participate

locally at their community hospital without travel-

ing to a distant center. NCH can also participate in

studies sponsored by academic medical centers, and

biotechnology and pharmaceutical companies.

Benefits include having access to promising new

interventions, being monitored very closely and

helping others who need cancer treatment in the

future. Last year, over 14% of patients diagnosed

with cancer and treated at NCH were able to take

advantage of clinical trials. The Commission on

Cancer requires only 2%, so NCH far exceeded this

requirement. Examples of four recent trials opened

at NCH include:

NSABP B-43: Testing Ductal Carcinoma In Situ

removed by surgery for HER2 (which is normally done

on invasive breast cancer) and providing two doses

of a drug specific for HER2 positive cancer if the

specimen tests positive.

RTOG 0825: Providing patients with the brain tumor,

glioblastoma multiforme, the opportunity to have the

drug avastin (which is approved in other types of

cancer) along with standard therapy of temodar and

radiation therapy.

RTOG 0848: To see if the addition of the drug, erlo-

tinib, and radiation therapy improves survival for

pancreatic patients who have had the head of the

pancreas surgically removed.

SAVI: An evaluation study for patients who have had

partial breast radiation therapy for their breast

cancer: looking at cosmetic outcome and if there

were any side effects.

NCH supports research and contributes greatly to

scientific knowledge that improves cancer care.

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Diagnostic Imaging

The department of Diagnostic Imaging at NCH

continues to a play vital role in diagnosing and treat-

ing cancer. Identifying an abnormality quickly and

accurately is a critical step that may lead to early

treatment. Our diagnostic imaging facilities include

state-of-the-art equipment and leading-edge technol-

ogy so cancers can be detected and treated earlier

and more effectively than ever before. The department

parlays the innovations and advances in areas such as

PET-CT (positron emission tomography combined with

computed tomography), breast MRI with MRI-guided

biopsies, and radiofrequency ablation.

A recent advancement for our Interventional Radiol-

ogy (IR) section, in collaboration with the Radiation

Oncology department, is the use of radioembolization

to treat patients with unresectable liver cancer. Often

referred to as “mircospheres,” these resin-based

beads (a beta radiating isotope) are injected into the

hepatic artery via a catheter by an interventional

radiologist. The microspheres lodge in the tumor and

the radiation will lead to damage of tumor tissue and,

in the best case, to a complete elimination of the tumor.

In 2010, we performed 16 procedures with promising

outcomes.

Our Diagnostic Imaging department includes:

Angiography

Interventional/Neurointerventional Radiology

Neuroradiology

Computerized Tomography, CT Angiography,

CT guided procedures

Fluoroscopy

Genitourinary / Gastrointestinal

Magnetic Resonance Imaging

MR Angiography

MR Cholangiography

Mammography

Bone Densitometry

Musculoskeletal

Nuclear Medicine/PET-CT

Ultrasound, Ultrasound Guided Procedures

GI Center

The Gastroenterology Center at Northwest Commu-

nity Hospital has been a regional leader in the diag-

nosis and treatment of even the most challenging GI

disorders for several years now. The GI Center offers

a full range of services, from routine colonoscopies

to procedures normally found only at a university

medical center. This includes treatment of Barrett’s

esophagus and cancers of the GI tract, including

advanced ERCP and endoscopic ultrasound with

fine needle aspiration. Our expert physicians, Dr.

Willis Parsons and Dr. Rameez Alasadi, perform more

complex procedures diagnosing and staging condi-

tions of the liver and pancreas than any other facility

in Chicagoland.

We are committed to building excellence in GI

professionals through on-site education. Each year,

for the past several years, the GI Center hosts on-site

workshops led by Dr. Willis Parsons for physicians

and nurses to learn the latest technologies and

techniques used in interventional GI procedures. Our

multimedia teaching gallery is equipped for teaching

the latest advances in gastroenterology. It includes

stadium seating, plasma monitors and the ability to

stream live images around the world. We have held

two national courses for nurses and technicians

involved with advanced GI procedures and have

planned our third course for February 2011. Our

expert physicians have offered numerous lectures to

physicians and surgeons to provide education on the

complex procedures done at our facility.

The GI Center at NCH is committed to evaluating

the latest technologies and offering our patients

the highest quality of service and treatment op-

tions available. We hold a GI Tumor Board monthly,

which consists of physicians across the organization

involved in providing care to patients diagnosed with

GI cancers. Physicians include: gastroenterologists,

pathologists, oncologists, radiation oncologists, sur-

geons and radiologists. Complex cases are reviewed

and treatment plans are discussed. This provides

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patients with a second or third opinion without ever

leaving the NCH organization. Also, the Tumor Board

ensures the highest quality of care is being provided

to our patients and standards of care are based on

evidence-based medicine.

The Illinois Center for Pancreatic

and Hepatobiliary Diseases

The Illinois Center for Pancreatic and Hepatobiliary

Diseases (ICPHD) is in its second year at NCH. Over

440 surgeries have been performed at NCH involv-

ing the liver and pancreas to date. The center is led

by Dr. Malcolm Bilimoria. Dr. Bilimoria is a surgical

oncologist and specializes in complex surgeries

including the Whipple surgery, which is a surgical

procedure for patients diagnosed with pancreatic

cancer.

Timing of care is crucial for patients diagnosed

with pancreatic cancer. The diagnosis is often

overwhelming and patients request prompt service.

The ICPHD staff includes two physician assistants, a

surgical nurse, two administrative assistants and a

nurse practitioner who serves as a nurse navigator.

The staff members are proud of their efforts in main-

taining timely services for our patients and will adjust

their schedules to meet the needs of the patients and

ensure quick access of services.

Patients receive educational materials and

brochures at their first appointment in the ICPHD.

Materials include information on pancreatic and

hepatobiliary diseases pertinent to the patient’s

condition and additional resources for patients and

their families.

Support Groups

Northwest Community Hospital held a focus group

this past year with patients who have had pancreatic

surgery. Plans are underway to host a support/edu-

cation group for these patients to provide education

and support that goes beyond their surgical experi-

ence. Our first support/education group occurred in

September 2010.

Outstanding Outcomes

Through the use of evidence-based medicine,

physician collaboration, state-of-the-art technology,

exceptional clinical staff and outcome monitoring

tools, we are able to provide care that results in the

best outcomes possible.

Inpatient Unit

The NCH inpatient Medical Oncology/Palliative Care

unit is a 31-bed, all-private-room setting. The unit is

located on the ninth floor of the South Pavilion, which

opened on May 1, 2010, and increased unit capacity

by nine beds. Each private room provides enhanced

opportunities for families to become more involved

in their loved ones’ care. The new space offers a

fresh and inviting healing environment by offering

a full complement of services. Oncology specialty

services include a dietitian, clinical-unit-based phar-

macist, and clinical resource manager to facilitate

discharges from the Hospital and to assist in difficult

decisions regarding ongoing care.

The nursing staff is specially trained to care for

those experiencing hematological/oncological ill-

nesses and end-of-life care. All registered nurses on

this unit are required to complete the Oncology Nurs-

ing Society’s Chemotherapy and a Biotherapy course

that is offered on-site.

Radiation Oncology

The Radiation Oncology department at NCH con-

tinues to offer the most comprehensive radiation

therapy services and programs. These include: exter-

nal beam radiation therapy; 3D-CRT treatment plan-

ning system; image guided, intensity modulated and

volumetric radiation therapy; HDR (high dose rate)

and LDR (low dose rate) brachytherapy: CyberKnife

(stereotactic radiosurgery, non-invasive); radiophar-

maceutical procedures; and Calypso (for real-time

treatment of prostate cancer). All treatment planning

is done on a dedicated CT scanner located within

the department.

The goal of any radiation oncology department is

to maximize therapeutic dose to the tumor area while

minimizing toxicity to surrounding structures. To this

end, NCH has committed itself by investing in the

most current technology available in cancer care. A

new Elekta Linear Accelerator was installed in the

summer. The first patient was treated in September.

Along with IGRT (image-guided radiation therapy),

this accelerator offers VMAT (volumetric modu-

lated arc therapy) technology. VMAT is a rotational

intensity modulated technique (IMRT) that reduces

treatment time (less time on treatment table) and

increases target accuracy. Cone beam CTs and kV

imaging are available, which allow images to be

acquired before treatment begins. These images are

merged to the planning images and enable staff to make

any correction in set-up prior to radiation treatment.

The NCH CyberKnife (SBRT) program continues

to grow. Almost 400 patients have been treated over

the past four years. Very precise, accurate, image-

guided radiation is delivered to the targeted area

in one to five treatments. The procedure is pain-

less with minimal side effects, allowing patients to

undergo their treatment and immediately resume

normal activity. Areas that have been treated include

the brain, spine, lung, pancreas, primary cancer sites

and metastasis. All services are provided by a team

of dedicated and compassionate staff consisting of

radiation oncologists, medical physicists, dosime-

trists, radiation therapists and oncology nurses. An

oncology social worker and dietician are on site for

supportive care.

At NCH, the radiation oncologists collaborate and

work with other specialty physicians to optimize can-

cer patient care. The Microsphere (SIRTEX) program

is one example where interventional radiologists

collaborate in the treatment of metastatic cancer to

the liver. The NCH Radiation Oncology department

offers the best in individualized cancer care in a

community setting.

Special Segments

Cancer Genetic Risk Assessment Program

Our genes affect virtually all aspects of how our

bodies grow and function. Alterations or mutations in

certain genes may increase a person’s lifetime risk

for certain types of cancer. While a mutated gene

does not cause cancer, it can increase an individual’s

risk for cancer. A person’s risk for cancer, however,

has many factors besides genetic. This includes diet,

exercise and exposure to environmental influences

like cigarette smoke. As a result, some people who

carry a mutated gene can live their entire lives and

never develop cancer while other people, who do

not carry a mutated gene, may develop the disease.

While increased risk for breast, ovarian, colon,

prostate and other cancers has been linked to

specific mutated genes, scientists are still working to

understand the specific interaction genes, behavior

and environment play on cancer risk.

While most cancer is not hereditary, approximately

10% of cancers are caused by an inherited genetic

predisposition. Patients who develop cancer at an

unusually early age or have a close relative who

develops two distinct kinds of cancer (rather than a

single cancer that spreads to other parts of the body)

may also have an increased cancer risk.

NCH’s Genetic Risk Assessment Program provides

genetic counseling for cancer risk assessment and

genetic testing for individuals with a personal or

family history of cancer. Knowing an individual has

an increased risk of cancer based on their personal/

family history or genetic testing can result in facilitat-

ing early detection and risk reduction strategies. This

summer, NCH launched this new and vital service for

our patients, which is led by Medical Director Gary

Kay, MD, and Genetic Counselor Holly LaDuca.

Genetic counseling involves reviewing an indi-

vidual’s medical and family history in order to assess

their personal risk for cancer. A cancer genetic

counseling session at Northwest Community Hospital

includes the following:

Review of genetics’ role in cancer

Discussion of the individual’s family/medical history

Personal cancer risk assessment

Discussion of appropriate screening tests, medical

evaluations and cancer prevention strategies

Discussion of available genetic testing, when appro-

priate, including risks, benefits and limitations

In addition to offering genetic counseling services,

our medical director and genetic counselor work

closely with healthcare providers in the Breast

Center, Prostate Center, Gastroenterology Center and

the Illinois Center for Pancreatic and Hepatobiliary

Diseases (ICPHD) to raise awareness of hereditary

predisposition to cancer, help identify patients who

would benefit from genetic counseling services, and

coordinate care for patients who have increased

cancer risks.

Genetic testing for cancer involves obtaining a

small amount of blood to look for a change in the

genetic material. This change may be associated

with an increased risk for cancers. The decision to

pursue genetic testing is a personal one. The genetic

counselor will help and support an individual in mak-

ing the choice that is right for them.

Genetic counseling is an ongoing process and

may involve more than one visit. The information

discussed and results of the genetic tests will be

kept confidential and will not be released without

written consent. Please visit nch.org/genes for more

information about our Genetics Program.

Palliative Care Services

Palliative Care Services was a goal for Northwest

Community Hospital that came to fruition in 2010.

This dynamic collaborative endeavor combines the

exceptional healthcare expertise of Northwest Com-

munity Hospital with specialist-level palliative care of

Midwest Palliative & Hospice CareCenter. We have

enhanced support for our cancer patients and their

families by integrating palliative care as part of the

treatment and care options available to them.

Palliative care medicine is specialized medical

care that promotes relief of symptoms and improves

quality of life for seriously ill patients and their fami-

lies. Provided by an interdisciplinary team, the goal

of palliative care is to help patients and their families

manage the challenges of serious illness. Research

demonstrates that palliative care is beneficial for

patients with complex illness—independent of prog-

nosis—particularly when they are hospitalized. It can

occur simultaneously with treatment that is aimed at

cure and recovery.

Palliative care plays an important role in the

care of cancer patients. Side effects of cancer treat-

ments such as pain, fatigue, nausea and vomiting

are often ongoing issues for patients with malignan-

cies. It is helpful to integrate supportive care via the

expertise of palliative care early in the treatment of

a malignancy.

The results of an August 2010 study in the New

England Journal of Medicine demonstrating the ben-

efit of palliative care combined with usual oncologic

care underscored Northwest Community Hospital’s

goal. Early integration of palliative care in a serious

diagnosis has been shown to help patients live lon-

ger and with an improved quality of life. At Northwest

Community Hospital, the Pancreatic Hepatobiliary

Support Service has been established to initiate a

supportive care plan for every patient before and

after surgery. Renowned physicians Dr. Malcolm

Bilimoria and Dr. Martha Twaddle are leading this

vital project.

These endeavors have been well received. During

the first three months of the program, Palliative Care

Services provided support to 140 patients, of which

37 percent were cancer patients. Midwest CareCen-

ter is a nationally recognized nonprofit hospice and

palliative care organization based in Glenview. With

this new partnership, Northwest Community Hospital

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now provides consultative palliative care services

with an integrated team of physicians, advanced

practice nurses, social workers and chaplains who

are available to see patients throughout the Hospital

and also in their homes.

NCH Nurse Navigators

Nurse navigators are instrumental in helping cancer

patients and their families navigate the increasingly

complex maze of cancer care. They offer support,

guidance and education when patients are deciding

between treatment options, scheduling appoint-

ments, arranging a referral and dealing with the

psychosocial issues that arise when facing a

cancer diagnosis.

Northwest Community Hospital was one of the

pioneers of this unique resource for cancer patients

and their families. Our history dates back to 1996

when the first breast care coordinator began guiding

patients through the breast cancer journey. Since

2006, two breast nurse navigators, a prostate nurse

navigator and a gastrointestinal (GI) nurse naviga-

tor joined the NCH staff. Most of our navigators are

credentialed advanced practice nurses who are certi-

fied in their area of expertise. Each of these roles has

developed and evolved in response to the individual

needs of our patients and their families.

Our experienced nurse navigators provide

educational and emotional support to patients with

a cancer diagnosis. They can guide the patient and

family through treatment options for a new diagnosis

or recurrent cancer, reinforcing information given

by their physicians and supporting the patient’s

decisions. Nurse navigators are involved in research

when patients are enrolled in clinical trials and they

use current research to improve patient outcomes.

The navigator will also ensure that the patient and

family are aware of, and have access to, all ancillary

services they might need, including financial coun-

seling, support groups and community resources.

The navigator will assist with communication among

healthcare providers to ensure continuity and follow-

through of treatment plans. Once cancer treatment is

complete, nurse navigators follow patients who need

help with management of short and long-term side

effects.

The addition of the Illinois Center for Pancreatic

and Hepatobiliary Diseases (ICPHD) produced a

genuine need for the role of a GI nurse navigator to

support patients and families who are scheduled for

surgeries involving the liver and pancreas.

The prostate nurse navigator supports men with

prostate cancer or other prostate conditions. One of

the unique programs developed at NCH for prosta-

tectomy patients includes preoperative teaching for

home urinary catheter care, provision of a home care

kit and postoperative telephone follow-up.

The breast nurse navigators work with all patients

having a breast biopsy at NCH by preparing them,

assisting with the procedure, and guiding patients

through the results and follow-up process.

NCH Community Outreach

Wellness is a concept that is truly on the front lines of

healthcare. In cancer, it means educating individuals

about healthy living to decrease the risks of largely

preventable cancers, and screening to detect cancer

at its earliest and most treatable stage. Our breast

and prostate nurse navigators have been bringing

health education and consultations to churches and

other public places including underserved communities.

Breast

This past year, the Hospital has provided 70 free

mammograms and is expected to reach 90 by the

end of the year. NCH provided 14 diagnostic work-

ups and four breast cancers were diagnosed. All

procedures were funded by the generous support of

the Susan Lasky Foundation and the NCH Foundation

“Gift-a-Mammogram” program.

Colon

On March 10, we teamed up with the American

Cancer Society (ACS) and the NWS Women’s “Real

Women Wear Blue” for colon cancer awareness to

remind community members about the need to get

screened for colorectal cancer and to talk to their

doctors about getting a screening test, especially for

people 50 and older. GI services also partnered with

the American Cancer Society and participated in

the“Daffodil Days” program by handing out daffodils

to patients.

The Hospital’s ICPHD team was actively involved in

Pancreatic Cancer Action Network Purple Strides—

PanCan Walk on May 1 to raise funds for pancreatic

cancer research.

Prostate

Here at NCH, community members can come in for

free or low-cost screenings for skin and prostate

cancer. Last year, 93 men were screened with a

Prostate Specific Antigen (PSA) blood test and a

digital rectal exam. In June 2010, NCH provided free

PSA screenings for 24 men at St. Collette’s Church

in Rolling Meadows as part of a community men’s

health event. Education and on-site consultation

with the prostate nurse navigator were provided.

The American Cancer Society does not support

routine testing for prostate cancer without a discus-

sion between the patient and physician about the

potential benefits and limitations of early detec-

tion. In response to this position statement, the two

low-cost screenings in September 2010 included an

education session with an NCH urologist. We had 87

members attend these screenings.

Skin

In July, 75 community members were screened for

one to two areas of concern at the NCH annual skin

cancer screening. The screening was free and edu-

cational materials were provided by the American

Cancer Society. Eighteen of the participants were

recommended to pursue a dermatologist for biopsy,

with eight of those being suspected for possible

basal cell carcinoma on clinical exam. No partici-

pants were suspected for melanoma.

Support Services

Northwest Community Hospital continues to serve

the community through support services to cancer

patients and their families by offering counseling

services, networking groups and resources through

a dedicated licensed clinical oncology social worker.

Patients and their families have access to a social

worker whether in the Hospital or utilizing Northwest

Community Hospital’s outpatient services. The role of

the social worker is to facilitate a patient’s well-being

and improve quality of life as much as possible. This

social worker is master’s prepared in social work and

is skilled in counseling patients and their families as

they learn to cope with cancer. The social worker

is there to be an advocate and is available to meet

individually with patients or as a family.

NCH also offers several networking groups. These

groups include:

Make Today Count, a general cancer support group

Reach for Support, a breast cancer group

Leukemia and Lymphoma Networking Group

Myleodysplastic Syndrome (MDS) group

Look Good...Feel Better, a make-up program for

women (sponsored by the American Cancer Society)

This fall we have started a new networking group

for those who have had pancreatic surgery. Our first

meeting was in September and focused on nutrition after

surgery. All of our networking groups are facilitated by

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licensed professionals and trained volunteers.

This year, several NCH employees who are cancer

survivors volunteered to be trained to assist fellow

employees as they cope with a cancer diagnosis.

These employees have appreciated the support they

received from fellow employees and want to give

back to others in the organization. We also have

created a brochure for employees that lists all the

services available to them through NCH.

The Schwartz Center Rounds is in its second

year and has been well attended throughout the

year. The Rounds is a multidisciplinary forum that

meets monthly in which caregivers discuss difficult

emotional and social issues that arise in caring

for patients.

Our ninth Annual Cancer Survivor Celebration, held

at the Arlington Heights Senior Center, was attended

by 180 cancer patients and families. This year, sev-

eral dog and handler teams of the NCH Animal-As-

sisted Therapy program attended the event. Animal-

Assisted Therapy has been a wonderful addition to

our support services. Patients and staff alike receive

comfort and stress reduction by these visits.

We continue to manage a Cancer Services Library

in Radiation Oncology and the Ambulatory Infusion

Clinic where books and CDs related to cancer can be

checked out. Cancer Resource Notebooks are also

available to any cancer patient, which provide

helpful hints and information to assist them through

their cancer journey.

In Radiation Oncology, we have added a cancer

ribbon board. Anyone can honor or remember a

cancer survivor by placing a ribbon on the board.

A selection of ribbon colors is available to represent

a specific cancer.

A resource that has helped over 100 of our cancer

patients is our Cancer Patient Assistance Program.

Through generous donations from staff and the

community, this fund helps patients in need of finan-

cial support while undergoing treatment at NCH.

The fund primarily focuses on household expenses

such as rent, mortgage and utilities.

This year, we added an additional fund: the Laura

Messmer Kowalski fund. Dedicated to helping our

cancer patients who have young children, this fund

helps to provide meals, as well as housecleaning and

child care services. Children under 12 years receive

a bag that includes diversion activities and an age-

appropriate book explaing cancer. A booklet is given

to parents to help them explain cancer to children

and counseling services are available for the family.

Major Site Analysis—Pancreas

According to the American Cancer Society (ACS)

facts and figures 2010, an estimated 43,140 new

cases of pancreatic cancer are expected to occur

in the US. There has been a significant increase in

the incidence of pancreatic cancer over the past

several decades, and it now ranks as the fourth

leading cause of cancer death in the United States.

Incidence rates of pancreatic cancer have been

stable in men since 1981 but have been increasing

in women by 1.7% per year since 2000. An estimated

36,800 deaths are expected to occur in 2010. The

death rate for pancreatic cancer has been stable in

men since 2003 but has been increasing slightly

(0.1% per year) since 1984 in women. Despite high

mortality rates, the etiology of pancreatic cancer is

poorly understood.

Risk Factors

Smoking

Diabetes

Pancreatitis

Excessive alcohol consumption

Family history of pancreatic cancer

Poor diet

Obesity

Early Diagnostic Tests and Screening includes:

Computed Tomography (CT) scan

Magnetic Resonance Imaging (MRI)

Endoscopic Retrograde Cholangiopancreatography

(ERCP)

Magnetic Resonance Cholangiopancreatography

(MRCP)

Endoscopic Ultrasound (EUS)

Endoscopic Ultrasound with Fine Needle Aspiration

(EUS/FNA)

PET/CT scan

Laparoscopic Ultrasound

NCH 5-YR PANCREATIC CANCER INCIDENCE 2005–2009 n = 477

Num

ber o

f Cas

es

180

160

140

120

100

80

60

40

20

02005 2006 2007 2008 2009

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•

•

•

•

•

•

•

•

•

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•

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Signs and Symptoms

Cancer of the pancreas often develops without

early symptoms, and often times these symptoms

don’t occur until the cancer is in an advanced stage.

Symptoms caused by pancreatic cancer may depend

on the site of the tumor within the pancreas and

the degree of involvement. Symptoms may include

weight loss, fatigue, weakness, pain in the upper

abdomen that may radiate to the back, or new onset

of uncontrolled blood sugar. Tumors that develop

near the common bile duct may cause a blockage

that leads to jaundice (yellowing of the skin and

eyes), dark-colored urine or pancreatitis.

Unfortunately, there are no screening tests for

pancreatic cancer. The disease is usually asymp-

tomatic and only 7% of cases are diagnosed at an

early stage. There are also no tumor markers specific

to pancreatic cancer. A serum CA19-9 level is not

a good measure for diagnosing pancreatic cancer.

Most patients will have an elevated level at diagno-

sis and an elevation during or after treatment may

signal recurrence. However, research is underway to

identify better methods of early detection.

Prognostic Factors

The prognosis of patients with pancreatic cancer

is based on the extent (stage) of the disease related

to the size of the tumor, the presence or absence

of nodal involvement, as well as the presence or

absence of distant metastases. These factors form

the basis for the staging system developed for

this disease.

NCH AJCC STAGE AT DIAGNOSIS 2005–2009 n = 477

Num

ber o

f Cas

es

180

160

140

120

80

60

40

20

0UNK Stg

Stg I

Stg II

Stg III

Stg IV

Tail

Body

Head

Overlapping

NCH PANCREATIC CANCER BY SUB-SITE 2005–2009 n = 477

16%

11%

11%

62%

NCH PANCREATIC CANCER BY MORPHOLOGY 2005–2009 n = 477

77%

6%6%5%

6%

Adenocarcinoma

Other

Neuroendoctrine Carcinoma

Treatment

Surgery, radiation therapy and chemotherapy

are treatment options that may extend survival

and/or relieve symptoms in many patients, but

seldom produce a cure. Surgery is the only way

to remove pancreatic tumors and is performed

only when the surgeon believes that the whole

tumor can be removed. Only less than 20% of

patients are candidates for surgery because

pancreatic cancer is usually detected after

it has spread beyond the pancreas. Surgery

begins with an intraoperative ultrasound of the

liver to ensure that the cancer has not spread.

Clinical trials have shown that for patients

who undergo surgery, adjuvant treatment

with the chemotherapeutic drug gemcitabine

lengthens survival. Erlotinib (Tarceva) has

been approved by the FDA for the treatment

of advanced pancreatic cancer. This targeted

anticancer drug blocks tumor cell growth and

has demonstrated a minimal improvement in

pancreatic cancer survival when used along

with gemcitabine. Clinical trials with several

new agents, combined with radiation and sur-

gery, may offer improved survival and should

be considered as a treatment option.

NCH PANCREATIC CANCER TREATMENT 2007–2009 n = 191

49%

10%7%

16%

12%

2%

4%

Surgery with Chemotherapy

Diagnostic Biopsy with Surger

Diagnostic Biopsy with Chemotherapy

Diagnostic Biopsy with Surgery, Radiation Therapy and Chemotherapy

Diagnostic Biopsy with Chemotheraphy and SurgeryDiagnostics/

Palliative Treatment

Surgery with Radiation Therapy and Chemotherapy

Survival

For all stages combined, the one- and five-year rela-

tive survival rates are 25% and 6%, respectively. Even

for those people diagnosed with local disease, the

five-year survival is only 22%. Obesity is associated

with lower survival rates for pancreatic cancer.

Interval (Months)

NCH: 3-YEAR OBSERVED SURVIVAL FOR PANCREATIC CANCER BY CS/AJCC STAGE REPORT Diagnosed 2007-2009, n = 191

Cum

ulat

ive

Surv

ival

Rat

e (%

)

90

80

70

60

50

40

30

20

10

01 2 3 4 5 6 7 8 9 10 12 15 16 1713 18

100

Stg I

Stg II

Stg III

Stg IVStg UNK

Interval (Years)Source: National Cancer Database by jbanasiak@facs.org

NATIONAL: DATA FROM NCDB 5-YEAR OBSERVED SURVIVAL FOR PANCREATIC CANCER Diagnosed in 2003, n = 1269

Cum

ulat

ive

Surv

ival

Rat

e (%

)

90

80

70

60

50

40

30

20

10

100

Stg I

Stg IIStg IIIStg IV

Stg 0

1 3 4 52

The multidisciplinary Cancer Committee is composed of both medical staff members and Hospital personnel

with a full range of specialty skill sets involved in the diagnosis, treatment, rehabilitation and support of

cancer patients. The committee is responsible for reviewing and maintaining the standards of care for cancer

patients at Northwest Community Hospital. In addition, the committee oversees the activities of the Cancer

Registry and our participation in the activities of the American College of Surgeons Commission on Cancer.

Physician Representatives

Mohammad Ahsan, MD Anesthesiology/ Pain Clinic

Jonathan Barker, MD Radiology

Malcolm Bilimoria, MD Surgical Oncology

Keith Bowersox, MDCardiothoracic Surgery

Richard Broderick, MDNeurosurgery

Melanie Castelli, MDPathology

George Cromydas, MDPulmonology

Mina Foroohar, MDNeurosurgery

Allyson Jacobson, MDGeneral Surgery

James Kim, MDUrology

Steven Leibach, MDHematology/Oncology

Najeeb Mohideen, MDRadiation Oncology

Stephen Nigh, MDChairmanRadiation Oncology

Willis Parsons, MDGastroenterology

Lon Petchenik, MDOtolaryngology

Donald Pochyly, MDMedical Education

Peter Rantis, MDGeneral Surgery

Robert Rao, MDGeneral Surgery

Arnold Robin, MDCancer Liaison Physician General Surgery

Tim Short, MDHospice & Palliative Care

Richard Siegel, MDHematology/Oncology

Josh Tunca, MDGynecologic Oncology

Martha Twaddle, MDHospice & Palliative Care

Jason Weiss, MDPathology

Ex-Officio Members

Juli Aistars, RN, APNProstate Nurse Navigator

Keith Ammons, MBA, RTT Director, Radiation Oncology & Cancer Services

Misbah Baggia, RHIT, CTRManager, Cancer Registry

Cindy Blim, RN, BSNManager, AIC & Wound Clinic

Linda BradyAmerican Cancer Society

Karen Colby, RN, MS, CNAA-BCDirector, 7S, 8S, 9S

Amy Dolce, APN, AOCN, CHPNCNS, Oncology

Cindy Dougherty, RN, MSMOB, CPHQDirector, QMI

Kathy Ferket, RN, MSN, APNExecutive Director, Patient Care Support & Children’s Partnership

Kim Jensen, LCSW, OSW-COncology Social Worker, Cancer Services

Holly LaDuca, MS, CGCGenetic Counselor

Kathy Lamont, RN, BS, MBADirector, GI Center

Christine Masonick, RN, BS, OCNManager, Breast Center

Karen McCauley, PT, MBADirector, PM&R

Joe Novak, PhDDirector, Mental Health

Ada Nwokedi, PharmD, MSPharmacy

Lydia Olson, MS, RTFacilitator, Radiation OncologyCharlene Padovani, MA, CHESAmerican Cancer Society

Christine PeiskerStrategic Marketing Manager, Marketing & Business Development

Laura Pollack, MBA Vice President, Growth

Anita Ratterman, RD, CSO, LDNDietitian, Cancer Nutrition Support

Gary SkibaVice President, Professional Services

Josie Smudde, RNCCoordinator, Cancer Services Data

Sue Weber, RN, BS, MBAManager, 9S

Bob Wisniewski, BSRTDirector, Imaging Services

Paul Zega, RPH, MHSDirector, Pharmacy

2009 statistical data compiled by Misbah Baggia RHIT, CTR

Cancer Committee

Northwest Community Hospital is a charitable organization and provides financial assistance to people who are eligible. For more information, please call 847.618.4542 or visit our website at www.nch.org.

As one of the premier providers of cancer care in the Chicago area, we exist to offer comprehensive, compassionate cancer care to our patients and their families.

Our commitment is to provide the latest technology and compassionate care to each individual. It is our goal to meet your needs whether physical, emotional or spiritual throughout your experience.

Cancer Services Philosophy and Mission Statement

800 W. Central Road

Arlington Heights, IL 60005 847.618.4YOU (4968)