BCI Annual Report 2012

Baptist Cancer Institute

2 0 1 2 CANCER PROGRAM A n n u a l R e p o r t

Table of Contents

2 Cancer Committee Report

6 Tumor Registry Report

18 Tumor Review: Hodgkin’s Disease

24 Tumor Review: Soft Tissue Sarcomas

30 Quality Assurance

32 Clinical Research and Education

36 Distinguished Individual in Cancer Care

38 Philanthropy

B a p t i s t C a n c e r I n s t i t u t e 2 0 1 2 A n n u a l R e p o r t

Baptist Cancer Institute (BCI) is affiliated with

Baptist Health, the only locally governed,

faith-based health system in Northeast Florida.

Baptist Health, a Magnet™ Health Care

System honored for excellence in patient

care, is comprised of Baptist Medical Center

Jacksonville, Baptist Medical Center Beaches,

Baptist Medical Center Nassau, Baptist Medical

Center South, Wolfson Children’s Hospital and

Baptist Clay Medical Campus.

Baptist Cancer Institute is one of the most

active clinical research institutes in the state

of Florida, with open studies in breast cancer,

lung cancer, gastrointestinal malignancies,

lymphoma, leukemia, head and neck cancer

and brain tumors. We work in collaboration

with physicians across the state and the

nation to conduct clinical trials that lead to

improved diagnostic approaches, reductions

in toxicities and new ways to fight these often

devastating diseases.

1

As the world progresses to electronic

information, Baptist Medical Center

and Baptist Cancer Institute (BCI) have

followed suit. This year, 2011, will be the

second year the Cancer Committee report

will be exclusively online. The Baptist

hospital systems – Baptist Jacksonville,

Baptist South, Baptist Beaches, and Baptist

Nassau – are now complete EMR hospitals.

As chairman of the Cancer Committee, we

will continue to follow the electronic medical

record impetus and make this report both

concise and informative. The Cancer program has

continued to be healthy, offering a wide breadth of

services and high-quality care for cancer patients in

Northeast Florida and Southeast Georgia. Cutting-edge

programs in neuro-oncology, breast care, and lung cancer

treatment are active in offering a high level of care which

translates into high satisfaction for patients.

Baptist Health offers a wide variety of not only cancer treatments, but

educational programs for both physicians and the public. At Baptist Jacksonville,

palliative care offers a multi-step program for our cancer patients. Close communications

with Hospice of Northeast Florida allows hospice to step in when more intensive care is

Cancer Committee

ReportTroy H. Guthrie Jr., MD, Cancer Committee Chairman


needed at the patient’s home. These programs allow

patients and their families to make every minute count

toward the highest quality of life. Clinical research

programs continue to be extremely active at BCI,

with research programs in breast cancer, lung cancer,

melanoma, neurological malignancies, prostate cancer,

hematological malignancies, and other solid tumors.

Research studies are offered through the auspices of the

National Cancer Institute clinical study groups, as well as

pharmaceutical-sponsored industry trials.

Screening programs in breast cancer, colon cancer,

prostate cancer, and skin cancers continue to expand,

offering education to the public as well as active

intervention. The genetic assessment program, under

the leadership of Melinda Fawbush, MSN, ARNP,

remains extremely active concentrating primarily on

breast cancer.

Multi-disciplinary conferences in breast cancer

are offered weekly, lung cancer bi-weekly, and

neuro-oncology monthly. These programs are

teleconferenced to satellite hospitals so that education

can be received by physicians and health care staff

in their own hospital. Psychosocial support continues

to be offered by George Royal, PhD, and

more recently, nutritional, physical therapy, and

occupational therapy programs are offered

through our multi-disciplinary cancer program.

The Cancer Committee at Baptist Medical

Center Jacksonville continues to meet

quarterly to provide leadership direction and

review of all aspects of the cancer program

and services as mandated by the American

College of Surgeons. At each meeting, the

activities of the tumor registry and current

clinical research, as well as goals of the

Cancer Committee, are reviewed.

Current leadership for the Cancer Committee

includes:

• Troy H. Guthrie, Jr., MD, Chairman, Cancer

Committee;

• Mark Augspurger, MD, Liaison to the American

College of Surgeons; Patricia Woods, RN, BSN,

OCN, Quality Improvement Coordinator;

• Paul Oberdorfer, MD, Community Outreach

Coordinator;

• Melissa McCarthan, RHT, CTR, Tumor Registrar; and

• Jan Peer, CCRP, Research Coordinator.

3

At each meeting, the Cancer Committee reviews,

revises, and reapproves current program goals to

determine whether they are being met and if they

are aligned with the latest requirements of the

American College of Surgeons.

This Annual Report, as required by the American

College of Surgeons, will include a prospective

and retrospective study of cancer disease sites,

as well as assess the quality of data provided by

the tumor registry. This year, Hodgkin’s disease

and soft tissue sarcoma will be the areas of review.

In 2011, more than 10 percent of all analytic

cases were reviewed on a prospective basis by

physician volunteers to ensure continued quality

and timeliness of data entered into the Baptist

Tumor Registry. In 2011, for the second time in

a row, there was a drop in the number of cases

accessed with the total number of analytic cases

being 1,624 compared to 1,656 the previous

year. The total number of analytic cases fell at

Baptist South, likewise, from 533 cases to 458

analytic cases. The slight drop in analytic cases

at Baptist Jacksonville appeared to be spread

out among tumor sites. Currently, the Tumor

Registry includes a total of 26,414 analytic cases

accrued since 1990. In 2011, the cancer clinical

research program included active participation in

the National Surgical Adjuvant Breast and Bowel

Project, Eastern Cooperative Oncology Group,

Radiation Therapy Oncology Group, and Mayo

Clinic Cancer Research Consortium, as well as

pharmaceutical industry sponsored research

trials. In 2011, approximately 50 percent of the

research patients participated in NCI group

studies and 50 percent were patients registered

on pharmaceutical studies.

Other Baptist Cancer Institute activities include:

• Major conferences for oncology nurses

• Prevention and community education programs

• Continued participation in the American Cancer

Society and Leukemia and Lymphoma Society

Committees

• Special oncology nursing programs for

community support of education in breast and

lung cancer

• Smoking cessation assistance programs for the

community as well as employees of Baptist

Health

• Cutting-edge prostate cancer treatment

programs, including seed implants and the state

of the art da Vinci Robotic Surgery unit

• Continued expansion of the stereotactic

radiosurgery radiation program with a marked

increase in the number of body sites being

treated

• Continued expansion of the limited breast

radiation program using the Mammosite®

technique

• Continued expansion of the digital breast

cancer-screening program with movement to

centralized diagnostic studies at the Baptist

Cancer Institute

• Participation in in-patient quality improvement

programs, including infection control

• Expansion of the chemotherapy and

radiopharmaceutical embolization programs for

treatment of liver malignancies

• Continued participation of indigent programs,

including the highly successful We Care program

• Continued expansion of a hospital-based

chemotherapy infusion unit

4

• On-site involvement of hospice and palliative

care programs for optimum support for both

the cancer patient and family

• Continued expansion of the Genetic Risk

Assessment Screening program, now focusing

on breast cancer, but also includes melanoma,

and colon cancers

• Continued active participation in the oncology

training program for the medical oncology

fellows from the University of Florida

Jacksonville and the Radiation Therapy

residents at Mayo Clinic Jacksonville

As Cancer Committee Chairman since 2005, it gives me great pleasure to see the continued expansion

of cancer services offered in Northeast Florida and Southeast Georgia in the year 2011. State-of-the-

art programs which run the entire spectrum of hematologic and solid tumor malignancies are being

offered in a multi-disciplinary approach to patients of all walks of life. A close collaboration of physicians,

hospital administrators, and allied professional staff has enabled the Baptist Cancer Institute to remain at

the forefront of care in this region for cancer patients.

Troy H. Guthrie Jr., MDCancer Committee ChairmanMedical Director, Education and ResearchBaptist Cancer Institute

• Continued expansion and utilization of the

comprehensive breast health program with

nurse coordinator at Baptist Jacksonville,

Baptist South and Baptist Beaches

• Rapid expansion of the Neuro-oncology

program, with continued expansion of the

radiosurgery program, as well as increased

sophistication of the Neurosurgery suites

and continued expansion of Neuro-oncology

clinical research studies

5

The Tumor Registry at Baptist Cancer

Institute has been approved since 1990

by the Commission on Cancer of the

American College of Surgeons. As part

of our approval, the Tumor Registry

collects data on cancer screenings

annually in terms of incidence, tumor

site, kinds of treatment provided,

and survival outcomes. Its data is then

entered into the Florida State Tumor

Registry and ultimately accumulated at the

national level as SEER data. This process

enables all American College of Surgeons

accredited cancer centers to compare their

own outcomes in terms of diagnoses, stage,

effectiveness of cancer treatment, and ultimate

outcome in terms of survival, to each other. This

enables Baptist Cancer Institute through its Tumor

Registry, as well as other accredited programs, to assess

their level of care when compared to others both within the

state of Florida, as well as at the national level and see if standards

of care are met to assess areas where quality improvement is needed to

address deficits within each program.

TumorRegistry Report

Troy H. Guthrie Jr., MD, Cancer Committee Chairman

Melissa McCarthan, RHIT, CTR

April Stebbins, RHIT, CTR

Rassy Sprouse, BSc


The registry assists the Cancer Committee with

evaluating outcomes, quality of medical care,

and assessment of treatment, recurrence, and

survival rates. Currently, the Baptist Tumor

Registry has accumulated data from both

Baptist Medical Center Jacksonville since 1990

and Baptist Medical Center South, where data

collection began in 2005. Physician volunteers

from both Baptist Jacksonville and Baptist South

assist tumor registry in assessing the accuracy of

analytic case data accumulation for each year.

Ten percent of all cases are evaluated by these

physician volunteers for accuracy of data as well

as timeliness of reporting.

Figure 1 demonstrates the number of cases

accumulated from 1990 through 2011 at Baptist

Medical Center Jacksonville. As you can see,

for the second year in a row, there is a drop in

the number of patients seen compared to 2010.

This decrease in the number of patients is less

dramatic than the previous year, but represents

the second year in 21 years that the Tumor

Registry has seen a decline in cases. Since 1991,

the Tumor Registry at Baptist Jacksonville has

seen a total of 26,414 analytic cases. Similar

to previous years, there remains a female

predominance of analytic cases with 2011 having

943 female cases and 681 male cases (Figure

2). Table 1 demonstrates the incidence of the

most common primary sites seen at Baptist

Medical Center Jacksonville with breast cancer

accounting for 434 cases or 27 percent, prostate

cancer 199 cases or 12 percent, Lung cancer

186 cases or 11 percent and female genital

cancers 106 cases or 7 percent. Of great interest,

melanoma came in as the sixth-most common

site with 90 cases or 6 percent. Colorectal,

a much more common malignancy, had only

89 cases or 5 percent and central nervous

system malignancies or neuro-oncology had 85

cases or 5 percent. In 2011, there continued

to be a decrease in prostate cancer, although

less dramatic when compared to 2010 and a

relatively dramatic drop in lung cancer cases

was seen compared to 2010, with only 186

cases being registered in 2011. Melanoma and

urinary bladder as primary sites showed the most

substantial increase in patient numbers accrued

to the 2011 Tumor Registry. Table 2 shows the

frequency of primary sites seen at Baptist South

which has a somewhat different incidence of

primary sites than Baptist Jacksonville with an

increased percentage of lung, colorectal, thyroid,

and kidney primaries and a marked decrease in

the frequency of melanoma, brain tumor, and

7

Figure 2 Male & Female Malignancies: 2011 (Baptist Jacksonville)

1000

800

600

400

200

0

681

943

No

. of

Ma

lig

nanc

ies

Male Female

Figure 1 Baptist Cancer Institute Analytic Cases by Year

1800

1600

1400

1200

1000

800

600

400

200

01990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

688 76

4 807

1004

1102

964

928

865 96

5

972 10

41 1138

1308

1139

1265

1253

1467

1630

1656

1744 1779

No

. of

Pa

tien

ts

Year

Figure 3 Analytic Cases: 2010 - 2011 (Baptist Jacksonville and Baptist South)

2000

1600

1200

800

400

0

1656

533

No

. of

Pa

tien

ts

Baptist Jacksonvi l le

Baptist South

2010 2011 2010 2011

458

1624

1624

female genital tract incidence. These differences

between sites seen at each hospital again

references the difference in terms of referral

pattern with expertise in melanoma and neuro-

oncology being located at Baptist Jacksonville

and only a modest presence of gynecologic

oncology at Baptist South. These tables also

indicate the male and female predominance

of malignancies by the primary site at both

institutions. There was a drop for the second

year in a row of 32 analytic cases of Baptist

Jacksonville and a decrease for the first time of

total cases seen at Baptist South from 533 cases

to 458 cases (Figure 3). These decreases in total

cases seen are almost certainly multi-factorial but

recent campaigns by other hospitals to attract

cancer cases may be a factor. Table 3 compares

the incidence of the five most common primary

8

Table 1 Primary Sites : Baptist Medical Center Jacksonville (2011)

Site Total % Male Female

Breast 434 27% 3 431

Prostate 199 12% 199 0

Lung 186 11% 89 97

Female Genital 106 7% 0 106

Melanoma 90 6% 53 37

Colorectal 89 5% 50 39

Brain & CNS 85 5% 37 48

Other Sites 63 4% 37 26


Blood & Bone Marrow 62 4% 36 26

Kidney 51 3% 30 21

Pancreas 51 3% 28 23

Urinary Bladder 49 3% 38 11

Lymph Node 47 3% 24 23

Stomach 21 1% 13 8

Unknown Primary 17 1% 7 10

Esophagus 11 1% 10 1

Liver 10 1% 7 3

Total 1,624 100% 681 943

sites seen at Baptist Jacksonville compared to

state and national statistics. Similar to previous

years, there is an essential doubling of the

incidence of breast cancer seen at Baptist Cancer

Institute compared to both Florida and the

United States and likewise a marked increase

in the number of female genital and melanoma

cancer cases seen compared to again the state

of Florida and the U.S. average. Offsetting

this is a modest decrease in the number of

prostate and lung cancer cases seen at Baptist

Jacksonville compared to both Florida and the U.

S. average. A 5 percent incidence of colorectal

cancer seen at Baptist Jacksonville unfavorably

compares to the overall national incidence

of 9 percent. This variance most probably

represents referral patterns of this primary site

to gastroenterologists for endoscopy and then

9

Table 2 Primary Sites : Baptist Medical Center South (2011)

Site Total % Male Female

Breast 127 27% 0 127

Lung 50 10% 24 26

Colorectal 47 10% 19 28

Thyroid 31 7% 5 26

Kidney 29 6% 18 11

Urinary Bladder 27 6% 19 8

Prostate 21 5% 21 0

UGI 19 4% 14 5


Lymph Nodes 18 4% 13 5

Blood & Bone Marrow 17 4% 11 6

Melanoma 16 4% 11 5

Brain & CNS 12 3% 4 8

Pancreas 10 2% 5 5

Female Genital 9 2% 0 9

Head & Neck 6 1% 6 0

Unknown Primary 4 1% 2 2

Total 458 100% 179 279

for surgery. Baptist Jacksonville fell within the

national average percentage for other primary

sites except for melanoma and CNS tumors

which certainly represent our active neuro-

oncology program, as well as the expertise in

melanoma care at Baptist Jacksonville.

The Tumor Registry also maintains a list of

individual cases discussed and attendance at

the Tumor Board as well as that of the multi-

disciplinary breast conference, neuro-oncology

conference, and lung cancer conferences.

Participation at these conferences assures the

adequate representation of all primary sites

are discussed as mandated by the American

College of Surgeons to maintain a commission

on cancer certified tumor registry. Separate

multi-disciplinary breast conferences are held at

Baptist Jacksonville, Baptist South, and Baptist

Beaches. All multi-disciplinary conferences

10

Table 3 Comparison Data with Florida and United States

Organ SiteBaptist Cancer

InstituteFlorida United States

Breast 27% 14% 14%

Lung 11% 15% 14%

Prostate 12% 15% 15%

Female Genital 7% 3% 4%

Melanoma 6% 5% 4%

“Figures for Florida and U.S. are estimates from Cancer Facts and Figures 2011”

as well as Tumor Board are patient focused

discussions regarding diagnoses and treatment

approaches. Continued medical education (CME)

and continuing education units (CEU) credits

are available by the Baptist Health continuing

education program for these conferences. The

Tumor Registry is also available for questions

concerning treatment outcomes or any other

questions that arise from medical staff or

community.

The Tumor Registry also reviews the organization

of the weekly multi-disciplinary tumor conference

as well as assists the Cancer Committee in

evaluation outcomes, quality of medical care,

assessment of complications, recurrence, and

survival rates. Currently, the Baptist Tumor

Registry accumulates data from Baptist

Jacksonville as well as Baptist South. Baptist

Medical Center Beaches has a separate Tumor

Registry. All data is reviewed prior to entering

it into the Tumor Registry and a composite 10

percent of patients are then further reviewed by

physician volunteers for accuracy and timeliness

of data entry. Currently, Melissa McCarthan,

RHIT, CTR; April Stebbins, RHIT, CTR; and

Rassy Sprouse, BS, staff the Tumor Registry

and are supervised by Linda Huntley, Director

of Oncology Services, as well as physician

supervisors Troy Guthrie, Jr., MD, and Mark

Augsperger, MD.

11

The number of breast cancer cases which are

accrued to the Baptist Health Tumor Registry

at Baptist Jacksonville consistently exceeds the

state of Florida and national average. In 2011,

there were a total of 434 cases entered into the

tumor registry representing 27 percent of all cases

which exceeds the national and state of Florida

average of 13 percent. Similar to previous years

and similar to the national average, the majority of

these cases are early stage breast cancer (Figure

4). Seventy-nine cases or 18 percent were DCIS,

190 cases (44 percent) were Stage I and 113

or 26 percent were Stage II. These early stage

breast cancers represent 88 percent of all breast

cancers seen and we would expect that all but a

few of these women would ultimately be cured of

their breast cancer. Stage III was 33 or 8 percent

in which many of the patients would ultimately

die of their breast cancer and Stage IV was 18

patients or 4 percent and we would expect all

of the patients to ultimately die of their breast

cancer. Out of these 434 cases, only one or less

than one percent is classified as unknown stage

assessing to the tenacity of our Tumor Registry in

adequately staging the patients.

Breast cancer consistently represents a very

high percentage of the cases seen at the Baptist

Cancer Institute compared to the U.S. average.

This attests to the effective network in which

primary care physicians work with our digital

mammogram screening program to diagnose

patients at an early stage and move them into

the organized breast cancer program run through

the multi-disciplinary Hill Breast Clinic. In 2011,

the breast health program spent its first full year

in the Hill Breast Center at the Baptist Outpatient

Center. Two nurse navigators assisted patients

and physicians to optimize patient convenience as

well as patient care. A breast survivorship program

with nutrition, physical therapy and psychosocial

support is in place to enhance the overall

experience in patients seen at the Hill Breast

Center. Cutting-edge surgery programs with

intraoperative radiation began in the fall of 2012.

Limited breast radiation with the MammoSite

and more recently IntraBeam® for intraoperative

breast radiation are in place. Cutting-edge

research programs both in the adjuvant and the

more advanced metastatic setting are offered at

the Baptist Cancer Institute, through both medical

oncology with cooperative group studies as well

as pharmaceutical sponsored and the radiation

therapy through the RTOG research group. Other

assets for optimizing the care of breast health

patients at the Baptist Cancer Institute through

the Hill Breast Center program include genetic

risk assessment led by Melinda Fawbush, MSN,

ARNP, which assists patients and their families in

making decisions for both the type of surgery and

other long-term preventive programs if they are

know to have increased genetic risks. Psychosocial

support is provided by George Royal, PhD, and

an increasing involvement in breast survivorship

services include nutrition, physical therapy, and

lymphedema treatment. All of these services

continue to enhance the breast health program

and increase Baptist Cancer Institute’s share of

breast care patients within Northeast Florida and

Southeast Georgia.

Breast Cancer

12

Figure 4 Baptist Cancer Institute Breast Cancer Staging: 2011

60

50

40

30

20

10

00 1 2 3 4 Unknown

18

44

26

8

4

0

Pe

rce

nt

S tage

Figure 5 Baptist Cancer Institute Breast Cancer-DCIS Accrual

90

80

70

60

50

40

30

20

10

0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

8

17

25

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29 30

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39

43

40

56

71

61

55

50

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55

68

81

85

Nu

mb

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80

79

Figure 5 shows the number of cases of ductal

carcinoma in situ seen at Baptist Cancer Institute

since the establishment of the Tumor Registry

in 1990. Seventy-nine cases were seen in 2011,

which is essentially the same as the previous year

in 2010. All of these cases of ductal carcinoma in

situ will be cured with local therapy and represent

a success of the wide use of screening digital

mammograms within our system.

13

Figure 6 Baptist Cancer Institute Lung Cancer Staging: 2011

50

40

30

20

10

00 1 2 3 4 Unknown

0%

32%

8%

13%

41%

6%

Pe

rce

nt

S tage

Baptist Cancer Institute saw 186 patients with

lung cancer in 2011. As in past years, the patients

who were accrued in our Tumor Registry were

predominantly advanced cases. Unfortunately, 77

cases were Stage IV, representing 41 percent of all

lung cancer seen. Twenty-five or 13 percent were

Stage III, who have approximately a 20 percent

chance of being cured. Fourteen patients were

Stage II, in which the cure rate is approximately 35

percent, and 58 or 32 percent were Stage I in which

over half the patients are cured with local therapy

(Figure 6). The proportion of patients with lung

cancer seen at Baptist Jacksonville is 11 percent,

slightly lower than the 14 percent seen nationally.

This percentage of patients, as well as total

numbers, represented a drop from the previous

years of 241 patients, which was 15 percent of

the cancer seen last year. Similar to statistics both

in Florida and the United States, the majority of

patients with lung cancer are Stage III and IV, which

are poorly curable. This presentation in advanced

stage represents no accepted screening program

for at least the patients seen in 2011. Recently,

the role of low-dose screening CT scans has been

reaffirmed at the national level, but is not widely

accepted since the number of false negatives and

unnecessary biopsies is a troublesome handicap

for its widespread use. One bright spot in lung

cancer at Baptist Health is the multi-disciplinary

lung cancer program led by Bridget Rossi, RN,

MSN, OCN, nurse navigator. She has established

a foundation to assist needy patients in all aspects

of their care from diagnosis to end of life. The role

of the stereotactic radiosurgery program at Baptist

Cancer Institute has likewise expanded since

selected patients with Stage I, particularly who are

frail, has become accepted. Research areas within

the Baptist Cancer Institute include the continued

participation in a cooperative group adjuvant

non-small cell lung cancer, as well as innovative

targeted therapies for metastatic and recurrent

non-small cell lung cancer.

Lung Cancer

14

Figure 7 Baptist Cancer Institute Prostate Cancer Staging: 2011

60

50

40

30

20

10

00 1 2 3 4 Unknown

0%

30%

62%

2% 3% 3%

Pe

rce

nt

S tage

In 2011, Baptist Cancer Institute Tumor Registry

assessed 199 prostate cancer cases, which was little

changed from 2010 when 204 cases were registered.

This still represents a dramatic drop from 2009 and

2008, when more than 300 cases were assessed each

year. This drop in prostate cancer accrual represents a

clear cut change in referral patterns in the community

where many patients are now being both biopsied

and referred to outside treatment facilities. However,

as in previous years, the vast majority of patients

are either Stage I (60 patients), which represented

30 percent of the patients seen, or Stage II (124

patients), which represented 62 percent of patients.

Thus 92 percent of patients were either Stage I or

Stage II in which the vast majority will be cured with

either surgery or some form of radiation treatment.

Only four patients or 2 percent and six patients or 3

percent were Stage III and Stage IV respectively. Five

patients or 3 percent were unknown stage which again

represents a success for our Tumor Registry which

accurately staged all but 3 percent of the patients

(Figure 7). Those patients generally were cases which

were referred outside our institute prior to completing

staging workup. The Baptist Cancer Institute continues

the prostate screening program which has been

sponsored by both Baptist Cancer Institute and

the NFL Jacksonville Jaguars for many years. The

prostate cancer prevention program trial was closed

in 2011 and unfortunately found no benefit from the

use of antioxidants either in the form of Selenium

or vitamins in decreasing the incidence of prostate

cancer. Radiation treatment at Baptist Cancer Institute

includes the state-of-the-art IMRT Radiation Therapy,

seed implants, and urologic surgeons have the da

Vinci Robotic Surgery Program. Patients entered on

an innovated immunotherapy program with the use

of Ipilimumab for advanced castrate resistant prostate

cancer continue to be followed in 2011 and 2012.

The use of innovative new treatments for patients

previously considered refractory to hormone treatment

has improved with two new drugs being approved by

the FDA for castrate resistant prostate cancer patients

seen at Baptist Cancer Institute.

Prostate Cancer

15

Figure 8 Baptist Cancer Institute Gynecological Cancer Staging: 2011

60

50

40

30

20

10

00 1 2 3 4 Unknown

6%

55%

4%

18%

10%

7%

Pe

rce

nt

S tage

In 2011, the Gynecologic Cancer Program at

Baptist Cancer Institute continued to be active in

terms of numbers of patients with 104 patients

seen in the calendar year 2011. As illustrated in

Figure 8, 59 percent or 62 patients were Stage

I and II which in general are felt to be readily

curable by surgery or surgery plus radiation. Only

28 percent of patients were Stage III and IV and

7 or 7 percent had inadequate information to

properly stage. This high percentage of patients

in early stage represents a success in American

cancer management with a high utilization by

American women of standard guidelines for

pelvic exam and Pap smear. The percentage of

female genital cancer seen at Baptist Cancer

Institute (6 percent) reflects favorably with the

5 percent average reported in other United

States tumor registries.

Female Genital Track Cancer

16

Figure 10 Melanoma Cancer Staging: 2011

50

25

0Stages 0 1 2 3 4 Unknown

0%

12%

43%

15%

6%

2%

Pe

rce

nt

S tage

12%

In 2011, Baptist Cancer Institute tumor registry

assessed 90 cases of patients diagnosed with

melanoma. This mirrors a trend which started

in 2005 with steadily increasing numbers of

melanoma patients seen at Baptist Jacksonville.

Most of those patients represented early stage

either Stage 0, which is in situ disease which

accounted for 12 patients or 13 percent, Stage I,

43 patients or 48 percent and Stage II, 15

patients or 17 percent. Overall, these Stages 0-II

represent a total of 78 percent of the patients

in early stage with an expectation of around 90

percent of those patients will be cured (Figure

10). Unfortunately, six patients or 7 percent and

two patients or 2 percent were Stages III and IV,

most of whom would not be expected to survive

five years. Another troublesome aspect is that

12 patients or 13 percent were unknown stage,

most probably representing leaving the institution

prior to completing staging and having their

treatment elsewhere.

These patients which represented 6 percent of

all cancer cases seen at Baptist Cancer Institute

and accrued into our Registry compares favorably

with the 5 percent rate for the state of Florida

and the 4 percent rate for the United States.

This high percentage of melanoma patients

seen at Baptist Cancer Institute almost certainly

represents the surgical and medical oncology

expertise in this tumor site which is recognized

throughout Northeast Florida and Southeast

Georgia. State-of- the-art surgical approaches

include lymph node mapping, and expertise in

wide local excision from melanomas occurring

in all sites of the body is present. Likewise,

medical oncology has extensive expertise in

the use of immunotherapy as both an adjuvant

treatment and a systemic treatment for metastatic

melanoma. A wide variety of research studies

including innovative adjuvant treatment protocols

through the ECOG study group and multiple

studies investigating the role of Ipilimumab

in metastatic melanoma was in place in 2011.

Multiple patients were referred from outside

the institution for involvement in those

research studies.

Melanoma

17

Tumor Review:Hodgkin’s Disease at Baptist Cancer

Institute Mark Augspurger, MD, Radiation Oncologist

Each year, approximately 7,500 new

cases of Hodgkin’s disease (HD) will

be diagnosed in the United States. In

contrast to the increase in incidence of

Non-Hodgkin’s lymphoma over the past

several decades, the annual incidence of

Hodgkin’s disease has remained stable.

There has been an increase in the accuracy of

diagnosis and staging, as well as an increasing

utilization of combination chemotherapy for the

treatment of HD. More than 75 percent of newly

diagnosed Hodgkin’s disease lymphoma cases will be

cured.


Epidemiology and Etiology

Hodgkin’s disease has a slight increased

incidence of male cases to female, approximately

1.3:1. The age of onset of Hodgkin’s disease is

a bimodal presentation with the largest group

of patients in the second and third decade of

life and a second smaller peak after age 50. The

second peak is probably an artifact of histologic

misclassification since recent studies have shown

that many of these cases diagnosed as Hodgkin’s

disease in the older age group were in fact Non-

Hodgkin’s lymphoma. In terms of race, Hodgkin’s

disease is much more common in Caucasians

than African Americans. There are no well

established etiologic factors causing HD. Case

match studies show that it’s slightly higher in a

familiar cluster pattern and is also more likely to

occur in those of higher economic status. There

has been extensive ongoing debate whether the

Epstein Barr virus is implicated in the etiology

of Hodgkin’s disease but to date this remains

unsettled. Patients infected with the Human

Immune Deficiency Virus (HIV) seem to have

a higher incidence of Hodgkin’s disease when

compared to age match control, but it is unclear

why this association occurs.

19

Figure 1 Cases by Gender (2001 - 2011)

50

40

30

20

10

0

48

39

No

. of

Ca

ses

Male Female

Figure 2 Cases by Race (2001 - 2011)

70

60

50

40

30

20

10

0

68

14

No

. of

Ca

ses

White Black Other

5

Signs, Symptoms and Diagnosis

Hodgkin’s disease is a lymph node based

malignancy and commonly presents as an

asymptomatic lymphadenopathy which may

progress to symptomatic disease. The majority

of patients, more than 80 percent, present

with lymphadenopathy above the diaphragm

involving the anterior mediastinum, cervical

and less commonly axillary and below the

diaphragm adenopathy. Only in the latest stages,

is visceral disease such as lung, liver, and bone

marrow involved. Involvement of Waldeyer’s

ring is quite uncommon. Approximately 40

percent of patients present with systemic

symptoms. Classically these B symptoms

include sweats, fever, weight loss and chronic

pruritis. These symptoms occur more frequently

in older patients and have a negative impact

on prognosis. Diagnosis is made by a biopsy

of a suitable lymph node and histopatholigic

examination by an experienced pathologist.

The diagnostic Reed-Sternberg cell is found

within the appropriate lymph node milieu and

these cells on histopathologic exam are typically

CD30+ and CD15+ by immunohistochemical

staining. Flow cytometry is generally not

helpful in making a definitive diagnosis of

Hodgkin’s disease. Staging is typically based

on the number of lymph node sites involved,

whether these lymph node sites are above or

below the diaphragm and whether or not the

patient is asymptomatic (A) or symptomatic (B.)

Typically, these cases of Hodgkin’s lymphoma

are separated into four histologic categories:

20

lymphocyte predominant, nodular sclerosing,

mixed cellularity, and lymphocyte depleted.

At one time, histopathologic subtype was

important, but more recently it has been found

that the pathologic stage trumps histologic

subtype in terms of long-term prognosis. The

staging system used is a modified Ann Arbor

staging system and consists of the following:

• Stage I is involvement of a single lymph node

region;

• Stage II is involvement of two or more

lymph node regions on the same side of the

diaphragm;

• Stage III is involvement of lymph node

regions on both sides of the diaphragm;

• and Stage IV is involvement of extra nodal

sites such as lung, liver or bone marrow and

not contiguous to a known nodal site.

The designation A means no symptoms and B

means the presence of fever, drenching sweats,

weight loss or intractable chronic pruritis. Bulky

disease is considered a maximum diameter

of a lymph node mass greater than 9cm. In

general, Hodgkin’s disease is staged clinically

with imaging studies such as CT scans or PET CT

scans rather than surgical pathologic staging.

Treatment and Outcome

Treatment of Hodgkin’s disease involves the

application of combination chemotherapy with

selective cases receiving radiation therapy

particularly for bulky disease. Currently, in 2013,

the only patients who are treated with radiation

alone are typically those who have Stage IA

disease involving high cervical nodes. For Stages

IB to Stage IVB, combination chemotherapy,

classically the ABVD (Adriamycin, Bleomycin,

Vinblastine, and Dacarbazine regimen) is

employed with radiation therapy reserved for

bulky lymphadenopathy usually given at the

completion of combination chemotherapy. For

most patients, four to six cycles of chemotherapy

is employed. Surgery other than lymph

node biopsy for diagnosis has no role in the

therapeutic management of Hodgkin’s disease.

Outcome is based on primarily stage with

obviously earlier stage disease doing significantly

better than later stage disease. Overall, for

Stage I, approximately 85-90 percent of patients

will be expected to be disease free at five years,

for Stage II 75-80 percent will be disease free

at five years, for Stage III 55-65 percent will

be alive and disease free at five years, and for

Stage IV 45-55 percent will be alive and free

of disease at five years. Adverse prognostic

factors include age greater than 50 years, bulky

disease, and advanced stage. Patients with

other immunodeficiencies such as HIV or post-

transplant, likewise, do poorer. For patients

who reoccur, combination chemotherapy with a

different chemotherapy regimen plus autologous

transplant appears to cure 25-30 percent of

those patients. A new targeted therapy is

currently available, brentuximab; a monoclonal

antibody to CD30 and appears to have high

response rates in the 70-80 percent range but

has been commercially available only for two

years and its exact role remains to be defined.

At Baptist Health, the Tumor Registry of Baptist

Cancer Institute accrued a total of 87 cases

21

Figure 3 Cases by Stage (2001 - 2011)

50

40

30

20

10

0

0 1 2 3 4 Unknown N/A

0

34

30

7 7

8Nu

mb

er

of

Ca

ses

S tage

1

between 2001 and 2011, an average of 8.7

cases were seen yearly. Out of those patients,

48 were male and 39 were female for the

expected slight male predominance of 1.3:1.0,

as seen in national databases (Figure 1). Again,

similar to national databases, there is a strong

predominance of caucasian patients with 68

being caucasian, 14 being African American

and five being other races (Figure 2). Staging

showed that predominance of patients were

early stage with 34 of 87 being Stage I, 30 of 87

being Stage II, seven were Stage III, seven were

Stage IV, eight were stage unknown and one was

non-analytic (Figure 3). In terms of treatment,

there was a major problem with our data. On the

initial data run, 50 of 89 were listed as having

received no therapy and seven of 89 were listed

as receiving surgery or biopsy only. This data

will be reviewed under our article for quality

assurance but to briefly summarize, most of these

patients listed as receiving surgery alone or no

chemotherapy actually received chemotherapy

as outpatients and were not captured by the

tumor registry. Survival was extremely good as

would be expected in more than 80 percent of

Stages I, II, and III being five year survivors and

only Stage IV dropping down to 57 percent and

as essentially expected in the national database

(Figure 4).

Thus, in summary, the information on Hodgkin’s

disease was flawed by a large number of cases

in which treatment was done outside of the

hospital and was not captured by the tumor

registry. However, all other aspects of the data

including number of cases, male to female ratio,

race, stage, and long-term survival appeared

consistent with that seen at the national level.

22

Figure 4 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005)

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

Cum

ula

tive

Sur

viva

l R

ate

s

0.0

Years from Diagnosis

1.0 2.0 3.0 4.0 5.0

Stage I Stage I I Stage I I I Stage IV

23

Soft tissue sarcomas are a group of rare,

but anatomically and histologically quite

diverse neoplasms. This is due to their

varying location within the soft tissues

of nearly all body sites. Currently, there

are more than three dozen recognizable

histological distinct subtypes occurring within

the body. Each year approximately 7,000 new

cases of soft tissue sarcoma are identified and

approximately 4,000 patients die of this disease. The

age adjusted incidence is two cases/100,000 persons.

Tumor Review: Soft Tissue

Sarcomas at Baptist Cancer

InstituteTroy Guthrie, MD, Medical Director,

Baptist Cancer Institute


Epidemiology and Etiology

In soft tissue sarcomas, there is a slight male

predominance with the male to female ratio

being approximately 1.1:1. Approximately 50

percent of soft tissue sarcomas will occur in

adults older than 60 years and 50 percent below

age 60. The vast majority of soft tissue sarcomas

occur in caucasians, 86 percent, 10 percent in

African Americans, and 4 percent in other ethnic

groups. There is no geographical distribution.

In terms of risk factors, soft tissue sarcomas

clearly have been reported to originate within

previously irradiated fields and often develop

decades after radiation. The majority of those

malignancies arising within radiation fields are

high grade lesions. Chemical exposures in certain

occupations such as those working in factories

making plastics or solvent exposure have likewise

been reported as a risk factor. There are rare

genetic syndromes such as von Recklinghausen

disease, tuberous sclerosis, and others which

have likewise been linked to specific types of soft

tissue sarcomas. In general, however, the vast

majority of soft tissue sarcomas are not linked to

any specific etiology.

Signs, Symptoms, and Diagnostic Workup

In terms of signs and symptoms, the majority

of soft tissue sarcomas present either in the

extremities or superficial trunk as a mass lesion

either exerting pressure or causing pain due to

mass expansion. Many of these malignancies are

found incidental to self-examination or physician

examination. Approximately, 15 percent of soft

tissue sarcomas arise in the retroperitoneal and

present as an abdominal mass with about half

of patients reporting pain. Physical exams of

patients with soft tissue sarcomas usually reveal

a palpable mass but little else is noted. General

laboratory testing likewise is non-diagnostic.

Imaging studies are the most important

evaluation procedures and usually include either

CTs or MRIs of the affected area as well as CT

scans, primarily of the lung looking for metastatic

lesions. Diagnosis is usually obtained either by

image guided core needle biopsy or excisional

biopsy performed by an experienced surgeon.

In general, if the lesion is on the extremity, the

pathway of the biopsy should be planned such

that it can be resected in total within a definitive

surgical procedure later since there is some risk

of seeding the tract with malignant cells and

having secondary lesions develop within the

biopsy tract if not completely excised.

25

Figure 1 Cases by Gender (2001 - 2011)

25

20

15

10

5

0

17

22

No

. of

Ca

ses

Male Female

Figure 2 Cases by Race (2001 - 2011)

35

30

25

20

15

10

5

0

26

10

White Black Other

3

No

. of

Ca

ses

Histopathology

In general, the histopathological diagnosis

is made of the tissue of origin, for example,

fibrosarcoma from fibrous tissue or

rhabdomyosarcoma from striated muscle

cells. The most important determinant of

prognosis is the grade of the tumor, with

grading being Grade I low grade, Grade II

intermediate grade, or Grade III high grade

tumors. Some histopathological types, such as

rhabdomyosarcoma or fibrous histiocytoma, are

automatically assigned a high grade status. The

staging of soft tissue sarcomas depends on four

factors: primary tumor, which is based on size

either greater than 5cm or less than 5 cm and

whether or not they are superficial a. deep, b.

grade of the tumor: being well differentiated

grade I; moderately differentiated grade II;

poorly differentiated grade III or undifferentiated

grade IV, presence or absence of lymph node

involvement, and presence or absence of

metastatic lesions. In general, early stage lesions

are low grade or intermediate lesions that are

small and advanced stage lesions are lesions

that are high grade, large lesions and may have

metastatic lesions. Because soft tissue sarcomas

tend to be asymptomatic until reaching a large

stage SEER data shows that most adult soft

tissue sarcomas present in more advanced Stage

III or Stage IV stages.

Treatment

The treatment of the primary lesion is surgical

resection with wide margins. In particular, for

soft tissue sarcomas occurring in the extremities,

it is felt when possible that the surgery should

be done by an experienced surgical oncologist

so that limb sparing when possible can be

achieved. If initial surgical resection of a soft

tissue sarcoma is impossible then preoperative

treatment with both radiation therapy and in

certain circumstances either systemic or limb

arterial perfusion of chemotherapy is advised.

Most often it is felt that patients needing this

treatment should be referred to medical centers

where a multi-disciplinary team experienced in

26

Figure 3 Cases by Stage (2001 - 2011)

20

15

10

5

0

0 1 2 3 4 Unknown N/A

0

7

3

10

1

14

Nu

mb

er

of

Ca

ses

S tage

4

managing soft tissue sarcomas is available. Thus

often soft tissue sarcomas, while diagnosed in

one institution, are referred outside for definitive

treatment particularly of the primary lesion.

In general, there is a low incidence of lymph

node involvement for soft tissue sarcomas and

routine lymph node dissection during surgical

procedures is not done.

The role of radiation therapy is both preoperative

and postoperative in the definitive management

of the primary site. In patients who have locally

advanced lesions, deployment of radiation

therapy either with or without adjuvant

chemotherapy has resulted in higher rates

of definitive resection of the primary site. In

patients who have been resected up front and

who have either positive or close margins and a

high histological grade, there have been both

retrospective and prospective studies showing

application of radiation therapy to the primary

site results in a drop in local recurrence rates.

The role of chemotherapy in soft tissue sarcomas

is much less well defined compared to surgery

and radiation. Typically, response rates to

chemotherapy are low. Complete remissions are

rarely produced and the duration of response

is quite short. Chemotherapy drugs used to

treat soft tissue sarcomas include doxorubicin,

ifosfamide, dacarbazine, and occasionally

other chemotherapy agents. Response rates

to combinations of chemotherapy agents such

as doxorubicin, ifosfamide +/- dacarbazine

are higher but do not seem to translate into

a long-term survival advantage. In general,

chemotherapy is reserved for improving local

control preoperatively and palliative treatment of

metastatic disease. Of note, some patients with

surgically resectable metastatic disease do seem

to benefit from surgical resection particularly

if the metastases are in the lungs. Targeted

therapy for certain soft tissue sarcomas, such as

dermatofibrosarcoma and certain other soft tissue

sarcomas, has an evolving role. These soft tissue

sarcomas (PDGFα) express a target such as c-KIT

or platelet derived growth factor alpha and can

be treated with targeted agents such as Imatinib

or Dasatinib.

27

Figure 4 Cases by Treatment (2001 - 2011)

20

15

10

5

0

SurgerySurgery/Radiation

None Surgery/Chemo Chemo All Others

12

11

5 4

3

4

Nu

mb

er

of

Ca

ses

The records of the Baptist Cancer Institute Tumor

Registry were reviewed from 2001 to 2011.

The cases were analyzed and compared to the

national cancer database. During this time, 39

patients with soft tissue sarcoma have been an

accession to our Tumor Registry averaging four

patients each year. Of those 39 patients, 17 were

male and 22 were female–slightly different from

the usual male/female ratio reported (Figure 1).

In terms of race, 26 were caucasian, 10 African

American, and three represented another ethnic

group (Figure 2). Staging showed seven were

Stage I, three were Stage II, 10 were Stage III,

one was Stage IV, 14 were unknown stage and

four were non-analyzable (Figure 3). This higher

proportion of non-analyzable and unknown stage

represents the fact that a large portion of patients

were referred to outside institutions, particularly

Mayo Clinic and the University of Florida

Gainesville for a specialized multi-disciplinary

team to treat these rare malignancies.

Treatment, in general, followed the same lines

as that reported in national databases (Figure 4).

Twelve of the patients or 30.8 percent received

surgery, 11 (28.2 percent) received surgery plus

radiation, and four (10.3 percent) received surgery

plus chemotherapy. A total of 27 of the 39 or

69.2 percent received some form of surgical

treatment as would be expected from national

databases. Five or (12.8 percent) were listed as

receiving no specific therapy but were referred

out and probably received standard care. Three

patients received chemotherapy alone in palliative

treatment. These percentages would be the same

as expected in national averages. Figure 5 shows

five year survival for our 39 patients and shows

81 percent of Stage I were alive at five years and

67 percent of Stage II were alive, 47 percent of

Stage III and only 14 percent of Stage IV had

survived five years. This is comparable to what is

published and shows that management of soft

tissue sarcomas is quite similar to that practiced

throughout the United States and end results

appear to be similar.

Thus this review of soft tissue sarcomas seen at

Baptist Cancer Institute from 2001 to 2011 shows

similar epidemiologic factors, similar treatments

except a higher percentage of patients referred

outside to receive specialized care. Our survival

data is likewise similar to that reported in national

SEER data.

28

Figure 5 Survival Rates Over Five Years (Cases Diagnosed 2003 - 2005)

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

Cum

ula

tive

Sur

viva

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ate

s

0.0

Years from Diagnosis

1.0 2.0 3.0 4.0 5.0

Stage I Stage I I Stage I I I Stage IV

29

The Tumor Registry and its database are

necessary for quality of care monitoring

provided by Baptist Cancer Institute.

The accuracy and dependability of

this essential service was evaluated

and examined as directed by the

American College of Surgeons and

the Commission on Cancer. A review of

the data that resulted in patient accrual

management and lifespan was assessed

during a 10-year period for Hodgkin’s

disease from 2001 through 2011. The

abstracts were reviewed for accuracy and

charts were pulled when deemed necessary.

Quality Assurance Troy H. Guthrie Jr., MD, Medical Director, Education and

Research, Baptist Cancer Institute, Melissa McCarthan, RHIT, CTR;

April Stebbins, RHIT, CTR;

and Rassy Sprouse, BS


The following are the results of the assessment

on the 87 patients entered by our Tumor Registry

during the above-mentioned time period. The

results are summarized as follows:

• Abstracts contained adequate information to

assess accuracy;

• There were no errors in the classification of

the Hodgkin’s patients identified in terms of

histology;

• Therapy of Hodgkin’s patients had many

problems in terms of identifying treatment.

• 50 out of 89 patients were listed as having no

therapy, and seven out of 89 patients were

listed as being treated with surgery alone.

Clearly this was inaccurate so charts were pulled

from the offices of 21st Century Oncology and

reviewed by Troy H. Guthrie, MD, and from the

office of Cancer Specialists of North Florida

and reviewed by Unni Thomas, MD. Of the

50 patients listed as having no treatments,

currently 10 have been identified as receiving

chemotherapy and three have been identified

as receiving chemotherapy plus radiation. Of

the seven patients listed as receiving surgery

alone to date, two have been listed as receiving

chemotherapy and one receiving chemotherapy

plus radiation. This is a laborious task and the

accuracy of data will continue to be reviewed

so that we can have accurate long-term follow-

up on Hodgkin’s disease patients from this time

period of 2001 to 2011; Kaplan-Meier curves

were readily available and appear to be accurate;

and demographics were available and appear to

be accurate.

Recommendations for correction include:

• Education was presented to the Tumor

Registry concerning treatment of Hodgkin’s

disease so that a red flag will be raised

if no therapy or surgery alone is listed as

treatment;

• Suggestions have been made to work

more closely with the clinicians of record

concerning any patient in whom the accuracy

of staging, treatment or survival including

phone calls would be warranted;

• Cancer physicians should be involved in

the abstraction process particularly up front

if information is missing or appears to be

inaccurate; and

• Request additional information from

physicians who refer patients for

management outside the institution so long

term follow-up can be accurate in terms of

treatment and survival.

31

In 2011, cancer research for the Baptist

Cancer Institute continued to function

at a high level on multiple sites,

including the Baptist Cancer Institute,

Florida Radiation Oncology Group,

and Cancer Specialists of Northeast

Florida. At any one time throughout

all campuses approximately 60 to

70 research protocols were available

for patients with diverse cancer sites

including breast, lung, gastrointestinal,

brain, melanoma, pancreatic, hematologic

malignancies, and other less common sites.

All protocols were available for patients at

Baptist Medical Center Jacksonville and Baptist

Medical Center South, as well as having referrals

from outside the Jacksonville area, including

Southeast Georgia. Studies were available to patients

originating from both national cooperative groups,

including the National Surgical Adjuvant Breast and Bowel

Project (NSABP), Eastern Cooperative Oncology Group (ECOG),

North Central Cancer Treatment Group (NCCTG), and Radiation

Therapy Oncology Group (RTOG), as well as many studies which came

through pharmaceutical companies and private research organizations (PRO).

Clinical Researchand Education


On campus, approximately 50 percent of the

studies were through National Cancer Institute

(NCI)-sponsored cooperative group studies

and the other half were industry sponsored

pharmaceutical studies.

All studies done on campus, either NCI-

sponsored or pharmaceutical-sponsored

were reviewed by the Baptist Medical

Center Institutional Review Board (IRB) for

appropriateness of research, conflict of interest

and protection of human rights. All studies were

then described in language understandable

by the public in an informed consent and

also published on the Baptist Cancer Institute

website. Phases of studies including phase I,

phase II, and phase III, were available in 2011.

In 2011, studies through the Baptist Cancer

Institute led to FDA approval for a number of

drugs, including Ipilimumab for the treatment

of metastatic melanoma, Aldo-herceptin for the

treatment of HER2+ breast cancer, and afatinib

for the treatment of EGFR mutation positive

non-small cell lung cancer. In addition to

treatment protocols, a number of registry

studies were done that include SystHERs

in HER2+ breast cancer that is metastatic,

treatment approaches in metastatic melanoma,

as well as studies in chronic myelocytic leukemia

and paroxysmal nocturnal hemoglobinuria. The

2011 patient accrual for all participants consisted

of 35 patients compared to the 65 patients in

2010 (Table 1). Accrual throughout the campus

has remained well below 100 patients per year

due to diverse reasons, including increasing

pressure on physicians to deal with increasing

patient volume, increasing complexity of

insurance and third party payment, as well as

reluctance of patients to participate in studies

that may cause economic pressure. Hopefully,

patient accrual will increase in 2012 to above

50 patients close to years past.

Baptist Cancer Institute continues to be an active

community cancer education program offering

CME sessions at the multi-specialty breast cancer

conference, neuro-oncology conference, and

lung cancer conference and tumor board. Table

2 lists the subjects of the annual tumor board

for 2012. Table 3 lists the active participants in

the cooperative groups at Baptist Health, as

well as those involved in the research programs

of the NSABP, and RTOG study groups. In

summary, the Baptist cancer program continues

to offer exciting clinical projects through

both cooperative group mechanisms as well

as pharmaceutical studies. A great deal of

enthusiasm on the campus exists for continuing

to increase patient accrual and increasing the

relevance of clinical trials for everyday treatment.

33

Table 2 Tumor Board : 2012

Table 1 Clinical Research BCI : 2008 – 2011

Year # of Patients

2008 88

2009 90

2010 65

2011 35

Breast Cancer Prevention Troy Guthrie, MD

Volatile Organic Compounds and the Early Detection of Lung Cancer Nir Peled, MD

Hosts of Lymphoma Troy Guthrie, MD

Melanoma Staging and Treatment Troy Guthrie, MD

Contemporary Head and Neck Oncology and Reconstructive Surgery Phillip Pirguosis, MD

Interventional Pain Management for the Spine Christopher Roberts. MD

Chronic Myeloid Leukemia Overview Troy Guthrie, MD

Melanoma Metastatic to Regional Lymph Nodes John Crump, MD

Post-mastectomy Radiation Therapy: Update and Indications Nicole Anderson, MD

Head and Neck Cancer Naeem Latif, MD

Multiple Myeloma Troy Guthrie, MD

Triple Negative Breast Cancer Dimitrios Agaliotis, MD

Non Small Cell Lung Cancer Troy Guthrie, MD

Cervix and Endometrial Cancer: Case Discussion and Brief Overview Michael Olson, MD

Prostate Cancer Naeem Latif, MD

The Management of Prostate Cancer Mark Augspurger, MD

Melanoma Update Gary Bowers, MD

Management of Anorectal Melanoma Hank Hill, MD

Neuro Oncology Tumor Board Multiple Presenters

34

Cooperative Group Trials (BCI)Dimitrios Agaliotis, MD, PhD – Medical Oncology

Jeff Bubis, DO – Medical Oncology

Stephen Buckley, MD – Gynecologic Oncology

Catherine Bush, RN, OCN, BSN – Study coordinator

Andrea Canto – Study Coordinator

Carlos Castillo, MD – Medical Oncology

Roxane Green – Regulatory Coordinator

Troy Guthrie, MD – Principal Investigator, ECOG, NSABP, Mayo Trials Group

Zhen Hou, MD, PhD – Medical Oncology

Douglas W. Johnson, MD – Sub-Investigator, Radiation Oncology

Robert A. Joyce, MD – Medical Oncology

Mohammad Khan, MD – Medical Oncology

Mathew Luke, MD – Medical Oncology

Alan Marks, MD – Medical Oncology

Joseph Mignone, MD – Medical Oncology

Yuval Naot, MD – Medical Oncology

Jeanine Richmond, RN, BSN, OCN, - Study Coordinator

Matthew Robertson, MD - Gynecologic Oncology

Mila Shteyn, MA - Study Coordinator

Alexander Moore – Study Coordinator

Unni Thomas, MD – Medical Oncology

Maria Valente – Medical Oncology

Prevention (NSABP and SWOG)Andrea Canto – STAR Program Coordinator

Troy Guthrie Jr., MD – Principal Investigator

RTOGCynthia Anderson, MD – Radiation Oncology

Mark Augspurger, MD – Radiation Oncology

Jessica Bahari, MD – Radiation Oncology

Abhijit V. Deshmukh, MD – Radiation Oncology

Kenneth Goldstein, MD – Radiation Oncology

Troy Guthrie, MD – Medical Oncology

Jeffrey Harris, MD – Medical Oncology

Douglas W. Johnson, MD – Principal Investigator

Anand Kuruvilla, MD – Radiation Oncology

Carla Malott, RN – Clinical Research Associate

Thomas Marsland, MD – Medical Oncology

Lois Morgan, RN – Clinical Research Associate

Michael Olson, MD – Radiation Oncology

Niraj Pahlajani, MD – Radiation Oncology

Shyam Paryani, MD – Radiation Oncology

Jan Peer, CCRP – Clinical Research Associate

Sonya Schoeppel, MD – Radiation Oncology

Neenad Sha, MD – Radiation Oncology

Dwelvin Simmons, MD – Radiation Oncology

Robert Still, MD – Surgeon

J. Wynn Sullivan, MD – Medical Oncology

Linda Sylvester, MD – Medical Oncology

Mitchell Terk, MD – Radiation Oncology

Carlos Vargas, MD – Radiation Oncology

John Wells, MD – Radiation Oncology

Larry Wilf, MD – Nuclear Medicine Radiologist

Michal Wolski, MD – Radiation Oncology

Cancer Risk Assessment and Genetics

Melinda Fawbush, ARNP, MSN

Troy Guthrie Jr., MD – Principal Investigator

Table 3

35

Distinguished Individual in

Cancer Care: E. Dayan Sandler, MD

Each year the Annual Report honors an

individual who has made a significant

contribution to the cancer program at

Baptist Health and to Baptist Cancer

Institute progress. In past issues, we

have honored both physicians and non-

physicians. This year we are honoring

Dayan Sandler, MD, Chief of Pathology

at Baptist Health. Dr. Sandler has made

numerous contributions to the cancer

program since joining the physician faculty in

1993.

Dayan obtained her Doctorate of Medicine from

the University of California School of Medicine San

Francisco, Calif., where she had previously obtained a

Doctor of Pharmacy. She did her post-graduate training

in the department of pathology at University of California San

Francisco from 1986-1990. She received intensive training in Cytology,

Dermopathology, and Hematopathology. After completing her pathology

residency, she received further training with a fellowship in nuclear medicine,


within the Department of Radiology again at the

University of California San Francisco in

1990-1991. She became a staff pathologist at

St. Mary’s Hospital in San Francisco from 1991

to 1992 prior to joining the clinical faculty at

Baptist Medical Center Jacksonville in 1993.

Here she has served in many positions, including

director of Immunohistochemistry, Histology,

Flow Cytometry Analysis Laboratory, and has

served as the director of Laboratory Medicine

from 1997 to the present. She also served as

the director of the Stem Cell Laboratory when

it functioned at Baptist Jacksonville from

1996-1999. She has been Chief of Pathology

since 2004 at Baptist Health. Dr. Sandler has

made numerous contributions to the cancer

program at Baptist Health, particularly in the

field of breast cancer. She has a breast cancer

consultation service and is the pathologist for the

Breast Conference. She also serves as primary

pathologist and as a major participant within the

recently established neuro-oncology

multi-disciplinary program. Dr. Sandler is widely

sought by both fellow pathologists and clinicians

for her opinions within the pathology field.

She has been an active member of the Cancer

Committee for 12 years, and more recently, has

served as committee chair of Baptist Health’s

System Breast Program Leadership.

She has been an active member of Tipping the

Scale Program, serving as both committee chair

and as a mentor. She has mentored four young

ladies, all of whom have gone to college.

On a personal note, her husband, Dr. Jeffrey

Sandler, is an Ear, Nose and Throat surgeon at

Baptist Medical Center South. They have three

children, Jonathan, Laura and Zachary, all of

whom are in college. Her greatest passion is

being with her family; all of them are outdoor

enthusiasts, and she loves kayaking, photography

and traveling.

E. Dayan Sandler, MD

37

Baptist Cancer Institute Donors | Calendar Year 2012

Ms. Julie K. Abbott

Mrs. Mary W. Ackerly

Acosta Sales and Marketing Co., Inc.

Adelante Group, Inc

Mrs. Letitia R. Aitken

All About Blinds

Mrs. Lucile W. Allsopp

Amanda Morrow LLC

Anonymous

Arlington Toyota

Mr. and Mrs. John Arnold

Mr. Sheridan T. Arnold

Mr. and Mrs. Paul M. Arvia

Mr. and Mrs. Douglas C. Asper

Atlantic Companies

Mr. and Mrs. Steven E. Austin

Mr. and Mrs. Stephen E. Bachand

Mr. Robert B. Bailey

Ms. Kathy Baker

Mr. and Mrs. Thompson S. Baker II

Ms. Purisima Balgos

Ms. Jacquelyn D. Bates

Ms. Cathy Battreall

Ms. Joan M. Bauer

Ms. Beverly R. Beck

Mrs. Beverly J. Behrens

Benchmark Custom Luxury Homes, Inc

Benchmark Homes Realty, Inc.

Mr. and Mrs. Gerald Bertisch

Mr. Robert E. Berwick

Mr. Otto J. Betz, Jr.

Mrs. Lucy Boesel

Mr. Robert Bon Durant

Ms. Connie Bones

Mr. Mac Bracewell

Ms. Kari M. Bracy

Ms. Lauren Braren

Mrs. Kay Brooks

Mr. John E. Buckey

Mr. and Mrs. Malcolm A. Buckey, Jr.

Mrs. Shirley J. Budden

Ms. Margaret A. Bulin

Mr. and Mrs. Phillip Burnaman

Ms. Lynn Y. Cabrera

Mrs. Gretchen H. Calvert

Cambridge Prep Academy

Mrs. Anastasia Cameron

Mr. Michael D. Cantrell

Ms. Esther F. Cantus

Dr. and Mrs. Perry G. Carlos

Ms. Marge Cash

Ms. Debbie Castroverde

Mr. and Mrs. George Catallo

Dr. and Mrs. Michael A. Chanatry

Ms. Robin C. Chandler

Claude Nolan Cadillac, Inc.

Mr. and Mrs. Gary A. Close

Coldwell Banker Walter Williams Realty, Inc.

Mr. C. Randolph Coleman

Mr. and Mrs. Douglas Coleman

Mr. and Mrs. Donald Cox

Ms. Esther G. Cruikshank

Ms. Sarah B. Dann

Mr. Earle Mauldin, III and Ms. Debbie L. Davidoff

Mr. and Mrs. John C. Davis

Ms. Carol DeGregorio

Mr. and Mrs. Greg Delaney

Mrs. Susan S. Delfs

Ms. Michelle Denbesten

Mr. and Mrs. Derek E. Dewan

Ms. Elana Dietz

Mr. and Mrs. Patrick S. Doran

Mrs. Robin Doyle

Drs. Mori, Bean & Brooks, PA

Mr. and Mrs. Charles N. Dunn, Jr.

Mrs. Lillian D. Durden

Mr. and Mrs. Gary Ehlig

Mr. Tucker W. Elliott

Mrs. Sharon A. Ellis

Mr. and Mrs. John H. Erstling

Mr. Gerard R. Evan

Mr. Lawrence W. Evans

Mr. and Mrs. William S. Fellner

Mr. and Mrs. Paul S. Ferber

Ferguson Enterprises

Fernandina Beach High School

Ms. Donna M. Fiedorowicz

First Coast Supply, Inc.

First Radiation & Oncology Group

Mr. and Mrs. Thomas J. Flanigan

Florida Blue

Florida Propane Partners, LLC

Ms. Judith Y. Flynn

Ms. Kathleen Foley

Fore In One Golf Services, Inc

Ms. Susan E. Forster

Mrs. Marie E. Frankiewicz

Ms. Virginia M. Fritz

Mr. and Mrs. Jim Furyk

Jim and Tabitha Furyk Foundation

Mr. and Mrs. James R. Gabrielsen

Mrs. Mary Louise Gallagher

Mrs. Charlene K. Gamewell

Mrs. Jane W. Gamewell

Gannett Foundation

Mrs. Margaret Gates

Georgia Xpress Lubes, Inc

Mr. and Mrs. Robert T. Golitz

Goodall Family Foundation

Mrs. Helene C. Gorab

Ms. Mary Ann Graham

Mr. and Mrs. Michael J. Grebe

Ms. J. A. Grunther

Mrs. Melody T. Gurney

Mrs. Pauline W. Guzek

Ms. Dorothy E. Hall

Mr. and Mrs. Y. E. “Chipper” Hall

Hamilton Family Foundation

Hanaya Enterprises LLC

Mrs. Maureen L. Hannan

Ms. Millie G. Harrison

Ms. April Hart

Ms. Elizabeth L. Harther

Mr. Greg Hartley

Dr. and Mrs. Gregory W. Hartley

Mr. John Haswell

Ms. Lisa Hathaway

Ms. Marion D. Haynes

Mrs. Shonda J. Heath

Major General Patricia P. Hickerson

Major General Patricia Hickerson

Mr. and Mrs. Robert E. Hill, Jr.

Mr. Hal Hitch

Ms. Susan Hitch

Mr. and Mrs. Howard I. Hodor

Mr. John J. Hofstetter

Mrs. Jill I. Hornsby

Mr. David K. Hunt

Mrs. Sharon Hunt

In the Pink Boutique, Inc

Innovations By Shelley

Ms. Melissa Intemann

Iridium Holding, Inc.

Ms. Roxanne Isaacs

J. McLaughlin

Jacksonville Jaguars Booster Club, Inc

Ms. Patricia A. Jensen

38

Mr. and Mrs. Walter Jewett

Mr. and Mrs. Richard O. Jones

Ms. Lucinda Jordan

K. Fehling & Associates

Mr. and Mrs. Ralph O. Kaufman, Jr.

Mr. Raphael M. Kelly

Ms. Shirley Ketchum Patterson

Mrs. Gail A. Killion

Ms. Beverly A. Koerner

Ms. Nancy Koob

Ms. Duffy M. Kopriva

Ms. Jennifer Lada

Ms. Shelley Laird

Mrs. Margaret V. Lehman

Mr. and Mrs. Herb LeMoyne

Lender Processing Services

Mr. and Mrs. Paul Lichlyter

Lilly USA, LLC

Ms. Lynda Linforth

Mr. Jeffrey Locke

Mrs. Jenny H. Lockett

Ms. Julia E. Lord

LuLu’s Waterfront Grille

Mr. and Mrs. William B. Lynch

Ms. Susan E. Mack

Ms. Diana Mackoul

Magnolia Point Women’s Club

Mrs. Virginia B. Maloney

Mr. and Mrs. James T. Mann

Ms. Barbara S. Maple

Marchese Communications

Mr. Randy Marshall

Ms. Beth McCague

Ms. Alison McCallum

Mr. and Mrs. Donald C. McGraw III

Mr. and Mrs. Rodney A. McLauchlan

Mrs. Christin McManus

Mr. and Mrs. Jeffrey G. McNeill

Mr. and Mrs. C. Keith Meiser

Mrs. Damara F. Merten

Ms. Marzena Mignone

Mrs. Barbara P. Miller

Ms. Betsy A. Miller

Mr. and Mrs. James R. Miller

Mr. Phillip Mills, CPA

Mr. John Minor

Mr. and Mrs. Michael Monaghan

Mrs. Melissa Morgan

Ms. Shelley Morgan

Mr. and Mrs. Eric B. Morris

Mr. and Mrs. Richard G. Morrison

Ms. Amanda Morrow

Mr. Charles A. Morrow, Jr.

Mrs. Christine C. Moyer

Mrs. Mary Murphy

Mr. and Mrs. Randal P. Nader

ND Industrial Corp

Dr. Kevin L. Neal, DDS

NFL Affiliate of the Susan G. Komen Foundation, Inc.

Mrs. Barbara Orr

Parker & Pennington, PA

Mrs. Ann Patsiga

Ms. Danielle Payne

Ms. Sharon Peacock

Mr. and Mrs. Joseph Pearce

Mrs. Gigi Pelletier

Dr. Patricia B. Pereira

Mrs. Marie C. Perry

PGA Tour, Inc.

PhRMA

Ms. Gussie D. Pokorny

Ponte Vedra Properties Realty LLC

Ms. Jane D. Porter

Mrs. Rose Puleo

Ms. Leigh Quijano

Mr. and Mrs. Brady L. Rackley

Ms Selina Rainey

Mr. Bernard E. Reidy

Ms. Barbara Resnick

Mr. and Mrs. Raymond S. Rizzo

Robert Williams Design, LLC

Ms. Cathleen Roden

Mr. A.C. Roemhild

Mr. and Mrs. Jack P. Rothacker

Ms. Nancy C. Rowe

Mr. and Mrs. William T. Roy

S.R.F.

Mrs. Robin Saltman

Dr. Brenda M. Samara, PhD

Mr. and Mrs. James R. Scielzo

Mr. and Mrs. Francis Seabrook

Seaside National Bank & Trust

Mr. Donald C. Shaffer

Mrs. Gail W. Shave

Mr. and Mrs. John H. Shields II

Mrs. Theodora P. Siragusa

Ms. Kerrie J. Slattery and Mr. Paul Lambert

Mr. and Mrs. James P. Smith, Jr.

Mr. and Mrs. Shepard C. Spink

Mrs. Martha Stachitas

Mrs. L. Elaine Stallings

Ms. Kimberly A. Steedman

Mr. and Mrs. C. L. Strickland

Mr. and Mrs. Thornton M. Swisher

Swisher International, Inc.

Mr. and Mrs. John Tancredi

Mrs. Cathleen C. Taylor

Mr. Joe T. Taylor

Mrs. Cynthia L. Thatcher

The Edna Sproull Williams Foundation

The Haskell Company

The Jacksonville Jewish Foundation

The RITA Foundation Inc.

Mr. and Mrs. Joseph A. Thompson

Mr. Kerry Tobin

Mr. Randolph Totten

Underwood Jewelers Corporation

Valentine Sales

Mrs. Julie Van Voorhis

Mrs. Julie Vermeulen

Ms. Tilghman H. Waesche

Mr. Ralph D. Wagoner

Mrs. Amy F. Wallman

Mr. and Mrs. Christopher W. Ware

Ms. Suzannah Warren

Ms. Elizabeth B. Watkins

Mr. Charles R. Weed

Mrs. Barbara T. Welch-Salmon

Mrs. Janette O. Wells

Ms. Donna WeMett

Mrs. Nancy M. Wertheimer

Mrs. Frances W. West

Dr. and Mrs. Robert E. Wharen, Jr.

Ms. Peggy A. Widicus

Ms. Debra H. Widner

Mr. and Mrs. John F. Wilbanks

Ms. Lisa J. Williamson

Mr. and Mrs. James T. (Tylee) Wilson

Ms. Tane M. Wilson

Ms. Janis A. Wotiz

Mr. Richard Yocolano

Mr. and Mrs. Richard Zanard

39

1235 San Marco BoulevardJacksonville, Florida 32207

904.202.2273

baptistjax.com

Documents

BCI Annual Report 2012