MD Anderson Cancer Center at CooperANNUAL REPORT 2014

Two Cooper Plaza, 400 Haddon AvenueCamden, NJ 08103

Dear Friend,

For the physicians, nurses and staff at MD Anderson Cancer Center at Cooper, 2014 will beremembered as a year of transformation. While we launched our partnership with MDAnderson Cancer Center and opened our new cancer center in Camden in the fall of 2013,for many of us the tangible effect of these initiatives didn’t fully impact our lives until 2014— when our patient volumes grew tremendously, the depth and scope of our programsexpanded and we became immersed in working with our new medical record systems andbusiness operations structure.

Transformation demands innovation, and in 2014 our team did an extraordinary job ofbeing positive, flexible and creative in managing and succeeding in this changingenvironment — continually focused on the enhancement of our program and, mostimportantly, the treatment and care of our patients.

In 2014, thanks to the commitment and dedication of our team, we were able to achievesignificant successes, including:

• 20% overall increase in new patient volumes.

• Successful physician recruitment in key disease-site specialties.

• Restructured and refocused clinical trials program.

• Increased number of patients originating beyond our traditional service areas.

• Highly visible regional advertising campaign.

• Increased consumer awareness of and preference for MD Anderson Cooper cancer services.

We look with eagerness and anticipation for the new year. We have set high, but attainable,goals for customer service, quality care and patient outcomes and are well positioned tomove into 2015 and achieve those goals.

I am honored to lead MD Anderson Cancer Center at Cooper. Our success is not based onany one individual, program or initiative, but on the comprehensive, coordinated effort ourteam puts forth every day, for every patient.

Sincerely,

Generosa Grana, MD, FACPDirector, MD Anderson Cancer Center at Cooper

1

The MD Anderson Cancer Center at CooperCancer Registry is responsible for theaccurate, timely collection of cancer patient

data. This data is used for evaluation of patientoutcomes. MD Anderson Cooper is accredited by the American College of Surgeon’s (ACoS)Commission on Cancer (CoC) and the NationalAccreditation Program for Breast Centers (NAPBC).The CoC is responsible for establishing standards to ensure high quality, multidisciplinary andcomprehensive cancer care delivery in hospitalsthroughout the United States, granting accreditationto only those facilities that have voluntarilycommitted to provide the best in cancer diagnosisand treatment and are able to comply with therigorous standards.

The Registry reports specifics of diagnosis, stageof disease, medical history, patient demographics,laboratory data and tissue diagnosis; and medical,radiation and surgical methods of treatment for eachcancer diagnosed at their facility. The data is used toobserve cancer trends and provide a research base

for studies into the possible causes of cancer withthe goal of reducing cancer incidence and death.

Registry data also serves as an ongoing resourceto the Cancer Committee in determining the mosteffective allocation of resources, in determiningcommunity education and outreach initiatives andin monitoring program quality.

The Registry provides vital statistics andinformation to clinicians and researchers as well as local, state and national cancer databases andcancer-related organizations. This contribution ofinformation advances the body of knowledge in the field of cancer and ultimately has a positiveimpact on cancer patient care.

For Cooper’s data to be comparable to thosecollected at other programs around the country,the registrars adhere to data rules established bythe collecting and credentialing organizations.Keeping up with these changes can be challenging,but Cooper Cancer Registrars understand thesignificance of their work and are experts in their field.

2

REQUIRED Physician MembersUmur Atabek, MD Cancer LiaisonSurgery

Todd Seigel, MD Radiology

Generosa Grana, MD Cancer Committee ChairCancer Conf. CoordinatorHematology/Medical Oncology

Tamara LaCouture, MDRadiation Oncology

Roland Schwarting, MDPathology

REQUIRED Non-Physician MembersKristin Brill, MDBreast Program

Margaret Carnuccio, CTRManager, Cancer Registry

Yinyin (Shirley) Yao, MS, CGC Genetics Counselor

Jackie Ellis-Mullin, CTRCancer Registry QA Coordinator

Cooper University Hospital Cancer Committee*

Kim Krieger, BA, CCRP Research Coordinator

Laura Mathern, MPH PI Representative

Evelyn Robles-Rodriguez, APN-CCommunity Outreach Coordinator

Barbara Sproge, MSN Palliative Care Educator

Christine Winn, FACHESVP, Cancer Program

Ann Steffney, MSN, RN, OCN Quality Improvement Coordinator

Carol Stratton, MSPT, ATC, CLT Rehabilitation Services

Leslie Tarr, MSW, CSW, OSW-CSocial Worker & Psychosocial Services Coordinator

Other AttendeesJessica Bennett, CPE Chaplain, Pastoral Care

Susan Breslin, RNClinical Infusion Manager

Frank DelRossi, CSWOutpatient Social Worker

Tondalya DeShields, RNOncology Outreach Program

Angela Frantz, RNBreast Nurse Navigator

Virginia Girard, RNNursing Educator

Linda Goldsmith, RDOutpatient Dietitian

Annette Harley, CTRCancer Registrar

Susan Hunter, APN Hematology/Medical Oncology

Dianne Hyman, MSNBreast Nurse Navigator

Frank Koniges, MDSurgery

Lisa McLaughlin, MSWOutpatient Social Work

Cori McMahon, PsyDBehavorial Medicine, Hematology/Medical Oncology

Alicia Michaux, RDOutpatient Dietitian

Alice O'Brien, RN Leuk/Lymph Nurse Navigator

Brian Palidar, CTRCancer Registrar

Beth RachkisMarketing/Communications

Dave Rodman Oncology Pharmacist

Mary Rooney, RNGU Nurse Navigator

Francis Spitz, MDSurgery

Karen Staller, CTRCancer Registrar

Pat StienesRadiology

Jackie SuttonPharmacy

Nick StamatiadesSr. Director, Finance/Operations

Colleen TegelerRadiation Therapy

Colleen ThorntonAmerican Cancer Society

Jackie Tubens, MSNGI Nurse Navigator

David Warshal, MD Gynecologic Oncology

*Committee members at time of publication.

Cancer Registry Department Staff

Peggy Carnuccio, CTR, ManagerJacqueline Ellis-Riffle, CTR, Cancer Registrar

Annette Harley, CTR, Cancer Registrar

Cancer Registry Report

Brian Palidar, CTR, Cancer RegistrarKaren Staller, CTR, Cancer Registrar

3

Top Five Cancer Sites TOTAL ANALYTICAL CASES 2004-2013

Patient’s County of Residence at Diagnosis 2013 ANALYTICAL CASES

BreastLungCorpus UterusColon/RectumPancreas

Cape May . . . . .3.45%

Cumberland . . . .4.24%

Hunterdon . . . .0.10%

Mercer . . . . . . .1.78%

Middlesex . . . . .0.10%

Monmouth . . . .0.20%

Ocean . . . . . . . .1.92%

Salem . . . . . . . .3.11%

Somerset . . . . . .0.10%

Out of State . . .2.81%

Unknown . . . . . .0.64%

0

50

100

150

200

250

300

350

400

450

Num

ber o

f Cas

es

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

County Count Percent

Camden 800 39.40%

Burlington 369 18.20%

Gloucester 275 13.56%

Atlantic 135 6.66%

Other 449 22.18%

TOTAL 100.00% {OTHER22%

CAMDEN39%

BURLINGTON18%

GLOUCESTER14%

C A N C E R R E G I S T R Y R E P O R T

ATLANTIC7%

286

154

91

109

40

347

172

114

127

35

386

206

145

154

45

384

159

126

117

44

351

181

154

142

56

377

174

150

121

53

385

188

182

130

57

421

202

161

126

65

404

229

196

133

86

313

122

95

104

15

4

MD Anderson Cancer Center at Cooper2013 ANALYTIC CASE DISTRIBUTION – BY SITE, SEX, AJCC STAGE

C A N C E R R E G I S T R Y R E P O R T

Primary Site

ORAL CAVITY & PHARYNXLipTongueSalivary GlandsFloor of MouthGum & Other MouthNasopharynxTonsilOropharynxHypopharynxDIGESTIVE SYSTEMEsophagusStomachSmall IntestineColon Excluding Rectum

CecumAppendixAscending ColonHepatic FlexureTransverse ColonSplenic FlexureDescending ColonSigmoid ColonLarge Intestine, NOS

Rectum & RectosigmoidRectosigmoid JunctionRectum

Anus, Anal Canal & AnorectumLiver & Intrahepatic Bile Duct

LiverIntrahepatic Bile Duct

GallbladderOther BiliaryPancreasPeritoneum, Omentum & MesenteryOther Digestive OrgansRESPIRATORY SYSTEMNose, Nasal Cavity & Middle EarLarynxLung & BronchusBONES & JOINTSBones & JointsSOFT TISSUESoft Tissue (including Heart)SKIN EXCLUDING BASAL & SQUAMOUSMelanoma -- SkinOther Non-Epithelial SkinBASAL & SQUAMOUS SKINBasal/Squamous cell carcinomas of SkinBREASTBreast

TotalCases

54123343364734523191096205851227307376311118171101685146245115229111149494139211404404

Male

3911733105361791897551315350518514212713130584102121112108882525202000066

Female

1506012311116651034174327221222341945415844144124031213324242119211398398

Sex

Stage 0

20101000009000511101001010110000020000000000550009090

Stage I

3000210000605322161020029171615500412007101706617171212000145145

Stage II

5020010011907301721303123291872202735102402222266651009999

Stage III

9032101011716442570225018011110133050480430340001919660003838

Stage IV

3011710015148827427422131293734043133265010218933322880002323

88

0000000000110100000000000000044000006101000221010000

Unk

4000011110163101000000001202100002600400400223301188

AJCC Stage

5

C A N C E R R E G I S T R Y R E P O R T

MD Anderson Cancer Center at Cooper2013 ANALYTIC CASE DISTRIBUTION – BY SITE, SEX, AJCC STAGE (continued)

Primary Site

FEMALE GENITAL SYSTEMCervix UteriCorpus & Uterus, NOS

Corpus UteriUterus, NOS

OvaryVaginaVulvaOther Female Genital OrgansMALE GENITAL SYSTEMProstateTestisPenisURINARY SYSTEMUrinary BladderKidney & Renal PelvisOther Urinary OrgansBRAIN & OTHER NERVOUS SYSTEMBrainCranial Nerves Other Nervous SystemENDOCRINE SYSTEMThyroidOther Endocrine including ThymusLYMPHOMAHodgkin LymphomaNon-Hodgkin Lymphoma

NHL - NodalNHL - Extranodal

MYELOMAMyelomaLEUKEMIALymphocytic Leukemia

Acute Lymphocytic LeukemiaChronic Lymphocytic Leukemia

Myeloid & Monocytic LeukemiaAcute Myeloid LeukemiaChronic Myeloid LeukemiaOther Myeloid/Monocytic Leukemia

Other LeukemiaOther Acute LeukemiaAleukemic, Subleukemic & NOS

MESOTHELIOMAMesotheliomaKAPOSI SARCOMAKaposi SarcomaMISCELLANEOUSMiscellaneous

Total

TotalCases

3474419618610645299827110111354572571641967620799704921171746123930208241333113737

2,028

Male

000000000827110168383002610162619744539281111112611381375121133111919

704

Female

34744196186106452990000451627231625705713354312110662010117133120200001818

1,324

Sex

Stage 0

10200001700000201910000000000000000000000000000000

136

Stage I

19221140137383164211380376310000505002822611150000000000000000000

642

Stage II

2039816101474700191360000880918800000000000000000000

335

Stage III

7992927236041541010271000111101129900000000000000220000

304

Stage IV

33812102120016501209110000440223191810000000000000000000

341

88

301100002000020115716412002010101171746123930208241300113737

199

Unk

91532102032105500000330817340000000000000110000

67

AJCC Stage

6

Performance for NQF Breast Care Measures

National standard for breast conserving surgery and radiation therapyRadiation therapy is administered within one year (365 days) ofdiagnosis for women under the age of 70 receiving breast conservingsurgery for breast cancer. MD Anderson Cancer Center at Cooper’scompliance with this standard was at 97%, compared to the statenorm of 84% and the national norm of 89%.

National standard for chemotherapy in hormone receptornegative breast cancer patientsCombination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCCT1cN0M0, or stage II or III hormone receptor negative breast cancer.MD Anderson Cancer Center at Cooper’s compliance with thisstandard was at 92%, compared to the state average of 84% andnational norm of 90%.

Measuring Quality

97%

84%89%

COOPER NJ US

92%84%

90%

COOPER NJ US

How do patients know if theyare receiving good qualityhealth care?

How do physicians andnurses identify the steps thatneed to be taken for betterpatient outcomes?

And how do insurers andemployers determine whetherthey are paying for the bestcare that science, skill andcompassion can provide?

Performance measures

Performance measures give the health care community a way to assessquality of care provided against recognized standards. While qualitymeasures come from many sources, those endorsed by the NationalQuality Forum (NQF) have become established as among the best. An NQF endorsement reflects rigorous scientific and evidence-basedreview, input from patients and their families, and the perspectives of people throughout the health care industry.

One of the ways MD Anderson Cancer Center at Cooper assesses thequality of the care we give to our cancer patients is to compare ourperformance in NQF standards to those of other hospitals in NewJersey and the United States.

National Quality Forum has established six measures for quality care in breast, colon and rectal cancer. Below you will find how MD Anderson Cooper compares to other hospitals in New Jersey and across the U.S. in these critical performance measures.

7

National standard for Tamoxifen or third generation aromataseinhibitor in hormone receptor positive breast cancer patientsTamoxifen or third generation aromatase inhibitor is considered oradministered within one year (365 days) of diagnosis for women withAJCC T1cN0M0, or stage I hormone receptor positive breast cancer.MD Anderson Cancer Center at Cooper’s compliance with thisstandard was at 92%, compared to the state norm of 79% and thenational norm of 85%.

92%

79%85%

COOPER NJ US

National standard for Image or palpable-guided needle biopsy(core of FNA) is performed to establish diagnosis of breast cancerMD Anderson Cancer Center at Cooper’s compliance with thisstandard was at 99%, compared to the state norm of 81% and thenational norm of 87%.

National standard for evaluating radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with >=4 positive lymph nodesMD Anderson Cancer Center at Cooper’s compliance with thisstandard was at 94%, compared to the state norm of 77% and thenational norm of 81%.

National standard for regional lymph nodes in surgically resected patientsAt least 12 regional lymph nodes are removed and pathologicallyexamined for resected colon cancer. The compliance rate for MDAnderson Cancer Center at Cooper was at 84%, compared to the state norm of 89% and the national norm of 88%.

Performance for Colon and Rectal Cancer NQF Measures

84%89% 88%

COOPER NJ US

99%

81%87%

COOPER NJ US

94%

77%81%

COOPER NJ US

8

Measuring Quality (continued)

Performance for Colon and Rectal Cancer NQF Measures (continued)

National standard for adjuvant chemotherapy for node positive patientsAdjuvant chemotherapy is considered or administered within 4 months(120 days) of diagnosis for patients under the age of 80 with AJCC stageIII (lymph node positive) colon cancer. The compliance rate for MDAnderson Cancer Center at Cooper was at 82% compared to the statenorm of 81% and the national norm of 85%.

National standard for radiation therapy of stage III rectal cancerRadiation therapy is considered or administered within 6 months(180 days) of diagnosis for patients under the age of 80 with clinicalor pathologic AJCC T4N0Mo or stage III receiving surgical resectionfor rectal cancer. The compliance rate for MD Anderson CancerCenter at Cooper was at 100%, compared to the state norm of 81% and the national norm of 88%.

COOPER NJ US

COOPER NJ US

9

EpidemiologyIn the year 2014, it is estimated that 46,420 people will be diag-

nosed with pancreatic cancer and 39,590 people will die of the diseasein the United States. For the last five-year period for which data isavailable (2006-2011), there were 7,778 cases of pancreatic cancer inthe state of New Jersey, with 444 of these cases originating in CamdenCounty. Nationwide, pancreatic cancer is the fourth most commoncause of cancer-related death in both men and women with mortalityrates relatively unchanged over the last ten years. Nationally, theincidence of pancreatic cancer has increased on average by 1% per year.

Risk FactorsAlthough the predisposing factors associated with pancreatic

cancer remain poorly understood, it is known that cigarette smoking,obesity, chronic pancreatitis, heavy alcohol consumption and occu-pational exposure to chemicals such as beta-naphthylamine andbenzidine increase the risk of developing the disease. It is believedthat increasing rates of obesity, coupled with an aging population, hascontributed to the slow but consistently increasing rate of pancreaticcancer in the U.S. Rates of pancreatic cancer are similar in men andwomen, though there is an increased rate of pancreatic canceramong African Americans compared to Caucasian Americans.

Approximately 10% of pancreatic cancer is believed to be geneti-cally-linked and inheritable. In particular, there is clearly an increasedrate of pancreatic cancer in those individuals with Peutz-Jegherssyndrome, familial pancreatitis, Familial Malignant Melanomasyndrome, Lynch syndrome, and BRCA1 and BRCA2 mutations.

Screening Multiple studies have looked at the use of endoscopic ultra-

sound, CT and MRI to screen high-risk individuals for pancreaticcancer. For the purpose of these studies, a high-risk individual wasdefined as a person with a first-degree relative having a history ofpancreatic cancer. These studies showed that screening asymptomatic,high-risk patients can lead to the detection of early pre-cancerouslesions. If detected, these lesions can be treated aggressively withsurgical resection, thereby preventing the development of pancreaticcancer. Unfortunately, the overall sensitivity of these screening tech-niques is low. In these studies even with yearly screening, severalpatients developed metastatic pancreatic cancer while under closeobservation. Currently, there is no effective screening test for pan-creatic cancer available to patients at average risk of developing thedisease.

Cancer RegistryIn 2013, 79 patients with pancreatic adenocarcinoma were seen

at the MD Anderson Cancer Center at Cooper, an increase of almost40% since 2009 when 57 patients with pancreatic adenocarcinomawere seen.

Pancreatic Cancer Report

A N N U A L R E P O R T 2 0 1 1

Benjamin E. Goldsmith, MDDepartment of Radiation OncologyMD Anderson Cancer Center at Cooper

10

Age at diagnosis 2013 vs (2006-2012), MD Anderson Cooper vs National Averages

In 2013 the average age of diagnosis at MD AndersonCooper was 67. This is consistent with national trendsof pancreatic cancer being diagnosed in the sixth andseventh decade of life. The national average age of diag-nosis is 72.

MD Anderson Cooper patients by Ethnicity 2013 vs (2006-2012), MD Anderson Cooper vsNational Averages

In 2013, 78.8% of patients seen for pancreatic ade-nocarcinoma at MD Anderson Cooper were Caucasianand 17.6% were African-American. These figures aresimilar to nationwide numbers, where 78.22% wereCaucasian and 12.17% were African-American.

Stage at Diagnosis 2013 vs 2006-2012, MD Anderson Cooper vs National averagesIn 2013, 47 of the 79 cases (59%), seen at MD Anderson Cooper were diagnosed with either stage I or II

pancreatic adenocarcinoma. Patients with stage I and II disease are potentially surgical candidates. Currently,surgery is the only known cure for pancreatic cancer with or without the use of chemotherapy and radiation.The number of stage I and II patients seen in 2013 represents a sharp increase from the period between 2006and 2012 when only 33% of patients seen at Cooper were early-stage, with approximately 50% of patients seenhaving stage IV, metastatic disease. (See Figure 1.)

TreatmentThe first-line treatment of pancreatic adenocarcinoma is surgery if the tumor is resectable and the patient

is healthy enough to undergo the procedure. Tumors arising in the head of the pancreas are treated with aWhipple procedure, also known as a pancreaticoduodenectomy, which traditionally removes the head of thepancreas, the distal stomach, the first and second portions of the duodenum, the common bile duct and thegallbladder. Pancreatic adenocarcinoma of the tail can be removed via a distal pancreatectomy. Chemotherapyand radiation therapy may be used neoadjuvantly (before surgery) or adjuvantly (after surgery). These treatmentsmay also be used as definitive treatment for those patients who cannot undergo surgery.

From 2006-2012, surgical resections were performed in 79 of 247 Cooper patients with pancreatic adeno-carcinoma. 21% received radiation therapy and 49% received chemotherapy. 32% received no therapy atCooper for their pancreatic cancer. (See Figure 2.)

0% 5% 10% 15% 20% 25% 30% 35%

No Treatment

Other Therapy

Surgery, Radiation & Chemotherapy

Chemotherapy Only

Radiation & Chemotherapy

Surgery & Chemotherapy

Surgery Only

32%

6%

12%

22%

9%

6%

14%

Figure 2: Cooper Pancreatic Cancer Cases 2006 to 2012

IVIIIIII

Stage

Num

ber

of C

ases

National 2006-2012

Cooper 2006-2012

Cooper 2013

0

10

20

30

40

50

Figure 1: Pancreatic Cancer Stage at Diagnosis

In 2013 at MD Anderson Cooper, 72% of patients seen with pancreatic adenocarcinoma received some form oftherapy, with 43% undergoing a surgical procedure. The remaining patients who received treatment underwentvarious combinations of chemotherapy and radiation for definitive or palliative treatment. Twenty-two of the79 patients with pancreatic cancer did not receive any form of treatment. (See Figure 3.)

Pancreatic Cancer Report (continued)

Figure 4: Observed Survival for Pancreas “C250,” “C251,” “C252,” “C253,” “C254,” “C257,” “C258,” “C259”Cases Diagnosed in 2003–2007 Data from 1463 Programs (National)

WARNING: The information within this graphic is not to be used for clinical decision making.

100

90

80

70

60

50

40

30

20

10

0

Cum

ulative Surviva

l Rate

0.0 1.0 2.0 3.0 4.0 5.0

Years From Diagnosis

®2014 National Cancer Data Base (NCDB). Commision on Cancer (CoC)

Stage 0

Stage I

Stage II

Stage III

Stage IV

11

0% 5% 10% 15% 20% 25% 30%

No Treatment

Other Therapy

Surgery, Radiation & Chemotherapy

Chemotherapy Only

Radiation & Chemotherapy

Surgery & Chemotherapy

Surgery Only

24%

4%

4%

25%

3%

14%

27%

Figure 3: MD Anderson Cooper Pancreatic Cancer Cases 2013

Survival DataNationally, the five-year overall survival for patients with invasive pancreatic cancer remains low at less

than 25%. This remains true even for those patients with early stage disease. Patients with pre-invasive, ‘in-situ’disease, have the best prognosis over time, while the majority of patients with metastatic pancreatic cancer,stage IV, at the time of diagnosis will succumb to their disease within the first year of diagnosis. (See Figure 4)

Comprehensive Care at MD Anderson Cancer Center at CooperMD Anderson Cooper is South Jersey’s leading provider in the detection, diagnosis and treatment of

pancreatic cancer. The Gastrointestinal Cancer Program combines state-of-the-art, compassionate medicalcare with innovative science to provide the best possible outcomes for patients.

Each patient seen at MD Anderson Cooper is evaluated by our multidisciplinary care team. Each of ourpatients is under the care of an entire team of experts, consisting of:

12

Comprehensive Care at MD Anderson Cancer Center at Cooper

MD Anderson Cooper brings together MD Anderson Cancer Center’s world-renowned expertise andCooper’s regional leadership in a partnership that opens up a broader range of options for cancer patients inSouth Jersey, Delaware and the greater Philadelphia region.

Our multidisciplinary gastrointestinal cancer team meets weekly to review each patient’s case with a compre -hensive evaluation and an individualized treatment plan using MD Anderson’s proven treatment approach. Eachrecommendation is based on comprehensive research and specialized cancer expertise. This partnershipprovides access to more clinical trials for more cancers to give patients more options in collaboration withnational and regional cancer specialists.

MD Anderson Cooper offers a full spectrum of radiation oncology treatment options including externalbeam radiation therapy and CyberKnife® radiosurgery. The CyberKnife system is designed to pinpoint anddestroy tumors using high doses of radiation with sub-millimeter accuracy.

Our medical oncologists offer patients the most advanced chemotherapy treatments and access to ground-breaking clinical trials that give patients options that may not be available elsewhere in the region.

• Surgical oncologists• Medical oncologists • Radiation oncologists • Gastroenterologists and advanced endoscopists• Interventional radiologists• Palliative care team• Pathologists

• Radiologists• Nurse navigator• Nurse practitioner• Nutritionists• Clinical research coordinators• Social workers

Pancreatic Cancer Report (continued)

Two Cooper Plaza, 400 Haddon AvenueCamden, NJ 08103

1.855.MDA.COOPER (1.855.632.2667) • MDAndersonCooper.org