St. John Medical Center Cancer Program 2012 ANNUAL REPORT

LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

TABLE OF CONTENTS

Report from the Director...... 3

Report of Cancer Committee Activities...... 4

Report from the Cancer Liaison Physician...... 5

Cancer Committee...... 6

Cancer Registry...... 7

Primary Site Table ...... 8

Report of Cancer Census...... 10

Lung Cancer Site-Specific Study...... 11

Cancer Programs...... 13

Support Programs...... 14 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

ST. JOHN HEALTH SYSTEM AND LAFORTUNE CANCER CENTER MISSION, VISION AND VALUES Mission Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable . Our Catholic health ministry is dedicated to spiritually centered, holistic care that sustains and improves the health of individuals and communities . We are advocates for a compassionate and just society through our actions and our words . Vision We envision a strong, vibrant Catholic health ministry in the U S. ,. which will lead to the transformation of healthcare . We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle . We will expand the role of the laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future . Values We are called to: • Service of the poor: generosity of spirit, especially for persons most in need • Reverence: respect and compassion for the dignity and diversity of life • Integrity: inspiring trust through personal leadership • Wisdom: integrating excellence and stewardship • Creativity: courageous innovation • Dedication: affirming the hope and joy of our ministry

2 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

REPORT FROM THE DIRECTOR

The pace of new advances in the treatment and cure of cancer is staggering . New chemotherapeutic agents are being produced at a rapid pace, as well as remarkable therapeutic radiation delivery systems such as our CyberKnife and TomoTherapy systems . The LaFortune Cancer Center at St . John Medical Center is positioned to fully participate in these advances in research and technology in our mission to deliver compassionate care and medical excellence .

Support services continue to be an integral component of our program, which includes dedicated social service support, an education resource center, sponsorship of multiple support groups and medical nutritional counseling . The Cancer Center is an active participant in numerous community activities that promote public education, screenings and disease prevention; fundraising; and celebration of survivorship .

Clinical research is available through sponsoring institutions, which include the National Cancer Institute, Eastern Cooperative Oncology Group, Radiation Therapy Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Clinical Trials Support Unit . Eligible patients who choose to participate may have an opportunity to receive cancer treatment that represents the most current science in cancer care .

The Cancer Registry abstracted 1,810 new cases during 2012, growing the database to more than 40,000 cases .

The Cancer Center team is dedicated to providing patient-centered care adhering to our mission and values and looks forward to the exciting challenges and opportunities in the delivery of cancer care .

Sincerely,

Phil Ames Director, Radiology Services LaFortune Cancer Center

3 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

REPORT OF CANCER COMMITTEE ACTIVITIES

The St . John Cancer Committee is proud of the role it played in the successful operation of St . John Medical Center in 2012 .

In the area of improving the delivery of efficient and competent oncological care to our patients, the pharmacy department again had a dedicated pharmacist responsible only for the oncology department . Working with MD Anderson, we added a series of chemotherapy audits designed to further minimize chemotherapy order mistakes . Chemotherapy orders and regimens are being standardized and will eventually be digitized into our electronic medical records . The goal is seamless communication from physician to pharmacy to nursing for every chemotherapy order administration . The process would be transparent, with multiple safety mechanisms built in to further minimize mistakes . Additionally, internal quality improvement processes were constantly reviewed and updated to minimize patient wait time in the chemotherapy infusion room .

To help with the quality of life of our patients undergoing cancer treatment, the St . John rehabilitation department took a major step forward when it was awarded the STAR (Survivorship Training and Rehabilitation) Program certification. This program is proven to help cancer survivors cope with their debilitating side effects caused by treatments .

St . John Medical Center continued its public outreach program to help educate and support patients and their families receiving treatment or who received treatment in the past . The annual Holiday Heart and Hope party was again a great success, with good attendance by past and present patients and much community involvement . St . John also continued to participate actively in other community functions, such as Relay for Life and the Susan G . Komen Race for the Cure . At Christmastime St . John participated in the Angel Tree Program to provide less fortunate and financially strapped families with gifts for their children.

The Cancer Center continued to hold weekly Tumor Board conferences and expanded to include a breast cancer conference once a month . The conferences were well-attended by our multidisciplinary team of medical oncologists, radiation oncologists, surgeons and pathologists .

Patients treated at the LaFortune Cancer Center continued to have access to the most advanced equipment and specialized care . The medical staff included dedicated medical oncologists, hematologists, a breast surgeon, radiation oncologists, radiologists, neurosurgery oncologists, orthopedic surgeons, gynecologic oncologists, colorectal surgeons, plastic surgeons and ENT . Patients have access to PET/CT scanners, CyberKnife technology and robotic urological procedures . The Cancer Center welcomed its second radiation oncologist, Reginald Westmacott, MD . He has been providing much- needed additional radiation oncology coverage for our expanding Cancer Center patient population .

Our patients continued to have access to clinical trials from large corporative groups, including NSABP and RTOG .

Sincerely,

Coty Ho, MD Co-Chair, 2012 Cancer Committee Medical Director, Hematology and Oncology LaFortune Cancer Center

4 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

REPORT FROM THE CANCER LIAISON PHYSICIAN

The cancer liaison physician provides a connection between the Commission on Cancer of the American College of Surgeons and the LaFortune Cancer Center of St . John Medical Center . The cancer program at St . John underwent a survey in 2010, and its accreditation was renewed until 2013 .

The Cancer Center continues to provide assistance with the management of patients suffering from many types of cancer . Patients with both hematologic malignancies and solid tumors are treated at the Cancer Center . Patients have access to a wide variety of different medical subspecialties for treatment of oncological problems . We have a dedicated medical oncology team, as well as radiation oncology and breast surgical oncology . Our surgical service is further supported by a well-staffed neurosurgery team, with expertise in dealing with primary CNS tumor resection . We also have dedicated colorectal surgeons . We collaborate closely with our large group of urologists . Our radiation oncology department provides state-of-the-art CyberKnife technology, and our urology staff can provide robotic surgery expertise . Our interventional radiology staff continues to provide excellent service for all types of biopsy examinations and minimally invasive procedures to aid in new cancer diagnoses and palliative measures during treatment .

Our programs continue to promote up-to-date medical treatment with support for the whole patient — mind, body and spirit . We have dedicated social workers, nutritionists, rehabilitation specialists, physical therapists and home health nurses assigned to the Cancer Center . We are proud to report that the St . John rehabilitation department was awarded the STAR (Survivorship Training and Rehabilitation) Program certification. The program was designed to help cancer survivors treat and cope with the possible debilitating side effects caused by cancer treatments . The St . John hospice program, along with our chaplain service, remains active with the care of our terminally ill patients and provides much support to their families .

The Cancer Center remains active within the community with projects, such as free new wigs for patients with hair loss while undergoing chemotherapy . Another important program for the community is Tulsa Project Woman . This program provides free mammographies and, if needed, breast biopsies, for the indigent population with financial needs. The Charity Fund makes available financial support to uninsured patients undergoing cancer treatment . The annual Tulsa Komen Race for the Cure and the local Relay for Life raised funds to help support cancer research activities at St . John . Other St . John-sponsored activities, such as the Art of Healing, bring together cancer survivors and their families in an annual celebration of their continued health and courage . Our St . John physicians routinely take turns putting together annual symposiums on different topics of cancer to educate and update their colleagues and hospital staff on various new treatments and advances in cancer care . The Cancer Center continues to work closely with the local American Cancer Society chapter to provide temporary housing for patients from afar undergoing treatment here .

St . John remains a community leader in healthcare and cancer treatment . We have four satellite hospitals in the surrounding communities, allowing us to deliver excellent medical care to the growing Tulsa area and its suburbs . We were voted again by the greater metropolitan population as the No . 1 hospital in the area for 2012 . A great number of cancer patients throughout northeastern Oklahoma are impacted by the broad-reaching and supportive care of our doctors, nurses and staff . We will continue in our endeavors to provide medical excellence and compassionate care to the cancer patient .

Sincerely,

Coty Ho, MD 2012 Cancer Liaison Physician Medical Director, Hematology and Oncology LaFortune Cancer Center

5 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

CANCER COMMITTEE COMMITTEE MEMBERS

The St . John Cancer Committee is Richard Ruben, MD...... Acting committee co-chair, composed of representatives from various Medical Oncology medical disciplines and support services Coty Ho, MD ...... Acting committee co-chair involved with the care of cancer patients . and cancer liaison physician, The committee met six times in 2012 Medical Oncology under the leadership of acting co-chairs Melissa Wood, RN...... Nursing manager, Inpatient Richard Ruben, MD, and Coty Ho, MD . Oncology Polly Robinson, PharmD...... Pharmacy The committee is concerned with the entire spectrum of care for cancer Heidi Macha, PharmD ...... Pharmacy patients seen at St . John Medical Center . Michael Harvey, MD...... Pathology Committee responsibilities include: Jack Mocnik Jr ., MD...... Radiology • Developing and evaluating annual goals Phil Ames...... Administrative director, and objectives for the clinical, educational LaFortune Cancer Center and programmatic activities related to Julie Kinzie, LCSW...... Social Services cancer . Candida Barlow, RN...... Manager, Clinical Research • Promoting a coordinated, Carol A . Lane, CTR...... Cancer Registry multidisciplinary approach to patient management . Fred Willison, MD...... Radiation Oncology John L . Eckenrode, MD ...... Medical Oncology • Ensuring educational and consultative cancer conferences cover all major sites Kathy Smarinsky ...... Vice president, St. John and related issues . Medical Center • Ensuring an active, supportive care system Doris Ghazal ...... Medical Staff Services is in place for patients, families and staff . Denise Rable ...... Surgery • Monitoring quality management and Mark Genesen, MD...... Gynecologic Oncology improvement through completion of Joyce George, RN...... Director, Medical Records quality management studies that focus on and Admissions access to care and outcomes . JoAnn Rushenberg, RN ...... Quality Assurance • Promoting clinical research . Brenda Frank, RN...... Nursing manager, Hospice • Supervising the cancer registry and Jodi Hudson...... ACS representative ensuring accurate and timely abstracting, staging and follow-up reporting . Kelly Berry, MPT ...... Manager, Rehabilitation Services • Performing quality control of registry data . Ronald Distefano, DO...... Pathology • Encouraging data usage and regular Suzanne Forsberg...... Nutrition reporting by planning and conducting a Donna Longfield, RN...... Nursing manager, minimum of two patient care evaluation Radiology/Radiation studies annually, one to include survival Oncology and comparison data, if available . Sister Julie Manternach...... Pastoral Care • Ensuring that content of the annual Tanyanika Towe, MD...... Medical Oncology report meets requirements . Douglas Shram, MD...... Palliative Care • Publishing the annual report on the St . Sandra Walker, RN...... Nursing director, Outpatient John Health System MedWeb by Nov . 1 of Oncology the following year . Andrew Crawford, DO ...... Gastroenterology • Upholding medical ethical standards . Jeff Delo, MD...... Medical Oncology

6 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

CANCER REGISTRY During 2012, the Cancer Registrars: • Abstracted 1,811 cases into the database . The St . John Cancer Registry maintains a complete database of all cancer cases • Abstracted the required 90 percent within diagnosed and/or treated at St . John . More the required six-month time frame . than 23,119 cases have been accessioned since • Registered 25 cases of cervical carcinoma the registry’s new reference date of 2000 . In in situ and 1,100 NRs . addition, 10,082 non-analytic cases and 1,143 cases of cervical carcinoma in situ have been • Completed follow-up on 90 percent of the registered . Three full-time cancer registrars 11,996 cases under follow-up . and one follow-up secretary are responsible • Reviewed and re-abstracted 10 percent of for collecting and maintaining complete and 2012’s accessioned cases . accurate data, including annual follow-up information for all cancer patients diagnosed • Prepared for the weekly Cancer Conference or treated at St . John . presentation . • Prepared for the Cancer Committee . • Prepared the annual report . • Participated in the Tulsa Community College student program . • Responded to 12 requests for studies or information from various departments, physicians and administrators .

DISTRIBUTION OF ANALYTIC CASES BY COUNTY

There were 1,811 analytic cases diagnosed at St . John in 2012 . Of them, 1,785 were from Oklahoma, and 26 were from other states . The case totals for Oklahoma counties are shown below:

14 8 6 11 35 38 1 110 12 2 37 44

17 1062 OTHER STATES 65 28 8 153 32 38 Kansas ...... 18 2 1 2 11 Louisiana...... 2 5 8 Missouri ...... 2 1 2 Alabama...... 1 1 4 1 Arkansas ...... 1 15 1 3 California...... 1 1 Tennessee...... 1 1 2 1 Total...... 26 2

7 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

2012 FREQUENCY COUNTS FOR PRIMARY SITE Code Frequency Percent Cum. Freq. Percent TONGUE 1 1 0.1 1 0.1 TONGUE OTH 2 2 0.1 3 0.2 PALATE 5 2 0.1 5 0.3 MOUTH 6 1 0.1 6 0.3 PAROTID GL 7 2 0.1 8 0.4 TONSIL 9 5 0.3 13 0.7 OROPHARYNX 10 2 0.1 15 0.8 PYRIFORM S12 1 0.1 16 0.9 ORAL CAVITY 14 2 0.1 18 1.0 ESOPHAGUS 15 18 1.0 36 2.0 STOMACH 16 14 0.8 50 2.8 SM INTESTINE 17 5 0.3 55 3.0 COLON 18 105 5.8 160 8.8 RECTOSIGM 19 17 0.9 177 9.8 RECTUM 20 33 1.8 210 11.6 ANUS 21 12 0.7 222 12.3 LIVER 22 19 1.0 241 13.3 GALLBLADDER 23 6 0.3 247 13.6 BILIARY TR 24 2 0.1 249 13.7 PANCREAS 25 51 2.8 300 16.6 DIGESTIVE 26 3 0.2 303 16.7 NASAL CAVITY 30 1 0.1 3.4 16.8 SINUS 31 1 0.1 3.5 16.8 LARYNX 32 11 0.6 316 17.4 LUNG 34 273 15.1 589 32.5 PLEURA-MED 38 2 0.1 591 32.6 BONE LIMBS 40 1 0.1 592 32.7 BONE 41 2 0.1 594 32.8 BLOOD SYS 42 48 2.7 642 35.5 SKIN 44 111 6.1 753 41.6 PERITONEUM 48 3 0.2 756 41.7 CONNECTIVE 49 10 0.6 766 42.3 BREAST 50 378 20.9 1,144 63.2 VULVA 51 7 0.4 1,151 63.6 VAGINA 52 1 0.1 1,152 63.6 CERV UTERI 53 16 0.9 1,168 64.5 CORP UTERI 54 57 3.1 1,225 67.6 UTERUS 55 2 0.1 1,227 67.8 OVARY 56 38 2.1 1,265 69.9 FEM GENIT 57 3 0.2 1,268 70.0

8 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

Code Frequency Percent Cum. Freq. Percent PENIS 60 2 0.1 1,270 70.1 PROSTATE 61 85 4.7 1,355 74.8 TESTIS 62 4 0.2 1,359 75.0 KIDNEY 64 96 5.3 1,455 80.3 REN PELVIS 65 2 0.1 1,457 80.5 URETER 66 4 0.2 1,461 80.7 BLADDER 67 69 3.8 1,530 84.5 URINARY 68 1 0.1 1,531 84.5 EYE 69 6 0.3 1,537 84.9 MENINGES 70 36 2.0 1,573 86.9 BRAIN 71 50 2.8 1,623 89.6 CENT NERVE 72 35 1.9 1,658 91.6 THYROID 73 52 2.9 1,710 94.4 ENDOCRINE 75 21 1.2 1,731 95.6 OTHER 76 1 0.1 1,732 95.6 LYMPH NODE 77 37 2.0 1,769 97.7 UNKNOWN 80 42 2.3 1,811 100.0 TOTAL 1,811 100.0 1,811 100.0

Mean = 47.66 Code = 50 Standard error of mean = 0.42 Standard deviation = 17.93 Frequency mode = 378

9 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

REPORT OF CANCER CENSUS

During 2012, St . John Medical Center continued to be busy with the growth of its cancer care service . LaFortune Cancer Center continued to treat a wide variety of cancer diagnoses . The bulk of the cases comprised of the following four major types of cancer: lung, breast, colorectal and lymphoma . There were 273 cases of newly diagnosed lung cancer in 2012 . There were 378 cases of breast cancer . There were 201 cases of colorectal cancer and 37 cases of lymphoma diagnosed at the hospital in 2012 .

The total of newly diagnosed cancers in Oklahoma continues to increase every year . In 2012, the state had 20,160 new cases .

PRIMARY SITE FOR 2012

Male Female Lung. . . 164 Breast. . .373 Skin . . . .71 Lung. . . 109 Colon. . . .68 Colon. . . .83 Pancreas. . 31 Skin . . . .40 Rectum. . .26 Lymphoma. .29 Lymphoma. .20 Rectum. . .24 Breast. . . .5 Pancreas. . 20

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LUNG CANCER SITE-SPECIFIC STUDY St. John Medical Center, Tulsa, Okla. Tanyanika Phillips, MD

Lung cancer remains the leading cause of cancer-related deaths in the U S. . According to the American Cancer Society, new cases of lung cancer represent 14 percent of all new cancer diagnoses; it is primarily a disease of the elderly, with more than 80 percent of cases over age 60 . At St . John, lung cancer was the second most common cancer diagnosed in 2012, with 78 percent of cases over age 60 .

The number of cases of lung cancer is shown below . Stage IV cases among national data (NCDB) are included in parentheses in the first chart and compared with local data at our hospital.

2008 2009 2010 2011 2012 ST. JOHN 272 57% IV NATIONALLY 126,035 127,788 126,204 124,289 N/A (35.9%) IV (36.7%) IV (40%) IV (39.9%) IV

St. John lung cancer cases by demographics, histology and stage of disease in 2012:

GENDER Male Female N=272 164 (61%) 108 (39%)

AGE <60 61–79 >80 65 (22%) 175(64%) 40 (14%)

RACE/ETHNICITY White Non-white 246 16

HISTOLOGY NSCLC Small cell lung CA N=272 242 30

STAGE Localized/regional disease Distant N=272 115 (42%) 157 (57%)

Our data was compared to NCDB data to identify the number of cases that present with early-stage disease and receive first course of surgery. Surgery remains the gold standard for initial treatment in patients with early-stage disease .

The 2011 NCDB data among NSCLC cases included 44,031 diagnosed with stage I or II lung cancer . There were 31,883 persons with stage I in 2011 and 12,148 diagnosed with stage II . Among stage I, 10,161 did not receive surgery . Among stage II, 4,821 did not receive surgery . Thus, 21,722 stage I lung cancer patients received at least some form of surgery, 17 of whom it was unknown whether surgery was performed in 2011 . And 7,327 patients with stage II received surgery, and only four cases were unknown whether surgery was performed .

11 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

A snapshot of the last year of our cases reveals that in 2012 most persons diagnosed with lung cancer were white, male, between the ages of 61 and 79 and histologically NSCLC adenocarcinoma predominant (62 percent) .

We compared our data with the NCDB’s, and 57 percent of total cases in 2012 had stage IV disease, compared with 39 9. percent nationally . Among the 125,230 diagnosed with lung cancer nationally, 88,806 (70 percent) received no surgery of the primary site .

Among the 42 percent (115 cases) with the localized disease defined as stage I or II, a random 10-percent sample was abstracted to identify those who received some form of surgery . Fifteen cases were randomly selected, and about half of the cases received surgery. Sixty-five percent of stages I and II lung cancer patients received surgery nationally .

Stages I and II (localized disease) St. John (115) 10% sample National NCDB (44,031) Surgery 50% 7 65% 29,049 No surgery 50% 8 35% 14,982

Our demographic data mirrors national data, but the number of persons who present with advanced disease is slightly higher, with nearly 60 percent of our cases stage III or greater at diagnosis compared to 40 percent nationally . It appears that fewer patients nationally are receiving surgery as the first course of treatment. If reviewed by early stage alone, however, there is still a greater percentage of patients (65 percent) receiving surgery as the first course of treatment.

Patients who present to St . John with early-stage disease received surgery in 50 percent of cases, which is lower than the national data . When surgery was not performed, the majority of reasons identified were linked to co-morbidities, particularly COPD, making patients less optimal candidates for surgery . Thus, radiation such as stereotactic radiosurgery was performed .

In summary, although lung cancer is a challenging disease, our institution is following guidelines by offering surgery as a first choice for early-stage patients. When not eligible for surgery, patients are offered radiation as a chance to aggressively treat it . National efforts in early detection are under way to identify a greater number of persons with early-stage disease . We are actively engaging in discussions to provide screening for patients at high risk for lung cancer to provide effective treatment sooner for patients in need .

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and Memorial Drive in Tulsa, as well as CANCER CONFERENCE St . John Sapulpa, St . John Owasso and The goal of the St . John Cancer Conference St . John Broken Arrow . Statistics on the is to improve the care of the community’s number of cancers found are documented cancer patients through the exchange of and may be obtained from the Breast information . The weekly conference is open Center . to all physicians, residents, medical students and nursing personnel . The third Wednesday CANCER PROGRAMS of every month is dedicated to breast cases .

There were 51 conferences for 2012 . A total Diagnostic of 215 cases were presented for prospective Radiology. State-of-the-art equipment treatment . and computers enable a highly trained staff to offer screening and diagnostic BREAST CENTER procedures for all types of cancer . Digital radiographic evaluation, nuclear medicine, The St. John Breast Center was the first mammography, CT, MRI, ultrasound, fully digital, comprehensive breast center interventional radiology and PET are in northeastern Oklahoma and provides available . state-of-the-art digital mammography services, minimally invasive biopsies, breast Pathology. The pathology department provides ultrasounds, breast MRIs, free breast self- a complete range of rapid, reliable, state-of- examination training, educational materials the-art testing services to diagnose cancer, and help with access to medical specialists determine prognostic factors and monitor the for consultative services . St . John Breast results of treatment . The department has Center at St . John Medical Center is 22 board-certified pathologists and a Ph.D. the only breast center in northeastern immunologist experienced in the diagnosis Oklahoma designated a Breast Imaging of all forms of cancer, with specific areas Center of Excellence by the American of interest and expertise in the diagnosis College of Radiology and is ACR-accredited . of cancer of the breast, skin, lymph nodes, Mammography services are offered at St . hematopoietic system, GI tract, GU tract John Outpatient Radiology at 81st Street and lungs . Physicians maintain subspecialty board certifications and/or special training in breast pathology, hematopathology, cytopathology, medical microbiology, dermatopathology, chemical pathology, medical immunology, molecular pathology and toxicology . In addition, there is expertise in fine needle aspiration and bone marrow biopsy and aspiration . Pathology consultations are available 24/7 . Treatment Modalities Medical Oncology. Medical oncology is a subspecialty of internal medicine in which physicians receive special training in the diagnosis and treatment of cancer . At St . John Medical Center, treatment may be given in the outpatient facilities of the LaFortune Cancer Center, at St . John’s

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Outpatient Hematology Services or at a Clinical Research Department. The St . John designated inpatient oncology unit . In all Health System Institutional Review Board locations, certified oncology nurses deliver meets monthly to review clinical research cancer therapy with great attention to patient trials . The IRB incorporates active and comfort and education . passionate members comprised of facility members, physicians, nurses and community Radiation Oncology. Indications for the use of members . Dr . Coty Ho serves on the IRB to radiation therapy in the treatment of disease support expert evaluation of oncology studies processes continue to expand, both as a single submitted for IRB review . The foundation modality or in a combined format . Methods of of the IRB is guided by the core values treatment include conventional external beam of service, presence, human dignity and radiation therapy, IMRT, superficial radiation wisdom, with commitment to the mission therapy, CyberKnife robotic radiosurgery, of service and day-to-day interactions with brachytherapy, TomoTherapy and radiolabeled those who serve and are served . monoclonal antibodies. Two board-certified radiation oncologists provide direction St . John has centralized research resources and oversight of these complex treatment by creating the clinical research department processes . to coordinate and conduct clinical trials by providing investigators with an efficient Respiratory Therapy . Sputum inductions infrastructure, committed research staff and for cytology are obtained . A variety of operational expertise to attain, perform and pulmonary function studies, including manage trials . Clinical Research has full- spirometry and diffusion capacity, are used time nurse coordinators and research nurses to evaluate patients . Treatment includes with 100 percent of their time dedicated to such modalities as supplemental oxygen, clinical trials . The Clinical Research Center humidity therapy and hand-held nebulization clinical staff is specifically trained to perform of bronchodilators . Incentive spirometry and research procedures and collect data as chest physiotherapy are used for treatment of mandated by study protocol and federal, state retained secretions, pneumonia, atelectasis and local regulations and guidelines . Clinical and pleural effusion . Research and the LaFortune Cancer Center have a designated oncology pharmacist, Matt Taliaferro, PharmD . Taliaferro has SUPPORT PROGRAMS completed human subject protection and CITI training and is registered through CTSU Cancer Registry. The Cancer Registry as the investigational pharmacist for the monitors all types of cancers diagnosed and/ Cancer Center . Clinical research physicians, or treated at St . John . More than 40,000 nurse coordinators and nurses are registered cases have been registered since the reference through CTSU and complete human subject date 1967, making St . John’s registry the protection and CITI training on an annual oldest approved program in Oklahoma . The basis . registry uses Rocky Mountain Cancer Data Systems, a software program containing all The Cancer Center participates in clinical data points required by the American College research trials by the National Institutes of Surgeons and Surveillance, Epidemiology of Health’s National Cancer Institute by and End Results (SEER) program . Three full- enrolling participants in clinical trials time cancer registrars (abstractors) and one through the Cancer Trials Support Unit . full-time follow-up secretary are responsible Active and long-term follow-up clinical for collecting and maintaining complete trials at the Cancer Center include Eastern and accurate data for all cancer patients Cooperative Oncology Group (ECOG), registered at St . John . Nearly 14,000 patients National Surgical Adjuvant Breast and Bowel are followed yearly . Project (NSABP), North Central Cancer

14 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

Treatment Group (NCCTG), Cancer and Leukemia Group B (CALGB) and Radiation Therapy Oncology Group (RTOG), affording access via the Main Cooperative Groups through the Cancer Trials Support Unit affiliation. The Cancer Center also provides active referrals for participants to clinical trials through the MD Anderson Clinical Research Network, Mayo Clinic and Baylor Medical Center .

St . John and the Cancer Center afford multiple institutional resources to conduct high-quality multidisciplinary cancer control, prevention and treatment trials throughout our comprehensive cancer center for our oncology patients . The Cancer Center’s robust network allows our oncology patients to stay Hospice. St . John Hospice, one of the oldest home and maintain active lifestyles supported hospices in Tulsa, provides expert, loving by their family, friends and community . care to people with a limited life expectancy . Engagement in clinical trials provides our The patient, family members and physicians oncology patients access to potential advanced work together with the St . John Hospice treatment options . The Alliance network would interdisciplinary team to establish a plan provide an immeasurable multidisciplinary for care that enhances the patient’s quality clinical trial support system to our oncology of life . The hospice team of professionals and patients if membership is granted to the volunteers support that plan by responding Cancer Center. We are hopeful you will find to the unique needs of the terminally ill and our comprehensive Cancer Center committed their families . and dedicated to excellence to support the work needed to implement and improve oncology Nutritional Counseling. A clinical dietitian patients’ lives through clinical trials . assists oncology patients in making the correct dietary choices . Nutrition screenings Enterostomal Therapy. An enterostomal by dietitians help manage optimal nutrition . therapy (ET) nurse provides services for people who have undergone surgery or who Pastoral Care. The St . John Medical Center are anticipating surgery resulting in an pastoral care department provides chaplain ostomy . The ET nurse also assists inpatients services that are consistent with Ascension who have problems with surgical drains, Health’s goal of providing spiritual care that fistulae or draining wounds. Outpatients are supports holistic care and healing . To that seen depending on the inpatient census of the end, chaplains (priests, sisters and ministers), ET nurse; however, phone consults with the pastoral care volunteer visitors and nursing patient or the patient's home health nurse are spiritual support team members are available always available . to meet the spiritual/emotional needs of patients, families and associates . Patients’ Home Health Care. Home Health Care at St . ministers, rabbis and spiritual counselors John Medical Center provides health services are recognized as integral partners with the to promote, maintain and restore health chaplains in providing spiritual care to a to individuals and families in their homes . diverse patient population . Home Health Care can also increase the level of patient independence while reducing the Pharmacy. The pharmacy department offers effects of disability and illness . a wide range of services to support the

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cancer program . These include providing Resource Center. The LaFortune Cancer and maintaining current information Resource Center provides comprehensive on chemotherapeutic and related drug educational material for patients and families . products; storage, preparation and The center offers free information from the dispensing of these products; storage and National Cancer Institute, American Cancer distribution of investigational chemotherapy Society and Leukemia Society of America, as drugs; and chemotherapy order verification. well as other sources . Also available at the The pharmacist plays a key role on the center are new wigs, hats and turbans for team in managing the treatment of cancer loan to chemotherapy patients . patients . Supportive Services. The LaFortune Cancer Great American Smokeout. The Great Center’s Supportive Services social worker American Smokeout is a program of the meets with patients and families to help American Cancer Society in which supportive evaluate needs and lend assistance when services and the St . John Siegfried Health necessary. The five most frequently identified Club participate every year . areas of need are financial counseling, transportation, family relations, medications Healthy Lifestyles . The Healthy Lifestyles and lodging . Free educational and support programs at St . John were designed to help programs are available to adult cancer individuals achieve their optimal level of patients and their families and friends . health . A dedicated team of physicians, nurses, dietitians, exercise physiologists and Reach to Recovery. The American Cancer clinical psychologists provide the congenial Society provides the program for mastectomy atmosphere needed for changing unhealthy patients . lifestyle habits into healthy ones . Weight Look Good Feel Better. A trained cosmetologist control and smoking cessation programs are provides skin care advice, as well as tips offered . for wearing wigs and scarves, on a monthly Rehabilitation Services. St . John basis . The program is co-sponsored by the Rehabilitation Services, accredited by The LaFortune Cancer Center, American Cancer Joint Commission, offers the most complete Society, National Cosmetology Association line of rehabilitation programs available and CTFA Foundation . in northeastern Oklahoma . Inpatient US TOO. The educational support group with rehabilitation provides services including a survivor-steering committee is led by a physiatry, physical therapy, occupational licensed clinical social worker . The meeting therapy, rehabilitation nursing, rehabilitation is typically attended by prostate cancer social work, speech-language pathology and survivors and their spouses and guests . therapeutic recreation . Myeloma Support Group. The Myeloma Outpatient rehabilitation provides physical, Support Group is co-sponsored by the occupational and speech therapy services Leukemia & Lymphoma Society for anyone to a varied caseload, including oncology affected by myeloma . patients . Outpatient rehabilitation currently has three physical therapists certified in Celebrating the Art of Healing. This annual manual lymphatic drainage and complete community event, sponsored by the Leukemia decongestive therapy for patients with & Lymphoma Society, Monte Cassino, Saint lymphedema . Currently, 25 to 30 new Francis Hospice, Grace Hospice and St . patients are admitted per month for pre/ John Medical Center, includes professional post-breast cancer surgery, lymphedema speakers and breakout sessions to provide prevention training and lymphedema local cancer survivors with a day of learning, management . healing and fun .

16 LAFORTUNE CANCER CENTER AT ST. JOHN 2012 ANNUAL REPORT

Holiday Heart and Hope. A yearly celebration for patients, families and caregivers, Holiday Heart and Hope is a day of fun, hope and therapeutic connections . Participants receive free chair massages, manicures, pictures with Santa Claus and lunch . The activities afford survivors the opportunity to celebrate and make important therapeutic connections with other survivors .

St. John Mini Relay for Life. The Mini Relay for Life is co-sponsored by the American Cancer Society and St . John Medical Center . More than 45 survivors and their families participated in the first annual event. A The staff of the Cancer Registry extends reception took place in honor of survivors, its sincere appreciation for the support of allowing each to share his or her story with the Cancer Committee, Medical Records, others . The event raised more than $10,000 Pathology, Radiology and the St. John for the American Cancer Society and honored medical staff for its cooperation and the Cancer Center’s survivors . assistance. Susan G. Komen Race for the Cure. Every year St . John sponsors a breast cancer survivor team, paying for every survivor’s registration, at the yearly fundraiser for the Komen foundation . In 2012, more than 145 participated on the St . John Survivor Team .

The ACS Day. The ACS Day is a collaborative effort between the American Cancer Society and LaFortune Cancer Center . Every month, an ACS patient services manager is on site to visit with patients regarding ACS services and resources, including disseminating personal health managers to every patient .

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