1. Texas Health Harris Methodist Hospital HEB Cancer Report
Cancer Care in Our Community

2. From the Chair
At Texas Health Harris
Methodist Hospital HEB, we
are committed to improving
the care of cancer patients in
the communities we serve.
Cancer Care in Our Community
A brief personal introduction is warranted since I just recently began serving as
chairman for the Texas Health HEB Cancer Committee in August 2015. I was born
in Denmark, raised in Sweden and came to the United States in 2002. Medical
school was completed at Karolinska Institute in Stockholm and residency and
subspecialty training in Hematology and Oncology was pursued at LSUHSC in
Shreveport LA. North Texas has been my home since 2008. I previously served as
Assistant Professor of Hematology/Oncology at the Dallas VA Medical Center and
The University of Texas Southwestern Medical Center at Dallas prior to joining Texas
Oncology HEB. While at the Dallas VA Medical Center I functioned as the cancer
liaison physician for a year prior to being appointed Cancer Committee Chairman
from 2010 until 2014.
The theme of this year’s report is “Cancer Care in the Community.” A vast majority
of patients diagnosed with cancer prefer to have their treatment and follow up
care close to where they live or work. This demand poses a number of significant
challenges to the medical community given the multifaceted nature of cancer, with
technically challenging management often integrating multiple different specialties
and ever increasing advances in research.
Close efficient collaboration between different subspecialty physicians, nursing
care, inpatient hospital care and clinic-based treatment is essential for successful
patient outcomes. I joined Texas Oncology in August of 2014, a few months prior to
the opening of our new Cancer Center, a comprehensive facility built in partnership
between Texas Oncology and Texas Health HEB. It has been my personal pleasure
to be able to experience first-hand the transition to this new cancer treatment
environment. Having worked as a physician in a variety of different settings on two
continents I am proud to be part of the cancer treatment team here at HEB. I believe
that the HEB community’s needs for easy access, high quality comprehensive
cancer care are currently being well met and it is my personal goal to make sure that
it remains so in the years to come. The ongoing work and data collection efforts of
the Texas Health cancer registrars and the Cancer Committee is integral to ensuring
that outstanding quality cancer care is being continuously provided and I would like
to extend a big “Thank You” to all the key persons involved.
Sincerely,
Henrik Illum, MD

3. Cancer Committee
The Cancer Committee at Texas Health HEB is a multidisciplinary
committee responsible for planning and initiating all cancer-
related programs and services. The committee has been working
diligently on creating standing orders for EGFR/ALK testing
for lung patients, creating a Women’s Health Day event that
includes Well-Woman exams and mammography, improving
chemotherapy orders, and discussing the benefits of a Palliative
Care Program. Alternates have been appointed to meet the
attendance requirement for accreditation. The Committee meets
bi-monthly.
Each year, the Cancer Committee performs studies to determine
if patients within our program are evaluated and treated
according to evidence-based national treatment guidelines and
to measure the quality of care and outcomes for our cancer
patients. In 2015 (using 2014 data) the Cancer Committee chose
to look at: the percentage of breast cancer patients receiving
and completing planned chemotherapy, lung cancer patients
diagnosed via the emergency department, patients with an early
age at diagnosis, breast patients requiring a mastectomy after
breast conserving surgery due to extent of disease, and patients
with 3 or more multiple primaries diagnosed and/or receiving 1st
course treatment in our facility.
2015 Cancer Committee Membership
Henrik Illum, M.D.
Medical Oncology, Cancer Committee Chair
Ajay Dubey, M.D.
Radiation Oncology – Past Chair
Mark Messing, M.D.
Gynecologic Oncology, Cancer Liaison Physician
Janice Tomberlin, M.D.
Radiation Oncology, Cancer Registry Quality Coordinator
Randall Davis, M.D.
Medical Oncology; Alternate: Thomas Anderson, M.D.
Ted Powell, M.D.
Pathology; Alternate: Horace Wu, M.D.
Robert McKenzie, M.D.
Colorectal Surgery
Eric Davis, M.D.
Radiology; Alternate: Lance Driskill, M.D.
Thomas Lyles, M.D.
Gastroenterology; Alternate: Jay Yepuri, M.D.
Alice Landers
Vice President, Professional and Support Services, THHEB
Mildred Jordan
Certified Tumor Registrar, Cancer Conference Coordinator
Kimberly Willis
Certified Tumor Registrar, Studies
Tammy Quattrochi, RN, OCN
Oncology Nurse Manager
Paige Jumper, RN
Quality Improvement Coordinator
Sandy Mathews, RN
Clinical Research Coordinator; Alternate: Angela Trommer, RN
Stephen Whisman, LCSW
Psychosocial Services Coordinator
David Damaske, Pharm D
Pharmacy; Alternate: Michelle Henke, Pharm D
Rick McMinn, B.C.C., Psy.D.
Pastoral Care
Siohban Cole
American Cancer Society
Adam Davis-Jarrett
Practice Administrator, Texas Oncology
Brenda Whitley
Community Outreach Coordinator
Tim Kotera
Physical Medicine and Rehabilitation
Mike Lofland
Fitness Center; Alternate: Ryan Karnes
Tracy Scimeca, R.D., L.D.
Nutrition
Cancer Liaison Physician’s Report
The Cancer Committee at Texas Health HEB continuously
monitors standards for compliance with Commission on Cancer
(CoC) required measures. Current measures include: Breast,
Lung, Colon, and Rectum.
RQRS – The Rapid Quality Reporting System (RQRS) is a quality
improvement tool that provides ‘real clinical time assessment’
of hospital level adherence to National Quality Forum endorsed
quality of cancer care measures. This web-based systematic
data reporting system advances evidence-based treatment
through a prospective alert system for anticipated care and
supports the care coordination required for Breast, Colon, and
Rectum cancers treated in our facility.
NCDB –The nationally recognized National Cancer Data Base
(NCDB)—jointly sponsored by the American College of Surgeons
and the American Cancer Society—is a clinical oncology
database sourced from hospital registry data that are collected
in more than 1,500 Commission on Cancer (CoC)-accredited
facilities. NCDB data are used to analyze and track patients with
malignant neoplastic diseases, their treatments, and outcomes.
Data represent approximately 70 percent of newly diagnosed
cancer cases nationwide and 30 million historical records.
Below you will find a detailed summary of our Cancer Program's
compliance with the CoC measures.
TexasHealth.org/HEB Page 4Page 3 Texas Health HEB Cancer Program
Comprehensive Cancer Care
Texas Health HEB offers advanced cancer care to patients
diagnosed and or treated for cancer on our campus.
Currently, a new Interventional Radiology Suite is under
construction and slated to open in 2016. A full scope
of surgical services is also available, including Robotic
Surgery. The Oncology Care Unit at Texas Health HEB is
a 19-bed unit staffed by highly trained nurses. Two Nurse
Navigators guide patients through the many facets of care
— one in the inpatient setting and the other housed at the
Texas Oncology Cancer Center assisting patients through
treatment and Survivorship. A Survivorship Program is in
place through Texas Oncology. Mammography Services
are provided through a written agreement with Solis
Women’s Health. In December 2014, our new Cancer
Center opened its doors providing Medical and Radiation
Oncology services to our patients. The Breast Center
is also located within this facility. We received a 3 year
accreditation for our Breast Center in September 2014.
Measure National or Recommended
CoC Compliance Rate
THHEB
2013
THHEB
2014
Breast
Radiation therapy is administered within 1 year (365 days) of diagnosis for women under
age 70 receiving breast conserving surgery for breast cancer.
90% 100% 77%*
Combination chemotherapy is considered or administered within 4 months (120 days) of
diagnosis for women under 70 with AJCC T1cN0M0, or stage IB - III hormone receptor
negative breast cancer.
90% 80% 100%
Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year
(365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB - III hormone receptor
positive breast cancer.
90% 100% 96%
Radiation therapy is considered or administered following any mastectomy within 1 year
(365 days) of diagnosis of breast cancer for women with ≥ 4 positive regional lymph nodes
90% 100% 100%
Image or palpation-guided needle biopsy (core or FNA) to the primary site is performed to
establish diagnosis of breast cancer
90% 100% 100%
Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer.
Not
Determined
79% 79%
Colon
Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis
for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.
90% 100% 50%
At least 12 regional lymph nodes are removed and pathologically examined for resected
colon cancer.
85% 97% 95%
Rectum
Preoperative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage
III; or Postoperative chemo and radiation are administered within 180 days of diagnosis
for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is
considered; for patients under the age of 80 receiving resection for rectal cancer.
Not
Determined
No
Data
100%
In 2015, the CoC has added 11 new measures;
• Cervix (3)
• Endometrium (2)
• Gastric (1)
• Non-Small Cell Lung (3)
• Ovary (2)
Plans are underway to insure compliance with these new
measures by holding educational activities in partnership with
our physicians.
The Commission on Cancer launched a Special Study in April
2015. This study was designed to investigate follow-up and
recurrence after cancer treatment in hopes of tailoring follow-
up based on individual risk for breast, lung and colorectal cancer
patients. It involves analyzing data from the National Cancer Data
Base (NCDB) to determine the most effective surveillance patterns
for these cancers. It is funded by 3 research funding contracts
through the Patient Center Outcomes Research Institute (PCORI).
Study data submission is required for all Commission on Cancer
approved programs. Texas Health HEB participated and submitted
their data within the required time frame.
Mark Messing, M.D., Gynecologic Oncology
Texas Health Harris Methodist Hospital HEB
Service Area Reports
*Patients are still within the time frame to receive treatment.

4. Cancer Registry
The Cancer Registry at Texas Health HEB is staffed by two
Certified Tumor Registrars (CTR) and one Non-CTR staff member
who reports non-diagnostic cases. Cancer registrars are data
information specialists that document the history, diagnosis,
treatment, and disease status for every cancer patient in the
United States. This information is used for patient research and
monitoring at our facility, by other healthcare providers and
public health officials at the state, national and international
level to monitor the effectiveness of cancer treatments, conduct
research, improve cancer treatments, and for the development
of prevention and screening programs. Data is submitted to the
Texas Cancer Registry, Rapid Quality Reporting System, and the
National Cancer Data Base. Our CTRs participate in many annual
activities at the local, state and national level as active members
of the Texas Tumor Registrars Association and the National
Cancer Registrars Association (NCRA), including attending this
year’s NCRA annual conference.
In May, Texas was proud to host NCRA 41st Annual Educational
Conference in San Antonio, Texas, and one of THHEB’s CTRs,
Kimberly Willis, co-chaired this event. This program provided
cancer data professionals and researchers with education
from internationally recognized standard setters including The
Surveillance, Epidemiology, and End Results (SEER) Program of
the National Cancer Institute, The Commission on Cancer and
the National Accreditation Program for Breast Centers (NAPBC).
We are also honored that one of our pathologists, Dr. Horace Wu,
was a speaker at this event.
The Cancer Registry was honored with the Texas Health HEB
Quality Cup award for 2014. This award recognizes departments
that are high performers in quality improvement. The Registry
was recognized for programs implemented or monitored in the
cancer program to increase managing physician Clinical Staging
and Guidelines Documentation Compliance; maintaining a rate
of 8% for Chemotherapy Complications compared to a national
rate of 40% to 50%; and maintaining a rate of 100% for patients
with ductal carcinoma in situ (DCIS) who undergo mastectomy
and also have a sentinel lymph node biopsy as compared to the
national guideline of 80%.
Texas Health Harris Methodist Hospital HEB
TexasHealth.org/HEB Page 6Page 5 Texas Health HEB Cancer Program
Service Area Reports
Site Texas Health HEB Texas United States
Female Breast 143 – 21% 16,080 – 14% 235,030 – 14%
Lung 115 – 16.8% 14,890 – 13% 224,210 – 14%
Colon/Rectum 56 – 8.2% 9,760 – 8% 136,830 – 8%
Corpus Uteri 63 – 9.2% 3,130 – 3% 52,630 – 3%
Non-Hodgkin's Lymphoma 31 – 4.6% 5,030 – 4% 70,800 – 4%
Cancer Conferences
Cancer Conference is held at Texas Health HEB every Wednesday
from 7:30 to 8:30 a.m. A multidisciplinary group of physicians
from Radiology, Pathology, Surgery, Radiation Oncology, and
Medical Oncology discuss diagnostic and treatment options
for cases that are interesting or difficult to diagnose. Clinical
stage, prognostic indicators, evidence-based guidelines used
in treatment planning, options for clinical trials, palliative care
(when applicable), psychosocial care, and genetic counseling are
some of the topics discussed when presenting prospective cases.
Breast Conferences are held every other Thursday at the
Breast Center.
Through November 2015, 38 Cancer Conferences and 20 Breast
Conferences have been held. A total of 211 cases have been
presented which is 30% of newly diagnosed cancer cases.
Clinical Trials
Clinical trials are research studies that involve people. They are
the final step in a long process that begins with research in a lab.
Most treatments we use today are the results of past
clinical trials.
Cancer clinical trials are designed to test new ways to:
• Treat cancer
• Find and diagnose cancer
• Prevent cancer
• Manage symptoms of cancer or side effects from its treatment
Currently, through October, 21 patients diagnosed and or treated
for cancer at Texas Health HEB were enrolled in a clinical trial.
Data Analysis
The Cancer Registry accessioned a total of 1,137 cases in 2014.
Of those, 682 were analytic, diagnosed and had all or part of
their first course of treatment at Texas Health HEB. Below you
will find a table with the top five major sites comparing our cases
to those of Texas and the United States.
2014 Statistical Review of the Top 5 Five Major Sites
*US & Texas –American Cancer Society Cancer Facts and Figures 2014
Analytic: First diagnosed and/or all or part of first course therapy at Texas Health HEB
Non-analytic: First diagnosed and all first course therapy received prior to admission at Texas Health HEB
*Tabulations for Stage Distribution include class of case 10-22 only
Texas Health H-E-B Primary Site Table 2014
CLASS OF CASE GENDER STAGE (Analytic Cases) VITAL STATUS
Diagnostic Site Total %Total Ana Non A Male Female 0 I II III IV N/A Unk Alive Dead
Breast Female 250 21.99 143 107 0 250 33 54 45 5 4 0 2 242 8
Lung 161 14.16 117 44 80 81 0 23 14 29 47 1 3 108 53
Corpus Uteri 69 6.07 64 5 0 69 0 34 5 14 7 0 4 64 5
Non-Hodgkins Lymphoma 63 5.54 31 32 29 34 0 9 4 1 13 0 4 54 9
Colon 59 5.19 41 18 32 27 1 5 9 14 10 0 2 46 13
Prostate 55 4.84 13 42 55 0 0 2 4 0 5 0 2 52 3
Pancreas 46 4.05 35 11 25 21 0 7 6 5 15 0 2 27 19
Other Hematopoietic 39 3.43 15 24 22 17 0 0 0 0 0 15 0 34 5
Lip Oral Cavity Pharynx 28 2.46 15 13 22 6 0 1 1 3 5 0 5 28 0
Thyroid 28 2.46 22 6 9 19 0 11 5 1 2 0 3 27 1
Multiple Myeloma 27 2.37 10 17 16 11 0 0 0 0 0 10 0 19 8
Lymphoid Leukemia 25 2.20 5 20 17 8 0 1 0 0 0 4 0 24 1
Ovary 24 2.11 16 8 0 24 0 4 0 6 6 0 0 22 2
Myeloid and
Monocytic Leukemia
22 1.93 15 7 14 8 0 0 0 0 0 15 0 15 7
Kidney 22 1.93 14 8 16 6 0 6 1 2 4 0 1 18 4
Rectum 21 1.85 15 6 11 10 0 2 4 3 4 0 2 19 2
Liver 19 1.67 4 15 15 4 0 1 0 0 2 0 1 13 6
Urinary Bladder 18 1.58 10 8 15 3 3 2 3 0 1 0 1 14 4
Benign Brain and CNS 17 1.50 12 5 3 14 0 0 0 0 0 12 0 17 0
Cervix 16 1.41 10 6 0 16 0 5 3 1 0 0 1 16 0
Stomach 16 1.41 9 7 11 5 1 1 1 4 2 0 0 12 4
Other Digestive Organ 15 1.32 12 3 9 6 0 0 1 0 5 6 0 8 7
Esophagus 12 1.06 8 4 9 3 0 2 1 1 3 0 1 8 4
Soft Tissue 11 0.97 7 4 1 10 0 2 1 1 3 0 0 10 1
Leukemia other 9 0.79 0 9 5 4 0 0 0 0 0 0 0 9 0
Unknown Sites 7 0.62 4 3 6 1 0 0 0 0 0 4 0 3 4
Ill-Defined Sites 6 0.53 6 0 5 1 0 0 0 0 0 6 0 6 0
Other Male Genital 6 0.53 4 2 6 0 0 2 1 0 0 1 0 5 1
Other Female Genital 6 0.53 5 1 0 6 3 1 0 1 0 0 0 5 1
Melanoma skin 6 0.53 3 3 4 2 0 0 0 0 2 0 1 4 2
Larynx 6 0.53 4 2 5 1 0 1 1 0 2 0 0 5 1
Other Skin 5 0.44 2 3 5 0 0 0 1 1 0 0 0 5 0
Brain & Nervous System 5 0.44 3 2 3 2 0 0 0 0 0 3 0 1 4
Hodgkin's Lymphoma 4 0.35 2 2 2 2 0 2 0 0 0 0 0 4 0
Anus 3 0.26 0 3 1 2 0 0 0 0 0 0 0 2 1
Small Intestine 3 0.26 1 2 3 0 0 0 0 0 1 0 0 2 1
Other Respiratory 2 0.18 2 0 0 2 0 1 0 0 1 0 0 1 1
Bones and Joints 2 0.18 2 0 0 2 0 1 0 0 1 0 0 1 1
Kaposis sarcoma 2 0.18 0 2 2 0 0 0 0 0 0 0 0 1 1
Other Urinary 2 0.18 1 1 0 2 0 0 1 0 0 0 0 2 0
Eye and Orbit 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 0
Other Endocrine System 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 0
Breast Male 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 0
Mycosis Fungoides 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 0
Other 0 0.00 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTALS 1137 100.00 682 455 458 679 41 180 112 92 145 77 35 953 184
Below is a summary of cancer occurrence by site and sex. Total number of cases diagnosed was 682, this only includes analytic cases, those
that were diagnosed and had all or part of their first course of treatment at Texas Health HEB.

5. EVENT DATE DESCRIPTION # OF PARTICIPANTS
Sun Safety 3-20-2015
Partnering with the American Cancer Society, the Registrars, Texas
Oncology, and THHEB staff dispensed ACS materials, sunscreen, sun
glasses, and hats to promote sun safety.
100
Women’s
Health Day
9-11-2015
Women’s Health Day was held 9/11/2015. Texas Oncology, Solis
Mammography, physicians from MacArthur OB/GYN and multiple
departments from Texas Health HEB promoted Sun Safety, Fitness, Breast
Health, CPR, AED, Nutrition and Smoking Cessation. Mobile Units offered
Screening Mammograms and Well-Woman exams.
41
Screening
Mammograms
21 – 3 call backs for additional films
Well Woman
Exams
10 – all results were negative
Patients should not have to travel great distances to receive quality cancer care. Texas Health HEB’s
Commission on Cancer (CoC) approved program is committed to providing quality cancer care in
accordance with evidence-based treatment guidelines in a community-based setting. Texas Health HEB
has received CoC accreditation with commendation since 2010. With the collaboration and support of
Texas Oncology, we are able to provide a complete scope of services to our patients on our campus.
American Cancer Society
In a continued partnership, Texas Health HEB and the American
Cancer Society is able to offer cancer patients and caregivers
compassion, support, and tools that can help them manage the
journey through their cancer experience. The American Cancer
Society resource center located in the Oncology Care Unit at
Texas Health HEB utilizes volunteers who connect patients to
American Cancer Society programs, as well as a range of local
and national services. Texas Health HEB and the American
Cancer Society have agreed upon patient materials that meet
the patient at the point of diagnosis so that patients are provided
with the tools needed to feel empowered and educated. In
addition to educational services, Texas Health HEB works with
each individual and provides access to supportive services that
meet each patient’s psychosocial need.
Bluebonnet Retreat
Bluebonnet Retreat, a free of charge camp exclusive to Texas
Health HEB, offers a unique experience for adult cancer patients.
During the three-day, two-night camp, attendees are provided
a creative, educational atmosphere of support with a focus
on wellness.
Clinical Educational Activity
Each year, an educational activity is offered to physicians and
allied health staff that focuses on the use of AJCC or other
appropriate staging in clinical practice. It also includes the
use of appropriate prognostic indicators and evidence-based
national guidelines used in treatment planning. On February 11,
2015 Esophageal Cancer- Staging and Use of NCCN Guidelines
in Treatment Planning was held. Four physicians and 3 non-
physicians were in attendance.
Community Outreach
Sun Safety, Women’s Health Day
Genetic Counseling
Genetic counseling is provided through our Texas Oncology physicians’ offices.
Fitness Center
The NEAT program (Nutrition Exercise and Attitudes for Tomorrow) began in May of
2000 and has served approximately 250 ladies over the years. It started as a small group
with the goal of helping patients recover from cancer treatment by reducing nausea and
fatigue with proper nutrition and exercise.
NEAT has helped patients develop supportive relationships over the years. It has
progressed from being a program for cancer patients going through treatment to a
support group for cancer survivors. This group enjoys picnics, Christmas parties, and
fun events to raise funds for cancer-related programs. Over 80 women are now on the
email list, with 50 participating in fitness classes regularly.
The new “Basics” class has helped reach new patients as they finish cancer treatment
and need to slowly begin an exercise program. We offer 10 classes a week including
cycle and yoga.
The IMPACT program was started this year to reach patients with any type of cancer.
Texas Oncology refers patients to THHEB for individual help with an exercise program
to meet their specific needs. We look forward to developing this program as a support
group to meet the needs of all cancer patients in this area. Patients meet with a fitness
specialist for an assessment prior to starting the program.
TexasHealth.org/HEB Page 8Page 7 Texas Health HEB Cancer Program
Diagnostic Radiology
A full scope of services is provided
including CT, MRI, Breast MRI, Nuclear
Medicine and Interventional Radiology.
THHEB is building a dedicated
Interventional Radiology (IR) suite in
conjunction with our ICU expansion
project. Interventional Radiologists are
able to perform a number of minimally
invasive, image-guided procedures across
many disciplines. These procedures
are less invasive and more targeted,
minimizing pain, overall risk to the
patient and recovery time. Interventional
Radiology is a diverse specialty that
includes a growing array of advanced
procedures such as tumor ablations and
neurovascular interventions, as well as
core services essential to day-to-day
patient management for hospitals and
health systems.
Endoscopy and Special Procedures
Texas Health HEB Endoscopy and
Special Procedures continue to be at the
forefront of the prevention, diagnosis
and management of gastrointestinal
cancer. Using minimally invasive
endoscopic techniques and the
latest technologies, we offer cutting
edge expertise in the evaluation and
management of esophageal, gastric, liver,
pancreaticobiliary, small intestinal and
colonic malignancies. THHEB offers a
full range of diagnostic and therapeutic
endoscopic procedures including
endoscopic ultrasound (EUS), endoscopic
retrograde cholangiopancreatography
(ERCP), cholangioscopy, pancreatoscopy,
endoscopic mucosal resection (EMR),
radiofrequency ablation (RFA) and
intestinal stenting in addition to routine
upper endoscopy and colonoscopy.
Jay N. Yepuri, M.D., M.S.
Digestive Health Associates of Texas, P.A.
Texas Health Harris Methodist Hospital HEB
Service Area Reports
Any participants needing additional examination were
followed through the Wellness for LifeTM
Program.
A Nurse Navigator was available to assist patients.
Look Good Feel Better
Look Good Feel Better is a non-medical, brand-neutral public service program that
teaches beauty techniques to cancer patients to help them manage the appearance-
related side effects of cancer treatment. Group programs are open to all women with
cancer who are undergoing chemotherapy, radiation or other forms of treatment.
Sessions are held in the Oncology Care Unit at Texas Health HEB. As of late 2015, sessions
will be held in the Community Room at the Cancer Center located on our campus.
Event Date # of Participants
March 31 5
June 23 6
September 22 6
November 17 Cancelled
GE Discovery IGS 740

6. TexasHealth.org/HEB Page 10Page 9 Texas Health HEB Cancer Program
Music Therapy
The THHEB surgical department did a performance
improvement project over a year ago and found that music
helped decrease pain and anxiety in our pre and post op
population, with the study focus on breast surgery patients.
Once data was reviewed, we felt it would be beneficial to all
surgical patients. Our Kindle Fires are loaded with a variety of
music genres. The patient is offered music in the pre-op area
with a Kindle and ear buds. The Kindle is returned, prior to
discharge. The Kindles have been programmed to access only
the music format and they are rendered useless outside of the
building. We have found that very few patients want to take
advantage of the opportunity when offered.
Nutrition Services
Nutritional education and support is provided by licensed
dietitians.
Oncology Care Unit
The Oncology Care Unit (OCU) is staffed by 30 registered
nurses, with 18 eligible for the Oncology Certified Nurse (OCN)
credential. These nurses must have experience in cancer care
and have completed educational programs specific to the care
of cancer patients including the Oncology Nursing Society
Chemotherapy and Biotherapy Course. Of our 18 eligible nurses,
13 are OCN certified, or 72%.
Nurses in the OCU use a Cancer Distress Screening Tool for all
oncology patients. This tool helps assess the emotional health
of our cancer patients and assists nursing staff in identifying
specific care needs and making appropriate referrals to address
these needs.
The Oncology Unit’s performance improvements focus on
Communication and Quietness, important factors in patient
satisfaction and comfort. Quality Improvements in the OCU are
focused around the HCAHPS (Hospital Consumer Assessment
of Healthcare Providers and Systems) survey- the first
national, standardized and publicly reported survey of patients’
perspectives of hospital care. OCU has two Service Excellence
Advisors working on all indicators.
Palliative Care
Plans are underway to establish a palliative care program at
THHEB. Under the direction of Dr. Melissa Johnson, the palliative
care program will provide specialized medical care for people
with serious illnesses. It not only focuses on providing patients
with relief from the symptoms, pain, physical stress, and mental
stress of a serious illness, it also works at preventing the potential
side effects of treatment. Palliative care improves the quality of
life for both the patient and their family and can be given at any
stage of treatment and aftercare. Anyone with a serious illness,
regardless of life expectancy, can receive palliative care.
Outpatient Therapy
Texas Health HEB has a strong therapy program that includes breast cancer recovery. Treatment includes traditional and aquatic therapy
for strengthening, stretching, exercise and pain relief, as well as wound care and lymphedema (swelling in an extremity due to cancer
surgery) programs. Patients undergoing treatment are evaluated and instructed regarding a personalized treatment plan to address their
individual needs. Lymphedema treatment can address wounds, lymphatic flow, axillary web syndrome, pain, and weakness. Wound care
can address healing of surgical wounds, drain sites, or fragile skin from radiation burns. Non-surgical debridement may be provided
within the clinical setting to promote wound closure. Lymphatic flow may be improved through a specific massage/mobilization
technique performed by a Certified Lymphedema Therapist trained to stimulate the lymphatic system. Compression and taping may
also be used in order to stimulate lymphatic flow with the ultimate goal of decreasing edema in the extremity. Axillary web syndrome
is common with breast cancer due to mastectomy and/or radiation in which a “cord” develops in the armpit resulting in decreased
function of an upper extremity. Pain management is done on an individualized basis depending on patient need. People undergoing
cancer treatment are frequently weak and report having no energy to perform daily tasks. A tailored exercise program may include
stretching and gentle resistive exercise, according to patient need, for strengthening and endurance. Exercises can be performed either
on land or in the water which provides further support for joint pain. Patients are educated regarding balancing work and rest in order
to complete necessary daily tasks with success. Each and every patient with a cancer diagnosis will be individually assessed, treated with
dignity and respect, and offered top quality treatment to meet their individual needs.
Pathology & Laboratory
The Pathology Department at Texas Health HEB and our board-
certified pathologists have been recognized by international
standard setters for excellence in the field. Our pathologists
have subspecialty training in surgical pathology, cytopathology,
hematopathology and breast pathology. They have received a
Certificate of Recognition in Multidisciplinary Breast Pathology
awarded by the College of American Pathologists (CAP) and
have been included in the National Accreditation Program
for Breast Centers (NAPBC) Best Practices in Pathology. In
conjunction with Medical Oncology and the Cancer Registry,the
Pathology Department developed a comprehensive molecular
testing protocol in 2014 for our patients diagnosed with cancer
allowing our medical oncologists to create customized plans
for treatment, follow up and monitoring of disease progression
or remission. Our surgical pathology reports utilize synoptic
formatting and contain documentation in compliance with
the College of American Pathologists and the American Joint
Commission on Cancer (AJCC) Seventh Edition Staging Manual.
The medical laboratory at Texas Health HEB is one of only 30
laboratories worldwide, one of two in Texas and the only one in
Tarrant County to achieve the CAP International Organization for
Standardization (ISO) 15189. The program optimizes processes
to improve patient care and strengthens quality standards while
reducing institutional errors and risks, and controls costs. Texas
Health HEB’s laboratory performed more than 770,000 clinical
laboratory tests in 2014.
Patient Navigation
Patient navigation services begin at the time of diagnosis and
are designed to provide a secure foundation of care for the
patient. Beginning with diagnosis, the nurse navigator meets with
the patient and their family to begin building a relationship of
trust, encouragement and support. The navigator assesses the
patient for any barriers to care and uses hospital and community
resources to reduce or eliminate issues that may interfere with a
patient’s treatment and recovery. On-going support is provided
through education and teaching regarding diagnosis, diagnostic
tests, therapies and possible side effects and the emotional effect
of cancer on the patient and the family. To aid in organizing
treatment paperwork, the patient is provided with an American
Cancer Society Personal Health Manager portfolio which also
includes information on clinical trials within the cancer research
community.
In addition to the initial navigation services provided while
the patient is in the hospital, outpatient follow up begins after
discharge. Patients are contacted to discuss the results of
physician follow up appointments and answer any questions
they may have. On-going support includes contacting patients at
intervals prior to therapy, during therapy and upon completion to
manage any side effects they may experience. Emotional support
is provided for the duration of service which is determined by
type of cancer.
Texas Health Harris Methodist Hospital HEB
Service Area Reports
Pastoral Care
Pastoral care and spiritual comfort are available at Texas Health 24 hours a day, every day of the year. Chaplains make daily visits to
patient areas to assess and meet patient and family needs. Support is offered through active listening, crisis response & intervention,
prayer, sacraments, and many other ways of assuring our patients’ well-being. Our chaplain staff responds to all codes, deaths, and
crises. When a chaplain is needed, the hospital operator will make contact and one will come immediately.

7. Performance Improvement
The Performance Improvement, Patient Safety and Risk (PIPSR)
department consists of registered nurses, clinical analysts and
administrative assistants who work closely with the hospital and
physicians on the medical staff to assist in providing the highest
quality care to patients.
PIPSR is committed to actively improving safety in a number
of ways:
• Infection Prevention manages issues ranging from the hand
hygiene of health care providers to isolation of patients with
possible infectious diseases to construction issues affecting
patient safety.
• Risk Management investigates issues relating to patient safety
within the hospital.
• Performance Improvement collects and coordinates data to
assist medical staff and hospital administrators as they track
specific patient safety concerns.
PIPSR is also proactive, offering educational opportunities and
communications to hospital staff.
Performance Improvement projects are implemented on the
Oncology Care Unit with commitment to provide high-quality
cancer care.
Pet Therapy
Molly, Max, Duke & Duchess, our four-legged, tail-wagging
friends from Pet Partners, uplift the spirits of patients and staff
during their weekly visits to the Oncology Care Unit. Each
Thursday, one of the four dogs and his or her owner interact
with patients, promoting a positive emotional, physical and
psychological experience. The program is coordinated through
Volunteer Services and each handler receives and wears an
identification badge and their pets have
a collar tag as well. Pet Partners trains,
screens and evaluates pets as well
as their handlers to assure they are
well-prepared to participate in our
animal-assisted therapy program.
Animal-assisted therapy can decrease
heart rate and blood pressure and provides
patients with an outward focus, mental
stimulation, entertainment, socialization
and a feeling of acceptance and
good rapport.
(right) Pet Partners "Molly"
Pharmacy
A full range of inpatient services is provided on our campus.
Radiation and Medical Oncology
In December 2014, Texas Oncology-Bedford and Texas Breast
Specialists-Bedford opened the doors to a new 38,000 foot
comprehensive cancer center. Texas Oncology’s community-
based treatment approach allows patients to stay near the
critical support of family and friends. In addition to advanced
treatment options, the new facility adds a focus on family and
friends as they support patients in their fight against cancer: a
new community room facilitates educational, support, and other
activities for patients and their caregivers. Along with providing
medical and radiation oncology outpatient services, the center
also brings breast cancer care and a mobile PET unit under the
same roof. Patients are benefitting from improved access and
complimentary parking, as well as the convenience of having
all outpatient services in one location, including chemotherapy,
radiation therapy, onsite lab, pharmacy, and cancer prevention
and screening.
Texas Oncology-Bedford provides patients with a broad range of
services. Its medical oncology team includes medical oncologists,
hematologists, and gynecologic oncologists. Radiation
oncologists treat patients with advanced technologies, including
external beam radiotherapy, high dose rate (HDR) brachytherapy,
image-guided radiation therapy (IGRT), and intensity modulated
radiation therapy (IMRT). Texas Oncology patients have the
opportunity to take part in some of the most promising clinical
trials in the nation for a broad range of cancers. Texas Oncology,
through its affiliation with US Oncology Research, has played
a role in more than 50 FDA-approved cancer-fighting drugs,
nearly one-third of all cancer therapies approved by the FDA to
date. Breast surgeons at Texas Breast Specialists–Bedford work
with patients in a multidisciplinary breast clinic, providing patient
consultation and risk assessment, as well as ultrasound and
office-based procedures. Oncology appointments are available
within 24 to 48 hours of the patient’s initial call, and new patient
orientation and financial counseling are available.
“A dog can express more with his tail in
seconds than his owner can express with
his tongue in hours.” — Unknown
TexasHealth.org/HEB Page 12Page 11 Texas Health HEB Cancer Program
Texas Health Harris Methodist Hospital HEB
Service Area Reports
Respiratory Therapy
The Pulmonary Rehabilitation Department provides smoking
education to the Bedford Teen Court on a quarterly basis. A
Breathing Club meets once a month and department staff
distributes smoking education information to all patients who
use tobacco.
Social Services
Social Services are available to all Oncology inpatients seven
days a week, 365 days a year. The Care Transitions Manager-
Social Worker (CTM-SW) uses the NCCN Distress Thermometer
for Patients to perform psychosocial assessments to help
identify any physical, emotional, and/or financial needs patients
and families might have. The CTM-SW provides information
and referral services for community resources to help with
these needs. The CTM-SW works closely with the Care
Transitions Manager-Registered Nurse for discharge planning,
assisting with planning and arrangements for care and
rehabilitation for patients, if needed, after discharge from the
hospital. These arrangements can include home health care
services, home medical equipment, placement for extended care
and rehabilitation at other facilities, alternate living arrangements,
and hospice referrals. The CTM-SW is also available for
consultation and assistance to hospital outpatients and to
patients referred by Oncologists’ offices.
Surgery
A full scope of surgical services is available, including Robot
Assisted Surgery.
Survivorship
Cancer survivors cope with their new life in different ways.
Often they are still dealing with side effects from treatment and
learning how to adjust to the many other changes they have
gone through. They may not be returning to normal life as
soon as they had hoped. Texas Health HEB and Texas Oncology
partner to provide patients with services to help them through
this transition. Upon discharge from the hospital, patients
are given a Survivorship Care Plan that includes pertinent
information related to their diagnosis and planned course of
treatment. Information on support services is also included.
Patients may be referred to a Medical or Radiation Oncologist
who also provide them a summary of care at the completion
of treatment. Texas Oncology has implemented a Survivorship
Program that consists of a one-hour scheduled visit with an
Advanced Practice Provider who reviews the patient’s diagnosis
and treatment summary, and the cancer follow-up schedule per
NCCN guidelines. Patients also receive counseling on the late-
and long-term effects of their treatment, and recommendations/
referrals or treatments for the concerns they are having are
provided. Patients also receive counseling on other health
maintenance topics such as nutrition, mental health, tobacco
cessation, sun exposure, environmental exposure and physical
activity. Patients are given a folder with community resources
and handouts, as well as copies of their pathology, and other
medical records pertaining to their diagnosis and treatment plan.
A copy of the note from the visit is sent to the patients and their
primary care physician in order to communicate and coordinate
their care plan.
Volunteer Services - Visiting Volunteer
The Visiting Volunteer Program is designed to provide support,
comfort, companionship and activities to our hospitalized
patients. The program is customized for the patient giving those
options such as reading, listening to music, playing various
games, watching television, enjoying a puzzle, help writing a
note or card, painting their nails, completing a craft activity or
simply having someone to talk to. The patient can also make
requests or suggestions for specific activities to meet their
needs. Visiting Volunteers are currently available one rotating
week day from 10 to 1 in Women Services and PCU.
Wound Care and Hyperbaric Oxygen Therapy
We are proud to be able to offer Hyperbaric Treatment to
patients with soft tissue radiation damage or for those whose
surgical flaps are compromised. We have treated a number of
patients with Negative Pressure Wound Therapy for non-healing
surgical areas post mastectomy.

8. TexasHealth.org/HEB Page 14Page 13 Texas Health HEB Cancer Program
The Breast Center at
Texas Health HEB
To meet NAPBC standards for accreditations, Quality measures must be monitored. Below you will find results from 2013 and 2014
Breast Measure CoC
Compliance Rate
THHEB 2014
Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age
70 receiving breast conserving surgery for breast cancer.
90% 77%*
Combination chemotherapy is considered or administered within 4 months (120 days) of
diagnosis for women under 70 with AJCC T1cN0M0, or stage IB - III hormone receptor
negative breast cancer.
90% 100%
Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year
(365 days) of diagnosis for women with AJCC T1cN0M0, or stage IB - III hormone receptor
positive breast cancer.
90% 96%
Radiation therapy is considered or administered following any mastectomy within 1 year (365
days) of diagnosis of breast cancer for women with ≥ 4 positive regional lymph nodes
90% 100%
Image or palpation-guided needle biopsy (core or FNA) to the primary site is performed to
establish diagnosis of breast cancer.
90% 100%
Breast conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer. Not Determined 79%
Each year the breast program leadership conducts or participates
in two or more center-specific studies that measure quality
and/or outcomes, and one or more of our physician members
participate in their specialty-specific quality improvement
program. The findings are communicated and discussed with the
breast center staff, participants of the interdisciplinary conference,
and the cancer committee, where applicable. Using 2014 data the
breast leadership conducted the following studies;
1. Percentage of patients receiving and completing planned
chemotherapy
2. Patients requiring mastectomy after lumpectomy due to
extent of disease.
Texas Breast Specialists-Bedford
At Texas Breast Specialists-Bedford, our multidisciplinary team of
medical professionals provides patients with the most advanced,
patient-friendly cancer care available. Our team consists of two
breast surgeons, a medical oncologist, a radiation oncologist
and a certified Breast Cancer Patient Navigator. Patients of
Texas Breast Specialists-Bedford benefit from our leading-edge
medical services and our participation in innovative research
programs.
In addition, our support services team is committed to
addressing the educational, emotional, financial and nutritional
needs of our patients. We deliver all of this with a level of
personalized care and convenience not typically found in large
metropolitan facilities.
Formerly known as the Breast Care Center of North Texas,
Texas Breast Specialists-Bedford was designed by three female
physicians with more than thirty collective years dedicated to the
prevention, diagnosis and treatment of breast cancer. Opened in
December 1999, Texas Breast Specialists-Bedford is dedicated to
providing the highest level of care in the diagnosis and treatment
of breast cancer patients.
Texas Breast Specialists - Bedford has the resources to help you
fight your battle with cancer. We offer a full range of leading-
edge treatment options at high levels of care and convenience.
We strive to bring brighter futures to cancer patients and help
improve cancer survival rates.
Through a written agreement, Texas Health HEB, Texas Breast Specialists, Texas Oncology and Solis
Mammography form the Breast Center at Texas Health HEB. Advanced breast care is provided to patients
in our center without walls. From diagnosis through follow-up, patients can receive all of their care on
the campus of Texas Health HEB. Diagnosis, surgery, radiation, medical oncology, physical medicine and
rehabilitation, a fitness center and support services are all available. A highly trained team of professionals
is available to guide breast cancer patients through treatment. Two Nurse Navigators are available, one
for inpatient and one for outpatient. These Navigators help facilitate any needs patients may have and to
help them navigate through the many facets of treatment. The National Accreditation Program for Breast
Centers conducted our survey on September 4, 2014. We successfully met all of the requirements and
were granted a three-year full accreditation.
Description of Services
• Convenient, in-office, minimally invasive ultrasound-directed
breast biopsies
• Surgery including lumpectomy, sentinel node biopsy, skin
sparing mastectomy with reconstruction when necessary
• In-office consultations available with a radiation oncologist
and medical oncologist to provide a smooth continuum of care
• N.E.A.T. Program®
(Nutrition, Exercise and Attitudes for
Tomorrow) offers exercise and nutrition classes specifically
designed for breast cancer patients
• On-site support group that meets monthly and offers partner
group meetings for patient spouses.
• Our Patient Emotional Care Program provides support from
a licensed Ph.D. social worker for emotional issues arising as
a result of having breast disease. Services include pre-surgery
assessment, post-surgery assessment and after-care
counseling either individually or in group sessions.
• Lymphedema Physical Therapy - Lymphedema, or swelling
of the arm following surgery or radiation to the underarm
area, occurs infrequently. Patients will be given instructions to
decrease the likelihood of developing lymphedema.
Fortunately, only a small percentage of patients experience
chronic problems with lymphedema. We work with
lymphedema-certified physical therapists to improve the
circulation of lymphatic fluid and decrease the lymphedema.
• Genetic counseling and testing
*Patients are still within the time frame to receive treatment.

9. TexasHealth.org/HEB Page 16Page 15 Texas Health HEB Cancer Program
Background
Texas Health HEB recognized that it had some lengthy delays when patients were to
receive their first dose of chemotherapy. Baseline data showed an average time of 14 hours
20 minutes from order to administration. Patients, physicians, nursing and pharmacy are all
affected by delays and process issues that existed. The project goal was to reduce the first
dose chemotherapy turnaround time (TAT) to six hours or less. Benefits to improving this
time were improved patient, physician and staff satisfaction as well as improved throughput
and efficiency and decreased waste.
Methods
LEAN Six Sigma methodology was used to drill down the inefficiencies and discover
improvements. This included examining the baseline data, breaking down the current
processes with flow charts and asking “what do our patients/physicians/staff expect”.
A majority of issues and areas for improvement centered around two areas:
• Time the patient arrives at the hospital to when orders are sent to pharmacy
• Time from when orders are sent to pharmacy to when they are verified by pharmacy
Improvements
There were a total of nine key improvements that were made to improve the process.
They are:
• Pharmacy policy change regarding variance for Body Surface Area
• Physician office sends lab results and protocols directly to hospital
• Revised chemotherapy order form
• New pharmacy policy allowing pharmacy to order needed labs to dose chemotherapy
• Physician office to create packet that gets sent to hospital to reduce delays
and questions
• Oncology unit ensuring they have adequate chemotherapy certified nurses working at
the same time
• A standard timing for hanging chemotherapy once received from pharmacy
• Oncology patients have a fast track admission area from 7 a.m.-7 p.m.
• Pharmacy and physicians standardized some calculations
2014 Quality Improvement Projects
Results
28 patients were followed after the improvements were put in place. There was a
reduction of almost seven hours in TAT. It took these patients an average of seven hours
and 40 minutes from the time they arrived to the time they received chemotherapy.
There are still a few opportunities to continue to work on to reduce the TAT. However,
some delays are unavoidable. For example, the medication is special order, not
normally stocked, the patient may have procedure related time conflicts or the process
is not followed as designed. Continued monitoring and communication will ensure
consistency of results.
Radiation Dose Quality Improvement
Over the past year, the Radiology Department implemented
Dose Watch — a web-based patient radiation dose monitoring
software used to capture, track and report radiation dose directly
from any imaging device or PACS system. This technology helps
us deliver the right radiation dose, while still producing the high
quality images needed for diagnostics and treatment planning.
By tracking our patient’s cumulative dose over time, we can
take steps to prevent excessive medical radiation exposure.
Dose Watch helps improve patient care by understanding each
patient’s exposure to radiation during imaging, identifying
sources of variability, and improving protocol and exam delivery.
Improvements with this system include:
• An alert notification system when dose levels exceed
predefined thresholds.
• A dose comparison analysis that allows us to compare study
dose metrics for all modalities, stratifying by site, device,
study description, period and patient age range.
• An easy to use dashboard that provides quick access to
patient’s cumulative radiation dose and medical history.
• Will allow us to compare our performance against national
and local Diagnostic Reference Levels (coming to the THR
system in 2016).
The Radiology Department at Texas Health HEB offers a wide
variety of advanced diagnostic services and is accredited by the
American College of Radiology in Computed Tomography (CT),
Nuclear Medicine and Magnetic Resonance Imaging (MRI).
First Dose Chemotherapy Turn Around Time Process Improvement
Texas Health Harris Methodist Hospital HEB

10. TexasHealth.org/HEB Page 18Page 17 Texas Health HEB Cancer Program
Prevention
Screening
Early Detection
Staging
Treatment Planning
Treatment
SURGERY
CHEMOTHERAPY
RADIATION
THERAPY
BIOLOGICALS
Rehabilitation
PHYSICAL
PSYCHOSOCIAL
SPIRITUAL
FINANCIAL
Continuing Care/Cure
Home Care
PALLIATIVE CARE
HOSPICE
BEREAVEMENT
Cancer Care
Continuum
The Journey Continues
When I started at Texas Health HEB in 1998, I was excited to work with such a talented and dedicated team of professionals to help
patients fight cancer. One story comes to mind. I remember attending a tumor conference and looking at the pathology template
that the hospital used. It was nearly identical to the one used at Harvard Medical School. I asked the pathologists where they got the
template—they responded that they generated it themselves. Great minds do indeed think alike.
I eventually became chair of the cancer committee in 2002. Several years later, the cancer committee, in conjunction with Mildred
Jordan and Alice Landers embarked on regaining certification as a Commission on Cancer designated Cancer Program. The purpose
was not to obtain a mere label or certificate. It was to bring together the outstanding and dedicated people and teams it takes to fight
cancer, review best practices, engage vigorous discussions about evidence based solutions, and implementing those plans.
We succeeded, and the hospital regained its designation as an American College of Surgeons Commission on Cancer designated
Cancer Program—this NE Tarrant county to do so.
But the work and passion of our physicians, administrators, nurses, and other staff and professionals didn’t stop there. Through the
leadership of Texas Health HEB president Deborah Paganelli, Alice Landers, VP, Professional and Support Services, a new oncology care
unit (OCU) opened in November 2012. This new space enabled Texas Health HEB’s physicians, nurses and professionals to care for
cancer patients in a more soothing, calming environment. The new OCU serves as a home for the outstanding nursing team ad Texas
Health HEB, as they serve as caregivers, educators, advocates, and allies of patients as they proceed through cancer treatment. The
outstanding care provided by our nursing staff was recognized as “best nursing team” in 2010 by ADVANCE for Nurses magazine in
2010, as well as highlighted during our 2010 ACoS accreditation and review.
Upon the heels of the opening of the new Oncology Care Unit, we underwent re-accreditation in 2013. We received multiple
commendations in our 2013 Re-Certification survey for the American College of Surgeons. We also obtained designation as an
accredited breast cancer program by the NAPBC (National Association of Programs for Breast Cancer) in 2014. It is notable that we
received a Best Practices recognition for our breast cancer pathology review and reporting, indicating a “Best in the Nation” status for
that commendation.
In December 2014, Texas Health HEB Cancer Center opened and enabled medical, radiation, gynecologic oncology patients to be
seen under one roof. This center has brought together outpatient radiation oncology and medical oncology services, as well as other
valuable therapeutic and educational services for our cancer patients and their families. It has introduced technological advances,
including Image Guided Radiation Therapy, as well as the upcoming introduction of RapidArc treatment, in a facility that is convenient,
accessible and comfortable for patients and staff alike.
We have come a long way since 2002. Thinking that it was time to pass the baton, the Chairmanship is now assumed by Dr. Henrik Illum.
Henrik already has done impressive work with a Commission on Cancer program in Dallas, and he brings a unique, fresh perspective, as
his medical experience spans both sides of the Atlantic. Already I can see that our fellow staff and colleagues are impressed by his energy,
insights, warmth, and enthusiasm.
As the reins are turned over, I want to extend a special thanks to Mildred Jordan, CTR, our lead tumor registrar, Kimberly Willis, CTR
as well as Alice Landers, VP, Professional and Support Services at Texas Health HEB and Deborah Pagenelli, President of Texas Health
HEB. Without their unwavering support and dedication, the great accomplishments of the HEB Cancer committee would not have
been possible.
There is no doubt that the future will bring new challenges and opportunities—including new regulations, new standards, and new
initiatives to improve the quality, safety, efficiency, and access to care our patients receive. I feel that we are well placed to meet those
challenges, because our greatest strength is the depth and breadth of our capabilities and compassion to treat cancer. Our status as an
ACoS Approved Cancer Program and certified breast cancer program by the NAPBC underscores the excellence and commitment to
constantly improve cancer care and outcomes for our patients and their families. By having a broad multidisciplinary focus on the patient,
we can deliver the best care, assist our patients by navigating them through the health care milieu, and enhance their survivorship. It has
been truly a wonderful experience to serve as chair of the cancer program, and to work with such a phenomenal group of people.
I am pleased that the journey continues, with great things to come.
Sincerely,
Ajay Dubey, MD

11. MB 1446 12/15
Doctors on the medical staff practice independently and are not employees or agents of the hospital.