2. 2 2015 CHI Memorial Cancer Report
Our
Mission
Cancer
Care
The mission of CHI Memorial and Catholic Health Initiatives is to nurture
the healing ministry of the Church, supported by education and
research. Fidelity to the Gospel urges us to emphasize human dignity
and social justice as we create healthier communities.
Reverence | Integrity | Compassion | Excellence
CHI Memorial has proudly served the Chattanooga, north Georgia
and surrounding communities since 1952. The cancer program has
consistently maintained accreditation with commendations from
the American College of Surgeons, Commission on Cancer: program
designation,“Comprehensive Community Cancer Program.”
4. 4 2015 CHI Memorial Cancer Report
On behalf of the cancer program at CHI Memorial
and the Rees Skillern Cancer Institute, the cancer
committee is pleased to present the 2015 cancer
program annual report. The CHI Memorial
cancer program is accredited by the American
College of Surgeons’ Commission on Cancer
as a Community Hospital Comprehensive Care
Program. Our program continues to provide
patients, their families, and physicians in our
community with a fully integrated, state-of-the-art,
multidisciplinary approach to the prevention, early
intervention, diagnosis and treatment of
malignancies.
This report highlights the events and services that have
contributed to the success of the cancer program and
summarizes the statistics from our cancer registry during
2014-2015. During the past year, the cancer committee
provided professional guidance in a number of cancer
related activities:
• enhancement and implementation of the cancer
services strategic plan
• maintenance and improvement of the cancer registry
data system
• continued promotion of physician use of the AJCC/
TNM staging system
• continued participation in expanded oncology and
UAB clinical trials and studies
• continued physician education through many weekly
cancer conferences
• continued participation of the continuing medical
education program through the Medical Association of
Georgia
• continued support of the cancer risk counseling
program
• expansion of the navigation and survivorship programs
• continued public education through outreach sites
and multiple community education and screening
programs
• continued promotion of the hospice program and
comprehensive pain management program
• continued support and expansion of the cancer
resource center and cancer resource team of specialists
• expansion of services in the infusion therapy program
• expansion of services in the radiation oncology program
• provision of data for special research study and grant
proposals
• participation in community outreach events including:
• sponsor for the Susan G. Komen Race for the Cure
• participation in the ACS Relay for Life
• sponsor for the 24th We Care Weekend
• Greater Chattanooga Colon Cancer Foundation’s
Rump Run
The cancer committee continues to oversee the overall
cancer program at CHI Memorial through coordination
and facilitation of all programs and services. The
committee sets annual goals to improve services and
the care of our patients. It focuses on identifying patient
needs and developing strategies to meet those needs.
Patients have the assurance of access to hospital-
associated resources, community resources for treatment,
rehabilitation, support and education on their disease.
2015 Message from the Cancer Committee Chairman
Sanford Sharp, M.D.
5. 2015 CHI Memorial Cancer Report 5
Upon diagnosis, patients may choose to be paired
with a nurse in our nurse navigator program. This
nurse will navigate the patient through treatment;
provide education; act as a liaison between patient
and doctor when questions arise; offer resources
for economic support; and provide comfort and
assistance all the way through the discharge and
recovery phase.
Navigators are available for the patient from the
beginning to coordinate appointments, ensure
adequate case presentation, facilitate communication
at treatment conferences, and establish a personal
relationship with the patient.
Nurse navigators ensure that each person
moves through the care process and is kept well
informed. In addition to scheduling appointments
and treatments, nurse navigators introduce the
patient to our supportive care resources and
information, such as social workers, nutritionists,
massage therapists, or tai chi. No cancer patient
needs to feel alone.
To reach a nurse navigator, call the center
for cancer support at (423) 495-7778.
Patient Navigation – Guidance for Patients
Our healing environment philosophy is about taking
care of all of the needs of our patients and families.
The Joe and Virginia Schmissrauter Center for
Cancer Support – This center offers assistance for
every step of a patient’s journey to living well with
cancer. Our services are available to anyone in the
greater Chattanooga area at no charge. The center
offers a team-based, holistic approach to cancer care
in these comfortable and convenient locations:
• CHI Memorial Hospital – Chattanooga,
Plaza Building, suite 307
• CHI Memorial Hospital – Hixson,
Professional Building
Cancer professionals and trained volunteers are
available in the centers for cancer support to help
patients and their families. The team is comprised
of a receptionist, four oncology nurse navigators,
two registered dieticians, chaplains, and three
masters-level prepared and licensed clinical
social workers. Other professionals are added to
complement the team on a contract basis.
Cancer Center for Support Services
6. 6 2015 CHI Memorial Cancer Report
Cancer Education/Prevention – Education
empowers patients in their fight against cancer.
In addition to books and other printed materials,
a variety of professionals and partners with other
organizations are brought in to present educational
programs throughout the year.
Cancer Risk and Screening Program – Early
identification and information on prevention and
monitoring are essential for a person at high risk
for cancer. The center for cancer support offers
genetic counseling and screening for breast and
colon cancer patients with support from the Myriad
Laboratory and other laboratories.
Support Groups – Led by registered nurses,
chaplains, social workers and/or family therapists,
support groups provide a private, supportive
environment where cancer patients and their
families can find emotional support and learn
about treatment modalities and symptom
management. Several groups are available to meet
different needs, including groups for:
• general cancer concerns
• prostate cancer
• multiple myeloma
• gynecological cancers
• breast cancer
• lung cancer
• leukemia/lymphoma
• pancreatic cancer
• caregivers
• loss, grief and bereavement
• mind-body skills
• smoking cessation classes
• survivorship
Cancer Survivors Network – This network offers a
comprehensive selection of stories and discussions
among survivors and caregivers on a variety
of topics. The cancer survivors network can be
accessed via touch-tone or rotary telephone at
1 (877) 333-4673. The link to the network is located
on the American Cancer Society website at
Cancer.org.
Cancer Center for Support Services (continued)
7. 2015 CHI Memorial Cancer Report 7
Sanford Sharp, M.D., pathology,
cancer committee chair, registry advisor
Bertrand Anz, M.D., medical oncology,
cancer liaison physician
Krishneudu Bhadra, M.D., lung services
John Boxell, M.D., ret.,
cancer program consultant
Eric Ellis, M.D., radiation oncology
Bob Goldman, M.D., palliative services
Peter Hunt, M.D., head and neck
Lee Jackson, M.D., urology
Kevin Lewis, M.D., chief medical officer
Charles Piez, M.D., diagnostic radiology
Maurice Rawlings, M.D., surgical oncology,
director, breast services
Eric Schubert, M.D., pathology,
coordinator, multi-disciplinary conferences
J. Lanett Varnell, M.D., radiology breast services
Betsy Washburn, M.D., surgical oncology
Kathy Dittmar, administrator, cancer services
Beena Anchanattu, RN, outpatient infusion
Penny Andrews, RN,
clinical research coordinator
Sherry Baierl, RN, quality performance
Jessica Brown, NP, survivorship program
Christine Dominguez, RN, palliative care
Rhonda Edwards, MSSW, ACSW,
social worker
Renee Epps, director, radiation oncology
Amy Fields, American Cancer Society
Barbara Guider, director,
MaryEllen Locher Breast Center
Debrah Hagen, MSSW, ACSW, social
worker
Sharon Hopper, R.D., dietician, cancer support
Leanna Jones, CPA, finance
Betsy Kammerdiener, M.Div, pastoral services
Marty Laird, D. Ph., pharmacy
Catherine Marcum, DNP, APN, cancer sisk counseling
Amy Parker, director, rehab/neurodiagnostics
Cynthia Perry, CTR, oncology data manager
Angela Posey, outreach coordinator
Betsy Quinn, RN, lung nurse navigator
Gere Schwert, MSSW, LCSW, social worker
Kim Shank, RN, navigation, colorectal risk counseling
Terri Shultz, RN, head and neck navigator
Hannah Walker, RN, director, oncology, nursing unit
2015 Cancer Committee
8. 8 2015 CHI Memorial Cancer Report
During the conferences, each newly diagnosed
case is presented and discussed among all involved
physician disciplines as well as ancillary staff. The
care team determines the best treatment options,
which are tailored to each patient’s case and
circumstances.
The multidisciplinary care team includes surgeons,
medical oncologists, radiation oncologists,
pathologists, radiologists, oncology nurses, nurse
navigators, dieticians, social workers and genetic
counselors. This team meets three to four times per
week for conferences. Physicians and staff at CHI
Memorial Hospital – Hixson are also included in the
conferences.
The following conferences are available to
physicians and staff at CHI Memorial as well as
physicians in the community:
• breast conference
• didactic conference
• gastrointestinal conference
• genitourinary conference
• general conference
• GI pathology conference
• gynecologic conference
• hem/lymph conference
• head and neck conference
• thoracic conference
Multidisciplinary Cancer Conferences and Team
9. 2015 CHI Memorial Cancer Report 9
Tumor Site Origins Residence by County at time of Diagnosis
Primary Site Total Percent County Total Percent
breast 435 16.6 Hamilton County, TN 1310 50.13
lung 418 16 Walker County, GA 253 9.68
prostate 307 11.7 Bradley County, TN 199 7.6
melanoma 216 8.3 Catoosa County, GA 173 6.6
colon/rectum 196 7.5 Whitfield County, GA 106 4.05
urinary bladder 108 4.1 Marion County, TN 96 3.67
lymphoma 103 3.9 Rhea County, TN 87 3.3
kidney & renal pelvis 86 3.3 Dade County, GA 51 1.95
pancreas 75 2.9 Jackson County, AL 36 1.37
thyroid 72 2.8 Sequatchie County, TN 32 1.22
oral cavity/pharynx 71 2.7 Murray County, GA 30 1.14
corpus uteri 61 2.3 Polk County, TN 26 0.99
leukemia 59 2.3 Meigs County, TN 26 0.99
esophagus 36 1.4 Chattooga County, GA 20 0.78
ovary 35 1.3 McMinn County, TN 16 0.63
myeloma 32 1.2 Grundy County, TN 14 0.55
larynx 28 1.1 DeKalb County, AL 13 0.53
brain/CNS 28 1.1 Bledsoe County, TN 13 0.53
other 247 9.5 other 112 4.29
CHI Memorial Cancer Program Patient Volumes 2014
10. 10 2015 CHI Memorial Cancer Report
2014 Cancer Experience
breast
lung
prostate
colorectal
head & neck
melanoma
GYN
bladder
lymphoma
other
18% 17%
16%
12%
8%
8%
8%
5%
4%
4%
11. 2015 CHI Memorial Cancer Report 11
By understanding our patient population, the Rees
Skillern Cancer Institute is able to offer community
education, screening programs, clinical trials, state-of-
the-art technology and enhanced support programs.
More than half of the patients (50.13%) diagnosed
and treated at CHI Memorial reside in Hamilton
County, Tennessee. The remaining patients
(49.87%) came from other counties in Tennessee,
north Georgia, Alabama and other areas.
Cancer Incidence
900
800
700
600
500
400
300
200
100
0
0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+
Distribution by Age at Diagnosis 2014 Analytic Cases
12. 12 2015 CHI Memorial Cancer Report
2005 -2014 Top Ten Cancer Sites at CHI Memorial
Site 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
breast 354 339 367 372 465 382 388 453 439 435
lung 260 308 292 330 373 425 382 347 384 418
prostate 257 299 372 367 477 348 413 400 349 307
skin (melanoma) 196 236 235 217 319 231 268 282 313 216
colorectal 174 183 223 202 274 256 238 234 241 196
head & neck 126 162 168 194 252 275 185 220 220 235
lymphoma 121 75 148 103 174 128 177 152 123 103
bladder 79 92 102 98 132 107 98 93 123 108
pancreas 35 35 42 47 58 45 57 67 56 75
corpus uteri 32 49 32 52 67 35 29 49 63 61
Cancer at CHI Memorial Cancer Institute
13. 2015 CHI Memorial Cancer Report 13
An estimated 231,840 new cases of invasive breast
cancer are expected to be diagnosed among women
in the United States during 2015, and approximately
2,350 new cases are expected in men. Excluding
cancers of the skin, breast cancer is the most
frequently diagnosed cancer in women.
The most common symptom of breast cancer
is a lump or a mass in the breast, which is often
painless. Less common symptoms include persistent
changes to the breast, such as thickening, swelling,
distortion, tenderness, skin irritation, redness, or
nipple abnormalities, such as ulceration, retraction, or
spontaneous discharge. Breast pain is more likely to
be caused by benign conditions and is not a common
symptom of breast cancer.
Modifiable risk factors associated with breast cancer
include weight gain after the age of 18 and/or
being overweight, the use of combined estrogen
and progestin, physical inactivity, and alcohol
consumption. In addition, recent research indicates
the long-term heavy smoking may also increase breast
cancer risk, particularly among women who start
smoking before their first pregnancy.
Non-modifiable factors associated with increased
breast cancer risk include high breast tissue density,
high bone mineral density, type 2 diabetes, certain
benign breast conditions, high-dose radiation to the
chest for cancer treatment at a young age also
increases risk. Risk is also increased by certain
reproductive factors, family history of breast
cancer and inherited mutations.
The MaryEllen Locher Breast Center at CHI
Memorial Hospital – Chattanooga is an NAPBC-
accredited center. Accreditation is granted
to centers that are voluntarily committed to
providing the best possible care to patients
with diseases of the breast. Each center must
undergo a rigorous evaluation and review of
its performance and compliance with NAPBC
standards. To maintain accreditation, centers
must monitor compliance with NAPBC standards
to ensure quality of care and undergo an on-
site review every three years. Because of this
certification, the breast center is able to offer a full
range of services for breast care, from screening
and diagnosis to advanced care. Our board-
certified physicians and support staff provide
women with the most-up-to-date options for
treatment.
Patients who visit MaryEllen Locher Breast Cancer
or one of the mobile coaches have access to
comprehensive coordinated services - from
screening to diagnostic workup of abnormalities
to treatment and support into survivorship.
National Accreditation Program for Breast Centers
14. 14 2015 CHI Memorial Cancer Report
After an abnormal mammogram, they meet
with doctors to learn about treatment, possible
lumpectomies, mastectomies, radiation therapy,
chemotherapy and hormone therapy.
The wait time from diagnosis to treatment is kept to
a minimum and the MaryEllen Locher Breast Center
staff strives to alleviate as much of the patient
anxiousness and stress as possible.
The breast center has nurse navigators who assist
patients with their options through resources for
information, education and support. Clinical trials
and research are available giving patients access to
new medications and collecting data to determine
therapy for current and future patients.
National Accreditation Program for Breast Centers
(continued)
Colorectal cancer is the third most common cancer.
In 2014, the United States expects 93,090 new cases
of colon cancer and 39,610 cases of rectal cancer.
Of these cases, 49,700 individuals may not survive.
The incidence of colorectal cancer has been
declining in the past two decades, as has the death
rate. The decline has been attributed to an increase
in screenings that aid in the early detection of
colorectal polyps, awareness of risk factors and
improvements in treatment options.
Individuals at a higher risk for colon cancer include
people age 50 and older, as well as those with
obesity, poor exercise habits, inflammatory bowel
disease, type 2 diabetes, diets rich in red meat, high
alcohol consumption and, possibly those with diets
poor in fruits and vegetables. Genetic conditions
such as familial adenomatous polyposis, hereditary
non-polyposis colorectal cancer or a family history
of colorectal cancer can also lead to increased risk.
Preventive screening for colorectal cancer is
imperative primarily because the disease presents
no symptoms in its early stages. Therefore the use
of screening methods such as sigmoidoscopy,
colonoscopy and radiological studies that allow for
early detection of polyps is vital.
Colorectal Cancer
15. 2015 CHI Memorial Cancer Report 15
Screening recommendations for people age 50 or
older include the following:
• stool DNA tests at varying intervals
• fecal occult blood test every year
• fecal immunocytochemistry test every year
• flexible sigmoidoscopy to be conducted every five
years
• barium enema every five years
• CTR colonoscopy every five years
• colonoscopy to be conducted every 10 years
As colorectal cancer progresses, it may produce blood
in the stools, change of bowel habits, abdominal
cramping and weight loss. Anemia may be a result
of continuous blood loss and can cause fatigue and
weakness. At this point, early detection becomes the
priority.
If colorectal cancer is detected, treatment may
involve surgery, radiation therapy and chemotherapy.
Frequently, one or more modalities are used
depending on the location (colon vs rectum) and
how advanced the disease is at diagnosis. Patients
with cancer in the colorectal area will likely see
different medical specialists who work together in
the diagnosis and treatment of the disease.
Overall Survival
The 5- and 10-year relative survival rates for
people with colorectal cancer are 65% and 58%,
respectively. When colorectal cancer is detected
at a localized stage, the 5-year survival is 90%;
however, only 40% of colorectal cancers are
diagnosed at this early stage, in part due to the
underuse of screening. If the cancer has spread
regionally, to involve nearby organs or lymph
nodes by the time of diagnosis, the 5-year survival
drops to 71%. If the disease has spread to distant
organs, the 5-year survival is 13%.
Colorectal Cancer (continued)
16. 16 2015 CHI Memorial Cancer Report
16
14
12
10
8
6
4
2
0
stage 0 stage I stage II stage III stage IV unk
Colorectal Treatment by Modality
other 0.15
surgery, chemo and radiation 0.08
excisional biopsy 0.09
surgery and chemo 0.15
surgery 0.2
biopsy and surgery 0.33
Age at Diagnosis by AJCC Stage
40-49
50-59
60-69
70-79
80-89
Other
17. 2015 CHI Memorial Cancer Report 17
CHI Memorial offers a comprehensive range of
services to meet all of your cancer care needs and
concerns.
GI Colorectal Center of Excellence
3T MRI technology
capsule endoscopy
endorectal ultrasound
ERCP
optical and virtual colonoscopies
robotic-assisted surgery
Gynecological Oncology Services
Head and Neck Center of Excellence
MaryEllen Locher Breast Center
bone density tests
cancer risk counseling
community outreach
dedicated breast MRI
diagnostic 2D & 3D tomosynthesis
mammography screening
mobile mammography services in north Georgia
and 25 counties in Tennessee
stereotactic ultrasound guided breast biopsies
ultrasound AWBUS diagnostics
Prostate Center of Excellence
partial nephrectomy
robotic-assisted prostatectomy
Radiation Center of Excellence
high dose rate brachytherapy
intensity-modulated radiation therapy (IMRT)
MammoSite treatments
Novalis Tx
TrueBeam STx
Thoracic Center of Excellence
CT and PET scans
endo-bronchial ultrasound
lung biopsies
lung cancer screening program
pulmonary rehab
respiratory testing
Holistic Support Services
chaplain services
genetic testing
oncology dietitians
oncology licensed clinical social workers
RN navigation
spiritual counseling
support groups
Complete Service Listing
18. memorial.org | (423) 495-2525
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