1. health and fitness
2. disease
3. cancer

Morehead Memorial Hospital Cancer Program
2014 Annual Report using 2013 Statistical Data
John Smith Jr. • Dalton McMichael Cancer Center
John Smith, Jr.•Dalton McMichael Cancer Center
The Smith-McMichael Cancer Center, built in 1994, was made possible by generous gifts from
John Smith, Jr. and Dalton McMichael. According to the National Cancer Institute, Rockingham
County was the 5th highest county in North Carolina for cancer incidence per capita. The Cancer
Center, located on the Morehead Memorial Hospital campus, serves as an undeniable necessary
resource for the citizens and neighbors of Rockingham County.
The cancer program at Morehead Memorial Hospital, a community hospital, has repeatedly
earned three-year accreditation by the American College of Surgeons (ACS) Commission on
Cancer. Morehead Memorial Hospital is one of 53 hospitals in North Carolina with the ACoS
accreditation. The Center has been continuously accredited since 1998.
Since its inception, the commission’s goal has been to reduce the morbidity and mortality of
cancer through education, standard setting and monitoring of quality of care. The standards
continue to promote multidisciplinary and quality patient-centered care which we strive to
uphold.
Introduction
The John Smith Jr-Dalton McMichael Cancer Center at Morehead
Memorial Hospital marked a major milestone in 2014 as it
commemorated the 20th anniversary of providing excellent services to
our patients and their families. Since its inception, the Cancer Center
continues to grow and flourish as it provides state-of-the-art cancer
treatment to patients and their families in Rockingham County and the
surrounding areas.
It has been an exciting year in the Cancer Center and I would like to highlight some of the major
accomplishments. The Cancer Center recently underwent a major transition as Novant Health
became the managing entity of medical oncology. This change will maximize our resources,
improve cancer care and provide long-term stability to the Cancer Center. The Cancer Center
recently hired two full-time oncologists who provide exceptional care to the cancer patients. We
were very fortunate to employ Dr. Boris Darovsky and Dr. Eric Neijstrom. They have both
provided excellent cancer treatment to the patients of Rockingham County for many years. Dr.
Kenneth Karb recently retired and he will certainly be missed. We wish him only the best in his
new endeavor as the Medical Director of Hospice of Rockingham County.
The Cancer Center is working hard to establish a Regional Breast Center and to obtain
accreditation for the center. The Commission on Cancer of the American College of Surgeons
conducted a survey of the cancer program at Morehead Memorial Hospital earlier this year. Dr.
Frederick L. Greene a senior surgeon at Carolinas Medical Center performed the survey. He
provided excellent feedback and information to help us to continue improving our Cancer Center
and the services we provide. We were delighted to be awarded the highest accreditation for a
three-year term.
I feel very privileged to be a part of this exceptional cancer program and I am very optimistic
regarding the future of the Cancer Center and Morehead Memorial Hospital. I am extremely
impressed by the dedication and hard work of all the staff at the cancer center.
In conclusion, I would just like to say "it's a New Day "at the John Smith Jr.-Dalton McMichael
Cancer Center. We are committed to providing the most comprehensive, state of the art, and
compassionate care for our cancer patients and their families. Over the next 20 years the Cancer
Center will continue to expand and enhance the excellent services provided to meet the needs of
our community.
Marc DeMason, MD
Cancer Committee Chairman
Table of Contents
Cancer Committee ............................................................................................ 2
Goals and Improvements .............................................................................. 3
Highlights of the Year ..................................................................................... 4
Diagnostic/Therapeutic Services ............................................................... 6
Support Services ............................................................................................... 7
Patient Education and Support ................................................................. 12
Community Education, Awareness and Screening Activities ....... 13
Professional Education ................................................................................ 14
Cancer Registry ............................................................................................... 15
2013 Cancer Registry Statistics ............................................................... 17
Endometrial Cancer: Comparison/Survival Data ............................. 20
Appendix ........................................................................................................... 22
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Cancer Committee
The Cancer Committee is a multidisciplinary group comprised of members from the
diagnostic and therapeutic specialties. The committee guides the identification, development,
implementation and evaluation of cancer-related activities at Morehead Memorial Hospital. The
committee meets bimonthly to accomplish these activities.
The following is a list of Cancer Committee members for 2014:
Marc DeMason, MD, FACS, Surgery, Cancer Liaison Physician, Chair, Cancer Committee
Boris Darovsky, MD, PhD, Medical Oncology
Mark Jordan, MD, Pathology
James Palermo, MD, Radiation Oncology
William McLeod, MD, FRC(S)C, FACOG, OB/GYN
Taylor Stroud, MD, Radiology
Adaline Brown, RHIT, CCS, CTR, Cancer Registry Coordinator
Torrey Goard, BS, Health Education Services
Tamara Hunt, VP Physician and Ambulatory Services, Cancer Program Administrator
Jonathan Terrell, MS, DABR Cancer Program Co-Administrator
Jackie Largin, RN, BSN, OCN, Cancer Center, Clinical Team Leader
Susan Netherland, RN, BSN, MBA, Quality Management
Susie Pool, MS, RRT, Social Worker
Cheryl Williams, BS, CME Coordinator, Cancer Conference Coordinator
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Annual Goals and Improvements
Clinical
All newly diagnosed breast cancer patients are being followed up on after their diagnosis to
ensure proper management of their disease. They are being referred to the surgeon for
further evaluation and all patients presented at Tumor Board are being tracked by the
assistant to the Pathologist.
Programmatic
Pursue accreditation as a NAPBC Breast Center
• A subcommittee has been formed and had one meeting
• Standards have been reviewed by all members
• Accreditation for breast ultrasound will be submitted in January 2015
• A site visit was made to an accredited center
• A meeting to explore offering genetic testing was held in December
• Will plan to apply for accreditation in 2015.
Improvements
• Radiation Oncology updated their patient monitoring devices with consolidated flat
screen displays thus allowing increased focus during treatment.
• A blanket warmer was added to the Cancer Center to increase the comfort of our patients
during their oncology treatments
• Radiation Oncology recruited a resident Medical Physicist to manage the quality of
patient treatment plans and delivery as well as manage the Radiation Oncology
department.
• Medical Oncology Pharmacist, Barry Siegel, adopted EPIC’s Beacon Oncology Software to
follow Novant standards of treatment for highly emetogenic regimes.
• Radiation Oncology amended policy to promote reporting of “Near-Miss” events in an
effort to address potential pitfalls before they manifest themselves. This is a key
component in promoting a culture of patient safety.
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Highlights of the Year
Resident Medical Physicist
On June 9th, Morehead Memorial Hospital recruited Jonathan Terrell, M.S., DABR for
the role of Medical Physicist and Radiation Oncology Manager. Jonathan joins the Smith
McMichael Cancer Center touting 7 years of experience and board certification through
the American Board of Radiology. Jonathan graduated from Appalachian State University
with a Bachelor of Science in Applied Physics and Applied Mathematics in 2002 and a
Master of Science in Applied Physics from the University of North Carolina at Charlotte in
2007. The position was previously staffed with a contracted physicist through Cone
Health of Greensboro, NC.
Shared Services Agreement with Novant Health
On July 1st, Morehead Memorial Hospital entered into a shared services agreement
with Novant Health. This relationship paved the way for the appointment of Howard
Ainsley as our Chief Executive Officer. Mr. Ainsley joins us from Hilo, HI after serving as
CEO for the East Hawaii Region of Hawaii Health Systems. Additionally, affiliation with
Novant Health will offer Morehead increased negotiation leverage with outside vendors
providing services to our health system.
Certified Nurses Ensure Quality of Care
The Smith-McMichael Cancer Center demonstrates an ongoing commitment to
quality cancer care, professional development, and patient care by having five oncology
certified nurses on staff; Jackie Largin, RN (clinical team leader), Tori Agee, RN, Ida
Barnes, RN, Lynn Wilbourne, RN, and Karen Woods, RN, who received her certification in
2012. Bonnie Pritchett, RN maintains chemotherapy certification. To receive
Accreditation with Commendation from the American College of Surgeons Commission on
Cancer, at least 25% of chemotherapy trained nurses must hold a current oncology
certification. Eighty-three percent of the chemotherapy nurses at The Smith-McMichael
Cancer Center hold this certification. In Morehead Memorial Hospital’s most recent
accreditation survey by DNV Healthcare, the surveyor noted that it was very unusual to
have five certified nurses at a cancer center, particularly a small community facility.
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Certification benefits patients, families, nurses and employers. Certification signifies to the
patients and families that the nurse taking care of them or their loved ones has the
knowledge, experience and expertise to do so. It strengthens patients’ confidence in the
nurse and offers peace of mind at a time in their lives when things are so uncertain.
Certification also offers both professional and personal accomplishment to the individual
nurse.
Novant Health Oncology Specialists
In mid-December, Cone Health relinquished the medical oncology practice at the
Smith McMichael Cancer Center to Novant Health. Formally titled Novant Health
Oncology Specialists Eden, NHOSE leases approximately half of the physical space at the
Cancer Center. With excellent management and continuity of care, NHOSE retained all
previous Morehead medical oncology employees. Patients should expect to see familiar
faces when returning for care.
Aligning with Novant, Dr. Boris Darovsky and Eric Neijstrom set up shop as our
resident medical oncologists. Dr. Darovsky returns to us after a brief sabbatical and Dr.
Neijstrom joins us from Annie Penn Hospital in Reidsville, NC. Both physicians are highly
regarded in the medical community and a true asset to Rockingham County and the
surrounding population.
New Physicians Join Morehead Staff
New physicians who provide care to cancer patients joined the Medical Staff.
They included:
• Scott Humble, MD
Pathology
• Eric S. Neijstrom, MD
Medical Oncology
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Diagnostic/Therapeutic and Laboratory Services
Diagnostic, therapeutic and laboratory services continue to provide a full scope of services to
support the needs of the cancer program. Services are listed below:
• Needle Localization
• Ultrasound Guided Core Biopsy
• Sentinel Node Injection
• Diagnostic Imaging
• CT Scanning
• CT Guided Biopsy
• Magnetic Resonance Imaging (MRI)
• Nuclear Medicine
• Digital Mammography
• Bone Densitometry
• Ultrasound
• Hematology
• Blood Chemistry
• Blood Bank
• Wide Variety of Pathology Services
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Support Services
Medical Oncology
A cancer diagnosis changes a person’s life. It can be frightening and overwhelming. Patients
and families are the primary focus of care. The Smith-McMichael Cancer Center takes pride in
providing compassionate care in a constantly evolving environment. Medical oncologists and
oncology nurses play an integral role in assisting patients and their families in their cancer
journey. The complex needs of patients with cancer and their families require specialty
competencies, knowledge and skill of the oncology nurses. The center is staffed with all registered
nurses and is proud to report that 83% of the cancer center’s nurses are nationally certified.
A multidisciplinary team approach is used to meet and deliver quality care to the cancer
patient. Patient care is provided through collaboration between staff from medical oncology,
radiation oncology, surgeons, pharmacy, social services, dietary services, rehabilitation services,
home health services, the chaplain and hospice. The cancer patient interacts with the medical
oncology nurse more than with any other member of the team and they become like family. The
medical oncology nurse uses the standards, recommendations and guidelines from the Oncology
Nursing Society to develop nursing policies and procedures to provide physical, emotional and
psychological support to the patient and their family.
The medical oncology nurses are challenged on a daily basis to deal with the numerous
symptoms, including pain and fatigue, cancer patients experience as a result of their cancer or its
treatments.
Radiation Oncology
The radiation oncology team utilizes 3-Dimensional Conformal, Intensity Modulated, Image
Guided, and Electron Beam Radiation Therapies to accurately target and treat physician defined
areas. Our seasoned team consists of a Receptionist, Nurse, Dosimetrist, Physicist, Radiation
Therapists, and Radiation Oncologists.
As part of recent transitions, our Receptionist is dedicated solely to the operations of
radiation oncology. They are the first face you will see when you walk in the door. Daily
interactions with staff will have them feeling like family. We truly pride ourselves in quality
patient interactions and service from all areas of the department.
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Nutritional Services
While eating healthy is important to all of us, it is essential for those who are being treated for
cancer. Eating a healthy diet can help a patient feel better, maintain strength and weight, increase
energy levels, improve tolerance of treatment side effects, and improve the body’s immune
function for decreased recovery and healing times.
Both cancer and its treatment may affect the patient’s appetite and tolerance to certain foods.
Therefore, all cancer patients and their families are provided medical nutrition therapy by a
registered dietitian upon request from the patient, the physician, or another health care provider.
This service includes:
• A complete nutritional assessment to determine the patient's nutritional needs during
cancer treatments and how to best meet those needs;
• Education about the direct and indirect relationship of diet and cancer; and,
• Nutrition counseling to assist patients in making dietary changes to improve their health
and the outcome of their treatments.
Rehabilitative Services
Rehabilitative Services help to accelerate recovery and help patients achieve their maximum
potential through physical therapy, occupational therapy, speech therapy and lymphedema
therapy services. All therapies are provided in an acute care, skilled nursing facility and/or an
outpatient facility.
Lymphedema services require a physician’s referral to begin treatment. Patients will receive
complete decongestive therapy including manual lymph drainage massage, compression
bandaging, garment fitting/management, remedial exercises, and patient/caregiver education.
Consultations for lymphedema risk/prevention are also given and require a physician
referral. Most of the lymphedema services are provided in the outpatient setting, but can be
performed in the other settings unique to Morehead Memorial Hospital.
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Social Services
The role of the social worker at the Smith-McMichael Cancer Center involves collaborating
with other community agencies to meet the needs of the patients, community and hospital. This
service extends to the Virginia agencies as well due to the significant number of patients from
Virginia receiving services at Smith-McMichael.
At the point of cancer diagnosis, the social worker meets with all self-pay patients to review
all options for both the patient and the organization. Eligibility requirements for all programs are
determined and the patient is guided through the process for applying for disability, Medicaid,
PCIP, or financial assistance. Patients are connected with the Department of Social Services for
Medicaid, food stamps, and emergency services applications. Rockingham County Aging Disability
and Transit Services (RCATS) assist with transportation needs for treatment and follow-up if a
patient meets the criteria. Area health departments offer medication assistance programs for
those without any type of medication insurance coverage. Caregivers of Rockingham County
provide volunteer services without charge to disabled and elderly individuals who qualify. Some
of the services include transportation, companionship, light housekeeping and meals.
Pharmaceutical patient care funds are assessed for replacement medications/free oral
medications for those who qualify. Copay assistance is also sought on an ongoing basis.
Home Health agencies, durable medical equipment companies, hospice agencies, private care
nursing, local pharmacies, Red Cross, and the Salvation Army are just a few of the agencies
providing services for our patients. National organizations such as the American Cancer Society,
Leukemia and Lymphoma Society, Colon Cancer Alliance, Cancercare, Blue Note Fund, Chris4Life,
Lymphoma Research Foundation, and Chronic Disease Fund provide financial assistance and
copay assistance for expensive chemotherapy medications.
Extraordinarily fortunate for this community, the Morehead Memorial Hospital Foundation
and the Barry L. Joyce Cancer Support Fund offer financial assistance for our patients. The
Foundation has provided transportation, medication and nutritional support for many of our
patients. Supplemental nutritional drinks can cost as much as $2 per bottle with a patient needing
six bottles per day. This cost quickly becomes a burden when it is the only source of nutrition.
Patients are often faced with paying for treatment needs while sacrificing payment of other
bills. After consultations with the social worker, options are sought to assist with these varied
expenses. The Barry L. Joyce Cancer Support Fund provides assistance to residents of Rockingham
County. Some of the resources approved for patients have been payment of utility bills,
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medications, gas, food, clothing, specialized equipment and even dentures. Over 800 Rockingham
County residents have received assistance from the Barry L. Joyce Cancer Support Fund in 2014.
The “Junkyard” provides sodas, bottle water, chips, cookies, candies, and even fruits for
cancer center staff to purchase for breaks. All profits are used to provide patients with resources
when other options have been depleted or do not provide individual needs. Adult diapers,
aluminum free deodorants, aloe vera gel, nonprescription medications and supplements are just a
few of the items purchased for patients with Junkyard funds.
The Center also receives donations from the community of crocheted/knitted scarves/hats,
medical equipment, and nutritional supplements. Some of the contributors include the Danville
Cancer Association, The Jerry Chaney Fund, Southern Area Agency on Aging Cancer Fund,
Martinsville Family Pharmacy, and various other service entities.
Chaplaincy Services
The spiritual needs of our patients are met by a team of individuals. Utilizing a Chaplaincy On
Call program, Morehead is able to care for those when they need it most.
These pastoral visits include one or more of the following:
• Informal spiritual assessments, active and empathic listening, pastoral presence and
support, and, if requested, prayer;
• Relevant printed support materials (“Care Notes”) for patients and families; and,
• Education and counseling for cancer patients regarding advance directives and DNR (Do
Not Resuscitate) or MOST (Medical Order for Scope of Treatment) orders as needed,
primarily with inpatients.
Hospice
Hospice of Rockingham County, Inc. has provided the highest quality end-of-life care to over
6,000 local residents in the past 27 years. Using an interdisciplinary approach, Hospice of
Rockingham County, Inc. provides care to patients in their own homes, assisted living facilities,
nursing homes, independent living facilities, or the Hospice Home. The hospice team includes
nursing, social work, chaplaincy, hospice aides, trained volunteers, and the patient’s physician and
touts over 250 years of collective service.
Research
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Information about the availability of cancer-related clinical trials is provided to our
patients. Physicians will discuss clinical trials and will refer patients as appropriate.
Advance Healthcare Directives
Regular community sessions for the completion of an advance directive – Health Care Power
of Attorney and/or Advance Directive for a Natural Death (“Living Will”) – are held for the benefit
of the community under the leadership of Chaplaincy Services. Hospital staff members serve as
notaries and community members as witnesses. Individuals register for the sessions, and
materials are provided to help them understand the need for advance directives. Afterwards, extra
copies are made for the participants, and instructions are given for the placement of these copies.
A copy is placed in the hospital’s Health Information Management Department if the individual has
a medical record there.
The Social Worker at the Cancer Center assists patients who desire to complete their advance
directives while at the Cancer Center.
Pharmacy
The Oncology Pharmacy is located in the Smith-McMichael Cancer Center and is staffed
Monday through Friday by a pharmacist and pharmacy lab technician. This pharmacy complies
with the latest USP 797 regulations for sterile pharmacy compounding and hazardous medicinal
compounding. The pharmacist maintains a profile on each patient and prepares all of the
approximately 11,000 chemotherapy preparations that are administered each year at the Cancer
Center.
The pharmacist serves as a resource to patients for drug counseling or for information on any
aspect of their therapy regimen, including drug education, side-effects management, drug
procurement and pain control. The pharmacist, with support from the Department of Pharmacy
Services, works closely with the other members of the oncology staff to ensure the safe and
effective use of chemotherapy agents. Our pharmacists review the current literature and attend
seminars to stay abreast of the latest developments in cancer care, including cytotoxic drug
therapy, changes in cancer practice guidelines, and clinical trial availability.
Patient Education and Support
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Patient/Family Education and Support
The oncology nurse is vital when it comes to educating the patient. Patients and family
interrelate with nurses more than any other member of the healthcare team, providing a great
opportunity for the nurse to educate and reinforce the teaching at each encounter.
Nursing staff uses Oncology Nursing Society standards-based care to:
• Counsel patients and families for any cancer-related needs;
• Prepare patient education materials; and,
• Provide education to the community on cancer-related topics.
A variety of teaching tools and methods are used to educate the patient and family. The
choice of tools or methods used is based on each individual patient’s needs and abilities. Printed
materials, visual, and audiovisual educational materials are used in conjunction with verbal
discussion and continued reinforcement. These materials are from The National Cancer Institute,
the American Cancer Society and various pharmaceutical companies.
Patients receiving chemotherapy or radiation therapy are verbally informed, as well as given
written information on possible side effects of their therapy, home management, and how and
when to contact the nurse or the physician.
Support Groups/Services
• Chair Yoga
• Survivorship Meetings
• Look Good...Feel Better
• Community of Hope Support Group
• Lymphedema Clinic
• Speech Therapy
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Community Education, Awareness, and Screening Activities
Morehead Memorial Hospital and Health Education Services provide prevention and
education services to the local community throughout the year. These collaborative activities
utilize employees from many hospital departments as well as employees and resources from the
American Cancer Society.
Displays are taken to health fairs throughout the community on topics of general cancer,
specific cancers, and hospital cancer services. Health education services participated directly
in four major health fairs to provide cancer education information.
In addition to providing direct screening and health assessment services, the hospital is
committed to providing cancer education through media to the community. Two 30-minute radio
programs on breast cancer were produced and aired on a local radio station. Also, a breast cancer
television spot aired throughout the month of October on a local television station.
A free community colon cancer screening was offered. Seventy-one hemoccult kits were given
out. Two came back abnormal and were referred for follow-up.
Morehead Memorial Hospital also works diligently to support our local cancer organizations,
the American Cancer Society, and Susan G. Komen for the Cure.
In 2012 and in 2013, Morehead Memorial Hospital, together with collaborating partners,
received a grant from Susan G. Komen for $40,000 to provide free screening and diagnostic
mammograms to women in need. In Rockingham County 206 women were served through these
funds. Morehead directly screened 55 women of which 15 were abnormal and required further
follow-up.
www.morehead.org
The hospital’s web site features a recently updated Smith-McMichael Cancer Center web
page. Featured items include Patient Education, Patient Support Services and the previous year’s
annual report.
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Professional Education
Staff Education
Committed to maintaining the highest professional standards and keeping abreast of the
latest treatments and technologies, staff participates in ongoing cancer education. Each year,
continuing education with emphasis on oncology is completed by staff.
The nurses read credible, evidence-based oncology educational resources, such as “The
Clinical Journal of Oncology Nursing,” “The Oncology Nursing Forum,” and “ONS Connect,” to assist
in maintaining their expertise and knowledge. These are all official journals of the Oncology
Nursing Society.
The radiation therapists achieve and maintain their expertise and knowledge by reading the
publications of the ASRT (American Society of Radiologic Technologists, Radiation Therapists).
The staff also attends cancer conferences, Tumor Board and in-services, read other
professional journals that pertain to their specialty, and consult current peer-reviewed literature
on cancer and the care of the cancer patient.
Physician Education
CME programs presented at Morehead Memorial Hospital related to cancer and the treatment
of cancer included the following:
Preventing Complications In Mechanically Ventilated Patients Sarah S. Lewis, MD
STEMI and Hypothermia
Brian C. Hiestand, MD
Breast Density and Breast Cancer Screening
Beth Brown, MD
Customer Service for Physicians
Physician Panel
ResMeds Solution for COPD
Mike Shafer
Use of the MoCA (Montreal Cognitive Assessment)
James Parsons, MD
Computerized Physician Order Entry
Dionne Galloway, MD
Diagnosis, Staging, and Management of Lung Cancer
Boris Darovsky, MD
All were approved for one hour AMA PRA Category 1 Credit™ and for one hour American Academy
of Family Physicians Prescribed credit.
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Cancer Conferences (Tumor Board)
Morehead Memorial Hospital had 22 cancer conferences in 2014 with each approved for one
hour AMA Category 1 credit and AAFP Prescribed credit.
According to the American College of Surgeons Commission on Cancer requirements for
hospitals our size, the number of cases must equal or exceed 15% of the annual analytical
caseload, and these cases must be representative of the hospital’s cancer case mix.
The total number of analytical cases added to the database in 2013 was 330. Thus, 50 cases
were the required number for presentation. The actual number presented in 2014 was 108. The
average attendance at the monthly Tumor Board was 27 with all physician specialties involved in
cancer patient care being represented at each conference. These included surgeons, at least one
medical oncologist, a radiation oncologist, a pathologist and a diagnostic radiologist.
Cancer Registry
The Cancer Registry for Morehead Memorial Hospital was established January 1, 1995 to
collect, manage, and analyze statistical data on all cancer patients diagnosed and/or treated at the
hospital and the Smith-McMichael Cancer Center. The registry’s program is patterned to meet the
requirements of the American College of Surgeons Commission on Cancer and is designed to
describe characteristics, modalities of therapy and patient survival experiences. The main
objective of any cancer registry is to collect and abstract basic cancer information related to
Morehead’s cancer population that will assist the various members of the medical community in
evaluating the effectiveness of cancer treatments, which in turn can be used to improve patient
outcomes. Physicians and hospital administrators use this data to evaluate staffing and
equipment needs, cancer rates in our patient population, and diagnostic and therapeutic trends.
This data is also used to evaluate compliance with national standards of care.
A total of 416 cases were accessioned into the database in 2013. Of these, 330 were
analytical cases. Analytic cases include all reportable cases first diagnosed and/or receiving all or
part of their initial treatment at Morehead Memorial Hospital and/or Smith-McMichael Cancer
Center in 2013. This includes patients receiving part of their initial therapy elsewhere. The other
86 cases were non-analytic cases, which includes cases seen for the first time at Morehead
Memorial Hospital and/or Smith-McMichael Cancer Center for subsequent treatment but who
received at least one complete course of treatment elsewhere.
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The cancer registry maintains lifetime follow-up on patients entered into the database. It also
serves as a reminder to physicians and patients to schedule physical examinations to assure
continued medical surveillance in hopes of improving early detection of recurrent or metastatic
disease. Since January 1, 1995, a total of 5,228 cases have been accessioned into the database. Of
these 2,970 are analytic cases that have to be followed at least annually or until they expire or
reach 100 years of age. Of these, 2,970 patients have expired with a total of 2,257 to be followed.
The American College of Surgeons Commission on Cancer requires at least an 80 percent
follow-up rate on all analytic patients accessioned in the database since it was established. Our
current follow-up rate is 92% percent. The American College of Surgeons Commission on Cancer
also requires at least a 90 percent follow-up rate on all analytic patients accessioned into the
database in the last five years. Our current follow-up rate is 91.9% percent.
The registry also collected data to assist in the 2014 Patient Care Evaluation Studies looking
at endometrial patients diagnosed from 2010-2013.
In an effort to keep abreast of the many changes and current issues, the cancer registry
staff attends various educational meetings throughout the year provided by the National
Association of Cancer Registrars, Commission on Cancer and the North American Association of
Central Cancer Registries.
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Cancer Cases Diagnosed in 2013
Gender
Anatomical Site
Head and Neck
Stage
Male
Female
0
I
II
III
IV
N/A
Unk
Total
8
3
0
1
1
1
4
0
2
11
Digestive System
52
25
4
10
12
17
16
0
2
77
Respiratory System
44
41
0
14
4
20
32
0
3
85
Bones and Joints
0
0
0
0
0
0
0
0
0
0
Soft Tissue
1
1
0
1
0
0
0
0
1
2
12
3
3
6
2
0
1
1
0
15
Breast
1
67
13
17
18
3
5
0
1
68
Female Genital
0
21
0
6
3
3
3
0
2
21
Male Genital
39
0
0
4
14
3
2
0
0
39
Urinary System
11
4
4
2
0
1
2
1
1
15
Eye and Orbit
0
0
0
0
0
0
0
0
0
0
Brain and CNS
5
9
0
0
0
0
0
10
0
14
Endocrine System
5
4
0
1
0
1
2
3
0
9
12
7
0
3
1
2
5
0
3
19
Myeloma
3
6
0
0
0
0
0
8
0
9
Leukemia
4
6
0
0
0
0
0
7
0
10
Mesothelioma
1
0
0
0
1
0
0
0
0
1
Skin
Lymphoma
Miscellaneous
10
11
0
0
0
0
0
17
0
21
Stage 0: Carcinoma in situ (confined to its site of origin)
Stage I, II, III: Higher numbers indicate more extensive disease/larger tumor size and /or spread of the cancer beyond the organ in which
it first developed to nearby nodes and/or organs adjacent to the location of the primary tumor.
Stage IV: The cancer has spread to another/other organ (s).
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Primary Site by County
Primary Sites
Rockingham
Caswell
Guilford
Stokes
Henry
Pittsylvania
Floyd
Halifax
Total
Adrenal
0
0
0
0
0
1
0
0
1
Anus / Anal Canal
1
1
0
0
0
0
0
0
2
Brain / Spinal Cord
7
2
0
0
0
1
0
0
10
Breast
43
1
0
0
6
7
0
0
57
Cervix Uteri
2
0
0
0
0
0
0
0
2
Colon/Rectum
19
1
0
0
10
2
0
0
32
Uterian
8
0
0
0
2
3
0
0
13
Esophagus
4
0
0
0
0
1
0
0
5
Gallbladder
1
0
0
0
0
0
0
0
1
Gastric and Omental
1
0
0
0
0
0
0
0
1
Lymphoma
11
0
0
0
3
0
0
0
14
Hypopharynx
1
0
0
0
0
0
0
0
1
Kidney
2
0
0
0
1
0
0
0
3
Larynx
5
0
0
0
1
1
0
0
7
Lip / Oral Cavity
3
0
0
0
0
0
0
0
3
Liver
4
0
0
0
1
0
0
0
5
Lung
54
1
0
0
10
1
1
0
67
Major Salivary Glands
1
0
0
0
0
0
0
0
1
Melanoma of the Skin
8
0
0
0
1
1
0
2
12
Mesothelioma
1
0
0
0
0
0
0
0
1
Nasopharynx
1
0
0
0
0
0
0
0
1
Colon and Rectum
0
0
0
0
1
0
0
0
1
Oropharynx
3
0
0
0
0
0
0
0
3
Ovary
1
0
0
0
1
0
0
0
2
Pancreas
9
0
0
0
1
0
0
0
10
Penis
1
0
0
0
0
0
0
0
1
Prostate
16
3
0
1
1
0
0
0
21
Renal Pelvis/Ureter
1
0
0
0
0
0
0
0
1
Soft Tissue Sarcoma
1
0
0
0
0
0
0
0
1
Stomach
3
0
0
0
1
0
0
0
4
Testis
1
0
0
0
0
0
0
0
1
Thyroid
1
0
0
0
0
0
0
0
1
Thyroid
2
0
0
0
0
0
0
0
2
Unstageable Site
24
0
1
1
7
4
0
0
37
Urinary Bladder
6
0
0
0
0
0
0
0
6
Total
246
9
1
2
47
22
1
2
330
Because of our geographical location, many of our patients are from neighboring counties in Virginia, 21.8% from Virginia and 78.2%
from NC
18 | P a g e
Cases diagnosed and treated with any of the first course of treatment at Morehead after the
registry’s reference dates are defined as analytic (Class of Case 0, 1, 2). All accessioned cases are
assigned a Class of Case based on the nature of involvement of the facility in the care of the patient.
Class of Case 0: Diagnosed at Morehead and all first course of treatment was elsewhere or a
decision not to treat was made elsewhere.
Class of Case 1: Diagnosed at Morehead and all or part of the first course of treatment was
done at Morehead.
Class of Case 2: Diagnosed at another facility and had all or part of their first course of
treatment at Morehead.
In 2013, we had a total of 330 analytical cases accessioned in the cancer registry database. Of
these, 36(10.9%) were Class 0, 179 (54.2%) were Class 1 and 115 (34.9%) were Class 2.
19 | P a g e
Review of Endometrial Cancer Cases Diagnosed & Treated
at Morehead Memorial Hospital, 2000-2013
Written by William McLeod, MD
Endometrial cancer is the most common gynecological malignancy in the developed world.
Adenocarcinoma is the most common type. The mortality rate falls in the range of 1.7 to 2.4% per
100,000 women. 80% of patients present with abnormal uterine bleeding, the cardinal symptom
of endometrial cancer. Approximately 68% of the women with the diagnosis of endometrial
cancer have the disease confined to the uterus, translating into a 96% five year survival. Type I
tumors, with favorable histology (grade I and II) make up 80% of endometrial cancers. These
tumors have a good long term prognosis. Type II tumors account for 10 to 20% of endometrial
cancers (grade III, clear cell and serous) have a poor prognosis.
Purpose of the Review
Limited by the small number of patients receiving care over the thirteen year period, we
set out to ascertain if the quality of care maintains the standard of care.
In addition, we would like to determine if there are any significant variations in access to care in
our region.
Data Collection from 2000 to 2013
In conjunction with MMH Smith-McMichael Cancer Center, a chart review of all cases of
endometrial cancers managed were reviewed over a thirteen year period from 2000 to 2013 (94
total cases). The National Cancer Data Base (2000-2011) and Cancer Registry (2012, 2013)
served as the resource base. The statistical analysis was compared with community cancer
programs in all states (437) and the State of North Carolina (15).
20 | P a g e
Results and Analysis
Maintaining the standard of care is the good, therefore a comparison of all cases treated for
corpus uteri cancers were compared to community cancer program (CCP-AS 437) hospitals in all
states. MMH was similar to CCP-AS in multiple metrics. The age of diagnosis is similar between
MMH and CCP-AS with the peak age between 50-59 years of age at 28% and 60-69 years of age at
28%, shown in Appendix I. Correlating with CCP-AS data, the stage of corpus uteri cancer is most
often diagnosed in stage one as demonstrated in Appendix II. At the time, the most common
histological type is endometrioid cancer followed by adenocarcinoma at both MMH and CCP-AS,
Appendix III. Surgery is the first course of treatment in both MMH/CCP-AS. This is followed by
surgery and radiation and reflects the early stage of diagnosis, Appendix IV. There was no
difference in the co-morbidity medical conditions for individuals treated at MMH versus all CPP –
AS.
On the socio-economic front, insurance status of corpus uteri cancer treated at MMH vs.
CCP-AS shows no significant differences, Appendix V. However, a noted difference between MMH
and CCP-AS was observed in household incomes at the time of diagnosis: MMH has a 98% rate of
patients with an income level below $39,000 versus 46% with CCP-AS, Appendix VI. For all
treated patients, the distance traveled for treatment was less than 50 miles.
Conclusion
A total number of 131 patients were treated for endometrial cancer from the years 2000 to
2013. The review demonstrates access to care is good with no individual traveling more than 50
miles for treatment. The age, stage and histology at the time of diagnosis reflect national data. The
first course of treatment is similar to national data. Income levels of the treated population reflect
the demographics of the local geography and the access to quality care for corpus uteri cancer
reflects the national data.
21 | P a g e
Appendix I
Appendix II
22 | P a g e
Appendix III
Appendix IV
23 | P a g e
Appendix V
Appendix VI
24 | P a g e