Faulkner Hospitals Cancer Program

Annual Report 2010

Faulkner Hospitals Cancer Program | Annual Report 2010
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It has been another produc-
tive year at Faulkner Hospital
with regard to cancer care.
We have chosen prostate
cancer as our focus this year,
particularly because of the
rapid changes in this eld.
Faulkner Hospital has always
had a robust prostate cancer
screening and treatment
program and this has grown
with the addition of the new-
est generation DaVinci robot.
We have expanded clinical
services with traditional open
surgical procedures and robotic prostatectomy. Working with
our Dana Faber colleagues we are also able to refer appropri-
ate patients for the latest technology in radiation therapy for
prostate cancer when indicated. This is a eld with exciting
changes and advances and Faulkner Hospital continues to in-
vest in improving the services we offer.
This year was our scheduled site visit from the American Col-
lege of Surgeons. Our surveyors were impressed not only
with the volume of cancer care provided but also the compre-
hensive nature of the care in each service line and the commit-
ment of the providers, the members of the Cancer Committee
and hospital leadership. We were again certied by the Amer-
ican College of Surgeons as an Accredited Cancer Program.
Finally, a number of members of the Cancer Committee and
Medical Staff are participating in a state wide project looking
at best practices in mastectomy and implant based recon-
struction. I am co-chairing the state wide commission. Alex
Kauffman, RN (cancer committee), Dr. Yoon Chun (Plastic
Surgery), Dr. Stephanie Caterson (Plastic Surgery), Dr. Charles
Hergrueter (Chief of Plastic Surgery) and Dr. Pardon Kenney
(Chief of Surgery) are all participating in the statewide com-
mission to improve outcomes, not just for patients in our own
institution but across the Commonwealth.
These are just a few of the exciting activities in cancer care at
Faulkner Hospital. Please look through our Annual Report to
learn more about the work were involved in and feel free to
contact me if you are interested in an educational forum being
offered on any of these topics.
Summary of Faulkner Hospitals Cancer Program
MARGARET M. DUGGAN,
MD, FACS
CHAIR CANCER COMMITTEE
About Faulkner Hospital
Faulkner Hospital is a 150 bed, non-prot, community teaching hospital located in southwest Boston.
Founded in 1900, Faulkner Hospital offers comprehensive medical, surgical and psychiatric care as
well as emergency, ambulatory and diagnostic services.
Faulkner Hospitals Cancer Program | Annual Report 2010
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Faulkner Hospital has been an Accredited Cancer Program
governed by the American College of Surgeons, Commis-
sion on Cancer since 1980. An essential component of the
program is the Cancer Registry which maintains a data base
on all cancer patients diagnosed or treated at Faulkner Hos-
pital. The current registry is comprised of one full-time and
one part-time CTR and one part-time registry clerk. Registry
personnel coordinate the collection, management and analy-
sis of data, as well as lifetime medical follow up which pro-
vides information for epidemiological, clinical, and research
studies and for educational purposes.
In 2009, the registry accessioned 1,370 analytic cases and treat-
ed an additional 60 cases that were recurrences or non-analyt-
ic, totaling 1,430 new cancer patients added to our data base.
The Registry contributes data to the National Cancer Data
Base, Massachusetts Cancer Registry and Harvard School for
Public Health. This data is utilized for incidence monitoring,
cancer prevention and awareness, identifying high-risk popu-
lations and to help improve and standardize care across the
country.
The AJCC TNM (Tumor, Nodes, Metastases) staging system
is used to describe the extent of the spread of cancer and is a
valuable indicator of prognosis and survival. Figure 1 repre-
sents stage at diagnosis for all sites as compared to NCDB data
for 2009.
Figure 2 reects the top ten most frequently seen cancers at
Faulkner Hospital and compares their frequency to the Ameri-
can Cancer Society estimate of new cases for 2009.
Overall, the cancer program has continued to expand and
work cooperatively with other departments in the hospital to
improve patient care and satisfaction. Faulkner Hospital offers
the highest quality cancer care and being accredited by the
American College of Surgeons is one important way in which
we demonstrate our commitment to that promise.
Cancer Registry Activity Report
Comparison AJCC Stage at Diagnosis
FAULKNER
NCDB
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 No Stage Unk
35%
30%
25%
20%
15%
10%
5%
0%
Site Frequency
FAULKNER
NCDB
Colon Rectum Bron/Lung Hem/Retic Skin Breast Prostate Bladder Thyroid Lymph Node
80%
70%
60%
50%
40%
30%
20%
10%
0%
Faulkner Hospitals Cancer Program | Annual Report 2010
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From 2003-2009, 653 cases of prostate cancer were diagnosed and/or treated at Faulkner Hospital; in
the latter part of this time period, the number of cases treated increased markedly (from 75 cases in
2007 to 258 cases in 2009, in association with the advent of robotic prostatectomy).
A detailed analysis of the 258 cases diagnosed in 2009 shows that the median age of Faulkner
Hospital prostate cancer patients is almost a decade younger than the national average, suggesting
successful early detection. The stage distribution at Faulkner further supports this conclusion, with
the vast majority of patients at Faulkner presenting in Stage II (typically curable disease). Indeed,
the vast majority (83 percent) of Faulkner patients are treated surgically, rather than by radiation or
hormonal therapy, and Stage II patients at Faulkner enjoy a 90 percent ve-year survival, in keeping
with the national norm.
Analysis of Prostate Cancer Cases 2003-2009
Tad J. Wieczorek, MD, FCAP
Women trust the breast care program at Faulkner Hospital because theres nothing routine about the
care and attention we provide. We combine our highly regarded services with the resources and expertise
of Dana-Farber/Brigham and Womens Cancer Center.
As a leader in all aspects of breast care, we not only provide you with comprehensive care and
personalized service, but offer peace of mind that comes from knowing youre getting the very best
care, close to you.
Whether its time for your annual mammogram, or youre concerned about your risk factors,
or you need leading-edge treatment for breast cancer, turn to the names you trust for breast care,
working together to care for you.
For more information, or to schedule an appointment, please call 617-983-7500.
www.faulknerhospital.org
Three of the many expert breast health care physicians at the breast care
program at Faulkner Hospital, left to right, Dr. Yoon Chun, Plastic Surgery;
Dr. Peggy Duggan, Breast Surgery; and Dr. Shara Oken, Mammography.
Dana-Farber/Brigham and Womens Cancer Center at Faulkner Hospital.
Theres no such thing
as routine breast care.
Faulkner Hospitals Cancer Program | Annual Report 2010
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Under 20 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+
FAULKNER
NCDB
Comparison of Age at Diagnosis
45%
40%
35%
30%
20%
25%
15%
10%
5%
0%
Prostate Cancer
300
250
200
150
100
50
N
u
m
b
e
r

o
f

N
e
w

C
a
s
e
s
2005 2005 2007 2008 2009
Year
Comparison of Treatment
FAULKNER
NCDB
Surgery Radiation Rad/Hormone Hormone Other No 1st Course
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Comparison of Stage at Diagnosis
FAULKNER
NCDB
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Unk
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2003-2009 National Prostate Survival Rate
120%
100%
80%
60%
40%
20%
0%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 9
0 1 2 3 4 5
Years
2003-2009 Faulkner Hospital Survival Rate.
100%
80%
60%
40%
20%
0%
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Stage 9
0 1 2 3 4 5
Years
Faulkner Hospitals Cancer Program | Annual Report 2010
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Prostate Cancer is the most common cancer diagnosis in men.
The incidence increases with age the treatment approach will
depend on the extent of disease, patient age and other co-mor-
bidities. Faulkner Hospital has developed a comprehensive
program to address the needs of our patients with prostate
cancer, including the pre-operative and post-operative recov-
ery issues specic to theses cases.
Like many other cancers, prostate cancer can be treated by
multiple modalities. As seen in our report, the vast majority
of our cases are treated primarily by surgery. However, some
patients benet from radiation therapy as their primary mo-
dality and depending on a patients age, co-morbid conditions
and stage of disease watchful waiting and hormonal therapy
could also be employed.
The back bone of Faulkner Hospital comprehensive prostate
cancer program is excellence in surgical services. Our urolo-
gists perform a high volume of radical prostatectomies, both
traditional open and robotic approaches. In 2009 the number
of prostatectomies rose to 258 which is three times the number
just two years earlier. The majority of cases are performed
by Dr. Robert Eyre, Associate Professor of Surgery (Urology),
Dr. James Hu, Assistant Professor of Surgery (Urology), and
Dr. Steven Chang, Instructor in Surgery (Urology) at Harvard
Medical School.
When radiation is the preferred approach, we have an ac-
tive collaboration with the radiation oncology departments
at Brigham and Womens Hospital for patients who choose
brachytherapy or radiation therapy for curative or palliative
treatment. Under the leadership of Dr. Anthony DAmico the
department is internationally renowned for their extensive
research in prostate cancer. See the Frequently Asked Ques-
tions regarding prostate seeds by Dr. Paul Nguyen, also of the
BWH/DFCC. This collaboration allows patients who chose to
have their prostate cancer care at Faulkner access to excellence
and innovation in surgery, radiation and systemic treatments.
The strength of the program is the breadth and depth of the
experience and knowledge of the clinicians in the program.
Our major contributing surgeons are described below. Each
brings a unique area of interest to the program, making pros-
tate cancer care at Faulkner Hospital an example of excellence
in service, caring and outcomes. Each surgeon has developed
a patient focused practice where education and training, as
well as academic involvement, are a critical piece of the entire
patient experience
Dr. Eyre has given several presentations over the past year to
a variety of civic organizations about prostate cancer. He also
gave the Presidential Address at the annual meeting of the
New England Section of the American Urological Association
in 2008 about technical modications he has made over his
career to the open radical prostatectomy to reduce intraopera-
tive blood loss, shorten length of stay, reduce the time of post-
operative catheterization, reduce post-operative narcotic re-
quirement, and to achieve early continence. He currently has
three studies underway where he is utilizing date from his last
300 consecutive open prostatectomies that he has performed.
He is comparing the differences in reported margin positivity
between different institutional pathology departments with a
single surgeon experience. He is also looking at outcomes of
patients over the age of 70 who undergo open radical prostate-
ctomy, as well as outcomes of men with Gleason grade 4+3 or
higher who undergo radical prostatectomy.
Dr. Eyre has an interest in the surgical management of post-
prostatectomy incontinence. He has reported his experience
with the male sling at the annual meeting of the New England
Section of the American Urological Association and at the an-
nual meeting of the Massachusetts chapter of the American
College of Surgeons.
Dr. Hu is internationally known for his
groundbreaking research comparing robotic
prostatectomy to open prostatectomy using
a SEER database of Medicare patients. He
has published extensively on various aspects
of prostate cancer, including 16 papers either
out or in press for 2010. In 2010, 138 robotic-
assisted laparoscopic radical prostatectomies
were performed at Faulkner Hospital. The
overall positive margin rate was 12.5 percent and the median
length of stay was 1 day, which measures favorably with
published series. A complete list of Dr Hus publications is
available on the Faulkner Hospital website (www.Faulkner-
Hospital.org).
Dr. Chang has published articles this year on the utility of
ultrasensitive PSA in post-radical prostatectomy surveillance
of men, on the effect of common medications on serum PSA
in the cohort of men being screened for prostate cancer, and
about the factors that impact baseline preference for PSA test-
ing. His references cam also be found on Faulkner Hospitals
website.
Dr. Eyre and Dr. Paul Church provide a full range of treatment
options for post-prostatectomy sexual dysfunction. Each has
30 years of experience with penile prosthesis surgery.
Faulkner Hospitals comprehensive prostate cancer program
Dr. James Hu
Faulkner Hospitals Cancer Program | Annual Report 2010
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What is prostate brachytherapy?
It is the implantation of tiny permanent radioactive seeds
in the prostate through needles placed in the perineum. The
radioactivity kills tumor cells in the prostate and eventually
the seeds become inert within a year. At the DFCI/BWH, it is
performed under general anesthesia with robotic assistance
and real-time intraoperative planning. Patients go home the
next day with minimal discomfort and are often able to return
to work a few days later.
Who is eligible for brachytherapy?
Low-risk prostate cancer now represents the majority of
prostate cancers diagnosed in the United States. Patients with
low-risk disease (i.e. disease that does not occupy more than
half of one lobe on digital rectal examination, with Gleason
score 6 or less and PSA less than 10) are excellent candidates
for brachytherapy, and select patients with favorable
intermediate-risk disease (Gleason 3+4=7 with PSA<10 and
fewer than half of the cores involved with cancer) may also be
excellent candidates. Patients will need to be evaluated with
an ultrasound to ensure the gland is not too large (typically
>60cc) and that the anatomy is suitable for brachytherapy.
Are the outcomes as good as other treatments?
With follow-up data extending out to 15 years, the PSA
control outcomes for brachytherapy appear to be equivalent to
surgery for low-risk disease and select patients with favorable
intermediate-risk disease.
What are the most common side effects?
The main short-term symptoms are urinary frequency
and urgency which can be managed with medications and
generally improves after 2 months. In the long-term, some
men may develop erectile dysfunction which often responds
to oral phosphodiesterase inhibitors. Signicant long-term
rectal bleeding is uncommon.
Is the radioactivity a hazard to others?
The vast majority of the radiation is deposited within the
prostate with extremely minimal radiation outside the body.
Radiation detectors attached to spouses have shown that the
total lifetime radiation exposure to the spouse as a result of
their partners brachytherapy is less than what we receive
in a single roundtrip ight from Boston to California. As a
precaution, patients are advised to avoid very close contact
with pregnant women or placing infants on their lap for 2
months after the procedure.
How do I get a patient evaluated for brachytherapy?
They should be referred to Dr. Paul
Nguyen who is the Director of Prostate
Brachytherapy and lectures nationally
on the subject. Contact the DFCI referral
hotline (877) 441-DFCI (441-3324), or email
DFCIGUCREFERRALS@partners.org.
FAQs about Prostate Brachytherapy:
An Excellent Treatment Option for Low-Risk Prostate Cancer
Faulkner Hospitals Cancer Program | Annual Report 2010
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If there was a surgeon with eyes
that could see with the clarity of a high-
powered microscope and hands that
could move with the precisions of a robot,
would you choose that surgeon for your
procedure? At Faulkner Hospital you can.
Faulkner Hospital offers the newest da
Vinci robotic surgery system to help
surgeons perform minimally invasive
procedures such as prostatectomy,
hysterectomy and certain forms
of general surgery.
For more information please
call 617-983-7500.
If there was a surgeon
that could see with the c
powered microscope and
could move with the prec
would you choose that surg
procedure? At Faulkner H
Faulkner Hospital offer
Vinci robotic surger
surgeons perform m
procedures such
hysterectomy an
of general surg
For more infor
call 617-983-7
With the da Vinci

robotic surgery system, they can.

| Prostate surgery |
| Gynecologic surgery |
| General surgery |
1153 Centre Street, Boston, Massachusetts 02130
www.FaulknerHospital.org
Faulkner Hospitals Cancer Program | Annual Report 2010
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Faulkner Hospitals Surgical Quality programs have ensured
that surgical patients undergoing cancer surgery are receiving
quality care through numerous ongoing programs. In 2010
Faulkner Hospital has been recognized by two national
organizations, American College of Surgeons (ACS) and
University Health Consortium (UHC) as a top provider in
several surgical quality care initiatives.
The ACS National Surgical Quality Improvement Program
(ACS NSQIP) is the rst nationally validated, risk-adjusted,
outcomes-based program to measure and improve the
quality of surgical care. The program employs a prospective,
peer controlled, validated database to quantify 30-day risk-
adjusted surgical outcomes, which allows valid comparison of
outcomes among all hospitals in the program. The American
College of Surgeons noted Faulkner Hospital as an exemplary
provider in preventing surgical site infections (SSI). A SSI is
an infection that occurs after surgery in the part of the body
where the surgery took place. An exemplary rating means
that Faulkner Hospital is a national leader in preventing
surgical sites infections. Faulkner Hospital has earned this
honor for the past 3 annual reports.
The University Health System Consortium (UHC) is an
alliance of more than 100 academic medical centers and nearly
200 of their afliate hospitals, representing more than 90
percent of the nations nonprot academic medical centers. Its
products and services help members measure and improve
clinical performance...UHC has noted Faulkner Hospital
as a top 10 provider in several Surgical Care Improvement
Programs (SCIP). Areas where Faulkner Hospital is a leader
in surgical care are in use of the appropriate antibiotic prior to
surgery, Deep Vein Thrombosis (DVT) prevention, and the use
of Beta Blockers to prevent cardiac injury.
Finally, Surgical Quality Program is the adoption of the World
Health Organization (WHO) checklist. The implementation
of this checklist is designed to help ensure that surgical teams
are able to implement the checklist consistently. By following
a few critical steps, health care professionals can minimize the
most common and avoidable risks endangering the lives and
well-being of surgical patients.
Faulkner Hospital is committed in providing quality care
for the oncological patients to promoting smooth and
complication free recovery from lifesaving cancer surgery.
Any questions regarding surgical quality, contact Alexandra
Koffman, RN, MSN, Surgical Quality Program Manager.
Surgical Quality Programs for the Surgical Oncological Patients
Skin Cancer Screening
2010 marks the American Academy of Dermatologys 25th anniversary of the National Skin Cancer Screening Pro-
gram. Dr. Eva Balash, along with Faulkner Hospitals Community Health & Benets program, has participated in
this campaign since the inception. Although many doctors have participated through the years, Dr. Balashs prac-
tice, Boston Family Dermatology, offers the free program to the community every spring. When questioned about
her driving motivation to keep hosting the free screening, Dr. Balash responded, It is very important to provide
a screening service to people who may not otherwise see a doctor. I have had the profound experience of being
able to detect potential problems early on in many patients at the free screenings, and have helped them from
developing more serious conditions. Dr. Balash screened twenty four patients in the spring of 2010.
Community Outreach Programs
Faulkners early detection health screening programs were created in response to information received through
continual communication and collaboration with community residents, service providers, and advisory groups, as
well as through the review of health status indicators. In 2009, Faulkners cancer related screenings served 232
participants, all of whom received the services free of charge thanks to physicians, nurses, clinical specialists, tech-
nicians, and health educators who donated their time and expertise. Such screenings include: cervical cancer, skin
cancer, colorectal cancer, and breast cancer.
Faulkner Hospitals Cancer Program | Annual Report 2010
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Approximately 184,000 women are diagnosed with breast
cancer each year in the United States, and 90% of these
women will live at least 5 years. Improvements in immediate
treatment outcomes have led to an increased focus on
morbidity among survivors. The Journal of Breast Cancer
Research and Treatment, 2008, published an article by Lee
et al. which attempts to capture the prevalence of residual
functional impairments following surgery. They conducted a
systematic review of 32 studies which focused on prevalence
and severity of upper limb problems following surgery
and radiation for breast cancer. The review found shoulder
restrictions, upper limb weakness, lymphedema, pain, and
reduced quality of life are commonly reported outcomes of
surgery and radiation for early breast cancer for months to
years following surgery.

The Faulkner Breast Centre and the Faulkner Rehabilitation
Services Department have recently joined forces to create a
new post-op program for breast surgery patients which offers
the initiation of physical therapy immediately following
mastectomy, axillary lymph node dissection, and/or breast
reconstruction. It has been designed with input from breast
surgeons, plastic surgeons, and our nursing colleagues at
Faulkner Hospital, as well as research on inpatient physical
therapy programs at Brigham and Womens Hospital,
Memorial Sloan Kettering Cancer Center and University of
North Carolina Hospital.
Immediately following breast surgery, patients are faced with
pain, post-op drains, sensory decits, and postural changes
due to protective guarding. Often they lack knowledge of
safe range of motion exercises, receive conicting information
regarding activity precautions, and remain unaware of
lymphedema risk reduction strategies. Upper extremity
weakness, pain, lymphedema and decreased range of motion
in the shoulder are common impairments associated with
breast surgery and sentinel lymph node biopsy or axillary
lymph node dissection. These symptoms can range from mild
to severe and may become chronic, with a profound effect on a
patients quality of life.
The Rehabilitation Services Outpatient Department at
Faulkner currently treats post-op breast surgery patients
referred anywhere from weeks to months after surgery with
complaints of continued pain, scar adhesions, limited shoulder
range of motion and functional limitations. The patient will
work with a physical or occupational therapist to help regain
range of motion, decrease scar adhesions, manage swelling
and initiate an exercise program to guide the patient towards
their prior level of function. The department also offers
lymphedema treatment for patients who develop lymphedema
in their upper extremity secondary to lymph node dissection
and/or radiation. Patients referred to outpatient therapy
will often report lack of information, immediate anxiety post-
operatively and delayed initiation of range of motion exercises
following surgery.
This new program was developed with the aim of decreasing
pain, soft tissue restrictions and shoulder impairments
associated with delayed initiation of motion. It recommends
initiation of physical therapy for breast patients during their
inpatient stay when prescribed by the surgeon to ease patient
anxiety and provide patients with information regarding
gentle range of motion exercises and gradual return to prior
level of function. The purpose of the physical therapy visit
will be to educate patient on short term precautions, review
gentle active motion exercises and deep breathing techniques,
discuss gradual return to activities, and review lymphedema
risk reduction strategies. Patients will be given verbal and
written instructions consistent with updated information
listed in the Faulkner Hospitals A Guide to Breast Surgery
which patients receive prior to surgery. The program is
currently under nal stages of development and will be
available later this fall. Program will be provided to patients
with surgeon referral.
Initiating Physical Therapy Immediately Following Breast Surgery
Faulkner Hospitals Cancer Program | Annual Report 2010
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Committee Chair
Margaret Duggan, MD
Matthew Blom
American Cancer Society
M. Madeleine Glennon, CTR
Cancer Registry
Eileen Joyce, LICSW
Social Work
Alex Koffman, RN, MSN
Quality Improvement
Edward Liston-Kraft, PhD
Professional and Clinical Services
Harvey Mamon, MD, PhD
Radiation Oncology
Stacey Miller, CHES
Community Health & Benets
Dan Morganstern, MD
Oncology
Faina Nakhlis, MD
Surgery
Janet OConnor
Oncology Coordinator
Shara Oken, MD
Radiology
Rosemary Ryan, MD
VNA Care Network, INC.
Debra Torosian, MA, RHIA
Health Information Services
James Warth, MA
Oncology
Tad Wieczorek, MD
Pathology
Faulkner Hospitals Cancer Committee Membership
Breast MRIs done at Faulkner Hospital now available system-wide
Faulkner Hospitals Department of Radiology recently
announced that breast MRIs performed at the Sagoff Centre are
accessible on the Picture Archive and Communication System
(PACS). Referring physicians throughout the entire Partners
network can view images taken at Faulkner Hospital without
needing to request lm.
PACS solves many of the limitations that were associated with
lm, says Brian McIntosh, Director of Radiology. While lm
could only be available in one place at a time, which could
result in delayed patient care, PACS allows patient studies to be
viewed from any referring physician on a Partners computer.
While PACS enables increased efciency for physicians,
the system also benets the patient. Those patients whose
images are stored on PACS no longer need to contact Faulkner
Hospitals Image Service Center to request a CD of their scans
if they are being seen by a Partners physician. By eliminating
this step, it is more convenient for our patients. Its one less
thing they have to worry about, adds McIntosh.
Dr. Parisa Lot reviews a breast MRI recently performed at
Faulkner Hospitals Sagoff Breast Imaging and Diagnostic Centre.
Breast MRI appointments are available six days a week and
include evening and weekend hours at Faulkner Hospitals
Sagoff Breast Imaging and Diagnostic Centre.
1153 Centre Street
Boston, Massachusetts 02130
Telephone: 617-983-7000
www.FaulknerHospital.org