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2011 Annual Report - Cancer Treatment Center
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Introduction

A NETWORK OF CARE

Melanoma is the focus of this year's annual report. As the most serious form of skin cancer, melanoma is the fifth most common type of new cancer diagnosis in American men and the seventh most common type in American women.

Over the past 30 years, the incidence of melanoma
has increased steadily in Caucasians, with a greater than
60 percent increase. Rapid increases have occurred among Caucasian women aged 15 to 39 years, in whom incidence
has increased by three percent annually since 1992. Among
Caucasian men older than 65, melanoma incidence
has increased by 5.1 percent annually since 1975.

(Click the orange arrow button to read more)



Because cancer diagnosis and treatment often
involve multiple physicians and cancer
care services, navigating the process as a
patient can be overwhelming. Providing
individualized cancer care is a team effort.
From the dedicated physicians and nurses
to a coordinated network of support staff,
Regional West involves seasoned
professionals in every facet of cancer
diagnosis and treatment that collaborate
to develop the best treatment plan for each
individual. Regional West's cancer
program offers compassionate care with
the latest in screening, diagnosis,
treatment, and support services working
together to ensure the best possible
outcome for our patients.

Carol Willis, MD Chairman,
Cancer Committee

References: 1) National Cancer Institute;
www.cancer.gov 2) The Skin Cancer Foundation;
www.skincancer.org/skin-cancer-information/melanoma

The ABCDEs
of Melanoma

Asymmetry: The shape of one half of the mole does not match the other half.
Border: The mole's edges are ragged, notched, or blurred in the outline.
Color: Uneven color with shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
Diameter: Melanoma lesions are often greater than six millimeters in diameter, approximately the size of a
pencil eraser.
Evolving: The mole has changed size, shape, or color.

Melanomas do not all look the same. Many show all of the ABCDE features, but some may present with just one or two of the abnormal areas. In more advanced melanoma, the mole's texture can change. The mole may become hard or lumpy and the surface might ooze and/or bleed. Sometimes the melanoma becomes itchy, painful, or tender.






Melanoma Treatment

Melanoma treatment depends on the type and stage of the disease, the tumor's size and location, and the patient's general health and medical history. The best-case scenario is that the tumor is completely excised during the biopsy and no further treatment is required. If the tumor has spread, further surgery may be required, in addition to radiation therapy and/or chemotherapy.

Melanoma Prevention Guidelines

- Avoid sunburn.
- See your physician every year for a professional skin exam.
- Stay out of the sun during midday hours, especially between 10 a.m. and 4 p.m.
- Avoid tanning and UV tanning booths.
- Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
- Use a broad spectrum sunscreen with an SPF of 15 or higher daily.
- For extended outdoor activity, use a water-resistant, broad spectrum sunscreen with an SPF of 30 or higher.
- Use a higher SPF when you are at higher elevations.
- Apply one ounce (two tablespoons) of sunscreen to your entire body 30 minutes before going outside.
- Reapply every two hours or immediately after swimming or excessive sweating.
- Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
- Avoid sunbathing and tanning salons.
- Studies suggest that your risk of melanoma increases by 75% if you start artificial tanning before you are 30 years old.
- Examine your skin from the top of your head to the bottom of your feet every month.

References: 1) International Agency for Research on Cancer Working Group on Artificial Ultraviolet Light and Skin Cancer (2006). The association of use of sunbeds with cutaneous melanoma and other skin cancers: A systematic review. International Journal of Cancer, 120: 116-1122. 2) American Cancer Society: www.cancer.org

Regional West Cancer Program

ACCOMPLISHMENTS AND ACTIVITIES:
CANCER TREATMENT CENTER AND DORWART CANCER CARE CENTER

Conducted "A Time to Heal" program for breast cancer patients
at Dorwart Cancer Care Center.

Increased "Reach to Recovery" referrals.

Expanded PET/CT to provide additional day every other week
due to increased patient volume.

Improved post surgical education and management of PEG
and J-Tube placement; continued development of in-house
specialists for this service.

Worked with the Regional West Marketing Dept. to develop
a comprehensive Cancer Program marketing campaign
(print, television, and website).

Continued work towards NAPBC Accreditation
(Breast Center of Excellence).

Regional West Cancer Program

2012 GOALS

Head and neck case management as clinical goal.

Breast Cancer task force development as part of a programmatic goal toward improving
breast cancer care and potentially creating a Breast Cancer Center of Excellence.

2011

CANCER CONFERENCE

Regional West Medical Center held 24 bimonthly multidisciplinary Cancer Conferences in 2011 to review
and discuss current trends in the treatment of cancer. Coordinators for 2011 were pathologists Peter Schilke, MD
and Randall Williams, MD. Physician representatives from all the appropriate disciplines, as well as other
cancer health care providers, attend and participate in these conferences. Average attendance for physicians who
actively participated in cancer care was 12. The multidisciplinary average attendance was 39.


A decision was made at the August Cancer Committee meeting to change the date and time of the Cancer Conference meetings. Effective August 16 forward, only prospective cases will be presented. With this change comes a higher demand of patient cases that need to be presented as well as the method in which these cases are discussed.

The conferences will be held on first and the third Monday of each month at 7 a.m.

One hundred twenty-three cases were presented. Sites discussed included: breast, colon, rectum, lung, esophagus, parotid gland, liver, appendix, prostate, kidney, melanoma, lymphoma, head/neck carcinoma, vocal cord, base of tongue, and gastrointestinal.

In June, Robert Fine, MD, Herbert Irving Professor of Medicine, Director of Experimental Therapeutics Program at Columbia University Medical Center in New York, presented an "Update on Treatment of Metastatic Hormone Refractory Prostate Cancer."

In November, Linda Lawlis, MS, CCC-SLP, Speech Pathologist, Rehabilitation Center at Regional West Medical Center, presented "Speech-Language Pathologist's Role in Head and Neck Cancer."

To arrange for a case presentation at Cancer Conference or for further information regarding the Cancer Registry, please call 308.630.2421.

Cancer Registry

By Cindy Keller, CTR
Cancer Registry Coordinator

As a component of Regional West’s Cancer Program, the
Cancer Registry is responsible for the accurate and timely
collection of cancer patient data used for the evaluation
of patient outcomes. The Cancer Registry is responsible
for monitoring and coordinating many Regional West
Medical Center Cancer Program activities and our
participation in the American College of Surgeons (ACoS)
Commission on Cancer (CoC) as an accredited program.
We have been accredited since 1985. In March 2011,
the Commission on Cancer awarded Regional
West’s Cancer Program the Outstanding Achievement Award.
Since the inception of the Outstanding Achievement Award,
Regional West Medical Center has had the distinction of
achieving the award for three consecutive surveys.The CoC
establishes standards to ensure high quality, multi-disciplinary
and comprehensive cancer care delivery in hospitals throughout
the United States and grants accreditation only to those facilities
that have voluntarily committed to providing the best in cancer
diagnosis and treatment and are able to comply
with rigorous standards.


The Cancer Registry is responsible for the data collection and follow-up of all cancer patients diagnosed and/or treated at Regional West. These cases are part of the computerized database utilizing Rocky Mountain Cancer Data Systems in Salt Lake City, Utah. The updated registry computer system allows instant retrieval capabilities. The database includes information on demographics, anatomic site, extent of disease at the time of diagnosis, history, staging of the cancer, and treatment summary. The total number of analytic cases added to the registry in 2011 was 370.


In October, Regional West's Data Specialist and Cancer Registrar attended the 34th Annual Tumor Registrars Association of Nebraska TRAN workshop held in conjunction with the 7th annual Nebraska CARES Cancer Summit in Omaha, Neb. The meeting was hosted by Nebraska Methodist Hospital. The 9th annual Nebraska Cancer Center meeting and Annual Cancer Physician Liaison meeting were held at Methodist Estabrook Cancer Center. Christopher Pezzi, MD, FACS, Chairman of the Quality Integration Committee for the Commission on Cancer, presented "NCDB and the New Role of the Cancer Liaison Physicians" at the meeting.

A Network of Care

PATIENT NAVIGATOR

Non-Hodgkin’s Lymphoma cancer survivor Kim Croft, RN, BSN knows
from personal experience that hearing the words, “You have cancer,”
can be devastating. As Regional West’s Cancer Patient Navigator,
Croft coordinates the treatment plan and support services for each
breast cancer patient treated at Regional West—at no cost to the patient.
In her role as patient advocate, she coordinates office visits, treatments,
and any financial or emotional support the patient may need.




Patients have her cell phone number and know they can call 24/7. “I’m here to help in any way that I can,” she says.“I can promise you that, as a patient, you won’t get lost in the system here.” Croft works with 20 to 25 breast cancer patients at a time. Future plans are to expand the Patient Navigator service to other cancers.

“As a cancer survivor, I feel very strongly that we have an excellent cancer treatment program and are so fortunate to have the providers that we do,” she adds. “Our goal is to move our patients through their cancer journey with as much expertise, comfort, and compassion as possible.”

Regional West's

PSYCHOSOCIAL CARE COMMITTEE

Most cancer survivors admit that a cancer diagnosis
immediately turns their world upside down. Worry about
treatment side effects, finances, family, work commitments,
and the future can take over and lead to panic and ongoing stress.

According to Carol Diffendaffer, PMHP, PMSW, OSW-C, Oncology
Social Worker at Regional West, the changing landscape of cancer
patient care motivated the Commission on Cancer to develop new
standards to directly address patients’ needs and concerns.
With up to one third of cancer patients experiencing
ongoing psychosocial distress throughout their cancer
journey, the new standard ensures that cancer patients
receive an extra layer of support when dealing with the
stresses associated with a cancer diagnosis.




To address the challenge, Regional West’s Psychosocial Care Committee was initiated to work closely with the cancer program in identifying and addressing different kinds of psychosocial distress, including challenges with adjusting to illness, stresses associated with receiving radiation and chemotherapy, emotional needs, relationships and care giving, coping with pain, insomnia, and much more.

Implemented in 2012, the Psychosocial Care Committee works closely with the Cancer Care Team in identifying and addressing the psychosocial needs of cancer patients.

Since patients meet with multiple providers and staff throughout the treatment process, committee members instituted a screening tool for measuring distress during the patient's initial Cancer Treatment Center visit. The Distress Thermometer, a single-item measure, asks respondents to rate their distress during the last week on an 11-point scale ranging from "no distress" (0) to "extreme distress" (10). The second part of the tool includes a list of 34 problems grouped into five categories (practical, family, emotional, spiritual/religious, and physical). By checking "yes" or "no," patients indicate which, if any, of the items have posed a problem for them in the past week. Health care professionals can then provide specific help, such as increased pain relief, financial counseling, etc.

Diffendaffer says that one of the tool's main benefits is that it allows patients to voice their concerns. She says that some people may be reluctant to discuss their concerns with staff they perceive to be too busy, not wanting to be seen as demanding or difficult.


"Knowing what stresses are impacting
a patient’s cancer journey helps those
of us connected with his or her care get
to the heart of where stress is coming
from,” she says.

“The screening tool allows us to provide
the tools, resources, and options to best
help our clients take control of and
manage the issues that are negatively
affecting their cancer journey."

Three in a Row

ACoS OUTSTANDING ACHIEVMENT AWARD

Regional West Medical Center is one of just 14 cancer
programs nationwide to earn three consecutive
Outstanding Achievement Awards from the American
College of Surgeons Commission on Cancer.

The award signifies that Regional West’s cancer
program is one of an elite group of exceptional cancer
programs nationwide. It recognizes outstanding effort
and commitment by the entire Regional West cancer
team—from administration to clinical and volunteer
staff—who provide high quality cancer care
to Regional West patients.



"Part of what sets Regional West's Cancer Program apart from the rest is its personalized approach and warm, supportive environment," says Jeff Kriewald, Director of Regional West's Cancer Treatment Center and the Dorwart Cancer Care Center
in Sidney.

"Our patients benefit from a customized, comprehensive care program designed by a highly skilled team of cancer specialists, including our experienced medical oncologists, radiation oncologist, surgeons, radiologists, pathologists, and family practice physicians, as well as skilled oncology nurses and other specially trained staff."





Kriewald says that physicians like Mark Hartman, MD, who serves as Medical Director of the Radiation Oncology Department, have been instrumental in helping expand Regional West's cancer program to where it is today. As the only board-certified radiation oncologist in the panhandle, Dr. Hartman works with cancer patients on a daily basis and has been an integral part of the cancer program's growth.

"We are able to offer the care and services that we do, thanks to professionals like Dr. Hartman," says Kriewald.

"This award is a testament to the efforts of those who provide superior cancer care to our patients every day."

The Team Approach to Cancer Care

When Alliance resident Mike Laverty was diagnosed with prostate cancer last August, a friend suggested that he get treatment at
world-renowned Johns Hopkins Cancer Center in Baltimore, MD. Mike’s surgeon, John Kabalin, MD, of Scottsbluff Urology Associates,
had graduated from Johns Hopkins School of Medicine, so he saw a natural connection and contacted the center. After visiting with a
Johnss Hopkins physician, Mike knew he’d receive excellent care there, so he proceeded with treatment…
at Scottsbluff’s Regional West Medical Center.









“I showed the Johns Hopkins doctor a copy of my treatment plan developed by Regional West physicians, and he said it was exactly the same plan that they would follow in Baltimore, so I decided to stay home for treatment,” says Laverty.

"Having surgery and radiation therapy just an hour from home has been wonderful. Family and
friends have been nearby the whole time and I can't imagine receiving better cancer care anywhere."

He especially appreciates not having to take extended time away from his job. During the course of 38 radiation treatments, Mike would have a morning treatment in Scottsbluff and soon be back in Alliance for a full day of work.

"Had I gone to Baltimore or Denver for treatment, this wouldn't have been possible," he says. "When I first met with Dr. Hartman to talk about radiation therapy, he handed me his cell phone number and told me to call him anytime — I couldn't believe it. Do the research—the care here is outstanding. Why would you go anywhere else?"






2012 Cancer Survivors'
Day Keynote Speaker

SPREADING HOPE THROUGH SONG

Charlie Lustman has led a rich and varied life, from
working as a commercial jingle writer in New York City,
enjoying fame as a popular recording artist in Denmark,
and being named the musical director for ABC’s Mike
and Maty Show. It wasn’t until Charlie developed
osteosarcoma, a rare form of cancer, that he embarked
on his life’s passion of sharing his survivorship journey
with others through writing and song.

Charlie has now taken his musical HOPE campaign
on the road and travels throughout the U.S. reaching out
to people with his message of empowerment and
overcoming life’s obstacles. He offers insight and hope
for cancer survivors and their friends and family as they
travel the path of survivorship.

As the keynote speaker and entertainment for this year's Regional West
Cancer Survivors' Day celebration held April 15, Charlie traveled over 3,000
miles from his home in Hawaii to entertain and inspire the crowd of almost 400
survivors, family, and friends.

“I want people to be inspired to live life like they’ve never lived before, and love
the people who surround you,” he says, quoting a line from one of his songs.
“All that we have in the end is each other, my friend.”

Cancer Committee Membership

Carol Willis, MD | Chairman, Cancer Committee | Pathologist
Todd Sorensen, MD | President/CEO Regional West Health Services
Vincent Bjorling, MD | Medical Oncologist
Ernest Bussinger, MD | Obstetrician/Gynecologist
Mark Hartman, MD | Radiation Oncologist
John Kabalin, MD | Urologist
Regine Leconte, MD | Medical Oncologist (Effective 5/3/10)
Clinton Merrill, MD | Medical Oncologist
William Packard, MD | Medical Oncologist (Retired 12/31/10)
Peter Schilke, MD | Pathologist
Richard Simmons, MD | Pathologist
Melissa Stade, MD | General Surgeon
Jason Walsh, MD | General Surgeon
Randall Williams, MD | Pathologist
Katie Metz, PA-C | General Surgery
Vance Siedenburg, PA-C | Radiation Oncology
Becci Bowman, RN, MSN, APRN | Internal Medicine
Sue Schoeneman, RN, BSN | Medical/Oncology
Christine Buhr, RN, BSN | Unit Mgr., 3rd Floor
Carol Diffendaffer, PMHP, PMSW, OSW-C | Social Worker
Jan Taylor, MT, (ASCP) | Vice President, Ancillary Services
Shirley Knodel, RN, MS | Chief Nursing Officer/Vice President, Patient Services
Nancy Sloan, Pharm.D. | Clinical Pharmacist
Cindy Keller, CTR | Cancer Registry Coordinator
Jeff Kriewald, B.S. RT(R)(T) | Director, Cancer Services
Kent Dunovan, PT | Director, Rehabilitation
Linda Rock, BA | Director, Prairie Haven Hospice
Rob Flynn, BSN, RN | Director, Medical Oncology Unit/2W2E/Peds (Relocated 3/2011)
Judith Heigel, CPMSM, CPCS | Medical Staff Coordinator
*Clinton Dorwart, MD | Family Practitioner, Sidney Regional Medical Center, Sidney
*Julie Glover | Director of Health Initiatives, American Cancer Society, Nebraska Region High Plains Division

*Honorary member


Physician Liaison Report

By JASON WALSH, MD | General Surgery

Regional West Physicians Clinic-Surgery, Vascular Diagnostics

As the American College of Surgeons Cancer Liaison Physician
for Regional West Medical Center, Jason Walsh, MD promotes
communication and collaboration between this organization, the
Heartland Division of the American Cancer Society, Regional West
Medical Center Cancer Committee, and local community agencies.
Dr. Walsh is responsible for evaluating, interpreting, and reporting
Regional West’s performance using the National Cancer Data Base
(NCDB) to the Cancer Committee. He serves on the Surgery
Committee and the Pharmacy and Therapeutic/Infection Control
Committee at Regional West.

In March 2011, Dr. Walsh, along with the Cancer Treatment Center Director and Cancer Registrar, attended the Commission on Cancer Survey Savvy: Investing in Quality Patient Care workshop in Chicago, Ill. The two day workshop provided information and tools on how to implement the new 2012 Cancer Program Standards. The workshop illustrated how to improve patient care and outcomes as well as how to communicate new methods to improve team involvement in the success of the cancer program.

2011

COMPARISON OF CANCER DATA

There were 417 cases of cancer and reportable tumors in the Regional West Medical Center Cancer Registry for 2011.
Of these, 47 cases were non-analytic, with a total of 370 cases qualifying for analysis (). Breast Cancer is the most frequently diagnosed and treated primary site at Regional West. All graphs shown include analytic cases only.


2011

COMPARISON OF CANCER DATA



2011

COMPARISON OF CANCER DATA



Cancer Incidence By Primary Site

2011 CASES

Cancer Treatment Center and Dowart Cancer Care Center

Primary Site Table M = male, F = female, AJCC Stage Grouping T, N, and M categories describe the anatomic extent of disease.
Stage groupings gather cases into homogeneous categories to facilitate analysis. See glossary.

(Click table to view larger. Click the orange arrow button to view the rest of the table.)

Cancer Incidence By Primary Site

2011 CASES - Continued

Cancer Treatment Center and Dowart Cancer Care Center

Primary Site Table M = male, F = female, AJCC Stage Grouping T, N, and M categories describe the anatomic extent of disease.
Stage groupings gather cases into homogeneous categories to facilitate analysis. See glossary.

(Click table to view larger)

Cutaenous Melanoma

By CAROL WILLIS, MD, MBA, FCAP

Pathology | Regional West Medical Center Laboratory Services

Cutaenous melanoma is a form of cancer that begins in melanocytes (cells that make the pigment melanin). Melanoma may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines. There are 76,250 estimated new cases of melanoma in the United States in 2012 with an estimated 9,180 deaths (1). The majority of cutaneous melanomas are diagnosed early (American Joint Committee on Cancer (AJCC) Stage 0 -1). Stage 0-1 melanomas have a greater than 90 percent five-year survival rate.

References: 1.) http://www.cancer.gov/cancertopics/types/melanoma

Structure of the skin
The outer layer of skin is called the epidermis and is made primarily of specialized cells called keratinocytes but has several other minor cell populations. The bottom layer is formed of basal keratinocytes abutting the basement membrane. The basement membrane is formed from products of keratinocytes and dermal fibroblasts, such as collagen and laminin, and is an important anatomical and functional structure. Additionally, in the epidermal compartment, melanocytes distribute singly along the basement membrane and can transform into melanoma. Melanocytes are derived from neural crest cells and migrate to the epidermal compartment near the eighth week of gestational age. Langerhans cells, or dendritic cells, are a third cell type in the epidermis and have a primary function of antigen presentation. These cells reside in the skin for an extended time and respond to different stimuli, such as ultraviolet (UV) radiation or topical steroids, which cause them to migrate out of the skin.

Who is at risk for melanoma?
Anyone can get melanoma, as it affects both men and women. Genetics plays a role in approximately five percent of patients with melanoma. Although melanomas may be found in places on the body never exposed to the sun, the major risk factor is cumulative exposure to sunlight which is why the majority of melanomas are diagnosed after the fifth decade (see graph: Age at Diagnosis). Although dark skin does not burn in the sun as easily as fair skin, everyone is at risk for skin cancer. Even people who don't burn are at risk for skin cancer. It doesn't matter whether you consider your skin is light, dark, or somewhere in between. Sunlight causes damage to the skin through ultraviolet, or UV rays (they make up just one part of sunlight). Two parts of UV, UVA and UVB, can both cause damage to skin (2).

What does Melanoma look like?
A change on the skin is the most common sign of skin cancer. This may be any new growth on the skin, a sore that doesn't heal, or a change in an old growth. Melanomas are typically characterized by asymmetry, border irregularity, color variation, a diameter of more than six mm, and evolution (ABCDE criteria).

Treatment and Prevention
Although wide surgical excision remains the mainstay of treatment (see graph: First Course Surgery), the best treatment is still prevention. Avoiding unnecessary exposure to sunlight and wearing protective clothing will prevent most of these cancers. Regular sunscreen use may reduce the risk of developing melanoma, according to results of a randomized controlled trial that was reported December 6, 2010 in the Journal of Clinical Oncology. The trial is the first prospective, randomized study to investigate the link between sunscreen use and melanoma. The study concluded that among adults age 25 to 75 years, regular application of SPF 15+ sunscreen in a five-year period appeared to reduce the incidence of new primary melanomas for up to 10 years (3).

References: 2.) http://www.cancer.gov/clinicaltrials/results/summary/2010/sunscreen-melanoma2010
3.) http://www.cancer.gov/cancertopics/pdq/genetics/skin/HealthProfessional/page4#Section_39

Melanoma

BY JOHN BLOMSTEDT III, DO

Regional West Physicians Clinic-Family Medicine, Gering

Skin cancer is the most common of all human cancers. For example, over one million new cases of non-melanoma skin cancer will be diagnosed this year. Basal cell skin cancer accounts for 80 percent of all skin cancers and is the least likely to metastasize, accounting for only two percent of skin cancer deaths. There will be over 200,000 cases of squamous cell skin cancer, or 20 percent of all skin cancers, and will account for four to six percent of skin cancer deaths. Malignant melanoma, on the other hand, accounts for only five percent of skin cancers but accounts for 75 percent of skin cancer deaths.





Cutaneous melanoma is becoming a much more common disease and is being diagnosed in our institution and around the world on a much more frequent basis. The incidence of melanoma has increased by 50 percent during the past decade at a rate faster than any other malignancy except lung cancer in women. In Australia, a continent of mostly Caucasian population and sun-bleached beaches, malignant melanoma is reaching nearly epidemic proportions. The disease is largely confined to Caucasians and the age-adjusted incidence rate in the United States is approximately 12 per 100,000. In 1935, only one in 1,500 people developed melanoma. This year we expect the incidence will be one in 50 people.

The typical melanoma patient has fair complexion and a tendency to sunburn. Red hair was associated with a tripling of relative risk and blond hair with a 60 percent risk increase.

Melanomas can be located anywhere on the body. In women they most commonly occur on the lower extremities. They occur most commonly on the back in men, however women are now getting them on their trunk as commonly as men. Typical features of cutaneous melanoma include asymmetry, irregular borders, multiple colors, a diameter greater than 6mm, and an evolving lesion.





With increasing efforts in education, more patients are presenting earlier with suspicious melanotic lesions and most new patients are diagnosed earlier in the disease process when it is simply cured by surgical intervention. Nevertheless, malignant melanoma, diagnosed late in its course, is a lethal disease. The incidence of and mortality from cutaneous melanoma are rising steadily among white populations throughout the world. In fact, the incidence is doubling every six to 10 years.

Exposure to sunlight, or ultraviolet radiation, is considered the major cause of cutaneous melanoma. The development of melanoma is multifactorial and appears to be related to multiple risk factors, including fair complexion/sun sensitivity, excessive childhood sun exposure and blistering childhood sunburns, an increased number of common or atypical/dysplastic nevi (moles), a family history of melanoma, the presence of a changing mole or evolving lesion on the skin, and, importantly, older age.

The primary mode of therapy is surgical excision of the lesion in question. The size of excision is based upon the Breslow thickness and nodal involvement. With low risk lesions, surgical excision may be adequate.





With high-risk lesions, adjuvant chemotherapy and biomodulation with Interferon Alfa has been utilized. Systemic chemotherapy for Stage IV disease remains unsatisfactory. Chemotherapy protocols utilizing DTIC and Cisplatin have been utilized with some success and these chemotherapy regimens have been combined with various doses of Interferon Alfa and Interleukin. A new treatment with great promise is BRAF inhibitors, and is the first to show increased survival rate. There is continued research in the area of medical treatment for malignant melanoma.

In a society where appearance is so important and where being tan is equated with a healthy appearance, it is little wonder that the incidence of malignant melanoma is increasing. There has been a big push in education to warn of the risks of UV radiation, and steps have been taken to decrease the use of tanning beds. Heroic efforts have been undertaken in Australia to deal with the “epidemic” of melanoma and have even included roadside billboards encouraging people to wear hats, wear long sleeves, and wear their sun block. Using the motto “slip, slap, and slop,” the incidence of sunscreen use in Australia has shown improvement and we should adopt it here.

Melanoma of the Skin
Diagnosed 2000-2009

National Cancer Data Base: Benchmark Reports All States – 1416 hospitals (395,179 cases), Hospitals in Nebraska
– 11 hospitals (1877 cases), and Regional West Medical Center (101 cases)

Source: 2012 National Cancer Data Base (NCDB), Commission on Cancer (CoC)

Melanoma of the Skin
Diagnosed 2000-2009

National Cancer Data Base: Benchmark Reports All States – 1416 hospitals (395,179 cases), Hospitals in Nebraska
– 11 hospitals (1877 cases), and Regional West Medical Center (101 cases)

Source: 2012 National Cancer Data Base (NCDB), Commission on Cancer (CoC)

Melanoma of the Skin
Diagnosed 2000-2009

National Cancer Data Base: Benchmark Reports All States – 1416 hospitals (395,179 cases), Hospitals in Nebraska
– 11 hospitals (1877 cases), and Regional West Medical Center (101 cases)

Source: 2012 National Cancer Data Base (NCDB), Commission on Cancer (CoC)

Melanoma of the Skin
Diagnosed 2000-2009


Glossary of Terms

AJCC STAGE: American Joint Committee on Cancer Staging Scheme using tumor size, node involvement and metastases to distant sites, T=primary tumor size; N=regional lymph node involvement; M=metastasis or distant spread

AJCC STAGE GROUPINGS (FOR MOST SITES): Stage 0: Carcinoma in-situ Stage I: Localized carcinoma Stage II: Limited local extension and/or limited regional lymph node involvement Stage III: More extensive local extension or regional lymph node involvement Stage IV: Involvement of distant sites

ANALYTIC: Cancer cases initially diagnosed and /or having received all or part of the first course of treatment at Regional West Medical Center

FIRST COURSE OF TREATMENT: Planned definitive therapy initiated within four months following initial diagnosis

NCDB: National Cancer Data Base

OBSERVED SURVIVAL RATE: The literal survival rate from counting each case in the Registry

STAGE GROUPING PURPOSE: T, N and M categories describe the anatomic extent of the disease. Stage grouping gathers cases into homogenous categories to facilitate analysis

UNKNOWN: Tumor is said to be unknown when the stage cannot be determined from the medical record or a medical authority

2011 Cancer Treatment Center Annual Report

Regional West Medical Center
Cancer Treatment Center
3911 Avenue B | Suite G100
Scottsbluff, NE 69361
Attention: Cindy Keller, CTR
Cancer Registry Coordinator



Phone: 308.630.2421
Email: Kellerc@rwmc.net
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2011 Annual Report published October 2012

Teresa Clark, Editor

Table of Contents

303.635.3711  |   Email  |   rwmc.net  |   Download PDF
Table of Contents
41%, All other sites 20%, Breast 12%, Prostate 14%, Lung/Bronchus 8% Colon 5% Bladder 47% All other sites 18% Breast 11% Prostate 12% Lung/Bronchus 8% Colon 4% Bladder 47% All other sites 18% Breast 11% Prostate 14% Lung/Bronchus 6% Colon 4% Bladder 5 0.5 13 17 63 0.5 6 7 87 6 10 13 69 1 #lancaster #lincoln #keith #deuel #kimball #cheyenne #banner #grant #garden #morril #ScottsBluff #cherry #box_buitte #sheridan #dawes #sioux