not be the success
it is without the
Robert Wollman, M.D.
2008 Cancer Committee Members Table of Contents
Saint John’s Health Center
Robert Wollman, MD, Radiation Oncology, Chairman
Letter From The Chairman 1
Trista Aarnes-Leong, RHIT, CTR, Cancer Registry
Warren Allen, MD, Pathology; Cancer Conference Coordinator Breast Cancer Report – Alice P. Chung, MD 3
Richard Andersen, PharmD, Pharmacy
Robert Andrews, MD, Otolaryngology 2008 Primary Site Table 6
Julie Ascher, Regulatory Compliance Manager
Cancer Registry Stats 7
Mary Bomba, MDiv, Chaplain Services
Stanley Brosman, MD, Urology
Cancer Liaison Physician Report 9
Mary Jo Byrne, MSW, Social Work
Rebecca Crane-Okada, PhD, RN, AOCN, CNS, Clinical Nurse Researcher
Pain Management Pharmacist 2008 Report 10
Maggie DiNome, MD, General Surgery; Community Outreach Coordinator
Margaret Eade, Service Line Director Spiritual Care Report 13
Teresa Fan, PharmD, Pharmacy
Janice Frost, RN, Interim Oncology Director Social Services Report 13
Mark Faries, MD, Surgical Oncology; QA Coordinator
Positive Appearance Center Report 14
Tiffany Grunwald, MD, Plastic Surgery
Omid Hamid, MD, Hematology/Oncology
Community Education – Cancer Center Outreach 14
Kathryn A. Henick, MD, Hematology/Onc; Cancer Registry Data Coordinator
Chia Chi Kao, MD, Plastic Surgery
Pathology Department 15
Daniel F. Kelly, MD, Neurosurgery
Ian Levin, MD, Diagnostic Radiology Cancer Conferences 1 16
Mary Luthy, Community Benefits
Doug Maier, Regulatory Affairs Diagnostic Radiology 17
Michael Nicholl, MD, Surgical Oncology
Cancer Registry 17
Margaret Pfeiffer, RN, MSN, Vice President Patient Care
Lisa Schwartz, MD, Radiation Oncology
Inpatient & Outpatient Services 18
Gagandeep Singh, MD, Cancer Liaison Physician
Deb Weintraub, MPH, American Cancer Society
JWCI Breast Center 19
Saint John’s Health Center • 1328 Twenty Second Street • Santa Monica, CA 90404 • www.cancercenters.stjohns.org
Letter from the Chairman
As chairman of the Saint John’s Health Center Cancer Committee, I am pleased to present our 2008 Oncology
Annual Report. The Cancer Program at Saint John’s Health Center continues to grow and expand.
The Oncology Annual Report details the activities of the Cancer Program at Saint
John’s Health Center but some of the highlights include:
• In-depth Analysis of Breast Cancer by Dr. Alice Chung
• Cancer Liaison Physician Report
• Cancer Registry Statistics
• Pain Management Report
• Clinical Trials Report
• Community Outreach Report
The Cancer Committee sets goals each year. The following goals were set and achieved in 2008:
• Community Outreach Activities that included programs presented on Colorectal Health,
Melanoma Awareness, and updates on Breast Cancer Research & Treatment.
• Quality Improvement Activities included Patient Satisfaction Scores, Improvement in Turn
Around Time for Physician Orders, and Decreasing Patient Length of Stay.
• Clinical Improvement Activities for staff included a pain management symposium for nursing personnel,
pain management education for new nursing graduates, and pain assessment education for staff.
• Programmatic endeavors include on-going review and updates on the cancer program
standards to ensure compliance at the time of three year accreditation survey.
Breast cancer is the focus of this Oncology Annual Report. Dr. Alice P. Chung, Assistant Director of the Breast
Center at Saint John’s Health Center evaluated the survival and treatment options for patients with breast cancer.
Our Cancer Program would not be the success it is without the support and enthusiasm of its members.
I would like to thank all of the physicians, nurses, and administrative staff who have graciously offered
their time and talent to making our Cancer Program a success throughout the 2008 year.
Robert Wollman, MD
Department of Radiation Oncology
Chairman, Cancer Committee
Robert Wollman, MD
Alice P. Chung, MD
2008 Oncology Report:
Breast Cancer At Saint John’s Health Center
Alice P. Chung, MD opening of the new Howard Keck Center, patients will have
Assistant Director, Breast Center access to the most updated technology in breast imaging,
Saint John’s Health Center; Lead Investigator housed in the Margie and Robert E. Petersen Breast Center,
as well as radiation oncology, located in the Vasek Polak
Partha S. Ray, MD Radiation Therapy Center. The Positive Appearance Center,
Surgical Oncology Fellow, John Wayne located in the Breast Center, carries an array of garments
Cancer Institute; Co-Investigator that address the cosmetic side effects of breast cancer.
Treatment for our patients is tailored to each individual
reast cancer affects about 1 out of and may include surgical excision with or without breast
every 7 women and is the second reconstruction, chemotherapy or hormonal therapy with the
most common malignancy in women, opportunity to participate in national clinical trials, genetic
counseling, and prevention and treatment of lymphedema.
following skin cancer. It is the second
leading cause of cancer-related death in With the latest recommendations set forth by the U.S.
women after lung cancer. Approximately Preventive Services Task Force, screening guidelines
200,000 new breast cancer cases are for breast cancer have come into question. Along
diagnosed each year, and over 40,000 with the American Cancer Society, Saint John’s Health
breast cancer deaths are reported per year. Center recognizes the importance of early detection
in the prevention and treatment of breast cancer. The
following breast cancer screening guidelines have
The John Wayne Cancer Institute at Saint John’s Health been maintained by the American Cancer Society:
Center, where the sentinel node biopsy was pioneered by
Drs. Donald Morton and Armando Giuliano, is recognized 1. Annual screening mammography starting at age 40
as one of the largest tertiary referral centers in the greater 2. Clinical breast examination every 3 years
Los Angeles area for patients with breast cancer. With the between age 20-39, and yearly at age 40
3. Self breast examination
monthly starting at age 20
Figure 1: Breast Cancer Patients by TNM Stage:
One modification that has been made in the
guidelines as a result of the U.S. Task Force
recommendations is that women should be
counseled that self breast examination has
both benefits and limitations. Because research
has shown that self breast examination plays
a very small role in cancer detection, it is now
acceptable for women to choose not to do this
exam or to do it less frequently. Women who
are considered to have an increased risk of
breast cancer should speak to their physicians
about the most appropriate screening program,
which may include the addition of breast
MRI. Significant risk factors include strong
family history, genetic mutation carriers, and
prior radiation exposure to the chest wall. Figure 2: Breast Cancer Patients by Age at Diagnosis:
Saint John’s Experience 2008:
In the year of 2008, 438 patients were
diagnosed with breast cancer, and 485 were
treated for breast cancer at Saint John’s Health
Center. Nineteen percent presented with Stage
0 disease; 43% were Stage I; 25% were Stage
II; 9% were Stage III, and 2% presented with
Stage IV disease (Figure 1). Over 50% of
patients were diagnosed between the ages of
50 and 69. However, 23% presented between
the age of 30 and 49, and 24% of patients
were over 70 (Figure 2). The primary diagnosis
was infiltrating ductal carcinoma, followed
by infiltrating lobular carcinoma and ductal Figure 3: Breast Cancer Patients by Histologic Type:
carcinoma in situ, with a small percentage
of patients presenting with other subtypes
(including micropapillary invasive carcinoma
and mucinous adenocarcinoma) (Figure
3). Over 60% of patients were treated with
surgery alone as the first course of treatment,
while 15% were treated with surgery and
radiation alone. Those that had chemotherapy
and/or hormonal therapy in addition to
surgery as their first course of treatment
represented less than 10% of all breast
cancer cases (Figure 4). In 2008, there were
4 breast cancer deaths and 38 breast cancer
recurrences that presented at Saint John’s
Health Center. Of the recurrences, 22 were
local recurrences, 14 were distant recurrences,
and 2 were recurrences of unknown type.
Figure 4: First Course Treatment Summary:
Many surgeons argue that
performing the SNB prior
to initiating chemotherapy
provides more accurate staging
than doing the procedure after
treatment, since the true effects
of preoperative chemotherapy
on the accuracy of SNB are
unknown. Opponents of this
argument believe that SNB
performed after chemotherapy
can spare patients an additional
operation by doing the axillary
staging at the same time as
the removal of the breast
cancer without significantly
compromising the accuracy
of the SNB. The Z-1071
trial is enrolling patients with
needle biopsy proven node-
positive breast cancers, which
are undergoing preoperative
Advances in Breast Cancer Therapy chemotherapy, to have SNB and axillary lymph node
dissection after chemotherapy. The estimated enrollment
Saint John’s physicians are involved in a number of research for this multicenter trial is 550, and this trial is now open
activities in an effort to improve treatment, survival, and to patients at Saint John’s Health Center. On completion,
quality of life for breast cancer patients. Under the direction this trial will determine the accuracy of SNB in node-
of Armando Giuliano, M.D., Chief of Medicine and Science positive breast cancer patients after completing preoperative
and the John Wayne Cancer Institute and Director of the new chemotherapy.
Margie and Robert E. Petersen Breast Center, Saint John’s
Health Center has been active in participating in breast cancer The John Wayne Cancer Center has recently been accepted
clinical trials, including multicenter randomized trials, such as an active site for the National Surgical Adjuvant Breast
as those led by the American College of Surgeons Oncology and Bowel Project (NSABP) cooperative group. Through
Group (ACOSOG). Patients enrolled in the ACOSOG this affiliation, additional multicenter clinical breast cancer
Z-10 and Z-11 trials have been followed for the acquisition trials will soon become available to patients at Saint John’s
of long-term outcome data to address the clinical question Health Center. In addition to multicenter trials, the John
of the prognostic significance of micrometastases in breast Wayne Cancer Institute/Saint John’s Health Center has also
cancer. In addition, two additional ACOSOG trials have been active in enrolling patients to clinical trials within its
recently been opened for enrollment at the John Wayne own institution. These trials include the study of outcome
Cancer Institute/Saint John’s Health Center: Z-1031 and in patients undergoing mastectomy with nipple-preservation
Z-1071. and breast reconstruction. This trial has recently been
modified to evaluate the safety of this procedure particularly
Women with large breast tumors frequently present as an in women who are carriers of the gene mutations, BRCA1
operative challenge, meaning the tumor may be difficult to and BRCA2. Saint John’s Health Center physicians have also
remove with breast conservation therapy or even mastectomy. collaborated with basic science laboratories at JWCI for the
In such cases when the tumor responds to estrogen, study of breast cancer biomarkers. In addition, collaboration
treatment with a hormonal therapy agent or anti-estrogen, with a biomedical imaging company, known as IntraMedical
such as an aromatase-inhibitor, may result in shrinkage of the Imaging, has led to a study to evaluate the efficacy of a
tumor that will improve the operability of the tumor. The novel hand-held camera to detect microscopic disease at the
Z-1031 is investigating three different aromatase-inhibitors margins of the lumpectomy cavity in patients undergoing
in post-menopausal women presenting with T2-T4 breast breast conservation therapy.
cancer to determine the most effective therapy in this setting.
The goal is to enroll a total of 567 patients, and Saint John’s In conclusion, there have been tremendous strides in the
Health Center is now a participating site for this trial. On diagnosis and treatment of breast cancer. The survival of
completion, this trial will determine the best hormonal breast cancer is increasing with an estimated 2.5 million
therapy to use in postmenopausal women in the preoperative breast cancer survivors in the United States today. Saint John’s
setting. Health Center is at the forefront of breast cancer research
and treatment and our physicians continue to practice their
Another area of controversy in breast cancer is the optimal commitment to the education, treatment, and prevention of
timing of lymph node evaluation by the sentinel node biopsy breast cancer.
(SNB) in patients undergoing preoperative chemotherapy.
Cancer Liaison Physician Report 2008
In 2008 the Cancer Program at Saint John’s Health Center At Saint John’s total patient care extended beyond medical
continued its primary goal of providing innovative, therapy for cancer to include a multi-specialty group of
comprehensive cancer care to fully satisfy its patient’s non-physicians at the service of our patients. Social service,
needs. With over 142,000 new cases expected in California spiritual care and specialized nursing services ensured that
for 2008, this task was a daunting, but welcome one. emotional and spiritual support needs of our patients were
met and exceeded. As palliative care became a national issue,
Throughout the year, Saint John’s physicians continued Saint John’s was at the forefront with our palliative care team.
their dedication to high quality research into epidemiology,
translational therapeutics, and clinical medicine in order In 2008 Saint Johns continued to exhibit the qualities
to promote advances in treatment, survival, and quality that have made it a recognized national leader in
of life for cancer patients. As in previous years, data cancer care. With the continued promise to this level
obtained from this research was presented and well of care that the New Saint John’s Hospital and the
received at various national and international meetings. upcoming Chan Soon-Shiong Center for Translational
In this year’s Cancer Program Annual Report, Dr. Sciences hold, the future can only be brighter.
Alice Chung highlights Saint John’s similar leadership
activities in regard to Breast Cancer throughout 2008.
Education remained a top priority in 2008. The physicians
at Saint John’s continued their mission to inform health
professionals and educate citizens regarding specific
health risks, early detection, and treatment for cancers
Omid Hamid, MD
known to be elevated in their communities. Multiple
educational symposia and community outreach projects
ensured that this goal was met and exceeded by our
Cancer Liaison Physician
physicians; a responsibility to improve clinical practice
at the local level and collaborate with local agencies
to reduce the burden of cancer in the community.
Cancer Committee 2008
Pain Management Pharmacist Report 2008
In 2008, the pain management pharmacist (PMP) made pain assessments and provided management to 1,497 patients who
were on PCA and/or epidural infusion, daily, Monday through Friday (Fig. 1). In addition, the PMP also followed patients
who were on the comfort care and palliative care for pain and symptoms management.
Figure 1 illustrates the trend in the number of PCA patients seen by the pain pharmacist in the last 9 years.
Figure 1. • In 2006, the total number of PCA patients
was lower than previous years. There
# PCA PATIENTS IN 2008 was a change in pain management
practice with one of the orthopedic group.
1963 Instead of having PCA as a scheduled
1863 medication, it now changed to be used
only when other medications fail.
• In 2007, there was a noticeable
(10%) increased in PCA patients, as
# PCA patients
1563 CL 1546.8 compared to 2006. The increased
1463 in PCA patients in 2007 may be due
to more surgeons are joining their
practices at St John Health Center.
LCL 1207.2 • In 2008, the total number of PCA
1163 patients captured on this report was
1063 12.4% lower than previous year due to
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 the pain pharmacist’s personal leave.
The PMP presented a semi-annual quality assurance report on pain management to the Pharmacy and Therapeutic Committee
(P&T). The report included data such as the number of PCA, comfort care and palliative care patients seen by the PMP,
numbers and types of interventions, drug utilization reviews, adverse events, and medication errors. The P&T Committee
reviews all protocol exceptions, therapeutic updates, formulary issues and other problem encountered.
Pain Management Pharmacist Daily Activities in 2008
A. Clinical Activities
• Manage PCA and epidural patients.
• Provide consultation on patients through pain pharmacist referral program. (see Fig. 2)
• Evaluate and provide pain and symptoms management on comfort care and palliative care patients.
• Provide “mandatory “pain consultation by admission diagnosis of pain.
• Review Omnicell dispensing and overrides reports.
• Attend multidisciplinary discharge rounds and patient care case conference.
Cancer Committee 2008
Pain Management Pharmacist Report 2008
B. Omnicell Review Figure 2.
The PMP continues to review
Omnicell (automated system) PAIN PHARMACIST REFERRALS YEARLY CHART
dispensing and overrides reports as 337
part of the medication monitoring
and utilizing reviews. At Saint John 287
Health Center, medication profiling
interfaces with the Omnicell. The 237
nursing staff requests to have certain
#Pain Rx referrals
medications that can be overridden 187 CL 176.3
for emergency or urgent uses.
Occasionally medication errors and 137
drug diversion are found during the
C. Special Projects 37
A one-month retrospective data
collection was done to evaluate safety -13
of using combination analgesic 2002 2003 2004 2005 2006 2007 2008
products in post-cesarean section YEAR
patients in October 2008.
I. Background information:
1. Combination analgesic products are described as products that contain an opioid plus acetaminophen in this data
2. Safety of acetaminophen use is described as acetaminophen use ≤ 4 grams per day in patients with normal liver function.
3. Under medication section of the physician order set, “order set post partum” offered the choice of using Percocet,
Darvocet N-100 and Tylenol for breakthrough pain.
II. Data collection methods:
1. Using billing and DRG codes to generate a list of patients who were post-cesarean patients in October 2008.
2. Reviewed opioids used from Omnicell reports in post-cesarean patients in October 2008.
3. Opioids being reviewed included combination analgesic products that contain acetaminophen.
4. Patients who received acetaminophen >4 grams per day were considered as having excessive doses of acetaminophen that
may increase potential risk of hepato-toxicity.
1. A total of 160 postpartum patients were identified in October, which included 49 post-cesarean patients and 111 patients
with vaginal delivery.
2. 7 out of 49 (14.3%) post-cesarean patients received greater than 4 grams of acetaminophen per day during this review.
3. 88% of the postpartum patients have orders for NSAIDs.
4. Current postpartum order set have Tylenol, Darvocet N-100 and Percocet available in check off boxes for mild, moderate
and severe pain.
4a. According to regulatory guidelines, no more than one medication should be checked off for mild pain, no more than one
medication should be checked off for moderate pain, and no more than one medication should be checked off for severe
4b. 55/160 (34.4%) patients had orders checked for Darvocet N-100 and Percocet (either 3 out of 4 orders, or all 4 orders).
4c. 6/160 (3.75%) patients had Darvocet N-100 ordered for pain management.
4d. Overall only 12/160 (7.5%) patients received Darvocet N-100.
IV.Items discussed with nursing educator and director at the OB/GYN units:
1. Regulatory level: Multiple opioids prescribed for moderate and severe pain.
2. Use of NSAIDs on schedule basis if no contraindication (provides synergistic effect with opioids)
3. Pain management issue: Darvocet N-100 (propoxyphene) is a poor analgesic. (American Pain Society and JCAHO
discouraged use of propoxyphene for chronic pain management)
4. Opioids are being ordered as Q3H on the order set (exceeds 4 grams of acetaminophen a day)
5. St John’s is the only Sister Charity Hospitals using Percocet-5 in the postpartum order set.
6. Revise postpartum order set.
1. Report findings to OB Committee.
2. Revise medication section of the order set for post partum.
3. Continue the use of NSAIDs in postpartum patients on schedule basis if no contraindication.
4. Delete Darvocet N-100 from the postpartum order set.
5. Changing oxycodone/acetaminophen 5/325 (Percocet-5) to q4h if needed for pain (not to exceed 12 tablets/day).
6. Adding hydrocodone/acetaminophen 5/500mg (Vicodin) q4h if needed for pain (not to exceed 8 tablets/day).
D. Education by The PMP in 2008
• Pain lectures to ICU training series.
• Pain lectures to new grad/hires during orientation.
• Pain management work rounds with UCLA Masters clinical nursing programs.
• Pain management work rounds with new hires.
• Pain management work rounds with USC 4th year pharmacy school student.
• A lecture on “Update on pain management” was given at Saint John’s Nursing Oncology Symposium.
The PMP, together with the clinical coordinator of the pharmacy department, published an article in the American Journal of
Health-System Pharmacists (AJHP) highlighting the role of the PMP at St John’s Health Center.
Pain Management Pharmacy Service In a Community Hospital. Teresa Fan, Tanya Elgourt. Am J Health-Syst Pharm- Vol 65
Aug 15, 2008 1-6
Spiritual Care 2008
ancer challenges the whole person: physical, emotional and spiritual. At Saint John’s Health
Center, the Spiritual Care Department attends to the spiritual and emotional needs of patients and their families.
An interfaith chaplain, trained in Clinical Pastoral Education (CPE) and board certified, visits oncology patients
on the inpatient unit and on referral to the John Wayne Cancer Institute Breast Center and Cancer Center. Respectful
of the many belief systems, faith traditions, and cultural practices of our patient population, the interfaith chaplain
helps patients and families draw upon their own spiritual resources. Patients may also choose to receive visits from
our faith-specific chaplains, including a full-time Catholic priest, a visiting rabbi and visiting Protestant clergy, or they
may request our assistance in contacting a representative from their own faith community. Chaplains can help patients
address the existential questions that often arise with a diagnosis of cancer. They can help patients manage stress, gain
perspective, and renew hope. Chaplains participate in rounds and are an integral part of the interdisciplinary care team.
otal patient care extends beyond that
provided by physicians and nurses. A
diagnosis of cancer brings with it profound psychological
trauma. Patients and their families are under a tremendous
amount of pressure to cope effectively with the treatments,
side effects and anxieties that accompany the diagnosis.
Clinical social workers assist patients and family members in
navigating their way through the disease process beginning
with initial diagnosis and throughout corresponding treatment.
They provide crisis intervention, brief insight oriented
psychotherapy, guided meditation for stress reduction, conflict
resolution, assistance with health care directives, improved
communication with the treatment team, discussion of end
of life issues, maintenance of a resource library and support
for staff members. They refer to national and local agencies
such as American Cancer Society, Wellness Community,
Our House and We Spark and in an effort to support both
the patients and their families. In addition, social workers
facilitate programs such as Aim at Melanoma to increase
cancer awareness and promote preventive interventions
both medical and non medical within the community.
The Positive Appearance Center, a non-
profit facility, was the first of its kind on the
Westside to address the cosmetic side
effects and comfort needs related to cancer
treatment. The Center has a warm boutique-like
setting which provides a nurturing environment
where cancer patients may receive individualized
and specialized care. The Center offers an array of
products and services to meet the needs of men and
women undergoing cancer treatment.
The Positive Appearance Center carries breast
prostheses, mastectomy bras, camisoles, and bathing
suits as well as wigs and other alternatives including
Cancer Outreach Activities Calendar Year 2008:
hats, caps, turbans and scarves. The Positive
The Community Education Program offered a
Appearance Center also carries support garments for
variety of programs, classes, health fairs and
lymphedema and has a certified fitter on staff for both
screenings for our community. In 2008, the
compression garments and mastectomy prosthesis and
following Community Education Forums were held:
bras. There is no charge for fittings or consultations.
Colorectal Cancer Awareness
In addition, the Positive Appearance Center carries Wednesday, March 19, 2008-2:00 to 4:00 p.m.
skin care products, sun blocks and sun protective Santa Monica Public Library, MLK Jr. Auditorium
hats, especially important for melanoma patients. The
Positive Appearance Center also hosts the Look Good, Speakers: Saint John’s oncologist, Sean Fischer, MD;
Feel Better program sponsored by the American Saint John’s gastroenterologist Martha Hierro, MD; Saint
Cancer Society. John’s surgeon Gagandeep Singh, MD; and Director, Saint
John’s Medical Radiology Dept. Ira Smalberg, MD
The Positive Appearance Center is open for walk-in
Spot A Spot-Melanoma Prevention
visits Monday through Friday from 10 am to 4pm.
Tuesday, May 13, 2008-- 6:30-8:30 pm
Appointments are encouraged, though not required,
Wednesday, May 15, 2008—2:00 to 4:00 pm
for fittings of prostheses and wigs. Home visits are Santa Monica Public Library-MLK Jr. Auditorium
available when needed.
Speakers: Saint John’s oncologist, Omid Hamid MD,
The Positive Appearance Center is located in the John Michael B Nicholl, MD (JWCI Fellow), Leonard W.
Wayne Cancer Institute Breast Cancer at Saint John’s Sender, MD, Medical Director of Cancer Institute at
Health Center. Children’s Hospital of Orange County, and Ali Ansary,
Director National Melanoma Awareness Project
Pathology Department 2008
he Saint John’s Department of prognosis. The full resources of the Saint John’s Laboratory
Pathology and Laboratory Medicine are often involved, including Hematology Flow Cytometry
provides key laboratory support during testing for the characterization of leukemias and lymphomas.
all phases of diagnosis and management of Each pathologist has areas of expertise, such as cancers of
cancer patients. The Anatomic Pathology Department the skin, of the breast, or of bone marrow, all of which
is composed of eight board-certified pathologists are frequently shared so that most cancer diagnoses are
plus key supporting staff such as pathology assistants, the product of a wealth of knowledge and experience.
cytotechnologists, histotechnologists and secretarial staff.
This team is responsible for the accurate diagnosis, grading When patients are undergoing therapy at Saint John’s,
and staging of all cancers that present and are treated at Saint the Laboratory provides an extensive menu of key tests
John’s Health Center and the John Wayne Cancer Center. to assess the patient’s status and to ensure their safety.
Monitoring for toxicity of certain chemotherapies, assessing
The pathologists work closely with clinicians, surgeons bone marrow response to therapy, and following tumor
and interventional radiologists during the biopsy and markers are some of the tests that oncologists rely upon.
surgical phase of cancer care to assure that diagnostic This support is one of the reasons that modern cancer
material is adequate and of sufficient quality. This care has become so remarkably effective and safe.
frequently requires making immediate cytologic or
frozen section diagnoses during biopsy procedures. Other integral services provided by the department
include intra-operative consultation with frozen section
During the diagnosis phase of cancer care, pathologists diagnosis, performance of bone marrow biopsies and
and lab personnel engage in an ongoing dialogue with fine needle aspiration biopsies of both palpable and
the treating medical oncologists, radiation therapists and deep-seated tumors. Since the John Wayne Cancer
oncologic surgeons to provide the information necessary Center and many Saint Johns associated physicians are
for cancer patients to receive the correct therapy for their actively involved in research protocols, the pathology
particular cancer. The department relies on molecular department has collaborated in the publication of many
diagnostic techniques such as immunochemistry to assist ground-breaking clinical studies affecting cancer care.
in determining the type of cancer cells involved and their
Cancer Conferences 2008
ancer Conferences at Saint John’s Health
Center are multidisciplinary, and include Breast
Conference, Neuro-Endocrine Conference, Pre-
Op Surgical Conference, Gastroenterology Conference,
Research Conference and General Tumor Board. The
conferences are attended by physicians from all specialties. Physicians
representing the fields of General Surgery, Surgical Oncology,
Neurosurgery, Hematology/Oncology, Radiation Oncology, Diagnostic
Radiology, Pathology, Internal Medicine, Family Practice, Pulmonary,
Gastroenterology, and Plastic Surgery all attended Cancer Conferences
in 2008. Cancer Conferences focus on pretreatment evaluation, staging, Mark Faries, MD
treatment strategies, referrals to research protocols and rehabilitation.
Cancer Conference Calendar
In 2008, there were a total of 140 meetings, with 296 cases Breast Cancer Tumor Board
presented. Of the total cases presented, 100% were prospective • Every Monday at 8 a.m. 3 West
cases. The primary sites presented reflect our caseload, with the General Tumor Board
most number of cases presented being breast and melanoma. • 2nd Wednesday at 8 a.m.
The other primary sites presented include but were not limited to: 3 West
Bladder, Colon, Esophagus, Gallbladder, Head and Neck, Leukemia, Gastroenterology Conference
Liver, Lung, Lymphoma, Meningioma, Pancreas, Pituitary Gland, • Last Tuesday at 7:30 a.m. 3 West
Prostate, Rectum, Small Bowel, Stomach, Testis, and Thyroid. Pre-Op Surgical Conference
• Every Friday at 7:30 a.m. Jack
Green Conference Room
• Wednesdays at 5:30 p.m. Jack
Green Conference Room
• 4th Wednesday at 8 a.m.
Diagnostic Radiology 2008
he Department of Imaging
performs a full range of routine
diagnostic procedures including
CT, MRI and ultrasound. Interventional
specialists perform therapeutic procedures
such as chemoembolization and radiofrequency
ablation of the liver under CT guidance.
Specialized staff in the Breast Cancer perform
stereo-tactic core biopsies and pre-operative
localization of breast lesions.
he Cancer Registry Department at Saint John’s Health Center is one of the five major components
of being an approved cancer program through the American College of Surgeons (ACoS)
Commission on Cancer (CoC).
Accurate data collection is a priority of the cancer registry. This is achieved by coordinating the collection, management,
analysis, lifetime follow-up and dissemination of the cancer registry data. Registry staff compiles a detailed computerized
cancer-focused abstract on every patient who is diagnosed and/or treated at our facility. Cancer abstracting must be performed
or supervised by a CTR using data standards defined by the CoC and the California Cancer Registry (CCR). Confidentiality is
maintained on each patient entered into our database according to HIPAA regulations.
In 2008, there were 2,052 new cancer cases added to the cancer data base. Of these, 1,746 were analytic cases
(diagnosed and/or treated at Saint John’s during their first course of treatment) and 306 cases were non-analytic cases
(patients receiving care at Saint John’s for recurrence of their disease). The entire data base exceeds 39,000 cases and
includes both living and expired patients. Each month the cancer registry conducts ongoing follow-up estimated
at 700-900 cases. These cases are updated on patient vital and disease status, recurrence and additional treatment
information as indicated, as well as the patient’s current physician and family member contacts. The ACoS CoC
requires that 90% of analytic cancer patients be updated annually with less than 10% of these cases being lost to
follow-up. Follow-up is achieved by contacting patients, physicians and facilities on the current follow-up status.
The data maintained by the Cancer Registry is available for use by the medical staff, hospital administration,
and other health care professionals for special studies, end-results reporting, medical education, patient
care evaluations, and research. In 2008, the Cancer Registry responded to approximately 50 requests for
data from physicians, administrators, hospital staff, and outside sources. The data is used for treatment
planning and evaluation, outcome measures, clinical research, and cancer program strategic planning.
For information regarding the Cancer Registry or for data requests, please contact the Cancer Registry at (310) 829-8860.
Outpatient Services 2008
atients requiring inpatient care
are treated at Saint John’s Health
Center’s 16-bed oncology unit, on
the fourth floor of the Chan Soon-Shiong
Life Sciences building. Having received
intensive training and certification in oncology
nursing, the staff is well qualified in caring for
the specialized needs of oncology patients
The oncology unit utilizes the interdisciplinary
team approach to patient care management with
daily patient care rounds, patient care conferences
and bioethics consultations. The interdisciplinary
team includes the oncology unit director, clinical
social worker, pastoral care, rehabilitation services,
certified oncology nurses, pharmacist and physicians.
Case Managers provide discharge planning,
emotional support and utilization review.
Saint John’s Health Center offers a full range of
referral based services from its’ world renown
physicians at the John Wayne Cancer Institute
and the Margie Peterson Breast Center.
The Margie Peterson Breast Center operates a full
service surgical clinic that provides consultations,
pre-operative and post-operative treatment and follow-
up. The highly skilled and dedicated nursing staff
provides comprehensive teaching services to the newly
diagnosed patient. The Department of Breast Imaging
located within the Breast Center provides state of the
art screening and diagnostic mammography exams,
stereotactic breast biopsy procedures, ultrasound
exams of the breast and ultrasound guided breast
biopsy procedures. Bone Density exams are provided
as well. The Breast Center works off the model of
“one stop shopping” to provide same day clinical
and imaging services to the patient’s they serve.
Support groups for patients and families focus on
cancer information, nutrition, stress management
and coping strategies. A library and audio-visual
resource center are open to all patients and family
members as well as the public. Genetic screening
is also available for patients and their families. The
Positive Appearance Center is a unique, one-stop
service, adjacent to the Breast Center that helps
patients deal with the cosmetic side effects and comfort
needs related to their disease and cancer treatment.
Paul Song, MD
Armando E. Giuliano, MD
JWCI Breast Center 2008 Report
he John Wayne Cancer Institute (JWCI) and its treatment. Both popular and professional books,
Breast Center was founded in 1993 literature, and videotapes are available for patients and their
by its current director, Armando E. families to use at the Center or to check out and take with
Giuliano, M.D. The Breast Center, located within Saint them for further review. Internet access is also available for
John’s Health Center (SJHC), provides multidisciplinary care patient and family use. The Breast Center offers treatment
to patients with breast problems. Cutting-edge research is for benign breast disease as well as a comprehensive
performed under the umbrella of JWCI which supports and approach to the detection and management of cancer in its
maintains the laboratories and administrative structure of the earliest forms. The program provides patients with breast
breast program. Thus, the Breast Center functions in a unique cancer screening, breast health education, supportive care,
environment that blends a rigorous academic program with and prevention strategies. Additionally the Center provides
the beauty and efficiency of an extraordinary community interdisciplinary care for patients with complex problems
hospital, Saint John’s Health Center, listed as one of the top in breast cancer. Patients are evaluated for multimodality
50 hospitals in the United States by AARP Modern Maturity treatment (surgery, radiation therapy, chemotherapy, and/
in May/June 2002. The state-of-the-art Breast Center was or hormonal therapy) by a team of physicians and nurses.
recognized by Self magazine in 1999 as one of the 10 best The program approaches the patient as a whole person and
breast centers in the United States. This recognition is based includes dedicated breast imaging, breast pathology, breast
on outstanding patient care and new and innovative clinical, radiation oncology, surgical oncology, medical oncology,
translational, and basic science research that is carried out in a nutritional counseling, psychosocial support, plastic and
warm, inviting, and non-threatening setting. reconstructive surgery, community service and outreach, and
research. We collaborate closely with the American Cancer
The Breast Center has two surgical oncologists, three Society and the Wellness Community.
dedicated breast imaging specialists, two endocrinologists
(dedicated to the management of hormone deficiency The Breast Center offers its patients a level of medical
syndrome in breast cancer), two full-time oncology nurses, expertise and an increasing repertoire of innovative
one physician assistant, the Banchik Family Breast Cancer diagnostic and therapeutic procedures not available at most
Library, and a Positive Appearance Center (to address body community hospitals and often not offered at other tertiary
image issues). The Library offers a comfortable setting in cancer centers. For instance, the Breast Center is one of the
which to review the latest information about breast cancer very few centers that also treat patients with breast disease-
related endocrine disorders such as osteoporosis and hormone deficiency syndrome. With the addition of our satellite digital
imaging unit, more than 22,000 breast imaging studies were performed in 2008. There were nearly 850 new breast cancers,
thyroid cancer, and parathyroid tumor cases evaluated in 2008. Annually there were over 12,000 patient visits.
In 1999, the John Wayne Cancer Institute expanded its spectrum of academic training programs to include a Breast Fellowship
for surgeons interested in advanced training in the field of breast disease. Commencing in 2002, the Society of Surgical
Oncology (SSO) recognized the need for a discrete Breast Fellowship, and the JWCI Breast Center at SJHC Interdisciplinary
Breast Fellowship program was subsequently approved by the SSO. In 2008, the number of fellows training in JWCI’s year-
long program increased from one to two.
The unique clinical resources of the Breast Center and the basic science resources of the JWCI have a proven track record in
obtaining grant and philanthropic support and have made major contributions to the treatment and understanding of breast
cancer. The sentinel node biopsy, which has altered breast cancer management throughout the world, was developed at this
institution from a philanthropic grant. Commencing in 1991, this grant enabled us to perform the research that has resulted in
a new way to treat breast cancer. This minimally invasive operation has had a major impact on the treatment of node-negative
women, especially those who are postmenopausal.
Saint John’s Health Center • 1328 Twenty Second Street • Santa Monica, CA 90404 • www.cancercenters.stjohns.org