Brookwood Oncology Program Annual Report 2007-2008

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Brookwood Oncology Program Annual Report 2007-2008

  1. 1. Brookwood Oncology Program Annual Report 2007-2008 DATA ENDING DECEMBER 2007
  2. 2. SYNOPSIS Brookwood Medical Center’s Oncology Program continues to serve our community by offering specialized treatment plans, a variety of support services and amazing care from our physicians and staff. We are able to provide this quality care due to our team of Oncology Specialists encompassing GYN, Surgical, Radiation, Medical, Pathologists, Radiologists, as well as nurses, therapists and dieticians. All of our specialists are dedicated to performing high quality patient care throughout our facility ensuring that our patients are always our first priority. ACCOMPLISHMENTS This year we have witnessed a lot of change within our Oncology Program. The Cancer Care Center was completely remodeled, increasing our number of exam rooms from 3 to 5, acquiring new exam tables in each room and purchasing the GE 16-slice, large bore CT Simulator. The 7th floor Oncology Unit, under the direction of Cheryl Smith, RN, is enjoying their new Stryker beds. These specialized beds weigh patients while lying in bed; they also convert into cardiac chairs from a bed position and deflate automatically for chest compressions. 3Women’s, under the direction of Christy Nation, RN, has seen the complete renovation of their new nurses’ station, as well as their patient rooms. Designed by Richard Tubbs, the patient rooms now have a relaxed spa like atmosphere with a new color scheme, furniture and artwork. The hospital’s cancer registry, coordinated by Judy Smith, RHIA, CTR, has accessioned 1343 cases. This is an increase of 67 cases over last year, which is reflective of our growing cancer program. Brookwood’s marketing department unveiled their new marketing campaign, involving commercials and billboards, which facilitated getting Brookwood’s name, services and high level of care out into the community. Also, this year, we have several nurses preparing for the Oncology Nursing Certification Exam. This will be a wonderful accomplishment for each of them as well as our hospital. These are just a few of the exciting things that happened this year. There is so much to be proud of here at Brookwood. EVENTS In September, some of our Brookwood employees enjoyed a presentation given by Dr. Mack Barnes, Gynecologic Oncologist, on Ovarian Cancer. His presentation was extremely informative and his ongoing dedication to our Gyn Oncology Program is greatly appreciated. Our 3rd annual Mammothon, which took place in October, was a big success, which is an important community outreach for our active Breast Cancer Program. Janet Dees, RN, Community Outreach Coordinator, visited our neighborhood schools speaking to our youth on the dangers of smoking. Janet also continues to grow our genetic testing program and our high-risk breast cancer assessment program. Oncology Program Overview | 2007-2008
  3. 3. ACKNOWLEDGEMENTS Thank you to Duke Martin for his continued leadership of our Cancer Support Group “Together”. This group has recently changed its name to “Friends Together” and will continue to offer comfort for our patients and family members. Thank you to our volunteers for their support throughout the year with various projects and departmental tasks. Thank you to our Oncology P.I. Committee members who serve diligently throughout the year striving to better our Oncology program. Our bimonthly meetings, lead by Dr. Manuel Carcelen, have given us a multidisciplinary approach to reaching our goals. Other leadership roles are held by William DeVos, MD, who serves as Tumor Conference Coordinator, Fred Dumas, MD and Sandra Tincher, MD, who both serve as Physician Advisors and Jaime Bitran, MD as Physician Liaison. LOOKING TO THE FUTURE Cyberknife of Birmingham, which is currently under construction, will be located on Brookwood’s campus next to the Cancer Center. Construction began in August and should be complete by the beginning of 2009. We are extremely excited that this cutting edge technology will be available in our region. We are looking forward to being able to provide another therapeutic option for some of the most difficult to treat tumors. The Cancer Center will also boast a new Varian iX Accelerator in 2009, with Rapid Arc capabilities, which will reduce a patient’s treatment time from 10 minutes to 2 minutes. This will really be beneficial to our patients and their comfort level. I look forward to participating in the growth of our Oncology Program. Through our Administrative Leader, Billy Connelley, MSHA, and the support of the Senior Team, 2009 will be an outstanding year for Oncology. Jenni Fisher, BS, CMD, RT(T) Manager, Brookwood Cancer Care Center THE ONCOLOGY PROGRAM AT BROOKWOOD MEDICAL CENTER provides state of the art treatment to cancer patients in our community. Last year there were 1,211 patients who received a new diagnosis of cancer at this institution, reflecting the continued growth of this program. As in previous years the top five sites were breast, uterine, lung, and colon, with ovarian cancer overtaking prostate cancer for the fifth place this year. The Cancer Registry collects information on these patients and participates in the National Cancer Database as required for all accredited programs by the American College of Surgeons Commission on Cancer. A review of the Brookwood experience in patients with breast cancers less than 2 cm and negative nodes treated with accelerated partial breast irradiation using MammoSite between 2003-2007 showed favorable outcomes, with a 3% recurrence rate and good/excellent cosmetic results in 83% of patients. These figures are consistent with those reported by the Mammosite Registry. As part of the commitment to incorporate new technologies and provide quality care to our patients in a comfortable environment the Cancer Center has undergone extensive renovation, which has allowed expansion of the facilities and the incorporation of a new CT simulator with a respiratory gating system, We are currently in the process of building the infrastructure for a CyberKnife, which hopefully will be operational in early 2009, and working towards completing upgrades to the physical plant in the inpatient oncology ward. Community outreach remains an important goal for the program, and as in previous years a number of activities to meet this need took place, including educational programs for elementary schools, senior citizens groups, and the workplace. Education on prevention and early detection of colon, breast, and lung cancer are an essential component of the program. As we prepare for our reaccreditation survey by the American College of Surgeons Commission on Cancer in 2009, and adjust to the challenges of an ever changing healthcare market, we remain optimistic that in the coming years Brookwood Medical Center will continue to be a leader in the efforts for prevention , diagnosis and treatment of cancer. Manuel F. Carcelen, MD Chairman, Oncology Performance Improvement Committee Chairman’s Report
  4. 4. STAGE IV 23% STAGE I 26% STAGE II 21% STAGE III 21% S + R + C 6% SURGERY 52% S + CHEMO 28% CHEMO 4% Colorectal Brookwood = 90 | Alabama = 2,350 | U.S. = 153,760 UNKNOWN 7% STAGE O 2% STAGE I 67% STAGE IV 6% Uterine Corpus Brookwood = 135 | Alabama = 460 | U.S. = 39,080 S + R 2% OTHER 1% SURGERY 84% S + R + C 1% RADIATION 1% S + CHEMO 12% STAGE III 15% STAGE II 6% TOP FIVE PRIMARY SITES (2007) | CANCER BY STAGE, TREATMENT & COMPARISON SURGERY 21% S + R 13% S + H 6% Breast Brookwood = 262 | Alabama = 2,750 | U.S. = 180,510 S + CHEMO 13% S + R + C 8% OTHER 2% S + R + H 12% STAGE I 30% STAGE O 27% STAGE III 12% STAGE IV 3% STAGE II 24% S + R + C + H 9% UNKNOWN 4% SURGERY 22% R + CHEMO 15% Lung Brookwood = 116 | Alabama = 3,850 | U.S. = 213,380 S + R + C 5% S + C 11% OTHER 7% CHEMO 14% NONE 19% UNKNOWN–N/A 9% STAGE I 25% STAGE IV 38% STAGE III 21% UNKNOWN–N/A 7% STAGE II 8% RADIATION 7% STAGE III 57% STAGE IV 6% STAGE II 5% STAGE I 25% UNKNOWN 6% SURGERY 37% S + C 59% S + C + OTHER 3% Ovary Brookwood = 69 | Alabama = n/a | U.S. = 22,430 CHEMO 2% NONE 10% MammoSite Update The ability to offer APBI using Mammosite to our Brookwood oncology patients began in June 2003. At the time of this update, December 2007, 172 patients have been treated with this technique. The Brookwood data for local control and cosmesis for patients treated with Mammosite were reviewed to include patients treated during the 4-year period from June 2003-June 2007 with a minimum of 3 months follow-up. This included 155 patients (range follow-up: 3 months-51 months, mean follow-up: 15 months). Cosmetic outcome was scored using Harvard criteria of good/excellent or fair/poor.1 Any telangiectasia was graded as a fair/poor outcome. Of the 155 evaluable patients, there were only 7 lost to follow-up at Brookwood. In addition, 2 patients have tested BRCA positive and have subsequently undergone bilateral mastectomies. Our criteria for Mammosite treatment has been: age at least 45 years old, tumor size no more than 2cm, negative margins and negative lymph nodes. Our actual Mammosite population consists 11pts less than 45 years of age (range: 41-44yrs), DCIS (43pts), T1N0 (102pts), and T2N0 (10pts). There have been 5 recurrences in our Mammosite patients BREAST CONSERVATION THERAPY FOR BREAST CANCER includes radiation to remaining breast tissue after lumpectomy to decrease local recurrence rates from 35% to 10% or less. This usually involves 5 weeks of external radiation to the whole breast (elective treatment of the entire breast for presumed occult disease) followed by a reduced field to the tumor bed for an additional 2 weeks. Advances in radiation technology now allow accelerated partial breast irradiation (APBI) as a potential option for treatment. This provides radiation to the tumor bed alone delivered internally twice a day over one week, thereby greatly reducing the overall treatment time required to deliver radiation. This may allow the benefits of radiation to patients whom otherwise may not have access to treatment due to barriers such as advanced age, transportation, or physical limitations. Also, since less tissue is radiated, there is the potential to decrease lung and cardiac toxicity and improve cosmesis. S + C + H 5% NONE 11%
  5. 5. SUMMARY OF CANCER INCIDENCE 2007—For 2007, a total of 1, 211 cases of cancer were diagnosed at Brookwood Medical Center. The most common presenting diagnosis is carcinoma of the female breast, comprising a total of 261 cases. This represents an increase of 30 cases over the previous year. Nationally, the number of breast cancers has been dropping but this is not yet apparent at Brookwood. The second most common diagnosis we see is carcinoma of the uterus with 133 cases, followed by lung cancer with a total of 116. Colon and rectal cancer represent 90 cases and ovarian cancer has now become No. 5 on the list with 63 cases diagnosed last year. Prostate cancer has become a less common diagnosis at Brookwood due to more patients being treated in the community rather than the hospital setting. When compared to national statistics, Brookwood treats a slightly higher number of female breast cancers and significantly less lung cancers. We continue to see an excessive number of gynecologic cancers representing patterns of referral to the Women’s Care Center. R. Fred Dumas, Jr., MD | Radiation Oncologist Medical Director, Brookwood Cancer Care Center DISTRIBUTION BY AGE & SEX (2007) 0-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ 35% 30% 25% 20% 15% 10% 5% 0% Age Distribution FIVE YEAR COMPARISON OF ANALYTIC CASES BY SITE (2003-2007) Site 2003 2004 2005 2006 2007 Breast 158 178 226 233 262 Lung 107 106 127 97 116 Prostate 77 45 73 103 60 Colorectal 75 87 92 100 90 Corpus Uteri 137 122 130 116 133 Ovary 53 63 81 69 63 Total 967 992 1111 1134 1211 INCIDENCE BY COUNTY (2003-2007) County 2003 2004 2005 2006 2007 Jefferson 452 473 477 539 565 Shelby 159 175 190 200 192 Talladega 44 43 55 65 71 Montgomery 27 21 24 26 36 Chilton 18 23 29 37 31 Tuscaloosa 17 18 23 24 30 St. Clair 24 29 36 33 29 Calhoun 23 26 35 18 24 Other 308 294 343 334 365 Total 1072 1102 1212 1276 1343 (recurrence rate of 3%). Three of these patients developed metastatic disease without local recurrence, one patient developed axillary nodal recurrence, and one patient developed inflammatory breast cancer with bone metastasis (see chart right). Our cosmetic outcome has been good/excellent in 128pts (83%) and fair/poor in 27pts (17%). In the patients with fair/poor cosmesis, 52% had a skin distance of 7mm or less compared to only 9% with good/excellent cosmesis. There were 9pts that only received Mammosite as a boost due to skin distance and all had good/excellent cosmesis. Grade 2 skin toxicity (moist desquamation) at 3 week follow up visit strongly predicted for poor cosmetic outcome. Chemotherapy was delivered in 37% of the fair/poor cosmesis group compared to 13% of the good/excellent cosmesis group. The time to develop poor cosmetic outcome ranged from 3-36 months with mean of 14 months. Recently, 5-year results for Mammosite were reported on 36 women tumor size limited to 2 cm, node negative, no extensive intraductal component and age greater than 44 years old. The data showed good to excellent cosmetic outcomes in 83% patients I MALE I FEMALE PATIENT CHARACTERISTICS OF MAMMOSITE RECURRENCES Patient 1 2 3 4 5 Age 67 60 54 53 44 Tumor Size 9 mm 11 mm 22 mm 25 mm DCIS LVI No Yes Yes Yes n/a Grade II III II III HNG Tx Date 1/04 11/04 11/04 1/05 4/05 Chemo CMF Refused CA Refused n/a Recur. Time 19 mo 11 mo 24 mo 12 mo 9 mo Recur. Type DM-lung DM-liver Axilla DM-liver Inflam.Breast- Ax,DM Expired 12/05 n/a n/a 3/06 n/a with a skin distance of less than 7mm resulting in significantly poorer cosmesis. The data also showed local recurrence rate of only 3% (both went on to develop death from metastatic disease) with younger age being significant predictor for recurrence.2,3 Patterns of failure with Mammosite have also recently been reported on 70 women with 2 year follow up with a 7% local failure rate. It was noted that the recurrences were seen in younger patients, lobular histology, or extensive intraductal component, and nodal positivity.4 The most recent report from the Mammosite Registry in 2007 with 1449 patients showed an overall good/excellent cosmetic outcome of 91%. The local recurrence rate is 2% with a median follow-up of 35 months.5 In summary, with our current inclusion criteria and treatment techniques, the patients treated with Mammosite at Brookwood have had excellent local control rates and cosmetic outcomes very consistent with the national statistics. Sandra Tincher, MD | Radiation Oncologist Cancer Registry Advisor, Brookwood Cancer Care Center 1 Harris JR, et al: Red J 5: 257-261, 1979. 2 Benitez PR, et al: Am J Surg 194: 456-462, 2007. 3 Chao KK, et al: Red J 69: 32-40, 2007. 4 Chen S. et al: Red J 69: 25-31, 2007. 5 Vicini FA, et al: Breast Cancer Symposium 2007, Abstract No. 274
  6. 6. 2007 ONCOLOGY PROGRAM STATISTICS ONCOLOGY CONFERENCES Total cases presented . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Prospective cases presented . . . . . . . . . . . . . . . . . . . . . . . 111 Percent of Prospective cases . . . . . . . . . . . . . . . . . . . . . . 92% Cancer conferences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Average staff attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 CANCER REGISTRY Total cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,343 Analytic cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,211 Non-analytic cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Cases in registry since reference date. . . . . . . . . . . . . 16,873 Follow-up contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,754 Percent of Cases Evaluated for Quality Control. . . . . . . 10% Number of Analytic Cases Reviewed for Quality Control . . 121 REFERENCES Cancer Facts & Figures 2007 | American Cancer Society Alabama Cancer Facts & Figures 2007 | American Cancer Society & Alabama Statewide Cancer Registry AJCC Cancer Staging Manual, 6th Edition | American Joint Committee on Cancer | Springer-Verlag | New York, NY 2002 International Classification of Diseases for Oncology, 3rd Edition World Health Organization | Geneva, Switzerland, 2000 Facility Oncology Registry Data Standards (FORDS) | American College of Surgeons | Commission on Cancer | Chicago, IL, 2007 Collaborative Staging Manual and Coding Instructions | American Joint Commission on Cancer | U.S. Department of Health and Human Services | Bethesda, MD, 2007 SEER Summary Staging Manual 2000 | Cancer Surveillance, Epidemiology and End Results Program | National Institute of Health | National Cancer Institute | Bethesda, MD, 2001 Multiple Primary and Histology Coding Rules | Field Study Manual | National Cancer Institute | Surveillance Epidemiology and End Results Program | Bethesda, MD, 2007 ONCOLOGY PERFORMANCE IMPROVEMENT COMMITTEE | 2007-2008 CHAIRMAN Manuel Carcelen, MD Pulmonary Medicine Chairman, Oncology P. I. Committee NON-PHYSICIAN MEMBERS Ellen Carmichael, CRNP Women's Health Clinical Excellence Manager, Quality Improvement Coordinator Billy Connelley, Jr., MSHA, RT(T) Vice President, Operations Janet Dees, RN, MBA Oncology and Community Outreach Coordinator Judy Smith, RHIA, CTR Cancer Registry Coordinator Jenni Fisher, BS, CMD, RT(T) Clinical Manager, Brookwood Cancer Care Center Karen Litwiniec, PharmD Manager, Pharmacy Services Christy Nation, RN Director, Women’s 3 Kristin Pruett, RHIT Director, Health Information Management Cheryl Smith, RN Director, 7 Main Tracy Flanagan, RHIT, CTR. Cancer Registrar Laura Ann Walley, RN, MSN Director, Medical Staff/ Performance Improvement PHYSICIAN MEMBERS R. Fred Dumas, Jr., MD Radiation Oncology Medical Director, Brookwood Cancer Care Center Cancer Registry Advisor Sandra Tincher, MD Radiation Oncology Cancer Registry Advisor Ruth Atkinson, MD Hematology/Oncology Luigi Bertoli, MD Hematology/Oncology Luis Pineda, MD Hematology/Oncology Mack Barnes, MD Gynecologic Oncology Jamie Bitran, MD General Surgery Cancer Liaison, Community Outreach Leader Agnes Cartner, MD Radiology J. Christopher Davis, MD Otolaryngology Bradley Dennis, MD Administration Chief Medical Officer William DeVos, MD Pathology Tumor Conference Coordinator Donald Simmons, MD Pathology Bryant Poole, MD Urology
  7. 7. PRIMARY SITE TABLE | 2007 ANALYTIC CASES M = Male | F = Female Unk. = Unknown Stage | N/A = Benign cases or cases not staged by AJCC SEX AJCC STAGE AT DX PRIMARY SITE TOTAL M F 0 I II III IV UNK N/A Lip 2 2 0 0 0 0 0 0 2 0 Base of Tongue 2 2 0 0 0 0 0 2 0 0 Parotid 3 2 1 0 0 1 1 0 0 1 Esophagus 9 7 2 0 3 4 0 2 0 0 Stomach 16 9 7 0 4 2 3 3 2 2 Small Intestine 4 1 3 0 0 1 1 0 0 2 Colon 64 26 38 1 15 18 13 17 0 0 Rectosigmoid 8 6 2 0 2 1 4 0 1 0 Rectum 18 13 5 1 6 0 2 4 2 3 Liver/Intrahep Bile 5 1 4 0 1 0 1 2 1 0 Gallbladder 2 1 1 0 1 0 0 1 0 0 Other & Unspec Parts of Biliary 2 1 1 0 0 0 0 2 0 0 Pancreas 21 14 7 0 3 2 4 10 1 1 Larynx 8 7 1 0 4 1 2 1 0 0 Bronchus/Lung 116 66 50 0 29 9 24 44 7 3 Thymus 2 1 1 0 0 0 0 0 0 2 Mediastinum, Heart & Pleura 1 1 0 0 0 0 1 0 0 0 Bones, Joints, Art. Cartilage 5 3 2 0 0 0 0 2 3 0 Hematopoietic/Re-ticuloendothelial 42 27 15 0 0 0 0 0 0 42 Skin 19 13 6 2 6 3 1 2 4 1 Retroperitoneum 11 0 11 0 0 0 0 0 0 11 Conn Subq tissue 12 4 8 0 1 2 1 1 7 0 Breast 262 1 261 70 79 64 31 7 10 1 Vulva 45 0 45 27 9 5 0 0 3 1 Vagina 5 0 5 3 0 1 1 0 0 0 Cervix 30 0 30 0 15 3 5 3 4 0 Corpus Uteri 133 0 133 0 90 8 20 8 5 2 Uterus NOS 2 0 2 0 0 0 0 0 0 2 Ovary 63 0 63 0 16 3 36 4 2 2 Other Female 3 0 3 0 1 0 1 0 0 1 Placenta 3 0 3 0 0 0 0 0 0 3 Prostate 60 60 0 0 0 58 0 2 0 0 Testis 4 4 0 0 4 0 0 0 0 0 Kidney 58 34 24 0 43 7 2 6 0 0 Renal Pelvis 6 3 3 1 3 1 1 0 0 0 Ureter 1 1 0 1 0 0 0 0 0 0 Bladder 42 29 13 20 9 4 2 7 0 0 Brain 21 13 8 0 0 0 0 0 0 21 Meninges 28 10 18 0 0 0 0 0 0 28 Other Central Nervous System 7 3 4 0 0 0 0 0 0 7 Thyroid 15 6 9 0 11 1 1 2 0 0 Other Endocrine 5 2 3 0 0 0 0 0 0 5 Lymph Nodes 25 12 13 0 4 6 7 4 4 0 Unknown Primary 21 9 12 0 0 0 0 0 0 21 TOTAL ANALYTIC 1211 394 817 126 359 205 165 136 58 162
  8. 8. BROOKWOOD ONCOLOGY SERVICES DIRECTORY Brookwood Medical Center . . . . . . . . . . . . . . . . . . . . . . 205-877-1000 Vice President of Operations . . . . . . . . . . . . . . . . . . . . . 205-877-1893 Brookwood Cancer Care Center . . . . . . . . . . . . . . . . . . 205-877-2273 Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-1094 Scheduling Coordinator . . . . . . . . . . . . . . . . . . . . . 205-877-2228 Oncology Nurse Coordinator . . . . . . . . . . . . . . . . . 205-877-2209 Nurse for Dr. Fred Dumas. . . . . . . . . . . . . . . . . . . . 205-877-2209 Nurse for Dr. Sandra Tincher . . . . . . . . . . . . . . . . . 205-877-2217 Oncology Coordinator. . . . . . . . . . . . . . . . . . . . . . . 205-877-1798 GYN Inpatient Oncology Unit . . . . . . . . . . . . . . . . . . . . . 205-877-5350 Inpatient Oncology Unit . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-1700 Nurse Navigator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-2687 Nutritional Support/Oncology Dietician . . . . . . . . . . . . 205-877-1033 Oncology Chaplain/Counselor . . . . . . . . . . . . . . . . . . . . 205-877-1720 Ostomy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-2582 Outpatient Medical Oncology. . . . . . . . . . . . . . . . . . . . . 205-877-2256 Physician Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-8800 ADDITIONAL SUPPORT SERVICES Alabama Foundation for Oncology . . . . . . . . . . . . . . . . 205-877-2225 American Cancer Society . . . . . . . . . . . . . . . . . . . . . 1-800-ACS-2345 Genetic Testing Breast, Ovarian, Colon and Melanoma Cancer . . 205-877-1798 Camp New Hope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-2224 Camp for children of cancer patients Camp Newsong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-2224 Camp for children who have had a family member die Cancer Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-1383 Hope Lodge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-513-9933 Smoking Cessation . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-QUITNOW Transportation Information. . . . . . . . . . . . . . . . . . . . . . . 205-877-1798 Women's Diagnostic Center. . . . . . . . . . . . . . . . . . . . . . 205-877-5200 Digital mammography, CAD, ultrasound and bone density CANCER SUPPORT GROUPS Bosom Buddies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-ACS-2345 For women with breast cancer Gynecologic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-975-9523 For women with GYN cancer Look Good Feel Better . . . . . . . . . . . . . . . . . . . . . . . . 1-800-ACS-2345 Free class on makeup application and hair care during cancer treatment Man to Man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-ACS-2345 For men with prostate cancer Reach to Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-ACS-2345 Information on exercises for breast surgery recovery, including range of motion exercises for surgical arm STRETCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-824-6666 Exercise class designed especially for women following breast surgery Friends Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205-877-1720 For patients with any type cancer and loved ones
  9. 9. Brookwood Medical Center 2010 Brookwood Medical Center Drive Birmingham, Alabama 35209 (205) 877-1000 www.bwmc.com Rev. 11/08

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