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9 2017 Cancer ProgramClinical Research/TrialsClinical research plays an important role in advancingthe body of knowledge in cancer medicine and makinga difference in the lives of cancer patients.Because Advocate Christ Medical Center’s CancerInstitute participates in clinical trials covering a vastnumber of disease sites and cancers, its patients canaccess a wide range of new, experimental drugs andtreatments without having to leave the community forcancer care.The Cancer Institute’s involvement in clinical trials issupported by qualified and dedicated research staffwho work with physicians and nurses throughout theentire process.The Cancer Institute strives to use research as a tool toincrease its patients’ options through clinical trials andto enhance the level of care through the developmentof evidence-based practice.Click here to view cancer clinical trials in progress atAdvocate Christ.Video message from Dr. Amar HamadPatient Centered Care and aMultidisciplinary Approach toCancer TreatmentDecisions about cancer treatment present a difficultchallenge for patients, primary care physicians andspecialists. It is at this time that our multidisciplinaryapproach and treatment planning become important toour patients, their families and physicians. This teamapproach and patient-professional partnership assuresquality care thus, reducing the anxiety level of thepatients and families going through this challengingjourney. All efforts are made to ensure timelyappointments and a multidisciplinary evaluation thatincludes diagnosis confirmation, staging of diseaseand evidence-based treatment plan options tailoredto your needs. Our physicians collaborate to deliveroutstanding care within a committed and caringatmosphere.

10 2017 Cancer ProgramNursing Excellence in CancerCareGenetics Cancer RiskAssessment ProgramWe have a dedicated team of oncology nurseswho work at each patient’s bedside to delivercompassionate, safe, holistic cancer care. The rangeof services provided by our nurses goes beyondmedication administration, encompassing thoroughassessments, symptom management, patient andfamily education, and emotional, spiritual, andpsychosocial support.Genetics plays a powerful role in preventing andtreating cancer. Most cancer occurs as the result ofan interaction between environment, lifestyle andgenetic factors. Approximately 5 percent to 10 percentof all cancers are caused by an inherited geneticchange. Identifying individuals and their familymembers with an inherited predisposition towardcancer helps establish tailored treatment, surveillanceand prevention. Knowing that an individual has anincreased risk of cancer based on personal/familyhistory or genetic test results can improve thatperson’s health and quality of life.Under the direction of a highly experienced oncologynursing leadership team, the nurses integratestandards of best practice with each patient’sindividualized needs. The commitment of our nursesto cancer care is demonstrated through the specializededucation and training in radiation oncology andadministration of chemotherapy and biotherapy, theircertification as oncology nurses, and their retentionrate in this specialty. For inpatient and outpatientsettings combined, 88 percent of our staff nurses arequalified to administer chemotherapy and biotherapy,70 percent of eligible staff nurses are certified asoncology nurses, and 40 percent of staff nurses have10 years of oncology experience.Nurse NavigationOncology Nurse Navigators help coordinate careand lessen the burden that patients and families mayexperience throughout the cancer continuum. Thesehighly qualified, knowledgeable patient navigatorsand oncology-certified nurses provide disease-specificfocus to their patients, as well as one-on-one supportto help patients navigate the cancer experience.Click here for additional information and to contact anurse navigator.Advocate Christ Medical Center’s Cancer Instituteestablished a Genetics Cancer Risk AssessmentProgram in 2008 to support our cancer patients andtheir family members. This program offers hereditarycancer risk assessment, genetic counseling andgenetic testing performed by our board-certified andlicensed genetic counselors.In 2016, the genetic counselors provided consultationto more than a thousand new patients. They attendedthe breast, gynecology oncology, and GI caseconferences and offered expert opinions during casereviews. The genetic counselors are active members ofAdvocate Christ’s Cancer Committee. In addition, theyprovide numerous educational offerings throughoutthe year to a variety of audiences, including medicalstudents, residents, physicians, nurses, supportgroups and the community at large.The genetic counselors have expanded theirservices to include seeing patients at AdvocateGood Samaritan, South Suburban and TrinityHospitals. They attend cases conferences, are a partof these hospitals’ Cancer Committees, and provideeducational opportunities to physicians, nurses,patients, and the community.Advocate Christ’s genetic counselors: Deborah Oleskowicz, MS, CGC Cristina Ruiz, MS, CGCLearn more about the genetic counseling program.

11 2017 Cancer ProgramCardio-Oncology ServicesEarly detection and advances in cancer treatmentmean more people are surviving cancer than everbefore. While this is certainly good news, it istempered by the growing evidence of treatmentinduced cardiomyopathy—a condition in whichdamage to the heart muscle inhibits the heart’s abilityto pump blood through the body—and possible heartfailure.At Advocate Christ Medical Center, cardio-oncologistSunil Pauwaa, MD, FACC, and his team in the CardioOncology program help to reduce heart risks.The Cardio-Oncology service supports patients whoare being treated for cancer by providing educationand monitoring during and after treatment, with thegoal of preventing or minimizing heart damage.Video message from Dr. Sunil PauwaaPalliative CareThe Palliative Care Team at Advocate Christ MedicalCenter provides a consultative service for patientsand families living with cancer and other chronicdiseases or serious illnesses. These patients mayhave significant physical, psychological, social andspiritual needs that can be overlooked in an acute caresetting that is focused more on curative measures thancomfort care.The Palliative Care Team consists of specializedclinicians, including board-certified palliative medicinephysicians, advanced practice nurses, registerednurses, medical social workers, and chaplains.The purpose of the Palliative Care team is to providesymptom management and to assist patients andfamilies define clear goals of care that improve thepatient’s quality of life.

12 2017 Cancer ProgramGilda’s ClubGilda’s Club Chicago (GCC) is delighted to be a part ofthe Advocate Christ Medical Center campus. In 2016,the Clubhouse hosted almost 700 people for morethan 5,600 free visits. GCC at Advocate Christ has afull Clubhouse on the ground floor of the OutpatientPavilion and is a resource not only to the medicalcenter, but also to the entire Southland.GCC supports all those living with cancer—men,women, teens and children—along with theirfamilies and friends, as well as those who havelost someone to cancer. Their innovative programis an essential complement to medical care andoffers support groups, educational lectures, healthylifestyle workshops, resource referrals, and socialopportunities.GCC offers more than 350 free activities each monthacross five locations, including the downtownClubhouse on Wells Street and GCC at AdvocateChrist. GCC’s mission is to ensure that all peopleimpacted by cancer are empowered by knowledge,strengthened by action and sustained by community.American Cancer SocietyAdvocate Christ Medical Center hosts an AmericanCancer Society (ACS) Patient Navigator on-site toassist with identifying and removing barriers to carewith the overall goal of providing positive healthoutcomes. The ACS Patient Navigator can providepatients, families and caregivers with tools andresources to meet their evolving needs along theircancer journey and empower patients to take an activerole in their treatment and life after treatment.There are many resources available through TheAmerican Cancer Society and additional communityorganizations. Some frequently provided servicesinclude distributing literature on cancer-relatedtopics including treatment options and side effects,coordinating transportation and/or lodging fortreatment, talking over financial concerns, locatingsupport groups, and providing programs to counteractappearance-related side-effects including free wigs.Call 708.684.3780 to speak with Alexandria Gorgosz,Advocate Christ Medical Center’s ACS PatientNavigator.To learn more about The American Cancer Society,please visit www.cancer.orgCancer Registry and 2016Cancer Data SummaryCancer Registrars are data information specialiststhat capture a complete history, diagnosis, treatment,cancer staging and health status for every cancerpatient at Advocate Christ Medical Center. Datais transmitted to the Illinois State Cancer Registrymonthly and National Cancer Database yearly duringthe Annual Call for Data. The data collected by thecancer registrars is essential information that is utilizedby researchers, health care providers and public healthofficials to better monitor the effectiveness of thetreatment that is administered by cancer site and stageof disease. Cancer patients are followed annually andtheir disease status is updated by the cancer registrystaff annually in order to provide survival statistics.Cancer registrars maintain their credentials bycontinually participating in educational seminars andworkshops in order to increase their knowledge oftreatment advancements and modalities.

13 2017 Cancer ProgramPrimary Cancer Sites – 2016Primary Cancer Sites – 2575473NCDB(n 227,439)(%) 2014*Stg 019.2%20.6%Stg I44.0%42.5%Stg II23.7%24.0%Stg III7.0%7.3%Stg IV4.0%4.1%N/A0.2%0.1%Unknown1.9%1.5%ACMC(n 362)(%) 2016NCDB(n 124,123)(%) 2014*LUNGStageStg 00.3%0.5%Stg I32.6%27.3%Stg II5.8%9.4%Stg III15.7%19.5%Stg osStageACMC(n 473)(%) eBroncLu hung s &seancrPaColonStomach0

14 2017 Cancer ProgramStageACMC(n 143)(%) 2016NCDB(n 69,396)(%) 2014*Stg 011.9%5.3%Stg I23.1%19.7%COLONStg II21.0%24.3%Stg III16.1%25.5%Stg IV21.7%20.2%N/A2.1%0.2%Unknown4.2%4.9%CORPUS UTERUSACMC (n 142)NCDB (n 42,297)Stage(%) 2016(%) 2014*Stg 00.0%0.7%Stg I62.0%68.1%Stg II4.2%4.7%Stg III13.4%11.8%Stg IV7.0%6.8%N/A8.5%0.2%Unknown4.9%7.7%StageACMC(n 82)(%) 2016NCDB(n 95,319)(%) 2014*Stg 00.0%0.0%PROSTATEStg I8.5%20.0%Stg II61.0%54.5%Stg III12.2%12.8%Stg IV14.6%10.4%N/A0.0%0.1%Unknown3.7%2.4%Source: 2014 NCDB, Commission on Cancer*2014 is the latest data available from the NCDB as of 10/19/2017

15 2017 Cancer ProgramAnalytic Cases by Age at DiagnosisPrimary SiteTotalPercentage0 – 29632.99%30 – 39632.99%40 – 491426.75%50 – 5938718.38%60 – 6964030.40%70 – 7949623.56%80 – 8927813.21%90 361.71%Total2,105100.00%Age at Diagnosis (in years) for 20160 – 293% 30 – 393%80 – 8913%40 – 497%90 2%50 – 5918%70 – 7924%60 – 6930%

16 2017 Cancer ProgramAnalysis of Pancreatic Cancer Statistics and Outcomes atAdvocate Christ Medical Centerby Marc Mesleh, MD, FACSPancreatic Adenocarcinoma remains the fourth leadingcause of cancer death in the United States. Thereare greater than 53,600 new patients diagnosed withPancreatic Cancer annually. Additionally, the mortalityrate remains between 8%-10% overall.when the cancer has spread to other organs, the5-year survival is only 3%. There have been majorimprovements in Chemotherapy and Radiationtreatments, and we expect these numbers to improvein the next few decades.There are several risk factors which appear to beincreasing the incidence. Studies have shown thatcigarette smoking, obesity, chronic pancreatitis andpossibly diabetes are some of the risk factors ofpancreatic cancer.Here at Advocate Christ Medical Center, weapproach Pancreatic Cancer as a MultidisciplinaryTeam. All cases are presented and reviewed at aTumor Board, where their workup and treatmentoptions are reviewed by a team including MedicalOncology, Radiation Oncology, Radiology, Pathology,Gastroenterology, Genetics and Surgeons. Inthis format, the team decides if the patient is asurgical candidate, and if they are appropriate forChemotherapy and Radiation.Although there have been major advances withrespect to early diagnosis (MRI/CT scan, EndoscopicUltrasound), the prognosis remains poor. Thisaggressive cancer is often already quite advanced atthe time it is first diagnosed. Studies of the NationalDatabase show that when patients are first diagnosedwith pancreatic cancer, only 15%-20% of patients arecandidates for surgical resection.Across the country, survival rates remain poor. Inthe most favorable cases, when the tumor can becompletely resected, and lymph nodes are negativefor cancer, there is a 30% 5-year survival rate.Unfortunately, when cancer is found in nearby lymphnodes, the 5-year survival decreases to 11%. In casesOur group strictly adheres to the NationalComprehensive Cancer Network (NCCN) Guidelineswith respect to workup and treatment options. Forexample, all patients undergo a staging workup withCT scan or MRI with contrast. Also an EndoscopicUltrasound (EUS) is typically performed to confirmthe diagnosis and assess for vascular involvement.Patients are then categorized as Resectable, BorderlineResectable or Unresectable (Table 1).ResectableBorderline ResectableUnresectable N o Portal Vein (PV) or SuperiorMesenteric Vein (SMV)Involvement PV/SMV Contact of 180 Degrees Un-reconstructable PV/SMVInvolvement SMA Abutment of 180 Degrees N o Superior MesentericArtery (SMA) or Celiac ArteryInvolvementTable 1 - NCCN Guidelines for Classification of Pancreatic Cancer. SMA Abutment 180 Degrees Metastatic Disease

17 2017 Cancer ProgramIn following the NCCN guidelines, we typicallyoffer surgical resection to patients with ResectablePancreatic Cancer. For those with BorderlineResectable Pancreatic Cancer, we start withNeoadjuvant Chemotherapy and occasionallyChemoradiation. If the patient tolerates treatment well,and the cancer has a good response to treatment, wewould then offer surgical resection.This study presents our experience at Advocate Christwith Pancreatic Cancer from August 2013 to December2016. We reviewed our pre-operative workup andclassification as Resectable/Borderline Resectableaccording to NCCN guidelines. Finally, we analyzedour outcomes with respect to morbidity, survivaldata, and patients who went on to receive adjuvantchemotherapy.RESULTS:This study examined all patients diagnosed withPancreatic Cancer at Advocate Christ over the timeframe of August 2013 to December 2016. In total,there were 200 patients diagnosed at Advocate Christ.Data was extracted from the Cancer Registry, as wellCharacteristicsas a physician-maintained database for patients whounderwent pancreatic surgery.In categorizing these patients according to NCCNguidelines, 53 patients were “resectable” and wenton for surgical resection, 5 patients were “borderlineresectable” and received neoadjuvant chemotherapyprior to surgery, and 142 patients were “unresectable”or not fit for surgery. Therefore, only 29% of patients atAdvocate Christ were surgical candidates. This closelymirrors national data on resectability rates.Preoperative staging workup included CT scan withArterial and Venous Phase contrast, MRI with Contrastand Endoscopic Ultrasound. All of the patients in thestudy group had one or a combination of these tests toassess for metastatic disease and local vessel invasion.The surgical characteristics are presented in (Table 2).In summary, there were several different pathologicdiagnosis found at resection. Additionally, thereare several different types of surgical resectionsincluded Whipple (Pancreaticoduodenectomy), DistalPancreatectomy, and Total Pancreatectomy.Number of Patients (%)Pathology Pancreatic Adenocarcinoma38 (65%) Pancreatic Neuroendocrine Tumor8 (14%) Ampullary Adenocarcinoma6 (10%) Duodenal Adenocarcinoma3 (5%) IPMN3 (5%)Surgical Resection Pylorus Preserving Whipple38 (65%) Standard Whipple7 (12%) Distal Pancreatectomy9 (16%) Subtotal Pancreatectomy3 (5%) Total Pancreatectomy1 (2%)Table 2 - Characteristics of Surgical Resections at ACMC

18 2017 Cancer ProgramFinally, we examined the survival data of patientsdiagnosed with Pancreatic Cancer here at AdvocateChrist. Within the study period, the overall survival forthese 200 patients was 53%. Dividing them into the58 patients who underwent resection had a survivalrate of 66%, compared to the 142 patients who wereunresectable had a 48% survival rate.CONCLUSION:Advocate Christ Medical Center is a High-VolumeCenter for Pancreatic Cancer. In the study period of justover 3 years, 200 new patients with pancreatic cancerwere diagnosed and treated. Additionally, 58 patientsunderwent surgical resection in this time period.In presenting patients in a Multidisciplinary TumorBoard, we strive to follow NCCN guidelines forworkup, staging and treatment. This analysis of thedata shows that Advocate Christ provided high-volumeand high-quality cancer care to our patients withPancreatic Cancer. While the overall prognosis forPancreatic Cancer remains poor, we have shown thatthe outcomes in our High-Volume Center are excellent.

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Each patient's multidisciplinary team includes highly qualified, knowledgeable individuals experienced in surgery, medical oncology, radiation oncology, gastroenterology, interventional radiology, certified oncology nursing, patient navigation, genetics, oncology research, nutrition, palliative care and cancer survivorship.