Erlanger Hospital Services

Cancer Center

Cancer Registry Report

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The Cancer Registry is a system to monitor all types of cancer and neoplasm’s diagnosed and/or treated within the Erlanger Health System. The data we maintain is a critical element in the evaluation of cancer care. Information processed in the Registry includes: Demographics, Medical History, Diagnostic Findings, Cancer Identification, Treatment, and Lifetime Follow-Up. All the data is collected in compliance with the American College of Surgeon’s Commission on Cancer (ACoS-CoC) and the Tennessee Cancer Registry (TCR), and is maintained with compliance to HIPAA (Health Insurance Portability and Accountability Act of 1996).

Registry data contributes to staging, treatment planning, and continuity of care for the cancer patient. The Registry is a valuable resource for research investigations. Accurate and complete data allows for optimal cancer program and administrative planning allocating hospital resources. The security of confidential patient information is maintained in the Registry database through established procedures. The Erlanger Cancer Committee supervises the Registry and ensures accurate and timely abstracting, staging, follow-up, and reporting.

The EHS Cancer Registry has a reference date of January 1, 1983, with a current database of 22,291 (as of 2004 Accession Year). During 2004 the Registry submitted data to the TCR and the National Cancer Data Base (NCDB). Over 35 reports of Registry data statistics and analysis were prepared by the Registry. Annual lifetime Follow-Up on all analytic patients is conducted on a monthly basis. More than 5,500 cases are currently under active follow-up with an average total follow-up rate of 95-percent (95%). The Registry is staffed by two Certified Tumor Registrars and one Registry Assistant. The responsibilities of the Registry include but are not limited to the following as an integral part of the Erlanger Cancer Program: Maintain Cancer Registry Database; State and National reporting; Lifetime patient follow-up; Outcomes analysis; Cancer Conferences; CoC liaison to the Cancer Committee; Partnership with American Cancer Society.

Statistical summary of registry data for 2004 is displayed in CHARTS #1-7, with a site-specific analysis of Cervical Cancer in CHARTS #8-10:

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CHART-1
Class of Case Distribution: For the Year 2004, EHS accessioned 1107 cases. 81% (down from 83% last year) of the cases were analytic which includes patients first diagnosed and/or first treated at EHS and required to be accessioned by the CoC. 19% were non-analytic cases which include patients treated here subsequently, or cases required by the TCR but not by the CoC.

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CHART-2
Distribution of Primary Sites – Analytic Cases 2000-2004: In 2004 the collection of benign brain neoplasms became a requirement of the CoC with a total of 23 cases accessioned, 10 male and 13 female. The number of Prostate cases in 2004 compared to 2000 is less than half. Breast Cancer cases have decreased since last year by 18% and by 37% compared to 2000. Female Genital Cases in 2004 compared to 2000 show an increase of 21%. The top five sites diagnosed at EHS for 2004 are Lung, Breast, Female Genital, Colorectal, and Malignant Brain/CNS. The 2004 Male top five sites are Lung, Colorectal, Malignant Brain/CNS, Oral Cavity, and Blood/Bone-Marrow. The Female 2004 top five sites are Breast, Female Genital, Lung, Colorectal, and Malignant Brain/CNS.

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CHART-3
Ten Leading Sites By Sex: Comparison of national statistics with EHS. The greatest difference in incidence of cancer at EHS compared to national data* is Prostate Cancer. Only 4% of Male Cancer cases at EHS are Prostate as opposed to 33% nationally. The incidence of Male Lung Cancer at EHS is double the percentage of national incidence. Female Lung Cancer incidence at EHS is 6% higher than nationally. The incidence of Female Breast Cancer at EHS is 8% below national statistics. (*Estimated New Cancer Cases by Sex, US, 2004)

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CHART-4
AJCC Stage By First Course of Treatment - The majority of patients diagnosed at Stages 0-II were treated with Surgery only, also patients with Unknown Stage and Staging N/A. The majority of Stage III & IV patients received Chemotherapy treatment. Summary of patterns of treatment for ALL patients at EHS: 483 (53%) received definitive Surgery, 339 (37%) received Chemotherapy, 302 (33%) received Radiation, 6 received Other Treatment, and 112 (12%) received None or Unknown if patient received treatment.

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CHART-5
Analytic Cases by Stage/Sex - The majority (33%) of Female incidence of cancer was diagnosed at Stage I, a 10% higher rate than Male incidence at Stage I (23%). The majority (33%) of Male incidence was diagnosed at Stage IV, nearly twice the incidence of Female Stage IV at 18%. Stages II and III averaged 17% for Male incidence, and Female incidence averaged 20%. Incidence diagnosed at Stage III was the same for both Female and Male at 18%.

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CHART-6
Per cent of Stage at Diagnosis by Accession Year 2000-2004 – Throughout the five-year surveillance, the majority of all cases diagnosed and/or treated at EHS was Stage I. There is a noticeable variance in 2004 of Stage II cases with about a 5% decrease compared to 2000. In 2004 compared to 2003, there was an approximate 5% increase of Stage IV and decrease in Stage III. The median value for each Stage is as follows: Stage 0 = 5.5%(2001); Stage I = 21.99%(2001); Stage II = 17.68%(2003); Stage III = 16.26(2001); Stage IV = 16.96%(2001); Stage UNK = 4.28%(2004); Stage N/A = 15%(2002).

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CHART-7
2004 Cases by County – Over 50% of cancer cases seen at EHS are from within Hamilton County. Georgia cases contribute the next largest population at 21%, with Walker County alone at 8% (3% higher than any of the remaining TN counties). The next highest percentage of cases at approximately 5% each is from Bradley, Marion and Rhea counties. Sequatchie County and Alabama cases represent about 2% each, and the remaining TN counties as well as Other States are at 1% or less.

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CHART-8
Cervix Cases 2001-2004 by AJCC Stage - The highest percent of incidence of Cervix cancer at EHS was diagnosed at Stage I for all four years from 2001 to 2004. The incidence of Stage III and IV cases had the lowest percent of incidence in 2002 and 2003. However in 2001 the percentage of Stage IV was higher than Stage III and equal with Stage II, in 2000 the percentage of Stage IV was equal with Stage III.

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CHART-9
Cervix Cases First Course TX – EHS 2001 & 2004 vs. NCDB (2001)* - First course of treatment for Cervix cancer patients at EHS shows a slight increase in the percentage of SURG ONLY treatment in 2004 compared to 2001, a decrease in CHEM/RAD treatment, and a doubled increase in SURG/CHEM/RAD treatment. RAD ONLY represents over 10% treatment in 2001, compared to 0% in 2004. National treatment data for 2001 shows an approximate 25% higher rate of SURG ONLY compared to EHS 2001 and 2004, and CHEM/RAD treatment nationally is less than half for both 2001 & 2004 at EHS.

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CHART-10
Cervix Five Year Survival – EHS vs. NCDB* - Compared with national data (NCDB), EHS shows a higher percentage of Five Year survival for Stages II-IV Cervix cancer cases. The survival rate for Stage I is 10% lower at EHS than nationally.

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*Source: NCDB. CoC. ACoS. Benchmark Reports.. ©Commission on Cancer, American College of Surgeons. NCDB Benchmark Reports, vI.I Chicago, IL,2002. The content reproduced from the applications remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any ancillary or derivative works based on the original Text, Tables, or Figures.)