Cancer Center Annual Report 2017

UNC REX CANCER CARE

ANNUAL REPORT 2017

A COMPREHENSIVE COMMUNITY CANCER PROGRAM Wakefield

Accredited by the American College of Surgeons Commission on Cancer
National Accreditation Program for Breast Centers

Cary East Raleigh Garner Raleigh Main Raleigh Blue Ridge

On the cover: UNC REX Cancer Care of Wakefield

11200 Governor Manly Way, Raleigh, NC 27614

UNC REX Cancer Care locations
Cary ~ East Raleigh ~ Garner ~ Raleigh Main ~ Raleigh Blue Ridge ~Wakefield

For more information or to schedule an appointment with UNC REX Cancer Care
Call 919-784-3105

www.REXhealth.com

ANNUAL REPORT | 3

UNC REX Cancer Care

Mission and Core Values

Mission
Our mission at UNC REX Cancer Care is to provide our patients with exceptional cancer care and to ensure
timely and convenient access to the most effective strategies that prevent, treat, and ultimately cure cancer
in the future. UNC REX Cancer Care provides expert, compassionate care to patients with cancer through
close collaboration among providers across all disciplines of oncology.

Core Values

 Impact
We strive to provide timely access to care in a caring and compassionate setting close to patients’ homes
and to relieve the burden of disease now and for the future through our research, clinical care, education,
outreach and advocacy.

 Excellence
We pursue excellence relentlessly and with integrity in all that we do, adhering always to the highest
standards of conduct.

 Compassion and Respect
We strive to exceed expectations for compassion and respect for those in our care and for one another.

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UNC REX Cancer Care Annual Report 2017

Table of Contents Page

 Mission and Core Values 3

 Introduction 5

 Accreditations and Eligibility Requirements 6

 Feature: Prevention and Screening Programs 7

 Patient Family Advisory Council 14

 Tumor Registry and Site Distribution 15

 Clinical Trials 17

 Publications and Presentations 2017 18

 Comprehensive Community Cancer Care 19

 Cancer Care Services and Locations 20

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Introduction

The REX Cancer Care Committee is the designated multidisciplinary body for program leadership, administrative
oversight, development, and review of oncology services at UNC REX Cancer Care. The Cancer Care Committee
is a committee of the UNC REX Hospital Medical Staff responsible for the overall direction of the oncology
program including coordination with Hospital and UNC Health System leadership. Its composition, as required by
the Commission on Cancer, includes Board-certified physicians from Surgery, Medical Oncology, Radiation
Oncology, Diagnostic Radiology, and Pathology, along with the Cancer Liaison Physician, Clinical Research
Manager, Palliative Care Specialist, and representatives from Hospital Administration, Nursing, Pharmacy,
Psychosocial Services, Cancer Registry and Quality.

Annually, as required by the Commission on Cancer, the UNC REX Cancer Care Committee prepares an annual
report with a focus on program outcomes. For 2017, the Committee selected CoC Standards 4.1 and 4.2:
Prevention and Screening Programs as the focus for the Annual Report. These findings, published here in the UNC
REX Cancer Annual Report, are also made publicly available to the organization and the community.

Cancer Care Committee Membership 2017 Committee Chair
ACoS Cancer Liaison Physician/ Surgical Oncology
 Courtney Bui, MD Medical Director, Rex Hematology Oncology Associates
 Yale Podnos, MD Surgeon / Breast Care Committee Chair
 Susan Moore, MD Executive Director, UNC REX Cancer Care
 David B. Eddleman, MD VP Operations UNC Rex Health
 Tom Grates, MBA Pulmonologist, Chair Cancer Conference Committee
 Chad Lefteris, MHA Hematology Oncology
 Hiren Mehta, MD Radiation Oncology
 Charles Eisenbeis, MD Pathology
 Nathan Sheets, MD Radiology
 Keith Volmar, MD Cancer Registry Manager
 Jay Alley, MD / Duncan Chapman, MD Cancer Research Manager
 Kathleen Foote, MBA, CTR Quality Coordinator
 Nancy Burns, RN, OCN Social Work /Psychosocial Services Coordinator
 Cynthia Jones, BS, CPHQ Palliative Care
 Kimberly Fradel, MSW,LCSW Oncology Nurse Manager (OP) / Clinical Leadership
 Jan Kimball, NP/ Ann Yeager, MD Genetic Counseling
 Mendy Moody, MSN, OCN Community Outreach Coordinator / Director
 Catherine Fine, MS, CGC / Ofri Leitner, MS, CGC
 Emmeline Madsen, MPH

Additional Supporting General Membership 2017 Douglas Hammer, MD ~ Family Practice
Matthew Strouch, MD ~ Surgery Robert Wehbie, MD ~ Medical Oncology
Meena Mohan, MD ~ Hospitalist Becky Jones, PharmD ~ IP Pharmacy
Jon Gerber, PharmD ~ OP Pharmacy Heather Sasser, RN, OCN
Jennifer Headen, MHA ~ RHOA Administrator Suzanne Smith, RD, CSO, LDN~ Nutrition
Nancy Reifsteck, OTR ~Rehab Kelsey Williams, RN, Manager (IP)
Gordon McGirt, MBA ~ Manager (OP RHOA) Robbie Tilley ~American Cancer Society
Katie Hardison, BS ~Staff /Committee Assistant

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UNC REX Cancer Care Accreditations

UNC REX Cancer Care is voluntarily accredited by the American College of Surgeons Commission (ACoS) per
the Commission on Cancer (CoC) Standards as a Comprehensive Community Cancer Program (CCCP). The pro-
gram assesses more than 2,800 newly diagnosed cancer cases each year, provides a full range of diagnostic and
comprehensive treatment services as noted below, either on-site or by referral, as well as participates in cancer-
related clinical research and cancer-related clinical trials, per CoC Standards.

UNC REX Cancer Care is voluntarily accredited by the National Accreditation Program for Breast Centers
(NAPBC), which holds organizations to the highest standards of care for patients with diseases of the breast.
UNC REX Care is also accredited by the Joint Commission and ACR Breast Imaging Center of Excellence.

UNC REX Cancer Care meets and /or exceeds the Commission on Cancer’s 12 Eligibility Requirements:

Eligibility Requirements Specifications

Cancer Committee Responsibilities Annual monitoring, assessing, and identifying changes that are needed in each
of the eligibility requirements.

Facility Accreditation The facility is accredited by a recognized federal, state, or local authority.

Cancer Committee Authority Bylaws or policy and procedure define the cancer committee’s authority and
responsibility for the program.

Cancer Conference Policy Program policy addresses the frequency, format, multidisciplinary attendance,
attendance rate, prospective case presentations and total case presentations,
discussion of stage and treatment planning, clinical trial options, and methods
to address opportunities.

Oncology Nurse Leadership An oncology nurse provides leadership within the program.

Cancer Registry Policy and Procedure Policy and procedure addresses the use of Commission on Cancer data and all
other cancer registry activities.

Diagnostic Imaging Services are provided. *

Radiation Oncology Services Radiation treatment service locations are currently accredited by a recognized
authority or, if not accredited, follow standard quality assurance practices. *

Systemic Services Policies or procedures are in place to guide the safe administration of systemic
therapy.*

Clinical Trial Information A policy or procedure is used to inform patients about clinical trials.

Psychosocial Services A policy or procedure is in place to ensure patient access to psychosocial ser-
vices.*

Rehabilitation Services Rehabilitative services are provided. *

Nutrition Services Nutrition services are provided.*

Source: CoC, 2016 * Services are available either on-site, at locations that are facility owned, or by referral.

ANNUAL FEATURE ANNUAL REPORT | 7

UNC REX Cancer Care: Prevention and Screening Programs

UNC REX Cancer Care has a strong history of community engagement and outreach to increase
awareness of cancer risk, prevention and early detection. Our programs are developed to align with
community areas of need, to build on successful strategies and to be consistent with evidence-based
practices.

COMMUNITY NEEDS ASSESSMENT

UNC REX Cancer Care uses information from multiple community health needs assessments to in-
form our community outreach activities. Each year findings from the following community health
needs assessments are reviewed by the Cancer Care Committee:

 UNC REX Cancer Care Incidence and Mortality Trends
 American Cancer Society Facts and Figures
 Wake County Community Health Needs Assessment
 Komen Community Health Needs Assessment.
 Behavioral Risk Factor Surveillance System

UNC REX Healthcare participates in a collaborative Wake County Com-
munity Health Needs Assessment (CHNA) that identifies the health needs
of Wake County residents as well as the resources available to address
those needs. The CHNA is conducted every three years through the col-
laborative efforts of Wake County Human Services, Advance Community
Health, Duke Raleigh Hospital, UNC REX Healthcare, WakeMed Health
and Hospitals, United Way of the Greater Triangle, and the Wake County
Medical Society Community Health Foundation.

The CHNA identified the following county priority areas to be addressed
through community health improvement efforts: Health Insurance Coverage, Transportation, Access
to Health Service, Mental Health and Substance Abuse.

In the capital city of Raleigh, NC, there are nu-
merous community resources available to resi-
dents that may not be available in surrounding
counties. The UNC REX Cancer Care service
area includes Wake, Franklin, Johnston, and
Harnett counties. Not surprisingly, the Komen
Community Health Needs Assessment identified
the highest priority cancer risk reduction and
prevention activities need in the counties border-
ing the service area.

Our needs assessments also identified key trends
in incidence and mortality. In North Carolina
cancer incidence rates are highest among breast,
lung, prostate, and colorectal diagnoses. The
highest mortality rates are in lung, colorectal,
breast, hepatopancreatic, and prostate diagnoses.

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The top five identified cancers diagnosed at late stage at UNC REX Cancer Care are Oral (42%), Lung
(41%), Lymphatic (31%), Digestive (25%), and Gynecologic (16%).
North Carolina ranks in the top ten states for screening for breast, colorectal and cervical cancer and is
above the national average in mammography, pap tests, fecal occult blood testing, and endoscopy.
Although these screening rates are higher than many other states, improvement opportunities remain.
Of note, North Carolina is ranked poorly for cancer risk factors including overweight and obesity prev-
alence, HPV vaccinations rates, and tobacco related risk factors.

Cancer incidence disparities also exist in individuals with lower socioeconomic categories. Individuals
in this population are more likely to engage in high risk behaviors and have less access to health care
and healthy behavior resources. Racial and ethnic disparities are similarly reflective of poor access to
health care resources. Prostate cancer rates for example are notably higher in African American men
including North Carolina and the UNC REX Cancer Care service area. Hispanics have lower rates for
the most common cancers but are highest in those associated with cancer-related infections.

Findings from the American Cancer Society and other sources on cancer risk factors have focused
heavily on achieving and maintaining a healthy weight, participating in an active lifestyle, consuming a
healthy diet, limiting alcohol consumption, refraining from tobacco use and accessing medical care.
Despite the impact of these recommendations to decrease cancer risk, many cancers can be positively
impacted with early detection and treatment including breast, prostate, and lung, colorectal, skin, and
cervical.

The UNC REX Cancer Care outreach programs strive to increase awareness, improve access to care
and increase community engagement to reduce cancer incidence and mortality rates.

PREVENTION PROGRAMS
Lay Health Advisor Program: Brothers & Sisters of Rex
Brothers & Sisters of Rex is a Lay Health Advisor program utilizing the skills and
time of over 30 specially trained volunteers to provide education to the community
on cancer prevention and early detection. Some of the volunteers are from the
original Save Our Sisters program that was created in the mid-1990’s through a
Breast and Cervical Cancer Early Detection Program (BCCEDP) funding require-
ment to have a lay health component of program offerings.

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That group, which
focused on address-
ing the breast health
needs of African
American women,
joined UNC REX
Healthcare in 2001
when funding from
Wake County was.
In 2014, Save Our
Sisters expanded to
become Brothers & Sisters in collaboration with efforts of the North Carolina Minority Prostate Cancer
Awareness Action Team to reach out to individuals on the importance of prostate cancer awareness
and education. The volunteer group quickly expanded and developed a knowledge base to inform out-
reach efforts on breast, prostate and colorectal cancer risk, prevention, and early detection.

In 2017, members were trained on lung cancer and tobacco prevention and cessation messaging to in-
clude in outreach efforts. Members of Brothers & Sisters provide health talks and information
throughout the year at community locations and reach an average of 5000 individuals each year.

 Faith-Based Campaigns
UNC REX Cancer Care conducts a community campaign in
local faith-based organizations in areas with increased need for
cancer awareness and early detection behaviors. Specially
trained Lay health advisors (LHAs) engage pastors and con-
gregation members in discussion on early detection of cancers.
A faith-based campaign has proven to be a very effective
method of engaging the community given in positive behavior
change. LHAs are equipped to engage and answer questions immediately and refer appropriately. A
simultaneous message directed to both men’s and women’s health issues have worked well to address
multiple cancer risks.

Annual Goals and Objectives:

 Engage community churches in discussion on self-care and health behaviors
 Engage with community members to increase awareness of breast cancer, prostate cancer, and

colorectal cancer risk, prevention, and screening
 Increase access to UNC REX Healthcare services for early detection, treatment, and survivor-

ship

Results: 1570 individuals reached
 2016: 11 churches 955 individuals reached
 2017: 17 churches

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 Barbershop and Salon Campaigns
Another community awareness campaign was conducted in local beauty salons and barbershops in are-
as with increased need for cancer awareness and early detection behaviors. Lay health advisors engage
barbers/stylists and clients in discussion on early detection of cancers.

Annual Goals and Objectives:

 Engage individuals in discussion on self-care and health behaviors
 Engage with community members to increase awareness of

breast cancer, prostate cancer, and colorectal cancer risk,
prevention, and screening
 Increase access to UNC REX Healthcare services for early
detection, treatment, and survivorship

Results:

 2016: 14 Barbershops 275 Individuals reached

10 Salons 316 individuals reached

 2017: 13 Barbershops 245 Individuals reached

11 Salons 281 Individuals reached

Similar to faith-based campaigns, a community campaign
within salons and barbershops can be a very effective method
of engaging the community. Although individual clients are
engaged during the visits, the stylists participate in the mes-
saging and sharing of information during the awareness
month and serve as a point of contact for clients if there are
needs or concerns related to cancer.

 Digital Campaigns
UNC REX Cancer Care conducted a breast cancer
awareness campaign in 2017 to increase access to
information on breast cancer early detection. The
campaign was developed with input from on-line
focus group participants to determine imagery and
wording that would resonate in the community.
The targeted population was on-line users seeking
information on breast health and breast cancer. During the campaign, there were 167,384 digital im-
pressions with over 2,500 individuals engaged in watching video content or additional digital content.
There were 88 follow up actions for appointments for breast care services.

 UNC REX OnLine Health Library
UNC REX Cancer Care strives to ensure that access to information on healthy lifestyle and cancer risk
and risk reduction is available to visitors to our web sites. The main UNC REX Healthcare website
provides highlights on information during cancer awareness months throughout the year and provides
access year-round to information for users on a variety of cancer related topics.

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Given that more and more individuals are seeking health information on-line, UNC
REX Healthcare partnered with Healthwise to provide on-line access to infor-
mation for patients and the community. Healthwise develops content through col-
laborative team efforts to provide information that is comprehensive, evidence-
based, and pertinent to users. Interactive tools are available for health and fitness and lifestyle check-
ups along with personal calculators to assist individuals in learning more about health. Numerous on-
cology topics are provided through information summaries from the National Cancer Institute.

 YOUR LIFE / REX CONNECTS / UNC REX Health Talk
Your Life is an electronic newsletter that provides information to subscribed users
throughout the year. Rex Connects is an on-line blog created by UNC REX
Healthcare. Both the newsletter and the blog space allow experts to provide in-
formation in the on-line community on health information and risks. The content
is developed to engage the audience in accessing information on health and to in-
crease access to services available at UNC REX Healthcare.

Impressions and engagement to these resources have increased notably. In 2017
there were 27,653 impressions and engagement of over
986 individuals with information on-line pertinent to
cancer prevention and risk reduction.

SCREENING PROGRAMS
 Low Dose CT Screening
UNC REX Healthcare developed a Low-Dose CT lung cancer screening program in 2016. The pro-
gram includes an on-line assessment, a nurse prescreen, an in-person nurse visit, a referral to an Ad-
vance Practice Provider for informed decision making and establishment of care, the LDCT screening,
and appropriate follow-up. A patient
can be referred directly for a LDCT
screening by a referring physician as
well.

The UNC REX Program is identified as
a Lung Cancer Screening Center by the American College of Radiology. Data is tracked and uploaded
to a national Lung Cancer Registry.

Annual Goals and Objectives:

 Increase awareness of lung screening
 Provide access to low-dose CT lung screening at UNC REX Healthcare
 Provide access to a self-assessment tool to inform on risk and eligibility for lung screening
 Screen patients for eligibility to identify appropriate individuals for care utilizing a clinical re-

source to inform referral to medical assessment
 Conduct LDCT Screenings on patients and ensure adequate follow-up
 Reduce late stage lung cancer diagnoses

Results: 297 patients screened 2 cancers diagnosed
528 patients screened (YTD) 5 cancers diagnosed
 2016
 2017

The LDCT program is proving to be a very effective program in growth of screening for lung cancer
and is a critical element in any Comprehensive Community Cancer Center.

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Mammography Assistance Program
Rex Mammography Assistance Program (MAP) is a program supported
through The Rex Healthcare Foundation Pink Ribbon Fund to provide fi-
nancial support to individuals in need of breast cancer screening and diag-
nostic imaging. The program provides access to screening and diagnostic
imaging services for individuals who might not otherwise access those
services

Annual Goals and Objectives:

 Increase breast cancer screening rates in underserved communities
 Decrease mortality and morbidity from breast cancer
 Provide assistance to individuals without access to care
 Fill gaps not met by the NC Breast and Cervical Cancer Control Program and other community

resources
 Engage individuals in UNC Patient Financial Assistance Program for additional support to sup-

port any additional follow up care or treatment

Results: In 2016, the following patients were provided services through MAP

 Screening 432 $192,800

 Diagnostic Mammography 396 $58,900

 Ultrasound 179

o Five (5) malignancies were diagnosed through the program

 Mobile Mammography Program
The Rex Mobile Mammography program is a mobile breast cancer
screening program. The mobile unit provides access to convenient
screening in a 15 county region in central/eastern North Carolina. The
mobile mammography program focuses on providing access to care in
areas that are otherwise underserved.

Annual Goals and Objectives:

 Increase breast cancer screening rates in underserved communities
 Decrease mortality and morbidity from breast cancer
 Provide assistance to individuals without access to care
 Provide screening resources to community and corporate locations
 Further develop the partnerships with community health centers to ensure access to care
 Further develop partnerships with local corporations to provide access to convenient screening
 Maintain funding for Mobile Mammography Program

Results:

 2016: 1837 screening mammograms
o Two (2) individuals were diagnosed with cancer

 2017: 3556 screenings have been conducted YTD.
o Ten (10) individuals have been diagnosed with cancer

ANNUAL REPORT |13

The mobile mammography program effectively extends services into a service area with otherwise
limited access to care, provides convenience for service, and engages Community Health Center part-

ners with a collaborative service offering to in-
crease rates of screening and detection of cancer at
an early stage.

RESOURCES AND REFERENCES
 American Cancer Society. Facts and Figures 2016. https://www.cancer.org/content/dam/cancer-

org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2016/cancer-facts-and-figures-
2016.pdf
 Commission on Cancer. American College of Surgeons. 2016. https://www.facs.org/quality-
programs/cancer/coc
 Lung Aware. Free Lung Aware online health assessment. https://www.rexhealth.com/rh/care-
treatment/heart-vascular/diagnostics-screening/health-aware/lung-aware/
 Lung Cancer Screening Could Save Your Life. https://www.rexhealth.com/rh/care-
treatment/cancer/early-detection/lung-screening/
 REX Connects: A Health and Wellness Blog from REX Healthcare. https://www.rexhealthblog.com/
 UNC REX Mobile Mammography https://www.rexhealth.com/rh/care-treatment/imaging-
radiology/mammography/mobile/
 UNC REX Cancer Care. https://www.rexhealth.com/rh/care-treatment/cancer/
 Wake County Community Health Needs Assessment. Executive Summary 2016: Opportunities and Chal-
lenges. www.rexhealth.com/app/files/public/6311/pdf-rex-community-2016-wake-county-chna-executive-
summary.pdf

ANNUAL REPORT |14

Patient and Family Advisory Council

The UNC REX Cancer Patient and Family Advisory Council (PFAC) is a dedicated team of cancer
survivors and volunteers who have an active role in improving the patient and family care experience
by identifying opportunities, gathering and providing feedback and perspectives on plans, activities
and programs related to patient and family health care.

Integrating the PFAC within the UNC REX Cancer Care setting is an excellent approach to learn from
our patients through their unique perspectives and experiences to actively increase the quality of care
together.

UNC REX Cancer Care recognizes the many benefits of working with patients and families towards
improving quality and safety, financial performance, patient outcomes as well as improving the patient
and family experience.

The PFAC is supported by executive sponsors, volunteer advisors and cancer center staff.

UNC Rex Cancer Center Patient and Family Advisory Council Charter Members 2017

Louis Arp, Advisory Chair Annie “Anna” Moore Freeman
Carla Reynolds Caroline Sullivan
Dr. Jean Carter Henry Lovett
Mary Mullins Patricia “Trish” Bell
Robert “Bob” Rohde Sharon McCloud
Sophia Palles Tyrrone “Ty” Cohen

ANNUAL REPORT | 15

UNC REX Cancer Tumor Registry

The UNC REX Cancer Registry has added over 65,000 cancer cases into the database since its inception in 1988.

In 2016, the registry added a record 3136 cases, with 2,826 as analytic cases with initial diagnosis and/or first course
of treatment at REX Healthcare. The additional 310 cases are non-analytic cases representing patients with recurrent
disease, initially diagnosed and/or treated elsewhere.

Analytic cases (A) are defined as patients diagnosed and/or treated at the reporting facility. The CoC requires that
analytic cases be abstracted by accredited programs. Non-analytic cases (NA) are defined as patients diagnosed
and/or treated elsewhere and seen at the reporting facility for diagnostic workup, in-transit care, disease recurrence or
persistence. Although the CoC does not require abstraction of non-analytic cases, these are required by the NC Cen-
tral Cancer Registry.

The primary function of the Cancer Registry is to collect and manage statistical data and clinical elements on the
UNC REX Cancer population. Information collected includes patient demographics, medical history, anatomical site
and histology of the primary cancer, extent of disease and treatment.

Patient follow-up is an important part of cancer care and maintaining the Registry. Each patient in the Registry is
followed annually to update information on disease recurrence, subsequent treatment, length of survival and overall
well-being. This information is utilized by the cancer program for studies and research by the American Cancer Soci-
ety and North Carolina Central Cancer Registry. Follow up information is obtained through communication to physi-
cians and patients.

 The Registry’s excellent Follow-up rate is 94% (90% or greater as required by the CoC Standard. 5.3)

The UNC REX Cancer Tumor Registry Team are Certified Tumor Registrars and
Members of the Association of North Carolina Cancer Registrars

Top Ten Cancer Sites by Group UNC REX Cancer Registry CY 2016

PRIMARY SITE TOTAL CLASS SEX AJCC STAGE

ALL SITES (% of Total) A NA M F 0 I II III IV Unk N/A
BREAST
3136 2826 310 1255 1881 300 765 582 379 477 276 357

916 (29%) 845 71 4 912 170 351 241 66 46 42 0

DIGESTIVE 454 (14%) 414 40 242 212 9 69 92 114 120 44 6

RESPIRATORY 347 (11%) 328 19 181 166 4 97 40 58 140 7 1

MALE GENITAL 289 (9%) 224 65 289 0 0 41 135 49 34 30 0

BLOOD & BM 239 (8%) 205 34 116 123 0 0 2 1 1 1 234

URINARY 215 (7%) 199 16 147 68 77 42 15 8 24 48 1

SKIN 142 (5%) 131 11 82 60 34 63 12 3 5 20 5

LYMPHATIC 142 (5%) 130 12 77 65 0 23 27 25 46 19 2

GYNECOLOGIC 110 (4%) 89 21 0 110 6 27 8 24 19 26 0

ENDOCRINE 110 (3%) 101 9 24 86 0 45 7 18 5 20 15

ANNUAL REPORT | 16

UNC REX Cancer Registry Site Distribution Detail CY 2016

PRIMARY SITE TOTAL CLASS SEX AJCC STAGE

ALL SITES A NA M F 0 I II III IV Unk N/A
BREAST
3136 2826 310 1255 1881 300 765 582 379 477 276 357

916 845 71 4 912 170 351 241 66 46 42 0

DIGESTIVE 454 414 40 242 212 9 69 92 114 120 44 6
ESOPHAGUS
STOMACH 18 15 3 12 6 0 0 2 9 4 3 0
COLON 45 40 5 22 23 0 12 4 4 17 8 0
RECTUM 147 136 11 68 79 1 29 39 47 28 3 0
ANUS/ANAL CANAL 84 80 4 49 35 1 15 17 22 14 15 0
LIVER 25 18 7 11 14 7 0 7 5 1 5 0
PANCREAS 19
OTHER 69 17 2 14 5 0 3 3 3 6 0 4
47
RESPIRATORY 347 63 6 44 25 0 4 14 9 39 3 0
NASAL/SINUS
LARYNX 2 45 2 22 25 0 6 6 15 11 7 2
LUNG/BRONCH 20
OTHER 323 328 19 181 166 4 97 40 58 140 7 1
2
BLOOD and BM 239 2 0 1 1 01001 0 0
LEUKEMIA 19 1 15 5 3 5 4 3 5 0 0
M. MYELOMA 93 306 17 163 160 1 90 36 55 134 7 0
OTHER 56 1 1 2 0 01000 0 1
90
MALE GENITAL 289 205 34 116 123 0 0 2 1 1 1 234
PROSTATE
TESTIS 273 81 12 48 45 0 0 2 1 1 1 88
OTHER
14 50 6 26 30 0 0 0 0 0 0 56
URINARY 2
BLADDER 215 74 16 42 48 0 0 0 0 0 0 90
KIDNEY/RENAL
OTHER 143 224 65 289 * 0 41 135 49 34 30 0
67
LYMPHATIC 5 210 63 273 0 40 135 46 34 18 0
HODGKIN'S 142
NON-HODGKIN'S 12 2 14 0 1 0 3 0 10 0
18
SKIN 124 202 00000 2 0
MELANOMA 142
OTHER 199 16 147 68 77 42 15 8 24 48 1
129
ENDOCRINE 13 134 9 103 40 73 32 13 5 11 9 0
THYROID 110 60 7 40 27 3 10 2 2 13 37 0
OTHER 5 0 4 1 10010 2 1
95
GYNECOLOGIC 15 130 12 77 65 0 23 27 25 46 19 2
CERVIX UTERI 110
CORPUS UTERI 18 0 14 4 0 4 6 3 5 0 0
OVARY 10 112 12 63 61 0 19 21 22 41 19 2
VULVA 61
OTHER 24 131 11 82 60 34 63 12 3 5 20 5
7
ORAL 8 120 9 73 56 34 60 10 3 4 17 1
LIP 54
TONGUE 11 2 9 4 0 3 2 0 1 3 4
OROPHARYNX 0
HYPOPHARYNX 28 101 9 24 86 0 45 7 18 5 20 15
OTHER 0
0 91 4 17 78 0 45 7 18 5 20 0
BRAIN & CNS 26
BRAIN (Benign) 54 10 5 7 8 0 0 0 0 0 0 15
BRAIN (Malignant)
OTHER 2 89 21 * 110 6 27 8 24 19 26 0
13
CONT TISSUE 39 91 10 1 3 1 3 0 2 0
BONE 16
1 52 9 61 0 21 4 13 8 15 0

20 4 24 0 2 3 6 8 5 0

25 7 41000 2 0

62 8 10023 2 0

52 2 39 15 0 4 3 9 30 8 0

000 0 00000 0 0

27 1 23 5 0 4 1 3 14 6 0

000 0 00000 0 0
000 0 00000 0 0

25 1 16 10 0 0 2 6 16 2 0

48 6 23 31 54

111 1 Brain and CNS Tumors 2

13 0 9 4 World Health Organization (WHO) 13

34 5 13 26 grading system 39

15 1 6 10 0 3 0 2 3 8 0

101 0 00000 1 0

ANNUAL REPORT | 17

Clinical Trials

With the collective help of our doctors and cancer patients who choose to participate, cancer clinical trials enable
testing of the latest research findings at the National Cancer Institute (NCI) and other research organizations.
These trials can take several years to complete, but the knowledge gained has led to an increase in the number of
people who survive cancer.

UNC REX Cancer Care participates in ongoing cancer clinical trials, including many in collaboration with UNC’s
Lineberger Comprehensive Cancer Center. Available clinical trials include biobanking and diagnostic studies,
therapeutic trials, quality-of-life and supportive care trials.

To learn about clinical trials offered by UNC REX Cancer Care, or your eligibility
Call 919-784-7209 http://www.rexhealth.com/rh/care-treatment/clinical-trials/cancer/

Breast Gastrointestinal

 ABC Trial A011502 -Adjuvant node + Breast ca  CHALLENGE NCIC CTG C0.21 - Exercise in high

 BWEL A011401 –Weight loss in early breast ca risk colon ca

 COMET AFT-25 - DCIS  HALO-109-301 -Stg IV pancreatic ca

 KEYNOTE 355 (MK-3475 PN355) -Untreated Locally  LCCC 1317- Metastatic Colorectal (1st Line)

recurrent or Stg IV mTNBC  LCCC 1324 -Exercise and p16 in adjuvant colorectal ca
 LCCC 1410 - Exercise and p16 in older breast ca pts  RTOG 0848 – Resected Pancreatic
 LCCC 1525 - 2nd line mTNBC

 LCCC 1609: GETSET Motivation in endocrine therapy Leukemia and Lymphoma

 NRG-BR002 -Radiation in Oligometastatic breast ca  CC-5013-NHL-008 MAGNIFY - Relapsed/Refractory
 NRG-BR003 - Adjuvant High Risk TNBC Follicular, MZL or MCL Lymphoma

 NSABP B54-i PENELOPE-b: High risk post neoadjuvant  LCCC 0824 – Biospecimen submission

 SWOG 1207 - Adjuvant High Risk  UTX-TGR-304: Treatment naïve and/or previously treated

CLL

Head and Neck GYN

 LCCC 1612 – Radiation and chemo in p16+ Oro-  NRG-GY004 - Ovarian, Fallopian or Peritoneal
pharyngeal Squamous Cell Cancers

Other Thoracic

 LCCC 0916 -Registry Carolina Senior  LCCC 1210 –Lung cancer: second line for elderly
 LCCC 9001 -Tissue Procurement  LCCC 1516 - Consolidation after 1st line platinum in-
 LCCC 1540 –Whole Brain Radiation and xerostomia
duction in Stg IV NSCLC

ANNUAL REPORT | 18

UNC REX Excellence in Publications and Presentations 2017

Publications

Analytic validation of immunohistochemical assays: a comparison of laboratory practices before and after introduc-
tion of an evidence-based guideline. Fitzgibbons PL, Goldsmith JD, Souers RJ, Fatheree LA, Volmar KE, Stuart
LN, Nowak JA, Astles JR, Nakhleh RE. Arch Pathol Lab Med 2017;141(9):1247-1254.

Analytic validation of immunohistochemical assays: new benchmark data from a survey of 1085 laboratories. Stuart
LN, Volmar KE, Nowak JA, Fatheree LA, Souers RJ, Fitzgibbons PL, Goldsmith JD, Astles JR, Nakhleh RE..
Arch Pathol Lab Med 2017;141(9):1255-1261.

Comparison of Patient Report and Medical Records of Comorbidities: Results From a Population-Based Cohort of
Patients With Prostate Cancer. Ye F, Moon D, Carpenter W, Reeve B, Usinger DS, Green RL, Spearman K,
Sheets N, Pearlstein K, Lucero AR, Waddle M, Godley PA, Chen RC. JAMA Oncol. 2017 Aug 1;3(8):1035-1042.

Dosimetric Predictors of Patient-Reported Xerostomia and Dysphagia With Deintensified Chemoradiation Therapy
for HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Chera B, Fried D, Price A, Amdur R,
Mendenhall W, Lu C, Das S, Sheets N, Marks L, Mavroidis P. Int J Radiat Oncol Biol Phys. 2017 Aug
1;98(5):1022-1027.

Professional practice evaluation for pathologists: development, life and death of the Evalumetrics program. Volmar
KE, McCall SJ, Schifman RB, Talbert ML, Tworek JA, Hulkower KI, Guidi AJ, Nakhleh RE, Souers RJ, Bashleb-
en CP, Blond BJ. Arch Pathol Lab Med 2017;141(4):551-558.

Presentations

Advances in Surgery: The Primary Care Pearls: Movie Night with the Surgeons. March 25, 2017. Wake Area
Health Education Conference. UNC REX Surgical Specialists, Raleigh, NC.
Back to the Future? The Jolie Effect, and a Thoughtful Approach to Breast Cancer. Rachel Jendro, DO
The Good, The Bad, and The Ugly: Atypical Benign Breast Disease. David Eddleman, MD
C.T.: An Extra-Terrestrial (Surgeon’s) Guide to Computed Tomography. Richard Chiulli, MD

Assessment of the Effect of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Pa-
tients with Cancer. Elizabeth C. Weddendorf, PharmD; Rebecca Jones, PharmD, BCPS; Jeffrey Crane,
MD; W. Russell Laundon, PharmD, MS, BCPS; Jared Peak, PharmD, CPP; Madison Sasser, PharmD, BCPS; S.
Wayne Smith, MD. Poster presentation at American Society of Health-Systems Pharmacist (ASHP) annual meet-
ing and Southeastern Residency Conference

Bridging the Gap: Improving Patient Care through Science and Innovation. Radiosurgery Society Annual Scientific
Meeting. November 2, 2017. Physics Session: Failure mode and effects analysis of linear accelerator-based in-
tercranial stereotactic radiosurgery using differing collimation, fractionation, and # of isocenters. Don Roback
PhD

Impact of College of American Pathologists Evidence-based Guideline on Immunohistochemistry Assay Validation
Practices. Nakhleh RE, Goldsmith JD, Souers RJ, Fatheree LA, Volmar KE, Stuart LN, Nowak JA, Astles R,
Fitzgibbons PL. Mod Pathol. 2017;30(S2):514A. Poster presentation at USCAP 2017.

Pearls in Surgery Lecture Series: Women’s Health Edition. October 21, 2017. Wake Area Health Education Con-
ference. UNC REX Surgical Specialists. UNC REX Healthcare, Raleigh, NC.
New Paradigms in DCIS: Observation and Management. David Eddleman, MD, MA
Radiographic Breast Screening: Best Practices and Latest Technology. Susan Holley, MD, PhD

New Benchmark Data from College of American Pathologists for Immunohistochemical Assay Validation. Nakhleh
RE, Stuart LN, Volmar KE, Nowak JA, Fatheree LA, Souers RJ, Fitzgibbons PL, Goldsmith JD, Astles R,. Mod
Pathol. 2017;30(S2):514A. Poster presentation at USCAP 2017.

Surgical Pathology Diagnostic Error Prevention United States and Canadian Academy of Pathology Annual Meet-
ing. CME Course. March 10, 2017. San Antonio, TX. . Keith Volmer, MD, and Nakhleh RE

*UNC REX contributors highlighted in bold

ANNUAL REPORT | 19

Comprehensive Community Cancer Care

UNC REX Cancer Care provides patients of Wake County and surrounding communities with exceptional cancer
care, including access to innovative treatments and support services. As the first nationally accredited Comprehen-
sive Community Cancer Center in North Carolina, we provide expert care, close to home, in several convenient lo-
cations. In collaboration with UNC Lineberger Comprehensive Cancer Center, our physicians also access the latest
in clinical trials. Our physicians are at the helm of ongoing cancer research.

Multidisciplinary care is the heart of our program. Our board-certified physicians meet regularly and work together
as a team to develop a comprehensive treatment plan tailored to our patients’ needs.

UNC REX Cancer Care includes:
 REX Hematology Oncology Associates
o Raleigh – Main Campus, Raleigh - Blue Ridge, East Raleigh, Cary, Garner, Wakefield
 UNC REX Radiation Oncology
o Raleigh-Main Campus, East Raleigh, Clayton, Smithfield, Wakefield
 UNC REX Surgical Oncology
o REX Surgical Specialists
 Raleigh, Knightdale, Garner, Knightdale
o REX Thoracic Surgical Specialists
o REX Neurosurgery and Spine Specialists
 Raleigh, Cary
 UNC Gynecologic Oncology at REX
 UNC REX Comprehensive Breast Care Program
 UNC REX Cancer Genetics Program

We also provide patients and their families with access to oncology support services, including:

 Patient Navigation  Financial Counseling
 Clinical Trials  Educational Programs
 Cancer Rehabilitation  Support Groups
 High Risk Nutritional Management  Survivorship Support
 Social Work and Psychosocial Support  Wellness Services

UNC REX Cancer Care Locations ANNUAL REPORT | 20

REX HEMATOLOGY AND ONCOLOGY ASSOCIATES CARY
Parkway Professional Park
RALEIGH – Main Campus Raleigh -BLUE RIDGE 150 Parkway Court, Suite 200
4420 Lake Boone Trail 2605 Blue Ridge Road Cary, NC 27518
Suite 200 Suite 190 T: 984-974-2150
Raleigh, NC 27607 Raleigh, NC 27607 F: 984-974-2151
T: 919-784-6818 T: 919-784-6060
F: 919-784-6826 F: 919-784-6061 EAST RALEIGH
117 Sunny Brook Road
WAKEFIELD GARNER T: 919-334-3900
11200 Governor Manly Way 300 Health Park Drive F: 919-250-9280
Suite 102 Suite 220
Raleigh, NC 27614 Garner, NC 27529
T: 919-570-7550 T: 919-250-5955
F: 919-570-7551 F: 919-250-5954

UNC REX RADIATION ONCOLOGY WAKEFIELD EAST RALEIGH
11200 Governor Manly Way 117 Sunny Brook Road
RALEIGH Suite 102 Raleigh, NC 27610
4420 Lake Boone Trail Raleigh, NC 27614 T: 919-334-3900
Suite 100 T: 919-570-7550 F: 919-250-9280
Raleigh, NC 27607 F: 919-570-7551
T: 919-784-3018
F: 919-784-1473

CLAYTON RADIATION ONCOLOGY SMITHFIELD RADIATION ONCOLOGY
Johnston Professional Plaza Johnston Medical Mall
2076 Highway 42 West Suite 1200
Suite 120 514 N. Bright Leaf Boulevard
Clayton, NC 27520 Smithfield, NC 27577
T: 919-585-8550 T: 919-209-3555
F: 919-585-5882 F: 919-938-7400

UNC REX BREAST CARE

REX BREAST CARE CENTER REX SURGICAL ASSOCIATES
(Diagnostic Imaging) (Breast Surgery)
3100 Duraleigh Road, Suite 204 3100 Duraleigh Road, Suite 205
Raleigh, NC 27607 Raleigh, NC 27607
T: 919-784-6186 T: 919-784-4160 F: 919-784-2708

UNC REX COMPREHENSIVE BREAST CARE PROGRAM

4420 Lake Boone Trail

Raleigh, NC 27607 T: 919-784-6878 F: 919-784-6899

ANNUAL REPORT |21

UNC REX Cancer Care Locations

REX NEUROSURGERY AND SPINE SPECIALISTS

T: 919-784-1410 F: 919-784-1409

RALEIGH CARY

4207 Lake Boone Trail, Suite 220 1505 SW Cary Parkway, Suite 302

Raleigh, NC 27607 Cary, NC 27511

REX SURGICAL SPECIALISTS

T: 919-784-7874 F: 919-784-2708

RALEIGH GARNER
300 Health Park Drive
Medical Office Building Suite 110
Garner, NC 27529
2800 Blue Ridge Road, Suite 300
WAKEFIELD
Raleigh, NC 27607 11200 Governor Manly Way, Suite 208
Raleigh, NC 27614
KNIGHTDALE
6602 Knightdale Blvd, Suite 201
Knightdale, NC 27545

REX THORACIC SURGICAL SPECIALISTS

RALEIGH T: 919-784-5650 F: 919-784-5651

4420 Lake Boone Trail, Suite 100

Raleigh, NC 27607

UNC GYNECOLOGIC ONCOLOGY AT REX

4420 Lake Boone Trail, Suite 201 Parkway Professional Park
150 Parkway Court, Suite 200
Raleigh, NC 27607 Cary, NC 27518

T: 919-784-6875 F: 919-784-6890

ANNUAL REPORT | 22

A- REX Cancer Care- Main Campus For more information or to schedule
B - REX Hematology Oncology Associates – Wakefield an appointment with
C - REX-UNC Radiation Oncology – Wakefield
D - REX Surgical Specialists – Wakefield UNC REX Cancer Care
E - REX Hematology Oncology Associates – Cary
F - REX Thoracic Surgical Specialists - Cary Call 919-784-3105
G - REX Neurosurgery and Spine Specialists – Cary
H - REX Hematology Oncology Associates – Garner www.REXhealth.com
I - REX Surgical Specialists – Garner
J - UNC Radiation Oncology at Clayton
K - UNC Radiation Oncology at Smithfield
L - UNC REX Cancer Care of East Raleigh



UNC REX Cancer Center
4420 Lake Boone Trail
Raleigh, NC 27607
919-784-3105

www.REXhealth.com