Boulder Community Hospital Cancer Program 2012 Community RepoRtRefleCting statistiCal data foR 2011 Table of Conentsa note for the Community primary site Chart Breast Cancer: outcomes and Quality of Care at Boulder Community Hospital/Rocky mountain Cancer Center Community support activities 2012 BCH Cancer services Breast Cancer Center of excel ence giotto: the new dimension in digital mammography northern Colorado's most Comprehensive Breast Cancer Care inpatient and outpatient Care BCH Cancer support services Cancer Clinical trials offered at Boulder Community Hospital Boulder Community Hospital Cancer Resources

A Note for the Communityas Chair of the Cancer Committee of Boulder Community Hospital, wel ness room. perhaps the most exciting feature of the unit wil i am pleased to present our cancer program's 2012 annual be an enclosed garden area, suitable for walking with a rol ing iV Report. our cancer program is overseen by our cancer committee. stand, relaxing on a bench or sitting under the shady, covered areas. this committee meets quarterly to review clinical programs, community outreach, and key initiatives to ensure we're meeting our cancer program has proudly been recognized by the the highest standards as set forth by the american Col ege of american Col ege of surgeons Commission on Cancer as surgeons' Commission on Cancer. this report highlights the efforts offering the very best in cancer care. We received multiple of the many disciplines involved in cancer care and reflects the commendations from the Commission on Cancer for our ongoing multidisciplinary approach to the diagnosis and treatment patient guidelines, community outreach programs and staff of cancer patients at Boulder Community Hospital. education when we were surveyed in march 2011. our next survey for recertification is scheduled for march 2014. We patients and families are treated using a multidisciplinary continue to look for ways to enhance our cancer program and approach. this includes specialists in medical oncology, radiation fulfill the health care needs of patients in our community. oncology, surgery, radiology, pathology, and pal iative care and pain medicine. there are also dedicated staff members in nursing, on behalf of the Cancer Committee, i would like to thank all pharmacy, patient and family counseling, genetic counseling, of our physicians, nurses, support staff, and administration for pal iative care, nutrition services and rehabilitative care. all of their role in the continued growth and success of the Boulder these disciplines are integrated to provide a comprehensive plan of Community Hospital cancer program. care for patients to meet their physical and emotional needs. anyone who has driven by the foothil s Campus of Boulder Community Hospital knows that major construction is underway. By fall of 2014, patients with cancer will be cared for on the new 1north, also to be known as the Bracken family patient Care unit. Contributions are coming in to support the construction of that unit, but we are so grateful to sandy and sal y Bracken for their very generous lead gift. this unit will feature 18 spacious rooms mark sitarik, md with sleeping facilities for loved ones, two family lounges with Cancer Committee Chair kitchenette facilities, computers with internet, and an exercise/ By fall of 2014, patients with cancer will be cared for on the new 1North, also to be known as the Bracken Family Patient Care Unit.

Primary Site Chart Primary Site
Stage Group
other oral Cavity Rectum & Rectosigmoid anus, anal canal, & anorectum liver & intrahepatic dile ducts other digestive organs* other Respiratory organs soft tissue (including heart) skin (excluding basal & squamous) Reproductive organs other genital, female penis & other genital, male Kidney & Renal pelvis

BreaST C anCer :
Outcomes and Quality of Care at Boulder Community Hospital/ Rocky Mountain Cancer CenterBreast cancer is the most common female cancer in the united attributed to the disease. the graph below (figure 1) tracks the states and the second most common cause of cancer death trend in the number of breast cancer cases diagnosed at Boulder in women. in 2011, an estimated 230,480 new diagnoses of Community Hospital (BCH) since 2007. the graph is notable for a invasive breast cancer and 57,650 new diagnoses of non-invasive 14% increase in the number of new cases diagnosed from 2007 (in situ) disease were expected to occur in women in the united (198 cases) to 2008 (255 cases). the number of new diagnoses states. the lifetime probability of developing breast cancer is 1 increased in 2010 and 2011 with 203 and 242 cases respectively.
in 7 in Colorado. approximately 39,520 women were expected to die from breast cancer in 2011. male breast cancer accounts the reason for the increase in number of newly diagnosed cases in for approximately 1% of all cases. 2008 is likely attributed to the onset of routine screening via digital mammography at BCH that same year. digital mammography is Boulder Community Hospital is the only breast center north of more sensitive than older film mammography at detecting breast denver that is ful y accredited by the national accreditation cancers, especial y in women with denser breasts. With improved program for Breast Centers (napBC), a program administered screening techniques, it would be expected to see a single annual by the american Col ege of surgeons. a center that achieves increase in the number of cases diagnosed. the decline in new napBC accreditation offers its patients every significant diagnoses after 2009 is also notable. this decline was seen at the advantage in their battle against breast disease.
national level as well and felt in part to be related to economic factors as well as the controversial recommendations from the us in 2011 in Colorado, 3,420 new diagnoses of female breast cancer preventative task force recommending screening mammography were expected and 510 deaths expected from the disease. during starting at age 50 as opposed to age 40. as shown in figure 1, the same year in Boulder County, there were 263 new diagnoses there was an increase in cases again in 2011. this can be attributed of breast cancer, 242 of which were diagnosed or treated at to an increase in breast cancer screenings in 2011. Boulder Community Hospital. in 2011, 28 deaths in the county were the fol owing graph from 2011 (figure 2) depicts the age annual mammography with clinical examination starting at age distribution of women at the time of diagnosis, comparing 40 remains the mainstay for screening patients with average BCH cases to the national Cancer data Base (nCdB) and the risk for breast cancer. as of 2009, screening mammograms state of Colorado. evident on the graph is the general trend for done at BCH and its satel ite locations have been digital. Breast a younger age at the time of diagnosis for our population. as mRi is available as an adjunct to mammography for high-risk you can see, 23.68% of women diagnosed at our hospital were patients. Breast cancer is typical y identified by an abnormality age 40-49 compared to 18.59% in the nCdB and 20.04% for seen on screening mammography (either a density or abnormal the state of Colorado. at BCH, 32.96% were diagnosed within calcifications) or a lump that the patient or her physician identifies. the 50-59 age range, compared to 25.13% in the nCdB, and once an abnormality has been recognized, additional diagnostic 27.53% for the state of Colorado. We had 12.58% of our cases imaging might include ultrasound. a biopsy is then performed, diagnosed between the ages of 70-79 compared with 18.18% in targeting the area of concern. in certain situations after a breast the nCdB and 16.23% for the state of Colorado. Women aged cancer has been confirmed, a breast mRi might be recommended 60 through 89 have the lowest percentage of diagnosis at BCH. to determine if there are additional areas of concern in the same this significant trend for diagnosis at a younger age is likely multi- or opposite breast. once a diagnosis has been established, the factorial. it may in part be related to a younger population more cancer will ultimately be given a stage. the stage establishes the committed to screening strategies compared to areas elsewhere extent of the cancer. stage 0 is early non-invasive disease. stage in the country. the fact that 23.68% of the new diagnoses in our 1 breast cancers are less than 2 cm in size without lymph node population fall into the 40-49 age range gives further support to involvement. stage i and i i breast cancers are larger and/or have recommending screening mammography starting at age 40.
lymph node involvement. stage iV breast cancers have spread to other organs outside the breast and draining lymph nodes. obviously, prognosis is more favorable with lower stage disease. age at Diagnosis
0% 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ as one would expect, the majority of cases are diagnosed at earlier stages (stage 0 and stage 1). the fol owing graph (figure 3) depicts the stage at diagnosis for women at BCH compared to the stage at diagnosis for the nCdB and state of Colorado in 2011. Stage of Diagnosis for Women
0% stage 0 stage 1 stage 2 stage 3 stage 4 once a diagnosis of breast cancer has been established, the breast health navigator plays a pivotal role in facilitating support, navigation and education services. these services include guidance through treatment options, financial, emotional and physical resources, family support, scheduling of appointments and help with navigating the health care system. patients receive personal support in office, by phone conversations and visits while in the hospital setting or in the cancer center for treatment. our breast health navigator provides services from the time of diagnosis and throughout the different phases of treatment and well into the post-treatment survivorship phase. a central aspect of our breast program is our weekly breast cancer conference. physicians from all disciplines involved in the care of breast cancer patients regularly attend the meeting, including general surgeons, radiologists, medical oncologists, radiation oncologists, plastic surgeons and pathologists. other important attendees include the breast health navigator, genetic counselor, social workers, lymphedema specialists, clinical trial nurses and cancer registrar. each and every patient that is either diagnosed at BCH, or diagnosed at another facility but cared for by a BCH physician, is presented and discussed in this multidisciplinary forum. patients' cases are frequently reviewed on more than one occasion as they move through the treatment process. Radiographic images and pathology are reviewed and discussed. surgical options are reviewed (lumpectomy versus mastectomy), as well as recommendations for radiation, anti-estrogen therapy and/or chemotherapy. other important issues that might be raised include need for genetic testing, identifying patients appropriate for clinical trials, identifying the need for social or financial assistance, etc. We feel that this type of multidisciplinary approach offers substantial benefit to our patients, al owing for multiple opinions to "weigh in" on final treatment recommendations offered by the physicians.
for women who are diagnosed at a younger age or who may Radiation plays an important role in reducing the risk of have a strong family history of breast, ovarian or other cancers, recurrence of the cancer in the breast and regional lymph genetic counseling and/or testing may be appropriate. BRCa nodes. Radiation is usual y recommended after lumpectomy mutations or other genetic disorders may increase a women's and sometimes recommended after mastectomy. options for risk for breast cancer, ovarian cancer or additional cancers. radiation after lumpectomy include standard whole breast genetic counseling and testing is available for patients and radiation (a daily treatment for 4-6 weeks) or a newer technique their families. in 2011, 80 women underwent testing for BRCa of partial breast radiation (twice-daily treatment for one week). mutations and 9 were found to be positive (see figure 4 below). our radiation oncologists are members of Rocky mountain on average, approximately 5% of all women diagnosed with Cancer Centers and actively participate in clinical research breast cancer carry a BRCa1 or BRCa2 mutation.
(through both us oncology and the national Cancer institute), offering trials to patients in appropriate clinical situations.
patients offered genetic testing at Boulder RmCC for BRCa in 2011 systemic treatments are treatments that are recommended number who were offered testing but by the medical oncologist to reduce the risk of breast cancer canceled due to coverage issues recurring in other areas of the body (most commonly bone, liver, lung and brain). these treatments may include anti-estrogen number of women with positive BRCa mutations therapy (tamoxifen or aromatase inhibitors) or chemotherapy number of true negative results with or without Herceptin (a specifical y targeted antibody (meaning there is a known mutation in the against a protein that some breast cancers make in excess). for family and the patient tested negative) early stage breast cancers, it is sometimes difficult to determine number of variances of uncertain significance which patients may or may not benefit from chemotherapy. to assist in decision-making recommendations for chemotherapy, we may offer a genomic test cal ed oncotype dX® to women with hormone receptor positive and lymph node negative surgical options for early stage breast cancer include breast tumors. oncotype dx evaluates the activity of 21 different conserving therapy (lumpectomy) or mastectomy. the genes in a woman's breast tumor tissue and estimates the prognosis for early stage breast cancer is equivalent when risk of a recurrence (high, low or intermediate) assuming treated with lumpectomy versus mastectomy. that anti-estrogen therapy is given. if the risk is "high", then Recommendations for the type of surgery are general y based there is likely an added benefit of chemotherapy to the anti- on tumor size relative to breast size, number of involved sites estrogen treatment. if the risk is "low", chemotherapy is and patient preference. of the patients that received surgery at unlikely to be an added benefit. the benefit of chemotherapy BCH in 2011, 54% underwent breast-conserving surgery and in the "intermediate" range is uncertain and is currently being 46% underwent mastectomy (figure 5). Breast reconstruction evaluated in a national clinical trial though the nCi. in 2011, 46 is an important option offered to women who undergo women underwent oncotype testing. twenty-seven were found mastectomy. options for reconstruction general y include to have a low recurrence score and seventeen an intermediate implants versus tissue flaps. score. two of the women had a high recurrence score.
Breast-conserving surgery vs mastecomy
the medical oncologists at Boulder Community Hospital are also members of Rocky mountain Cancer Centers. they are active participants in clinical trials with both u.s. oncology and the Breast Conserving national Cancer institute. We have two clinical research nurses who screen patients for clinical trials and assume responsibility for the oversight involved with managing data, complying with regulatory requirements, and assuring tests and disease evaluation are completed at appropriate times. they also oversee patient and family education about all aspects of clinical trials, and training for physicians, staff and themselves on any new initiatives or changes to existing protocols. many other services are also available to breast cancer patients, including support groups, nutrition talks, counseling, rehabilitation services, integrative care services, educational talks, meditation, music, art and yoga classes. Resources on other community services are also provided. Quality measures are very important in assessing breast cancer programs and outcomes. We evaluated several quality measures at our institution and compared our results to state and national data. as previously mentioned, radiation therapy is an important component of breast conservation therapy. at Boulder Community Hospital, over 92.2% of women undergoing breast conservation therapy received radiation therapy, exceeding national data in 2009 (figure 6). a second quality measure is the recommendation for chemotherapy in hormone receptor negative patients with tumors exceeding 1 cm in size. again, BCH far exceeded national results: 100% of women with this type of cancer were considered for or underwent chemotherapy treatment within 4 months of diagnosis in 2009 (figure 7). final y, endocrine therapy remains an important part of treatment for hormone receptor positive breast cancer. at BCH, 72.5% of women diagnosed with this type of breast cancer in 2009 received a recommendation for endocrine therapy, again exceeding state and national results (figure 8). it is important to note that the 72.5% mentioned above is not a true reflection of our actual y numbers. many of the remaining 27.5% were referred to BCH for the purpose of radiation treatment only, and the rest of their treatment took place elsewhere. Quality measures by aSCO and nCCn:
1. Radiation administered within 1 year for women <70 years old after receiving breast conserving surgery
nQF Measure: radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70
receiving breast conserving surgery for breast cancer.

performance Rate aCs division (great West) Census Region (mountain) CoC program type (Comp) all CoC approved programs 2. Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with aJCC t1c, n0, m0 or stage ii or iii eRa and pRa negative breast cancer nQF Measure: Combination chemotherapy is considered or administered within 4 months (120 days of diagnosis for
women under 70 with aJCC T1c, n0, M0, or Stage II or III era and Pra negative breast cancer.

aCs division (great West) Census Region (mountain) CoC program type (Comp) all CoC approved programs 3. tamoxifen or aromitase inhibitors are considered or administered within one year of diagnosis for women with aJCC t1c, n0, m0 or stage ii or iii hormone receptor positive breast cancer nQF Measure: Tamoxifen or third generation aromatase inhibitor is considered or
administered within 1 year (365 days) of diagnosis for women with aJCC T1c, n0, M0 or
Stage II or III era and Pra positive breast cancer.
performance Rate
aCs division (great West) Census Region (mountian) CoC program type (Comp) all CoC approved programs Breast cancer has one of the highest survival rates of any cancer. this is primarily due to the fact that two-thirds of the patients are diagnosed at an earlier stage when curative treatment is possible. earlier diagnosis and referral to specialist teams make a significant difference to survival rates. When comparing the overall survival for Boulder Community Hospital breast cases in 2007-2011 to the most recent survival data available from the nCdB 2003-2005 there is greater benefit in survival at 5 years. in summary, the breast cancer program at Boulder Community Hospital provides exceptional and comprehensive cancer care. our accreditation with the national accreditation program for Breast Centers (napBC) shows our dedication to achieving high standards. our physicians and nurse navigator present educational talks within our community to increase awareness, education and prevention of breast cancer. our review of breast cancer patients diagnosed and treated at Boulder Community Hospital found our demographics and treatment standards to be comparable to the state of Colorado and national data. We are proud to exceed state and national standards on all quality measures and overall survival. We strive to continue to uphold this high level of care with every individual patient.

Community Support Activities 2012Boulder Community Hospital is committed to continual y improving the care that we provide to individuals with cancer, and community outreach is a strong focus of our dedication to this mission. We are proud of our partnerships within the community and the programs in which we participate. our dedicated medical professionals and volunteers contribute countless hours to the community outside the hospital and participate in many different health events that have helped cancer patients in many different areas. We are deeply grateful to our individual, organizational, corporate and foundational donors for their support in the many events that have improved the care and enhanced the lives of countless cancer patients. Here are some highlights from this year: aPr 15 — red Lipstick Fund
this new fund was established through the BCH foundation by friends of marsha
moritz to assist cancer patients with everyday needs, not specifical y related to treating
their disease, such as housing and transportation. about $250,000 was pledged to the
Red lipstick fund at an april 15 fundraiser at tebo family medical pavilion.
JUne 18 — Holes for Hope
128 golfers participated in the third annual Holes
of Hope golf tournament benefitting BCH cancer
services and held at lake Val ey Country Club.
this year's event raised $36,425!
aUG 11— B Strong ride
the 2nd annual B strong Ride benefited the inpatient Cancer unit at BCH, the george Karl foundation and liVestRong —
so local, metro and national cancer fighting efforts are addressed. the event attracted more than 800 participants and raised
$350,000+ in donations!
aUG 19 — CU Women's Tennis Marathon for Breast Cancer
the Cu Women's tennis team held their annual tennis marathon for Breast Cancer on august 19.
approximately $10,000 was raised to benefit our Breast Cancer treatment fund and the tebo Cancer Center.
aUG 25 — Macy's Shop for a Cause
$1,200 was raised at this fun event to benefit the
BCH auxiliary's Breast Cancer treatment fund.
SePT 22 — Light the night Walk
Boulder Community Hospital was a sponsor of the leukemia & lymphoma society's local light the night walk which included
about 3,000 people and raise more than $130,000.
SePT 27 — Boulder Busts Cancer
thanks to our 2012 sponsors, artists, event volunteers, special guests, in-kind donors, and generous patrons for their unwavering
support of the Boulder Community Hospital auxiliary's Breast Cancer treatment fund. over $82,000 was raised and will provide
diagnostic services to breast cancer patients at BCH and mammograms to those in need from our community.
SePT 29 — CU Pink Game
BCH partnered with the university of Colorado athletic department and safeway stores for a joint breast cancer awareness
campaign centering around the Cu-uCla football game. 125 breast cancer survivors were provided free tickets to the game and
went down on the field before the game, formed a human tunnel and high-fived the Cu football players as they came onto the
field for their pre-game warm-ups. additonal y, safeway donated $10,000 to BCH breast cancer services in a halftime ceremony.
OCT — Softball for a Cure
in october, BCH received a $3,700 donation from the annual softball for a Cure tournament that benefits cancer research.
nOV — Movember
BCH promoted participation in movember to hospital employees and the public. movember is
an international movement where men grow moustaches in november to raise awareness of and
funds for men's health issues, especial y prostate cancer. KBCo on-air personality Keefer signed
up for the BCH movember team and KBCo promoted movember on its website. We had 44 team
members this year compared to 12 last year.
DeC — american Cancer Society Cancer Prevention Study
the hospital helped promote local participation in the american Cancer society's new Cancer prevention study-3. 469 people
participated in the study through Boulder locations, representing 35% of total denver metro participants.
Servicesover the past many years, Boulder Community Hospital has worked diligently to maintain the highest quality our cancer services. We provide the community with local access to a broad range of inpatient and outpatient services, including the latest diagnostic technologies and cancer treatments available. BCH is accredited by the american Col ege of surgeons' Commission on Cancer (CoC) program. the CoC is a group of professional organizations dedicated to improving survival and quality of life for cancer patients through standard-setting, prevention, research, education, and the monitoring of comprehensive quality care. the CoC's approvals program recognizes select programs throughout the nation that offer high-quality, comprehensive cancer care and have proven that they meet the stringent standards of the american Col ege of surgeons. to become an accredited cancer program such as Boulder Community Hospital, excel ence must be proven in the areas of: clinical trials, cutting edge treatment service, support services, prevention and early detection, community outreach, cancer monitoring, education, quality improvement, research, clinical services, and state/federal data reporting.
in march of 2011, BCH was re-accredited, 3 years with Commendation, as a Community Hospital Comprehensive Cancer program. BCH underwent a rigorous evaluation process, which covered the entire scope of our cancer services. in order to maintain approval, facilities with approved cancer programs must undergo an onsite review every three years.
Breast Cancer Center of ExcellenceBreast cancer is the most common and deadliest form of cancer afflicting Boulder County women. luckily, breast cancer is also highly treatable if detected early.
at BCH, we've made a very deliberate effort to improve the quality of our breast cancer care. We're ful y committed to providing the most comprehensive, multidisciplinary breast cancer program in Colorado. our approach is based on three major pil ars: providing local access to the most advanced diagnostic and treatment technologies available, a high level of communication and coordination by our physicians, and providing a wide range of in-house cancer support specialists and programs. in 2011, we treated 242 breast cancer patients.
Digital Mammography

Stereotactic Breast Biopsy
digital mammography is a groundbreaking technology in the stereotactic breast biopsy is an important tool in the fight fight against breast cancer. it is available at three BCH against breast cancer. this outpatient, non-surgical procedure locations: Boulder Community foothil s Hospital, Community is used to determine if breast abnormalities, often cal ed medical Center and Boulder medical Center. a digital lesions, are cancerous or non-cancerous. fortunately, mammogram produces quicker results and uses less radiation approximately 85 percent of breast abnormalities are than standard film mammography. it also offers significant benign and do not present health risks. With stereotactic advantages in image storage and transmission. for the patient, breast biopsy, a tiny amount of tissue is removed from the these benefits translate into shorter exam times, reduced need breast lesion in order to determine if cancer is present. for repeat mammograms, and more accurate detection of the advantage of this procedure is that physicians can abnormalities. medical studies indicate digital mammography make a rapid, accurate, and conclusive cancer diagnosis is better at screening women in three specific categories: those without surgery. for the patient, a biopsy causes minimal under age 50; of any age with extremely dense breasts; and scarring and involves less trauma, pain, time and expense pre- or perimenopausal women of any age. than surgery. Breast size, the location of the lesion and other medical conditions determine whether a woman is a candidate to have this type of procedure.
BCH features the most advanced breast mRi technology currently available. mRi is a non-invasive procedure that doctors can use to determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram). each exam produces hundreds of images of the breast, cross-sectional in three directions (side-to-side, top-to-bottom, front-to-back) which are then read by a radiologist. no radiation is involved. Breast mRi screenings can detect small breast abnormalities sometimes missed in a traditional mammogram, and can successful y visualize breast implants and the dense breast tissue common in younger women.
Giotto: The New Dimension in Digital MammographyBoulder Community Hospital recently acquired the giotto mammography/stereotactic biopsy unit, an innovative piece of equipment from italy for screening and diagnosing breast cancer. the giotto's ergonomic design al ows for flexible positioning, its high-quality 3d images assist radiologists in detecting breast cancer at an early stage, and it is the only system that can perform a stereotactic biopsy with the patient in a prone (face down) position. Flexible Positioning
positioning with the giotto is more comfortable and more flexible than positioning with any other mammography unit. in
addition to positioning the patient side to side in the conventional position, it can also position the patient face to face with
the technician or in a seated position. the giotto's sensitive Compression system (sCs) decreases discomfort during breast
compression. it does this by selecting the compression speed, sensing the density of the breast.
Outstanding Image Quality
the giotto provides outstanding image quality due to a technology cal ed selenium 2, which provides high resolution and
"low noise." the giotto's user interface clearly detects subtle lesions even in dense glandular tissue. in addition, the giotto
exposes the patient to less radiation that conventional mammography.
Stereotactic Biopsies
the giotto image 3d is the only digital mammography system able to perform stereotactic biopsy with the patient in a face
down, upright or lateral (on the side) position.
We are excited to be first hospital in the united states to be using two of giotto's most impressive technologies, digital mammography and stereotactic biopsy. Bringing new technologies and innovative treatments to Boulder Community Hospital exemplifies our commitment to the fight against breast cancer.
Northern Colorado's Most Comprehensive Breast Cancer CareBoulder Community Hospital is ful y committed to providing the finest breast cancer program in Colorado. Boulder Community Hospital is the only breast center north of denver that is ful y accredited by the national accreditation program for Breast Centers (napBC), a program administered by the american Col ege of surgeons. a center that achieves napBC accreditation offers its patients every significant advantage in their battle against breast disease. The hallmarks of the BCH approach are:

A team of experienced physicians who work together to plan and coordinate each patient's treatment; A Breast Health Navigator, an experienced oncology nurse who personalized guidance through breast cancer treatment, from diagnosis to recovery and beyond; Access to the latest advances in diagnostic technology; A comprehensive treatment program; Extensive rehabilitation services and emotional support groups. Inpatient and Outpatient CareBCH offers both inpatient and outpatient care and services to cancer patients. acutely ill cancer patients are cared for on the second floor of the beautiful foothil s Hospital. the unit boasts spacious rooms with mountain views. the nurses who care for cancer patients have earned certification from the oncology nursing society.
Boulder Community foothil s Hospital (BCfH) has been designated a Breast imaging Center of excel ence by the american Col ege of Radiology (aCR), a national professional organization serving more than 32,000 radiology specialists. in order to receive this honor, BCfH underwent aCR's thorough review and successful y achieved accreditation in mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. in addition, Boulder medical Center, Community medical Center and medical imaging Center are accredited by the aCR in mammography and ultrasound.
the tebo family medical pavilion is a state-of-the art outpatient cancer treatment center. located on the campus of foothil s Hospital, the tebo pavilion was designed in a unique partnership between BCH and Rocky mountain Cancer Centers (RmCC), Boulder County's largest group of physicians specializing in cancer diagnosis and treatment. this 42,000 square foot complex is armed with state-of-the art specialty imaging including the staffed gril o Health information Center, a pet/Ct scanner and an advanced linear accelerator that can provide cutting edge intensity modulated Radiation therapy and image-guided Radiation therapy. the tebo Center also offers an array of cancer support services.
Physician Communication
and Coordination
BCH offers one of the best post-mastectomy programs Weekly Breast Cancer Conference
available, with skil ed therapists providing one-on-one care to help ensure a successful recovery. Rehabilitation can decrease BCH's weekly breast cancer conference is the cornerstone of swel ing and pain and help patients regain their range of our multidisciplinary breast cancer program. doctors in medical motion more quickly. oncology, radiology, radiation oncology, breast surgery, plastic surgery and pathology meet weekly to jointly plan care for every Breast Health navigator
newly diagnosed breast cancer patient. in this way, patients benefit from the col ective expertise and experience of multiple the breast health navigator is a certified oncology nurse who physicians. each patient is fol owed with the help of a Breast provides services solely for breast cancer patients and their Health navigator (described later in this report) until the decisions families. she offers patients much needed educational and regarding that patient's care are finalized. this highly coordinated emotional support and provides personalized guidance through team approach offers patients the most optimal care.
breast cancer treatment - from diagnosis to recovery and beyond. much of the breast health navigator's time is spent directly on We firmly believe that staying on top of clinical innovations is patient education, explaining the advantages and disadvantages crucial to maintaining our commitment to be a breast cancer of various treatment options. the navigator serves as a triage center of excel ence. our physicians accomplish this goal in manager to assess the patient's educational and social needs several ways, from reading professional journals to attending and to refer the patient to the proper resources. frequent clinical y relevant national meetings. physicians in different communication with the patient's medical team members specialties have attended the national y recognized school ensures that the patient is provided with optimal care. of Breast oncology program (soBo) at emory university in atlanta. soBo training utilizes a panel of experts to review Besides providing direct patient services, the breast health all aspects of breast oncology, including biology, pathology, navigator also provides breast cancer screening and treatment radiation, surgery and medical therapy. BCH has a core group education for staff and the community. of physicians who have been certified by soBo. Inpatient/Outpatient Treatment
the decision to pursue breast cancer treatment—surgery, then
perhaps radiation, hormonal (anti-estrogen) therapy, and/or
chemotherapy—can be emotional y overwhelming. as a breast
cancer center of excel ence, Boulder Community Hospital is
committed to providing the technology and expertise to guide
patients through the entire continuum of care. We believe in a
holistic approach to breast cancer, which includes integrative
therapies, counseling and emotional support as part of the
treatment process.
BCH Cancer Support ServicesBCH has integrated innovative, high-tech cancer fighting Center for Integrative Care
equipment and expertise with a full range of support services. the tebo family medical pavilion on the foothil s Hospital those resources include our extensive rehabilitation programs, campus is home to the Center for integrative Care, which the innovative Center for integrative Care, Registered nurse provides an array of complementary therapies that can aid in Breast Health navigator, the seven levels of Healing® program healing and recovery. available services include acupuncture, and support groups.
massage therapy, Healing touch/Reiki therapy, music therapy, and wel ness and integrative care consultation with a registered nurse. the center also has a small meditation/ the hospital offers a comprehensive range of inpatient and labyrinth area and provides access to support groups and outpatient rehabilitation services that support cancer patients counseling services. throughout their recovery. Cancer patients can receive specialized therapy on our inpatient Rehab unit to improve Seven Levels of Healing®
strength and their ability to function independently. they the seven levels of Healing,® introduced to Colorado by Rocky also learn strategies and coping mechanisms to help them mountain Cancer Centers, is a comprehensive, seven-week function in their home and work environments. We address a educational program offered at the tebo family medical variety of conditions, such as weakness related to lymphoma, pavilion. the program focuses on the fundamental concerns neurological deficits caused by brain or spinal cord tumors, shared by cancer patients and their loved ones and how to and speech deficits caused by tumors in the throat. after effectively navigate the journey through cancer. seven levels leaving the hospital, many patients continue to receive services of Healing is based on the belief that many dimensions— through the extensive outpatient program offered by BCH's mental, emotional, spiritual, and physical—must be addressed neurologic, orthopedic and Cancer Rehabilitation Center.
in order for the healing process to be complete.
oncology patients who are significantly limited by pain have access to BCH's respected pain management program. the rehabilitation center offers cancer survivors a variety of in addition to seven levels of Healing, BCH patients have access classes that focus on stretching, strengthening, conditioning to an extensive range of support and educational groups. BCH and balance. integrative therapy services, such as bodywork, also provides support groups for caregivers, loved ones, newly emotional support and relaxation training, also are available.
diagnosed breast cancer patients, advanced breast cancer patients and prostate cancer patients. We also offer information on non-BCH programs available in our area, including support groups for ovarian cancer, leukemia/lymphoma cancers, and other cancers.
The hospital offers a comprehensive range of inpatient and outpatient rehabilitation services that support cancer patients throughout their recovery. Cancer Clinical Trials Offered at Boulder Community Hospitalat Boulder Community Hospital we are proud to make clinical trials accessible to our cancer patients. Cancer clinical each clinical trial has an action plan or protocol explaining the trials are essential for identification of new, more effective complete plan for the trial. your physician who considers you for therapies and play a significant role in producing advances in a trial, will ask you to participate and use the same protocol.
disease prevention, detection, treatment, and rehabilitation. the clinical trials offered at Boulder Community Hospital are for patient safety, each protocol must be approved by the frequently the same trials offered at major cancer research organization that sponsors the study, such as the national centers throughout the u.s. through a partnership with the Cancer institute, and by the institutional Review Board (iRB) Colorado Cancer Research program (CCRp), we are able to at each hospital or other study site. the iRB, which includes offer and connect patients with a large variety of clinical trials consumers, clergy and health professionals, reviews the local y. these research studies are approved and supported by protocol to try to be sure that the research will not expose the national Cancer institute (nCi). many of the treatments we patients to extreme or unethical risks.
have offered through CCRp have become standard therapies for major forms of cancer, such as breast, colon, leukemia, Clinical Trials nurse
lung, melanoma, and prostate.
Coordination of clinical trials is accomplished by clinical trials Clinical trials, also known as research studies, test new ways nurses (Ctns), who are Rns educated in cancer treatment and to treat people with cancer. the goal of this research is to find certified through the oncology nursing society. the oncology better ways to treat cancer and help cancer patients. Clinical physician notifies the Ctn that there is a patient to consider trials test many types of treatment such as new drugs or for a clinical trial. the Ctn works closely with the physician to combinations of drugs, new approaches to surgery or radiation assure the patient is eligible for the study. Ctns bring strong therapy, new combinations of treatments, or new methods scientific knowledge, direct patient care experience, critical such as using genetic engineering therapy. there have been thinking skil s, as well as interpersonal and patient advocacy many genetic tests designed to further determine the types of skil s. the role of the Ctn is to address unique issues that arise triggers for cancer.
before, during, and after a patient is on a clinical trials.
a clinical trial is a careful y researched process that meets Three Phases of Clinical Trials
strict investigational criteria during a long and careful cancer Cancer clinical trials include research in three different phases. research process. studies are done with cancer patients to find each phase answers different questions about the new treatment.
out whether promising treatments are safe and effective.
phase i: trials are the first step in testing a new treatment in We encourage you to access the fol owing web sites for more information on Cancer Clinical trials: phase ii: trials focus on learning whether the new treatment • American Cancer Society has an anticancer effect.
• National Cancer Institute phase i i: trials compare the results of people taking the new treatment with the results of people taking standard treatment (e.g., which group has better survival rates? • Mayo Clinic Cancer Center fewer side effects?). in most cases, studies move into phase i i testing only after a treatment shows promise in phases i and ii. thousands of people around the country may be included in phase i i trials.
Clinical Trials at Boulder Community Hospital (BCH)
What other options do people with my type of cancer have? BCH clinical trials offer some phase ii and many phase iii How do the possible risks and benefits of this trial compare treatment trials.
with those options? protocols available at BCH include, but are not limited to: Participation and Care
What kinds of therapies, procedures and/or tests will i have during the trial? • Gastrointestinal (stomach, colon) Will they hurt, and if so, for how long? • Genitourinary (bladder, ovarian, uterine) How do the tests in the study compare with those i would have • Head and neck outside of the trial? Will i be able to take my regular medications while in the Where will i have my medical care? Who will be in charge of my care? How could being in this study affect my daily life? • Cancer control trials-smoking cessation, pain control, and Can i talk to other people in the study? side effect controls Cost Issues
Existing protocols close frequently and new protocols Will i have to pay for any part of the trial such as tests or the open frequently. study drug? if so, what will the charges likely be? Questions to ask
What is my health insurance likely to cover? anyone considering a clinical trial should feel free to ask any Who can help answer any questions from my insurance questions or bring up any issues concerning the trial at any time.
company or health plan? the fol owing suggestions may give you some ideas as you Will there be any travel or childcare costs that i need to think about your own questions.
consider while i am in the trial? The Study
Helpful Tips to ask Your Doctor
What is the purpose of the study? about Trials
Why do researchers think the approach may be effective? When you talk with your doctor or members of the research team: Who has reviewed and approved the study? 1. Consider taking a family member or friend along for support How are study results and the safety of participants being and for help in asking questions or recording answers.
2. plan ahead what you would like to ask—but don't hesitate How long will the study last? to ask any new questions you think of while you're there. What are my responsibilities if i participate? 3. Write down your questions in advance to make sure you remember to ask them al .
Possible risks and Benefits
What are my possible short term benefits?
4. Write down the answers so that you can review them whenever you want. What are my possible long term benefits? 5. Consider bringing a tape recorder or make a voice What are my short term risks, such as side effects? recording on your cell phone even when you write What are my possible long term risks? Cancer Registrythe cancer registry is an integral part of our cancer program and functions in accordance with guidelines set by the american Col ege of surgeons (aCos). the cancer registry at Boulder Community Hospital has a beginning reference date of January 1, 1988, and is under the management and direction of the Boulder Community Hospital and the cancer committee. the cancer registry works with physicians, administrators, and health care planners to provide support for cancer program development, ensure compliance of reporting standards, and serves as a valuable resource for cancer information with the ultimate goal of preventing and control ing cancer.
through the cancer registry, recorded information for each malignancy is maintained and is inclusive but not limited to patient demographics, primary site, histology, stage of disease, treatment, recurrence, and fol ow-up data. fol ow-up is performed annual y on patients in the registry. fol ow-up directly benefits patients and physicians by reminding them of the need for medical checkups. Continued surveil ance ensures early detection of possible recurrence or a new primary malignancy. outcome data provides survival information, reflecting the effectiveness of treatment modalities. the registry fulfil s requests for cancer data from staff physicians, al ied health professionals, outside institutions, and requests for fol ow-up information from other cancer registries. all data requests are handled with the utmost care for the patient's confidentiality. the cancer registry maintains data management and regulatory reporting on cancer statistics for various healthcare agencies. as required by law, all active cancer cases are reported to the Colorado Cancer Registry (CCR). the data submitted is shared with the north american association of Central Cancer Registries (naaCCR) and the Center for disease Control national program of Cancer Registries (CdC-npCR). in addition, cancer cases are submitted to the aCos' Commission on Cancer's national Cancer data Base (nCdB). the nCdB is a comparative data base for ongoing assessment of cancer patient care and is a joint project of the aCos and the american Cancer society.
the national Cancer Registrars association serves as the premier education, credentialing, and advocacy resource for cancer data professionals. Cheryl Varela, CtR Cancer Registry Coordinator Boulder Community Hospital Cancer Resources
Boulder Community Hospital General Information 303-440-2273 Inpatient Oncology
oncology unit, foothil s Campus
oncology nurse manager—susan spitz, Rn Outpatient Oncology
outpatient Chemotherapy services—Rocky mountain Cancer Center
Support and rehabilitation
Center for integrative Care Breast Cancer navigator—nanna Christensen Cancer Rehabilitation Oncology Data and Information
Cancer Registry, Cheryl Varela, CtR
gril o Health information Center www.gril Clinical trials-maryte anilionis, ms, Bsn, Rn, oCn Community Support and Services
american Cancer society
Reach to Recovery, american Cancer society look good, feel Better, american Cancer society Boulder County services and programs Diagnostic Imaging
BCH foothil s Campus, 48th and arapahoe, Boulder
BCH Broadway Campus, north Broadway and Balsam, Boulder Community medical Center, 1000 W. south Boulder Rd., lafayette Boulder medical Center, 2750 Broadway, Boulder medical imaging Center, 36 garden Center, Broomfield Buffalo Ridge medical Center, 16677 lowell Blvd., Broomfield Women's Imaging Centers (Mammography)
BCH foothil s Campus, 48th and arapahoe, Boulder
Community medical Center, 1000 W. south Boulder Rd., lafayette Boulder medical Center, 2750 Broadway, Boulder medical imaging Center, 36 garden Center, Broomfield Visit the BCH website at for more details on our cancer services. for additional cancer-specific information, visit or call 1-800-227-2345.
Boulder Community Hospital, Tebo Family Medical Pavilion
4715 arapahoe avenue, Boulder, CO 80303


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International Journal of Obesity (2004) 28, 1124–1133 & 2004 Nature Publishing Group All rights reserved 0307-0565/04 $30.00 Pretreatment predictors of attrition and successfulweight management in women PJ Teixeira1*, SB Going3, LB Houtkooper3, EC Cussler2, LL Metcalfe2, RM Blew2, LB Sardinha1 andTG Lohman2 1Department of Exercise and Health, Faculty of Human Movement, Technical University of Lisbon, Lisbon, Portugal;

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