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    Cancer Patient Volume

    Table 1 shows the numbers of new patient cancer cases seen by our doctors in all PAMF departments from 2007 through 2011. We expect the number of cancer cases to increase over time, as people live longer.

    The number of new patient cancer cases at PAMF decreased slightly in 2011, after 3 consecutive years of growth. The largest decreases in new cases—21% and 10%—were in gynecologic and brain and nervous system cancers, respectively (Table 1). This observation is consistent with a reported national trend of declining cancer incidence rates.

    Table 1. New Patient Cancer Cases in All PAMF Departments by Cancer Type
    Table 1 represents the number of new patients cancer cases decreasing slightly in 2009 to 2011, after 3 years of consecutive growth. The largest decreases in new cases of 21% and 10% were in gynecologic and brain and nervous system cancers respectively.


    The total numbers of patient visits in all PAMF departments are shown by type of cancer in Table 2.

    Table 2. Total Patient Visits in All PAMF Departments by Cancer Type
    Table 2 represents the total number of patient visits in all departments by cancer type from 2007 to 2011. Brain and nervous system was 297 in 2007 and peaked in 2009 at 558. Breast has steadily increased each year, but dropped slightly in 2011. Gastro, Gynecologic, Lung, Lymphoma, Melanoma, and Prostate all followed the trend with slight increases from 2007 to 2010 then slight drops in 2011.
    The total numbers of PAMF oncology and hematology visits reflect the work we have done for our cancer patients (Figure 1). Since 2007, there has been a steady increase in cancer patient office visits, likely as a result of improved long-term survival and a need for ongoing oncologic care. There were nearly 30,000 oncology office visits in 2010 and again in 2011, and the total number of office visits increased by over 100% from 2007 through 2010 (Figure 1).

    Figure 1. Oncology and Hematology Visits at PAMF by Year (2007 through 2011)Figure 1 represents the total number of oncology and hematology visits from 2007 to 2011. Since 2007 there was a steady increase in cancer patient office visits, in 2010 and 2011, there were about 28,000 office visits.
    Patient infusion visits accounted for the total number of treatments performed at our 4 infusion centers from 2007 through 2011 (Figure 2).

    Figure 2. Number of Patient Infusion Visits at PAMF by Year (2007 through 2011)
    Figure 2 represents the number of patient infusion visits from 2007 to 2011. Demand for infusion rates has increased steadily from 2007 to 2011 with 27,182 patients visiting in 2011.
    PAMF has a total of 51 infusion chairs in Fremont, Mountain View, Palo Alto and Santa Cruz. Since 2008, the demand for our infusion services, measured by the number of patient infusion visits, has dramatically increased (Figure 2). As our patients live longer and new therapeutic agents become available, this trend is likely to continue. Anticipating this increased demand, we will expand our infusion capabilities by 13 chairs when our new Sunnyvale Cancer Center opens in 2013.
    We rigorously screen our patient population, as indicated by the total number of colonoscopy and mammography procedures we performed from 2007 through 2011 (Table 3).

    Table 3. Total Procedures Performed at PAMF by Year (2007 through 2011)
    Table 3 represents the total procedures performed from 2007 to 2011. The most common being Mammography at 34,710 in 2011 and the fewest being Electromagnetic Navigation-Guided Biopsy/Endobrochial Ultrasound of 60 in 2008 and 98 in 2011
    Figure 3 shows the types of new cancer cases seen at PAMF in 2011. The largest group, breast cancer cases, accounted for 26 of new patient cancer cases.

    Figure 3. New Cancer Cases Seen at PAMF by Cancer Type (2011)
    Figure 3 shows the types of new cancer cases seen in 2011. The largest group, breast cancer cases, accounted for 26 of new patient cancer cases.

    Prostate and lymphoma/myeloma cancers were the second- and third-most-common new cancer cases, accounting for 18% and 15%, respectively.
    In Figure 4, the 5-year survival rates of patients at PAMF with stages 1 through 4 breast cancer are compared with the survival rates of the U.S. national standard from 2007 through 2011 (1).

    Figure 4. 5-Year Survival Rates of Patients with Breast Cancer by Stage at Diagnosis Compared With the U.S. National Standard (2007 through 2011, N = 2,856)
    Figure 4 represents the 5-year survival rates of patients with breast cancer by stage at diagnosis as compared with the U.S. national standard from 2007 through 2011. The best outcomes seen at stage 1 or 2 with a 90% survival rate over the 5 years, as compared to national standard of just under 90% for the national standard.

    Reference group as reported in reference 1. Small patient numbers prevented calculation of the statistical significance of the data.

    Cancer stages were assigned at diagnosis; at all breast cancer stages, PAMF patients’ survival rates exceeded the survival rates of the national standard. However, the patient numbers used in this analysis were small, which prevented determination of the statistical significance of these results.

    The excellent outcomes in our stage 1 and 2 breast cancer patients highlight the importance of effective screening and advances in multidisciplinary cancer care. Improved survival rates in stages 3 and 4 breast cancer patients are also consistent with national trends.
    Similar results for the same period are shown in Figure 5 for patients with stages 1 through 4 colon cancer.

    Figure 5. 5-Year Survival Rates of Patients with Colon Cancer by Stage at Diagnosis Compared With the U.S. National Standard (2007 through 2011, N = 766)
    Figure 5 represents the 5-year survival rates of patients with colon cancer by stage at diagnosis compared with the U.S. national standard from 2007 to 2011. PAMF patients survival rates exceeded those of the national standard for all stages, although the patient numbers used in this analysis were small.

    Reference group as reported in reference 1. Small patient numbers prevented calculation of the statistical significance of the data.

    As with the breast cancer survival rates, at all stages PAMF colon cancer patients’ survival rates exceeded those of the national standard from 2007 through 2011 (1). However, the patient numbers used in this analysis were small, which prevented determination of the statistical significance of these results.

    As with breast cancer, the excellent prognosis for stages 1 and 2 colon cancer underscores the need for and value of screening programs.

    The survival rate for patients with stage 3 colon cancer showed dramatic improvement, due to more effective, routine use of adjuvant chemotherapy. For patients with stage 4 colon cancer, survival rates are also improving, because of advances in combination chemotherapy and targeted treatments. Recent advances in the pathologic analyses of colon cancers have led to the use of more individualized treatments. As recently as 5 to 10 years ago, the median survival rate for metastatic colon cancer patients was 18 months; currently, the median survival rate is 28 months.