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Using 2014 Cancer Registry Data DeCesaris Cancer Institute 2015GEATON AND JOANN DECESARIS CANCER INSTITUTE CANCER REGISTRY ANNUAL REPORT Cancer Committee Members 2014 Required Physician Members Stephen Cattaneo MD Thoracic Surgeon Luqman Dad MD Radiation Oncologist Cancer Liaison Physician Peter Graze MD Hematology-Oncology Barry Meisenberg MD Medical Director DeCesaris Cancer Institute Chair Cancer Committee Hematology-Oncology Sanford Robbins MD Director Pathology Amy Sarina MD Diagnostic Radiology Lorraine Tafra MD Medical Director of the Breast Center and Breast Surgeon Angel Torano MD Radiation Oncologist Required Non-Physician Members Ashley Allenby MGC CGC Genetics Counselor Mary Ann Bleeke LCSW-C ACHP-SW Palliative Care Services Jamie Caldwell PhD Director Pharmacy Jan Clemons RN MSN OCN Director Inpatient Oncology Catherine Copertino BSN MS OCN Executive Director Cancer Program Administration Oncology Nursing Leadership Joanne Ebner RN BSN TTS Cancer Prevention Nurse Coordinator Cancer Prevention Coordinator Commission on Cancer Evelyn Graze RN MSN OCN Director Outpatient Oncology Matthew LeBlanc RN Rehabilitation Coordinator John Moxley MS MHA CCRP Clinical Research Coordinator Jessica Post CTR Cancer Conference Coordinator Maureen Shackelford RD LD Registered Dietitian Samir Shah BS CTR Manager Cancer Registry and Cancer Registry Quality Coordinator Ashley Varner MSW MBA OSW-C Psychosocial Services Coordinator Optional Members Senyat Asafa Representative American Cancer Society Arun Bhandari MD Hematology-Oncology Madelaine Binner MBA CRNP DNP Survivorship Program Bonnie Bresnahan RT R T Director Radiation Oncology and Cancer Registry Marguerite Cook Director of Giving AAMC Foundation Maria Geronimo RN MSN MBA Program Coordinator Thoracic Oncology Brian Hasson PhD Chief Medical Physicist Paul Hayes MD Director The Breast Center Susan Hull Practice Manager Oncology Surgery Shirley Knelly MS CPAQ LCADC Corporate Compliance Officer Vice President Patient Safety Carol Pressey MD Primary Care Physician Family Practice Steven Proshan MD General and Colorectal Surgeon Teresa Putscher RN BSN OCN Nurse Navigator Jackie Shanahan RN OCN Nurse Navigator Jason Taksey MD Hematology-Oncology Susanne Tameris Practice Manager Annapolis Oncology and Hematology Stanley Watkins MD Hematology-Oncology Amy Welsh MBA Marketing Strategist Marketing and Communications Kathy Whittaker RN BSN Manager Patient Advocacy In June 2015 patients families and supporters joined the staff of DeCesaris Cancer Institute to commemorate National Cancer Survivors Day. AAMCs Living Live in Full Bloom was a joyous day of celebration in which we recognized survivors physicians care team members and community members who have done an especially remarkable job of advancing the cause of survivorship. Participants attended free workshops to learn more about the benefits of nutrition complementary medicine and physical activity. More than 375 people attended the 2015 event. Cancer Survivors Celebrate Living Life in Full Bloom The Geaton and JoAnn DeCesaris Cancer Institute at Anne Arundel Medical Center AAMC is one of the leading providers of comprehensive cancer care in the region. Our expertly skilled physicians nurses and staff are at the forefront of the latest advancements in cancer prevention screening diagnosis and treatment. This multidisciplinary team works collaboratively with patients to develop a personalized plan that respects a patients unique healthcare needs. Together patient and care team maintain a focus on restoring health via a holistic approach. At the DeCesaris Cancer Institute we continue to broaden the scope of services available to cancer patients and their families across the continuum of cancer care. This includes prevention specialized diagnostic and treatment services community support resources for survivors and end-of-life care. Teams of providers and staff with disease-specific expertise meet monthly to review cancer cases at AAMC and ensure that each patient is receiving the most appropriate care. There were 1763 total reportable cases in 2014. Geaton and JoAnn DeCesaris Cancer Institute Focusing on a Patients Unique HealthCare Needs Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 2015 Annual Report 2 Barry Meisenberg MD Medical Director DeCesaris Cancer Institute Standard 5.3 Follow-up since registry reference date 2000 STANDARD 5.3 FOLLOW-UP OF PATIENTS SINCE 2000 182 patients 1 follow-up REQUIRED FOLLOW-UP RATE 80 CURRENT FOLLOW-UP RATE 86.68 Total number of cases since 2000 18329 Standard 5.4 Follow-up within last 5 years 2010-2014 STANDARD 5.4 FOLLOW-UP OF PATIENTS DIAGNOSED WITHIN LAST 5 YEARS 79 patients 1 follow-up REQUIRED FOLLOW-UP RATE 90 CURRENT FOLLOW-UP RATE 93.07 Total number of cases within last 5 years 7882 DeCesaris Cancer Registry The DeCesaris Cancer Institute Cancer Registry systematically tracks the diagnosis treatment and lifetime follow-up of cancer patients. Researchers physicians and healthcare providers use our data to improve the outcome of cancer treatment. The American College of Surgeons Commission CoC requires that cancer programs maintain an 80 percent tracking rate of all eligible cancer patients starting from the reference year 2000. The CoC also requires a 90 percent follow-up rate on all patients diagnosed with cancer within the last five years. 3 All Tumor Boards for 2014 80 of Cases Discussed Prospectively Exceeding Standard 1.7 Conference Total Tumor Med Onc. Rad Onc. Surgeon Pathologist Radiologist Cases Prospective Board Conf. Presented Cases 1 BRAINCNS 50 48 50 48 Not Required 36 392 390 2 GU-ONCOLOGY 23 23 23 22 Not Required Not Required 109 108 3 GYNOCOLOGY 9 9 9 9 9 Not Required 60 60 4 THORACIC 51 51 51 48 50 49 431 310 5 BREAST 46 46 45 46 46 46 155 154 6 GENERAL 38 38 38 34 38 37 279 255 7 HEMATOLOGY 11 11 Not Required Not Required 11 Not Required 51 51 Total Average Average Average Average Average Total Cases Total Cases Attendance Attendance Attendance Attendance Attendance 228 99 99 95 99 91 1477 1328 FOR ALL CASES REVIEWED 1. Photographs 2. NCCN Compliance 3. Detection Treatment 4. Clinical Trials X Case discussion includes AJCC Staging consideration for need of Genetic testing counseling Palliative Psychosocial Nutrition Rehab Services. Individual tumor board activity reports are available upon request. Measuring Performance Commission on Cancers Rapid Quality Reporting System RQRS PRESENTING 2014 CANCER REGISTRY DATA The DeCesaris Cancer Institute participates in the CoCs Rapid Quality Reporting System RQRS. This reporting and quality improvement tool provides real clinical-time assessment of hospital-level adherence to National Quality Forum-endorsed quality of cancer care measures for breast and colon cancers. The five rating dials display the year-to-date facility performance rate achieved in 2014. There is one rating dial for each of the measures monitored and reported through RQRS. The year-to-date YTD performance rate is based on the total number of cases for which chemotherapy was given or was expected to be given within the past year 365 days. For this measure this includes all cases of patients diagnosed within the past 24 months. Red needle points to the current YTD performance rate. Shaded areas represent the range of performance rates for other participating programs Green Top quartile 75th 100th percentile Yellow 50th 75th percentile Red 25th 50th percentile 1 2 10 20 30 40 50 60 70 80 90 78.6 n14 1 2 3 3 Reading the Dials The colon cancer measure for the number of nodes removed and pathologically examined reflects the proportion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. The rates shown in these dials indicate the proportion of patients for whom adjuvant chemotherapy was expected to be started within the last 365 days. Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 2015 Annual Report 4 COLON MEASURES 50 60 70 80 90 10 20 30 40 100.0 n 23 10 20 30 40 50 60 70 80 90 At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. Adjuvant chemotherapy is considered or administered within four months 120 days of diagnosis for patients under age 80 with AJCC stage III lymph node positive colon cancer. 50 60 70 10 20 30 40 50 60 70 80 90 10 20 30 40 100.0 n 19 10 20 30 40 BREAST MEASURES Radiation therapy is administered within one year 365 days of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer. Combination chemotherapy is considered or administered within four months 120 days of diagnosis for women under age 70 with AJCC T1cN0M0 or stage II or III hormone receptor-negative breast cancer. Tamoxifen or third-generation aromatase inhibitor is considered or administered within one year 365 days of diagnosis for women with AJCC T1cN0M0 or stage II or III hormone receptor-positive breast cancer. 90 50 60 70 80 100.0 n 32 88.0 n 191 97.7 n 254 90 80 5 Measuring Performance Commission on Cancers Rapid Quality Reporting System RQRS Colon ACT Colon 12RLN ACT-adjuvant chemotherapy is considered or administered within four months 120 days of diagnosis for patients under age 80 with AJCC stage III lymph node posi- tive colon cancer. Performance Rate 90 12RLN-The colon cancer measure for the number of nodes removed and pathologically examined reflects the propor- tion of patients who were diagnosed within the last 365 days and for whom 12 or more regional lymph nodes were examined. Performance rate80 ACT AAMC ACT Maryland State 12RLN AAMC 12RLN Maryland State Breast MAC Breast HT MAC-combination chemotherapy is considered or administered within four months 120 days of diagnosis for women under age 70 with AJCC T1cN0M0 or stage II or III hormone receptor-negative breast cancer. Performance Rate90 BCS AAMC BCS Maryland State Breast BCS BCS-radiation therapy is administered within one year 365 days of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer. Performance Rate90 HT-tamoxifen or third-generation aromatase inhibitor is considered or administered within one year 365 days of diagnosis for women with AJCC T1c N0 M0 or stage II or III hormone receptor-positive breast cancer. MAC AAMC MAC Maryland State HT AAMC HT Maryland State At DeCesaris Cancer Institute our goal is meet and exceed national averages. These graphs reflect our ongoing commitment to continually improve the delivery of quality cancer care. 100 80 60 40 20 0 100 80 60 40 20 0 100 80 60 40 20 0 2009 20092008 20082014 20142010 20102011 20112012 20122013 2013 20092008 20142010 2011 2012 2013 100 80 60 40 20 0 20092008 20142010 2011 2012 2013 100 80 60 40 20 0 20092008 20142010 2011 2012 2013 2014 DCI Cancer by Body System and Sex Non-Hodgkin Lymphoma 30 3 Melanoma of the Skin 13 1 Leukemia 20 2 All Other Sites 235 22 Colon Rectum 65 6 Kidney Renal Pelvis 21 2 Ovary 26 2 Uterine Corpus 55 5 Thyroid 27 2 Lung Bronchus 137 13 Breast 456 42 Oral Cavity Pharynx 28 4 Lung Bronchus 119 18 Pancreas 20 3 Kidney Renal Pelvis 31 5 Urinary Bladder 46 7 Colon Rectum 61 9 Prostate 123 18 Non-Hodgkin Lymphoma 39 6 Melanoma of the Skin 32 5 Leukemia 26 4 All Other Sites 153 23 MALES FEMALES Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 2015 Annual Report 6 Summary by Body System Sex Class Status and Best AJCC Stage Report Sex Class of Case Status Stage Distribution - Analytic Cases Only Primary Site Total M F Analy NA Alive Exp Stg. 0 Stg. I Stg. II Stg. III Stg. IV Not Staged Unk. ORAL CAVITY PHARYNX 42 2.4 28 14 41 1 33 9 0 3 2 5 29 0 2 Tongue 13 0.7 9 4 12 1 10 3 0 1 1 0 10 0 0 Salivary Glands 5 0.3 3 2 5 0 3 2 0 0 1 1 2 0 1 Floor of Mouth 1 0.1 1 0 1 0 1 0 0 0 0 0 1 0 0 Gum Other Mouth 2 0.1 2 0 2 0 1 1 0 1 0 0 1 0 0 Nasopharynx 1 0.1 1 0 1 0 0 1 0 1 0 0 0 0 0 Tonsil 16 0.9 10 6 16 0 15 1 0 0 0 3 12 0 1 Oropharynx 2 0.1 1 1 2 0 2 0 0 0 0 1 1 0 0 Hypopharynx 2 0.1 1 1 2 0 1 1 0 0 0 0 2 0 0 DIGESTIVE SYSTEM 254 14.4 123 131 252 2 170 84 2 46 64 66 67 2 5 Esophagus 19 1.1 14 5 19 0 10 9 0 3 8 2 6 0 0 Stomach 19 1.1 11 8 19 0 10 9 0 5 7 3 4 0 0 Small Intestine 11 0.6 5 6 11 0 8 3 0 1 3 1 4 0 2 Colon Excluding Rectum 87 4.9 36 51 87 0 73 14 1 17 20 31 17 0 1 Cecum 16 8 8 16 0 15 1 0 3 5 8 0 0 0 Appendix 5 0 5 5 0 4 1 0 0 1 2 2 0 0 Ascending Colon 23 12 11 23 0 21 2 0 3 8 10 2 0 0 Hepatic Flexure 2 0 2 2 0 1 1 0 2 0 0 0 0 0 Transverse Colon 6 1 5 6 0 5 1 1 1 1 2 1 0 0 Descending Colon 5 1 4 5 0 4 1 0 1 0 3 0 0 1 Sigmoid Colon 19 10 9 19 0 17 2 0 5 4 5 5 0 0 Large Intestine NOS 11 4 7 11 0 6 5 0 2 1 1 7 0 0 Rectum Rectosigmoid 39 2.2 25 14 39 0 32 7 1 7 10 13 7 1 0 Rectosigmoid Junction 11 6 5 11 0 9 2 0 1 2 6 2 0 0 Rectum 28 19 9 28 0 23 5 1 6 8 7 5 1 0 Anus Anal Canal Anorectum 8 0.5 1 7 7 1 7 1 0 0 4 2 1 0 0 Liver Intrahepatic Bile Duct 13 0.7 8 5 13 0 4 9 0 5 0 0 5 1 2 Liver 8 6 2 8 0 4 4 0 4 0 0 1 1 2 Intrahepatic Bile Duct 5 2 3 5 0 0 5 0 1 0 0 4 0 0 Gallbladder 4 0.2 2 2 4 0 3 1 0 0 1 2 1 0 0 Other Biliary 8 0.5 1 7 8 0 5 3 0 4 2 1 1 0 0 Pancreas 44 2.5 20 24 43 1 16 28 0 3 9 10 21 0 0 Retroperitoneum 1 0.1 0 1 1 0 1 0 0 1 0 0 0 0 0 Peritoneum Omentum Mesentery 1 0.1 0 1 1 0 1 0 0 0 0 1 0 0 0 RESPIRATORY SYSTEM 263 14.9 123 140 259 4 138 125 1 79 25 56 97 0 1 Nose Nasal Cavity Middle Ear 1 0.1 0 1 1 0 0 1 0 0 0 0 1 0 0 Larynx 6 0.3 4 2 6 0 4 2 1 2 0 2 1 0 0 Lung Bronchus 256 14.5 119 137 252 4 134 122 0 77 25 54 95 0 1 BONES JOINTS 2 0.1 1 1 2 0 2 0 0 1 0 0 0 0 1 SOFT TISSUE including Heart 11 0.6 6 5 11 0 10 1 0 4 2 5 0 0 0 SKIN EXCLUDING BASAL SQUAMOUS 49 2.8 33 16 49 0 43 6 7 19 6 11 3 1 2 Melanoma Skin 45 2.6 32 13 45 0 41 4 7 17 6 10 3 0 2 Other Non-Epithelial Skin 4 0.2 1 3 4 0 2 2 0 2 0 1 0 1 0 BREAST 458 26.0 2 456 458 0 449 9 72 220 116 35 9 1 5 FEMALE GENITAL SYSTEM 102 5.8 0 102 102 0 92 10 1 48 9 22 17 0 5 Cervix Uteri 9 0.5 0 9 9 0 8 1 0 6 0 1 1 0 1 Corpus Uterus NOS 55 3.1 0 55 55 0 50 5 1 32 4 8 7 0 3 Corpus Uteri 52 0 52 52 0 48 4 1 32 3 7 6 0 3 Uterus NOS 3 0 3 3 0 2 1 0 0 1 1 1 0 0 Ovary 26 1.5 0 26 26 0 24 2 0 5 3 9 9 0 0 Vagina 2 0.1 0 2 2 0 2 0 0 1 1 0 0 0 0 Vulva 7 0.4 0 7 7 0 6 1 0 3 0 3 0 0 1 Other Female Genital Organs 3 0.2 0 3 3 0 2 1 0 1 1 1 0 0 0 MALE GENITAL SYSTEM 134 7.6 134 0 134 0 127 7 0 15 84 15 18 0 2 Prostate 123 7.0 123 0 123 0 117 6 0 9 82 13 18 0 1 Testis 11 0.6 11 0 11 0 10 1 0 6 2 2 0 0 1 URINARY SYSTEM 122 6.9 77 45 122 0 102 20 24 49 19 7 14 0 9 Urinary Bladder 70 4.0 46 24 70 0 57 13 24 21 13 4 6 0 2 Kidney Renal Pelvis 52 2.9 31 21 52 0 45 7 0 28 6 3 8 0 7 BRAIN OTHER NERVOUS SYSTEM 51 2.9 18 33 51 0 39 12 0 0 0 0 0 51 0 Brain 15 0.9 6 9 15 0 6 9 0 0 0 0 0 15 0 Cranial Nerves Other Nervous System 36 2.0 12 24 36 0 33 3 0 0 0 0 0 36 0 ENDOCRINE SYSTEM 44 2.5 15 29 44 0 41 3 0 23 4 4 4 5 4 Thyroid 39 2.2 12 27 39 0 38 1 0 23 4 4 4 0 4 Other Endocrine including Thymus 5 0.3 3 2 5 0 3 2 0 0 0 0 0 5 0 LYMPHOMA 79 4.5 43 36 79 0 63 16 0 22 17 13 25 0 2 Hodgkin Lymphoma 10 0.6 4 6 10 0 10 0 0 1 7 1 1 0 0 Non-Hodgkin Lymphoma 69 3.9 39 30 69 0 53 16 0 21 10 12 24 0 2 NHL - Nodal 37 23 14 37 0 27 10 0 10 7 9 10 0 1 NHL - Extranodal 32 16 16 32 0 26 6 0 11 3 3 14 0 1 MYELOMA 24 1.4 11 13 24 0 18 6 0 0 0 0 0 24 0 LEUKEMIA 46 2.6 26 20 46 0 39 7 0 0 0 0 0 46 0 Lymphocytic Leukemia 26 1.5 16 10 26 0 26 0 0 0 0 0 0 26 0 Acute Lymphocytic Leukemia 1 1 0 1 0 1 0 0 0 0 0 0 1 0 Chronic Lymphocytic Leukemia 22 13 9 22 0 22 0 0 0 0 0 0 22 0 Other Lymphocytic Leukemia 3 2 1 3 0 3 0 0 0 0 0 0 3 0 Myeloid Monocytic Leukemia 14 0.8 9 5 14 0 9 5 0 0 0 0 0 14 0 Acute Myeloid Leukemia 6 4 2 6 0 1 5 0 0 0 0 0 6 0 Chronic Myeloid Leukemia 8 5 3 8 0 8 0 0 0 0 0 0 8 0 Other Leukemia 6 0.3 1 5 6 0 4 2 0 0 0 0 0 6 0 Other Acute Leukemia 1 0 1 1 0 0 1 0 0 0 0 0 1 0 Aleukemic Subleukemic NOS 5 1 4 5 0 4 1 0 0 0 0 0 5 0 MESOTHELIOMA 6 0.3 4 2 6 0 3 3 0 4 1 0 1 0 0 MISCELLANEOUS 76 4.3 34 42 75 1 42 34 0 0 0 0 0 75 0 Total 1763 678 1085 1755 8 1411 352 107 533 349 239 284 205 38 2014 Caseload by Diagnosis Breast 26 Digestive Systems 14 Hematopoietic 8 Genitourinary 15 GYN 6 Miscellaneous 5 Skin 3 Endocrine 3 Head Neck 2 BrainCNS 3 Respiratory 15 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 2015 Annual Report 8 1763 Cases in 2014 2014 Age at Diagnosis in years Unknown 90 80-89 70-79 60-69 50-59 40-49 30-39 0-29 AJCC Stage Group at Diagnosis n1592 Unknown NA Stg IV Stg III Stg II Stg I Stg 0 0 100 200 300 400 500 0 100 200 300 400 500 33 0 184 389 443 329 146 44 24 32 163 246 219 338 494 100 Anne Arundel Medical Center DeCesaris Cancer Institute Cancer Registry 2015 Annual Report 9 2014 Cancers by Race Breast Prostate Caucasian 78.38 359 Caucasian 87.16 224 Caucasian 86.99 107 Caucasian 88.50 100 African American 18.56 85 African American 11.28 29 African American 9.23 25 African American 10.62 12 African American 13.01 16 Hematopoietic Reticuleondo System Bronchus Lung Other 0.88 1 Other 3.06 14 Other 1.56 4 Colon Caucasian 76.4 68 African American 23.6 21 Other Caucasian 89.3 242 Other 1.48 4 Clinical outcomes of Stereotactic Body Radiation Therapy SBRT for the treatment of early-stage Non-Small Cell Lung Cancer NSCLC in the Community Hospital Setting. Ryan Bathras Cody Tidwell and Luqman Dad MD Clinical outcomes of patients treated with multiple SBRT courses to the Lung Does our clinical experience support that it is safe to offer patients multiple courses of lung SBRT Ryan Bathras Cody Tidwell and Luqman Dad MD Study on the timing and impact of surveillance imaging following treatment of early-stage NSCLC with SBRT Do we need to image at 3 months post-completion Ryan Bathras Cody Tidwell and Luqman Dad MD The Memorial Sloan Kettering Cancer Center MSKCC Nomogram Overestimates the Likelihood of Sentinel Lymph Node Metastasis in Patients with Non-suspicious Axillary Ultrasound AXUS Sophia Cologer Charles Mylander PhD Martin Rosman MD Rubie Sue Jackson MD Tiffany Chichester MD Reema Andrade MBBS and Lorraine Tafra MD Patient Perspectives on the Causes of Unplanned Cancer Admissions. Raquel Millet Jan Clemons Jessalyn Barbour and Barry Meisenberg MD Care Processes and Outcome Disparities among Black and White Patients with Colorectal Cancer Amara Ndumele and Barry Meisenberg MD An Evaluation of Endobronchial Ultrasound with Transbronchial Needle Aspiration in Assessing Lymph Node Involvement in Lung Cancer Matthew Williams Laura Korpon Maria Geronimo Barry Meisenberg MD and Stephen Cattaneo MD Accuracy of CT and PET Scans in Assessing Lymph Node Involvement in Lung Cancer Matthew Williams Laura Korpon Maria Geronimo Barry Meisenberg MD and Stephen Cattaneo MD Rapid Access Chest and Lung Assessment Program RACLAP Reduces Time to Definitive Treatment and Frequency of Biopsies in Early Stage Lung Cancer Matthew Williams Laura Korpon Maria Geronimo Teresa Putscher Barry Meisenberg MD and Stephen Cattaneo MD Summer Student Internship in Clinical Research The DeCesaris Cancer Institute annually hosts area college students in a formal clinical research internship. Students are assigned to a medical staff member or other mentors for the purposes of furthering clinical research and performance improvement projects toward a goal of presentation and publication. During the internship students work with AAMC physician leaders and other professionals as appropriate and help to collect analyze and display data on some aspect of performance patient satisfaction or quality as well as other appropriate study designs. Additionally students also participate in clinical shadowing or observation to gain more insight into the medical profession. The summer internship culminates with a presentation session in which all students give a six-minute structured project presentation similar to an abstract presentation at national meetings. Additionally students draft and submit to the internship team a 300- word structured scientific abstract. Completed Clinical Research Internship Projects in Oncology Giving to AAMCGiving to the Community As a nonprofit organization AAMC honors its tax-exempt status and fulfills its responsibilities to the community through programs and activities providing treatment promoting health and responding to the communitys needs. Call our Foundation at 443-481-4747 or visit askAAMC.orgfoundation to learn how your gift can make a difference in the health of your community. DeCesaris Cancer Institute