2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers

 
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
Cancer Treatment Centers of America Global, Inc.

        2019-2020
        Treatment Results
        FOR PATIENTS AND CAREGIVERS

Elaine B., Breast Cancer
CTCA Tulsa

            LENGTH OF LIFE | QUALIT Y OF LIFE | PATIENT EXPERIENCE | PATIENT SAFE T Y | QUALIT Y OF CARE
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
Table of Contents
                                                                                                                    PATIENT TREATMENT RESULTS 2019 | 2020

                                                                                                                      SECTION 1                                      SECTION 4

Dear Patients and Caregivers,                                                                                         About this Report                              Our Patient Experience Results
                                                                                                                        3 Why We Publish Our Treatment Results        35 	HCAHPS Inpatient Survey
We believe all patients should have access to as much information as possible in order to make                                                                             Background and Methodology
the most informed decisions about their care. As part of that commitment, we are pleased to share                       3 Our Commitment to Transparency
with you this seventh annual edition of our Patient Treatment Results. Cancer Treatment Centers                         3 Our Beginnings                              36   Inpatient Satisfaction Results
of America® (CTCA) was among the first cancer care providers in the nation to make treatment                                                                          42 	OAS CAHPS Survey Background
                                                                                                                        4 Our Beliefs
results available to the general public, and, to our knowledge, this is the most comprehensive                                                                             and Methodology
presentation of treatment results now published by any cancer care provider. It reflects the quality                    4 Accessibility
                                                                                                                                                                      42	Outpatient and Ambulatory Surgery
of clinical care we have provided to patients from around the world at our comprehensive care and                       4 Health Insurance and Verification               Patient Satisfaction Results
research centers and outpatient care centers in Atlanta, Chicago, Philadelphia, Phoenix and Tulsa.
                                                                                                                        5 Sponsors of this Report                     46 	Outpatient Survey Background
Five-year survival rates for CTCA® patients treated between 2000 and 2015 are provided for 11                           6 CTCA Patient Demographics                        and Methodology
cancer types. For reference, we have also provided companion data for the same cancer types
                                                                                                                                                                      46 	Outpatient Satisfaction Results
and timeframe as reported by the National Cancer Institute in its Surveillance, Epidemiology and                      SECTION 2
End Results (SEER) Program, which is undertaken in collaboration with the American College of                                                                         52 	Physician Transparency Star Rating
Surgeons and American Cancer Society.                                                                                 Our Length of Life Results                           Background, Methodology and Results
                                                                                                                        9   Independent Researchers’ Letter
The CTCA patient survival data appearing in this publication were independently analyzed and                                                                         SECTION 5
interpreted by Bert Spilker, MD, PhD, and Chengjie Xiong, PhD. Their biographical sketches are                         10   Statistical Methodology
included in this publication. Neither is affiliated with, or employed by, CTCA.                                        13   Breast Cancer
                                                                                                                                                                     Safe Care, Quality Care
                                                                                                                                                                      53   Our Philosophy and Methodology
Additionally, we have included data on various safety and quality of care measurements during                          14   Colon Cancer
treatment, critically important results not commonly reported by most cancer providers, as well                                                                       54   AHRQ Survey: Patient Safety Culture
                                                                                                                       15   Esophageal Cancer
as patient self-reports of quality of life and the overall patient experience.                                                                                        58   Quality Metrics
                                                                                                                       16   Kidney Cancer
All data sources and survey methodologies are provided in their respective sections throughout                                                                        63   Overall QOPI Quality Score and QOPI Metrics
                                                                                                                       17   Non-Small Cell Lung Cancer
the publication.                                                                                                                                                      66   Project-Specific Areas of Focus
                                                                                                                       18   Small Cell Lung Cancer
We hope you find this important information valuable, and we would be pleased to respond to                            19   Ovarian Cancer                           SECTION 6
any feedback or questions you may have about the results.
                                                                                                                       20   Pancreatic Cancer                        Our Clinical Leadership
Thank you for your interest in Cancer Treatment Centers of America.                                                    21   Prostate Cancer                           69	Medicine & Science
Sincerely,                                                                                                             22   Rectal Cancer                             69	Department Chairs and Vice Chairs
                                                                                                                       23   Stomach Cancer                            71   Chiefs of Staff

                                                                                                                      SECTION 3                                      SECTION 7
                                                                                                                      Our Quality of Life Results                    Our Research
Maurie Markman, MD
                                                                                                                       25 	Assessment Background                     73   Publications and Presentations
President, Medicine & Science
                                                                                                                            and Methodology
Cancer Treatment Centers of America                                                                                                                                   79   Accreditations and Certifications
                                                                                                                       27   Quality of Life Results by Cancer Type
                                                                                                                       32	Quality of Life Results in
                                                                                                                           Aggregate and by Facility

                                                                                                       © 2019 IPB
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
About this Report       1

                                                         Our Length of Life Results

             Our Vision
 To be recognized and trusted by people                  Our Quality of Life Results
 living with cancer as the premier center
           for healing and hope.

           Our Mission                              Our Patient Experience Results
    CTCA® is the home of integrative
    and compassionate cancer care.

We never stop searching for and providing
   powerful and innovative therapies
       to heal the whole person,
                                             Our Patient Safety and Quality Results
 improve quality of life and restore hope.

            Our Values
                 Hopeful                                   Our Clinical Leadership
             Compassionate
              Empowering
                 Ethical
               Responsive
               Innovative                               Our Research Publications
              Team Spirited
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
About This Report

                                                                                       Why We Publish our Treatment Results

                                                                                       At Cancer Treatment Centers of America® (CTCA), we        became one of the first in the country to offer a full
                                                                                       believe in empowering patients. We believe patients       range of integrative treatment services, including
                                                                                       deserve access to information—especially health           surgery, chemotherapy and radiation therapy as
                                                                                       outcomes, including survival, patient safety and          well as nutrition, mind-body and spiritual support.
                                                                                       quality care data as well as patient self-reported data   In 1990, CTCA opened a second hospital, located
                                                                                       on care experience and symptom management.                in Tulsa, Oklahoma, establishing itself as a premier
                                                                                       When patients have access to information about            center of hope and healing for cancer patients.
                                                                                       the centers and professionals to whom they
                                                                                       entrust their lives, they are able to make more           As demand grew, the CTCA hospital in Zion was
                                                                                       informed decisions about their care.                      expanded twice. In 1991, CTCA broke ground on
                                                                                                                                                 a five-story, 78,886-square-foot facility. Then in
                                                                                       OUR COMMITMENT TO TRANSPARENCY                            2015, a six-story 168,078-square-foot inpatient
                                                                                                                                                 tower became the centerpiece of a campus-wide
                                                                                       At CTCA®, we believe that transparency in the             modernization.
                                                                                       publication of our treatment results is vital to
                                                                                       upholding our promise to patients and their               CTCA also expanded its presence in Tulsa by
                                                                                       families. Regardless of the outcome, it holds us          opening a state-of-the-art hospital in 2005. The
                                                                                       accountable to continually improve the care we            stunning 195,845-square-foot center became
                                                                                       deliver. We engage leading independent research           Oklahoma’s only major hospital completely
                                                                                       organizations, such as Bert Spilker & Associates, LLC,    focused on treating cancer. Also in 2005, CTCA
                                                                                       Press Ganey® and Healthcare Performance                   Philadelphia opened its doors, becoming the first
                                                                                       Improvement (HPI®) to conduct various analyses            CTCA hospital on the East Coast.
                                                                                       of our treatment results. We utilize valid and tested     CTCA Phoenix, a modern 210,000-square-foot
                                                                                       tools and participate in nationally recognized            hospital located in Goodyear, Arizona (suburban
                                                                                       activities to further our commitment to safe, high-       Phoenix) joined the CTCA family in 2008. In 2012,
                                                                                       quality care for the patients we serve.                   CTCA Atlanta began welcoming patients to its
                                                                                                                                                 location in suburban Newnan.
                                                                                       OUR BEGINNINGS
Job L. | E S O P H AG E A L C A N C E R | CTCA Tulsa                                                                                             Building on the goal of offering patients increased
                                                                                       In the early 1980s, Richard J Stephenson and his          access to advanced cancer therapies and
                                                                                       family suffered the loss of their mother, Mary            personalized care in convenient, cost-effective
“Throughout my treatment, I was impressed with the commitment to the Mother            Brown Stephenson, to cancer. When she died, her           outpatient settings, in 2018 and 2019 CTCA
                                                                                       grieving son and his family asked, “What would it         opened five outpatient care centers in Chicago,
Standard® of care, the belief that patients are taken care of the way you would want   take to actually change the face of cancer care?”         Phoenix and their surrounding communities.
any member of your family treated. CTCA truly cared about my patient experience,       In 1988, CTCA was born, founded on what is now
                                                                                       known as the Mother Standard® of care—a patient-
treating my whole person and actively monitoring my quality of life. Any issues were
                                                                                       centered approach that combines compassion
quickly addressed, and I had access to a variety of supportive care therapies that I   with advanced technology and treatment options.
took advantage of.”                                                                    The American International Hospital in Zion, Illinois,
                                                                                       located between Chicago and Milwaukee, served
                                                                                       as the first CTCA location. With Mr. Stephenson
                                                                                       as chairman of the board, the cancer program

                                                                                                                                                                               ABOUT THIS REPOR T         3
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
Sponsors of this Report

    OUR BELIEFS                                          Accessibility, Services and Insurance:
    The CTCA Comprehensive Cancer Care Network           Reducing the Stress of Cancer Care
    of hospitals and outpatient care centers
    offers an integrative approach to care that
    combines surgery, radiation, chemotherapy and        ACCESSIBILITY
    immunotherapy with advancements in precision         CTCA understands that speed and accessibility of
    cancer treatment and supportive therapies            care are important to patients and their caregivers,   SPONSORS OF THIS REPORT
    designed to manage side effects and enhance          which is why we are dedicated to providing
    quality of life both during and after treatment.     efficient, convenient cancer care for our patients
    At CTCA, each patient is served by a                 while reducing their stress as much as possible.                    Maurie Markman, MD                                      Julian Schink, MD
    multidisciplinary team of physicians, nurses,                                                                            President, Medicine & Science                           Chief Medical Officer
                                                         CTCA Comprehensive Cancer Care Network
    registered dietitians and other care providers.                                                                          CTCA                                                    CTCA
                                                         hospitals and outpatient care centers are located
    These teams include individuals with extensive       in or near five major U.S. cities: Atlanta, Chicago,                  A nationally renowned board-certified                  Dr. Schink brings more than 25
    experience in treating cancer. Together they         Philadelphia, Phoenix and Tulsa. Each city has an                     medical oncologist, Dr. Markman                        years of oncology experience to
    develop and implement an individualized              airport that is serviced by most major airlines. We    is President of Medicine and Science and serves        his position as Chief Medical Officer at CTCA.
    treatment plan tailored to each patient’s            assist many patients with travel arrangements,         on the National Board of Directors at CTCA. Dr.        Board-certified in gynecologic oncology as well
    unique diagnosis and life goals.                     including lodging accommodations for themselves,       Markman has more than 20 years of experience in        as obstetrics and gynecology, he is dedicated to
    For these reasons, patients, physicians, employers   their caregivers and families either on-site at our    cancer treatment and gynecologic research.             caring for patients and advancing the treatment of
    and insurers can depend on CTCA to offer             hospitals or in nearby hotels.                         For his remarkable achievements in clinical practice   gynecologic malignancies.
    comprehensive, compassionate and truly                                                                      and oncology research, Dr. Markman was recently        Prior to joining CTCA, Dr. Schink held numerous
    personalized cancer care.                            HEALTH INSURANCE AND VERIFICATION                      named by OncLive® as an inductee of the 2018           academic positions, including Vice Chair of
                                                         CTCA verifies the insurance and benefits of            Giants of Cancer Care® recognition program. In         obstetrics and gynecology and professor at
                                                         prospective patients, including in-network             2011, he received the esteemed American Society        the University of Wisconsin Medical School,
                                                         and out-of-network benefits, deductibles, plan         of Clinical Oncology (ASCO) Statesman Award.           and subsequently an endowed professorship
                                                         coverage percentages and co-pays. The verification     Presented annually, the Statesman Award recognizes     at Northwestern University Feinberg School of
                                                         process typically takes less than 24 hours. CTCA       individual ASCO members who have shown                 Medicine as the John and Ruth Brewer Chair in
                                                         financial counselors are also available to patients    extraordinary volunteer service, dedication and        Gynecology and Cancer Research.
                                                         and caregivers should they need assistance with        commitment to ASCO, their hospital community           Published in numerous medical journals and more
                                                         the financial arrangements for their care.             and the patients they serve for at least 20 years.     than 125 publications dedicated to oncology and
                                                         CTCA maintains contracts with many major               Prior to joining CTCA, Dr. Markman served as the       women’s health, Dr. Schink has also authored more
                                                         national and regional insurance companies,             Vice President for Clinical Research and Chairman of   than 10 chapters in oncology textbooks, focusing
                                                         employers and other health care companies that         the Department of Gynecologic Medical Oncology         much of his academic work on gestational
                                                         have approved patient access to CTCA hospitals. We     at MD Anderson Cancer Center in Houston. Prior         trophoblastic disease. He served as principal
                                                         treat patients who have both in-network and out-of-    to that, he served as Chair of the Department of       investigator and co-investigator for many clinical
                                                         network benefits with these carriers.                  Hematology/Oncology and Director of the Taussig        trials responsible for improving and expanding
                                                                                                                Cancer Center at the Cleveland Clinic Foundation,      cancer treatment options.
                                                                                                                and Vice Chair of the Department of Medicine at        Additionally, Dr. Schink serves as Chief of
                                                                                                                Memorial Sloan-Kettering Cancer Center in New York.    Gynecologic Oncology for CTCA, Medical Director
                                                                                                                Dr. Markman received his MD from New York              of Gynecologic and Medical Oncology and Senior
                                                                                                                University.                                            Vice President of Clinical Affairs for CTCA Chicago.
                                                                                                                                                                       Dr. Schink received his MD from The University of
                                                                                                                                                                       Texas at San Antonio.

4   CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                      ABOUT THIS REPOR T        5
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
CTCA Patient Demographics                                                                                                              CTCA Patient Demographics
    JULY 1, 2017 - JUNE 30, 2018                                                                                                           JULY 1, 2017 - JUNE 30, 2018

    New Patients BY GENDER                                                 New Patients BY AGE GROUP
    Analytic and Non-Analytic                              Analytic and Non-Analytic
    Patient demographics are based on data provided by the tumor registry from July 1, 2017 - June 30, 2018.

                                                                            90+  15 Types                                                  New Patients1 ANALYTIC AND                                                 Cancer Types BY STAGE
    New
    New Patients
        Patients11 ANALYTIC
                   ANALYTIC AND
                            AND                                            Cancer
                                                                            Cancer   Types BYBY STAGE
                                                                                                 STAGE                                     New
                                                                                                                                           NewPatients
                                                                                                                                                PatientsBY
                                                                                                                                                         BY GENDER
                                                                                                                                                            2GENDER                                                  New
                                                                                                                                                                                                                     New  Patients
                                                                                                                                                                                                                           Patients  BY
                                                                                                                                                                                                                                      BY AGE
                                                                                                                                                                                                                                          AGE GROUP
                                                                                                                                                                                                                                              GROUP
    4,080
    NONANALYTIC22
    NONANALYTIC                                                          80-89
                                                                           Analytic 224
                                                                            AnalyticPatients
                                                                                    PatientsOnly
                                                                                             Only                       44%%   176
                                                                                                                               176         NONANALYTIC
                                                                                                                                           Analytic
                                                                                                                                           Analyticand
                                                                                                                                                    andNon-Analytic
                                                                                                                                                       Non-Analytic
                                                                                                                                                                                                                      Analytic
                                                                                                                                                                                                                     Analytic
                                                                                                                                                                                                                               Patients
                                                                                                                                                                                                                     Analyticand
                                                                                                                                                                                                                                        Only
                                                                                                                                                                                                                              andNon-Analytic
                                                                                                                                                                                                                                 Non-Analytic                  4%        176
                    44%                                                                       1,067                                                                                                                                                                      Unknown
    Male
                                                                          70-79
                                                                            261
                                                                            261 77%%                                           Unknown
                                                                                                                               Unknown                                                                                261 7%
                               9,192                                      60-69                                                  2,862
                                                                                                                                           5,150                                                                                                               3%        119
    5,150
    5,150                                              5,112               N/A
                                                                            N/A
                                                                          50-59                                         33%%   119
                                                                                                                               119 3,021
                                                                                                                                           4,080
                                                                                                                                           4,080
                                                                                                                                                                                                                   90+
                                                                                                                                                                                                                    90+
                                                                                                                                                                                                                    N/A     15
                                                                                                                                                                                                                             15

                     56
                     56%%                56%                                                            1,383                              Non-              56%                                                  80-89
                                                                                                                                                                                                                   80-89
                                                                                                                                                                                                                   1,184 29%   224
                                                                                                                                                                                                                                224                                      Stage 0
    Non-
    Non-                                                                   1,1,1184
                                                                          40-49
                                                                                 84 29                                         Stage
                                                                                                                               Stage00                      44
                                                                                                                                                            44%%                              4,042                                           1,067
                                                                                                                                                                                                                                               1,067      20%
    Analytic
    Analytic                                           4,042
                                                       4,042
                                                       Female             30-39     29  482
                                                                                         %%                      20
                                                                                                                 20%%          807
                                                                                                                               807
                                                                                                                                           Analytic
                                                                                                                                           Male
                                                                                                                                            Male
                                                                                                                                                                                    44%
                                                                                                                                                                                                                  70-79
                                                                                                                                                                                                                   70-79
                                                                                                                                                                                                                    Stage IV                                             807
    Patients
    Patients                                44
                                            44%%          Analytic
                                                          Analytic
                                                                           Stage
                                                                            StageIV
                                                                          18-29
                                                                                  IV
                                                                                    138
                                                                                                                                           Patients
                                                                                                                                                                     9,192
                                                                                                                                                                     9,192                    Analytic            60-69
                                                                                                                                                                                                                   60-69                                                  2,862
                                                                                                                                                                                                                                                                           2,862
                                                                                                                                                                                                                                                                         Stage 1
                                                                                                                                                                                                                                                                             3,021
                                                                                                                                                                                                                                                                              3,021
                                                          Patients
                                                          Patients                 0
                                                                                                                 Stage
                                                                                                                  Stage11
                                                                                          500 1000 1500 2000 2500 3000
                                                                                                                                                                                   56
                                                                                                                                                                                   56%%
                                                                                                                                                                                              5,112
                                                                                                                                                                                              5,112
                                                                                                                                                                                              Patients            50-59
                                                                                                                                                                                                                   50-59
                                                                                                                                                                                                                    694               17%            20%                 801
                                                                            694
                                                                            694              17
                                                                                             17%%          20
                                                                                                           20%%                801
                                                                                                                               801                                                            Female
                                                                                                                                                                                               Female
                                                                                                                                                                                                                  40-49
                                                                                                                                                                                                                   40-49
                                                                                                                                                                                                                    Stage III
                                                                                                                                                                                                                  30-39
                                                                                                                                                                                                                   30-39            482
                                                                                                                                                                                                                                     482
                                                                                                                                                                                                                                                  1,383
                                                                                                                                                                                                                                                   1,383
                                                                            Stage
                                                                            StageIIIIII                                                                                                                                                                                  Stage II
                                                                                                                               Stage
                                                                                                                               StageIIII
                                                                                                                                                                                                                  18-29
                                                                                                                                                                                                                   18-29        138
                                                                                                                                                                                                                                 138
                                                                                                                                                                                                                           00     500
                                                                                                                                                                                                                                   500 1000
                                                                                                                                                                                                                                        1000 1500
                                                                                                                                                                                                                                              1500 2000
                                                                                                                                                                                                                                                    2000 2500
                                                                                                                                                                                                                                                          2500 3000
                                                                                                                                                                                                                                                                3000
    New Patients BY CANCER TYPE                       3
                                                                                                                                           New Patients BY STATE OR TERRITORY
    New
    New Patients
          Patients
    Analytic       BY
                    BY STATE
                       STATE
             and Non-Analytic    OR
                                  OR TERRITORY
                              Patients TERRITORY                                                                                           Analytic and Non-Analytic
    Analytic
    Analyticand
             andNon-Analytic
                Non-Analytic

    3000                                                                                                        2,879                                    WA
                WA
                WA                                                                                                                         New    53 BY
                                                                                                                                           NewPatients
                                                                                                                                               Patients BY CANCER TYPE33 ND
                                                                                                                                                           CANCER TYPE                                                                                                 ME
                53
                53                                                                                              30.2%      ME
                                                                                                                           ME                                  MT                                                                                                      10
    2500                                MT
                                        MT                  ND
                                                            ND                                                             10
                                                                                                                           10              Analytic
                                                                                                                                            Analyticand
                                                                                                                                                     andNon-Analytic
                                                                                                                                                          Non-AnalyticPatients
                                                                                                                                                                       Patients
                                                                                                                                                                        28                        20
         OR
          OR                            28
                                         28
                                      2,276
                                      2,276                 20
                                                             20                                         VT
                                                                                                        VT99     4,612
                                                                                                                 4,612
                                                                                                                                                   OR                 2,276                                      MN                               VT 9    4,612            NH 6
         2,088                                                           MN
                                                                         MN                                               NH66
                                                                                                                          NH                       43         ID                                  SD             55      WI                               NY               MA 14
    2000 43
          43               ID
                            ID                              SD
                                                            SD           55
                                                                          55                                    NY
                                                                                                                 NY       MA14
                                                                                                                          MA   14          3000
                                                                                                                                            3000              41                                                                                          172
          21.9%            41
                            41                              23
                                                             23
                                                                                  WI
                                                                                  WI
                                                                                 210
                                                                                  210                           172
                                                                                                                172       RI22
                                                                                                                          RI
                                                                                                                                                                         WY                       23                     210          MI                2,879
                                                                                                                                                                                                                                                         2,879             RI 2
                                                                                                                                                                                                                                                                           CT 29
                                          WY
                                          WY                                                MI
                                                                                             MI                                                                           13                                                          253              PA30.2
                                                                                                                                                                                                                  IA                                      30.2%%
                                                                                                                                            2500 628NV
                                          13
                                          13                                                253
                                                                                            253              PA
                                                                                                              PA          CT
                                                                                                                          CT2929                                                                  NE                                                                   NJ 180
    1500                                                                  IA
                                                                           IA                                                                                                                                                                          753
             628
             628NV
                 NV                                      NE
                                                          NE              74
                                                                           74                               753
                                                                                                             753      NJ
                                                                                                                      NJ 180
                                                                                                                         180               2500
                                                                                                                                                                                                  45
                                                                                                                                                                                                                  74
                                                                                                                                                                                                                           IL IN OH                                        DE 53
                   62
                   62            UT
                                 UT                  1,06645
                                                          45                       1,132
                                                                                     IL
                                                                                   825
                                                                                      IL ININ OH
                                                                                    825% 250
                                                                                          250
                                                                                                  OH
                                                                                                 215
                                                                                                  215                     DE
                                                                                                                           DE53
                                                                                                                          MD
                                                                                                                               53
                                                                                                                           MD156
                                                                                                                               156
                                                                                                                                                   2,08862
                                                                                                                                                  2,088          UT
                                                                                                                                                                 14         C0                                            825 250 215 WV
                                                                                                                                                                                                                                                      VA
                                                                                                                                                                                                                                                                           MD 156
    1000                         14
                                 14           C0
                                              C0                                    11.9              WV
                                                                                                       WV VA  VA                           2000 CA
                                                                                                                                            2000 21.9                       56                         KS           MO                 KY 43 178                           DC 12
                                                      11.2% KS                                                                                      21.9                                                                                                           1
         CA
         CA
        207
         207
                         647                  56
                                              56             KS
                                                                          546MO
                                                                             MO                 KY
                                                                                                KY     43
                                                                                                        43   178
                                                                                                             178    1
                                                                                                                    1
                                                                                                                          DC
                                                                                                                           DC1212              207     %%
                                                                                                                                                          1,018                                        113          223                 85
     500             1,018
                     1,018
                        6.8% 166            314
                                                            113
                                                            113             223
                                                                             223                85
                                                                                                85
                                                                                             269 188          NC
                                                                                                               NC                          1500
                                                                                                                                            1500
                                                                                                                                                                                                                                                       NC
                                                                                                                                                                                                                                                       324
                                                                  230      5.7%
                                                                                                       2.0% 324
                                                                                                              324                                                   AZ                                  OK                       TN 230
                             AZ 1.7%
                            AZ         3.3%                       OK
                                                                   OK                    TN
                                                                                         TN230
                                                                                             230
                                                                                             2.8%                                                                   398            NM                   731          AR 1,132
                                                                                                                                                                                                                          1,132                   SC
        0                   398
                            398      NM
                                     NM                           2.4
                                                                  731
                                                                  731%        AR
                                                                              AR                          SC
                                                                                                          SC                                                                       51        1,066
                                                                                                                                                                                              1,066                 159           AL       GA 193
                                     51
                                      51                                                                                                   1000
                                                                                                                                            1000
                  950
                  950
                                                                             159
                                                                              159
                                                                                     MS AL
                                                                                     MS     AL      GA
                                                                                                    GA   193
                                                                                                          193                                             950 647
                                                                                                                                                               647                           11.2
                                                                                                                                                                                              11.2%%                       MS
                                                                                                                                                                                                                          11.9
                                                                                                                                                                                                                           11.9%%
                                                                                                                                                                                                                          103 407
                                                                                                                                                                                                                                          1,158
                                                                                           407 1,158
                                                                                     103 407
                                                                                    103
                                                                                                   1,158                                                                                           TX             546
                                                                                                                                                                                                                   546 LA
                                                             TX
                                                              TX                                                                                                          166
                                                                                                                                                                           166 314
                                                                                                                                                                                314                                                  269 188  188
                                                                     te

                                                                                                                                                                6.8
                                                                                                                                                                 6.8%%
                               al

                                                                              LA
                                                                               LA
                                                                   ian

                                                                     ic

                                                                                                                                            500
                                                                                                                                             500                                                   417
                                                                                                   h

                                                                                                                                                                                                                                    269
                               y

                                                                                                                                                                                                                   5.7%82
          st

                                                                                           al
                    n

                                                                                                             r
                                                 ng

                                                                                                                                                                                                        230
                                                                                                                                                                                                         230      5.7
                             ge

                             ne

                                                                                                 ac

                                                                                                           he
                                                                  at

                                                                  ta

                                                                                                                                                                                                                       %
                  lo

                                                                                         ct
        ea

                                                             417
                                                             417
                                                                 ar

                                                                              82
                                                                               82
                                                                re

                                                               os

                                                                                               om
                                               Lu
                Co

                          Kid
                           ha

                                                                                                                                                                          1.7
                                                                                                                                                                           1.7%%                                                              2.0
                                                                                                                                                                                                                                               2.0%%FL
                                                                                                         Ot
                                                                                       Re
                                                             Ov
      Br

                                                            nc

                                                             Pr

                                                                                                                                                                                    3.3
                                                                                                                                                                                     3.3%%                                          2.8
                                                                                                                                                                                                                                     2.8%%
                        op

                                                                                                           FL
                                                                                                           FL                                              AK                                           2.4
                                                                                                                                                                                                         2.4%%
                                                                                             St

                                                                                                                                                                                                                                                  314
                                                          Pa
                      Es

                   AK
                   AK                                                                                     314
                                                                                                          314                                  00          25
                   25
                    25
    1 The overall patient population includes patients evaluated           at CTCA. Non-analytic patients are those who received                                                                                     OTHER/UNKNOWN 29

                                                                                                                                                                                                          tee
                                                                                                                                                                             all

                                                                                                                                                                                                     riiaan
                                                                                                                                                                                                           n
                                                                            OTHER/UNKNOWN
                                                                            OTHER/UNKNOWN           29
                                                                                                    29 at CTCA due to progressive or

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                                                                                                                                                                                                     acch
                                                                                                                                                                                                          h
                                                                                                                                                                          geea

                                                                                                                                                                          neey
                                                                                                                                                                             y
                                                                                                                                                  asst
                                                                                                                                                     t

                                                                                                                                                                                                       taal
                                                                                                                                                                                                           l
                                                                                                                                                              onn

                                                                                                                                                                                                                                                       err
                                                                                                                                                                                                    sttaat
                                                                                                                                                                                                     ngg
    across all CTCA hospitals, including those who received                subsequent   cancer treatment

                                                                                                                                                                                                                                                    thhe
                                                                                                                                                                                                   eaat
                                                                                                                                                           ollo

                                                                                                                                                                                                  ecct
                                                                                                                                               reea

                                                                                                                                                                                                LLuun
                                                                                                                                                                       haag

                                                                                                                                                                       idn

                                                                                                                                                                                                 ma
                                                                                                                                                                                                 vaar

                                                                                                                                                                                                crre

                                                                                                                                                                                                roos

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                                                                                                                                                         CCo

                                                                                                                                                                     KKid

                                                                                                                                                                                                                                                  OOt
                                                                                                                                                                                               RRe
                                                                                                                                                                                              OOv
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    non-cancer directed therapy or received palliative care only.          recurrent disease.

                                                                                                                                                                  opph

                                                                                                                                                                                           annc

                                                                                                                                                                                             PPr

                                                                                                                                                                                          SSt
                                                                                                                                                              EEsso

                                                                                                                                                                                        PPa
    2 Analytic patients are those who are diagnosed and/or                 3 Includes 9,192 patients of which 353 had multiple primary                                             HI
                                            HI
                                             HIof cancer treatment                                                                                                                                           VI 22                     PR 1
    received all or part of their first course                          22sites, equating to 9,525
                                                                     VI22
                                                                     VI                        PR11primary cancers.
                                                                                              PR                                                                                   23
                                         23
                                         23

6   CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                           ABOUT THIS REPOR T           7
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
About this Report

         Our Length of Life Results       2

            Our Quality of Life Results

       Our Patient Experience Results

Our Patient Safety and Quality Results

              Our Clinical Leadership

           Our Research Publications
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
Stacy F.                                    Our Length of Life Results
LU N G C A N C E R
                                                                                                               SECTION 2 SPOTLIGHT
CTCA Chicago

“My medical oncologist talked to            Independent Researchers’ Letter                                    • Bert Spilker & Associates, LLC, an
                                                                                                                 independent health care consulting firm,
me about immunotherapy. I hadn’t            Dear Reader:                                                         produced the study design for the analyses
                                            We analyzed the data provided by Cancer Treatment                    and interpretation of the data.
heard of this option before. I soon         Centers of America® (CTCA) and the National Cancer
                                            Institute’s Surveillance, Epidemiology, and End                    • After reviewing data sources, the National
found out that immunotherapy                                                                                     Cancer Institute’s Surveillance, Epidemiology,
                                            Results (SEER) Program database from 2000 through
uses the body’s immune system               2015 for the purpose of compiling survival rates for                 and End Results (SEER) comparison sample
                                            eleven (11) cancers of interest. Our efforts employed                was chosen by matching basic characteristics
to fight cancer cells. I did about six      the statistical guidelines that govern these types of                (e.g., categories or range of values) on several
                                            analyses by leading practitioners. Although the lack                 of the most important factors that affect
weeks of immunotherapy, and I               of direct comparability of the two data sets imposes                 survival outcomes.
immediately knew it was working.            certain limitations on the interpretation of the results
                                            as stated elsewhere in this publication, we believe                • The analyses of both the CTCA and SEER
It’s amazing to me that my own              the analyses provide an accurate representation of                   samples only include cancer patients with
                                            survival rates for CTCA® patients.                                   one of 11 cancer types whose initial diagnosis
body can be used to identify and                                                                                 occurred between 2000 and 2015. The graphs
                                            Sincerely,
                                                                                                                 on the following pages illustrate the findings.
fight the bad cells. I am still in
                                            Bert Spilker, PhD, MD       Chengjie Xiong, PhD
active treatment and continuing
immunotherapy.”                             BERT SPILKER, PHD, MD
                                            Bert Spilker, PhD, MD, is the founder of Bert Spilker & Associates, LLC (BS&A), a health care consulting company
                                            working with more than 100 health care clients and contracting with over 150 experts on a variety of research
No case is typical. You should not expect   areas of specialization.
to experience these results.
                                            Prior to forming BS&A, Dr. Spilker served as the Senior Vice President of Scientific and Regulatory Affairs
                                            for Pharmaceutical Research and Manufacturers of America (PhRMA) based in Washington, D.C. where he
                                            represented the U.S. pharmaceutical industry both nationally and internationally. Dr. Spilker also served as
                                            President and co-founder of Orphan Medical, Inc., a pharmaceutical company that developed and marketed
                                            medical products for patients with orphan/rare diseases.
                                            He currently serves as Clinical Professor of Pharmacy Practice at the University of Minnesota and Adjunct
                                            Professor of Medicine and Clinical Professor of Pharmacy at the University of North Carolina at Chapel Hill.
                                            Dr. Spilker completed his medical training in pharmacology and internal medicine at Cornell Medical College,
                                            State University of New York (Downstate Medical Center), University of California at San Francisco, University of
                                            Miami Medical School (PhD to MD Program) and Brown University Medical School.

                                            CHENGJIE XIONG, PHD, MS
                                            Chengjie Xiong, PhD, MS, studies novel statistical design of experiments and clinical trials, linear and nonlinear
                                            mixed models, longitudinal data analysis, survival analysis and reliability, diagnostic accuracy, advanced
                                            meta-analysis, categorical data analysis, order restricted statistical inferences, and their applications in medicine,
                                            public health, biology, education and engineering.
                                            Dr. Xiong remains active in interdisciplinary research and has provided statistical consulting for academia,
                                            private industries and government agencies across the country, including directing the database management
                                            and statistical analyses for several National Institutes of Health (NIH) funded projects.
                                            He received a BS in Mathematics from Xiangtan University (China), an MS in Applied Mathematics from Peking
                                            University (China), and a PhD in Statistics from Kansas State University.

                                                                                                                           OUR LENGTH OF LIFE RESULTS                9
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
METHODOLOGY
                                                                                                                       For both the CTCA and SEER samples, only cancer                         The survival curve for each cancer type (defined
                                                                                                                       patients whose initial diagnosis occurred between                       as the probability of a cancer patient’s survival as
                                                                                                                       2000 and 2015 were analyzed. Cancer cases with                          a function of time from the initial diagnosis) was
                                                                                                                       missing information on either the date of initial                       estimated by the Kaplan-Meier nonparametric
                                                                                                                       diagnosis or date of last contact were deleted                          product-limit estimator. 1 Three statistical tests were
                                                                                                                       from the CTCA database because the survival                             then used to compare the survival curves between
                                                                                                                       time or censoring time for such patients could                          the CTCA database and the SEER database.
                                                                                                                       not be computed. Cancer patients with missing                           Two of these tests, the log rank test and Wilcoxon
                                                                                                                       SEER Summary Stages were also excluded from                             test, are nonparametric and thus, valid to compare
                                                                                                                       the analyses. For patients with multiple cancers                        survival curves that have any shapes.1 These tests are
                                                                                                                       in the SEER and CTCA databases, only the first or                       different, however, in their sensitivity (or the power)
                                                                                                                       primary cancer diagnosed was used for the survival                      to detect survival differences. The log rank test is
                                                                                                                       comparisons. Patients with a histologic code                            considered the most sensitive or powerful when the
                                                                                                                       (ICD-O-3) between 9590 and 9989 were excluded                           risk or the hazard of death between CTCA and SEER
     Statistical Methodology                                                                                           from the analyses because these histologic types                        samples is approximately proportional, whereas the
                                                                                                                       are generally not included by SEER for any non-                         Wilcoxon test tends to be more sensitive when the
                                                                                                                       hematopoietic cancer types. Patients who did not                        ratio of hazards of death is higher at earlier times
     DATA SELECTION                                                                                                    receive treatment from CTCA were also excluded                          than at later ones. The third test, the likelihood ratio
     Two databases were considered for this study.           The SEER database was selected to conduct these           from the analyses.                                                      test, is the most restrictive of the three in the sense
     The National Cancer Institute’s Surveillance,           analyses because of its comprehensive content             The survival outcomes from the SEER database were                       that it is appropriate to use only for special survival
     Epidemiology, and End Results (SEER) Program            and access to patient-level data (and because             provided by the SEER Limited-Use Data File as the                       curves (called exponential distributions) whose
     database and the National Cancer Database (NCDB).       of restrictions imposed on the use of the NCDB            number of completed months. These numbers were                          hazards of death are constant across time.2
     The SEER database is an authoritative data set          database for comparative analysis and external            then converted to the number of years by dividing                       Ninety-five percent confidence interval (95% CI)
     created for use as an epidemiological tool to           reporting purposes).                                      the number of total months by 12. Although the                          estimates for the individual survival rates, as well
     monitor the incidence and mortality of cancer           The SEER comparison sample was chosen by                  exact dates for the initial diagnosis and death                         as the difference in survival rates between the
     in the United States. SEER collects patient             the categories in categorical factors (e.g., cancer       were available in the CTCA database, the CTCA                           CTCA and SEER samples at specific time points
     demographics, tumor characteristics and survival        stages) with the CTCA cancer cohort and selecting         survival outcomes were computed using the same                          after diagnosis, were based on the estimated
     data from 17 regional registries throughout the U.S.,   the overlapping ranges in continuous factors              methodology as the SEER database; the number of                         survival curves and the relevant asymptotic normal
     representing 28 percent of the U.S. population.         (e.g., age at diagnosis) from the CTCA cancer             completed months was computed by first dividing                         distributions. All these analyses were implemented
                                                             cohort. These factors affect survival outcomes.           the exact days from the initial diagnosis to death, or                  using the standard SAS package of statistical tests
     The NCDB compiles cancer registry data from                                                                       last contact for those who remained alive, by 365.24
     cancer programs in the U.S. and Puerto Rico,            The SEER Limited-Use Database (2016) was used                                                                                     (i.e., SAS/PROC LIFETEST).3 Adjusted analyses were
                                                             to select the SEER comparison sample. The final           (as was done by SEER), then rounding down to the                        also done (results not shown) using the stratified
     capturing approximately 75% of newly diagnosed                                                                    number of completed months, and finally dividing
     cancers in these areas. It includes data on patient     survival analyses included only patients from both                                                                                log rank test and the Wilcoxon test as well as Cox’s
                                                             the CTCA and SEER databases whose following               the result by 12. For those patients who were still                     proportional hazards models to compare the
     characteristics, tumor staging, tumor histology,                                                                  alive or lost to follow-up at the time of entering the
     type of first treatment, disease recurrence and         cancer characteristics were available from the two                                                                                survival outcomes between the CTCA and SEER
                                                             databases: SEER Summary Stages, primary tumor             databases, survival time was treated as statistically                   samples after adjusting for the effects of age at
     survival using standardized coding definitions. It is                                                             censored at the difference between the date of last
     commonly used to guide quality improvement and          sites, cancer histologic types, gender and age at                                                                                 diagnosis, gender (except for breast and prostate
                                                             initial diagnosis. For example, if a specific SEER        contact and the date of initial diagnosis.1                             cancers), race, marital status at diagnosis, insurance
     pursue investigator-initiated research questions.
     The NCDB provides insight into analytic cancer          Summary Stage had only patients in one database,                                                                                  status at diagnosis and year of initial diagnosis. The
     diagnoses and primary treatments. The main              none of these patients was used in the analyses.                                                                                  technical details of these statistical analyses are
     limitation of the data is that the cohorts are not      To match the age at initial diagnosis, the range (i.e.,                                                                           available from CTCA.
     population-based; they are identified from the          minimum and maximum ages) was computed for
     hospitals at which the patients presented for           each sample. Only patients whose age at initial
                                                             diagnosis fell into the overlap of the two ranges         1 Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data. New York: John Wiley, 1980.
     diagnosis and/or treatment.
                                                             from the CTCA and SEER samples were included in           2 Lawless JF. Statistical Methods and Methods for Lifetime Data, New York: John Wiley & Sons, Inc., 1982.
                                                             the comparative survival analyses.                        3 SAS Institute Inc., SAS/STAT User’s Guide, Volume 2, Version 6, 1990. Cary, NC, USA.

10   CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                    OUR LENGTH OF LIFE RESULTS             11
2019-2020 Treatment Results - FOR PATIENTS AND CAREGIVERS - Cancer Treatment Centers
Length of Life Results
                                                                                                                            BREAST CANCER

                                                                                                                           The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for breast
                                                                                                                           cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It includes
                                                                                                                           estimates of the percentage of breast cancer patients with distant (metastatic) disease who survived for six
                                                                                                                           months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.
                                                                                                                           • This analysis included breast cancer patients from CTCA who had primary tumor sites (as coded by
                                                                                                                             ICD-O-2 (1973+)) from C500 to C509, were diagnosed from 2000 to 2015 (including 2000 and 2015) and
                                                                                                                             received at least part of their initial course of treatment at CTCA. All patients included in the analysis were
                                                                                                                             considered analytic patients by CTCA.
                                                                                                                           • Breast cancer patients with distant (metastatic) disease from the SEER database and breast cancer patients
                                                                                                                             with distant (metastatic) disease from the CTCA database were included in the analysis. In addition, the
                                                                                                                             analysis excluded patients whose medical records were missing any of the following information:

                                                                                                                                                – SEER Summary Stages                                              – Date of initial diagnosis
                                                                                                                                                – Primary tumor sites                                              – Age at initial diagnosis
                                                                                                                                                – Cancer histologic types                                          – Gender & Race

                                                                                                                                                                                      BREAST CANCER SURVIVAL RATE
     LIMITATIONS
                                                                                                                                                           Patients DiagnosedBREAST    CANCER(Metastatic)
                                                                                                                                                                                 with Distant     SURVIVAL Cancer
                                                                                                                                                                                                               RATE Between 2000-2015
     Direct statistical comparisons of survival outcomes between groups of cancer patients have limitations                                                   Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                                                                                                                                                               CTCA (n=788) and SEER* (n=64,690)
     because of the possible confounding effects of other factors cited below and elsewhere in this report.                                                                           CTCA (n=632) and SEER* (n=38,935)
     Accordingly, the data appearing in this report should be considered directional, not definitive.
                                                                                                                                              100
     First, although a large sample of patients was available from the SEER Program across many geographic
                                                                                                                                               90   94
     regions in the U.S., both samples, including the sample from CTCA, are convenience samples. This precludes
     the assumption of a causal interpretation of the statistical inferences. Second, although some types of                                   80             86

                                                                                                                        Percent of Patients
     matching, as described earlier, were implemented to select the appropriate SEER and CTCA comparison                                       70        75                 76
     samples, the distributions of important covariates, such as age at initial diagnosis, gender, race, marital                               60                      66               69
     status at diagnosis, insurance status at diagnosis and year of initial diagnosis, were not exactly the same                                                                                      62
                                                                                                                                               50                                57                               56
     between the CTCA sample and SEER sample. Hence, even with the adjusted analyses, possible confounding                                                                                   50                                 50
     of these factors to the analyses and results may not be ruled out. Further, many factors (e.g., household                                 40                                                          43                               45
                                                                                                                                               30                                                                          38                             39        36
     income, mobility, etc.) other than those considered in the analyses and available from the databases may                                                                                                                        33
     have contributed to the actual survival outcomes. As a result of these factors, the possible confounding of                               20                                                                                                    29        26        24
     the results of these analyses may not be ruled out. Finally, the survival analyses were based on the statistical                          10
     comparisons of the rate of death from all possible causes, not solely cancer-specific death. These data are
                                                                                                                                                0
     not included in the CTCA data set and, therefore, not available for statistical comparison.                                                     0.5           1         1.5             2          2.5            3           3.5           4         4.5           5
     Visit cancercenter.com/ctca-results for further information about the methodology used to calculate the
                                                                                                                                                                                                 Years (after initial diagnosis)
     CTCA results and read about the analysis limitations.
                                                                                                                                                                                                       CTCA                 SEER
                                                                                                                           *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
                                                                                                                           They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
                                                                                                                           sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

12   CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                          OUR LENGTH OF LIFE RESULTS           13
Length of Life Results                                                                                                                  Length of Life Results
         COLON CANCER                                                                                                                             ESOPHAGEAL CANCER

          The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for colon                             The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for
          cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It includes                                esophageal cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015.
          estimates of the percentage of colon cancer patients with distant (metastatic) disease who survived for six                            It includes estimates of the percentage of esophageal cancer patients with distant (metastatic) disease who
          months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.                                         survived for six months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.
          • This analysis included colon cancer patients from CTCA who had primary tumor sites (as coded by                                      • This analysis included esophageal cancer patients from CTCA who had primary tumor sites (as coded by
            ICD-O-2 (1973+)) from C180 to C189, were diagnosed from 2000 to 2015 (including 2000 and 2015) and                                     ICD-O-2 (1973+)) from C150 to C159, were diagnosed from 2000 to 2015 (including 2000 and 2015) and
            received at least part of their initial course of treatment at CTCA. All patients included in the analysis were                        received at least part of their initial course of treatment at CTCA. All patients included in the analysis were
            considered analytic patients by CTCA.                                                                                                  considered analytic patients by CTCA.
          • Colon cancer patients with distant (metastatic) disease from the SEER database and colon cancer patients                             • Esophageal cancer patients with distant (metastatic) disease from the SEER database and esophageal
            with distant (metastatic) disease from the CTCA database were included in the analysis. In addition, the                               cancer patients with distant (metastatic) disease from the CTCA database were included in the analysis.
            analysis excluded patients whose medical records were missing any of the following information:                                        In addition, the analysis excluded patients whose medical records were missing any of the following
                                                                                                                                                   information:
                             – SEER Summary Stages                                              – Date of initial diagnosis
                             – Primary tumor sites                                              – Age at initial diagnosis                                            – SEER Summary Stages                                             – Date of initial diagnosis
                             – Cancer histologic types                                          – Gender & Race                                                       – Primary tumor sites                                             – Age at initial diagnosis
                                                                                                                                                                      – Cancer histologic types                                         – Gender & Race

                                                                   COLON CANCER SURVIVAL RATE                                                                                                           ESOPHAGEAL CANCER SURVIVAL RATE
                                        Patients Diagnosed COLON
                                                               with CANCER     SURVIVAL Cancer
                                                                     Distant (Metastatic)     RATE Between 2000-2015                                                                             ESOPHAGEAL
                                                                                                                                                                                 Patients Diagnosed               CANCER
                                                                                                                                                                                                        with Distant         SURVIVAL
                                                                                                                                                                                                                       (Metastatic)        RATE
                                                                                                                                                                                                                                      Cancer  Between 2000-2015
                                            Patients Diagnosed with Distant
                                                             CTCA   (n=788) (Metastatic)
                                                                              and SEER*  Cancer Between 2000-2015
                                                                                            (n=64,690)                                                                               Patients Diagnosed
                                                                                                                                                                                                      CTCA (n=788) and SEER* (n=64,690) 2000-2015
                                                                                                                                                                                                        with Distant (Metastatic) Cancer Between
                                                                   CTCA (n=788) and SEER* (n=64,690)                                                                                                         CTCA (n=291) and SEER* (n=15,311)

                           100                                                                                                                                      100
                            90                                                                                                                                       90
                            80   87                                                                                                                                  80
     Percent of Patients

                                                                                                                                              Percent of Patients
                            70                                                                                                                                       70
                                           71
                            60        64                                                                                                                             60   64
                            50                           54                                                                                                          50
                                                    51
                            40                                       44                                                                                              40        47
                                                              40                                                                                                                     38
                            30                                                     34                                                                                30
                                                                          31                   28
                            20                                                          25                                                                           20                       26
                                                                                                        21   20 17                                                                                 20
                            10                                                                                        16 15   15 13                                  10                                 16                                      6      7   5     6       5   6     4   4       4
                                                                                                                                      12 12                                                                    13 11       11 8
                             0                                                                                                                                        0                                                                 8
                                  0.5           1         1.5             2          2.5            3           3.5     4      4.5      5                                  0.5            1         1.5           2          2.5            3          3.5           4       4.5           5
                                                                              Years (after initial diagnosis)                                                                                                         Years (after initial diagnosis)
                                                                                    CTCA                 SEER                                                                                                               CTCA                SEER
          *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.         *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
          They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the          They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
          sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.                                 sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

14        CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                         OUR LENGTH OF LIFE RESULTS            15
Length of Life Results                                                                                                                             Length of Life Results
         KIDNEY CANCER                                                                                                                                       NON–SMALL CELL LUNG CANCER

          The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for kidney                                       The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for
          cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It includes                                           non-small cell lung cancer patients with distant (metastatic) disease who were diagnosed between 2000
          estimates of the percentage of kidney cancer patients with distant (metastatic) disease who survived for six                                      and 2015. It includes estimates of the percentage of non-small cell lung cancer patients with distant (meta-
          months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.                                                    static) disease who survived for six months to five years after the initial diagnosis, as recorded in the CTCA®
                                                                                                                                                            and SEER databases.
          • This analysis included kidney cancer patients from CTCA who had primary tumor site (as coded by
            ICD-O-2 (1973+)) of C649, were diagnosed from 2000 to 2015 (including 2000 and 2015) and received at                                            • This analysis included non-small cell lung cancer patients from CTCA who had primary tumor sites (as
            least part of their initial course of treatment at CTCA. All patients included in the analysis were considered                                    coded by ICD-O-2 (1973+)) from C340 to C343 or from C348 to C349, were diagnosed from 2000 to
            analytic patients by CTCA.                                                                                                                        2015 (including 2000 and 2015) and received at least part of their initial course of treatment at CTCA. All
          • Kidney cancer patients with distant (metastatic) disease from the SEER database and kidney cancer patients                                        patients included in the analysis were considered analytic patients by CTCA.
            with distant (metastatic) disease from the CTCA database were included in the analysis. In addition, the                                        • Non-small cell lung cancer patients with distant (metastatic) disease from the SEER database and non-small
            analysis excluded patients whose medical records were missing any of the following information:                                                   cell lung cancer patients with distant (metastatic) disease from the CTCA database were included in the
                                                                                                                                                              analysis. In addition, the analysis excluded patients whose medical records were missing any of the
                             – SEER Summary Stages                                              – Date of initial diagnosis                                   following information:
                             – Primary tumor sites                                              – Age at initial diagnosis
                                                                                                                                                                                 – SEER Summary Stages                                             – Date of initial diagnosis
                             – Cancer histologic types                                          – Gender & Race
                                                                                                                                                                                 – Primary tumor sites                                             – Age at initial diagnosis
                                                                                                                                                                                 – Cancer histologic types                                         – Gender & Race

                                                                   KIDNEY CANCER SURVIVAL RATE                                                                                                               NONSMALL CELL LUNG CANCER SURVIVAL RATE
                                                           KIDNEY    CANCER(Metastatic)
                                                                                SURVIVALCancerRATE Between 2000-2015
                                        Patients Diagnosed     with Distant                                                                                                                 PatientsNON-SMALL
                                                                                                                                                                                                      Diagnosed withCELL LUNG CANCER SURVIVAL RATE
                                                                                                                                                                                                                        Distant (Metastatic) Cancer Between 2000-2015
                                            Patients Diagnosed with Distant
                                                             CTCA   (n=788) (Metastatic)
                                                                              and SEER*  Cancer Between 2000-2015
                                                                                            (n=64,690)                                                                                          Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                                                                                                                                                                                                 CTCA (n=788) and SEER* (n=64,690)
                                                                   CTCA (n=228) and SEER* (n=20,824)                                                                                                                 CTCA (n=2,336) and SEER* (n=283,704)
                           100                                                                                                                                                 100
                            90                                                                                                                                                  90
                            80                                                                                                                                                  80
     Percent of Patients

                                                                                                                                                         Percent of Patients
                            70                                                                                                                                                  70
                                 70                                                                                                                                                  68
                            60                                                                                                                                                  60
                            50                                                                                                                                                  50
                                      51   49
                            40                                                                                                                                                  40             47
                            30                      36   37                                                                                                                     30        39
                                                                                                                                                                                                              34
                            20                                27     29
                                                                          22       25                                                                                           20                      24              25
                                                                                        18     21            19                                                                                                                       19
                            10                                                                          16        14   17            16        15                               10                                 16                             15 7             6              5   8         7
                                                                                                                                12        11        10                                                                       12                              12                             4           4
                                                                                                                                                                                                                                              9                          10
                             0                                                                                                                                                   0
                                  0.5           1         1.5             2          2.5            3           3.5         4         4.5           5                                 0.5           1          1.5           2          2.5          3          3.5           4       4.5           5
                                                                              Years (after initial diagnosis)                                                                                                                    Years (after initial diagnosis)
                                                                                    CTCA                 SEER                                                                                                                          CTCA              SEER
          *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.                     *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
          They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the                      They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
          sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.                                             sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

16       CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                                   OUR LENGTH OF LIFE RESULTS            17
Length of Life Results                                                                                                                               Length of Life Results
        SMALL CELL LUNG CANCER                                                                                                                               OVARIAN CANCER

        The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for small                                           The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for ovarian
        cell lung cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It                                             cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It includes
        includes estimates of the percentage of small cell lung cancer patients with distant (metastatic) disease who                                        estimates of the percentage of ovarian cancer patients with distant (metastatic) disease who survived for six
        survived for six months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.                                      months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.

        • This analysis included small cell lung cancer patients from CTCA who had primary tumor sites (as coded                                             • This analysis included ovarian cancer patients from CTCA who had primary tumor site (as coded by
          by ICD-O-2 (1973+)) from C340 to C343 or from C348 to C349, were diagnosed from 2000 to 2015                                                         ICD-O-2 (1973+)) of C569, were diagnosed from 2000 to 2015 (including 2000 and 2015) and received at
          (including 2000 and 2015) and received at least part of their initial course of treatment at CTCA. All                                               least part of their initial course of treatment at CTCA. All patients included in the analysis were considered
          patients included in the analysis were considered analytic patients by CTCA.                                                                         analytic patients by CTCA.
        • Small cell lung cancer patients with distant (metastatic) disease from the SEER database and small cell                                            • Ovarian cancer patients with distant (metastatic) disease from the SEER database and ovarian cancer
          lung cancer patients with distant (metastatic) disease from the CTCA database were included in the                                                   patients with distant (metastatic) disease from the CTCA database were included in the analysis. In
          analysis. In addition, the analysis excluded patients whose medical records were missing any of the                                                  addition, the analysis excluded patients whose medical records were missing any of the following
          following information:                                                                                                                               information:

                             – SEER Summary Stages                                             – Date of initial diagnosis                                                        – SEER Summary Stages                                            – Date of initial diagnosis
                             – Primary tumor sites                                             – Age at initial diagnosis                                                         – Primary tumor sites                                            – Age at initial diagnosis
                             – Cancer histologic types                                         – Gender & Race                                                                    – Cancer histologic types                                        – Gender & Race

                                                           SMALL CELL LUNG CANCER SURVIVAL RATE                                                                                                                      OVARIAN CANCER SURVIVAL RATE
                                                         SMALL CELL LUNG CANCER SURVIVAL RATE                                                                                                                      OVARIAN CANCER SURVIVAL RATE
                                        Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015                                                                                Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                            Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015                                                                                Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                                             CTCA   (n=788) and SEER* (n=64,690)
                                                             CTCA (n=349) and SEER* (n=56,817)
                                                                                                                                                                                                                  CTCA   (n=788) and SEER* (n=64,690)
                                                                                                                                                                                                                  CTCA (n=237) and SEER* (n=40,893)

                           100                                                                                                                                                  100
                            90                                                                                                                                                   90   95
                            80                                                                                                                                                   80             88
                                                                                                                                                                                           79                 78
     Percent of Patients

                                                                                                                                                          Percent of Patients
                            70   76                                                                                                                                              70
                                                                                                                                                                                                         71
                            60                                                                                                                                                   60                                63   66
                                                                                                                                                                                                                                      61
                            50                                                                                                                                                   50                                          56                   54
                                                                                                                                                                                                                                           49                   49
                            40        45                                                                                                                                         40                                                                        43               43
                                           40                                                                                                                                                                                                                        38                   38
                            30                                                                                                                                                   30                                                                                                  34             32
                                                                                                                                                                                                                                                                                               30        27
                            20                                                                                                                                                   20
                                                    21    21
                            10                                               7            5    6       4      4         4           4         4                                  10
                                                               11   13             9                                3           3         3           3
                             0                                                                                                                                                    0
                                  0.5           1          1.5           2          2.5            3              3.5       4       4.5           5                                    0.5           1         1.5           2          2.5            3           3.5           4         4.5           5
                                                                             Years (after initial diagnosis)                                                                                                                     Years (after initial diagnosis)
                                                                                   CTCA                    SEER                                                                                                                        CTCA                 SEER
        *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.                      *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
        They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the                       They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
        sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.                                              sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

18       CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                                      OUR LENGTH OF LIFE RESULTS           19
Length of Life Results                                                                                                                       Length of Life Results
         PANCREATIC CANCER                                                                                                                           PROSTATE CANCER

        The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for                                          The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for
        pancreatic cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015.                                        prostate cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015.
        It includes estimates of the percentage of pancreatic cancer patients with distant (metastatic) disease who                                   It includes estimates of the percentage of prostate cancer patients with distant (metastatic) disease who
        survived for six months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.                               survived for six months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.
        • This analysis included pancreatic cancer patients from CTCA who had primary tumor sites (as coded by                                        • This analysis included prostate cancer patients from CTCA who had primary tumor site (as coded by
          ICD-O-2 (1973+)) from C250 to C254 or from C257 to C259, were diagnosed from 2000 to 2015 (including                                          ICD-O-2 (1973+)) of C619, were diagnosed from 2000 to 2015 (including 2000 and 2015) and received at
          2000 and 2015) and received at least part of their initial course of treatment at CTCA. All patients included                                 least part of their initial course of treatment at CTCA. All patients included in the analysis were considered
          in the analysis were considered analytic patients by CTCA.                                                                                    analytic patients by CTCA.
        • Pancreatic cancer patients with distant (metastatic) disease from the SEER database and pancreatic cancer                                   • Prostate cancer patients with distant (metastatic) disease from the SEER database and prostate cancer
          patients with distant (metastatic) disease from the CTCA database were included in the analysis. In addition,                                 patients with distant (metastatic) disease from the CTCA database were included in the analysis. In addition,
          the analysis excluded patients whose medical records were missing any of the following information:                                           the analysis excluded patients whose medical records were missing any of the following information:

                             – SEER Summary Stages                                     – Date of initial diagnosis                                                        – SEER Summary Stages                                            – Date of initial diagnosis
                             – Primary tumor sites                                     – Age at initial diagnosis                                                         – Primary tumor sites                                            – Age at initial diagnosis
                             – Cancer histologic types                                 – Gender & Race                                                                    – Cancer histologic types                                        – Gender & Race

                                                       PANCREATIC CANCER SURVIVAL RATE                                                                                                                PROSTATE CANCER SURVIVAL RATE
                                                     PANCREATIC    CANCER
                                        Patients Diagnosed with Distant    SURVIVAL
                                                                        (Metastatic)   RATEBetween 2000-2015
                                                                                     Cancer                                                                                                        PROSTATE   CANCER
                                                                                                                                                                                     Patients Diagnosed with Distant   SURVIVAL
                                                                                                                                                                                                                     (Metastatic)  RATE Between 2000-2015
                                                                                                                                                                                                                                  Cancer
                                           Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015                                                                        Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                                            CTCA (n=788) and SEER* (n=64,690)                                                                                                            CTCA (n=788) and SEER* (n=64,690)
                                                            CTCA (n=1,555) and SEER* (n=64,946)                                                                                                          CTCA (n=321) and SEER* (n=34,487)

                           100                                                                                                                                          100
                            90                                                                                                                                           90   97
                                                                                                                                                                                        90
                            80                                                                                                                                           80        85                 82

                                                                                                                                                  Percent of Patients
     Percent of Patients

                            70                                                                                                                                           70                      73             74
                            60                                                                                                                                           60                                                   65
                                 58                                                                                                                                                                        61                             58
                            50                                                                                                                                           50
                                                                                                                                                                                                                     52                                 49
                            40                                                                                                                                           40                                                        45                               43
                            30                                                                                                                                           30                                                                        39                             37
                                           32                                                                                                                                                                                                                34                             35
                                      28                                                                                                                                                                                                                                     31
                            20                                                                                                                                           20                                                                                                            27        25
                            10                           18 8              7                                                                                             10
                                                    14          11 6              4    6       3      5     3   4       3   3     2   3       2
                             0                                                                                                                                            0
                                  0.5           1         1.5    2          2.5            3              3.5       4       4.5           5                                    0.5           1         1.5           2          2.5            3           3.5           4         4.5           5
                                                                     Years (after initial diagnosis)                                                                                                                     Years (after initial diagnosis)
                                                                           CTCA                    SEER                                                                                                                        CTCA                 SEER
        *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.               *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
        They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the                They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
        sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.                                       sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

20       CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                              OUR LENGTH OF LIFE RESULTS           21
Length of Life Results                                                                                                                 Length of Life Results
        RECTAL CANCER                                                                                                                           STOMACH CANCER

        The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for rectal                              The chart below reflects the Cancer Treatment Centers of America® (CTCA) and SEER survival rates for
        cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015. It includes                                  stomach cancer patients with distant (metastatic) disease who were diagnosed between 2000 and 2015.
        estimates of the percentage of rectal cancer patients with distant (metastatic) disease who survived for six                             It includes estimates of the percentage of stomach cancer patients with distant (metastatic) disease who
        months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.                                           survived for six months to five years after the initial diagnosis, as recorded in the CTCA® and SEER databases.
        • This analysis included rectal cancer patients from CTCA who had primary tumor site (as coded by ICD-O-2                                • This analysis included stomach cancer patients from CTCA who had primary tumor sites (as coded by
          (1973+)) of C209, were diagnosed from 2000 to 2015 (including 2000 and 2015) and received at least part                                  ICD-O-2 (1973+)) from C160 to C169, were diagnosed from 2000 to 2015 (including 2000 and 2015) and
          of their initial course of treatment at CTCA. All patients included in the analysis were considered analytic                             received at least part of their initial course of treatment at CTCA. All patients included in the analysis were
          patients by CTCA.                                                                                                                        considered analytic patients by CTCA.
        • Rectal cancer patients with distant (metastatic) disease from the SEER database and rectal cancer patients                             • Stomach cancer patients with distant (metastatic) disease from the SEER database and stomach cancer
          with distant (metastatic) disease from the CTCA database were included in the analysis. In addition, the                                 patients with distant (metastatic) disease from the CTCA database were included in the analysis. In addition,
          analysis excluded patients whose medical records were missing any of the following information:                                          the analysis excluded patients whose medical records were missing any of the following information:
                             – SEER Summary Stages                                            – Date of initial diagnosis                                           – SEER Summary Stages                                       – Date of initial diagnosis
                             – Primary tumor sites                                            – Age at initial diagnosis                                            – Primary tumor sites                                       – Age at initial diagnosis
                             – Cancer histologic types                                        – Gender & Race                                                       – Cancer histologic types                                   – Gender & Race

                                                          RECTAL CANCER SURVIVAL RATE                                                                                                           STOMACH CANCER SURVIVAL RATE
                                        Patients Diagnosed with CANCER
                                                       RECTAL            SURVIVAL Cancer
                                                                Distant (Metastatic) RATE Between 2000-2015                                                                                  STOMACH    CANCER
                                                                                                                                                                               Patients Diagnosed with Distant   SURVIVAL
                                                                                                                                                                                                               (Metastatic)  RATE Between 2000-2015
                                                                                                                                                                                                                            Cancer
                                           Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015                                                                  Patients Diagnosed with Distant (Metastatic) Cancer Between 2000-2015
                                                            CTCA (n=788) and SEER* (n=64,690)                                                                                                      CTCA (n=788) and SEER* (n=64,690)
                                                            CTCA (n=243) and SEER* (n=15,179)                                                                                                      CTCA (n=372) and SEER* (n=22,990)

                           100                                                                                                                                    100
                            90                                                                                                                                     90
                            80   88                                                                                                                                80
                                           77
     Percent of Patients

                                                                                                                                            Percent of Patients
                            70        74                                                                                                                           70
                            60                                                                                                                                     60   66
                            50                      59   59                                                                                                        50
                            40                                47   48                                                                                              40        44
                            30                                          37       39                                                                                30             34
                            20                                                        29     28                                                                    20                      25
                                                                                                      24
                                                                                                           20 20                                                                                19 16
                            10                                                                                      15 16   13 14   13 12                          10
                                                                                                                                                                                                        11 11                   6       7      5     6       4       5         5           4
                                                                                                                                                                                                                    9      9                                             3         3
                             0                                                                                                                                      0
                                  0.5           1         1.5           2          2.5            3           3.5     4      4.5      5                                  0.5           1         1.5      2          2.5            3              3.5           4       4.5           5
                                                                            Years (after initial diagnosis)                                                                                                   Years (after initial diagnosis)
                                                                                  CTCA                 SEER                                                                                                         CTCA                    SEER
        *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.          *The SEER data represent national results over a large number of institutions and have been included for illustrative purposes.
        They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the           They are not intended to represent a controlled study and/or a perfect analysis of the CTCA data because of variability in the
        sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.                                  sample sizes of the two databases, the clinical condition(s) of the patients treated and other factors.

22       CTCA Patient Treatment Results 2019 | 2020                                                                                                                                                                                                      OUR LENGTH OF LIFE RESULTS            23
About this Report

            Our Length of Life Results

         Our Quality of Life Results     3

       Our Patient Experience Results

Our Patient Safety and Quality Results

              Our Clinical Leadership

           Our Research Publications
Scott D.                          Our Quality of Life Results
CO LO R E C TA L C A N C E R
                                                                                                        SECTION 3 SPOTLIGHT
CTCA Atlanta

                                  Assessment Background and Methodology                                 • CTCA measures and intervenes on
“My oncologist was caring and                                                                             27 different indicators of quality of
passionate about us working                                                                               life (symptoms and activities of daily
                                  Cancer Treatment Centers of America® (CTCA) was                         life) for treating patients.
as a team to treat and fight      among the first U.S. cancer hospitals to use quality of
                                  life metrics as part of its routine assessment of patient             • Between July 1, 2017 and June 30,
my cancer. Most importantly,      well-being and quality of care. Research demonstrates                   2019, more than 8,692 patients
he listened to me. I learned      Patient Self-Reported Outcome (PSRO) data are a                         completed both baseline and
                                  valuable part of a patient’s treatment plan. Several                    return self-assessments.
that cancer affects the whole     studies validate the potential of routine assessment data
                                  in improving both the precision and degree of patient-                • Graphs on pages 27-31 reflect a
person, not just the organ(s),                                                                            change in score for patients by
                                  centered care – making sure the right care is delivered
and CTCA has offerings to help.   to the right patients at the right time. The benefits                   cancer type who self-reported at
                                  of PSRO data not only include better health-related                     least one symptom as severe at
I took advantage of nutrition,                                                                            baseline in comparison to their
                                  quality of life and fewer emergency room visits, but also
                                                                                                          return visit.
emotional and psychological       improvements in health service outcomes and survival.1,2,3
support, and acupuncture.”        CTCA® patients self-report their symptoms and quality                 • Graphs on pages 32 and 33 reflect
                                  of life concerns as part of our patient evaluation                      CTCA aggregate and facility patient
                                  process. This process includes a symptom assessment,                    self-reported outcome data for five
                                  called the Symptom Inventory Tool (SIT), that patients                  (5) key areas across cancer types.
                                  complete in correspondence with their treatment cycle,
                                  not more frequently than every 21 days. Upon arrival,
                                  patients complete the electronically administered SIT
                                  using a tablet computer. CTCA team members utilize
                                  these results as part of their patient assessment and
                                  evaluation process. These two complementary processes
                                  (patient self-assessment and reflection, and analyzing
                                  the data as a starting point for discussion) help CTCA
                                  care teams readily identify when patients may benefit
                                  from referral and/or more directed intervention to help
                                  them cope with their symptoms, side effects and quality
                                  of life concerns. The data also exist real-time within
                                  the electronic health record. More than 94 percent of
                                  patients voluntarily participate in the SIT assessments.

                                  1 Basch E, Deal AM, Kris MG, et al: Symptom monitoring with
                                  patient-reported outcomes during routine cancer treatment: A
                                  randomized controlled trial. J Clin Oncol 10.1200/JCO.2015.63.0830.
                                  2 Jensen R, Snyder CF: PRO-cision Medicine: Personalizing Patient
                                  Care Using Patient-Reported Outcomes. J Clin Oncol 10.1200/
                                  JCO.2015.63.0830.
                                  3 Snyder CF, Herman JM, White SM, et al: When using patient-
                                  reported outcomes in clinical practice, the measure matters: A
                                  randomized controlled trial. J Oncol Pract 10:e299-e306, 2014.

                                                                                                             OUR QUALIT Y OF LIFE RESULTS          25
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