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- 10 - E. Articles Published' ° A Review of Certain Special Nursing Problems of Patients with Cancer," by N,rs. Patterson. A chapter in Treatment of Cancer and Allied Diseases, edited by Drs. Pack and Ariel. F. Programs planned for professional visitors: Since January 1951, the Nursing Department has sponsored programs, ranging from one-half to four days, for 65 visitors. The Instructors in this Department plan and execute these programs, which are geared toward the length of time the visitor has to spend and the particular interests expressed. These visits generally include a complete tour of the Center; demonstra- tions of specialized procedures; visits to the clinics and to the operating room; and attendance at conferences and lectures.

- 11 - III. STATISTICS FUND $11,960.00 Through the support of several members of Memorial's Department of Statistics, the New York City Cancer Committee has suostan~ially aided in our statistics program. This work falls into four main categories, an explanatiomof which follows: Anticipatory coding of all cancer cases by site: Memorial's statistical service was set up with a plan toward the persistent and detailed evaluation of the work being done at the Center. In this connection there was also instituted the principle of anticipating basic questions apt to arise. As rapidly as time and personnel permitted, patient charts dating back to 1935 were abstracted and processed statistically according to an anticipatory code. The function of this far-seeing plan is apparent in the volume of the assistance the Department of Statistics has been able to give, despite its small staff. During the first six months of 1951, 1629 cases of cancer of the breast were coded and 1118 previously coded cases had follow- up information added to their punch cards. 364 cases of intrinsic larynx cancer (1935 - 1945) were reviewed and brought up to date, tabulated and charted. 281 extrinsic larynx cases (1935 - 1942) were reviewed and brought up to date; 204cases (1943 - 1947) were added to the series - data on the 485 cases were tabulated and charted. 181 cases of thyroid cancer (1947 - 1949) were abstracted and added to the previous series of 301 - data on the 482 cases were tabulated. 205 cases of cancer of the paranasal sinuses and nasal cavity were abstracted. Abstracting of the 1944 and 19Y5 cases of cancer of the cervix was begun. All cases oi'cancer of the small intestine (39 cases from 1927 to 1950) were abstracted and coded~. II. Construction of indices of daily hospital activity, including admissic.ns, d'_sc?:a^c<e~, diagnoses, and -si?dtment: The development at the Memorial Hospital of the Four-Featured Index, which has been describedin previous reports, is filling a long felt universal need for the indexing of basic data in a compact and accessible way which enables visiaalization of the listings and mechanical sorting for tabulating purposes. Advice on its application is sought every week. In this activity index, Memorial is pioneering to produce a tool for the general use of all workers in the field.

- 12 - The index provides the following information on each patient: 1) the anatomic site of origin of the neonla.am; 2) its histological classification; 3) record of ascoc?.ated medical conditions and postoperative complicatiozs; 4) taLulation of patient days and related information. L'nd.Fr ti::s prograr!, 1514 admissions so far have been coded, punched, and cross-indexed. The Department of Statistics uses the In`.ernaticnal Statistical Classification of Diseases, Injuries, and Causes of Death for the general disease index. Under each anatomic code number, there is an alphabetical card index of histologic t.y-pes, (arranged as a dictionary type index of tumors with nc:meri^al equivalents), which furnishes a record of total case hoaa,.,zg of any specific tumor under study and of medical conditions and postopera- tive complication. Each day admissions are coded on punch cards and the experience of the individual patient is checked through~ t:1e month so that an activity report may be made shcwinz,along,xith other related information, the number of patients admitted and discharged~. For each operation that has been per.for.med si_nce January 1950, a punch card has been filled out containi-ag the patient's name, the name of operation, date, surgeon, service, Aatrology report, and chief diagnosis. These carc'.s forn the skeleton of a complete index of operations on punch car3s. A sub-committee to the Medical Records Cormittee has been Appointedto clarify and define certain of the more compli- ca':,e;? pro~_e3iares to insure vroper classification. The biomet~ician has net wTa*n s everal membe: s of this comm3ttee and grad .~:ally c,Pf i.ni - tious t:-i.11 be for ,hcoyiing. The consultant has wor: :~ea out the de'l-a.ils of a surgical code whach will be applied to the cards. The isae.. of operations has provided lists of all suraical proce~.rses by serv~ice and has saved countless hot1:..s of the medical sta?'f by Lrak~_rg reaOily available t•n::n request lists of all p*leUl1C)n-zG+„oIA:ires, r3'_~'=C2. muctect7rLas, CSCD.11bi::E.'d i`esect]lons of the inanC-;bln, m€uth cs.ncer and ra.c _cal r.ecl€ d_.ssection and similar irlfcrmation. III. Pl2.onj,nr; o-tca criT:_cal ana,]!ysi.5 of special studies: From the po.'_nt of view of the analysts, this area of activity is the m-,st crucial one anrl the one t4hirn r.ea-iires the most hi;'niy specialized skill. The DePar-.ment of Statistics has carried

13 out a number of such studies in cooperation with various other departments of Memorial Center. Gynecology Service: For a project of this group in cooperation with the Pathology Department, a special code for evaluation of radical hysterectomy with pelvic node dissection was prepared by the Department of Statistics. The difference in the League of Nations Grading of cervix cancer before operation and the findings of the operation constitutes a significant contribution to the knowledge on this subject. Gastric and Mixed Tumor'Service: A member of this group is studying retroperitoneal tumors with the help of the De- partment of Statistics. Statistical abstractions of the details of all cases of retroperitoneal cancer, of which Memorial has an unusually large number, are in preparation. Thoracic Service: In response to a request from~this service, lists were prepared of patients with achalasia and cardio- spasm~. This service also requested figures on cytological tests done in connection with lung cancer. Fr=a study previously per- formed we were able to obtai~n the results of cytological tests on sputums, washings and aspiration biopsy in a series of 128 cases of resection for cancer of the lung. The Department of Statistics has also compiled a list of all cases of cancer of the esophagus seenat Memorial, Hospital from 1930 through 1950. Breast Service: For the chief of the Breast Ser- vice, a study was done on the results of radical mastectomy plus administration of testosterone as compared with radical mastectomy alone. A preliminary report was completed on two series of breast cancer cases, those (350) who had the standard procedure - radical mastectomy - and those (218) who had radical mastectomy plus administration of testosterone. The survival rate curves were plotted for the two groups. For one of the attending surgeons on the Breast Service, a study was und'erta.ken in June to determine the occurrence of lymphedema of arm following radical mastectomy for cancer of the breast. At the pr--sent date 1084 cases have been coded and punched and are being sorted.

-14 - Head and Neck Service: One of the operations em- ployed extensively and perfected at Memorial Hospital is the radical neck dissection for eradication of neck node metastases. For the chief of the Head and Neck Service the statistical department abstracted the records of 599 patients having 655 neck dissections performed from 1928 to 1945• The resulting statistical tables appear in the article "Neck Dissection" in Cancer, May 1951. An interesting fact disclosed by this study is that in 303 patients with cervical metastases in whom neck dissection was performed, 101+ patients or 34.3% were free of disease at five years from date of neck dissection. At the request of one of the Attending Surgeons on the Head and Neck Service a paper on combined resection of primary mouth cancer, mandible and neck (the "Conmando") was read by the biometrician, and a critical analysis of some of the statements contained in~the article was made. The conclusion reached was that more time is needed before the apparent im- provement in cure rates for this very advanced type of mouth cancer can be accepted as real. Nevertheless, the three and four year results are very encouraging. The study of the relationship between smoking and cancer of the mouth has been uaderiray in the statistical department for two years. Approximately 2000 cases have been interviewed since July, 1949, men and women with mouth cancer matched with men and women with no mouth complaint. A special code was con- structed for the study of this material. All the cases have been coded and punched, and the collected data are now ready for analysis. Division of Experimental Chemotherapy: A member of this Division of the Sloan-Kettering Institute requested help in planning a study of all patients with leul.emia and other forms of cancer that have received any form~of chemotherapy at Memorial Hospital since such treatment was instituted. Division of Experimental Pathology: The head of the Cytochemistry Section of the Division requested a sound statisti- cal basis:for planning alproject of mass screening of populations for cancer of the cervix. Conferences with the biometrician and the consultant to the department resulted in a plan. Department of Public Information: Since the first of the year, a Quadrennial Report of Memorial Center has been in prepara- tion. In cooperation with the Department of Public Information,

f k, 15 the Department of Statistics has prepared a list of the new cases of cancer seen at Memorial Hospital by anatomic site for 1947, 1948) 1949 and 1950 plus the percentage distribution of the total cancer cases for the four year period. From this data, uniform tables were constructed for each service containing the new cases of cancer by site plus all the benign and precancerous lesions seen on that particular service. For each service, a table of operations performed'in 1950 was prepared; these tables will be included as a part of the Quadrennial Report. All statistical figures included in the individual reports were checked by the statistical department. A table was prepared of the number of x-ray treatments given according to service for each of the years 1947, 1948, 1949, and 1950 for inclusion in the Quadrennial Report. For a representative of the Associated Press, the Department of Statistics prepared some figures on incidence of children's tumors. 2.06% of all cancers are in the 0 - 19 age group; approximately 30;~ of bone cancers of upper and lower extremities occur in patients under twenty years of age. Public Information requested for the American Cancer Society the latest cure rates available in cancer of the breast, cervix, larynx, and many other sites. The five-year cure rates on cancer of the breast, cervix, corpus, lip, larynx, tongue, and on children with cancer by histologic type were pre- pared. IV. Participation in cancer education activities: Education Prcgrem: The Statistics Department has participated in the Education Program at Memorial Hospital to an increasing degree. The biomei;rician has continued lectures to the medical students, has given alecture to the staff on "Cancer Statistics" and arranged to have a lecture given at Memorial Center by Dr. Cle_essen, an eminent statistician from Denmark, who spoke on geographic variations in incidence of cancer. 3aries E?aing Society: On March 16, the biometrician presented "A Comparative Report on Cancer of Intrinsic and Extrinsic Larynx from Several Cancer Treatment Centers" at the meeting of the James Ez+ringSociety. The paper aroused considerable interest in that it stressed the need for a uniformimethod of presenting end results. New York City Cancer Committee: On May 9th, the 25th anniversary of the I.ew Yorl~ City Cancer Committee, the

-16- consul:tant spoke to this group on the improvement in cancer cure rates. Visitors; From all over the world visitors have come to Memorial Center to study the operation of the Department of Statistics and to obtain help in planning similar record and follow-up systems. They have come from the Radiumhemmet in Stockholm, from the Danish Cancer Registry in Copenhagen, from Iruiiay Yugoslavia, Italy, England, and from Michigan, Ohio, Illinois, and from other institutions in New York City (Bellevue and Kings County Hospital). Requests for help have been received from University of Kansas Hospital, from the University of Colora- do and from the American Cancer Society. In answer to these re- quests, a detailed description of the system with enclosed samples of cards filled out, codes and nomenclatures have been sent. Arrangements are underway to record and publish this information for distribution and general reference under the title of "Techniques in cancer record keeping, tabulation and analysis, and follow-up techniques."