1. Oncology Call Points & Disease State August 2009 For Internal Purposes Only * Do Not Copy * Do Not Distribute

2. Onc. Call Points & Disease States 2 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Module 3 Goal Understand the oncology call points Know which cancer patients have VCFs & why End result: comfort calling on oncology referral market Focus cancer center targeting Educate spine specialists on patients

3. Onc. Call Points & Disease States 3 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Beth Faiman, RN MSN, APRN-BC, AOCN Nurse Practitioner, Multiple Myeloma Program Cleveland Clinic Foundation Pre-Doctoral Research Fellow at Case Western Reserve University Cleveland, Ohio Beth is an Adult Nurse Practitioner at the Cleveland Clinic in Cleveland, Ohio, where she has worked since 1994. She is also a full- time pre-doctoral research fellow at the Frances Payne Bolton School of Nursing at Case Western Reserve in Cleveland, Ohio, pursuing a PhD in research. Beth is an active author, presenter, and educator on the topic of Multiple Myeloma, general cancer diagnosis and treatment, as well as management of skeletal and other cancer complications. She is an appointed delegate on the International Myeloma Foundation Nurse Leadership Board.

4. Overview of Oncology Market Beth Faiman MSN, APRN-BC, AOCN Nurse Practitioner, Multiple Myeloma at Cleveland Clinic Pre-Doctoral Fellow, Case Western Reserve University eMail to: faimanb@ccf.orgfaimanb@ccf.org

5. Onc. Call Points & Disease States 5 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Objectives Focus on educating the Oncology community: Who are the key players, stakeholders, their role, interest and best way to access. Specific cancers that cause fractures Case study Call points and ways to target key players Q&A disease state

6. Onc. Call Points & Disease States 6 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Epidemiology Approximately 1.4 million Americans will be diagnosed in 2009 565,000 will die Even metastatic cancer is now a chronic disease American Cancer Society 2009

7. Onc. Call Points & Disease States 7 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Oncology & Hematology: What are the roles? Treating Physicians Hematology – Myeloma, lymphoma, leukemia Medical Oncology - Breast, Lung, Prostate, Melanoma Palliative medicine – All tumor types Pain management – All tumor types Surgical oncology - Solid tumors Radiation oncology - All tumor types Other key parts of the team Advanced Practice Nurses/Physician Assistants Nurses, nursing assistants, technicians

8. Onc. Call Points & Disease States 8 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Specific Cancers that have VCFs Multiple Myeloma (All Stages have VCFs) 20,000 diagnosed annually chronic Breast Cancer (Late Stages) 174,000 diagnosed annually chronic Lung Cancer (Late Stages) 170,000 diagnosed annually Shortened survival Prostate Cancer (Late Stages; 18-36 mos. after ADT) Most common male cancer Blastic lesions harder to move

9. Onc. Call Points & Disease States 9 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Case Study: Before BK 63-year old Multiple Myeloma patient complaining of fatigue and lower back pain NP discovers pain NP did physical exam/sent for labs NP refers for X-ray & STIR MRI NP/Hem. Onc. refers to Rad. Onc. Tx. plan developed

10. Onc. Call Points & Disease States 10 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Oncology Treatment Team Medical Oncologist/ Hematologist Oncology Midlevels (Onc. Nurses) Radiation Oncologist Oncology Pharmacist Case Worker FamilyPatient = Key Call Points Palliative Care Pain Management /IR/INR

11. Onc. Call Points & Disease States 11 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Your Key Messages Fixate fracture, reduce pain, increase QOL Minimally invasive with rapid recovery Radiation alone will not correct the deformity Don’t forget the data (CAFÉ) Increase treatment compliance Safe and effective Remember: Cancer in the US is a chronic disease and patients are living longer than ever.

12. Question and Answer Thank you!

13. Onc. Call Points & Disease States 13 For Internal Purposes Only * Do Not Copy * Do Not Distribute Rev. Date: 8.10.2009, Ver. #: 1 Presenter’s Biography Nurse Practitioner, Multiple Myeloma Program Cleveland Clinic Foundation Pre-Doctoral Research Fellow at Case Western Reserve University Cleveland, Ohio Beth Faiman received a bachelor of science in nursing and registered nurse certification at Ursuline College in Pepper Pike, Ohio, in 1996. She received a master of science in nursing and certification as an adult nurse practitioner at Kent State University in Kent, Ohio in 2002. She holds an advanced oncology nurse certification through ONCC. Beth is currently employed as an Adult Nurse Practitioner at the Cleveland Clinic in Cleveland, Ohio where she has worked since 1994. She is also a full-time pre-doctoral research fellow at the Frances Payne Bolton School of Nursing at Case Western Reserve in Cleveland, Ohio.pursuing a PhD in research. Beth is an active author, presenter, and educator on the topic of multiple Myeloma, general cancer diagnosis and treatment, as well as management of skeletal and other cancer complications. She is an appointed delegate on the International Myeloma Foundation Nurse Leadership Board. She is currently Editor-in-Chief of The Oncology Nurse. Beth has recently authored a chapter in Cancer Nursing: Principles and Practice, and Site specific cancer series: Myeloma, and authored many articles relating to the treatment of refractory and relapsing myeloma treatment.