The Senate and DeWine: One Constituent’s Impact

The evening of June 6 Senate and House conferees met to discuss the Fiscal Year (FY) 2006 Supplemental Appropriations bill. There was an attempt to add to the bill a "deeming" resolution establishing the appropriations allocation for FY 2007, Senators on the conference committee introduced an amendment to this resolution which would add the $7.1 billion for health and education programs that were part of the Specter-Harkin Amendment.

In order for it to pass the amendment needed the support of two Republican Senators. One Voice Against Cancer (OVAC) assumed Senator Arlen Specter (R-PA) would support the effort and felt Senator Mike DeWine’s (R-OH) vote was a key to the amendment’s passage but was unsure of his support.

I contacted Rebecca Dague, colon cancer survivor and C3: Colorectal Cancer Coalition advocate who lives in Ohio, to ask she call Senator DeWine to urge him to support the amendment. She called his office that night to leave a message and followed up with another call the next morning.

The next day (June 7) I recieved a message from OVAC which said the Senators on the conference committee approved the amendment and that Senators Specter and DeWine were the two Republicans who supported it. Unfortunately, House members of the confernce committee did not accept its adoption into the bill.

A short while after this Nancy Roach, C3 President, attended an OVAC meeting which discussed the vote on the amendment. She said the OVAC people were "very, very surprised" that Senator DeWine voted for the amendment. At the time of the meeting Nancy did not konw of Rebecca’s contact with Senator DeWine.

Nancy’s email went on to say:

"Your personal connection makes a big impact when it comes to specific asks. Elected officials want to be re-elected, so they want to please voters — and that means YOU."

I do not claim that Rebecca’s calls to Senator DeWine were THE reason he voted for the amendment but it could very well have been the nudge needed to get his support. Most of us do not have Sneators and Representatives in position’s as key to the passage of cancer legislation but that does not matter. What does matter is that you remember you do not know what will push elected officials to decide one way or the other so it is vital for youi to start, build and maintain a relationship with them and their staffs.

The Hill is feeling the impact of the cancer community in general and C3 in particular. Members of Congress must realize that in addition to their support we want adequate funding of cancer programs. The FY 2007 Labor/HHS appropriations process is not over thus you still have opportunity to influenc the final bill Congress sends to the President. 

Posted by Dusty Weaver on June 28th, 2006
Posted in: Policy & Advocacy News | No Comments »

Dextrose injections reduce pain after radiofrequency ablation

Radiofrequency ablation (RFA) destroys liver tumors caused by spreading colon or rectal cancer by generating heat.  However, when tumors are on the surface of the liver, RFA heat can also damage other organs in the abdomen, causing pain.  Risk of damaging internal organs can also limit patients who can safely be treated with RFA for liver mets.

Researchers, headed by J. Louis Henshaw in the Department of Radiology at the University of Wisconsin randomly assigned 20 patients, who were scheduled to undergo RFA, to have an injection of 5% dextrose in water into their abdominal cavities or not have such an intraperitoneal injection.

Patients in the dextrose group reported significantly less pain in the 24 hours after the procedure than the controls.  They also used significantly less pain medication.  Patients had the use of a patient-controlled analgesia pump that enabled them to use morphine as necessary for pain relief.  Those in the experimental dextrose/water group averaged 17.3 mg of morphine versus 125.2 mg for the controls.

In another study at Wisconsin, researchers studied both dextrose and saline solutions to protect abdominal organs in swine during RFA.  The animals were pretreated with dextrose in water, saline solution, or no solutions prior to radiofrequency ablation of liver tumors.  Afterwards, heat injuries to the animals’ lungs and diaphragms were analyzed.  The swine who had been injected with dextrose and water had the fewest thermal injuries.

The team, led by Paul F. Laeseke, concluded:

Instillation of D5 into the peritoneal cavity before hepatic radiofrequency ablation decreases the risk and severity of diaphragm and lung injuries compared with no pretreatment or pretreatment with 0.9% saline in this animal model. Pretreatment with D5 may increase both the safety of and the number of patients eligible for treatment with thermal therapies.

Both studies are reported in the May 2006 issue of the American Journal of Roentgenology.

A discussion of the.studies appears in Diagnostic Imaging Online.

radiofrequency ablation

Posted by Kate Murphy on June 27th, 2006
Posted in: Research & Treatment News | No Comments »

Dr. Sam Wieand, NSABP Biostatistician, has died

   H. Samuel (Sam) Wieand, Ph.D. died on June 10, 2006 from a recurrence of non-Hodgkins lymphoma. He was 62. Sam had been part of the National Surgical Adjuvant Breast and Bowel Project for twenty years until his recent retirement.  He was deeply involved in NSABP colon and rectal cancer clinical trials and contributed significantly to their success.

Dr. Wieand served as director of the NSABP Biostatistical Center from 1995 through 2000.  Beyond his professional involvement, he was a member of the NSABP Patient Advocacy Working Group as a cancer survivor.

He was an associate editor of the Journal of Clinical Oncology and Professor of Biostatistics at the University of Pittsburgh.

NSABP has established the H.Samuel Wieand Memorial Lectureship in his memory.  Writing about him, the NSABP said,

In addition to being a warm and caring man and a brilliant biostatistician, Sam was a friend and mentor to many. He contributed enormously to the accomplishments of the NSABP, particularly in the area of colorectal cancer research.

Sam will be missed by his family and by all who have known and worked with him. His spirit is sure to live on in the contributions he made to cancer research.

A Personal Note from Kate:  Sam was a special friend and mentor to me.  We served together on the NSABP Patient Advocacy Working Group. I began as a totally confused advocate knowing little or nothing about cancer research, but Sam taught me an enormous amount, quietly, patiently, and never with any condescension. He understood the importance of cancer clinical trials for patients and refused to take short-cuts. 

He generously asked me to co-author an article for the Art of Oncology section of The Journal of Clinical Oncology where we wrote about the essential importance of randomized clinical trials in A Commentary on Treatment at Random.  While he had published many journal articles, this was my first!  Still, he treated my ideas and my contributions to the article with respect and with his special humility and kindness.

I will miss him greatly.

Posted by Kate Murphy on June 25th, 2006
Posted in: Research & Treatment News | 2 Comments »

Better lymph node staging techniques may identify patients who have stage III colon or rectal cancer

Techniques that identify the key lymph nodes and the lymph channels that drain areas of the colon or rectum where cancer is located can identify more patients with lymph nodes that contain cancer.  Patients with nodes positive for cancer — stage III diagnosis —benefit from chemotherapy. 

Patients who don’t have positive nodes — stage II — have less benefit from chemotherapy and deciding whether the risk outweighs the benefit is difficult for both doctors and patients.

Because it is important to make sure that the staging is accurate, better techniques to locate lymph nodes and test them for cancer may find patients who are need to have their cancer upstaged from stage II to stage III and be treated with chemotherapy after their surgery.

Using a technique called lymphatic mapping along with identification of sentinel nodes,  surgeons at the John Wayne Cancer Center in California found that 1 in 4 stage II patients  had cancer that had spread to very small lymph nodes and were actually stage III.

Surgeons were able to locate sentinel nodes in almost all patients.  Pathologists located the rest.  Dye was used to stain the sentinel nodes and their lymphatic channels during surgery so that small nodes could be found and tested during the pathological examinations after surgery critical to accurate staging.

Anton Bilchik, M.D., Ph.D. and his colleagues reported their research findings in the June 2005 Archives of Surgery.  They concluded:

In a multicenter trial, ultrastaging of colon cancer is feasible and accurate. In stage II CRC, 24% of patients had nodal carcinoma cells not detected by conventional staging methods. Surgical technique (adequate lymph node retrieval) and focused pathological analysis may improve staging accuracy and the selection of patients for chemotherapy. The unnecessary toxicity and expense of chemotherapy may be avoided in those patients who are truly node negative.

Bilchik et al. Arch Surg. 2006;141:527-534

Another discussion of the research is available on Medpage Today, June 19, 2006.

sentinel node lymphatic mapping colon cancer staging

Posted by Kate Murphy on June 23rd, 2006
Posted in: Research & Treatment News | 1 Comment »

Senate Appropriations Committee Adopts Subcommittee Allocations

Thursday, July 22 the Senate Appropriations Committee adopted subcommittee allocations in a meeting of the full committee. This part of the budget and appropriations process is where the Appropirations Committee slices the single budget pie into into allocations for each of the 12 subcommittees each of which has oversees a particular part of the federal government. The subcommittees take their particular slice of the pie and further slice it among the individual agencies within their jurisdiction.

In our case the Appropriations Committee gives a slice of the pie to the Labor-HHS-Education Subcommittee. This subcommittee then divides its slice of the pie among Labor-HHS-Education and related agencies such as the National Institutes of Health, National Cancer Institutes and the Centers for Disease Control and Prevention, which are of interest to us.

Here is portion related to Labor-HHS-Education:

• Enacted Fiscal Year 2006 $141,200 billion
• President’s Request Fiscal Year 2007 $137,798 billion
• Allocation Fiscal Year 2007 $142,800 billion
• Proposal vs. 2006 1.1% increase

Comittee Chairman Thad Cochran (R-MS) said,

"The Senate Appropriations Committee was presented with a challenge this year in deeming ourselves a spending cap and then determining the most equitable and responsible way to divide that allocation among the 12 subcommittees. While I recognize the many needs that our committee is asked to meet, I believe we have acted prudently in seeking to restore fiscal responsibility by not increasing discretionary spending for the next fiscal year. I realize that the task before the subcommittee chairman will be difficult as they work to meet many competing interests with a scarce amount of resources, but I am confident that the Committee will present conscientious and fiscally sensible spending bills to the Senate."

I agree with Chairman Cochran that the task of the subcommittee will be difficult. Then again it is their job to make the difficult decisions. Our job as constituents interested in cancer is to keep the pressure on the subcommittee members as well as other Senators to get cancer related appropriations to the level needed to adequately fund the war against cancer.

The members of the Labor-HHS-Education Subcommittee are:

• Majority Members
• Senator Arlen Specter (Chairman) (R-PA)
• Senator Thad Cochran (R-MS)
• Senator Judd Gregg (R-NH)
• Senator Larry Craig (R-ID)
• Senator Kay Bailey Hutchison (R-TX)
• Senator Ted Stevens (R-AK)
• Senator Mike DeWine (R-OH)
• Senator Richard Shelby (R-AL)

• Minority Members
• Senator Tom Harkin (Ranking Member) (D-IA)
• Senator Daniel Inouye (D-HI)
• Senator Harry Reid (D-NV)
• Senator Herb Kohl (D-WI)
• Senator Patty Murray (D-WA)
• Senator Mary Landrieu (D-LA)
• Senator Richard Durbin (D-IL)

If you are a constituent of one of these Senators you have an excellent opportunity to influence the appropriations process like no one else by telling your Senator you want a high priority given to increased funding for cancer programs. Here are the level recommended by One Voice Against Cancer (OVAC) you can mention to the Senator:

• $29.45 billion for the National Institutes of Health to sustain and build on its research progress;
• $5.03 billion for the National Cancer Institute which is the bare minimum required to protect past investment and to maintain the current pace of discovery;
• $427.5 million for eight proven cancer educaton, outreach, and prevention and screening programs at the Centers for Disease Control and Prevention;
• $200 million for the National Center on Minority Health and Health Disparities in order that it might fulfill its mission and achieve its goals and objectives; and
• $175 million for Nursing Workforce Programs at the Health Resources and Services Administration to help address the nationwide nursing shortage.

 Members of the full committee are:

• Majority Members
• Senator Thad Cochran, Chairman (R-MS)
• Senator Ted Stevens (R-AK)
• Senator Arlen Specter (R-PA)
• Senator Pete Domenici (R-NM)
• Senator Christopher Bond (R-MO)
• Senator Mitch McConnell (R-KY)
• Senator Conrad Burns (R-MT)
• Senator Richard Shelby (R-AL)
• Senator Judd Gregg (R-NH)
• Senator Robert Bennett (R-UT)
• Senator Larry Craig (R-ID)
• Senator Kay Bailey Hutchison (R-TX)
• Senator Mike DeWine (R-OH)
• Senator Sam Brownback (R-KS)
• Senator Wayne Allard (R-CO)

• Minority Members:
• Senator Robert Byrd, Ranking Member (D-WV)
• Senator Daniel Inouye (D-HI)
• Senator Patrick Leahy (D-VT)
• Senator Tom Harkin (D-IA)
• Senator Barbara Mikulski (D-MD)
• Senator Harry Reid (D-NV)
• Senator Herb Kohl (D-WI)
• Senator Byron Dorgan (D-ND)
• Senator Dianne Feinstein (D-CA)
• Senator Richard Durbin (D-IL)
• Senator Tim Johnson (D-SD)
• Senator Mary Landrieu (D-LA)

If your Senator is not on the Labor-HHS-Education Subcommittee but is a member of the full committee that Senator does not have direct influence on the Labor-HHS-Education bill. However, you can still ask your Senator to use his or her committee membership to influence the amount of cancer funding in the final bill.

 If neither of your Senators is a member of either the subcommittee or the full committee you still need to contact your Senators to tell them you want a high priority given to cancer funding.

Congress is abouit half way through the budget and appropriations process thus there is still time to influence the final appropriations bill by doing things like sending your members of Congress emails, scheduling an in-district meeting during the August recess and writing letters to the editor.

We’ve come a long way towards the goal of eleminating the suffereing and death caused by cancer. Those of us with colon cancer know of the recent advances made in the treatment of the disease. Now is not the time to slow the progress. We want more than the sympathy and support of Congress. We want the dollars needed to adequatly fund federal cancer programs because, like the President said in 2003, "We cannot win the war against cancer unless we fund the war against cancer."

Posted by Dusty Weaver on June 22nd, 2006
Posted in: Policy & Advocacy News | No Comments »