Surgery to remove colorectal cancer that has spread to the liver can be demanding on patients.  However, given its effectiveness in curing a percentage of carefully chosen patients, short-term disability and lowered health-related quality of life may be an acceptable trade-off for those patients who will benefit from surgery.

Surgical researchers in the Netherlands compared health-related quality of life before and after surgery for three groups of patients with liver metastases from colon or rectal cancer.

• Group 1 consisted on 60 patients with operable liver mets that were removed successfully.
• Group 2 included 17 patients whose mets couldn’t be removed during the surgery.
• Group 3 was a control group of 20 outpatients with inoperable mets.

Health-related quality of life was measured for all three groups at baseline before surgery, 2 weeks after surgery, and 3 months after surgery

• After surgery, health-related quality of life clearly deteriorated for the Group 1 patients, but 3 months later, quality of life had returned to the before-surgery baselines.
• For Group, quality of life deteriorated as well after their operation, but symptoms did not return to baseline at 3 months.
• Group 3 patients had hardly any loss of health-related quality of life over the three months.

The research team concluded:

The fast recovery of health-related quality of life, generally within 3 months, justifies an aggressive surgical approach to colorectal liver metastases. However, careful preoperative evaluation is crucial to avoid needless laparotomy, considering the ongoing deteriorated health-related quality of life of group 2

B.S. Langenhoff and colleagues reported their results in the British Journal of Surgery

Langenhoff et. al. British Journal of Surgery, Volume 93, Number 8, August 2006, pp. 1007-1014(8)

WHAT THIS MEANS FOR PATIENTS

 If you have liver mets that have a good possibility of being successfully removed surgically, you can look forward to recovering your quality of life within 3 months or so after your operation.

However, it is important that the extent of mets be carefully evaluated before surgery by an experienced surgeon since unsuccessful surgery reduces quality of life below that of people who do not have surgery attempted.

The American Psychosocial Oncology Society (APOS) provides help in finding local counseling services for people coping with distress from cancer. A toll-free helpline — 1-866-APOS-4-HELP – is answered live, Monday through Friday from 9 am to 5 pm.

Voice mail is available at other times with calls being returned within 24-48 hours.

Trained counselors provide referrals community resources for psychosocial counseling. If no resources are available in a caller’s community, Helpline staff will provide counseling via telephone to callers in crisis.

Anita Mitchell is alive and without any evidence of cancer, despite a diagnosis of metastatic (stage 4) colon cancer a year ago.  Her story will be featured on a live Health Talk broadcast on Monday evening, July 31st at 8:30 p.m. (Eastern).

Joining Anita are Dr. Lowell Anthony,  Director of Gastrointestinal and Neuroendocrine Oncology at Louisiana State University Health Sciences Center in New Orleans, and Dr. Thomas H. Cartwright, president of the medical staff at Ocala Regional Medical Center in Florida.  Rick Turner will host the panel.

• Colorectal Cancer: Understanding Your Options
• Monday, July 31, 2006
• 8:30 p.m. Eastern
• Via Webcast or Teleconference
• To Register

Registration is required.

Congress hasn’t yet made final decisions on funding for cancer research and prevention programs. Money is very tight this year, and without stronger support from Congress, these programs are at risk.

Last week the Senate Appropriations Committee completed its consideration of the Labor-HHS-Education Appropriation bill, which contains funding for nearly all federal cancer programs. The House Appropriations Committee completed its work last month on its own version of the bill. Now, each chamber’s version will be scheduled respectively for consideration by the full Senate or House, though many congressional observers believe that won’t happen until well into the fall and perhaps, after the elections.

Both House and Senate versions of the bill are severely lacking in what they propose to do for cancer patients and for cancer research, with the House version being worse.

The following chart gives an idea of how far we need to go to meet the budget levels needed for cancer research, screening, and treatment. A brief explanation of the columns:

1. “Current 2006” describes the levels currently allocated for fiscal year 2006, i.e., the budget that Congress passed last year.
2. “2007 Do-No-Harm” is the amount necessary to avoid cuts in cancer programs, as identified by One Voice Against Cancer, a coalition of cancer and health organizations in which C3 plays a key role.
3. “House 2007” is the amount allocated thus far by the House Appropriations Committee in its Labor-HHS-Education Appropriation bill.
4. “Senate 2007” is the amount allocated last week by the Senate Appropriations Committee in its Appropriation bill.

Amounts included in this chart are from initial sources of information and may change slightly as more congressional data is made available.

Obviously, Congress has not yet done what it must if it is to show its support to colorectal cancer patients and families.In fact, it hasn’t even come close to increasing cancer programs enough to account for inflation, and the House bill actually makes small (but real) cuts!  Therefore, C3 and its advocates must work diligently during the rest of the summer and in the fall to ensure that Congress hears about our priorities.

Just what can you do? The most immediate, important (and even fun) thing is to set up visits with your Representative and two Senators when they are home in the district or state in August. These meetings can be amazingly effective in elevating the issue of colorectal cancer for Members of Congress. And it is in August that Congress takes its longest recess – or “work period” – during which Members of Congress are often very visible and available in their home communities and regions. This provides an extraordinarily good time for constituents to meet with them and impress upon them: 1) what it means to be someone living with colorectal cancer or to be a family member of a person who has had colorectal cancer, and 2) what it is that you need them to do to support cancer research, screening, and treatment.

And…it is not as difficult as you might think! We at C3 stand ready to help you every step of the way. If you are interested in doing more to convince your Members of Congress of the importance of cancer funding, please email us at advocacy@fightcolorectalcancer.org, and Dusty Weaver and/or I will be in touch with you. Thanks for all your summer efforts.

After colon or rectal surgery, there is a period when the bowel’s rhythmic forward motion or peristalsis stops. Traditionally, patients are not allowed water or food until the bowel begins moving again, usually when gas is passed or there is a bowel movement.  This can be a difficult two or three days for patients, sometimes longer.

Nursing researchers at Flinders University in Australia reviewed studies of early feeding in the medical literature and found that reintroducing food and water before peristalsis resumed was safe, well-tolerated by patients, and beneficial.  They found 15 studies in the medical literature between 1995 and 2004 that looked at the benefits and risks of allowing food and water after colon surgery before peristalsis had resumed.

All of the studies concluded that early feeding was safe based on low complication rates.  Complications for nearly 1,000 patients averaged 12.5% with no increased risk of leaking at the surgical connection (anastomosis), bowel obstruction, or aspiration pneumonia. Complications in the 15 studies ranged from 0 to 25%.

Studies found that earlier resumption of bowel activity and shorter hospital times can result from a program that combines early feeding with:

• early mobilization — getting out of bed and walking after surgery
• epidural anesthesia
• good patient education

The literature review by nursing student Wai Quin Ng appears in June 2006 issue of The Journal of Clinical Nursing.

A poster of Wai Quin Ng’s study Start Early, Go Home Early is available as a PDF file online.

WHAT THIS MEANS FOR PATIENTS

If you are planning colon surgery, talk to your surgeon about trying water and food earlier in your hospital recovery even before your bowels begin working again.  Point out that studies have not found increased risks for leaking at the surgical connection, pneumonia from inhaling food, or bowel obstruction. 

Work with the nursing staff to get out of bed and walk as soon as possible.

Discuss the risks and benefits of epidural anesthesia to control pain during the first recovery days.