C. Difficile infections related to use of heartburn medications

Clostridium difficile (c.diff.) is a bacterial infection in the gastrointestinal tract which causes severe diarrhea, fever, and  abdominal pain.  Although c.difficile is often associated with hospitalization,, recent outbreaks have been found in community settings.  Antibiotic use has also been associated with the disease.

Researchers at McGill University in Montreal have found the risk of c.difficile infection is more than three and a half times more likely in people who have been taking heartburn medications known as proton pump inhibitors    There was no increased risk of c.difficile infection among patients treated with a different antacid — an H₂-receptor antagonist.

Patients in the study were located using a primary care data base in the United Kingdom, identifying those who had received a prescription for oral vancomycin as having community-acquired clostridium difficile associated disease (CDAD).  Since CDAD is the only indication for oral vancomycin, this provided a good way to accurately identify community cases of CDAD.

The research team identified 317 cases of community-acquired CDAD between 1994 and 2004 along with 3167 controls close in age and from the same medical practices who had not been hospitalized and had no sign of CDAD.  Patients with CDAD were 3.5 times more likely to be using a proton pump inhbitor drug than the controls.

The strongest association between CDAD and drug treatment was for antibiotic use during the three months prior to diagnosis.  CDAD patients were more than eight times as likely to have been taking an antibiotic.  However, nearly half (45%) of CDAD patients had not been on antibiotic treatment.

There was also an increased risk of CDAD among patients who also had other illnesses including renal failure, cancer, inflammatory bowel disease, and infections that were resistant to multiple antibiotics.

Proton pump inhibitors include brand names Prilosec, Prevacid, Nexium, Protonix, and Aciphex, some of which are available as over-the-counter drugs in the United States.  The H₂-receptor antagonists, which were not associated with CDAD, include brand names such as Tagamet, Pepcid, Zantac, and Axid, which are also available as non-prescription drugs.

Writing in the September 26, 2006 Canadian Medical Association Journal, Dr. Sandra Dial and her colleagues at McGill in Montreal conclude:

Proton pump inhibitor use was associated with an increased risk of community-acquired CDAD, when cases were defined by receipt of prescription for oral vancomycin therapy. Prior antibiotic exposure was also a significant risk factor, but a significant proportion of the patients with community-acquired CDAD had no such exposure.

Posted by Kate Murphy on September 27th, 2006
Posted in: Research & Treatment News | 3 Comments »

A Washington WOW experience

Several weeks ago Nancy Roach, C3 President, asked if I wanted to attend something called Celebration on the Hill (COTH). From what I could find out this American Cancer Society (ACS) event held September 19-21 in Washington, DC sounded like a big version of a local Relay for Life.

Last Wednesday, a couple of C3 staff and I were in the office planning future C3 activities. We planned to go to COTH later in the afternoon. Someone went to the COTH website and found a streaming video link. That was when I discovered the true size of this event.

The video was not one static camera pointed at the stage but several different views including crowd shots. There must have been a dozen or more cameras feeding an onsite production truck.

We went to the site around 5 pm. It went from 7th Street to the reflecting pool on the west side of the Capitol. The Wall of Hope started here so we walked through that first. The wall consisted of banner from all 50 states along with the District of Columbia and a couple of U.S. Territories.

I found Arkansas and signed the banner from my town. I also found the banner from the place where my aunt and cousin live. Their names were on it as both are cancer survivors.

The next area had a tent for each state and territory. This was a place for people to meet each other and rest. I heard most Members of Congress stopped by these tents to talk to constituents.

Each of us made donations to get luminaries. This is the best and most emotional part of every Relay. It is a joy and a sorrow to see them in the dark when they are lit. They were lined up by state around the Reflecting Pool, sometimes two and three deep. Each one represented a person with cancer. Some simply had the name while others were elaborately decorated. Many had a sentiment about the person.

This was not just about lighting some candles. Every Member of Congress, all 535 of them, received a visit from cancer advocates. Congress get visits all the time from groups but very few have enough participants present to get a visit with every Member.

This was a huge WOW experience for Carlea Bauman, C3 Executive Director, Jim Wetekam, C3 Director of Policy Communication, and I. ACS used a huge amount of resources to pull this off. It got the three of us to thinking and dreaming about the possibilities for C3.

I hope this is the start of something big for cancer advocacy. Sometimes people affected by cancer are looked upon with pity. When we tell our government officials what we want them to do they tell us they support cancer. Then they do little to act upon this support and we do little to make cancer an issue.

It is time this changed. We must becomed informed about the issue, decide what we want, and how best to bring this to the attention of our government.

One of my goals if for cancer to become an issue on par with groups such as the AIDS and gun lobbies. A similar goal is for colon and rectal cancer to get the same level of attention breast cancer now receives. Both of these will not happen overnight and will require much work.

Talk doesn’t cook rice. We’re here to cook. Let’s start cooking.

Posted by Dusty Weaver on September 23rd, 2006
Posted in: Policy & Advocacy News | No Comments »

Favorable Factors for Successful Resection of Lung Mets

When colon or rectal cancer has spread to the lungs only, removing them surgically can lead to long-term remissions and, in some cases, cures. Reviewing patients who had lung metastases surgically resected, surgeons in Japan identified four factors that led to a better prognosis.

Favorable factors included:

• Three or fewer tumors in the lung
• No spread to hilar and/or mediastinal lymph nodes
• Lung mets occuring later than original colon or rectal tumor
• Normal carcinoembryonic antigen (CEA) before surgery

The research team studied 58 patients who had surgery for lung metastases.  Overall, the five-year survival rate was 29% with a median survival time of 27 months.  Sixteen patients had all four favorable features and had a five-year survival of 67%, significantly better than patients without the characteristics.  Median survival time for these patients was 86 months.

Thirteen patients had a repeat surgery for lung mets.  They had a five-year survival rate of 37% with a median survival time of 32 months.

The team headed by Rintaro Koga concluded:

The four factors selected in our multivariate analysis appear to be favourable factors for the practical identification of those patients who are most likely to benefit from surgical resection. Repeated pulmonary resection for lung-only recurrence may benefit carefully selected patients.

Koga et. al. Japanese Journal of Clinical Oncology published early online on August 25, 2006.

Posted by Kate Murphy on September 22nd, 2006
Posted in: Research & Treatment News | 8 Comments »

Optimal use of colorectal cancer screening and existing chemotherapy could reduce deaths by 50%

If current colorectal cancer screening methods were maximized and existing chemotherapy used by all age groups, deaths from colon and rectal cancer in the United States could be reduced by 50% by the year 2020.

Researchers used a microsimulation model (MSCAN-COLON) to simulate the 2000 U.S. population with respect to risk factors for colon and rectal cancer, use of colorectal cancer screening, and treatment use. Using this data, they were able to project deaths from colorectal cancer in the year 2020 under three different scenarios:

• No changes in risk factor prevalence, screening use, and treatment use.
• Contining the trends in the three factors during the period from 1995-2000.
• Risk factors are reduced, screening is increased to 70% of the population, and treatment use is extended to all age groups

The simulation model projected:

• If there is no change, mortality from colorectal cancer will decrease by 17% by 2020.
• If the current 1995-2000 trends continue, mortality will decrease by 36%.
• If risk factors are reduced, screening rates increased, and treatment use expanded, deaths will be reduced by 49%.

The team led by Iris Vogelaar and her colleagues in the Netherlands and at Memorial Sloan Kettering in New York wrote in the October 2006 issue of Cancer:

Currently available interventions for risk-factor modification, screening, and treatment have the potential to reduce CRC mortality by almost 50% by the Year 2020. However, without action now to further increase the uptake of current effective interventions, the reduction in CRC mortality may be only 17%

Vogelaar et. al. Cancer Volume 107, Issue 7 Pages 1624 - 1633

Posted by Kate Murphy on September 22nd, 2006
Posted in: Research & Treatment News | No Comments »

NIH Reauthorization Legislation Moving Forward

The National Institutes of Health (NIH) is authorized by Congress to support the following mission:

NIH is the steward of medical and behavioral research for the Nation. Its mission is science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.

Congress provides funding for NIH which is distributed to institutions and researchers to achieve this goal.

Periodically, Congress reviews and modifies the legislation which guides NIH, a process called “re-authorization”. Congress reauthorized NIH in 1993. Congressman Joe Barton (R-TX), chair of the House Energy and Commerce Committee, has made NIH reauthorization a priority since becoming chair in 2004.

Since then, Chairman Barton’s staff has worked with stakeholder groups to define legislation that will reform NIH while continuing to support research.

Friends of Cancer Research reports that:

House Energy and Commerce Committee Chairman Joe Barton (R-TX) is bringing an updated version of a bill to reauthorize the National Institutes of Health (NIH) before his Committee for a vote …

Overall, the draft bill focuses on the organization and function of the Office of the Director of NIH and its relationship to the individual NIH institutes and centers by providing enhanced authorities for strategic planning and support of trans-institute initiatives. The bill would standardize a detailed series of reporting requirements covering research and other activities supported by NIH to promote greater accountability and increased transparency of NIH funds.

See C3’s letter to the House Energy and Commerce Committee regarding this legislation.

Posted by Judi Sohn on September 19th, 2006
Posted in: Policy & Advocacy News | No Comments »