Fran Campion and Bill Watson are the winners of a $35,000 Wedding Giveaway sponsored by the Washington Post.  They will marry on October 6th in Pottsville, PA — one year to the day after Fran’s last chemotherapy treatment for stage III colon cancer.

Fran and Bill were chosen by readers of the Express, a free publication of the Washington Post.  Family and friends were joined by colorectal cancer patients across the country in voting for the courageous young couple.

Fran, 28, was diagnosed with colon cancer in February of 2006.  She and Bill spent Valentine’s Day meeting with her surgeon.

Votes for Fran and Bill were championed by the Colon Club, an organization dedicated to raising awareness of colon and rectal cancer, with a particular focus on young colorectal cancer survivors.

Writing in the northern New Jersey Record,  African American columnist Lawrence Aaron talks about finally having a colonoscopy.  Why did he put it off so long?

The psychology is complex – vanity, denial, inconvenience, and my desire to hold back the tide of time. Fear. I believed I was healthy as Seabiscuit and didn’t want to hear otherwise.

I didn’t consider myself at risk. I couldn’t think of one person in my family – not even distant cousins – who have suffered from colon cancer. The messages of early detection were lost on me.

What finally persuaded him was a reminder from the American Cancer Society that African Americans are at much higher risk of dying of colorectal cancer than whites.  Black men in Passaic County in northern New Jersey have the highest mortality rate of any group diagnosed with colon cancer,

Anesthetized for the procedure, Aaron does not remember it.  He was also surprised that the pain or cramping he expected afterwards didn’t happen. Like many others, he reports that, “Drinking a gallon of colon-cleansing laxative the night before was worse than the procedure.”

FROM 2007 ASCO PROSTATE SYMPOSIUM

Men treated  with external beam radiation for rectal cancer had  a 70% lower risk of being diagnosed with prostate cancer than would normally be expected for men of their age and race.  However, among rectal cancer patients who did not receive radiation, there was little difference from what would have been expected.  Men with colon cancer developed prostate cancer later on just slightly above the expected rate.

Karen Hoffman, M.D. from Massachusetts General Hospital analyzed Surveillance, Epidemiology, and End Results (SEER) data for nearly 1,600 men who had radiation treatment for rectal cancer from 1988 through 1997.  Twenty men subsequently developed prostate cancer, far fewer than would have ordinarily been expected.

Dr. Hoffman presented her analysis At the 2007 ASCO Symposium in Kissimmee, Florida.  She commented,

Rectal and prostate cancers tend to be diagnosed at a similar decade of life. Inadvertent irradiation of the prostate during treatment for rectal cancer may sterilize or cyto-reduce subclinical prostate cancer or precancerous intra-epithelial lesions, or may impede prostate cancer development by altering the local hormonal or stromal milieu.

Her ASCO Prostate Symposium presentation was reported by MedPage Today.

Although religious and spiritual support improves quality of life for people who are dying of cancer, half of those patients receive no support from their religious communities and nearly three quarters say they receive little or no support for their spiritual needs from the medical community.  Forty-two percent said that they had religious or spiritual support from neither a religious community nor the medical care system.

As part of the Coping with Cancer study, researchers interviewed patients with advanced cancer whose cancer had progressed despite chemotherapy and who were expected to live less than a year.  The research team asked  about the importance of religion and spirituality to them, their personal participation in religious services and prayer, and the support received both from religious communities and medical staff, including chaplains.

They also evaluated quality of life and the patients’ ways of religious coping.  Patients were asked if they wanted all measures to extend life even if death were imminent and whether they had advanced directives in place including a living will or a do-not-resuscitate order.

Nearly all — 9 out of 10 — of the patients considered religion or spirituality important, 68% said it was very important. Fifty-six percent attended religious services at least once a month prior to their cancer diagnosis, although attendance fell to 44% after diagnosis.  Nearly half prayed or performed some personal religious activity before diagnosis and that rose to 61% after diagnosis.

African Americans were more likely to consider religion very important than whites.  They were also much more likely to report that they were supported by their religious communities than either whites or Hispanics. 

There was a significant correlation between overall spiritual support from religious communities and the medical staff and quality of life.  Religious and spiritual support improved quality of life — an important goal for patients near the end of their lives.

People for whom religion was very important were twice as likely to want all measures to extend their lives.

Tracy A. Balboni and her colleagues report the results of their study in the February 10, 2007 issue of the Journal of Clinical Oncology.

The study authors reflected on the barriers that medical staff have in providing spiritual support to patients without imposing religious views.  However, they concluded that given the importance of spiritual support to quality of life, health care professionals should find ways to provide that support to patients.  They wrote,

Methods for meeting patient spiritual needs should be explored, and the impact of such interventions should be assessed. In addition, the appropriate roles of various health care providers (eg, physicians,
nurses) in managing spiritual needs should be clarified. Although incorporating R/S into care requires delicacy, attention to tihis dimension of health has the potential to enhance patient wellbeing at the end of life.

Writing in an editorial in the same issue of the Journal of Clinical Oncology, Betty Ferrell offers three steps that oncologists can take to improve opportunities for patients to receive religious and spiritual support.

• Master a basic assessment of spirituality that focuses on patients’ faith and beliefs, the importance of faith in their lives, whether they have a religious or spiritual community that supports them, and, finally, how they want the healthcare system should address their spiritual needs.
• Assess their own spiritual and religious beliefs, including their understanding of cultural diversity and the religious language they use in discussing spiritual issues with patients. 
• Advocate for maintenance and expansion of chaplaincy programs, especially in light of decreasing budgets.  Include chaplains in interdisciplinary care conferences and advanced directives planning.

An article about the study appears in Reuters Health.

Bills requiring health insurers to cover colorectal cancer Screening tests are being considered by the New Mexico Legislature. Health insurance policies issued in the state would be required by these bills (HB 510 and SB 851) to “provide coverage for colorectal screening for determining the presence of precancerous or cancerous conditions and other health problems.”

The House Consumer and Public Affairs Committee gave HB 510 a “do pass” recommendation and referred it to the House Health and Government Affairs Committee on February 13, while on February 16 the Senate Corporations and Transportation Committee gave a similar recommendation to SB 851 and referred it to the Senate Public Affairs Committee.

Something I’ve not seen in other colon and rectal cancer screening mandates is this requirement:

“The coverage shall make available colorectal cancer screening, as determined by the health care provider in accordance with the evidence-based recommendations of the United States preventive services task force [USPSTF].”

According to its web site the USPSTF is “the leading independent panel of experts in prevention and primary care” whose “recommendations are considered the ‘gold standard’ for clinical preventative services.”

A Fiscal Impact Report was written for each bill (Senate here and House here) and following are some items I found interesting:

• New Mexico received the grade of “F” in the Colorectal Cancer Legislation Report Card issued by the National Colorectal Cancer Research Alliance;
• 38% of New Mexico adults age 50 and older reported never having had a colorectal cancer screening examination;
• Colorectal cancer is very treatable when detected early and can be prevented by removal of polyps; and
• Citation of a recent analysis by the American Cancer Society which “shows that colorectal cancer screening have risen faster and are significantly higher in states that have passed these coverage laws.”

The Senate version (SB 851) is sponsored by Sen. Cynthia Nava while Rep. Andrew J. Barreras is the sponsor of the House version (HB 510). If you are a resident of New Mexico, contact your state legislators and tell them to vote “yes” on these bills.