Again this year saddlecloths of Preakness Stakes horses will carry the Blue Star of Hope, the symbol of colorectal cancer awareness.  Colon cancer survivor Janet Turcotte embroiders the saddlecloths and has added the Blue Star to each one to encourage race fans to be screened for colorectal cancer. 

The Preakness Stakes, part of the Triple Crown, will be run on May 19th at Pimlico Race Course and will be seen by over 17 million people.

Janet, an active advocate for C3 Colorectal Cancer Coalition, was diagnosed with advanced colorectal cancer four years ago and is currently battling a third recurrence.  Despite being in active treatment, she continued to embroider the Preakness saddlecloths this year, something that she has done for over twenty years.  She says,

The event this weekend is important to me because I didn’t learn the facts about colorectal cancer – especially that it’s preventable – until I was diagnosed with late stage disease.  As the thoroughbreds carry this symbol in the race to the finish line, I can only hope that through awareness and prevention, we too can win the race against colorectal cancer.

Pimlico Race Course officials are supporting Janet in her efforts to increase awareness of colorectal cancer and the fact that screening can prevent it.  Karen De Francis, executive vice president at Pimlico says,

Janet has been a part of the Preakness for many years. We are proud to again support her efforts in raising awareness in the fight against colorectal cancer.

Nearly 150,000 men and women in the United States will be diagnosed with colon or rectal cancer this year, and 55,000 will die of it.  But, as Janet emphasizes, it is a disease that can be prevented.  Regular screening can find and remove pre-cancerous polyps before they ever turn into cancer.

C3 joins the American Cancer Society in urging all men and women over the age of 50 to talk to their doctors about colorectal cancer screening, be screened, and keep their screening exams up-to-date.

People with a family history of colorectal cancer or with a personal history of polyps or inflammatory bowel disease need earlier and more frequent screening.

Watch for the Blue Star of Hope in the Winner’s Circle this weekend.

Aggressive treatments in the last week of life increase difficult symptoms during dying while longer time in hospice care appears to reduce distress at the time of death for people with advanced cancer.

As part of the Coping with Cancer study, researchers interviewed patients with advanced cancer and their caregivers.  After the patient’s death, caregivers were asked about aggressive treatments during the last week of life, measures of the overall quality of the individual’s death, and the length of hospice care.  Results were reported at the 2007 Annual Scientific Meeting of the American Geriatric Society.

Aggressive treatments were defined as:

• hospitalization in an intensive care unit
• ventilator support
• non-palliative chemotherapy
• resuscitation
• use of a feeding tube

The number of aggressive treatments received during the last week of life was associated with

• more psychological distress
• more physical distress
• a poorer quality of death
• a lower possibility of dying in the place that the patient chose

Ninety percent of patients who receive no aggressive treatments in the last week died in the place they preferred compared to only one third of those who received two or more.

Gabriel K. Silverman, one of the researchers at Carnegie Mellon University and the University of Pittsburgh School of Medicine, reported:

The more time patients spent under hospice care, the greater their quality of death. For example, patients who received at least 5 weeks of hospice care were in less physical distress in their last week of life than those who lived less than a week with hospice, and those who received no hospice at all were in the most physical distress at the end of their lives. These results suggest that when patients are actively dying, the use of aggressive treatments should be considered with caution and only pursued with the full understanding of patients or their surrogate decision makers.

Commenting on the study in an interview with Medscape, Robert Arnold M.D. Chief of the Palliative Care and Medical Ethics section of the University of Pittsburgh School of Medicine, said,

As a doctor, if I had a patient or family who wanted aggressive, life-sustaining care toward the end of their life, I would view it as a red flag warning of patient or caregiver distress. Often patients and their families are suffering, sad, or distressed at the end of life, and when dying occurs in medical settings they may hope that aggressive treatment will help the suffering, but often it doesn’t.

SOURCE:  Laurie Barclay MD, Medscape Medical News, May 3, 2007 reporting on AGS 2007 Annual Scientific Meeting: Abstract P4.

I recently had the opportunity to travel to California and attend the American Association for Cancer Research (AACR) Conference as part of their Scientist < -> Survivor Program. AACR is the oldest and largest scientific organization in the world focused on every aspect of high-quality, innovative cancer research Through the program, survivor and patient advocates are able to develop stronger backgrounds in cancer research and related issues. I applied and was accepted into the program to represent C3.

This trip would prove not only to be informative, but would also give me the opportunity to meet and discuss with fellow participants what new and exciting innovations are being developed now and for the future in regards to cancer research and prevention.

Read the rest of this entry »

More than half of patients in a Phase II clinical trial that added Tarceva® (erlotinib) to FOLFOX and Avastin® (bevacizumab) had to discontinue the trial because of serious side effects.  Another 25% withdrew their consent, also because of difficult side effects. 

Overall, none of the 35 patients in the trial completed it so no conclusions about the effectiveness of the combination could be drawn.

The study added Tarceva to FOLFOX and Avastin, a standard initial treatment for people with advanced colorectal cancer.  The trial’s goal was to determine progression-free survival or the length of time patients being treated with the combination had no growth of tumors.

Major side effects included rash, neuropathy, and diarrhea.

Erlotinib targets and blocks the EGFR tyrosine kinase cellular pathway.  It is effective in non-small cell lung cancer and pancreatic cancer.  Side effects when given alone include mild to moderate rash and diarrhea.

Dr. J.A. Meyerhardt and colleagues in Boston, where the trial was done, concluded:

The combination of FOLFOX, bevacizumab and erlotinib led to higher than expected early withdrawal due to toxicity, limiting conclusions regarding efficacy. These findings raise concern regarding the tolerability of adding more agents to already complex combination regimens for metastatic colorectal cancer.

SOURCE:  Meyerhardt et.al., Annals of Oncology, early online access, May 2007.

Large volume polyethylene glycol (PEG) solution or oral sodium phosphate (NaP) are commonly used to cleanse the colon before colonoscopy.  Both work by pulling large amounts fluids into the bowel producing copious watery stools.  Because so much fluid is lost in the process, body electrolyte balance can be affected.

Gastroenterologists in Canada were concerned that the oral sodium phosphate might cause undetected kidney damage.  Over ten years, they measured serum creatinine, an indicator of kidney failure, immediately before colonoscopy and again before a repeat colonoscopy procedure for nearly 800 patients. Most patients had the second level analyzed between one and five years after their first measurement.

There was no difference in chronic kidney failure between  the two different colonoscopy bowel  preps over several years.  Kidney damage was found in a small percentage of patients (7.7 percent) but there was no significant difference between those who used oral sodium phosphate as a prep (6.8 percent) or those who received PEG solution (8.7 percent).

The research team found that only age and blood pressure increased risk for chronic kidney failure among patients in their study.

R Abaskharoun and colleagues writing in the Canadian Journal of Gastroenterology concluded:

Baseline creatine clearance was similiar in both the NaP and PEG groups and the absolute difference after colonoscopy did not differ. The present study concluded that the ingestion of oral NaP for colon cleansing before colonoscopy did not result in frequent renal damage that went clinically undetected.

SOURCE:  Abaskharoun et.al., Canadian Journal of Gastroenterology, Volume 21, Number 4: 227-231, April 2007.

Patients who are elderly, have cardiac problems, hypertension, or already have chronic kidney disease need to be aware that the FDA has raised concerns about a rare acute kidney failure associated with colon cleansing with sodium phosphate products including Fleet’s Phospho-soda® and Visicol® tablets.  This condition was rare and appeared shortly after colonoscopy.

Writing in the American Journal of Nephrology, Glen Markowitz and his pathology team at Columbia University reported on 21 cases of an acute kidney failure after colonoscopy preparation with oral sodium phosphate in examination of 7,400 kidney biopsies.  Sixteen of the twenty-one cases had hypertension and fourteen were being treated with an ACE inhibitor.

In the AJN article, Dr. Markowitz suggests that

Strategies to prevent the development of acute phosphate nephropathy after OSPS include rigorous attention to adequate hydration and possibly not administering ACE-I, ARB, diuretics, and NSAID on the day before and the day of the colonoscopy procedure. OSPS should be used with great caution in elderly patients.

SOURCE: Markowitz et. al,, American Journal of Nephrology, 2005.

WHAT THIS MEANS FOR PATIENTS

People preparing for colonoscopy can be reassured that overall there was no difference in the development of chronic kidney problems whether an oral sodium phosphate prep or a PEG solution was used.

However, patients with existing kidney disease or hypertension, or who are elderly or using ACE inhibitors should discuss the choice of colonoscopy prep carefully with their doctors.  Before colonoscopy, a careful medical history and review of medications — both prescription and over-the-counter — is necessary before choosing the best prep for the patient.

All patients should be staying adequately hydrated during the prep process, drinking extra clear fluids as recommended by their gastroenterologists.

PEG solutions include Colyte®, Go-Lytely®, Nu-Lytely®, and Half-Lytely®. 

Oral sodium phosphates include Fleet’s Phospho-soda® liquid, Visicol® tablets, and OsmoPrep® tablets.