Sodium phosphate tablets outperform two liter PEG colonoscopy prep

Getting the colon free of stool and ready for colonoscopy is a major challenge.  In some studies fully one third of people say that the prep is the key barrier to their being screened for colorectal cancer.

Gastroenterologists offer a variety of strong laxatives designed to completely cleanse the colon from a gallon of polyethylene glycol solution  (PEG) to a much smaller volume of sodium phosphate liquid (Eleet Phospho-soda®).  In recent years sodium phosphate has been available in tablet form (Visicol® and OsmoPrep®). 

The Halflytely® bowel preparation reduces the amount of PEG solution to two liters and adds four bisacodyl laxative tablets.

In order to compare the  safety and colon-cleansing effectiveness of sodium phosphate tablets to the two-liter PEG prep, researchers randomized 481 adults having a colonoscopy to use either

• 32 sodium phosphate tablets with clear liquid of their choice
• 2 liters of PEG solution plus 4 bisacodyl tablets

Colonoscopists did not know which prep their patients had received and rated cleansing from excellent to inadequate both overall and for the ascending colon.  The sodium phosophate tablets were significantly better than the PEG solution for cleaning stool in both assessments.

Patients who took sodium phosphate tablets were less likely to have gastrointestinal symptoms including bloating, abdominal pain, or vomiting than those who used PEG plus the bisacodyl: (64 percent versus 79 percent.) Overall, adverse events were less likely for the sodium phosphate tablets than for the PEG liquid (66 percent versus 82 percent.)

Both groups had changes in laboratory tests, but fluctuations were more common with sodium phosphate tablets especially for phosphorous, sodium, and potassium.

Led by John F. Johanson, M.D., the team concluded,

The colon-cleansing efficacy of the new 32-tablet NaP dosing regimen in this study was found to be significantly better than the 2L PEG solution plus bisacodyl tablets regimen. The 32-tablet NaP dosing regimen was associated with fewer adverse events. As expected electrolyte shifts were more common and of greater magnitude in the NaP group compared with the PEG plus bisacodyl group; however, both treatment groups demonstrated significant changes in electrolytes and creatinine.

SOURCE:  Johanson et. al., American Journal of Gastroenterology, early online articles, June 15, 2007.

WHAT THIS MEANS FOR PATIENTS

Patients preparing for a colonoscopy can feel comfortable that sodium phosphate tablets will clean the colon as well as or better than a two liter container of PEG solution.

They may have less bloating, cramping, and vomiting with the tablets.

However, patients with kidney or cardiac problems will want to discuss the choice of colonoscopy prep carefully with their doctors since there is a greater change in body electrolyte balance with tablets.

Posted by Kate Murphy on June 18th, 2007
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Labor HHS Mark-Up Postponed

I ventured up to Capitol Hill this morning for one last ditch effort to make the House Appropriations Committee Members understand that the funding established in the Subcommittee for The National Institutes of Health (NIH) and The National Cancer Institute (NCI) are not sufficient to continue our fight against cancer.

As I approached the Committee Room I was pleasantly surprised to see the sign on the door that said, “LHHS Mark-Up postponed.” What does this mean for us? This gives us a chance to rally the troops and reach out to the Appropriations Committee Members’ Offices with our message.

Let them know that 1.9% increase for NIH and 1.5% increase to NCI are some of the worst numbers we have seen in years and are not adequate to fight this war against cancer!!

The message is simple:
• Over 52,000 people will die from colorectal cancer in 2007 alone.
• 186 members of the House of Representatives signed a letter in support of a 6.7% increase for NIH.
• Failure to provide adequate funding will stall the next generation of breakthroughs for cancer patients. The current bill proposed in the House would do just that.

TAKE ACTION TODAY!!

For a listing of Committee Members and their phone numbers, click here (PDF file)

Posted by Joe Arite on June 14th, 2007
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NCI increase recommended by subcommittee insufficient to maintain progress

Last month, in a show of support for adequate funding of cancer research, 186 House members signed a letter backing a 6.7 percent increase for the National Institutes of Health (NIH), which includes the National Cancer Institute (NCI). C3 advocates joined others in the cancer community in requesting a 6.7 percent increase for NCI and NIH.

Last week the House Appropriations Labor, Health and Human Services, and Education (LHHS) Subcommittee marked up a bill containing only a 1.9 percent increase for NIH and a 1.5 percent increase for NCI. This is inadequate to maintain the progress we’ve made against cancer.

There will be 153,700 new cases and 52,180 deaths from colon and rectal cancer this year. Without sufficient funds cancer research which could provide a cure will slow to a crawl. There will be less basic research of cancer, which means we won’t know how normal cells become cancerous and the best intervention points. Fewer new treatments will result in fewer options for people suffering from colorectal cancer. Decreased investigation of how to better use existing treatments means we won’t know who would benefit from what treatment.

Should this small increase pass it will continue the inadequate funding of the past several years and would actually be a decrease when inflation is considered.

The House Appropriations Committee is scheduled to meet this Thursday to consider the LHHS Subcommittee recommendation. We need to tell all the members of the committee that this increase is unacceptable and that they can - and must - do better for us. We want a little less talk and a lot more action.

Call the members of the Appropriations Committee and let them know these numbers are unacceptable! For a listing of committee members and their phone numbers, click here (PDF file).

Posted by Dusty Weaver on June 13th, 2007
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Smoking reduces amount of irinotecan available in the body

Cigarette smokers being treated with irinotecan (Camptosar) had a significantly reduced concentration of the drug in their blood than non-smokers. 

In the body, irinotecan is converted to SN-38 which active in treating colorectal cancer.  However, smokers had 40 percent less SN-38, and it was converted more quickly to a non-active state. 

Possibly as a result of lower amounts of active drug, smokers had less toxicity during treatment.  In particular, only 6 percent of those in the study had severe reduction in white blood cells compared to 38 percent of non-smokers.  While they had somewhat less serious diarrhea, it was not significant.

Jessica M. van der Bol headed a team in the Netherlands, Sweden, and the United States who evaluated irinotecan activity and side effects in 49 smokers and 141 non-smokers who were receiving cancer treatment.

They concluded,

This study indicates that smoking significantly lowers both the exposure to irinotecan and treatment-induced neutropenia, indicating a potential risk of treatment failure.  The data suggest that additional investigation is warranted to determine whether smokers are at increased risk for treatment failure.

In an accompanying editorial, Neal L. Benowitz from the Division of Clinical Pharmacology at San Francisco General Hospital Medical Center suggests that smokers may need to be treated with increased doses of irinotecan.  He also urges that doctors encourage smokers to quit reminding them that smokers with cancer have

• Decreased overall survival
• Decreased response to radiation treatment
• An increased risk of second primary cancers
• An increased risk of infections, including pulmonary infection

SOURCE:  Jessica M. van der Bol et. al., Journal of Clinical Oncology, Volume 25, Number 19, July 1, 2007, published early online June 11, 2007.

Editorial by Neal L. Benowitz in the same issue.

What this means for patients

Smokers may have a reduced response to irinotecan and should discuss this with their doctors before beginning treatment.  Your doctor may want to increase the dose of irinotecan to compensate.

Smoking remains dangerous even after a diagnosis of cancer.  Trying to quit may improve your chances for a better outcome.

Posted by Kate Murphy on June 12th, 2007
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Missouri’s experience with colorectal cancer screening legislation

In our effort to get colorectal cancer screening legislation passed at the state level we can forget to look at the effect of such a mandate. Thanks to an article published Wednesday, May 23 in the Maryville (Missouri) Daily Forum we have that opportunity.

In 1999 Missouri enacted HB 191 which, among other things, required health insurers and similar entities to provide colorectal cancer exams and laboratory tests coverage for nonsymptomatic persons in accordance with American Cancer Society (ACS) guidelines. This caused Missouri to receive an “A” on the latest colorectal cancer legislative report card issued by the National Colorectal Cancer Research Alliance.

Missouri experienced a 10 percent decrease in the number of annual estimated colon cancer deaths since passage of HB 191. The number of colon cancer deaths went from about 1,300 in 2001 to an estimated 1,170 in 2007. “Missourians can be proud that out state is contributing to the drop in colon cancer deaths,” said retired Missouri State Senator Patrick Dougherty, the sponsor of HB 191 in 1999.

Sen. Dougherty added, “We know legislation makes a difference. The states like Missouri that require insurance coverage are also the states that have higher screening rates.” The article cited an ACS study released last May which found that screening rates in states with coverage laws had risen 40 percent faster between 1999 and 2004 than states without such laws.

We extend a late thank you to Sen. Dougherty and others in Missouri who worked to pass this legislation which is a vital part of the fight against colon and rectal cancer.

Go here to read the Maryville Daily Forum article.

Go here for information about HB 191.

Go here to see the Colorectal Cancer Legislative Report Card.

Posted by Dusty Weaver on June 11th, 2007
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