One third of over 740 respondents to a Mayo Clinic survey said that the laxative preparation was the most troublesome part of colorectal cancer screening.

Overall, the likelihood of being screened rose when the need for laxative preparation was removed.

People who had already had one screening with a laxative were the group most likely to say that they were “much more likely” to undergo screening in the future if there were a test that didn’t require a laxative.  They also  regarded the laxative as “a big problem” most often.

Timothy J. Beebe, PhD and his team from the College of Medicine at the Mayo Clinic concluded:

In this prospective survey, laxative preparation appeared to be a major disincentive to CRC screening. Emerging data suggest that performance of laxative-free computed tomographic colonography may represent an attractive option that removes this relatively common disincentive to CRC screening participation.

Computed tomographic colonography (CTC) or so-called virtual colonoscopy can avoid laxatives by tagging stool with contrast agents.

However, in an accompanying editorial, Perry J. Pickhardt, M.D. from the University of Wisconsin Medical School in Madison points out that laxative-free or non-cathartic preparation for virtual colonoscopy are not prepless.  Patients still must adhere to dietary restrictions prior to the procedure and must drink contrast agents.

While a laxative-free regimen might increase compliance in those who put off screening because of the laxative preparation, Dr. Pickhardt believes that there are drawbacks to non-cathartic preps including:

• The need for oral contrast agents and dietary restrictions that may extend for 48 hours or more.
• Potential for missed polyps.
• False positive results that would result in unnecessary follow-up optical colonoscopies
• Not being able to have “one-stop” testing where optical colonoscopy could be done on the same day to remove polyps found on CTC.

He also points out that the group that most disliked laxative preps were people who had already been screened, and it was critical to reach those who had never been tested at all.

In conclusion, Dr. Pcikhardt wrote,

Because increased participation in effective screening programs represents the overriding challenge facing CRC prevention, offering both cathartic and noncathartic options for CT colonography may very well be the most prudent approach for our heterogeneous population that expresses divergent preferences and needs. Although it may initially appear counterintuitive, the noncathartic approach to CT colonography may in fact turn out to be more onerous overall than a low-volume preparation that incorporates laxatives, especially for patients with positive findings on examination.

SOURCE:  Beebe et. al., Mayo Clinic Proceedings, Volume 82, Number 6, June 2007.

Pickhardt, Mayo Clinic Proceedings, Editorial, Volume 82, Number 6, June 2007.

NEWS FROM ASCO 2007

Stage III colon cancer patients who followed a “Western diet” with emphasis on red meat, fat, refined grains, and dessert were significantly more likely to have their cancer return than those who reported they ate a “prudent diet” with emphasis on higher intakes of fruit and vegetables, poultry, and fish.

Researchers, led by Jeffrey A. Meyerhardt, asked patients in both arms of chemotherapy clinical trial to complete diet questionnaires during their treatment and six months afterwards.  Over 130 food items were included along with vitamin and mineral supplements, with space for patients to include foods or supplements not listed.

The foods were correlated as to how much they fit a prudent pattern or a Western pattern of eating.  The completed answers were divided into five groups or quintiles from the most prudent to the most Western.

Patients whose diet most closely resembled the Western pattern and fell into the fifth quintile were nearly four times more likely to have their cancer return or die within three years that those in the first quintile who ate the most prudent pattern foods.

Risk of dying or having cancer return was was 3.91 times higher for Western pattern eaters.  Recurrence risk was 3.14 times higher.

The diet evidence was particularly strong since all patients were enrolled in a clinical trial and consistently received one of two treatments.  There was no statistical difference between disease-free survival or recurrence between the two chemotherapy groups so differences in recurrence could reasonably be assumed to be due to differences in diet pattern.

Further analyses are underway to try to pinpoint what specific foods or food combinations are most responsible for the difference in disease-free and recurrence-free survival.

SOURCE: Abstract #4019 ASCO 2007 Gastrointestinal (Colorectal) Cancer Poster Display/Discussion Session

NEWS FROM ASCO 2007

Alvimopan (Entereg®) reduced complications from the temporary loss of gastrointestinal function that follows bowel resection surgery (post-operative ileus).  Compared to colorectal cancer patients who received a placebo, hospital stays were shorter, time to bowel recovery was faster, and there were fewer complications from ileus.

James L. Weese M.D. and colleagues analyzed four randomized, double-blinded clinical trials with over 700 patients that compared alivimopan to a placebo in patients undergoing bowel resection.  Patients were all scheduled to have their post-operative pain managed by intravenous opioids via a PCA (patient-control analgesia) pump.  His analysis looked specifically at bowel resection for colorectal cancer.

Patients with nasal gastric tubes had them removed on the first day after surgery.  They were encouraged to begin walking that day.  Solid food was offered on the second post-operative day.

Patients who received alvimopan

• Had a faster GI recovery:  were able to tolerate solid food and have their first bowel movement sooner
• Had a shorter hospital stay:  Colorectal cancer patients left the hospital in an average of 5.7 days on alvimopan as opposed to staying 7.1 days if they were getting a placebo.
• Had fewer post-operative ileus-related complications including needing a nasal gastric tube reinserted, having a prolonged hospital stay, or having to be readmitted to the hospital.
• Had less nausea, vomiting, diarrhea, and fever.

Alvimopan blocks the activity of opioid drugs such as morphine on the intestinal tract without interfering with pain control.

More than 250,000 people undergo bowel resection each year in the United States, a majority of them as part of colorectal cancer treatment.  Post-operative ileus is a temporary cession of normal gastrointestinal function, and occurs to some extent after all bowel resections. 

Post-operative ileus

• Delays the passage of intestinal gas (flatus) and stool.
• Makes it difficult for patients to eat solid food.
• Causes abdominal distension and bloating.
• Increases nausea and vomiting.
• Can be made worse by opioid pain relievers

SOURCE:  Abstract #4014 ASCO 2007 Poster Display/Discussion

Photo taken at C3′s Call-on Congress awards dinner, March 2007.

I was ready—C3 materials somewhat neatly displayed at my half table at last week’s National Cancer Survivors Day event at The Wellness Community of Central New Jersey, Bedminster, my passion and enthusiasm stoked. When would the people come to me? Would I have the time to talk about the work of C3, convince some to go to the One Minute Advocate Page and support HR 1738? Would people listen? Would people come and ask for more information?  Yes! 

Approximately 100 people were expected to attend the outdoor event held in the outdoor area of the holistic wellness facility. As people walked around collecting information and adding more neon and pastel armbands, they usually found their way to me and to C3. I wondered if they would be interested in our advocacy efforts and would take the jump to become a One Minute Advocate or more.

At first, I was surprised at the level of response to the one-page information sheet pertaining to The Colorectal Cancer Prevention, Early Detection, and Treatment Act (HR 1738). Although most of the people whom I spoke with did not have colorectal cancer, many knew someone who did. They promised to go to the C3 website, the Advocacy pages and to tell others. I felt that C3 rush again!
Many responded to me when I told them that I was a Survivor. Repeatedly, I heard, “You look so well. Stage III colorectal cancer. I will tell my friend. I will tell my sister. I will tell my dad.” I urged them to check out the C3 website. I explained that we work to educate, advocate and raise funds for The Lisa Fund, research for late stage colorectal cancer research.

It was great to meet other advocates, volunteer and professional, and find encouragement from other groups engaged in Cancer education, information and advocacy. We briefly exchanged Call on Congress stories, ideas, and that contagious advocacy excitement.

Earlier last week, I visited Rep. Bill Pascrell’s (D-N.J.) town hall meeting in Verona, N.J. Although I was told that Rep. Pascrell was going to be busy, I did have the opportunity to speak again with Ben Rich, Chief of Staff, who acknowledged me warmly. I apprised him of the key points of HR 1738, gave him the one page summary of the Bill, and asked him to remind Rep. Pascrell that this Bill could implement some of what we discussed at the March breakfast during Call on Congress. Ben assured me that he would inform Rep. Pascrell.

The town meeting was a good time to meet New Jersey staff members and talk with them about C3, colorectal screening and the need for Federal screening centers. Unfortunately, I had to leave early since I had to facilitate a holistic wellness circle. 

I reflected on this busy advocacy week as I traveled to the circle location. All was well, indeed!

The Cancer Prevention Program of the Baltimore, Maryland County Health Department provides free colorectal cancer screening, including colonoscopy, for county residents age 50 and over.  Participants must be income-eligible and lack health insurance or have health insurance that does not cover screenings.

All care is provided through private medical offices in the Baltimore area. Nurse case management staff help patients enroll and schedule a screening with a private health care provider. Assistance with diagnosis and treatment if problems are found during screening is also available through the program.

More information is available a 1-866-MD-COLON or 410-887-3556.