US News and World Report lists top-ranking hospitals for treating cancer in the United States.  The rankings are based on data considered important in deciding on a good hospital along with a reputation score developed by surveying a random sample of doctors who are cancer specialists.

The University of Texas M.D. Anderson Cancer Center in Houston tops the list with a score of 100.  68 percent of interviewed physicians included it among their top five hospitals.  Memorial Sloan Kettering  Cancer Center in New York ranked second with a score of 96.3 and a 66% physician reputation.

Rounding out the top five cancer hospitals are Johns Hopkins Hospital in Baltimore, the Mayo Clinic in Rochester, Minnesota, and Dana- Farber Cancer Institute in Boston.  Overall, fifty hospitals are included in the cancer speciality list.

In addition to the percentage of physicians naming a particular hospital as one of their own top five hospitals for cancer care, the ranking scores also considered:

• Mortality index:  comparison of death rates to expected rates nationwide
• Numbers of Medicare patients treated for cancer in 2003-2005.
• Nurse to patient ratios
• NCI designated comprehensive cancer center (yes or no)
• How many of 7 advanced services such as stereotactic radiosurgery or PET scanning are available.
• Available patient services such as genetic testing, pain management, palliative care, and translators.
• Accreditation by key organizations. (yes or no)

The US News rankings web site lets potential patients search for a cancer hospital by region, state, or distance from them.

WHAT THIS MEANS FOR PATIENTS

While patients may prefer to be treated in a community hospital near where they live, a second opinion at one of the highly ranked cancer hospitals may be a good choice for getting state-of-the-art care. 

Colorectal cancer treatment has moved rapidly in the past few years with new drugs, new biologic agents, and improved surgery and radiology treatments.  Having a multidisciplinary team of surgeons, medical oncologists, and radiologist working together to develop a comprehensive cancer treatment plan may improve outcomes and help balance effectiveness and quality of life.

Earlier today, the Senate Agriculture Appropriations Subcommittee marked up their Appropriations bill. The bill includes the largest increase for the Food and Drug Administration (FDA) in recent memory and is significantly larger than the House bill.

Senator Kohl, Chairman of the Subcommittee, announced $186 million in additional funding for the FDA, which is $120 million above the President’s request.

C3: Colorectal Cancer Coalition would like to thank Chairman Kohl and the other Members of the Subcommittee for the substantial increase in funds to FDA. This increase will result in enhanced drug safety for all colorectal cancer patients.

On July 25 CancerCare will present a Telephone Education Workshop featuring Daniel Haller, MD and Keith Lyons MSW, who will colorectal cancer research from the American Society of Clinical Oncology annual meeting in Chicago.

• Colorectal Cancer: Report from the 2007 American Society of Clinical Oncology (ASCO) Annual Meeting
• July 25, 2007
• 1:30 to 2:30 p.m.
• To sign up

Dr. Haller is Professor of Medicine in the Department of Medicine at the , University of Pennsylvania and Medical Director of the hematology-oncology outpatient practice at  the University of Pennsylvania Hospital.  Keith Lyons is Program Coordinator for Gastrointestinal Cancers at CancerCare.

After introductory presentations by Dr. Haller and Mr. Lyons, telephone participants will be able to ask questions.

Smoking increases the risk of colon and rectal cancer, but a large study of matched groups of smokers and never-smokers in Hawaii has found factors that impact on that risk, including whether or not cigarettes were filtered.

Researchers interviewed nearly 4000 Hawaiians, including Caucasians, Japanese, Native Hawaiians, Filipinos, and Chinese.  Two thousand pairs of smokers and never-smokers were matched for ethnicity, sex, and age.

• Overall, they found that there was a 23% increased risk for colorectal cancer in men and a similar 27% increase for women.
• The longer both men and women smoked, the greater the colorectal cancer risk.  Over 40 pack-years increased risk for men by 50%, for women by 38% over those who never smoked.  There were similar elevated risks for each ethnic group.
• Non-filtered cigarettes increased the risk for both colon and rectal cancer:  colon cancer risk by 60% and rectal cancer by almost 85%.
• Filtered cigarettes did not increase the possibility of colon cancer but did raise rectal cancer risk by 37%.

Margreet Luchtenborg and her colleagues concluded,

The data from this large study corroborate previous reports of a positive association between smoking and colorectal cancer and suggest that the association may vary by type of cigarette.

SOURCE:  Luchtenborg et al. Cancer Epidemiology, Biomarkers, & Prevention, Volume 16, Issue 7, July 1, 2007.

Now that there are several effective drugs to treat advanced colon and rectal cancer,  is it better to give several at once in combination or one after the other in sequence? 

The current issue of The Lancet has reports of two large randomized trials to compare overall survival and serious side effects of sequences of chemotherapy versus combination strategies.  The CAIRO  trial tested strategies with oral capecitabine (Xeloda®), irinotecan (Camptosar®),and oxaliplatin (Eloxatin®).  The FOCUS trial studied continuous infusion 5FU (fluorouracil), irinotecan, and oxaliplatin.

Neither trial included biologic agents bevacizumab (Avastin®), cetuximab (Erbitux®), or panitumumab (Vectibix®) which have become part of standard treatment for metastatic colorectal cancer.

A comment  in The Lancet considers whether or not this new information should prompt a change in standard chemotherapy regimens in the United States and Europe.

In the Netherlands CAIRO trial, 820 patient who had not been previously treated for metastatic colorectal cancer were randomized to receive either:

• Sequential strategy:  (First) single drug capecitabine, (Second) single drug irinotecan, (Third) combination of oxaliplatin and capecitabine (CAPOX).
• Combination strategy:  (First)combination of capecitabine and irinotecan (CAPIRI) followed by (Second) combination of capecitabine and oxaliplatin (CAPOX).

In both strategies, patients remained on each regimen until their cancer progressed and then moved to the next line of treatment.

There was no significant difference in overall survival in the CAIRO trial between the two groups.  Median overall survival for the sequential strategy was 16.3 months; for the combination strategy 17.4 months.  There was more serious hand-foot syndrome in the sequential arm (13 percent versus 7 percent for the combination arm.)

The FOCUS trial, conducted in the United Kingdom, used continuous infusion 5FU rather than oral capecitabine.  2135 patients were randomized to one of three strategies:

• A:  Continuous infusion 5FU with leucovorin followed by single agent irinotecan.
• B:  Continuous infusion 5FU followed by either 5FU plus irinotecan (FOLFIRI) or 5FU plus oxaliplatin (FOLFOX)
• C: Either FOLFIRI or FOLFOX from the beginning of treatment.

Median survival for the A strategy that used two single drugs was 13.9 months,  not as good as either B or C.  For B, median survival was 15.0 months for FOLFIRI and 15.2 months for FOLFOX.

When combinations were given from the beginning, median survival for the FOLFIRI group was 16.7 months compared to 15.4 months for FOLFOX.  Statistically, using the combination FOLFIRI strategy for first-line treatment was superior to other treatment approaches.

Writing for the CAIRO trial, lead author Miriam Koopman MD, concluded,

Our results show that, for patients with advanced colorectal cancer, combination treatment with all effective cytotoxic drugs was no better than their sequential use. Progression-free survival over all subsequent treatment lines was not significantly different between the study groups. Additionally, sequential treatment was associated with less toxicity during first-line treatment than was combination therapy.

For the FOCUS trial, Matthew T. Seymour MD and his colleagues wrote,

Our data challenge the assumption that, in this non-curative setting, maximum tolerable treatment must necessarily be used first-line. The staged approach of initial single-agent treatment upgraded to combination when required is not worse than first-line combination, and is an alternative option for discussion with patients.

Comments from Hans-Joachim Schmoll and Daniel Sargent on the meaning of these two trials and their impact on patient decision-making will be discussed in a subsequent C3 News and Events post.

SOURCE 

For CAIRO trial:  Koopman et. al.The Lancet, Volume 370, Number 9582, July 14, 2007.

For FOCUS trial:  Seymour et. al. The Lancet, Volume 370, Number 9582, July 14, 2007