Although rectal cancer surgery that preserves the muscle the closes the rectum (anal sphincter-sparing surgery) has doubled in the last sixteen years, more than half of patients in the United States do not receive it.  When the anal sphincter is removed, a permanent colostomy is necessary. 

Analyzing data from the National Inpatient Sample, a randomized selection of patients treated in United States hospitals, researchers found that 27 percent of rectal cancer patients had sphincter-preserving surgery in 1988.  By 2003, the rate had increased to 48 percent.  They noted that there has been no significant change in that rate since 1999.

However, they discovered that patients who were older, black, or male had less chance for sphincter-saving surgery.  In addition, those whose treatment was covered by medicaid or who lived in low-income zip codes also had lower rates of such surgery.

Concluding, the team wrote,

Despite a significant increase in the rate of sphincter-sparing surgery with reestablishment of intestinal continuity, most radical resections for rectal cancer in hospitals in the United States result in a colostomy. Patients vulnerable to proctectomy without sphincter preservation were older, male, black, used Medicaid insurance, or lived in lower income zip codes.

They also noted,

Worldwide, “centers of excellence” in rectal cancer surgery report high rates of anal sphincter-sparing surgery (70-90 percent) after proctectomy

SOURCE: Ricciardi et al, Diseases of the Colon and Rectum,Volume 50, Number 8, August 2007.

WHAT THIS MEANS FOR PATIENTS

A second surgical opinion is important for people with rectal cancer particularly if they have been told that they will need a permanent colostomy.

Patients can locate a board-certified member of the American Society of Colon and Rectal Surgeons practicing near them.

CancerCare will hold a Telephone Education Workshop: Living with Colon Cancer on November 16, 2007 from 1:30 PM to 3:30 PM, Eastern time.

Speakers include:

• Howard A. Burris, III  MD:  Chief Medical Officer, Director of Drug Development, Sarah Cannon Research Institute
• Edith P. Mitchell MD:  Clinical Professor of Medicine in Medical Oncology, Director of Diversity & Minority Programs, Thomas Jefferson University, Kimmel Cancer Center
• Keith Lyons MSW: Program Coordinator for Gastrointestinal Cancers at CancerCare

After the speakers’ presentations, telephone participants will have an opportunity to ask questions.

Pre-registration is necessary to reserve a place on the call.  Information about how to join the workshop from your own telephone will be sent to you prior to the call, including the telephone number needed.

C3 Colorectal Cancer Coalition is a partner with CancerCare in presenting this Telephone Workshop.

Spouses who are caring for a loved one with cancer have a significantly increased risk of being clinically depressed.  In a study done at Princess Margaret Hospital in Toronto, nearly forty percent of caregiving spouses were depressed, almost twice as many as the twenty-three percent of their partners with cancer.

All patients in the study had metastatic cancer, either lung cancer or GI cancer.

Risk for depression was increased by several factors, including some that were part of the existing relationship between the partners:

• Caregiver’s perception of the difficulty of the tasks involved in caring for their spouse.
• Worries that their partner would not be available in times of need or anxious attachment.
• Distrust of their partner’s goodwill  leading to caregiver need for independence and emotional distance or avoidance attachment.
• Dissatisfaction with the marriage relationship.

Average age of the spouses in the study was 60, and two thirds of them were women.  They had been in the relationship with their partners for an average of 30 years.  About half were not working.  Patients had been ill with cancer for a median of a little over two years.

The research team concluded,

Spouse caregivers of patients with advanced cancer are a high-risk population for depression. Subjective caregiving burden and relational variables, such as caregivers’ attachment orientations and marital dissatisfaction, are important predictors of caregiver depression.

SOURCE:  Braun et al, Journal of Clinical Oncology, Volume 25, Number 30, October 20, 2007.

WHAT THIS MEANS FOR PATIENTS AND FAMILIES

Depression serious enough to need treatment is common among spouses who are caring for patients with advanced colorectal cancer.

Caregivers who are persistently feeling sad, anxious or hopeless, have had changes in their normal eating or sleeping, or who have lost interest in activities they previously enjoyed may be clinically depressed. 

They should talk to their doctors, a psychotherapist, or an oncology social worker because depression can be treated.

Patients, too, can be depressed, although less frequently than caregivers.  They may need to be aware of the signs of depression in their spouses and urge them to seek help.

All the members of the Ancaster Avalanche AA Major PeeWee team ran in the Ninth Annual Wellwood 5K Run for Colorectal Cancer Awareness.

The Walk/Run was held at McMaster University in Ontario on Sunday, November 14.

Two young members of the team placed among the top ten finishers in the 5K race.

The annual walk and run is held to raise awareness of colorectal cancer and to benefit Wellwood, a resource center in Hamilton, Ontario dedicated to helping people live well with cancer.

All of Wellwood’s programs are free and led by trained volunteers who have their own experiences with cancer.

An infusion of ibandronate (Boniva®) given to colorectal cancer patients whose cancer had spread to their bones prevented or delayed more serious problems from those bone metastases.

Researchers in Greece randomly gave infusions of ibandronate or a placebo to patients with bone mets.  They measured the numbers of skeletal events and the time before they appeared.

Skeletal events included:

• bone fracture
• spinal cord compression
• need for radiation therapy to the bone
• need to change chemotherapy
• surgery to bone

Ibandronate infusions reduced the percentage of patients who experienced a skeletal event and increased the the time before the first one occurred.  Thirty-nine percent of patients who had the drug had a skeletal issue compared to 78 percent of those receiving a placebo.  The drug prolonged the time until the first event by at least six months — 279 days with ibandronate compared to 93 days with placebo.

It also increased the time before bone mets grew worse — 214 days versus 81 days with placebo.

The drug was well tolerated with very few serious side effects.  There was no more kidney problems in patients who received the drug compared to those who were given a placebo.

The research team concluded,

Ibandronate provided significant clinical benefits for patients with bone metastases secondary to CRC. These results indicate that ibandronate may be an effective treatment for patients with metastatic bone disease following CRC. Larger studies are required for further assessment.

SOURCE: Heras et al, European Journal of Cancer Care, Volume 16, Issue 6, November 2007