Psychological distress in colorectal cancer survivors should be assessed

Cancer survivors who have psychological distress have a poorer overall quality of life and may have problems caring for themselves.  They have difficulty following treatment recommendations and taking care of their health.

While such distress is not common in colorectal cancer survivors, it does exist in about eight percent of them six months after diagnosis, and almost 7 percent twelve months after they first heard of their cancer according to an Australian study.

The Queensland researchers found factors that were related to psychological distress and predicted it twelve months after diagnosis including:

• psychological distress at six months
• other physical illness or problems
• perceived threat of cancer

Factors that reduced risk for psychological distress were

• Optimism
• Social support

Writing in the January 18th issue of Cancer, , Bridget Lynch and her team said,

Distress screening at regular intervals is needed to efficiently detect colorectal cancer patients who require in-depth psychological intervention. Threat appraisal is a modifiable variable that should be included in interventions for colorectal cancer survivors. Further research is needed to investigate the potential for physical activity to reduce distress after cancer.

SOURCE:  Lynch et al. Cancer, Volume 112, Issue 6, January 18, 2008.

Posted by Kate Murphy on March 17th, 2008
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Clinical Trial: Continuing Avastin after colorectal cancer progresses

Does it help to continue Avastin® (bevacizumab) once colorectal cancer being treated with FOLFOX and Avastin gets worse?

Patients are being recruited for a phase III randomized trial to help answer that question.

Many people with cancer that has spread outside their colons (stage IV) are initially treated with the biologic agent Avastin along with FOLFOX or XELOX chemotherapy that contains Eloxatin® (oxaliplatin).  Once tumors progress and get larger on this first-line therapy, the chemotherapy is changed, usually to a regimen based on Camptosar® (irinotecan), sometimes also including Erbitux® (cetuximab). 

All patients in the SWOG-S0600 trial will receive either irinotecan alone or in the FOLFIRI combination.  In addition they will be randomly assigned to one of three arms:

1. Erbitux (cetuximab)
2. Both Erbitux and a low dose of Avastin (bevacizumab)
3. Both Erbitux and a higher dose of Avastin

In order to be eligible patients must

• Have metastatic colorectal cancer
• Have progressed on first-line therapy that included both oxaliplatin (FOLFOX, XELOX, or OPTIMOX) and Avastin.
• Have tumors that can be measured
• Not have tumors that have spread to the brain.

The trial is being run collaboratively in the United States and Canada by five  cancer collaborative groups:  Southwest Oncology Group, North Central Cancer Treatment Group, Cancer and Leukemia Group B, Eastern Cooperative Oncology Group, and National Cancer Institute of Canada Clinical Trials Group. 

Principal investigators for the trial are Dr. Philip Gold and Dr. Anthony Shields, SWOG; Dr. Axel Grothey, North Central Cancer Treatment Group; Dr. Leonard Saltz, CALGB; Dr. Steven Cohen, ECOG; and Dr. Scott Berry, NCIC-Clinical Trials Group

SWOG- S0600 is available in many community sites throughout the United States and Canada.  Find a trial site near you and a contact number.

The primary goal of the trial is to find out if there is a difference in overall survival time among the three trial arms.  Researchers will also be studying the time it takes before cancer progresses (progression-free survival), whether tumors shrink (response rate), and serious side effects in the three different treatment plans.

The trial is featured in the NCI Cancer Bulletin.

Posted by Kate Murphy on March 17th, 2008
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Senate adds $2.1 billion to NIH budget

Thursday, March 13 the Senate passed an amendment (S. Amdt. 4203) to the Fiscal Year (FY) 2009 Congressional Budget Resolution (S. Con. Res. 70) which increased funding to the National Institutes of Health (NIH) by an additional $2.1 billion. The vote was 95 yeas, 4 nays and 1 not voting

This addition, along with the $950 million already contained in the resolution would provide NIH with an increase of $3 billion or 10.3 percent over the FY 2008 appropriation.

A doubling of the NIH budget started with FY 1998 and ended with FY 2003. These prior investments in cancer research, education, prevention, awareness, treatment and control brought real progress against colon and rectal cancer.

In floor remarks Sen. Arlen Specter of Pennsylvania, the amendment’s sponsor, noted that since the doubling took place “NIH has failed to keep pace with biomedical inflation and as a result has lost 15 percent of its purchasing power.” He added:

“I, like millions of Americans, have benefited tremendously from the investment we have made in the National Institutes of Health and the amendment that we offer today will continue to carry forward the important research work of the world’s premier medical research facility.”

Cosponsors of the amendment were:

• Tom Harkin, Iowa
• Olympia J. Snowe, Maine
• Susan M. Collins, Maine
• Robert P. Casey, Jr., Pennsylvania
• Edward M. Kennedy, Massachusetts
• Elizabeth Dole, North Carolina
• Barbara A. Mikulski, Maryland
• Hillary Rodham Clinton, New York
• Carl Levin, Michigan
• John E. Sununu, New Hampshire
• Christopher J. Dodd, Connecticut
• Daniel K. Inouye, Hawaii
• Sherrod Brown, Ohio
• Robert Menendez, New Jersey
• Debbie Stabenow, Michigan
• Norm Coleman, Minnesota
• John F. Kerry, Massachusetts
• Richard Durbin, Illinois
• Ted Stevens, Alaska
• Gordon H. Smith, Oregon
• Jeff Bingaman, New Mexico
• Thad Cochran, Mississippi
• Benjamin L. Cardin, Maryland
• John D. Rockefeller, IV, West Virginia
• Barak Obama, Illinois
• Blanche L. Lincoln, Arkansas
• Frank R. Lautenberg, New Jersey
• Tim Johnson, South Dakota
• Orrin G. Hatch, Utah
• Joseph R. Biden, Jr. Delaware

Please take this time to contact your Senators and either thank them for voting for the amendment or express your disappointment if they voted against it.

Go here to see how your Senators voted.

Posted by Dusty Weaver on March 15th, 2008
Posted in: Policy & Advocacy News | No Comments »

Colon Cancer Day at the Capitol in Kentucky March 19

Advocates from the Colon Cancer Prevention Project in Kentucky will travel to the state capitol in Frankfort to support passage of HB 415, the Kentucky Colon Cancer Screening Act.

• Colon Cancer Day at the Capitol
• Wednesday, March 19, 2008
• 10:00 am - 2:00 pm
• Senate Health and Welfare Committee at 10 am Capitol Annex Room 131
• Lunch from 11 am to 1 pm in Capitol Annex Room 111
• Frankfort, Kentucky
• For reservations, call (502) 352-2987 or
• email sturner3@alltel.net

Colorectal Cancer Prevention Project

The mission of the Colon Cancer Prevention Project is to eliminate preventable colon cancer death and suffering by increasing screening rates through education, advocacy and health systems improvement in Kentucky and surrounding communities.

March is National Colorectal Cancer Awareness Month

Colorectal Cancer is Preventable, Treatable, and Beatable

Posted by Kate Murphy on March 15th, 2008
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CDC reports more people being screened for colorectal cancer

More Americans age 50 and over reported having been screened for colorectal cancer either with an FOBT test or colonoscopy or sigmoidoscopy in 2006 than in 2004 according to a report from the Centers for Disease Control and Prevention.  Nearly 61 percent report having used a take-home stool test kit in the past year or having had lower endoscopy in the past ten years.

In 2006, 60.8 percent had completed either FOBT or endoscopy compared to 56.8 percent in 2004 and 53.9 percent in 2002.

People who had never been screened at all declined from 34.2 percent in 2002 to 32.2 percent in 2004 to 29.5 percent in 2006.

The report was based on the 2006 Behavioral Risk Factor Surveillance System telephone survey.  During the survey people were asked if they had ever used a "special kit at home to determine whether the stool contains blood (FOBT)," whether they had ever had "a tube inserted into the rectum to view the colon for signs of cancer or other health problems (sigmoidoscopy or colonoscopy)," and when these tests were last performed.  Identical questions were asked in 2006, 2004, and 2002.

Those reporting a lower endoscopy sometime in the past ten years increased with each report — from 44.8% in 2002, to 50.1% in 2004, and to 55.7% in 2006.  On the other hand, FOBT was used less often declining from 21.6% in 2002, to 18.5% in 2004, and to 16.2% in 2006.

Image from CDC

Age, income, education, insurance status and ethnic background made a difference in whether people were screened or not.

• 54.7% of people from 50 to 64 had been screened versus 69.3% age 65 and older
• 45.5% with less than high school diploma vs. 68.7% of college graduates
• 36.7% with no health insurance vs. 68.7% with health coverage
• 47.2 Hispanic vs. 62% of Non-Hispanic

As annual household income rose, so did screening participation.

Less than $15,000 — 48.4%

$15,000 to 34,999 –  53.9%

$35,000 to 49,999 –  62.0%

$50,000 to 74,999 –  67.2%

Over $75,000        –   70.4%

Among racial groups

• 62.6% of White, non-Hispanics had been screened
• 59.0% of Black, non-Hispanics
• 55.9% of Asian or Pacific Islanders
• 48.4% of Native Americans/Alaskan Natives
• 46.2% of those who called themselves other

There were also wide disparities among states ranging from 51.8 percent in Mississippi to 70.5 percent in Connecticut.

In an editorial note accompanying the statistics, the Centers for Disease Control and Prevention noted,

The findings in this report indicate that overall use of colorectal cancer tests increased from 2002 to 2006. Although this increase is encouraging, disparities persist in colorectal cancer test use. Colorectal cancer test use increased among racial/ethnic minorities, those without health insurance, those with annual household incomes <$35,000, and those with less than a high school education; however, these groups had a substantially lower prevalence of colorectal cancer test use than did other groups surveyed. Factors that might contribute to disparities in colorectal cancer test use include lack of awareness of the need for screening, lack of recommendation for screening from a physician, lack of health insurance, and lack of a usual source of health care.

Answers to questions asked during the survey were limited because they did not make a difference between flexible sigmoidoscopy which is recommended every 5 years and colonoscopy with an every 10 year guideline.  People responding to the survey also didn’t indicate whether their endoscopy was for screening or because they had symptoms of colorectal cancer.

SOURCE: Morbidity and Mortality Weekly Report, March 14, 2008.

Posted by Kate Murphy on March 15th, 2008
Posted in: Research & Treatment News | No Comments »