Happy Holidays!

Very best wishes for a wonderful holiday season and a happy and healing New Year.

I hope everyone whose lives are touched by colorectal cancer find a day of peace and respite from anxiety.  Feel strong today!

In this season, I am especially grateful remembering all the folks who brought me safely through this last bout with colon cancer.

I am grateful for Dr. Brian Anderson who hung on until he got the unexpected diagnosed and Dr. Jose Guillem and his team at Memorial Sloan Kettering who did the surgery with such skill.  Dr. Jonathan Wright at Upstate Medical University has promised to keep me healthy, watching diligently for all the little surprises that hereditary non-polyposis colon cancer can produce.

Heidi Cross, ostomy nurse at Crouse Hospital, dried my frustrated tears and got me properly outfitted with a pouching system that works and introduced me to wonderful support group full of good people and good ideas.  I also learned a lot from Shaz’s Ostomy Pages.

The Healing Ministry at St. James Church in Skaneateles and the St. James Prayer Chain made this entire experience much, much easier that it might have been.  When I think of all their prayers, I realize that it could have been worse and it wasn’t.  I went into the OR totally unafraid because I knew that while I slept, they prayed.

Many thanks are due to the team at C3 who picked up work cheerfully. when I couldn’t do it.

Most of all, the ACOR Colon List friends gave me support and love and very practical help.  What a special, special bunch! 

Finally, I could not have done all of this without my family — my sisters, my sons, and my wonderful husband Tom who drove back and forth from New York, stayed in motels, and was there all of the time when I needed him.

As Julian of Norwich wrote,

And so our good Lord replied to all the questions and doubts that I could raise, saying most reassuringly: "I am able to make everything well, and I know how to make everything well, and I wish to make everything well, and I shall make everything well; and thou shalt see for thyself that all manner of things shall be well.

Love to you all — doctors, nurses, friends, family — the support we need to get through.  May all things be well for you.

(That’s Bob in the snow who is bothered by very little and is the fuzzy soul of patience.)

Strong days to all of you.  Find your own patience and courage and healing.

Kate

Enjoy a holiday song from the Centers for Disease Control.

The CDC helps prevent colorectal through its Screen for Life colorectal cancer screening awareness program and the Screening Demonstration Program.

To expand the work of the CDC,  HR 1738: The Colorectal Cancer Prevention, Early Detection, and Treatment Act will expand the demonstration program at the Centers for Disease Control and Prevention (CDC) to provide colorectal cancer screenings and treatment for low-income, uninsured and underinsured people across the United States. 

To get advocate for passage of this legislation, go to CoverYourButt.Org and get involved.

Uninsured people diagnosed with colorectal cancer are more likely to die of the disease than those with health insurance according to a new study published by the American Cancer Society.

After five years 34 percent of white colorectal cancer patients with private insurance had died compared to 55 percent of those with no health insurance.  For African Americans with colon or rectal cancer, 42 percent of insured died, but 59 percent of uninsured were dead.

Overall, uninsured patients with any cancer are twice as likely to die as the insured.  After five years 35 percent of uninsured died, compared to 23 percent of the insured.

The ACS study analyzes data from National Health Interview Survey (NHIS) in 2005 and 2006 and the National Cancer Data Base (NCDB) from 1999 and 2000 relating health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer for patients from 18 to 64.  Older patients with access to Medicare were not included in the analysis.

People with private health insurance were more likely to be up-to-date with colorectal screening — either had fecal occult blood testing within the past two years or an endoscopy within the past ten.

Colorectal Cancer Screening Up-to-Date

• 44.2 percent of all people surveyed
• 48.3 percent of those with private health insurance
• 39.5 percent of those covered by Medicaid
• 18.8 percent of uninsured at the time of the NHIS interview
• 14.9 percent of people uninsured for more that 12 months

Those with private health insurance were more likely to be diagnosed with colorectal cancer at an early stage I and less likely to be diagnosed at stage IV where survival is very limited.  Despite insurance status, African Americans were less often diagnosed at stage I and more often diagnosed at stage IV.

Diagnosis at Stage I – Rounded

• 26 percent of privately insured whites first diagnosed at stage I
• 14 percent of Medicaid or uninsured whites
• 22 percent of insured African-Americans
• 15 percent of Medicaid or uninsured African-Americans

Diagnosis at Stage IV – Rounded

• 20 percent of privately insured whites first diagnosed at stage IV
• 30 percent of Medicaid or uninsured
• 25 percent of privately insured African-Americans
• 33 percent of Medicaid or uninsured African-Americans

After five years, colorectal cancer patients with private insurance are much more likely to be alive than those on Medicaid or without insurance.  Again, African Americans have lower survival despite insurance.

Survival at 5 years – Rounded

• 66 percent of privately insured whites
• 47 percent of whites on Medicaid
• 45 percent of uninsured whites
• 58 percent of privately insured African Americans
• 41 percent of African Americans either on Medicaid or uninsured.

Although the study differentiates between Medicaid and lack of insurance, many colorectal cancer patients first obtain Medicaid coverage when they are diagnosed.  Only 46 percent were on Medicaid prior to finding out they had colon or rectal cancer.  So worries about paying for care may well have delayed diagnosis or prevented screening.

Along with information about the ACS study, Associated Press writer Mike Stobbe reports the story of Peggy and Edward Hicks, a family without insurance. Edward Hicks had surgery in 2005 for colon cancer.  Although chemotherapy was suggested after the operation, he didn’t get it.  When he felt a lump in his stomach in February of 2007, it took several months to get an appointment with a cancer specialist.  When he finally saw on, chemotherapy was prescribed, and his wife Peggy was able to get the drug paid for by a pharmaceutical company.

But that took time.  Edward didn’t start chemo until mid-June.  He died in August at the age of 64.  Although friends think his life might have been prolonged if he’d had chemo earlier, Peggy doesn’t agonize over it according to the AP story.  Instead she worries about $21,000 in hospital bills and other unpaid costs of his care.

SOURCE: Ward et al. CA: A Cancer Journal for Clinicians, Published Online Before Print, December 20, 2007.

Despite a previous public health advisory in July of 2005, the FDA continues to receive reports of life-threatening side effects from improper use of fentanyl pain patches.  On December 21, 2007, the FDA issued another public health advisory about using the patches safely.

Reports include information that patients are replacing the patches more often than prescribed, using more patches at one time than prescribed, and exposing the patches to heat from heating pads, electric blankets, saunas, hot baths etc.  Heat will increase the amount of drug that is released from the patch, sometimes to dangerous levels.

In addition, patches are sometimes being prescribed inappropriately for short-term or occasional pain. 

FDA emphasizes that the patches are a powerful narcotic drug that should not be used for

… acute pain following surgery, for headaches, occasional or mild pain

According to FDA, fentanyl patches are appropriate only for patients who are already opioid-tolerant,  who have been taking other narcotic pain medicine on a regular basis to treat moderate to severe pain.  For patients who are not already used to opiod pain drugs, the amount of fentanyl in one patch at the lowest dose is enough to cause serious side effects including difficulty breathing and death.

FDA  highlights the following important safety information on the fentanyl skin patch which C3  News has copied directly.

• The fentanyl patch should only be used by patients who are opioid-tolerant and have chronic pain that is not well controlled with other pain medicines.  They are not to be used to treat sudden, occasional, or mild pain or pain after surgery. 
  
• Healthcare professionals who prescribe and patients who use the fentanyl patch should be aware of the signs of fentanyl overdose including the following:  trouble breathing or slow or shallow breathing; slow heartbeat; severe sleepiness; cold, clammy skin; trouble walking or talking; or feeling faint, dizzy, or confused.  If these signs occur, patients or their caregivers should get medical attention right away.
• Patients prescribed the fentanyl patch should tell their doctor about all the medicines that they take.  Some medicines may interact with fentanyl causing dangerously high fentanyl blood levels and serious, life-threatening breathing problems.
• Patients and their caregivers should be told how to use the fentanyl patch.  This important information, including instructions on how often to apply the patch, reapplying a patch that has fallen off, replacing a patch, and disposing of the patch, is provided in the patient information that comes with the fentanyl patch .
• Heat may increase the amount of fentanyl that reaches the blood and can cause life-threatening breathing problems and death.
  • Patients should not use heat sources such as heating pads, electric blankets, saunas, or heated waterbeds or take hot baths or sun bathe while wearing a patch. 
  • A patient or caregiver should call the patient’s doctor right away if the patient has a fever higher than 102ºF while wearing a patch.

After use, fentanyl patches should be folded over so that the sticky side sticks to itself and thrown down the toilet.  Putting used patches in the garbage may make it possible for animals or children to get hold of them — a life-threatening danger.  Patches also should be stored well out of the reach of children or pets.

Fentanyl transdermal systems are marketed as Duragesic® and generics.

• Additional FDA information for health care professionals. 
• Fentanyl label with black box warning.

At the request of the FDA manufacturers of fentanyl transdermal systems are developing a new Medication Guide for patients.

Massage therapy after surgery can reduce pain when combined with routine pain medication according to a study among patients in  two Veterans Administration hospitals.  the patients, all men, were recovering from chest or abdominal surgery.

They were randomly assigned to receive:

• Routine care
• Twenty minutes of personal attention, but no massage, from a massage therapist each day in addition to routine care,
• A five minute back massage from a massage therapist each evening plus routine care.

Measures of pain intensity, pain unpleasantness, and anxiety were assessed every morning and evening.

Over four days of post-operative recovery, all three groups had less pain intensity, pain unpleasantness, and anxiety.  But the massage group had a significantly greater decreases of three measures.  They also had more rapid reduction in pain intensity and unpleasantness.

There were no differences in the use of opiate pain medicine, complications, or the average length of time each group remained in the hospital.

When asked if massage made their pain worse (1) or better (10), the average response was 8.3.

Researchers caution that only men were part of the study and if patients were reluctant to be touched, they were not included.

Allison R. Mitchinson MPH, NCTMB. a certified therapeutic massage therapist, and her team concluded,

Massage is an effective and safe adjuvant therapy for the relief of acute postoperative pain in patients undergoing major operations.

Massage may potentially be a safer alternative as-needed form of pain relief. With proper training, health care providers at the bedside (especially nurses) may now have a powerful non-pharmacologic tool to directly address their patients’ pain and anxiety.

SOURCE: Mitchinson et al. Archives of Surgery, Volume 142, Number 12, December 2007.

An another article about the research study appeared on MedPage Today on December 17, 2007.

A Personal Point of View

After my surgery this summer, I was in extra pain because I couldn’t lie on my back because of rectal surgery.  Turning was difficult., and I ached in addition to the pain from surgery.  Massage therapists from Memorial Sloan Kettering’s Integrative Medicine Department eased both pain and stress with massage. 

Kate