NCI Teleconference: Why Statistics Matter for Advocates

NCI is offering a teleconference *Why Statistics Matter for Advocates*. This follows up a conference held in April of 2005. The teleconference is free and available on a toll-free line. Playbacks are also possible for a month after the teleconference.

+ *Why Statistics Matter for Advocates: Follow Up from the April, 2005 SEER Advocacy Conference*
featuring Dr. Brenda Edwards, Associate Director, NCI Surveillance Research Program

+ Wednesday, October 19, 2005 at 2:30 p.m. (EST)

+ USA Toll-Free: 1-800-857-6584 Passcode: 4683#

+ Toll-Free Playback: 1-800-229-6227 until Nov. 19, 2005 at 10:30 p.m. (EST)

Toll-free playbacks of the first in this series of teleconferences *Eliminating Suffering and Death Due to Cancer by 2015: The Future of Cancer Research* featuring Dr. Andrew C. von Eschenbach, Director, National Cancer Institute is available until October 20, 2005.

Toll-Free Playback: 1-866-443-2931 until Oct. 20, 2005 at 5:30 p.m. (EST)

Posted by Kate Murphy on October 13th, 2005
Posted in: Research & Treatment News | No Comments »

Age and gender do not make a difference in how soon to repeat colonoscopy after removing a suspicious polyp

Neoplastic polyps either are already malignant or have the potential to become cancerous over time. When a non-malignant neoplastic polyp is discovered and removed during colonoscopy, a follow-up colonoscopy is scheduled to watch for additional polyps. Current [guidelines](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3686&nbr=2912&string=)
call for follow-up colonoscopy after 3 – 5 years unless there is unusual risk.

Researchers were concerned that age or gender might make a difference in how often such follow-up should be scheduled. They reviewed the information in a database of 1800 patients who had two colonoscopies where a neoplastic polyp was removed during the first one.

They found that 19% of patients had at least one new polyp bigger than 5 millimeters on the second colonoscopy. Six percent had a polyp larger than 10 millimeters. However, there was no difference in the overall risk of polyps recurring in any age group or gender.

They wrote in the November/December 2005 issue of the *Journal of Clinical Gastroenterology* — 39(10):894-899:

Conclusions: Similar rates of neoplasia recurrence were observed among patients of different gender and age groups on surveillance colonoscopy. From a health resource utilization perspective, these findings support current recommendations for similar surveillance intervals for patients regardless of age and gender.

It is important to note that last year a survey published in the [Annals of Internal Medicine](http://www.annals.org/cgi/content/summary/141/4/264) found that half of gastroenterologists and from 50 to 80 percent of general surgeons would perform colonoscopy more frequently than the guidelines call for. The authors of the study asked, *”Are physicians doing too much colonoscopy?”*

[Read the abstract of the article in the *Journal Clinical Oncology*.](http://www.jcge.com/pt/re/jclngastro/abstract.00004836-200511000-00009.htm;jsessionid=DLd1Nrh6yh1i2eU2xQ51sqtxG5Fr0DTluBn0U5Q37sStEni3zbXX!-1774793403!-949856145!9001!-1)

Posted by Kate Murphy on October 10th, 2005
Posted in: Research & Treatment News | No Comments »

Radiotherapy before surgery for rectal cancer increases sexual problems in men

Radiation therapy given before surgery to remove rectal cancer can reduce the risk that the cancer will return at the site of the original tumor. In some cases it can shrink tumors significantly allowing for surgery that spares the sphincter muscle closing the anus and avoiding a permanent colostomy.

However, research in the [October 2005 *Annals of Surgery*](http://www.annalsofsurgery.com/pt/re/annos/toc.00000658-200510000-00000.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1) found that radiotherapy results in more sexual problems in men than surgery alone.

Surgeons studied the difference between surgery alone and surgery with pre-operative radiotherapy in 201 men being treated for rectal cancer. They assessed the ability to achieve and maintain an erection, have an orgasm, and be sexually active at 7 time points, beginning before surgery and ending 4 years later.

The most severe dysfunction was found 8 months after surgery when there was a 7.4% difference in achieving an erection, 12.6% difference in maintaining one, and a 16.2% difference in having orgasm between the radiotherapy and surgery only groups. In addition, men who had radiotherapy were 13.7% less likely to be sexually active. Recovery of sexual functioning after the 8 month point was slow, but never returned completely.

The effect increased with age.

The researchers were able to build and validate a model to help patients and doctors predict how much radiotherapy might effect the sexuality of an individual man.

The research and the predictive model were reported in the *Annals of Surgery* (240-4:502-511, October 2005). The lead author was Alexander G. Heriot. The team concluded:

Conclusions: Radiotherapy has an adverse effect on sexual function, the effect being maximal at 8 months after surgery. The risk of sexual dysfunction can be quantified preoperatively using the proposed index and can assist patients in making better informed choices on the type of treatment they receive.

In [a Dutch study in the March 20, 2005 edition of the *Journal of Clinical Oncology*](http://www.jco.org/cgi/content/abstract/23/25/6199), 900 men and women, who were part of a randomized trial surgery alone or surgery and radiotherapy, also showed poorer sexual functioning in males. Females also had sexual problems after pre-surgical radiotherapy.

In addition, radiation-treated patients recovered normal bowel movements more slowly and were less active 3 months after surgery than those who had surgery alone.

However, the patients reported no significant differences in health-related quality of life on questionnaires answered before treatment and at 3, 6, 12, 18, and 23 months after treatment.

Since there is a way of predicting the risk of sexual problems after radiation treatment for rectal cancer developed by Dr. Heriot’s team, patients should be encouraged to discuss risks and benefits of radiation prior to surgery.

[Read the abstract of the Heriot study in the *Annals of Surgery*.](http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200510000-00005.htm;jsessionid=DLXGyCyb1Tc8BDtrfGDR254EBG0zJn5b48F6zJPWzjOts8wwT9il!586698740!-949856144!9001!-1)

[Read the Marijnen study abstract in the *Journal of Clinical Oncology.*](http://www.jco.org/cgi/content/abstract/23/9/1847)

Posted by Kate Murphy on October 10th, 2005
Posted in: Research & Treatment News | No Comments »

Financial help ready for Katrina victims with cancer

More than $500,000 has been donated to the [ASCO Foundation](http://asco.org/ac/1,1003,_12-002144-00_18-0042423,00.asp) to help pay for cancer-related expenses for people affected by Hurricanes Katrina and Rita.

Patients and their families can get assistance by calling **800 813 HOPE.**

Those funds will be managed by [CancerCare](http://www.cancercare.org/), an organization with the staff and resources to get help into the hands of those cancer patients who need it. In addition, the [Lance Armstrong Foundation](http://www.livestrong.org/site/c.jvKZLbMRIsG/b.594849/k.CC7C/Home.htm) and the [Susan G. Komen Foundation](http://www.komen.org/intradoc-cgi/idc_cgi_isapi.dll?IdcService=SS_GET_PAGE&ssDocName=katrina) have contributed additional money to CancerCare for the effort.

Diane Blum of CancerCare writes:

The ASCO Foundation has asked CancerCare to be the primary organization to disburse more than $500,000 that has been raised to help cancer patients who have been displaced by Hurricanes Katrina and Rita. We have also received funds from the Lance Armstrong Foundation and the Komen Foundation for this purpose. These organizations recognize CancerCare’s long experience in providing financial assistance along with psychosocial support

We will be able to distribute up to $2500 per family for cancer treatment and supportive care, durable medical equipment, homecare, childcare, transportation and lodging. We will also provide support services in the form of counseling, support groups, and education.

Professionals and advocates with questions about the program can call Jane Levy, CancerCare’s Director of Patient Assistance at 212 712-8356.

Again, patients affected by Katrina or Rita should call 800 813 HOPE for financial assistance with cancer-related expenses.

Posted by Kate Murphy on October 7th, 2005
Posted in: Research & Treatment News | No Comments »

Local excision of small rectal tumors carries increased risk of local recurrence

Although some surgeons believe that removing small, early rectal tumors through the anus rather than a larger opening in the abdomen is safer surgery for patients and reduces the need for colostomy, two studies show this treatment carries a higher risk of local recurrence.

A study published in the October, 2005 edition of [*Annals of Surgery*](http://www.mdlinx.com/HemeOncLinx/thearts.cfm?artid=1337876&specid=17&ok=yes) reviewed outcomes for 319 consecutive patients treated for T1 rectal cancers over a 17 year period. 151 were treated with ransanal excision (LE). A second group of 160 had surgery that opened the abdomen and removed the tumor and part of the rectum (RAD). This group actually had more poor progrostic factors than the local excision group including larger tumors and an 18% rate of lymph node spread.

Despite poorer expected prognosis the RAD group had fewer local recurrences at the surgical site, fewer distant recurrences, and significantly better recurrence-free survival. However, overall survival and disease-specific survival were similar for both groups.

A [T1 tumor](http://www.cancer.gov/cancertopics/pdq/treatment/rectal/Patient/page2) is limited to the inner lining of the colon and does not extend into the muscular layers. These cancers have not spread to lymph nodes or distant sites. Transanal excision can avoid removing the sphincter requiring colostomy in some situations so patients and surgeons may choose the more limited operation.

David J. Bentrem, M.D. headed the study team, who concluded,

Despite a similar risk profile in the 2 surgical groups, patients with T1 rectal cancer treated by local excision were observed to have a 3- to 5-fold higher risk of tumor recurrence compared with patients treated by radical surgery. Local excision should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence, prolonged surveillance, and possible need for aggressive salvage surgery. Radical resection is the more definitive surgical treatment of T1 rectal cancers

In a different study published in the June 2005 Supplement of the [*Journal of Clinical Oncology*](http://meeting.jco.org/cgi/content/abstract/23/16_suppl/3526), researchers analyzed information in the National Cancer Database. In the database, there were 1114 patients who had T1 rectal cancers that were treated with surgery only. Slightly more than half (616 or 55.3%) were treated with local excision through the anus (LE). The other group (498 or 44.7%) had surgical resections that opened the abdomen (SR).

Local excision was more likely to be chosen by patients and surgeons if:

+ tumor was close to the anus: for tumors within 5 cm of the anal verge 58% were removed by local excision (LE) versus 42% treated with standard resection (SR)

+ tumor was small: for tumors less than 1 cm, 77% were treated by LE versus 23% by SR.

+ patients had no other serious medical problems: 58% for LE versus 42%. SR

Mortality and morbidity due to surgery were significantly worse for standard open resection than local excision: Thirty-day mortality was 2.4% for SR compared to 0.5% for LE; morbidity rates for SR was 12.7% versus 4.4% for local excision.

However, local recurrence rates significantly favored standard resection at both 5 years and 8 years. At 5 years 12.7% of patients treated with local excision had experienced local recurrence compared to 6.1% of those who had standard resections. This difference was 14.4% versus 9.5% eight years after surgery. At five years there was no difference in overall survival between the groups.

Y. N. You MD and colleagues reported their results at the 2005 ASCO meeting, and they were published in the June 1, 2005 supplement to the *Journal of Clinical Oncology.* She wrote.

Patients considering LE for T1 rectal cancer may expect lower rates of perioperative morbidity and mortality, but are likely to face greater risks of local/regional tumor recurrence. For those treated with LE, long-term and vigilant oncological follow-up is essential.

[Read the abstract of the Bentrem research in the *Annals of Surgery.*](http://www.mdlinx.com/HemeOncLinx/thearts.cfm?artid=1337876&specid=17&ok=yes)

[Read the abstract of the You study in the *Journal of Clinical Oncology.*](http://meeting.jco.org/cgi/content/abstract/23/16_suppl/3526)

[See the slides of Dr. Nancy You's presentation at the 2005 meeting of the American Society of Clinical Oncology](http://asco.org/ac/1,1003,_12-002511-00_18-0034-00_19-003345,00.asp)

Posted by Kate Murphy on October 7th, 2005
Posted in: Research & Treatment News | 3 Comments »