Colorectal Cancer News in Brief: October 16

Briefly: The elderly are much more likely to have their colons perforated during colonoscopy, and inflammatory bowel disease patients who are part of a colonoscopy surveillance program before a diagnosis of colorectal cancer are diagnosed at an earlier stage and have much better survival than patients who don’t have colonoscopies before diagnosis.

There is help online for seniors and their caregivers who are having surgery and cancer survivors who are coping with “chemobrain”.  The FDA is cracking down on the unapproved marketing of some codeine drugs.

Research Reports

  • Patients over 75 are 6 times more likely to experience a colon perforation during a colonoscopy or sigmoidoscopy.  Doing a treatment intervention during the endoscopy, such as removal of polyps, triples the risk for all patients.  Varut Lohsiriwat and his team reviewed nearly 9000 colonoscopies and 1,100 sigmoidoscopies done in a large GI training center in Bangkok.  They found 15 perforations (1.5/1000). Gender, experience of the endoscopist, or method of sedation didn’t affect perforations.  Dr. Lohsiriwat wrote, “Our findings have indicated that special precautions should be made during therapeutic endoscopy and while performing colonoscopic examination in the elderly, particularly in patients over 75 years. Non-invasive investigation of the colon such as CT colonography, if applicable, might be considered in such advanced age patients.” The study was published in BMC Gastroenterology, Volume 9, 2009.
  • Regular colonoscopy surveillance of patients with inflammatory bowel disease (IBD) finds colorectal cancer at an earlier stage and prevents deaths from the colorectal cancer.  Researchers in the Netherlands compared outcomes for IBD patients who were part of a surveillance program before a colorectal cancer diagnosis with IBD patients who were not.  Five year colorectal cancer specific survival for the surveillance group was 100 percent compared to 75 percent of those who didn’t have surveillance before cancer diagnosis.  Only one surveillance patient died of colorectal cancer compared to 29 in the non-surveillance group.  Results of the research were published in the British Journal of Cancer by M. W. M. D. Lutgens in an advance online edition October 13, 2009.

Other Headlines

  • The American Society of Anesthesiologists has help for older patients getting ready for surgery.  A Surgical Checklist for Seniors and Caregivers has a list of things to discuss with your doctor before and after surgery.  A Geriatric Anesthesia Q & A discusses some of the additional risks seniors face including Postoperative cognitive dysfunction (POCD) that can cause long-term memory loss, difficulty learning, and problems concentrating.  Older adults are also at higher risk for postoperative delirium, confusion and disorientation after surgery that can last as long as a week.  Postoperative delirium is frightening for both patients and families, but there are steps to both prevent it and cope if it happens.  Read Kristy’s story about managing her Mom’s delirium.
  • Worried about chemobrain?  The American Cancer Society has tips and resources for coping with foggy thinking during and after chemotherapy and links to puzzle sites where you can give your brain a workout.  Besides using a detailed daily planner with everything you need  to remember in one place, the ACS recommends having a one place to put things that you lose a lot like keys and glasses.  Talking to friends and going to a support group also helps as do good health habits including enough sleep and a nutritious diet.
  • As part of its crackdown on marketing of unapproved drugs, the FDA has warned four companies to stop marketing codeine sulfate tablets that have not been FDA approved.  In announcing the warning letters, Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research (CDER), said, “Consumers deserve and expect that their drugs meet modern FDA standards for safety, effectiveness, labeling, and quality. Removing unapproved products that do not meet those standards is an FDA priority.” Codeine sulfate manufactured by Roxane Laboratories is approved as safe and effective to meet needs for the pain drug.

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