This week we have research reports about risk of complications after hand-assisted laparoscopic colectomies, the benefit of music therapy during hospice treatment, and a gene that predicts better response to cetuximab.
In other headlines, we found an excellent overview of the progress made in colorectal cancer treatment with data and references. In addition, there is information about management of colonoscopy sedation in HIV patients receiving antiretroviral medicines and a lifting of the FDA ban on concentrated liquid morphine for terminally ill patients until an acceptable substitute can be found.
- Hand-assisted laparoscopic colectomies didn’t have any more serious longterm complications than more limited laparoscopic surgery. In hand-assisted laparoscopic surgery (HALS) a slightly longer incision is made to allow the surgeon to insert a hand into the abdomen and work with laparoscopic instruments. Comparing over 500 patients, half of whom had standard laparoscopic colectomies and half whose laparoscopic surgery was hand-assisted, researchers found no differences in rates of incisional hernias, small bowel obstruction, or wound infections. About 2 percent of patients had to have the laparoscopic surgery converted to an open operation, and incisional hernias were considerably higher in this group (25 percent compared to 5 percent who didn’t need conversion.) Surgeon Dr. Toyooki Sonoda from Weill Medical College of Cornell University writes about the study in the January 2009 issue of the Journal of the American College of Surgeons.
- Music therapy during hospice care for patients and their families helps caregivers after the patient’s death. They have memories of joy and empowerment rather than pain and distress. They report feeling stronger having contributed to their loved one’s comfort through music. Lucanne McGill from University of Winsor School of Music interviewed caregivers after family members who had participated in music therapy died. She writes about her research in Palliative and Supportive Care, March 2009.
- Mutations in the TP53 gene predicted better outcomes from treatment with Erbitux® (cetuximab) in a French study. In a group of 64 colorectal cancer patients treated with Erbitux, 41 had mutations in the TP53 gene and, as a group, had better disease control with their tumors either shrinking or remaining stable. Median time before the cancer got worse (time to progression) was 20 weeks in patients with a TP53 mutation versus 12 weeks in those without mutation. Writing in the British Journal of Cancer, Rouen scientist A. Oden-Gangloff said, “This study suggests that TP53 mutations are predictive of cetuximab sensitivity, particularly in patients without KRAS mutation, and that TP53 genotyping could have a clinical interest to select patients who should benefit from cetuximab-based chemotherapy.”
- Certified physician assistants Maura Polansky and Alicia Ross have written an excellent overview of progress in screening and treating colorectal cancer in the Journal of the American Academy of Physician Assistants. They include data for colorectal cancer incidence and survival and information about progress in treatment from 5-FU through recent targeted therapies. Five year survival for all patients improved from 49.39 percent in 1975 to 65.5 percent in 1999. Screening rates doubled between 1987 and 2000, but still remain below 50 percent. New drugs have improved median survival and increased liver resectability for patients with metastatic colorectal cancer. A very good review of what we know about colorectal cancer today with a list of key references.
- Patients who are being treated with some antiretroviral regimens may need special consideration with sedation for colonoscopy. Because antiviral drugs block a critical enzyme necessary to metabolize the usual drugs used for sedation, dangerously high doses can build up. Not giving the antiviral medicine for a day or so is not sufficient to reduce this effect. Two expert pharmacists and a gastroenterologist discuss how to manage sedation safely in an article in Journal Watch. Beginning with low doses of sedative and pain medicines and carefully increasing them to keep colonoscopy patients comfortable is suggested by all three. HIV patients can have colonoscopies, but need special care. Read detailed discussions of the pharmacology interactions of antivirals and sedation in Journal Watch from the New England Journal of Medicine.
- On April 3, News in Brief reported an FDA warning to manufacturers of some opiate drugs to stop making and distributing them because they were not approved. The warning included high concentrate 20 mg/ml morphine sulfate oral solution which is widely used to help with pain in terminally ill patients. The palliative care community told FDA that there was no other product on the market to meet the patient need, and FDA has lifted the ban until a suitable alternative can be developed. FDA said, “The FDA appreciates the help we received from the palliative care community about how this drug is being used today to help patients. We want to continue to talk to them as we move forward on this difficult issue.”