In studies reported this week fewer specialists managing colorectal cancer were found in US counties with large African American populations, older adults with cancer had significantly worse physical and mental health, and palliative sedation at the end of life did not hasten death.
In other headlines, colorectal cancer screening for the uninsured will begin on July 1 in Minnesota, and if screening reveals cancer, treatment will be covered under the Minnesota Medical Assistance program. The FDA warned consumers not to use Zicam nasal gel or swabs to avoid loss of smell, and doctors advised patients on long-term Xeloda therapy to carry a letter from their oncologist explaining possible loss of fingerprints if they travel internationally.
- Communities with large percentages of African Americans have less access to the doctors critical to colon and rectal cancer care. Analyzing data from the HHS Area Resource File, researchers discovered that as the percentage of African Americans in individual US counties increases, the numbers of gastroenterologists, radiation oncologists, and colorectal cancer surgeons decreases. Awori J. Hayanga, MD wrote in the June 2009 Archives of Surgery, “Increasing numbers of minority patients in counties is accompanied by a differential access to specialists. This may affect the likelihood of a patient to receive appropriate care.”
- Measuring health-related quality of life, older adults with most cancers, except melanoma and endometrial cancer, have poorer physical health than matched over 65 controls. However, only older cancer patients with lung, colorectal, and prostate cancer had significant reductions in mental health. Bruce Reeve and his team linked data from the Medicare Health Outcomes Survey (MHOS) and NCI SEER cancer registry to determine how a cancer diagnosis affects both physical and mental health and quality of life. They reported their results online June 9, 2009 in the Journal of the National Cancer Institute. A JNCI Memo to the Media has more information about the study.
- Palliative sedation given to manage severe symptoms at the end of life does not reduce survival time when compared to patients treated with standard hospice protocols, according to a study in the July Annals of Oncology. The study resolves some ethical questions of using sedation for unmanageble end-of-life pain even if it might hasten death. Dr. M. Martoni wrote, “Palliative sedation therapy does not shorten life when used to relieve refractory symptoms and does not need the doctrine of double effect to justify its use from an ethical point of view.”
- On July 1, 2009, with funds from an increased tobacco tax, the Minnesota Colorectal Cancer Prevention Act will provide screening for uninsured and underinsured residents of Minnesota. Program participants must have family incomes less than 250 percent of poverty and be over 50 or at high risk of colon cancer. If cancer is found during screening, patients will be covered by Medical Assistance for their treatment. The American Cancer Society recognized state representative Maria Ruud, a nurse practitioner, as Legislator of the Year for her leadership in writing the legislation and getting it passed.
- On June 16, 2009 the FDA warned consumers to stop using and throw away intranasal Zicam Cold Remedy Nasal Gel and Zicam Cold Remedy Swabs. The zinc-containing products have been linked to a loss of the sense of smell, for many people with the first use. Zicam Cold Remedy Swabs, Kid Size has been discontinued, but the FDA is concerned that some people may still have it in their homes. Because children may not report loss of a sense of smell, the FDA is particularly concerned with the use of zinc in the noses of children. The FDA has sent a warning letter to Matrixx Initiatives telling them that these products cannot be marketed without FDA approval.
- Hand-foot syndrome side effects from Xeloda® (capecitabine) may cause loss of fingerprints with long-term use. The July 2009 Annals of Oncology reports on a case of a man with head and neck cancer who took oral Xeloda for over three years as maintenance therapy. He was detained trying to enter the United States because his fingerprints could not be detected. In a letter to the editor of Annals, doctors say that patients on long-term capecitabine therapy should be warned about the possibility of fingerprint loss and carry a letter from their oncologist explaining the situation. They point out that it is unclear how soon fingerprint loss may occur.