A study in the United Kingdom compared cancer in people diagnosed with schizophrenia and bipolar disorder compared to matched controls.  They found almost triple the risk for colon cancer among schizophrenics compared to controls.  There was no similar increase in risk for people diagnosed with bipolar disorder.

Nearly 41, 000 people were included in the study that matched cases of breast, colon, rectal, esophageal, prostate, and respiratory cancers to similar people without cancer.  Patients in the study were treated in more than 450 general practices contributing to the QRESEARCH database.

There were 5,100 cases of colon cancer which were matched to 24,500 cases without colon cancer.   After adjusting for smoking, body mass index, socioeconomic status, other illnesses, and medicines, people with schizophrenia has 190 percent increased risk of also having colon cancer.  Odds ratio, after adjustment, was 2.90.

Antipsychotic medications increased the risk.  Patients taking antipsychotics had nearly four times the risk of having colon cancer than controls. (Adjusted odds ratio 4.08.)

However, no similar  colon cancer risk increase was found in people diagnosed with bipolar disorder.

There was also a small increased risk for breast cancer and a decreased risk for lung cancer among schizophrenics.

Julia Hippisley-Cox, MD and her team concluded,

Patients with schizophrenia have a significantly higher risk of colon cancer and a lower risk of respiratory cancer compared with patients without schizophrenia after adjustment for confounders. In contrast, the risks of cancer in patients with and without bipolar disorder are similar, suggesting that residual confounding is unlikely to explain the findings. The increased risk of colon cancer is particularly marked in patients with schizophrenia who take antipsychotic medications.

SOURCE: Hippisley-Cox et al, Archives of General Psychiatry, Volume 64, Number 2, December, 2007.

What This Means for Patients

People who have been diagnosed with schizophrenia have a greatly increased risk for colon cancer and should be certain to be screened for colorectal cancer, probably using the most sensitive method available.

Patients, with schizophrenia and their doctors and caregivers should make colorectal screening a priority.

Based a report from a single hospital in France, having a second surgery to remove colorectal cancer that has spread to the liver can provide good long-term outcomes.  In this study about one in four patients who had a second liver surgery were alive and cancer free five years after their surgery.

Surgeons at the University Hospital of Bordeaux in France reviewed records of forty patients who had a second operation to remove tumors in their liver that had spread from a colon or rectal cancer.

They found that complications after surgery were not significantly higher than complications during a first liver resection.  Blood transfusions and time in the hospital were not different.

After three years, 55 percent of patients were alive and 49 percent were free of cancer.  After five years, 31 percent were still living and 27 percent were disease free.

The length of time between the first and second surgery and whether or not there was cancer outside of the liver independently predicted survival.

Antonio Sa Cunha, MD and his colleagues concluded

A second liver resection because of recurrent liver metastases from colorectal cancer is safe and provides a survival benefit similar to that with single hepatectomy. Our analysis suggests that the benefit of treatment is limited in patients who undergo a second hepatectomy within 1 year of the first operation and in those with extrahepatic disease.

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

WHAT THIS MEANS FOR PATIENTS

Although this is a small study in a single hospital, it confirms other reports of successful removal of liver mets that have returned after an initial resection.  More than one in four patients in this study were still alive and cancer free after five years.

Patients with second liver mets should feel confident about talking to a surgeon about their removal.

Not having cancer outside of the liver contributed to survival, as well as needing the second operation more than a year after the first one.

Doctors at Memorial Sloan Kettering Cancer Cancer in New York combined IV chemotherapy with chemo infused directly into an artery leading to the liver to treat advanced colorectal cancer.

All patients had already been heavily treated with chemotherapy, and their liver tumors could not be surgically removed.  All had previously received oxaliplatin.

Thirty-nine patients received systemic IV Camptosar (irinotecan or CPT-11) along with hepatic arterial infusion (HAI) of floxuridine and dexamethasone.

Reviewing results, the doctors found that:

• 44 percent of patients had a partial shrinkage of their tumors
• Median time before liver tumors began to grow again was 8.6 months.
• Median time before progression of any colorectal cancer in the body was 6.5 months.
• Median survival time after beginning the chemo/HAI treatment was 20.1 months.
• Median overall survival after diagnosis of metastatic cancer was 32 months.
• 18 percent of patients were eventually able to have liver tumors removed surgically.

Serious side effects included low white cell counts (13 percent) and diarrhea (15 percent).  Rare problems were bleeding within the abdomen (2 percent) and a bleeding duodenal ulcer (2 percent.)

The research team concluded,

Hepatic arterial infusion with floxuridine and dexamethasone plus systemic irinotecan achieves a response rate of 44% and a median overall survival of 20 months in heavily pre-treated patients with colorectal hepatic metastases all receiving previous oxaliplatin; 18% of patients proceeded to surgical resection or ablation.

SOURCE: Gallagher et al, Annals of Oncology, Volume 18, Number 12, December 2007.

Proton pump inhibitors (PPIs) reduce production of acid in the stomach and are widely used to treat problems resulting from excess stomach acid.  They include such brand name drugs as Prilosec®, Prevacid®, Nexium®, and Protonix®.

Because they can lead to bacterial overgrowth in the intestinal tract and potentially change intestinal bile salts, there has been concern that proton pump inhibitors might increase the risk for colorectal cancer.

However, researchers in the Netherlands found no increased risk when  proton pump inhibitors were used in the five years before colorectal cancer diagnosis.  There was no greater risk if they used at all during that time or if they were used for more than a year.  However, the research did not look at longer exposure to PPIs.

In a case control study, the research team compared PPI use in 600 cases of colorectal cancer with a matched control group who didn’t have cancer.

Eva Van Soest and her team concluded,

The present study indicates no association between PPI use and the risk of colorectal cancer. Larger numbers of long-term PPI users are needed to confirm the absence of a risk-increasing effect of long-term PPI exposure.

SOURCE: Van Soest et al. American Journal of Gastroenterology, early online publication, December 7, 2007.

Despite considerable pain from their cancer, some patients refuse morphine and other opiate medicines.  Caregivers have often attributed this to a fear of becoming addicted to drugs, but an in depth study has found something different.

When first offered opiate drugs to control pain, patients often rejected them because they saw them only as “a comfort measure for the dying.”

During interviews, patients identified issues including anticipation of death, morphine as a last resort, and ‘no choice’ but to begin their use.  Opiods were more acceptable when health professionals had confidence in their value and when side effects were well-managed.

Dr. C.M. Reid and colleagues in the United Kingdom concluded,

Among cancer patients the idea that opioids represent a comfort measure for the dying and not legitimate analgesics may represent a greater barrier to their uptake than concerns about tolerance or addiction.

SOURCE: Reid et al. Annals of Oncology, early online publication December 10, 2007.