Patients and caregivers both sometimes don’t tell each other about cancer-related concerns. However, a study of patients with gastrointestinal cancer and their spouses showed that disclosing concerns was not harmful to either patient or caregiver. Furthermore, low levels of disclosure and high levels of holiding back increased psychological distress for both. Couples who withheld problems had more difficulty with their relationship.

Laura S. Porter and a team at Duke University Medical Center [questioned 47 patients and their spouses](http://www3.interscience.wiley.com/cgi-bin/abstract/109924613/ABSTRACT) about how much they disclosed concerns about cancer and how often they “held back.” Patients also answered questions about their quality of life, and spouses responded to a measure of caregiver-strain. All participants completed measures of psychological distress and relationship functioning that included intimacy, empathy,and avoiding or criticizing each other.

Overall most of the couples reported moderately high levels of disclosure and low levels of holding back.

The study appears in the December 2005 issue of *Psycho-Oncology.*

The FDA [notified consumers and health professionals](http://www.fda.gov/medwatch/safety/2005/safety05.htm#MBI) on November 29, 2005 that MBI Distributing (also known as Molecular Biologics) has signed a [consent decree](http://www.fda.gov/bbs/topics/NEWS/2005/NEW01265.html) to stop manufacturing and distributing over-the-counter eye drops until it corrects manufacturing deficiencies found during FDA inspections.

The problem eye drops include those sold as Oxydrops, Bright Eyes, Bright Eyes II, Clarity Vision for Life, Visitein, and Can-C. The FDA found that the company lacked controls during manufacturing to ensure that the eye drops were sterile. In addition, two brands Visitein and Clarity Vision for Life are unapproved drugs.

The FDA also said that Biogesic, Bio-Ice, and Bio-Heat, over-the-counter pain-relievers sold by MBI, do not provide consumers with adequate warnings for safe use.

The FDA recommends that consumers, health care providers, and caregivers throw out any Oxydrops, Bright Eyes, Bright Eyes II, Clarity Vision for Life, Visitein, and Can-C eye drops as well as Biogesic, Bio-Ice, or Bio-Heat. They should not be used.

Adverse events resulting from the use of the eye drops or pain-relievers should be reported to the MedWatch, the FDA’s voluntary reporting program at 1-800-FDA-1088; by FAX at 1-800-FDA-0178; by mail to MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD, 20857-9787; or [online.](https://www.accessdata.fda.gov/scripts/medwatch/)

Wound infections are a serious complication of surgery to treat colon and rectal cancer leading to longer hospital stays and a doubling of the risk of death after surgery.

However, recent research with patients having surgery for colon or rectal cancer reported in the [*Journal of the American Medical Association*](http://jama.ama-assn.org/cgi/content/abstract/294/16/2035) found that those who received a higher concentration of oxygen during surgery and for six hours afterwards had about a 40% lower risk of an infected surgical site (SSI).

Nearly 300 patients were randomized to receive either 80% of 30% concentration of inspired oxygen during surgery. Patients in the study were watched for signs of wound infection for 14 days after their operations. Those receiving the higher oxygen percentage had an infection rate of 14.9% compared with 24.4% for those receiving lower amounts. Preparation for surgery, use of antibiotics, and anesthesia techniques were standardized.

Fourteen hospitals in Spain participated in the research led by F. Javier Belda, MD, PhD, who concluded:

Patients receiving supplemental inspired oxygen had a significant reduction in the risk of wound infection. Supplemental oxygen appears to be an effective intervention to reduce SSI in patients undergoing colon or rectal surgery.

More [detailed information about the study](http://www.medscape.com/viewarticle/515400) along with information from an [accompanying *JAMA* editorial by E. Patchen Dellinger, MD](http://jama.ama-assn.org/cgi/content/extract/294/16/2091) is available on *Medscape.*

German researchers have found [significant clinical differences](http://gut.bmjjournals.com/cgi/content/abstract/54/12/1733) in patients with a family history of colorectal cancer and a well-known genetic mutation and those with similar family histories but no mutation.

The team from Munich compared two groups of patients with colorectal cancer, both of which met the Amsterdam criteria for hereditary non-polyposis colon cancer (HNPCC). The first group (25 families) had mutations in either the MLH1 or MSH2 gene as well as high microsatellite instability (MSI) in their tumors.

The second group of 16 families met the Amsterdam criteria for a strong family colorectal cancer history, but did not have MLH1 or MSH2 mutations, and their tumors did not show microsatellite instability.

In addition there were other clinical differences between the two groups:

+ Median age of onset of colorectal cancer was earlier in group 1 than group 2 (41 versus 55)
+ Median age for all tumors was earlier in group 1 (43 versus 56)
+ Group 1 had more additional colorectal tumors found at the same time (synchronous) as well as synchronous tumors outside their colons.
+ Group 1 was more likely to have additional tumors found later (metasynchronous) both in the colon and outside it.
+ Group 2 was more likely to have multiple adenomas, and it appeared that the time it took for adenomas to progress to cancer was longer for them.
+ Tumors in Group 1 were much more likely to be found high in the colon (proximal) versus nearer to the rectum (distal) than those in Group 2. (68% vs. 14%)

The research team concluded:

These data show that HNPCC includes at least two entities with clinical and molecular differences. This will have implications for surveillance programmes and for cancer research

The Amsterdam criteria is used to identify families with a particular inherited pattern of colorectal cancer — HNPCC or Lynch Syndrome.

+ One member diagnosed with colorectal cancer before age 50.
+ Two affected generations.
+ Three affected relatives, one of them a first-degree relative of the other two.
+ Familial adenomatous polyposis should be excluded.
+ Tumors should be verified by pathological examination.

Women who are treated with radiotherapy for anal, cervical, and rectal cancer have a higher risk of pelvic fractures according to a [new study in the *Journal of the American Medical Association*](http://jama.ama-assn.org/cgi/content/short/294/20/2587). More than 90% of the fractures were broken hips.

Using SEER (Surveillance, Epidemiology, and End Results) cancer registry data from 1986 through 1999, Dr. Nancy Baxter and a team at the University of Minnesota, analyzed fractures in nearly 6,500 women over the age of 65 who either received radiation to their pelvic area (2,855) or did not (3,573). They also looked at bones that had not been irradiated in the spine and arm.

After adjusting for other important factors, women who had received radiation for anal cancer were more than 3 times more likely to have pelvic fracture than those who didn’t have radiotherapy. Fourteen percent (14.0%) of them had broken pelvic bones compared to 7.5% of the non-radiation group. 8.2% of women with cervical cancer and radiation had pelvic fractures compared to 5.9% of those who did not. For rectal cancer 11.2% of the radiated group experienced fractures compared to 8.7% of others.

However, there was no difference in spine or arm fracture rate in any of the three groups.

The authors suggested that women who had received pelvic radiation might be targeted for therapy to prevent hip fractures such as bone density scanning, medication, or physical therapy to prevent falls.

They concluded:

Pelvic irradiation substantially increases the risk of pelvic fractures in older women. Given the high baseline risk of pelvic fracture, this finding is of particular concern.

Find more information about the study in a [*Reuters Health* article.](http://today.reuters.com/news/newsArticle.aspx?type=healthNews&storyID=2005-11-22T212236Z_01_ARM276923_RTRUKOC_0_US-RADIOTHERAPY-BONE-FRACTURE.xml&archived=False) or on [*MedPage Today*](http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/2199)