Alaska Native Americans have a much higher rate of both colorectal cancer and resulting deaths than other populations—about twice those of the U.S. white population (age-adjusted) for the period of 2004 to 2008. They also have the highest rate of CRC cases of all Native American groups—nearly five times higher than American Indians living in the Southwest, for example.

The reasons? Unknown. But health officials do know that improved screening can prevent CRC, and earlier CRC detection saves lives. And in fact, statewide screening rates among Alaskan Natives improved from 29 percent in 2000, to 41 percent in 2005.

A study in the March 2012 journal Gastrointestinal Endoscopy described pilot projects conducted from 2005 to 2010 designed to increase CRC screening in rural and remote Alaskan Native populations.

Projects included training rural mid-level practitioners in flexible sigmoidoscopy; sending an endoscopist to remote areas to conduct CRC screening at three regional hospitals; creation and use of a CRC first-degree relative database to find and screen people at heightened risk; and training patient navigators to help guide patients through the screening and track results to ensure complete followup of positive results.

From 2005 to 2010, the Alaskan Native screening rate rose from 41 percent to 55 percent, with improved outreach to average-risk and increased risk rural families. However, the study also identified remaining challenges—geography; a limited capacity in the healthcare system; high staff turnover; and difficulty getting patients to screening appointments.

Source: American Society for Gastrointestinal Endoscopy, “Reducing Colorectal Cancer Disparities in Alaska Native Population,” March 2012 Gastrointestinal Endoscopy (a special issue devoted to CRC).

Take-away lesson: Awareness of a huge disparity in cases and deaths, along with initial planning to improve screening was, in itself, associated with a large improvement in screening a rural, at-risk population. But despite using multi-prong approaches to overcome geography and lack of health care access, more work is needed. It’s not good enough to screen just over half of a population that gets and dies from CRC at so much higher rates.

Improved CRC screening results, challenges to reach Alaska Natives

Alaska Native Americans have a much higher rate of both colorectal cancer and resulting deaths than other populations—about twice those of the U.S. white population (age-adjusted) for the period of 2004 to 2008. They also have the highest rate of CRC cases of all Native American groups—nearly five times higher than American Indians living in the Southwest, for example.

The reasons? Unknown. But health officials do know that improved screening can prevent CRC, and earlier CRC detection saves lives. And in fact, statewide screening rates among Alaskan Natives improved from 29 percent in 2000, to 41 percent in 2005.

A study in the March 2012 journal Gastrointestinal Endoscopy described pilot projects conducted from 2005 to 2010 designed to increase CRC screening in rural and remote Alaskan Native populations.

Projects included training rural mid-level practitioners in flexible sigmoidoscopy; sending an endoscopist to remote areas to conduct CRC screening at three regional hospitals; creation and use of a CRC first-degree relative database to find and screen people at heightened risk; and training patient navigators to help guide patients through the screening and track results to ensure complete followup of positive results.

From 2005 to 2010, the Alaskan Native screening rate rose from 41 percent to 55 percent, with improved outreach to average-risk and increased risk rural families. However, the study also identified remaining challenges—geography; a limited capacity in the healthcare system; high staff turnover; and difficulty getting patients to screening appointments.

Source: American Society for Gastrointestinal Endoscopy, “Reducing Colorectal Cancer Disparities in Alaska Native Population,” March 2012 Gastrointestinal Endoscopy (a special issue devoted to CRC).

Take-away lesson: Awareness of a huge disparity in cases and deaths, along with initial planning to improve screening was, in itself, associated with a large improvement in screening a rural, at-risk population. But despite using multi-prong approaches to overcome geography and lack of health care access, more work is needed. It’s not good enough to screen just over half of a population that gets and dies from CRC at so much higher rates.

Before 1980, colorectal cancer death rates were actually higher for whites than African Americans.

But, as rates began falling in the 1980′s for both blacks and white patients, decreases for whites were substantially greater than those for blacks.  Between 1985 and 2008, mortality rates for whites with colorectal cancer fell 40 percent, while black rates declined by less than 20 percent.

The decrease in black death rates was higher than those for whites at every stage at diagnosis, but strikingly different when cancer had spread to distant sites.   For whites whose colon or rectal cancer was first found at stage IV, death rates fell by more than 30 percent, while black rates declined by less than 5 percent.

Over time, five year survival after regional and distant diagnoses grew for white patients but remained essentially unchanged for blacks.

Anthony Robbins, MD, PhD and his team from the American Cancer Society analyzed information from the Surveillance, Epidemiology, and End Results (SEER) Program looking for changes in colorectal cancer mortality rates by race and stage at diagnosis from 1985 through 2008.  They found that 60 percent of the disparities between black and white rates were due to late stage diagnosis.

They reported decreases in colorectal cancer death rates between 1985-1987 to 2006-2008 by stage:

Once cancer had spread regionally to lymph nodes or to distant organs, five year survival was lower in blacks than whites. Survival didn’t change significantly over time for blacks over time for regional disease, although there was a small increase that began in 2002 for metastatic cancer.

Percentage of patients living five years or more after diagnosis:

In discussing their observations, Dr. Robbins and his group looked for possible reasons for the disparities that continued even as death rates dropped and survival improved.  Among factors they considered were:

• Less screening for blacks than whites.  Although screening rates have improved for both blacks and whites, colorectal screening for blacks continues to lag behind.
• Differences in treatment for both colon and rectal cancer.  Blacks were less likely to receive adjuvant chemotherapy for stage III colon cancer or surgery for rectal cancer.  They also were treated less often at high volume, high quality cancer centers and got modern chemotherapy less often.
• Although there may be biological reasons for disparities, lack of access to prevention and quality care is more likely, Robbins writes.  In clinical trials where all patients had the same treatment, there were no differences in outcomes between blacks and whites.

Dr. Robbins and colleagues concluded,

In conclusion, colorectal cancer death rates have decreased for each stage of the disease in both whites and blacks since 1985, although for every stage, the decreases were smaller for blacks, especially for distant-stage disease. In the most recent time period, disparities in regional-stage and distant-stage mortality rates accounted for approximately 20% and 60% of the overall black-white disparity, respectively. Efforts to reverse the overall racial disparity in CRC mortality must target late-stage disease.

In an editorial accompanying the article, Electra Paskett, PhD, from the Ohio State University wrote,

In summary, disparities in colorectal cancer outcomes exist, and we know why. It is time to start addressing these disparities so that good health can be something everyone can experience.

Dr. Paskette stressed the importance of:

• Improving screening rates among blacks by making sure insurance covers screening for everyone and that health providers have systems in place and incentives to recommend screening to their patients.
• Making sure that there are not financial barriers to prompt, quality treatment when cancer is diagnosed.
• Using patient navigators to improve use of preventive screening and ensure access to prompt quality care.
• Enrolling more minority patients in clinical trials, including using families and communities to improve accrual.

SOURCES:  Robbins et al., Journal of Clinical Oncology, Early Release, December 19, 2011.

Paskett, Journal of Clinical Oncology, Early Release, December 19, 2011.

What Can Advocates Do?

Patient advocates can play an important role in narrowing the gap in colorectal cancer death rates between blacks and whites in the United States. They can:

• Work to make sure that the full range of colorectal cancer screening options are available to everyone without discrimination due to insurance status, income, race, ethnicity, or the community where they live.
• Insist that every American have full access to insurance coverage and a means to pay for quality evidence-based cancer care.
• Raise awareness of the value of screening to prevent colorectal cancer in ways that are meaningful to minority communities.
• Advocate for funding and programs to provide patient navigation.
• As research advocates, increase enrollment of minorities in cancer clinical trials.

Colorectal cancer screening rates for colorectal cancer improved between 2000 and 2008 for white, black and Asian-Americans aged 50 and over—but barely improved for Hispanics and actually worsed for American Indians and Alaska Natives.

The latest statistics, just reported by the federal Agency for Healthcare Research and Quality on March 23, found that:

• In 2008, among adults aged 50 or over, about 60 percent of whites reported ever having been screened (up from 51 percent in 2000);
• About 55 percent of blacks and Asian Americans had been screened at least once (compared to 44 percent in 2000);
• In the same age group, only 44 percent of Hispanics reported ever having been screened (slightly increased from just 35 percent in 2000), even though this population has the third-highest death rate from colorectal cancer;
• Screening rates actually decreased among American Indians and Alaska Natives, to only 37 percent in 2008 (compared to 41 percent in 2000).

Among people without health insurance, screening rates were significantly lower in all ethnic groups:

• Among both whites and blacks with no health insurance, the at-least-once screening rate was about 30 percent (increased barely from 26% in 2000);
• Screening worsened to an abysmal 13 percent (down from 16 percent in 2000) among Hispanics with no health insurance.

In summary, even among those with insurance, only half—and often far fewer—people over age 50 are getting even one screening. Among the uninsured, screening is just not being done for a cancer that can be prevented or cured if caught early.

Source: Agency for Healthcare Research and Quality, 2010 National Healthcare Quality and Disparities Reports

Overall, colorectal cancer screening rates were higher in 2008 than in 2006.

By 2008 almost 2 of every 3 Americans over the age of 50 had either had a fecal occult blood test in the past year or sigmoidoscopy or colonoscopy within the past ten years.

Health insurance made a huge different with two-thirds (66.6 percent) of people with insurance up-to-date with screening compared to about one-third (37.5 percent) of those without health insurance.

From 2002 through 2008, screening rates for people with health insurance went up almost 11 percentage points, while rates for the uninsured went up less than 5 percent.

Rates also lagged for the poor, for those without a high school education, and Hispanics.

States with the highest rates included New Hampshire, Utah, and Connecticut while Mississippi, Louisiana, and New Mexico had the lowest.

People who were 65 and older were much more likely to have been screened than younger adults — 72.8 percent compared to 58.2 percent for those from 50 to 64.

Overall screening rates were:

• 53.8 percent in 2002
• 60.7 percent in 2006
• 64.2 percent in 2008

Information for the Centers for Disease Control analysis comes from the 2002, 2004, 2006, and 2008 Behavioral Risk Factor Surveillance System (BRFSS) surveys.  The BRFSS surveys come from randomly dialed telephone calls to people in the United States over the age of 15.  About half of calls made reached someone, and three out of four of those reached were willing to answer the survey questions.  In 2008, 250,000 people were surveyed.

SOURCE: Centers for Disease Control, Morbidity and Mortality Weekly Report, January 14, 2011

How many more lives could we save if we simply delivered, consistently, the things that work?

That was the challenge that Dr. Arthur Kellerman laid down to people attending the AACR Science of Cancer Health Disparities conference in Miami on September 30.

Dr. Kellerman, an emergency room physician, told a sobering story of his patient Diane, who arrived in the emergency room in pain.  Asked to describe what hurt, she pointed to her right breast.  When her gown was lifted, doctors and nurses could see a huge cancer that had broken through her skin.  Uninsured, she had tried to treat it with over-the-counter salves. She died two months later.

He said that, like Diane, 1000 Americans die every week because they don’t get health care that meets medical standards.

In his keynote address, Money, Maps, and Moms, Kellerman pointed out that the United States spends more taxpayer dollars per person than any of the countries like France or Canada with government health care, yet ranks far below them in outcomes for that care.

In terms of amenable mortality — deaths of people under 75 that could have been prevented with timely and effective health care — the United States is now last among 14 Western European countries, Canada, Australia, New Zealand, and Japan.

109.7 of every 100,000 Americans die from treatable conditions, compared to rates in the three leading countries of 64.8 in France, 71.2 in Japan, and 71.3 in Australia.  If the United States could have matched the average amenable mortality in those three countries, 101,000 fewer people would have died over two years.

Dr. Kellerman quoted James S. Marks of the Robert Woods Johnson Foundation, who wrote, “Why Your Zip Code May be More Important to Your Health than Your Genetic Code” in talking about the importance of geography or place and its impact on cancer incidence, treatment, and access to care and the influence of environment on diet, exercise, and other potentially cancer-causing exposures.

In another story, Dr. Kellerman talked about a homeless patient who came back to the emergency room with infections around the protruding screws that had been placed in his legs a couple of weeks before to treat broken bones.  After his surgery he’d been discharged back to the street, with no place else to go.

Both orthopedic and internal medicine residents were called down to readmit the old man and both adamantly refused, getting into a loud argument in front of the patient and the entire ER over whose job it was.

A wise attending physician finally picked up the phone and asked for a number.  “Are you going to call the chief resident?” one of the doctors asked.  “Don’t worry.  He’ll back me up.  We’re not admitting this guy.”

“No,” the older doctor said, “I’m calling your mother to see what she would do.”

Blushing, both residents reached for their admitting orders.

Finally, Kellerman issued what he called the top cancer challenges for the twenty-first century:

• Money: Health care and cancer care costs too much.  We need to deal with costs making sure that people are getting the most effective care, not just the care they can afford.
• Unequal treatment: How many more lives could we save if we simply delivered, consistently, the things that work.
• Geography:  We must unravel the effects of place on cancer incidence, treatment, and outcomes.
• Professionalism:  We must kindle a fierce commitment to professionalism in the fields of medicine and public health.  Our patients depend on us to do our best. We owe them no less.

Arthur L. Kellerman, MD, MPH holds the Paul O’Neill – Alcoa Chair in Policy Analysis at the RAND Corporation.  Prior to that he  was Professor of Emergency Medicine and Associate Dean for Health Policy at the Emory School of Medicine in Atlanta.  He founded the Department of Emergency Medicine at Emory and was its first Chair.

Insurance makes a difference for people with rectal cancer.

Rectal cancer patients without insurance or covered by Medicaid are almost twice as likely to die within five years as those privately insured.

Not only are they diagnosed at a later stage, but fewer receive recommended treatments at every stage.

More than half of the difference between patients with private insurance and those without was due to differences in how early they were diagnosed and whether or not they got standard treatment.

Researchers looked at information from the National Cancer Data Base, a national hospital-based cancer registry, to study insurance and other factors related to survival among 19,154 rectal cancer patients aged 18 to 64 years old.

They analyzed the impact of  insurance, age, sex, race and ethnicity, neighborhood education and income levels, cancer treatment facility type, stage, pathology features, and treatment on survival at five years.

Rectal cancer patients were diagnosed between 1998 and 2002, and their progress was followed until 2007.

Results

• Uninsured patients were diagnosed at Stage I (17.6 percent) less often than those with private insurance (31 percent).
• Uninsured were diagnosed at late Stage IV (22.5 percent) more often than privately insured (13.8 percent).
• Uninsured were twice as likely not to have a high school diploma (38.9% versus 19.9%) and be poor (44.8 percent vs. 24.1%).
• Patients with private insurance were more likely to be treated in comprehensive community cancer centers, while patients with no insurance were more likely to be treated in teaching/research hospitals.

Differences in standard treatment

• Stage I:  95.1 percent of private patients had surgery with or without chemo/radiation  compared to  83.4 percent of uninsured.
• Stage II:  91.4 percent of privately insured had recommended surgery with or without chemo/radiation while 79.4 percent of uninsured did.   7.7 percent of private patients had chemo/radiation but no surgery compared to 19.2 percent of uninsured.
• Stage III:  4.7 percent of private patients had chemo/radiation without surgery while twice as many (9.6 percent) of uninsured patients received this substandard treatment.
• Stage IV:  More than 3 times as many uninsured patients (14.8 percent) had no treatment at all compared to 4.4 percent of those with insurance.  Again, uninsured patients got less surgery (42.2 percent) than those with insurance coverage (60 percent).

Writing in an early online edition of Cancer, Anthony S. Robbins, MD, PhD and his team in the Department of Surveillance and Health Policy Research at the American Cancer Society said,

Our main finding that most of the excess mortality seen among Medicaid-insured and uninsured patients was explained by 2 modifiable factors (stage and treatment) suggests that improving insurance coverage and reducing cost-related barriers to primary care, CRC screening, and high-quality treatment would have a major impact on CRC survival disparities.

SOURCE: Robbins et al., Insurance status and survival disparities among nonelderly rectal cancer patients in the National Cancer Data Base, Cancer, Early View, June 2010.

In 2010, experts predict that 4,400 fewer Americans will be diagnosed with colon and rectal cancer than in 2009.

According to new American Cancer Society statistics for 2010, 142,570 people will hear the difficult words, “You have colorectal cancer”, down from 146,970 in 2009.

Still, 51,370 families will get painful news when loved ones die from colorectal cancer.

Continuing this year, African Americans are more likely to develop colorectal cancer than whites and other races, to die of it, and to have poorer survival at every stage of the disease.

Each year the American Cancer Society estimates the number of new cases and deaths from cancer expected in the United States in that year.  They study trends in cancer rates and look at the impact of various types of cancer.

In 2010 colorectal cancer will again be the third most commonly diagnosed cancer in men and women and the second most common cause of cancer death.

2010 Colon and Rectal Cancer

Incidence

• In 2010, 102,900 new cases of colon cancer and 39,670 cases of rectal cancer will be diagnosed for a total of 142,570.
• This is a reduction of 4,400 new cases over last year’s estimate of 146,970.
• 72,090 men will be diagnosed with colorectal cancer (9 percent of all cancers) and 70,480 women (10 percent of the total).
• Incidence rates are projected at 59.0 per 100,000 men and 43.6 per 100,000 women – a decrease from 61.2 for men and 44.8 for women in 2009.
• Over a lifetime, 1 in 19 men and 1 in 20 women will develop colon or rectal cancer.

Deaths

Although the number of deaths from colorectal cancer are expected to increase in 2010, rates for both new cases and deaths continue to go down. As the American population grows and ages, more people are vulnerable to colorectal cancer.

• 51,370 deaths from colorectal cancer are expected in 2010, up 1,450 from 49,920 in 2009.
• 26,580 men and 24,790 women will die.
• After all cancer rates peaked for men in 1990, colorectal cancer death rates dropped by 10.27  per 100,000 men from 30.77  to 20.51, accounting for a third of the decrease in all cancers.
• For women, cancer rates peaked in 1991.  Since then women’s colorectal cancer death rates have dropped from 20.30 to 14.53, accounting for about 30 percent of the overall cancer death rate decrease.

Five year survival

• In the years between 1975 and 1977, just over half of people with colorectal cancer lived five years past diagnosis (52 percent).
• By 1999 through 2005, two out of three would live those five years (66 percent).

African American Disparities

Incidence Rates Per 100,000 by Race and Ethnicity

Five-Year Survival Percentages by Race

2010 Overall Cancer Burden

• 1,529,560 new cases of cancer are expected in 2010.
• 569,490 people will die of cancer.
• Incidence rates (rates per 100,000 people) have been going down 1.3 percent each year for men in the years 2000 through 2006.
• For women, incidence decreased by 0.5 percent each year from 1998 through 2006.

Although the rates of new cancers and cancer deaths are going down, cancer remains the leading killer of people under the age of 85 in the United States.

One in four deaths is due to cancer.

In 2010, 1,529,560 people will be diagnosed with cancer and 569,490 will die.

In reporting cancers statistics for 2010, the ACS team wrote,

Although progress has been made in reducing incidence and mortality rates and improving survival, cancer still accounts for more deaths than heart disease in persons younger than 85 years. Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment.

SOURCE: Jemal et al., Cancer Statistics, 2010, CA: A Cancer Journal for Clinicians, published online July 7, 2010.

For comparisons to 2009, see Jemal et al., Cancer Statistics 2009, CA: A Cancer Journal for Clinicians, Volume 59, Number 4, July/August 2009.

Image: Figure #3: Jemal, Cancer Statistics 2009,  CA Cancer J Clin 2010, online July 7, 2010.

African Americans get more colorectal cancer than whites and die more often.

Whether this is because of different biology or lack of access to high-quality medical care has long been debated.

In a new study, blacks had very similar rates of polyps found during a screening flexible sigmoidoscopy.  But they were less likely to get a recommended follow-up colonoscopy.

While about 1 in 4 people had polyps discovered during their sigmoidoscopy, nearly identical percentages for blacks and whites, blacks got colonoscopy follow-up about 12 percent less often than whites.

For those who did get a colonoscopy, adenomas and advanced adenomas were just as likely in whites and blacks, as was the rate of cancers discovered.

The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial screened 60,572 people for colorectal cancer using flexible sigmoidoscopy.  Doctors recommended those who had abnormalities discovered during the screening test have a colonoscopy.  However, the trial did not pay for the follow-up exam.

Analysis of the PLCO trial found,

• 23.9 percent of whites had abnormalities found during flexible sigmoidoscopy compared to 25.5 percent of blacks, which was an insignificant difference.
• 72.4 percent of whites got a diagnostic colonoscopy compared to 62.6 percent of blacks
• During colonoscopy, 23.1 percent of blacks and 22.5 percent of whites had an advanced adenoma found.
• Nearly identical percentages had cancer discovered (2.1 percent of blacks and 1.5 percent of whites).
• Advanced adenomas were more frequently found on the right side of the colon in blacks (8.5 percent) than in whites (5.5 percent) suggesting that full colonoscopy that reaches the right side of the colon may be particularly important in screening African Americans.

Lead author Adeyinka O. Laiyemo, MD, MPH, from Howard University School of Medicine, and colleagues concluded,

We observed a lower follow-up for screen-detected abnormalities among blacks when compared with whites but little difference in the yield of colorectal neoplasia. Health-care utilization may be playing more of a role in colorectal cancer racial disparity than biology.

The study did not look at reasons that African Americans were less likely to get follow-up colonoscopies.  However, in an editorial accompanying the study results in the Journal of the National Cancer Institute, John Z. Ayanian, MD, MPP, from the Department of Health Care Policy discussed some potential barriers to follow-up care.

He pointed out that other research has shown:

• Blacks are less likely to have a primary care physician.
• They live more often in low-income communities with limited access to gastroenterologists.
• They may lack insurance that covers colonoscopy.
• They may not be able to afford out-of-pocket costs for colonoscopy not covered by insurance.

The barriers concerned Dr. Ayanian, who wrote,

These gaps in follow-up care were particularly concerning because up to one-quarter of participants who did not undergo colonoscopy were likely to have advanced adenomas that were neither detected nor removed. Valuable opportunities to prevent colorectal cancer were thus lost in these patients.

He called for programs like that in New York City which increased colonoscopy screening rates for black adults from 35 percent to 64 percent in four years to be expanded to other communities.  The program in New York uses public education, improved tracking systems, and patient navigators to get low-income people to screening.  He also cited the expanded Centers for Disease Control and Prevention program that will promote colorectal cancer screening for low-income Americans in 22 states and four tribal organizations.

He said,

Colorectal cancer is one important disease in which racial and socioeconomic disparities in outcomes can most readily be eliminated by ensuring that all eligible adults are effectively screened and abnormal findings are fully treated.

SOURCES:

Laiyemo et al., Journal of the National Cancer Institute, Advance Access, March 31, 2010.

John Z. Ayanian, Racial Disparities in Outcomes of Colorectal Cancer Screening: Biology or Barriers to Optimal Care?, Journal of the National Cancer Institute, Advance Access, March 31, 2010.

Briefly: African Americans are diagnosed with colorectal cancer at later stages and have surgery less often which contributes to their poorer survival.  Women have a greater risk of a missed or early colorectal cancer after a negative colonoscopy.

If you can’t have a loved one with you during a painful procedure, just looking at your partner’s picture may make it hurt less.

The American Society for Radiation Oncology has a new website for patients, and open enrollment for Medicare plan coverage begins on November 15 and extends through the end of the year.

Research News

• African Americans were more likely to die of colorectal cancer in a study of over 13,000 patients.  They were more likely to have stage IV disease when diagnosed and less likely to have surgery.   But after late stage and lack of surgery were taken into account, racial differences in survival disappeared.  Writing in the November 2009 issue of the Journal of the American College of Surgeons, Dr. Timothy L. Fitzgerald and team said, “These data suggest that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes between African-American and Caucasian patients.”
• Canadian women were more likely than men to be diagnosed with an early colorectal cancer in the three years after a negative colonoscopy.  Researchers in Manitoba studied billing records for nearly 46,000 patients who had a clear colonoscopy and found that women with a negative colonoscopy were about as likely as women in the general population to develop colon cancer during the first three years after their test.  Then their risk dropped to about 40 to 50 percent lower.  The men’s  risk was 40 to 50 percent lower throughout the follow-up period.  Older women and those whose colonoscopy wasn’t done by a gastroenterologist were the most likely to have a missed or early colorectal cancer.   Harminder Singh MD, MPH and his team at the University of Manitoba reported their results in the American Journal of Gastroenterology online November 10, 2009.
• Looking at the picture of a loved one or holding your boyfriend’s hand reduces painful feelings, according to a study done by psychologists at UCLA. Women reported less pain when heat was applied to their forearm if they were holding their partner’s hand rather than a stranger’s hand or a ball during the experiment.  Just looking at a picture of their loved one also reduced the amount of pain they said they had.  Sarah Master PhD led the study.

Other Headlines

• The American Society for Radiation Oncology (ASTRO) has launched a newly designed patient website RT Answers. The new site is easier to navigate and includes more pictures.  The front page helps patients search for a radiation oncologist and provides a gateway to treatment information.
• Medicare beneficiaries can make new coverage choices during the annual open enrollment period from November 15 through December 31.   Online comparisons of original Medicare, Medicare Advantage, and supplemental Medigap policies are available from CMS.  Also changes in Part D Prescription Drug coverage plans can be made during open enrollment.

Clinical features of colon tumors can predict survival, acupressure bands reduce nausea during radiation therapy, and there was no connection between the amount of fish a person ate and risk for colorectal cancer.  Although blacks have an increased risk for colon and breast cancer, hospitals matter.  All patients — white or black — did worse in hospitals that treated a majority of black patients.

Surgical robots are being developed with a light touch that can tell the difference between normal and tumor tissue.

Research Reports

• About 12 percent of stage I and II colon cancer patients in a German study had one or more clinical characteristics that increased their risk of dying from their cancer.  Overall, cancer-specific survival for the group was 94.8 percent at 5 years and 91 percent at ten years.  However, invasion of lymphatic vessels, poor tumor grade, or length of tumor greater than 6 centimeters reduced survival.  With one poor characteristic, five and ten year cancer-specific survival was 94.8 percent and 88.9 percent.  With all three, survival fell to 87.5 percent at 5 years and 72.9 percent at ten years.  Patients with none of the characteristics had a five year survival of 96 percent.  None of the patients in the study had chemotherapy after their surgery. The study of a prospective Munich database was reported by surgeon Ralf Gertler in the European Journal of Cancer online August 19, 2009.
• Colorectal and breast cancer patients of any race who are treated in hospitals where more than half of patients are black have higher death rates.  For colorectal cancer, the increased risk was almost 30 percent even after adjusting for other risks like age, stage, race, and socioeconomic factors.  “Efforts aimed at increasing early detection through screening and decreasing incidence with preventative services are essential for decreasing racial disparities in mortality, but where a patient receives care after a cancer diagnosis may be equally important,” senior study author Arden M. Morris, MD, MPH said.  The study was published in the July 20, 2009 issue of the Journal of Oncology.
• Acupressure wristbands reduced nausea from radiation therapy.  However, there was no additional effectiveness if patients were given information before using the bands that led them to expect results. Joseph Roscoe, PhD, and his colleagues at the University of Rochester reported their on their study in the Journal of Symptom and Pain Management online March 31, 2009.
• Researchers in Japan found no connection between how much fish an individual eats and colorectal cancer.  Following nearly 40,000 people for 9 years, the scientists found 566 cases of colorectal cancer but no difference in risk between those who ate the most fish and those who ate the least. Y. Sugawara reports study results in the British Journal of Cancer on August 25, 2009.

Other Headlines

• Robots may have a lighter — and better — touch than surgeons.  Tumors usually feel stiffer than surrounding tissue, and in open surgeries, doctors put light pressure on organs to identify areas with potential cancer.  With minimally invasive (laparoscopic) surgery, they cannot feel tissue.  A new robotic system is being developed to replace the surgeon’s hand, systematically putting light pressure on organs to locate tumors.  The robots use less pressure and use it consistently.  Medical News Today on August 22 had an article about the Canadian CSTAR project that is developing the robots.