Summer’s over. The black squirrels in the front yard are scurrying around hunting acorns and my inbox is full of neat nuggets of colorectal cancer news — and I don’t want to leave them buried all winter.

So here they are in brief.  You can check the links for more details.

Mixed Results Using Acupuncture for Radiation Nausea

The good news is that almost all patients felt they had less nausea after either real or sham acupuncture to manage nausea and vomiting during radiation therapy.  Nine out of ten wanted more treatments.

The sham procedure used non-penetrating needles just pressed against the skin, but neither the patients who got real acupuncture or those who got sham treatments knew which they received.

Ninety-five percent in the real acupuncture group and 96 percent in the sham acupuncture group believed that the treatment had been effective against nausea.  However, 70 percent of the real group and 62 percent of the sham group did experience nausea — for an average of 10 days for real treatments and 9 days for sham.

In addition, 25 percent of the real group and 28 percent of the sham group vomited.

So measured objectively, there was still significant nausea and whether or not acupuncture was “real” or just pretend, it made no measurable difference.

Dr. Anna Enblom from the Karolinska Institute in Stockholm said,

The beneficial effects seem not to come from the traditional acupuncture method, but probably from the patients’ positive expectations and the extra care that the treatment entails.

Read more in articles by Dr. Enblom and her colleagues in Annals of Oncology and earlier this year in PLoS ONE where acupuncture, both real and sham was compared to standard nausea care.  Dr. Enblom also was featured in a news release from the Karolinska Institute.

Why Research on Fruits and Veggies and Colorectal Cancer Risk is Confusing

More fruits?  More veggies? Less colon cancer? Less rectal cancer?

Doesn’t make a difference.  Makes a big difference.

Are you confused when you read media stories based on new research about the impact of diet on colon and rectal cancer?

It may be that different fruits and vegetables have different effects depending on where cancer develops — in the proximal colon (near the top), the distal colon (near the rectum), or the rectum itself.

The research team from the Western Australian Bowel Health Study compared fruit and vegetable intact between people who had been diagnosed with colon or rectal cancer and a similar group of cancer-free individuals. They specifically looked at where the cancer was in the colorectal tract.

While total intake of fruits and vegetables and total intake of vegetables did reduce distal cancer, neither had any impact on proximal or rectal cancer. Brassica vegetables like broccoli and cabbage reduced proximal colon cancer risk, while risk for distal cancer was significantly reduced by eating dark yellow vegetables and apples.

Rectal cancer risk was increased by drinking fruit juice.

The discovery of differences should impact future diet studies for reducing colorectal cancer risk. Epidemiologist and study author Professor Lin Fritschi, PhD explained.

Fruits and vegetables have been examined extensively in nutritional research in relation to CRC, however, their protective effect has been subject to debate, possibly because of different effects on different subsites of the large bowel.

It may be that some of the confusion about the relationship between diet and cancer risk is due to the fact that previous studies did not take site of the CRC into account. The replication of these findings in large prospective studies may help determine whether a higher intake of vegetables is a means for reducing the risk of distal CRC.

The study was reported in the October Journal of the American Dietetic Association.

The bottom line for people who want to reduce their risk of colon and rectal cancer is that eating fruit and vegetables does help prevent cancer in some parts of the colon and rectum, but doesn’t guarantee that cancer won’t occur.  Getting fruit from juice may not be the best choice because that does increase rectal cancer risk.

Even a Little More Exercise Helps

Although recommendations are for 150 minutes of exercise a week or 30 minutes a day to reduce risk of dying from cardiovascular disease or cancer, even less activity can increase life expectancy.

Following over 415,000 people in Taiwan over an average of 9 years, researchers found that even 15 minutes a day (92 minutes a week) of physical activity increased life expectancy three years compared to those people who had no exercise at all. The no exercise group had a 17% increased risk of dying compared to the low-exercise group.

After an initial 15 minutes every day (low-volume exercise) every additional 15 minutes of daily exercise decreased risk of dying from any cause by 4% and dying from cancer by1%.

Dr Chi Pang Wen MD from the National Health Research Institutes in Zhunan, Taiwan reported study results in the October 1, 2011 issue of The Lancet.

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.

Studies report that ginger can reduce blood pressure and reduce cholesterol which all help to decrease risk of coronary artery disease. One study showed that ginger is as effective as prescription drugs such as Reglan to treat nausea and vomiting associated with cancer chemotherapy.

Last week there was a big write-up in the Los Angeles Times, so most of my patients cut out the article and asked me if it is okay to take ginger.

We have known for quite a while that ginger ale can help some patients with nausea and vomiting.  A study in the British journal Lancet in 1982 showed it was actually more effective than Dramamine® in preventing motion sickness in seasick Danish sailors.  In another test conducted at Brigham Young University, 36 students were asked to take either 100 mg. of Dramamine (dimenhydrinate), two capsules of Ginger or a placebo. They had to sit in a special rotating chair. None of the students who took Dramamine or the placebo could do the whole six minutes, but half of the students with ginger could finish.  We usually recommend two capsules before your travel and every four hours.

Ginger has also some other interesting effects such as an anti-inflammatory and can help to fight a flu, bronchitis and sore throat because it contains antiviral compounds such as gingerols, shogaolsm and sesquiterpenes which can reduce fevers, pains and cough. Ginger also contains a proteolytic enzyme called zingipain which can help in patients with bunions and arthritis pains. Ginger can be also applied  externally as a compress and can reduce pain particular for  fibromyalgia, joint stiffness, abdominal cramps and skin inflammations.

We usually recommend preparing a warm ginger tea to help break a high fever and rid mucus buildup in the sinuses by drinking a cup every 2-3 hours.

There is one issue you need to check with your physician:  if you have a history of  blood-clotting problems, you need to discuss whether you can take ginger. We know that ginger can prevents blood clots, therefore discuss with your oncologists that you are taking ginger because it can influence blood clotting.

Patients who got ginger (Zingiber Officinale) in capsules twice a day for three days before chemo and three days after reported significantly less nausea that those who were treated with placebo.  All patients in the study also received standard anti-nausea therapy on the day of chemo.

Almost 650 patients, mostly women, were randomly assigned to ginger supplements or a placebo in a blinded trial that will be reported at the 2009 ASCO annual meeting.

Julie Ryan, PhD, MPH, who headed the study at the University of Rochester, told reporters at an ASCO press briefing,

As many as 70 percent of patients who undergo chemotherapy experience nausea and vomiting. We found that patients who received traditional anti-nausea drugs along with ginger supplements prior to chemotherapy experienced significantly less nausea associated with their chemotherapy. However, as with all supplements, patients should speak with their doctors first before taking ginger.

SOURCE: Ryan et al., Ginger for Chemotherapy-related Nausea in Cancer Patients, ASCO 2009 Abstract #9511.

The patients in the study were receiving radiation to the intestinal tract and had already experienced some nausea during treatment.  Wearing the bands reduced nausea scores by about 24 percent.

To test the theory that the reduction was caused by patient expectations or a placebo effect, half of the group who wore wristbands received a positive handout saying that research showed wristbands reduced nausea.  The other half had a neutral handout.  There was no difference between the two groups.  Both had less nausea.

Another group who didn’t have wristbands, had a very small reduction in nausea of about 5 percent.

Joseph A. Roscoe, Ph.D., who led the study at the University of Rochester’s Wilmot Cancer Center explained,

We know the placebo effect exists, the problem is that we don’t know how to measure it very well.  In this study we attempted to manipulate the information we gave to patients, to see if their expectations about nausea could be changed. As it turned out, our information to change people’s expectations had no effect – but we still found that the wristbands reduce nausea symptoms.

The research team concluded,

Acupressure bands are an effective, low-cost, nonintrusive, well-accepted, and safe adjunct to standard antiemetic medication. An attempt to boost the efficacy of the acupressure bands by providing positive information was not successful.

SOURCE: Roscoe et al., Journal of Pain and Symptom Management, published online March 28, 2009.

Ginger root

Although ginger is often recommended as a simple remedy for chemotherapy nausea, ginger capsules don’t seem to work any better than a sugar pill to improve the effects of standard nausea drugs.

In a randomized study, 162 patients received either ginger capsules or a placebo for chemotherapy-induced nausea and vomiting. Neither the patients or their doctors knew which they were getting.  All patients were already receiving an 5-HT₃ inhibitor such as Zofran® or Kytril®.  Some were also being treated with Emend® (aprepitant).

All patients in the trial had already had at least one episode of nausea or vomiting during chemotherapy.  They were given either 1 gram or 2 grams of ginger within a capsule or a identical looking placebo in addition to their regular anti-nausea medicine for three days after chemotherapy.

Researchers found no different in either acute nausea and vomiting on the day of chemo or delayed nausea over the next few days.  Combining ginger with Emend actually increased acute nausea and vomiting.

Despite blinding, patients were able to guess accurately whether or not they were actually getting ginger or a sugar pill.

There were no significant differences in side effects between the two groups, although the patients who got ginger capsules had less fatigue.

Dr. Suzanna M. Zick and her colleagues at the University of Michigan in Ann Arbor concluded,

Ginger provides no additional benefit for reduction of the prevalence or severity of acute or delayed CINV when given with 5-HT₃ receptor antagonists and/or aprepitant.

SOURCE: Zick et al., Supportive Care in Cancer, Online First, November 13, 2008.

The most common side effects were headache, experienced by about four percent of patients and constipation in less than one percent.

Information from the FDA about the new oral Aloxi approval.

Intravenous Aloxi has been available since 2003 to manage both acute nausea and vomiting in the hours after chemotherapy and delayed nausea during following days.

The patient brochure for IV Aloxi provides additional help to manage chemotherapy-induced nausea including avoiding:

• Solid food right before and after treatment
• Caffeine and alcohol
• Spicy or greasy foods
• Cooking odors, smoke, perfume
• Your favorite foods after receiving chemotherapy so they don’t become triggers for nausea
• Unpleasant sights, sounds, and smells that might trigger nausea
• strenuous exercise

The brochure also suggests

• Eat lightly on the day of treatment.
• Eat several small meals during the day instead
  of large ones.
• Drink cool, clear fluids, such as sports drinks,
  ginger ale, or lemon-lime sodas.
• Eat foods that are cool or at room temperature.
• Eat bland foods (dry toast or soda crackers).
• Take care of your mouth.
• Take part in hobbies or practice relaxation techniques.

The makers of Aloxi also provide a calendar that helps patients record vomiting, nausea, and how they felt in the days after chemotherapy.  The information can then be shared with the doctor or oncology nurse.