Colorectal Cancer Treatment News

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Patients Of UK's Second Biggest Killer To Gain Access To Potentially Curative Cancer Treatment

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28 Feb 2006

The National Institute for Health and Clinical Excellence (NICE) published their Final Appraisal Determination (FAD), which advocates the use of the potentially life-saving treatment Eloxatin (oxaliplatin) in combination with 5-fluorouracil (5FU) and folinic acid (FA) for patients with early stage (adjuvant) Bowel Cancer .

The FAD is the last stage prior to NICE issuing final guidance, at which point doctors are expected to begin implementing the recommendation and the NHS will need to be prepared to fund the treatment. In the UK, the FAD and final guidance will benefit approximately 8000 patients who are diagnosed with stage III bowel cancer and are eligible for adjuvant treatment[1].

?Not enough bowel cancer patients are currently gaining access to combination chemotherapy, which has been proven to offer them their best chance of survival,? says Neil Brookes, Chief Executive of Bowel Cancer UK. ?This guidance will be a huge step towards ensuring that all patients who can benefit from these treatments will gain access to their best chance of overcoming the disease.?

NICE based its recommendation to give NHS patients access to the potentially life-saving drug combination on data from a major international trial. Four year disease-free survival data in patients with stage III bowel cancer showed that adding Eloxatin to the standard chemotherapy reduced the risk of relapse after initial surgery by 25%*[2]. Once guidance is issued, oncologists are calling for all patients with adjuvant bowel cancer who could benefit, to get access to Eloxatin-based combination chemotherapy.

?The efficacy in terms of disease-free survival shown by Eloxatin in this group of patients is unmatched by any other licensed therapy,? says Dr Rob Glynne Jones, Consultant Oncologist at Mount Vernon Hospital and Medical Advisor at Bowel Cancer UK. ?Routine access to Eloxatin has the potential to save thousands of lives each year.?

Colorectal cancer is the third most common cancer in the UK, with over 30,000 new cases diagnosed annually in England and Wales, and the second most common cause of death from cancer after lung cancer[3]. If the disease is diagnosed early enough, before the cancer spreads beyond the colon (which is known as stage III colon cancer), surgery followed by a course of adjuvant chemotherapy currently offers the best chance for cure.

?The FAD confirms that treatment choices in bowel cancer should be made jointly by patients and their clinicians.? says Hilary Whitaker, CEO of Beating Bowel Cancer. ?Final guidance is expected in April 2006 and patients should start discussing their treatment options with clinicians now.?

The Final Appraisal Determination (FAD) from NICE recommends the following as options for the adjuvant treatment of patients with stage III (Duke's C) colon cancer following surgery for the condition:
-- Eloxatin in combination with 5FU/FA
-- Capecitabine as monotherapy

Eloxatin with 5FU/FA is the only combination chemotherapy licensed in the UK as a potentially curative treatment for stage III colon cancer. Eloxatin has been shown to demonstrate a predictable and manageable side effect profile, showing acceptable tolerability in the majority of patients. Side effects commonly associated with Eloxatin in combination with 5FU/FA include cumulative peripheral sensory neuropathy (a condition affecting nerves in the hands and feet, causing tingling and numbness), a decrease in white blood cells, reduced platelet count (thrombocytopenia), diarrhoea, nausea, vomiting and gastrointestinal inflammation. Side effects are generally reversible once treatment is complete.

http://www.medilexicon.com/medicalnews.php?newsid=38481∞

Virtual Colonoscopy Considerably More Expensive

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31 Oct 2006

Wake Forest University Baptist Medical Center researchers have found that "virtual" colonoscopy using a computer tomography (CT) scanner is considerably more expensive than the traditional procedure due to the detection of suspicious images outside of the colon.

"Virtual colonoscopy will certainly play a role in the future of colon cancer screening," said gastroenterologist Richard S. Bloomfeld, M.S., M.D., assistant professor of medicine at Wake Forest Baptist and a member of the research team. "It is important to understand the implications of findings outside the colon before we advocate wide-spread use of this technology."

Virtual colonoscopy, also known as CT-colonography (CTC), was developed at Wake Forest Baptist. It allows doctors to use CT scanners to look at the colon to detect polyps (small growths in the colon that may become cancerous if they are not removed) and cancers. Virtual reality software allows them to look inside the body without having to insert a long tube (conventional colonoscopy) into the colon or without having to fill the colon with liquid barium (barium enema).

Research performed at Wake Forest Baptist and elsewhere has shown that CTC is better able to see polyps than barium enemas and is nearly as accurate as conventional colonoscopy. Most patients report that CTC is more comfortable than either procedure.

The current research evaluated CTC for use as a colorectal cancer screening tool in an average risk population. It revealed that findings outside the colon -such as lung nodules and indeterminate kidney lesions-added about $231 to each CTC performed because of the need for additional testing. Those tests often reveal that the extra-colonic findings are benign.

"Finding things outside of the colon on a virtual colonoscopy can be a good thing or a bad thing," Bloomfeld said. "It's a good thing if we find unknown conditions that are treated, but a bad thing if we put people through more invasive tests with risks and additional costs for no reason."
http://www.medilexicon.com/medicalnews.php?newsid=55369∞

UCLA Cancer Researchers Develop Quality Measures For Colorectal Cancer Surgery

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19 Nov 2006

A set of quality measures used to evaluate the quality of care received by patients undergoing surgery for colorectal cancer has been created by UCLA researchers in an effort to improve care before, during and after the surgery.

Improving the quality of surgical care for colorectal cancer patients is vital as the number of resections continues to increase in an aging population, said Dr. Clifford Ko, an associate professor of surgery, a researcher at UCLA's Jonsson Cancer Center and lead author of the study. About 148,000 people will get colorectal cancer this year alone, and about 90 to 95 percent of those will undergo surgery.

Colorectal cancer is the second most common cancer type among new cancers being diagnosed in the United States and as such, is treated at major academic medical centers as well as in community hospitals and surgical centers. Because it is treated in so many different places, guidelines outlining the best care for patients provide a valuable tool.

Ko and his colleagues came up with 92 quality of care indicators in six broad areas that encompass everything from surgeon credentials to patient-care provider discussions to medication use. The study is published in the Nov. 15 of the Journal of the National Cancer Institute.

The new quality indicators cover all aspects of surgical care, including a patient's health evaluation before the surgery to the most appropriate surgical techniques to resect varying types of colorectal cancer to creating a list of medications the patient already is taking to avoid dangerous interactions. The new quality indicators, which expand on a set of practice guidelines created by the National Cancer Institute in 2000, also detail the best post-operative patient management practices.

"You can do the best operation in the world, but it doesn't mean much if the patient doesn't do well after surgery," Ko said.

To come up with the quality indicators, Ko and his team carried out structured interviews with leaders in the field of colorectal cancer surgery, as well as a systematic review of the literature. A panel of 14 colorectal surgeons, general surgeons and surgical oncologists then evaluated the list and rated the indicators for validity, Ko said.

Of the 142 indicator on the original list, 92 were determined to be valid by the panel of experts and now make up the new list of quality indicators.

Ko and his team hope the quality indicators will be used as a checklist by surgeons and others in the community caring for colorectal cancer surgery patients. Most healthcare professionals probably already are doing some of the things on the checklist, Ko said, but the quality measures could serve as a safeguard to ensure that everything that should be done actually gets done.

"If we do all the right things, the patient will do better before, during and after surgery," Ko said. "The more information we have, the better job we can do."

The new quality indicators will be distributed to healthcare professionals in the community in CD form. Additionally, UCLA researchers will be presenting their work at conferences and meetings in order to raise awareness about the new quality indicators. Ko said the indicators can be used by individual institutions to measure the quality of their care as well as devise ways to improve it.

"These indicators identify potentially meaningful and important steps for providing high quality of care among health care systems, hospitals and providers offering surgical care to patients with colorectal cancer," the study states.

Quality of care measures have been developed for many diseases. They're used by regulatory agencies such as the Centers for Medicare and Medicaid Services to evaluate quality of care in a variety of diseases. Until now, no quality of care indicators had been developed for colorectal cancer other than the NCI's practice guidelines.

Ko and his team next will use the quality of care indicators to determine if they impact a patient's outcome after colorectal cancer surgery. They hope to determine if there are any further ways that surgeons and others caring for colorectal cancer patients can improve outcome, prognosis and quality of life.
http://www.medilexicon.com/medicalnews.php?newsid=56739∞

See also:
http://www.medilexicon.com/medicalnews.php?newsid=56742∞

UK Lags Behind In New Cancer Drug Uptake And Survival

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11 May 2007

A new Swedish report into worldwide patient access to new cancer treatments and survival rates reveals "stark inequalities" among nations with the UK lagging behind.

The report is published in the cancer journal Annals of Oncology.

Report authors, Dr Nils Wilking, clinical oncologist at the Karolinska Institute in Stockholm, Sweden, and Dr Bengt J?nsson, director of the Centre for Health Economics at the Stockholm School of Economics, reviewed access to 67 innovative cancer drugs in 25 countries with a total population of 984 million.

The report included 19 European nations, plus Australia, Canada, New Zealand, Japan, South Africa and the USA.

Leaders in the use of new cancer treatments are Austria, France, Switzerland and the US, with France replacing Spain among the top four since the authors last reviewed the situation in their 2005 report.

The poorest performers, where uptake of new cancer drugs is "low and slow" as the authors described it, are New Zealand, Poland, Czech Republic, South Africa and the UK.

Dr J?nsson said:

"The greatest differences in uptake were noted for the new colorectal and lung cancer drugs: bevacizumab, cetuximab, erlotinib and pemetrexed."

Their report shows that:


Lung and colorectal cancer are two of the world's top cancer killers for both men and women. According to a source quoted in the report, in 2002 lung cancer killed over 848,000 men and 330,000 women, and colorectal cancer killed 278,000 men and 250,000 women worldwide.

In reviewing survival rates, Dr Wilking said:

"Progress in medical treatments has meant that over half of the patients diagnosed with cancer will now be 'cured' or die from other causes. However, these benefits are only realised once the drugs get to the patients."

"Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. Where you live can determine whether you receive the best available treatment or not. To some extent this is determined by economic factors, but much of the variation between countries remains unexplained," he added.

The report includes their main findings with respect to survival rates and treatment outcomes:


Dr J?nsson said:

"Around one sixth of the differences between these five countries in five-year cancer survival is due to differences in the uptake of new drugs in each country."

The report describes two other kinds of analysis where access to newer cancer drugs was linked to improved patient survival.

It also examines investment and spending in cancer research where imbalances in spending and how it is targeted exist between Europe and the USA. According to Dr J?nsson:

"Not only is the magnitude of public research at a different level in the United States, it is also directed to clinical research to a greater extent. There is a need for a significant increase in the public research for cancer in Europe, particularly devoted to clinical research."

The authors urged decision and policy makers in all countries to take action to remove these inequalities:

"It is our hope that this report will inspire policy makers and decision makers to take action to address these imbalances so that access to new innovative cancer drugs does not become dependent on the patient's country of residence," they said.

They suggest a number of recommendations, including reducing the review time for new drug authorization, minimizing the delay between authorization and market availability while prices and reimbursements are negotiated, and making sure budgets look ahead and include enough money for new drugs.
http://www.medilexicon.com/medicalnews.php?newsid=70580∞

Pharmacists' Role In Managing Bowel Cancer Highlighted In New Practice Guidance, UK

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15 May 2007

New guidance on best practice for pharmacists when advising on suspected, or diagnosed, bowel cancer has been prepared by the national charity Beating Bowel Cancer and supported by the Royal Pharmaceutical Society of Great Britain. The guidance for pharmacists, which will be distributed with the 19 May edition of the PJ, is part of a broader campaign, spearheaded by Beating Bowel Cancer, which aims to raise awareness of the disease amongst primary healthcare professionals.

The new campaign is being piloted in 11 PCT's across England. Part of the initiative is to provide pharmacy staff and their customers with important information on symptoms to look out for, and encouraging customers to seek further support if they are concerned. Community pharmacies will be displaying eye-catching 'toilet door' posters and leaflets in a bid to increase awareness of bowel cancer, the UK's second biggest cancer killer.

Bowel cancer affects one in 18 people during their lifetime, and is the second biggest cause of cancer deaths in the UK. It affects men and women equally and can strike at any age. If the disease is caught and treated in time up to 90% of these lives could be saved.

"Early diagnosis of bowel cancer is essential to ensure a positive outcome for patients," said Hilary Whittaker, Chief Executive of Beating Bowel Cancer. "We need to make people aware of this huge disease and, with six million people visiting UK pharmacies every day, the pharmacy environment is ideal for an awareness campaign as it has such wide reach. We hope that it will encourage people to get any symptoms investigated, and not to 'hide them behind closed doors'."

Paul Gimson, Lead Pharmacist for Long Term Care at the Royal Pharmaceutical Society of Great Britain, commented: "The role of community pharmacists in raising awareness of particular health issues is becoming more widely recognised. We are pleased to work with Beating Bowel Cancer on this initiative to provide pharmacists with information which will help them to identify the symptoms of bowel cancer and advise the general public accordingly. This work further highlights the valuable role that community pharmacy has to play in improving public health." The guidance document will be available on the Society's website www.rpsgb.org via the Download Documents page under 'Guidance documents'. It will also be available from Beating Bowel Cancer's website via www.beatingbowelcancer.org/medical.

Beating Bowel Cancer was set up in 1999 and exists to raise awareness of symptoms, promote early diagnosis and encourage open access to treatment choice for those affected by bowel cancer. For more information on the charity, and bowel cancer, visit www.beatingbowelcancer.org.

www.rpsgb.org
http://www.medilexicon.com/medicalnews.php?newsid=70993∞

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