Health News: Cancer
Colon Cancer Screening Rates Remain Low
MONDAY, July 14 (HealthDay News) -- Only half of U.S. men and women older than 50 are getting screened for colorectal cancer, despite the success these tests have in reducing deaths linked to the disease, a new report says.
Still, the current rate of screening is an improvement from the 43 percent who received the tests back in 2000, the researchers noted. The statistics come from a national survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) in 2005. Experts discuss the findings in the July issue of Cancer Epidemiology, Biomarkers & Prevention.
"Colorectal cancer is one of the leading cancer killers in the United States, behind only lung cancer. Screening has been shown to significantly reduce mortality from colorectal cancer, but a lot of people are still not getting screened," Jean A. Shapiro, a CDC epidemiologist, said in a news release issued by the journal's publisher, the American Association for Cancer Research.
Insurance coverage may be part of the problem, Shapiro said. Only 24 percent of people lacking health insurance had colorectal cancer screening compared with more than 50 percent of insured Americans. "If we can increase the number of people who have health care coverage, we should be able to increase colorectal cancer screening rates," Shapiro said.
Beyond health insurance, the researchers reported that people were far more likely to have had colorectal cancer screening tests if they were college educated, had a household income of $75,000 or more, and had seen their doctor at least twice in the previous year. Of those who saw their doctors in the past year, about half who did not receive testing said they had "never thought about it." Another 20 percent said their doctor did not order the test.
"Many doctors are aware, but some may still need to be educated about the importance of colorectal cancer screening," Shapiro said.
By Rick Nauert, Ph.D., Psych Central
The fight against cancer includes managing the physical and mental fatigue associated with medical treatment for the malignancy. Often, the psychosocial aspects of the disease add insult to already lowered defense mechanisms.
New research discovers regular exercise and psychological counseling help individuals deal with this stress significantly improving quality of life.
Fatigue is one of the most common symptoms of patients with cancer and those undergoing treatment with radiation and chemotherapy. According to the American Cancer Society, 90 percent of patients in cancer treatment experience fatigue that can range from "mild lethargy to feeling completely wiped out."
The reviewers, led by Paul Jacobsen of the H. Lee Moffitt Cancer Center in Tampa, Fla., said that fatigue affects patients' quality of life, with one-third feeling that it, "interferes with their ability to work, relationships with others and physical and emotional well-being."
There has been growing interest in helping these patients manage the symptoms of exhaustion with nonpharmacological treatments, and the systematic review aimed to determine the effectiveness of psychological therapy and exercise in meeting the goal.
The review appears in the November issue of the journal Health Psychology. Each evidence-based review in this series centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.
The reviewers evaluated 41 studies. Of these, 17 looked at activity-based interventions in which patients either performed supervised or home-based exercises three to five times a week, for exercise periods that ranged from 10 to 26 weeks.
Some of these studies included patients undergoing or about to start cancer treatment, while others were comprised only patients who had completed treatment.
Twenty-four studies evaluated psychological interventions. There were a variety of types of interventions, including techniques such as weekly telephone counseling about how to conserve energy and group therapy to teach skills like stress management and relaxation training.
About half of the studies focused on patients who had breast cancer, while others included patients with more than one type of cancer, such as colorectal and prostate.
Jacobsen and his colleagues found that 44 percent of the activity-based trials and 50 percent of the psychological studies that were of good quality reported significant, if not earth shattering, results. Patients who received either of the two types of interventions reported less fatigue than patients in the control groups did, the researchers concluded.
"The overall effects of both psychological and activity-based interventions on fatigue were modest," Jacobsen said. "The effects of psychological interventions were sufficiently large, however, to say that they were unlikely to have occurred by chance alone using conventional definitions of statistical significance."
Jacobsen concluded the results only provide "limited support" for the use of these types of nonpharmacological treatments to manage cancer fatigue.
Steven Passik, associate attending psychologist at the Memorial Sloan-Kettering Cancer Center, said that although there is currently limited research that interventions such as counseling or exercise have a strong benefit on fatigue, patients prefer to try these methods rather than take more medications.
"Some of the main barriers of managing cancer fatigue have proven to be a lack of communication from health care providers to patients about how to battle fatigue, as well as an overall reluctance of many patients to take any more drugs to treat the symptom," Passik said.
"So, more research like this study is needed to find what types of interventions work best for patients." Jacobsen added that if cancer patients do choose to exercise during their treatments, they should take caution.
"Patients should consult with their physicians before initiating an exercise regimen," he said.
For more than half a century, chemotherapy has played a major role in cancer treatment. It's often oncologists' first line of defense against cancer, either alone or in combination with surgery, radiation, or other therapies.
"Chemotherapy isn't just one thing," says Stephen I. Shibata, M.D., associate professor of medical oncology at City of Hope National Medical Center in Duarte, California. "It's a variety of different treatments — all of which have different side effects and different potential benefits in terms of the way they attack the cancer."
In fact, when oncologists create a treatment regimen for a cancer patient, they choose from more than 100 chemotherapy drugs. In most cases, patients receive a combination therapy that consists of more than one chemotherapy medication — the rationale is that giving a patient a variety of drugs with different actions is likely to destroy more cancer cells and reduce the chance that the patient will become resistant to a particular drug.
Patients are often treated with these medications in cycles over a specific period of time. Some drugs are given continuously over a number of days, while others are given several times a week. And there are many routes of delivery, too, ranging from intravenous infusion to oral pills.
A Systemic Treatment
Unlike surgery and radiation, which destroy cancer cells within a specified
area, chemotherapy works throughout the body. Because cancer cells multiply
more quickly than normal cells, chemotherapy agents are designed to target such
rapidly multiplying cells. The more rapidly the cells divide, the more
effective the drugs are at killing them. Unfortunately, there are normal cells
— in the roots of the hair, the intestines, and the lining of the mouth — that
also multiply quickly and are therefore susceptible to the medications' toxic
effects. That's why many patients fear treating their cancer almost as much as
getting the diagnosis.
There's no doubt that some forms of chemotherapy cause debilitating side effects. Many patients complain of exhaustion, nausea, reduced immunity, and mouth sores. Others are devastated by the toll chemotherapy takes on their appearance (it causes hair loss, dry skin, and brittle nails). So it's no surprise that patients are reluctant to begin treatment. But experts claim that every drug — and every patient — is different.
"It's important for patients to be aware of the potential side effects but also to realize that the effects differ between patients," says Shibata. "Some might experience a lot of side effects, while others only have a few — even with the very same treatment regimen."
The Future of Chemo
Scientists are working hard to develop new forms of chemotherapy that can more
effectively differentiate between cancer cells and normal cells. Such
"targeted therapies" are intended to destroy only cancerous cells,
leaving normal cells untouched.
"Some of these treatments attack the cancer's blood supply; others attack the way the cancer cells receive growth signals," says Shibata. But all of them work to spare normal cells and dramatically reduce the occurrence of side effects. So perhaps some years from now, starting a chemotherapy regimen may be no more daunting than beginning a course of antibiotics.
Chemotherapy destroys cancerous cells. Unfortunately, it also kills healthy, infection-fighting cells at the same time, suppressing the immune system and thereby making patients more vulnerable to infection.
"Most chemotherapies will decrease the activity of your bone marrow," says Stephen I. Shibata, M.D., associate professor of medical oncology at City of Hope National Medical Center in Duarte, California. "The drugs reduce the production of red blood cells, which may lead to anemia, and white blood cells, which can affect your immune system." Even a mildly depressed white cell count can reduce the body's ability to fight off foreign invaders.
Here are eight simple ways to boost your immunity and prevent post-chemotherapy infections.
Chemotherapy drugs work by killing the rapidly proliferating cancer cells that are making you sick. The downside is that they can also damage healthy white blood cells, which are normally the backbone of your immune system and are constantly replenished. A reduced white blood cell count, a common side effect of cancer treatment, leaves you susceptible to infections, including those caused by bacteria or fungi.
If you are undergoing chemotherapy, your blood work will probably show that your white cell count hits a low point, or nadir, between treatments. The cell count improves as the marrow in your bones rebuilds your immune system by producing new white cells, also known as leukocytes. Your immune system includes several types of white blood cells, including granulocytes and lymphocytes, whose job is to seek and destroy dangerous germs or cells that are damaged or abnormal because of an infection or mutation.
Neutrophils, a type of granulocyte, are the most common white cells in the blood; they help ward off the infections that are common to cancer patients. White cells also include B lymphocytes, or B cells, which produce antibodies and fight infection, and T lymphocytes, or T cells, which help regulate immune response and attack bacteria and other harmful invaders in the blood. Your doctor will probably be monitoring the number of all these cells in your blood during therapy. If your levels have not rebounded before you start your next round of treatment, he or she may give you a short break or prescribe drugs such as filgrastim (Neupogen) or the longer-lasting pegfilgrastim (Neulasta) to help your body make more white blood cells.
When your white cells are low, a small infection can quickly escalate into a serious health threat. You should alert your doctor if you have any of the following symptoms because they may be signs of an infection that requires immediate medical intervention:
To protect yourself, especially when your cell counts are low, avoid crowds and contact with people who have colds, the flu, or more serious viruses, such as chicken pox. Do not get an immunization without consulting your doctor, and avoid people who have recently been vaccinated.
Finally, your skin is your first line of defense against infection and other illnesses. Here are some ways to support your skin's natural defenses:
· Bathe with warm water every day and pat, don't rub, your skin dry.
· Avoid anything that makes cuts in the skin — no matter how small. Consider switching from a razor to an electric shaver, and avoid cutting your cuticles.
· Wash your hands frequently. That means before eating, after using the bathroom, or after being in public places.
· Wear gloves if you must change diapers or cat boxes or if you garden.
· Use a toothbrush with soft bristles and floss gently.