Colon Cancer Foundation, Squatty Potty & DuClaw Brewing Company are coming together to offer ‘unicorn farts’ beer for getting tested during National Colorectal Cancer Awareness Month

 

March 1, 2021 (New York, NY) – Colorectal cancer is crappy. As the nation’s second-deadliest form of cancer, it kills thousands every year. This March, adults can enjoy a limited-edition glittery beer that can’t be purchased with money, but can only be accessed with their own poop during National Colorectal Cancer Awareness Month.

The unusual ask is part of the clever ‘Give a Crap Challenge’ hatched by the Colon Cancer Foundation, Squatty Potty and DuClaw Brewing Company with help from Everlywell, CraftShack and Diablo Doughnuts to help the Colon Cancer Foundation reach their goal of providing 10,000 colorectal cancer screenings to underserved communities in 2021.

As a result of signing up, participants will also help to raise awareness for the 75 million people in the U.S. who are 45+ and should be regularly tested for colorectal cancer (and their loved ones who can help to encourage “the talk”).

For 400 eligible participants, it’s as easy as: Click. Squat. Sip. –

  1. Click – Sign up at www.GiveACrapChallenge.com between March 3 – 7 for a chance to participate and receive the screening, Squatty Potty and beer.

(One hundred lucky entrants will be randomly selected from signups to participate at no cost. Another 300 can instantly participate by making an $85 donation.)

  1. Squat – Take your noninvasive colorectal cancer screening test in the privacy of your own home and mail to the lab in the prepaid envelope.
  2. Sip – Enjoy your 6-pack of DuClaw’s ‘Thanks for Giving a Crap’ edition of Sour Me Unicorn Farts glittered sour ale on your doorstep from CraftShack & relish in the fact that you gave a crap today! (You’ll receive secure, personalized results of your screening from to your device.)

“This is us, arms in the air shouting from the rooftops that colorectal cancers are no longer simply an old person’s disease,” said Cindy Borassi, president of the Colon Cancer Foundation. “The fight against the second-leading cause of cancer death among U.S. men and women is serious…and sometimes, the best way to engage people is with a little humor!”

Participants will get exclusive access to the limited-edition pilot batch of this year’s much anticipated Sour Me Unicorn Farts glittered sour ale made with fruity cereal, a trio of fruits, edible glitter plus the addition of graham cracker. The beer will be gifted in 12oz 6-packs. The label will say, ‘Thanks for Giving a [rainbow poop emoji]’ with a blue star for colorectal cancer awareness.

The promotion will run during National Colorectal Cancer Awareness Month in March, with signups opening up on Wednesday, March 3, on National Colorectal Cancer Screening Day, closing on Sunday, March 7.

Marketing will include a series of short, humorous videos produced by Squatty Potty and feature the brand’s famous rainbow ice cream-pooping unicorn ‘Dookie’ as an employee at DuClaw Brewing Company, getting into all sorts of trouble.

[Squatty Potty is notorious for the 2015 viral video featuring the Prince of Poop and Dookie educating people on the benefits of squatting to eliminate more effectively.]

Additionally, with the help of celebrities and influencers, the campaign will activate a social #GiveACrapChallenge on TikTok and other platforms, where participants can ask a parent or loved one, “When was the last time you pooped?” as a way to encourage “the talk” about getting tested because you “give a crap” about them. Participants can donate any amount by texting CRAP to 512-920-5521. For every $35 contribution, one colorectal cancer screening will be donated to someone in need.

For more on the promotion including restrictions, visit www.GiveACrapChallenge.com. To apply to receive a donation of testing kits to distribute to underserved communities, or to learn more about Colorectal Cancer Awareness Month, visit www.coloncancerfoundation.org.

More about Colorectal Cancer & affected populations:

  • 2nd leading cause of cancer death among men and women in the U.S.
  • Regular testing is recommended for adults 45+.
  • 75M people should be regularly tested, half being underserved and uninsured.
  • African Americans are at high risk, with incidence rates +20%, and death rates +40%.
  • Anyone >45 with symptoms should see their primary care provider as soon as possible.
  • The recent and tragic deaths of actors Chadwick Boseman, 43, and Natalie Desselle-Reid, 53, as a result of colorectal cancer illustrate the younger trend:
    • The fastest growing incidence among those 20-29.
    • The most cases under 50 among those 40-49.

About the Campaign Collaborators:

Colon Cancer Foundation

The Colon Cancer Foundation is a 501(c)3 non-profit organization registered in the state of New York and is listed by the IRS as a public charity. The organization is dedicated to supporting colorectal cancer research; educating the public about the importance of early detection, and forming strategic partnerships in the fight against colorectal cancer. The foundation offers those affected by colorectal cancer a platform to increase public awareness of colorectal cancer, while also working to lower incidence and death rates through public education, collaborations, and early-screening education. The Colon Cancer Foundation hosts annual events and challenges that seeks to raise money to support the foundation’s mission.

For more information please visit (www.coloncancerfoundation.org/) or connect with us on InstagramFacebook or Twitter.

Squatty Potty, LLC

Founded in 2011, Squatty Potty, LLC is a consumer products company whose product lines consist of toilet stools, sprays and other bathroom accessories. Its flagship product, the Squatty Potty stool, is designed to help users assume the squatting position while using the bathroom, delivering fast, complete elimination with comfort and ease. In 2014, the Company was featured on ABC’s hit TV show Shark Tank, and became the second most successful company in the history of the show. In 2015, the Company launched a wildly successful marketing campaign featuring a viral YouTube video that has garnered over 140 million views to date and won the 2016 Webby Award. Currently Squatty Potty products are sold in over 6,000 retail locations globally including Bed, Bath & Beyond, Walmart and Target.

DuClaw Brewing Company

Baltimore-based and fearlessly innovating in craft beer since 1996: Craft Be Cherished. Rules Be Damned. DuClaw beer is available in 19 U.S. states and DC plus Canada and France, with additional U.S. distribution through Brew Pipeline. www.duclaw.com.

CraftShack

The premier online marketplace and platform for specialty craft beers delivered to your door. www.craftshack.com.

Diablo Doughnuts

Baltimore doughnut shop that’s ‘Local as F*ck.’ Home of the original Unicorn Farts doughnut and original collaborator on the Sour Me Unicorn Farts beer. www.410dough.com.

Agencies who worked on the campaign include Elevation Advertising, 212 Communications and Social Endurance.  

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Full Job Description

The Colon Cancer Foundation® is seeking a driven Public Relations Intern with a passion to reducing colorectal cancer incidence and death. Candidates should be extremely organized and adept at multitasking; the ideal candidate is a self-starter with a positive and collaborative attitude to join a dynamic and growing organization. We are offering school credit for this internship—you MUST be currently enrolled in a college/ university program to apply.

Day-to-day responsibilities include, but are not limited to:

  • Assisting with the maintenance of updating organization’s press lists
  • Media monitoring and tracking
  • Clipping and organizing press placements into weekly coverage reports
  • Promote stakeholder involvement and engagement, including patient engagement, physician engagement, donor outreach, networking with colleges and universities
  • Draft content for clients and internal projects including press releases, reporter pitches, blogs, e-blasts, website content, feature articles, and social media posts
  • Assist with other projects that come along

Candidate will have the opportunity to broaden their knowledge of public relations while assisting the following:

  • Product Pitching—including brainstorming pitching topics and aiding in the creation of captivating graphics

 

 

Colorectal cancer (CRC) is the leading gastrointestinal neoplasia, which has historically been known to primarily affect individuals over 50 years of age, and screening is currently recommended for those 50 and older. This might soon change to 45 years and older. While CRC incidence has been decreasing among individuals older than 55 years, young-onset CRC has shown an opposite trend. From 2000 to 2017, the incidence rates of young adults with CRC has increased, particularly among those aged 40-49 years. Evidence suggests a discrepancy among racial and ethnic minorities, markedly amidst those who are of non-Hispanic and African American descent. 

About 20% of hereditary colon cancer syndromes are prevalent in young adults with CRC, which makes accessibility to genetic testing of utmost importance to reduce future development of the disease. Despite the need for overall accessibility, ethnic and racial groups are disparately referred to genetic counseling services.

A study conducted at UT Southwestern Medical Center and Parkland Health and Hospital System assessed 385 young adults between the ages of 18-49 years old with colorectal adenocarcinoma. The study measured the following outcomes: 

  • Are patients receiving a referral to get a genetic test?
  • Did the patient attend the genetic counseling appointment?Number of patients who were able to complete a genetic test

The study determined that 50% (n=225) of patients with young-onset CRC received a referral for genetic counseling services. Nonetheless, it was reported that a smaller portion of African American (n=49) patients were referred to receive genetic counseling as opposed to Hispanic patients (n=116). A downward trend was consistently noticed in African American patients from being referred to and attending appointments. Many patients report that they did not attend an appointment because they either missed it or never scheduled it. The most common reasons for not receiving the genetic test were  the inability to afford the cost, not receiving a referral to genetic counseling services, or the patient not returning their saliva sample.

Similar trends were reported among 1,647 African American women with breast cancer <50 years old who were enrolled in the Florida State Cancer Registry a year after their diagnosis. A population-based study was conducted which suggested that roughly 50% of these women were referred to and/or had access to genetic counseling services, even though the national guidelines specify that all patients should be referred. Likewise, several studies on ovarian cancers report similar disparities which need to be addressed.

All patients diagnosed with young-onset CRC should be referred to or have access to genetic counseling, regardless of their racial or ethnic background. Genetic counseling services can be of help in guiding and managing treatments among those diagnosed with CRC. 

 

Cancer is one of the most expensive conditions to treat worldwide. Financial stress and hardship after a cancer diagnosis is a well-documented fact in the U.S. Cancer patients spend more out-of-pocket for medical care and treatment than their counterparts without cancer, adding to their financial hardship. In addition to leaving patients and their families with debt and potential bankruptcy, these financial stressors also compound negative physical health effects.

Despite this, screening for financial hardships is not currently a part of clinical practice, and discussions around patient financial stressors occur infrequently in clinics. To address these challenges, screening for financial hardship after a diagnosis should be introduced to improve cancer patients’ quality of life during treatment and survivorship.

The Financial Burden of Cancer Patients and Survivors

 Dr. Robin Yabroff of the American Cancer Society said in an interview that cancer survivors experience consistent financial stress related to their diagnosis and post-treatment—40% of Americans cannot afford an unexpected expense over $400. In fact, over 50% of cancer survivors report being stressed about paying high medical bills or have delayed medical care due to high costs. Given that financial burden is strongly correlated with gap in insurance programs, unsurprisingly cancer survivors aged between 18-64 are more likely to experience financial stress relative to non-cancer survivors. With many new drugs and medical devices priced at $100,000 or higher, financial hardship has increased exponentially for cancer patients. Moreover, health insurers are constantly shifting care costs to patients by introducing higher deductibles, copayments, and coinsurance. To top all of this, a cancer diagnosis indefinitely and negatively impacts employment, resulting in loss of income and employment-sponsored health insurances in some cases.

Consequently, patients with cancer and their families experience ‘financial toxicity’, a term associated with hardships with paying medical expenses, psychological stress about affording to pay, and delaying or forgoing medical care due to costs. A recent study co-authored by Dr. Yabroff and Dr. Yousuf Zafar in CA: A Cancer Journal for Clinicians, highlights three main factors contributing to financial hardship as the rising cost of cancer treatments:

  • Increase in patient eligibility to treatment concurrent with expanding treatment options
  • Increase in duration of said treatment
  • Changing health-insurance design, which has shifted costs on patients

In addition, newer radiation and surgical oncology treatments are expensive. A simultaneous rise in the number of uninsured and underinsured patients and an increased prevalence of high-deductible and copayment health insurance options complicate matters.

Need for Financial Hardship Screening After Cancer Diagnoses

 Financial hardship negatively impacts a cancer patient’s mental health, physical willpower, and financial wellbeing as seen through increased debt, savings depletions, and filing for bankruptcy protection. This in turn can affect treatment adherence through forgone or delayed medical care, resulting in reduced survival. The higher the out-of-pocket costs for cancer therapeutics, the higher the risk for delayed treatment initiation or abandonment, risking early mortality and/or diminished quality of life.

A pilot study by Shankaran et al., revealed that introducing financial navigation programs could serve to lower anxiety surrounding the cost of medical expenditures, even if the actual cost remains the same. Training programs infinancial navigation provided by hospital staff can decrease and/or optimize patient out-of-pocket spending while reducing losses to health care facilities. However, a real-time online survey of oncology navigators found that 50% identified lack of resources as a barrier for getting financial assistance, highlighting the considerable room for improvement when connecting patients to the resources they need.

Treatment-related financial toxicity has been addressed by various professional outlets, patient-advocacy organizations, and the National Cancer Institute (NCI). For instance, the American Society of Clinical Oncologysuggests that cancer treatment providers should discuss treatment costs with their patients. Other organizations, including the National Academies of Sciences, Engineering, and Medicine and the President’s Cancer Panel recommend addressing the high costs of cancer care. While a large majority of NCI-designated cancer centers conduct some version of financial screening, only a small fraction actively follow-up on the effectiveness of the screen and connecting patients to financial resources. The collective research in this space highlights the need for implementing financial hardship screening and mitigation after cancer diagnoses to improve patients’ quality of life during and after treatment.

 

Conclusions

 The convergence of increasingly high-cost cancer care and treatment options, lack of health insurance or underinsurance, high out-of-pocket costs, and widening disparities in the ability to cover medical expenses or access quality medical care, provide a strong argument for the implementation of financial hardship screening for cancer patients and their loved ones along with access to suitable financial resources.

The Colon Cancer Foundation provides information on financial assistance programs that patients can access.

Much of the illness trajectory in cancer patients is strongly associated with symptom management during—and maybe even years after—chemotherapy treatment. Though chemotherapy drugs are the more common  mode of cancer treatment, along with surgery and radiation, patients may experience side effects associated with their quality of life.

According to a study published by the Paediatrics and Child Health Journal, supportive care during intensive chemotherapy is credited with improvements in overall morbidity and mortality rates in adults and children. Symptom and pain management may be classified as supportive care for patients in active treatment. While chemotherapy-related side effects can be anticipated, it is rather challenging to predict if the effects will be mild, moderate, or severe. Of the 236 cancer patients studied in the article, the effects ranged sporadically and were individually unique.

Supportive care methods and recommendations were addressed during a recent CURE Educated Patient Metastatic Colorectal Cancer Webinar hosted by speakers Nina N. Grenon, DNP, AOCN; Amber S. Norton, RN, BSN, OCN; and Kelley A. Rone, APRN, BSN. Speaking from their clinical and patient experiences, the care providers agreed that chemotherapy treatment may look different on a day-to-day basis, but the key, according to Ms. Grenon is “to make adequate adjustments” and to “dose adjust, rather than hold out from continuing treatment.” The expert panelists encouraged patients to communicate as much as they can with their providers, so that dose adjustments, paint management, or overall symptom management can happen early, rather than letting it get to the point where their cancer treatment needs to be paused.

Appetite suppression and fatigue are the most common side effects of a chemotherapy regimen, and the research article emphasizes that this can coincide with other symptoms such as nausea or vomiting, which is typically experienced by almost half the patients receiving chemotherapy.

The panelists noted that appetite suppression and fatigue directly correlate with each other; if a patient does not eat, then they will be fatigued or if a patient is fatigued then they will not want to eat. In order to break this cycle, they recommend:

  • Smaller meals
  • Flavoring water
  • Foods that will not increase nausea
  • Keeping the mouth moist
  • Setting an alarm to eat

Most importantly, patience is a crucial element to any treatment regimen. Encouraging the patient to eat whatever they can throughout the day is a great place to start. “You don’t have to eat three meals a day…eat what you can throughout the day, even if you just eat small bites all day long, at least you’re getting something opposed to nothing,” Norton reassures. With that, following up with a nutritionist and maintaining communication with your provider can make all the difference. Having a holistic approach to care rather than isolating focus on specific symptoms tends to provide a less challenging segway into survivorship and healing.

Assessment and identification of sources of distress in cancer patients provide an opportunity to improve quality of life during care and restoration of dignity. Adequate communication amongst the patient’s care team will allow the patient to make good progress and respond well to the primary treatment, while also ensuring that their quality of life is maintained.

Can you support the Colon Cancer Foundation achieve its goal of distributing 10,000 CRC screening kits to the underserved and underinsured? You can easily donate toward this campaign here.

Preventive colorectal cancer (CRC) screening has always been a struggle in the U.S. According to the CDC, only about 69% of U.S. adults were up-to-date on their CRC screening in 2018. When combined with the restrictions and safety concerns raised by the SARS-CoV-2 pandemic, 2020 saw a major dip in the number of average-risk adults going in for a colonoscopy, which is the most common CRC screening and surveillance tool in the U.S.

During the early months of the pandemic (March-April 2020), hospitals and clinics decided to reduce in-person visits and halt elective procedures so they could divert their clinical staff toward managing the surge in COVID-19 patients. This led to a dramatic drop in routine preventive screenings, including screening colonoscopy. Additionally, those who needed a follow-up colonoscopy to confirm findings from an abnormal fecal immunochemical test (FIT) test could not come in to receive those, which further delayed diagnosis among these high-risk patients.

The San Francisco Health Network, for example, reported a 70% decrease in the total number of primary care in-person visits between February and May 2020, which led to a big drop in CRC screening tests: FIT tests reduced by about 85% and colonoscopy by about 90%. The authors predicted that a persistent decrease through early June could lead to 19,000 fewer CRC diagnoses and 4,000 excess deaths nationally as a direct impact of COVID-19.

Statistics from the American Cancer Society confirmed a 90% drop in colonoscopies due to the pandemic by April 2020, compared to two months earlier. Overall, they predict 1.75 million fewer colonoscopies were conducted between March and June 2020, which could have delayed CRC diagnosis in 18,800 patients and will lead to 4,500 excess deaths by 2030.

Combine that with the fact that lack of insurance, or underinsurance, remains a significant problem in the U.S. Statistics released from an August 2020 report from The Commonwealth Fund showed that in the first half of 2020:

  • 5% of adults were uninsured
  • 5% were insured but faced a coverage gap in the previous year
  • 3% were underinsured

Unemployment related to the COVID-19 pandemic may have further exacerbated insurance coverage in the nation and created health access issues.

The backlog of CRC screening will create a number of unprecedented challenges and will force healthcare systems to adapt and adopt new protocols. Among its many recommendations to resume CRC screening, the National Colorectal Cancer Roundtable recommends offering at-home stool-based testing, such as the FIT test, as a safe and equally effective alternative.

With this in mind, the Colon Cancer Foundation has set a goal of helping provide 10,000 CRC screenings for people from the underserved and underinsured community in 2021. We will be working through industry partnerships, diagnostic companies, and retailers to provide free screenings—we need your support to accomplish this goal. For every $35 you donate, we will be able to provide one screening FIT test kit to the underserved and underinsured community.

Can you support the Colon Cancer Foundation achieve its goal of distributing 10,000 CRC screening kits to the underserved and underinsured? You can easily donate toward this campaign here.

 

A seven-year model proposed by the Center for Medicare & Medicaid Services (CMS) has been temporarily restrained following multiple lawsuits filed by pharmaceutical corporations and physician organizations. The Most Favored Nation (MFN) model, which was scheduled to go live on January 1, 2021, is now stalled.

The CMS Innovation Center announced the mandatory MFN model on November 20, 2020, to test whether reimbursing care providers for Medicare Part B drugs and biologicals (these are drugs administered in a doctor’s office or at an infusion center) at rates that match international prices would reduce the nation’s health care spending. This would also meet the requirements of President Trump’s Executive Order on lowering drug prices for U.S. patients.

The model has the following key payment structure:

  • MFN price: Instead of basing reimbursement on the drug manufacturer’s average sales price (ASP), Medicare would calculate reimbursement for a drug by blending the drug’s lowest adjusted international price (MFN price) and the ASP. There is also a single add-on payment per dose that Medicare enrollees are not responsible for.
  • Four-year phase-in period: The MFN price will be introduced at 25% per year over the first four years, and will be 100% of the MFN price during years four to seven
  • ASP: To control patient cost-sharing, the formula will not allow the model payment amount to exceed the ASP

This nationwide mandatory model requires participation by all providers and suppliers that receive Medicare Part B fee-for-service payments for the 50 drugs currently included in this model, chosen based on annual spending in 2019 and expected to be updated annually.

Several physician organizations have strongly denounced this rule and filed lawsuits that stopped CMS from implementing the MFN model at the beginning of January 2021. This includes a multi-organization lawsuit filed by the Association of Community Cancer Centers (ACCC) in collaboration with the Pharmaceutical Research and Manufacturers of America, the Global Colon Cancer Association, and the National Infusion Center Association, asserting that CMS has exceeded its statutory authority with implementing this model while simultaneously failing to follow appropriate rulemaking procedures.

“This a temporary victory for cancer patients and providers yet we still have a way to go.  It is important that any policies enacted don’t limit our ability to serve patients and their families. Poorly designed policies such as MFN can have devastating impacts on patients, particular those in rural and underserved areas who are vulnerable to changes that will limit the care they receive,” said ACCC President Dr. Randall A. Oyer, in a statement.

The Colon Cancer Foundation’s Lakshmi Yeturu sat down (virtually!) with Dr. Brian Dooreck to find out more about his initiative to arm newly diagnosed colorectal cancer patients and caregivers with substantial resources as they bravely face their diagnosis and treatment.

Can you tell me a little bit about yourself: your personal and academic background and your interests?

My name is Dr. Brian Dooreck. I am a gastroenterologist focused on GI [gastrointestinal] and liver disease. I trained at the University of Miami Jackson Memorial Hospital and have been in clinical practice for 15 years in South Florida, seeing patients for all GI-related issues. My training goes back to New York, Boston, Tel Aviv, NYC, and Miami. As a clinical gastroenterologist, I am quite involved with my patients in a relatively busy practice, but I am also engaged in other aspects of the medical, nonprofit, and entrepreneurial worlds.

The Colorectal Cancer Provider Outreach Program [CRC POP] was just an idea a few months ago that quickly became reality. What I have repeatedly experienced over the years is that when we diagnose people with colorectal cancer, we’re telling them that they have a problem. As they are waking up from sedation [following a colonoscopy], we tell them: ‘You have a problem and this is what we need to do: you need to get labs, you need to get a CAT scan, you need to see a surgeon, you need to get the follow-up biopsies and then see me in a week or two. We will get through this; we will work together.’

But what we have not been doing—and I have realized this now after having spoken to groups representing over 1200 gastroenterologists—is telling patients, ‘Listen, go home, look into these websites and call these numbers. I will see you in a week or two and we will go over things.’ But you have support starting now:

  1. You want to take out your phone and text this number: COLON to 48-48-48, which pops up a PDF with all the organizations, their websites, and their phone numbers
  2. Go to our website, go to the Colorectal Cancer Help Page that has links to the websites of patient organizations
  3. Look at your EMR discharge instructions; you’ll find more information there

So, there are these three areas which we can share with patients at the bedside, post-procedure as we’re delivering their diagnosis, and it can direct them to resources that they are otherwise, and most likely, going to trip over if they were Googling, ‘Am I going to die from colon cancer?’ They’re not going to find it on their own, but they may join a social media network group and see a Facebook posting. They’ll probably trip over rather than go to it directly, or they’ll go to it much later in the game.

What I am trying to do is get patients to these resources much earlier, when they have just been diagnosed.

What prompted you to work within gastroenterology and hepatology? Specifically, within colorectal cancer?

I chose gastroenterology early on in my internal medicine training, probably by my first or second year in New York City. I specifically remember just having related to it. From the aspect of your social life or social disposition, having abdominal pain, colitis, diarrhea, or bloody stools is a real damper to your Saturday night dating and it would really affect your social life.

I also understood it. I think we’ve all had diarrhea, we’ve all had abdominal pain and I know what it’s like. You can walk around with heart disease, kidney failure, lung disease, and lung cancer and you may not have to tell someone. But to have to urgently run to the bathroom, not be able to eat meals, have severe cramping, or if you are losing weight because of it, you will be forced to tell someone. That really is something I related to. I felt I could help people’s quality of life in a much broader, quicker way.

Would you mind describing your past work and research efforts within this field and their significance to colorectal cancer?

Over the years, during my clinical research and fellowship at the university, I have been involved in different aspects of research and I’ve always had an alignment with colorectal cancer. I started realizing that GI is my field of interest quite early on. I remember rotating through Memorial Sloan Kettering Cancer Center, where Dr. Sidney Winawer was one of the pioneers of colon polyp detection. So, for me I’ve always had a proximity and drive towards it; I’ve always been much more interested in the clinical aspects of the field.

Personally, being engaged with social media platforms, I saw a great ability to leverage technology to further benefit our patients. This tool that we have created allows patients to get the support they need at the time of diagnosis ‘here and now,’ and it will alleviate so many levels of burden. There is nothing more shocking than telling someone ‘you have cancer.’ There are about 14,000 gastroenterologists in the United States and about 150,000 people diagnosed each year with colorectal cancer. So, we have 14,000 gastroenterologists making those diagnoses each year. You can add multiples of that to account for family members and other people that are simultaneously affected by that one diagnosis.

How many of those people are going to go through the support services that are available from the five organizations we’re partnering with at the time of diagnosis? We expect that very soon, the support that we are providing at the time of diagnosis can not only help the patient and their family, but also promote screening and prevention for those organizations that have preventive screening programs. So, the benefits are huge and using the providers for this is our goal.

What was your primary inspiration to develop this program aimed at newly diagnosed colorectal cancer patients?

Like I said, having seen this now a thousand times if not more. We are not leveraging the available resources, and you know it is quite different for colorectal cancer. For breast cancer, for example, if you feel a lump, you can get a mammogram, get a biopsy and ultrasound, and follow up with the doctor. It is a period of 2-3 weeks, probably, and you as the patient know what’s going on and you’re aware of the conversation. With prostate cancer, you know something is not feeling right if the PSA is high, the physical exam is off. When you get the biopsy results, you are awake or aware the whole time, so you know what’s going on and you are a part of the conversation.

In the case of colon cancer, you come to me saying, ‘I have some rectal bleeding’, ‘Oh I have hemorrhoids’, ‘I feel perfectly fine’, ‘I need to get a screening’, ‘I’ve been 5 six years late’, ‘OMG I have colon cancer and I kind of blew it off for a few years.’ You come to me feeling fine and not suspecting a problem. Then you go to sleep [for the colonoscopy procedure], wake up 15-20 minutes later and you have colon cancer. We don’t hear anything after the cancer diagnosis. That’s our differentiator and what we do in my field, in my space, in my world is we’re dealing with a cancer where the diagnosis is made at the bedside post-sedation and more than ever everything becomes very clouded for the patient. So, with CRC POP, we can help people through that cloud.

 What inspired you to be at the forefront of the Colorectal Cancer Provider Outreach Program (CRC POP)? Who are your lead collaborators on this project and are you looking to expand your partner organizations?

The focus of the Colorectal Cancer Provider Outreach Program [CRC POP] is reaching the providers who will then share the resources with their patients.

We are currently partnering with five supporting organizations: American Cancer Society, Colorectal Cancer Alliance, Fight Colorectal Cancer, Colon Cancer Coalition, and the Colon Cancer Foundation. These five organizations are, in my eyes, equal partners and our goal is to reach providers and to give patients the options of these five organizations. Each organization has its own strengths and weakness, specialty, and focus—it is up to the patients to find what best serves their needs.

We received support from a company called Easy Texting that’s giving us the ability to allow patients to text the word ‘COLON’ to 48-48-48 at the bedside. This will generate a PDF with the link and phone numbers to these five organizations. My goal is to work closely with three national associations: the American College of Gastroenterology, the American Gastrointestinal Association, and the American Society of Gastrointestinal Endoscopy, to develop better communication with the 14,000 gastroenterologists in the U.S., and to use their influence to quickly, and easily, reach more providers and in turn more patients.

Part II of this interview can be found here.

 

H.R. 1570 – Removing Barriers to Colorectal Cancer Screening Act of 2020 has been passed by Congress. The bill—which passed the House vote on December 9, 2020, and the Senate on December 21, 2020, and will become law once signed by the President—will be phased in over the next eight years. This bill has been devised to improve colorectal cancer (CRC) screening rates within the Medicare population, which in turn will allow earlier diagnosis and improve health outcomes. The Colon Cancer Foundation was a co-signee on a letter drafted by 35 other organizations and led by the American Cancer Society Cancer Action Network, urging Congressional leaders to include this bill in the end-of-year funding package.

The bill modifies cost-sharing requirements for CRC screening among seniors enrolled in Medicare such that they will no longer be required to pay coinsurance if a polyp is discovered and removed during a regular screening colonoscopy. While the 2010 Affordable Care Act ensured that Medicare fully covers preventive screening for colorectal cancer, removing a polyp found during a routine screen makes it a diagnostic procedure, which adds a cost-sharing responsibility on the patient. As a result, the patient may end up having to pay 20% of the cost for removing the polyp as co-insurance, and this surprise bill may amount to several hundred dollars, depending on the facility where the procedure was conducted. For seniors living on a fixed income, this unexpected cost could be a financial burden.

When caught early, removing a polyp not only improves patient outcomes and quality of life, but also saves downstream costs for the health care system as a whole. However, prior knowledge of the cost-sharing requirement associated with polyp removal during a routine screening procedure could deter individuals from going in for their regular screening and raise the risk of a polyp or a potential tumor going undetected.

Cindy Borassi, Interim President, Colon Cancer Foundation, said, “This is a big win and significant step toward correcting the “colonoscopy loophole.” By addressing and eliminating the loophole of financial obligations in case a polyp is detected during a screening procedure, we are ensuring that our seniors will continue to make their preventive care a priority and undergo this routine yet potentially life-saving screening test without cost. Once made into law, H.R. 1570 will also help reduce advanced colorectal cancer cases among our Medicare enrollees.”

The ongoing COVID-19 pandemic has affected elective colorectal cancer (CRC) surgical practices, and its impact on mortality after CRC surgical resections has been slowly emerging.  Early on, studies done in Italy and the United Kingdom presented specific recommendations in hopes of reducing the impact on CRC surgical outcomes, but have yet to conclude which of the proposed ideas can be implemented.

During the early weeks of the pandemic, there was uncertainty surrounding the influence of the SARS-CoV-2 virus on CRC surgical patients as well as intensive care capacity. Various recommendations were put in place to alter CRC surgical practices, which in turn would help reduce mortality. Researchers in Italy proposed that a benefit of changing surgical practices would be that it would reduce postoperative complications such as anastomotic leaks. They hypothesized that laparoscopic surgery for CRC would be the answer, although there remains a lot of uncertainty in regards to whether or not the SARS-CoV-2 virus would survive in the CO2

used for the surgery. Hematologists in the U.K. suggested that another benefit would be to decrease the need for intensive care at a time when hospital resources are being redirected towards the pandemic. A third benefit would be to reduce complications which would drastically reduce the length of hospital stay while releasing bed space, which would in turn reduce the risk of hospital-acquired infections. Despite the benefits of the proposed changes in CRC surgical practices, elective CRC surgeries must continue in order to prevent delayed operations and/or an increase in emergency procedures at a later time. 

A cohort study at the University of Birmingham, U.K., conducted by Bhangu. A et a,l analyzed patients undergoing CRC resection without any suspicion of COVID-19. The data were collected on eligible patients from the first recorded case of COVID-19 through April 19, 2020. Eligible patients were 18 years and older, looking to undergo elective CRC surgery. The study particularly focused on patients who had a stoma, in which their surgeons were asked if this was their “normal practice” or a “change in practice due to COVID-19.” Patients with a stoma with a change in practice due to COVID-19 were labelled as “COVID-end-stoma.” The study concluded that the rate of stoma formation was 34.2% as opposed to the 27.2% which was seen before the pandemic started. A total of 1.8% of patients died within 30 days of surgery, 3.8% went onto develop postoperative COVID-19, and 4.9% had an anastomotic leak. While anastomotic leaks were lower pre-pandemic (4.9% vs 7.7%) and length of hospital stays was shorter (6 vs 7 days), mortality was higher post-pandemic (1.7% vs 1.1%). The causes of change in practice in patients who had a COVID-stoma were recommendations from specialty associations, to avoid possible complications requiring critical care, wish to reduce length of inpatient stay, fear of patients suffering from a SARS-CoV-2 infection postoperatively, lack of access to postoperative intensive care, and very difficult working conditions with donning full PPE.

Alterations in surgical practices for CRC surgeries is an effort to decrease the duration of surgery, resource usage, and hospital stay.