The American Society of Clinical Oncology held their annual meeting from June 4-8, 2021, where over 400 abstracts related to colorectal cancer (CRC) were presented. We at the Colon Cancer Foundation highlight some notable ones related to technological advancements, socioeconomic factors, and clinical care below.
- Using AI to Predict CRC progression: What if artificial intelligence (AI) could be used to predict disease progression and mortality in patients with metastatic CRC? That is the question Carlos Maria Galmarini presents in their abstract. By using patient datasets from two randomized phase III clinical trials, Galmarini and team created synthetic “fingerprints” (SFs) for each patient by integrating 44 various clinical features. These SFs were subsequently inputted into a deep learning framework (DLF) to categorize patients based on similarities. The SF/DLF system was able to categorize metastatic CRC into different subtypes based on clinical features that correlate with higher risk of disease progression and mortality, indicating that AI could prove beneficial to the cancer community.
- Using miRNA and Machine Learning to Detect Cancer: Circulating microRNA (miRNA) have been associated with certain types of cancers, and their expression profiles are theorized to be cancer biomarkers. As such, Juntaro Matsuzaki and team investigated whether the combination of a novel diagnostic blood test and machine learning techniques could be used as a tool for the early detection of cancer. By processing the serum samples from individuals without cancer and comparing it to individuals with breast, colorectal, lung, stomach, and pancreatic cancer respectively, the team analyzed the entire miRNA expression profile of the samples using next generation sequencing. The expression profile was then used to train machine learning models. The diagnostic model showed an 88% accuracy for all five cancer types, indicating that circulating miRNAs can be useful biomarkers for the early detection of these cancers.
- Intersection of Race & Rurality in CRC Surgical Treatment & Outcomes: It is widely known that racial disparities exist when it comes to CRC care, but the intersection of rurality and race on surgical treatments and outcomes among patients with nonmetastatic CRC has not been fully explored. To fill this knowledge gap, Niveditta Ramkumar and team studied 57, 710 Medicare patients who underwent surgery for non-metastatic CRC between 2016 and 2018. The patients were categorized by their race and area of residence, which was classified as metropolitan, micropolitan, and small/rural. Results showed that Hispanic patients and other minorities living in non-metropolitan areas had higher odds of facing 90-day surgical complications compared to individuals living in metropolitan areas. There was no such disparity found for white patients. Additionally, patients from minority groups had higher odds of 90-day mortality in rural areas compared to metropolitan areas, while white patients had lower odds. These results indicate the necessity to further explore the intersection of race and rurality when it comes to CRC treatment and outcomes so that specific guidelines can be enacted to protect patients belonging to vulnerable socioeconomic groups.
- Impact of Socioeconomic Status on CRC Care: Socioeconomic factors are known to affect CRC care at all levels, but the research surrounding this topic is limited and conflicting. Therefore, Rajan Shah and team set out to explore how socioeconomic status (SES) affects CRC stage at presentation, receipt of diagnostic imaging and treatment, and overall survival. To meet this end, the team identified and analyzed data from 39,802 colon cancer and 13,164 rectal cancer patients in Canada using the Ontario Cancer Registry. In both cohorts, patients of lower SES were more likely to present at a higher stage, less likely to receive MRIs and other diagnostic tests and treatments, and had a less likely chance of overall survival. These results indicate the importance of focusing on CRC patients of lower SES to eradicate disparities in CRC care.
- Access to Cancer Care for Medicaid Patients: According to the abstract presented by Victoria A. Marks, one in five Americans are insured with Medicaid. However, the large number of Medicaid patients does not necessarily indicate an increased access to care at Medicaid facilities. Thus, the team investigated the acceptance of Medicaid patients with new cancer diagnoses at various facilities across the U.S. They evaluated access to cancer care for a variety of cancer types (colorectal, breast, urologic, and skin) at hospitals accredited by the Commission on Cancer, and used data from the American Hospital Association and Centers for Medicare & Medicaid Services to study Medicaid access. Results showed that Medicaid acceptance was lowest in for-profit facilities and comprehensive cancer community centers. In hospitals that accepted Medicaid, only 68% of them accepted all four cancer types. These results suggest there are disparities that need to be addressed in regard to cancer care access for Medicaid patients, both between and within facilities.
- Influence of Fellowship Training on CRC Post-Operative Outcomes: Christopher Thomas Aquina and team set out to investigate the relationship between fellowship training and surgical outcomes in CRC patients. Using two New York-based patient databases, the team identified patients who underwent stage I-III colorectal adenoma resection between 2004 and 2014. They analyzed the relationship between patient surgical outcomes and surgeon certification via the American Board of Colorectal Surgery. High volume colon surgeons (HVCS) were identified as those who performed more than 15 colon cancer resections annually, and high volume rectal surgeons (HVRS) were identified as those who performed more than 10 annual rectal resections. Results showed that patients with board-certified, HVC/HVR surgeons had better outcomes post-surgery and were associated with improved survival following resection. This suggests that individuals seeking CRC resections should go to board-certified, HVC/HVR surgeons for the best chance of recovery and survival.
The Colon Cancer Foundation is very excited to announce our new class of 2021 interns. . Scroll through to learn more about our amazing team!!
Hi! My name is Laura Banazek and I am an Events Intern with the Colon Cancer Foundation. I am an upcoming graduate of California Polytechnic State University, San Luis Obispo earning a B.S. in Experience Industry Management with a concentration in Event Planning. During my last four years of college, I have been very involved with my major department and sorority. I served on my sorority’s executive board as the VP of Membership Education and Programming and am currently the Event Technology and Registration Lead for the 2021 Cal Poly Experience Industry Management Auction.
As an Events Intern with CCF I am excited to gain new experience in event logistics and brand partnerships! I am passionate about creating memorable experiences and building meaningful relationships. After graduation, I dream of working as an Event Planner in either a non-profit or corporate setting. In my spare time I love getting outdoors (going on walks or to the beach!) and spending time with my friends/family. I am so grateful for the opportunity to intern with CCF and am looking forward to the many projects to come!
Kyla de Guzman
My name is Kyla de Guzman and I am a new Public Relations Intern for the Colon Cancer Foundation! I am a Junior at Montclair State University, majoring in Public Relations and minoring in Creative Writing. I am involved in my school’s Drama club, a member of the National Society of Leadership and Success and a part time receptionist at Dumont Animal Hospital; while maintaining a 3.7 GPA. In my spare time I love making playlists, reading, creating TikToks, thrifting and hanging out with my friends.
I am so excited and proud to be a part of CCF’s Public Relations Intern! My career goal is to work as a public relations consultant for high end fashion brands. Thanks to CCF I am able to apply my public relation course in real world experience. I am pleased to be part of a small but mighty organization that wants to spread awareness as best we can.
Hello! My name is Devyn Fatzynytz and I am a Junior Communications Student with a minor in Psychology at The College of New Jersey, and I am very excited to start my position as a Summer PR Intern with the Colon Cancer Foundation.
I have always had a love for writing and creating compelling messages as a means of a creative outlet. This combined with my love for people and making meaningful connections with others drew me to public relations as my field of interest. I am particularly excited about my opportunity with the Colon Cancer Foundation because I can work for a cause with the meaningful mission of finding a cure for colorectal cancer, while increasing resources and screening for disadvantaged communities.
A little more information about myself, I am from Jefferson Township, New Jersey. I am the oldest of three, and value my family and friends tremendously. Some of my hobbies include playing soccer, running and art. Over the summer I paint wall murals for small businesses and people’s home interiors as a side gig in my free time, and have waitressed for the past four years at a local diner in Wharton, NJ.
Some of my on campus activities include TCNJ girl’s club soccer where I held a position as social chair, Delta Zeta sorority as intramural chair in 2019, and being a member of the Anti-Violence Initiates team dealing with dating abuse prevention.
This past Sprint semester I have been a research assistant, analyzing qualitative research data on the topics of gender disparities and women in leadership, while also being trained in comparing and contrasting results to identify themes in stories.
In terms of my background in Communications and Public Relations, I have taken several beneficial classes in interpersonal communications, strategies of public relations and interpersonal health communications among others. I also have prior PR internship experience with McNeil, Gray & Rice, a PR firm in Boston, MA.
My name is Rachel Herrmann, and I am excited to join the Colon Cancer Foundation’s team as its new Colorectal Cancer Prevention Intern. I am originally from Rochester, New York, and am a recent graduate of Cornell University where I majored in biology and minored in global health. Currently, I am pursuing a Master’s degree in public health through the London School of Hygiene and Tropical Medicine. During my time at Cornell, I worked as a research assistant at the Wilmot Cancer Center, so I am glad to be back working in the cancer field.
My career goal is to work for a nonprofit organization to implement public health initiatives in under-served communities, so I am thrilled to be starting my career with the CCF.
Throughout my internship at the CCF, I will be writing articles about current research in the colorectal cancer sphere in addition to working on the Early-Age Onset Colorectal Cancer Summit.
In my spare time, I love to play tennis as well as travel (I’ve been to twenty countries so far). I also love to play with my two-year-old Cavalier King Charles Spaniel, Charlie!
Hello! I am Carolene, a Communications Intern at CCF. I received my Bachelor of Science degree from the University of Miami with majors in English and Neuroscience. I am passionate about CCF’s mission to lead the fight against colorectal cancer, and I strive to aid CCF’s mission by creating content that informs readers about the importance of colorectal cancer prevention, detection, and eradication. I am proud to be working towards such a worthy cause and I am excited about what lies ahead!
My name is Laurel Levinsohn and I’m excited to be a part of the Colon Cancer Foundation! I’m a senior at Washington University in St. Louis, majoring in Cognitive Neuroscience with minors in Spanish and Children’s Studies, on the pre-med track. My career goal is to go into medicine, possibly as a pediatric specialist or as an OB/GYN. During my time with CCF, I hope to help the organization be equipped for success as it grows, and ultimately help work toward a world without colon cancer. I am excited to use my Spanish skills to help create resources that can reach a more diverse population, especially those who are often underserved in healthcare.
I love food, fitness, and working with kids. On campus, I am involved in Spoon University, a food publication, SODA: Student Organ Donation Advocates, and WashU Student Interpreters, through which I am gaining skills to serve as a medical Spanish interpreter. I hope that this position will be one way I can contribute to promoting preventive medicine and making healthcare more accessible.
My name is Susan Pistone; I’m one of the Colon Cancer Foundation Interns. I have a Bachelor’s Degree in Communications Studies and a minor in Public Relations. Currently, I’m pursuing a Health Promotion Management Graduate Degree from American University. In my spare time, I love the gym, kickboxing, and running. Previously, I have worked with other Public Health organizations such as Global Health Alliance to host virtual Public Health webinars. My goals would be to have a career in Public Health in roles preventing disease or corporate wellness. Public Health is my passion, and I want to spread awareness about various diseases in any future position.
My name is Abigail Saathoff and I am the Social Media Intern for the Colon Cancer Foundation! I am a rising junior at the University of Northern Iowa double majoring in Strategic Public Relations and Digital Journalism with minors in Business Communication and Marketing. I am actively involved in various organizations at UNI including; Alpha Delta Pi sorority, the Residence Hall Association, Panhellenic Council, and more. Outside of my student organizations and classes I love crafting, and fell in love with jewelry stamping just a few months ago! I also love reading and watching movies.
I’m extremely excited for this opportunity to be CCF’s Social Media Intern. Right now, I’m still not 100 percent on what I want to do in my future, but know I want to help people, work for a non-profit and work in social media or public relations, so I think I’m in the perfect place! I’m excited to learn a lot all the while making graphics, writing posts and building our social media platforms that make a difference and raise awareness of Colorectal Cancer. I’m very proud to be working for such an incredible organization, and I look forward to my time here.
Hello! My name is Rachel and I play an exciting role as a graphic design intern here at CCF! I spent almost 10 years working in office management before deciding what I wanted to be “when I grew up”, and now I am studying Graphic Design at Academy of Art University, where I earned my AA and am now finishing up my BFA. I love art and design and being creative and am so thankful to be able to pursue a second career in my dream job! I hope to go into either advertising or publishing, but I also do a lot of volunteering and love supporting causes I care about, like colorectal cancer awareness! I am learning a lot here at the Colon Cancer Foundation and love that I play a small part in helping to one day eliminate deaths from colorectal cancer.
At home (which is also the office) I have two kiddos and love to spend time outdoors with them or play with legos! I also love art and illustration and hope to illustrate a children’s book someday. I have been a military spouse for 11 years now, and we have gotten to live in so many places around the country! We are originally from New Mexico, which holds a special place in my heart. We hope to settle there when my husband retires from the service. I am also creating an art/children’s book about New Mexico.
Cancer has a massive impact globally, with an estimated 1.8 million cases per year in the U.S. The advances in screening, early diagnosis, and treatment modalities have greatly improved cancer-related morbidity and mortality. With approximately 16.9 million cancer survivors as of January 2019 in the U.S. alone, this number is only expected to grow. When diagnosed, many of these survivors were probably working, thus needing to adapt their lifestyle and work ability around their diagnosis and upcoming treatment. However, this aspect of cancer survival receives very little coverage in research and modern-day media.
The National Comprehensive Cancer Network’s (NCCN) 2021 Virtual Annual Conference highlighted many important aspects of cancer survivorship. Speaker, Anna J. Tevaarwerk, M.D., from the University of Wisconsin Carbone Cancer Centre, highlighted the importance of accommodating cancer survivors returning to work. Her talk, titled, ‘Helping Cancer Survivors Return to Work,’ discussed the impact of cancer and its treatment on a survivor’s work ethic, performance, and/or employment satisfaction and how employers can better assimilate survivors who choose to or need to work during or after their treatment.
The ‘Return to Work’ Issue
During her presentation, Dr. Tevaarwerk shared that around 46% of those diagnosed with cancer are in the 20-64 age group—the ‘working age group’ in the U.S. So, most are either in the workforce, in school, or not in the workforce. Additionally, the average retirement age in the U.S. is 64, but this is predicted to rise. This highlights how cancer survivors may have to undergo and recover from treatment while remaining within the working age group.
This also means, that the majority of patients or survivors will either want or need to continue working after their diagnosis. But evidence indicates that their successful return to work post-diagnosis is much more challenging than it should be. Some of these work limitations are physical and are likely to impair their ability to work:
- Increased fatigue
- Decreased stamina
- Lack of productivity and the persistent side effects of the treatment itself Additionally, the numerous appointments and frequent sick leave associated with cancer treatments can interfere with daily tasks, resulting in unpredictable absences from work. Psychosocial, mental, and/or emotional issues may also emerge when a person is diagnosed with cancer, leading to:
- Decreased confidence in being able to work
- Reduced self-esteem
- Increase anxiety about being shunned at work
- Fear of being a burden on your colleagues or employer
While most survivors appear ‘normal’ on the outside, many of these psychological and psychosocial stressors associated with cancer treatment and self-confidence/body dysmorphia anxiety (e.g., hair loss associated with chemotherapy), can often make it very hard for survivors to return to work. Unfortunately, many are unable to stop working or reducing their work hours even during active treatment – especially with patients receiving palliative (treatment targeting the symptoms rather than the cancer itself) or non-curative (treatments that slow progression and tumour growth) treatments that are ongoing and need to remain in the workforce.
Consequences of Work Limitations
Explaining the impact of the above stressors on patients who need to work, Dr. Tevaarwerk said, “Cancer treatment creates demands on patient time that may impact employment and may require job accommodation such as increased personal calls or messages during work hours, perioding breaks for rest, reduced physical exertion, job restructuring and/or modification, provision or mobility assistance, improved building access and parking close to your work area, or modified office temperatures.”
As a survivor with, undergoing, or recovering from cancer and its treatment it can be quite challenging to ask for these adjustments from your employer and can leave survivors feeling productively inadequate. Additionally, the impact of reducing work hours may lead to financial toxicity that culminates in treatment delays/lack of treatment adherence, treatment discontinuation, health insurance threat (becoming uninsured/paying for increased out-of-pocket expenses), lack of stable income, and psychosocial distress.
For many survivors, work also means a lot more than income—survivors may continue or want to return to work because, as Dr. Tevaarwerk says it creates a “sense of normalcy, distraction, need for activity, and social contacts.” While there is no direct line between these concepts, it is important to highlight that work is important for a lot of reasons outside of income, and many survivors may find a sense of purpose that encourages them to continue to return to work.
Post-Diagnosis Work Outcomes
Cancer employment support varies widely in the U.S. depending on the system you are operating in, according to Dr. Tevaarwerk. “Work-related productivity due to loss of health may change significantly, with lower levels of productivity happening after diagnosis and at the end of treatment,” she said, with the main driver being absenteeism, which includes a loss of working days due to treatment. Additionally, patients receiving curative treatment have shown increased work ability, decreased work limitations, and a steady rise in hours worked when compared to their counterparts receiving palliative cancer therapy.
Dr. Tevaarwerk added that due to the stigma surrounding cancer, and the possibility of being laid off or misrepresented at work, patients find it extremely difficult to share their diagnosis and treatment plans with their employer. Thus, a majority of the time the type of treatment a cancer patient is receiving is unclear, meaning that employment facilities tend to be inadequately prepared to support a cancer patient either during (if they decide that they are in the position where they are able to comfortably continue working) or after their treatment. She added that the phrase ‘return to work’ is misleading as it “implies that a cancer survivor stops working and then re-starts only once at the exact same job,” when in reality a cancer survivor may never stop working, or may stop and start more than once, or may take up a very different level or job.
Overcoming Work Limitations and Barriers
To make returning to work successful, it is important for employers and their employees who are survivors to work together to create an accommodative environment that supports both their needs. A proactive discussion between both parties can help establish physical and emotion boundaries. Dr. Tevaarwerk highlighted several key things an employer can do to support the successful return of a cancer survivor to work:
- A proactive discussion between the employer and employee to establish work-related boundaries (performance adjustments, work intensity etc.)
- Increasing the availability of emotional support options within the workplace (physical work-place adjustments, increased work-from home hours, staggering schedules etc.)
- Making shared decisions to mitigate work impact
Overall, the return to work of a survivor is complicated and influenced by numerous factors and the work ability and performance of a survivor or patient often depends on survivor characteristics, work conditions (flexibility/climate), and the interplay between complex employee-employer social systems. Being at work is considered both necessary and fulfilling, and is strongly associated with mental, emotional, physical, and therapeutic benefits for those suffering from chronic conditions like cancer. Therefore, understanding the ‘return-to-work’ dilemma that cancer survivors face and adjusting it to be more accommodative would open up a range of opportunities that could benefit both the employer and the survivor.
March 2021 brought 21 updated recommendations and guidelines from the American College of Gastroenterology (ACG) regarding colorectal cancer (CRC) screening.
While the American Cancer Society recommends CRC screening for those aged 45 and up, the ACG recommends regular CRC screening for those aged 50-75, which follows the current recommendations set by the U.S. Preventive Services Task Force and the Multi-Speciality Task Force. For those aged 76 and beyond, the ACG recommends that the decision to screen for CRC be dependent on the health status and lifestyle of each individual, as the risks of CRC screening can outweigh the benefits depending on the individual’s situation.
The recommendation to start screening at age 50 is only for those at average risk for CRC. For those who have a family history of CRC or advanced polyps and are therefore at a two-fold increased CRC risk, the ACG recommends screening starting at the age of 40 or 10 years before the youngest affected relative—whichever comes first.
The various CRC screening options include:
- Stool-based tests like fecal immunochemical test (FIT) and multitarget stool DNA (mtsDNA)
- Blood-based tests like Septin 9
- Direct visualization like colonoscopy, flexible sigmoidoscopy, CT colonography, and colon capsule
The ACG recommends that colonoscopy and FIT should be the primary CRC screening methods. While advising against the Septin 9 blood test due to its low CRC detection sensitivity, the ACG does recommend the other screening methods outlined above for individuals who do not want to undergo a colonoscopy or FIT. It is important to note that all non-colonoscopy screening methods require a follow-up colonoscopy in the case of a positive result.
In terms of chemopreventive methods, multiple long term studies have indicated that aspirin can reduce CRC incidence and mortality. However, these studies showed mixed results and did not break down the results by individual CRC screening history, so the ACG recommends against the usage of aspirin as a substitute for traditional CRC screening methods.
Recommendations for Improving the Quality of Colonoscopy Screening
Of all the screening methods, a direct visualization test like the colonoscopy is the most commonly performed procedure in the U.S. However, the colonoscopy does come with a main drawback: the results of the test are dependent upon the colonoscopist. The Adenoma Detection Rate (ADR), defined by “the fraction of persons aged 50+ who have one or more adenomas detected and removed,” is a good indicator of colonoscopy performance quality. Several studies have identified a link between colonoscopists with higher ADR rates and a reduction in CRC in their patients. Therefore, the ACG recommends remedial training for colonoscopists with an ADR of <25%.
The ACG further recommends that colonoscopists spend at least six minutes inspecting the mucosa before the scope is withdrawn from the anus, as a withdrawal time of six minutes or more increased the detection of neoplastic lesions and reduced the risk of post-colonoscopy CRC (PCCRC). An additional indicator of colonoscopy quality is the cecal intubation rate (CIR), which is defined as “the passage of the colonoscope tip into the cecal caput.” It is recommended that colonoscopists achieve a CIR of at least 95%, as studies have shown that a low CIR is associated with an increased risk of PCCRC.
Recommendations for Increasing Awareness About CRC Screening
As CRC remains the third leading cause of cancer in the U.S. among men and women, screening outreach is essential to increase participation in CRC screening. Studies have found that various screening outreach methods like brochures, invitations, reminders, patient navigation, patient reminders, clinical interventions, and clinical reminders were associated with increased CRC screening rates. Additionally, having primary care providers involved in screening outreach methods increased patient participation in CRC screenings. Therefore, the ACG recommends all the above to increase screening participation.
To improve adherence to follow-up colonoscopies after positive non-colonoscopy results, the ACG recommends mail and phone reminders, patient navigation, and provider interventions.
The Colon Cancer Foundation implemented various campaigns this March to increase CRC screening participation in honor of National Colon Cancer Awareness Month. One of the most notable was the #GiveaCrapChallenge, where CCF partnered with Squatty Potty and DuClaw Brewing Company to screen 100 people for colon cancer. Participants traded a stool sample via a FIT kit for a limited edition, six-pack brew sample from DuClaw. These types of innovative screening outreach methods can increase participation in CRC screening, allowing for earlier detection of CRC.
Early detection can significantly reduce the incidence and mortality of CRC. Though there are currently no randomized clinical trials that compare the various CRC screening intervals in terms of the number of life-years gained, the Cancer Intervention and Surveillance Modeling Network, through various studies, recommends the following:
- Annual FIT
- Colonoscopy every 10 years
- mtsDNA test every 3 years
- Flexible sigmoidoscopy every 5-10 years
- CT colonography every 5 years
- Colon capsule every 5 years
PURPOSE: Support and further the mission of an organization
focused on raising awareness about timely preventive screening for
colorectal cancer, understanding the cause(s) of early-age onset
colorectal cancer, and ensuring patients’ quality of life remains central
during colorectal cancer treatment.
If you’d like to read more, click here – Internship PDF
APPLICATION PROCESS: Send us your resume and a cover letter at
firstname.lastname@example.org. Expect an invitation for a virtual interview
if we are impressed with what you offer! Both undergraduate and
graduate students may apply.
The Colon Cancer Foundation receives resumes on a rolling basis. If you
are not a perfect match for our current openings, we will retain your
resume with the organization for future opportunities.
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. Part I of this interview can be found here.
Can you tell us more about the mission of the Colorectal Cancer Provider Outreach Program (CRC POP) ?
The premise is quite simple. Provide our patients with guidance and direction to the support that is available to them at the time of diagnosis at the bedside.
If a newly diagnosed patient approached you for support, how would you describe CRC POP to them?
The Colorectal Cancer Provider Outreach Program is designed to provide you access to nationally available support organizations, their websites and phone numbers, to call them, connect with them, engage with them, lean into them, pull from them, share with them, and get whatever support you and your family need. There’s no monetization, there’s no hope, there’s no sale, and there’s no email being collected—there’s nothing more than just providing direction to you at the time of diagnosis to reinforce that you’re not alone and to provide you with the support you need here and now.
What kind of resources do you look to arm them with?
- For their mobile phone, texting the word ‘COLON’ to 484848
- All our providers have the ability to put a PDF on their website
- All our providers have the ability to put an order in their electronic medical records
And that’s all that’s needed…there’s not much more to it. The providers are being given the simplest of tools to lead patients to a centralized web page, centralized PDF, and a centralized text number to give patients direction.
Does CRC POP seek to provide resources for caregivers and loved ones as well?
As I mentioned earlier, of the 150,000 people diagnosed with colon cancer every year, every diagnosis has a family member or a support system around them. So, if you take that number and extrapolate it out, every person that is affected may affect, on average, three or five or six other people. Do the math and that number becomes a lot more than 150,000. 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
How has CRC POP progressed since it was founded? In your opinion do you think patients will seek POP as a resource for comfort or information following their diagnosis?
his idea was conceived in May or June of 2020; we had initial calls in July, drafted it and we launched on October 1st. We are now in a position where CRC POP is set up, it is up and running and we are in the process of sharing it with GI providers through social media.
Our goals are to connect with the three GI Associations, to find tools through them, through the National Colorectal Cancer Roundtable and the American Cancer Society. In addition, we want to connect with endoscopy centers. I am all about finding the outcomes and results we need to get to the providers quicker, faster, and easier.
I’m not going to be cold calling. Instead, we have started by getting about 10 of the largest groups aware of this and signed onto it in principle, including Gastro Health and GI Alliance. About 1200 GI doctors represented by those 10 groups now know what we’re doing and it’s now about ‘How do you utilize what is there?’
Personally, do you associate the terms ‘comfort’ or ‘information’ with the aims of CRC POP? Or is there another term you think better resonates the mission of CRC POP?
The missions are for me clearly ‘reassurance and support’. I would say reassurance and support at the time of diagnosis, provided by the doctor to the patient.
Do you feel like this program will make a real-world impact on the scale of patient information access?
My goal is to measure it every month and to know how many clicks, how many calls each of these organizations are getting because you’re suddenly taking the active, potential user of a resource and providing them with the information in their hands. If it helps one person feel more reassured, more secure and they get the information they need then it is serving its purpose. That’s my goal, to have increased utilization month to month to month by the 14,000 gastroenterologists in the country.
In short, your goal is to measure how this is impacting the patients that you, your partners, or the gastroenterologists that have signed on to this program are diagnosing, and to eventually put this out there so every single board-certified gastroenterologist who can diagnose colorectal cancer introduces their newly diagnosed patient to CRC POP?
Ideally, that would be wonderful because we’re diagnosing the cancer and we’re sending the patient home. And this is how it goes: we diagnose someone and 10 minutes later I’m doing a procedure on another patient and that person is home in a cold panic, not understanding, clouded, diagnosed, Googling ‘Am I going to die from colon cancer?’ What I’m doing is providing reassurance at the time of diagnosis that gives them the guidance they want and need through whatever resources they choose to tap into. What the organizations do, what happens from that point of contact is between the organizations and the patient or the person reaching out. What I’m doing is providing people the direction.
So, what you are saying is that you are being there for the patient even when you’re physically not there for them after they’ve been diagnosed?
Yes, correct, I’ll see them in two weeks but in that two-week window, a lot of things need to be done. They need to get labs, they need to see a surgeon, they need to see an oncologist, they need to get a CAT scan. But besides that, I’m not there for them. They will call my office maybe but imagine having a 24/7, 1-800 number to call to speak to someone, to have a group to join, a community to have. Have their questions answered on things like ‘Am I going to die?’
In these cases, people’s world is thrown upside down, their blueprints in life are ripped up, and that’s kind of what we are trying to provide support for in the simplest of terms. Leveraging free technology and helping people.
Lastly, I just wanted to conclude on an open-ended note. For those within the non-scientific/medical community, do you think that this program will pave the avenue to improve the scale of information made available to patients after they are diagnosed?
I mean the level of information available from these organizations is huge and the level of information they provide is not just clinical, emotional, financial, academic, research, or trial-based. The level of advocacy, lobbying, or opportunity they can provide people is probably so individualized that it’s not measurable. So, I think that the potential of what happens from the contact made by a person—be it a patient, their family member, or their caregiver—with any of these organizations is truly dependent on what they want or need from it and what they express their needs to be. I can almost guarantee you that any organization that is not able to provide that assistance or that direction will say, ‘Listen, we’re really good at this we are excellent at that, but we don’t know anything about that. You know who does? This organization. Ask for this person, here’s the phone number.’ That’s what will happen.
If so, could you describe why it is imperative to support the large-scale sharing of medical information that ensures that all patients are adequately informed about their diagnoses?
Well, I wouldn’t say it’s imperative in the sense that the medical care is not going to get affected in theory. But in terms of imperative to providing the highest quality of care, no doubt. Imperative to providing the most empathetic role as a provider and position, no doubt. Imperative in improving people’s quality of life and sharing something to help someone else at a level that’s not technical, cold, calculated, or that can be measured in a medical chart. That’s imperative. The role of this is imperative because it’s not us who’s being told we have colon cancer and I always say it could be one in a million but you’re that one it’s a 100%.
That’s where I see the role of this program and the reality is it just takes a little courage and a little change in a little shift in mindset of the gastroenterologist to get a new part of their working algorithm or new part of their process into play. You get into their knee jerk response: I diagnose colon cancer, I tell the patient to text 484848, type in the words ‘COLON’, remind them resources are available right now.
As COVID-19 continues to spread like wildfire, it becomes increasingly important to tackle the growing backlog of cancer surgeries. While returning to normal is currently not an option, a lot of hospitals around the world, especially hospitals in COVID-19 hot spots, have begun implementing COVID-19 surgical pathways to help ease the surgical burden. The 2020 European Society of Surgical Oncology (ESSO)’s virtual summit opened our eyes to the inescapable fact that COVID-19 will reshape the face of surgical oncology.
Impact of COVID-19 on High-Income Regions
With the pandemic in full swing and cases ever on the rise, surgeons, particularly cancer surgeons, across the world are debating the necessities of implementing long-term change with operation scheduling, minimal person-to-person contact, and elective surgery cancellations. As expected, COVID-19 has resulted in a drastic reduction of surgical activity worldwide, with coronavirus hot spots Europe and the U.S. seeing massive reductions.
What Was the Cancer Surgery Burden in Europe’s Biggest Hotspot, Italy?
An elective oncological survey was conducted by Marco Montorsi, MD, and his team to understand how COVID-19 had affected surgical care of Italian cancer patients. The survey was sent to 54 surgical units in three stages: before, during, and after the first wave of the COVID-19 pandemic in March 2020.
During the peak of the first wave, the survey identified a clear reduction in the number of cancer resections scheduled per week, alongside:
- 70% reduction in surgical beds
- 76% reduction in surgical activity
- Almost complete cancellation of outpatient surgeries
Also seen was a prolongation in the time-interval between cancer multidisciplinary team (MDT) discussions and the surgery itself. Disease biology, tumor aggressiveness, and interval from neoadjuvant treatments were the three primary criteria that defined the urgency of the surgery and thereby its need to be performed during the pandemic.
Dr. Montorsi stated that a follow-up elective survey is in the making to monitor the effects of the ongoing second wave. He explained that the aims of the second survey are “to investigate the impact of COVID-19 in surgical departments in the past months of heavy pandemic, understand outcomes of COVID-19 patients undergoing oncological surgery, and to investigate how many alternative treatments to surgery have been performed and how many of these are considered to be a bridge to surgery.”
Dr. Montorsi also highlighted that during the heat of the pandemic in Italy, surgeons tried to devise a new priority model for elective surgeries performed on cancer patients. They found that of the minimally invasive surgeries performed during the COVID-19 pandemic, liver and pancreatic cancer surgeries were vastly reduced but colorectal cancer surgery rates in Italy remained similar to previous years, showing that certain hospitals remained a safe environment to perform cancer surgeries in, if strict Personal Protective Equipment guidelines were followed.
However, as the pandemic continues to be a destructive force in the health care industry, an increasing number of surgeons are becoming unavailable to perform surgeries after contracting COVID-19. So, the large question remains, “How do we proceed?” Dr. Montorsi asked. In Italy alone, an estimated 400,000 cancer surgeries need reprogramming in the gap between the COVID-19 waves, and with more and more of the workforce becoming susceptible to COVID-19, this question really needs to be addressed sooner rather than later.
How Does the U.S. Compare to Italy?
Let’s look at the big picture. The U.S is now the worst COVID-19 affected country worldwide, with a total of 13.5 million cases and 268k deaths by December 1st 2020 and climbing. It is no surprise that cancer patients are suffering more and fighting harder to survive than they have ever before. The fight is real for everyone but increasing amounts of data show that cancer patients are more vulnerable to worsened outcomes if they contract SARS-CoV-2, which includes increased need for oxygenation via ventilation and raised infection-associated mortality.
Secondly, cancer patients are getting delayed diagnoses due to the decreased availability or suspension of diagnostic and screening services. This alone is terrifying because a patient’s diagnosis for their cancer stage and grade is the only way treatment can be determined. Additionally, pre-diagnosed but un-staged cancer patients are also reluctant to be screened because they do not want to risk contracting COVID-19. This effectively means that patients are being diagnosed later and later, thereby worsening their prognosis and increasing their fight for survival by 100-fold. Thirdly, pre-determined treatment options for patients prior to COVID-19 outbreaks have been altered or cancelled altogether depending on the rate of tumor progression, to free hospital bed availability for terminal or life-threatening COVID-19 patients and to minimize exposure to vulnerable immunosuppressed individuals like cancer patients during treatment or surgery. While this is done with careful consideration by the patients’ MDT, there is no guarantee that tumor progression is unaffected when the patient is not receiving treatment or is receiving an alternative treatment.
What Are the Implications for Cancer Surgery?
Capacity for surgery has been drastically reduced as operation theatre space and ventilators have been reallocated to provide for the critical care capacity of COVID-19 patients. Moreover, reports have shown that there is increased risk for contracting COVID-19 postoperatively for any non-COVID elective surgeries, making patients, especially vulnerable ones (i.e., cancer patients, immunosuppressed, and the elderly), more reluctant to undergo surgery in COVID-19 overflow hospitals. Studies conducted in China, Europe, and North America have shown that cancer patients, particularly lung-cancer patients, who contract COVID-19 have a higher risk of mortality, increased ICU admission risk, and severe clinical effects when compared to non-cancer COVID-19 patients. Additionally, a recent meta-analysis showed that all-cause mortality was significantly higher in cancer patients when compared to non-cancer patients, and similar to previous coronavirus outbreaks, the reported mortality rate was 84% in cancer patients compared to 39% in non-cancer patients, further demonstrating the vulnerability of cancer patients to the SARS-CoV-2 infection.
As a result, most MDT’s have opted to put their patients on neoadjuvant chemotherapy, radiotherapy, or hormonal therapy as therapeutic buffers until surgery become available again. However, these options are usually not effective as primary treatment options and therefore also increase the risk of cancer-associated mortality. In order to help oncologists and cancer surgeons navigate this complex field of decisions, the American College of Surgeons “has recommended that in early stages of the pandemic, semi-elective surgery, such as for nearly obstructing colon cancers, stenting for oesophageal cancers and most gynecological cancers, should continue.” In response, health care facilities like hospitals, cancer care centers, and surgical centers are trying to rapidly reorganize elective cancer procedures to ensure that cancer patients continue to receive all the essential care while minimizing their exposure to the deadly COVID-19 infection.
The COVID-19 pandemic has led to a catastrophic global disruption in the field of surgical oncology, severely delayed cancer diagnoses and treatment, and halted many ground-breaking surgical clinical trials. Many studies including Dr. Montorsi’s elective oncological survey, Mehta and Goel’s COVID-19 and cancer patient outcome, Rickards et al., study on COVID-19’s impact, have repeatedly tried to objectively quantify the impact of COVID-19 on cancer care. However, with the continuous progress of this pandemic, it has become impossible to gather data and understand the real-time effects on surgical care. While models are under development to try and ease this burden, much of the work to recenter surgical oncology remains to be done.
– Describe yourself (Personal background, academic background, interests…)
I am a general surgery resident at Massachusetts General Hospital (MGH). I just completed two years (2018-2020) of dedicated research in the field of colorectal surgery and surgical oncology with a specific interest in colorectal cancer and surgical prehabilitation.
I am originally from the California Bay Area but have done all of my education and training out east. My undergraduate years were spent at Johns Hopkins University and I subsequently received a Masters in Microbiology & Immunology from the Johns Hopkins Bloomberg School of Public Health. I graduated from Jefferson Medical College in 2015 with AOA distinction before heading up to Boston for my surgical training. I am now in the midst of my 6th of 7 years at MGH with plans to pursue a fellowship in colorectal surgery.
– Tell us about any awards and distinctions you have received
I have been fortunate to have received numerous prior awards for my research that has been presented at other regional and national meetings both in medical school and residency. In medical school, I was elected to AOA in my third year. In residency, I was named the General Surgery Consultant of the Year in 2018 by our MGH Emergency Medicine colleagues. My research work in prehabilitation was funded by an NIH T32 training grant and my NCT clinical trial is funded by numerous institutional grants.
– What made you interested in doing work in colon cancer?
Unfortunately, my family does have a history of colon cancer within it and I know firsthand the struggles that my family members have gone through. Therefore when I began residency, I had not originally believed that I would choose a career in colorectal surgery. However, once I rotated on our service here at MGH and interacted with the patients and was able to create personal connections with them based on shared experiences with this disease, I realized that this was my calling to treat these patients.
– Tell us about your past work and research efforts in the past and its significance to colon cancer
Much of my prior work was focused on colon cancer among octogenarians and how we can improve care for that population, which is significant given the growing number of aging citizens within this country paired with a longer lifespan. My latest work on this topic, which is to be published in Surgery next month, introduces the idea that older patients (>80) may have a different phenotype and both medical and surgical treatments may need to be tailored more specifically to their needs.
– Describe the current work you are conducting
My current work is in surgical prehabilitation or “prehab” where I designed and am a co-investigator on a clinical trial purposed to investigate if exercise and nutritional prehabilitation benefits patients with gastrointestinal cancers. Specifically, we are investigating if these prescribed modalities improve surgical outcomes, survival, tumor biologics, and quality of life. The progress of our trial, unfortunately, got a bit derailed by the pandemic but we are hoping to restart this fall.
– What is your mission and goals in the current work that you are doing?
Currently, there is a time window between the date of colon cancer diagnosis and the date of surgery that is not being optimized to its full potential. My goal is to introduce prehab into this time window. During this time, we should be building our patient’s cardiopulmonary fitness and increasing their protein reserves in preparation for the stress of their surgery. Just as runners train for a marathon, we should be preparing our patients. My mission is to determine the optimal components of prehab, personalize them for individual patients, and ultimately prove the benefit that I believe exists.
– What are your goals for your future?
My short-term goals are to successfully complete a residency in June 2022 followed by a fellowship in colorectal surgery. Long-term I plan to become an academic colorectal surgeon with both clinical and research pursuits that continuously try to improve care for patients with colon cancer.
– When did you first know that you wanted to work in this particular field of research, and why were you so passionate about that?
As a former college athlete, I have always been interested in how I can intersect exercise and surgery. The concept of prehabilitation was speculated upon in some of my early readings in residency and I was fortunate to find a mentor who shared a passion for this topic. This helped me harness my focus and work on this particular field during my two years of dedicated research within residency.
While working on prehab and speculating on how exercise might be able to affect tumor biology, the topic of pathologic complete response (pCR) arose. We speculated, could exercise work synergistically with neoadjuvant therapy to promote a pCR? This is entirely pure speculation as there is currently no data to that exists to study this idea, however, it did spark my interest into pCR and led to the research project for which I received this award.
– For those who may not have the scientific background that you do, why is it so important that we all support the research being done in the field of colon cancer treatment and prevention?
It is tremendously important! Despite having great screening tools, colon cancer is the second leading cause of cancer death in this country. So much work is still left to be done and research support is critical so that physicians and scientists can continue to make improvements on how this disease is detected, treated, and ultimately prevented.
– How has this award changed your life so far?
I am extremely grateful for this award. It has been incredibly beneficial for my career already in that it has sparked new acquaintances and conversations with other leaders and researchers of colon cancer. My hope is that some of these conversations turn into collaborations to help unite and synergize our efforts to fight this disease.
The 2020 Challenge has gone virtual during this unprecedented time. By going virtual you can still raise awareness and fund colorectal cancer research sorely needs now more than ever. Our goal is to collectively take 1.8 million steps a day (representing 1.8 Million diagnoses per year). This will enable us to cover 41,672 miles OR ~ 83 Million steps! Most importantly we hope each of you will join us in meeting the American Heart Association’s recommended 10,000 steps per day. Let’s “Take Action Together To Defeat Colorectal Cancer!” Sign up today!
Learn why Sanjay and his family are participating in the 2020 Virtual Challenge.
The bery family did it’s own virtual event in Harry Dunham their local park in Basking Ridge, New Jersey. The kids ran 5 k and seema/ Sanjay walked 3.2 k, wearing their Colon Cancer Challenge. 2020 was the 12th year that Bery Colon Cancer Helpers participated in this Challenge — the locations have varied over the years from Central Park, Citi Field, Randall’s Island, and now Harry Dunham park.
After each Challenge the BCCH (bery colon cancer helpers) would go to a le Pain Quoitden ( a Belgium cafe chain ) in Manhattan for tartine lunch. We replicated that by creating our own le pain quoitden in our own kitchen (do not miss the cookbook in the 4th picture) and making our own open-faced tar-tine. Donate today.
We are extremely excited to continue the legacy of the physical Colon Cancer Challenge by going virtual this year. Next year the physical Colon Cancer Challenge will return stronger than ever! In the meantime please stay safe and help us reach our goal of 1.8 million steps per day.
The Colon Cancer Foundation (CCF) is a 501(c)3 non-profit organization dedicated to a World Without Colorectal Cancer through awareness, prevention, screening, and research.