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Send in Your Poop, Get a Six Pack in New ‘Give a Crap Challenge’

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 Instagram, Facebook 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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What Should Patients Know About Colorectal Cancer Screening? 

March is National Colorectal Cancer Awareness Month—an observance of patients, survivors, caregivers, and advocates to educate their communities about the disease. It is also an opportune time to promote awareness about the importance of screening, prevention, and treatment.

The third most common cancer diagnosed in the US, colorectal cancer (CRC) is one of the leading causes of morbidity and mortality worldwide. Although CRC incidence rates have declined in the U.S., disease burden remains high. About 19 million colonoscopies were done in the USA in 2017 and the number seems to be increasing primarily due to various screening programs. The U.S. Preventive Services Task Force currently recommends average-risk adults to begin screening at the age of 50 years, while the American Cancer Society suggests starting earlier, at 45 years.

Screening tests can successfully recognize precancerous polyps and can help catch early-stage colon tumors. Numerous screening options are currently available and your doctor can help you choose the right test:

Stool-based tests: 

  • Guaiac Fecal occult blood test (gFOBT)
    • gFOBT analyzes the presence of blood in stool. The stool is put on guaiac saturated paper and if blood is present, a reaction occurs which causes the paper to turn blue.
    • Although this is a common screening test, it has a high incidence rate of false positives, which can occur if you have consumed red meat prior to testing
  • Fecal immunochemical test (FIT)
    • FIT analyzes the presence of blood in stool but at a higher accuracy as compared to gFOBT. It identifies blood via antibodies found on the surface of red blood cells.
    • FIT does not have high false positive rates after patients consume red meat.
    • However, FIT may miss tumors that do not bleed at all and the test has to be refrigerated in order to perform accurately.
  • Stool DNA test (FIT-DNA test)
    • FIT-DNA is similar to FIT but is a multi-target test that has the ability to identify small amounts of blood in stool as well as cells that have been shed in the stool.

Blood-based tests:

  • Septin 9 is a blood-based test to screen for CRC.

Structural Tests:

  • Flexible Sigmoidoscopy (FS)
    • Outpatient procedure
    • Patients are told to avoid food/drinks from midnight the night before
    • No sedation required
    • The time commitment required for a FS is 3-4 hours compared to a colonoscopy, which requires 48 hours
  • Colonoscopy
    • Gold Standard
    • Outpatient procedure in which the patients are under sedation. A tool is inserted to visualize any abnormalities and/or polyps. A device is inserted alongside the tool to remove tissue for examinations/biopsies.
    • A few downsides to this screening test are:
      • Invasiveness of the procedure
      • Advance bowel preparation with dietary restrictions
    • Risk of tears and bleeds
  • CT Colonography (Virtual Colonoscopy)
    • Minimally-invasive test to visualize the entire colon
    • High sensitivity to polyps and CRC detection
    • Alternative in patients who refuse or are unable to undergo a colonoscopy procedure

Screening for CRC should be offered to those older than 50 years as well those who have a family history of CRC and/or predisposing conditions. Patients should discuss their choice of screening test with their doctor, depending on their situation and preferences. For example, screening tests such as FIT and FS are cost-effective, yet decrease the risk of CRC.

Early detection of CRC can help improve both response to treatment and survival!

 

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Public Relations and Community Engagement Intern

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

 

 

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Disparity Among Young Colorectal Cancer Patients Seeking Genetic Counseling

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. 

 

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Should Financial Hardship be a Quality Care Measure After a Cancer Diagnosis?

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.

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A Closer Look at Symptom Management During Chemotherapy Treatment

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.

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Colon Cancer Foundation to Provide CRC Screening Kits to the Underserved and Uninsured

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.

 

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CMS’ Most Favored Nation Rule Stopped for Now

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.

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Medicaid Expansion Under the Affordable Care Act Was Good News for Colorectal Cancer Care

Medicaid expansion under the Affordable Care Act (ACA) in 2014 has had a notable impact on the diagnoses of early stage colorectal cancer compared to non-expansion states, according to a recent study published in the Journal of American College of Surgeons (JACS). In addition to cancer diagnoses, changes in cancer staging, surgical outcomes, and decisions regarding treatment all saw a positive effect of Medicaid expansion.

The study included Medicaid and uninsured patients listed in the National Cancer Database before the expansion (2011-2012) as well as post expansion (2015-2016). Specifically, the study analyzed 4,438 patients who resided in 19 states that have implemented the expansion as well as 6,017 patients who resided in 19 non-expansion states. Comparatively, patients in states that had expanded Medicaid access saw a multitude of benefits including:

  • Increase in stage I diagnoses
  • Increased treatment at integrated network programs
  • Quicker treatment post-diagnosis (within 30 days)
  • More palliative care for stage IV patients
  • More minimally invasive surgeries

Expansion in all-but 12 states has allowed for more low-income patients to receive crucial public health screenings including colonoscopies, which is one of the screening methods that detects colorectal cancer. The 12 states that did not adopt the expansion include: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. People who were most impacted by the expansion, according to the study, were in the 40 to 64 age group without health insurance or who had Medicaid.

According to the American Cancer Society (ACS), having adequate access to health care and screenings is especially crucial for colorectal cancer, the fourth most common cancer in the U.S, as research has shown that rates of diagnoses amongst people below the age of 65 are increasing. The ACS also reports that one in three people who should receive regular screenings do not, due to lack of insurance or barriers to health care access.

The expansion of the ACA is a step in the right direction for increasing screenings. However, the positive impact of the ACA doesn’t stop with increased screening—-it improves surgical outcomes and limits invasive procedures, as well as limits the number of cases of advanced colorectal cancer.

Doctors assure patients that colorectal cancer is relatively manageable and treatable if detected early. Dr. Samer T. Tohme, surgical oncologist at University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center and one of the lead authors of the current JACS study, says, “Studies show that patients who are diagnosed with cancer at an earlier stage are more likely to have better treatment options, improved quality of care, and longer survival.” Once diagnosed at an early stage, the patient may be spared the tough job of making significant decisions regarding their treatment plan.

Advanced stages of colorectal cancer are associated with increased length of treatment, cost, distance traveled, and overall complexity of care, according to the research study. Medicaid expansion gives a large population of people a chance to avoid many of the stressors associated with dealing with an advanced chronic illness.

Patients in expansion states diagnosed with advanced colorectal cancer have access to palliative care services if needed. Palliative care is an essential element of health care since it provides people with the dignity of symptom relief and comfort during end-stages of a terminal illness.

Overall, the ACA has provided a key framework for the future of oncology care and prevention in the U.S. According to Dr. Richard S. Hoen, surgical oncology fellow at UPMC and a co-author of the study, “Studies like ours are building an increasing body of network that suggests the Affordable Care Act and Medicaid expansion are improving health care access and treatment for cancer patients.”

The advances that the ACA expansion was able to deliver to colorectal cancer patients across the U.S. are also improving overall cancer care while reducing morbidity and mortality rates. To evaluate your risk for colorectal cancer or obtain a colonoscopy, contact your primary care provider.

 

 

 

 

 

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Increased Risk of CRC in Patients With Slow-Transit Constipation

Slow-transit constipation (STC) is reported to occur in 15-30% of people in the U.S. The most widely accepted definition of STC is two or fewer bowel movements per week or straining at stool more than 25% of the time. Research continues to point to STC as a risk factor for colorectal cancer (CRC).

A study published in 2020 that looked at 2,165 patients (median age 54 years), found that the cumulative probability of CRC was 0.2% 5 years after STC diagnosis and 0.4% 10 years after STC diagnosis. This was not significantly different (p=0.575) than among those without STC diagnosis. However, this may be due to the small number of patients (5) who were diagnosed with CRC.

Although the authors of the 2020 study did not find a significant difference among those with and without STC diagnosis, it is well established that STC increases CRC risk. Gurérin et al. in their 2014 study of over 100,000 patients identified a statistically significant risk of CRC among those with STC:

  • 56% higher for CRC
  • 260% higher for benign neoplasm
  • 256% higher for benign neoplasm in colon
  • 262% higher for anal and rectal polyps

Current management options for STC range from dietary counseling, pharmacological therapy, and surgery. 

While the etiology of STC remains unclear, there is increasing evidence that it is caused by an imbalance in the gut microbiome. Zhang et al. in their 2021 review published in Gastroenterology Report found that gut microbiota may play a major role in modulating colonic motility, secretion, and absorption. However, there is still much research needed to understand how the gut microbiome modulates movement of fecal matter through the small intestine and colon.

Conversations about the role of the gut microbiome in CRC development were a part of the Early-Age Onset Colorectal Cancer Summit held by the Colon Cancer Foundation in May 2022.

 

Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

 

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