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

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

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

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

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

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

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

 

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

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

The Financial Burden of Cancer Patients and Survivors

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

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

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

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

Need for Financial Hardship Screening After Cancer Diagnoses

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

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

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

 

Conclusions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

The model has the following key payment structure:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stay tuned for Part II of this interview!

 

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

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

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

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

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

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

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

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

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

 

December 16, 2020 02:05 PM Eastern Standard Time

CRANBURY, N.J.–(BUSINESS WIRE)–CURE Media Group is excited to announce that its has expanded its Strategic Alliance Partnership (SAP) program roster with the addition of 12 new partners.

“We are excited to join forces with such prominent organizations across different cancer communities during these past few months,” said Mike Hennessy Jr., president and CEO of MJH Life Sciences™, parent company of CURE Media Group. “Each of these partners are dedicated to improving the overall quality of life for patients with cancer through research, education and awareness, and we look forward to collaborating together with them to provide relevant, practical information that meet their audience needs across CURE and MJH multi-dimensional media platforms.” The new partners are as follows:

Bone Marrow & Cancer Foundation is dedicated to improving the quality of life for cancer and transplant patients and their families by providing vital financial assistance, comprehensive resources, educational information, physician referrals, and emotional support programs.

Cancer Support Community is an organization whose mission is to ensure that all people impacted by cancer are empowered by knowledge, strengthened by action and sustained by community. CSC focuses on three areas of support: direct service delivery, research, and advocacy.

The Clearity Foundation’s programs Treatment Decision Support and Steps Through OC help women with ovarian cancer and their families select the best possible therapies for their unique disease and receive the emotional support they need for their OC journey.

Colon Cancer Foundation is a national non-profit organization with a mission to lead the fight against colorectal cancer (CRC) by supporting research, leading advocacy efforts, and promoting treatment and prevention through education and awareness.

Colorectal Cancer Alliance is a national non-profit organization committed to ending colorectal cancer with programs to screen, care and cure.

Foundation for Women’s Cancer is a non-profit organization dedicated to supporting research, education and public awareness of gynecologic cancers. FWC is the official foundation of the Society of Gynecologic Oncology.

Imerman Angels is a non-profit organization with a mission to provide comfort and understanding for all cancer fighters, survivors, previvors and caregivers through a personalized, one-on-one connection with someone who has been there.

LUNgevity is the nation’s leading lung cancer organization investing in lifesaving, translational research and providing support services and education.

Lymphoma Research Foundation is the nation’s largest non-profit organization devoted to funding innovative lymphoma research and providing people with lymphoma and healthcare professionals with up-to-date education about this type of cancer.

MMRF is the largest nonprofit organization in the world focused on accelerating the cure for multiple myeloma.

Partnership to Reduce Cancer in Rhode Island – a 501c3 tax-exempt, charitable non-profit is the state’s comprehensive cancer control coalition, operating in conjunction with the support of the Rhode Island Department of Health’s Comprehensive Cancer Control Program.

Tigerlily Foundation is a national breast cancer foundation providing education, awareness, advocacy and support to young women 15-45 years old before, during and after breast cancer.

The SAP program provides partnering advocacy organizations, medical associations and institutions, and community cancer centers with national reach and visibility, utilizing the breadth of the MJH oncology communications platform to showcase their cutting edge initiatives, content, research, and thought leadership. Through the SAP program, we foster collaboration and an open exchange of information among trusted peers for the benefit of patients and their families. As part of this joint effort, CURE Media Group will work with the partners to share information and highlight the different cancer communities they support.

For a full list of CURE Media Group’s SAP partners, click here.

About CURE Media Group

CURE Media Group is the leading resource for cancer updates, research and education. It combines a full suite of media products, including its industry-leading website, CUREtoday.com; innovative video programs, such as “CURE Connections®”; a series of widely attended live events; CURE® magazine, which reaches more than 1 million readers; and the dynamic website for oncology nurses, OncNursingNews.com, and its companion publication, Oncology Nursing News®. CURE Media Group is a brand of MJH Life Sciences™, the largest privately held, independent, full-service medical media company in North America, dedicated to delivering trusted health care news across multiple channels.

 

Contacts

CURE Media Group Media Contact

Alexandra Ventura, 609-716-7777

aventura@mjhlifesciences.com

As the COVID-19 pandemic shows no evidence of slowing down, many cancer surgeons worldwide have begun to devise models to aid with the prioritization of canceled (backlog) elective and upcoming cancer surgeries. Researchers have also strongly advised conducting COVID-19 testing at various time points before and after any surgical procedures with the aim of minimizing the risk of COVID-19—related mortality peri- and postoperatively, particularly in high-risk patients undergoing major surgeries. Thus, in most ways, it can be argued that elective surgeries on non-COVID patients are burdened similarly to those with COVID-19, by increasing waiting times and costs.

 

The SWALIS 2020 Model 

In 2009, the SWALIS prioritization model was developed “to implicit urgency criteria, time-based priority-based scheduling, and waiting list measuring indexes.” During the 2020 European Society of Surgical Oncology (ESSO)’s annual meeting, speaker and scientist, Roberto Valente, MD, Ph.D., who was involved in modifying this model, shared their findings from implementing it in Spring 2020 to prioritize elective surgery throughout and beyond the COVID-19 pandemic in Italy.

The SWALIS 2020 is a ‘software-aided inter-hospital multidisciplinary pathway’ that dynamically reorders the surgical waiting list for cancer patients from least to most urgent in real-time, thereby ensuring priority-based surgical access and scheduling for past, present, and incoming patients. There are three main stages to this dynamic scheduling:

  • Clinical triage assessed using patient clinical history, pre-administrative information, clinical urgency, and demand modulation
  • Prioritization and selection calculated by dividing the maximum by the actual waiting time for that patient
  • Timely allocation of the surgery computed by the expected priority and weekly forecasted capacity demand

SWALIS 2020 uses these three steps to automatically allocate resources on the basis of oncological demand and significantly reduces the timeframe from consult to surgery by autonomously putting together an MDT for the patient, allowing hospitals adopting SWALIS 2020 to rapidly respond to the patients’ needs depending on the level of surgical urgency. Data shows that these three urgency categories were most commonly used to classify tumor progression when using the SWALIS 2020 model during the pandemic: A1 – 15 days (certain rapid disease progression), A2 – 21 days (probably progression), and A3 – 30 days (potential progression).

The results following the SWALIS 2020 feasibility phase (n=55 patients) showed that 240 referrals were successfully prioritized using this model without any major criticalities. Additionally, when researchers monitored the waiting time data for patients and operation theatre allocation for surgeons, they found that 222 cancer patients underwent surgery without related complications or delayed discharges. These results allowed Dr. Valente and his team to objectively quantify the effectiveness of the SWALIS 2020 model—it was 88.7% effective in week 1, then persistently 100% effective during the remainder of the phase. Even at a 30% or lower capacity, this model can consistently and smoothly manage active and backlogged waiting lists, making it one of the first autonomic models for dynamic patient scheduling. Dr. Valente and his team concluded that the SWALIS 2020 model for dynamic patient scheduling was effectively optimizing oncological surgeries based on urgency. The success of this early pilot study paves the way for future collaboration to create an effective dynamic waiting list and surgical scheduling platform during the next phase of the pandemic.

 

Conclusions

While health care professionals may argue that the change in cancer surgical oncology catalyzed by the ongoing COVID-19 pandemic is disruptive, scientists and researchers strongly believe that this reshaping will vastly improve the future of cancer care and strengthen the health economy. One could make the argument that this restructuring is necessary for improving patient outcomes and facilitating patient care. Consequently, many automated models similar to SWALIS 2020, which create waiting lists and guide elective prioritization, are being developed to fundamentally alter the field of surgical oncology for the better.