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

 

With activities in full swing across the U.S. during National Colorectal Awareness month in March, the Colon Cancer Foundation (CCF) spoke to Whitney Jones, MD, founder of the Colon Cancer Prevention Project (CCPP, Louisville, Kentucky), about the foundation’s history, their success with flipping colorectal cancer (CRC) screening rates in the state, and their vision for the future.

Back in 2003, Dr. Jones, a gastrointestinal specialist, was shocked when he encountered several individuals who should have been screened for CRC, presenting with advanced colon cancer in his clinic. Intrigued by this, he found out that Kentucky ranked 49th for CRC screening rates and led the nation in incidence and mortality. It was then that he decided to make changes in the space and started the foundation the same year.

Partnerships to Help Move the Needle on Preventive Screening

While early years were focused on developing informational flyers and attending health fairs, by 2008 CCPP’s attention shifted to influencing policy changes, such as making sure CRC screening received preventive care coverage. They simultaneously developed a screening program for the state’s uninsured populations under the oversight of an advisory committee (healthcare providers, policy experts, and legislators) that continues to meet on a monthly basis even today.

In 2015, CCPP began promoting lead-time messaging and on-time screening, with a particular emphasis on high-risk and younger populations. “We called out, not the guidelines, but in fact our strategy for implementing our guidelines,” he said, which culminated in a paper on establishing a standard process for timely messaging for CRC screening for both average-risk and high-risk individuals, with an overall goal of changing mindsets. “If we have to reach disparate populations, we have to start earlier, message more frequently, and offer more choices,” Dr. Jones said.

CRC screening compliance is mainly driven by primary care providers (PCPs) and health care systems. “Gastroenterologists are the catchers, and the PCPs and health systems are the pitchers,” he said. “We can no longer trust opportunistic screening as in the past. We need to aim for a more systematic, longitudinal, benchmarked system for evidence-based and guideline-driven screening.”

This, he added, will require participation from payers, Medicaid, and the Department of Insurance to instill policies such as coverage for a colonoscopy following a positive FIT test, or genetic testing for those who meet criteria. Additionally, partnering with organizations that understand the local landscape—such as the Cancer Prevention Programs at a safety-net university-based hospital—provides vital on-the-grounds insight. Dr. Jones’ recommendation is for each state to create a statute for an advisory committee or a technical advisory committee that includes lawmakers and insurance companies, to help develop, clarify, and implement CRC policy.

To spread the success of their state-based screening programs, CCPP is partnering with FightCRC to replicate Kentucky’s success in other states—especially in the context of stakeholder engagement. “The key was really in engaging all of our partners that we have now and asking them, ‘What power can you bring from your organization to really advance something?’” He strongly believes that having a CRC-focused organization lead the charge can have a huge impact on moving the needle and getting things done for the community.

Family Health History for On-Time Screening

We all know that disparate platforms make it difficult for sharing information across electronic health records (EHRs). Add to that the time constraints faced by practitioners and gathering accurate information about a person’s family health history (FHH) could be really challenging. Dr. Jones’ vision rises a step above that—using an AI-based system that will gather FHH, critical to Hereditary Cancer Risk Assessment, prior to a patient’s appointment and integrate it within their EHR, compare it to existing guidelines, and provide the physician with a recommendation that can guide the conversation during the patient visit. “Logistics and informatics will play a significant role in improving our struggles with on-time screening,” Dr. Jones added.

45 IS The New 50: Now What?

While the debate over when to start screening average-risk adults is over (see USPSTF draft recommendation), onboarding 20-21 million people across the country in the 45-49 age group is going to be a challenge, especially during the COVID-19 pandemic. Catching-up will require a dramatic increase in the utilization of stool-based testing. “While we cannot conduct colonoscopy in all the new population, we can definitely send them stool-based testing kits. That’s what health systems should focus on,” Dr. Jones said.

In Kentucky, CCPP has been preparing hospitals, health systems, insurance companies, and large group payers since mid-2020 to adopt these guidelines as soon as they are finalized. The focus is on communicating with folks in their late 30s to inform them about symptoms, screening the high-risk population at age 40 or sooner with colonoscopy, identifying candidates for whom genetic testing is appropriate and for average risk individuals, and screening with either stool-based tests or colonoscopy in a shared decision-making model.

“Forty-five should be the finish line for starting risk-based CRC screening communication, not the starting point,” Dr. Jones said.

 

Colon Cancer Foundation To Host Virtual Challenge in Support of Colorectal Cancer Awareness Month in March

  • The CCF Virtual Fitness and Fundraising Challenge will take place the week of March 14th
  • Event week to conclude with a Virtual Concert and Online Celebration on Sunday, March 21st
  • Participants to Support the Foundation’s goal of screening 10,000 people in 2021; Online registration is open at coloncancerfoundation.org

NEW YORK – March 10, 2021 – March is National Colorectal Cancer Awareness Month and this year the Colon Cancer Foundation (CCF) is helping promote the importance of early detection in successfully beating the disease. CCF is honoring awareness month with a range of activities aimed at the Foundation’s ambitious goal of providing 10,000 colorectal cancer screenings to the nation’s most underserved and vulnerable communities in 2021.

Highlighting the events will be the CCF Fitness and Fundraising Challenge, which takes participants on a fun-filled, 45-mile virtual experience through the past, present and future of the Foundation. The unique aspect of the virtual challenge allows each participant to safely walk or run solo or in teams of five to complete the 45-mile distance and the best part is, there are over 70 fitness activities that convert into “mileage.”  Each entry will pay for a life-saving cancer screening kit for one person and help CCF reach their goal of screening 10,000 people in 2021.

“We are excited to host the CCF Fitness and Fundraising Challenge, which not only provides a great incentive for fitness, but an opportunity for the community to support our foundation’s goal of screening 10,000 people in 2021,” said Cindy Borassi, President of the Foundation. “Despite the ongoing pandemic, it is important now more than ever that we stay connected as a community. Join us and help save lives from colon cancer.”

With each mile logged, participants will unlock amazing stories and photos from CCF’s past and present and hear all about how CCF is helping to shape the future of colon cancer prevention, treatment, and care. Participants will be treated to special live-streamed events during the week to help them stay motivated and engaged. With live-streamed cooking demonstrations by noted Chef Claes Petersson and Chef Chintan Pandya, a 2020 James Beard Award finalist, excitement levels are sure to be high.

Funds raised through the Challenge will benefit the Colon Cancer Foundation’s outreach efforts and all athletes will get a special invite to the “Virtual Concert for a Cause” to celebrate their accomplishment.

The “Virtual Concert for a Cause” is set for Sunday, March 21st at 5pm EST and will feature performances by N.E.D (No Evidence of Disease); renowned classical pianists Francois Xavier Poizat and Slava Gryaznov; Mark MK, Niren Chaudhary, along with Rachelle Babler and Mark Huls. Stand alone virtual concert tickets are available for $10 (suggested donation $35), with all proceeds benefiting CCF’s mission.

For more information about the #CCFChallenge or to register, please visit at coloncancerfoundation.org.

 

About the Colon Cancer Foundation

The Colon Cancer Foundation (CCF) is a 501(c)3 non-profit organization with a mission to fight against colorectal cancer (CRC) by supporting research, leading advocacy, and promoting prevention through education and awareness. For over 15 years, CCF has led the charge against this disease by hosting innovative events such as our Annual Early Age-Onset CRC Summit and the Colon Cancer Challenge; providing grants to young investigators; and forming strategic partnerships to raise awareness about CRC and the importance of on-time screening through ground-breaking multimedia campaigns. Together with our partners and supporters, we work towards our vision of A World Without Colorectal Cancer™. For more information, please visit coloncancerfoundation.org or connect with us on Instagram, facebook or twitter.

 

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.

 

Media Contact

Dan Cruz, 619.925.7671

dan@socialendurance.com

 

# # #

Under advice from the Citywide Colorectal Cancer Control Coalition (C5), the NYC Department of Health has updated its screening guidance to recommend that adults with an average risk of colorectal cancer (CRC) should begin screening at age 45. This announcement, which coincides with the National Colorectal Cancer Awareness Month in March, comes prior to the anticipated final recommendation from the U.S. Preventive Services Task Force (USPSTF), which currently remains in a draft form.

NYC’s screening recommendation advices the use of:

  • Colonoscopy every 10 years OR
  • Stool-based testing at required intervals, to be followed up with a colonoscopy in case of a positive stool test

Average risk adults are stratified based on the following characteristics:

  • No personal or family history of CRC
  • No personal or family history of adenomas or sessile serrated polyps
  • No personal history of inflammatory bowel disease
  • No personal history of genetic syndromes (e.g., familial adenomatous polyposis, other polyposis syndrome, Lynch syndrome)
  • No other source of increased risk (e.g., cystic fibrosis, history of abdominopelvic radiation)

The guidance also points out that those at an increased risk—either due to personal or family history of polyps CRC—may need to be screened before age 45. A colonoscopy is recommended for those at a higher risk of developing CRC.

Adults with an increased risk are stratified based on the following characteristics:

  • History of CRC
  • History of adenoma, sessile serrated polyp (SSP), or certain hyperplastic polyps
  • Inflammatory bowel disease
  • Known or suspected genetic syndrome (e.g., familial adenomatous polyposis, other polyposis syndrome, Lynch syndrome)
  • CRC, advanced adenoma, or advanced SSP in one first degree relative before 60 years of age
  • CRC, advanced adenoma, or advanced SSP in two or more first degree relatives at any age
  • CRC, advanced adenoma, or advanced SSP in one first degree relative 60 years of age or older

 Useful Resources for Providers and Patients

The department has developed several downloadable, and easy-to-follow resources for both health care providers and patients:

For the public/patients:

Information on screening tests:

All the information sheets are available in multiple languages.

Aspirin is a non-steroidal anti-inflammatory drug (NSAIDs) that is commonly used as a pain reliever, antipyretic (fever reducer), and preventative medication for cardiovascular illnesses. It is cost-effective, generic, and available over the counter. Aspirin has also been recommended as being beneficial in preventing the development of colorectal cancer (CRC). 

Aspirin has the ability to inhibit proliferation and allow apoptosis (cell-programmed death) of CRC cell lines. Approximately 10-20 billion aspirin tablets are consumed annually in the United States, making it one of the most commonly used medications in the world. The U.S. Preventive Services Task Force (USPSTF) has recommended that the use of aspirin can be of benefit in reducing the risk of CRC. Andrew Chan, M.D. wrote in Nature Reviews Cancer that the USPSTF recommendation is a ‘crucial step’ for cancer prevention.

The CAPP2 trial tested the effect of high-dose aspirin in carriers of the Lynch Syndrome. Also known as hereditary nonpolyposis CRC, Lynch syndrome is a hereditary condition that increases the risk of CRC and endometrial cancers. The trial concluded that 63% of patients who were given high-dose aspirin (600 mg/day) for a mean period of about 2 years saw a reduction in CRC development compared to the placebo group, over a period of about 5 years.  Comparably, the Cancer Prevention Program trial (CAPP3 trial) is a randomized trial that began recruitment in 2014 also targeted individuals with Lynch Syndrome but used varying doses of aspirin (100 mg, 300 mg, or 600 mg/day) for a duration of 2 years. Their follow-up period was 5-10 years later. Similarly, two large prospective cohort studies led by Dr. Chan at Harvard University established that the use of aspirin for 6 years or longer led to a 19% decreased risk of CRC. 

The data currently available on the benefits of aspirin were reviewed by Cuzick et al. who reiterated that the use of aspirin (75-325 mg/day) for greater than 5 years when started between the ages of 55-65 years, has shown benefit.

Although aspirin is chemopreventive for CRC, it is not without its adverse effects. Aspirin is an antiplatelet medication, which makes bleeding one of its most serious risk factors and therefore increases the risk for a hemorrhagic stroke by 32-36% and gastrointestinal bleeds by 30-70%. However, once the chemopreventive effects of aspirin are taken into consideration, the benefits outweigh the risk which is confirmed by an overall 4% reduction in CRC mortality. 

While there is an abundance of evidence as to the benefits of aspirin in the prevention of CRC, questions remain around the adequate dosage and duration of administration. 

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More about Colorectal Cancer & affected populations:

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

About the Campaign Collaborators:

Colon Cancer Foundation

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

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

Squatty Potty, LLC

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

DuClaw Brewing Company

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

CraftShack

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

Diablo Doughnuts

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

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

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Full Job Description

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

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

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

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

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

 

 

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

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

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

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

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

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

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

 

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

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

The Financial Burden of Cancer Patients and Survivors

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

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

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

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

Need for Financial Hardship Screening After Cancer Diagnoses

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

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

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

 

Conclusions

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

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

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

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

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

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

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

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

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

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