Use of the internet by colorectal cancer patients

OBJECTIVE: To identify the frequency of Internet use by colorectal cancer patients. MATERIALS AND METHODS: Fifty patients interviews. RESULTS: Only four patients (8%) had used the internet to access information about colorectal cancer though 36% would have used it if a site had been recommended. CONCLUSION: The Internet is a resource rarely used by patients but there is potential for its use as an adjunct to written and verbal information.     

The quality of patient-orientated internet information on colorectal cancer

Objective The Internet provides an enormous amount of patient‐orientated information on colorectal cancer. This study examined its accessibility and quality. Methods Sites were identified using two search engines (Google and Hotbot) and the search terms ‘bowel cancer’ and ‘colon and rectal cancer’. The first 100 sites in each search were visited and classified. Sites that contained patient information were assessed using the ‘Discern’ instrument for reliability and quality of information on treatment choices. Results Google identified 55 700 sites for the search term ‘colorectal cancer’ and 214 000 for ‘bowel cancer’. Hotbot produced 27 700 and 190,000, respectively. Four hundred sites were studied. Only 25 (6%) sites were duplicated in the searches. One hundred and eighteen (30%) provided information, 70 (18%) were lists of links, 27 (7%) were adverts, 22 (6%) promoted medical centres, 51 (13%) were dead links, 15 (4%) were message boards. Of the 118 that provided information 73 (62%) advised on treatment and 73 (62%) were designed for patients. The sources of information were clear in 55 (47%) and the date when this information was reported was given in only 63 (53%). By adapting the Discern instrument, sites were classified as excellent 18 (15.3%), very good 19 (16.1%), good 28 (23.7%), fair 8 (6.8%) and poor 45 (38.1%). Conclusions The Internet provides a wealth of information on colorectal cancer but the best sites are difficult for patients to distinguish from the thousands of sites returned by search engines. Clinicians should guide patients to quality sites to avoid confusion and misinformation.     

Patient perspectives on consequences of resection for colorectal cancer: A qualitative study

Background

Colorectal cancer is diagnosed in approximately 500,000 patients each year in Europe, leading to a high number of patients having to cope with the consequences of resection for colorectal cancer. As treatment options tend to grow, more information on the effects of these treatments is needed to engage in shared decision-making. This study aims to explore the impact of resection for colorectal cancer on patients' daily life.

Methods

Patients (≥18 years of age) who underwent an oncological colorectal resection between 2018 and 2021 were selected. Purposeful sampling was used to include patients who differed in age, comorbidity conditions, types of (neo)adjuvant therapy, postoperative complications and the presence/absence of a stoma. Semi-structured interviews were conducted, guided by a topic guide. Interviews were fully transcribed and subsequently thematically analysed using the framework approach. Analyses were carried out using the following predefined themes: (1) daily life and activities; (2) psychological functioning; (3) social functioning; (4) sexual functioning; and (5) healthcare experiences.

Results

Sixteen patients with a follow-up period of between 0.6 and 4.4 years after surgery were included in this study. Participants reported several challenges experienced because of poor bowel function, a stoma, chemotherapy-induced neuropathy, fear of recurrence and sexual dysfunction. However, they reported these as not interfering much with daily life.

Conclusion

Colorectal cancer treatment leads to several challenges and treatment-related health deficits. This is often not recognized by generic patient-reported outcome measures, but the findings on treatment-related health deficits presented in this study contain valuable insights which might contribute to improving colorectal cancer care, shared decision making and value-based health care.     

甘肃地区胆囊结石及胆囊切除与大肠癌相关性的队列研究

目的 探讨胆囊结石及胆囊切除与大肠癌之间的关系.方法 应用回顾性队列研究方法分析2000-2007年5573例胆囊结石和8187例非胆囊结石患者的资料,分为胆囊结石组(胆囊切除亚组、胆囊不切除亚组)和对照组;比较两组间、两亚组间大肠癌累积发病率以及胆囊结石组内大肠癌发病与性别、年龄、结石病程、大肠癌肿瘤部位、超重、高血压病、糖尿病、血脂、肝功能等因素的相关性.结果(1)大肠癌累积发病率胆囊结石组为0.43％(24/5573),对照组为0.13％(11/8187),两组比较,差异有统计学意义(x2=11.879,P=0.001).(2)大肠癌累积发病率胆囊结石组胆囊切除亚组为0.45％(17/3809),胆囊不切除亚组为0.40％(7/1764),两亚组间差异无统计学意义(x2 =0.069,P=0.793).(3)胆囊结石病程＜15年时大肠癌累积发病率为0.23％(8/3467),≥15年时为0.76％(16/2106),差异有统计学意义(x2=8.550,P=0.003).(4)伴有血清甘油三酯水平升高者,在胆囊结石组大肠癌病例中占20.83％(5/24),非大肠癌病例中占5.86％(325/5549),差异有统计学意义(x2 =9.621,P=0.002).(5)胆囊结石组大肠癌发病风险与性别、年龄、超重、高血压病、糖尿病、肝功能异常等因素无相关性(x2 =1.444,P=0.229;x2 =7.833,P=0.251;x2=1.151,P=0.283;x2=0.797,P=0.372;x2=0.939,P=0.332;x2=2.103,P=0.147).(6)胆囊结石组发生的大肠癌中直肠癌和右半结肠癌,分别占41％(10/24)、38％(9/24),左半结肠癌和多发性癌分别占17％(4/24)和4％(1/24).结论 胆囊结石症可能是大肠癌发生的高危因素之一;病程≥15年或血脂升高的胆囊结石患者,发生大肠癌的危险性增加;与胆囊结石症有相关性的大肠癌以直肠癌和右半结肠癌较多.     

Internet information on colorectal cancer: commercialization and lack of quality control

Objective The objective of this study was to evaluate the effectiveness of the internet as a source of information for colorectal cancer (CRC). Method Six of the most common search engines (Yahoo, Google, MSN search, Alta Vista, Excite and Lycos) were used for the search of the generic term ‘CRC’. First 300 links were analysed and classified by information type, provider, readership and commercial orientation. Results The average time delay was 1.70 s before matches were located. A total of 3.2827 million matches on CRC were found using the six search engines ranging from 700 (Excite) to 1 417 000 (Lycos) websites. Approximately 50% of the links were based on information from textbooks or governmental websites. Commercial companies giving information about private hospitals and products provided over 50% of the websites on CRC. The distribution of target readers was uneven, although a majority of websites were delivering CRC information to public and patients. Readability of information was difficult to comprehend by the public. Conclusion The internet is becoming an essential tool for disseminating information about CRC to consumers. Half of the links on CRC are commercially oriented, containing information on goods or private health services. Less than 1% information is being provided by professional societies. To provide relevant CRC information, key consensus criteria for evaluating healthcare‐related websites have to be established. There is an urgent need for CRC information on the internet to be regulated through the establishment of government‐funded organizations (e.g. NHS) or professional societies (e.g. ACPGBI).     

对比微波消融与肝切除术治疗结直肠癌肝转移效果:Meta分析

目的采用Meta分析对比微波消融(MWA)与肝切除术(LR)治疗结直肠癌肝转移(CRCLM)的效果和安全性。方法检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、万方、中国知网、维普数据库关于MWA与LR治疗CRCLM的文献,检索时间自建库至2020年8月31日。依据纳入及排除标准筛选文献,以Review Manager 5.3和Stata 14软件进行Meta分析。结果最终纳入13篇文献、共1 534例CRCLM患者,MWA组685例,LR组849例。经异质性检验,1年总体生存率(OS)(I~2=0%,P=0.72)、3年OS(I~2=0%,P=0.86)、5年OS(I~2=0%,P=0.90)均无明显异质性,采用固定效应模型进行分析,结果显示MWA组与LR组间1年OS[HR=0.99,95%CI(0.95,1.02),P=0.44]、3年OS[HR=1.02,95%CI(0.93,1.11),P=0.74]差异均无统计学意义,LR组5年OS高于MWA组[HR=0.82,95%CI(0.69,0.97),P=0.02]。异质性检验示并发症无明显异质性(I~2=0%,P=0.78),以固定效应模型进行分析,结果显示MWA组并发症发生率低于LR组[RR=0.35,95%CI(0.23,0.52),P0.000 01)]。结论 MWA治疗CRCLM早、中期疗效(1、3年OS)与LR相当,远期疗效(5年OS)不及LR,但安全性更高。     

Awareness of heredity in colorectal cancer patients is insufficient among clinicians: a Norwegian population-based study

Objective  The assessment of family history and medical data is crucial in identifying families with Lynch syndrome (LS). Among consecutive colorectal cancer (CRC) patients, we aimed at identifying all patients with a hereditary predisposition, and to study a possible discrepancy with assessments made by the responsible clinicians.
Method  All consecutively diagnosed patients with CRC from two Norwegian hospitals were included, and information on family history was collected in a detailed interview. We assessed information in medical records, and tumours were examined for LS-associated histopathological features.
Results  Among 562 patients, there was no documentation of family history in 388 (69.0%) medical records, and in 174 (31.0%) patients, there was no clinical assessment of the information that was collected on family history. Based on detailed interviews and extended pathological examination, we found that 137 (24.4%) of the 562 patients could be classified as possible LS according to the Revised Bethesda Guidelines (RBG); and that 46 (33.6%) of these patients could be identified by family history alone.
Conclusion  Family history and relevant information in patient records can identify patients with possible LS. However, clinicians often fail to include information on hereditary factors and to assess relevant data in medical records. Familial CRC is therefore not acknowledged, and genetic counselling is not offered.     

CT导向125I粒子植入治疗结直肠癌肝转移

目的 探讨CT导向下125I粒子植入治疗技术在结直肠癌肝转移瘤治疗中的意义.方法 2006年7月至2007年8月对15例结直肠癌肝转移患者采用CT引导下125I放射性粒子植入,粒子植入前采用治疗计划系统(treatment planning system,TPS)模拟布源或遵循Halarism的125I经验公式(mCi=Da×5),计算术中所需125I粒子的总活度及治疗粒子的数量.在螺旋CT导向下将125I放射性粒子植入肝转移瘤实质内及肿瘤边缘. 结果 治疗3个月后行肿瘤影像学评价,15例患者中完全缓解(complete remission,CR)2例,部分缓解(partial remission,PR)10例,稳定(no change,NC)3例.随访至今全组15例全部存活,随访时间最长20个月,最短6个月,近期平均生存期12个月.结论 CT导向下125I粒子植入是治疗直肠癌肝转移瘤的安全、微创、有效的方法 .     

The changing impact of age on colorectal cancer surgery. A trend analysis

Objective  The aim of the study was to evaluate the changing influence of age on the outcomes of colorectal cancer surgery in a retrospective trend analysis.
Methods  Data on 985 patients undergoing colorectal cancer surgery were collected during 1975–1984 and 1995–2004. Variables and outcomes of patients aged < 65, 65–74, 75–84 and 85+ years were compared with intra- and interdecade analyses. Endpoints of the study were postoperative mortality, 5-year overall and cancer-related survivals.
Results  The rate of elderly patients undergoing colorectal cancer surgery increased significantly from 1975–1984 to 1995–2004. Distribution of American Society of Anesthesiology score and cancer stage remained unchanged over time. The rate of palliative procedures decreased over time, most significantly in the older age groups. In 1995–2004 the palliation rate was similar across all age groups. The rate of emergency surgery also decreased, but it remained higher in older age groups. Operative mortality rate decreased over time across all age groups, but age-related differences were still observed in the 1995–2004 series. Cancer-related survival after curative surgery increased from 58% in 1975–1984 to 64% in 1995–2004 in 75+ years patients, while it increased from 56% to 78% in patients aged 74 years or younger.
Conclusions  Elderly patients with colorectal cancer benefited substantially from healthcare progress during the last 30 years. The reduction of palliative procedures and the decline in operative mortality document the efficacy of not restricting the access to radical surgery for these patients.     

Endoscopic treatment of superficial colorectal neoplasms. Retrospective analysis of a single center technique and results

Endoscopic Submucosal Dissection (ESD) is a technique developed in Japan for “en bloc” resection of larger superficial neoplasms of the gastrointestinal tract as an alternative to the traditional Endoscopic Mucosal Resection (EMR), with removal of the lesion in multiple fragments (“piecemeal”). ESD offers a lower recurrence rate and allows a more accurate histopathological examination. This procedure is however considered technically difficult and therefore requires an adequate learning curve, it is time consuming with more discomfort for the patient, it has a higher complication rate, it is more expensive. To overcome these disadvantages, in the Western countries a hybrid technique called Circumferential Submucosal Incision - Endoscopic Mucosal Resection (CSI-EMR) has been developed and is especially employed for colonic lesions.This article analyzes retrospectively the results obtained in a single centre by a single operator in the treatment of 23 patients (12 men and 11 women, average age 65,6 years), all suffering from superficial, larger than ≥ 20 mm colorectal neoplasms: 9 were treated with ESD for rectal lesions and 14 were treated with CSI-EMR for colonic lesions.Findings show a technical success rate of 66,6% for ESD and 78,5% for CSI-EM, and a 0% recurrence rate during follow-up, 4,3% bleeding and 13% perforation complications. The histology of the removed lesions showed 13 (56,5%) low grade dysplasia adenomas, 8 (34,7%) high grade dysplasia adenomas, one grade 1 sigmoid colon adenocarcinoma infiltrating the submucosal layer without lymphovascular invasion, with free margins (R0), treated conservatively, and one grade 1 cecum adenocarcinoma, infiltrating the submucosal layer, with lymphovascular invasion and involved excision margin, treated surgically with no residual neoplastic disease in the surgical specimen.These data are in line with the most significant ones in literature, except for the higher complication rate, which the authors ascribe to the “learning curve” and the smaller number of treated patients.     

Modulators of ceramide metabolism sensitize colorectal cancer cells to chemotherapy: A novel treatment strategy

Irinotecan is a first-line chemotherapeutic agent for patients with metastatic colorectal cancer (CRC). Response rates of less than 40% underscore the problem of treating CRC with irinotecan. Our studies have shown that chemosensitization correlates with high levels of ceramide, whereas resistance correlates with high levels of glucosylceramide (GlcCer). The purpose of this study was to characterize the role of ceramide in irinotecan-mediated CRC cell death. We used four human CRC cell lines to assess ceramide metabolism, cell viability, and apoptosis after treatment with irinotecan. Fumonisin B1 (FB1) and 1-phenyl-2-palmitoylamino-3-morpholino-1-propanol (PPMP) were used to inhibit de novo ceramide synthesis and GlcCer production, respectively. L-threo-dihydrosphingosine (safingol) was used to inhibit secondary proliferative pathways mediated by an atypical protein kinase C that is activated by ceramide. Irinotecan elicited dose- and time-dependent increases in ceramide, which preceded apoptosis. When FB1 was added to irinotecan, CRC cell death was significantly decreased. A significant increase in intracellular levels of GlcCer also was noted after treatment with irinotecan. When GlcCer production was blocked by treating cells with PPMP in addition to irinotecan, ceramide levels increased to 228% of control values and cell death increased by 88%, compared to irinotecan alone. When irinotecan was combined with both PPMP and safingol, cell death was increased by 225% to 325%, compared to irinotecan lone. CRC cell death due to irinotecan is mediated, at least in part, by the de novo synthesis of ceramide. Blocking further metabolism of ceramide can enhance this cytotoxicity. Targeting ceramide pathways is a novel strategy for the treatment of patients with CRC. Presented in part at the Surgical Forum of the American College of Surgeons, New Orleans, Louisiana, October 7–12, 2001; and at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002 (oral presentation). Supported in part by a grant from the National Cancer Institute (CA 77632); the Rogovin-Davidow Foundation, Los Angeles, California; and the Rod Fasone Memorial Cancer Fund, Indianapolis, Indiana.     

A meta-analysis examined the effect of stoma on surgical site wound infection in colorectal cancer

To assess the impact of a stoma on surgical site wound infection in colorectal cancer, we conducted a meta-analysis. A thorough review of the literature up to September 2022 revealed that 3223 participants had colorectal cancer at the start of the investigations; 258 of them had a stoma, while 2965 did not have a stoma. Using dichotomous or contentious methods and a random or fixed-effect model, odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were estimated to evaluate the impact of a stoma on surgical site wound infection in colorectal cancer. The stoma present had significantly higher surgical site wound infections (OR, 4.37; 95% CI, 3.08–6.21; P < 0.001) with no heterogeneity (I2 = 12%) compared to stoma absent in colorectal cancer. The stoma present had significantly higher surgical site wound infections compared to the stoma absent in colorectal cancer. The low number of selected studies in the meta-analysis calls for care when analysing the results.     

A primary study on TRISS in A Chinese hospital

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Patient preferences for outcomes associated with surgical management of prostate cancer

PURPOSE: We used utility assessment to evaluate patient preferences for current urinary and sexual function after radical prostatectomy. MATERIALS AND METHODS: We measured preferences in 209 community volunteers enrolled in a prostate cancer screening study who underwent radical prostatectomy between 1994 and 1998. We compared preferences in 3 outcome groups, namely men bothered by current urinary and sexual functioning, only bothered by current sexual functioning and not bothered by current sexual or urinary functioning. Preferences were assessed via a computer based interview using time trade-off and standard gamble methods. Current functioning was assessed via a standardized questionnaire. RESULTS: Median time trade-off and standard gamble utilities were high at 0.9 across outcome groups, indicating that men were not willing to give up many remaining life years (10% of remaining life expectancy) with current functioning to achieve ideal functioning. However, mean time trade-off and standard gamble scores significantly decreased as the burden increased in men bothered by current sexual and urinary function (0.77 and 0.82), bothered by current sexual function only (0.87 and 0.89) and not bothered by sexual or urinary function (0.92 and 0.96, respectively). CONCLUSIONS: Health related quality of life was generally good in this observational study of patients treated for prostate cancer with radical prostatectomy. In addition, those bothered by urinary and/or sexual function would not be willing to trade much of the remaining life span to achieve perfect functioning. However, the perception of side effects was bothersome enough in some men to warrant appropriate patient counseling regarding the potential risks and benefits.