Improving treatment and quality of life for patients with colorectal cancer

Author: Hagen Kennecke, M.D., MHA, FRCPC, medical director, Gastrointestinal Oncology, Providence Cancer Institute

In 2021, the U.S. Preventive Services Task Force issued revised guidelines for colorectal cancer screenings, aligning with changes made by the American Cancer Society (ACS) three years prior. The revised screening recommendations came after data collected over 20 years showed an increase in colorectal cancer diagnoses in patients under age 55.

The ACS recommendation stated that “adults aged 45 years and older with an average risk of colorectal cancer undergo regular screenings with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability.”

Higher incidence among younger patients

The data informing the revised recommendations revealed a 51% increase in the incidence of colorectal cancer in adults under age 55 from 1994 to 2014, and an 11%  increase in mortality in the same group from 2005 to 2015.

We don’t know for certain why younger adults are being diagnosed with colorectal cancer, but there is evidence that a diet high in fat, processed meat (WHO Group 1 carcinogen) and red meat (WHO Group 2 carcinogen), combined with low fiber and lack of exercise, may be contributing factors. Family history accounts for only a small proportion of patients diagnosed with colorectal cancer.

Although we’re catching cancer at earlier stages because of preventive screening, colorectal cancer is the second most common cause of cancer death in the United States. Preventive measures such as a healthy whole food diet and regular exercise are critical to reducing the number of colorectal cancer cases. But it also takes research and clinical trials, such as the ones Providence Cancer Institute currently offers, to develop novel treatment options that will improve survival rates of patients and improve their quality of life.

Advances in treatment

Early in my medical career, while caring for colorectal cancer patients, I realized treatments had not significantly advanced since the early 1990s. Although surgery had gotten much better, we were still treating all patients the same way, which meant using chemotherapy and radiation. Yet, many patients required a permanent colostomy bag after treatment. 

Around the same time, a close friend was diagnosed with rectal cancer in his 40s, and I saw how the treatments affected his daily life. Since then, I’ve been dedicated to improving both treatment and quality of life for patients with colorectal cancer.

In the past 20 years, there have been many encouraging improvements for patients and their care teams. We’re getting much better at treating early-stage colorectal cancer by using minimally invasive surgeries that require shorter hospital stays. Significant improvements have been made in determining who needs chemotherapy after surgery and how much.

Rectal cancer is a very active area of clinical research at Providence. We’re conducting studies of immunotherapy combined with chemotherapy, radiation and surgery; innovative surgical approaches, such as transanal total mesorectal excision; shorter courses of pelvic radiation; and endoscopic surgery to improve bowel function and reduce toxicity. We’re also using progressive technologies to personalize care for our colorectal cancer patients. This includes using an FDA-approved blood test to detect the presence of circulating tumor DNA.

We currently are recruiting for three clinical trials focused on personalized treatment of colorectal cancer based on unique molecular characteristics of the cancer. Two of the trials are sponsored by the National Cancer Institute through our participation in the Pacific Cancer Research Consortium.

Helping younger patients preserve bowel function

Recently, I presented a research study at the American Society of Clinical Oncology (ASCO) 2021 annual meeting, which involved a large group of patients treated in Canada and the U.S. The study was a cumulation of five years of work on a new treatment for patients with early-stage rectal cancer requiring minimal surgery. Our results show that most patients can be treated with three months of chemotherapy, followed by surgical excision and no further treatment. This is particularly helpful for patients who may need a permanent colostomy bag and younger patients who want to preserve their bowel function.

A national follow-up study is planned with U.S. and Canadian research groups to offer this strategy to a larger group of patients and to evaluate whether radiation can be used to help more patients avoid surgery.

NAPRC accreditation puts a spotlight on Providence

Last year, Providence’s Rectal Cancer Program earned accreditation from the National Accreditation Program for Rectal Cancer (NAPRC). Providence Portland and Providence St. Vincent medical centers were the first in the Pacific Northwest and among the first 25 in the nation to earn this honor. For patients with rectal cancer, that means lower rates of cancer recurrence, lower rates of permanent colostomies and better long-term survival.

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