With Colorectal Cancer Treatment, Physical Toxicity Is Not the Only Concern

Enhancing support for patients with low anterior resection syndrome: insights and educational resources from the LARSCAT project

PURPOSE

To address the educational gaps and support needs of patients with low anterior resection syndrome (LARS) following rectal cancer surgery. The LARSCAT project aimed to develop comprehensive resources to better inform patients and enhance their quality of life.

METHODS

A qualitative study was conducted between November 2022 and March 2023. Seven focus groups were formed, including six patients, two surgeons, and three nurses. Patients had undergone rectal cancer surgery with stoma reversal 2 to 12 years earlier, and all experienced major LARS. The focus groups, held in-person and online, explored the impact on daily life, social and sexual health, mood, rest, and relationships. Thematic analysis was performed to identify key issues and support strategies following the COREQ guidelines.

RESULTS

Participants reported insufficient information regarding potential dysfunctions after rectal cancer surgery, and difficulties finding reliable information online. The timing of receiving information varied according to individual coping mechanisms. LARS symptoms significantly impacted daily life, social activities, sexual health, and mood. Patients emphasised the need for more tailored information and supplementary written materials to read at their own pace. Consequently, three comprehensive documents were created and made available online.

CONCLUSION

This study highlights a significant gap in patient education on the long-term effects of rectal cancer surgery. The resources developed by the LARSCAT project aim to provide essential support to patients and healthcare professionals. Future research should focus on integrating these resources into routine care and evaluating their impact on patient outcomes and quality of life.

The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

BACKGROUND

The best strategy for surveillance testing in stage II and III colon cancer patients following curative treatment is unknown. Previous randomized controlled trials have suffered from design limitations and yielded conflicting evidence. This observational comparative effectiveness research study was conducted to provide new evidence on the relationship between post-treatment surveillance testing and survival by overcoming the limitations of previous clinical trials.

METHODS

This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims (SEER-Medicare). Stage II and III colon cancer patients diagnosed from 2002 to 2009 and between 66 to 84 years of age were eligible. Adherence to surveillance testing guidelines-including carcinoembryonic antigen, computed tomography, and colonoscopy-was assessed for each year of follow-up and overall for up to three years post-treatment. Patients were categorized as More Adherent and Less Adherent according to testing guidelines. Patients who received no surveillance testing were excluded. The primary outcome was 5-year cancer-specific survival; 5-year overall survival was the secondary outcome. Inverse probability of treatment weighting (IPTW) using generalized boosted models was employed to balance covariates between the two surveillance groups. IPTW-adjusted survival curves comparing the two groups were performed by the Kaplan-Meier method. Weighted Cox regression was used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for the relative risk of death for the Less Adherent group versus the More Adherent group.

RESULTS

There were 17,860 stage II and III colon cancer cases available for analysis. Compared to More Adherent patients, Less Adherent patients experienced slightly better 5-year cancer-specific survival (HR = 0.83, 95% CI 0.76-0.90) and worse 5-year noncancer-specific survival (HR = 1.61, 95% CI 1.43-1.82) for years 2 to 5 of follow-up. There was no difference between the groups in overall survival (HR = 1.04, 95% CI 0.98-1.10).

CONCLUSIONS

More surveillance testing did not improve 5-year cancer-specific survival compared to less testing and there was no difference between the groups in overall survival. The results of this study support a risk-stratified, shared decision-making surveillance strategy to optimize clinical and patient-centered outcomes for colon cancer patients in the survivorship phase of care.

Hsa_circ_0071589 promotes carcinogenesis via the miR-600/EZH2 axis in colorectal cancer

Previous studies have revealed that miRNAs and lncRNAs participate in the pathogenesis of colorectal cancer (CRC); however, whether circular RNAs (circRNAs) are also involved remains unclear. In the present study, qRT-PCR was used to examine the expression of hsa_circ_0071589, miR-600, and enhancer of zeste homolog 2 (EZH2) in CRC. MTT assay, colony formation assay, transwell assay, and wound-healing assay were performed to assess the effects of hsa_circ_0071589, miR-600, and EZH2 on CRC cell viability, proliferation, invasion, and migration. Bioinformatics analysis, luciferase reporter assay, and RIP assay were used to explore the correlations among hsa_circ_0071589, miR-600, and EZH2 expression in CRC cells. The results showed that hsa_circ_0071589 expression was significantly higher in CRC tissues than in normal tissues. Blockage of hsa_circ_0071589 in CRC cells inhibited tumor growth, invasion and migration. Hsa_circ_0071589 was able to promote the expression of EZH2 by acting as a sponge of miR-600. In addition, miR-600 expression was negatively correlated to hsa_circ_0071589 expression in CRC tissues. These results demonstrated that the hsa_circ_0071589/miR-600/EZH2 axis may play critical regulatory roles in the pathogenesis of CRC and may serve as a novel therapy target in CRC.