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Colorectal cancer is the second most common cause of cancer deaths in the United States. Although studies prove that screening reduces colorectal cancer morbidity and mortality and is recommended for everyone over the age of 50, only 60 percent of Americans have been screened.
Penn Medicine’s West Philadelphia Gastrointestinal (GI) Health Outreach and Access Program has worked to to improve the colorectal cancer screening rates in the West Philadelphia community.

Founded in November 2011 with seed funding from an anonymous donor, the Abramson Cancer Center of the University of Pennsylvania established the program, which provides education about colorectal cancer screening and physical navigation through the screening process for people who live in the following zip codes:

• 19104
• 19131
• 19139
• 19143
• 19151

Patient navigator, Alicia Lamanna, works with patients on a one-on-one basis and addresses barriers that might prevent them from getting a screening test. She also ensures patients understand the information by using language that is easy to comprehend.

Assisting patients every step of the way

The patient navigation program is committed to providing every patient the assistance and encouragement they need throughout the entire screening process.

The program provides the following:

• Help with scheduling a colonoscopy
• Education about the screening including literature, instructions for the screening preparation and motivational information
• Encouragement and support
• Reminder phone calls about the screening appointment
• Instructions for the day of screening
• Miralax-Dulcolax-Crystal Light prep free of charge
• Transportation assistance with Septa tokens
• Accompaniment to and from the screening exam

Finally, one week after the procedure, Alicia, communicates the physician's findings and recommendations both verbally and in writing to everyone who participates in the screening.

To qualify for the program patients must:

1. Be between the ages of 50 and 75
2. Live in one of the five participating West Philadelphia zip codes
3. Have an order or prescription for a colonoscopy from your Penn primary care physician

Whether the reasons are financial, insurance or personal — such as being embarrassed or nervous — that keep someone from getting a colorectal screening, the outreach program provides the assistance needed to obtain this life-saving screening.

Patient Navigation Works

A study to determine the feasibility, acceptability and use of the program was recently completed.

Of the 125 patients who completed a screening colonoscopy through this program, 46 (37%) were found to have at least one adenomatous (precancerous) polyp and 3 patients were found to have cancer 1 primary colorectal cancer, 1 metastatic breast cancer, 1 currently unknown origin (unpublished data). These results show that this program has great potential to prevent colorectal cancer.

In addition, satisfaction with the program has been high, with 92% strongly agreeing with the statement: “Overall, I am satisfied with the navigation services I received from the navigator.”

In addition, 36% of the patients who completed the program stated they would have been, “highly unlikely to have completed the colonoscopy without the patient navigator.”

Get More Information

For more information about the program and preventing colorectal cancer, visit the 2012 CANPrevent Colorectal Cancer Conference from the Abramson Cancer Center, or call Alicia Lamanna at 215-439-8281.

As an American College of Surgeons Commission on Cancer accredited Center, Penn’s Abramson Cancer Center is pleased to share these results with the public.

Ursina Teitelbaum, MD, is a Penn Medicine assistant professor of medicine and medical oncologist specializing in gastrointestinal cancer, caring for older adults and symptomatic management of cancer patients.  In this first of two posts, Dr. Teitelbaum discusses the importance of colorectal cancer screening.

It is an exciting time to be a gastrointestinal oncologist, because of the array of advances in detection, prevention and treatment of colorectal cancers available today. 

In February, a study published in the New England Journal of Medicine reported the best evidence to date that colonoscopies, a colorectal cancer screening test, can actually prevent cancer deaths. Early detection has always been a goal of colonoscopy because colorectal cancers that are caught early are more amenable to surgical cure.  The premise of this study, however, was that the removal of precancerous polyps during colonoscopy might prevent the cancer from ever occurring. This prospect seemed to be realized by the finding of a greater than 50 percent decrease in death rate from colorectal cancer among patients who had a screening colonoscopy.

Decreasing the incidence of colon cancers in addition to detecting early colon cancers before they have an opportunity to spread is an incredible achievement in the existing screening programs.  Colorectal cancer is among the most common of all cancers diagnosed today, with more than 140,000 cases diagnosed annually in the United States. Roughly 100,000 cases are colon and 40,000 are rectal cancers.  These can be very lethal cancers, with more than 50,000 people dying yearly from colorectal cancer.

I work closely with gastroenterologists, surgical oncologists, radiation oncologists, and other medical specialties in the multidisciplinary care of colorectal cancer patients at Penn Medicine. All of us work relentlessly to bring the most aggressive and individualized care plans to every patient.  I also personally explain the rationale for each therapy and how to manage the side effects and symptoms of the cancer and the treatments for them.

Patients with early stage or locally advanced colon cancers often meet with me after their surgery to determine if they can benefit from postoperative (adjuvant) chemotherapy to enhance their chance for cure.  I like to call it an “insurance policy” for increasing the chances that the cancer won’t come back.  The chemotherapy regimens in this postoperative setting are quite tolerable and do not involve extreme nausea, fatigue, or hair loss.

But even when colon cancer has spread outside the original location and is considered stage IV cancer, there are many treatment modalities available including innovative clinical trials for colorectal cancer, biologic therapies and immunotherapies.  Penn uses advanced molecular profiling of every patient’s individual cancer to help personalize the therapy. 

In my next post, I will talk about how Penn Medicine takes a personalized approach to cancer treatment.

Learn more about the Abramson Cancer Center’s Gastrointestinal Cancers Program.

John Turino was diagnosed with colon cancer in 1996. A South Jersey resident, John is married with an 18-year-old son and is chairperson of the tri-state chapter of the Colon Cancer Alliance.

My story begins on May 15, 1996. I was experiencing extreme pain on my left side. I was sent to a radiologist for a barium enema, and X-ray to look at my colon, but the liquid was unable to pass through. A tumor had blocked off the descending colon and broken the membrane. The CT scan confirmed that I had colon cancer.

I was devastated.

After trying for 10 years to have a child, my barely 3-year-old son was facing the possibility of being fatherless. For the first time in my life, at the age of 41, I was scared and alone.

You see, back in the 90s, the word "cancer" meant “death.” It was considered an elderly disease. No one ever talked about cancer. In fact, some people avoided me like the plague, thinking they could catch it from me. There was no support group I could join. There was no one to talk to about my experience, because no one knew what to expect. My wife, I'm sure, was experiencing this as well. She had no caregiver training and did not know how to deal with my cancer diagnosis.

The day of my surgery, I drove to the hospital with my wife. We grabbed each other's hands and silently cried as we looked together, ahead.

The surgery went very well. I stayed in intensive care for nine horrible days. When I got home, I had to heal for a couple of weeks before I started my weekly rounds of chemotherapy. I was relieved that I did not need radiation therapy.

I drove myself to and from the oncologist's office every Tuesday for a year. I was determined not to let my son grow up without a dad, and he came with me every trip. We'd go into the office and the first thing that hit me was this horrible odor. Every time I walked into the office for my treatment, I could never get past this odor. And every week, as they drew my blood for a white blood cell count, I was hoping mine was low, so that I did not have to have chemo that week. Each week, coming out of the office, I would get halfway to the car, vomit into the parking lot, close the door and drive off. I became very sick, but as soon as I started to recover, it was time for my next treatment.

Today, it has been almost 16 years that I have survived this disease. I still get a colonoscopy every five years to keep it in check, and the fear of cancer returning never goes away, no matter how many years go by or how strong I become.

Giving Back

About 150,000 people in the United States are diagnosed with colon cancer annually, making it one of the most common forms of cancer. Yet few people know much about it or are comfortable discussing it.

It starts as a growth, or polyp, in the colon or rectum. Some polyps can develop into cancer, but if detected in the early stages, colon cancer is 90 percent curable.

Most people are encouraged to begin screening by the age of 50. Besides colonoscopy, screening options include virtual colonoscopy, and flexible sigmoidoscopy.

Today, I have found a major way to give back and educate others about this disease.

I strive to create awareness of colon cancer through myriad programs, noting it remains the number-two cancer killer, behind lung cancer, even though colonoscopies and other screenings make it one of the most preventable types of cancer.

I am currently the chairperson of the tri-state chapter of the Colon Cancer Alliance, which encompasses New Jersey, Pennsylvania and Delaware. My goal in life is to help spread the word about colon cancer through the Colon Cancer Alliance and to reach as many people as I can.

Based in Washington, D.C., the Colon Cancer Alliance is a national patient advocacy group that strives to end the suffering caused by colorectal cancer through support, education and research.

The Colon Cancer Alliance’s signature programs include:

• “Buddy” program: Designed to provide experienced listeners who have “been there” to support newly diagnosed patients
• Regional seminars: Providing up-to-date information from top healthcare professionals; designed for new patients, advanced disease patients, survivors, caregivers, nurses and others
• Connections online: Features include blogs, videos, personal pages, message boards and chat; opportunities to seek advice or provide data, updates to loved ones
• Tributes page: Web pages can be created to memorialize or otherwise honor a friend, family member or loved one
• Toll-free helpline: A chance to learn more about screening and treatment options and receive advice on treatment effects
• Voices Volunteer program: An opportunity to allow advocates to use their voices to help the alliance succeed in its mission
• “Undy” 5k run/walk: An untypical race highlighted by entrants in boxers and bloomers spreading the word about colorectal cancer.

The Philadelphia “Undy” is scheduled for Sept. 8, 2012. Registration for participants and teams is now open on the website, www.undy5000.org

This is the beginning of my journey to help those in need.

March is National Colorectal Cancer Awareness Month, and it is the perfect time to schedule a screening for colorectal cancer.

Screening tests for colorectal cancer can detect cancer at an earlier, more treatable stage. Here, Greg Ginsberg, MD, director of endoscopic services at Penn Medicine, and physician at the Abramson Cancer Center, talks about screening for colorectal cancer.





Get screened for colorectal cancer. Schedule an appointment with a Penn physician today.