Colorectal Cancer: Coping with Colorectal Cancer
Guest: Dr. Kristin Wallace – Hollings Cancer Center, MUSC
Host: Dr. Linda Austin – Psychiatrist, MUSC
Dr. Linda Austin: Dr. Kristin Wallace is Assistant Professor and an epidemiologist at the Hollings Cancer Center here at the Medical University of South Carolina. Dr. Wallace, you are the leader of a very interesting study looking at patients with colorectal cancer. I understand that one of the observations that triggered this research is that African-Americans have a different course of illness with colorectal cancer. Can you talk about that a little bit?
Dr. Kristin Wallace: What we found in South Carolina, and all around different parts of the United States, is that African-Americans tend to have a higher incidence, which means they have a higher burden of colorectal cancer. They also have lower survival rates, overall, for colorectal cancer. This is true whether you look at stage 1, stage 2, stage 3, or stage 4. So, we started out with a study focused just on stage 4 colorectal cancer patients. These are patients with, usually, advanced disease. We want to, essentially, look at what kinds of factors lead to the differences in survival between African-Americans and Caucasians.
Our study started out to answer these broader questions. So, it came up very early on that one of the key reasons could be that African-Americans and Caucasians simply don’t get the same level of treatment. They don’t get the same types of treatment. And that’s a very complicated question. So, we set out to answer a very simple question right from that the start, and that’s to say, there is a recommended treatment for most people with advanced colorectal cancer. We wanted to ask the basic question: were African-Americans and Caucasians receiving that treatment at the same rates? What we thought would be a very simple answer turned out to be very complicated. It branched into all kinds of things having to do with how patients understood their disease. There were not only biologic factors, but cultural and social factors.
We thought the best place to start, then, was to talk to patients about their experiences with their diagnosis. So, we’re asking a group of both Caucasians and African-Americans to answer questions about issues around their diagnosis: what were the difficulties? What were the challenges? What was easy for them? And then about their treatment, to describe, basically, the types of treatment they received, the side effects from their treatment, their social supports, their spiritual supports, and what kinds of factors lead them to decide to take a certain treatment, or not.
Dr. Linda Austin: Do you have a hypothesis that you’re working on, or do you have any preliminary observations you can share about some of the, let’s say, spiritual or cultural issues that might have an impact on African-Americans and Caucasians in cancer survival?
Dr. Melanie Thomas: I think we want to go into this very open-minded. And I think treatment is a very personal decision, whether someone chooses to have chemotherapy. Someone simply might not want to take chemotherapy. But we want to ensure that those decisions about whether to take a certain therapy are based on what we know, medically, to be best for a certain patient. So, as long as the patient understands the risks and benefits of a treatment, they’re essentially free to decide what they want.
We’re worried about, maybe, structural barriers, access to care: couldn’t get to the hospital for the therapy; didn’t have transportation, basic barriers that we want to make sure aren’t a problem for patients. And, we want to be wide open in terms of our expectations about the role of spirituality, the role of family, the role of faith, and the interaction with the physician with regard to what the patients had to tell us. This is new ground for us, and for this research.
Dr. Linda Austin: How are you getting your patients?
Dr. Melanie Thomas: We have two different traditional avenues. We’re partnering with Low Country Oncology, which is a private oncology practice here in the Charleston area, and we’re also recruiting patients through Hollings Cancer Center, the medical oncology clinic. And, certainly, we’re open to any kind of community involvement. It’s a rare cancer, and there aren’t that many stage 4 colorectal cancer patients at Hollings, so the more people we can talk to about their illness and their coping strategies, and the treatment decision-making, the better off we’ll be.
Dr. Linda Austin: Since this is not a clinical trial in the sense that a patient is given a medication that might be lifesaving, it would seem to me that a person’s motivation for participating is sharing the importance of telling a story, and helping physicians, and clinicians, understand what is important to patients.
Dr. Melanie Thomas: Yes. I think we all want to tell our story. And we believe that these patients have a particularly compelling story. We don’t know much about how people cope with advanced disease, particularly advanced stage colorectal cancer. There’s been some work done for breast cancer, but, typically, people don’t like to talk about advanced disease; it’s difficult for people. And we feel that there’s a lot to be learned in terms of helping other patients.
One of the things we’ve heard so far in very preliminary interviews is the need for support, the need to be in contact with other patients with advanced stage disease, and the development of services for people with advanced stage disease, all very important from a clinical perspective, and for the patients. It’s not that your family and friends can’t understand, or that they’re not supportive, but it’s just different having someone who’s been there, who understands what it means to be going through chemotherapy, and to be losing the feeling in your extremities, or some of the very trying side effects. I think when we ask the patients themselves, it’s a service to their ongoing struggle with the disease, as well as informing for future interventions.
Dr. Linda Austin: Dr. Wallace, thanks so much for talking with us.
Dr. Melanie Thomas: Thank you very much.