March is the national Colorectal Cancer Awareness Month and this year marks the 20^th Anniversary since being officially recognized in the US. Colorectal cancer is the third leading cause of cancer-related deaths in the US and is the most common cause of cancer death in men younger than 50. The incidence is rising in young people.  1 in 5 colorectal cancer patients are 20 to 54 years old.   A recent study showed that 51% of people age 50 to 54 have not had a colonoscopy.   Awareness of the risks and promoting screening are vital for prevention. 

Prevention

Exercise, a healthy diet, and a biodiverse gut microbiome are all important factors in colorectal cancer prevention.  Exercise reduces the risk of developing many types of cancer, including distal colon cancer by 23%.  The gut microbiome is an area of intense research.  Foods or supplements that increase the gut microbiome such as fiber, whole grains, fruits and vegetables have been shown to reduce the risk of colorectal cancer.  Foods that decrease gut microbiome diversity, such as processed meat and sugar increase the risk of colorectal cancer.  Probiotics provide a high dose of a few types of bacteria and decrease the biodiversity of the gut microbiome.  While we have no proof that the use of probiotics increases the risk of colorectal cancer, we should use caution with these supplements in at-risk patients.

Chemotherapy after surgery: Less is more

After surgery for newly diagnosed colon cancer, approximately 20 % of patients will have spread of cancer to 1-3 lymph nodes (Stage IIIA).  Recent studies have shown that giving 3 months of chemotherapy is just as effective as 6 months with fewer side effects.  Most notably, neuropathy is less severe and more reversible.  The quality of life during and after treatment has greatly improved for patients Stage IIIA disease without compromising good outcomes. 

Chemotherapy for Stage IV disease. More is better for right-sided colon cancer

The standard chemotherapy for Stage IV disease has been FOLFOX (3 chemotherapy drugs 5-FU, leucovorin, and oxaliplatin) combined with a biologic agent bevacizumab. Recent studies have shown patients with right-sided colon cancer who develop stage IV disease have shorter survival and are more likely to have an inherited predisposition such as Lynch Syndrome. Using a 4-drug chemotherapy combination (FOLFOXIRI) with bevacizumab increases survival over the 3-drug combination in patients with right-sided disease.   The right colon is derived from the midgut and the left colon comes from the hindgut.   This embryologic difference may lead to differences in the biology of the disease.  Patients with Stage IV right-sided colon cancer require more intense chemotherapy

Targeted therapy for Stage IV disease:  chemotherapy-free regimen for BRAF mutated colon cancer

All patients with colorectal cancer must have genomic testing done on their tumor specimens.  BRAF mutations occur in roughly 10% of all colorectal cancer. The combination of the targeted therapy cetuximab and the oral BRAF inhibitor encorafenib is effective and prolongs survival.  This chemotherapy-free regimen is an example of effective treatment with a better quality of life.

So now that we are all aware that exercise prevents cancer, I invite you to join us at the annual “Get Your Rear In Gear” 5K Race on Saturday March 28 at Independence Park, at the corner of Hawthorne Lane & 7^th Street.  Oncology Specialists of Charlotte (OSC) has sponsored this event for many years since the inception 11 years ago. Every year OSC nominates a patient ambassador. Our team has been the largest team for several of these years with up to 200 runners/walkers. This year our patient ambassador is a father/husband diagnosed with stage IV colon cancer at the age of 39. Join our team and come out to this event. Our team is “It’s Miller Time!” found online at www.coloncancercoalition.org

A native of Charleston, South Carolina, Dr. Favaro received his MD and Ph.D. from The Medical University of South Carolina following an eight-year dual degree program. He was elected to the Alpha Omega Alpha honor society during his time in medical school. He completed his internal medicine training at the University of Texas, Southwestern in Dallas, TX, and his fellowship training in Medical Oncology and Hematology at Duke University Medical Center. Dr. Favaro is board certified in both Medical Oncology and Hematology.

Dr. Favaro’s research experience includes basic science work in viral replication and tumor cell growth, as well as clinical research, focused on the development of new treatment for cancer. He has written a Ph.D. dissertation, co-authored a book on pharmacology, and been an author on multiple publications in peer-reviewed medical journals. Dr. Favaro is a principal investigator on several clinical trials currently open in his practice.

Charlotte Magazine has named Dr. Favaro one of the Top Doctors in Hematology/Oncology. His professional interests include clinical care of patients with cancer and blood disorders. He has served on multiple advisory boards as well as served as a discussant in continuing medical education videos for Research to Practice. He also develops and participants in continuing medical education programs and serves as expert witness in medical malpractice cases.

Dr. Favaro believes that physician-owned practices are best suited to offer patient-oriented, efficient care. Physician autonomy improves the value of the care delivered and leads to greater patient satisfaction.

Outside of the clinical setting, Dr. Favaro has a strong interest in health care policy. He has served on the board of Community Oncology Alliance and has lobbied in Washington, DC on behalf of community oncology. Dr. Favaro led in the development of the first local chapter of the Community Oncology Alliance Patient Advocacy Network (CPAN) and he has served as president of the North Carolina Oncology Association. Dr. Favaro has spoken at support group meetings for patients with colon cancer and multiple myeloma and has participated in local fundraising races for cancer.

Dr. Favaro is married with two children and enjoys traveling, running, and spending time with his family.

A native South Carolinian, Hadley obtained her BSN from Clemson University and then her nurse practitioner education at Francis Marion University in Florence, SC.

She previously worked Urgent Care and Family Medicine in SC, as well as a summer Medical Mission trip to Romania in 2012 to treat patients at 10 medical clinics in various villages. When she’s not caring for patients, Hadley enjoys the outdoors, hiking, reading and spending time with her family.  

Hadley will be working with our oncologists through patient care in chemo teaches, follow-up intervals, disease management, and survivorship summaries. 

A native South Carolinian, Natalie obtained her BSN from the University of South Carolina and then her nurse practitioner education in Charleston, SC at Medical University of South Carolina.

She previously worked as an operating room nurse at the trauma center at Palmetto Health Richland Hospital in Columbia, SC.  She has experience in neurosurgery, pediatrics, trauma and plastics.  Additionally, Natalie worked in cardiology at Palmetto Health for several years.  When she’s not caring for patients, she enjoys reading, fitness, travelling, spending time with family and friends in SC and in Charlotte with her husband and her dog Layla.

Natalie will be working with our oncologists through patient care in chemo teaches, follow-up intervals, disease management, and survivorship summaries.

Brooke relocated to Charlotte from Pennsylvania after obtaining her Bachelor of Science from the University of Pittsburgh, and then her BSN from Queens University in Charlotte.

Once in Charlotte, she worked as an oncology nurse and obtained her certification, OCN, Oncology Certified Nurse and joined Oncology Specialists of Charlotte as first a chemo nurse, and then advanced to the position of lead chemo nurse for several years. Brooke took a sabbatical from her nursing career to raise a family and study for her nurse practitioner education at George Washington University. She and her husband have a daughter, son, and a dog Furry.

She has trained in internal medicine, family medicine, pediatrics, and OB/GYN to fulfill her educational rotations in managing acute and chronic disease states in outpatient settings.

Brooke will be working with our oncologists through patient care in chemo teaches, follow-up intervals, disease management, and survivorship summaries.