Podcasts about rectal cancer

Among patients with colorectal cancer and synchronous liver metastases, the subgroup with a primary cancer in the rectum is especially challenging. Compared with colon cancer, most patients with stage IV rectal cancer will have locally advanced primary tumors at increased risk for obstructive and/or post-operative complications resulting in delays in systemic therapy. In this episode from the HPB team at Behind the Knife, listen in on the discussion about treatment sequencing for synchronous liver metastasis from rectal cancer Hosts Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.  Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center. Learning Objectives ·      Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach) ·      Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences ·      Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for. Papers Referenced (in the order they were mentioned in the episode): 1)    Conrad C, Vauthey JN, Masayuki O, et al. Individualized Treatment Sequencing Selection Contributes to Optimized Survival in Patients with Rectal Cancer and Synchronous Liver Metastases. Ann Surg Oncol. 2017 Dec;24(13):3857-3864.  https://pubmed.ncbi.nlm.nih.gov/28929463/ 2)    Maki H, Ayabe RI, Nishioka Y, et al. Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer. Ann Surg Oncol. 2023 Sep;30(9):5390-5400. doi: 10.1245/s10434-023-13656-4. Epub 2023 Jun 7. Erratum in: Ann Surg Oncol. 2023 Sep;30(9):5405. https://pubmed.ncbi.nlm.nih.gov/37285096/ Additional Suggested Reading Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006 Jul;93(7):872-8.  https://pubmed.ncbi.nlm.nih.gov/16671066/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Welcome back to The Genetics Podcast! Today, we're joined by Dr. Luis Diaz, Head of the Division of Solid Tumor Oncology at Memorial Sloan Kettering and a White House Appointee to the National Cancer Advisory Board. Dr. Diaz's career has been defined by his commitment to translating cutting-edge cancer genomics into clinical practice. In this episode, he and Patrick dive into his groundbreaking trial on mismatch repair (MMR)-deficient rectal cancer, along with his pioneering work on liquid biopsies, immunotherapies targeting tumors with microsatellite instability, and advancements in precision oncology. To learn more about Dr. Diaz and his work, visit his research page here: https://www.mskcc.org/research-areas/labs/luis-diaz.

In this episode of the Evolving Wellness Podcast, we're joined by Dr. Roger Seheult, an ICU physician, pulmonologist, and sleep expert, who's also the founder of the wildly popular YouTube channel MedCram. Dr. Seheult reveals the surprising connection between light exposure and health, discussing how hospital lighting environments are contributing to illness and the critical role of circadian rhythms in healing. He shares fascinating insights from his research and practical advice on improving circadian health, including the benefits of infrared light, forest bathing, and aligning with natural sunlight. From shift work impacts to the science of daylight savings and even melatonin myths, this episode is packed with valuable tips and eye-opening information for optimizing your health through better light management. Sponsored By:  Black Lotus Shilajit Visit: ⁠www.blacklotusshilajit.com⁠ and Use Code: SARAHK for 15% the entire site! Upgraded Formulas: Use code: YOGI for 10% off at ⁠www.upgradedformulas.com⁠ Viva Rays Go to ⁠vivarays.com⁠ & use code: YOGI to save 15% Timestamps:  00:00:00 - Introduction  00:03:31 - The MedCram YouTube Channel  00:04:47 - Discovering Circadian Biology   00:08:59 - The Benefits of Infrared Light   00:11:26 - Why You Can't Biohack Light   00:13:08 - Case Study: Light's Role in COVID-19   00:15:30 - The Healing Power of Nature 00:19:41 - The Science of Circadian Rhythms & Light Exposure at Night   00:24:02 - Hormonal Health & Cancer Rates 00:26:04 - Shift Work and Night Shifts 00:28:43 - How Daylight Savings Affects Flu Spikes   00:30:27 - Harvard Kennedy School Study: Sunlight & Flu Prevention   00:33:38 - The Dangers of Over-Supplementation   00:36:19 - Practical Tips for Night Shift Workers   00:38:53 - Ketosis, Intermittent Fasting, and Circadian Health   00:39:43 - The Link Between Eating at Night and Rectal Cancer   00:45:45 - Breakfast vs. Dinner: Timing and Health Benefits   00:48:08 - Medication Timing and Its Impact on Circadian Rhythms   00:50:15 - Training Your Circadian System for Optimal Health   00:51:03 - Why We Crave Snacks at Night   00:55:33 - Changing the Medical System 01:03:33 - UV Light and the Risk of Skin Cancer   01:07:44 - The Truth About Melatonin Supplementation   Check Out Dr. Roger: Website  Youtube X (Twitter) Instagram This video is not medical advice & as a supporter to you and your health journey - I encourage you to monitor your labs and work with a professional! ________________________________________ Get all my free guides and product recommendations to get started on your journey! https://www.sarahkleinerwellness.com/all-free-resources Check out all my courses to understand how to improve your mitochondrial health & experience long lasting health! (Use code PODCAST to save 10%) -  https://www.sarahkleinerwellness.com/courses Sign up for my newsletter to get special offers in the future! -https://www.sarahkleinerwellness.com/contact Free Guide to Building your perfect quantum day (start here) - https://www.sarahkleinerwellness.com/opt-in-9d5f6918-77a8-40d7-bedf-93ca2ec8387f My free product guide with all product recommendations and discount codes: https://www.sarahkleinerwellness.com/resource_redirect/downloads/file-uploads/sites/2147573344/themes/2150788813/downloads/84c82fa-f201-42eb-5466-0524b41f6b18_2024_SKW_Affiliate_Guide_1_.pdf My Circadian App - Apple My Circadian App - Android My Circadian App - Youtube

In this episode of SurgOnc Today®, Prakash Pandalai, MD, Georgios Karagkounis, MD, and Fadwa Ali, MD, review the evolution of the Watch and Wait strategies in the management of rectal cancer patients with an emphasis on challenges, current clinical trials, and future directions.

Newfoundland and Labrador leads the country in colo-rectal cancer rates, and people are also being diagnosed younger. It used to be that you'd start talking to your doctor once you reached the age of 50, but some experts are saying that uncomfortable conversation should be happening a decade or more earlier. Dr. Jerry McGrath is a gastroenterologist and the Medical Director of the Newfoundland and Labrador Colon Cancer Screening Program.

Deputy Editor Salma Jabbour hosts Dr. Christopher Anker, Professor of Radiation Oncology and Program Co-Leader in the Cancer Host and Environment program at the University of Vermont Cancer Center, and Dr. Leila Tchelebi, Associate Professor of Radiation Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, respectively the first and second authors of a guideline published in this issue, Executive Summary of the American Radium Society Appropriate Use Criteria for Non-Operative Management for Rectal Adenocarcinoma: Systematic Review and Guidelines

MSI-high/MMRd rectal cancer treatment guidelines are being re-written. A brief synopsis of why treatment guidelines are changing so quickly in this space. Also, listeners helped out in explaining the ribociclib storage & stability change. Hint: https://www.novartis.com/news/novartis-implements-manufacturing-adjustments-ribociclib-ensure-alignment-latest-regulatory-standards-ebc-end-q2

Send us a textCurious about the latest breakthroughs in oncology treatment? Prepare to have your perspective shifted and hopefully a few laughs too, as we dissect the most compelling research and clinical insights with our expert hosts, Professor Craig Underhill, Dr. Kate Clarke, and Professor Christopher 'CJ' Jackson. Today's episode covers an eclectic mix of papers. Craig tackles patient-reported outcomes. Kate looks at oral cannabis for nausea and vomiting. And CJ reviews the ASCO Guidelines for the management of locally advanced rectal cancer.  Plus each Host presents their favourite Quick Bite papers. For papers, bios and other links visit the Show Notes on our website.For the latest oncology news visit www.oncologynews.com.au.We invite healthcare professionals to join The Oncology Network for free - you'll also receive our free weekly publication The Oncology Newsletter.The Oncology Podcast - An Australian Oncology Perspective

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In this episode, Tom Varghese, MD, FACS is joined by Calista M Harbaugh, MD, MSc, from the University of Michigan. They discuss Dr Harbaugh's recent study, “Association of National Accreditation Program for Rectal Cancer Accreditation with Outcomes after Rectal Cancer Surgery,” in which the authors found that hospitals accredited by the National Accreditation Program for Rectal Cancer are associated with lower short- and long-term morbidity and mortality, but few programs achieve accreditation status.   Disclosure Information: Drs Varghese and Harbaugh have nothing to disclose.   To earn 0.25 AMA PRA Category 1 Credits™ for this episode of the JACS Operative Word Podcast, click here to register for the course and complete the evaluation. Listeners can earn CME credit for this podcast for up to 2 years after the original air date.   Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more.   #JACSOperativeWord

  Dr. Meyerhardt is the Chief Clinical Officer for Dana-Farber and Co-Director of the Colon and Rectal Cancer Center as a medical oncologist specializing in cancers in the GI tract. He is also the Douglas Gray Woodruff Chair in Colorectal Cancer Research and a Professor of Medicine at Harvard Medical School.       Dr. Meyerhardt received his MD from Yale School of Medicine in 1997. He completed a residency in internal medicine at Beth Israel Deaconess Medical Center, in Boston, followed by a medical oncology fellowship at DFCI. He joined the Gastrointestinal Cancer Center at Dana-Farber in 2002.

Dr. Sepideh Gholami and Dr. Aaron Scott join us to discuss the latest evidence-based guideline from ASCO on the management of locally advanced rectal cancer. They review the recommendation highlights on topics including assessment, total neoadjuvant therapy, timing of chemotherapy, nonoperative management, and immunotherapy. Additionally, we discuss the importance of this guideline for both clinicians and patients, and the outstanding research questions in the management of locally advanced rectal cancer. Read the full guideline, “Management of Locally Advanced Rectail Cancer: ASCO Guideline” at www.asco.org/gastrointestinal-cancer-guidelines. TRANSCRIPT  This guideline, clinical tools, and resources are available at www.asco.org/gastrointestinal-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.24.01160    Brittany Harvey: Hello, and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one at ASCO.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Aaron Scott from the University of Arizona Cancer Center and Dr. Sepideh Gholami from Northwell Health, co-chairs on, “Management of Locally Advanced Rectal Cancer: ASCO Guideline.” Thank you for being here, Dr. Scott and Dr. Gholami. Dr. Sepideh Gholami: Thank you for having us. Brittany Harvey: Then, before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Scott and Dr. Gholami, who have joined us here today, are available online with a publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to kick us off on the content of this episode, Dr. Gholami, first, what is the purpose and scope of this guideline on locally advanced rectal cancer? Dr. Sepideh Gholami: Well, I think, historically, this is the group of patients with locally advanced rectal cancer for which we've used multiple therapies to address their management. And with the advent of the total neoadjuvant approach, we really have seen tremendous changes. So the purpose really of these guidelines was to consolidate the various approaches that we've had in several clinical trials and to provide the oncology community a general management recommendation guideline to really optimize the outcomes for these patients. And I would further notice that with the specifics to like which patients are included for these, so we define patients with locally advanced rectal cancer as any of those patients with T3 or T4 tumors and/or lymph node positive disease. Brittany Harvey: Great. I appreciate you providing that background and context of this guideline. So then, next, I'd like to review the key recommendations of this guideline. So, Dr. Scott, starting with the first section of the guideline, what are the recommendations for assessment of locally advanced rectal cancer? Dr. Aaron Scott: Yeah, thank you. So really, we were charged with trying to answer, I think, several very important questions as it comes to the treatment of locally advanced rectal cancer. And the first step in doing so is to define the patient group. So, as far as the first section goes in the assessment, we were really charged with defining what locally advanced rectal cancer means. We think that this is best done with a high resolution pelvic MRI, dedicated rectal sequence prior to any treatment for risk assessment and proper staging, and the use of standardized synaptic MRI is recommended that includes relation of the primary tumor to the anal verge, sphincter complex, pelvic lymph nodes, the mesorectal fascia, otherwise known as the MRF, and includes assessment of the EMVI tumor deposits and lymph nodes. Brittany Harvey: I appreciate you reviewing those highlights for assessment of locally advanced rectal cancer. So following that, Dr. Gholami, what does the panel recommend regarding total neoadjuvant therapy and standard neoadjuvant chemotherapy for patients with proficient mismatch repair or microsatellite stable tumors? Dr. Sepideh Gholami: Yeah, thanks so much for that question, Brittany. I would say that the guidelines really provide a lot more details, but in general, the consensus was that TNT should be offered as really initial treatment for patients with low rectal locally advanced rectal cancers or those who have higher risk for local and distant metastases. Those risk factors included anyone with either T4 disease, extramural vascular invasion and/or tumor deposits identified on the MRI for any threatening of the mesorectal fascia or the intersphincteric plane. Brittany Harvey: Excellent. So then, Dr. Gholami just discussed who should be offered TNT. But Dr. Scott, what are the recommendations regarding timing of TNT? Dr. Aaron Scott: So the way I take this question, think about this question, is a lot of the work that we put toward defining whether chemoradiation plus consolidation versus induction chemotherapy is the right choice, and there are a lot of implications to consider in this situation. The panel recognizes that the decision to proceed with chemoradiation followed by chemo versus chemotherapy followed by chemoradiation often depends on logistics regarding the time to treatment start, concern for distant metastases, and desire for local control that may impact surgical decision making. When we look at the subgroup analysis for overall survival of patients treated with TNT, it doesn't seem to matter which approach you take. Either induction or consolidation doesn't seem to have an impact on overall survival. However, there are other outcomes that may be of importance. Based on the CAO/ARO/AIO-12 randomized phase II trial, both pathologic complete response rates and sphincter sparing surgery were numerically higher with consolidation chemo. That said, there was no difference in disease free survival. So if you have a patient that really wants to consider some sort of sphincter sparing surgery, or a patient has a highly symptomatic disease burden, etc., these are patients that we would recommend starting with chemoradiation followed by consolidation chemotherapy. Brittany Harvey: Understood. And so you have both mentioned radiation included in treatment regimens. So Dr. Gholami, what is recommended in the neoadjuvant setting? Short course radiation or long course chemoradiation? Dr. Sepideh Gholami: Yeah, we actually had a really long discussion about this, but I think in general the consensus was that if radiation is included in any patient's treatment plan, neoadjuvant long course chemoradiation is preferred over short course RT for patients with locally advanced rectal cancer. And really the recommendation was based on the long term results that we've seen from the RAPIDO phase 3 clinical trial, which showed a significant higher rate of five year local regional failure with a total neoadjuvant approach with short course of 10% compared to the standard chemo RT with only 6% of the local recurrence rate. So that's why they opted for the long course, if the patients can actually tolerate it. Brittany Harvey: Excellent. I appreciate reviewing the recommendation and the supporting evidence that the panel reviewed to come to those recommendations. Then following that, Dr. Scott, for those patients who have a complete clinical response after initial therapy, what is recommended regarding nonoperative management? Dr. Aaron Scott: First, I would like to just say that this is really an area that still remains somewhat controversial and needs more investigation to best select patients for this approach. This topic was not systematically reviewed for the ASCO guideline. However, the expert panel was surveyed and most agreed with the time interval used in the OPRA phase 2 trial, which assessed patients for clinical complete response within eight weeks plus or minus four weeks after completion of TNT. Expert panel members and reviewers noted that if the radiation therapy component of TNT is delivered first, then an eight week interval following subsequent chemotherapy may result in a prolonged period of no treatment and therefore a first assessment of this response in this scenario would occur on the earlier side of the recommended interval. If a near clinical complete response is noted, then reevaluation within eight weeks is recommended to assess for developing a clinical complete response. Brittany Harvey: Absolutely. That information is helpful to understand what is recommended regarding nonoperative management and clinical complete responses. Then the final clinical question, Dr. Gholami, for patients with tumors that are microsatellite instability high or mismatch repair deficient, which treatment strategy is recommended? Dr. Sepideh Gholami: Yeah, I think we really came up to summarize that in general, when there is no contraindication to immunotherapy, then patients with MSI high tumors should be really offered immunotherapy. The evidence for this recommendation was relatively low, though, just due to the small sample size of the data that's currently available. But we did want to highlight that the data is very promising, but a definitive recommendation by the committee should be validated in future larger clinical trials. Brittany Harvey: Absolutely. Well, thank you both for reviewing the highlights of these recommendations for each clinical question. Moving on, Dr. Scott, in your view, what is the importance of this guideline and how will it impact both clinicians and patients with locally advanced rectal cancer? Dr. Aaron Scott: This would be the first guideline through ASCO to spell out management options for locally advanced rectal cancer. This has largely been needed due to the increased number of phase II and III trials investigating the specific patient population that have investigated a variety of different TNT approaches and treatment combinations utilizing systemic therapy, radiation, and surgical treatment. So, in this guideline, we really set out to define what locally advanced rectal cancer is, have organized and analyzed impactful large randomized studies to address multimodality therapy, and have consolidated this information into what we consider a concise and generalizable approach to help clinicians and patients individualize their management based on specific clinical pathologic features of their cancer. Brittany Harvey: Yes, this has been a mountain of work to review all the evidence, consolidate it into a concise review of that evidence, and develop recommendations for best clinical practice for management of locally advanced rectal cancer. So then, finally, to wrap us up, Dr. Gholami, what are the outstanding questions regarding management of locally advanced rectal cancer? Dr. Sepideh Gholami: Yeah, I think I just want to reiterate, Brittany, what you mentioned, this was a tremendous amount of body work, and we really would like to thank the committee and everyone from ASCO to help us with creating these general guidelines. I think one of the outstanding questions really still remains is the use of circulating tumor DNA as a management tool for patients with rectal, locally advanced rectal cancer. And also, I think outside of what we can think of the straightforward populations to deduce from PROSPECT, be really interested to see what other patient populations, for example, could also potentially maybe avoid radiation therapy. And lastly, I think we really wanted to highlight that this guideline really focuses on the locally advanced, and it would be great to see future guidelines for early stage rectal cancer which will be forthcoming. Brittany Harvey: Definitely. We'll look forward to answering those outstanding questions and for upcoming guidelines on earlier stage rectal cancer. So, I want to thank you both so much for, as you said, the tremendous amount of work that went into these guidelines and thank you for taking the time to speak with me today, Dr. Scott and Dr. Gholami. Dr. Aaron Scott: Thank you. Dr. Sepideh Gholami: Thank you so much for having us. Appreciate it. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast. To read the full guideline, go to www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please read and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Dr Scott Kopetz from The University of Texas MD Anderson Cancer Center in Houston, and Dr John Strickler from Duke University in Durham, North Carolina, discuss recent updates on available and novel treatment strategies for colorectal cancer, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/ASCO2024/CRC).

Rectal cancer is on the rise and it's high time we shine a light on it.  Because let's face it, our health — and even our bathroom habits, deserve our attention. Yes, we're talking about poop! But before you hit pause or start squirming in your seat, let me tell you why you need to stick around.  Joining us today is Marisa Peters, a true warrior who battled and survived rectal cancer. Not only is she a survivor, but she's also a passionate advocate of women's health. Motivated by her triumphant battle against late-stage cancer, Marisa founded Be Seen, a movement dedicated to emphasizing the significance of self-advocacy during pivotal moments in our lives. Marisa is a mother to three boys and previously had a career on Broadway as a vocalist.  Today, she's not here just to share her story but to shed light on this topic that's often shrouded in silence. We're delving into the signs and symptoms of rectal cancer, and all those little red flags that might be waving when your digestive system isn't quite on its A-game. And most importantly: regular screenings.  Get ready to laugh, learn, and maybe even cringe a little as we discuss all things related to rectal health. Trust me, you won't want to miss this! Visit whydidigetcancer.com for full show notes. --- This episode is sponsored in part by ButcherBox. I LOVE HIGH-QUALITY PROTEIN. I have a houseful at least once a week in the summer. I keep frozen protein ready for last-minute dinners. That's why I'm loving the offer from ButcherBox. They offer $30 off your first box and then FREE chicken thighs, salmon, or top sirloin FOR A YEAR IN EVERY BOX! Yup, you're getting paid to eat grass-fed and sustainable harvest protein.   ButcherBox: Meat Delivery Subscription   --- GUM Let's talk about a dental company that's making waves - GUM! First off, their Summit Toothbrush helps kick plaque to the curb.  And their unwaxed dental floss is PFAS-free! Why does that matter? PFAS are those pesky "forever chemicals" you don't want hanging out in your dental floss.  So, whether you're tackling plaque with their Summit toothbrush or keeping your floss game strong with their PFAS-free floss, GUM has you covered.  Find them at your nearest Costco, major retailers, or pharmacies, and let's keep those smiles shining bright! Happy brushing!   This podcast is for informational purposes only and none of the information should be construed as medical advice. Listeners should seek guidance from their own medical team before making any medical or lifestyle changes.

Marisa Peters is a rectal cancer survivor, women's health thought leader, and founder of BE SEEN. Marisa was diagnosed with Stage 3 rectal cancer in 2021 when she was 39 years old despite being an otherwise healthy and active mother of three young boys. She is on a mission to help other people take their colorectal health very seriously because it is, well, very serious. This conversation was so informative and, dare I say, even fun! The timing could not have been more perfect as we recorded this right before I was scheduled for my second colonoscopy as someone who has a family history of colon cancer. This gave Marisa and me much content for fodder!   Friends, listen to this episode, go sign the BE SEEN Pledge, and then get yourself scheduled for a colonoscopy. This is critical self-care.  Listen in to hear Marisa share: Symptoms of colon cancer to be looking for: blood loss through poop, increased urine urge, stomach pain, extreme fatigue  What you should be asking your doctor for if you have any concerns about color-tectal symptoms Her journey of being dismissed by doctors as she experienced symptoms over the course of 5.5 years before finally being diagnosed Your different options for your colonoscopy prep What to expect during your first colonoscopy How she talked to and continues to talk to her children about her cancer diagnosis and treatment What family support looked like and how they had to learn how to receive support as people who were used to being the givers of support in their community How to hold space for family and friends after they have gone through treatment - when they may be cancer free, but are still recovering physically and emotionally Why you and your family should take the BE SEEN Pledge to take steps toward maintaining colorectal health Links mentioned: Connect with Marisa and Be Seen: beseen.care Take the Be Seen Pledge: https://beseen.care/take-the-be-seen-pledge Marisa and Be Seen on IG Marisa and Be Seen on FB Marisa on LinkedIn Learn more about your ad choices. Visit megaphone.fm/adchoices

The new drug Dostarlimab guides the body's immune system to recognise the cancer cells as harmful and kill them. Patients who followed the six months of treatment showed a complete clinical response with no evidence of tumours during follow-up exams.

Welcome to another insightful episode of the Oncology Brothers podcast! In this episode, hosts Rahul and Rohit Gosain delve into the world of locally advanced rectal cancer, focusing on the latest treatment strategies and advancements in the field. Joined by esteemed guests Dr. Deborah Schrag, a medical oncologist from Memorial Sloan Kettering Cancer Center, and Dr. Krishan Jethwa, a radiation oncologist from the Mayo Clinic, the discussion centers around the groundbreaking Prospect study. This study challenges the traditional approach to rectal cancer treatment, emphasizing the importance of balancing therapeutic efficacy with minimizing chronic side effects. The conversation covers a range of topics, from the utilization of different chemotherapy regimens to the evolving paradigm of radiation therapy. Dr. Schrag and Dr. Jethwa provide valuable insights into determining the optimal treatment course for patients with locally advanced rectal cancer, including the selective omission of surgery and the significance of MSI high status in treatment decisions. Tune in to learn about the latest advancements in rectal cancer treatment, the implications of the Prospect study, and the importance of personalized, multidisciplinary approaches in oncology care. Don't miss out on this informative discussion that sheds light on the complexities of managing rectal cancer and the evolving treatment landscape. Stay informed and up-to-date with the Oncology Brothers podcast as they continue to explore the dynamic world of oncology treatment. Subscribe now and join the conversation! Guests: Dr. Deborah Schrag, Medical Oncologist, Memorial Sloan Kettering Cancer Center Dr. Krishan Jethwa, Radiation Oncologist, Mayo Clinic

Through elaborate multidisciplinary collaboration, institutions with National Accreditation Program for Rectal Cancer (NAPRC) standards can deliver a “high level of care” in the surgical treatment of patients with rectal cancer, according to Steven Wexner, MD, PhD, and Arielle Kanters, MD. In a conversation with CancerNetwork®, Wexner and Kanters detailed the history and advancement of the NAPRC as an interdisciplinary initiative to improve the outcomes of those undergoing surgery for rectal cancer. Wexner is the chair in the Department of Colorectal Surgery and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic, Florida, the founding chair of the NAPRC for the American College of Surgeons Commission on Cancer, and part of the executive committee of the Commission on Cancer. Kanters is a colorectal surgeon, associate fellowship program director, and surgeon leader of the NAPRC program at Cleveland Clinic Main Campus. Wexner spoke about the inspiration for developing the NAPRC as a mission to elevate the level of surgical outcomes in patients with rectal cancer across the United States to those he observed in European countries such as the United Kingdom and Scandinavia. He enlisted leaders from organizations including the Society of Surgical Oncology and the College of American Pathologists to outline and apply appropriate standards for surgical care in rectal cancer. Additionally, Kanters highlighted how enforcing precise guidelines and compliance measures through the NAPRC program facilitates multidisciplinary efforts with colleagues who specialize in radiology and pathology. She stated that these principles help individuals develop their skills across each department, thereby maintaining a high level of treatment for patients with rectal cancer.  Findings from a study published in the Journal of the American College of Surgeons indicated that mortality and complication rates appeared to be lower for patients who received surgery for rectal cancer at NAPRC-accredited institutions compared with those who were treated at non-accredited practices. Wexner and Kanters also discussed how potential advancements related to the use of neoadjuvant or adjuvant therapy may further improve patient outcomes in the field. Additionally, they spoke about updated research on immunotherapy and other modalities that they anticipate at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. Reference Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. J Amer College Surg. Published March 28, 2024. doi:10.1097/XCS.0000000000001064

In this episode of SurgOnc Today, Alexander Parikh, MD, MPH, from the University of Texas – San Antonio and Chair of the SSO HPB disease site working group, and Laleh G. Melstrom, MD, MSCI, from City of Hope National Medical Center, are joined by Timothy Newhook, MD, from the University of Texas MD Anderson Cancer Center and Andreas Kaiser, MD, from the City of Hope. We will be discussing the management of synchronous rectal cancer with liver metastases.

For the first time in 100 episodes, we have a guest! In this week's episode, I'm joined by my good friend Jonathan Bradshaw to discuss his colorectal cancer journey, and the legal and social definitions of disability, with a little bit of nostalgia thrown in!Jonathan was diagnosed with Stage III Rectal Cancer in 2021 at age 40. His treatment included the removal of my colon and everything after, and he will poop in a bag for the rest of his life.  Despite being the largest cohort, Jonathan finds a lack of male representation in the Ostomate Community. He tries to be a voice and information source for men entering the poop-bag life.Jonathan's TEDx talk: Seat To Feet Investment PhilosophyJonathan's website: jpbradshaw.comJonathan's Instagram: @idbuyuamonkeySupport the showWatch my TEDx talk Email badattitudespod@gmail.comFollow @badattitudespod on Instagram, Facebook, Twitter, and ThreadsSupport the pod ko-fi.com/badattitudespodBe sure to leave a rating or review wherever you listen!FairyNerdy: https://linktr.ee/fairynerdy

Rick Greene, MD, discusses with Jean-Nicolas Vauthey, MD, a comparison of different surgical approaches to synchronous liver metastases from rectal cancer and their analysis of both clinicopathological and biological tumor factors associated with completion of the reverse approach. Professor Vauthey is the senior author of, “Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer.” Dr. Vauthey is Professor of Surgery and Chief of the Hepato-Pancreato-Biliary Section, and the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX.

In this episode, Better Edge hosts a thought-provoking panel discussion with distinguished oncologists John Hayes, MD, Sheetal Kircher, MD, and renowned colorectal surgeon, Vitaliy Poylin, MD, on organ preservation approaches for rectal cancer. The conversation between these Northwestern Medicine experts delves into the evolution of treatment modalities, highlighting the shift from a one-size-fits-all approach to a more nuanced, patient-specific strategy. Their insights offer an insightful exploration of the balance between aggressive disease control and improved quality of life.

For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Pippa Hudson speaks to specialist surgeon Dr Maré du Plessis as we mark the start of Colo-rectal Cancer Awareness Month. For more podcasts go to www.primediaplus.com See omnystudio.com/listener for privacy information.

In celebration of the 125th Anniversary of ASCRS, our Then & Now series covers the struggles and triumphs of our specialty throughout history and to our present day as we look toward the future of colorectal surgery. In this episode, we're talking about rectal cancer with Dr. Julio Garcia-Aguilar.

The most important podcast you will hear this year. Ian Paquette speaks with Sean Langenfeld about nuances in Rectal Cancer management. Don't miss it! From the Jan 2024 DCR CPG - update on Rectal Cancer.

When fifty-something Raphaela Ilgenfritz started feeling tired all the time, she thought her fatigue was tied to menopause.  That led to a serious of doctor visits, which led to a colonoscopy, which led to a diagnosis of rectal cancer, or, as it is more commonly in the United Kingdom, where she lives, bowel cancer.  She had to be outfitted with a colostomy bag, a challenge she immediately embraced.  Raphaela founded Stoma4life, a support group for those with below-the-belt cancers, which grew into a podcast, heard on UKHealthRadio.  This is her story.

In this heartwarming episode, Graham takes the guys on an incredible journey. A true salt-of-the-earth Maritimer and former hockey coach to Taylor, Graham shares the unexpected twists of his battle with rectal cancer. Imagine waking up on July 9, 2021, with a downward pressure in your ass, setting off a series of events that led to a whirlwind of emotions culminating in a cancer diagnosis. Graham regales the hosts with the poignant moments of his experience, from the installation of an ostomy—earning him the endearing title of a "double bagger"—to the transformative cancer treatment that ultimately left him cancer-free. As a baby boomer, Graham's openness about his personal hardships shines through, breaking the mold of traditional stoicism. Join the guys for a candid and uplifting conversation that explores Graham's resilience, vulnerability, and triumph over adversity. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN

In this heartwarming episode, Graham takes the guys on an incredible journey. A true salt-of-the-earth Maritimer and former hockey coach to Taylor, Graham shares the unexpected twists of his battle with rectal cancer. Imagine waking up on July 9, 2021, with a downward pressure in your ass, setting off a series of events that led to a whirlwind of emotions culminating in a cancer diagnosis. Graham regales the hosts with the poignant moments of his experience, from the installation of an ostomy—earning him the endearing title of a "double bagger"—to the transformative cancer treatment that ultimately left him cancer-free. As a baby boomer, Graham's openness about his personal hardships shines through, breaking the mold of traditional stoicism. Join the guys for a candid and uplifting conversation that explores Graham's resilience, vulnerability, and triumph over adversity. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN

Dr Kristen K Ciombor from the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, and Dr J Randolph Hecht from UCLA's David Geffen School of Medicine in Santa Monica, California, discuss the current management and actual cases of relapsed/refractory metastatic colorectal cancer moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/RRmCRC2023)

From MMR/MSI and Neoadjuvant Therapy to "Watch and Wait" and ctDNA, special guests Dr. Al Benson and Dr. Samantha Hendren join the co-hosts for a conversation about the latest NCCN rectal cancer guidelines.     CO-HOSTS Avery Walker, MD, FACS, FASCRS El Paso, TX Avery Walker is dually board-certified in General Surgery and Colorectal Surgery. He earned his medical degree at the University of Illinois in Chicago, his General Surgery residency at Madigan Army Medical Center in Tacoma, Washington, and his Fellowship in Colon and Rectal Surgery at The Ochsner Clinic in New Orleans. A former active-duty officer in the United States Army, Dr. Walker served 13 years as a general and colorectal surgeon with his most recent duty station in El Paso, TX at William Beaumont Army Medical Center. While there he was the Chief of Colon and Rectal surgery as well as the Assistant Program Director for the general surgery residency program. He currently practices colon and rectal surgery at The Hospitals of Providence in El Paso, TX. Dr. Avery Walker is married and has two daughters aged 13 and 9.   Biddy Das, MD, FACS Houston, TX (Twitter @BiddyDas) Dr. Bidhan “Biddy” Das has board certifications for both colon and rectal surgery, and general surgery. His passion for medical education and medical process improvement has resulted in book chapters and publications, and national and regional presentations on those subjects. Highlighting his medical expertise on fecal incontinence, he has been featured on patient education videos and national and international television and radio as a featured expert on these colorectal conditions. Dr Das also has a particular interest in surgeons redefining their careers -- he serves as both a software consultant and private equity consultant in Boston, New York City, and Houston.   Erin King-Mullins, MD, FACS, FASCRS Atlanta, GA (Twitter @eking719) Dr. Erin King-Mullins is a double board-certified general and colorectal surgeon. She graduated summa cum laude from Xavier University of Louisiana. After obtaining her medical degree at Emory University in Atlanta, she completed her internship and residency in general surgery at the Orlando Regional Medical Center in Florida. Her fellowship training in colorectal surgery at Georgia Colon & Rectal Surgical Associates concluded with her joining the practice and serving as Faculty/Research Director for the fellowship program until her transition into private practice with Colorectal Wellness Center. She has a husband with whom she shares an amazing, blended family of 4 daughters. The kids keep them pretty busy, but their favorite times are spent on warm sunny beaches.   Jonathan Abelson, MD, MS Arlington, MA (Twitter @jabelsonmd) Dr. Abelson was born and raised in Scarsdale, New York in the suburbs of New York City.  He has 2 older brothers and both of his parents are dentists.  Dr. Abelson went to college at University Pennsylvania, took 2 years off between college and medical school to work in healthcare consulting.  He then went to medical school at University of Virginia, returned to New York for general surgery residency at Weill Cornell on the upper east side of Manhattan.  Dr. Abelson then did colorectal fellowship at Washington University in St. Louis and am now at Lahey clinic in Burlington, Massachusetts for my first job after training.  He is 2 years into practice and has a wife and two sons. His wife works in wellness consulting and they have a dog named Foster who we adopted in St. Louis.

Dr Tanios Bekaii-Saab from the Mayo Clinic in Phoenix, Arizona, discusses the role of novel therapeutic management approaches for patients with colorectal and gastroesophageal cancers. NCPD information and select publications here (https://www.researchtopractice.com/ONS2023GE/AudioInterview)

On SurgOnc Today®, J. Joshua Smith, MD, PhD, Glen Balch, MD, and Christina Bailey, MD, discuss modern rectal cancer trials and their relevance to clinical practice.

Is a more curative pathway for metastatic colon cancer patients emerging?  Join Biddy, Jon and Sam as they share cases, perspectives and approaches regarding metastatic colon cancer patients.   CO-HOSTS Biddy Das, MD, FACS Houston, TX (Twitter @BiddyDas) Dr. Bidhan “Biddy” Das has board certifications for both colon and rectal surgery, and general surgery. His passion for medical education and medical process improvement has resulted in book chapters and publications, and national and regional presentations on those subjects. Highlighting his medical expertise on fecal incontinence, he has been featured on patient education videos and national and international television and radio as a featured expert on these colorectal conditions. Dr Das also has a particular interest in surgeons redefining their careers -- he serves as both a software consultant and private equity consultant in Boston, New York City, and Houston.   Jonathan Abelson, MD, MS Arlington, MA (Twitter @jabelsonmd) Dr. Abelson was born and raised in Scarsdale, New York in the suburbs of New York City.  He has 2 older brothers and both of his parents are dentists.  Dr. Abelson went to college at University Pennsylvania, took 2 years off between college and medical school to work in healthcare consulting.  He then went to medical school at University of Virginia, returned to New York for general surgery residency at Weill Cornell on the upper east side of Manhattan.  Dr. Abelson then did colorectal fellowship at Washington University in St. Louis and am now at Lahey clinic in Burlington, Massachusetts for my first job after training.  He is 2 years into practice and has a wife and two sons. His wife works in wellness consulting and they have a dog named Foster who we adopted in St. Louis.   Sam Eisenstein, MD La Jolla, CA  (Twitter @DrE_UCSD) Sam Eisenstein is an Assistant Professor of Colon and rectal surgery and director of Inflammatory Bowel Disease surgery at UC San Diego Health.  He has worked there for the past 8 years after graduating both residency and fellowship at The Mount Sinai Medical Center in New York.  Sam is best known as the founder and organizer of the IBD-NSQIP collaborative, a large multi institutional data collaborative examining outcomes after IBD surgery, but he also is involved in several clinical trials for perianal Crohn's and has extensive experience with stem cell injections for anal fistulae. He is also on the scientific advisory board for the Crohn's and Colitis Foundation for his work on the next big IBD data collaborative, IBD-SIRQC (Surgical Innovation, Research and Quality Collaborative).  Sam has a Wife and 3 kids (6,8, and 3) and spends most of his free time running around after them these days, but also enjoys traveling and getting out into nature with his family.  

This week's episode is part 1 of 5 of a joint mini-series with The Fellow On Call. We will be recapping the current treatment of locally advanced rectal cancer and covering a plenary session abstract from the ASCO 2023 annual meeting,  the PROSPECT Trial. We also cover the concept of non-inferiority trials.

This week's episode will be focusing on the diagnosis and treatment of rectal cancer. We will go over important details on the diagnosis, staging and treatment of both locally advanced and metastatic rectal cancer.

Host Dr. Shannon Westin interviews guests Dr. Ethan Basch and Dr Deborah Schrag on their JCO simultaneous publication paper at ASCO's 2023 annual meeting: "Patient-reported outcomes during and after treatment for locally advanced rectal cancer (Alliance N1048). TRANSCRIPT The Disclosure for guests on this podcast can be found in the show notes  Dr. Shannon Westin: Hello, and welcome to another episode of JCO After Hours, the podcast where we get in-depth on articles that are published in the Journal of Clinical Oncology. It is your host, Shannon Weston, GYN Oncologist and Social Media Editor for the JCO. And I'm so thrilled to bring you our first podcast that will be a simultaneous podcast JCO publication and ASCO presentation at ASCO 2023, dropping on June 4, 2023. And it is an exciting one. We'll be discussing “Patient-reported Outcomes During and After Treatment for Locally Advanced Rectal Cancer: The PROSPECT Trial Alliance N1048” (10.1200/JCO.23.00903)  And let me introduce both of these amazing people that are going to be with us today. First is Dr. Deborah Schrag. She's the chair in the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York City, New York. Welcome. Dr. Deborah Schrag: Thank you.  Dr. Shannon Westin: And then I'm also accompanied by Dr. Ethan Basch, the Chief of the Division of Oncology and Physician in Chief at NC Cancer Hospital at the University of North Carolina, Chapel Hill, North Carolina, my alma mater. So welcome.  Dr. Ethan Basch: Thanks, Shannon. Nice to be here. Dr. Shannon Westin: And this is a good one. I was really intrigued by this work and I can't wait to talk about this with the audience, and I think that you're going to get a lot of excitement around this. So let's dive right in. I think we should start, first, let's speak a little bit about the role of patient-reported outcomes, assessing patient experience, especially as it relates to the evaluation of new therapies. Dr. Ethan Basch: Yeah, I'm happy to take that question, and thanks for asking it. All of us who practice oncology or accrue to trials recognize that patients receiving cancer treatment are highly symptomatic, either from their disease or from the sequelae of treatment. And as such, assessing and managing symptoms is really a cornerstone of what we do as oncology providers or investigators. But unfortunately, there's now abundant evidence that we as clinicians or investigators miss many of the symptoms and side effects that our patients experience, in fact, up to half of them. And so over the years, there have been a number of strategies developed to try to bridge this gap to fill in the pieces. And patient-reported outcomes is the one that has emerged to fill this gap, by informing us about the experiences of our patients. And without patient-reported outcomes and trials, we really have an incomplete understanding of the properties of products, the experiences of patients. And so when we are trying to do a risk-benefit assessment, for example, from data in a clinical trial, if we don't have patient-reported outcomes, we actually have an inadequate assessment of what was happening on the ground in that trial, particularly when it comes to adverse event assessment.   Dr. Shannon Westin: I think it's been great how we've been able to start incorporating these more. But before we go too far down that line, this study was particularly done in rectal cancer and we have a very diverse audience. And so just to level set, can one of you speak a little bit about the current standard of care for locally advanced rectal cancer?  Dr. Deborah Schrag: So, rectal cancer has a nasty tendency to come back in the pelvis. And Shannon, you're an OBGYN, so you know how miserable that can be. These are called locally recurrent cancers and they are just miserable. They cause a great deal of symptoms and a great deal of suffering. And back in the 1970s and '80s, a strategy to treat pelvic or local recurrence of rectal cancer was developed and that strategy was radiation. And it used to be that 10%, 20%, even 30% of patients who had rectal cancer surgery would have a cancer come back. And these were people who couldn't sit down, constant pain, leaking, trouble urinating, trouble moving their bowels.  Radiation was a tremendous innovation. Radiation has been part of the management of locally advanced rectal cancer since 1990. Since 2004, we've given that radiation before surgery in the neoadjuvant setting. So this has been the predominant way that we treat these cancers really for the last two decades. We give about five and a half weeks of chemotherapy and radiation. Patients then have surgery, recover from the surgery, and many, not all, go on to receive some postoperative chemotherapy. It depends a little bit on what's found at surgery. But those three phases, the chemoradiation phase first, followed by surgery, followed by chemotherapy has been the prevailing care standard.  When we launched this trial, we wondered whether we could improve upon that and whether we could capitalize on some of the innovations and discoveries, and advances that have taken place in the past couple of decades. Development of better surgical technique, better chemotherapy, better imaging. And that was really what this trial was about. But the key thing is really what Dr. Basch said at the outset. We cure these patients. More and more often, we cure these patients. And so we want people to live not just long, but well. And so we really have to pay close attention to the symptoms. And the only way we could do that was by actually asking patients to tell us what their symptoms were, both during the acute phase of treatment as well as longer-term as they were followed up and recovered.  Dr. Shannon Westin: Thank you so much. So I think this is a great time for us to just talk very briefly about the overarching PROSPECT trial. What were the two arms and how did it impact standard of care? Dr. Deborah Schrag: Essentially, the two groups in PROSPECT were a chemo first and radiation only if you need it group, that was the experimental group. And the standard control group was the chemotherapy and radiation for everybody. So the chemo and radiation therapy group involved our typical 5040 centigrade worth of pelvic radiation given over five and a half weeks. So Monday to Friday for five and a half weeks with some sensitizing fluoropyrimidine chemotherapy, and physicians and patients could choose whether that was given as oral capecitabine or as intravenous 5-FU, they work just the same, followed by surgery. So that's the standard group. The experimental group received six cycles of a very common chemotherapy regimen used in gastrointestinal cancer, FOLFOX, and gave that regimen six times two weeks apart, followed by restaging with a pelvic MRI and examination by the surgeon. If patients were responding and the tumor had decreased in size by at least 20%, patients could go straight to the operating room. But if patients were poor responders to chemotherapy, they had a second chance, if you will, to get the chemoradiation. We call that group the chemo first with selective chemoradiation group. That was the intervention. And we followed patients and our outcome was disease-free survival. And we have about five years of follow-up in our patients. So this is a very mature study.  Dr. Shannon Westin: And what happened? What were the results? Tell us, how did this impact standard of care?  Dr. Deborah Schrag: So the upshot is it was designed as a non-inferiority trial and it met the prespecified non-inferiority hypothesis. The exact point estimates were that at five years, essentially 80.4% and 78.6% of participants were alive and disease-free in each group. So that's really almost exactly the same at five years. And the results for overall survival and for local recurrence were also nearly identical. Dr. Shannon Westin: So congratulations. Why don't you now, if you could, walk us through how you assess the patient experience on this particular trial? So specifically looking at the endpoints that you assessed and also the time points that you chose.  Dr. Ethan Basch: Thanks for the question. I'll take that. So in this trial, particularly because it was a non-inferiority trial being conducted in a curative context, we really wanted to get a sense of the adverse effects, the side effects of the treatment that are most salient in this population. And so to do that, we used two different approaches. The first was that we selected 14 symptomatic adverse events from the patient version of the CTCAE, also known as the PRO-CTCAE. The patient version of the CTCAE was developed about ten years ago. The purpose of it is to enable the patient voice to be brought into clinical trials around those side effects for which patients are in the best position to answer. But this was really the first large randomized trial into which the PRO-CTCAE was integrated. So this is really a landmark for that tool which is maintained by the NCI. Dr. Deborah Schrag: The PRO-CTCAE was developed by Dr. Basch, and I was his partner. So I'm going to say that Dr. Basch shepherded this tool. This was his brainchild, this was his project, this was his labor of love. He had this vision that we could do better in oncology by engaging patients in reporting their own symptoms and way back in the mid-aughts when both he and I had less gray hair. He worked really hard to develop this system. Its precursor was developed at Memorial Sloan Kettering when Dr. Basch and I worked there in the aughts, and it was tested and found to make a difference, it was very well received by patients. The NCI was persuaded that Ethan was on to something and issued a contract, a large contract, which engaged, I believe it was eight cancer centers around the country. And it took a huge amount of work.  This system was developed with a way to get the right words so that patients would understand, so that we have things like construct validity, content validity, so that it would work in Alaska and Maine and Hawaii and New Mexico. The system has now been translated into over 30 languages, but this has really been a career-defining endeavor and labor led by Dr. Basch. He's had wonderful assistance from Amylou Dueck, amazing statistician who's helped, and I've been a good partner to him as well, and many others along the way. But this is really the culmination of a vision that it took more than a decade, almost two decades to realize.   And I would just say to any junior investigators out there with a good idea, sometimes you have to be patient and just keep at it, as Dr. Basch has. And now we're starting to see that PRO-CTCAE is becoming standard. It's integrated in many trials. He didn't start a company. It's freely available. The NCI has it. It's NCI intellectual property. Again, available around the world. I'm just very proud of my colleague and academic partner. Dr. Shannon Westin: It's a great, inspiring story, and I love how you spelled out the timeline because it's so true. Sometimes the best ideas do take a long time to get to fruition, so I love that story. Dr. Ethan Basch: The truth of the matter is that this idea of patients reporting their own adverse events was really hatched in conversations that Deb and I had together more than 20 years ago at a coffee shop on the Upper East Side. And I think the observation at that time was that we use the CTCAE for clinical investigators to evaluate patients' adverse events on trials. But that doesn't really make sense for highly subjective phenomena like nausea or fatigue. I mean, the only way an investigator can know about a patient's fatigue is if the patient themselves reports it. And it was our empiric observation in the many clinical trials that we had been involved with that it just seemed like that stuff was being underreported, and so then we subsequently unmasked that, in fact, is the case. In looking at multiple instances perspective, we found that, indeed, there's a massive underreporting of patients' symptomatic side effects in clinical trials.   This has been a partnership that Deb and I have had with other colleagues, again, for more than two decades. And so it is really gratifying in the PROSPECT trial to see this coming to fruition. I think the other piece of this, though, as long as we're handing out compliments or accolades, is that Deb has been working for more than a decade on the PROSPECT trial because of a belief that over-treatment or that treatment could be peeled away to improve the experience of patients. And I think the reason why Deb has had an interest in employing the PRO-CTCAE in this trial is because I think it's been her belief that what it's really about is the patient experience, especially in the non-inferiority setting. What's more important than what patients report themselves? And so Deb has championed this and made this happen. And it's no coincidence that Deb's PROSPECT trial is the first major trial the PRO-CTCAE was in, it's because she's a champion for the patient experience and the patient voice. So right back at you, Deb.   I would say the Pro CTCAE now is embedded in hundreds of clinical trials throughout the industry. I mean, it's really been widely proliferated. It's gratifying, and it shows the power of an idea. I'd say the PROSPECT trial is really the alpha for this approach. Dr. Deborah Schrag: I just would like to inspire physicians. I know there are doctors out there and investigators out there who have different ideas that are not mainstream or they want to take risks, and not everything is going to work out. And some kooky ideas are just that. They're kooky or different, and they're not going to work, but sometimes you've just got to hang in there. Dr. Ethan Basch: I think it does show the power of an idea, or certainly the power of an idea that Deb Schrag is involved with, which is always one to bet on, for sure.  Dr. Shannon Westin: I would like to get some advice here because we build in these types of PROs, we always are worried about how much burden is too much. How many things can the patients be asked to do and we don't want to put too much burden? You all had a really nice participation rate. I think it was like 83%. Any tips that you have for keeping patients engaged and encouraging participation and kind of walking that balance between how much is too much? Like, we want to get all the data we want to get, but how do we meet that balance?  Dr. Ethan Basch: So as Deb alluded to, we've come really far in 20 years, and the idea of engaging patients directly through connected health technologies, it's in the zeitgeist now. I mean, it's just a given. I mean, we're all connected in so many ways. And even patients who formerly have been so hard to reach generally can be reached with one interface or another. So in this trial, we used a strategy that I would really advocate for. So first we had an electronic PRO platform that could be accessed through the web or through a handheld device. But there was also what we call an automated telephone system or an IVR system, an interactive voice response system like what the airlines use when you get the electronic voice and you can use the push buttons or speak into it. And so we gave patients a choice of using either of those, the idea being to meet people where they are.   And then for those patients who did not report at the expected times, a CRA actually called them to recapture the information that was missed. And so by using this kind of strategy, we had a very high adherence rate and very little missing data. Just as a couple of quick asides, in this and other studies, we found that the patients who choose the telephone-type interfaces tend to be more rural. They have lower health literacy, lower SES, lower educational attainment. And so you really need to think about that with any technology like this one because there is a risk that this digital divide will increase disparities or representation in how we capture data or administer care. So the way that we did in this trial, I think kind of got it right in many ways and I think as an exemplar for other studies.  Dr. Shannon Westin: Thank you for that. That's I think hopefully helpful for all the young investigators in the audience that are designing these types of trials. On that same note, around the population, what about the population that participated in this trial? Again, as a GYN Oncologist, I'm always intrigued by our different areas of solid tumors. Do you think this trial is pretty representative of the population and specifically the group that participated in the PRO outcomes? Dr. Deborah Schrag: So the first part of your question I will answer second. The patients who reported are highly representative of the total population. So I don't think there's any issue there. If you look at what's called Table 1 for the trial overall and Table 1 for the patients who participated in PRO reporting, the characteristics, and attributes are the same. So the results generalized. So that's very good. The bigger issue was upstream with the participants who went in the trial. And I think the biggest place where we need to make improvements is to recruit populations of patients to clinical trials who are more representative of the United States of America. And we did not achieve that. We tried in this trial, but we did not succeed. So we have unacceptably low participation from African Americans. And the racial and ethnic diversity in the clinical trial does not reflect the racial and ethnic diversity in the United States or more importantly, of patients who get rectal cancer. This is for all kinds of reasons, people are marginalized, we've got structural racism that persists. We've got issues related to mistrust. And I would just say we need to do a hell of a lot better. We didn't fail here because we're bad or because we didn't try. It's a challenging, pernicious, and persistent problem, but it is an important one and it's an important deficit.  Dr. Shannon Westin: 100%. Yeah, I think across the United States this is an issue, globally as well, but especially I think we have an opportunity within our recruitment within the United States to really provide that diversity. So I think we're all familiar with the NCI and the push to have those plans, but yeah, I don't think no one would think you didn't try hard enough. I think it's definitely something that we are systemically dealing with. Dr. Deborah Schrag: Yeah, getting cancer treatment is hard. Getting cancer treatment when you're living with a lot of challenges, for example, poverty or single parenting or living in a marginalized community or with poor transportation access, or food insecurity is even harder, if not impossible. And because of the way these cooperative group trials are funded, we didn't provide any support for transportation or food or any of the other things. This was a publicly sponsored trial and I think it is worth us having a very serious conversation about what we need to do to subsidize and support trial participants to ensure that we do have more representative participation. We fell short here. Dr. Shannon Westin: Can you walk us through a little bit of the PRO findings during that, the new adjuvant chemo versus the chemoradiation group? What did you conclude? Dr. Deborah Schrag: We've got an OBGYN interviewing us here. The genesis of this trial for me personally, colorectal cancer is occurring more and more in young patients, and you can't carry a pregnancy to term once you've had pelvic radiation and it usually tips you into early menopause. And this is a real concern when we have 35-year-old women with rectal cancer.  Dr. Ethan Basch: So Deb already noted the non-inferiority results in the study, and I think in the setting of a non-inferiority result, the PRO findings become of interest. And in fact, the PRO results in the two arms are quite different from each other. The two key periods when we evaluated PROs were first during neoadjuvant therapy and then in the period following surgery, one-year post-surgery, and then 18 months post-surgery. So during neoadjuvant therapy, we evaluated PROs in the two groups, which again were chemotherapy alone with selected use of radiation, which in the end, very few patients required, versus the prior standard of chemoradiotherapy. What we found was during active neoadjuvant treatment, almost all symptoms were worse with the investigation arm with chemotherapy alone, in fact, eleven of the symptoms were worse. Now, this is not a big surprise because it's FOLFOX therapy and these are the symptomatic adverse events that we would expect to see being worse during FOLFOX chemotherapy. However, diarrhea was better with FOLFOX than it was with the standard of chemoradiation. And I think that, again, intuitively, is what we might expect.  What becomes interesting is the period 12 and 18 months after the surgery. And what we found in that in those time points was that the symptoms were either the same between groups but for three key symptomatic adverse events, they were significantly worse with chemoradiation therapy. And those specifically were neuropathy, fatigue, and sexual function. And Deb made a point earlier about one of the reasons that she conceived of the trial being concerned about sexual function or the ability to carry a pregnancy in young patients who undergo chemoradiation. And in fact, we see, perhaps not that surprising that sexual function is significantly better with the chemotherapy alone arm and that's durable.   I think there's a question mark about sensory neuropathy. We saw that neuropathy was better in the FOLFOX  arm and the chemotherapy arm at both 12 and 18 months. And one could see that as a little bit of a head-scratcher because we might expect to see that neuropathy would be worse in a FOLFOX arm because of the exposure to oxaliplatin as opposed to radiation. I think that that will warrant some further evaluation. But the empiric finding is that the late effects are in fact significantly worse in the chemoradiation arm for those three areas. Dr. Shannon Westin: Yeah, I was intrigued by the neuropathy because that's why in my experience, we don't use a ton of FOLFOX, but occasionally we'll treat our patients with mucinous ovarian cancer, and I feel like the neuropathy is a really difficult strategy. But I'm especially interested in those long-term adverse events after radiation. We do a ton of radiation for patients with cervical cancer and other of our cancers and I was really intrigued by this opportunity to potentially lose some of those long-term side effects. Any thoughts as to why there really wasn't a difference in that overall health-related quality of life at all these time points?  Dr. Ethan Basch: Yeah, it's a great question. So in this study, we did use an overall quality of life or health-related quality of metric and it was no different at any time point between the two arms. I think it's a limitation of the tool that was used. The tool that was used when this study was designed, it's called the EQ-5D. It's used in a lot of health economic evaluations for cost-effectiveness analyses in Europe, in clinical trials. So it gets dropped into a lot of studies but it really is not sensitive to the nuances of symptoms like we see in this trial. It asks about overall global physical function, anxiety, depression, but it really doesn't get into the weeds of neuropathy or sexual function, some of the domains that really were most important here. So I think some of this is that the tool just wasn't sensitive enough to pick up that nuance.  On the other hand, I think it's reassuring that a very high-level global health-related quality-of-life tool was no different. It suggests that big, big picture, there's not a huge difference in the overall functioning of people between these two potential treatment approaches. But when you get into the more detail, we do see the differences in those individual symptoms.  Dr. Shannon Westin: And then I guess the bottom line, how are we going to use these results to inform what we do for this patient population? Dr. Ethan Basch: Yeah, I think it's nuanced. I think that goal of collecting this kind of information, like any information on trials, is that when one of us walks into the room with a patient, we sit down to make a choice when there are different options is to say what are the pluses and minuses of each. So for a patient who's really concerned about those short-term acute toxicities like nausea and fatigue during neoadjuvant treatment, then they might want to go with the standard of chemoradiation. But if they're really concerned about bowel function, or if they're really concerned about long-term sexual function or to some extent neuropathy, then probably the better choice for them would be FOLFOX alone, chemotherapy alone, the investigational approach. But really it's more information for that shared decision-making. It's a little more nuanced, it's a little bit more for us to think about in those conversations with our patients, but it really helps patients ultimately to make an informed decision so they can know what to expect.  Dr. Shannon Westin: Well, I just want to say congratulations. I know you've convinced me, and I bet you've convinced everyone listening that we need to be incorporating the PRO-CTCAE in all of our upcoming large practice-changing trials. So congratulations on your work, not only in this trial but with that measure as a whole. It's really exciting.  Dr. Ethan Basch: Thanks so much. The evidence really does suggest that without employing a tool like the PRO-CTCAE or another PRO tool in a trial to understand the symptomatic adverse events from the patients directly, we will have an incomplete understanding of what's going on in that trial. And it's really to the detriment of us as investigators or to drug developers not to include these kinds of tools because we really won't understand the impact on the ultimate end users of the treatments which are the patients. Dr. Shannon Westin: Well, thank you so much, and thank you to our listeners. We have been hearing about the simultaneous publication of JCO and presentation at ASCO 2023 of the Alliance N1048 Trial: Patient-reported outcomes during and after treatment for locally advanced rectal cancer from the PROSPECT trial.   I'm so grateful for all of you who've listened. Please check out our other podcasts on the website and wherever you get your podcasts and otherwise. Hopefully, we'll see you around ASCO 2023. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bios: Ethan Basch is the Chief of the Division of Oncology and Physician in Chief at NC Cancer Hospital at the University of North Carolina. Deborah Schrag is the chair in the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York City, New York.  Article: Patient-reported outcomes during and after treatment for locally advanced rectal cancer (Alliance N1048)  

Treatment for colon and rectal cancer has vastly improved in the past decade or so, according the FPG Medical Director of Colon and Rectal Surgery, Samir Agarwal, MD. Learn more about the risks of colorectal cancers and the benefits of the new, minimally-invasive surgical techniques.You can also watch the video recording on our YouTube channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.YouTubeCheck out our other interviews with SMH experts at smh.com/podcast.

As part of our community health partnership with Valley Health, our conversation this month focused on colon cancer awareness. March is Colorectal Cancer Awareness month. Joining me for the conversation was Dr. Maureen Hill, a fellowship-trained surgical oncologist and board-certified surgeon with Valley Health Surgical Oncology.  We talked about the incidence of colon cancer, who is at risk, and what family history actually means. Dr. Hill explained the types of screening for colorectal cancer and walked us through the process if a test comes back showing the cancer. We discussed how to know which screening option is best for you and talked about the advances that have been made regarding the prep prior to a colonoscopy and she busted a few myths about colostomy bags. She told us about the technology that Valley Health employs for advanced surgical treatments that include: minimally invasive & robot-assisted techniques 2 surgical oncologists (Dr. Hill and Dr. Devin Flaherty) 1 colorectol surgeon (Dr. Maria Sophia VIllanueva) who also treats benign colorectal conditions access to treatment options such as radiation therapy and chemotherapy when indicated multidisciplinary collaboration and team approach to treatment The Valley Health Rectal Cancer Program was the first in our tri-state region to earn accreditation by the National Accreditation Program for Rectal Cancer. Screening colonoscopies are performed at most Valley Health hospitals and the Endoscopy Center at Winchester Medical Center. Learn more about their program: https://www.valleyhealthlink.com/colorectalcancer/ To listen to other conversations in our Community Health series, click here: https://bit.ly/VHhealthpod 

You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer. You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/ Learning Objectives 1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer 2. Discuss the different options for management of early-stage rectal cancer 3. Describe patient related factors that favor local excision of rectal cancer References: Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704. Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260. Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333. O'Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other colorectal episodes here: https://behindtheknife.org/podcast-category/colorectal/

From "watch and wait" to resection, determining the best approach for high stakes recurrent rectal cancer cases is no easy task. Join Avery, Biddy, Jon, and Sam as they share their personal stories, perspectives and approaches to recurrent rectal cancer.    CO-HOSTS Avery Walker, MD, FACS, FASCRS El Paso, TXAvery Walker is dually board-certified in General Surgery and Colorectal Surgery. He earned his medical degree at the University of Illinois in Chicago, his General Surgery residency at Madigan Army Medical Center in Tacoma, Washington, and his Fellowship in Colon and Rectal Surgery at The Ochsner Clinic in New Orleans. A former active-duty officer in the United States Army, Dr. Walker served 13 years as a general and colorectal surgeon with his most recent duty station in El Paso, TX at William Beaumont Army Medical Center. While there he was the Chief of Colon and Rectal surgery as well as the Assistant Program Director for the general surgery residency program. He currently practices colon and rectal surgery at The Hospitals of Providence in El Paso, TX. Dr. Avery Walker is married and has two daughters aged 13 and 9.   Biddy Das, MD, FACS Houston, TXDr. Bidhan “Biddy” Das has board certifications for both colon and rectal surgery, and general surgery. His passion for medical education and medical process improvement has resulted in book chapters and publications, and national and regional presentations on those subjects. Highlighting his medical expertise on fecal incontinence, he has been featured on patient education videos and national and international television and radio as a featured expert on these colorectal conditions. Dr Das also has a particular interest in surgeons redefining their careers -- he serves as both a software consultant and private equity consultant in Boston, New York City, and Houston.   Jonathan Abelson, MD, MS Arlington, MADr. Abelson was born and raised in Scarsdale, New York in the suburbs of New York City.  He has 2 older brothers and both of his parents are dentists.  Dr. Abelson went to college at University Pennsylvania, took 2 years off between college and medical school to work in healthcare consulting.  He then went to medical school at University of Virginia, returned to New York for general surgery residency at Weill Cornell on the upper east side of Manhattan.  Dr. Abelson then did colorectal fellowship at Washington University in St. Louis and am now at Lahey clinic in Burlington, Massachusetts for my first job after training. He is 2 years into practice and has a wife and two sons. His wife works in wellness consulting and they have a dog named Foster who we adopted in St. Louis.   Sam Eisenstein, MD La Jolla, CA   Sam Eisenstein is an Assistant Professor of Colon and rectal surgery and director of Inflammatory Bowel Disease surgery at UC San Diego Health.  He has worked there for the past 8 years after graduating both residency and fellowship at The Mount Sinai Medical Center in New York.  Sam is best known as the founder and organizer of the IBD-NSQIP collaborative, a large multi institutional data collaborative examining outcomes after IBD surgery, but he also is involved in several clinical trials for perianal Crohn's and has extensive experience with stem cell injections for anal fistulae. He is also on the scientific advisory board for the Crohn's and Colitis Foundation for his work on the next big IBD data collaborative, IBD-SIRQC (Surgical Innovation, Research and Quality Collaborative).  Sam has a Wife and 3 kids (6,8, and 3) and spends most of his free time running around after them these days, but also enjoys traveling and getting out into nature with his family.

On today’s episode, I am speaking with Dr. Lara Lambert. Dr. Lambert is an internal…

School is in session! The Accelerators (Drs. Anna Brown, Matt Spraker, and Simul Parikh) sit down for a radiation oncologist and colorectal specialist Dr. Nina Sanford for an informal lesson on the state of radiotherapy for rectal cancer in 2023.  We work our way through an informal discussion of total neoadjuvant therapy, sequencing of therapies, radiotherapy techniques, and my favorite new #RadOnc concept, PULSAR. We close the show by peer reviewing Simul's case and discussing the finer points of rectal cancer contouring.Here are other some things we discussed during the show:We talked about a lot of rectal studies, just check out Rad Onc Tables GI TabTodd's Twitter poll on IMRT for rectal cancer Bob Timmerman's excellent editorial about his SBRT constraintsTzeng sarcoma study referenced for bowel constraintsThe Janus StudyWax Lips and Fun Dip CandyPodcast art generously donated by Dr. Danielle Cunningham. Intro and Outro music generously donated by Emmy-award winning artist Lucas Cantor Santiago.The Accelerators Podcast is a Photon Media production. 

We were inspired by The Guardian's article about using sugar kelp to combat climate change so we are rerunning an episode of Boxerblu and Bram that teaches us about The Johnny Appleseed of Sugar Kelp!https://www.theguardian.com/environment/2023/mar/01/specieswatch-sugar-kelp-north-sea-carbon-climate-crisisThis episode covers: Elvis weddings being banned in Las Vegas by the company that owns Elvis's likeness; how parents in Killingly, Connecticut don't want mental health care in their schools; Shuvinai Ashoona's Arctic Art; an experimental rectal cancer drug that showed a 100% success rate; and the Johnny Appleseed of Sugar Kelp farming

Editor-in-Chief, Robert Amdur, MD, discusses radiation and chemotherapy programs to use prior to surgical resection of rectal cancer. The main reference for the podcast is a Topic Discussion paper published in the January 2023 issue of PRO titled “Neoadjuvant therapy in the post-German rectal trial era: making sense in the absence of consensus” (2023, Issue 1, January/February). The discussion explains the concepts driving the evolution of neoadjuvant therapy, recommended radiotherapy and chemotherapy programs, and situations where it is acceptable to observe without surgery.

Margaret Lang - Survivor of Rectal Cancer   Margaret, is a real estate agent, mother, former high school teacher and now author, she experienced cancer and transformed her life by successfully meeting that challenge. Hopefully chronicling the journey in her book, "Moving Forward: With, Through, and Past Cancer,” will bring faith and hope to many.   www.movingforwardwithmargaret.com   Margaret has been cancer-free for three years.

On today's show, we'll highlight what you need to know about rectal cancer, and the painful symptoms that can occur.  Our first guest is Tommy Chong, part of the legendary comedy team of Cheech and Chong. Tommy will share his battle with rectal cancer and the triumphs he's achieved in overcoming his pain. Then Dr. […]

This episode is hosted by Matt Yurgelun, M.D, a GI medical oncologist at the Dana-Farber Cancer Institute in Boston, MA, and features a discussion between Zsofia Stadler, M.D, a GI medical oncologist at the Memorial Sloan Kettering Cancer Center, New York, NY and Andrea Cercek, M.D, a GI medical oncologist also at the Memorial Sloan Kettering Cancer Center, New York, NY.Together they discuss "PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer" which was published in the New England Journal of Medicine and found here https://pubmed.ncbi.nlm.nih.gov/35660797/This study showed a remarkable response to immune checkpoint inhibitors in Lynch syndrome-associated rectal cancers. This exciting work is reviewed and includes insightful discussion of the design, outcomes, side effects, and future questions raised by researchers.This episode was recorded on October 25th, 2022 and reflects expert opinion at the time of the recording.  If you enjoyed this podcast, you can listen to more high quality scientific podcasts here

Our oral board review course includes 92 scenarios that meticulously cover 115 SCORE core topics. Each scenario includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as general surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Learn more about the Oral Board Review episodes at https://behindtheknife.org/premium/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Are the results from Luis Diaz as good as touted. What trial should they do going forward? A 100% CR rate in Stage II and III rectal cancer??