In Inherited Colorectal Cancer, Treatment Includes Emotional Support

Having a rapport with kids is not something that immediately comes to mind when thinking of a colorectal surgeon, but when treating hereditary colon cancer, it’s a critical part of the job. 

“Before I was even a doctor, I had an instant bonding with kids,” says James Church, MD, director of the Hereditary Colorectal Cancer Center in the Department of Surgery. “I know how to relate to children even though I’m not a pediatric surgeon.” 

Before exiting retirement to join the team at Columbia in 2021, Dr. Church spent 30 years at the Cleveland Clinic, building and leading one of the most reputable colorectal divisions in the world. One of his previous mentees, Ravi P. Kiran, MD, now chief of the Division of Colorectal Surgery at Columbia, convinced him to move to New York to pass on his vast expertise to a new generation of surgeons.

About 5% of people who develop colorectal cancer have inherited gene mutations that cause the disease. The two most common inherited colorectal cancer syndromes are Lynch syndrome, which develops into cancer with relatively few polyps, and familial adenomatous polyposis, or FAP, carriers of which develop hundreds or thousands of polyps in their colon.

During his tenure at the Cleveland Clinic, Dr. Church oversaw a registry of families with hereditary colorectal cancer that allows coordination and integration of care for affected adults and children in all stages of disease. 

For people with FAP, surgery to remove the colon is inevitable; there are simply too many polyps to remove successfully with colonoscopy. He has treated some of the trickiest, most difficult cases, sometimes caring for four generations of a single family.

For young patients and their parents, surgery can be scary to contemplate. “To take a 13-year-old child, remove their colon and rectum, give them a bag, and send them off to school—that’s not good,” says Dr. Church. “Our first priority is to prevent death from cancer. But very close behind is the priority to maintain as normal a quality of life as possible.”

Dr. Church emphasizes critical emotional and psychological support for families with hereditary colorectal cancer. “Every year, you’re undergoing several checkups, colonoscopies, and scans,” he says, “but you are always worried that you’re going to get cancer at some point.”

In 2019, Dr. Church and his daughter, Emma Wood, PsyD, co-authored a study about the mental health effects of FAP. They found that mental health symptoms were present in about 70% of patients surveyed; 6% had dealt with suicidal thoughts. But only 10 out of 100 patients had been offered psychological help at any point during treatment.

“These patients go through terrible anxiety, and it’s unrecognized and untreated by doctors,” says Dr. Church. After completing the study, he hired a psychologist to join the Cleveland Clinic team that managed FAP patients. This treatment model became the blueprint for the program he is building at Columbia, too.

“Being compassionate is not a weakness,” Dr. Church wrote in a column for the journal Diseases of the Colon and Rectum. “It is as much a part of the care of sick people as antibiotics, chemotherapy, and surgery.”


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