February, 2008
ArchivesAetna to delay implementation of policy for monitored anesthesia during colonoscopy
Aetna announced on February 27 that they would delay a proposed change in insurance coverage for the services of a anesthesiologist for monitored anesthesia care (MAC) during routine upper and lower endoscopic procedures including colonoscopy.
The policy was to go into effect on April 1.
The new policy, announced in late December, would have continued to cover moderate sedation administered by the physician doing the procedure but would only pay for deeper sedation via monitored anesthesia care for high-risk patients.
According to a Aetna press release,
Aetna will now delay implementation until patient-friendly alternatives – which will not require the added expense of an anesthesiologist – are approved by the Food and Drug Administration (FDA) and available in the marketplace.
Aetna expects that new devices and sedatives, now being reviewed by the FDA, will be available in late summer and will provide patient experiences similar to those delivered with MAC. However, they will be able to be administered by the treating doctor and won’t require an additional anesthesiologist.
Troyen A. Brennan, M.D., Aetna’s chief medical officer, said,
Once these new options are available in the marketplace, we will move forward with our policy. Aetna considers the health of our members, and their access to preventive screenings and affordable quality health care, top priorities. Our goal is to improve the consistency of care delivered to our members nationally, align that care with the best evidence available and remove unnecessary costs from the health care system. These are worthwhile goals that should be shared by the medical community, and we will continue to work with care providers to achieve them.
He also said,
We have determined that in those few markets where monitored anesthesia care (MAC) has become the routine approach to sedation, implementation of our policy on April 1 would inconvenience our members in those markets and potentially depress cancer screening rates in the short term.
Media coverage of the proposed policy has been confusing and frightening for patients potentially leading to reduced screening rates for colorectal cancer. It was not always clear that moderate sedation — drugs to relax patients and relieve pain — would still be available for all colonoscopies. Patients with a medical condition that required deeper sedation administered by an anesthesiologist would also have that covered under the new policy. However, anesthesiologist care would not be routine.
One sedative drug Diprivan® (propofol) has been part of this controversy. The drug induces sedation rapidly and patients recover from it quickly and are able to leave the recovery area sooner. However, its FDA approved label says,
For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN® Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.
Thus the need for an anesthesiologist if Diprivan is used during colonoscopy.
The American Gastroenterological Society announced that they commend Aetna on the decision to delay implementation of the policy,
The AGA Institute commends Aetna for listening to our concerns. Aetna will now delay implementation until patient-friendly alternatives for sedation — which will not require an anesthesiologist — are approved by the FDA.
What this means for patients
People insured by Aetna having screening colonoscopies will continue to be able to have monitored anesthesia care using drugs that require an anesthesiologist after April 1 whether or not they are high-risk.
Not all upper endoscopies and colonoscopies use MAC for sedation. Moderate sedation using drugs that make you sleepy and relaxed and manage pain will continue to be available for you as it was before.
You should discuss what sedation is going to be used for your colonoscopy and whether an anesthesiologist will be present with your gastroenterologist before your test.
If you believe that you have an need for deep sedation because of your age, prior colonoscopy experience, past surgeries, or other medical reason talk to the gastroenterologist about using an anesthesiologist to monitor your care.
In any event, sedation to make patients comfortable during colonoscopy is available and is routinely used. No one need fear colonoscopy because of unnecessary pain.
People who have had a colonoscopy can help reduce deaths from colorectal cancer by assuring their friends and family who have not been screened that colonoscopy is not painful.
Posted by Kate Murphy on February 29th, 2008
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Women with from families with Lynch Syndrome don’t understand need for screening for endometrial cancer
Although they are at a greatly increased risk for ovarian cancer and cancer of the uterine lining, most women from families with an inherited mutation for Lynch syndrome or hereditary non-polyposis colon cancer (HNPCC) don’t understand that risk or get screened for those cancers.
Researchers at the National Human Genome Research Institute and the National Cancer Institute interviewed women who had a family member with Lynch syndrome before and after their own genetic testing. Because they had a first-degree relative who had already tested positive for one of the mutations that causes Lynch syndrome, the women were at 50 percent risk of having a mutated gene themselves.
Before counseling very few women (five percent) with an inherited risk for Lynch syndrome thought that they might have an increased risk for cancer outside the colon. But nearly all (86 percent) understood that they had a risk for colon cancer greater than the average person.
While more than half had had a colonoscopy — two-thirds of those who were over 25 had colonoscopy — only a third had screening for endometrial cancer.
Lynch syndrome is a genetic mutation directly passed from parents to their children. Mutation carriers have an increased risk to be diagnosed early with many cancers including colon, endometrial, small intestine, ovary, liver, pancreas, kidney, ureter, and brain. Four genes (MLH1, MSH2, MSH6, and PMS2), whose job it is to detect and repair damaged DNA, are linked to the syndrome. People with a mutation in one of these genes have a lifetime risk close to 90 percent for Lynch syndrome associated cancer.
Dr. Henry Lynch first used the term hereditary nonpolyposis colon cancer to differentiate it from familial adenomatous polyposis (FAP), another inherited mutation causing many polyps and leading to colon cancer. More recently, the term Lynch syndrome has been used to more accurately describe the disease which does arise from polyps and includes cancers outside of the colon.
Guidelines recommend that women who have a Lynch syndrome mutation or who are at high risk for one because of family history begin colonoscopies at age 20 to 25 and repeat them every 1 to 3 years. In addition, they should begin screening for endometrial and ovarian cancers between age 25 and 35 and repeat them every year. Those who test negative for the family mutation are at no higher risk than the general population and can begin colorectal cancer screening at 50.
Screening for endometrial cancer can be via transvaginal ultrasound or uterine biopsy or both.
Writing in the Journal of Clinical Oncology, Donald Hadley and his colleagues said,
Women in families with Lynch syndrome are less aware of their risks for extracolonic cancers and undergo endometrial cancer screening significantly less often than colonoscopy before genetic counseling. Given the significantly increased risks for endometrial and ovarian cancers and the mortality associated with ovarian cancer, additional efforts to inform families of cancer risks and screening recommendations seem prudent. Physicians play a critical role in ensuring appropriate cancer screening in women with Lynch syndrome.
SOURCE: Hadley et al. Journal of Clinical Oncology, Volume 26, Number 6, February 20, 2008.
Posted by Kate Murphy on February 29th, 2008
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Strong social networks speed recovery after surgery
Patients having surgery who had a wide network of friends and family had less pain and anxiety before surgery. After their operations, they also had less pain and needed less pain medicine.
Patients with limited social networks stayed longer in the hospital after surgery.
Continue reading…
Posted by Kate Murphy on February 25th, 2008
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Clinical trial: Preventing chemotherapy-induced neuropathy
A clinical trial is underway to test alpha-lipoic acid (ALA) to prevent peripheral neuropathy in patients treated with platinum-based drugs cisplatin or oxaliplatin.
Both cisplatin and oxaliplatin can leave patients with tingling, numbness, or pain in their hands and feet. In some cases, they lose function in their hands or can no longer manage daily activities.
Oxaliplatin (Eloxatin) is used to treat both advanced colorectal cancer and stage II and III colon cancer after surgery. Although the peripheral neuropathy caused by oxaliplatin tends to fade once treatment ends, some people are left with permanent problems.
Posted by Kate Murphy on February 25th, 2008
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Deaths and colorectal cancer cases fall in 2008 projections
In the new Cancer Facts and Figures 2008 the American Cancer Society estimates that new cases of colon and rectal cancer will decline this year. Deaths from colorectal cancer are also expected to go down, falling under 50,000.
2008 estimates are for 148,810 new cases of colon and rectal cancer and 49,960 deaths.
Posted by Kate Murphy on February 22nd, 2008
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