Your Medicare Rights and Protections  is available online for download.  It includes information about:

• the right to file a complaint
• how to get the health services needed health services
• the right to privacy
• where to get answers to questions

It includes information about rights in the original Medicare Plan, Medicare Health Plans (including Medicare Advantage), Medicare Prescription Drug Plan, and private Medigap insurance policies.

Medicare questions can be answered by calling 1–800–MEDICARE (1-800-633-4227).

Medicare Medicare rights

CT colonography — so-called virtual colonoscopy — has few complications and an excellent safety profile.  Reviewing over 20,000 CT colonographies, the Working Group on Virtual Colonoscopy found only four cases where patients needed to be hospitalized after a virtual colonoscopy procedure. Overall the complication rate was 0.018%.

Risk of perforating the colon during air inflation were reduced when automatic carbon dioxide was used.

None of the complications or colon perforations occurred during screening colonography; all happened during diagnostic studies of patients who had symptoms of a potential colon problem.  About half of the CT procedures were diagnostic.

The results of the Working Group study were reported at the 2006 American Roentgen Ray Society meeting by Dr. Perry Pickhardt from the University of Wisconsin Medical School.  The presentation is discussed online in Diagnostic Imaging.

virtual colonoscopy CT colonography

Researchers in Australia have linked a protein — insulin-like growth factor binding protein 3 (IGFBP-3) – with better survival in physically active colorectal cancer patients.  Increased levels of the protein resulted in a 48% reduction in colorectal cancer deaths during a median follow-up time of nearly 6 years.

For those who were not physically active, IGFBP-3 made no difference in survival.

Insulin-growth factor 1 (IFG-1) levels made no difference for either physically active or inactive patients.

The team headed by Dr. Andrew Hayden in Melbourne concluded:

This study supports the hypothesis that the beneficial effects of physical activity in reducing colorectal cancer mortality may occur through interactions with the insulin-like growth factor axis and in particular IGFBP-3. 

Their results were published in the May 2006 issue of Gut

physical activity survival

On March 17, 2006 the FDA approved OsmoPrep™, a tablet form of sodium phosphate for colonoscopy preparation.  OsmoPrep™ is manufactured by Salix Pharmaceuticals.  It is an additional option for bowel cleansing for people unable to tolerate liquid preps.

Recommended dosage is 32 tablets (48 grams of sodium phosphate) taken with at least 2 quarts of clear liquids.  The prep is given in divided doses of 4 tablets with 8 ounces of clear liquid every 15 minutes.  Twenty tablets are taken the night before the colonoscopy and an additional 12 pills the next day, 3 to 5 hours prior to colonoscopy.  The tablets produce a large amount of watery diarrhea which removes all stool from the colon so that the its walls can be examined for polyps, colorectal cancer, or other abnormalities.

It is critical that patients drink the recommended amount of clear liquids.

Randomized clinical trials conducted by Salix, which will be published later this year, compared the 32 tablet OsmoPrep™ regimen  to a kit of 2 liters of HalfLytely™ and Bisacodyl tablets.  In the trials a significantly greater percentage of patients who used OsmoPrep™ recorded a mean bowel cleansing score of “excellent” compared to the HalfLytely™ kit users. 

Similar oral sodium phosphate preparations, such as Fleet’s Phospho-soda™ (21 patients) and Visicol™ tablets (1 patient) have been implicated in acute phosphate nephropathy, a rare kidney failure.  None had used OsmoPrep™.

The OsmoPrep™ manufacturers warn against use of the bowel cleansing prep with patients who have kidney or cardiac conditions or possible bowel obstruction.

Considerable caution should be advised before OsmoPrep Tablets are used in patients with severe renal insufficiency, congestive heart failure, ascites, unstable angina, gastric retention, ileus, acute obstruction or pseudo-obstruction of the bowel, severe chronic constipation, bowel perforation, acute colitis, toxic megacolon, gastric bypass or stapling surgery, or hypomotility syndrome. Use with caution in patients with impaired renal function, patients with a history of acute phosphate nephropathy, known or suspected electrolyte disturbances (such as dehydration), or people taking drugs that affect electrolyte levels. Patients with electrolyte abnormalities such as hypernatremia, hyperphosphatemia, hypokalemia, or hypocalcemia should have their electrolytes corrected before treatment with OsmoPrep Tablets.

More information about the new prep is available on Medscape.

colonoscopy preparation

Patients with stage III colon cancer are less likely to die from their disease if they receive chemotherapy after surgery to remove their colon tumors (adjuvant treatment).  But not all older stage III patients on Medicare will be treated with chemotherapy, and, of those who begin treatment, not all will complete it.

Researchers at the University of Washington discovered factors among elderly patients that led to discontinuing chemotherapy prematurely.  Analyzing information from a combined cancer information (SEER) and Medicare database, they found that about 20% of patients did not complete chemotherapy.  They had poorer survival than those who were able to finish treatment.

Factors that made it more difficult to complete chemotherapy included:

• Being female
• Increasing age
• Being widowed
• Having poor social and psychological support
• Frail health
• Having to be hospitalized during treatment other than for chemotherapy itself

Race, household income, or clinical information about the tumor did not appear to affect chemotherapy completion.  Patients treated by medical oncologists were more likely to finish chemotherapy.

Patients were more likely to be receive adjuvant chemotherapy at all if they were younger than 75, male, married, and living in a higher-income census tract.  African Americans had lower rates of chemo.

Sharon A. Dobie and her colleagues reported their findings in the May 3, 2006 issue of the Journal of the National Cancer Institute.

In an accompanying editorial in the same issue of the Journal of the National Cancer Institute, Victor Grann and Franco Muggia review the history of adjuvant chemotherapy treatment for colon cancer and call for additional prospective studies that would help understand the factors that predict which patients will be unable to complete a full course of chemotherapy..