Over the past twenty years, the cost of caring for cancer patients doubled, but still remained about 5 percent of all medical expense in the United States.

An increase in the number of people with cancer — fueled by an aging population — drove the growing expense rather than a greater cost per individual.

Expressed in 2007 dollars, out-of-pocket costs for patients and their families fell, while the costs paid by private insurance and Medicaid rose.  Average Medicaid expense in from 2001 though 2005 was almost five times as high as 1987, while Medicare costs doubled. Read the rest of this entry »

It’s just the prep that’s awful!

That’s what many people say about colonoscopy, and it’s a big reason why they avoid screening.

Two studies reported during Digestive Disease Week 2010 looked at ways to make the prep easier for patients.

In one, doctors at Henry Ford Hospital in Detroit gave a drug usually prescribed for constipation or a placebo to patients along with a gallon of polyethylene glycol with electrolytes (PEG-EL) and told them to stop drinking the PEG solution when their bowel movements were clear.

A second trial in Europe compared 4 liters of PEG-EL to 2 liters of PEG-EL  with ascorbic acid (MoviPrep®). Read the rest of this entry »

When endoscopists frequently find polyps during their exams, there are fewer interval cancers diagnosed between tests.

The adenoma detection rate or the percentage of time that at least one polyp is found during all of the colonoscopies done by an individual endoscopist is one measure of quality performance.  When that rate falls below 20 percent, the risk of colorectal cancer being diagnosed within the next five years goes up significantly.

When the rate was below 11 percent, the risk of an interval cancer was more than 10 times higher than when adenomas were found more than 20 percent of the time according to research published this week in The New England Journal of Medicine.

The same study found that reaching the cecum — or cecal intubation rate — had no impact on interval cancers. Read the rest of this entry »

FOBT screening saves lives, but only when it is done right.

Three out of four primary care doctors did a fecal occult blood test once during an office visit, a method that is ineffective in finding cancer or preventing death from colorectal cancer. One out of four used the in-office test exclusively.

Less than half of doctors had a system in place to be sure that home tests were completed and returned.  Read the rest of this entry »

When people were offered a personal choice of either FOBT or colonoscopy screening by their primary care provider, more actually completed the test they chose than if only one option was offered.

In a study of  1,000 ethnically and racially diverse people, the lowest percentage had a colonoscopy when that was the only test offered.  More completed fecal occult blood testing if it was the single choice. Overall 65 percent of the 1,000 patients studied were screened after their doctor recommended testing. Read the rest of this entry »