A brief look this week at

• Blood sugar and colorectal cancer risk
• Outcomes for people with defective mismatch repair on oxaliplatin
• Medicare’s preventive services

High blood sugar readings increase colon cancer risk

Scientists at Albert Einstein College of Medicine, analyzed blood samples from 4,902 postmenopausal women in the NIH Women’s Health Initiative study. Both blood glucose and blood insulin levels were measured when women entered the study.

After 12 years, 81 women had been diagnosed with colorectal cancer. Women who had the highest levels of glucose in their blood at the beginning of the study were twice as likely to have colon or rectal cancer than those with the lowest readings.  Surprisely, initial circulating insulin levels made no difference.

In a news release from Albert Einstein College of Medicine, study author Geoffrey Kabat, Ph.D., a senior epidemiologist at Einstein, said,

The next challenge is to find the mechanism by which chronically elevated blood glucose levels may lead to colorectal cancer. It’s possible that elevated glucose levels are linked to increased blood levels of growth factors and inflammatory factors that spur the growth of intestinal polyps, some of which later develop into cancer.

SOURCE:  Kabat et al., British Journal of Cancer, advance online publication, November 29 2011.

Disease-free survival significantly higher for patients with defective mismatch repair (dMMR) on FOLFOX

Scientists reviewed clinical and tissue information from 303 stage III colon cancer patients who were treated with FOLFOX after surgery in 9 French hospitals over a 5 year period.

About 1 in 10 (11.2%) had tumors with defective mismatch repair (dMMR) discovered either by analyzing markers for microsatellite instability or immunohistochemistry for missing proteins involved in dMMR.

Three years after surgery 90.5% of dMMR patients were alive and cancer-free compared to 73.8% of patients with proficient mismatch repair.

Aziz Zaanan and his colleagues concluded,

Mismatch repair status is an independent prognostic biomarker for disease-free survival in patients with stage III colon cancer receiving adjuvant FOLFOX chemotherapy.

SOURCE: Zaanan et al, Clinical Cancer Research, Volume 17, Number 23, December 1, 2011.

Are you are Medicare?  Preventive services are now free.

Medicare now covers a whole list of preventive services, including colorectal cancer screening and an annual Wellness Visit to your doctor without deductibles or co-payments.

Here’s a helpful booklet from Medicare that explains your benefits: Your Guide to Medicare’s Preventive Services.

On November 29, the Centers for Medicare and Medicaid Services announced that there was enough evidence that intensive behavioral counseling was reasonable and necessary to prevent disease or disability and that Medicare beneficiaries were entitled to coverage as a preventive service.

This is particularly good news for people trying to prevent colon or rectal cancer since studies have consistently found a link between body mass index (fatness) and colorectal cancer, including the World  Cancer Research Foundation which included BMI and colorectal cancer in their 2007 comprehensive analysis reported in  Food, Nutrition, Physical Activity and the Prevention of Cancer.

This year the WCRF updated their analysis for colorectal cancer looking at new studies published since 2007 as part of the Continuous Update Project.  They wrote,

The CUP Panel agreed that the recent evidence was consistent with the conclusion of the Second Expert Report; the evidence that greater body fatness is a cause of colorectal cancer is convincing.

With the latest CMS coverage decision, Medicare patients with a BMI of 30 or over  can get:

• One face-to-face visit every week for the first month
• One face-to-face visit every other week for months 2-6
• One face-to-face visit every month for months 7-12, if the individual has lost at least 6.6 pounds.

The benefit is limited to counseling delivered in primary care settings by primary care doctors or primary care nurse practitioners, clinical nurse specialists, or physician assistants.

Benefits are also provided for screening to determine BMI and nutritional assessment.

CMS defines intensive behavioral counseling as providing the 5-As:

• Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
• Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
• Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
• Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
• Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

CMS estimates that 1 in 3 people receiving Medicare are obese.

Patrick Conway, MD, MSc, CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards and Quality said,

This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease. We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.

Body Mass Index (BMI) is calculated using weight and height. It doesn’t measure “fatness” directly but correlates well to overall amount of body fat. You can use this CDC calculator to find out your own BMI.

However, almost half of Medicare patients with a negative colonoscopy got another exam within 7 years, and for one in four there was no clear evidence that they needed one.

Because colonoscopies have real risks and are expensive, over-testing can be both dangerous and costly. Given limited numbers of physicians who do colonoscopies, unecessary procedures add to long waiting lists for screening and for necessary follow-up exams.

Although Medicare regulations call for reimbursement only after 10 years in cases where the first procedure didn’t find a problem, payments are being made for earlier exams.  In fact, Medicare denied payment for only 2 percent of colonoscopies for which there was no clear indication of need.

Researchers at the University of Texas in Galveston reviewed a representative sample of Medicare claims for a  colonoscopy between 2001 and 2003.  Since they were looking for average risk patients who had a negative screening colonoscopy, they filtered out any tests that included removing a polyp or a biopsy or other procedure done during the exam.  They also removed any colonoscopies that included a diagnosis such as bleeding or pain and any that were done for patients who had a Medicare claim in the previous 3 months that included a diagnosis or symptoms of colorectal disease that might have indicated need for a  diagnostic colonoscopy.

In their sample of 5% of the Medicare population:

• 236,145 Medicare patients 66 and older had a colonoscopy in 2001-2003.
• 114,468 had an negative exam with no polyps removed, no biopsies or other procedure.
• 24,071 had a negative screening colonoscopy after all possible medical reasons for doing the test were eliminated.

The research team then looked for repeated colonoscopies within 5 and 7 years of the first test.  Again they eliminated any exams for which a diagnosis or other Medicare claims indicated a good reason to repeat the test.  If they couldn’t find a reason, they classified the colonoscopy as repeated with no clear indication.

In their sample of 24,071 who had a completely negative screening colonoscopy between 2001 and 2003,  8,608 had another colonoscopy within 7 years, and for 3,656 no reason other than routine screening could be found for doing the test.

However, only 86 patients (2 percent) actually had payment denied by Medicare.

Although the US Preventive Services Task Force recommends against routine screening for people between age 75 and 84 and against any screening for those over 85, one third of patients who were 80 or older at their initial negative screening colonoscopy had another exam within 7 years.

The study authors pointed out,

This is of special concern, given the increased potential for complications and decreased benefit of this examination in the very old.

Repeating a colonoscopy early after a negative exam was more likely to occur when:

• Endoscopist doing the first colonoscopy did more than 1,200 procedures a year.
• Exam took place in a doctor’s office rather than hospital or ambulatory surgical center.
• Patients were male.
• Exam took place in the Middle Atlantic or North Central regions of the United States.
• Patients had less than a high school education.

For average risk patients without a family history of inherited colorectal cancer, the natural development of cancer from even quite large polyps is slow.  Before the era of colonoscopy, doctors at the Mayo Clinic followed 226 patients who had barium enemas with advanced adenomas (over 1 cm) for 5, 10, and even 20 years.  During that time only 2.5% became cancer at 5 years and 8% at 10 years.  Seven out of ten cancers were found at an early stage before spreading to lymph nodes or distant sites.

After analyzing their results, James Goodwin, MD, and his colleagues at the University of Texas concluded,

A large proportion of Medicare patients who undergo screening colonoscopy do so more frequently than recommended. Current Medicare regulations intending to limit reimbursement for screening colonoscopy to every 10 years would not appear to be effective.

SOURCE:  Goodman et al., Archives of Internal Medicine, online first May 9, 2011.

What This Means for Patients

Although the research was done in Medicare patients over 65, there is no reason to believe that younger patients are not also being screened more often than guidelines call for for.

• After your screening colonoscopy, be sure that you have a copy of the the results that describe if adenomas (polyps) were found and what their size and description was. If you don’t understand the report, ask your doctor to explain it.
• Check to see if the recommendation for the next screening exam fits within the guidelines for colorectal cancer screening.  If the return recommendation is sooner that guidelines call for, ask why!

For people at average risk of colorectal cancer, colonoscopy screening is recommended beginning at age 50 and then every 10 years unless adenomas or cancer are found.

The US Preventive Services Task Force says that elderly people between 75 and 84 should not be routinely screened for colorectal cancer and those over 85 should not be screened at all.  If your older relative is getting colonoscopy recommendation that don’t fit the guidelines, ask why. They are at higher risk for complications from the procedure and may well not benefit from screening.

But remember:

• Symptoms of colorectal cancer at any time – even after a negative screening colonoscopy — and at any age call for diagnostic colonoscopy.
• People with a family history of colorectal cancer or a personal medical history of cancer, adenomas, or inflammatory bowel disease (ulcerative colitis or Crohn’s disease) are not at average risk. They should follow screening and surveillance programs for increased and high risk, including beginning earlier than 50 and being screened more often.

Using a computer simulation program, researchers estimated the total lifetime costs for screening and any subsequent treatment of colorectal cancer in people over age 50, using three different kinds of testing (fecal occult blood test, or FOBT; a mix of FOBT and colonoscopy; or colonoscopy alone).

“With rising chemotherapy costs and aging of the population, the Medicare program will face increased costs” in caring for colorectal cancer, said researcher Luuk Goede, MD. His study was aimed at predicting the cost impact of different types of screening in the pre-Medicare population.

The results predicted that total screening costs for the pre-Medicare age group would increase (about 8 percent for FOBT testing; 12.6 percent for the FOBT/colonoscopy program; and almost 14 percent for colonoscopy screening). But if total screening and treatment costs were tracked after the population aged into Medicare, “treatment savings in the older age group fully offset the increased costs in the younger group” for all types of screening, according to Dr. Goede.

What This Means for Patients:

This type of population-based estimate of future costs helps focus public expenditures for screening. But the message for individuals remains the same: Don’t wait until you go on Medicare. Start routine screening for colorectal cancer by age 50 for those with average risk. Legislation in Congress would create a National Colorectal Cancer Screening Program. Urge your Members of Congress to support this lifesaving program.

Source: Medical News Today, Oct 19, 2010

Previously: Colorectal Cancer Screening Before 65 Could Save Medicare Dollars, October 6, 2008

These checks are sent automatically to seniors when 2010 prescription costs reach the coverage gap.

It is not necessary to apply for the check!

But scam artists are already at work, contacting  seniors and other Medicare beneficiaries asking for social security numbers, bank accounts, and pretending to help them apply for the $250 rebates.

The Centers for Medicare and Medicaid Services has begun a national education campaign to help consumers protect themselves against rebate check fraud.  It includes radio, television, and print advertising along with outreach efforts.

CMS Acting Administrator Marilynn Tavenner told the press,

Since early April, we have learned of seniors across the country who are being asked for personal information to help them get a rebate check,” Beneficiaries who reach the donut hole will get a check mailed to the same address Medicare uses to send them information now without doing anything special. Seniors should be on the look-out for scams where people they don’t know ask them for their personal information in order to get their checks. This is not how the process will work. Checks will come directly to beneficiaries who qualify for this benefit under the Affordable Care Act. Seniors or family members should contact us at 1-800-MEDICARE to report any of these types of calls or go to www.stopmedicarefraud.gov to learn more about efforts to fight scams like these.

Rebate checks are part of the Affordable Care Act which will continue to provide discounts for prescription drugs until the coverage gap is finally closed in 2020.

If someone acts you for personal information over the phone, especially if they ask for social security numbers or bank accounts, HANG UP.

And then let Medicare know.

Reviewing published medical literature, a task group from the National Colorectal Cancer Roundtable found research identifying both barriers to screening and factors that made it easier.

The most frequently mentioned barrier related to healthcare providers was lack of a doctor’s recommendation.  Having a usual source of health care facilitated getting screened.

Other barriers included:

• Low level of education
• African American race
• Hispanic ethnicity
• female gender

Being married or living with a partner was the most frequent personal faciliator.

Lack of health insurance or dual coverage with Medicare and Medicaid were most frequently reported insurance barriers to getting screened, while Medicare coverage was consistently reported as facilitating it.

Idris Guessous led the study team from the National Colorectal Cancer Roundtable Screening Among the 65 Plus Task Group.

SOURCE: Guessous et al., Preventive Medicine, Volume 50, Issues 1-2, pages 3-10, January-February 2010.

• The Colorectal Cancer Association of Canada is sponsoring a contest for print and video ads that raise awareness of colorectal cancer.
• Clinical trials at the NIH Clinical Center in Bethesda, MD are an option for cutting-edge treatment at no cost.
• When co-pays are raised for Medicare, the elderly make fewer outpatient visits but are hospitalized more often and stay in the hospital longer.

Raise CRC awareness with an ad or video and win!

Your print or video public service announcement to raise awareness of colorectal cancer and its prevention could be a winner.

The Colorectal Cancer Association of Canada will award $2,500 for the best video and $1,000 for the best print ad that reduces colorectal cancer by encouraging:

• Prevention= health lifestyles, diet and exercise, screening
• Awareness= signs, symptoms, stats
• Education= knowledge about treatments
• Support= cancer coaching and psychosocial aspects
• Advocacy = access to diagnostics and medicine

Entries must be submitted online and be received by March 31, 2010.

Cancer clinical trials at the National Institutes of Health in Bethesda

The National Cancer Institute Center for Cancer Research in Bethesda, MD, just outside of Washington D.C., conducts cancer clinical trials, including trials for colon and rectal cancer.

There is no cost to participate in a clinical trial at the NIH Clinical Center.  In addition, transportation expenses are paid and there is a per diem to cover meals and lodging for outpatients.

Higher co-pays for Medicare end up costing more

When Medicare co-pays are raised for ambulatory visits, plan members make fewer out-patient visits, but are hospitalized more often and for more days.

In plans that raised co-pays, there were 20 fewer out-patient visits per 100 enrollees each year, but 2 more hospitalizations and 13 more days in the hospital compared to plans that kept co-pays stable.

For every 100 patients in plans that raised co-pays, the plan got $5,950 in extra money from co-pays and saved $1,200 from fewer outpatient visits for a net savings to the insurance plan of $7,150.  However, with an average cost of $11,o65 for each hospitalization of a patient 65 to 84, the increase in hospitalization cost $24,000 for each 100 plan enrollees.

Increased co-pays hit low-income, black, and less-educated patients particularly hard, decreasing numbers of visits and increasing hospitalizations.

Writing in the January 28, 2010 issue of the New England Journal of Medicine, lead author Amal N. Trivedi, MD, MPH and team concluded,

Increasing copayments for ambulatory care reduced the use of outpatient care among elderly enrollees in managed-care plans, but this decline was offset by an increase in hospitalizations, particularly among enrollees with low socioeconomic status and those with chronic disease. Increasing copayments for ambulatory care among elderly patients may have adverse health consequences and may increase spending for health care

On Thursday afternoon, Senate Majority Leader Reid (NV) set the procedural wheels in motion for a vote on the Patient Protection and Affordable Care Act.

The first procedural vote is expected around 8pm on Saturday.  It will be a cloture vote on the motion to proceed.  Majority Leader Reid is working to line up the 60 votes needed to pass the cloture motion (a cloture motion must be approved by three-fifths of the Senate).

Continue reading for more information on the upcoming Senate vote as well as a summary of some of the provisions included in the Senate bill that C3 thinks are important for people living with colorectal cancer.

Typically, a cloture vote will be followed by a second procedural vote – a vote on the motion to proceed.  This vote requires a simple majority vote to pass.  However, Senate Republicans have agreed to waive this second procedural vote and forego reading the bill on the Senate floor in exchange for an all-day debate on the bill on Saturday (without this agreement, the Senate rules would have only required one hour of debate before the cloture vote).

The New York Times reports that Democratic Sens. Ben Nelson (NE), Mary Landrieu (LA), and Blanche Lincoln (AR) “are proving tough sells” on health care reform, “raising the prospect that one or perhaps all three of them could scuttle the bill before the fight over it even begins on the Senate floor.”  Should the cloture vote fail, Democrats may be forced “to regroup and redraw the measure or even switch to a more contentious procedural shortcut around the need for a 60-vote majority.”  Politico has a good article on the fast track options for moving the legislation forward.

Be sure to tune in and watch the debate and vote on Saturday.  You can watch the vote on C-Span’s website.

The $849 billion Patient Protection and Affordable Care Act includes a public option that will extend health insurance coverage to 31 million Americans.  The reimbursement rates for the public plan will not be tied to Medicare, and co-ops will still be offered.  The bill will create an insurance exchange where people can compare and purchase health insurance, it expands Medicaid coverage to those earning 133 percent of the federal poverty level, and it offers subsidies to help those without employer sponsored insurance purchase health insurance.

Increasing the number of Americans with health insurance will help reduce mortality rates from colorectal cancer.  Many studies show that people who are uninsured are substantially less likely to be screened for colorectal cancer.  In addition, insurance status strongly influences survival among those diagnosed with colorectal cancer – individuals with private insurance who are diagnosed with Stage II colorectal cancer have better survival outcomes than individuals who are uninsured and are diagnosed with Stage I colorectal cancer.

Like the House health reform bill, the Senate bill eliminates pre-existing condition exclusions.  Eliminating pre-existing conditions exclusions is very important for cancer patients.  Pre-existing condition exclusions lock the millions of Americans with at least one chronic illness (nearly one third of the population) into existing plans and employment.

The bill will eliminate cost-sharing requirements for all preventive services (including colorectal cancer screening) that have a United States Preventive Services Task Force (USPSTF) A/B rating, and require coverage of these tests by private insurance.

It also has a section regarding community preventive screenings, and specifically lists cancer screenings as one of the community interventions needed to improve public health.

The bill establishes a prevention and public health fund to be administered through the Office of the Secretary at the Department of Health and Human Services to provide for an expanded and sustained national investment in prevention and public health programs.  This new fund will support public health activities including prevention research and health screenings.

Many colorectal cancer patients face a lifetime of cancer treatment.  Caps on insurance result in very difficult decisions about the care they will receive and how they are going to pay for it.  The Patient Protection and Affordable Care Act eliminates “unreasonable annual benefits” and lifetime limits on the dollar value of benefits for any participant or beneficiary for all group health plans and health insurance coverage required to provide “essential health benefits” (i.e., any insurance company or plan that participates in the new health insurance exchange).

Senate Democrats have complied a section-by-section summary of the bill along with a timeline for implementation of the various provisions in the bill.  In addition, the Congressional Budget Office (CBO) has reviewed the legislation.  CBO’s analysis and cost estimate of the bill is available online.

The cloture vote on Saturday is an important step in getting a final health reform bill sent to the President, but there is still a long road ahead for health reform and many areas where the pending bills could be improved.

C3 has been closely following the various health reform proposals introduced in Congress, and will continue to work with legislators to advocate for the access to care that is critical to preventing, treating and beating colorectal cancer.  Please feel free to share your thoughts with us by leaving comments below.

If you can’t have a loved one with you during a painful procedure, just looking at your partner’s picture may make it hurt less.

The American Society for Radiation Oncology has a new website for patients, and open enrollment for Medicare plan coverage begins on November 15 and extends through the end of the year.

Research News

• African Americans were more likely to die of colorectal cancer in a study of over 13,000 patients.  They were more likely to have stage IV disease when diagnosed and less likely to have surgery.   But after late stage and lack of surgery were taken into account, racial differences in survival disappeared.  Writing in the November 2009 issue of the Journal of the American College of Surgeons, Dr. Timothy L. Fitzgerald and team said, “These data suggest that improvements in screening and rates of operation may reduce differences in colorectal cancer outcomes between African-American and Caucasian patients.”
• Canadian women were more likely than men to be diagnosed with an early colorectal cancer in the three years after a negative colonoscopy.  Researchers in Manitoba studied billing records for nearly 46,000 patients who had a clear colonoscopy and found that women with a negative colonoscopy were about as likely as women in the general population to develop colon cancer during the first three years after their test.  Then their risk dropped to about 40 to 50 percent lower.  The men’s  risk was 40 to 50 percent lower throughout the follow-up period.  Older women and those whose colonoscopy wasn’t done by a gastroenterologist were the most likely to have a missed or early colorectal cancer.   Harminder Singh MD, MPH and his team at the University of Manitoba reported their results in the American Journal of Gastroenterology online November 10, 2009.
• Looking at the picture of a loved one or holding your boyfriend’s hand reduces painful feelings, according to a study done by psychologists at UCLA. Women reported less pain when heat was applied to their forearm if they were holding their partner’s hand rather than a stranger’s hand or a ball during the experiment.  Just looking at a picture of their loved one also reduced the amount of pain they said they had.  Sarah Master PhD led the study.

Other Headlines

• The American Society for Radiation Oncology (ASTRO) has launched a newly designed patient website RT Answers. The new site is easier to navigate and includes more pictures.  The front page helps patients search for a radiation oncologist and provides a gateway to treatment information.
• Medicare beneficiaries can make new coverage choices during the annual open enrollment period from November 15 through December 31.   Online comparisons of original Medicare, Medicare Advantage, and supplemental Medigap policies are available from CMS.  Also changes in Part D Prescription Drug coverage plans can be made during open enrollment.

Catherine Knowles is C3′s new Director of Policy

The health care reform debate continues.  Last week, the Senate Finance Committee discussed Senator Baucus’s proposal and considered hundreds of amendments.  The Committee will hold a final vote on the proposed bill later this week.  This will allow the Congressional Budget Office (CBO) time to complete its analysis of the bill and provide a final cost estimate.  After the Finance Committee has approved the bill, it will be combined with the bill from the Senate Health, Education, Labor and Pensions Committee before it is scheduled for a vote on the floor by the full Senate.

C3 has been closely following the various health reform proposals introduced in Congress, because access to care is critical to preventing, treating and beating colorectal cancer.  Please feel free to share your thoughts with us by leaving comments below.

Continue reading for more information on some of the amendments adopted by the Senate Finance Committee that C3 thinks are important for people living with colorectal cancer.

C3 was pleased to see that the Senate Finance Committee made significant changes to the health reform overhaul package it considered that will make health care more affordable and accessible.

Sen. Cantwell (D-WA) sponsored an amendment that will let states create low-cost health insurance plans for low-income families.  The amendment is designed to encourage states to enact a program mirroring the Washington State Basic Health plan.  It will allow states to put people making more than 133 percent of the federal poverty level (the upper threshold for Medicaid in the mark) and less than 200 percent of the federal poverty level (approximately $44,000 for a family of four) in a state-based government plan.  The amendment provides a federally funded, non-Medicaid, state plan which combines the innovation and quality of private sector competition with the purchasing power of the states.  It passed 12-11.  This amendment would help expand coverage to people who currently cannot afford insurance.  And without insurance, people are less likely to be screened, let alone able to be treated for colorectal cancer.

The committee also adopted along party lines an amendment sponsored by Senate Finance Health Subcommittee Chairman Rockefeller (D-WV) regarding so-called “Cadillac” insurance policies – expensive policies with low deductibles, limited co-pays and extensive benefits.  Senator Baucus proposed taxing the insurers for plans that cost over $8,000 anually ($21,000 for a family) in order to help offset costs of coverage for the uninsured.  In addition, there is an underlying assumption that “Cadillac” policies encourage inappropriate over-use of medical care – and taxing these policies could help make them less attractive.   However, some of the committee were concerned that some consumers – people in high-risk jobs, or older Americans – have to spend that much for “Chevrolet” coverage.  They felt that the costs should be increased.  Under the Rockefeller amendment, the cost of the plans for retirees older than 55 and those in high-risk professions must total $9,850 for individuals and $26,000 for families before they are considered “Cadillac” and therefore taxable.  The threshold tops the amounts in the underlying proposed bill by $1,100 for individuals and $3,000 for families.

Colorectal cancer patients tend to be older – most people are diagnosed over age 50.  And the cost of insurance policies increases significantly as people age.  The Rockefeller amendment will increase affordability to policies for retirees over age 55.

The Rockefeller amendment also guarantees that the independent commission set up to find savings in Medicare cannot propose increases to Medicare premiums.  This will reassure Medicare recipients who are concerned about cuts in benefits accompanied by increases in premiums.

The Committee also addressed comparative effectiveness research.  Comparative effectiveness research (CER) compares treatments – for example, does ibuprofen, aspirin or acetaminophen work better for a headache?  Senator Baucus proposed the formation of a Patient-Centered Outcomes Research Institute (PCORI) which would be responsible for coordinating CER data and communicating results with health care providers and the public.  Comparative effectiveness will help determine what therapies can be used to effectively treat those with colorectal cancer.  Any provisions related to comparative effectiveness research should be conducted through an open and transparent process involving all stakeholders, starting from the research planning stage.  During the Senate Finance Committee markup, Sen. Grassley (R-IA) sponsored an amendment designed to improve the PCORI governance of patient-centered outcomes research institute.  The amendment would not allow the Secretary of Department of Health and Human Services, the National Institutes of Health, and other high-ranking officials, including elected officials and appointees, from being board members of the institute.   It was agreed to by voice vote.  Ensuring that patient voices are represented and that politics is kept out of comparative effectiveness research is extremely important to ensuring that patients continue to have access to innovative and life-saving medical treatments.

You can read the entire text of the Senate Finance Committee bill as amended online.