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Medical Forum / Diseases and Disorders / Cancer / March 2008Not cancer, but of interest. Not pay because patient is "too young ? "
Even state controlled HMO's have set limits that don't make sense. from BBC Health news today (13 Mar) Terry Pratchett Best-selling fantasy author Terry Pratchett is to donate $1m for research into Alzheimer's disease. The creator of the Discworld series was diagnosed with a rare early- onset form of the disease in December. Pratchett, 59, announced the pledge of about £494,000 at the Alzheimer's Research Trust annual conference. Telling leading dementia specialists of his determination to find a cure, he said: "I intend to scream and harangue while there is time." Personally, I'd eat the arse out of a dead mole if it offered a fighting chance Terry Pratchett There are 15,000 people in the UK with early-onset dementia, which strikes under the age of 65 years. Mr Pratchett has a rare form of the disease called posterior cortical atrophy, in which areas at the back of the brain begin to shrink and shrivel. He says he is starting to notice its effect on him. "I've given up my driving licence because I didn't feel confident driving. And if I've got something inside out, it's a little bit puzzling getting it the right way round again." He added: "The curious thing is that writing goes on, although the typing doesn't." Mr Pratchett is paying for the Alzheimer's drug Aricept because the NHS says he is too young to get it for free. Lack of funds The author told the conference he is prepared to go to extreme lengths in order to beat the disease. He said: "Personally, I'd eat the arse out of a dead mole if it offered a fighting chance. "I am, along with many others, scrabbling to stay ahead long enough to be there when the cure comes along. "Say it will be soon - there's nearly as many of us as there are cancer sufferers, and it looks as if the number of people with dementia will double within a generation. "In most cases, alongside the sufferer you will find a spouse suffering as much. "It is a shock to find out that funding for Alzheimer's research is just 3% of that to find cancer cures." In total, an estimated 700,000 people in the UK have Alzheimer's disease. However, the Alzheimer's Research Trust estimates that just £11 per patient is spent annually on research into the disease - compared with £289 for each cancer patient. Rebecca Wood, chief executive of the Alzheimer's Research Trust, said the trust currently had to turn down two out of every three research projects due to lack of funds. She said: "Whilst we were deeply saddened to learn of Mr Pratchett's diagnosis, we are delighted that he has chosen to speak out about his experiences with Alzheimer's disease, to raise awareness about its impact and the desperate need for more research. "Research is the only way to beat this disease and help people like Terry - to prevent them losing their thinking skills and keep them doing the things they love." Are you affected by the issues raised in this story? Send us your comments by filling out the form below. I had no idea that Pratchett had Alzheimer's. He made Death funny, even sympathetic. Maybe he'll add a new (?) character, Dementia, and something good will come of this. Until then, how sad. Similar problems happen with cancer treatment and diagnosis as well. I haven't heard of someone being denied a medication (or payment for it) solely because of age, but my sister's insurance company balked at paying for her colonoscopy, saying she was too young. This was despite having a younger brother (me) with stage 3 colon cancer. My oncologist, and others, said any close relative (esp. sibling or child) of a colon cancer patient should get a colonoscopy when they're 10 years younger than the patient was at time of diagnosis. For older siblings, of course, this means ASAP. In the end, she was able to get them to pay, but it took some arguing. This is more of the problem of bureaucrats, whether within government or insurance companies, making medical decisions instead of leaving that to the trained professionals. Solutions? --- CSM > Similar problems happen with cancer treatment and diagnosis as well. > I haven't heard of someone being denied a medication (or payment for [quoted text clipped - 9 lines] > medical decisions instead of leaving that to the trained > professionals. Solutions? i hear our government's planning on supplying stool kits to GP's for colon cancer testing. Colonoscopies are expensive. A patient shared the following with us, in 2003. J Sep 8 2003, 8:03 pm Newsgroups: alt.support.cancer, alt.support.prostate.prostatitis From: "me" <snipped> Date: mon, 8 sep 2003 20:03:01 -0500 Local: mon, sep 8 2003 8:03 pm Subject: my detailed colonoscopy bill, total costs $1700.00 I am posting this here for archive purposes, being that I could not find such a thing when I had looked earlier. The following is my detailed colonoscopy bill, Total costs, total cost, total bill (keywords) for a colonoscopy with polyp removal. Colonoscopy price cost fees medical bill incurred: I hope that someone might find this useful My insurance: blue cross, colonoscopy 7/2003 I refused the ($500) upper scope proceedure, As I knew the problem was lower. Two colon polyps were found, along with one internal bleeding hemmorhoid. All tests came back negative for cancer (benign), and one polyp Was supposedly large. I live in the usa, in the capital city of louisiana. The entire cost of this proceedure was as follows: (I was not responsible for costs beyond what blue cross negotiates): 1. Initial dr. appointment, charged $100, Blue cross negotiated fee $84.21 2. Medication, discomfort/healing (proctofoam), $24.17, Blue cross negotiated fee $23.51 3. Medication to empty colon: charged $45.21, Blue cross negotiated fee $43.90 4. Colonoscopy (beyond exploratory) charged $1000, Blue cross negotiated fee $644.38 5. Outpatient facility, charged $800.00, Blue cross negotiated fee $578.00 6. Pathology lab examination polyps/tissue removed, charged $422.00 Blue cross negotiated fee $267.95 7. Bill from labcorp holdings (?), charged $41.80 Blue cross negotiated fee $25.13 8. Follow-up checkup/consultation, charged $40.00 _______________________________________________ ++++++++++++++++++++++++++++++++++++++++++++++ Grand total out-of-pocket: $1707.08 Total original charges were $2473.18, but blue cross negotiated discounts saved $766.10 I have a $2500 deductable, so I had to pay every bit of this out-of-pocket. Grand total out-of-pocket: $1707.08 On Mar 14, 11:10 pm, J "i hear our government's planning on supplying stool kits to GP's for colon cancer testing. Colonoscopies are expensive. A patient shared the following with us, in 2003. " A lot has been done/known since 2003! From what I understand, stool samples are a not good way to detect colorectal cancer. Better than nothing, perhaps. My husband died from rectal cancer in 2005, so I have followed this subject closely. My life would be worth the $2K if that is what it cost. Your 2003 writer had a high deductible....and from choice, I am sure. Higher deductible, lower premiums. Chance you take. > On Mar 14, 11:10 pm, J "i hear our government's planning on supplying > stool kits to GP's for colon [quoted text clipped - 9 lines] > writer had a high deductible....and from choice, I am sure. Higher > deductible, lower premiums. Chance you take. Well, yes, but it would have to be that amount annually or every 2 years or (whateveer frequency) and there's still no guarantee cancer would be found on time. Cancer does not follow a screening schedule. Neither are perfect - fecal occult blood test or colonosocopy. They're claiming it would save lives in our Province < http://www.cbc.ca/canada/ottawa/story/2008/03/14/colon-cancer.html?ref=rss [excerpts] The Ontario government has launched a public education campaign to encourage residents in the province to undergo screening for colon cancer. "This is a very serious issue," said Health Minister George Smitherman said Friday. Smitherman said colon cancer, also known as colorectal cancer, kills about 3,250 people in Ontario each year. After lung cancer, it is the second-leading cause of cancer death for men and women combined. Currently, only one in five people age 50 and over is screened for the disease in the province, while about 7,800 new cases are diagnosed every year. The society estimates that 1,750 men and 1,500 women died of colorectal cancer in Ontario in 2007. An estimated 4,200 men and 3,600 women were diagnosed in 2007. The society recommends that men and women age 50 and over, with an average risk of the disease, have a fecal occult blood test at least every two years. People who have a close relative with colorectal cancer, personal history of colorectal cancer, inflammatory bowel disease, some inherited syndromes, or benign polyps should work out an individual plan of screening with their doctors, it says. Most colorectal cancers develop from small growths, called polyps, in people who have an average risk of the disease. Fecal occult blood testing is designed to identify polyps early so they can be removed during a colonoscopy or surgery before they become cancerous. --------------------------------------------------------------------------------- And it would save more lives for those Americans who don't have health insurance - yes? J > --------------------------------------------------------------------------------- > > And it would save more lives for those Americans who don't have health > insurance - yes? > J I would say, no it wouldn't. Those without health insurance would not go to a Dr. period. Many without are young and think they are invinceable. Many choose not to buy insurance but rely on Emergency Rooms. Elderly are covered by Medicare. Poor, by Medicaid. I know that every year in my annual physicals a smear was/is taken as a routine part of the exam. Even when my "primary" was my OB/GYN. I am not sure that the test would be timely or accurate given the following guidlines: Fecal Occult Blood Test This test detects blood in your stool, which can be a sign of bleeding anywhere from your nose and mouth to your rectum, such as from an ulcer, a polyp, or cancer. If you're over 50, you should have this test annually during the years when you don't have either a colonoscopy or sigmoidoscopy to screen for colon cancer. Keep in mind, however, that both colonoscopy and sigmoidoscopy are better at detecting cancer than a fecal occult blood test. prepare for the test If the traditional test is used, you collect samples of your stool at home and send them to a laboratory or clinic for analysis.Your doctor gives you a kit with all of the materials you need.A newer test uses flushable pads to detect blood in the toilet bowl following a bowel movement, so that no stool samples are required. For several days before taking the samples, you must avoid medicines that can interfere with the results. These include NSAIDs and blood thinners (see "Medication precautions," page 35) which can cause minor stomach bleeding, thereby giving an abnormal test result. If you have hemorrhoids, wait until they stop bleeding before doing the test. Women shouldn't collect stool samples near the time of menstruation. Finally, avoid using toilet bowl cleaners for several days before the test, because these chemicals can affect the results if they come in contact with your stool sample. For several days before the test, you also need to avoid foods and vitamins that can affect the test result. Foods to avoid include red meat (the blood it contains can turn your test positive), radishes, turnips, cabbage, cauliflower, horseradish, uncooked broccoli, and cantaloupe (all of which contain a chemical that can turn the test positive), and citrus fruits and vitamin C supplements (which can turn the test falsely negative). I also think that by the time this test proves there is cancer, we are a bit down the road! Still, I will grant, better than nothing! > > --------------------------------------------------------------------------------- > [quoted text clipped - 51 lines] > I also think that by the time this test proves there is cancer, we are > a bit down the road! Still, I will grant, better than nothing! FWIW, I was a good bit down the road (stage 3, tumor nearly occluding) when a colonoscopy found the tumor. I'd had visible blood at times, but an occult blood test came up negative, so they said that was probably just hemorrhoids, and no worry. My CEA test came up negative as well. Maybe my case is just that unusual, but it took a colonoscopy to find the cancer. Since colon cancer is slow to grow, the procedure doesn't need to be very frequent. Depending on the situation, once every five to ten years is enough. Even at $2K each, that comes up to $200 to $400 per year, starting at 50 for most, earlier for those with family history. This compares favorably with the $350K or so my treatment has cost so far. > > --------------------------------------------------------------------------------- > > [quoted text clipped - 25 lines] > I also think that by the time this test proves there is cancer, we are > a bit down the road! Still, I will grant, better than nothing! Colonoscopies don't necessarily pick up early (flat) cancers? < http://www.sciencedaily.com/releases/2008/03/080317093901.htm > ScienceDaily (Mar. 17, 2008) Doctors may one day be able to detect early stages of colon cancer without a biopsy, using a new technique developed by researchers at the Stanford University School of Medicine. "What's more, doctors biopsy only the cancers that form easily visible growths called polyps. Early stage cancers that remain flat aren't detected." (that might be incorrect?) If I recall correctly, 15% of people who get colorectal cancer in Ontario are high risk and will continue to get colonoscopies as recommended by their doctors, if they go. It was (on) Oprah today that men tend to be "reluctant patients" which I already knew. :) http://www.cbc.ca/canada/ottawa/story/2008/03/14/colon-cancer.html?ref=rss The other 85% may not realize they too are at rish. Hence the awareness campaign. The test is described on this next web page and some of the TV blurbs. http://coloncancercheck.ca/yourrole.html So the US is moving froward with probably expensive technology and we're moving backwards with probably much less expensive testing. Probably none perfect. In haste, J > In haste, > J Latest here from MEDSCAPE...... Guidelines Issued for Early Detection of Colorectal Cancer March 10, 2008 -- The American Cancer Society has issued guidelines for the screening and surveillance for the early detection of colorectal cancer (CRC) and adenomatous polyps in asymptomatic, average-risk adults. The new consensus guidelines, which were jointly developed with the US Multi-Society Task Force on Colorectal Cancer and the American College of Radiology, beginning in 2006 to 2007, are published in the March 5 First Look issue of CA: A Cancer Journal for Clinicians and will appear in the May-June 2008 print issue. "In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer," write Bernard Levin, MD, from The University of Texas M.D. Anderson Cancer Center in Houston, Texas, and colleagues from the American Cancer Society Colorectal Cancer Advisory Group, the US Multi-Society Task Force, and the American College of Radiology Colon Cancer Committee. "CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized." This update of each contributing organization's guidelines groups screening tests into those that primarily detect cancer early and also can detect adenomatous polyps, thus offering a greater potential for prevention through polypectomy. Clinicians should make patients aware of the full range of screening options whenever feasible. At a minimum, however, clinicians should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test for which benefits are primarily limited to early detection of cancer. The 3 sponsoring organizations strongly concur that the main goal of screening should be the prevention of CRC. "In the last decade, there has been an increase in the number of technologies available for CRC screening, and in the case of stool tests, there has been growth in the number of commercial versions of guaiac-based and immunochemical-based stool tests (gFOBT [guaiac-based fecal occult blood test] and FIT [fecal immunochemical test])," the authors of the guidelines write. "It is our hope that these new recommendations will facilitate increased rates of CRC screening and that referring clinicians find these new guidelines ease some of the challenges they have experienced in promoting CRC screening to their patients." In the first phase of the guidelines update process, stool tests were reviewed, including the gFOBT, the FIT, and the stool DNA test (sDNA). In the second phase, the panel developed recommendations for the structural examinations, including flexible sigmoidoscopy (FSIG), colonoscopy, double-contrast barium enema (DCBE), and computed tomographic (or virtual) colonography (CTC). The panel discussed these issues, heard presentations from outside experts, relied on previous evidence-based reviews, and searched MEDLINE (National Library of Medicine) and bibliographies of identified articles for literature related to CRC screening and specific to individual tests published between January 2002 and March 2007. When evidence was insufficient to provide a clear, evidence- based conclusion, final recommendations were based on expert opinion. Testing options for the detection of adenomatous polyps and cancer for asymptomatic adults 50 years and older include FSIG every 5 years, colonoscopy every 10 years, DCBE every 5 years, or CTC every 5 years. Testing options that primarily detect cancer in asymptomatic adults 50 years and older include annual gFOBT with high-test sensitivity for cancer; annual FIT with high-test sensitivity for cancer; or sDNA with high-test sensitivity for cancer, although the optimal interval for sDNA is uncertain. Each screening test has unique advantages, has been shown to be cost- effective, and has associated risks and limitations. Ultimately, patient preferences and availability of testing resources guide the selection of screening tests. The disadvantages of the structural tests are that they require bowel preparation, but their primary advantage is that they can detect polyps as well as cancer. Conscious sedation is used for colonoscopy. FSIG is uncomfortable, and screening benefit is limited to the portion of the colon that is directly examined. Risks for colonoscopy, DCBE, and CTC may rarely include perforation; colonoscopy may also be associated with bleeding. Positive findings on FSIG, DCBE, and CTC usually result in referral for colonoscopy. The advantages of the stool tests are that they are noninvasive, they do not require a bowel preparation, they can be done in the privacy of the patient's home, and they are more readily available to patients without adequate insurance coverage or local resources. However, these noninvasive tests are less likely to prevent cancer vs the invasive tests; they must be repeated at regular intervals to be effective; and, if the test is abnormal, an invasive test, namely colonoscopy, will be required. For patients who are unwilling to have repeated testing or to undergo colonoscopy if the test results are abnormal, stool testing is ineffective and should not be recommended. This update of the CRC screening guidelines focused on screening in average-risk adults and did not consider evidence concerning CRC screening or surveillance for individuals at increased and high risk. Patients with a personal history of adenomatous polyps or curative- intent resection of CRC, a family history of either CRC or colorectal adenomas diagnosed in a first-degree relative before age 60 years, or a history of inflammatory bowel disease of significant duration or 1 of 2 hereditary syndromes should continue to follow recommendations issued previously by the American Cancer Society or the US Multi- Society Task Force for individuals at increased risk. "There is compelling evidence to support screening average-risk individuals over age 50 years to detect and prevent CRC," the panel concludes. "Screening of average-risk individuals can reduce CRC mortality by detecting cancer at an early, curable stage and by detecting and removing clinically significant adenomas. . . . No CRC screening test is perfect, either for cancer detection or adenoma detection." Some of the authors of the guidelines have disclosed various financial relationships with Exact Sciences, Vital Images, Medicsight, Covidien, Viatronix, Fleet, Olympus, Given Imaging, Avantis, NeoGuide, G.I. View, American BioOptics. Genzyme, Epigenomics, GeneNews, and licensure of a CT colonography software patent to GE Medical Systems. CA Cancer J Clin. Published online March 5, 2008. On Mar 19, 1:27 pm, turtletrot1 <turtletr...@bellsouth.net> wrote:..... Now more and the highlights of the actual study..... Study Highlights * Evidence on screening tests from MEDLINE studies and bibliographies between 2002 and 2007 and unpublished manuscripts from experts were reviewed at 2 meetings and at follow-up conference calls. * The primary goal of CRC screening should be colon cancer prevention through structural examinations if available and if patients are willing and able to undergo the examinations. * Stool tests are less likely to prevent cancer vs structural examinations; are effective only if repeated regularly; and, if abnormal, necessitate colonoscopy. * Blood in the stool can be from CRC or polyps 1 cm or more in size. * Annual high-sensitivity gFOBT is an option in CRC screening: o 2 stool samples from each of 3 consecutive stools are collected. o Nonsteroidal anti-inflammatory drugs, vitamin C supplements of more than 250 mg, and red meat can affect results. o Rehydration of gFOBT slides is not recommended because of increased false-positive rates. o Results might be improved if tests are processed in the laboratory vs the office. o 3 randomized controlled trials showed that gFOBT screening detected cancer at an earlier stage and reduced CRC mortality by 15% to 33%. o gFOBT test after digital rectal examination in office is not recommended for CRC screening because of low sensitivity of 4.9% for advanced neoplasia and 9% for cancer. o Positive result is indication for colonoscopy. * Annual FIT screening is an option for CRC screening: o 2 tests might be more optimal than 1 test. o No dietary restrictions are needed. o Positive test is indication for colonoscopy. * sDNA test to detect altered DNA in adenoma and carcinoma cells shed in the stool is an option in CRC screening, but the appropriate testing interval is not known: o At least 30 g of 1 entire stool specimen must be shipped in a special ice pack. o sDNA is more sensitive for cancer vs advanced adenomas. o Current test will not identify all cancers. o Positive result is indication for colonoscopy. o The manufacturer's recommendation of 5-year interval testing was not endorsed. * FSIG to examine the rectum, sigmoid, and descending colon every 5 years is an option in CRC and polyp detection: o Annual highly sensitive gFOBT or FIT can be added to regimen. o 10-year interval can be considered if regular insertion beyond 40 cm with bowel preparation is done by experienced endoscopist. o Limitations include examination of only distal part of colon, less than 1:20,000 risk for perforation, and possible discomfort. o Positive test result is indication for colonoscopy. * Colonoscopy every 10 years is acceptable for CRC and polyp screening: o Full bowel cleansing and usually sedation are needed. o Appropriate interval between negative examinations is not clear because there are no long-term data. o Up to 12% adenomas and 5% cancers can be missed. o Risks include perforation in 1 of 1000, postpolypectomy hemorrhage, and hospitalization. * DCBE or air-contrast barium enema every 5 years is an option for CRC and polyp screening: o Bowel cleansing is needed. o Abnormal test result is indication for colonoscopy. o Decision for testing should be based on patient preference, cost, and radiologist training. * CTC every 5 years is an option for CRC and polyp screening: o Bowel cleansing is needed. o Room air or carbon dioxide is infused through a rectal catheter. o Duration is 10 minutes. o Polyp size 6 mm or larger is indication for colonoscopy. * Future screening recommendations might consider risks for certain subgroups. ---------------------------------------------------------------------- >> ----------- >> [quoted text clipped - 51 lines] > I also think that by the time this test proves there is cancer, we are > a bit down the road! Still, I will grant, better than nothing! Me wonders if a valid test is possible/probable given the complicated prep/avoidances. Gad! Fig csm7532@hotmail.com wrote in news:f5e3a95a-d2f8-454a-b680-f213e21764c4 @i29g2000prf.googlegroups.com: > I had no idea that Pratchett had Alzheimer's. He made Death funny, > even sympathetic. Maybe he'll add a new (?) character, Dementia, and [quoted text clipped - 16 lines] > --- > CSM From my experience, the docs individualize the schedule & type of test depending on family history & what they find during a colonoscopy or on a smear. Since I was clean as a whistle, I get a 10-year repreive with the smear test in between. Of course that doesn't mean that when they go in 10 years from now, they will not find cancer, but the numbers are on my side. The prep for this test is miserable enough to be a deterrant for most to want to overdo it. Ugh. The cost - we could debate that one - I guess if they find something it was worth whatever the cost, & if not, opinions vary. What is peace of mind worth? What is the optimal interval? Not sure we have answers. Fig > csm7...@hotmail.com wrote in news:f5e3a95a-d2f8-454a-b680-f213e21764c4 > @i29g2000prf.googlegroups.com: [quoted text clipped - 34 lines] > > Fig I was surprised to be told that in my case, the schedule is 5 years. This was after having full-blown cancer, not just a polyp or two; but the follow-up (first complete) scope was clear. I trust my doctors to set a safe, reasonable interval. I wouldn't trust the insurance company, nor the government. The prep may deter a lot of people, while the whole idea deters others. A lot of men won't get prostate checks for similar reasons. To me, it's silly---but I have to admit to avoiding the dentist for far too long, so we all have our medical sins. I wonder how the numbers really work out. IOW, if it costs $X to do a test, it detects a disease early in 1/Y cases, and saves $Z in treatment due to the early detection, is is $Z/Y > $X?. If not, how can we compare the few lives saved and the peace of mind to the overall cost ($X - $Z/Y)? The math nerd emerges, checks his shadow, and decides on another six years before taking himself too seriously. --- CSM |
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