06/21/2010 - 14:18

One Voice Against Cancer (OVAC), a broad coalition of cancer-related organizations representing millions of Americans, held a special event in Washington, D.C. on June 16-17, 2010. The event included one day of advocate training and one day of visits with Congressional representatives.

The purpose of the visits was two-fold. First, OVAC is raising awareness for the need for more cancer research. Secondly, OVAC advocates are asking Congress to at least sustain the current levels of federal support for cancer research through a number of federal programs. Unfortunately, cancer funding for FY2011 is not a sure bet due to mounting pressure from the Administration and Congress to freeze or reduce spending on critical items.

OVAC and Preventing Colorectal Cancer.Org (PCC) are asking that you write your Congressional representative to ask that cancer research funding does not get reduced, or even cut, next year.

Here are some of the programs that OVAC is recommending that should be funded in FY 2011:

  • ♦$35.2 billion for the National Institutes of Health (NIH), which includes $5.8 billion  for the National Cancer Institute (NCI) and $240 million for the National Center on Minority Health and Health Disparities.
  • ♦$601 million for the Centers for Disease Control (CDC)
  • ♦Funding for the Health Resource and Service Administration (HRSA) which includes:  $267.3million to support Title VIII Nursing Programs and $18.6 million to support the Patient Navigator Program
  • ♦$495 million increase for the Food and Drug Administration (FDA) to further coordinate and integrate cancer research from early stage discovery to the front lines.

Among other resources, the National Institutes of Health (NIH) and the National Cancer Institute (NCI) spearhead important initiatives for national cancer research activities in the United States and abroad.  Many advances over the past decade in the treatment of cancer are directly attributable to NIH and NCI sponsored studies and related research grants.

OVAC advocates recognize that despite the successes and progress in cancer detection and treatment in recent years, the incidence of cancer is projected to nearly double by 2020- particularly among the baby boomer population.  This looming cancer crisis is a call to action.

After spending the day on Capitol Hill with OVAC, it became clear that cancer funding cannot be taken for granted during the next federal budgeting cycle.  For example, one Congressional staffer remarked, "Budgets are choices and choices are values. It's really important that citizens and advocates make their values clear to their representatives and express how they would like to see them appropriate the Senate Labor-HHS-Education FY2011 budget."

Please make sure that you contact your Congressional representative, to let them know how important it is to fund the federal agencies referenced above.  To locate your representatives, www.congress.org offers a helpful resource (go to the bottom of the page to locate the appropriate directory).

06/08/2010 - 09:18
The Propofol Availability Conundrum
 
What does the lack of propofol availability mean to you as a practicing anesthesiologist?
 
Over the last 6-8 months, our profession has been besieged by many different forces making our job to provide our comprehensive level of high quality anesthesia services very difficult. Our focus is always to make sure our patients have the best and safest experience that is available to them for their surgical and therapeutic procedures.
 
 As many of you know, over the last few months the sedative-hypnotic, propofol, a mainstay for practicing anesthesia personnel has been difficult if not impossible to attain. Numerous production interruptions and decisions by manufacturers to leave the market have severely hampered our clinical options.  The American Society of Anesthesiologists has been constantly updating the anesthesia community and working closely with the FDA (Federal Drug Administration) to overcome these severe propofol shortages. Just last week Teva announced it was no longer going to produce propofol and Hospira has recalled numerous lots of its propofol. APP who markets and produces generic propofol/Diprivan and Fresenius Propoven are really the only viable options at this point. What was a very affordable and readily available drug is now not so inexpensive and not so available.
 
Anesthesiologists and anesthetists function in many practice settings from the operating room to the endoscopy suites and beyond. We are resourceful clinicians and have been challenged to provide the best and safest pharmaceutical options to our patients. There have been anecdotal reports of increased utilization of Pentothal and ketamine for use with inductions as well as the use of etomidate and Brevital.  The costs and availability of these drugs has been altered as well. 
 
Precedex which is traditionally an ICU drug and now has an application as a MAC sedation agent (monitored anesthesia care) is an option; but the costs are fairly prohibitive compared to generic propofol and it too has characteristics that make it cumbersome to use in various clinical settings. 
 
These drugs are not so easily available and have been universally displaced by the overwhelming use of propofol. What other options exist? Most recently in November of 2009, Eisai introduced Lusedra (fospropofol) which was approved as a sedative-hypnotic for use as MAC sedation in diagnostic and therapeutic procedures. It is a prodrug form of propofol and thus has different pharmacodynamics and pharmacokinetics.  It is a viable option that provides a consistent level of propofol-like sedation with a single bolus injection.
 
We continue to utilize benzodiazepenes and narcotics to balance our delivery of care to our patients but there are a few alternatives that may have a role in our toolbox. Anesthesia providers take pride in the quality of the care in which they provide their patients.
 
We can revisit some of the older drugs which we have almost uniformly dismissed; or we have the option of learning new medications and using our clinical acumen to take our profession and the care of our patients to an even greater level.
 
Just my thoughts,
 
Stanford Plavin MD
President Ambulatory Anesthesia of Atlanta LLC
Board Vice Chair: Preventing Colorectal Cancer.org
Consultant Eisai Pharmaceutical
03/18/2010 - 13:19

  The March 17, 2010, issue briefing in the Cannon House Office Building was truly remarkable.  Representative Kathy Dahlkemper (D-PA), pictured, spoke about her House Resolution (HR 1053) which raises awareness of colon cancer in women.  Also, Theresa Vawter the health legislative assistant from the Office of Kay Granger (R-TX) presented facts related to HR 1189, the Colorectal Cancer Prevention, Early Detection, and Treatment Act.  Dr. Morris from C3 served as moderator for the panel which presented the importance of screenings, and the barriers that many face in receiving these lifesaving services.

03/05/2010 - 09:51
 
It’s Colon Cancer Awareness Month and this is an opportunity to pause and think about the realities of this disease. Consider these facts:
·         Colorectal Cancer is the third most commonly diagnosed cancer and second leading cause of cancer death.
·         In 2009, the American Cancer Society estimated 146,970 new Colorectal Cancer cases were diagnosed and 49,920 cases resulted in death.
·         Early detection is vital—over 80% of all cases of Colorectal Cancer can be prevented with recommended screening.
·         Leaders in the field have estimated that by adopting recommended Colorectal Cancer screening guidelines, 30,000 lives could be saved annually.
 
All of these facts are shocking. First of all, whenever I mention, ”Colorectal Cancer is the second leading cause of cancer death,” people don’t believe me. My own family members who work in healthcare think I’m wrong. Most people tend to believe that lung cancer, then breast cancer, then other types of cancer are claiming the most lives. Many times I have pulled out my iPhone during one of these conversations and shown disbelievers websites that verify my claim. 
 
For mainstream America, the incidence of Colorectal Cancer unfortunately appears to be a well-kept secret. With an estimated 50,000 deaths annually, how can this be?  All of us, including the media, need to focus on this cancer, which in most cases can be treated if detected early. 
 
What can we do? I recently went to a forum that celebrated achievements in reducing the incidence of Colorectal Cancer and discussed opportunities to expand screening to underserved populations. After a whole morning spent discussing options, however, there was still no clear solution for increasing awareness in a significant way. Yes, we should pass legislation that would expand screening benefits to more people in the Medicare population. Yes, we should spend money on public service announcements. And, yes, we must break down real and perceived barriers to screening. But, if we’re to really hit mainstream America and make an impact and get people running to their doctors saying, ‘I’d like a colonoscopy,’ we’re need  to generate an  up-swell of grassroots support that includes letter writing to insurance companies, letters to editors of newspapers and magazines, and getting comfortable with the idea of talking about our backsides. If you’ve got specific ideas on how this can be achieved, let me know.

 

02/02/2010 - 18:42

I want to thank the Coalition for publishing the issue brief addressing safety protocols for administering propofol and similar anesthetic agents during colonoscopy screenings. I found it to be very insightful. Thank you.

01/29/2010 - 09:16
Yesterday the Colorectal Cancer Coalition (C3) in partnership with Olympus held an event at the National Press Club entitled ‘The State of Colorectal Cancer Screening and Prevention Forum.’ The event presented not only the current statistics but also current challenges and opportunities within the Colorectal Cancer (CRC) community.
The primary message shared by all of the presenters was this: screening rates for colorectal cancer are far below the screening rates of comparable populations for other cancers. As an example, Cervical Cancer screenings are done on 87% of the eligible population; whereas, the screening rates for colorectal cancer are closer to 33%. These numbers are shocking when you consider the fact that colon cancer is the second leading cause of cancer deaths in America. Why does it seem to be the overlooked/undervalued exam?
Experts from the CDC, leading research centers, and the American Cancer Society weighed in with opinions on what actions might be taken to improve the screening rates. Debate ensued regarding many questions such as: are the screening guidelines confusing? do people actually read screening guidelines? do state governments need to issue more mandates? do we need more research? Is there a shortage of gastroenterologists? Are Primary Care Physicians doing their part to advocate for screening? 
At the end of it all, it seemed clear that a massive upswell in reporting on screening rates and insurance ratings (who covers what? Are polypectomies included?) needs to take place. Public awareness needs to be drawn to our cause. If people understand that they can avoid cancer by getting a colonoscopy; and if they understand that early detection leads to a very high likelihood of survival while the alternative is not only expensive but often lethal perhaps we’ll see a meaningful change in screening rates.

 

01/25/2010 - 18:17

Evidence-Based Colorectal Cancer Screening
 
Having become familiar with colorectal cancer screening issues over the past year, the need for evidence-based guidelines and sound reimbursement policies, in my opinion, are more important than ever. It has been surprising to me how some screening and reimbursement policies are driven by ad hoc data or economic interests that don’t always focus on the patient’s best interests. Colorectal cancer still is the second leading cause of cancer deaths in the United States. Health plans and other payers need to promote a multi-tiered approach to preventing colorectal cancer. With emerging screening and care options, it is important to establish evidence-based protocols to establish the appropriateness of any particular intervention. Having read several peer-reviewed journal articles recently on sedation options for patients who are getting screened, I have been taken aback by some stakeholder groups that do not always appear to put patient-safety concerns first.  By working together and for the common good, we can literally save thousands of patients’ lives as new screening and treatment options are made available.  However, in the same vein, we need to be careful not to jump on the latest fad. Establishing evidence-based approaches are an important first step. Supporting appropriate, timely and consistent reimbursement policies is also essential – along with keeping patients’ educated on their ever-changing screening and treatment options. Please contact Preventing Colorectal Cancer.Org to see how you can get involved in promoting a fair public policy debate that creates sound coverage policies. 
 
Garry Carneal, JD, MA
PCC Board Member
 

01/14/2010 - 14:56
Preventing Colorectal Cancer.Org is working together with C3 (Colorectal Cancer Coalition) advocates to fight for increased federal spending on Colorectal Cancer education, screening and research. The three day event (3/15-18) is called ‘Call on Congress’ and it includes briefings on current issues facing the colorectal cancer community from leading experts and Members of Congress.
 
Last year, two of our doctors presented at the ‘advocate training’ day in Alexandria, VA, and also at a Capitol Hill briefing. It was an exciting experience and we hope to have another successful event this year.
 
 
Regan Weaver,
PCC Project Coordinator

 

 
 
 
 
 
 
 
 
 

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