Health Day

Only half of U.S. men and women older than 50 are getting screened for colorectal cancer, despite the success these tests have in reducing deaths linked to the disease, a new report says.

Still, the current rate of screening is an improvement from the 43 percent who received the tests back in 2000, the researchers noted. The statistics come from a national survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) in 2005. Experts discuss the findings in the July issue of Cancer Epidemiology, Biomarkers & Prevention.

“Colorectal cancer is one of the leading cancer killers in the United States, behind only lung cancer. Screening has been shown to significantly reduce mortality from colorectal cancer, but a lot of people are still not getting screened,” Jean A. Shapiro, a CDC epidemiologist, said in a news release issued by the journal’s publisher, the American Association for Cancer Research.

Insurance coverage may be part of the problem, Shapiro said. Only 24 percent of people lacking health insurance had colorectal cancer screening compared with more than 50 percent of insured Americans. “If we can increase the number of people who have health care coverage, we should be able to increase colorectal cancer screening rates,” Shapiro said.

Beyond health insurance, the researchers reported that people were far more likely to have had colorectal cancer screening tests if they were college educated, had a household income of $75,000 or more, and had seen their doctor at least twice in the previous year. Of those who saw their doctors in the past year, about half who did not receive testing said they had “never thought about it.” Another 20 percent said their doctor did not order the test.

“Many doctors are aware, but some may still need to be educated about the importance of colorectal cancer screening,” Shapiro said.

More than one-third of elderly patients on Medicare take a companion with them for routine medical visits.

And patients who are accompanied on such visits tend to be more satisfied with the visit, according to a study published in the July 14 issue of the Archives of Internal Medicine.

“I think it’s a fabulous idea [to have companions on medical visits],” said senior study author Debra L. Roter, a professor of health behavior and society at Johns Hopkins Bloomberg School of Public Health in Baltimore. “And we have a very good notion of interventions now, ideas that can help companions and patients prepare for their visit in a more proactive and effective way. The consequences seem to be especially valuable for those elderly people that we generally think of as most vulnerable, those who are the sickest, the oldest and the least well-educated. Those are the people who seem to benefit the most by having somebody with them.”

A previous study led by Roter had also indicated that it was common for older adults to take someone with them on medical visits, usually a spouse or adult child.

“We found that companions actually do lots of very helpful things for the patient, but our study was only one, and it was relatively small,” Roter said.

She and a colleague decided to do analyze a larger population of 12,000 community-dwelling Medicare beneficiaries aged 65 and older who had participated in a 2004 survey. Roter had actually written several of the questions for that earlier survey.

Many of the findings dovetailed with the earlier, smaller study.

Here, 38.6 percent of participants said they were usually accompanied on routine medical visits. Those accompanied were usually older, less educated, and in poorer health.

Companions could be spouses (53.3 percent), adult children (31.9 percent), other relatives (6.8 percent), roommates, friends or neighbors (5.2 percent), non-relatives (2.8 percent) or nurses, nurses aids, legal or financial officers (under 1 percent).

More than 60 percent of companions helped with doctor-patient communications by writing down instructions (44.1 percent), giving information on the patients’ medical conditions or needs (41.6 percent), asking questions (41.1 percent) or explaining doctors’ instructions (29.7 percent).

Patients who were accompanied on visits were 15 percent more satisfied with their doctor’s technical skills, 19 percent more satisfied with the doctors’ information-giving, and 18 percent more satisfied with their personal skills compared with unaccompanied patients.

“This tells us that this is a national phenomenon,” Roter said. “These patient companions are commonly very active, so they don’t just stay in the waiting room. They come into the exam room with the patients, and they’re active in the communication process in a helpful way.”

Study author Jennifer L. Wolff, an assistant professor of health policy and management at Bloomberg, hopes the findings will lead to more research on better ways to use companion visits to advantage.

“This study is important in terms of thinking about the role of the visit companion, both within the encounter and also outside the encounter,” she said. “We don’t have a very good understanding of roles that family caregivers play in medical processes. It would be very exciting to relate this to safety issues, for example, adverse drug reactions or issues around adherence to medications. Theoretically, it makes sense that when an older adult has a family caregiver who is actively engaged in the health-care process, there could be some beneficial outcomes.”

Another expert agreed but offered a note of caution.

“This has pushed the science to the next level by quantifying the findings, and by doing this for more people,” said Marcia G. Ory, a professor of social and behavioral health with the Texas A&M Health Science Center School of Rural Public Health in College Station. “It’s also looking at the functions of the companions.”

“There are implications for clinicians, for companion visitors as well as for the older patient him or herself,” Ory added. “Physicians need to know how to appropriately interact with the [companion visitor]. The companion visitor needs to understand what their role is. It’s also important for the message to go to the patient that the patient is ultimately responsible for their own health care, but they don’t do it in a vacuum. They live in families.”

“In the past, we’ve ignored the third party, but we don’t want the pendulum to swing and ignore older patients,” Ory said. “It’s that delicate balance that will get us the best quality of care.”

Every summer, an estimated 6,200 Americans are hospitalized for heat exposure. In 2005, about 180 of those people who were hospitalized died, according to the latest News and Numbers from the U.S. Agency for Healthcare Research and Quality.

Severe heat exposure, which is called hyperthermia, occurs when the body’s temperature rises to 106 degrees Fahrenheit or higher. Symptoms of heat exposure can include nausea, vomiting, weakness, headache and muscle cramps.

In severe cases, called heat stroke, victims may suffer from a rapid pulse, difficulty breathing, mental confusion, seizure and even a coma, according to AHRQ.

Those at highest risk are the poor, the elderly and people lacking health insurance, according to an AHRQ analysis. That analysis, based on 2005 data, found that:

• People who lived in communities where the average household income was less than $36,999 were hospitalized at twice the rate of people from wealthier areas where average household incomes exceeded $61,000.
• The rate of hospital admissions for hyperthermia for people without health insurance was significantly higher (17 percent) than hospital admissions for uninsured patients as a whole (5 percent).
• People 65 and older were hospitalized for hyperthermia at 15 times the rate of people age 17 and younger.
• Hospital admissions for hyperthermia in the South (3.1 per 100,000 population) were more than twice that of the Midwest and West (1.4 per 100,000 each). The Northeast had a rate of 1.7 per 100,000 for hyperthermia.