Is the prospect of getting a colonoscopy less dreadful if you know you'll be knocked unconscious during the big event? The majority of patients in a small survey said yes, but some experts argue that it's the pre-procedure bowel cleansing that generally makes people put off getting the test, not the screening itself.
Whichever it is, removing barriers to screening is important. Even though colorectal cancer screening is recommended for people starting at age 50 and every 10 years thereafter, only about half of people who should be screened get the test. As I've written before, roughly half of states require insurance companies to cover colon cancer screening, whose cost generally ranges from about $1,000 to $3,000.
With people paying more out of pocket for healthcare these days, cost considerations may come into play when it comes to sedation. Traditionally, patients have been given drugs that put them into "twilight" or "conscious" sedation, in which they're out but can still move and respond to voice commands. This sort of sedation is typically given by the gastroenterologist or a nurse anesthetist, and the cost is included in the physician's fee, which typically runs about $700, says Steven Frank, a staff anesthesiologist at Greater Baltimore Medical Center and the lead author of the study, the results of which were presented at the Annual Meeting of the American Society of Anesthesiologists on Saturday. Some doctors now offer deeper sedation to patients, however, and an anesthesiologist must be present to administer the drug and monitor the patient, adding anywhere from $150 to $400 to the cost, says Frank. (In either case, a facility fee adds roughly an additional $950 to the total, he says. Prices will vary depending on geographical region, insurance, and other factors.)
Both methods of sedation are medically acceptable; the choice is left up to the physician performing the procedure. Sedation practices vary by region, however, according to Frank. In the Northeast, the proportion who receive full vs. conscious sedation is split about 50/50. But in the West and mountain states, where anesthesiologists are more scarce, only about 15 percent of patients receive full sedation when they undergo an endoscopic procedure, he says.
Frank and his fellow researchers identified 155 patients at Greater Baltimore Medical Center who had had endoscopic procedures performed since 2003 with both conscious sedation and full sedation. Seventy-eight percent of the 93 who responded said they preferred total sedation, and 80 percent say they would be more likely to have a colonoscopy for routine cancer screening if knew they'd be completely asleep during the procedure.
"It's not often that anesthesia can contribute to reducing morbidity and mortality," says Frank. But if people have fear and anxiety over pain, telling them that they're going to be asleep [during a colonoscopy] might encourage more people to get tested for colon cancer."
Anything that encourages people to get recommended screening is a plus, say experts. But some aren't convinced that sedation is or need be a key factor. "It's interesting what these researchers have found," says Dorado Brooks, the director of colorectal cancer for the American Cancer Society. "But the vast majority of patients who undergo a colonoscopy with conscious sedation have no pain or discomfort. When you ask them if they're willing to have the test again, they say they are."