Word: transplanter
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Geisbush is not alone. In the past decade, more than 12,000 American women have taken their chances with transplant therapy, in many cases only after battling their insurers to make sure the bills got paid. Lately, public opinion--plus a few multimillion-dollar lawsuits--had begun to change that. Ten states require insurers to cover transplants; most health plans elsewhere in the U.S.--seeing which way the legislative wind was blowing--have decided to go along too. Patients know, however, that a company that makes up its mind to offer coverage can later change it, and that laws requiring...
That's why cancer advocates and the insurance industry were so anxiously awaiting last week's release of the most definitive studies yet undertaken to evaluate the treatment. The news, on its face, was not good. Transplant therapy, the studies suggest, may not improve survival odds any more than traditional therapy. The findings, however, are preliminary, and further study may overturn them altogether. By week's end, all that was certain was that an already heated debate would get hotter still and that patients who want the therapy are not giving up hope. "With this treatment," says Geisbush, "at least...
Some insurers, however, had long dug in their heels over transplant therapy, and last week's announcement may make them dig deeper still. The five new studies looked at two types of breast cancer: high-risk cases, in which the disease has spread to 10 or more lymph nodes; and metastatic cases, in which it's migrated even further. Of the three studies that focused on high-risk cases--surveying a total of 1,462 breast-cancer patients--only one found a statistically significant advantage for transplant therapy. The two studies that focused on metastatic disease showed no real advantage...
...that's where things get muddy. It took experimenters years to collect the volunteers they needed to give their findings any statistical oomph--in part because women didn't want to risk being in the half of the sample group that received conventional therapy instead of the transplant. Over that time, transplant methods improved, and it is thus possible that higher mortality rates from women earlier in the research are dragging down more positive results from women later on. For now, the only answer appears to be more and better studies...
...insurers will react to all this is unclear. US Healthcare (now merged with Aetna) and some Blue Cross/Blue Shield plans helped bankroll three of the recent studies, an act of good corporate citizenship that seemed to signal a willingness to keep paying for transplant treatments in breast-cancer cases. A doctor working with Kaiser-Permanente, the nation's largest HMO, offers more direct reassurance. "It will be up to the doctor and the patient," predicts oncologist Louis Fehrenbacher...