BONE-MARROW TRANSPLANTS: Study Results Likely to Fuel Debate
As rumors swirl that studies testing the efficacy of expensive bone-marrow treatments for advanced breast cancer are likely to show that the treatment is not effective, the American Society of Clinical Oncology has pushed up its disclosure deadline and is bracing for "a firestorm of controversy." Critics charge that some of the studies, begun nearly a decade ago, "are flawed, outdated or ambiguous," the Wall Street Journal reports. "Believers (in the high-dose therapy) will figure out how to make the (results) positive," said John Durant, executive vice president of the society. However, "[d]isbelievers will figure out how to make them negative," he added, underscoring the likely debate. The Journal reports that one study, sponsored by the National Cancer Institute, is "expected to show no clear-cut benefit at all," while the findings of a second NCI- funded study are expected to come under fire "because they are based on a drug regimen most doctors don't follow." Dr. William Peters of the Barbara Ann Karmanos Cancer Institute, who led one of the four unreleased studies, warns that "[n]o single study answers all the questions." Dr. Peters' study compares high dose therapy following the bone marrow transplant with low dose therapy of the same drugs -- "a regimen few doctors use as part of conventional treatment, preferring to use lower doses of different medicines," the Journal reports. The two U.S. studies, and others from South Africa and Sweden, are all expected to produce conflicting or at least ambiguous results, which "may give insurers new ammunition in their fight to stop covering the costly procedure" (Jeffrey/Waldholz, 3/24).
Waiting for the Word
While experimental treatments account for less than 2% of insurers' claims annually, bone marrow treatments -- including those for breast cancer patients -- are among the most commonly requested, according to an article in the March issue of Best's Review. "When a customer says he wants this, but there is no evidence to support it, you know you will fail in the marketplace if it isn't covered," said Dr. Lee Newcomer, senior vice president of health policy for UnitedHealth Group. Last year, UnitedHealth approved all 208 requests for the bone-marrow treatments for advanced breast cancer, according to the review, in part because denying such claims could precipitate costly settlements. Earlier this year, a California jury required Aetna U.S. Healthcare to pay $120 million to a woman whose husband was denied experimental chemotherapy treatments (release, 3/24).