dras knowledge

Saturday, April 20, 2002

HDC SCS for breast cancer; a condensed history

Author's note: This is one the first posts I devote to making a point about politics in healthcare.

Has anyone ever heard of High Dose Chemotherapy with Hematopoietic Stem Cell Support for Breast Cancer? It’s basically heavy-duty chemotherapy followed by bone marrow transplants for the treatment of breast cancer. Through the 1990’s private payers refused coverage because nothing was showing it really helped. Despite this, the politics within medicine allowed an empire to be built around the treatment. You can well imagine how easy it was to get various legislation in the books requiring private payors to have no limitation or exclusion to coverage. This treatment became some cancer center's bread and butter. Today, this treatment is only done under well-controlled clinical trials and other extenuating circumstances. Why? Scientists and scholars published the body of evidence that had been loudly speculated to exist: NEJM 2000; 342(15): 1069-76. Not only did the treatment not help in most cases, patients typically did worse than those in the control group.