Correspondence

Insurance Payments for Bone Marrow Transplantation in Metastatic Breast Cancer

N Engl J Med 2000; 342:1138-1139April 13, 2000

Article

To the Editor:

Autologous bone marrow transplantation has been a controversial treatment for metastatic breast cancer. Proponents of the procedure have pointed to studies indicating an increase in disease-free survival with this approach, whereas others have suggested that the improved survival has been due to patient selection.1

From 1996 through 1998, the number of requests for autologous bone marrow transplantation for metastatic breast cancer received by Anthem Blue Cross increased from 64 per year to 83 per year. Two important events occurred in May 1999: the company expanded the indications for autologous bone marrow transplantation for metastatic breast cancer to include stage II (four or more positive nodes) through stage IV disease, rather than stage IV alone, and the results of several trials of autologous bone marrow transplantation were presented at the annual meeting of the American Society of Clinical Oncology. Those trials, which included the two largest randomized U.S. studies ever conducted, showed that autologous bone marrow transplantation had no advantage over conventional cancer therapy.2,3 The results were widely reported in the media.4

In the months that followed, we at Anthem Blue Cross saw a considerable drop in the number of requests for autologous bone marrow transplantation for metastatic breast cancer. Whereas one would expect that the volume of requests would increase with a broadening of the indications for the procedure and that the distribution of requests would be randomly distributed according to month, we saw an abrupt drop-off in requests by June 1999. The total number of requests in 1999 was 42, as compared with 83 in 1998. In the last five months of 1999, there were only four requests for the procedure. Given that our membership increased by 200,000 members in 1999 and that there were no other important changes in benefits or patterns of care, we are left with the conclusion that the negative trial results are responsible for this change.

Derek van Amerongen, M.D.
Anthem Blue Cross and Blue Shield, Mason, OH 45040

4 References

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   Garcia-Carbonero R, Hidalgo M, Paz-Ares L, et al. Patient selection in high-dose chemotherapy trials: relevance in high-risk breast cancer. J Clin Oncol 1997;15:3178-3184
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   Peters WP, CALGB, et al. A prospective, randomized comparison of two doses of combination alkylating agents (AA) as consolidation after CAF in high-risk primary breast cancer involving ten or more axillary lymph nodes (LN): Preliminary results of CALGB 9082/SWOG 9114/NCIC MA-13. Presented at the 35th Annual Meeting of the American Society of Clinical Oncology, Atlanta, May 15–18, 1999.
   

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   Stadtmauer EA, O'Neill A, Goldstein LJ, et al. Phase III randomized trial of high-dose chemotherapy (HDC) and stem cell support (SCT) shows no difference in overall survival or severe toxicity compared to maintenance chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) for women with metastatic breast cancer who are responding to conventional induction chemotherapy: the `Philadelphia' intergroup study (PBT-1). Prog Proc Am Soc Clin Oncol 1999;18:1-a abstract.
   

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   Eddy DM, Henderson C. A cancer treatment under a cloud. New York Times. April 17, 1999:A26.
   

Citing Articles (3)

Citing Articles

1. 1

   Sigrid Droste, Annegret Herrmann-Frank, Fueloep Scheibler, Tanja Krones. (2011) Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: A systematic literature review. BMC Medical Ethics 12:1, 6
   CrossRef

2. 2

   Diana E Lake, Clifford A Hudis. (2004) High-Dose Chemotherapy in Breast Cancer. Drugs 64:17, 1851-1860
   CrossRef

3. 3

      . (2001) Vergelijking van conventionele chemotherapie met hoge-dosis chemotherapie plus stamceltransplantatie bij gemetastaseerd mammacarcinoom. Medisch-Farmaceutische Mededelingen 39:9, 180-181
   CrossRef