False Hope: Bone Marrow Transplantation for Breast Cancer
Oxford University Press, Jan 25, 2007 - Medical - 368 pages
In the late 1980s, a promising new treatment for breast cancer emerged: high-dose chemotherapy with autologous bone marrow transplantation or HDC/ABMT. By the 1990s, it had burst upon the oncology scene and disseminated rapidly before having been carefully evaluated. By the time published studies showed that the procedure was ineffective, more than 30,000 women had received the treatment, shortening their lives and adding to their suffering. This book tells of the rise and demise of HDC/ABMT for metastatic and early stage breast cancer, and fully explores the story's implications, which go well beyond the immediate procedure, and beyond breast cancer, to how we in the United States evaluate other medical procedures, especially life-saving ones. It details how the factors that drove clinical use--patient demand, physician enthusiasm, media reporting, litigation, economic exploitation, and legislative and administrative mandates--converged to propel the procedure forward despite a lack of proven clinical effectiveness. It also analyzes the limited effect of technology assessments before randomized clinical trials evaluated decisively the procedure and the ramifications of this system on healthcare today. Sections of the book consider the initial conditions surrounding the emergence of the new breast cancer treatment, the drivers of clinical use, and the struggle for evidence-based medicine. A concluding section considers the significance of the story for our healthcare system.
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ABMT Accessed adjuvant Antman argued ASCO audit autologous bone marrow BCBSA benefit Bezwoda bone marrow transplantation Breast Cancer Action breast cancer patients CALGB CalPERS Cancer Center cancer treatment chemotherapy with autologous Clin Oncol Clinical Oncology contract conventional treatment court cyclophosphamide disease dose chemotherapy drugs ECRI effectiveness enrolled ERISA evaluation evidence experimental treatment federal groups HDC/ABMT for breast HDC/ABMT procedure health insurers health plans HealthNet Henderson high-dose chemotherapy high-risk breast cancer Hospital Interview by RA investigational involved issue litigation lymph nodes managed mandate McGivney medical procedures medicine metastatic breast cancer National Cancer Institute oncologists Oncology outcomes overall survival participate patient care costs Peters phase 2 studies phase 3 trials plaintiffs protocol RA Rettig randomized clinical trials randomized trials regimen reported response scientific standard stem cell technology assessment toxicity treatment of breast tumor Weiss women’s health