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New guidelines offer hope for bewildered cancer patients
In this story:
May 30, 1997
Web posted at: 12:09 a.m. EDT (0409 GMT)From Correspondent Dan Rutz
LAWRENCEVILLE, Georgia (CNN) -- Ten years after Mary Ann Hayes' was apparently cured of cancer, it showed up again last summer. She's been on an emotional roller-coaster since.
It's not just the disease, which would be enough for most people to worry about by itself. What has made her condition even more difficult is the conflicting advice she has gotten from doctors, and the difficulties she has encountered with the insurance companies.
When the cancer returned, it showed up in Hayes' bones. Doctors said a bone marrow transplant was her only hope.
When her insurance companies refused to pay for the treatment, claiming it would do no good, the doctors changed their minds.
Which left Hayes confused, angry, and more than a little distrustful.
"I don't especially think the insurance companies are just letting people die," Hayes said. "I don't know. But I know that they have guidelines and that's what they intend to go by, and they don't intend to step out of them for any exceptions."
UCLA uses panel of 150 experts
Hayes suspects the reason she was refused by the insurance company was money, not her well-being. And she's grown suspicious of her doctors, too. The same doctor who first urged her to get a bone marrow transplant now says he agrees with the decision to hold off.
"If the bone marrow was not something I needed," she said, "then I should have never been told..."
There may at last be hope for people like Hayes caught in similar medical cross-fires.
Dr. Robert Figlin of the University of California at Los Angeles and a team of 150 experts have come up with state-of-the-art cancer guidelines for the seven most common malignancies, including breast cancer.
"It talks about the appropriate use of transplantation in advanced disease breast cancer," says Figlin. "It talks about where it's not helpful."
Figlin says the UCLA guidelines can help assure both patients and doctors that refusals by HMOs and other insurance companies are based on good medicine instead of cost.
'It's what's fair for the patient'
"My personal position," says Figlin, "is it's what's fair for the patient. They're the people with cancer."
Bone marrow transplants aren't just expensive, they're risky. And in cases such as Hayes', the UCLA guidelines don't recommend it unless standard drugs control her cancer first.
If Hayes' doctors really do agree, she wishes they'd made that clear from the start.
"If they had not told me that was what I needed," she says, "I would have never wanted a bone marrow transplant."
UCLA's guidelines are not binding on insurance companies, and may even support their decisions. But they can also help patients who are unreasonably denied care.
And in cases like Hayes', they might even prevent the kind of misunderstanding that leads to false hope and distrust.
Related stories:
- HMOs: The cost of cutting prices - May 23, 1997
- Are HMOs the wrong prescription for patients? - April 2, 1997
- Poor and elderly do worse in HMOs - October 1, 1996
- Critics say HMOs hiding facts to save bucks - May 31, 1996
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