The Last Resort

Tawnya Geisbush wakes up every day fighting two battles--one against breast cancer, the other against her insurance company. It's hard to say which is the more stubborn opponent.

Geisbush, 32, a veterinarian from Phoenix, Ariz., was recently found to be suffering from metastatic breast cancer, an especially aggressive malignancy that had already ranged well beyond the site of the original disease. Eventually she and her doctors agreed they should attack the advancing cancer with what many people believe is the most potent weapon available: high-dose chemotherapy accompanied by a transplant of stem cells, precursors of disease-fighting immune-system cells.

No sooner did she steel herself for the procedure, however, than her insurer, the Trustmark Insurance Co., made things more complicated. Since the $90,000 treatment was still considered experimental, it was ineligible for coverage under the terms of Trustmark's policy. "Whether it's a $100,000 charge or a $10 charge, we make our decisions based on that contract language," says Lloyd Sarrel, Trustmark's assistant vice president for benefits. Geisbush, understandably, has bigger things than contracts on her mind. "I'm in a fight for my life," she says. "I shouldn't be having this fight with the insurance company."

Geisbush is not alone. In the past decade, more than 12,000 American women have taken their chances with transplant therapy, in many cases only after battling their insurers to make sure the bills got paid. Lately, public opinion--plus a few multimillion-dollar lawsuits--had begun to change that. Ten states require insurers to cover transplants; most health plans elsewhere in the U.S.--seeing which way the legislative wind was blowing--have decided to go along too. Patients know, however, that a company that makes up its mind to offer coverage can later change it, and that laws requiring reimbursement can always be rewritten.

That's why cancer advocates and the insurance industry were so anxiously awaiting last week's release of the most definitive studies yet undertaken to evaluate the treatment. The news, on its face, was not good. Transplant therapy, the studies suggest, may not improve survival odds any more than traditional therapy. The findings, however, are preliminary, and further study may overturn them altogether. By week's end, all that was certain was that an already heated debate would get hotter still and that patients who want the therapy are not giving up hope. "With this treatment," says Geisbush, "at least some people have survived."

Battling cancer with immune-system transplants is a straightforward--if searing--procedure. Used only with the most lethal cancers, it involves flooding the body with toxic chemotherapy drugs in an effort to overwhelm the malignancy. While the drugs do kill cancer cells, they also destroy most of the disease-fighting cells in the immune system. That's why doctors harvest marrow cells from the bones or stem cells from the bloodstream--both of which give rise to new immune cells--before they begin chemotherapy. When the treatment is done, these cells are reinfused into the body, in the hope that the immune system will rebound. Punishing as the therapy is, advocates say it can work, and patients are clamoring for it--but at no small price. In the U.S., well over half a billion dollars may have been spent on breast-cancer-related transplants in the past 10 years.