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False Hope: Bone Marrow Transplantation for Breast Cancer

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In the late 1980s, a promising new therapy 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 quickly before having been meticulously evaluated. By the time published research showed that the process was ineffective, much more than 30,000 ladies had received the treatment, shortening their lives and adding to their suffering. This book tells of the rise and demise of HDC/ABMT f

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3 responses to “False Hope: Bone Marrow Transplantation for Breast Cancer”

  1. u know who Avatar
    u know who
    1 of 1 people found the following review helpful
    5.0 out of 5 stars
    excellent discussion of the breast cancer transplantation experience, October 8, 2011
    By 

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    This review is from: False Hope: Bone Marrow Transplantation for Breast Cancer (Hardcover)

    I highly recommend this book to anyone interested in learning more about the history of hematopoietic cell transplantation for breast cancer. As an oncology fellow, I was generally aware that we used to do autologous transplants for breast cancer, but then found out they don’t work, and we don’t do them any more. However, I didn’t really know much more than that. People don’t talk about it. This book is an excellent reference, presenting the development and widespread uptake of the procedure from multiple perspectives. The story of breast cancer transplantation has implications for current health care policy. We all see the writing on the wall that we will need to trim the fat from our practices- minimize over- and underutilization of resources. This story is a reminder that we need good quality evidence to support our choices. A great read for those of us in the medical profession, as well as anyone interested in health care policy. At times it reads a little bit like a report, and you can tell that multiple authors contributed based on slight differences in writing style. However, overall, the book is a very engaging read.

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  2. nz Avatar
    nz
    1 of 1 people found the following review helpful
    3.0 out of 5 stars
    Important reading, but a little tedious, December 31, 2008
    By 
    nz (USA) –

    This review is from: False Hope: Bone Marrow Transplantation for Breast Cancer (Hardcover)

    Similar to the NEJM review, I think the book had a little bit of a “I told you so attitude”. As a budding oncologist though, it is an absolutely fascinating story and important to learn about. There is definitely a lot of name dropping — even names a young physician can recognize. The story is easily applicable to other new, expensive, unproven technologies ready to be unleashed.

    On content, I think the book would have benefited if it addressed the technical questions more thoroughly and perhaps been a little less gossipy. A more thorough chapter devoted to the differences between Phase II and Phase III randomized trials — something more technical, and co-written with an epidemiologist would have been beneficial (chapter could have also included a discussion on biomarkers and end points). Also, there was a lot of inside-baseball on the procedure from the oncology community — but we don’t hear anything at all regarding financial analysis run by insurance companies on the procedure. We only hear details regarding the technology assessments. I also though that it was hard to understand the problem they are trying to address — access vs. evaluation — without a result from the other side (i.e. a contested treatment that was denied while being evaluated, but wound up being helpful — e.g. AIDS drugs in trials?). This was tangentially mentioned, but not really adequately compared to.

    The last chapter on their solution to the problem was poorly done and I think would have tremendously benefited from feedback from people who are a little more critical. First — their explanation for the failure of medical journalists sounds reasonable — just like HDC to cure breast cancer sounds reasonable — but if you think about the stellar job journalists did on WMDs and the financial crisis — it seems more like a deeper institutional problem with journalism itself, then minor technical problems with medical journalism in particular that resulted in shoddy reporting. Second, there are some rather inflamatory comments in this part, that are contradicted by other parts of the book (e.g. Duke having a financial incentive to put people on HDC/ABMT — even though they mention Peters insisted everyone went on a Trial (as the authors suggest should be the case)). Also suggesting ASCO do more in terms of patient advocacy while ignoring other institutions that already issue guidelines and seem more prone to that kind of work, such as the NCCN — seems like a blunder. There is no clear explanantion why ASCO is in a better position than the NCCN.

    Only other stylistic point would be it gets a bit redundant at times.

    Overall a good read, if a little tedious, — especially for future oncologists or anyone in medicine.

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  3. Gerald Rogan "Dr. Jerry" Avatar
    Gerald Rogan “Dr. Jerry”
    1 of 1 people found the following review helpful
    5.0 out of 5 stars
    Where is the evidence?, December 24, 2008
    By 
    Gerald Rogan “Dr. Jerry” (Sacramento) –
    (REAL NAME)
      

    This review is from: False Hope: Bone Marrow Transplantation for Breast Cancer (Hardcover)

    False Hope explains how high dose chemotherapy and bone marrow transplant (HDC-BMT) was blocked by insurers because there was not enough evidence to show an improved survival benefit. Leading oncologists promoted it because of improved progression free survival and overall response rate, and the patient was facing death.
    Only one insurance company supported evidence development with a grant. Eventually the evidence showed HDC-BMT was no better than regular chemotherapy but the death rate from the HDC-BMT was 15%. Eventually HDC-BMT was abandoned, but not until thousands of patients received no incremental benefit from the high dose treatment, while some died faster, and billions of dollars was wasted.
    False hope is essential reading for insurance coverage decision makers and those interested in the details of health care policy and cost. The book draws us to think about the benefit and risk our new evidence-based coverage paradigm poses with respect to technology enhancements of existing treatments. False Hope helps us better understand how we can spend much more for health care in the U.S. without improving its value.
    It paradoxically explains how blocking coverage by insurers can actually cost them more than if they were to allow coverage with evidence development.

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