Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, May 28, 1994 TAG: 9405310124
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: By LAURA WILLIAMSON STAFF WRITER NOTE: below
DATELINE: LENGTH: Long
Two children run in and out of the living room, pressing their fingers against newly washed sliding glass doors. Dana Garman shifts her restless infant in her lap, sticks a pacifier in the baby's mouth and smiles at her impish brood.
As the children play, she speaks unemotionally about the cancer that threatens to destroy her body and force her young family into debt.
"I thought you remove the breast, and you're cured," she said. "It's not that easy."
Garman, 33, discovered a massive lump in her left breast while feeding her youngest child. Doctors removed the breast- robbing the baby of her mother's milk- only to discover a dozen cancerous lymph nodes nearby. Further testing showed the cancer had spread to her liver, a condition that almost always proves fatal.
Dana Garman's life depends on a bone marrow transplant, the most aggressive cancer treatment available. The procedure may extend her life a few years, but it will rob her family of its future.
Bone marrow transplants cost as much as $100,000- and the Garmans' insurance won't cover it.
That's not surprising. At least 16 insurance companies in Virginia do not provide coverage of the expensive, potentially life-saving procedure because it's still considered experimental. The lack of coverage prompted the General Assembly to pass a law this year forcing insurance companies to offer coverage of transplants for breast cancer patients starting in January.
Bone marrow transplants are recommended for breast cancer patients when cancer has spread to another part of the body or when 10 or more lymph nodes under the arm show evidence of cancer. The more cancerous lymph nodes there are, the higher the chances of the cancer spreading or recurring, said Dr. William Fintel, Garman's oncologist.
Dana Garman qualifies for a transplant under both scenarios. But the recently passed law won't help her.
Even if she could wait for it to go into effect, she still wouldn't be covered.
Garman, a Craig County school bus driver, gets her insurance through her husband's employer. Frank Garman works for the state, which, because of a federal loophole, doesn't have to supply the insurance benefits it forces others to provide.
"We enjoy an exemption from state insurance laws," said Tony Graziano, acting director of the Office of Health Benefits. "The change in the law doesn't affect us, but they are considering offering it."
In fact, the change in the law affects only about one-third of those covered by health insurance in Virginia. When the state forces insurance companies to pay for health benefits, it can't touch companies that are self-insured, because federal laws protect them.
The state, like most large employers in Virginia, is self-insured. But self-insured businesses aren't the only ones that may slip past the mandate. The new law merely requires insurance companies to offer coverage of bone marrow transplants for breast cancer patients. It doesn't require employers to buy it.
Blue Cross/Blue Shield of Virginia has been offering a supplemental insurance policy to cover transplants for breast cancer patients for two years, Public Affairs Director Jim Goss said. Of 22,000 groups that buy insurance through them, 178 have purchased this type of policy, covering 38,000 Virginians.
Blue Cross does not offer its supplemental policy to individual subscribers but is awaiting state permission to do so.
The state's largest insurer doesn't include coverage of this treatment in its regular policies, Goss said, because it has not yet been proved effective. Cost, he added, is not the issue.
Del. Mary Christian, D-Hampton, who sponsored the bone marrow transplant bill, said it would cost about $2.85 per month per person to offer this policy to groups of 50 or more employees. Groups smaller than 50 would pay about $5 per month per insured person. Individual policyholders would pay about the same.
Goss said Blue Cross/Blue Shield companies in several states were contributing to a five-year research study with the National Cancer Institute to compare the effectiveness of bone marrow transplants with chemotherapy, a more traditional method of treating breast cancer.
In Virginia, the Blues put up $3 million to include women from across the state in the study, which is now in its third year. Women eligible for the study will be treated at no charge, Goss said.
Dana Garman applied for the program but was told she was ineligible because she had already received chemotherapy. Participants in the study are randomly treated either with chemotherapy or with bone marrow transplants, but not both.
Of 34 Virginia women who inquired about the study, 17 were evaluated and six declared eligible, Goss said. Of those, four are receiving treatment. Nationally, 84 women are being treated through this study.
According to the North American Autologous Bone Marrow Transplant Registry, the number of women in the United States and Canada receiving transplants is going up, from 261 in 1989 to 893 in 1992. At the same time, the number of women dying after receiving transplants is going down: mortality rates within three months of transplants dropped from 22 percent in 1989 to 6 percent in 1992.
Bone marrow transplants allow doctors to administer much higher doses of chemotherapy, Fintel said, allowing them to kill more cancer cells.
When Dana Garman undergoes the procedure in several weeks, doctors will "harvest" her stem cells- needed to generate new blood cells- by drawing blood from one of her arms, separating and freezing the stem cells, and returning the rest of the blood to her body through her other arm.
They will repeat the procedure until they have enough stem cells to replace the blood in her body. After they freeze the stem cells, they will treat Garman with potentially lethal doses of chemotherapy to try to kill the cancer cells in her body. The procedure also kills the bone marrow, destroying her ability to produce new blood cells.
Doctors will transplant Garman's frozen stem cells into her body and keep her in a sterile room while her body replaces the destroyed blood cells and rebuilds its immunities, said Dr. Saul Yanovich, who will perform the procedure on Garman at the Medical College of Virginia in Richmond.
The procedure is expensive because patients must stay in the hospital for several weeks to recover. Stem cell transplants, a relatively new procedure, are less expensive than removing all of the bone marrow, he said, because the recovery period is shorter.
Garman's transplant could be as relatively inexpensive as $60,000, he said, compared with $120,000 for a complete bone marrow transplant.
But the Garmans are counting on a bill of $80,000 to $100,000, based on an estimate they received from the medical college. Without insurance to cover it, they've been trying to raise money privately and have come up with more than $25,000 from local church groups, friends and a hospital bowl-a-thon.
The Garmans have to give the medical college $13,500 up front, and they can pay off the rest over time. That's a relief, Dana Garman said, but it also means that they can't afford to build an addition to their house for her son and two daughters- who all share the same room- or to put money aside for their children's college educations.
"We'd like to offer them another bath and a bedroom before they start dating," she said.
Her positive outlook weakens at the thought of not being there to see that day.
"I try not to dwell on the kids' living without me," she said, a tear glistening in the corner of her eye. Her oldest, Matthew, is 5. Martha is 2, and Kelly, 1.
Looking comfortable in jeans, a striped pullover shirt and a pair of white sneakers, Dana Garman gives little hint that her life is in danger. Only the blue scarf covering her scalp, stripped of her once-curly gray hair by repeated doses of chemotherapy, warns that something is very wrong.
"When you feel good," she said, "it's easy to forget."
by CNB