Change of Address Changes Outlook for Brain Cancer Patient

"It worked beautifully," said Malkin, chief of neuro-oncology at Froedtert Hospital. "Her tumor just went away. She went into remission and stayed in remission for nine years."

Over those nine years Medicare picked up the cost of the drug, which now runs about $8,000 a month without questioning it, Malkin said.

Brain scans were done every few months and each time remission was confirmed. Each time there was no sign of the tumor. Medicare continued to pay for the drug.

Malkin, a professor of neurology at the Medical College of Wisconsin, said he has no doubt that the tumor's disappearance was caused by the interferon.

"You don't see spontaneous remissions with this disease," he said.

Now, Malkin estimates that Oertel has less than five months to live if she doesn't get treatment with interferon.

She has been receiving other treatments that are covered by Medicare, but the tumor remains.

The prospect of getting Medicare approval for interferon is looking as grim as Oertel's prognosis.

Not that Malkin hasn't tried.

Over the last several months, Malkin has made calls and sent emails to a cast of officials, hoping that someone would be able to intercede and get the drug approved.

He has contacted both U.S. Sens. Herb Kohl and Russ Feingold from Wisconsin, Oertel's congressman, Thomas Petri, her state senator and assemblyman, the state Commissioner of Insurance, the private company that administers Medicare in Oertel's area and the Medicare office in Chicago - all without success.

His office also contacted Biogen, the maker of interferon (Avonex) to see if it would supply the drug for free on the grounds of medical hardship. That too was denied because the drug was being used for someone who was not diagnosed with MS.

In a February email to Petri's office, Malkin said Oertel's case illustrates some the problems with health care now being debated in Washington.

"I have been practicing neuro-oncology for more than 20 years, yet decisions I wish to make on behalf of my patients are second-guessed or outright denied by representatives of insurance carriers who cannot even pronounce the name of the tumor I am treating," he wrote.

"My staff and I spend hundreds of wasted hours trying to obtain authorizations and appealing wrong decisions when we could be treating patients."

In a given year, Malkin said, his office appeals cases for dozens of patients. That out of about 200 new brain cancer patients he sees each year.

ASCO's Lichter said Malkin's story is not unique, but the but the issues are not always clear cut.

On the one hand, he said, are doctors who may have a "boundless urge to save their patients."

On the other, are the insurance companies that must use good sense and not rubber-stamp every request for an expensive, unproven drug.

Insurers have to balance the needs of one patient against those of millions of people who pay premiums, he said.

"We wouldn't be talking about this if these were $10 generics," Lichter said.

Cancer cases often are the most troublesome when it comes to cost vs. benefit.

In recent times, the cost of cancer medications has shot up 14% a year, according to a January study in the journal Health Affairs.

The expense of these new cancer therapies, which often produce an added survival benefit that is at best measured in weeks or months, has been the subject of national debate in and out of medicine.

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