How do lifestyle factors and exposure to environmental substances affect our cancer risk?
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by sarcomatexas - March 08, 2010
Hi, my wife was diagnosed by our local health care provider with a soft-tissue sarcoma in the breast in January. Due to the rareness of this type of cancer we decided to obtain a second opinion from MD Anderson Cancer Center, for several reasons, one they are in our backyard (we live less than 100 miles away, but also because they are the best (ranked # 1 four out of the last five years). Our insurance provider refuses to refer us "in-network" because they feel like they can "handle it." Our appeal is this Friday and we are desperately trying to put together a strong enough case with evidence demonstrating that she is much better hands at MDACC since Scott & White doesn't even have a soft-tissue sarcoma specialist.
I've found several case studies that support cancer centers above hospitals, but need more and searching is taking forever. If anyone can point me in the right direction where I can gather more data for our appeal I would be greatly appreciative. Here's my wife's story.
I am a wife and mother of four young children ages 4, 6, 8. & 10 and I am currently fighting a rare form of sarcoma cancer in my breast. The hardest fight though, is not against the cancer itself but against my insurance carrier, Scott and White Health Plan. There is no provision in my contract for treating this rare and aggressive type of cancer and because my network doesn't have a specialist or qualified sarcoma surgeon, I was referred to a general surgeon who recommended an emergency mastectomy just days after I was diagnosed. I was told that once the mastectomy was performed I would be cancer free as sarcoma rarely reacts to chemo or radiation. Fortunately, my husband and I decided that since we live so close to MD Anderson Cancer Center in Houston we would try to get their expert opinion on this treatment. Unanimously, every doctor I spoke with affiliated with MDACC advised me to have surgery by a sarcoma specialist. It took many fights with Scott & White (S&W) just to be allowed to have their "second opinion" and the opinion we got from them was radically different than that we received from the general oncologist and general surgeon at S&W. The sarcoma experts at MDACC believe I may not have a true sarcoma but a rare form of cancer called sarcomatoid carcinoma which is actually a mix of sarcoma and carcinoma and can be treated by chemo and radiation. Last week, I had a segmental mastectomy and two sentinel nodes removed by Dr. Kelly Hunt at MD Anderson. We are still waiting on the final pathology report and we have a hearing scheduled Friday with Scott and White to determine if they will cover this procedure that I've already had as "in-network." My surgery was cancelled the day before it was supposed to happen because my carrier would only approve the out-of-network coverage at a rate of 50/50%. Our state representative, Fred Brown, took up our case and lobbied to MD Anderson to accept my lower rate of 50/50% (They typically only accept an insurance rate of 60/40). After completing their own independent investigation to determine if there was a qualified sarcoma surgeon in my network, they accepted our insurance at the 50/50 rate and I was able to have the surgery. MD Anderson concluded that there was not an adequately qualified surgeon in my network that could give me the same "standard of care" as the sarcoma team at MD Anderson. Scott and White is arguing that they can give me the same "standard of care" for this type of rare and aggressive cancer as I can get from a specialized department at MD Anderson, the best cancer center in the nation and the only sarcoma department in Texas. To read more about my story, please visit my website www.lisasmithblog.com We feel determined in our fight to get the best medical treatment that would give me the best chance at surviving for 50+ more years and we believe we will get that type of treatment at MD Anderson.
Recently diagnosed with sarcoma cancer possibly sarcomatoid carcinoma (tumor was removed a week ago) we're waiting on the results. www.gladchatter.com
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