SUSAN E. KELLY AND BARBARA A. KOENIG
Dose Chemotherapy for Breast Cancer:
How Social Context Shapes the
Assessment of Innovative, Aggressive,
and Lifesaving Medical Technologies
In 1995, two women at Dana-Farber Cancer Institute were given accidental overdoses of chemotherapy as they underwent experimental high-dose treatment for metastatic breast cancer. One woman died, the other was seriously injured. 1 The goal of high-dose chemotherapy is to kill the maximum number of cancer cells; the drugs used are so potent they destroy not only the malignant cells but the patient's own blood-producing system as well. Even at conventional levels, the drugs given are highly toxic. Experimental high‐ dose chemotherapy requires doses so large the patient must subsequently be "rescued" by infusion of new bone marrow or blood-producing stem cells. Breast cancer patients risk death in order to buy a chance at cure. The mistaken doses of chemotherapy at Dana-Farber tragically highlight the tension between hope for cure and the destructive potential of aggressive, potentially lifesaving therapies. If desperate women—and their physicians—are willing to take such risks, how can new therapies such as bone marrow transplant for breast cancer be evaluated? Innovative, dramatic, and lifesaving technologies hold special cultural appeal in the United States. What features of this unique social context shape the technology assessment process?
High-dose chemotherapy for breast cancer is but one of many experimental technologies that have been widely adopted for use against life-threatening illness while their safety and effectiveness are still in question. A recent press release from the National Cancer Institute begins, "Thousands of breast cancer