Del. pays for residents' cancer treatment

DOVER, Del. - For years, odds were if you lived in Delaware you were more likely to die from cancer than people living in other states.

These days, living in Delaware may mean you're more likely to survive.

That's what former motorcycle club member Emma Fulton discovered when the state paid for her cancer treatment.

When doctors told her she had colorectal cancer, Fulton was 62 and had no health insurance. She turned to a new state program that pays for the cancer treatment of all uninsured residents diagnosed after 2004.

"If it wasn't for that program I'd be waiting to die," said Fulton, who is cancer-free three years after surgeons removed the upper part of her colon.

Fulton is one of at least 350 uninsured Delaware residents who have been provided the service - free cancer treatment for up to two years.

The idea for the program began in 2001, after newly elected Delaware Gov. Ruth Ann Minner heard that her tiny state had big cancer numbers, big enough to give it the sixth highest cancer mortality rate in the nation.

"As soon as I saw the numbers, I knew we had to do something," said Minner, whose first husband, Roger, died of lung cancer in 1991.

Over the following years, Minner, along with doctors and advocates, embarked on an ambitious program to offer free cancer treatment for all residents. The program is not just for low-income families - a family of four that earns as much as $122,525 can get free treatment.

Between July 2004 and June 2007, the Delaware Cancer Treatment Program paid for cancer treatment for 348 patients such as Fulton, costing an average $33,525 per person.

The program costs $16 million per year, with $11 million of that coming from the federal government.

Cancer experts in Delaware have praised the program, saying other states could replicate it.

But with less than a million residents, Delaware can undertake some programs that larger states cannot.

So far only Pennsylvania officials have come to look.

"We are doing things here that many said couldn't be done, or were politically unpopular, like our smoking ban," Minner said.

Minner, the state's first female governor, said she had to overcome the notion among Delawareans that the state's high cancer rate was caused by factors other than smoking, such as pollution from factories.

But state officials said it was the types of cancers typically related to tobacco use that were killing more Delaware residents per capita than anywhere else.

In 2000 the state declared that the previous year's cancer statistics showed that the lung cancer incidence rate in Delaware was considerably higher than the national rate.

In 1999 the rate was 81.9 per 100,000, while the country averaged 70.7 per 100,000.

The death rate was 68.2 in Delaware. The U.S. rate was 55.4.

Among Minner's first acts was to pass a draconian law banning smoking in all public places by 2002.

The campaigns are paying off. Smoking is now below the national average and the lowest rate recorded since tracking began in 1982, according to the American Cancer Society.

Minner credits the program's success to the 15-person advisory council she formed to develop a clear and usable plan. So far all 15 remain on the panel.

The program relies on federally funded cancer screening programs to detect some cancers early - a common practice in many states. But once cancer is found Delaware pays "nurse navigators" who see patients through the maze of cancer care.

One of the cancer doctors is Nicholas J. Petrelli, a nationally recognized expert on colorectal cancer and director of the Helen F. Graham Cancer Center at Christiana Care.

He advocated colorectal cancer screening, offered free to uninsured Delaware residents over age 50.

"Getting any type of screening test is better than none at all, but this is the gold standard," he said.

In the first nine months of 2007 the state reports that 74 percent of all Delawareans over 50 had had at least one colonoscopy, up from 52 percent in 2002.

Many states have cancer treatment programs, Petrelli said, but patients are often left to fend for themselves after cancer is found.

Helping patients make their way through often confusing cancer care options was one of the panel's major priorities, said panel chairman Bill Bowser.

"We wanted to do the things that would make a difference and were possible," said Bowser, whose son underwent more than three years of chemotherapy for leukemia at age 13.

Bowser's family was fortunate to have a social worker assigned to them to coordinate care, a common practice at children's hospitals. "We thought everybody could use some help," Bowser said.

Fulton, who at 66 now qualifies for Medicare, said she's glad the help was there.

"You can have blood pouring out of your eyeballs and hospitals will still ask if you have insurance," said Fulton.

But not in her state. Not if you have cancer.