by
Carol Ko, Staff Writer | January 09, 2014
From the January 2014 issue of HealthCare Business News magazine
So it’s considered of such value there that they are putting a huge investment into proton therapy for an institution that treats only children. And then of course, we treat a lot of children, University of Florida does as well, so major areas where they’re going to be treating children for cancer rely a lot on proton therapy.
HCBN: I know that these conferences also focus on ongoing challenges such as patient selection, treatment techniques, and standardization. I was wondering if you could speak to some of these issues.
JC: Proton therapy is a major investment in technology and we have a very large physics group whose expertise we benefit enormously from to make proton therapy more certain.
People in the field always talk about uncertainties. We want uncertainties to drop down to zero. So quality assurance is a major issue in proton centers and how that is managed from one center to another — I hope that will be discussed at the conference. I think there’s more variability than I wish, but that’s true with standard radiation therapy also.
The technical commitment, the expense of operating a center, and then the case selection — those are the main challenges. There were some centers that justified their \ existence based on the treatment of patients with prostate cancer. It’s a way of keeping their center from not losing money. I don’t think it’s a wise strategy. I do think there are issues to be addressed that are not actually on the drawing boards right now — that is, reimbursements for proton therapy for patients who clearly need it.
HCBN: Can you tell me a little bit more about proton therapy for prostate? Why is focusing on this treatment a losing strategy? Do you think the patients that seek proton treatments for prostate could seek out equivalent, cheaper options?
JC: They’re being touted as equivalent options.
For example, what is now euphemistically termed “watchful waiting.” The problem is we’re not wonderfully adept at predicting which patients are going to progress and which ones are not. We have some biomarkers, but it’s far from perfect. Same thing is true in cancer of the breast.
The second option is external radiation therapy with X-rays using a technique called intensity-modulated radiation therapy. The third is radioactive seed implants. The fourth is radical prostatectomy. Those are all options available to men with early cancer of the prostate.
The former head of radiation oncology at Stanford some years ago told me when they first started treating prostate cancer, men from Silicon Valley came to the center already having done their own research and told them what they wanted. Even if somebody said, “you’re not a good candidate for our treatment,” they said, “fine, I’ll go\ somewhere else.”
