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Proton therapy goes mainstream

by Gus Iversen, Editor in Chief | October 07, 2015
From the October 2015 issue of HealthCare Business News magazine

Proton for prostate: gold standard or cash cow?
Researchers have been experimenting with protons as a form of radiation therapy since the 1950s, so it’s nothing new. The rapid growth of proton therapy may be credited to the accumulation of evidence and the maturing of the technology.
“Radiation is a very effective tool to cure cancer, but we also know radiation has significant side effects to normal tissue – the elimination of unnecessary radiation is critical to patient care,” says Dr. Steven Frank, medical director at the MD Anderson Proton Therapy Center. He and his colleagues in Texas have been treating patients with proton therapy for nearly a decade.

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But not everyone is convinced that the benefits justify the cost. Amitabh Chandra, a professor at Harvard University’s Kennedy School of Government and Harvard Business School, says the increasing investment in proton therapy is financially irresponsible and an indication that real health reform is a long way off.

Chandra readily acknowledges the importance of proton therapy for head and neck tumors (and pediatric patients like Ashya King), but points to the frequent use of proton to treat prostate cancer as an example of reckless spending where the evidence has yet to illustrate the benefits.
“We are covering a technology that’s extraordinarily expensive in an immensely lucrative manner without any evidence that it works,” says Chandra. He says case studies have not been conducted to illustrate the benefits of treating prostate cancer because, “it would basically turn off the lights” — meaning the business model would collapse.
A 20-year study from Johns Hopkins recently concluded that for very unaggressive prostate cancers, the best treatment is to simply monitor the disease. The findings, published in the Journal of Clinical Oncology, revealed that only two out of 1,298 study participants actually died of the cancer. Even with the reduction of side effects, treating very unaggressive prostate cancer with proton therapy may do more damage than not treating it at all — it would also create unnecessary spending.
Prostate cancer is extremely common, with over 3 million cases diagnosed in the U.S. every year, according to the Mayo Clinic. For the cases that do require radiation therapy, protons are either a new gold standard in care or a cash cow — or perhaps both.

For Frank, it’s a complex problem with converging interests. “The emotions run high from patients that are diagnosed with prostate cancer who want access to proton therapy and the physicians that are trying to provide it for them, health care policy makers that are trying to control and reduce costs, insurance companies that are trying to increase profitability, and hospitals, urologists and radiation oncologists that lack access to proton therapy and may ‘lose’ their patients financially,” he says.

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