Thursday, January 03, 2013

Dear men: Are proton beams less toxic?

A couple of weeks ago, I explained the business rational for the rapid expansion of proton beam radiation treatment facilities throughout the US.  Misguided reimbursement policies of the federal government aid and abet this land grab by investors and hospitals.

In their zeal to build, those hospitals attempt to portray to men that their treatment for prostate cancer using proton beams will be less dangerous than treatment using standard radiation, intensity-modulated radiotherapy, or IMRT.  That there is no basis for this assertion makes no difference during the marketing campaign.

Now comes some literature on the topic, reported in an article by Charles Bankhead at Medpage Today.  It is entitled "Proton Rad Tx Not Less Toxic."  The summary:

  • Proton therapy for cancer is new, expensive and increasingly being utilized due in part to a theroretical potential reduction in toxicity compared with intensity-modulated radiotherapy.
  • In this retrospective study of men with prostate cancer, ages greater that 65, there was no difference in gastrointestinal or other toxicities at 12 months post-treatment with proton therapy or intensity-modulated radiotherapy.

Median Medicare reimbursement for proton therapy was $32,428 compared with $18,575 for IMRT.
"Our findings on toxicity should be considered in conjunction with our findings on cost," James B. Yu, MD, of Yale University, and co-authors wrote in conclusion. "We found that Medicare's reimbursement per patient for proton radiation therapy was 1.7 times that of IMRT.

"The relative reimbursement of new medical technologies needs to be considered carefully so that physicians and hospitals do not have a financial incentive to adopt a technology before supporting evidence is available."
 "Declaring that proton therapy is new, awarding it high reimbursements, and stating that it has theoretical dosimetric advantages is not acceptable," Mary Feng, MD, and Theodore S. Lawrence, MD, of the University of Michigan in Ann Arbor asserted in their commentary. "We need prospective clinical trials directly comparing protons to IMRT photons."

To date nine [proton radiation] facilities have begun operation, but eight others are in development. 

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