Health News Review

The Oregonian reports something you don’t hear very often these days – a medical center saying “NO” – at least for now – to the medical arms race.

And by dropping their plans to acquire a proton beam therapy facility, they said “NO” in a big way.   The Oregonian reports:

In recent years, large medical centers around the country have been building massive proton therapy machines costing $100 million and up, marketing them to men with prostate cancer.

For now, Oregon Health & Science University won’t be one of them, with officials saying the treatment’s cost and continued debate over its benefit have caused them to scrap a push to build one here.

Though the technology is considered useful in some pediatric cancers, studies continue to question its benefit for adults. “It is a technology that for adult tumors may have some advantages but those advantages have not been proven in head to head studies,” Beer said. Things could change as the therapy evolves, but “We felt that we couldn’t really justify this sort of investment based on the promise that this technology offers as it stands today.”

The treatment costs significantly more than conventional radiation therapy. Supporters say the therapy offers fewer side effects, but that claim has been undermined by studies released this year, most recently in the Journal of the National Cancer Institute. Critics call proton therapy an example of profit-driven medicine gone awry.

Proton therapy center operators have received other bad news this year. The federal government recently announced that it will follow through on plans issued this summer to cut Medicare reimbursement for proton therapy by nearly a third. That means centers’ per-patient revenue dropped from an estimated $36,000 to $25,000.

One such decision doth not a trend make.  But methinks we’ll hear this again elsewhere.

Thanks to The Oregonian for covering this.

Maybe someone in Oregon paid attention when, almost exactly one year ago, Ezekiel Emanuel and Steven Pearson appeared in the paper’s op-ed pages calling the proliferation of proton beam facilities – “crazy medicine and unsustainable public policy.”

 

(Addendum on December 21:  See next day’s post, “Texas-sized Battlefield Breakthrough hype by Dallas radio station – proton & robots.

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Comments

Leonard Arzt posted on December 20, 2012 at 3:37 pm

President Reagan coined the phase “there you go again.” Ditto to you, Gary. Not all hospitals can afford to have proton therapy. Of course its more expensive than conventional X-ray radiation. But if they could, they would all have it. OHSU explored its options and is fully aware of the benefits of proton therapy. They also are aware a proton center will soon open in Seattle where patients who need proton therapy can get it. There is no medical arms race, or proton race. Simply a small movement toward the best technology that radiation treatment can offer to do less harm to cancerous tumors.

Leonard Arzt, National Association for Proton Therapy

    Gary Schwitzer posted on December 20, 2012 at 5:48 pm

    And my fellow Minnesotan Walter Mondale said to Reagan, “I’m reminded a little bit of what Will Rogers once said about (Herbert) Hoover. He said, ‘It’s not what he doesn’t know that bothers me; it’s what he knows for sure that just ain’t so.”

    It’s what you know for sure that just ain’t so that paints you in a corner.

    Leonard, first, I’m tickled but curious about how/why someone whose apparent fulltime job is promoting proton beam therapy – a multi-million dollar industry – can find time in his busy day to leave a comment on the blog of one little old journalist. But I guess if I were being paid as you are, I might try to do the same thing. I just wouldn’t sleep well.

    Instead, I write every day about media messages including claims about health care interventions. And I try to help people evaluate claims and evidence. And I sleep very well.

    OHSU, if I’m not mistaken, is one of the evidence synthesis sites for the US Agency for Healthcare Research & Quality. And their people wrote the evidence document for prostate cancer screening. We’re talking about a leading center for evidence-based practice.

    So, unless you’re willing to share some marketplace secret about how they made their decision, I’m willing to bet that it was based on lack of evidence, just as the OHSU spokesman alluded in his interview with The Oregonian.

    And, Leonard, do you really want to go on the record with your statement that there’s no medical arms race ?!? Because the credibility of anything you say thereafter is severely damaged in the eyes of anyone who hears this from you.

    Just sayin’

    Gary Schwitzer
    Publisher
    HealthNewsReview.org

Dennis Reed McNeely posted on December 20, 2012 at 5:44 pm

We saw a similar technology go “south” in 1989 with the biliary lithotripter. It looked like gallstones could be “blasted” with ultrasound and pass on….alas only 1% of patients had successful resolution and the FDA wisely disapproved. The physics for proton therapy likewise looks unassailable. We should not forget our forefather in science Francis Bacon who stated (paraphrased) that if we want to know we must look to nature. What actually happens is what matters. Difficult when financial pressures push one to be “first”!

Robert Marckini posted on December 20, 2012 at 8:50 pm

I represent 6,300 men who had proton therapy for prostate cancer. We are from all 50 U.S. States and 33 countries and we were treated at 10 U.S. proton centers and three from Europe and Asia. The overwhelming majority of us are cancer free and the quality of our lives has been preserved. Two comprehensive surveys of our membership (patient reported data) have shown that the results, especially with regard to quality of life, are far superior to the other forms of treatment. The physics of proton therapy can’t be refuted. Essentially all of the radiation is deposited on the tumor volume. With all other forms of radiotherapy, most of the radiation is deposited on healthy tissue. This results in more morbidity (side effects) and potentially secondary cancers later in life. I encourage you to take a closer look at proton thearpy. Time and science will prove that proton is superior. I’d be happy to talk with you at any time about my group and my research. Thank you.

    Gary Schwitzer posted on December 20, 2012 at 9:36 pm

    Robert,

    I’m pleased for you that you are satisfied with your choice.

    Long-term data on outcomes – more than the physics of proton therapy – is what many have questioned. You know this. OHSU knew this.

    That’s what The Oregonian wrote about. That’s what we wrote about.

    You wrote, “Time and science will prove that proton is superior.” Yes, that’s why they do the trials. The question is whether – at this time, the science has proven that proton is superior.

    Best wishes for your continued good health.

Richard Hoffman, MD posted on December 21, 2012 at 10:01 am

The National Cancer Institute tracks US cancer epidemiology through its SEER tumor registries. Remarkably, SEER reports that men diagnosed with localized prostate cancer (hasn’t spread beyond the prostate) have a 0% chance of dying from this cancer over the next 5 years–regardless of whether the man receives treatment. This means that we need to follow men for at least 10 to 15 years following diagnosis to determine whether treatment improves cancer survival. More importantly, to know whether proton beam therapy is more efficacious than other forms of radiotherapy–or surgery or active surveillance—we need to conduct randomized controlled trials. These trials also provide the most definitive results for comparing complication risks across treatments. This is because subjects complete comprehensive, validated quality-of-life measures (particularly assessing urinary, sexual, and bowel function) at baseline and then at scheduled intervals following treatment. We eagerly await the first publication of results from such studies evaluating proton beam therapy (and robotic prostatectomy).

Many cancers detected with PSA screening are considered overdiagnosed–they would never cause problems during a man’s lifetime and thus do not require treatment. Therefore, even low complications rates from an unnecessary treatment are unacceptable.

Greg Pawelski posted on December 21, 2012 at 11:38 am

There’s no clear evidence that proton beam therapy is better for prostate cancer and recent new results suggest it may cause more complications. But only a rigorous clinical trial will tell? According to the University of North Carolina, Chapel Hill, one was supposed to start this past summer and give results in three to five years.

Susan Fitzgerald posted on December 27, 2012 at 3:04 pm

And just to reinforce the point, here is yet another article on research showing proton therapy does not have an edge in the long term:

“After six months, nearly 10 percent of IMRT-treated patients, and six percent of proton therapy patients, had side effects including incontinence, a burning sensation while urinating or difficulty getting an erection. However, the difference disappeared a year after treatment, when nearly one in five patients suffered side effects regardless of which radiation treatment they had.”

http://www.reuters.com/article/2012/12/27/us-prostate-therapy-idUSBRE8BQ0IJ20121227