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Is proton therapy the ‘magic bullet’ for cancer?

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Is proton therapy the ‘magic bullet’ for cancer?

Our Review Summary

This report on a controversial technology provides the reader with a limited understanding of the benefits, harms and issues related to its application. The story features unsupported quotes from an entrepreneur intent on promoting the technology. And while cost is mentioned, it is only in the context of acquisition costs of existing technology to institutions. No mention is made of the costs of treatment, comparison costs or insurance coverage (other than to indicate that the technology is not available in England). The benefits are overstated and harms are ignored. Even the “hook” for the story – that proton beam represents a new technology – is not true.

 

Why This Matters

Questions surrounding the perceived benefits of proton beam therapy and the more generally available IMRT (Intensity Modulated Radiation Therapy) and other targeted forms of radiation therapy remain essentially unresolved. Proton beam centers are enormously expensive, and while the treatment has the potential to reduce side effects through targeting tumors more precisely, outcomes with proton beam have not lived up to expectations in some of the more common solid tumors. The controversy is perhaps no more evident than in the treatment of prostate cancer. The prostate gland lies in a rather tight spot anatomically and in close proximity to the bladder, bowel and rectum. Protecting surrounding tissue is important to maintain quality of life while treating the tumor. But the jury is still out on whether proton beam offers any advantage over the far less expensive IMRT, with proton beam just about twice as expensive. Prostate cancer is arguably the driving force behind the enthusiasm of many institutions to develop a proton beam center. Despite the lack of demonstrated enhanced efficacy, many men opt for proton beam therapy based on a set of unproven assumptions.

There are circumstances where proton beam therapy is thought to be the preferred treatment option (pediatric brain cancers, melanoma of the eye, and certain brain tumors in adults to name a few) ,where its precision is clearly an advantage. This report’s unabashed enthusiasm over a new technology that is limited in its availability, more costly, and not proven to be better than routinely available radiation therapy options is unfortunate.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does mention the cost of building a proton beam treatment center ($125 Million) but it does not speak to the real issue of the costs of treatment directly. Medicare reimbursement for proton beam treatment of prostate cancer is about $32,000, whereas IMRT is reimbursed at about half that amount.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

These statements from an entrepreneur clearly do not constitute documentation of benefit:

where patients receive a powerful dose of targeted radiation that kills only those cancerous cells….” “a therapy that offers precision and minimal side effects.” “It does a lot less collateral damage to the patient – that’s the great thing about proton therapy” “I have a number of letters from parents of young kids saying if it had not been for this treatment we would have lost our kid,” he said. “That’s something I really cherish. When I feel a bit depressed, for whatever reason, I go back to those letters and they are very exciting.”

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The only harm that is suggested is the lack of availability of the treatment.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story provides no independent evaluation of the evidence, only quotes from an entrepreneur and anecdotes about letters from parents.

Does the story commit disease-mongering?

Not Applicable

A story such as this one, that makes only broad, sweeping claims about cancer – in general – never provided enough information about any one disease or condition to even warrant a satisfactory or unsatisfactory grade.  This can only be ruled as Not Applicable.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

It would not have been difficult find an independent source to give perspective on the claims in this story.

But no independent source appeared in this story.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Let’s take a look a the alternatives mentioned:

  • “Successful methods such as chemotherapy work by killing the cancer cells, but they also destroy healthy tissue” 
  • “Health practitioners have been searching for a magic bullet that goes straight to the source of the cancer — and everything from monoclonal antibodies, which carry cancer drugs direct to cancer cells, to straight surgery to cut out tumors have been used with varying degrees of success.” 

There is no mention of other forms of targeted radiation therapy and importantly, their relative merit in cancer treatment as compared to proton beam therapy.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The reader is told that there are a limited number of sites (and none in England) offering proton beam therapy, but that hope is on the way in the form of a less expensive device from Mr. Jongen’s company. The story states that “the proton therapy market is expected to more than double by 2018, with an estimated 300 proton therapy rooms,” but it doesn’t explain where they are.

Nonetheless, we’ll give the story the benefit of the doubt for supplying a general overview.

Does the story establish the true novelty of the approach?

Not Satisfactory

Why the story suggests that proton beam therapy for cancer is new or novel is a mystery. Proton beam therapy has been available for over 20 years. What is not available and perhaps should have been the focus of the story is a smaller and less expensive device that is under development by Mr. Jorgen. Excerpt:

“In Belgium, engineer and nuclear physicist Yves Jongen is pioneering a new therapy that targets cancers with proton radiation; a therapy that offers precision and minimal side effects. “I started to designing (sic) equipment (for) proton therapy of cancer — that was a radically new idea,” Jongen told CNN.

Does the story appear to rely solely or largely on a news release?

Not Applicable

We are not aware of any news release that prompted this story. But because no independent perspective appears – only the inventor/entrepeneur is interviewed – and because there isn’t any true news in the piece, the only grade we can give the story under these circumstances is a questioning Not Applicable.

Total Score: 1 of 8 Satisfactory

Comments (4)

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Gary Schwitzer

January 26, 2015 at 3:51 pm

In response to our review, someone on Twitter pointed out a new article published in the British Journal of Urology entitled, “Proton Therapy Websites: Information Anarchy Creates Confusion.”

http://onlinelibrary.wiley.com/doi/10.1111/bju.12667/full

It was an analysis of websites with information about proton beam therapy (PBT). The authors concluded:

“claims of clinical superiority on PBT websites with minimal peer-reviewed reference become all the more concerning. Our present study provides evidence that claims on PBT websites may overestimate benefits and underestimate risks. The unregulated nature of web-based health information has led to a dilution of quality upon which consumers are potentially basing treatment decisions. Claims must be founded on high-quality evidence with accurate reporting of risks and benefits so consumers can make informed healthcare decisions.”

When a news story by a leading international news organization also adds to the confusion, it is also all the more concerning.

Reply

Robin Holmes

January 27, 2015 at 2:37 pm

I would have to agree that Proton Therapy is much more expensive, but the reason it’s used with children less damage to other parts of the brain. I have seen many women receive Radiation and cyber knife for Breast cancer. It can be brutal. After much research we opted for Proton for prostrate Cancer with my husband who also has Breast cancer. We called it proton radiation vacation. No burns, no pain and less risk of secondary cancer that radiation can cause. Less side effects and same outcome is reason enough to support Proton Therapy for Breast cancer. Radiation does damage healthy tissue that would not be damaged with proton therapy. This is a turf war in my opinion. Women should be given the option of Proton Therapy just like men have the option with Proton Therapy. After discussing options with three Cancer specialist in Memphis no one mentioned Proton being an option because St Judes is the only medical center with the expensive equipment. An educated consumer would opt for Proton and we drove to MD Anderson for Proton Therapy. We need to support Proton Therapy for breast cancer.

Reply

Ricky Nations

December 8, 2016 at 6:57 am

A good evaluation of the CNN story. My son had an epndymoma tumor in his spinal cord and proton therapy worked well and was a blessing for my son and our family.

Reply