Proton beam therapy: if you build it, they will come

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A “research letter” in the Archives of Internal Medicine this week concludes:

“To our knowledge, we show for the first time that the availability of a technology, in this instance a proton beam facility, in one’s HRR (hospital referral region*) is associated with a higher likelihood of receiving proton beam therapy compared with those living in an HRR where this technology is not available.”

* The Dartmouth Atlas defines HRR this way: “Hospital service areas make clear the patterns of use of local hospitals. A significant proportion of care, however, is provided by referral hospitals that serve a larger region. Hospital referral regions were defined in this Atlas by documenting where patients were referred for major cardiovascular surgical procedures and for neurosurgery.

The authors write:

“The number of treatment options for localized prostate cancer continues to expand, amidst growing concern regarding overdiagnosis and overtreatment of low-risk disease.  Treatment patterns, however, may be driven by availability of novel technologies rather than by clinical indications.

No prostate cancer treatment has been proven superior to the others. There are, however, substantial differences in cost, which are becoming more important to society and are a focus of health care reform in the United States.While there are theoretical advantages to proton beam therapy from a radiation physics standpoint, no study yet has demonstrated its superiority to modern photon-based therapy in terms of either oncologic or quality of life outcomes…

Proton beam therapy has not been shown to be superior to other treatments for prostate cancer and is substantially more expensive.Caution should be taken when considering implementation of this technology in additional regions, which may lead to greater use of this technology.”

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