In the BMJ: “Is spending on proton beam therapy for cancer going too far, too fast?”

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In a feature in the BMJ this week, journalist Keith Epstein asks, “Is spending on proton beam therapy for cancer going too far, too fast?” Excerpts:

“…the spread of proton beam therapy for cancer has such momentum it now seems unstoppable. Millions of dollars have been invested in building the particle accelerators necessary to deliver it.

Globally, 39 facilities are in use. The US has 10 proton beam centres, and 19 more are being built. More than $370m (£230m; €277m) are being spent on a project to bring accelerators to centres in Minnesota and Arizona. And the UK’s health secretary Andrew Lansley announced in December that £150m would be put into delivering such treatment in the NHS.

Some people have recognised the rashness of the dash to introduce these machines, which have been described as the world’s “most costly and complicated medical devices.”

Harvard Medical School radiation oncologist Anthony Zietmen told the BMJ: “We rush into treatments before they are proved. Sometimes people are later found to have been harmed.” Zietman, who is involved in the Massachusetts General trial, added: “I don’t think we’re doing harm (with proton therapy), but we don’t know. In some instances, proton therapy might be inferior to existing treatments, and the quality of life might not be as good.

Robert Foote, a radiation oncologist at the Mayo Clinic who is overseeing a $370m project that will bring accelerators to new centres in Minnesota and Arizona within the next four years, is also worried that some centres are adopting the proton beam therapy before enough research has been done and, possibly, for the wrong indications.

He worries that some centres with big commercial investors will be keen to recoup their investment fast by putting through a large volume of patients, especially with prostate cancer, rather than using the technology for those most likely to benefit, such as children, a focus at the non-profit Mayo Clinic.

Foote says that two models of proton care have emerged in the US: “one to make money—the other to provide the best care possible for the people who need it.”


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