US health care: “haven for many, but sick Americans often jilted” – proton beam therapy a case in point

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The National Association for Proton Therapy states that there are currently 10 proton beam radiation facilities operating in the US, with 5 more under construction and 2 “in development.”

Currently, the UK has none, but the National Health Service has announced plans to build centers in Manchester and London.  Until then, the NHS says it will fund treatment elsewhere for those cases contributed appropriate.

In April, a journalist wrote in the BMJ, “Is spending on proton beam therapy for cancer going too far, too fast?

Then, a UK oncologist wrote in the BMJ, “Randomised controlled trials of proton beam therapy are needed.”

“…the evidence for the clinical efficacy of protons is weak and based mainly on uncontrolled studies, which are potentially subject to selection bias. The absence of evidence from randomised controlled trials makes the assessment of cost effectiveness difficult, and it is largely based on modelling exercises.The lack of such trials partly reflects doctors’ reluctance to enter patients into trials comparing protons and photons because of the perceived superiority of protons.

In the 1980s it was unclear whether fast neutrons improved the therapeutic ratio in hypoxic tumours, such as head and neck cancers. The higher radiobiological effectiveness of neutrons compared with photons offered a theoretical advantage. However, the Edinburgh randomised trial comparing fast neutrons and photons showed that local control was similar but late severe morbidity from radiation was significantly higher in patients treated with neutrons. With the projected 1500 patients a year to be referred for proton therapy, the UK should rigorously evaluate the clinical efficacy and toxicity of protons in adequately powered randomised controlled trials. Only then will we know whether proton therapy is a real clinical advance.”

Photo by - Creative Commons

Most recently, a British journalist wrote, “US healthcare system a haven for many, but sick Americans are often jilted.”  Her opening anecdote was about proton beam therapy:

Ethan Fidler is a 10-year-old from England who has spent six weeks in Florida and by now is missing football. Many would think him a lucky boy, and indeed he is – not because of Disney World or the beaches but because the the British national health service was willing to fly him four thousand miles and pay upwards of £50,000 for specialised radiation treatment for his brain tumour.

The NHS – often derided in the US as “socialised medicine” – sprang into action for Ethan and there is every likelihood he will be cured. His doctor at the University of Florida institute of proton therapy in Jacksonville, Danny Indelicato, is delighted with him. His mother, quantity surveyor Julia Fidler, who has been in Florida with Ethan throughout, while his dad, Mark, stayed home with their daughter, is astounded.

“I was amazed. To be told that this was something that could happen for Ethan – I was staggered,” Fidler said. “To just be told that all this is going to be available for your son. It gives you a massive sense that they must really feel they can cure Ethan or they wouldn’t go to these extremes. Every parent must feel that. It does give you confidence.”

Ethan is in the US because the NHS as yet does not have proton therapy machines, although the UK government has just agreed to fund two of them, in London and Manchester. But while the British boy is getting cutting-edge cancer treatment here, others who live in America are struggling to obtain the medical care they need. And when they are seriously ill or have a long-term condition, many will not be able to pay the bills that pile through the door. Two-thirds of personal bankruptcies in the US are related to healthcare costs.

It’s an interesting perspective:  the “socialized medicine” country sends its patient to the US for treatment not yet available there.  But, the story explains:

“…not everybody in the US with cancer gets the treatment they need. The costs of healthcare in the US are extremely high and good insurance coverage is unaffordable for many Americans. Around 40 to 50 million people are uninsured, even though they work.”




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