This story reports on the hype, the promise and the controversies around proton beam therapy. The potential benefit of proton beam therapy is that it can accurately target deep-seated cancers without damaging surrounding tissues. For this reason it is an attractive idea for certain rare and serious tumors such as tumors of the brain or eye where surgery or conventional radiation would be very destructive. However, it is increasingly being used to treat more common cancers, such as prostate and lung cancer. Moreover, proton beam therapy is extraordinarily costly because the equipment involved requires huge investments from hospitals. Given the current economic climate in healthcare, the acceleration of this technology has raised serious questions about its cost-effectiveness and issues around access to care, given that it is currently only available in academic medical centers.
This story does a good job of describing the problem of limited availability to those patients who could truly benefit from proton therapy while at the same time it is increasingly being used in cancers for which there is questionable benefit, especially prostate cancer. The story also rightly points out the limited evidence that it is any better than conventional radiation and that the low risk of side effects may be an underestimation.
The story also highlights the perverse incentives to use the therapy to treat prostate cancer so that hospitals can recover their high costs of investing in the technology. However, the story could have more explicitly compared the cost of proton beam radiation to conventional radiation to give the reader a sense of the scope of the cost difference.
Overall, this was a very enlightening in-depth piece about a growing concern in health care.
Although the story mentions the high upfront cost of proton therapy, it does not describe the cost of treatment compared to other alternatives.
The story points out that there have been no controlled treatment trials for proton therapy in prostate cancer–increasingly the targeted use–so there really are no good data on benefits. Since the technology is relatively new there are probably no good long-term survival estimates even from case series.
The story mentions side effects of proton therapy, such as incontinence and sexual side effects in men with prostate cancer, and explains that they may be more common than reported in studies.
The story mentions that there is a lack of randomized trials comparing proton therapy to conventional radiation.
The story does not appear to engage in disease mongering. However, the article doesn’t indicate that many of the 186,320 new prostate cancer cases are early-stage for which the benefit of any treatment–let alone proton beam–remains uncertain.
The story quotes multiple experts who provide meaningful perspectives on the value of proton therapy.
The story mentions conventional radiation and surgery as the alternatives to proton therapy.
The story accurately describes the limited availability of proton therapy.
The story accurately describes the novelty of proton therapy.
Because the story quotes multiple experts, the reader can assume that the story does not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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