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.
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.
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.
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.”
The only harm that is suggested is the lack of availability of the treatment.
The story provides no independent evaluation of the evidence, only quotes from an entrepreneur and anecdotes about letters from parents.
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.
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.
Let’s take a look a the alternatives mentioned:
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.
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.
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.
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.
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
Comments (4)
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Gary Schwitzer
January 26, 2015 at 3:51 pmIn 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:
When a news story by a leading international news organization also adds to the confusion, it is also all the more concerning.
Robin Holmes
January 27, 2015 at 2:37 pmI 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.
Ricky Nations
December 8, 2016 at 6:57 amA 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.
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