One Argument Against Proton Beam Therapy Now Gone

The Mayo proton case in interesting, indeed.

After being "cited as 'Exhibit A' in what’s wrong with American health care by Dr. Ezekiel J. Emanuel, chair of the University of Pennsylvania’s Department of Medical Ethics & Health Policy and a prominent health care commentator, in the New York Times," (see link at bottom) Mayo pressed onward justifying the high cost by utilizing PRIVATE DONATED funds.

For example, the centerpiece of Mayo’s center, called a Synchrotron, lies in the Richard O. Jacobson Building, named after an Iowa trucking, warehousing and packaging magnate who donated $100 million toward its construction. (info taken right out of Skeeter's article)

The overall healthcare cost equation is not any different or better, it's just that they don't have to pay back as many bonds needed to build the place.

Proton therapy for the small set of rare brain or ocular cases is phenominal, but keep in mind that even the NCCN currently takes the position that proton therapy is not recommended for routine use in the treatment of PC.


http://www.startribune.com/mayo-s-proton-beam-therapy-adds-to-debate-over-high-tech-costs/250899661/

Post Edited (NKinney) : 6/10/2015 2:37:50 PM (GMT-6)

Oh, I'm not upset about the word "proton."

I do, at times, get upset about misleading information.

Let me be quite clear on the Norm Kinney Rule of Economics 101: price does not necessarily relate directly to actual cost.

This "gimmick" is not sustainable.

this idea kind of confirms something I read years ago...here in the US, we want three things from the medical system: universal access, low cost, and the latest and greatest of everything. Problem is, we can only have 2 of 3. Universal access and low cost? No new stuff. Universal access and latest and greatest? Impossible costs. Low cost and latest and greatest? Can you say rationing?

The newest is not necessarily the best. Call me a trogolodyte, a philistine, and a luddite.

It is not a treatment gimmick nor is better pricing a bad thing through lower cost of funds via donations. Many other centers have received significant donation but charge more for Proton Therapy than IMRT. Thus Mayo seems to be breaking with the normal pricing model to increase use and gain a competitive advantage. Often when we see this it is referred to as a pricing gimmick because it often doesn't hold up over time. Let's see what happens with their system.

Proton therapy can be a very good thing in the certain applications and not so good in others. This is true with most any form of treatment. To date, Proton Therapy simply has not been proven to be better than Photon Therapy (IMRT, IGRT, SBRT) for prostate cancer. And in almost every instance it is decidedly more expensive.

One of the issues is that prostate cancer is most often multifocal and may extend outside the prostate. Because of this the very fine beam of the proton therapy can be a disadvantage for PCa. However, the fine beam can be a decided advantage for the other cancers mentioned where the very thin beam can be better than Photon. Also there is information that the nature of the Proton therapy can cause more damage to healthy cells at entry points. The Bragg effect is the Proton advantage as it stops the beam before passing through the body. With Photon therapies the beam continues through the body and affects tissue after radiating the Prostate. IMRT has greatly improved and minimizes the effect. So both are imperfect and have advantages and disadvantages. I am sure that both will continue to evolve and improve. It remains that the Proton Centers look to the greater frequencies of prostate cancers to help pay for the equipment. If it were limited to the cancers it is best in treating, it would most likely be cost prohibitive for them.

In 2013 the American Society of Radiation Oncologists published their opinion that Proton therapy was evolving for PCa and that it supported its use in studies but not for routine treatment. It supports studies that will compare it to Photon.

I think they are upfront about the reason for the lower than normal cost and possibilities of cost increases, based on the article, so I don't think calling it a gimmick is justified. They also aren't proposing it as normal treatment for prostate cancer.

"Keole said he expects Mayo Clinic's proton center will be a clinical-trial site that evaluates proton therapy, possibly including more-common cancers such as prostate and breast cancer."

"If evidence shows that the proton therapy is more effective than IMRT, Mayo Clinic may seek higher reimbursement."

I am happy there are people out there with deep pockets willing to put their money to use in these types of endeavors. Wouldn't it be nice if all research teams could get everything they need to do their research for free? You could pay for more brains to apply to the task.

I wasn't lowest risk before choosing treatment, with just one G8 biopsy core, but I was a "good candidate" for surgery. Scans were all clean. Chose open surgery with one of the best "nerve-sparing" surgeons in the world. The bill was in the $65k range, but of course they don't collect that much. Post-surgery pathology says I was really G7, but with one place with a tiny surgical margin. Was I over-treated? Recovery from surgery was not fun. Still not 100% continent. Turns out nerves haven't recovered after 21 months. PSA wasn't totally eliminated. So I'm on to other treatments in spite of my "good candidate" status.

If proton therapy were developed to the point that it could have reliably blasted my G7 cancer with less collateral damage than surgery or photons, why wouldn't that be a good thing? Even if it didn't get the bit that escaped, maybe recovery would have been easier and maybe I wouldn't still have incontinence and 100% ED issues. That would be worth a lot. I'd be delighted to have someone subsidize treatments, and I'm very grateful to those who volunteer for the clinical trials that help develop new treatments.

I'd love to see Dr. McCoy's medical tools become reality too, but that won't happen without a lot of investment dollars.

Proton, works as well, if not better than some treatments. It seems to have fewer side effects, so why all the neigh sayers? Everyone must make their own decisions and be their own medical advocates in treatment. People pay more for certain cars than others, both will get you from point A to point B. When it is your life, why not choose the course that may be best for you and pay a little more for the treatment. Proton has been around for many years now, the evidence is there. It is not experimental, it is a proven technology. My two cents.....

I had proton late last year. I took 3-4 months to decide. I felt like I did my DD. I had excellent surgeon locally, but would have had Dr Patel do robotic surgery if I had gone that route. If I was to have surgery I wanted robotic and someone with lots of experience. Brachytherapy, IMRT, and Proton were my radiation choices. The cost of any treatments never entered my thinking. If Medicare covered 80%, then my BC supplement would cover the other 20%. I'm retired, can afford to go out of town for any treatment for as long as necessary, so travelling to one of the best places for radiation was feasible for me. My wife is also retired and could accompany me.

As best I could tell, all the radiation options I considered were probably equally effective. it came down to side effects for me. Proton treatment seemed like the best option for me, but I wanted to talk with many men who had been treated before deciding. I talked with about 30 men who had been treated at UFPTI before I made my decision. I was careful to select men to talk with who had been diagnosed with a range of Gleasons, not just 3+3 like mine. I wanted to talk with some GS 7's and 8's as well as Gs 6's and a range of PSA from 2 to 20. I talked to men who were as young as 45, and as old as 88. I talked to some who had finished 5 years ago, and some 6 months earlier. Their testimonies were 100% in favor of proton. All would do it again without hesitation. None had been encouraged or hand picked to be on the call list.
I made my decision to have proton and began treatment on November 18, 2014. During my treatment it occurred to me lying on that table every day with a balloon up my butt that there had to be an awful lot of moving parts in this treatment. So many in fact that the odds of getting a successful treatment seemed problematic. I had equipment made from MRI's and CT's to precisely develop my PTV which, if not precise, most likely would affect my outcome. What if my prostate moved? Would the field of coverage be compromised? This special equipment for me had to be selected and in place for my daily treatment. Then there's the hardware and software behind the proton delivery. I'd say the Unix-based PC's used in the treatment rooms went down maybe 5 times while I was there for 8 weeks. With a career in IT I was curious why so many crashes. No one had an answer. We were supposed to have treatment at least 4 times each week, preferably 5 times. I was there during Thanksgiving, Christmas, and New Year's. Special scheduling was planned to ensure at least 4 consecutive treatments and no more than 4 off days. I started on a Tuesday before Thanksgiving and was treated T***, off Saturday, and was to be treated again SMTW before the holiday. Treatment would resume on Monday after Thanksgiving. I got a call on Sunday that the equipment was down and no treatment that day. It was Wednesday before it was back up. The TG holiday break was cancelled. During the remaining 7 weeks the system went down again several times but only for a few hours. Enough though for me to wonder what in the hell was going on. How could I be sure it was actually working right, I would ask myself lying on that table. Was I really lying in my pod or someone else's. Did the technician change my actuator or was he too busy checking out the pretty assistant?

I had serious doubts lying on that table. Surgeons make mistakes too, but it's a one shot, 2 hour deal for them. The proton center had 39 opportunities to screw up. Too late now, but not 100% sure I made the right decision as the other men did I talked with.

Norm Kinney,

Dont know what soured you so much on Proton treatment. Given it is a very pricey perhaps too pricey option for some insurance plans . But "Slimy marketing gimmick" Really?? In my opinion is is far from a gimmick or a slimy or a sham as you put it. It is not over treatment, I would have given my left nut to be treated with protons at Loma Linda, but did not qualify as I have mets. I especially dislike the "overuse " or the overtreatment of that term. That term does not apply to this treatment. There are many ethical Doctors out there who recommend it if the conditions are right. Just my opinion for what it's worth. NCCH aside.

Post Edited (Wings of Eagles) : 6/13/2015 7:03:56 PM (GMT-6)