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Proton Community Forum
October 10, 2014
To The Editor
All Things Considered
National Public Radio
1111 North Capitol Street
Washington, DC 20002
RE: Proton Therapy Community Dismayed by Inaccuracies in
Oct 1 All Things Considered Story on Proton Center Closure
Knowing that NPR prides itself on fair and accurate reporting, we were surprised and disappointed by the number of inaccuracies in Jenny Gold’s story entitled, “Proton Center Closure Doesn't Slow New Construction” on the 10/1/14 edition of All Things Considered. We believe that the reporter has been misinformed by some of her sources. Although the story was originally reported by Kaiser, since it aired on NPR, we would like to share some of the inaccuracies with you and ask that NPR revisit proton therapy with a more accurate report as to its benefits for thousands of patients with various kinds of cancers. Unfortunately, the story that just aired could leave listeners with a false impression of proton therapy's cost, efficacy and value to patients.
One of the major inaccuracies in the story refers to the upcoming closing of the proton therapy center at Indiana University. The story reports that, "I never thought that in my lifetime that I would see a proton center close," says Amitabh Chandra, an economist at Harvard's Kennedy School of Government, who studies the cost of American medical care.
Perhaps Dr. Chandra has forgotten about the Harvard Cyclotron Laboratory, the first facility in the U.S. to treat cancerous tumors with proton beam radiation, which closed about twelve years ago and certainly during Dr. Chandra’s lifetime. Ironically, the center was located at Dr. Chandra’s employer, i.e. Harvard University. The facility, which began with a research cyclotron, treated 9,116 patients with protons from 1961 to 2002 (see: http://users.physics.harvard.edu/~wilson/cyclotron/history.html and http://www.ptcog.ch/archive/patient_statistics/Patientstatistics-updateMar2014.pdf). The Harvard Cyclotron Laboratory was shut down due to the advanced age of the equipment – the same 40 year lifespan of the system located at Indiana University which is mentioned in the article. The proton therapy program was reestablished at Massachusetts General Hospital (MGH) in 2001. This facility was largely funded through federal support provided through the National Cancer Institute and private philanthropy. In addition, not only has the MGH facility thrived and successfully treated thousands of patients, they have filed for a Certificate of Need (CON) application to further expand their proton service by adding a second proton accelerator (See: http://www.protominternational.com/index.php/protom-mgh-purchase-agreement). The rationale for expansion is clearly presented by MGH in their CON application and is evidence of their commitment to proton therapy.
The article says, "There are already 14 proton therapy centers in the U.S., and a dozen more facilities are under construction, even though each can cost $200 million to build."
Implying that each of these centers may cost $200 million is inaccurate and very misleading. Although the advanced technology of proton centers is not inexpensive, smaller machines, advanced design and refinements in technology are reducing the cost of construction for many new centers. Some of the new centers will cost well below $50 million and closer to $35 million to build. Implying that construction costs for all new centers will be as high as $200 million is simply wrong.
Referring to Dr. Chandra, the story also says, "He's surprised because until now, industry growth has been entirely in the other direction, even though there's little evidence that proton therapy is better than standard radiation for all but a few very rare cancers. 'But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,' Chandra says."
In response to that statement, first, there exists a substantial and increasing level of evidence that proves proton therapy is a superior form of radiation therapy for multiple disease sites.Earlier this year, for example, a team at MD Anderson Cancer Center published their comparative effectiveness research and concluded that the episodic cost of care using intensity modulated proton therapy in advanced stage head and neck cancer was less costly and of higher value than more traditional radiation therapy. [Frank et al, Oncology Payers 2014]. A team at the Mayo Clinic also published their comparative effectiveness research earlier this year and concluded that disease-free survival is significantly higher at five years for patients receiving proton treatment than for patients receiving more traditional radiation called IMRT (72% versus 50%).
An article from three leading physicians at the University of Maryland states that, "The Particle Therapy Co-operative Group (PTCOG) lists in excess of 50 ongoing clinical trials with proton therapy, encompassing an array of malignancies ranging from cancers of the breast, prostate, lung, esophagus, head and neck, base of skull, pediatric, liver, sarcomas, etc." The article continues, "As a larger number of centers participate in these trials, extensive data will be generated, contributing to an explosion in knowledge and evidence in this field." In short, we already have substantial evidence that proton therapy is effective for many cancers, but the body of evidence is growing.
Second, the claim that proton therapy is substantially more lucrative for physicians and providers is untrue. In fact, physicians who provide care in hospital-based proton facilities are reimbursed at the same exact Medicare rates whether they are using protons or conventional radiation therapy. Because proton therapy facilities are highly labor intensive and very expensive to operate, they may, in fact, be less profitable than other types of radiation centers.
The story also says that, "Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the group's national medical officer."
Dr. Finley should review Cigna’s medical policies to see which disease sites they are actually covering. Additional covered sites beyond eye cancers include: head and neck—skull base chordomas and chondrosarcomas. Proton therapy is highly effective for treating these and many other cancers. Over time, we are learning more and more about its efficacy for a variety of tumor sites.
Dr. Finley's references in the story to the cost of proton therapy versus standard radiation are inaccurate. While proton therapy initially may be more expensive than traditional radiation, depending upon the complexity of the case, the total costs of medical care for a proton therapy patient may be lower than with traditional radiation because short term and long term side effects are often minimized or avoided. These side effects can be costly to treat as well as physically devastating to patients. Thanks to proton therapy's precise targeting, which avoids damaging healthy tissue, long term quality of life for patients often is dramatically improved. In some cancers, proton therapy also reduces the likelihood of a secondary, radiation induced cancer.
Unlike traditional radiation, which travels through the body like a bullet, affecting any organ or tissue in its path, proton radiation can be more precisely controlled, so that it conforms to the shape of the tumor that is being treated. This precision can greatly reduce or even eliminate the painful and often expensive-to-treat side effects of traditional radiation. Lifestyle benefits for patients often are immense while they are being treated, but proton therapy also helps some patients avoid longer term, serious complications of traditional radiation.
Recent studies in The New England Journal of Medicine and JAMA Internal Medicine revealed, for instance, that women who have traditional radiation for breast cancer -- particularly left sided breast cancer -- are at increased risk for heart attacks and other cardiac complications later. They can avoid that risk -- and the attendant costs to the medical care system as well as to their personal health -- through the use of proton therapy to treat their breast cancer. Proton radiation does not expose women's hearts to the dangers of traditional radiation.
In a National Association for Proton Therapy study prepared by Dobson/DaVanzo & Associates, an independent health economics and policy consulting firm, approximately 97 percent of patients who received only proton radiation for prostate cancer reported that they have not experienced a recurrence of their disease. In contrast, 10-30 percent of men who have a prostatectomy (surgery) experience a recurrence of their cancer, according to a recent estimate. Also, a 2006 study revealed that 11 percent of patients treated with a conventional form of radiation experience a recurrence within 8 years.
Like most members of the proton community, which include many of the most esteemed institutions in American medicine, we respect NPR's editorial integrity. We are calling your attention to the errors in this story in the hope that we can work together with you to present accurate information about proton therapy in the future so that your listeners can be correctly informed about this remarkable and lifesaving technology. We can arrange for your reporters to speak to genuine experts in the field who will provide accurate information and to patients who can share their stories about this extraordinary technology.
Please contact us for an accurate update or to discuss another opportunity regarding the benefits of proton therapy.
Tyler J. Wilson
|Leonard J. Arzt
The National Association for Proton Therapy
The Proton Therapy Consortium
1301 Highland Drive
Silver Spring, MD 20910
Stuart L. Klein
Chairman, The National Association for Proton Therapy
Chairman, The Proton Consortium
Executive Director, The University of Florida Proton Therapy Institute
Assistant Dean and Lecturer, University of Florida College of Medicine
John B. Frick
Vice Chairman, National Association for Proton Therapy
Vice Chairman, The Proton Consortium
Board of Directors, ProCure Treatment Centers, Inc.
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