Any APM updates

[BobbyHeenan]

Mods - please move to an older thread if need be.

I was inquiring if anyone has any updates or hearsay/rumors regarding APM status. A couple of things I've "heard" but I am not well versed on this at present:

- APM may be delayed until after the election
- ASTRO is going to fully back APM but with a proton exemption; apparently proton lobby had some pull in getting it delayed thus far


Any updates?

My instinct is that if protons get an exemption we're about to see a massive expansion of proton facilities. It makes a lot of sense to put one in if you have an exemption, correct?

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[Mandelin Rain]

The battles that ASTRO chooses to fight/not fight definitely benefit the vast majority of radiation oncologists in America and increase our standing in medicine and society at large.

 

[scarbrtj]

Mods - please move to an older thread if need be.

I was inquiring if anyone has any updates or hearsay/rumors regarding APM status. A couple of things I've "heard" but I am not well versed on this at present:

- APM may be delayed until after the election
- ASTRO is going to fully back APM but with a proton exemption; apparently proton lobby had some pull in getting it delayed thus far


Any updates?

My instinct is that if protons get an exemption we're about to see a massive expansion of proton facilities. It makes a lot of sense to put one in if you have an exemption, correct?

If ASTRO wants protons exempted I seriously don't want to hear one more g*****m thing from them again about Choosing Wisely. There's umpteen times more data for IMRT being effective in breast cancer than protons being effective for anything. But they're going to pillory one and protect the other? C'mon.

 

[RickyScott]

If ASTRO wants protons exempted I seriously don't want to hear one more g*****m thing from them again about Choosing Wisely. There's umpteen times more data for IMRT being effective in breast cancer than protons being effective for anything. But they're going to pillory one and protect the other? C'mon.

Would be totally disgusting. Just another example of them working against interests of the majority of their membership. Very fitting they are chaired by someone who recently started a completely unnecessary and damaging residency program.

 

[thecarbonionangle]

Heard same about protons. Guess you better get into protonangle game folks!

 

[RickyScott]

If ASTRO wants protons exempted I seriously don't want to hear one more g*****m thing from them again about Choosing Wisely. There's umpteen times more data for IMRT being effective in breast cancer than protons being effective for anything. But they're going to pillory one and protect the other? C'mon.

Worried that xrt it is moving towards system where it is not financially feasible unless at price gouging monopolistic academic center with high negotiated rates &hypofract or protons. Bad for society, bad for pts, but somehow choosing wisely.

 

[evilbooyaa]

Unfortunate if there is a proton exemption (unless patients are on a clinical trial).

 

[thecarbonionangle]

Particle therapy is the future? Many are saying it!

 

[elementaryschooleconomics]

Student Doctor Network: I wonder if protons will be exempt from APM?

MD Anderson:

 

[RadRadRad]

trying to figure out how protons will help #endcancer. There is almost no data for dose escalation beyond what can be delivered via photons improving outcomes in any site. Negative randomized trials for lung, esophagus, gbm. Prostate with benefit but not survival benefit from increased dose and can easily be delivered with Imrt. Breast and head and neck moving towards less dose.

maybe he means #endchordoma.
Although pmh ig-Imrt 74 gy data looked pretty good too!

 

[RickyScott]

trying to figure out how protons will help #endcancer. There is almost no data for dose escalation beyond what can be delivered via photons improving outcomes in any site. Negative randomized trials for lung, esophagus, gbm. Prostate with benefit but not survival benefit from increased dose and can easily be delivered with Imrt. Breast and head and neck moving towards less dose.

maybe he means #endchordoma.
Although pmh ig-Imrt 74 gy data looked pretty good too!

What benefit is there in prostate?

 

[Gfunk6]

From what I can gather there is a 60% probability that protons will be exempted. Of course, there are other technologies also on the short list to be potentiality exempted including MR-linacs and BgRT linacs (e.g. Reflexion).

Even if protons are exempted, it will most likely not be forever - probably around two years. Given that it takes 18 months to build a proton center (at least) I don't think there will be rash of new centers to take advantage of this loophole.

 

[scarbrtj]

trying to figure out how protons will help #endcancer.

Because the center giving anti-cancer therapy via protons will be more long-term viable and profitable than the center across the street which will eventually be driven out of business, or somewhat relegated to obscurity, due to less reimbursement. (Of course only if the proton places get this "government subsidy" of sorts will this be the case; else they're gonna die a slow death.) If I'm giving completely acceptable radiation, but a center nearby is giving equally effective... no better or worse... treatment but gets to charge much more just because they have a different machine, eventually they'll be #endingcancer and the other poor unprotonated saps will be #outofbusiness. What a country!

 

[thecarbonionangle]

trying to figure out how protons will help #endcancer. There is almost no data for dose escalation beyond what can be delivered via photons improving outcomes in any site. Negative randomized trials for lung, esophagus, gbm. Prostate with benefit but not survival benefit from increased dose and can easily be delivered with Imrt. Breast and head and neck moving towards less dose.

maybe he means #endchordoma.
Although pmh ig-Imrt 74 gy data looked pretty good too!

crossed out cancer so must be ending it! Stay tuned folks! Mdacc tripled down on IMPT expansion. They know which way the wind is blowing. Weak minded nearby region programs best watch out! They should all be shut down!

 

[thecarbonionangle]

What benefit is there in prostate?

BEAUTIFUL dvh. No need to say or see more!

 

[BobbyHeenan]

Yes - the MDACC expansion leads one to believe their finger on teh pulse says APM exemption soon.

I would support an exemption for protons for certain disease sites and definitely would support exemption on randomized trials. Would NOT support a proton exemption for prostate or breast on a "registry trial."

I think probably a role for protons in head/neck and maybe even left sided IM node breast among others. I'm even willing to entertain whole pelvis prostate...but routine prostate only I can't support....and that keeps the lights on from what I can gather.

 

[radiaterMike]

Some of these registries enroll any patient receiving proton therapy. These are fine for the collection of data. But a registry to justify need is a scam.

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

 

[GapCalc]

The obvious way to get around aggressive APM-related cuts is just to buy a proton center. Just $30-40 mil and you're set.

 

[BobbyHeenan]

Some of these registries enroll any patient receiving proton therapy. These are fine for the collection of data. But a registry to justify need is a scam.

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

ClinicalTrials.gov

clinicaltrials.gov

They're just Trojan horses to check the box for "enrolled in a trial."

I don't need more un randomized breast or prostate data. Especially prostate.

And the fact that ASTRO supported "registry" trials for protons for prostate as part of Choosing Wisely is shameful.

 

[Gfunk6]

More APM rumors I heard through the grapevine:

1. CMS is going to announce final rules in the Fall
2. Planned implementation on 1/1/21

If COVID persists through 2020 end, may be punted again.

 

[Irradi8or]

More APM rumors I heard through the grapevine:

1. CMS is going to announce final rules in the Fall
2. Planned implementation on 1/1/21

If COVID persists through 2020 end, may be punted again.

What I’ve heard: HOPPS should be coming out soon, and MPFS shorty after. RO-APM final rule by August/September. However I’m hearing start date for RO-APM is not 1/1/2021 - closer to 4/2021 or later. Hearing conflicting things on protons so not sure there. But it’s all hearsay