Become a Proton Master in 2.5 days

[communitydoc13]

40 years ago

40 years ago?

I would guess that even 15 years ago the stance of most leaders was that protons are a very limited tool and not the pathway for moving the field meaningfully forward.

The real explosion in centers began around 2010. This was not prompted by new science. This was strictly revenue and prestige seeking behavior.

I do agree that once an intervention becomes disseminated, the onus on evidence increases remarkably. Pharmaceutical interventions are almost uniformly developed for wide dissemination, thus the robust (perhaps less than it used to be as we move to an n of 1 model in molecular medicine), phased clinical trial approach.

If protons had only been kept in the hands of a few of the most prestige organizations, there would be very little pressure for evidence.

I mean...I wouldn't care about it.

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[drowsy12]

the timing fits with the shift to an increase corporate foothold in medicine in general but with cancer specifically. I mean can you blame them? Even the dumbest CEO or hospital president can figure out that it makes huge financial sense to build satellites or buy out other hospitals and charge higher rates, so that happened. The proton bag is similarly too appealing to many hospital presidents, throw on the fact that every major hospital board of trustees is made up of at least a few folks that are easily impressed by new shiny objects (and the potential to help KIDS!) and it is no surprise that since 2010, we have seen an explosion of network/satellite cancer care sites as well as proton.

the academic medical centers increasingly becoming MORE controlled by the hospital (money, profit seeking) over the traditional university forces make this all make sense.

 

[NotMattSpraker]

40 years ago?

Ha that seemed wrong but this is Rad Onc, I publish what I want.

This is my favorite ever proton editorial by Glatstein and as far as I could tell it is the last time anyone wrote an editorial like this for proton therapy. Now 15 years old. Should randomized clinical trials be required for proton radiotherapy? An alternative view - PubMed

Simul, Nina, and I took a crack at this last year, and my draft was way meaner than the final. Im sure it would not have gotten published. Need for Evidence-Based Adoption of New Technologies in Radiotherapy

If protons had only been kept in the hands of a few of the most prestige organizations, there would be very little pressure for evidence.

Man. I agree. It's too bad. Most Rad Oncs agree it is reasonable to use protons on several niche indications, even with limited data. Peds, spine sarcomas, reirradiation, do it. We don't need 50 centers in this country!

But, it does depend who you ask. Check out NAPT's advocacy report: NAPT’s 2023 Advocacy Report: Download Now

And their member survey. Prostate is out (but not really), breast is in! Just Released: 2023 NAPT Member Survey – Executive Summary

This stuff is so gross. I tried to make some resources with our patient podcast. Feel free to share and/or listen or give feedback. Weve had great feedback from interested patients, but I have to admit I dont think this helps the main problem. I was initially thinking good info is needed to fight propaganda, but it might be wasted effort. Anyway, here they are (sorry if I shared these already, I cant remember).

The Insider's Guide to Radiation Therapy: Proton Therapy - Oncology Unscripted

On this episode of Oncology Unscripted, patient advocates Julie Johnson and Katie Coleman and radiation oncologist Dr. Matt Spraker continue The Insider's Guide to Radiation Therapy! Here are the figures/graphics we referenced during the show...

oncologyunscripted.buzzsprout.com