Duke announces proton therapy, $50 million anonymous gift

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IonsAreOurFuture

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corporate.dukehealth.org

Anonymous Donor Gives $50 Million to Duke for Proton Beam Therapy

DURHAM, N.C. – An anonymous donor has made a $50 million gift to Duke University Health System toward the development of a proton beam therapy center.The donation is the largest philanthropic gift received by Duke University Health System.“This is a historic gift, both for Duke and for the state...
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I just noticed that Duke has been pledged $50 Million of $120 Million total cost of a proton center.

The article says 800 patients a year will be treated, which sounds like a 3 or 4 room center to me, pretty big.
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“We want to reduce treatment side effects as much as possible to improve our patients’ quality of life and function,” said Chris Willett, M.D., chair of the Department of Radiation Oncology. “For brain tumor patients, that means reducing toxicity that damages cognition and in breast cancer patients that means limiting damage to heart function.”

[citation(s) needed]

Also, did you know that, according to Duke, "In adults, proton therapy is the preferred treatment for complicated head and neck malignancies, large base of skull tumors, esophageal cancer, localized recurrent cancer, and certain ocular tumors and is becoming the standard for adult patients with low-grade gliomas and meningiomas, and breast, GI, and prostate cancers."

Non. Sense.

We've been so accustomed to the deluge of nonsense in this field we don't even bat an eye when an NCI-designated cancer center spews it all over.
 
OTN said:
“We want to reduce treatment side effects as much as possible to improve our patients’ quality of life and function,” said Chris Willett, M.D., chair of the Department of Radiation Oncology. “For brain tumor patients, that means reducing toxicity that damages cognition and in breast cancer patients that means limiting damage to heart function.”

[citation(s) needed]

Also, did you know that, according to Duke, "In adults, proton therapy is the preferred treatment for complicated head and neck malignancies, large base of skull tumors, esophageal cancer, localized recurrent cancer, and certain ocular tumors and is becoming the standard for adult patients with low-grade gliomas and meningiomas, and breast, GI, and prostate cancers."

Non. Sense.

We've been so accustomed to the deluge of nonsense in this field we don't even bat an eye when an NCI-designated cancer center spews it all over.
Click to expand...

Meanwhile your typical academic satellite job will make you write an essay to explain why you didn’t follow the suggested treatment plan in via pathways.
 
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OTN said:
“We want to reduce treatment side effects as much as possible to improve our patients’ quality of life and function,” said Chris Willett, M.D., chair of the Department of Radiation Oncology. “For brain tumor patients, that means reducing toxicity that damages cognition and in breast cancer patients that means limiting damage to heart function.”

[citation(s) needed]

Also, did you know that, according to Duke, "In adults, proton therapy is the preferred treatment for complicated head and neck malignancies, large base of skull tumors, esophageal cancer, localized recurrent cancer, and certain ocular tumors and is becoming the standard for adult patients with low-grade gliomas and meningiomas, and breast, GI, and prostate cancers."

Non. Sense.

We've been so accustomed to the deluge of nonsense in this field we don't even bat an eye when an NCI-designated cancer center spews it all over.
Click to expand...

We literally just had a randomized trial presented that does not say this.

So frustrating to see when hyperbole (at best) or just straight lies are presented by the literal leaders of our field. This isn't a Florida Cybnerknife PE start up endeavor, this is a huge NCI center just spouting bull****. I feel powerless too.

No wonder no one outside the field believes our good data for HCC or Kidney SBRT....leaders are lying about our tech all the time.
 
And there are people out there wondering why the creditability of academic institutions (meaning the university systems at large) has been on a downward slide for the past 15 years.
 
Last edited:
BobbyHeenan said:
We literally just had a randomized trial presented that does not say this.

So frustrating to see when hyperbole (at best) or just straight lies are presented by the literal leaders of our field. This isn't a Florida Cybnerknife PE start up endeavor, this is a huge NCI center just spouting bull****. I feel powerless too.

No wonder no one outside the field believes our good data for HCC or Kidney SBRT....leaders are lying about our tech all the time.
Click to expand...

That last line is a really, really good point. Proton therapy has been (inappropriately) propped up by academicians for so long, in the face of data which shows equivalence or worse outcomes with protons (rib fx in breast, ORN in H+N, equivalence in prostate). Not only is it an (appropriate) scapegoat for wasteful spending, but how can other specialties believe us when it comes to data when we're so obviously full of it with respect to protons?
 
OTN said:
That last line is a really, really good point. Proton therapy has been (inappropriately) propped up by academicians for so long, in the face of data which shows equivalence or worse outcomes with protons (rib fx in breast, ORN in H+N, equivalence in prostate). Not only is it an (appropriate) scapegoat for wasteful spending, but how can other specialties believe us when it comes to data when we're so obviously full of it with respect to protons?
Click to expand...

Not to mention when/if we can show a benefit to some fancy tech or fighting for indications/reimbursement...why wouldn't the regulatory/insurance line be - "how is this different than protons for prostate you all told us was better for years?"
 
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Simul: “I have discussed this in significant detail with ASTRO board members, including former president Jeff Michalski. I have sent him misleading infographics from large medical centers and had discussions with him on LinkedIn, but they simply cannot admit when they are doing something wrong.

ASTRO’s close ties to the proton industry influence many of its decisions, for example, exempting proton therapy from payment reform. We know that if we recommended proton therapy as much as these centers do, we would have a hard time passing our oral exams.”
 
I wonder if Willett has enough energy still to push PBT for short-course rectal Ca 🙂
 
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yesmaster said:
Why do insurance companies pay for protons for all these bogus indications?
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Higher priced insurance products with better coverage compared to lower priced products with a narrower spectrum of what they will pay for I would assume.
 
yesmaster said:
Why do insurance companies pay for protons for all these bogus indications?
Click to expand...
If memory serves United Health Care used to deny protons for prostate. A judge ruled in favor or a patient and there was talk of a class action suit. UHC subsequently changed their guidelines (and invested in proton facilities themselves).
 
yesmaster said:
Why do insurance companies pay for protons for all these bogus indications?
Click to expand...

Up until the this randomized trial many "experts" were saying or at least advertising that protons were the way to go. If push comes to shove do you want to go to court or be in the papers with the guy from MDACC (or Duke) saying you're not covering standard of care?

Even after the trial we've got the talking point of "it is A standard of care."

So it's just whether they want to pick battles or not.
 
I don’t like Duke or MDA but with how screwed up health insurance authorizations are, I do like that UNH has to pay up. Honestly it doesn’t even matter what the evidence is anymore, it just matters what happens at the negotiating table and the courtroom.
 
These days, insurance companies are integrating vertically (PBMs, hospital networks, protons etc...). I think they are doing this because there is some law (correct me if I am wrong) that says they need to invest 85% of their revenue into paying for healthcare. However, if their subsidiaries are the ones delivering that health, they can simply overpay themselves, and reap a huge profit while remaining compliant.
 
OTN said:
"Perhaps most interesting was proton versus photon PMRT incurred significantly more complications (OR 2.0), specifically capsular-contracture (OR 4.4)."
Click to expand...

This has been my experience as well. One of our plastics will not do proton reconstruction cases any more.
 
BobbyHeenan said:
This has been my experience as well. One of our plastics will not do proton reconstruction cases any more.
Click to expand...
Just like the busiest robotic GU surgeon I know in the area for salvages tells me that salvage RP after protons is the toughest salvage case he does (much more fibrosis/scarring vs IMRT, or cryo/hifu)

The greatest grift in our field and it's not just financially more toxic, but clinically too
 
isn’t salvage prostatectomy done open? haven’t followed the issue
 
Lamount said:
These days, insurance companies are integrating vertically (PBMs, hospital networks, protons etc...). I think they are doing this because there is some law (correct me if I am wrong) that says they need to invest 85% of their revenue into paying for healthcare. However, if their subsidiaries are the ones delivering that health, they can simply overpay themselves, and reap a huge profit while remaining compliant.
Click to expand...

If I only get a slice of pie for myself, the obvious solution is to order a bigger pie
 
This definitely makes me want protons for my breast cancer.

Protons versus Photons Postmastectomy Radiotherapy Effects on Breast Reconstruction Outcomes and Dosimetry Analysis

"The complication rates for protons vs photons were: Infection/necrosis (20% vs 13%, OR:1.6, p=0.2), capsular contracture (30% vs 10%, OR:3.9, p<0.001), Absolute Reconstruction Failure (16% vs 12%, OR:1.4, p=0.4) and Overall Reconstruction Failure (56% vs 36%, OR: 2.2, p=0.01)."

"Proton PMRT was associated with higher rates of implant capsular contracture and reconstruction failures compared to photons with equivalent local-control."
 
As Nancy Lee has stated - protons live in a data free zone. Randomized trials for photons versus protons exist for two purposes:

1. "See? We told you protons are better" (5% of the time)
2. *negative results are hand-waved away*

The dosimetry of protons is too good to even trust clinical data guys, that is how superior they are. Plus you can bill way more than photons and in case whatever ASTRO is pushing as their latest "model" passes, protons are exempt anyway, because . . . reasons.
 
SneakyBooger said:
This definitely makes me want protons for my breast cancer.

Protons versus Photons Postmastectomy Radiotherapy Effects on Breast Reconstruction Outcomes and Dosimetry Analysis

"The complication rates for protons vs photons were: Infection/necrosis (20% vs 13%, OR:1.6, p=0.2), capsular contracture (30% vs 10%, OR:3.9, p<0.001), Absolute Reconstruction Failure (16% vs 12%, OR:1.4, p=0.4) and Overall Reconstruction Failure (56% vs 36%, OR: 2.2, p=0.01)."

"Proton PMRT was associated with higher rates of implant capsular contracture and reconstruction failures compared to photons with equivalent local-control."
Click to expand...

On a retrospective study 😳

The real question is whether they actually stopped offering this treatment.

Has any center stopped offering prostate radiation after PartiQoL? Sameer, you still lurking on this forum?
 
NotMattSpraker said:
Has any center stopped offering prostate radiation after PartiQoL? Sameer, you still lurking on this forum?
Click to expand...
No chance. Protons were not better, but they were not worse either. As long as they reimburse higher and are technically still an option, they will be used. Which, ok. The slimier part is I guarantee people are still making deceptive sales pitches about them being more precise and easier to control…clearly implying less side effects/better tumor targeting even if they don’t come out and say it.
 
MDACC continues to offer prostate proton radiation after PartiQoL, that I can tell you with 100% certainty.
 
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