NYT: For Cancer Centers, Proton Therapy’s Promise Is Undercut by Lagging Demand

[fiji128]

Article is interesting as it gets into some of the specifics of these centers. Hard to believe there are still people out there willing to speculatively put 10s or 100s of millions of dollars into this at this point.

For Cancer Centers, Proton Therapy’s Promise Is Undercut by Lagging Demand

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[seper]

Nice article, Interestingly, it says that UMD unit is treating 85 patients per day and is losing money. Also, fun to see that 2013 prostate SEER-Medicare study has led to reimbursement change.

 

[RickyScott]

Would like to point out that protons are ultimate " bait and switch." I have had pts go to proton center for treatment of skin cancer,mets, rectal etc, and they just end up on the linacs. FDA really needs to regulate how they are advertised, because marketing is deliberately vague.
Also, I doubt UM is treating 85 most days, Would be interesting to find out if Regine et al knew the just of the story when they posed for pictures etc.

 

[seper]

that's one lousy mugshot

 

[BruiservonWillebrand]

Proton therapy is going to make a great case study in business schools one day.

 

[Gfunk6]

I am waiting for the next ASTRO "Choose Wisely" campaign to make a recommendation for low-risk prostate cancer.

1. Refer to academic medical center whenever possible so that they can treat 1.8 Gy per fraction to 79.2 Gy
2. If patient needs to be treated in an private practice/community hospital, we strongly recommend moderate or extreme hypofractionation or brachytherapy

 

[BobbyHeenan]

Would like to point out that protons are ultimate " bait and switch." I have had pts go to proton center for treatment of skin cancer,mets, rectal etc, and they just end up on the linacs. FDA really needs to regulate how they are advertised, because marketing is deliberately vague.

As part of the sales pitch from the manufactures, I have heard and seen good data that by opening the proton center most cancer centers saw linac volume increase 20-30%. This is a known phenomenon and marketing strategy. You get them in the door with direct to consumer marketing and sort the rest out later. You may take a loss or break even on the proton side (as an aside, if you're treating 80+ per day and still losing money you built too big of center and were extremely over optimistic), but as a whole you may be better off if you increase photon volume and/or med onc volume.

 

[medgator]

I am waiting for the next ASTRO "Choose Wisely" campaign to make a recommendation for low-risk prostate cancer.

1. Refer to academic medical center whenever possible so that they can treat 1.8 Gy per fraction to 79.2 Gy
2. If patient needs to be treated in an academic center, we strongly recommend moderate or extreme hypofractionation or brachytherapy

You mean private/community center?

 

[medgator]

As part of the sales pitch from the manufactures, I have heard and seen good data that by opening the proton center most cancer centers saw linac volume increase 20-30%. This is a known phenomenon and marketing strategy. You get them in the door with direct to consumer marketing and sort the rest out later. You may take a loss or break even on the proton side (as an aside, if you're treating 80+ per day and still losing money you built too big of center and were extremely over optimistic), but as a whole you may be better off if you increase photon volume and/or med onc volume.

It's like doing SAVI to keep (some of) the breast/general surgeons happy while you keeping your linac running with all of those non-Breast brachy candidates

 

[BobbyHeenan]

I am waiting for the next ASTRO "Choose Wisely" campaign to make a recommendation for low-risk prostate cancer.

1. Refer to academic medical center whenever possible so that they can treat 1.8 Gy per fraction to 79.2 Gy
2. If patient needs to be treated in an private practice/community hospital, we strongly recommend moderate or extreme hypofractionation or brachytherapy

ASTRO addressed protons for prostate in one of the Choosing Wisely campaigns and said something like "Don't recommend protons routinely for prostate cancer unless on a trial or registry."

THe whole registry thing for prostate cancer is absolutely ridiculous though and was a huge cop out from ASTRO. What further can we possibly gain from putting men on a registry trial for the most common malignancy in men in the US that have been treated with this modality for over a decade now? We cannot answer the questions of superiority/inferiority/equivalency without a randomized trial and if ASTRO was committed to this they wouldn't put "registry trial" in the recommendations.

If the registry shows better outcomes the naysayers will want randomized data and vice versa. The skeptic/cynic in me says the registry is a Trojan horse for insurance coverage.

 

[RickyScott]

You could argue that for some hospitals, a 30 million dollar proton unit is more financially sensible and would bring in more patients than a 5 million dollar a year MDACC affiliation. Obviously, this has nothing to do with the medial appropriateness of protons, which we all know is very limited.

 

[Gfunk6]

Another great article with some choice quotes

As Proton Centers Struggle, A Sign Of A Health Care Bubble?

In the absence of evidence showing protons produce better outcomes for prostate, lung or breast cancer, “commercial insurers are just not reimbursing” for these more common tumors, said Brandon Henry, a medical device analyst for RBC Capital Markets.

The rebellion by private insurers “is very, very good” and may signal the health system “is finally figuring out how to say no to low-value procedures,” said Amitabh Chandra, a Harvard health policy professor who has called proton facilities unaffordable “Death Stars.”

Proton centers are fighting back, enlisting patients, legislators and nonprofits to push for reimbursement. Oklahoma has passed and Virginia has considered legislation to effectively require insurers to cover proton therapy in more cases.

An entire day at the 2017 National Proton Conference in Orlando was dedicated to tips on getting paid, including a session titled “Strategies for Engaging Health Insurance on Proton Therapy Coverage.”

 

[Irradi8or]

Here's some more anti-proton news from just 3 days ago in Tennessee:

Tennessee governor vetoes cancer proton therapy bill

Tennessee governor vetoes cancer proton therapy bill