Don’t see protons getting a rug pulling tbh. Used to. Don’t anymore. Not after APM got successfully tanked. Even United commercial policy eg deems protons and photons equivalent for prostate. CMS is essentially forced to consider the cost of proton equipment in its reimbursement. It should always reimburse pretty reasonable. Maybe not Boardwalk level but at least Illinois Avenue.
Nearly every 3-4 room center that was not attached to a major university/academic campus (e.g. UPENN, MGH, Mayo or MD Anderson) has gone bankrupt or had to refinance at least once to stay afloat:
Biggest solution would be data to support routine use in our biggest indications. Cost becomes less of a deal if the data is there to support a high-cost therapy (e.g. CAR-T)
Fascinating. You are very plugged in to the proton gossip!
You are correct.
To all these proton centers struggling financially, I say good riddance. I need a physicist. The lone somewhat positive clinical trial for protons in esophagus used a composite endpoint (while described as brilliant by some, I'd consider this binning or "cheating" as standard endpoints should do the trick when your data is good). The biological fundamentals seem to remain poorly understood per this community doc's non-expert review of the literature. The same academic docs who were gushing about head and neck indications, when they got their machines and had first hand experience with acute toxicity benefits, are now less enthusiastic as reports of excessive late toxicity emerge.
Ha. Cox block.
Well, on the bright side, the money that 'Bama generated in the first half of 2021 is enough to pay half of Nick Saban's salary.
"we investigated ourselves and.. No just kidding. We didn't even do that. Now fyck off.."
The Maryland budget shows some of the downsides of living the proton life:
Has there been any public commentary or any push back regarding the end point(s) of that trial?
iirc the endpoints changed; but last iteration i saw had a ph2 component with late grade 3+ as an endpoint. Surprised it hasn't been published yet since the ph2 cohort should have all reached the specified timepoint.
Yeah. All crap. By the time a research group is demonstrating difficulty establishing an endpoint to study with a study underway, you know you can’t believe a damn thing.
Obviously, I've never done it (or even a small investigator initiated trial). Must be a horrendous amount of work and take tremendous time as well as organization skills and vigilance.
Yeah the insights are dollars and they say the trials have to work in favor of protons being a better treatment even if it means marginally so by making up some statistical bs via contorted side effect endpoints.
Hurts to see a pure and beautiful concept get chopped into sausage in the multi-institutional or cooperative group setting. But often for the better as the changes remove some local bias and make the protocol and results more relevant to a larger number.
No, I think billing rules do not allow for proton boost (just like SBRT boost). Maybe bad data?
I think a large part is that UAB doesn't treat a lot of prostate pts
But which form of PBT would use fewer than 15 fractions?
Peds?
I trained at a center that had a moral high ground initially during my PGY-2 year "we don't put prostates on protons". By PGY-5...prostates were getting protons.
Could be from re-plans counting as distinct plans ie: 30 fraction course being counted as 2 x 15 fraction courses.
To be honest, anybody who tells me what I “should” be doing, I automatically ignore. I’ve learned a lot being out in the real world and most of it is what gfunk has stated about the underlying factor in any decision is money.
For about 5 years I ranted on this board about the price gouging at academic centers. I assume almost every resident assumed I was some type of q anon loony until some hospitals published their negotiated prices.
lol its because residents are groomed to think community practitioners are greedy.
That's a nice moral position to be in. Enviable. Enjoy it while it lasts.
