Is the “world’s biggest, most expensive medical device” actually better than existing therapies? That’s not yet clear, even as the football-field-sized facilities are popping up all over the globe.
The first $100 million federally funded particle accelerator designed to kill cancer cells treated its first patient in 1990 in Loma Linda, Calif. Today, 11 such facilities operate in the U.S. with 13 more approved to begin construction here, and several racing to be the first to open in the U.K.
Despite their incredible cost, each facility generates $50 million in annual revenue, which may be spurring their proliferation.
But researchers haven’t yet decided if the therapy is any better than traditional cancer treatments.
What Are They
As in traditional radiation therapy, which uses X-rays, energized particles are aimed at a tumor in order to kill malignant cells by damaging their DNA.
Proton beam therapy is a bigger more precise way to do the same thing: by essentially pointing a particle accelerator at a tumor, doctors can direct a beam of even more energized particles at very precise locations, delivering higher doses of radiation to cancer cells and minimizing the radiation delivered to nearby healthy cells.
The particle accelerators, like the one at CERN that revealed the Higgs Boson particle for the first time last year, require huge swaths of space and cutting edge technology to get protons energized.
In theory, proton therapy is good for patients with advanced cancers who have endured high levels of radiation already without remission; the proton beam allows doctors to keep attacking the tumor without further harming the rest of the patient’s body.
It’s also good for patients with tumors near critical organs like the spinal cord.
It’s expensive therapy, but not necessarily more expensive than chemotherapy, depending on which drugs are prescribed, said Dr. Stefan Both, Assistant Professor of Radiation Oncology at the Hospital of the University of Pennsylvania in Philadelphia. He works in the Roberts Proton Therapy Center, the largest and most advanced medical proton facility in the world.
Medicare pays $32,000 per patient for proton therapy compared to $19,000 for radiation, and most insurance providers also cover the treatment. The cost is still less expensive than surgery, according to the National Association for Proton Therapy (NAPT).
Worth The Expense?
The number of proton facilities recently approved in the U.S. has some questioning whether so many centers are necessary. As this op-ed in The New York Times noted last month, two facilities are in the works in the Washington D.C. area plus one in Baltimore, though it’s unlikely there are enough patients with specific need to merit all those centers in one area.
For children with brain tumors, studies show proton therapy is better than conventional therapies, and it extends life. But for other cancers, like prostate cancer, the evidence is mixed.
“There are some early results suggesting that protons might have an advantage, but they’re very limited, there’s not a big body of evidence,” Both told HealthBiz Decoded.
The Roberts Cancer Center, part of the University of Pennsylvania’s Abramson Cancer Center, treats about 100 patients in the center daily, he said.
They try to keep the number of prostate cancer patients getting treatments slots low, around 20 percent of the total patients treated at the Roberts Center. Using the sophisticated resources of the proton beam to treat prostate cancers is controversial at some other centers, he said, where as many as 50 percent of the patients are being treated for prostate cancer even though there is no proven advantage over regular radiation.
About 30,000 cancer patients worldwide have been treated with proton therapy since 1990, according to NAPT.
Both is hopeful that proton therapy, in combination with other treatments, will prove to be advantageous for many patients, but researchers need more data to make that assessment.
Meanwhile, the facilities are becoming more popular than ever before.
“In the U.S., everything is market driven,” Both said. “Consumers like to have a choice.”
Time Will Tell
The facilities are becoming more popular in Western Europe and Asia as well as the U.S. and U.K., Both said.
In time, the data may reveal that so many expensive devices are actually worthwhile for patients and a cost-benefit analysis may retroactively approve all the new construction going on right now.
“It’s all about what the outcome data is going to show,” he said. “When you have something like proton therapy which has an emerging role, I think that it’s best to collect all the data in registry studies or randomized trials.”
Both hopes that all new centers will be affiliated with an academic institution so that all treatments can be recorded and results analyzed as they are at U Penn. The quicker the data is analyzed and published, the sooner we will know if we were right, he said.
“Definitively, time is going to tell,” he said. “That’s how we treat everything we do.”
If in time we learn that the therapy isn’t advantageous to enough people to justify all the new expensive facilities, those facilities won’t survive to the same degree, he said.