Is there a viable future for proton therapy?

by Loren Bonner, DOTmed News Online Editor | April 10, 2014

Proton therapy's growth has been largely due to the traditional fee-for-service model of payment, but health care reform is slowly eroding that payment structure.

"Last year we said it [proton therapy] was caught between these two worlds, but this year, we see it preparing for the transition," said Pericak.

New research could help. While the Mayo Clinic hasn't treated any patients yet with proton therapy, its new Center for the Science of Healthcare Delivery could help in the search for answers about the value of proton therapy in relation to cost.

"We can have access to claims information to understand how much it costs for treatment and to see what happens with costs over time, like treating side effects," said Dr. Robert Foote, chair of the department of radiation oncology at the Mayo Clinic in Rochester, Minn. (Because proton therapy is able to directly target tumors more precisely, it claims to reduce side effects in patients who are being treated).

The future is small, not big
Based on research conducted at the Advisory Board Company, Pericak said that small scale single proton therapy rooms will lead adoption in the future because of lower barriers to entry and thinning hospital budgets.

Today, small-scale makes up only about 7 percent of proton therapy rooms. In the future, Pericak predicts that figure will grow to 30 percent.

The other logical reason is that single rooms favor the local strategy that is already playing out in the makeup of proton centers around the country. When there were only a few centers in the country, they had to accommodate a large population. But as more centers come online, that will no longer be necessary.

Dr. Jeffrey Bradley, director of the S. Lee King Center for Proton Therapy at Washington University School of Medicine said its proton center, built in the bottom of a parking garage, is a single room with the smaller footprint Mevion proton therapy unit, and was attractive because it was a "lower initial investment."

The prostate debate
Many speakers at the conference who have had a stake in the game for a long time said that proton therapy needs to branch out.

"The reliance on prostate cancer is a losing issue," said NAPT's Frick. "There are simply too many other options for prostate cancer treatment that cost a lot less."

Dr. Carl Rossi, medical director for the Scripps Proton Therapy Center said: "Don't put all your eggs in the prostate cancer basket."

But it's tough when there's not much research on other tumor sites that are appropriate for proton therapy. Treating head and neck cancer is advancing rapidly, for example, but proton therapy is not well known in this area.

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