by
Sean Ruck, Contributing Editor | March 23, 2018
From the March 2018 issue of HealthCare Business News magazine
HCB News: Are there certain cancers proton therapy is widely approved for at this point?
SW: The vast majority of cancer indications are widely approved for coverage by Medicare. Commercial insurers still lag behind. For the most part, they cover pediatric, skull-based tumors, ocular melanomas, central nervous system and liver cancers. A smaller portion of commercial insurers cover proton therapy for additional cancers including head and neck cancer.
HCB News: What do you think is the biggest challenge proton therapy currently faces?
SW: The biggest challenge is expanding commercial coverage for more cancer indications. Our members are striving to meet that challenge by continuing to develop the clinical evidence demonstrating the therapeutic benefits of proton therapy. We’re also exploring innovative methods to bring down the costs to provide the service. For instance, by utilizing hypofractionation, it allows clinicians to give higher daily doses and fewer treatments while delivering the same biological equivalent dose. In many instances, hypofractionation can bring the cost down to equal or close to the cost of IMRT. Our members are also analyzing short- term cost benefits as well as the cost savings from preventing long-term side effects such as secondary cancers caused by previous radiation treatments.
HCB News: Is there any notable difference between the average life span of proton therapy equipment compared to other modalities?
SW: Your average linear accelerator is replaced every 10 years. Yet, we have proton therapy equipment that has been treating patients for almost 30 years which is attributable to the extraordinary amount of maintenance that occurs on these machines every night. If you factor in the cost of purchasing three linear accelerators over the same period, the cost of the equipment narrows greatly between the two machines.
HCB News: Have there been any major studies published since our last talk that you'd like to highlight?
SW: Over 100 studies were published last year on proton therapy and there are a few I would like to mention. One abstract highlighted a multi-institutional study that demonstrated patients treated with proton therapy for esophageal cancer had fewer post-operative heart and lung complications than patients treated with other types of radiation.
There were two notable prostate cancer abstracts. One was a follow-up to a previous study that compared outcomes between proton therapy and IMRT. The expanded study analyzed a more contemporary and larger patient population than the previous study. Compared with IMRT, the proton therapy patients had a significantly higher survival rate, fewer bladder complications and fewer secondary cancers.
