Is High-Tech Cancer Therapy Too Costly?
Proton Beam Radiation Treatment Is At Heart Of Debate Over Rising Health-Care Costs
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The High Cost Of Cancer
Medicare and Medicaid payouts amounted to $627 billion in 2007,23 percent of all federal spending. A big reason why is the cost of high-tech procedures. Dr. Emily Senay reports.
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Proton beam radiation is highly targeted - delivering its dose only to the tumor and sparing the surrounding tissue, which is important for certain rare cancers. (CBS)
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When Rianta Wimberly started going blind from an inoperable brain tumor, her mother Glenda got on the Web, found a radiation treatment called proton beam therapy and sent a desperate email to doctors at Massachusetts General Hospital, CBS News' Dr. Emily Senay reports.
"She has lost her peripheral vision and is experiencing difficulty seeing," Glenda wrote.
Just weeks later, Rianta was getting the therapy and the tumor was shrinking.
"With four treatments left, I have 98 percent of my vision left," Rianta said.
And with no side effects. That's because proton beam radiation is highly targeted - delivering its dose only to the tumor and sparing the surrounding tissue, which is important for certain rare cancers.
"It's a real delight to be able to offer patients proton therapy you see that during the treatment they have less side effects," said Jay Loeffler, the chair of radiation oncology at Massachusetts General Hospital Cancer Center.
But proton beam therapy is at the heart of the debate over rising health-care costs. It's the most expensive device in medicine today.
The technology is two decades old, but Mass. General is one of five proton centers, and there are eight others in the works.
The massive facility at the University of Pennsylvania - soon to be the world's largest - will cost $140 million.FYI: Find out where to find this treatment and other information.
"This is three stories. This gantry that spins around the patient; this rotates completely around the patient," said Dr. James Metz of the University of Pennsylvania Abramson Cancer Center.
It's total weight?
"Close to a million tons of equipment," Metz said.
A giant machine called a cyclotron produces the radioactive particles called protons.
"So this is the cyclotron itself, this is a 200-ton piece of machinery that accelerates the protons to 230 million electron volts," Metz said.
Huge magnets direct the beam of radiation the length of a football field into treatment rooms.
"Now we're leaving the cyclotron area and walking along the beam line," Metz said. "The beam will travel thru these magnets and that will steer the beam into the different rooms."
Radiation oncologist Dr. Richard Stock, of Mt. Sinai Hospital, says competitive pressure is driving the building boom.
"It's kind of a vicious cycle because if one center opens up, other centers and other hospitals surrounding it have to try to compete for patients," Stock said.
And while there's little disputing the value of proton beam for certain rare cancers, increasingly it is being used for more common cancers like prostate. At double the cost of standard treatments, many experts say it's being used without proof it's more effective.
"There is no good evidence, medical evidence that it is better than the current state of the art intensity modular radiation therapy," Stock said.
Is this a better treatment for adults than conventional?
"In my opinion it's a better treatment. the bigger issue though is, is the increased costs associated with protons worth it to society? in my opinion it's worth it if we can reduce the initial costs of building proton centers," Loeffler said.
But while the cost is extraordinary … so are the results for this family.
"This was my only option, thru unbreakable faith I'm here," Rianta said.
Glenda said: "She has unbreakable faith, I have unspeakable joy."
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See all 116 CommentsHers is a powerful story, we all cheer her victory at Meningioma Mommas!
Momma Beth
Stereotactic Radiation Therapy (Radiosurgery):
This is a technique based on the principle that a single relatively high dose of radiation delivered precisely to a small area will arrest or kill the tumor while minimizing injury to the surrounding nerves & brain tissue. The source of radiation is from either radioactive cobalt (called gamma ray) or a linear accelerator (LINAC)
I''m involved with building one of these new proton therapy institutes and I am looking forward to the day it opens for business!
During my treatment a 6 year old boy was treated for a brain tumor that the Doctors said was inoperable. Proton therapy gave him a life.
Quality of life is paramount for all of us and Proton therapy certainly gives us that.
Proton beam radiation is also an effective treatment for many other tumors without causing "collateral damage".
For the best life after cancer I chose Proton...and very pleased!
Fred Spruell
X-rays used in x-ray therapy goes completely through the body. Thus it damages the normal tissue before reaching the cancer and continues to damage the normal tissue beyond the cancer as it travels out the other side of the body.
Protons stops after damages the cancer, it doesn%u2019t exit the cancer, and thus does not damages normal tissue beyond the cancer.
One way to understand proton therapy is to compare its properties with the other 2 types of cancer therapies, chemotherapy and surgery.
With chemotherapy, it can%u2019t stop going beyond the cancer and damages normal tissue such as the gut (Nausea/vomiting), bone marrow (loss of blood cells) and hair follicles (baldness). Wouldn%u2019t it be great if they had a chemotherapy that stopped like protons?
With surgery, they do stop after reaching the cancer like proton therapy. We wouldn%u2019t accept a technique that continues cutting beyond the cancer to the other side of the body just because we can%u2019t stop cutting.
Proton therapy may cost more as the initial treatment, but not curing cancer or causing side effects cost more, not just in medical expenses, but in so many other ways.
1,400,000 Americans will get cancer each year with over = getting x-ray therapy. The existing proton centers can only treat a few thousand patients per year. Good luck getting in.
I''ve met people who were saved by proton when surgery was impossible to treat their brain tumor. Why must the media make the expense of this treatment the focus of stories? It is clearly a superior treatment for many forms of cancer. How can we put a price on that?
How can you set a value on the quality of life afforded by having proton treatment instead of surgery, or the length of life proton gives those with inoperable cancers? For what it costs to send one person on a space trip, proton treatment could improve or save many thousands of lives.
Focusing on the cost is not focusing on the true aspects of this proven treatment method. How about a story which tells of the thousands of persons who''ve been treated with proton therapy at Loma Linda and elsewhere who are so deeply grateful that this treatment exists?
Anyone who asks the question, "is proton worth the cost?" has not talked with enough proton patients, and has likely been listening to proponents of other less costly types of cancer treatments - who claim their methods are just as good. They are not.
Bill Vancil, Madison, WI
Anyway, we should realize that there are high start-up costs for any wortwhile innovation. But as these innovations catch on, research and production costs come down. Because of initial costs, should we have given up on space exploration, nuclear research, microcomputers, ad nauseam? No, thank God. Proton treatment belongs to that category. Not only have new techniques become less expensive after the test of time, the sharing of knowledge and refinement of techniques. Such innovations generate a chain reaction in the form of new discoveries that benefit the human race.
The best evidence of any new treatment''s success is when others adopt it. The wisdom of doing so is directly proportional to the risk, in this case the high start-up cost. Loma Linda, thanks to the support of the Seventh Day Adventist Church and the state of California, bravely took the step of pioneering the treatment and for fifteen or so years, the rest of the medical world watched and waited. And now, new proton treatment centers are sprouting all over the world. Need we say more?
The Rev. Dr. Federico Agnir
Prostate Cancer survivor
Treated at Loma Linda January 2003
I completed treatment for prostate cancer at Loma Linda University Medical Center in May of 2007. My treatment hasn''t changed my lifestyle in the least. In less than one year my PSA is 38% of what it was prior to treatment and is still decreasing.
I think the opponents of proton beam therapy are seeing their client base threatened and are acting accordingly.
John Barna-Lloyd
Coldspring Texas
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