Is High-Tech Cancer Therapy Too Costly?

Proton Beam Radiation Treatment Is At Heart Of Debate Over Rising Health-Care Costs

(CBS)  "I am the mother to a beautiful 30-year-old woman, she was diagnosed with a meningioma tumor," said Glenda Wimberly.

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.

---

FYI: Find out where to find this treatment and other information.

---

The massive facility at the University of Pennsylvania - soon to be the world's largest - will cost $140 million.

"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."

[cgmason2]

It is a GOOD THING for the public to know about Proton Beam Therapy; it is BAD FOR THOSE who have made cancer a billion dollar a year business through other treatments.
I received Proton Beam Therapy from the Proton Institute in Jacksonville, FL for a C2 Chordoma, (the second cervical vertebrae in my neck). Some are benign, mine wasn''t. I was told by a doctor at another institution that he could buy me time...maybe two years. The surgeon who "de-bulked" the tumor said this would be what I would die from, although he did referred me to the Proton Institute in Jacksonville. (I am grateful to him that he knew of Proton Beam Therapy). I was told at the Proton Center, that I would NOT die from this cancer...the Proton Beam was initially invented for children with brain and spinal tumors. Other forms of radiation does too much damage on their growing bodies.
Because of it''s pin-point accuracy, the Proton Beam is directed ONLY TO THE TUMOR, doing no damage entering the body, and NOT exiting it. Conventional radiation damages going in and out of the body as it passes also threw the tumor as well as other vital organs.
Quality of life after treatment?...there really is no comparison. Many people who seek out Proton Beam information FIRST and don''t have to have surgery, don''t have to deal with Chemotherapy or Conventional Radiation.
I am thrilled to have a life to look forward to now because of Proton Beam Therapy!

[jacobystwin]

I completed my proton treatment at Loma Linda one year ago, I have had no adverse side effects and my PSA has been declining ever since.

The most unfortunate thing about proton therapy itself is that it requires treatment once a day for about 2.5 months. That, plus the cost for those denied insurance coverage, sadly, prevents many working men from receiving the benefits of this fantastic medical technology. Ironically, retired men on MEDICARE, don''t have those problems or worries - they''re covered.

Loma Linda treats 45 different types of cancer many involving children whose growing tissue cells are so susceptible to the incidental damage caused by scattered and entry/exit radiation of standard photon treatment.

Unfortunately, as evidenced by your news story, the medical community is disingenuously using anecdotal evidence to discredit proton therapy advocates for using anecdotal evidence. If anybody in the medical profession really cared about the efficacy of the proton modality and its benefit to people, they%u2019d get off their fat check books and analyze and create the scientific evidence they claim is lacking. It%u2019s typically these conflicting medical interests that are killing our health care system, raping our pocket books and sacrificing our cumulative quality of life to protect their own medical specialties and the almighty dollars generated by maintaining the status quo.

[jleftwich1]

I completed proton beam treatment for prostate cancer at Loma Linda in Sept of 2003. It was a completely enjoyable experience and a complete success with no side effects during of after treatment. Medicare and my supplemental insurance paid for everyting but I would have been more than willing to pay out of pocket for the fantastic treatment I recaeived. I have friends who have chosen surgery and other treatments with resulting side effects I am glad I do not have to deal with.

[romain_kid]

I am a 14 year survivor of protron theorpy with very little side affects. To me, this is the only way to go. Friends who had other types of treatment for prostate cancer are no longer with me. My quality of life is Great as far as no cancer. If it were not an excellent type of treatment why would medicare pay 80 percent of the treatment costs? I would do the same thing over, again, knowing what I have experienced in these 14 years.

[shedorman]

I was thrilled to hear of your report on Proton Beam Radiation Therapy. The treatment for prostate cancer should be more widely used. And more sites should be built. There are very few side effects with this form of treatment compared to other treatments for prostate cancer. Please report more on Proton Beam Therapy. We would surely appreciate it. Thank you for you time.

[jjtug]

I was treated at Loma Linda for Prostate cancer in 1999. My free 9 year old web site is dedicated to informing men about Protons - www.prostateproton.com. I have been without side effects whatsoever for 8 years and six months since being treated.
My Doctor at Loma Linda has this to say:
"When I treat a prostate cancer patient with protons the total normal tissue dose is ~ 250% less than with sophisticated x-ray therapy." He has treated over 6,000 men with Prostate cancer.
The doctor quoted in the article seems to be misinformed, "certain rare cancers" is ludicrous. At Loma Linda and other Proton centers, Protons will treat breast cancer and now treat many other cancers and benign conditions, this research is continuing.

My Loma Linda Dr. says; "The current Medicare reimbursement rates reflect the expense associated with developing this technology. This is not unique to proton therapy and has been applied to other emerging medical technologies. As the cost of the technology inevitably decreases, so will the cost of treatment."

Bob Marckini%u2019s great new book You Can Beat Prostate Cancer And You Don%u2019t Need Surgery to Do It, is available at Amazon.com or LuLu Publications.
I AM A LAYMAN, NOT A DOCTOR.You are welcome to call me, send an e-mail to [e-mail] and I''ll provide a number - I have devoted over 3 hours each day to Protons since 1999 and my website receives about 8,000 hits each month. Jim Tuggey

[danb-nb]

I recently finished prostate proton treatment at MD Anderson in Houston. I had trouble getting admitted in any proton therapy program. During the admission search it appears all facilities are running flat out and a large list of applicants are waiting. Everyone I met in the program was happy with the results in spite of the minor side effects. I returned to work within weeks of driving back from Houston to Seattle.

[otucker613]

I received treatment for Prostate Cancer at Loma Linda University Medical Center (LLUMC)in 2005, finishing in December and there is no way I can even begin to tell the Loma Linda story, or explain the great experience of being a guest (not patient) at that wonderful institution. I had a PSA of 9.7. At present it is 0.01. To have 44 radiation treatments and leave the facility with NO side effects and no cancer was miraculous to say the least. Don''t talk to me about cost. The important thing is to seek and receive the best treatment available. Maybe someone being concerned about price needs to experience the feeling of being told you have a incureable cancer and then learn about a treatment like Proton Treatment. Then lets see if cost matters. If you desire a good quality of life and discernable side effects afterwards, cost is out the window. You can''t put a price on that.

[beebedraw]

I was thrilled to be watching the CBS news the other day and see the segment on proton beam radiation for cancer. Last year at this time I was at Loma Linda University Medical Center in California receiving proton therapy for prostate cancer. I am very happy with the results and I am glad that I chose this modality. Very often in the lists of treatment modalities for prostate cancer, protons is not in the list. So thanks for airing the segment about proton therapy. I only wish that the segment had not put so much emphasis on the high cost of proton treatment. When one has cancer and wants to have a good quality of life, cost does not matter. Maybe the cost of protons will come down as more people turn to this form of treatment. At the end of the segment Katie had it right when she said that the higher cost is worth it when it involves someone you love.

[bill904]

I was treated at Loma Linda for the prostrate cancer I had with proton therapy from October 2003 through the end of that year. Fortunately (for me) it was quite successful with only minimal and temporary side effects following the treatments. That is precisely why I went there and elected that form of treatment after conducting a most comprehensive evaluation of all the treatments that were available to me at the time. In addition, I don''t believe the costs were in any way any more substantial than the alternative treatments.
How does the author regarding the CBS News article correlate ''cost with quality of life'' following the eradication of this or any cancer? Perhaps one should not be judgemental unless they wore the shoes of the patients - especially those (and there are many) that elected ''more conventional'' treatments that resulted in nightmare and permanent side effects.

[joecoyote1]

As a prostate cancer survivor who received proton therapy at Loma Linda University nearly two years ago, I will state unequivocally that the extra cost, if any is worth it. Worth it, because:
1. There is no ''sick time'' during treatment, no side effects to even think about.
2. While I do not have statistical numbers, my estimate is that over a population of men treated with protons, vs other modalities, the total cost over several years is less, resulting from a reduced need for ''repair'' or follow up treatment.
3. Lifestyle does have value. To think of a prostatectomy, with attendant incontinence, impotence, etc. is incomprehensible. To think of seeds, with the attendant risk of migration is not a comfortable thought either.
4. How do we measure value and success? All that counts is presented in Pastor_Lee''''s respose above.

Several months ago, I went to a ''prostate cancer support group'' session in my community. I was dumbfounded to see 12 men plus myself at the meeting. As one of the older ones, I was taken aback when I found that all the others had had surgery, and with one exception, all were still either incontinent or leaking, some after as much as 10 years. Would you, as a human being consider this as success? Ten years of having to wear a diaper, when there is a non invasive, very successful modality available?
JoeCoyote

[mimi422]

My husband, age 72 & in good health, has just been diagnosed with early prostate cancer. He was very depressed with the choice of treatments offered with all the side-effects mentioned in the above comments.

I searched on the internet until I found the Proton Beam treatment. My husband was so relieved. He is to be treated at MPRI within the next two months. Medicare & his insurance will pay for it. Of course, he paid into Medicare all the many years he worked. He pays for his insurance & Medicare, Part B, now, so he has earned the right to have the treatment.

I''m sure you believe this expensive treatment is wasted on a 72 year old man who may, or may not have a lot of years left. My husband worked very hard for a college education. He worked 34 years in a very stressful profession. He has contributed his part to society & he deserves a treatment that is effective & will not destroy the rest of his life.

I have read where smaller, cheaper units are being planned in more cities. In the past, expensive medical equipment seemed to be available only to large city hospitals, then as the costs went down, the smaller hospitals would acquire them.

We should be offering the highest quality of medical care in the world!!!

I am so thankful for Proton treatment for prostate cancer patients & most of all for the patients with eye, brain & spinal cord tumors where their very lives depend on it. I just hope it becomes available to every person who can benefit from it.

Mimi422

[billybmiller-2009]

Dear CBS, I was treated for prostrate cancer at Loma Linda Medical Center and University October 2002 through January 2003. At that time the cost at Loma Lindia was not unreasonable and the treatment was far, far superior to all of the alternatives, and no side effects compared to the other alternatives. At that time Loma Linda was not only the ONLY location doing the Proton Beam Treatment of that type, but the first and only center that knew what they were doing.
I believe your story is probably based on these newer and probably much more expensive centers that have just recently got started, and have very little experience compared to Loma Linda. Your story comments this treatment has been used for about 20 years. That is probably accurate, but none of these "NEW CENTERS" have been around for more than a few years, and in my opinion have no where near the experience or efficiency record, or the "cost efficiency" that Loma Linda enjoys. I believe CBS should re-evaluate there story and look into the "positive side" of Proton Beam Therapy "at Loma Linda"... Please do some research and read the testimonials on the "BOB" website "[e-mail]" [e-mail]
You will find Many, Many Years of happy patients there who love to tell the Loma Linda story. I also believe you will find Loma Linda is "The Most Cost Efficient" way to deal with cancer... Please look at your story again...
Yours Truly, Billy B. Miller, [e-mail]

[billybmiller-2009]

Dear CBS, I was treated for prostrate cancer at Loma Linda Medical Center and University October 2002 through January 2003. At that time the cost at Loma Lindia was not unreasonable and the treatment was far, far superior to all of the alternatives, and no side effects compared to the other alternatives. At that time Loma Linda was not only the ONLY location doing the Proton Beam Treatment of that type, but the first and only center that knew what they were doing.
I believe your story is probably based on these newer and probably much more expensive centers that have just recently got started, and have very little experience compared to Loma Linda. Your story comments this treatment has been used for about 20 years. That is probably accurate, but none of these "NEW CENTERS" have been around for more than a few years, and in my opinion have no where near the experience or efficiency record, or the "cost efficiency" that Loma Linda enjoys. I believe CBS should re-evaluate there story and look into the "positive side" of Proton Beam Therapy "at Loma Linda"... Please do some research and read the testimonials on the "BOB" website "[e-mail]" [e-mail]
You will find Many, Many Years of happy patients there who love to tell the Loma Linda story. I also believe you will find Loma Linda is "The Most Cost Efficient" way to deal with cancer... Please look at your story again...
Yours Truly, Billy B. Miller, [e-mail]

[ronet41]

I had proton treatment in 2004, without any side effects. It was 40 treatments and was like a vacation to Southern California. I found out I had PSA of 11.9 and then biopsy showed a Gleason score of 7. I had lost an uncle to prostate cancer just 8 years previous.
My Urologist wanted to implant seeds but I had a cousin who did that and is now impotent and wearing a diaper.
I know now and always felt that Loma Linda was a God given Blessing for me.
Ron Warren, Mount Airy, NC.

[adrbill]

Diagnosed w/prostrate cancer in 2004 - PSA 9.7; received proton therpay same year at LLMU; very comfortable "vacation" type of therapy (about an hour per day waiting/treatment); returned to work immediately - NO(!) side-effects; current PSA 0.7: willing to assist (no charge) to present "our" side of this story.

[adrbill]

Diagosed w/ prostate cancer in 2004 - PSA 9.7; LLMU treatment (proton beam therapy) same year - very comfortable 40 day "vacation" like experience(!); returned to work immeduately - NO(!) side-effects; current PSA 0.7 - continuing w/o side-effects; wondering why the media won''t present both sides of this issue, since it is available(?!?). If you want assistance in this regard, please ask me (no charge!).

[protopro1]

I received treatment for Prostate Cancer at Loma Linda University Medical Center (LLUMC)in 2007, finishing in September and no amount of words can even begin to tell the phenomenal story of that institution and the even more phenomenal Proton Beam Treatment. NONE!! To have 44 radiation treatments and leave the facility with virtually no side effects and no cancer is miraculous to say the least. The cost of such treatment should never be a determining factor in seeking treatment IF you desire a good quality of life afterwards. I was a stage II cancer patient with a PSA of 7.6 and a Gleason score of 7(4+3) going in. Currently, after 4 months, my PSA was tested at 1.7 and heading south. I repeat NO discernable side effects. You can''t put a price on that, no matter what network signs your paycheck.

[christyt32-2009]

I think this story is missing a big piece of the puzzle. Yes, proton therapy is expensive - up front. However, if you were to compare the quality of life for those who have undergone proton therapy vs. any other method, I believe you would find the real value. You will also need to take into consideration those patients who miss work, or withdraw from their lives because of the lasting side effects after surgery, photon radiation, etc. Who really cares what the up front cost is? That''s a blip. It''s what happens AFTER treatment, where people must continue living their lives - if they are able to do so. I am confident that in the long run, proton therapy is much cheaper overall. I hope proton therapy centers will continue to be built, despite the short-sightedness of stories such as this.

[cnsjones-2009]

Every negative story or comment about proton therapy for cancer that I have ever read or heard about always IGNORES two factors: "Quality of Life," and %u201CInoperable Tumors.%u201D
The CBS story says: "There is no good evidence, %u2026 that it is better than the current state of the art intensity modular radiation therapy..."
For prostate cancer, ALL modalities are approximately equal, EXCEPT for side effects such as nausea, diarrhea, urinary problems and incontinence, rectal and bowel problems, erectile dysfunction, and others. The proton, with the remarkable physics of the Bragg peak, STOPS the radiation at the target, and virtually eliminates damage to surrounding tissue and organs. Thus side effects are minimal to none.
I was diagnosed with aggressive prostate cancer, Gleason 8, PSA 5, and I completed my proton treatment in March 2007. To date I have had NO serious side effects from the protons, and am living a normal life. And that is Quality of Life!.
Then there are OUR children. What happens if there is an inoperable tumor? Are we supposed to just give up? NO! For now there is the option of proton therapy, which can kill the cancerous cells while causing minimum damage to the surrounding rapidly growing normal cells of a child!
That is why there is a rapidly growing number of proton centers, and why money spent for these facilities is well spent! In the mean time, Medicare pays for proton therapy, and so do most mainstream insurance companies.

Fuller Jones